Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

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Κυριακή 2 Ιουνίου 2019

Chromosoma

Meiotic behavior of a complex hexavalent in heterozygous mice for Robertsonian translocations: insights for synapsis dynamics

Abstract

Natural populations of the house mouse Mus musculus domesticus show great diversity in chromosomal number due to the presence of chromosomal rearrangements, mainly Robertsonian translocations. Breeding between two populations with different chromosomal configurations generates subfertile or sterile hybrid individuals due to impaired meiotic development. In this study, we have analyzed prophase-I spermatocytes of hybrids formed by crossing mice from Vulcano and Lipari island populations. Both populations have a 2n = 26 karyotype but different combinations of Robertsonian translocations. We studied the progress of synapsis, recombination, and meiotic silencing of unsynapsed chromosomes during prophase-I through the immunolocalization of the proteins SYCP3, SYCP1, γH2AX, RAD51, and MLH1. In these hybrids, a hexavalent is formed that, depending on the degree of synapsis between chromosomes, can adopt an open chain, a ring, or a closed configuration. The frequency of these configurations varies throughout meiosis, with the maximum degree of synapsis occurring at mid pachytene. In addition, we observed the appearance of heterologous synapsis between telocentric and metacentric chromosomes; however, this synapsis seems to be transient and unstable and unsynapsed regions are frequently observed in mid-late pachytene. Interestingly, we found that chiasmata are frequently located at the boundaries of unsynapsed chromosomal regions in the hexavalent during late pachytene. These results provide new clues about synapsis dynamics during meiosis. We propose that mechanical forces generated along chromosomes may induce premature desynapsis, which, in turn, might be counteracted by the location of chiasmata. Despite these and additional meiotic features, such as the accumulation of γH2AX on unsynapsed chromosome regions, we observed a large number of cells that progressed to late stages of prophase-I, indicating that synapsis defects may not trigger a meiotic crisis in these hybrids.



De novo genome assembly of the cichlid fish Astatotilapia latifasciata reveals a higher level of genomic polymorphism and genes related to B chromosomes

Abstract

Supernumerary B chromosomes (Bs) are accessory elements to the regular chromosome set (As) and have been observed in a huge diversity of eukaryotic species. Although extensively investigated, the biological significance of Bs remains enigmatic. Here, we present de novo genome assemblies for the cichlid fish Astatotilapia latifasciata, a well-known model to study Bs. High coverage data with Illumina sequencing was obtained for males and females with 0B (B−), 1B, and 2B (B+) chromosomes to provide information regarding the diversity among these genomes. The draft assemblies comprised 771 Mb for the B− genome and 781 Mb for the B+ genome. Comparative analysis of the B+ and B− assemblies reveals syntenic discontinuity, duplicated blocks and several insertions, deletions, and inversions indicative of rearrangements in the B+ genome. Hundreds of transposable elements and 1546 protein coding sequences were annotated in the duplicated B+ regions. Our work contributes a list of thousands of genes harbored on the B chromosome, with functions in several biological processes, including the cell cycle.



Maternal regulation of chromosomal imprinting in animals

Abstract

Chromosomal imprinting requires an epigenetic system that "imprints" one of the two parental chromosomes such that it results in a heritable (cell-to-cell) change in behavior of the "imprinted" chromosome. Imprinting takes place when the parental genomes are separate, which occurs during gamete formation in the respective germ-lines and post-fertilization during the period when the parental pro-nuclei lie separately within the ooplasm of the zygote. In the mouse, chromosomal imprinting is regulated by germ-line specific DNA methylation. But the methylation machinery in the respective germ-lines does not discriminate between imprinted and non-imprinted regions. As a consequence, the mouse oocyte nucleus contains over a thousand oocyte-specific germ-line differentially methylated regions (gDMRs). Upon fertilization, the sperm provides a few hundred sperm-specific gDMRs of its own. Combined, there are around 1600 imprinted and non-imprinted gDMRs in the pro-nuclei of the newly fertilized zygote. It is a remarkable fact that beginning in the maternal ooplasm, there are mechanisms that manage to preserve DNA methylation at ~ 26 known imprinted gDMRs in the face of the ongoing genome-wide DNA de-methylation that characterizes pre-implantation development. Specificity is achieved through the binding of KRAB-zinc finger proteins to their cognate recognition sequences within the gDMRs of imprinted genes. This in turn nucleates the assembly of localized heterochromatin-like complexes that preserve methylation at imprinted gDMRs through recruitment of the maintenance methyl transferase Dnmt1. These studies have shown that a germ-line imprint may cause parent-of-origin-specific behavior only if "licensed" by mechanisms that operate post-fertilization. Study of the germ-line and post-fertilization contributions to the imprinting of chromosomes in classical insect systems (Coccidae and Sciaridae) show that the ooplasm is the likely site where imprinting takes place. By comparing molecular and genetic studies across these three species, we suggest that mechanisms which operate post-fertilization play a key role in chromosomal imprinting phenomena in animals and conserved components of heterochromatin are shared by these mechanisms.



Molecular and genetic organization of bands and interbands in the dot chromosome of Drosophila melanogaster

Abstract

The fourth chromosome smallest in the genome of Drosophila melanogaster differs from other chromosomes in many ways. It has high repeat density in conditions of a large number of active genes. Gray bands represent a significant part of this polytene chromosome. Specific proteins including HP1a, POF, and dSETDB1 establish the epigenetic state of this unique chromatin domain. In order to compare maps of localization of genes, bands, and chromatin types of the fourth chromosome, we performed FISH analysis of 38 probes chosen according to the model of four chromatin types. It allowed clarifying the dot chromosome cytological map consisting of 16 loose gray bands, 11 dense black bands, and 26 interbands. We described the relation between chromatin states and bands. Open aquamarine chromatin mostly corresponds to interbands and it contains 5′UTRs of housekeeping genes. Their coding parts are embedded in gray bands substantially composed of lazurite chromatin of intermediate compaction. Polygenic black bands contain most of dense ruby chromatin, and also some malachite and lazurite. Having an accurate map of the fourth chromosome bands and its correspondence to physical map, we found that DNase I hypersensitivity sites, ORC2 protein, and P–elements are mainly located in open aquamarine chromatin, while element 1360, characteristic of the fourth chromosome, occupies band chromatin types. POF and HP1a proteins providing special organization of this chromosome are mostly located in aquamarine and lazurite chromatin. In general, band organization of the fourth chromosome shares the features of the whole Drosophila genome.



Spindle assembly without spindle pole body insertion into the nuclear envelope in fission yeast meiosis

Abstract

Centrosomes represent the major microtubule organizing center (MTOC) in eukaryotic cells and are responsible for nucleation of the spindle, the vehicle of chromosome segregation. In human female meiosis, however, spindle assembly occurs in the absence of centrosomes or other MTOCs and microtubules are nucleated around chromosomes. In yeast, spindle formation in mitosis and meiosis depends on the activity of spindle pole bodies (SPBs), the functional equivalents of centrosomes; thus, SPBs and centrosomes use similar machineries to assemble spindles. Here, we develop a system to explore the molecular mechanisms supporting acentrosomal spindle formation using fission yeast meiosis as a model scenario. We achieve this situation by removing access of the SPBs to the nucleus after their duplication. Under these conditions, we observe self-assembly-based spindle formation in the nuclear environment, conferring an ability to segregate chromosomes independently of the SPBs. Our results open the possibility to utilize the experimental advantages of fission yeast for insights into the molecular basis of acentrosomal spindle formation in meiosis.



Outer kinetochore protein Dam1 promotes centromere clustering in parallel with Slk19 in budding yeast

Abstract

A higher order organization of the centromeres in the form of clustering of these DNA loci has been observed in many organisms. While centromere clustering is biologically significant to achieve faithful chromosome segregation, the underlying molecular mechanism is yet to be fully understood. In budding yeast, a kinetochore-associated protein Slk19 is shown to have a role in clustering in association with the microtubules whereas removal of either Slk19 or microtubules alone does not have any effect on the centromere clustering. Furthermore, Slk19 is non-essential for growth and becomes cleaved during anaphase whereas clustering being an essential event occurs throughout the cell cycle. Hence, we searched for an additional factor involved in the clustering and since the integrity of the kinetochore complex is shown to be crucial for centromere clustering, we restricted our search within the complex. We observed that the outermost kinetochore protein Dam1 promotes centromere clustering through stabilization of the kinetochore integrity. While in the absence of Dam1 we failed to detect Slk19 at the centromere, on the other hand, we found almost no Dam1 at the centromere in the absence of Slk19 and microtubules suggesting interdependency between these two pathways. Strikingly, we observed that overexpression of Dam1 or Slk19 could restore the centromere clustering largely in the cells devoid of Slk19 and microtubules or Dam1, respectively. Thus, we propose that in budding yeast, centromere clustering is achieved at least by two parallel pathways, through Dam1 and another via Slk19, in concert with the microtubules suggesting that having a dual mechanism may be crucial for ensuring microtubule capture by the point centromeres where each attaches to only one microtubule.



ChIP-cloning analysis uncovers centromere-specific retrotransposons in Brassica nigra and reveals their rapid diversification in Brassica allotetraploids

Abstract

Centromeres are indispensable functional units of chromosomes. The evolutionary mechanisms underlying the rapid evolution of centromeric repeats, especially those following polyploidy, remain unknown. In this study, we isolated centromeric sequences of Brassica nigra, a model diploid progenitor (B genome) of the allopolyploid species B. juncea (AB genome) and B. carinata (BC genome) by chromatin immunoprecipitation of nucleosomes containing the centromere-specific histone CENH3. Sequence analysis detected no centromeric satellite DNAs, and most B. nigra centromeric repeats were found to originate from Tyl/copia-class retrotransposons. In cytological analyses, six of the seven analyzed repeat clusters had no FISH signals in A or C genomes of the related diploid species B. rapa and B. oleracea. Notably, five repeat clusters had FISH signals in both A and B subgenomes in the tetraploid B. juncea. In the tetraploid B. carinata, only CL23 displayed three pairs of signals in terminal or interstitial regions of the C-derived chromosome, and no evidence of colonization of CLs onto C-subgenome centromeres was found in B. carinata. This observation suggests that centromeric repeats spread and proliferated between genomes after polyploidization. CL3 and CRB are likely ancient centromeric sequences arising prior to the divergence of diploid Brassica which have detected signals across the genus. And in allotetraploids B. juncea and B. carinata, the FISH signal intensity of CL3 and CRB differed among subgenomes. We discussed possible mechanisms for centromeric repeat divergence during Brassica speciation and polyploid evolution, thus providing insights into centromeric repeat establishment and targeting.



How dynamic could be the 45S rDNA cistron? An intriguing variability in a grasshopper species revealed by integration of chromosomal and genomic data

Abstract

To better understand the structure and variability of the 45S rDNA cistron and its evolutionary dynamics in grasshoppers, we performed a detailed analysis combining classical and molecular cytogenetic data with whole-genome sequencing in Abracris flavolienata, which shows extraordinary variability in the chromosomal distribution for this element. We found astonishing variability in the number and size of rDNA clusters at intra- and inter-population levels. Interestingly, FISH using distinct parts of 45S rDNA cistron (18S rDNA, 28S rDNA, and ITS1) as probes revealed a distinct number of clusters, suggesting independent mobility and amplification of the 45S rDNA components. This hypothesis is consistent with the higher genomic coverage of almost the entire cistron of 45S rDNA observed in A. flavolineata compared to other grasshoppers, besides coverage variability along the 45S rDNA cistron in the species. In addition, these differences in coverage for distinct components of the 45S rDNA cistron indicate emergence of pseudogenes evidenced by existence of truncated sequences, demonstrating the rDNA dynamics in the species. Although the chromosomal distribution of 18S rDNA was highly variable, the chromosomes 1, 3, 6, and 9 harbored rDNA clusters in all individuals with the occurrence of NOR activity in pair 9, suggesting ancestry or selective pressures to prevent pseudogenization of rDNA sequences in this chromosome pair. Additionally, small NORs and cryptic rDNA loci were observed. Finally, there was no evidence of enrichment and association of transposable elements, at least, inside or nearby rDNA cistron. These findings broaden our knowledge of rDNA dynamics, revealing an independent movement and amplification of segments of 45S rDNA cistron, which in A. flavolineata could be attributed to ectopic recombination.



S. cerevisiae Srs2 helicase ensures normal recombination intermediate metabolism during meiosis and prevents accumulation of Rad51 aggregates

Abstract

We investigated the meiotic role of Srs2, a multi-functional DNA helicase/translocase that destabilises Rad51-DNA filaments and is thought to regulate strand invasion and prevent hyper-recombination during the mitotic cell cycle. We find that Srs2 activity is required for normal meiotic progression and spore viability. A significant fraction of srs2 mutant cells progress through both meiotic divisions without separating the bulk of their chromatin, although in such cells sister centromeres often separate. Undivided nuclei contain aggregates of Rad51 colocalised with the ssDNA-binding protein RPA, suggesting the presence of persistent single-strand DNA. Rad51 aggregate formation requires Spo11-induced DSBs, Rad51 strand-invasion activity and progression past the pachytene stage of meiosis, but not the DSB end-resection or the bias towards interhomologue strand invasion characteristic of normal meiosis. srs2 mutants also display altered meiotic recombination intermediate metabolism, revealed by defects in the formation of stable joint molecules. We suggest that Srs2, by limiting Rad51 accumulation on DNA, prevents the formation of aberrant recombination intermediates that otherwise would persist and interfere with normal chromosome segregation and nuclear division.



The molecular basis of monopolin recruitment to the kinetochore

Abstract

The monopolin complex is a multifunctional molecular crosslinker, which in S. pombe binds and organises mitotic kinetochores to prevent aberrant kinetochore-microtubule interactions. In the budding yeast S. cerevisiae, whose kinetochores bind a single microtubule, the monopolin complex crosslinks and mono-orients sister kinetochores in meiosis I, enabling the biorientation and segregation of homologs. Here, we show that both the monopolin complex subunit Csm1 and its binding site on the kinetochore protein Dsn1 are broadly distributed throughout eukaryotes, suggesting a conserved role in kinetochore organisation and function. We find that budding yeast Csm1 binds two conserved motifs in Dsn1, one (termed Box 1) representing the ancestral, widely conserved monopolin binding motif and a second (termed Box 2-3) with a likely role in enforcing specificity of sister kinetochore crosslinking. We find that Box 1 and Box 2-3 bind the same conserved hydrophobic cavity on Csm1, suggesting competition or handoff between these motifs. Using structure-based mutants, we also find that both Box 1 and Box 2-3 are critical for monopolin function in meiosis. We identify two conserved serine residues in Box 2-3 that are phosphorylated in meiosis and whose mutation to aspartate stabilises Csm1-Dsn1 binding, suggesting that regulated phosphorylation of these residues may play a role in sister kinetochore crosslinking specificity. Overall, our results reveal the monopolin complex as a broadly conserved kinetochore organiser in eukaryotes, which budding yeast have co-opted to mediate sister kinetochore crosslinking through the addition of a second, regulatable monopolin binding interface.



Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Molecular Systems Biology


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Fab‐Fc array measurements are used to analyse humoral responses to vaccination. Accounting for antibody qualities and not just the overall response magnitude allows predictive modeling of protection in two different simian immunodeficiency virus (SIV) vaccine studies.

Srivamshi Pittala, Kenneth Bagley, Jennifer A Schwartz, Eric P Brown, Joshua A Weiner, Ilia J Prado, Wenlei Zhang, Rong Xu, Ayuko Ota‐Setlik, Ranajit Pal, Xiaoying Shen, Charles Beck, Guido Ferrari, George K Lewis, Celia C LaBranche, David C Montefiori, Georgia D Tomaras, Galit Alter, Mario Roederer, Timothy R Fouts, Margaret E Ackerman and Chris Bailey‐Kellogg
Published online 02.05.2019 Open Access

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A sequencing‐based method is developed to quantify transcriptional and translational processes, enabling high‐throughput measurements in absolute units of genetic regulatory components and the burden synthetic genetic constructs place on the host cell.

Thomas E Gorochowski, Irina Chelysheva, Mette Eriksen, Priyanka Nair, Steen Pedersen and Zoya Ignatova
Published online 03.05.2019 Open Access

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Transcriptome profiling and genome‐scale mapping of DNAmethylation, seven histone modifications, nucleosome positions, chromatin accessibility, EBF1 and CTCF binding are performed in B cells from CLL patients and healthy donors.

Jan‐Philipp Mallm, Murat Iskar, Naveed Ishaque, Lara C Klett, Sabrina J Kugler, Jose M Muino, Vladimir B Teif, Alexandra M Poos, Sebastian Großmann, Fabian Erdel, Daniele Tavernari, Sandra D Koser, Sabrina Schumacher, Benedikt Brors, Rainer König, Daniel Remondini, Martin Vingron, Stephan Stilgenbauer, Peter Lichter, Marc Zapatka, Daniel Mertens and Karsten Rippe
Published online 22.05.2019 Open Access

Corrigendum
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Robin Beekhof, Carolien van Alphen, Alex A Henneman, Jaco C Knol, Thang V Pham, Frank Rolfs, Mariette Labots, Evan Henneberry, Tessa YS Le Large, Richard R de Haas, Sander R Piersma, Valentina Vurchio, Andrea Bertotti, Livio Trusolino, Henk MW Verheul and Connie R Jimenez
Published online 24.05.2019



ALEXANDROS SFAKIANAKIS ANAPAFSEOS 5 AGIOS NIKOLAOS CRETE 72100 GREECE +306932607174 +302841026182

Medicine & Science in Sports & Exercise

Delayed Onset Muscle Soreness and Topical Analgesic Alter Corticospinal Excitability of the Biceps Brachii
Introduction The interactive effect of delayed onset muscle soreness (DOMS) and a topical analgesic on corticospinal excitability was investigated. Methods Thirty-two participants completed Experiments A (No DOMS) and B (DOMS). For each experiment participants were randomly assigned to two groups: 1) topical analgesic gel (Topical Analgesic, n=8), or 2) placebo gel (Placebo, n=8) group. Prior to the application of gel (pre-gel), as well as 5, 15, 30, and 45 min post-gel, motor evoked potential (MEP) area, latency, and silent period, as well as cervicomedullary MEP (CMEP) and maximal compound motor unit action potential (Mmax) areas and latencies were measured. In addition, pressure-pain threshold (PPT) was measured pre-DOMS and at the same time points in Experiment B. Results In Experiment A, neither group showed a significant change for any outcome measure. In Experiment B, both groups exhibited a significant decrease in PPT from pre-DOMS to pre-gel. Following the application of topical analgesic, but not placebo, there was a significant increase in PPT at 45 min post-gel, respectively compared to pre-gel and a main effect of time for the silent period to increase compared to pre-gel. Participants with DOMS had reduced MEP and CMEP areas, and increased corticospinal silent periods compared to those who did not have DOMS. Conclusion These findings suggest that DOMS reduced corticospinal excitability and following the administration of menthol-based topical analgesic there was a reduction in pain, which was accompanied by increased corticospinal inhibition. Corresponding author: Duane C. Button School of Human Kinetics and Recreation, Memorial University of Newfoundland, 230 Elizabeth Avenue, St. John's, Newfoundland, Canada, A1C 5S7 Email: dbutton@mun.ca GRANTS: This study was supported by a Memorial University Seed, Bridge, and Multidisciplinary Fund (to D. C. Button). DISCLOSURES: No conflicts of interest, financial or otherwise, are declared by the authors. We declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for publication: 21 May 2019. © 2019 American College of Sports Medicine

Aerobic Training and Green Tea Extract Protect against NMU-induced Prostate Cancer
Introduction Aerobic training and green tea extract can be used to reduce the risk of prostate cancer. The goal of this study was to evaluate the effects of eight-week aerobic exercise training and administration of green tea extract on the level of nuclear factor kappa B (NF-kB), cyclooxygenase-2 (COX-2) and p53 tumor suppressor protein (p53) in prostate of rats which were stimulated by N-Methyl-N-nitrosourea (NMU) to induce the prostate cancer. Methods 60 adult male Wistar rats were assigned into six groups including healthy control (HCt), cancer control (CCt), cancer training (CTr: 45 min/day at low-moderate intensity, 5 times/week, 8 weeks), cancer extract (CEx: 1.34 ml of green tea extract, 3 times/week, 8 weeks), cancer training+ cancer extract (CTr+CEx) and sham groups. Rats were sacrificed 48 hours after the last intervention session, and the prostate tissue was isolated to measure the levels of NF-kB, COX-2, and p53. Results The NF- kB level in CCt group was increased significantly compared to the HCt (P=0.02). In the CTr group, NF-kB level was decreased significantly compared to the CCt and CEx groups (P=0.001 and 0.05, respectively). In addition, the levels of P53 protein were reduced in CTr, CEx and CTr+CEx groups compared to CCt group (P=0.001, 0.02 and 0.004, respectively). No significant changes were found in the level of COX-2 between groups. Conclusions These results suggest that a long-term exercise training combined with the intake of green tea extract may reduce levels of NF-kB and p53 in rats with prostate cancer. Given the importance of recognizing complementary therapies in this regard, future studies are warranted. Corresponding author: Marziyeh Saghebjoo; University of Birjand, Avini Blvd, Birjand, South Khorasan, Iran; Mailbox number: 97175/615; E-mail: m_saghebjoo@birjand.ac.ir Iran National Science Foundation (INSF) has financially supported this work with code approval number 96001504. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and do not constitute endorsement by ACSM. There are no conflicts of interests. Accepted for publication: 21 May 2019. © 2019 American College of Sports Medicine

High-Intensity Single-Leg Cycling Improves Cardiovascular Disease Risk Factor Profile
Introduction Regular exercise can reduce the risk of developing cardiovascular disease through risk factor modification, with high intensity exercise and more recently small muscle mass training providing alternatives to moderate intensity exercise. Methods This study randomly assigned 53 healthy middle-aged adults (age: 62 ± 6 y) to complete 24 sessions (8 wk; 3 d.wk-1) of exercise training, using either high intensity double-leg cycling (n=17; HITDL), high intensity single-leg cycling (n=18; HITSL) or moderate intensity double-leg cycling (n=18; MCTDL). Biomarkers of cardiovascular risk (total cholesterol, triglycerides, HDL-c, LDL-c, apo-B48, glucose), anthropometry measures (body mass, body mass index, waist circumference, waist-to-hip ratio), resting blood pressure and aerobic capacity were assessed pre- and post-intervention. Results Total work completed was greater (p<0.01) in MCTDL (5938 ± 1462 kJ) compared with the HITDL (3462 ± 1063 kJ) and HITSL (4423 ± 1875 kJ). Pre- to post-training differences were observed for waist-to-hip ratio (0.84 ± 0.09 vs 0.83 ± 0.09; p<0.01), resting systolic blood pressure (129 ± 11 mmHg vs 124 ± 12 mmHg; p<0.01), total cholesterol (5.87 ± 1.17 mmol·L-1 vs 5.55 ± 0.98 mmol·L-1; p<0.01) and LDL-c (3.70 ± 1.04 mmol·L-1 vs 3.44 ± 0.84 mmol·L-1; p<0.01), with no differences between conditions. Additionally, aerobic capacity increased following training (22.3 ± 6.4 mL·kg-1·min-1 vs 24.9 ± 7.6 mL·kg-1·min-1; p<0.01), with no differences between conditions. Conclusion These findings suggest that all three modes of exercise can be prescribed to achieve cardiovascular risk reduction in an ageing population. Corresponding author Dr Nicole Gordon Murdoch University 90 South Street Murdoch, Western Australia, 6150, AU Email: N.Gordon@murdoch.edu.au The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation and do not constitute endorsement by ACSM. No funding was received for this study. The authors declare no conflicts of interest. Accepted for publication: 22 May 2019. © 2019 American College of Sports Medicine

Validity of Cardiorespiratory Fitness Measured with Fitbit Compared to VO2max
Purpose Cardiorespiratory fitness (CRF), broadly defined as the body's ability to utilize oxygen, is a well-established prognostic marker of health, but it is not routinely measured. This may be due to the difficulty of acquiring high-quality CRF measures. The purpose of this study was to independently determine the validity of the Fitbit Charge 2's measure of CRF (Fitbit CRF). Methods 65 healthy adults between the ages of 18 and 45 (55% female, 45% male) were recruited to undergo gold standard VO2 max testing and wear a Fitbit Charge 2 continuously for one week during which they were instructed to complete a qualifying outdoor run to derive the Fitbit CRF (units: mL•Kg-1•min-1). This measure was compared with VO2 max measures (units: mL•Kg-1•min-1) epoched at 15 and 60 seconds. Results Bland Altman analyses revealed that Fitbit CRF had a positive bias of 1.59 mL•Kg-1•min-1 compared to laboratory data epoched at 15 seconds and 0.30 mL•Kg-1•min-1 compared to data epoched at 60 seconds (N=60). F statistics (2.09; 0.08) and p-values (0.133; 0.926) from Bradley-Blackwood tests for the concordance of Fitbit CRF with 15 and 60 second laboratory data, respectively, supports the null hypothesis of equal means and variances indicating there is concordance between the two measures. Mean absolute percentage error was less than 10% for each comparison. Conclusions The Fitbit Charge 2 provides an acceptable level of validity when measuring CRF in young, healthy, and fit adults who are able to run. Further research is required to determine if it is a potentially useful tool in clinical practice and epidemiological research to quantify, categorize, and longitudinally track risk for adverse outcomes. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Corresponding Author: Job G. Godino, PhD, 858-822-3749, jgodino@ucsd.edu, 9500 Gilman Drive #0811, La Jolla, CA 92093 The authors acknowledge funding support for the publication of this work from the Mobilize Center, a National Institutes of Health (NIH) Big Data to Knowledge Center of Excellence supported by NIH grant U54 EB020405. The authors have no conflicts of interest to report. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for publication: 3 May 2019. © 2019 American College of Sports Medicine

Supraspinal Control of Recurrent Inhibition during Anisometric Contractions
Purpose Increase in recurrent inhibition was observed during eccentric compared with isometric and concentric maximal voluntary contractions but the neural mechanisms involved in this specific control of the Renshaw cell activity are unknown. This study was designed to investigate the supraspinal control of the recurrent inhibition during anisometric contractions of the plantar flexor muscles. Methods To that purpose, the paired Hoffmann-reflex (H-reflex) technique permitted to assess changes in homonymous recurrent pathway by comparing the modulations of test and conditioning H-reflexes (H' and H1 respectively) in the soleus muscle (SOL) during maximal and submaximal isometric, concentric and eccentric contractions. Submaximal contraction intensity was set at 50% of the SOL electromyographic activity recorded during maximal isometric contraction. 14 volunteer subjects participated in an experimental session designed to assess the activity of the recurrent inhibition pathway. Results The results indicate that the amplitude of H1 normalized to the maximal M-Wave were similar (p > 0.05) regardless of the muscle contraction type and intensity. Whatever the contraction intensity, the ratio between H' and H1 amplitudes was significantly decreased (p < 0.05) during eccentric compared with isometric and concentric contractions. Furthermore, this ratio was significantly smaller (p < 0.05) during submaximal compared with maximal contractions whatever the muscle contraction type. Conclusion Together, the current results confirm the supraspinal control of the Renshaw cell activity when muscle contraction intensity is modulated and show that this control remains similar for isometric, concentric and eccentric contractions. Data further suggest that recurrent inhibition pathway may serve as variable gain regulator at motoneuronal level to improve resolution in the control of motor output for the SOL during eccentric contractions. CORRESPONDING AUTHOR: Julien Duclay, University Paul Sabatier, Faculty of sport science, 118 route de Narbonne, F-31062 Toulouse Cedex 9, FRANCE. Mail: julien.duclay@univ-tlse3.fr No funding was received for this work. The authors have no conflicts of interest to declare. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication: 14 May 2019. © 2019 American College of Sports Medicine

Optimal Approach to Load Progressions during Strength Training in Older Adults
Progressive resistance training (RT) is one of the most effective interventions for reducing age-related deficits in muscle mass and functional capacity. PURPOSE To compare four approaches to load progressions in RT for older adults to determine if an optimal method exists. METHODS 82 healthy community-dwelling older adults (71.8 + 6.2 y) performed 11 weeks of structured RT (2.5 days/week) in treatment groups differing only by the method used to increase training loads. These included percent 1RM (%1RM): standardized loads based on a percentage of the one repetition maximum (1RM); rating of perceived exertion (RPE): loads increased when perceived difficulty falls below 8/10 on the OMNI RES perceived exertion scale; repetition maximum (RM): loads increased when a target number of repetitions can be completed with a given load; repetitions in reserve (RiR): identical to RM except subjects must always maintain >1 'repetition in reserve', thus avoiding the possibility of training to temporary muscular failure. RESULTS Multiple analyses of covariance indicated no significant between-group differences on any strength (chest press 1RM; leg press 1RM) or functional performance outcome (usual walking speed, maximum walking speed, 8 foot timed up-and-go, gallon jug transfer test, 30 second sit-to-stand). The RPE group found the exercise to be significantly more tolerable and enjoyable than subjects in the RiR, RM, and %1RM groups. CONCLUSION Given the RM, RPE, %1RM, and RiR methods appear equally-effective at improving muscular strength and functional performance in an older population, we conclude that the RPE method is optimal because it is likely to be perceived as the most tolerable and enjoyable, which are two important factors determining older adults' continued participation in RT. Corresponding author: Dr. Andrew N.L. Buskard, Laboratory of Neuromuscular Research and Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, 1507 Levante Avenue, Coral Gables, Florida, 33146, USA, Tel: +1 305 284 3105, Fax: +1 305 284 3003, E-mail: andrewbuskard@miami.edu No outside funding was obtained for this study, but equipment and laboratory support were provided by the University of Miami under the auspices of graduate research support for the first author's PhD in exercise physiology. The authors have no professional relationships with companies or manufacturers who will benefit from the results of the study. The results of this study do not constitute an endorsement by the American College of Sports Medicine (ACSM). The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 8 May 2019 © 2019 American College of Sports Medicine

The Effect of Growth Restriction on Voluntary Physical Activity Engagement in Mice
INTRODUCTION The purpose of this study was to determine the effect of growth-restriction on the biological regulation of physical activity. METHODS Using a cross-fostering, protein restricted nutritive model, mice were growth-restricted during either gestation (GUN; N=3 litters) or postnatal life (PUN; N=3 litters). At 21 days of age, all mice pups were weaned and fed a non-restrictive healthy diet for the remainder of the study. At 45 days of age mice were individually housed in cages with free moving running wheels to assess physical activity engagement. At day 70, mice were euthanized, and the nucleus accumbens was analyzed for dopamine receptor 1 expression. Skeletal muscle fiber type and cross-sectional area of the soleus, extensor digitorom longus, and diaphragm were analyzed by immunohistochemistry. The soleus from the other hind leg was evaluated for calsequestrin 1 and annexin A6 expression. RESULTS The PUN female mice (15,365 ±8,844 revolutions·day-1) had a reduction (P=0.0221) in wheel revolutions per day as compared to the GUN (38,667±8648 revolutions·day-1) and CON females (36,421.0± 6,700 revolutions·day-1). PUN female mice also expressed significantly higher Drd1compared (P=0.0247) to the other groups. PUN female soleus had a higher expression of calsequestrin 1, along with more Type IIb fibers (P=0.0398). CONCLUSION Growth-restriction during lactation reduced physical activity in female mice by reducing the central drive to be active and displayed a more fatigable skeletal muscle phenotype. Address for correspondence: David P. Ferguson, 308 W. Circle Dr. Room 27S, East Lansing, MI, 48824, 517-355-4763, Fergu312@msu.edu This project was funded by Michigan State University Department of Kinesiology Start up funds. The authors have no conflicts of interest to report, and the results of this study are not endorsed by the ACSM. The results of this study are also presented clearly and honestly, without inappropriate data manipulation, fabrication, or falsification. Accepted for Publication: 4 May 2019 © 2019 American College of Sports Medicine

The Longitudinal Associations of Fitness and Motor Skills with Academic Achievement
PURPOSE This study aimed to examine both independent and dependent longitudinal associations of physical fitness (PF) components with academic achievement. METHODS 954 4th-7th graders (9-15y [Mage=12.5y], 52% girls) from nine schools throughout Finland participated in a two-year follow-up study. Register-based academic achievement scores (grade point average [GPA]) and PF were assessed in the spring of 2013-2015. Aerobic fitness was measured with a maximal 20-m shuttle run test, muscular fitness with curl-up and push-up tests, and motor skills with a 5-leaps test and a throwing-catching combination test. Structural equation modelling was applied to examine the longitudinal associations adjusting for age, gender, pubertal stage, body fat percentage, learning difficulties and mother's education. RESULTS The change in aerobic and muscular fitness were positively associated with the change in GPA (B=0.27, 99% confidence interval CI=0.06-0.48; B=0.36, CI=0.11-0.63, respectively), while the change in motor skills were not associated with the change in GPA. Better motor skills in year 2 predicted better GPA a year later (B=0.06, CI=0.00-0.11; B=0.06, CI=0.01-0.11), while aerobic and muscular fitness did not predict GPA. GPA in year 1 predicted both aerobic (B=0.08, CI=0.01-0.15) and muscular (B=0.08, CI=0.02-0.15) fitness, and motor skills (B=0.08, CI=0.02-0.15) a year later. CONCLUSION The changes in both aerobic and muscular fitness were positively associated with change in academic achievement during adolescence, while the change in motor skills had only borderline significant association. However, better motor skills, although not systematically, independently predicted better academic achievement one year later, while aerobic or muscular fitness did not. Better academic achievement predicted better motor skills, aerobic and muscular fitness. Developmental changes in adolescence may induce parallel and simultaneous changes in academic achievement and PF. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Corresponding author: Heidi J. Syväoja, LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland, Rautpohjankatu 8, FI-40700, Finland, tel. +358 (0)400248133, fax +358207629501, heidi.syvaoja@likes.fi This study was funded by the Academy of Finland (grant 273971) and the Finnish Ministry of Education and Culture (OKM/92/626/2013). The authors declare that there are no conflicts of interest. The results of the present study do not constitute endorsement by ACSM. The Authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication: 26 April 2019. © 2019 American College of Sports Medicine

Estimating Tibial Stress throughout the Duration of a Treadmill Run
Introduction Stress fractures of the tibia are a problematic injury amongst runners of all levels. Quantifying tibial stress using a modelling approach provides an alternative to invasive assessments that may be used to detect changes in tibial stress during running. This study aimed to assess the repeatability of a tibial stress model and to use this model to quantify changes in tibial stress that occur throughout the course of a 40-minute prolonged treadmill run. Methods Synchronised force and kinematic data were collected during prolonged treadmill running from fourteen recreational male rearfoot runners on two separate occasions. During each session, participants ran at their preferred speed for two consecutive 20-minute runs, separated by a 2-minute pause. The tibia was modelled as a hollow ellipse and bending moments and stresses at the distal 1/3 of the tibia were estimated using beam theory combined with inverse dynamics and musculoskeletal modelling. Results Intraclass correlation coefficients indicated good-to-excellent repeatability for peak stress values between sessions. Peak anterior and posterior stresses increased following 20 minutes of prolonged treadmill running and were 15% and 12% greater respectively after 40 minutes of running compared with the start of the run. Conclusion The hollow elliptical tibial model presented is a repeatable tool that can be utilised to assess within-participant changes in peak tibial stress during running. The increased stresses observed during a prolonged treadmill run may have implications for the development of tibial stress fracture. Corresponding author: Hannah Rice, PhD, Sport and Health Sciences, Richards Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK, H.Rice@exeter.ac.uk This research was supported by Brooks Running Company, Seattle, WA, USA. The authors declare no conflicts of interest. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 8 May 2019 © 2019 American College of Sports Medicine

Myocardial Adaptations to Competitive Swim Training
Purpose Swim training is performed in the prone or supine position and obligates water immersion, factors which may augment cardiac volume-loading more than other endurance sports. At present, prospective data defining the cardiac responses to swim training are lacking. We therefore studied myocardial adaptations among competitive swimmers in order to establish a causal relationship between swim training and left ventricular (LV) remodeling. Methods Collegiate swimmers were studied before and after a 90-day period of training intensification. Transthoracic echocardiography was used to examine LV structural and functional adaptations under resting conditions and during an acute LV afterload challenge generated by isometric handgrip testing (IHGT). A sedentary control population was identically studied with IHGT. Results In response to a discrete period of swim training intensification, athletes (n=17, 47% female, 19±0.4 years old) experienced eccentric LV remodeling, characterized by proportionally more chamber dilation than wall thickening, with attendant enhancements of resting LV systolic (LV twist) and diastolic (early and late phase tissue velocities) function. Compared to baseline and controls, athletes post training demonstrated greater systolic twist impairment during IHGT. However, training induced LV dilation coupled with gains in diastolic function offset this acquired systolic susceptibility to acute afterload resulting in relative preservation of stroke volume during IHGT. Conclusion Swim training, a sport characterized by unique cardiac loading conditions, stimulates eccentric LV remodeling with concomitant augmentation of systolic twist and diastolic relaxation. This volume mediated cardiac remodeling appears to result in greater systolic susceptibility to acute afterload challenge. Further work is required to establish how training-induced changes in function translate to human performance and whether these are accompanied by physiologic trade-offs with relevance to common forms of heart disease. Address for correspondence: Aaron Baggish, M.D. Cardiovascular Performance Program Massachusetts General Hospital 55 Fruit Street, Yawkey 5B Boston, MA, 02114 Email: abaggish@partners.org This study was funded in part by a research grant from the American Heart Association FTF2220328 (A.L.B.). The results of this study are presented clearly, honestly and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the ACSM. CONFLICTS OF INTEREST: The authors have no conflicts of interest to report. Accepted for publication: 22 April 2019. © 2019 American College of Sports Medicine



ALEXANDROS SFAKIANAKIS ANAPAFSEOS 5 AGIOS NIKOLAOS CRETE 72100 GREECE +306932607174 +302841026182

Allergy and Clinical Immunology

Common and different roles of IL-4 and IL-13 in skin allergy and clinical implications
Roesner, Lennart M.; Zeitvogel, Jana; Heratizadeh, Annice

Current Opinion in Allergy and Clinical Immunology: May 30, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/ACI.0000000000000553
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Purpose of review This review summarizes the mode of action of IL-4 and IL-13 in skin allergy, upcoming therapeutics and depicts key outcomes of the latest clinical trials.

Recent findings Atopic dermatitis is considered to be one of the most common inflammatory skin disease in industrialized countries. Accompanied by strong pruritus, atopic dermatitis has a significant impact on quality of life in severely affected individuals. Aside from unspecific immunosuppressant medications, therapeutics targeting the key cytokines IL-4 and IL-13 and their downstream mediators are under development or have been approved just recently with outstanding potential.

Summary The recent development of several biologics and small compounds has the potential to revolutionize the treatment of atopic dermatitis, and applying this set of state-of-the-art drugs will provide a unique chance to gain insights into this skin disorder, patient subgroups, and key inflammatory mediators.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.


ALEXANDROS SFAKIANAKIS ANAPAFSEOS 5 AGIOS NIKOLAOS CRETE 72100 GREECE +306932607174 +302841026182

Anesthesiology

Safety in the nonoperating room anesthesia suite is not an accident: lessons from the National Transportation Safety Board
Purpose of review To review the findings of National Transportation Safety Board-related airline near misses and catastrophes and apply these principles to the nonoperating room anesthesia (NORA) suite. Recent findings NORA is a specialty that has seen tremendous growth. In 2019, NORA contributes to a larger proportion of anesthesia practice than ever before. With this growth, the NORA anesthesiologist and team are challenged to provide safe, high-quality care for more patients, often with complex comorbidities, and are forced to utilize deeper levels of sedation and anesthesia than ever before. These added pressures create new avenues for human error and adverse outcomes. Summary Safety in modern anesthesia practice often draws comparison to the aviation industry. From distinct preoperational checklists, defined courses of action, safety monitoring and the process of guiding individuals through a journey, there are many similarities between the practice of anesthesia and flying an airplane. Consistent human performance is paramount to creating safe outcomes. Although human errors are inevitable in any complex process, the goal for both the pilot and physician is to ensure the safety of their passengers and patients, respectively. As the airline industry has had proven success at managing human error with a dramatic improvement in safety, a deeper look at several key examples will allow for comparisons of how to implement these strategies to improve NORA safety. Correspondence to Jason D. Walls, MD, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA. Tel: +1 215 662 3773; e-mail: jason.walls@uphs.upenn.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Transfusion in adults and children undergoing neurosurgery: the outcome evidence
Purpose of review Transfusion is a common practice during neurosurgery. However, there is no evidence-based consensus on transfusion practice in neurosurgery. This review summarizes the evidence pertinent to the commonly used transfusion triggers in neurosurgical patients. Recent findings In the field of neurosurgery, there is only one randomized controlled trial, performed in patients with traumatic brain injury, to investigate the transfusion trigger of red blood cells. There is a lack-of-quality evidence pertinent to the transfusion triggers of other blood products. Most of the transfusion triggers used for neurosurgical patients are extrapolated from the evidence based on studies performed in nonneurosurgical patients. Clinical experience and expert opinions have played a major role in transfusion practice in neurosurgery. Summary There is a scarcity of high-quality outcome-based evidence for transfusion practice in neurosurgery. In the absence of quality evidence, the transfusion practice in neurosurgical patients should be based on the understanding of the complex pathophysiology related to anemia and coagulopathy and the balance between the risks and benefits associated with blood product transfusion. The practice guided by tissue oximeter and viscoelastic tests appears promising, but needs to be validated by future studies. Correspondence to Tianlong Wang, MD, PhD, Department of Anesthesiology, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Beijing 100053, China. Tel: +86 139 1052 5304; e-mail: w_tl5595@hotmail.com Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Do you remember 'supply and demand'?
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Neurological complications after cardiac surgery: anesthetic considerations based on outcome evidence
Purpose of review Neurological complications after cardiac surgery remain prevalent. This review aims to discuss the modifiable and outcome-relevant risk factors based on an up-to-date literature review, with a focus on interventions that may improve outcomes. Recent findings There is a close relationship between intraoperative blood pressure and postoperative neurological outcomes in cardiac surgical patients based on cohort studies and randomized controlled trials. Adopting an optimal and personalized blood pressure target is essential; however, the outstanding issue is the determination of this target. Maintaining cerebral tissue oxygen saturation at least 90% patient's baseline during cardiac surgery may be beneficial; however, the outstanding issues are effective intervention protocols and quality outcome evidence. Maintaining hemoglobin at least 7.5 g/dl may be adequate for cardiac surgical patients; however, this evidence is based on the pooled results of thousands of patients. We still need to know the optimal hemoglobin level for an individual patient, which is of particular relevance during the decision-making of transfusion or not. Summary The available evidence highlights the importance of maintaining optimal and individualized blood pressure, cerebral tissue oxygen saturation and hemoglobin level in improving neurological outcomes after cardiac surgery. However, outstanding issues remain and need to be addressed via outcome-oriented further research. Correspondence to Wei Mei, MD, Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan 430030, China. Tel: +86 27 83662673; e-mail: wmei@hust.edu.cn Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Anesthesia and brain tumor surgery: technical considerations based on current research evidence
Purpose of review Anesthetics may influence cancer recurrence and metastasis following surgery by modulating the neuroendocrine stress response or by directly affecting cancer cell biology. This review summarizes the current evidence on whether commonly used anesthetics potentially affect postoperative outcomes following solid organ cancer surgery with particular focus on neurological malignancies. Recent findings Despite significant improvement in diagnostic and therapeutic technology over the past decades, mortality rates after cancer surgery (including brain tumor resection) remains high. With regards to brain tumors, interaction between microglia/macrophages and tumor cells by multiple biological factors play an important role in tumor progression and metastasis. Preclinical studies have demonstrated an association between anesthetics and brain tumor cell biology, and a potential effect on tumor progression and metastasis has been revealed. However, in the clinical setting, the current evidence is inadequate to draw firm conclusions on the optimal anesthetic technique for brain tumor surgery. Summary Further work at both the basic science and clinical level is urgently needed to evaluate the association between perioperative factors, including anesthetics/technique, and postoperative brain tumor outcomes. Correspondence to Daqing Ma, Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital 369 Fulham Road, London SW10 9NH, UK. Tel: +44 203315 8495; fax: +44 203315 5109; e-mail: d.ma@imperial.ac.uk Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Neuroanesthesia and outcomes: evidence, opinions, and speculations on clinically relevant topics
Purpose of review The objective of this review is to identify outstanding topics most relevant to neuroanesthesia practice and patient outcomes. We discuss the role of awake craniotomy, choice of general anesthetic agents, monitoring of anesthetic 'depth', mannitol-induced diuresis, neurophysiological monitoring, hyperventilation, and cerebral hypoperfusion. Recent findings Awake craniotomy, although a technique likely underused, is associated with enhanced recovery after surgery and prolonged survival after brain tumor resection compared with surgery under general anesthesia. The choice of general anesthetic must balance patient and surgical factors. Although propofol may be associated with favorable oncologic outcomes, currently available retrospective evidence does not specifically address neurosurgical patients. Both the definition and monitoring of anesthetic 'depth' remains elusive. Neuroanesthesiologists need to recognize and manage intraoperative light anesthesia in a timely fashion. Further evidence related to the optimal management of mannitol-induced diuresis and hyperventilation in neurosurgical patients is needed. Contemporary neurophysiological monitoring can reasonably detect intraoperative neurologic injury; however, its effect on patient outcome is unclear. Finally, cerebral hypoperfusion without stroke may be common; however, the clinical significance requires further investigation. Summary We provide an overview of several topics that are relevant to neuroanesthesia practice and patient outcomes based on evidence, opinions, and speculations. Our review highlights the need for further outcome-oriented studies to specifically address these clinically relevant issues. Correspondence to Lingzhong Meng, MD, Professor and Division Chief, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, PO Box 208051, New Haven, CT 06520, USA. Tel: +1 203 785 2802; e-mail: lingzhong.meng@yale.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Anaesthesia for stroke thrombectomy: technical considerations based on outcome evidence
Purpose of review Stroke is the second leading cause of death and the third leading cause of disability worldwide. Treatment is time limited and delays cost lives. This review discusses modern stroke management, during a time when treatments and guidelines are rapidly evolving. Recent findings Stroke thrombectomy has become the therapy of choice for large vessel occlusion (LVO) strokes. Perfusion imaging techniques, both computed tomography (CT) and MRI, now allow treatment beyond a set time window in specific patients. Both general anaesthesia and conscious sedation are options for patients undergoing stroke thrombectomy. Summary An individualized approach to the patient's anaesthetic management is optimal, and depends on close communication with the neurointerventionalist regarding patient and procedure-specific variables. No specific anaesthetic agent is preferred. Guiding principles are minimization of time delay, and maintenance of cerebral perfusion pressure. Correspondence to David L. McDonagh, MD, 5323 Harry Hines Blvd., Dallas, TX, USA. Tel: +1 214 648 6400; e-mail: David.mcdonagh@utsouthwestern.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Neurophysiological monitoring during neurosurgery: anesthetic considerations based on outcome evidence
Purpose of review This article reviews the recent outcome studies that investigated intraoperative neurophysiological monitoring (IONM) during spine, neurovascular and brain tumor surgery. Recent findings Several recent studies have focused on identifying which types of neurosurgical procedures might benefit most from IONM use. Despite conflicting literature regarding its efficacy in improving neurological outcomes, many experts have advocated for the use of IONM in neurosurgery. Several themes have emerged from the recent literature: the entire perioperative team must always work together to ensure adequate communication and intervention; systems and checklists, in which each member of the perioperative team has a clearly defined role, can be useful in the event of a sudden intraoperative changes in electrophysiological signals; regardless of the IONM modality used, any sudden change in electrophysiological signal should prompt an immediate and appropriate intervention; a multimodal IONM approach is often, but not always, advantageous over a single IONM approach. Summary For neurosurgical procedures that can be complicated by neural injury, the use of IONM should be considered according to specific patient and surgical factors. Future studies should focus on improving IONM technology and optimizing sensitivity and specificity for detecting any impending neural damage. Correspondence to Shaun E. Gruenbaum, MD, PhD, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA. Tel: +1 904 956 3398; e-mail: gruenbaum.shaun@mayo.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Awake craniotomy: anesthetic considerations based on outcome evidence
Purpose of review This review highlights anaesthesia management options for awake craniotomy and discusses the advantages and disadvantages of different approaches, intraoperative complications and future directions. Recent findings For lesions located within or adjacent to eloquent regions of the brain, awake craniotomy allows maximal tumour resection with minimal consequences on neurological function. Various techniques have been described to provide anaesthesia or sedation and analgesia during the initial craniotomy, and rapid return to consciousness for intraoperative testing and tumour resection; there is no evidence that one approach is superior to another. Although very safe, awake craniotomy is associated with some well recognized complications; most are minor and self-limiting or easily reversed. In experienced hands, failure of awake craniotomy occurs in fewer than 2% of cases, irrespective of anaesthesia technique. Although brain tumour surgery remains the most common indication for awake craniotomy, the technique is finding utility in other neurosurgical procedures. Summary Several anaesthetic approaches are available for the management of patients during awake craniotomy. The choice of technique should be based on individual patient factors, location and duration of surgery, and anaesthesiologist expertise and experience. Appropriate patient selection and excellent multidisciplinary team working is associated with high levels of procedural success and patient satisfaction. Correspondence to Martin Smith, MBBS, FRCA, FFICM, Department of Neuroanaesthesia and Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London WC1N 3BG, UK;. E-mail: martin.smith@ucl.ac.uk Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Anesthesia and airway management for gastrointestinal endoscopic procedures outside the operating room
Purpose of review To review the anesthestic and airway management for gastrointestinal procedures outside of the operating room. Recent findings The number of gastrointestinal endoscopic procedures performed is steadily increasing worldwide. As complexity, duration and invasiveness of procedures increase, there is ever greater requirement for deeper sedation or general anesthesia. A close relationship between anesthetic practitioners and endoscopists is required to ensure safe and successful outcomes. The American Society of Gastrointestinal endoscopy and the British Society of Gastroenterology have recently released guidelines for sedation and general anesthesia in gastrointestinal endoscopy, highlighting the need for careful monitoring for all cases, and anesthetic expertise in complex cases. The recent advances in high-flow nasal oxygenation in sedation may provide alternative options for oxygenation during gastrointestinal sedation, especially in deep sedation and this may reduce the need for general anesthesia. Summary The advances in gastrointestinal endoscopic intervention have increased the requirement for deep sedation and anesthetic involvement outside of the operating room. Careful titration of anesthetic intervention and close monitoring are required to ensure patient safety. Correspondence to Jaideep J. Pandit, St John's College, Oxford OX1 3JP, UK. Tel: +44 1865 221590; e-mail: jaideep.pandit@dpag.ox.ac.uk Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.



ALEXANDROS SFAKIANAKIS ANAPAFSEOS 5 AGIOS NIKOLAOS CRETE 72100 GREECE +306932607174 +302841026182

Otolaryngology & Head and Neck Surgery



ALEXANDROS SFAKIANAKIS 
The evolving roles of computer-based technology and smartphone applications in facial plastic surgery
Purpose of review This article aims to provide a comprehensive review of the established and emerging applications of various computer-based technologies and smartphone applications in the field of facial plastic surgery. Recent findings Computer-based technologies and smartphone applications have widespread utility across various domains of facial plastic surgery; these include preoperative consultation, surgical planning, intraoperative navigation, custom implant creation, postoperative assessment, physician productivity, communication, and education. Smartphone applications are being utilized for assessment of patients such as those with facial paralysis. Three-dimensional (3D) imaging and 3D printing has influenced preoperative counseling, surgical planning, and execution. The incorporation of intraoperative navigation has the potential to improve the accuracy and precision of facial reconstruction. Summary Current advances in computer-based technology have made a significant impact on the practice of facial plastic and reconstructive surgery. These technological advances have influenced how we counsel patients, perform procedures, assess outcomes, and learn new techniques. Correspondence to Kalpesh T. Vakharia, MD, Department of Otolaryngology – Head and Neck Surgery, University of Maryland School of Medicine, MD 21201, USA. Tel: +1 (667) 214 1772; e-mail: kvakharia@som.umaryland.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Current approaches to cleft lip revision
Purpose of review Cleft lip repair requires multidisciplinary follow-up throughout a child's life and often requires lip revision surgery in adolescence to restore function and symmetry of the lip. There is significant variability in the approaches taken for lip repair and therefore a review of current techniques and subsequent guidance to secondary cleft lip repair is warranted. Recent findings New methods of secondary reconstruction can be divided into superficial or muscle related. Recent suggestions for superficial reconstruction include botulinum toxin injection, silicone gel sheeting, local flap reconstruction, fat grafting, and CO2 laser ablation. Suggestions for muscular reconstruction include pedicled prolabial flaps, modified Abbe flap, and orbicularis oris eversion. Summary Secondary cleft lip deformities can be classified as superficial or muscle related. Superficial problems require relatively minor treatments such as laser, local scar revisions, small local flaps, mucosal excision, or fat grafting. Muscle deformities generally require total lip revision and rerepair as a first step to achieving longstanding improvements in lip esthetics and function. Cleft lip revision should only be considered in concert with the patient, be based on the patient's concerns and desires, and offered at the appropriate timeline to improve social integration and/or psychosocial wellbeing. Correspondence to Damir Matic, MD, MSc, FRCSC, Associate Professor, Plastic and Reconstructive Surgery, London Health Sciences Centre, Victoria Hospital Campus, Room E2-646, 800 Commissioners Rd E, London, ON, Canada. Tel.: +1 519 685 8557;. e-mail: Damir.matic@lhsc.on.ca Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

An update in facial gender confirming surgery
Purpose of review To summarize current surgical and nonsurgical approaches to facial gender confirming surgery (FGCS) and highlight standards of care and areas of future research. Recent findings Gender nonconforming individuals may encounter considerable internal coping and external social stressors that may contribute to gender-associated dysphoria. FGCS provides patients the ability to align facial appearance with gender identity, using recently described advances in surgical and nonsurgical techniques. The majority of FGCS is performed on transwomen (individuals identifying as female), yielding the more common term of facial feminization surgery (FFS). Although no set protocols or standards are in place, certain procedures are commonly performed to alter sex-determining characteristics of the face, and further research may help define guidelines. As many training programs have minimal exposure to FGCS, promotion of transgender health awareness is paramount for diverse and inclusive surgical training. Summary Although demand for FGCS is increasing, there remains a need for improving surgical approaches, developing evidence-based care guidelines, and implementing education and awareness in training programs. Correspondence to Rahul Seth, MD, University of California San Francisco, 2233 Post Street, 3rd Floor, San Francisco, CA 94115, USA. Tel.: +1 415 885 7494;. fax: +1 415 885 7785; e-mail: rahul.seth@ucsf.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Update on empty nose syndrome: disease mechanisms, diagnostic tools, and treatment strategies
Purpose of review To discuss the proposed pathophysiology of empty nose syndrome (ENS), summarize and evaluate the role of validated diagnostic tools in the diagnosis of ENS, and review the medical and surgical treatment strategies for patients with ENS. Recent findings Historically, ENS has been associated with a reduction in nasal turbinate size; new data suggest that impaired trigeminal nerve function may also play a role in the pathophysiology of the disease. The newly validated empty nose syndrome 6 item questionnaires and Cotton test are steps forward to standardize the diagnosis of ENS. Finally, there has been a marked increase in surgical treatment strategies to reconstitute turbinate volume with various implant materials. Summary The diagnosis of ENS remains controversial but the last several years have seen a rejuvenation of interest in this disease entity. The validated empty nose syndrome 6 item questionnaires and Cotton test provide a standardized and objective means by which to characterize ENS. Prevention of iatrogenic ENS through avoidance of excessive turbinate reduction remains critical in preventing paradoxical nasal obstruction. Nasal humidification, patient education, and treatment of possible concomitant medical conditions (e.g., depression) constitute first lines of treatment. We support the cautious use of these screening tools as adjuncts to clinical decision-making. Although injectable implants to augment turbinate volume show promise as a therapeutic surgical technique, there is insufficient data to fully support their use at this time. Correspondence to Toby O. Steele, MD, Department of Otolaryngology – Head and Neck Surgery, University of California Davis, Davis, CA 95616, USA. E-mail: tosteele@ucdavis.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Contemporary management of frontal sinus fractures
Purpose of review Frontal sinus fracture management is evolving. This article will highlight recent literature and provide an evidence-based algorithm in the contemporary management of frontal sinus fractures. Recent findings The role of transnasal endoscopic treatment of frontal sinus fractures has expanded to include fracture reduction and posterior table reconstruction. Evidence continues to support the safety of nonoperative management in select frontal sinus outflow tract fractures. Summary The management of frontal sinus fractures with frontal sinus outflow tract injury continues to evolve with a trend toward observation and minimally invasive approaches. Restoration of the frontal sinus outflow tracts with transnasal endoscopic techniques is being used increasingly in the acute and delayed setting. For severe fractures, the role of conservative treatment paradigms requires further research. Correspondence to E. Bradley Strong, MD, Department of Otolaryngology – Head and Neck Surgery, University of California Davis, 2521 Stockton Blvd., Suite 7200, Sacramento, CA 95817, USA. Tel: +1916 734 2801; fax: +1916 703 5011; e-mail: ebstrong@ucdavis.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Rib cartilage in Asian rhinoplasty: new trends
Purpose of review Costal cartilage has many advantages over other grafting materials because of its large quantity and high biocompatibility. As a result, it has been considered as a good option for Asian rhinoplasty. However, costal cartilage is difficult to use and is associated with a high complication rate. To avoid the disadvantages and complications of costal cartilage graft, several techniques have been proposed in the literature. This review addresses the conventional uses of costal cartilage in Asian rhinoplasty and recent updates. Recent findings Different techniques have been reported for Asian rhinoplasty using costal cartilage. Solid-block costal cartilage and diced cartilage with or without wrapping materials are widely used for dorsal augmentation. Many different grafting techniques for the tip and septal reconstruction have been reported by numerous surgeons. When using costal cartilage graft, surgeons should pay attention to both graft complications, such as warping or infection, and donor-site morbidity. Several strategies have recently been developed to avoid these complications. Summary This article summarises grafting options for Asian rhinoplasty using costal cartilage and possible complications. This information may assist with proper selection of appropriate techniques for harvesting, carving and grafting costal cartilage. Correspondence to Yong Ju Jang, MD, PhD, Professor, Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82 2 3010 3710; fax: +82 2 489 2773; e-mail: jangyj@amc.seoul.kr Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.


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