bluuebunny/crossref_metadata_2025 huggingface dataset:
Plotting the field: Fragments and narrative in Malinowski's stories of the baloma
Authors: Brandel Andrew , Bagaria Swayam
Published: March 2019

Anthropologists have long relied on powerful concepts operant in the societies where they have carried out fieldwork to unlock the meanings of various, even seemingly disparate, practices and experiences, and which, in virtue of their sharing a name, are given coherence by ethnographic and ethnological texts. In this essay, we examine how anthropological icons like hau, mana, and the shaman, are created, and suggest that there might be fragments encountered during fieldwork that do not, in themselves, necessarily add up to a coherent whole, but which are fit into stories of these kinds because of the pressure of narrativity within conventional notions of anthropological theory. To illustrate this argument, we draw in particular on Malinowski’s stories of the baloma, Trobriander spirits of the dead, reading his well-known fieldwork diaries alongside his published account, in order to show how life is always stitched across multiple registers of storytelling, some of which take the form of narrative and others that do not. Attending to the space between these modalities, or to their crossings, a different picture of theory begins to emerge, and which hews a bit closer to our ordinary experience of social life.
Factors affecting sleep among Thai people with dementia attending an outpatient psychiatric department
Authors: Suvanchot K.Sinsak , Pensuksan Wipawan Chaoum
Published: March 2019

Sleep quality is a well-studied aspect of overall health, especially for those who have other compounded health issues like dementia. This study identified what factors affected sleep quality among Thai people with dementia who attended an outpatient psychiatric department. While we considered factors associated with poor sleep quality, we discussed the impact that family relationship specifically has on sleep quality for this population. A cross-sectional study was conducted among 80 patient–caregiver dyads. All patients were assessed by the TMSE, a neuropsychiatric assessment (Thai Mental State Examination). The PSQI (Pittsburgh Sleep Quality Index) was administered and multiple factors affecting sleep were investigated through face-to-face interviews with each patient and caregiver dyad. Interviews were conducted by a psychiatric nurse at a hospital offering outpatient psychiatric care. A chi-square test, t test, Spearman correlation, Pearson’s correlation, and logistic regression were applied to identify statistically significant associations. Overall, we found that the prevalence of poor sleep in our target population was 70%, with a high sleep score (8.14 ± 4.20). Factors affecting sleep included mental health problems, night-time cough and urinary frequency, pain and fever during the night, sleep environment problems, and stimulant use (63.8%, 57.5%, 47.5%, 20%, and 7.5%, respectively). Other factors previously associated with poor sleep quality in other studies were not associated in this study. Those with perceived poor family relationships are at a 5.57 times greater risk for poor sleep than those with perceived good family relationships. On the contrary, those without mental health problems significantly decreased their overall risk for poor sleep. Further investigation into these associations should be studied. In conclusion, health-care providers are encouraged to consider the impact of family context on sleep quality for people with dementia.
Optimal greenhouse lighting scheduling using canopy light distribution model: A simulation study on tomatoes
Authors: Xu L , Wei R , Xu L
Published: March 2019

Light is considered the most important environmental factor for greenhouse crops, and lack of lighting limits the productivity of greenhouses. Many studies have focused on improving the energy efficiency of lighting in agriculture. In this study, LED lights were mounted in the top, middle and bottom of the plant canopy to provide additional photosynthetically active radiation. Assuming that 100% of the predicted outdoor radiation is available, the canopy light distribution model was used to determine the relationship between the light energy consumption and the optimal yield. Decision-making on lighting scheduling may be considered as a constrained optimisation, and the status of the LEDs in a period acts as the decision variable. Besides, there are two objective functions: one is the energy consumed by the LED device; the other is the expected yield calculated by the crop model of tomatoes. The optimal solution of the multi-objective optimisation is not unique but corresponds to an infinite number of yield/energy combinations. Farmers can select these combinations according to additional restrictions such as energy efficiency ratio or photoperiod. The yield of our strategy was increased by 12.3% under the constraint of equal energy consumption compared to the greenhouse threshold control strategy. Given the same output as the constraint, the energy consumption was reduced by 30.1%.
Research note: The accuracy of the mean spherical semi-cubic illuminance approach for determining scalar illuminance
Authors: Mangkuto RA
Published: March 2019

In a previous study comparing alternative approaches for determining scalar illuminance from cubic illuminance data, the approach using mean spherical semi-cubic illuminances (representing the positive and the negative x-, y-, z-axes) was found to have the highest accuracy. However, this approach, referred to as Approach 2, becomes less accurate as more point sources are introduced into the scene. This research note reports the results of calculations of additional scenes with up to 20 point sources so as to evaluate the accuracy limit of the said approach, in comparison with the original approach using vector and symmetric components as proposed by Cuttle (Approach 1). It is concluded that for a very large number of point sources, the mean and standard deviation of the ratio between the calculated and the true scalar illuminance using Approach 2 will converge respectively to 0.86 and 0.015. Approach 2 in general yields more accurate predictions of scalar illuminance only when the number of sources is small. Overall, Approach 1 is to be preferred for its consistency.
Upper Extremity Function Assessment Using a Glove Orthosis and Virtual Reality System
Authors: Adams Richard J. , Ellington Allison L. , Armstead Kate , Sheffield Kristen , Patrie James T. , Diamond Paul T.
Published: March 2019

Hand motor control deficits following stroke can diminish the ability of patients to participate in daily activities. This study investigated the criterion validity of upper extremity (UE) performance measures automatically derived from sensor data during manual practice of simulated instrumental activities of daily living (IADLs) within a virtual environment. A commercial glove orthosis was specially instrumented with motion tracking sensors to enable patients to interact, through functional UE movements, with a computer-generated virtual world using the SaeboVR software system. Fifteen stroke patients completed four virtual IADL practice sessions, as well as a battery of gold-standard assessments of UE motor and hand function. Statistical analysis using the nonparametric Spearman rank correlation reveals high and significant correlation between virtual world-derived measures and the gold-standard assessments. The results provide evidence that performance measures generated during manual interactions with a virtual environment can provide a valid indicator of UE motor status.
Determination of the Optimal Location for Bone Graft Harvest in the Distal Radius
Authors: Matson Andrew P. , Federer Andrew E. , Meisel Erin M. , Barchick Stephen R. , Ruch David S. , Richard Marc J.
Published: March 2019

Background: The distal radius is commonly used as a bone graft donor site for surgery in the hand and wrist. The aim of this study was to evaluate the volume and relative density of cancellous bone in the distal radius. Methods: Thirty-four consecutive computed tomographic scans of the wrist in 33 patients without distal radius pathology were included. For each subject, 6 spherical regions of interest (ROIs) were identified within the distal radius. In each ROI, volumetric measurements and mean Hounsfield unit (HFU) values were recorded by 2 observers using a 3-dimensional imaging reconstruction software. Results: Compared with proximal bone, distal bone had larger volume (0.82 vs 0.27 cm3) and greater relative density (178 vs 152 HFU) on average. Among the 6 ROIs, the distal-central region had the largest average volume (1.20 cm3) and the distal-ulnar ROI had the greatest average relative density (193 HFU). Conclusion: Based on these results, we recommend performing cancellous autograft harvest relatively distal and ulnar within the distal radius.
Are human rights western—And why does it matter? A perspective from international political theory
Authors: Mende Janne
Published: March 2019

A widespread assumption alleges that human rights are not universal, as they claim to be, but are instead Western oriented. Yet a growing body of research provides evidence that human rights are not just Western. Both perspectives are critical of repressive dimensions in the human rights regime, though they recommend different approaches to addressing them. This article explores both viewpoints from an International Political Theory perspective. Examining the pluralist idea, institutionalization, and application of human rights, the first section argues that human rights are not just Western. The second section investigates why it nevertheless matters to ask whether human rights are Western. This article develops four interrelated criteria: dynamic pluralism, awareness of power and inequalities, contextual universalism, and open normativity. These criteria help determine whether human rights are (not just) Western, and, more importantly, they provide the basis for an emancipatory human rights regime.
Needs management in families affected by childhood-onset dystrophinopathies
Authors: Conway Kristin M , Eichinger Katy , Trout Christina , Romitti Paul A , Mathews Katherine D , Pandya Shree K ,   Muscular Dystrophy Surveillance, Tracking and Research Network (MD STARnet)
Published: March 2019

Purpose:

To collect information about the needs of families affected by childhood-onset dystrophinopathies residing in the United States.

Methods:

Individuals with an eligible dystrophinopathy were identified by the Muscular Dystrophy Surveillance, Tracking, and Research network. Between September 2008 and December 2012, 272 caregivers completed a 48-item survey about needs related to information, healthcare services, psychosocial issues, finances, caregiver demographics, and the individual’s functioning.

Results:

Overall, at least 80% of the survey items were identified as needs for more than one-half of caregivers. Among the needs identified, physical health and access to information were currently managed for most caregivers. Items identified as needed but managed less consistently were funding for needs not covered by insurance and psychosocial support.

Conclusions:

Healthcare providers, public health practitioners, and policymakers should be aware of the many needs reported by caregivers, and focus on addressing gaps in provision of needed financial and psychosocial services.
Quadratic Indirect Effect of National TVET Expenditure on Economic Growth Through Social Inclusion Indicators
Authors: Ali Asadullah Muhammad
Published: March 2019

The recent movement of social-investment state encouraged national educational initiatives taken by the policy makers of developed countries to enhance individual’s social inclusion for national economic gains. Benefiting from human capital theory, the author has reexamined the indirect effect of nation expenditure of technical and vocational education and training (TVET) on economic growth through social inclusion by isolating the effective key social inclusion dimensions (employment, earnings, and multidimensional poverty) from each other. A 15-year data set, ranging from 2000 to 2014, collected from Organisation for Economic Co-operation and Development (OECD) database of 21 OECD member European countries was used for hypotheses testing. The statistical results obtained through the quadratic indirect effects demonstrate clear support for the entire hypotheses. However, the results demonstrate that the indirect effects decrease as the values of TVET expenditure increases, particularly, when the indirect effect is investigated through the wages or when the overall index value of social inclusion indicators is introduced as a mediator. The study offers some implications for the researchers and the policy makers who are interested in determining the overall effectiveness of human capital development initiatives in the welfare-state/social-investment states.
Long non-coding RNA PVT1 promotes tumor progression by regulating the miR-143/HK2 axis in gallbladder cancer
Authors: Chen Jianan , Yu Yan , Li Hua , Hu Qiuyue , Chen Xiaolong , He Yuting , Xue Chen , Ren Fang , Ren Zhigang , Li Juan , Liu Liwen , Duan Zhenfeng , Cui Guangying , Sun Ranran
Published: March 2019

Background

The long non-coding RNA PVT1 (lncRNA PVT1) has been reported to act as an oncogenic regulator of several cancers. However, its expression and function in gallbladder cancer (GBC) remain largely unknown.

Methods

In situ hybridization (ISH) and quantitative real-time PCR (qPCR) were performed to detect the expression of PVT1 and miR-143 in GBC tissues and cell lines. Immunohistochemistry (IHC) assays were performed to assess the expression of the hexokinase 2 (HK2) protein. The relationships among PVT1, miR-143 and HK2 were evaluated using dual-luciferase reporter, RNA immunoprecipitation (RIP) and biotin pull-down assays. The biological functions of PVT1, miR-143 and HK2 in GBC cells were explored with cell counting kit 8 (CCK-8), 5-ethynyl-20-deoxyuridine (EdU), colony formation, transwell, wound healing and glucose metabolism assays in vitro. For in vivo experiments, a xenograft model was used to investigate the effects of PVT1 and HK2 on GBC.

Results

PVT1 was upregulated in GBC tissues and cells and was positively associated with malignancies and worse overall survival. PVT1 knockdown inhibited cell proliferation, migration, and invasion in vitro and restrained tumor growth in vivo. Further studies demonstrated that PVT1 positively regulated HK2 expression via its competing endogenous RNA (ceRNA) activity on miR-143. Additionally, HK2 expression and function were positively correlated with PVT1. Furthermore, we observed that the PVT1/miR-143/HK2 axis promoted cell proliferation and metastasis by regulating aerobic glucose metabolism in GBC cells.

Conclusions

The results of our study reveal a potential ceRNA regulatory pathway in which PVT1 modulates HK2 expression by competitively binding to endogenous miR-143 in GBC cells, which may provide new insights into novel molecular therapeutic targets for GBC.
Hypertonic Saline in Human Sepsis: A Systematic Review of Randomized Controlled Trials
Authors: Orbegozo Diego , Vincent Jean-Louis , Creteur Jacques , Su Fuhong
Published: March 2019

The role of hypertonic saline in sepsis remains unclear because clinical data are limited and the balance between beneficial and adverse effects is not well defined. In this systematic literature review, we searched PubMed and Embase to identify all randomized controlled trials up until January 31, 2018 in which hypertonic saline solutions of any concentration were used in patients of all ages with sepsis and compared to a cohort of patients receiving an isotonic fluid. We identified 8 randomized controlled trials with 381 patients who had received hypertonic saline. Lower volumes of hypertonic saline than of isotonic solutions were needed to achieve the desired hemodynamic goals (standardized mean difference, −0.702; 95% CI, −1.066 to −0.337; P < .001; moderate-quality evidence). Hypertonic saline administration was associated with a transient increase in sodium and chloride concentrations without adverse effects on renal function (moderate-quality evidence). Some data suggested a beneficial effect of hypertonic saline solutions on some hemodynamic parameters and the immunomodulatory profile (very low–quality evidence). Mortality rates were not significantly different with hypertonic saline than with other fluids (odds ratio, 0.946; 95% CI, 0.688–1.301; P = .733; low-quality evidence). In conclusion, in our meta-analysis of studies in patients with sepsis, hypertonic saline reduced the volume of fluid needed to achieve the same hemodynamic targets but did not affect survival.
Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children
Authors: Hoagland Monica A. , Ing Richard J. , Jatana Kris R. , Jacobs Ian N. , Chatterjee Debnath
Published: March 2019

Button battery ingestions result in significant morbidity and mortality in children—before, during, and even after removal. The injuries created by a button battery lodged in the esophagus develop rapidly and can be severe. The current of the button battery, conducted through saliva and the tissue drives a highly alkaline caustic injury, leading to liquefactive tissue necrosis. In June 2018, new guidelines were released from the National Capital Poison Center, which include the use of preoperative protective, pH-neutralizing and viscous barrier interventions with honey and/or sucralfate administered within 12 h of ingestion. In addition, the use of postremoval irrigation of the esophagus with 50–150 mL 0.25% acetic acid is done in the operating room to help neutralize the site of tissue injury. Given that anesthesiologists play an important role in the management of esophageal foreign body removal, the entire specialty needs to be aware of the supporting data behind this and general perioperative considerations for management and potential complications of button battery ingestion.
Perioperative Epidural Use and Risk of Delirium in Surgical Patients: A Secondary Analysis of the PODCAST Trial
Authors: Vlisides Phillip E. , Thompson Aleda , Kunkler Bryan S. , Maybrier Hannah R. , Avidan Michael S. , Mashour George A.
Published: March 2019

BACKGROUND:

Postoperative delirium is an important public health concern without effective prevention strategies. This study tested the hypothesis that perioperative epidural use would be associated with decreased risk of delirium through postoperative day 3.

METHODS:

This was a secondary, observational, nonrandomized analysis of data from The Prevention of Delirium and Complications Associated With Surgical Treatments Trial (PODCAST; NCT01690988). The primary outcome of the current study was the incidence of delirium (ie, any positive delirium screen, postanesthesia care unit through postoperative day 3) in surgical patients (gastrointestinal, hepatobiliary-pancreatic, gynecologic, and urologic) receiving postoperative epidural analgesia compared to those without an epidural. As a secondary outcome, all delirium assessments were then longitudinally analyzed in relation to epidural use throughout the follow-up period. Given the potential relevance to delirium, postoperative pain, opioid consumption, sleep disturbances, and symptoms of depression were also analyzed as secondary outcomes. A semiparsimonious multivariable logistic regression model was used to test the association between postoperative epidural use and delirium incidence, and generalized estimating equations were used to test associations with secondary outcomes described. Models included relevant covariates to adjust for confounding.

RESULTS:

In total, 263 patients were included for analysis. Epidural use was not independently associated with reduced delirium incidence (adjusted odds ratio, 0.65 [95% CI, 0.32–1.35]; P = .247). However, when analyzing all assessments over the follow-up period, epidural patients were 64% less likely to experience an episode of delirium (adjusted odds ratio, 0.36 [95% CI, 0.17–0.78]; P = .009). Adjusted pain scores (visual analog scale, 0–100 mm) were significantly lower in the epidural group on postoperative day 1 (morning, −16 [95% CI, −26 to −7], P < .001; afternoon, −15 [95% CI, −25 to −5], P < .01) and postoperative day 3 (morning, −13 [95% CI, −20 to −5], P < .01). Adjusted mean oral and IV morphine equivalents were also significantly lower on postoperative day 1 in the epidural group (74% lower [95% CI, 55%–85%]; P < .0001). Finally, postoperative epidural use was not significantly associated with new sleep disturbances or changes in depression symptoms.

CONCLUSIONS:

Postoperative epidural use was not associated with a reduced overall incidence of delirium. However, longitudinal analysis revealed reduced adjusted odds of experiencing an episode of delirium in the epidural group. Epidural use was also associated with reduced postoperative pain and opioid consumption. An appropriately designed follow-up study is warranted to further analyze the relationship among epidural use, postoperative delirium, and related outcomes.
Early Treatment With Metformin in a Mice Model of Complex Regional Pain Syndrome Reduces Pain and Edema
Authors: Das Vaskar , Kroin Jeffrey S. , Moric Mario , McCarthy Robert J. , Buvanendran Asokumar
Published: March 2019

BACKGROUND:

Metformin, an adenosine monophosphate (AMP)–activated protein kinase activator, as well as a common drug for type 2 diabetes, has previously been shown to decrease mechanical allodynia in mice with neuropathic pain. The objective of this study is to determine if treatment with metformin during the first 3 weeks after fracture would produce a long-term decrease in mechanical allodynia and improve a complex behavioral task (burrowing) in a mouse tibia fracture model with signs of complex regional pain syndrome.

METHODS:

Mice were allocated into distal tibia fracture or nonfracture groups (n = 12 per group). The fracture was stabilized with intramedullary pinning and external casting for 21 days. Animals were then randomized into 4 groups (n = 6 per group): (1) fracture, metformin treated, (2) fracture, saline treated, (3) nonfracture, metformin treated, and (4) nonfracture, saline treated. Mice received daily intraperitoneal injections of metformin 200 mg/kg or saline between days 14 and 21. After cast removal, von Frey force withdrawal (every 3 days) and burrowing (every 7 days) were tested between 25 and 56 days. Paw width was measured for 14 days after cast removal. AMP-activated protein kinase downregulation at 4 weeks after tibia fracture in the dorsal root ganglia was examined by immunohistochemistry for changes in the AMP-activated protein kinase pathway.

RESULTS:

Metformin injections elevated von Frey thresholds (reduced mechanical allodynia) in complex regional pain syndrome mice versus saline-treated fracture mice between days 25 and 56 (difference of mean area under the curve, 42.5 g·d; 95% CI of the difference, 21.0–63.9; P < .001). Metformin also reversed burrowing deficits compared to saline-treated tibial fracture mice (difference of mean area under the curve, 546 g·d; 95% CI of the difference, 68–1024; P < .022). Paw width (edema) was reduced in metformin-treated fracture mice. After tibia fracture, AMP-activated protein kinase was downregulated in dorsal root ganglia neurons, and mechanistic target of rapamycin, ribosomal S6 protein, and eukaryotic initiation factor 2α were upregulated.

CONCLUSIONS:

The important finding of this study was that early treatment with metformin reduces mechanical allodynia in a complex regional pain syndrome model in mice. Our findings suggest that AMP-activated protein kinase activators may be a viable therapeutic target for the treatment of pain associated with complex regional pain syndrome.
Randomized Trial Comparing Early and Late Administration of Rocuronium Before and After Checking Mask Ventilation in Patients With Normal Airways
Authors: Min Se-Hee , Im Hyunjae , Kim Bo Rim , Yoon Susie , Bahk Jae-Hyon , Seo Jeong-Hwa
Published: March 2019

BACKGROUND:

During induction of general anesthesia, it is common practice to delay neuromuscular blockade until the ability to deliver mask ventilation has been confirmed. However, the benefits of this approach have never been scientifically validated. We thus compared the early and late administration of rocuronium before and after checking mask ventilation to investigate the efficiency of mask ventilation and the time to tracheal intubation in patients with normal airways.

METHODS:

Patients (n = 114) were randomized to receive IV rocuronium either before (early rocuronium group, n = 58) or after (late rocuronium group, n = 56) checking mask ventilation. Expiratory tidal volumes (VTs) were measured at 10, 20, 30, 40, 50, and 60 seconds after apnea during mask ventilation. We graded the ease of mask ventilation and measured the time from apnea to tracheal intubation. The primary outcome was the average of mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea. The main secondary outcome was the time from apnea to tracheal intubation. STATA was used for statistical analysis.

RESULTS:

The average of mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea was larger in the early rocuronium group than in the late rocuronium group (552 mL breath−1 [165 mL breath−1] vs 393 mL breath−1 [165 mL breath−1], mean difference, 160 mL breath−1; 95% CI, 98−221 mL breath−1; P < .001, unpaired t test). Because the interaction between time and group was significant in mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea (P < .001, linear mixed effects model), pairwise comparisons were performed at the 6 time points. The differences in VTs between the groups were significant at 10, 20, 30, 40, and 50 seconds after apnea (P < .001 each, contrast statements in STATA). The time from apnea to tracheal intubation was shorter in the early rocuronium group than in the late rocuronium group (116 seconds [42 seconds] vs 195 seconds [41 seconds]; mean difference, −79 seconds; 95% CI, −96 to −64 seconds, P < .001).

CONCLUSIONS:

The early administration of rocuronium before checking mask ventilation resulted in a larger mask VT and earlier tracheal intubation than the late administration of rocuronium after checking mask ventilation in patients with normal airways.
Real-Time Ultrasound Improves Accuracy of Caudal Block in Children
Authors: Adler Adam C. , Belon Craig A. , Guffey Danielle M. , Minard Charles G. , Patel Nihar V. , Chandrakantan Arvind
Published: March 2019

BACKGROUND:

Caudal block, the most common regional anesthetic in children, is predominantly performed using palpation to determine placement. The efficacy of the palpation technique is unknown with respect to block success. While ultrasound has been suggested for use during caudal block, its use is infrequent.

METHODS:

A single-blinded prospective observational trial was performed evaluating provider success rate of caudal blocks placed by palpation alone. After needle insertion and partial local anesthetic injection, an ultrasound was performed to confirm correct location.

RESULTS:

A total of 109 caudal blocks were performed during the prospective observational study. Success rate for caudal blocks done by palpation alone was 78.9% as confirmed by ultrasound. In 21.1% of caudal blocks, the provider incorrectly judged the needle to be in the caudal space as confirmed with ultrasound.

CONCLUSIONS:

Real-time ultrasound visualization of local anesthetic injection provides reliable and immediate confirmation during caudal block in children.
Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study
Authors: Abu Elyazed Mohamed M. , Mostafa Shaimaa F. , Abdelghany Mohamed S. , Eid Gehan M.
Published: March 2019

BACKGROUND:

Hernia repair is associated with considerable postoperative pain. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in patients undergoing open midline epigastric hernia repair (T6–T9).

METHODS:

Sixty patients 18–65 years of age were randomly allocated into 2 groups. Patients in the erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block at the level of T7 transverse process using 20 mL of bupivacaine 0.25% on each side, while the control group received bilateral sham erector spinae plane block using 1 mL of normal saline. All patients underwent general anesthesia for surgery. Pain severity (visual analog scale), consumption of intraoperative fentanyl, time to first request of rescue analgesia, and postoperative pethidine consumption were recorded over the first 24 hours postoperatively.

RESULTS:

At 2 hours postoperatively, the visual analog scale pain score was significantly lower in the erector spinae plane block group compared to the control group (estimated main effect of 2.53; P < .001; 95% CI, 1.8–3.2) and remained lower until 12 hours postoperatively (P < .001 from postanesthesia care unit admission to 4 hours postoperatively, .001 at 6 hours, .025 at 8 hours, and .043 at 12 hours). At 18 and 24 hours, visual analog scale pain scores were not significantly different between both groups (P = .634 and .432, respectively). Four patients in the erector spinae plane block group required intraoperative fentanyl compared to 27 patients in control group. The median (quartiles) of intraoperative fentanyl consumption in the erector spinae plane block group was significantly lower (0 µg [0–0 µg]) compared to that of the control group (94 µg [74–130 µg]). Ten patients in the erector spinae plane block group required postoperative rescue pethidine compared to 25 patients in control group. The median [quartiles] of postoperative rescue pethidine consumption was significantly lower in the erector spinae plane block group (0 mg [0–33 mg]) compared to that of the control group (83 mg [64–109 mg]). Time to first rescue analgesic request was significantly prolonged in the erector spinae plane block group compared to control group (P < .001).

CONCLUSIONS:

Ultrasound-guided bilateral erector spinae plane block provided lower postoperative visual analog scale pain scores and decreased consumption of both intraoperative fentanyl and postoperative rescue analgesia for patients undergoing open epigastric hernia repair.
Road to Perioperative Medicine: A Perspective From China
Authors: Wang Tianlong , Deng Xiaoming , Huang Yuguang , Fleisher Lee A. , Xiong Lize
Published: March 2019

With the development of anesthesiology, patient safety has been remarkably improved, but the postoperative mortality rate at 30 days is still as high as 0.56%–4%, and the morbidity is even higher. Three years ago, the Chinese Society of Anesthesiology proposed that the direction of the anesthesiology development should be changed to perioperative medicine in China. Anesthesiologists should pay more attention to the long-term outcome. In this article, we introduced what we have done, what the challenges are, and what we should do in the future with regard to the practice of perioperative medicine in China.
Proliferator-Activated Receptor-Gamma Coactivator-1α Haploinsufficiency Promotes Pain Chronification After Burn Injury
Authors: Miao Jiamin , Zhou Xue , Ding Weihua , You Zerong , Doheny Jason , Mei Wei , Chen Qian , Mao Jianren , Shen Shiqian
Published: March 2019

BACKGROUND:

Tissue injuries such as surgery and trauma are usually accompanied by simultaneous development of acute pain, which typically resolves along with tissue healing. However, in many cases, acute pain does not resolve despite proper tissue repair; rather, it transitions to chronic pain. In this study, we examined whether proliferator-activated receptor-gamma coactivator-1α (PGC-1α), a master regulator of mitochondria biogenesis, is implicated in pain chronification after burn injury in mice.

METHODS:

We used PGC-1α+/+ and littermates PGC-1α+/− mice of both sex. Burn injury was induced on these mice. Hindpaw mechanical withdrawal thresholds and thermal withdrawal latency were examined.

RESULTS:

Hindpaw mechanical withdrawal thresholds and thermal withdrawal latencies were comparable at baseline between PGC-1α+/− and PGC-1α+/+ mice. After burn injury, both PGC-1α+/+ and PGC-1α+/− mice exhibited an initial dramatic decrease of withdrawal parameters at days 3 and 5 after injury. While PGC-1α+/+ mice fully recovered their withdrawal parameters to preinjury levels by days 11–14, PGC-1α+/− mice failed to recover those parameters during the same time frame, regardless of sex. Moreover, we found that PGC-1α+/− mice resolved tissue inflammation in a similar fashion to PGC-1α+/+ mice using a chemiluminescence-based reactive oxygen species imaging technique.

CONCLUSIONS:

Taken together, our data suggest that PGC-1α haploinsufficiency promotes pain chronification after burn injury.
Dose–Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal–Epidural Anesthesia
Authors: Xiao Fei , Shen Bei , Xu Wen-ping , Feng Ying , Ngan Kee Warwick D. , Chen Xin-zhong
Published: March 2019

BACKGROUND:

Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90) of patients when administered as a prophylactic infusion at a fixed rate based on the individual body weight.

METHODS:

Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0.25, 0.375, 0.5, or 0.625 µg/kg/min (n = 20 per group) started immediately after intrathecal injection of 10 mg hyperbaric bupivacaine and 5 µg sufentanil using a combined spinal–epidural technique. An effective dose was defined by the occurrence of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to <90 mm Hg) during the interval from the initiation of spinal anesthesia to delivery of the infant. Values for ED50 and ED90 of prophylactic phenylephrine were calculated using probit analysis.

RESULTS:

Hypotension occurred in 13/20, 8/20, 2/20, and 1/20 patients in the groups that received phenylephrine infusion at 0.25, 0.375, 0.5, or 0.625 µg/kg/min, respectively. The calculated values for ED50 and ED90 were 0.31 (95% CI, 0.24–0.36) and 0.54 (95% CI, 0.46–0.76) µg/kg/min, respectively. No difference was found in the incidence of adverse effects and neonatal outcomes among groups.

CONCLUSIONS:

Under the conditions of this study, when phenylephrine was given as a fixed-rate prophylactic infusion during spinal anesthesia for cesarean delivery to prevent hypotension, the values for ED50 and ED90 were 0.31 (95% CI, 0.24–0.36) and 0.54 (95% CI, 0.46–0.76) µg/kg/min, respectively.
Development and Testing of an Integrated Score for Physical Behaviors
Authors: KEADLE SARAH KOZEY , KRAVITZ ELI S. , MATTHEWS CHARLES E. , TSENG MARILYN , CARROLL RAYMOND J.
Published: March 2019

Purpose

Interest in a variety of physical behaviors (e.g., exercise, sitting time, sleep) in relation to health outcomes creates a need for new statistical approaches to analyze the joint effects of these distinct but inter-related physical behaviors. We developed and tested an integrated physical behavior score (PBS).

Methods

National Institutes of Health-American Association of Retired Persons Diet and Health Study participants (N = 163,016) completed a questionnaire (2004–2006) asking about time spent in five exercise and nonexercise physical activities, two sedentary behaviors (television and nontelevision), and sleep. In half of the sample, we used shape-constrained additive regression to model the relationship between each behavior and survival. Maximum logit scores from each of the eight behavior-survival functions were summed to produce a PBS that was proportionally rescaled to range from 0 to 100. We examined predictive validity of the PBS in the other half-sample using Cox Proportional Hazards models after adjustment for covariates for all-cause and cause-specific mortality.

Results

In the testing sample, over an average of 6.6 yr of follow-up, 8732 deaths occurred. We found a strong graded decline in risk of all-cause mortality across quintiles of PBS (Q5 vs Q1 hazard ratio [95% CI] = 0.53 [0.49, 0.57]). Risk estimates for the PBS were higher than any of the components in isolation. Results were similar but stronger for cardiovascular disease (Q5 vs Q1 = 0.42 [0.39, 0.48]) and other mortality (Q5 vs Q1 = 0.42 [0.36, 0.48]). The relationship between PBS and mortality was observed in stratified analyses by median age, sex, body mass index, and health status.

Conclusions

We developed a novel statistical method generated a composite physical behavior that is predictive of mortality outcomes. Future research is needed to test this approach in an independent sample.
Loading Behaviors Do Not Match Loading Abilities Postanterior Cruciate Ligament Reconstruction
Authors: CHAN MING-SHENG , SIGWARD SUSAN M.
Published: March 2019

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.
Objectively Measured Physical Activity Is Associated with Vertebral Size in Midlife
Authors: MODARRESS-SADEGHI MAHSA , OURA PETTERI , JUNNO JUHO-ANTTI , NIEMELÄ MAISA , NIINIMÄKI JAAKKO , JÄMSÄ TIMO , KORPELAINEN RAIJA , KARPPINEN JARO
Published: March 2019

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.
Dynamics of Locomotor Fatigue during Supra-critical Power Exercise
Authors: SWISHER AUSTIN R. , KOEHN BLAKE , YONG STANLEY , CUNHA JONATHAN , FERGUSON CARRIE , CANNON DANIEL T.
Published: March 2019

Purpose

We aimed to measure 1) the dynamics of locomotor fatigue during constant supra-critical power cycling and 2) the magnitude of any reserve in locomotor power at intolerance to constant and ramp-incremental cycling in recreationally active volunteers.

Methods

Fifteen participants (7 women and 8 men, 22 ± 3 yr, 3.34 ± 0.67 L·min−1 V˙O2peak) completed ramp-incremental and very-heavy constant power (205 ± 46 W) exercise to the limit of tolerance. Immediately after intolerance, the ergometer was switched into the isokinetic mode, and participants completed a short (~5 s) maximal isokinetic effort at 70 rpm. The time course of locomotor fatigue during constant supra-critical power exercise was characterized with these short maximal isokinetic sprints at 30, 60, 120, and 180 s and at the limit of tolerance. Each bout was terminated after the isokinetic sprint.

Results

Constant power exercise duration was 312 ± 37 s. Isokinetic power production values at 30, 60, 120, and 180 s and at the limit of tolerance (at 312 ± 37 s) was 609 ± 165, 503 ± 195, 443 ± 157, 449 ± 133, and 337 ± 94 W, respectively. Of the total decline in isokinetic power, ~36% occurred within the first minute of exercise, and significant (P < 0.05) reductions in isokinetic power occurred at all time points versus the baseline maximal isokinetic power (666 ± 158 W). In addition, a significant power reserve of 132 ± 74 W (64% of the task requirement) and 119 ± 80 W (47%) was present at the limit of constant power and ramp-incremental exercise, respectively.

Conclusions

Locomotor fatigue occurred rapidly during supracritical power exercise with pseudo-exponential kinetics. Instantaneous isokinetic power production at the limit of tolerance exceeded that of the task requirement, regardless of the constant or ramp work rate profile. Thus, the perceptual and physiologic limits were dissociated at the limit of tolerance in recreationally active volunteers.
Prevalence of human immunodeficiency virus and Hepatitis (B & C) among drug users in a tertiary care public hospital
Authors: Asif Aftab , Ayub Sumaira , Komal Afreen , Noor Shahbaz , Jalal Umer
Published: March 2019

Objective: To find out the prevalence of human immunodeficiency virus (HIV) and Hepatitis (B & C) among the drug users in a tertiary care public hospital.

Methods: The study was conducted at addiction ward of Mayo Hospital Lahore. A total of 453 drug users were admitted in drug addiction ward from 1st of August 2016 to 31st of July 2017. Their history was taken using self-constructed case history form and they were screened for HIV and hepatitis (B & C). Additionally three types of screening tests including Unigold, Determine and Bioline were used for HIV screening.

Results: Of 402 (100%) drug users, 394 (98%) were male and 8 (2%) were female. Their mean age was 32.2 (8.8) years. Overall prevalence of HIV virus was 21.1%, Hepatitis C 34.3% and Hepatitis B 3.2% in drug users. Among HIV positive drug users, 84.7% drug users took drugs through injections as compared to 15.3% who took drugs orally. Among HCV positive drug users, 68.9% drug users took drugs through injections as compared to 31.1% oral drug users. Relapse rate of drug use among all drug users was also very high as 83.3%. Of these drug users, 47.2% had previously sought treatment while other 52.8% never sought any treatment. Family history of drug abuse indicated that 32.2% drug users had family members who were also drug users. Moreover, about 11.4% drug users had previous history of blood transfusion.

Conclusion: HIV and hepatitis B & C were prevalent among drug users specially those who took drugs through injections. Relapse rate was significantly high and history of drug use in family may also predispose an individual towards becoming a drug addict.

How to cite this:Asif A, Ayub S, Komal A, Noor S, Jalal U. Prevalence of human immunodeficiency virus and Hepatitis (B & C) among drug users in a tertiary care public hospital. Pak J Med Sci. 2019;35(2):459-463. doi: https://doi.org/10.12669/pjms.35.2.500

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
When is deceased organ donation suitable? A critical reflection on medical criteria
Authors: Ahmad HR , Haider SG , Rizvi Adib , Naqvi Anwar
Published: March 2019

How to cite this:Ahmad HR , Haider SG , Rizvi A, Naqvi A. When is deceased organ donation suitable? A critical reflection on medical criteria. Pak J Med Sci. 2019;35(2):581-582. doi: https://doi.org/10.12669/pjms.35.2.570

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sociodemographic determinants associated with parental knowledge of screening services for thalassemia major in Lahore
Authors: Manzoor Iram , Zakar Rubeena
Published: March 2019

Objective: To assess the sociodemographic factors affecting parental knowledge regarding availability of screening services for thalassemia major.

Methods: A cross sectional study was conducted among biological parents of thalassemic children at three registered centers of blood transfusion in Lahore. A sample of 186 parents was selected through systematic random sampling. A pretested questionnaire was used to collect data. IRB clearance was obtained and informed consent was taken before data collection. Data was analyzed at SPSS version 23 and chi square test was applied and p value was fixed at ≤ 0.05 as significant.

Results: Parents of registered thalassemic children have adequate knowledge about Disease transmission and screening services. 91% of the participants knew that thalassemia major gets transmitted through parents. Cousin marriage was mentioned as a source of transmission by 77% of the participants. 91% of the parents knew about prenatal screening and 89% about premarital screening. Knowledge of parents was significantly associated with male gender, higher education and income.

Conclusion: Male gender, higher education and income are associated with better knowledge of parents.

How to cite this:Manzoor I, Zakar R. Sociodemographic determinants associated with parental knowledge of screening services for thalassemia major in Lahore. Pak J Med Sci. 2019;35(2):483-488. doi: https://doi.org/10.12669/pjms.35.2.613

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.