Neural Regeneration Research

Physiological effects of amyloid precursor protein and its derivatives on neural stem cell biology and signaling pathways involved Raquel Coronel, Charlotte Palmer, Adela Bernabeu-Zornoza, María Monteagudo, Andreea Rosca, Alberto Zambrano, Isabel Liste Neural Regeneration Research 2019 14(10):1661-1671 The pathological implication of amyloid precursor protein (APP) in Alzheimer’s disease has been widely documented due to its involvement in the generation of amyloid-β peptide. However, the physiological functions of APP are still poorly understood. APP is considered a multimodal protein due to its role in a wide variety of processes, both in the embryo and in the adult brain. Specifically, APP seems to play a key role in the proliferation, differentiation and maturation of neural stem cells. In addition, APP can be processed through two canonical processing pathways, generating different functionally active fragments: soluble APP-α, soluble APP-β, amyloid-β peptide and the APP intracellular C-terminal domain. These fragments also appear to modulate various functions in neural stem cells, including the processes of proliferation, neurogenesis, gliogenesis or cell death. However, the molecular mechanisms involved in these effects are still unclear. In this review, we summarize the physiological functions of APP and its main proteolytic derivatives in neural stem cells, as well as the possible signaling pathways that could be implicated in these effects. The knowledge of these functions and signaling pathways involved in the onset or during the development of Alzheimer’s disease is essential to advance the understanding of the pathogenesis of Alzheimer’s disease, and in the search for potential therapeutic targets.

Challenges in microRNAs' targetome prediction and validation Jesus Eduardo Rojo Arias, Volker Busskamp Neural Regeneration Research 2019 14(10):1672-1677 MicroRNAs (miRNAs) are small RNA molecules with important roles in post-transcriptional regulation of gene expression. In recent years, the predicted number of miRNAs has skyrocketed, largely as a consequence of high-throughput sequencing technologies becoming ubiquitous. This dramatic increase in miRNA candidates poses multiple challenges in terms of data deposition, curation, and validation. Although multiple databases containing miRNA annotations and targets have been developed, ensuring data quality by validating miRNA-target interactions requires the efforts of the research community. In order to generate databases containing biologically active miRNAs, it is imperative to overcome a multitude of hurdles, including restricted miRNA expression patterns, distinct miRNA biogenesis machineries, and divergent miRNA-mRNA interaction dynamics. In the present review, we discuss recent advances and limitations in miRNA prediction, identification, and validation. Lastly, we focus on the most enriched neuronal miRNA, miR-124, and its gene regulatory network in human neurons, which has been revealed using a combined computational and experimental approach.

Can we further optimize therapeutic hypothermia for hypoxic-ischemic encephalopathy? Anthony Davies, Guido Wassink, Laura Bennet, Alistair J Gunn, Joanne O Davidson Neural Regeneration Research 2019 14(10):1678-1683 Perinatal hypoxic-ischemic encephalopathy is a leading cause of neonatal death and disability. Therapeutic hypothermia significantly reduces death and major disability associated with hypoxic-ischemic encephalopathy; however, many infants still experience lifelong disabilities to movement, sensation and cognition. Clinical guidelines, based on strong clinical and preclinical evidence, recommend therapeutic hypothermia should be started within 6 hours of birth and continued for a period of 72 hours, with a target brain temperature of 33.5 ± 0.5°C for infants with moderate to severe hypoxic-ischemic encephalopathy. The clinical guidelines also recommend that infants be rewarmed at a rate of 0.5°C per hour, but this is not based on strong evidence. There are no randomized controlled trials investigating the optimal rate of rewarming after therapeutic hypothermia for infants with hypoxic-ischemic encephalopathy. Preclinical studies of rewarming are conflicting and results were confounded by treatment with sub-optimal durations of hypothermia. In this review, we evaluate the evidence for the optimal start time, duration and depth of hypothermia, and whether the rate of rewarming after treatment affects brain injury and neurological outcomes.

P2X7 receptor signaling during adult hippocampal neurogenesis Hannah C Leeson, Tailoi Chan-Ling, Michael D Lovelace, Jeremy C Brownlie, Ben J Gu, Michael W Weible Neural Regeneration Research 2019 14(10):1684-1694 Neurogenesis is a persistent and essential feature of the adult mammalian hippocampus. Granular neurons generated from resident pools of stem or progenitor cells provide a mechanism for the formation and consolidation of new memories. Regulation of hippocampal neurogenesis is complex and multifaceted, and numerous signaling pathways converge to modulate cell proliferation, apoptosis, and clearance of cellular debris, as well as synaptic integration of newborn immature neurons. The expression of functional P2X7 receptors in the central nervous system has attracted much interest and the regulatory role of this purinergic receptor during adult neurogenesis has only recently begun to be explored. P2X7 receptors are exceptionally versatile: in their canonical role they act as adenosine triphosphate-gated calcium channels and facilitate calcium-signaling cascades exerting control over the cell via calcium-encoded sensory proteins and transcription factor activation. P2X7 also mediates transmembrane pore formation to regulate cytokine release and facilitate extracellular communication, and when persistently stimulated by high extracellular adenosine triphosphate levels large P2X7 pores form, which induce apoptotic cell death through cytosolic ion dysregulation. Lastly, as a scavenger receptor P2X7 directly facilitates phagocytosis of the cellular debris that arises during neurogenesis, as well as during some disease states. Understanding how P2X7 receptors regulate the physiology of stem and progenitor cells in the adult hippocampus is an important step towards developing useful therapeutic models for regenerative medicine. This review considers the relevant aspects of adult hippocampal neurogenesis and explores how P2X7 receptor activity may influence the molecular physiology of the hippocampus, and neural stem and progenitor cells.

Gamma-aminobutyric acid (GABA) promotes recovery from spinal cord injury in lampreys: role of GABA receptors and perspective on the translation to mammals Daniel Romaus-Sanjurjo, María Celina Rodicio, Antón Barreiro-Iglesias Neural Regeneration Research 2019 14(10):1695-1696

Modulating neuronal plasticity with choline Eunice W. M. Chin, Eyleen L.K. Goh Neural Regeneration Research 2019 14(10):1697-1698

Human neural stem cell transplants to address multiple pathologies associated with traumatic brain injury Helene Clervius, Mirza Baig, Anil Mahavadi, Shyam Gajavelli Neural Regeneration Research 2019 14(10):1699-1700

Glutathione precursors shield the brain from trauma Lilia Koza, Daniel A Linseman Neural Regeneration Research 2019 14(10):1701-1702

Delayed peripheral treatment with neurotrophin-3 improves sensorimotor recovery after central nervous system injury Sotiris G Kakanos, Lawrence D.F. Moon Neural Regeneration Research 2019 14(10):1703-1704

Diterpenes and the crosstalk with the arachidonic acid pathways, relevance in neurodegeneration Juan M Zolezzi, Nibaldo C Inestrosa Neural Regeneration Research 2019 14(10):1705-1706

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

6948891480

alsfakia@gmail.com

Médecine & Droit

Contentieux des professionnels de santé avec les caisses d'assurance maladie Publication date: Available online 29 May 2019 Source: Médecine & Droit Author(s): François Taquet Résumé La présente étude porte sur l'actualité jurisprudentielle, émanant tant de la 2° civile de la Cour de cassation que des juridictions du fond, et s'étalant sur la période allant de septembre 2018 à mars 2019. Abstract This article examines current case law, emanating from the Cassation Court and the Courts of Appeal, and extending over the period from September 2018 to March 2019.

L'accès aux médicaments : quelles contributions des règles sur les brevets de l'Accord de partenariat transpacifique global et progressiste ? Publication date: Available online 22 April 2019 Source: Médecine & Droit Author(s): Ngoc Ha Nguyen Résumé La protection renforcée destinée aux brevets dans les accords de libre-échange nuirait à l'accès aux médicaments et poserait des difficultés pour les pays en développement au sujet de la protection de la santé publique. En ce qui concerne l'Accord de partenariat transpacifique global et progressiste, toutefois, après l'abandon des États-Unis, le régime juridique applicable aux brevets semble moins rigide et, dès lors, plus favorable à l'accès aux médicaments. Ceci résulte, d'une part, de certaines souplesses contenues dans cet accord même ; et, d'autre part, de la suspension des obligations matérielles et procédurales. Cet article vise donc à analyser ces deux aspects pour justifier les contributions de cet accord à l'accès aux médicaments. Abstract Enhanced protection for patents in free trade agreements would undermine access to medicines and show difficulties for developing countries with respect to public health issue. In the context of the Comprehensive and Progressive Trans-Pacific Partnership Agreement, however, after the withdrawal of the United States, the legal regime applicable to patents seems less rigid and, therefore, more favorable to access to medicines. This results, on the one hand, from certain flexibilities contained in this agreement itself; and on the other hand, the suspension of some material and procedural obligations. This article aims to analyze these two sides to justify the contribution of this agreement to ensure access to medicines.

Impact de la Loi no 2019-222 du 23 mars 2019 de programmation 2018–2022 et de réforme pour la justice sur l'office du médecin légiste Publication date: Available online 22 April 2019 Source: Médecine & Droit Author(s): Laurent Martrille, Antoine Perrin, Bruno Py Résumé La loi de programmation 2018–2022 et de réforme pour la justice risque d'impacter l'office du médecin légiste quant à la confection des scellés judiciaires et dans ses relations avec les officiers de police judiciaire. En effet, les nouvelles dispositions de l'article 60 du code de procédure pénale autorisent désormais les médecins requis à placer sous scellés les prélèvements effectués au cours d'une autopsie ou d'un examen médical. Il en résulte une nouvelle organisation du travail des médecins légistes que la réforme de 2010 n'avait pas intégrée. Par ailleurs, la présence des officiers de police judiciaire lors des autopsies devra probablement être repensée. Enfin, l'article 163 du code de procédure pénale n'a pas été modifié, donnant ainsi plus de compétences aux personnes qualifiées qu'aux experts désignés par un juge d'instruction. Abstract The new provisions of the article 60 of the French Code of Criminal Procedure now authorize the medical examiners to seal the samples taken during an autopsy or a medical examination. The result will be a new organization of the work of forensic doctors that the 2010s reform did not integrate. In addition, the presence of judicial police officers during the autopsies will probably have to be rethought. Moreover, the article 163 of the same code has not been amended, giving more competence to qualified persons than to experts appointed by an investigating judge.

Le risque médico-judiciaire des infections nosocomiales Publication date: Available online 8 April 2019 Source: Médecine & Droit Author(s): Bertrand Gachot, Pierre Coriat Résumé Au cours de ces dernières années, le terme d'infection nosocomiale a laissé la place à celui, plus large, d'infection associée aux soins, la plausibilité de l'association entre l'infection et les soins prodigués devant dans tous les cas faire l'objet d'une analyse rigoureuse. En expertise, pour qu'une infection associée aux soins soit à la demande du magistrat qualifiée de nosocomiale, il faudra qu'elle ait bien été contractée dans un établissement de santé et soit en lien avec un acte ou l'environnement de soins. Le Code de Santé Publique tout comme la jurisprudence la plus récente, judiciaire et administrative, donnent désormais une définition proche de l'infection nosocomiale. Le principe de la responsabilité sans faute des établissements de santé en matière d'infection nosocomiale a été consacré par la loi du 4 mars 2002, les cas les plus graves (décès ; déficit fonctionnel permanent > 25 %) étant indemnisés par l'ONIAM. Abstract These last years in France, the term 'nosocomial infection' has been replaced by 'health-care associated infection', which has a much broader definition. In all cases, the plausibility of the association between infection and the care provided deserved to be rigorously analyzed. To qualify an infection as nosocomial, the expert witness must at the judge's request determine that infection actually occurred within the health facility and is linked to health care. French Public Health Code as well the most recent jurisprudence give currently a rather close definition of nosocomial infection. The principle of faultness liability in the field of nosocomial infection has been enshrined in the law of March 4th 2002, the most severe situations (death; permanent functional deficit > 25 percent) being compensated by ONIAM, the French national office of compensation for nosocomial infection.

Fin de vie… encore et toujours Publication date: April 2019 Source: Médecine & Droit, Volume 2019, Issue 155 Author(s): Aline Cheynet de Beaupré Résumé La fin de vie n'est pas la question au cœur des états généraux de révision des lois de bioéthique françaises – et n'a pas à l'être- mais l'étude réalisée par le Conseil d'État en juin 2018 se présente comme un modèle du genre qui gagnerait à devenir le rapport de référence sur la question de la fin de vie lorsqu'il s'agira, un jour peut-être, de la réviser. Abstract End of life is not the question at the heart of the Estates General purporting to the revision of the French bioethics laws - and it does not have to be - however, the study carried out by the Council of State in June 2018 presents itself as a model of its kind, that should be entitled to become the reference report on the end of life issue, when the time will come, one day perhaps, to revise it.

L'enseignement en milieu hospitalier universitaire et les enjeux juridiques de la supervision de médecin-résidents Publication date: April 2019 Source: Médecine & Droit, Volume 2019, Issue 155 Author(s): Gabrielle Trépanier Résumé Dans nos hôpitaux universitaires québécois, les médecins résidents travaillent quotidiennement auprès des patients sous la responsabilité d'un médecin superviseur. Lorsqu'une procédure judiciaire est intentée contre un résident, l'examen des rôles et responsabilités du résident, du médecin responsable et de l'établissement hospitalier est fait. Cela soulève des enjeux juridiques complexes. D'abord, le médecin-responsable doit avoir rempli son obligation d'enseignement et avoir respecté les critères de délégation d'actes médicaux. Ainsi le médecin-responsable ne peut déléguer à son résident que des actes médicaux de complexité appropriée à un résident qualifié et adéquatement supervisé. Lorsque le résident commet une faute, une analyse approfondie du contexte de soin (actes médicaux versus non médicaux, suivi postopératoire, couverture de la garde, etc.) est nécessaire afin de déterminer si le résident était le préposé du médecin-responsable ou de l'hôpital. Il incombera alors à l'assureur du médecin ou de l'hôpital de réparer le préjudice subi par le patient. Enfin, dans certaines situations, le résident peut engager sa propre responsabilité déontologique. Abstract In our Quebec teaching hospitals, resident physicians work daily with patients under the supervision of a staff-physician. When a legal procedure is initiated against a resident, the review of the roles and responsibilities of the resident, the physician and the hospital is done. This raises complex legal issues. First, the staff-physician must have fulfilled his teaching obligation and met the criteria for delegation of medical acts. Thus the physician may only delegate to his resident medical procedures of appropriate complexity to a qualified and properly supervised resident. When the resident commits a fault, an in-depth analysis of the care context (medical versus non-medical procedures, postoperative follow-up, daycare coverage, etc.) is required to determine whether the resident was the physician's or the hospital's assistant. It will then be up to the insurer of the doctor or hospital to repair the injury suffered by the patient. Finally, in some situations, the resident may engage his or her own ethical responsibility.

Editorial Board Publication date: April 2019 Source: Médecine & Droit, Volume 2019, Issue 155 Author(s):

Les médecins devaient-ils dénoncer le pilote suicidaire de la Germanwings ? Publication date: April 2019 Source: Médecine & Droit, Volume 2019, Issue 155 Author(s): Pierre Loiseau, Cécile Manaouil Résumé Le pilote suicidaire de la Germanwings qui a entraîné la mort de 149 personnes le 24 mars 2015, aurait-il dû être signalé par ses médecins ? Si le Droit romano-germanique ne peut souscrire à cette idée, la Common Law s'en accommoderait aisément. D'un point de vue anglo-saxon, l'intransigeance du secret médical continental serait même à l'origine de la catastrophe… Une opposition en apparence frontale, que le Droit comparé permet de nuancer : si le secret s'inscrit dans une logique individuelle, l'altruisme s'inscrit dans une logique collective. Abstract Should the suicidal pilot of the Germanwings be denounced by his doctors? If Romano-Germanic Law cannot subscribe to this idea, the Common Law would easily live with it. From an Anglo-Saxon point of view, the intransigence of the continental medical secret would even be at the origin of the catastrophe… Apparently, a head-on opposition, which the Comparative Law allows to qualify: if the secret is part of an individual logic, altruism is part of a collective one.

Rapport de la mission parlementaire sur la bioéthique : vers la procréation sans sexe pour tous Publication date: Available online 27 March 2019 Source: Médecine & Droit Author(s): Aude Mirkovic Résumé Le rapport parlementaire propose la « procréation sans sexe pour tous », laquelle passe par l'assistance médicale à la procréation pour les couples de femmes et les femmes seules, la procréation post mortem et le double don de gamètes. Abstract The parliamentary report proposes "non-sexual procreation for all", which goes through medically assisted procreation for couples of women and single women, post-mortem procreation and dual gamete donation.

Le consentement du patient aux actes de secours lors d'interventions extrahospitalières Publication date: Available online 26 March 2019 Source: Médecine & Droit Author(s): Bertrand Quaglierini, Nicolas Genotelle Résumé Le recueil du consentement de la personne aux soins qui lui sont proposés est un principe quasi-absolu. Ce recueil s'impose également aux secouristes intervenant comme primo-intervenants en amont de la chaîne de santé stricto sensu ; d'autant plus que, du fait de la régulation médicale par le SAMU, cette intervention s'assimile à un acte de soins. Le principe du consentement aux soins s'impose donc à la fois dans un but d'humanisme et dans celui de prévenir tout éventuel contentieux. Pour autant, il existe de nombreuses situations où la gestion du consentement de la personne secourue pourra poser des difficultés pour les secours non médicalisés. Il convient alors d'analyser comment les systèmes de secours peuvent gérer et limiter le risque face aux différentes situations de refus de prise en charge, afin de respecter la dignité des personnes, mais ne pas non plus commettre un abandon de soins. Un travail de concert entre secouristes et médecin régulateur est alors indispensable, surtout à défaut de consentement. Il permettra de déceler les hypothèses où la lucidité est altérée et de mettre en œuvre proportionnellement les mesures utiles. Il permettra également de délivrer une information efficace au patient, corollaire de la question du consentement, et de sensibiliser ce dernier sur les conséquences de sa décision, en veillant qu'elle ait été exprimée en parfaite connaissance de cause. Il semblerait alors utile que les référentiels et recommandations portant sur le secours d'urgence à personne, émanant de la Direction générale de la sécurité civile et gestion de crise, détaillent plus ces situations difficiles afin que les secouristes puissent les anticiper plus efficacement. Enfin, nous proposons un formalisme qui pourrait être envisagé et mis en place dans les cas de refus de prise en charge chez une personne lucide, et nous présentons les intérêts d'une telle mise en place. Abstract The acquirement of a person's consent to the medical care that is proposed to a patient is an absolute basic principle in rescue health care. This is mandatory for first arrival rescuers ; especially since their actions are, in view of the French Emergency Medical Service call centers, considered as being a medical act. The basic principle of consent to first medical care hence imposes itself as a humanitarian act as well as preventing any potential litigation. Nevertheless there are numerous situations where the management of the consent of the person in need of non-medical assistance will present difficulties. It is the necessary to analyze how the rescue health care system can manage and limit the risks s linked to the different situations when treatment is refused by the person in need of such help ; and this so as to respect the individual's dignity whilst not abandoning the needed health care. A collaboration between rescue personnel and the call center coordinating medical doctor is then mandatory especially when no consent is obtained. This will enable the detection of hypotheses where the individual's lucidity is altered and implement proportionately required and helpful measures. It will also equally enable the transmission of efficient information to the patient, in relation to the matter of patient consent and to ensure that the patient is aware of the consequence of his or her decision and that this decision was fully expressed. It would hence be deemed useful that the referenced work frame and recommendations, pertaining to the emergency rescue of a person, established by the General Management of Public Safety and Crisis Management detail more in detail these difficult and delicate situations so as to ensure that rescue personnel can better anticipate them. To conclude were commend a formalization of procedures that could be implemented in situations where a patient that has full mental capacities refuses the proposed health care, and we give the advantages of such a procedure be discussed.

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

6948891480

alsfakia@gmail.com

Atmospheric Environment

The impact of wildfires on particulate carbon in the western U.S.A Publication date: 15 September 2019 Source: Atmospheric Environment, Volume 213 Author(s): Weeberb J. Requia, Brent A. Coull, Petros Koutrakis Abstract Most of the previous investigations on the relationship between PM2.5 chemical characteristics and wildfire focused on the predictions of particle components concentrations or future pollution scenarios. Little research has focused on trends analyses based on large temporal datasets. Our research addresses this gap by quantifying the long-term impacts of wildfires on ambient particulate carbon levels (organic carbon - OC and elemental carbon - EC) in the western U.S. over a long of 29 years (1988–2016). We quantified the past wildfire-related increases in EC and OC concentration using Generalized Additive Models (GAMs). We used a framework that derives "penalties" (wildfire penalty, in μg/m3 per year) for each season (warm and cold) by accounting for the differences of the β values between two models – adjusted (wildfire included as covariate in the model) and unadjusted model (wildfire is removed from the model). While the wildfire impact is incorporated into the unadjusted trends, the control by wildfire in the adjusted model removes the impact of inter-annual wildfire variation on EC and OC trends. Therefore, we considered that any differences between the unadjusted and wildfire-adjusted trends are entirely attributable to the impact of long-term wildfire changes. A positive penalty (βunadjusted> βadjusted) suggests that an increase in EC and OC is associated with long-term wildfire changes between 1988 and 2016. Wildfires increased in the warm season and decreased in the cold season. We estimated an annual increase of 20.106 km2 of area burned (95% CI: 20.103; 20.109) in the warm period. EC and OC concentrations increased during the warm and cold season. EC and OC concentrations had an annual decrease of 0.03 μg/m3 (95% CI: −0.14; 0.08) and 0.10 μg/m3 (95% CI: −0.21; 0.01), respectively. In the cold period, our analyses showed an increase of 0.05 μg/m3 (95% CI: −0.07; 0.17) and 0.07 μg/m3 (95% CI: −0.04; 0.19) per year for EC and OC, respectively. In the warm season, during the study period (1988–2016), the estimated total concentration change (total penalty) for EC was 0.003 μg/m3 (95%CI: 0.001 and 0.005) and for OC was 0.015 μg/m3 (95%CI: 0.008 and 0.022). In the cold season the penalties were statistically insignificant.

Observation-based estimates of the mass absorption cross-section of black and brown carbon and their contribution to aerosol light absorption in East Asia Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): Chaeyoon Cho, Sang-Woo Kim, Meehye Lee, Saehee Lim, Wenzheng Fang, Örjan Gustafsson, August Andersson, Rokjin J. Park, Patrick J. Sheridan Abstract In this study, we estimated the contribution of black carbon (BC) and brown carbon (BrC) to aerosol light absorption from surface in-situ and aerosol robotic network (AERONET) columnar observations. The mass absorption cross-section (MAC) of BC (MACBC) was estimated to be 6.4 ± 1.5 m2 g−1 at 565 nm from in-situ aerosol measurements at Gosan Climate Observatory (GCO), Korea, in January 2014, which was lower than those observed in polluted urban areas. A BrC MAC of 0.62 ± 0.06 m2 g−1 (565 nm) in our estimate is approximately ten times lower than MACBC at 565 nm. The contribution of BC and BrC to the carbonaceous aerosol absorption coefficient at 565 nm from the in-situ measurements was estimated at 88.1 ± 7.4% and 11.9 ± 7.4%, respectively at GCO. Similarly, the contribution of BC and BrC to the absorption aerosol optical depth (AAOD) for carbonaceous aerosol (CA), constrained by AERONET observations at 14 sites over East Asia by using different spectral dependences of the absorption (i.e., absorption Ångström exponent) of BC and BrC, was 84.9 ± 2.8% and 15.1 ± 2.8% at 565 nm, respectively. The contribution of BC to CA AAOD was greater in urban sites than in the background areas, whereas the contribution of BrC to CA AAOD was higher in background sites. The overall contribution of BC to CA AAOD decreased by 73%–87% at 365 nm, and increased to 93%–97% at 860 nm. The contribution of BrC to CA AAOD decreased significantly with increasing wavelength from approximately 17% at 365 nm to 4% at 860 nm.

Extreme levels and chemistry of PM from the consumer fireworks in the Netherlands Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): Harry ten Brink, René Otjes, Ernie Weijers Abstract Mass concentrations of Particulate Matter (PM) in New-Year's nights can be high in the Netherlands because of the unconstrained use of consumer fireworks. In the study presented here the chemical compounds of the PM were determined. It is for the first time that this information was used to deduced the average composition of the explosive mixture/black powder. Measurements were made during the turn of the year 2007–2008 at an urban background location, when hourly PM10 mass concentrations exceeded 2000 μg m−3 at street sites. These extreme levels were due to the stagnant weather conditions occurring that night. The on-line artefact-free "MARGA" was deployed for assessment of the major compounds. These were found to be the (hygroscopic) salts KCl, MgSO4 and K2SO4. The mass ratio of sulphur and potassium showed that a standard black powder mix is used as explosive. The potassium was for 65% present as KCl. This is the reduction product of the oxidiser KClO4, which is hence the main oxidiser. The rest of the potassium was present in the form of K2SO4. We proved that this compound derives from the "standard" oxidiser KNO3 of black powder. The formation of the SO42--salts is explained as follows. The sulphur in the black powder oxidises to H2SO4. This compound reacts with the reduction product of the KNO3 to K2SO4. MgSO4 forms in a reaction of the main colouring agent magnesium with the H2SO4. The full composition of the PM, including carbonaceous material and trace metals, was obtained from an analysis of 24-hr filter samples. This showed that the mentioned salts comprised about half of the mass, while almost all of the remainder is "carbon" deriving from the incomplete combustion of the cardboard wrapping. About 85% of the PM10 is in the more harmful PM2.5.

Ozone dose-response relationships for soil microbial dynamics of winter wheat in North China Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): Enzhu Hu, Ruinan Dong, Xiangli Nan, Zaijian Yuan, Hongxing Zhang, Xiaoke Wang, Weiwei Zhang Abstract Dynamic responses of soil microbial properties of winter wheat (Triticum aestivum L.) to elevated ozone concentration have never been quantified. In this study, the winter wheat was cultivated under two contrasting ozone treatments: non-filtered ambient air (hereinafter called NF) and elevated ozone (effective increase in 9-h mean ozone concentration of 34.91 ± 1.42 nL·L−1 (mean ± SE) above ambient, hereinafter called EO3). Linear regressions between the response ratio of each variable (i.e. EO3/NF) and the increments of exposure- or flux-based ozone indices (i.e. EO3 - NF) were conducted. The results showed that the response ratios of soil microbial biomass C and N, as well as cumulative CO2 and N2O effluxes significantly correlated with the increments of ozone indices. The ΔPOD0 (increment of integrated phytotoxic ozone dose with no threshold) and the ΔAOT40 (increment of accumulated hourly O3 concentrations over a threshold of 40 nL·L−1) performed better than ΔSUM06, ΔW126 and the increments of other flux-based ozone indices. They showed stronger linear relationships with soil microbial biomass than that with gas effluxes. The expanded deviations from the effect-free line indicated distinct cumulative detrimental ozone impacts on soil microbial properties. Ammonia nitrogen content and nitrite reductase activity showed non-significantly adaptive and self-adjustment responses to accumulative ozone stress. The ozone dose-response relationships obtained here will benefit the ecological modeling that evaluates the dynamic responses or predicts the feedback effects of sustainable agro-ecosystems under global climate change.

Activity size distribution of radioactive nuclide 7Be at different locations and under different meteorological conditions Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): A. Ioannidou, K. Eleftheriadis, M. Gini, L. Gini, S. Manenti, F. Groppi Abstract The activity size distributions of the natural radionuclide tracer 7Be in different size fractions (<0.4 μm, 0.4–0.7 μm, 0.7–1.1 μm, 1.1–2.1 μm, 2.1–3.1 μm, 3.1–4.2 μm, 4.2–5.8 μm, 5.8–9.0 μm > 9.0 μm) were determined at four different site places in Northern Italy during the four seasons of the year 2011. One cascade impactor operated at the LASA-station considered the reference station and the other used for simultaneous measurements at the three other sites. Three sets of independent samples were collected during every season of the year 2011. The initial activity distribution inverted into smooth size distribution. The model parameters successfully defined to obtain the best fit-curve and two or three modes were resolved, with the predominant fit at the accumulation range. The lowest Activity Median Aerodynamic Diameter (AMAD) values were observed during summer. The AMAD values were anticorrelated with 7Be activities, while they were correlated with Relative Humidity. Similar AMAD values in suburban and urban regions were observed during all periods of the year. AMAD values of 7Be aerosol particles in areas with poor air quality were greater than those at the less polluted environments far from anthropogenic activities regions. This indicates that 7Be AMAD values could be used as an index of air quality conditions in areas like the Po Valley.

Heterogeneous photochemistry of dicarboxylic acids on mineral dust Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): Milena Ponczek, Nathalie Hayeck, Corinne Emmelin, Christian George Abstract Dicarboxylic acids have low volatilities and hence are present mostly in the particulate phase, including the surface of dust particles. Mineral dust, globally the most emitted aerosol, has photocatalytic properties that can initiate photo-induced heterogeneous chemistry of organic compounds, which is still poorly characterized. We investigated the photochemistry of five dicarboxylic acids (DCA) i.e., succinic (butanedioic) acid, glutaric (pentanedioic) acid, adipic (hexanedioic) acid, pimelic (heptanedioic) acid and suberic (octanedioic) acid on Arizona test dust (ATD) particles upon UV-A light irradiation (0–1.4 mW cm−2). Gas-phase products were monitored by a high-resolution proton-transfer-reaction mass spectrometer (PTR-ToF-MS), and surface sorbed products were extracted and analyzed by ultra-high-performance liquid chromatography coupled to a heated electrospray ionization high-resolution mass spectrometer (UHPLC-HESI-HRMS). Monoacids and aldehydes were the main observed and quantified gaseous products. In contrast, shorter chain DCA and highly oxygenated products were found at the surface of the dust particles. Interestingly, the photochemistry of these DCAs presented an even-odd alternation concerning their heterogeneous reactivity, with odd-numbered carbon diacids being more reactive than their even-numbered homologous ones. We present and discuss a reaction mechanism for the C4–C8 DCA heterogeneous photooxidation catalysed by TiO2/Fe2O3-rich dust particles. Our results suggest that photochemical processing on dust surfaces should be regarded as a possible efficient pathway for altering their surface properties impacting ice nucleation and cloud condensation properties.

Source apportionment of carbonaceous aerosols in the vicinity of a Mediterranean industrial harbor: A coupled approach based on radiocarbon and molecular tracers Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): Lise Bonvalot, Thibaut Tuna, Yoann Fagault, Alexandre Sylvestre, BouAlem Mesbah, Henri Wortham, Jean-Luc Jaffrezo, Nicolas Marchand, Edouard Bard Abstract Located in the Mediterranean Basin and close to Marseille (France), Fos-sur-Mer is situated in the vicinity of industrial harbor and agricultural lands. Its location makes it prone to mixed pollution contributions, combining the influence of residential, industrial, agricultural, maritime road and traffic sources. For this study, the origins of carbonaceous particles sampled over several months are investigated by a coupled approach based on analyses of radiocarbon (14C), elemental to total carbon ratio (EC/TC) and various molecular tracers (levoglucosan, methoxyphenols, malic and glyceric acids), giving information about their background origins. Accelerator mass spectrometry with a gas ion source give the opportunity to quantify the fossil and non-fossil fractions for each individual sample, avoiding to pool them. Analyzing 14C in micro-samples (down to a few μg of carbon) complements the approach based on chemical tracers, which are useful to identify sources, but insufficient to quantify accurately the modern and fossil carbon fractions. The measurements in about 30 samples collected during summer and fall/winter 2013, allow the detection of a strong seasonality of the pollution: the fall/winter PM2.5 fraction concentration equals to three times the summer concentration and we observe a significant fluctuation of the relative contributions of fossil and non-fossil fractions (fNF is ≈ 0.83 for fall/winter samples and ≈0.59 for summer samples). Significant correlations between 14C, levoglucosan and different methoxyphenols, allow the identification and quantification of a major influence of biomass burning emissions during fall and winter. Biomass burning organic carbon (OCBB) and elemental carbon (ECBB) contribute to 45% and 8% of the TC, respectively, whereas their total contribution is only 3% in summer samples. Biogenic emissions from the vegetation are the main sources of carbon during summer (≈57%). Significant correlations between summer OCbio and malic acid and DL glyceric acid suggest a secondary origin for this fraction. The total fossil carbon concentration (ECF and OCF) from vehicular, shipping and industrial sources is constant throughout the year, which is compatible with intense road and maritime traffics and industrial activity during both seasons. Overall, our study based on 14C and molecular tracers illustrates the power of a coupled approach in order to both identify and quantify biomass burning, biogenic, traffic and industrial sources of carbonaceous aerosols, forming a complex mix of background PM origins in a typical industrious harbor of the Mediterranean region.

The Ruthenium-106 plume over Europe in 2017: a source-receptor model to estimate the source region Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): Niccolò Maffezzoli, Giovanni Baccolo, Elena Di Stefano, Massimiliano Clemenza Abstract Between the end of September and the beginning of October 2017, low but detectable air concentrations of Ruthenium-106 (R106u) were measured throughout the European atmosphere. To date, the source has not been clearly identified. This study aims at constraining the location of the most likely emission source, by combining HYSPLIT back trajectories and a multi-site source-receptor model. The model follows a concentration weighted trajectory (CWT) approach, based on a R106u measurement dataset gathered by the International Atomic Energy Agency (IAEA) shortly after the event and shared by the French Institut de Radioprotection et de Sûreté Nucléaire (IRSN). The back trajectories are computed using Global Data Assimilation System (GDAS) and ERA-Interim meteorological data, with horizontal resolution from 1.5° to 0.5°. The effect of the starting altitude was also investigated. The source-receptor model results show that the most likely emission source region extends from Ukraine to the West to the Russian Volga and Ural regions to the East, in accordance with two previous studies. The analyses also show that the identified source region is relatively insensitive to the type of meteorological data, their horizontal resolution and values of starting altitude. The model precision is found to increase with increasing number of receptors. The method is fully open-source, requires low computational resources and is therefore suited to estimate the source origin of radioactive pollutants on a real time basis, providing an additional tool to more sophisticated atmospheric models.

Magnetic characteristics of atmospheric dustfall in a subtropical monsoon climate zone of China and its environmental implications: A case study of Nanjing Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): Longsheng Wang, Shouyun Hu, Mingming Ma, Yingjun Zhang, Xiaohui Wang, Qing Wang, Zhenhua Zhang, Buli Cui, Xianbin Liu Abstract Nanjing is located in the subtropical monsoon climate zone of China. In this study, a series of monthly collections of atmospheric dustfall was performed in different directions from a high-rise building in Nanjing from February 2015 to March 2016. A series of magnetic parameters including χ, χfd%, χARM, SIRM, magnetic hysteresis loops, high-temperature κ-T curves and SEM images was measured from atmospheric dustfall samples. The research shows that the type and size of magnetic minerals within atmospheric dustfall samples in Nanjing are similar to those found in northern cities in China, but the atmospheric dustfall samples in Nanjing have higher magnetic mineral concentrations. Coarse-grained magnetite dominated magnetic minerals. The peak concentrations of magnetic minerals contained from atmospheric dustfall of Nanjing occurred in summer. The relationship between magnetic parameters and meteorological data shows that the high values are mainly influenced by precipitation rather than by wind direction. Combined with results of the SEM images and the weak relationship between magnetic parameters and the data of PM 2.5 and PM10, all these indicate that the atmospheric dustfall of Nanjing is mainly from near-source polluted dustfall rather than from long-distance dustfall. This research suggests that environmental magnetism as a simple, economic and nondestructive technology, will be a useful tool in atmospheric dustfall research.

Precipitation chemistry and deposition at a high-elevation site in the Pacific Northwest United States (1989–2015) Publication date: 1 September 2019 Source: Atmospheric Environment, Volume 212 Author(s): Anne M. Johansen, Clint Duncan, Ashleen Reddy, Naomi Swain, Mari Sorey, Annika Nieber, James Agren, Matt Lenington, David Bolstad, Barbara Samora, Rebecca Lofgren Abstract Emissions from fuel combustion and agricultural activities contribute significantly to the continuous atmospheric entrainment of pollutants into protected and vulnerable ecosystems where long-term monitoring is often a challenge. Here, results are presented from a 26-year study (1989–2015) of wet precipitation collected at Paradise Station (1654 m above sea level), Mount Rainier National Park, Washington, USA. Weekly samples were analyzed for pH, conductivity and major anions and cations. While precipitation concentrations for sulfate, nitrate, protons and conductivity peaked in the early 2000s, overall trends decreased by 54%, 46%, 41%, and 37%, respectively. Associated pH values increased from 5.2 to 5.6, and were largely controlled by non-sea-salt contributions of sulfate and neutralizing calcium, potassium and magnesium. Between 1999 and 2015, nitrogen (N) deposition rates from ammonium increased by a factor of 3.6, from 0.27 to 0.96 kg N ha−1 yr−1 (p = 0.02), while nitrate deposition did not change statistically (0.91–0.74 kg N ha−1 yr−1, p = 0.30). Combined, these N sources are reaching reported critical loads of 2.0 kg N ha−1 yr−1. Results indicate that emission regulations focused on stationary sources have effectively decreased apparent acid precipitation, however, increased nitrogen deposition from ammonium may lead to further fertilization and acidification of delicate soils and waters. Continued long-term monitoring is thus imperative to track continued anthropogenic inputs to vulnerable ecosystems.

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

6948891480

alsfakia@gmail.com

Sports & Exercise

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

The Physiological Roles of Carnosine and β-Alanine in Exercising Human Skeletal Muscle Carnosine (β-alanyl-L-histidine) plays an important role in exercise performance and skeletal muscle homeostasis. Dietary supplementation with the rate-limiting precursor β-alanine leads to an increase in skeletal muscle carnosine content, which further potentiates its effects. There is significant interest in carnosine and β-alanine across athletic and clinical populations. Traditionally, attention has been given to performance outcomes with less focus on the underlying mechanism(s). Putative physiological roles in human skeletal muscle include acting as an intracellular pH buffer, modulating energy metabolism, regulating Ca2+ handling and myofilament sensitivity, and scavenging of reactive species. Emerging evidence shows that carnosine could also act as a cytoplasmic Ca2+–H+ exchanger and form stable conjugates with exercise-induced reactive aldehydes. The enigmatic nature of carnosine means there is still much to learn regarding its actions and applications in exercise, health and disease. In this review, we examine the research relating to each physiological role attributed to carnosine, and its precursor β-alanine, in exercising human skeletal muscle. Corresponding Author: Prof. Craig Sale, Nottingham Trent University, Erasmus Darwin Building, Clifton Lane, Nottingham, United Kingdom, NG11 8NS. Tel: 0115 8483505, craig.sale@ntu.ac.uk No funding was received for writing this manuscript. GGA has been supported financially by Fundação de Amparo à Pesquisa do Estado de São Paulo (FASESP; grant number: 2014/11948-8). MDT has received a British Council award to support a studentship focused on research into carnosine (grant number: 209524711). JJM, GGA, and MDT collectively declare that they have no competing interests. CS has received β-alanine supplements free of charge from Natural Alternatives International (NAI) for use in experimental investigations; NAI have also supported open access page charges for some manuscripts. The review is presented honestly, and without fabrication, falsification, or inappropriate data manipulation. The viewpoints expressed in the review do not constitute endorsement by the American College of Sports Medicine. Accepted for Publication: 29 April 2019 © 2019 American College of Sports Medicine

Effects of Instrument-assisted Soft Tissue Mobilization on Musculoskeletal Properties Purpose Instrument-assisted soft tissue mobilization (IASTM) has been reported to improve joint range of motion (flexibility). However, it is not clear whether this change in the joint range of motion is accompanied by any alterations in the mechanical and/or neural properties. This study aimed to investigate the effects of IASTM in plantar flexors and Achilles tendon on the mechanical and neural properties of them. Methods This randomized, controlled, crossover study included 14 healthy volunteers (11 men and 3 women, 21–32 y). IASTM was performed on the skin over the posterior part of the lower leg for 5 min and targeted the soft tissues (gastrocnemii, soleus, and tibialis posterior muscles; overlying deep fascia; and Achilles tendon). As a control condition, the same participants rested for 5 min between pre and post measurements without IASTM on a separate day. The maximal ankle joint dorsiflexion angle (dorsiflexion range of motion), peak passive torque (stretch tolerance), and ankle joint stiffness (slope of the relationship between passive torque and ankle joint angle) during measurement of dorsiflexion range of motion and muscle stiffness of the triceps surae (using shear wave elastography) were measured before and immediately after the interventions. Results Following IASTM, the dorsiflexion range of motion significantly increased by 10.7 ± 10.8% and ankle joint stiffness significantly decreased by -6.2 ± 10.1%. However, peak passive torque and muscle stiffness did not change. All variables remained unchanged in the repeated measurements of controls. Conclusion IASTM can improve joint range of motion, without affecting the mechanical and neural properties of the treated muscles. Corresponding author: Naoki Ikeda, Faculty of Sport Sciences, Waseda University, Mikajima 2-579-15, Tokorozawa, Saitama 359-1192, Japan, Phone: +81-4-2947-6766, Fax: +81-4-2947-6766, E-mail: n.ikeda2@kurenai.waseda.jp This study was supported by JSPS KAKENHI (grant number 16H01870). The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and the results of the present study do not constitute endorsement by the American College of Sports Medicine. The authors declare no conflict of interest. None of the authors has a professional relationship with any company or manufacturer who will benefit from the results of the present study. Accepted for Publication: 8 April 2019 © 2019 American College of Sports Medicine

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

6948891480

alsfakia@gmail.com

Surgery

Management of Failed Back Surgery Syndrome (FBSS) Mohammed K Abubakar, Shamsuddeen Mohammad Archives of International Surgery 2018 8(2):47-53 This article aims to highlight the current management of failed back surgery syndrome (FBSS) based on a systematic review of current literature. Literatures reviewed were from the Internet medical search engine such as PubMed, MEDLINE, and Embase. The search was narrowed down to the topic under review. In all, 1,345 articles were initially obtained. These were subsequently narrowed to 83 reviews so as to meet the objective of the review which describes persistent or recurring low back pain with or without sciatica following one or more spine surgeries. The increase in the number of patients undergoing back surgery has led to a corresponding increase in patients whose expectations are not met. Poor outcome following back surgery ranges from 10% to 40%. Outcome worsens with increase in the number of reoperation. Evaluation of this patient should be by detailed history, physical examination, and investigation. The treatment approach should be holistic and all encompassing. Patients psychological state and expectations should be assessed. Etiology of FBSS may include wrong diagnosis, failure to address the primary pathology, and intraoperative surgical errors. Treatment of FBSS is multidisciplinary. The treatment modalities include pharmacological, physical, interventional, spinal cord stimulation, psychological, and surgical.

Pattern of breast ultrasound findings in Zaria, North Western Nigeria Sefiya A Olarinoye-Akorede, Halima Aliyu, Haruna G Yunusa Archives of International Surgery 2018 8(2):54-58 Background: With increasing level of breast cancer awareness among Nigerians, more patients are presenting with breast symptoms. Ultrasound is relied upon significantly since mammographic facilities are few and breast magnetic resonance imaging is either too expensive or unavailable. Our study aimed at presenting the breast ultrasound findings among symptomatic and asymptomatic patients at Ahmadu Bello University Teaching Hospital, Zaria. Patients and Methods: This was a retrospective review of 603 patients who were referred from Surgical and general out-patient departments of our hospital for breast ultrasound scan between January 2015 and July 2017. Whole breast scans were performed using a single Mindray DC-8 (2011) Ultrasound machine, fitted with a 7–12 MHz transducer. The findings were described, recorded, and a final assessment category assigned using the American College of Radiology (ACR) Breast Imaging Reports and Data systems (BI-RADS) classification as follows: 1 (negative), 2 (benign), 3 (probably benign), 4 (suspicious), 5 (highly suggestive for malignancy), and 6 (known biopsy proven malignancy). Histological diagnoses were sought for abnormal ultrasound findings. Data analysis was done using Statistical Package for Social Sciences (SPSS) software for Windows version 20, Chicago, IL. Results: The patients comprised of 591 females and 12 males, with a mean age of 35.7 ± 13.0 years. The most common indication was breast lump (44.3%). BI-RADS 1 was the most common category (44.6%), followed by BI-RADS 3 (25.9%). Mass lesion was the most frequent sonographic finding (45.3%). Others were calcifications, 33 (5.5%); architectural distortion, 67 (11.1%); edema, 52 (8.6%); vascular lesion, 1 (0.16%); and ductal abnormalities, 55 (9.1%). The incidence of breast cancer increased with increasing age. Conclusion: Our predominant ultrasound findings were negative (normal or benign). This supports the use of ultrasound as a first-line diagnostic breast imaging modality in our community. Its added advantage of availability, radiation safety, and less cost makes it an indispensable tool.

Peculiarities of renal cell carcinoma in young adults Muhammed Ahmed, Nasir Oyelowo, Ahmad Bello, Ahmad Tijani Lawal, Hussein Yusuf Maitama, Khalifa Abdulsalam, Adetola Musliu Tolani Archives of International Surgery 2018 8(2):59-62 Background: We observed an increase in incidence of sporadic renal cell carcinoma in young adults (< 40years). The presentation and outcome seems to be different from those in the elderly. We retrospectively reviewed the clinical presentations, pathological findings, management and outcomes in these patients as well as comparison with those in older patients. Patients and Methods: The age, clinical presentation, pathological findings and outcomes following treatment of patients diagnosed and managed for renal cell carcinoma at this center from January 2008 to January 2017 were retrieved from hospital records and analyzed. Patients where divided into young adults (< 40 years) or older adults (> 40 years). Results: A total of 61 patients were reviewed within the period with young adults n = 25 (41%) vs older adults n = 36 (59%). A male:female ratio of 2:1 was found in both groups. Flank pain (77.8% in older adults compared to 72% in young adults) and Hematuria (63.9% of Older adults compared to 52.0% of Young adults.) were both higher in older adults but not statistically significant with P values not <0.05 however Flank mass (100% in older adults and 72.0% in younger adults) was also higher in older adults as well as statistically significant with P value of 0.001. Metastasis and stage of the diseases were equally statistically significantly higher in older adults with P values 0.001. Mean 5 year survival in months for young adults was 25 months (56-3 months) and older adults was 15 months (45- 5 months). Conclusion: Sporadic RCC in young adults presents commonly with an early disease. It seldoms presents with flank mass as compared to the older adults. Hematuria, flank pain and histological type and grade occurs in similar distribution in both groups survival was better in the young.

A randomized comparison of patient satisfaction with oral and vaginal misoprostol for induction of labor at term Umar S Hauwa, Oladapo S Shittu, Bala M Audu, Hajaratu–Sulayman Umar Archives of International Surgery 2018 8(2):63-68 Background: Induction of labor has the potentials for preventing maternal complications and improving pregnancy outcome especially in low-resource settings like Nigeria. The various routes of administration of misoprostol have been proven to affect the safety and efficacy of the drug. However, there is paucity of studies that compared the satisfaction of women regarding the oral and vaginal routes. The aim of this study is to compare patient satisfaction with administration of oral and vaginal misoprostol for induction of labor at term. Patients and Methods: A randomized comparative study, where 169 women admitted for induction of labor at the delivery suite of Ahmadu Bello University Teaching Hospital were assessed for their satisfaction with regard to the oral and vaginal routes of misoprostol administration using the 5-point Likert scale. Data were analyzed using SPSS version 20. Results: The request for analgesia was similar in both groups [17.9% vs 17.9%, relative risk (RR); 1.00 95% confidence interval (CI) 0.5–1.9]. However, more women in the oral group were very satisfied compared with the vaginal group (57.6% vs 33.3%), and a significant proportion of women in the oral group expressed their willingness to use the same route of labor induction in subsequent pregnancies (RR 1.1, 95% CI 1.0–1.3, P = 0.04). There was no difference in terms of maternal and neonatal outcomes for both routes. Conclusion: Women had higher satisfaction with oral misoprostol and preferred the oral route compared with the vaginal route.

Study of the effect of Tamsulosin in the spontaneous expulsion of ureteric calculi Ravikumar , Saikalyan A Guptha, Sriharsha Kurabalakota, Jay Prakash, Sanjay Parachuri, AS Karthik Archives of International Surgery 2018 8(2):69-74 Background: To increase the expulsion rate and reduce the analgesic requirement, there is a great deal of enthusiasm for adjuvant pharmacological interventions which is non-invasive and cost-effective. Tamsulosin shortens hospital stay, decreases operative interference. Tamsulosin increases stone expulsion rate and decreases expulsion time and has been shown to be safe and cost effective. The aim was to study the effect of Tamsulosin in the spontaneous expulsion of calculi in the ureter and to study the side effects of use of Tamsulosin for ureteric stones. Patients and Methods: A prospective, randomized controlled study was conducted to compare the effect of Tamsulosin between two groups. This study included a total of 50 patients, 25 patients were chosen randomly and advised to take plenty of oral fluids and treated with NSAIDs (Diclofenac sodium) and the other 25 patients were treated with Tamsulosin (alpha blocker) 0.4mg HS for one month along with oral fluids and NSAIDs (Diclofenac sodium). The patients were then observed weekly and ultrasound scan was repeated after 15 days to look for any passage of calculi. If the stone was passed successfully, it was confirmed with ultrasonography. After one month if treatment failed, conservative management was discontinued and the patient was advised surgery. Independent t-test and Chi-square test' was the test of significance. Results: Majority of the patients were in the age group of 20-40 yrs. The mean size of the calculus was 7.18 mm on the right side and 6.62 mm on the left side. Out of the 25 patients who were on alpha 1 blocker (Tamsulosin) 16 patients had passed the calculi and 9 patients had no results with a success rate of 64%. In the 25 patients who were not on Tamsulosin 6 patients passed the calculi and 19 patients did not pass the calculi. Conclusion: Tamsulosin is an effective and safe drug in the management of calculi in the ureter and should be considered before ureteroscopy or extracorporeal lithotripsy for uncomplicated ureteral calculi.

Spontaneous rupture of an unscarred uterus in a multipara at 32 weeks of gestation: A case report Caleb Mohammed, Joel A Adze, Stephen B Bature, Mohammed-Durosinlorun Amina, Taingson C Matthew, Abubakar Amina, Jonah Musa Archives of International Surgery 2018 8(2):75-77 Uterine rupture is still a public health problem in developing countries. Most spontaneous uterine rupture in this region occurs in unscarred uterus due to prolonged obstructed labor and injudicious use of oxytocics. Antepartum uterine rupture is uncommon; the diagnosis is not always obvious; and maternal, fetal morbidity and mortality are high. A 30-year-old gravida 7 para 5 +1 2alive, at 32 weeks of gestation, booked in a primary healthcare center and presented with sudden onset abdominal pain and vaginal bleeding of 4-h duration. Ultrasound scan revealed a major degree placenta previa; however, intraoperatively an anterior uterine rupture was detected with a fresh still-born male fetus weighing 1,650 g with intact membranes within the abdominal cavity. She had a subtotal hysterectomy performed. This case highlights the occurrence of spontaneous uterine rupture in an unscarred uterus; increased awareness on the need for early presentation enables prompt diagnosis and treatment.

Incidental finding of multiple splenosis in patient who had ventral hernia repair Purav Goel, Mohit Bhatia, Sachin Ambekar Archives of International Surgery 2018 8(2):78-80 Splenosis in itself is a rare condition and its presence in a patient with ventral hernia can pose an unusual challenge. Ventral incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair to various mesh repairs and laparoscopic repair. Splenosis is a benign condition caused by an ectopic autotransplantation of splenic tissues after splenic trauma or surgery. It is usually diagnosed accidentally and usually occurs within the abdominal and pelvic cavity. We report a female patient who had undergone splenectomy for abdominal trauma at the age of 12 years and was diagnosed as a case of abdominal splenosis at the age of 47 years on laparoscopy done for paraumbilical incisional hernia. This case report intends to share some important aspects of ventral hernia and splenosis and the approach followed in the repair of ventral hernia in our case.

Fatal tetanus infection originating from fungating advanced breast cancer: Case report and review of the literature Abdullahi Adamu, Zubair Hadi Ismail, Muhammad Inuwa Mustapha, Sefiya Adebanke Olarinoye-Akorede Archives of International Surgery 2018 8(2):81-86 Tetanus is an acute and potentially fatal disease caused by an exotoxin produced by a bacterium, Clostridium tetani. The cultural habit of application of concoctions made from mud and animal dung to chronic and necrotic wounds in our environment may provide a portal of entry for serious tetanus infection. There is a paucity of published data of tetanus infection arising from a necrotic breast tumor as a possible portal of entry in study area necessitating our report on a 48-year-old woman with extensive and fungating invasive ductal carcinoma of the breast who acquired fatal tetanus infection presumably from application of animal dung to the necrotic chest wall tumor. Patient and caregiver's education, clinical awareness, timely treatment, and proper tetanus vaccination in predisposed patients before surgical excision, debridement, or chemotherapy might be necessary to prevent this catastrophe.

Primary extragnathic osteosarcoma with visual loss in an adolescent female Modupeola O Samaila, Shehu Abdullahi, Halima O Aliyu, Benjamin Fomete, Abdullahi Jimoh Archives of International Surgery 2018 8(2):87-90 The majority of primary osteosarcoma cases affect the metaphyseal plates of long bones, while approximately 5%–10% cases involve the craniofacial bones and are mainly located in the maxilla and mandible. Primary osteosarcoma of the cranial vault is uncommon, and it usually occurs as a metastatic focus from primary diseases elsewhere in older patients. An 18-year-old female presented to our hospital with a 6-month history of a left-sided skull mass involving the forehead and part of the left orbit and 3 months of left visual loss. Clinical examination revealed a 32 × 26 cm firm to soft mass involving the left frontal, parietal and temporal bones, and part of the left orbit. She had no other contributory complaints or significant medical history. A clinical diagnosis of orbital malignancy was made with differential of metastatic left-sided skull tumor. A computed tomography scan revealed a sclerotic lesion arising from the left parietal–temporal bones with sunburst appearances, while fine needle aspiration cytology of the mass showed loose clusters and singles of malignant spindle cells. Incisional biopsy of the mass was diagnosed as fibroblastic variant of osteosarcoma. Extragnathic primary osteosarcoma is uncommon and accounts for less than 1% of craniofacial osteosarcoma. In general, osteosarcoma has a bimodal age of occurrence in adolescents and adults >65 years, and the preferential sites of involvement are the femur, tibia, humerus, and gnathic bones in decreasing frequencies. Our patient is within the first age group; however, the site is unusual and is often associated with secondary osteosarcoma in adults >65 years.

Mucocele of the appendix: A case report and review of literature Ibrahim Umar Garzali, Amina I Elyakub, Ibrahim Eneye Suleiman, Nasirudeen L Oloko, Ibrahim Abba Muktar Archives of International Surgery 2018 8(2):91-94 Mucocele represents mucinous dilation of the lumen of vermiform appendix resulting from obstruction or increase secretion. It is a rare disease with an incidence of 0.2–0.7% of all appendectomies and 8–10% of all appendiceal tumours. The clinical presentation is atypical with most cases usually asymptomatic. Mucocele of the appendix indicates dilation of the appendix lumen irrespective of the aetiology. Four types of appendiceal mucocele are defined by the cause of obstruction: retention cysts, epithelial hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. Mucocele of the appendix is a rare condition of the appendix that requires high index of suspicion for a definitive preoperative diagnosis. The treatment for appendiceal mucocele is typically surgical resection. We report a case of a 37-year-old woman with recurrent right iliac fossa pain of 20 years duration. Abdomen was full, moved with respiration with a positive pointing sign. There was marked right iliac fossa tenderness with rebound tenderness and guarding. She had an abdominopelvic ultrasonography that revealed features of acute appendicitis. She had surgery with intraoperative finding of marked distension of the appendix from the tip to the base with necrosis at the base, a right hemicolectomy was done.

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

6948891480

alsfakia@gmail.com