Timing of Postoperative Stroke and Risk of Mortality After Noncardiac Surgery: A Cohort Study.

Background: Postoperative stroke is a devastating complication of surgery, given its association with severe long-term disability and mortality. Previous investigators have confirmed the association of stroke with postoperative mortality. However, limited data exist regarding the relationship between the timing of stroke and survival.

Native American genetic ancestry and pigmentation allele contributions to skin color in a Caribbean population.

Our interest in the genetic basis of skin color variation between populations led us to seek a Native American population with genetically African admixture but low frequency of European light skin alleles. Analysis of 458 genomes from individuals residing in the Kalinago Territory of the Commonwealth of Dominica showed approximately 55% Native American, 32% African, and 12% European genetic ancestry, the highest Native American genetic ancestry among Caribbean populations to date. Skin pigmentation ranged from 20 to 80 melanin units, averaging 46.

Evaluating the Efficacy of Two Regional Pain Management Modalities in Autologous Breast Reconstruction.

Unlabelled: At our institution, multimodal opiate-sparing pain management is the cornerstone of our enhanced recovery program for autologous breast reconstruction. The purpose of this study was to compare postoperative outcomes and pain control metrics following implementation of an enhanced recovery program with two different regional analgesia approaches.

Methods: This retrospective cohort study identified 145 women who underwent autologous breast reconstruction from 2015 to 2017.

Primary Stroke and Failure-to-Rescue Following Thoracic Endovascular Aortic Aneurysm Repair.

Objective: To characterize the impact, on failure to rescue, of cerebrovascular accident as a first postoperative complication after thoracic endovascular aortic aneurysm repair (TEVAR).

Design: A retrospective cohort study using of National Surgical Quality Improvement Program Participants User File.

Setting: United States hospitals taking part in the National Surgical Quality Improvement Program.

The Acute Effects of Foam Rolling and Dynamic Stretching on Athletic Performance: A Critically Appraised Topic.

Clinical Scenario: Dynamic stretching and foam rolling are commonly used by athletes to reduce injury and enhance recovery, thereby improving athletic performance. In contrast to dynamic stretching, little research has been conducted on the acute effects of foam rolling as part of the preexercise warm-up routine. Previously, when researchers implemented foam rolling with static stretching as a warm-up, some found that foam rolling slightly improved flexibility and performance outcomes.

Improving Operating Room Efficiency: First Case On-Time Start Project.

Background: Operating rooms (ORs) are costly to run, and multiple factors influence efficiency. The first case on-time start (FCOS) of an OR is viewed as a harbinger of efficiency for the daily schedule. Across 26 ORs of a large, academic medical center, only 49% of cases started on time in October 2011.

Anesthesia-related cardiac arrest.

Background: Much is still unknown about the actual incidence of anesthesia-related cardiac arrest in the United States.

Methods: The authors identified all of the cases of cardiac arrest from their quality improvement database from 1999 to 2009 and submitted them for review by an independent study commission to give them the best estimate of anesthesia-related cardiac arrest at their institution. One hundred sixty perioperative cardiac arrests within 24 h of surgery were identified from an anesthesia database of 217,365 anesthetics.

Lack of neuromuscular origins of adaptation after a long-term stretching program.

Context: Static stretching is commonly used during the treatment and rehabilitation of orthopedic injuries to increase joint range of motion (ROM) and muscle flexibility. Understanding the physiological adaptations that occur in the neuromuscular system as a result of long-term stretching may provide insight into the mechanisms responsible for changes in flexibility.

Objective: To examine possible neurological origins and adaptations in the Ia-reflex pathway that allow for increases in flexibility in ankle ROM, by evaluating the reduction in the synaptic transmission of Ia afferents to the motoneuron pool.

Excite and receive solenoid radiofrequency coil for MRI-guided breast interventions.

A radiofrequency coil based on a solenoid design was developed and integrated with a novel device for MR-guided breast interventions using a circumferential approach. The transmit/receive tapered solenoid design conforms to the shape of the pendent breast, and provides open circumferential needle access to breast tissue under rotational symmetry. Phantom and in vivo studies using a healthy volunteer demonstrated a superior uniformity using the tapered solenoid coil compared with a commercial 8-channel diagnostic imaging coil.

Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices.

Context: A lack of published comparisons between measures from commercially available computerized posturography devices and the outcome measures used to define the limits of stability (LOS) makes meaningful interpretation of dynamic postural stability measures difficult.

Objectives: To compare postural stability measures between and within devices to establish concurrent and construct validity and to determine test-retest reliability for LOS measures generated by the NeuroCom Smart Balance Master and the Biodex Balance System.

Design: Cross-sectional study.

High incidence of burnout in academic chairpersons of anesthesiology: should we be taking better care of our leaders?

Background: Burnout is a work-related psychologic syndrome characterized by emotional exhaustion, low personal accomplishment, and depersonalization.

Methods: By using an instrument that included the MBI-HHS Burnout Inventory, we surveyed academic anesthesiology chairpersons in the United States. Current level of job satisfaction compared with 1 and 5 yr before the survey, likelihood of stepping down as chair in the next 2 yr, and a high risk of burnout were the primary outcomes.

Intersession reliability of Hoffmann reflex gain and presynaptic inhibition in the human soleus muscle.

Unlabelled: Hayes BT, Hicks-Little CA, Harter RA, Widrick JJ, Hoffman MA. Intersession reliability of Hoffmann reflex gain and presynaptic inhibition in the human soleus muscle.

Objective: To determine the day-to-day reliability of Hoffmann reflex (H-reflex) gain and presynaptic inhibition of spinal reflexes in the human soleus muscle.

Access to tuberculosis diagnosis in Itaboraí City, Rio de Janeiro, Brazil: the patient's point of view.

Setting: Itaboraí Municipality in Rio de Janeiro, Brazil.

Objective: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs).

Design: A cross-sectional study was conducted in Itaboraí City, Rio de Janeiro, Brazil.

A novel MR-guided interventional device for 3D circumferential access to breast tissue.

MRI is rapidly growing as a tool for image-guided procedures in the breast such as needle localizations, biopsy, and cryotherapy. The ability of MRI to resolve small (<1 cm) lesions allows earlier detection and diagnosis than with ultrasound. Most MR-guidance methods perform a two-dimensional compression of the breast that distorts tissue anatomy and limits medial access.

The interrelationships among sex hormone concentrations, motoneuron excitability, and anterior tibial displacement in women and men.

Context: Sex hormone fluctuations have been implicated as a contributing factor to the high rates of noncontact injury to the anterior cruciate ligament in females.

Objective: To determine the strength of the relationships among variables of sex hormone concentrations, motoneuron excitability, and anterior tibial displacement (ATD) in women and men and to determine if these relationships differ between the sexes.

Design: Cohort study.

Shoulder joint position sense after thermal, open, and arthroscopic capsulorrhaphy for recurrent anterior instability.

Identifying the optimal surgical treatment for recurrent, anterior glenohumeral instability remains a challenge. Our purpose was to compare shoulder joint position sense among open, arthroscopic, and thermal capsulorrhaphy patients after repair of recurrent anterior instability and to compare these patients to healthy, control subjects. Sixty-seven adults (45 post-surgical patients, 22 controls) volunteered to participate in the study.

Postoperative nausea and vomiting: prevention and therapy.

As we enter the new millennium, the armamentarium available to treat and prevent postoperative nausea and vomiting continues to expand. There remains a finite incidence of postoperative nausea and vomiting, particularly among high-risk populations. This review examines recent studies of drugs, both new and old, and their impact on postoperative nausea and vomiting prophylaxis and treatment.

Heterogeneities in glaciofluvial deposits using an example from new hampshire.

The strong influence of subsurface heterogeneity on contaminant migration and in situ remediation calls for an improved understanding of its origins and more efficient methods of characterization. Accordingly, an outcrop study of physical and chemical heterogeneity was conducted in a glaciofluvial deposit in Deerfield, New Hampshire, in order to uncover processes controlling the spatial variation of sediment properties and evaluate the extent to which geologic information can be used to characterize the observed variation. The results indicate that physical and chemical properties at the Deerfield site have distinctly different spatial correlation structures.

A comparison of the volume and pH of gastric contents of obese and lean surgical patients.

Unlabelled: Obese surgical patients are typically considered to be more likely than lean patients to possess high-volume and low-pH (HVLP) gastric contents after a standard preoperative fast, based on a study of a population predominately consisting of patients receiving intramuscular preoperative sedation. We revisited this issue in a study population of 256 fasted surgical patients, of which 232 received no preoperative antacid or gastric prokinetic drug. Immediately after endotracheal intubation, an 18-French sump tube was placed, and gastric contents were withdrawn.

Sleep-disordered breathing and systemic hypertension in the older male.

Objective: To investigate the relationship between sleep-disordered breathing (SDB) and essential hypertension in a population of older male hypertensives.

Patients: One-hundred forty consecutive older hypertensive males.

Measurements: Monitoring of sleep-related breathing abnormality with a portable sleep apnea monitor (level III device).

Determination of the effective charge of a protein in solution by capillary electrophoresis.

This paper describes two methods to estimate the effective charge of a protein in solution by capillary electrophoresis and demonstrates these methods by using representative proteins. In one method, a "charge ladder"--a series of derivatives of a protein differing by known increments of charge but differing only minimally in hydrodynamic drag--is generated by covalent modification of the epsilon-amino groups of lysines with 4-sulfophenyl isothiocyanate or acetic anhydride. In the second method, the equivalent of a charge ladder is produced by noncovalent association of a protein with differently charged ligands.

Comparison of inversion restraint provided by ankle prophylactic devices before and after exercise.

The prudence of prophylactic ankle taping continues to be questioned as recent studies have identified other forms of ankle stabilization as more effective means of injury prevention. The purpose of our study was to compare the effectiveness of three ankle prophylaxes (adhesive taping, lace-up brace, and semirigid orthosis) with a control condition (no support) in limiting inversion under dynamic loads imposed by repetitive walking (4 mph) and running (9 mph) on an 8.5 degrees laterally tilted treadmill.

Isokinetic evaluation of quadriceps and hamstrings symmetry following anterior cruciate ligament reconstruction.

After anterior cruciate ligament (ACL) reconstruction, isokinetic muscle parameters are commonly measured to assess the dynamic status of the knee and to monitor progress in rehabilitation. This study evaluated the symmetry of the quadriceps and hamstrings musculature in postsurgical and contralateral normal limbs of subjects who had undergone one of two types of ACL reconstruction. Subjects were also evaluated for differences on selected isokinetic parameters between types of surgery and lengths of postoperative periods.