Head Trauma Rehabilitation

Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom Objectives: To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care. Setting/Participants: TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010–2018. Design: A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Main Measures: Primary outcomes: (a) reduction in dependency (UK Functional Assessment Measure), (b) cost-efficiency, measured in time taken to offset rehabilitation costs by savings in costs of ongoing care estimated by the Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA), and (c) estimated life-time savings. Results: The mean age was 49 years (74% males). Including patients who remained in persistent vegetative state on discharge, the mean episode cost of rehabilitation was £42 894 (95% CI: £41 512, £44 235), which was offset within 18.2 months by NPCNA-estimated savings in ongoing care costs. The mean period life expectancy adjusted for TBI severity was 21.6 years, giving mean net life-time savings in care costs of £679 776/patient (95% CI: £635 972, £722 786). Conclusions: Specialist rehabilitation proved highly cost-efficient for severely disabled patients with TBI, despite their reduced life-span, potentially generating over £4 billion savings in the cost of ongoing care for this 8-year national cohort.

Strengthening the Evidence Base: Recommendations for Future Research Identified Through the Development of CDC's Pediatric Mild TBI Guideline Objective: The recently published Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury (mTBI) was developed following an extensive review of the scientific literature. Through this review, experts identified limitations in existing pediatric mTBI research related to study setting and generalizability, mechanism of injury and age of cohorts studied, choice of control groups, confounding, measurement issues, reporting of results, and specific study design considerations. This report summarizes those limitations and provides a framework for optimizing the future quality of research conduct and reporting. Results: Specific recommendations are provided related to diagnostic accuracy, population screening, prognostic accuracy, and therapeutic interventions. Conclusion: Incorporation of the recommended approaches will increase the yield of eligible research for inclusion in future systematic reviews and guidelines for pediatric mTBI.

Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury: Examining Associations With Demographics, Healthcare Utilization, Institutionalization, and 1-Year Outcomes Objectives: To assess the relationship of acute complications, preexisting chronic diseases, and substance abuse with clinical and functional outcomes among adults 50 years and older with moderate-to-severe traumatic brain injury (TBI). Design: Prospective cohort study. Participants: Adults 50 years and older with moderate-to-severe TBI (n = 2134). Measures: Clusters of comorbid health conditions empirically derived from non-injury International Classification of Diseases, Ninth Revision codes, demographic/injury variables, and outcome (acute and rehabilitation length of stay [LOS], Functional Independence Measure efficiency, posttraumatic amnesia [PTA] duration, institutionalization, rehospitalization, and Glasgow Outcome Scale–Extended (GOS-E) at 1 year). Results: Individuals with greater acute hospital complication burden were more often middle-aged men, injured in motor vehicle accidents, and had longer LOS and PTA. These same individuals experienced higher rates of 1-year rehospitalization and greater odds of unfavorable GOS-E scores at 1 year. Those with greater chronic disease burden were more likely to be rehospitalized at 1 year. Individuals with more substance abuse burden were most often younger (eg, middle adulthood), black race, less educated, injured via motor vehicle accidents, and had an increased risk for institutionalization. Conclusion: Preexisting health conditions and acute complications contribute to TBI outcomes. This work provides a foundation to explore effects of comorbidity prevention and management on TBI recovery in older adults.

The Contribution of Social Support, Professional Support, and Financial Hardship to Family Caregiver Life Satisfaction After Traumatic Brain Injury Objectives: (a) To assess whether 3 changeable environmental variables (social support, professional support, and financial hardship) contribute to explaining differences in well-being of family caregivers after traumatic brain injury (TBI), above and beyond the influence of neurobehavioral functioning. (b) To assess the unique and relative contribution of social support, professional support, and financial hardship to life satisfaction of family caregivers. Participants: Adult family caregivers (n = 136) of individuals who received inpatient rehabilitation following a TBI. Measures: The Social Provisions Scale; Brief Scale of Financial Hardship after Brain Injury; Satisfaction with Life Scale; and adapted scales measuring professional support and neurobehavioral functioning. Design: Cross-sectional study using survey methodology. Results: Social support, professional support, and financial hardship explained a significant amount of variance in life satisfaction after controlling for neurobehavioral functioning (R2 change = 0.34, considered a large effect size). Social support and financial hardship were significant unique predictors within the model, but professional support was not. Conclusion: Social support and financial hardship are prominent environmental variables that may hold promise for targeted intervention development and testing designed to support family adaptation after TBI.

A Systematic Review of Sleep-Wake Disturbances in Childhood Traumatic Brain Injury: Relationship with Fatigue, Depression, and Quality of Life Objective: To systematically appraise the literature on the prevalence, types, and predictors of sleep-wake disturbances (SWD), and on the relationship between SWD, fatigue, depression, and quality of life in children and adolescents with traumatic brain injury (TBI). Methods: MEDLINE, PubMed, PsychInfo, Web of Science, and EMBASE databases were searched, reference lists of retrieved articles were also searched for relevant articles, and study methods were evaluated for risk of bias. Results: Of the 620 articles assessed, 16 met inclusion criteria. Sleep-wake disturbances were common in childhood TBI. The most common types of SWD reported were insomnia and excessive daytime sleepiness, with mild TBI participants showing a trend toward more sleep maintenance insomnia, while sleep-onset insomnia was typical in those with moderate-severe TBI. Predictors of SWD reported in studies involving mild TBI participants included TBI severity, male sex, preexisting SWD, high body weight, and depression; while injury severity and internalizing problems were associated with SWD in moderate-severe TBI participants. Sleep-wake disturbances were also associated with fatigue and poor quality of life following TBI. Conclusion: Sleep-wake disturbances are highly prevalent in childhood TBI, regardless of injury severity. Routine assessments of SWD in survivors of childhood TBI are recommended.

Healthcare Utilization and Missed Workdays for Parents of Children With Traumatic Brain Injury Background: We enrolled patients in a prospective study in which we obtained estimates of the direct and indirect burden for families of children with traumatic brain injury (TBI) relative to a control group of families of children with orthopedic injury (OI). Methods: Parents were surveyed at 3 time points following injury: 3, 6, and 12 months. At each follow-up contact, we asked parents to list the number of workdays missed, number of miles traveled, amount of travel-related costs, and whether their child had an emergency department (ED) visit, hospital admission, any over-the-counter (OTC) medications, and any prescription medications during that time period. We assessed the difference in these outcomes between the TBI and OI groups using multivariable logistic and 2-part regression models to account for high concentrations of zero values. Results: Children with TBI had significantly greater odds of having an ED visit (3.04; 95% CI, 1.12-8.24), OTC medications (1.98; 95% CI, 1.34-2.94), and prescription medications (2.34; 95% CI, 1.19-4.59) than those with OI. In addition, parents of children with TBI missed significantly more days of work (19.91 days; 95% CI, 11.64-28.17) overall during the 12 months following injury than their OI counterparts. Conclusion: Extrapolating our results to the entire country, we estimate that pediatric TBI is associated with more than 670 000 lost workdays annually over the 12 months following injury, which translates into more than $150 million in lost productivity. These missed workdays and lost productivity may be prevented through safety efforts to reduce pediatric TBI.

Protocol for a Randomized Controlled Trial of CI Therapy for Rehabilitation of Upper Extremity Motor Deficit: The Bringing Rehabilitation to American Veterans Everywhere Project Constraint-induced movement therapy (CI therapy) has been shown to reduce disability for individuals with upper extremity (UE) hemiparesis following different neurologic injuries. This article describes the study design and methodological considerations of the Bringing Rehabilitation to American Veterans Everywhere (BRAVE) Project, a randomized controlled trial of CI therapy to improve the motor deficit of participants with chronic and subacute traumatic brain injury. Our CI therapy protocol comprises 4 major components: (1) intensive training of the more-affected UE for target of 3 hour/day for 10 consecutive weekdays, (2) a behavioral technique termed shaping during training, (3) a "transfer package," 0.5 hour/day, of behavioral techniques to transfer therapeutic gains from the treatment setting to the life situation, and (4) prolonged restraint of use of the UE not being trained. The primary endpoint is posttreatment change on the Motor Activity Log, which assesses the use of the more-affected arm outside the laboratory in everyday life situations. Data from a number of secondary outcome measures are also being collected and can be categorized as physical, genomic, biologic, fitness, cognitive/behavioral, quality of life, and neuroimaging measures.

Prevalence of Medical and Psychiatric Comorbidities Following Traumatic Brain Injury Objective: To examine the prevalence of selected medical and psychiatric comorbidities that existed prior to or up to 10 years following traumatic brain injury (TBI) requiring acute rehabilitation. Design: Retrospective cohort. Setting: Six TBI Model Systems (TBIMS) centers. Participants: In total, 404 participants in the TBIMS National Database who experienced TBI 10 years prior. Interventions: Not applicable. Main Outcome Measure: Self-reported medical and psychiatric comorbidities and the onset time of each endorsed comorbidity. Results: At 10 years postinjury, the most common comorbidities developing postinjury, in order, were back pain, depression, hypertension, anxiety, fractures, high blood cholesterol, sleep disorders, panic attacks, osteoarthritis, and diabetes. Comparing those 50 years and older to those younger than 50 years, diabetes (odds ratio [OR] = 3.54; P = .0016), high blood cholesterol (OR = 2.04; P = .0092), osteoarthritis (OR = 2.02; P = .0454), and hypertension (OR = 1.84; P = .0175) were significantly more prevalent in the older cohort while panic attacks (OR = 0.33; P = .0022) were significantly more prevalent in the younger cohort. No significant differences in prevalence rates between the older and younger cohorts were found for back pain, depression, anxiety, fractures, or sleep disorders. Conclusions: People with moderate-severe TBI experience other medical and mental health comorbidities during the long-term course of recovery and life after injury. The findings can inform further investigation into comorbidities associated with TBI and the role of medical care, surveillance, prevention, lifestyle, and healthy behaviors in potentially modifying their presence and/or prevalence over the life span.

Factors Influencing Primary Care Follow-Up After Pediatric Mild Traumatic Brain Injury Objective: To identify socioeconomic, demographic, and caregiver factors associated with children attending primary care provider (PCP) follow-up after emergency department (ED) evaluation for mild traumatic brain injury (mTBI). Setting: Pediatric trauma center ED. Participants: Children 8 to 18 years of age sustaining mTBI less than 48 hours prior to an ED visit. Mean age of the 183 participants was 12 years with no significant differences between those who attended follow-up and those who did not in race, ethnicity, insurance provider, or PCP office setting. Design: Thirty-day longitudinal cohort study. Main Measures: Insurance type, PCP practice setting, and a caregiver attitudes survey regarding mTBI recovery and management (5 questions each scored on a 5-point Likert scale). The primary outcome was attending a PCP follow-up visit within 1 month of injury. Results: Females were more likely than males to attend PCP follow-up (adjusted odds ratio: 2.27 [95% confidence interval: 1.00-5.18]). Increasing scores on the caregiver attitudes survey indicating greater concerns about recovery were significantly associated with attending PCP follow-up (adjusted odds ratio: 1.12 per unit increase in composite score [95% confidence interval: 1.02-1.23]). No other socioeconomic, demographic, or injury characteristics were associated with attending PCP follow-up. Conclusions: The ED counseling regarding PCP follow-up of mTBI should stress the importance of follow-up care to monitor recovery and identify presence of lingering symptoms.

Performance Validity in Collegiate Football Athletes at Baseline Neurocognitive Testing Objective: To assess the prevalence of invalid performance on baseline neurocognitive testing using embedded measures within computerized tests and individually administered neuropsychological measures, and to examine the influence of incentive status and performance validity on neuropsychological test scores. Setting: Sport-related concussion management program at a regionally accredited university. Participants: A total of 83 collegiate football athletes completing their preseason baseline assessment within the University's concussion management program and a control group of 140 nonathlete students. Design: Cross-sectional design based on differential incentive status: motivated to do poorly to return to play more quickly after sustaining a concussion (athletes) versus motivated to do well due to incentivizing performance (students). Main Measures: Immediate Post-Concussion and Cognitive Testing (ImPACT), performance validity tests, and measures of cognitive ability. Results: Half of the athletes failed at least 1 embedded validity indicator within ImPACT (51.8%), and the traditional neuropsychological tests (49.4%), with large effects for performance validity on cognitive test scores (d: 0.62-1.35), incentive status (athletes vs students; d: 0.36-1.15), and the combination of both factors (d: 1.07-2.20) on measures of attention and processing speed. Conclusion: Invalid performance on baseline assessment is common (50%), consistent across instruments (ImPACT or neuropsychological tests) and settings (one-on-one or group administration), increases as a function of incentive status (risk ratios: 1.3-4.0) and results in gross underestimates of the athletes' true ability level, complicating the clinical interpretation of the postinjury evaluation and potentially leading to premature return to play.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Spine

"Sailboats in Boothbay, Maine" No abstract available

Mechanical Function of the Nucleus Pulposus of the Intervertebral Disc Under High Rates of Loading Study Design. Bovine motion segments were used to investigate the high-rate compression response of intervertebral discs (IVD) before and after depressurising the nucleus pulposus (NP) by drilling a hole through the cranial endplate into it. Objective. To investigate the effect of depressurising the NP on the force–displacement response, and the energy absorption in IVDs when compressed at high strain rates. Summary of Background Data. The mechanical function of the gelatinous NP located in the center of the IVDs of the spine is unclear. Removal of the NP has been shown to affect the direction of bulge of the inner anulus fibrosus (AF), but at low loading rates removal of the NP pressure does not affect the IVD's stiffness. During sports or injurious events, IVDs are commonly exposed to high loading rates, however, no studies have investigated the mechanical function of the NP at these rates. Methods. Eight bovine motion segments were used to quantify the change in pressure caused by a hole drilled through the cranial endplate into the NP, and eight segments were used to investigate the high-rate response before and after a hole was drilled into the NP. Results. The hole caused a 28.5% drop in the NP pressure. No statistically significant difference was seen in peak force, peak displacement, or energy-absorption of the intact, and depressurized NP groups under impact loading. The IVDs absorbed 72% of the input energy, and there was no rate dependency in the percentage energy absorbed. Conclusion. These results demonstrate that the NP pressure does not affect the transfer of load through, or energy absorbed by, the IVD at high loading rates and the AF, rather than the NP, may play the most important role in transferring load, and absorbing energy at these rates. This should be considered when attempting surgically to restore IVD function. Level of Evidence: N/A

Locally Applied Simvastatin as an Adjunct to Promote Spinal Fusion in Rats Study Design. Basic Science. Objective. To determine if locally delivered simvastatin can enhance bone formation in a rat spinal fusion model. Summary of Background Data. The bone-anabolic properties of statins in fracture healing are well established, however, few studies have evaluated the impact of locally delivered statins in spinal fusion. Methods. We formulated poly(lactic-co-glycolic acid) (PLGA) nanoparticles by adapting previously published techniques. Two types of nanoparticles were created: simvastatin nanoparticles (SimNP) and nanoparticles without simvastatin (BlankNP). Drug elution from SimNP was characterized. Osteoblastic differentiation was analyzed using MC3T3-E1 cells cultured in differentiation medium containing SimNP or BlankNP. Forty male 12 week old outbred Wistar rats underwent uninstrumented posterolateral fusion using iliac crest bone graft and BlankNP, SimNP or simvastatin drug. X-rays to assess bone formation were obtained at 4 weeks and 9 weeks post-operatively. Spines were explanted at 9 weeks for micro-CT analysis, and a blinded manual assessment of fusion (MAF). Results. SimNP achieved a release efficiency of 74.1% with ∼50% release occurring in the first day. Simvastatin and SimNP treated cells showed significantly greater expression of osteopontin (OPN) and osteocalcin (OCN). On micro-CT analysis, SimNP animals had higher bone volume and percent bone volume (bone volume/total volume) than control animals. SimNP rats had higher X-ray scores at 4 weeks (p=0.010) and 9 weeks (p<0.001) relative to BlankNP. MAF showed that SimNP had a higher fusion rate than BlankNP (42.9% vs. 0%, p=0.006). Conclusion. We were able to validate that sustained release of simvastatin via a PLGA nanoparticle. SimNP was able to induce an increase in mineralization as well as an increase in markers of bone formation. X-ray analysis, micro-CT quantification, and MAF assessment of SimNP treated rats showed significantly greater bone formation and fusion mass strength relative to vehicle treated animals. Simvastatin may be a safe, cost-effective bone anabolic agent for use in spinal fusion. Level of Evidence. N/A

AMP-Activated Protein Kinase Activation in Dorsal Root Ganglion Suppresses mTOR/p70S6K Signaling and Alleviates Painful Radiculopathies in Lumbar Disc Herniation Rat Model Study Design. Animal experiment: a rat model of lumbar disc herniation (LDH) induced painful radiculopathies. Objective. To investigate the role and mechanism of AMP-activated protein kinase (AMPK) in dorsal root ganglia (DRG) neurons in LDH-induced painful radiculopathies. Summary of Background Data. Overactivation of multiple pain signals in DRG neurons triggered by LDH is crucial to the development of radicular pain. AMPK is recognized as a cellular energy sensor, as well as a pain sensation modulator, but its function in LDH-induced pain hypersensitivity remains largely unknown. Methods. The LDH rat model was established by autologous nucleus pulposus transplantation into the right lumbar 5 (L5) nerve root. At different time points after AMPK agonist metformin (250 mg/kg/d) or mammalian target of rapamycin (mTOR) inhibitor rapamycin (5 mg/kg) intraperitoneal administration, thermal and mechanical sensitivity were evaluated by measuring paw withdrawal latency (PWL) and 50% paw withdrawal thresholds (PWT). The levels of AMPK, mTOR, and p70S6K phosphorylation were determined by Western blot. We also investigated the proportion of p-AMPK positive neurons in the right L5 DRG neurons using immunofluorescence. Results. LDH evoked persistent thermal hyperalgesia and mechanical allodynia on the ipsilateral paw, as indicated by the decreased PWL and 50% PWT. These pain hypersensitive behaviors were accompanied with significant inhibition of AMPK and activation of mTOR in the associated DRG neurons. Pharmacological activation of AMPK in the DRG neurons not only suppressed mTOR/p70S6K signaling, but also alleviated LDH-induced pain hypersensitive behaviors. Conclusion. We provide a molecular mechanism for the activation of pain signals based on AMPK-mTOR axis, as well as an intervention strategy by targeting AMPK-mTOR axis in LDH-induced painful radiculopathies. Level of Evidence: N/A

ERRFI1 Inhibits Proliferation and Inflammation of Nucleus Pulposus and Is Negatively Regulated by miR-2355-5p in Intervertebral Disc Degeneration Study Design. In vivo and in vitro studies of the role of miR-2355-5p and its possible targets in intervertebral disc degeneration (IVDD). Objective. To elucidate the regulatory role of miR-2355-5p in IVDD and the underlying mechanisms. Summary of Background Data. IVDD, which is caused by multiple factors, is the main cause of lower back pain with or without extremity pain. However, the underlying cellular mechanisms of IVDD pathogenesis are not well elucidated. Cell hyper-proliferation, inflammation, and epidermal growth factor receptor activation have been implicated in IVDD. Up-regulated miR-2355-5p level was identified to associate with IVDD. ERRFI1 (the product of mitogen-inducible gene 6 [MIG6]) was known to inhibit epidermal growth factor receptor activation. Methods. We monitored the expression of miR-2355-5p and ERRFI1 in IVDD tissues and lipopolysaccharides (LPS)-treated nucleus pulposus (NP) cells. We explored the effects of ERFFI1 on NP cells proliferation and LPS-induced pro-inflammatory cytokines production. We searched the targets of miR-2355-5p and explored the effects of miR-2355-5p on NP cells proliferation and cytokines production. Results. We identified the up-regulation of miR-2355-5p and down-regulation of ERFFI1 in IVDD samples and LPS-treated NP cells. ERFFI1 inhibited NP cells proliferation and LPS-induced pro-inflammatory cytokine production. MiR-2355-5p targeted ERFFI1 and negatively regulated ERFFI1 expression. MiR-2355-5p regulated IVDD by targeting ERFFI1. Conclusion. MiR-2355-5p negatively regulated ERFFI1 and prevented the effects of ERRFI1 on inhibiting NP cells proliferation and inflammation. Level of Evidence: N/A

Prevalence and Predictive Factors of Concurrent Cervical Spinal Cord Compression in Adult Spinal Deformity Study Design. Retrospective cross-sectional cohort. Objective. To investigate the prevalence and predictive factors of concurrent cervical spinal cord compression (CSCC) in patients with adult spinal deformity (ASD). Summary of Background Data. In patients with ASD undergoing major thoracolumbar realignment surgery, concurrent CSCC potentially increases the risk of progression of myelopathy or cervical cord injury due to various perioperative factors including poor intraoperative neck positioning and hypotension. However, the prevalence of CSCC in ASD patients has not been previously studied. Methods. This study included ASD patients who were indicated for major thoracolumbar corrective surgery (>5 levels). The presence of CSCC was determined using the modified Cord Compression Index (Grades 0–3) based on the cervical magnetic resonance imaging (MRI). Significant CSCC was defined as Grade>2, and the distribution of compression level as well as the number of Grade>2 segments were investigated in each patient. A multivariate regression analysis was performed to identify the predictors of CSCC with variables being the patients' characteristics including radiographic sagittal alignment parameters. Results. Of 121 patients with ASD, 41 patients (33.8%) demonstrated significant CSCC on MRI. Intramedullary T2 hyper-intensity (myelomalacia) was present in eight patients (6.6%). Thirty-five of 41 patients were asymptomatic or with myelopathy that is difficult to detect. Significant CSCC was most commonly observed at C4/5 level. Four patients (3.3%) underwent cervical decompression and fusion prior to thoracolumbar reconstruction. Multivariate regression analysis revealed old age, increased body mass index (BMI), and PI-LL mismatch independently predicted the CSCC grade. Conclusion. The prevalence of concurrent significant cervical cord compression in patients with ASD is relatively high at 33.8%. Preoperative evaluation of cervical MRI and examinations for signs/symptoms of myelopathy are essential for patients with (1) older age, (2) increased BMI, and (3) high PI-LL mismatch to avoid progressive myelopathy or cord injury during ASD surgery. Level of Evidence: 4

Sagittal Alignment Outcomes in Lordotic Cervical Spine: Does Three-Level Anterior Cervical Discectomy and Fusion Outperform Laminoplasty? Study Design. A prospective cohort study. Objective. To compare the radiological outcomes between three-level anterior cervical discectomy and fusion (ACDF) and plate-only open-door laminoplasty (LAMP) in patients with lordotic cervical spine. Summary of Background Data. Both three-level ACDF and LAMP are important surgical methods for multilevel cervical spondylotic myelopathy, but the cervical sagittal alignment outcomes and the lordosis preserving abilities between the two specific approaches have not been carefully compared. Methods. Sixty patients, all of whom had lordotic cervical spines and underwent three-level ACDF (n = 22) or LAMP (n = 38) for the treatment of multilevel cervical spondylotic myelopathy, were prospectively studied. Upright neutral cervical lateral radiographs were assessed preoperatively, at 3 days after surgery, and at the last follow-up (1.5 years). The primary radiological outcomes are C2–7 Cobb angle, and the secondary outcomes include C2–7 sagittal vertical axis , disc height, Harrison angle, and Ishihara index. The relationship between preoperative parameters and follow-up outcomes were assessed. Results. Preoperative cervical sagittal alignment parameters were similar between the two groups. Patients in the ACDF group obtained larger C2–7 Cobb angles than those the LAMP group early after surgery. However, the lordosis in the ACDF group decreased significantly during follow-up, leading to similar outcomes between the two groups. The lordosis-preserving ability of ACDF is significantly poorer than that of LAMP. Secondary radiological parameters also showed similar trends. In both groups, the preoperated Ishihara index was significantly related to follow-up C2–7 Cobb angles. For patients with Ishihara index less than 20, ACDF is more likely to produce a larger C2–7 Cobb angled at the time of follow-up. Conclusion. In patients with lordotic cervical spine, the sagittal alignment outcomes of the two approaches were similar, and the lordosis-preserving ability was poorer in ACDF. Further research should focus on the factors related to the lordosis-preserving ability of multilevel ACDF. Level of Evidence: 3

Pain Intensity and Fear Avoidance Explain Disability Related to Chronic Low Back Pain in a Saudi Arabian Population Study Design. A cross-sectional study. Objective. The aim of this study was to describe multi-dimensional profiles for people with chronic low back pain (CLBP) and to examine the associations between CLBP-related disability and individual, psychosocial and physical factors in a Saudi population. Summary of Background Data. CLBP-related disability is a multidimensional phenomenon. There is growing interest in exploring factors associated with CLBP-related disability in Saudi Arabia but research is limited in comparison to other countries. Methods. Participants completed questionnaires covering demographics, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. Oswestry Disability Index (ODI) was used to measure disability. Participants also performed a standardized sequence of physical performance tests and a Pain Behavior Scale was used to evaluate pain behaviors during performance of these tests. The relationships between disability and all variables were explored using univariate and multivariate regression analyses. Results. One hundred and fifteen participants were included, 63% of whom were female. Participants demonstrated moderate disability (mean [SD]: 26.6 [13.5]). The mean (SD) back beliefs score was 28.6 (7.3). Mean depression, anxiety, and stress (DASS 21) scores indicated mild distress; however, 26% to 39% scored in the moderate to severe range for at least one subscale. In univariate analyses, pain intensity and fear avoidance beliefs (physical activity and work) were moderately associated with disability (r = 0.56, 0.49, 0.52, respectively, P < 0.001), with all other factors demonstrating weak association. Multivariate regression revealed that pain intensity, fear avoidance beliefs, psychological distress, and participants' age were all found to be associated with disability, accounting for 52.9% (adjusted R2 = 0.529) of variability. Conclusion. This study provides a unique insight into the clinical profile of people with CLBP in a Saudi Arabian population. Pain and psychosocial factors were significantly associated with disability. This study supports the contention that CLBP-related disability is a multifactorial biopsychosocial condition across different cultures. Level of Evidence: 3

Scoliosis and Cardiopulmonary Outcomes in Osteogenesis Imperfecta Patients Study Design. Retrospective clinical study of individuals with osteogenesis imperfecta (OI). Objective. To assess the relationship between severity of scoliosis and pulmonary function, and to assess the relationship between restrictive lung disease and self-reported quality of life in individuals with OI. Summary of Background Data. OI is a heritable connective tissue disorder characterized by osteopenia and a predisposition to fracture. Respiratory insufficiency is a leading cause of mortality. Literature on pulmonary function in this population has shown a negative correlation between percent-predicted vital capacity and severity of scoliosis. However, it has been suggested that decreased pulmonary function in OI may be due to intrinsic pulmonary disease, in addition to the impact of vertebral compression fractures and scoliosis. Methods. Anterior-posterior spine radiographs and pulmonary function tests from 30 individuals with OI were reviewed. Radiographs were evaluated for scoliosis, defined as a curve ≥ 10°. If more than one curve was present, the largest curve was used. Pulmonary function was defined as the forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio. Restrictive pulmonary disease was defined as FEV1/FVC > 80%, while obstructive disease was defined as FEV1/FVC < 70%. Bivariate correlation analysis was performed, using Spearman rho correlation coefficient (P < 0.05). Quality of life was assessed by SF-36. Results. The mean age was 27.6 years (range: 12–42 yrs). 57.6% were female. OI type IV was the most common (46.7%), followed by OI type III (33.3%), OI type I (10%), OI type IX (6.67% each), and OI type VIII (3.33%). Pulmonary comorbidity was present in 40% of individuals, while 6.67% had a cardiac comorbidity. The correlation between scoliosis and pulmonary function was weak and not significant (R = −0.059, P = 0.747). Conclusion. Pulmonary function is not significantly correlated with scoliosis, supporting the hypothesis that decreased pulmonary function is intrinsic to OI and/or chest wall deformities, rather than secondary to scoliosis. Level of Evidence: 4

The Change in Sway and Neuromuscular Activity in Adult Degenerative Scoliosis Patients Pre and Post Surgery Compared With Controls Study Design. Prospective cohort study. Objective. The purpose of this study is to quantify the extent of change in sway associated with maintaining a balanced posture within the cone of economy (CoE), in a group of adult degenerative scoliosis (ADS) patients' pre and postsurgery and compare them to matched non-scoliotic controls. Summary of Background Data. Patients with spinal deformities adopt a variety of postural changes in the spine, pelvis, and lower extremities in their effort to compensate for the anterior shift in the gravity line. ADS patients are known to exhibit an increased sway within their CoE. Greater sway expends more energy while standing when compared with healthy controls. Spinal alignment surgery has been shown to improve sagittal vertical axis and balance. Methods. Thirty-three ADS patients and performed a series of functional balance tests a week before and 3 months after surgery along with 20 non-scoliotic control. Results. ADS patients demonstrated more initial CoM (P = 0.001) and head (P = 0.011) displacements. Postoperatively ADS patients exhibited less CoM sway (P = 0.043) and head sway (P = 0.050), in comparison to their presurgery measures. Postsurgical ADS patients demonstrated more CoM (P = 0.002) and head (P = 0.012) displacements and increased muscle activity in comparison to non-scoliotic controls. Conclusion. Surgical alignment reduced the amount of sway, reduced the center of mass displacement, and reduced spine and lower extremity energy expenditure in ADS' patients. In symptomatic preoperative ADS patients, sagittal sway increased along with greater lumbar spine and lower extremity neuromuscular activity in comparison to a non-scoliotic control. Although surgical alignment improved ADS functional parameters during a dynamic balance test, these parameters approached but did not fully achieve non-scoliotic control parameters when measured 3 months after surgery. Level of Evidence: 3

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Medicine & Science in Sports & Exercise

Persistent Impairment in Cardiopulmonary Fitness after Breast Cancer Chemotherapy Purpose Anthracycline chemotherapy (AC) is associated with acute reductions in cardiopulmonary fitness (V˙O2peak). We sought to determine whether changes in V˙O2peak and cardiac function persisted at 12 months post-AC completion, and whether changes in cardiac function explain the heightened long-term heart failure risk. Methods Women with breast cancer scheduled for AC (n = 28) who participated in a nonrandomized trial of exercise training (ET; n = 14) or usual care (UC; n = 14) during AC completed a follow-up evaluation 12 months post-AC completion (16 months from baseline). At baseline, 4 months, and 16 months, participants underwent a resting echocardiogram (left ventricular ejection fraction; global longitudinal strain), a blood sample (troponin; B-type natriuretic peptide), a cardiopulmonary exercise test, and cardiac MRI measures of stroke volume (SV), heart rate, and cardiac output (Qc) at rest and during intense exercise. Results Seventeen women (UC, n = 8; ET, n = 9) completed evaluation at baseline, 4 months, and 16 months. At 4 months, AC was associated with 18% and 6% reductions in V˙O2peak in the UC and ET groups, respectively, which persisted at 16 months (UC, −16%; ET, −7%) and was not attenuated by ET (interaction, P = 0.10). Exercise Qc was lower at 16 months compared with baseline and 4 months (P < 0.001), which was due to a blunted augmentation of SV during exercise (P = 0.032; a 14% reduction in peak SV), with no changes in heart rate response. There was a small reduction in resting left ventricular ejection fraction (baseline to 4 months) and global longitudinal strain (between 4 and 16 months) and an increase in troponin (baseline to 4 months), but only exercise Qc was associated with V˙O2peak (R2 = 0.47, P < 0.01). Conclusion Marked reductions in V˙O2peak persisted 12 months after anthracycline-based chemotherapy, which was associated with impaired exercise cardiac function. Clinical Trial Registration: ACTRN12616001602415.

Effect of Creatine Supplementation on the Airways of Youth Elite Soccer Players Introduction Owing to its well-established ergogenic potential, creatine is a highly popular food supplement in sports. As an oral supplement, creatine is considered safe and ethical. However, no data exist on the safety of creatine on lung function in athletes. The aim of this project was to evaluate the effects of a standard course of creatine on the airways of youth elite athletes. Methods Nineteen elite soccer players, 16–21 yr old, completed a stratified, randomized, double-blind, placebo-controlled, parallel-group trial. The creatine group (n = 9) ingested 0.3 g·kg−1⋅d−1 of creatine monohydrate (CM) for 1 wk (loading phase) and 5 g·d−1 for 7 wk (maintenance phase), and the placebo group (n = 10) received the same dosages of maltodextrin. Airway inflammation (assessed by exhaled nitric oxide, FENO) and airway responsiveness (to dry air hyperpnoea) were measured pre- and postsupplementation. Results Mild, unfavorable changes in FENO were noticed by trend over the supplementation period in the CM group only (P = 0.056 for interaction, η2 = 0.199), with a mean group change of 9 ± 13 ppb in the CM group versus −5 ± 16 ppb in the placebo group (P = 0.056, d = 0.695). Further, the maximum fall in forced expiratory volume in 1 s after dry air hyperpnoea was larger by trend postsupplementation in the CM group compared with the placebo group: 9.7% ± 7.5% vs 4.4% ± 1.4%, respectively (P = 0.070, d = 0.975). These adverse effects were more pronounced when atopic players only (n = 15) were considered. Conclusion On the basis of the observed trends and medium to large effect sizes, we cannot exclude that creatine supplementation has an adverse effect on the airways of elite athletes, particularly in those with allergic sensitization. Further safety profiling of the ergogenic food supplement is warranted.

Testosterone and Resistance Training Improve Muscle Quality in Spinal Cord Injury Purpose Spinal cord injury (SCI) negatively impacts muscle quality and testosterone levels. Resistance training (RT) has been shown to increase muscle cross-sectional area (CSA) after SCI, whereas testosterone replacement therapy (TRT) has been shown to improve muscle quality in other populations. The purpose of this pilot study was to examine if the combined effects of these interventions, TRT + RT, may maximize the beneficial effects on muscle quality after SCI. Methods Twenty-two SCI subjects randomized into either a TRT + RT (n = 11) or TRT (n = 11) intervention for 16 wk. Muscle quality measured by peak torque (PT) at speeds of 0°·s−1 (PT-0°), 60°·s−1 (PT-60°), 90°·s−1 (PT-90°), and 180°·s−1 (PT-180°), knee extensor CSA, specific tension, and contractile speed (rise time [RTi], and half-time to relaxation [½TiR]) was assessed for each limb at baseline and postintervention using 2 × 2 mixed models. Results After 16 wk, subjects in the TRT + RT group increased PT-0° (48.4%, P = 0.017), knee extensor CSA (30.8%, P < 0.0001), and RTi (17.7%, P = 0.012); with no significant changes observed in the TRT group. Regardless of the intervention, changes to PT-60° (28.4%, P = 0.020), PT-90° (26.1%, P = 0.055), and PT-180° (20.6%, P = 0.09) for each group were similar. Conclusions The addition of mechanical stress via RT to TRT maximizes improvements to muscle quality after complete SCI when compared with TRT administered alone. Our evidence shows that this intervention increases muscle size and strength while also improving muscle contractile properties.

Bone Biomarker Response to Walking under Different Thermal Conditions in Older Adults Endurance exercise can cause a decrease in serum ionized calcium (iCa) and increases in parathyroid hormone (PTH) and c-terminal telopeptide of type I collagen (CTX), which may be due to Ca loss in sweat. Purpose This study aimed to determine whether exercise in a warm environment exaggerates the decrease in iCa and increases in PTH and CTX compared with a cool environment in older adults. Methods Twelve women and men 61–78 yr old performed two identical 60-min treadmill bouts at ~75% of maximal heart rate under warm and cool conditions. Serum iCa, PTH, and CTX were measured every 15 min starting 15 min before and continuing for 60 min after exercise. Sweat Ca loss was estimated from sweat volume and sweat Ca concentration. Results Sweat volume was low and variable; there were no differences in sweat volume or Ca concentration between conditions. iCa decreased after 15 min of exercise, and the change was similar in both conditions. Increases in PTH (warm: 16.4, 95% confidence interval [CI] = 6.2, 26.5 pg·mL−1; cool: 17.3, 95% CI = 8.1, 26.4 pg·mL−1) and CTX (warm: 0.08, 95% CI = 0.05, 0.11 ng·mL−1; cool: 0.08, 95% CI = 0.01, 0.16 ng·mL−1) from before to immediately after exercise were statistically significant and similar between conditions. Adjusting for plasma volume shifts did not change the results. Conclusion The increases in PTH and CTX, despite the low sweat volume, suggest that dermal Ca loss is not a major factor in the decrease in iCa and increases in PTH and CTX observed during exercise in older adults.

Objectively Measured Physical Activity Is Associated with Vertebral Size in Midlife Background Vertebral fractures reduce the quality of life and are a major burden to the health care sector. Small vertebral size is associated with increased vertebral fracture risk. Previous studies have investigated the relationship between physical activity (PA) and vertebral size, but their results seem somewhat contradictory. In this population-based birth cohort study, we aimed to evaluate the relationship between objectively measured PA and vertebral size. Methods The study population consisted of 1202 cohort participants who underwent PA and vertebral size measurements at the age of 46 to 48 yr. Moderate-to-vigorous PA (MVPA, ≥3.5 METs) was measured by a wrist-worn accelerometer (Polar Active; Polar Electro, Finland) for 14 d. The vertebral axial cross-sectional area (CSA) of the L4 vertebra was measured and calculated from lumbar magnetic resonance imaging scans at 46 to 48 yr. We analyzed the association between the daily amount of MVPA (min·d−1) and vertebral CSA using multivariable linear regression analysis. Results The daily amount of MVPA was significantly and positively associated with CSA in both sexes. For every minute per day of MVPA, men had 0.71 mm2 (95% confidence interval, 0.36–1.06) and women 0.90 mm2 (95% confidence interval, 0.58–1.21) larger CSA. Conclusions Physical activity of at least moderate intensity is positively associated with vertebral size and may thus prevent future vertebral fractures.

Sedentary Time and White Matter Hyperintensity Volume in Older Adults Purpose Cerebrovascular disease in the form of white matter hyperintensities (WMH) increases with age and is associated separately with sedentary time and reduced kidney function. A better understanding of the relationships among these variables would help clarify whether sedentary time should be considered more closely in older adults at particular levels of kidney function to reduce the risk of WMH. Methods We analyzed information from 94 healthy community-dwelling older adults to determine the association of sedentary time and WMH in nondemented, nondepressed older adults, and whether level of kidney function was an effect modifier of the relationship between sedentary time and WMH. Sedentary behavior was measured using the Sedentary Behavior Questionnaire. White matter hyperintensity was assessed using whole-brain 3T magnetic resonance imaging T1- and T2-weighted images. Kidney function was calculated by the epi-chronic kidney disease formula for estimated glomerular filtration rate (eGFR). Exposures or predictors were sedentary time, age, sex, education in years, Framingham stroke risk 10-yr prediction score, and eGFR. The analytical approach was multiple linear regression. Results Adjusting for age, sex, education in years, Framingham stroke risk 10-yr prediction score, greater sedentary time was associated with greater WMH but this effect was dependent on level of eGFR (sedentary time–eGFR interaction b = −0.0005, P = 0.022). At eGFR values of 69, 81, and 93 mL·min−1 per 1.73 m2 (the 25th, 50th, and 75th percentiles), sedentary time b coefficients were b = 0.021 (95% confidence interval [CI], 0.011–0.031), b = 0.015 (95% CI, 0.008–0.022), and b = 0.009 (95% CI, 0.003–0.016). The effect weakened linearly as eGFR increased, with no significant association at eGFR ≥97 mL·min−1 per 1.73 m2. Conclusions Findings suggest that sedentary time is associated with WMH in persons with an eGFR ≤96 mL·min−1 per 1.73 m2 and that this association is stronger with lower levels of kidney function.

Shared Neuromuscular Performance Traits in Military Personnel with Prior Concussion Concussions are common in military personnel and may result in increased risk of musculoskeletal injury. One plausible explanation for this risk could be that neuromotor deficiencies enhance injury risk after a concussion through altered muscular activation/contraction timing. Purpose To compare military personnel with at least one concussion during the past 1 month to 2 yr (CONCUSSED) to military branch-matched, age-matched, and Special Operations Forces group–matched controls (CONTROL) on physiological, musculoskeletal, and biomechanical performance. Methods A total of 48 (24 CONCUSSED, 24 CONTROL) male Air Force and Naval Special Warfare Operators age 19 to 34 yr participated in the study. Participants self-reported demographics/injury history and completed the following assessments: 1) physiological—body composition, anaerobic power and capacity, aerobic capacity and lactate threshold; 2) musculoskeletal—lower extremity isokinetic strength testing, including time to peak torque; and 3) biomechanical—single-leg jump and landing task, including landing kinematics of the hip, knee and ankle. A machine learning decision tree algorithm (C5.0) and one-way ANOVA were used to compare the two groups on these outcomes. Results Despite nonsignificant differences using ANOVA, the C5.0 algorithm revealed CONCUSSED demonstrated quicker time to peak knee flexion angle during the single-leg landing task (≤0.170 s; CONCUSSED: n = 22 vs CONTROL: n = 14), longer time to peak torque in knee extension isokinetic strength testing (>500 ms; CONCUSSED: n = 18 vs CONTROL: n = 4) and larger knee flexion angle at initial contact (>7.7°; CONCUSSED: n = 18 vs CONTROL: n = 2). Conclusion The findings supported the hypothesis that CONCUSSED military personnel would demonstrate altered neuromuscular control in landing strategies and muscular activation. Future research should assess prospectively neuromuscular changes after a concussion and determine if these changes increase risk of subsequent musculoskeletal injuries.

Loading Behaviors Do Not Match Loading Abilities Postanterior Cruciate Ligament Reconstruction Purpose Strategies that underload the surgical limb after anterior cruciate ligament reconstruction (ACLr) are observed in submaximal tasks. It is not known what underlies these strategies in early rehabilitation. The purpose of this study was to determine if underloading can be attributed to the inability to meet task demands with and without attention to limb loading or learned behavior. Methods Twenty individuals (110.6 [18.1] days) post-ACLr and 20 healthy individuals (CTRL) participated in this study. Participants performed standing, sit-to-stand, and squat tasks under natural, instructed, and feedback conditions. Limb-loading symmetry was calculated as the between-limb ratio of vertical ground reaction force impulse during each task. General Linear Model repeated-measures analysis, 2 (group) × 3 (condition), determined the effects of group and condition on limb-loading symmetry for each task. Results Significant interactions were observed for each task (all P < 0.001). Compared with CTRL, ACLr exhibited greater asymmetry during natural (deficits: standing, 10%, P = 0.001; sit-to-stand, 25%, P < 0.001; squat, 15%, P < 0.001) and instructed (deficits: sit-to-stand, 13%, P = 0.001; squat, 8%, P = 0.04), but not feedback conditions. The CTRL maintained symmetry across conditions and tasks. Anterior cruciate ligament reconstruction exhibited greater asymmetry in natural compared with instructed (deficits: standing, 11%, P < 0.001; sit-to-stand, 14%, P < 0.001; squat, 8%, P = 0.001) and feedback (deficits: standing, 10%, P = 0.001; sit-to-stand, 21%, P < 0.001; squat, 15%, P < 0.001) conditions. Conclusions The presence of loading asymmetries in natural but not feedback conditions indicates that individuals 3 months post-ACLr shift loading away from surgical limb despite the ability to meet task demands which may be suggestive of nonuse behavior. Even when instructed to load symmetrically, individuals continued to exhibit some degree of asymmetry.

Effects of Exercise on Stress-induced Attenuation of Vaccination Responses in Mice Studies suggest that exercise can improve vaccination responses in humans. Chronic stress can lead to immunosuppression, and there may be a role for exercise in augmenting immune responses. Purpose To investigate the effects of acute eccentric exercise (ECC) and voluntary wheel exercise training (VWR) on antibody and cell-mediated immune responses to vaccination in chronically stressed mice. We hypothesized that both ECC and VWR would attenuate chronic stress-induced reductions in vaccination responses. Methods Mice were randomized into four groups: control (CON), stress (S)-ECC, S-VWR, and S-sedentary (SED). Stressed groups received chronic restraint stress for 6 h·d−1, 5 d·wk−1 for 3 wk. After the first week of stress, S-ECC were exercised at 17 m·min−1 speed at −20% grade for 45 min on a treadmill and then intramuscularly injected with 100 μg of ovalbumin (OVA) and 200 μg of alum adjuvant. All other groups were also vaccinated at this time. Stress-VWR mice voluntarily ran on a wheel for the entire experiment. Plasma was collected before, and at 1, 2, and 4 wk postvaccination. Enzyme-linked immunosorbent assay was performed to analyze anti-OVA IgG and IgM antibodies. After 3 wk of chronic stress, all mice were injected with OVA into the ear to determine the delayed-type hypersensitivity. Results We found that chronic restraint stress significantly reduced body weight and caused adrenal hypertrophy. We also found both S-ECC and S-VWR groups had significantly elevated anti-OVA IgG (P < 0.05), whereas no significant differences between the two exercise groups. Neither S-ECC nor S-VWR altered anti-OVA IgM or delayed-type hypersensitivity responses compared with S-SED group. Conclusions Acute eccentric exercise and voluntary exercise training alleviated the chronic stress-induced anti-OVA IgG reductions in vaccination responses.

Neuromuscular Fatigue and Metabolism during High-Intensity Intermittent Exercise Purpose To examine the degree of neuromuscular fatigue development along with changes in muscle metabolism during two work-matched high-intensity intermittent exercise protocols in trained individuals. Methods In a randomized, counter-balanced, crossover design, 11 endurance-trained men performed high-intensity intermittent cycle exercise protocols matched for total work and including either multiple short-duration (18 × 5 s; SS) or long-duration (6 × 20 s; LS) sprints. Neuromuscular fatigue was determined by preexercise to postexercise changes in maximal voluntary contraction force, voluntary activation level and contractile properties of the quadriceps muscle. Metabolites and pH were measured in vastus lateralis muscle biopsies taken before and after the first and last sprint of each exercise protocol. Results Peak power output (11% ± 2% vs 16% ± 8%, P < 0.01), maximal voluntary contraction (10% ± 5% vs 25% ± 6%, P < 0.05), and peak twitch force (34% ± 5% vs 67% ± 5%, P < 0.01) declined to a lesser extent in SS than LS, whereas voluntary activation level decreased similarly in SS and LS (10% ± 2% vs 11% ± 4%). Muscle [phosphocreatine] before the last sprint was 1.5-fold lower in SS than LS (P < 0.001). Preexercise to postexercise intramuscular accumulation of lactate and H+ was twofold and threefold lower, respectively, in SS than LS (P < 0.001), whereas muscle glycogen depletion was similar in SS and LS. Rate of muscle glycolysis was similar in SS and LS during the first sprint, but twofold higher in SS than LS during the last sprint (P < 0.05). Conclusions These findings indicate that, in endurance-trained individuals, multiple long-sprints induce larger impairments in performance along with greater degrees of peripheral fatigue compared to work-matched multiple short-sprints, with these differences being possibly attributed to more extensive intramuscular accumulation of lactate/H+ and to lower rates of glycolysis during multiple long-sprint exercise.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Dental anxiety in 18-year-old Norwegians in 1996 and 2016Kjetil Strøm, Anne B. Skaare & Tiril WillumsenPages:...

Dental anxiety in 18-year-old Norwegians in 1996 and 2016Kjetil Strøm, Anne B. Skaare & Tiril WillumsenPages: 1-7 | DOI: 10.1080/00016357.2019.1637933

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

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Acta Oncologica and online now on Taylor & Francis Online: Letter to the Editor Completeness...

Acta Oncologica and online now on Taylor & Francis Online:Letter to the EditorCompleteness of pediatric cancer registration in the Finnish Cancer RegistryM. Jokela, M. K. Leinonen, N. Malila, M. Taskinen & L. M. Madanat-HarjuojaPages: 1-4 | DOI: 10.1080/0284186X.2019.1638522AR-V7 expression in circulating tumor cells as a potential prognostic marker in metastatic hormone-sensitive prostate cancerAndreas Josefsson, Jan-Erik Damber & Karin WelénPages: 1-5 | DOI: 10.1080/0284186X.2019.1637540Original...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

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Laser vision correction surgery, or refractive eye surgery, is an increasingly popular procedure that...

Laser vision correction surgery, or refractive eye surgery, is an increasingly popular procedure that treats nearsightedness, farsightedness and astigmatism. The surgery allows people who wear eyeglasses or contacts to no longer need prescription lenses.Other laser vision correction proceduresThe most common alternative to LASIK is called PRK (photorefractive keratectomy). PRK works best in people with low-to-moderate nearsightedness and who have thin corneas or dry eyes. In this technique, surgeons...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:53

SMILE (Small Incision Lenticule Extraction) is the latest advancement in laser vision correction to...

SMILE (Small Incision Lenticule Extraction) is the latest advancement in laser vision correction to treat nearsightedness. The SMILE procedure is minimally invasive, and involves removing a small piece of tissue from the cornea with a laser, rather than creating a flap or altering the surface. Most patients feel no pain during or after the procedure, and are able to return to their daily activities quickly.

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:52

LASIK (Laser-Assisted In-Situ Keratomileusis) is the most common type of refractive surgery and is...

LASIK (Laser-Assisted In-Situ Keratomileusis) is the most common type of refractive surgery and is recommended to treat varying degrees of nearsightedness, farsightedness and astigmatism. This outpatient procedure is quick and relatively painless, and generally results in minimal post-operative pain and rapid vision recovery. During LASIK, the surgeon makes a small flap in the cornea, which is a clear, dome-shaped surface that covers the front of the eye, and folds it back. Then a laser reshapes...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

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Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort...

Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years | Simon G F Abram, Andrew Judge, Tanvir Khan, David J Beard & Andrew J PricePages: 1-11 | DOI: 10.1080/17453674.2019.1639360

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:50

Functional and histological improvements of small nerve neuropathy after high-concentration capsaicin...

Functional and histological improvements of small nerve neuropathy after high-concentration capsaicin patch application,A case studyTrouvin, Anne-Priscillea,b,*; Perrot, Sergea,bPAIN Reports: July 09, 2019 - Volume Latest Articles - Issue - pdoi: 10.1097/PR9.0000000000000761Neuropathic: PDF OnlyOPENAbstractAuthor InformationArticle MetricsIntroduction: Small fiber neuropathy has been found to occur in a large variety of pathological onditions, and the gold standard for diagnosis of small fiber neuropathy...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:49

Is Early Chemical Thromboprophylaxis in Patients with Solid Organ Injury a Solid Decision? Skarupa,...

Is Early Chemical Thromboprophylaxis in Patients with Solid Organ Injury a Solid Decision?Skarupa, David MD1; Hanna, Kamil MD2; Zeeshan, Muhammad MD2; Madbak, Firas MD1; Hamidi, Mohammad MD2; Haddadin, Zaid MD2; Northcutt, Ashley MD2; Gries, Lynn MD2; Kulvatunyou, Narong MD2; Joseph, Bellal MD2Journal of Trauma and Acute Care Surgery: July 9, 2019 - Volume Publish Ahead of Print - Issue - pdoi: 10.1097/TA.00000000000024382019 WTA Podium Paper: PDF OnlyBUYPAPAbstractAuthor InformationArticle MetricsBackground...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

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Development of Transfusion Guidelines for Injured Children Using a Modified Delphi Consensus Process,...

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:49

National Cancer Institute

National Cancer Institute theNCI11 JulThe #ChildhoodCancer Data Initiative aims to identify existing tools or develop new tools that will allow us to ana… https://t.co/dB1Jq2BndXDetails  |  RetweetNational Cancer Institute theNCI11 JulWalking with purpose after a diagnosis of HPV-related head and neck cancer: https://t.co/Xs0IR3YFXX @NCIResearchCtr… https://t.co/pvsJWRkVKxDetails  |  RetweetNational Cancer Institute theNCI11 JulThere are two main types of radiation therapy, external beam and internal....

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

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Oncology Reports - Spandidos Publications

Effects of gossypol on apoptosis‑related gene expression in racially distinct triple‑negative breast cancer cellsSamia S. Messeha, Najla O. Zarmouh, Patricia Mendonca, Hayfaa Alwagdani, Carolyn Cotton, Karam F.A. SolimanView Abstract ❯Matrine improves skeletal muscle atrophy by inhibiting E3 ubiquitin ligases and activating the Akt/mTOR/FoxO3α signaling pathway in C2C12 myotubes and miceLi Chen, Linlin Chen, Lili Wan, Yan Huo, Jinlu Huang, Jie Li, Jin Lu, Bo Xin, Quanjun Yang, Cheng GuoView Abstract...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:46

Physiological and transcriptional comparison of acetate catabolism between Acinetobacter schindleri ACE...

Physiological and transcriptional comparison of acetate catabolism between Acinetobacter schindleri ACE andEscherichia coli JM101,  Juan-Carlos Sigala; Lucy Quiroz; Eduardo Arteaga ; Roberto Olivares; Alvaro R Lara ...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:43

Suppressed immune microenvironment and repertoire in brain metastases from patients with resected non-small...

Suppressed immune microenvironment and repertoire in brain metastases from patients with resected non-small cell lung cancer,  Y Kudo; C Haymaker; J Zhang; A Reuben ; D Y Duose ...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

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Cancer Survivorship and Subclinical Myocardial Damage,  Steven S Coughlin; Gaston Kapuku Response...

Cancer Survivorship and Subclinical Myocardial Damage,  Steven S Coughlin; Gaston KapukuResponse by Florido and Selvin to Commentary regarding article: "Cancer Survivorship and Subclinical Myocardial Damage: The Atherosclerosis Risk in Communities (ARIC) Study"  Roberta Florido, MD, MHS; Elizabeth Selvin, PhD, MPH

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:43

Integrative and Comparative Biology

Chemical responses to the biotic and abiotic environment by early diverging metazoans revealed in the post-genomic age  Beth Okamura; Paul F Long; Laura D Mydlarz  Mitochondrial ecophysiology: assessing the evolutionary forces that shape mitochondrial variation  Jessica L McKenzie; Dillon J Chung; Timothy M Healy; Reid S Brennan ; Heather J Bryant ...  High-Throughput Segmentation of Tiled Biological Structures using Random Walk Distance Transforms  Daniel Baum; James C Weaver; Igor Zlotnikov ; David...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:42

FEMS Microbiology Ecology

Community succession in an anaerobic long-chain paraffin-degrading consortium and impact on chemical and electrical microbially influenced iron corrosion  Renxing Liang; Irene Davidova; Shin-ichi Hirano; Kathleen E Duncan; Joseph M Suflita  Differences in soil microbial response to anthropogenic disturbances in Sanjiang and Momoge Wetlands, China  Jing Wei; Jie Gao; Na Wang; Ying Liu ; Yuwan Wang ...  Mimosa caesalpiniifolia Benth. adapts to rhizobia populations with differential taxonomy and symbiotic...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

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"Each Unbearable Day": Narrative Ruthlessness and Environmental and Reproductive Injustice in Jesmyn...

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:37

Encounter on the Great Plains: Scandinavian Settlers and the Dispossession of Dakota Indians, 1890-1930....

Encounter on the Great Plains: Scandinavian Settlers and the Dispossession of Dakota Indians, 1890-1930. By Karen V. Hansen  Kimberly K Porter  For the Love of Murphy's: The Behind-the-Counter Story of a Great American Retailer. By Jason Togyer  Mary A Larson  Podcasts: The Archives of American Art Oral History Collection. Archives of American Art, Smithsonian Institution  Rose Chiango

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:37

The Fetish Revisited: Marx, Freud, and the Gods Black People Make,  Laura S Grillo  Virgin Whore. By...

The Fetish Revisited: Marx, Freud, and the Gods Black People Make,  Laura S Grillo  Virgin Whore. By Emma Maggie Solberg,  Jessica Barr  Hindu Pasts: Women, Religion, History. By Vasudha Dalmia,  Emilia Bachrach

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:36

Functional MRI, Basic Principles and Emerging Clinical Applications for Anesthesiology and the Neurological...

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:36

BOSTN Bundle Intervention for Perioperative Screening and Management of Patients With Suspected Obstructive...

BOSTN Bundle Intervention for Perioperative Screening and Management of Patients With Suspected Obstructive Sleep Apnea,: A Hospital Registry StudyBACKGROUND: We developed and implemented a perioperative guideline for obstructive sleep apnea (OSA), comprising a preoperative screening tool (BOSTN) and clinical management pathways. OSA was suspected with 2 or more of the following: body mass index ≥30 kg/m2, observed apnea, loud snoring, daytime tiredness, and neck circumference ≥16.5 inches in women...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:33

Adultification of Black Children in Pediatric Anesthesia, BACKGROUND: Unconscious racial bias in...

Adultification of Black Children in Pediatric Anesthesia,BACKGROUND: Unconscious racial bias in anesthesia care has been shown to exist. We hypothesized that black children may undergo inhalation induction less often, receive less support from child life, have fewer opportunities to have a family member present for induction, and receive premedication with oral midazolam less often. METHODS: We retrospectively collected data on those <18 years of age from January 1, 2012 to January 1, 2018 including...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:33

Wound Repair and Regeneration Accepted Articles Accepted, unedited articles published online and citable....

Wound Repair and RegenerationAccepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset Version of Record will appear in the future.The Impact of First‐Aid Dressing Design on Healing of Porcine Partial Thickness WoundsKatie F. Wlaschin Ph.D., Jana Ninkovic Ph.D., George W. Griesgraber Ph.D., Semra Colak Atan Ph.D., Alexi J. Young Ph.D., Junia M. Pereira Ph.D., Michael J. Solberg, Graham Smith, Patrick J. Parks M.D. Ph.D., Amy K. McNulty Ph.D., Delony L....

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:29

Wound Repair and Regeneration Early View Online Version of Record before inclusion in an issue Fibronectin‐derived...

Wound Repair and RegenerationEarly ViewOnline Version of Record before inclusion in an issueFibronectin‐derived Epiviosamines enhance PDGF‐BB‐stimulated human dermal fibroblast migration in vitro and granulation tissue formation in vivoAtulya Prasad PhD, Fubao Lin PhD, Richard A. F. Clark MDVersion of Record online: 05 July 2019Akermanite bioceramic enhances wound healing with accelerated reepithelialization by promoting proliferation, migration, and stemness of epidermal cellsFangfang Wang MM, Xiaoya...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:29

Archives of Disease in Childhood

Original articleSeizure frequency, healthcare resource utilisation and mortality in childhood epilepsy: a retrospective cohort study using the THIN databaseMelissa Myland, Brian Buysse, Wan Tsong et al. (2019-07-04)10.1136/archdischild-2019-316910Gelatin tannate for acute diarrhoea and gastroenteritis in children: a systematic review and meta-analysisIvan D Florez, Javier M Sierra, Laura F Niño-Serna (2019-07-04)10.1136/archdischild-2018-316385Origins of disparities in preventable child mortality...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:28

Regional Anesthesia & Pain Medicine

Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study: a concern on the influence of patient's breathingHongye Zhang, Yongsheng Miao, Zongyang Qu (2019-06-21)10.1136/rapm-2019-100593Response to Dr Mion: ketamine for acute pain managementSteven P Cohen, Eric S Schwenk (2019-06-13)10.1136/rapm-2019-100717Injectate spread in interfascial plane block: a microscopic findingHun-Mu Yang,...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:27

Current Difficult Airway Management

—Not Good Enough!Takashi Asai, M.D., Ph.D.; David Hillman, M.D. Author NotesFrom the Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan (T.A.); and the Faculty of Health and Medical Sciences, Surgery, University of Western Australia, Perth, Australia (D.H.).Accepted for publication June 14, 2019.Correspondence: Address correspondence to Dr. Asai: asaita@dokkyomed.ac.jpAnesthesiology Newly Published on July 10, 2019. doi:10.1097/ALN.0000000000002885In safety-critical...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:26

Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants

: A Single-center, Retrospective Study,Jorge A. Gálvez, M.D., M.B.I.; Samuel Acquah, M.D.; Luis Ahumada, Ph.D.; Lingyu Cai, M.S.; Marcia Polanski, S.C.D, M.S., M.S.W.; et al Lezhou Wu, Ph.D.; Allan F. Simpao, M.D., M.B.I.; Jonathan M. Tan, M.D., M.P.H.; Jack Wasey, B.M., B.Ch., M.A., M.Sci., M.Sc.; John E. Fiadjoe, M.D. Author NotesFrom the Section of Biomedical Informatics (J.A.G., L.A., L.W., A.F.S., J.M.T., J.W.), Department of Anesthesia and Critical Care Medicine (J.A.G., A.F.S., J.M.T., J.W.,...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:26

Anesthesiology

Perioperative MedicineHypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants: A Single-center, Retrospective StudyJorge A. Gálvez, M.D., M.B.I.; Samuel Acquah, M.D.; Luis Ahumada, Ph.D.; Lingyu Cai, M.S.; Marcia Polanski, S.C.D, M.S., M.S.W.; Lezhou Wu, Ph.D.; Allan F. Simpao, M.D., M.B.I.; Jonathan M. Tan, M.D., M.P.H.; Jack Wasey, B.M., B.Ch., M.A., M.Sci., M.Sc.; John E. Fiadjoe, M.D.Anesthesiology Published online July 10, 2019. doi:10.1097/ALN.0000000000002847Postoperative...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:21

Blood transfusion history and risk of non-Hodgkin lymphoma: an InterLymph pooled analysis AbstractPurpose...

Blood transfusion history and risk of non-Hodgkin lymphoma: an InterLymph pooled analysisAbstractPurposeTo conduct a pooled analysis assessing the association of blood transfusion with risk of non-Hodgkin lymphoma (NHL).MethodsWe used harmonized data from 13 case–control studies (10,805 cases, 14,026 controls) in the InterLymph Consortium. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression, adjusted for study design variables.ResultsAmong non-Hispanic...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:19

Soy and tea intake on cervical cancer risk: the Singapore Chinese Health Study AbstractPurpose Soy...

Soy and tea intake on cervical cancer risk: the Singapore Chinese Health StudyAbstractPurposeSoy isoflavones and tea catechins have immunomodulating and chemopreventive properties relevant for cervical carcinogenesis; however, there are limited epidemiologic data on the relationship of soy and tea consumption with cervical cancer risk. The aim of our study was to examine effects of soy and tea intake on cervical cancer risk among Singapore Chinese women.MethodsThe association between intake of soy...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:18

The association between coffee consumption and bladder cancer in the bladder cancer epidemiology and...

The association between coffee consumption and bladder cancer in the bladder cancer epidemiology and nutritional determinants (BLEND) international pooled studyAbstractBackgroundInconsistent results for coffee consumption and bladder cancer (BC) risk have been shown in epidemiological studies. This research aims to increase the understanding of the association between coffee consumption and BC risk by bringing together worldwide case–control studies on this topic.MethodsData were collected from 13...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:18

Healthy dietary patterns and risk and survival of breast cancer: a meta-analysis of cohort studies AbstractPurposes...

Healthy dietary patterns and risk and survival of breast cancer: a meta-analysis of cohort studiesAbstractPurposesDietary patterns have been found to be associated with the overall cancer risk and survival. However, the associations of healthy dietary patterns and breast cancer remain unclear. We aimed to conduct a meta-analysis of prospective cohort studies to estimate the pooled results of the association of healthy dietary patterns with breast cancer risk and survival.MethodsPubMed, EMBASE, and...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:18

JAMA Online First

VIEWPOINTA New Supreme Court Ruling on Drug LiabilityMitchell C. Johnston; Marcia M. Boumil, JD, LLM; Gregory Curfman, MDJAMA INSIGHTSClinical Use of Bone Turnover MarkersDouglas C. Bauer, MDTRENDING NOW ON JAMA NETWORK OPENAssociation of Cardiorespiratory Fitness and Mortality Among Adults Undergoing Exercise Treadmill TestingAndrogen Deprivation Therapy and Dementia Diagnosis in Men With Prostate CancerPush-up Exercise Capacity and Future Cardiovascular Events in Active Adult MenEstimating Implicit...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:17

Feed thickeners : carob bean gum, rice cereal, corn starch or alginate

Clinical Aspects of Thickeners for Pediatric Gastroesophageal Reflux and Oropharyngeal DysphagiaAbstractPurpose of ReviewThe purpose of this review is to discuss current knowledge and recent findings regarding clinical aspects of thickeners for pediatric gastroesophageal reflux and oropharyngeal dysphagia. We review evidence for thickener efficacy, discuss types of thickeners, practical considerations when using various thickeners, and risks and benefits of thickener use in pediatrics.Recent FindingsThickeners...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:15

Popular Remedies for Esophageal Symptoms: dietary manipulation, apple cider vinegar, melatonin, acupuncture, and various herbal products (rikkunshito, STW 5, slippery elm, licorice, and peppermint oil, among others).

Popular Remedies for Esophageal Symptoms: a Critical AppraisalAbstractPurpose of ReviewPopular remedies are of ongoing interest to patients experiencing common esophageal symptoms, particularly as typical pharmacologic interventions have been subject to increased scrutiny. Herein we summarize the available data regarding potential risks and benefits of several such remedies.Recent FindingsWith emphasis on reflux and non-cardiac chest pain, research is ongoing into the clinical utility and diverse...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:10

The Utility of Esophageal Motility Testing in Gastroesophageal Reflux Disease (GERD), AbstractPurpose...

The Utility of Esophageal Motility Testing in Gastroesophageal Reflux Disease (GERD),AbstractPurpose of ReviewHere, we discuss how esophageal motor testing plays important roles in patients with suspected gastroesophageal reflux disease (GERD). In addition to guiding appropriate placement of catheters for ambulatory reflux monitoring, esophageal high-resolution manometry (HRM) rules out confounding diagnoses, such as achalasia spectrum disorders, that can present with symptoms similar to that of...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:07

JAMA Otolaryngology–Head & Neck Surgery

ORIGINAL INVESTIGATIONAssessment of Patient Outcomes After Adjuvant Vocal Fold Steroid Injection for Fibrosis After Microlaryngeal SurgeryYing-Chieh Hsu, MD; Li-Jen Liao, MD, PhD; Tsung-Wei Huang, MD, PhD; et al.Association of Feeding Evaluation With Frenotomy Rates in Infants With Breastfeeding DifficultiesChristen Caloway, MD; Cheryl J. Hersh, MS, CCC-SLP; Rebecca Baars, MS, CCC-SLP; et al.Audio Interview: Association of Feeding Evaluation With Frenotomy Rates in Infants With Breastfeeding DifficultiesCLINICAL...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:06

Acta Biochimica et Biophysica Sinica

Original Articles   MicroRNA-23a promotes colorectal cancer cell migration and proliferation by targeting at MARK1  Xiaoli Tang; Meiyuan Yang; Zheng Wang; Xiaoqing Wu; Daorong Wang  SPAG4L/SPAG4Lβ interacts with Nesprin2 to participate in the meiosis of spermatogenesis  Xiaohua Li; Yong Wu; Lihua Huang; Linfei Yang ; Xiaowei Xing  YAP mediates the positive regulation of hnRNPK on the lung adenocarcinoma H1299 cell growth  Lipei Xu; Tingting Zhang; Wensi Huang; Xiaohui Liu ; Junlei Lu ...  Peroxidase...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:05

The future of apolipoprotein E mimetic peptides in the prevention of cardiovascular disease, Purpose...

The future of apolipoprotein E mimetic peptides in the prevention of cardiovascular disease,Purpose of review This review aims to discuss the recent developments in the area of apolipoprotein E (apoE) mimetics and their therapeutic potential for treating cardiovascular disease, the leading cause of mortality worldwide. Recent findings Ongoing research efforts target the development of novel therapies that would not only reduce circulating levels of atherogenic lipoproteins, but could also increase...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:02

Role of serum amyloid A in atherosclerosis, Purpose of review Acute phase serum amyloid A (SAA) is...

Role of serum amyloid A in atherosclerosis,Purpose of review Acute phase serum amyloid A (SAA) is persistently elevated in chronic inflammatory conditions, and elevated levels predict cardiovascular risk in humans. More recently, murine studies have demonstrated that over-expression of SAA increases and deficiency/suppression of SAA attenuates atherosclerosis. Thus, beyond being a biomarker, SAA appears to play a causal role in atherogenesis. The purpose of this review is to summarize the data supporting...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:01

Is hypertriglyceridemia atherogenic? Purpose of review Hypertriglyceridemia occurs mainly because...

Is hypertriglyceridemia atherogenic?Purpose of review Hypertriglyceridemia occurs mainly because of metabolic disorders secondary to diabetes, alcohol intake, and/or overweight. Genetic factors have also been clearly identified in most severe cases. Triglycerides are generally considered as 'bystanders' for cardiovascular diseases. However, biological and basic research provides strong data suggesting that triglyceride-rich lipoproteins could be involved in the pathophysiology of cardiovascular diseases....

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:56

Non-HDL cholesterol should not generally replace LDL cholesterol in the management of hyperlipidaemia,...

Non-HDL cholesterol should not generally replace LDL cholesterol in the management of hyperlipidaemia,Purpose of review Non-HDL cholesterol was originally conceived as a therapeutic target for statin treatment in hypertriglyceridaemia when apolipoprotein B100 assays were not widely available. Recently non-HDL cholesterol has been recommended to replace LDL cholesterol in the clinical management of dyslipidaemia routinely in general medical practice. This is misguided. Recent findings Non-HDL cholesterol...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:54

Diagnosis and management of linear scleroderma in children, Purpose of review Linear scleroderma...

Diagnosis and management of linear scleroderma in children,Purpose of review Linear scleroderma is the most common subtype of localized scleroderma (LoS) in children. It can be associated with extracutaneous manifestations and long-term sequelae. Thus, appropriate diagnosis and management are key to improve the prognosis. In this review, we summarize the most relevant recent publications for the diagnosis, evaluation of disease activity and adequate management of patients with linear scleroderma....

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:47

A new second-generation supraglottic airway device (Ambu® AuraGain•) versus intubating laryngeal mask...

A new second-generation supraglottic airway device (Ambu® AuraGain•) versus intubating laryngeal mask airway as conduits for blind intubation – A prospective, randomised trialK Sudheesh, GM Chethana, H Chaithali, SS Nethra, D Devikarani, G ShwethaIndian Journal of Anaesthesia 2019 63(7):558-564Background and Aims: The Ambu® AuraGain• is a new single-use supraglottic airway device with gastric channel, designed to facilitate intubation. The study aimed to assess the success rates of proper placement...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:34

Role of topical magnesium in post-operative sore throat: A systematic review and meta-analysis of randomised...

Role of topical magnesium in post-operative sore throat: A systematic review and meta-analysis of randomised controlled trialsNarinder P Singh, Jeetinder K Makkar, Vincent Wourms, Andrés Zorrilla-Vaca, Ronald B Cappellani, Preet M SinghIndian Journal of Anaesthesia 2019 63(7):520-529Background and Aims: Post-operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N-methyl-D-aspartate receptor antagonist, has anti-nociceptive and anti-inflammatory properties,...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:33

Otology & Neurotology

What is the Role of Hyaluronic Acid Ester in Myringoplasty? Systematic Review and Meta-AnalysisObjective: To reveal odds of tympanic membrane closure and postoperative hearing outcomes for myringoplasty utilizing hyaluronic acid ester via systematic review and meta-analysis. Data Sources: 1) Search of English articles in PubMed/Medline, Embase, and Cochrane databases published between January 1, 1998 and March 31, 2018. Study Selection: Inclusion criteria: 1) English language; 2) clinical studies;...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:25

Medical Care

Insurance Loss in the Era of the Affordable Care Act: Association With Access to Health ServicesBackground: Every year, millions of Americans lose their health insurance and remain uninsured for various reasons, potentially impacting access to medical services. Objective: To examine trends in health insurance loss in the periods shortly before and after implementation of Patient Protection and Affordable Care Act (ACA) and to assess the association of past-year health insurance loss with access to...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:24

Annals of Surgery

Intravenous Patient-controlled Analgesia Versus Thoracic Epidural Analgesia After Open Liver Surgery: A Prospective, Randomized, Controlled, Noninferiority TrialObjective: We conducted a randomized, controlled, noninferiority trial to investigate if intravenous, multimodal, patient-controlled analgesia (IV-PCA) could be noninferior to multimodal thoracic epidural analgesia (TEA) in patients undergoing open liver surgery. Summary Background Data: The increasing use of minimally invasive techniques...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:23

Neurology

Levetiracetam Is No More Effective Than Phenytoin in Children with Convulsive Status EpilepticusNo abstract availableAntiplatelet Therapy Is Safe for Secondary Prevention of Stroke—Even with Cerebral MicrobleedsNo abstract available"Chemical Plasmapheresis" Drug for Myasthenia Gravis Is Safe, Lowers Antibodies, and Produces Hints of Efficacy in Phase 2 TrialNo abstract availableNew Study Links Chronic Renal Dysfunction and Proteinuria with a Risk of Parkinson's Disease in the ElderlyNo abstract availableGliomas...

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

07:21

Se è importante, l'ippocampo vuole il replay, Da MIND: I centri di elaborazione neurali ripercorrono...

Se è importante, l'ippocampo vuole il replay,Da MIND: I centri di elaborazione neurali ripercorrono più volte le sequenze degli eventi recenti per consolidare i nuovi ricordi, che saranno poi usati anche nel pensiero astratto e... - Leggi l'articolo → 

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

06:54

Homo sapiens in Europa già 210.000 anni fa, Una nuova analisi di un cranio scoperto in Grecia ha...

Homo sapiens in Europa già 210.000 anni fa,Una nuova analisi di un cranio scoperto in Grecia ha rivelato che è di un essere umano anatomicamente moderno vissuto 210.000 anni fa. È il fossile più antico di Homo sapiens fuori dall'Africa... - Leggi l'articolo →

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

06:53

L'Antropocene incalza: la plastica è già nelle rocce, I processi geologici hanno iniziato...

L'Antropocene incalza: la plastica è già nelle rocce,I processi geologici hanno iniziato a incorporare in rocce litoranee la plastica finita in mare. Questo materiale onnipresente è sempre di più un marcatore dell'era segnata dalle attività umane. Buona lettura!

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

06:52

Otology & Neurotology

What is the Role of Hyaluronic Acid Ester in Myringoplasty? Systematic Review and Meta-AnalysisObjective: To reveal odds of tympanic membrane closure and postoperative hearing outcomes for myringoplasty utilizing hyaluronic acid ester via systematic review and meta-analysis. Data Sources: 1) Search of English articles in PubMed/Medline, Embase, and Cochrane databases published between January 1, 1998 and March 31, 2018. Study Selection: Inclusion criteria: 1) English language; 2) clinical studies;...

Αλέξανδρος Γ. Σφακιανάκης

1h

Medical Care

Insurance Loss in the Era of the Affordable Care Act: Association With Access to Health ServicesBackground: Every year, millions of Americans lose their health insurance and remain uninsured for various reasons, potentially impacting access to medical services. Objective: To examine trends in health insurance loss in the periods shortly before and after implementation of Patient Protection and Affordable Care Act (ACA) and to assess the association of past-year health insurance loss with access to...

Αλέξανδρος Γ. Σφακιανάκης

1h

Annals of Surgery

Intravenous Patient-controlled Analgesia Versus Thoracic Epidural Analgesia After Open Liver Surgery: A Prospective, Randomized, Controlled, Noninferiority TrialObjective: We conducted a randomized, controlled, noninferiority trial to investigate if intravenous, multimodal, patient-controlled analgesia (IV-PCA) could be noninferior to multimodal thoracic epidural analgesia (TEA) in patients undergoing open liver surgery. Summary Background Data: The increasing use of minimally invasive techniques...

Αλέξανδρος Γ. Σφακιανάκης

1h

Neurology

Levetiracetam Is No More Effective Than Phenytoin in Children with Convulsive Status EpilepticusNo abstract availableAntiplatelet Therapy Is Safe for Secondary Prevention of Stroke—Even with Cerebral MicrobleedsNo abstract available"Chemical Plasmapheresis" Drug for Myasthenia Gravis Is Safe, Lowers Antibodies, and Produces Hints of Efficacy in Phase 2 TrialNo abstract availableNew Study Links Chronic Renal Dysfunction and Proteinuria with a Risk of Parkinson's Disease in the ElderlyNo abstract availableGliomas...

Αλέξανδρος Γ. Σφακιανάκης

1h

Academic Medicine

What Makes the "Perfect" Inpatient Consultation? A Qualitative Analysis of Resident and Fellow PerspectivesPurpose: To characterize the methods of inpatient consult communication, given new communication modalities; to explore residents' and fellows' perspectives on the ideal consult and how this affects their teaching, learning, and patient safety; and to identify barriers to and strategies for optimizing consultations. Method: Using qualitative grounded theory, the authors conducted semistructured...

Αλέξανδρος Γ. Σφακιανάκης

17h

Psychiatry

Impulsivity, suicidality, and emotional dysregulation in women having borderline personality disorder with and without substance dependenceSamir A Magd, Moustafa Rakhawy, Rania Mamdouh, Somaya ShaheenEgyptian Journal of Psychiatry 2019 40(2):59-63Objective The objective of this article is to detect differences between women having borderline personality disorder (BPD) with and without substance dependence regarding impulsivity, suicide, and emotional dysregulation. Patients and methods A total of...

Αλέξανδρος Γ. Σφακιανάκης

17h

Cancer Letters

Interference with the bromodomain epigenome readers drives p21 expression and tumor senescencePublication date: 1 October 2019Source: Cancer Letters, Volume 461Author(s): Liana P. Webber, Veronica Q. Yujra, Pablo A. Vargas, Manoela D. Martins, Cristiane H. Squarize, Rogerio M. CastilhoAbstractHead and neck cancer (HNSCC) are one of the most common solid malignancies of the world, being responsible for over 350,000 deaths every year. Much of the complications in managing and treating HNSCC advent...

Αλέξανδρος Γ. Σφακιανάκης

17h

Nursing Science

Letter to the EditorNo abstract availableLetter to the EditorNo abstract availableReconceptualizing the Electronic Health Record for a New Decade: A Caring Technology?Since the 2009 publication by Petrovskaya et al on, "Dilemmas, Tetralemmas, Reimagining the Electronic Health Record," and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based...

Αλέξανδρος Γ. Σφακιανάκης

17h

Foot Weakness Caused by Proximal Extensor Hallucis Longus (EHL) Rupture, Ma, Rex MD1; Bartolo, . Kathryne...

Foot Weakness Caused by Proximal Extensor Hallucis Longus (EHL) Rupture,Ma, Rex MD1; Bartolo, . Kathryne MD2; Lew, Henry MD, PhD3American Journal of Physical Medicine & Rehabilitation: July 8, 2019 - Volume Publish Ahead of Print - Issue - pdoi: 10.1097/PHM.0000000000001262

Αλέξανδρος Γ. Σφακιανάκης

17h

Asia Pacific Journal of Tourism Research, Volume 24, Issue 8, August 2019 is now available online...

Asia Pacific Journal of Tourism Research, Volume 24, Issue 8, August 2019 is now available online on Taylor & Francis Online.This new issue contains the following articles:ArticlesHow geographic, cultural, and institutional distances shape location choices of China's OFDI in tourism? – an empirical study on B&R countriesTaotao Deng, Yukun Hu & Yang YangPages: 735-749 | DOI: 10.1080/10941665.2019.1630451Experiencing the real village – a netnographic examination of perceived authenticity...

Αλέξανδρος Γ. Σφακιανάκης

17h

Advances in Skin & Wound Care

Validating the Italian Version of the International Skin Tear Advisory Panel Classification SystemOBJECTIVE To validate the International Skin Tear Advisory Panel (ISTAP) Classification System in Italian. METHODS In collaboration with the ISTAP, the classification system was translated into Italian using a forward-back translation process. To validate the translated system, a convenience sample of 212 health professionals classified 30 photographs of skin tears originally used by ISTAP. The wound...

Αλέξανδρος Γ. Σφακιανάκης

17h

The AAG Review of Books, Volume 7, Issue 3, Summer 2019is now available online on Taylor & Francis...

The AAG Review of Books, Volume 7, Issue 3, Summer 2019is now available online on Taylor & Francis Online.This new issue contains the following articles:Issue PDFVolume 7, Issue 3Pages: 153-227 | DOI: 10.1080/2325548X.2019.1615330Book ReviewsThe Newark Earthworks: Enduring Monuments, Contested MeaningsWilliam Gustav GartnerPages: 153-156 | DOI: 10.1080/2325548X.2019.1615311The Cry of the Renegade: Politics and Poetry in Interwar ChileDon MitchellPages: 157-159 | DOI: 10.1080/2325548X.2019.1615312Becoming...

Αλέξανδρος Γ. Σφακιανάκης

17h

Art Journal, Volume 78, Issue 2, Summer 2019 is now available online on Taylor & Francis Online....

Art Journal, Volume 78, Issue 2, Summer 2019 is now available online on Taylor & Francis Online.This new issue contains the following articles:General ContentTitle pagePages: 1-1 | DOI: 10.1080/00043249.2019.1626147Editorial Board and Information for AuthorsPages: 2-2 | DOI: 10.1080/00043249.2019.1626148Table of ContentsPages: 3-3 | DOI: 10.1080/00043249.2019.1626149Funding InformationPages: 4-4 | DOI: 10.1080/00043249.2019.1626152In This IssueMaking SpaceJordana Moore SaggesePages: 5-5 | DOI:...

Αλέξανδρος Γ. Σφακιανάκης

17h

Acta Agriculturae Scandinavica, Section B — Soil & Plant Science and online now on Taylor &...

Acta Agriculturae Scandinavica, Section B — Soil & Plant Science and online now on Taylor & Francis Online:ArticlesResponse of selected drought tolerant wheat (Triticum aestivum L.) genotypes for agronomic traits and biochemical markers under drought-stressed and non-stressed conditionsSonto Silindile Mkhabela, Hussein Shimelis, Alfred O. Odindo & Jacob MashiloPages: 1-16 | DOI: 10.1080/09064710.2019.1641213

Αλέξανδρος Γ. Σφακιανάκης

17h

Current Medical Research and Opinion, Vol. 35, No. 8, 03 Aug 2019" is    now available online on Taylor...

Current Medical Research and Opinion, Vol. 35, No. 8, 03 Aug 2019" is    now available online on Taylor & Francis Online    You can view the issue table of contents at    https://www.tandfonline.com/toc/icmo20/35/8?ai=1msw4&ui=843fx&af=T    This new issue contains the following articles:    National trend of utilization, clinical and economic outcomes of    transcatheter aortic valve replacement among patients with chronic    obstructive pulmonary disease    Min Ji Kwak, Viraj Bhise,...

Αλέξανδρος Γ. Σφακιανάκης

17h

Energy Sources, Part A: Recovery, Utilization, and Environmental Effects and online now on Taylor...

Energy Sources, Part A: Recovery, Utilization, and Environmental Effects and online now on Taylor & Francis Online:ArticlesBiodiesel Production from Tannery Waste using a Nano Catalyst (Ferric-Manganese Doped Sulphated Zirconia)Vijaya Kumar Booramurthy, Ramesh Kasimani & Sivakumar PandianPages: 1-13 | DOI: 10.1080/15567036.2019.1639849Pyrolysis behaviors and product distribution of Shengli Lignite at different heating rate and final temperature by TG-FTIR and Py-GC-MSZhenyong Miao, Yongjiang...

Αλέξανδρος Γ. Σφακιανάκης

17h

Investigative Radiology

Ultrasound Time-Harmonic Elastography of the Aorta: Effect of Age and Hypertension on Aortic StiffnessObjectives The aim of this study was to investigate ultrasound time-harmonic elastography for quantifying aortic stiffness in vivo in the context of aging and arterial hypertension. Materials and Methods Seventy-four participants (50 healthy participants and 24 participants with long-standing hypertension) were prospectively included between January 2018 and October 2018, and underwent ultrasound...

Αλέξανδρος Γ. Σφακιανάκης

17h