Search

There is a broad scope of literature investigating whole-body vibration (WBV) effects on blood flow (BF). However, it is unclear how therapeutic localized vibrations alter BF. Low-frequency massage guns are advertised to enhance muscle recovery, which may be through BF changes; however, studies using these devices are lacking. Thus, the purpose of this study was to determine if popliteal artery BF increases from localized vibration to the calf. Twenty-six healthy, recreationally active university students (fourteen males, twelve females, mean age 22.3 years) participated. Each subject received eight therapeutic conditions randomized on different days with ultrasound blood flow measurements. The eight conditions combined either control, 30 Hz, 38 Hz, or 47 Hz for a duration of 5 or 10 min. BF measurements of mean blood velocity, arterial diameter, volume flow, and heart rate were measured. Using a cell means mixed model, we found that both control conditions resulted in decreased BF and that both 38 Hz and 47 Hz resulted in significant increases in volume flow and mean blood velocity, which remained elevated longer than the BF induced by 30 Hz. This study demonstrates localized vibrations at 38 Hz and 47 Hz significantly increase BF without affecting the heart rate and may support muscle recovery.

INTRODUCTION: Medical toxicology expertise has expanded into the addiction medicine realm including outpatient medication for opioid use disorder (MOUD) and addiction treatment. Concomitantly, the emergency department (ED) and hospital are increasingly seen as important sites for the screening, prevention, and treatment of patients with substance use disorders and addiction. This analysis seeks to characterize patients seen by medical toxicologists for opioid use and opioid use disorder (OUD) in the ED and inpatient consultation setting (inpatient) versus in the OUD clinic (outpatient) setting. METHODS: We searched the American College of Medical Toxicology’s Toxicology Investigators Consortium Case Registry, a prospective, de-identified, national dataset that includes patients receiving medical toxicology consultation following prescription opioid misuse. The dataset also includes patients seen in outpatient MOUD clinics during the same period between June 2013 and November 2015. Intentional self-harm patients were excluded. We analyzed medical history, drug use patterns, and other factors with odds ratios and confidence intervals. RESULTS: Of 110 patients identified, 60 (54.5%) were inpatients and 50 (45.5%) outpatients. Mean age (39 years), gender (68% male), and race breakdown (60% white/non-Hispanic) were similar. The outpatient group was more likely to have Medicare/Medicaid coverage (p

Background Tramadol is a widely used synthetic opioid. Substantial research has previously focused on the neurological effects of this drug, while the efficacy of various treatments to reduce the associated side effects has not been well studied. This study aimed to evaluate the protective effects of naloxone, diazepam, and quercetin on tramadol overdose-induced seizure and sedation level in male rats. Methods The project was performed with 72 male Wistar rats with an average weight of 200–250 g. The rats were randomly assigned to eight groups. Tramadol was administered intraperitoneally at an initial dose of 25 mg/kg/day. On the 14th day, tramadol was injected at 75 mg/kg, either alone or together with naloxone, diazepam, and quercetin (acute and chronic) individually or in combination. The rats were monitored for 6 h on the last day, and the number, the duration, and the severity of seizures (using the criteria of Racine) were measured over a 6-h observation period. The sedation level was also assessed based on a 4-point criterion, ranging from 0 to 3. Data were analyzed in SPSS software using Kruskal–Wallis, Chi-square, regression analysis, and generalized estimating equation (GEE) tests. The significance level was set at P Results The naloxone-diazepam combination reduced the number, severity, and cumulative duration of seizures compared to tramadol use alone and reduced the number of higher-intensity seizures (level 3, 4) to a greater extent than other treatments. Naloxone alone reduced the number and duration of seizures but increased the number of mild seizures (level 2). Diazepam decreased the severity and duration of seizures. However, it increased the number of mild seizures (level 2). In comparison with the tramadol alone group, the acute quercetin group exhibited higher numbers of mild (level 2) and moderate (level 3) seizures. Chronic quercetin administration significantly increased the number of mild seizures. In the GEE model, all groups had higher sedation levels than the saline only group (P Conclusion The combined administration of naloxone and diazepam in acute-on-chronic tramadol poisoning can effectively reduce most seizure variables compared to tramadol use alone. However, none of the treatments improved sedation levels.

Background Pseudomonas aeruginosa is common in chronic rhinosinusitus (CRS) and frequently resistant to antibiotic treatment. We recently described the ciprofloxacin and ivacaftor-releasing biodegradable sinus stent (CISS)-a drug-delivery system that administers ciprofloxacin and the mucociliary activator (ivacaftor) at high local concentrations with prolonged mucosal contact time and sustained delivery. The objective of this study is to evaluate the efficacy of the CISS in a rabbit model of P aeruginosa (PAO1 strain) sinusitis. Methods Ciprofloxacin/ivacaftor (double layer) was coated on biodegradable poly-D/L-lactic acid (PLLA). A total of 10 sinus stents (5 bare PLLA stent controls, 5 CISSs) were placed unilaterally in rabbit maxillary sinuses via dorsal sinusotomy after inducing infection for 1 week with PAO1. Animals were assessed 3 weeks after stent insertion with sinus culture, nasal endoscopy, computed tomography scan, histopathology, and in-vivo sinus potential difference (SPD) assay. Results Rabbits treated with CISS had significant reductions in computed tomography (∆ Kerschner scale: control, 0.55 ± 0.92; CISS, -5.92 ± 1.69; p = 0.024) and endoscopy (control, 4.0 ± 0.0; CISS, 1.875 ± 0.74; p = 0.003) scores. A 2-log reduction of PAO1 was observed (control, -2.14 ± 0.77; CISS, 1.84 ± 1.52; p = 0.047). SPD revealed significantly increased Cl- transport in the CISS group compared with the control group (Cl- -free + forskolin ΔPD: control, -4.23 ± 1.04 mV; CISS, -18.36 ± 6.31 mV; p = 0.026). Finally, marked improvements were noted in the histology of the mucosa and submucosa in treated animals. Conclusion The CISS had robust clinical efficacy in treating P aeruginosa rabbit sinusitis. The innovative design of double-layered drug coating on the surface of the biodegradable stent may provide therapeutic advantages over current treatment strategies for P aeruginosa sinusitis.

Background: Methanol poisoning is an important cause of mortality and morbidity worldwide. Although it often occurs as smaller sporadic events, epidemic outbreaks are not uncommon due to the illicit manufacture and sale of alcoholic beverages. Objective: We aimed to define methanol poisoning outbreak (MPO), outline an approach to triaging an MPO, and define criteria for prioritizing antidotes, extracorporeal elimination treatments (i.e., dialysis), and indications for transferring patients in the context of an MPO. Methods: We convened a group of experts from across the world to explore geographical, socio-cultural and clinical considerations in the management of an MPO. The experts answered specific open-ended questions based on themes aligned to the goals of this project. This project used a modified Delphi process. The discussion continued until there was condensation of themes. Results: We defined MPO as a sudden increase in the number of cases of methanol poisoning during a short period of time above what is normally expected in the population in that specific geographic area. Prompt initiation of an antidote is necessary in MPOs. Scarce hemodialysis resources require triage to identify patients most likely to benefit from this treatment. The sickest patients should not be transferred unless the time for transfer is very short. Transporting extracorporeal treatment equipment and antidotes may be more efficient. Conclusion: We have developed consensus statements on the response to a methanol poisoning outbreak. These can be used in any country and will be most effective when they are discussed by health authorities and clinicians prior to an outbreak.

Very little is known about the effects of whole body vibration on the supraspinal central nervous system. Though much clinical outcome data and mechanistic data about peripheral neural and musculoskeletal mechanisms have been explored, the lack of central understanding is a barrier to evidence-based, best practice guidelines in the use of vibrational therapy. Disparate methods of administration render study to study comparisons difficult. To address this lack of uniformity, we present the use of targeted subcutaneous vibration combined with simultaneous in vivo electrophysiological recordings as a method of exploring the central effects of peripheral vibration therapy. We used implanted motors driven by both Grass stimulators and programmed microcontrollers to vary frequency and location of stimulation in an anesthetized in vivo rat model while simultaneously recording firing rate from gamma-aminobutyric acid (GABA) neurons in the ventral tegmental area. We show that peripheral vibration can alter GABA neuron firing rate in a location- and frequency-dependent manner. We include detailed schematics and code to aid others in the replication of this technique. This method allows for control of previous weaknesses in the literature including variability in body position, vibrational intensity, node and anti-node interactions with areas of differing mechanoreceptor densities, and prefrontal cortex influence.

The Toxicology Investigators Consortium (ToxIC) Case Registry was established by the American College of Medical Toxicology in 2010. The Registry contains data from participating sites with the agreement that all bedside medical toxicology consultations will be entered. Currently, 83% of accredited medical toxicology fellowship programs in the USA participate. The Registry continues to grow each year, and as of 31 December 2016, a new milestone was reached, with more than 50,000 cases reported since its inception. The objective of this seventh annual report is to summarize the Registry's 2016 data and activity with its additional 8529 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2016. Detailed data was collected from these cases and aggregated to provide information which includes the following: demographics (age, gender, race, ethnicity, HIV status), reason for medical toxicology evaluation (intentional pharmaceutical exposure, envenomation, withdrawal from a substance), agent and agent class, clinical signs and symptoms (vital sign abnormalities, organ system dysfunction), treatments and antidotes administered, fatality and life support withdrawal data. Fifty percent of cases involved females, and adults aged 19-65 were the most commonly reported. There were 86 patients (1.0%) with HIV-positive status known. Non-opioid analgesics were the most commonly reported agent class, with acetaminophen the most common agent reported. There were 126 fatalities reported in 2016 (1.5% of cases). Major trends in demographics and exposure characteristics remained similar overall with past years' reports. While treatment interventions were commonly required, fatalities were rare.

Approximately half a million patients with autism spectrum disorders are subjected to chelation therapy in the US annually. The overwhelming majority of such cases are chelated for non-accepted medical indications. These patients may seek evaluation when a urine sample is assayed after the administration of a chelating agent and the values obtained have been improperly compared to references ranges for non-chelated urines, causing falsely elevated results. Legitimate practitioners confronted with such data must decide, preferably in consultation with the patient or their guardian(s), whether to do further testing using legitimate methodology or to simply dismiss the results of the improper testing. Bayesian principles tell us that further testing is likely to yield results within normal reference ranges. However, under some circumstances, it is useful to do such testing in order to demonstrate that there is no need for chelation therapy. Unnecessary chelation therapy is expensive, can cause significant acute adverse effects, and may be associated with long-term consequences.

To the Editor, Little is known regarding medical toxicologists' financial compensation by poison control centers (PCCs) in the United States or about toxicologist attitudes regarding compensation. Our aim was to survey and describe the opinions of American College of Medical Toxicology (ACMT) member toxicologists regarding their compensation by PCCs. The ACMT practice committee conducted an anonymous survey of all ACMT members. Three times between July and September 2008, ACMT members were contacted by e-mail and asked to fill out an online survey. An additional attempt was made to collect survey responses at the ACMT national meeting. No compensation was provided for study participation. The survey format was designed to be short and simple in order to maximize response rates. One hundred fifty-two ACMT members provided survey responses (27.6%). Forty (26.2%) respondents described themselves as poison center directors, 24 (15.8%) as associate/assistant directors, 51 (33.6%) as poison center consultants, and 17 (%) as providing teaching/administrative services. Twenty (13.2%) respondents reported having no poison center involvement. Of those respondents without PCC involvement, 14 (70%) reported being geographically distant from their PCC. All respondents felt that toxicology consultations provided by medical toxicologists were useful (100%). One hundred twenty-seven (84.1%) strongly agreed and 24 agreed (15.9%) with this statement. One hundred fortyeight (97.4%) agreed that medical toxicologists should be compensated for their time. Only two respondents (1.3%) disagreed. One hundred six respondents (70.2%) disagreed with the statement that toxicologists are fairly compensated for providing services to poison centers. Thirty-seven (24.5%) of those “strongly disagreed.” Only 34 respondents (22.5%) felt that toxicologists are fairly compensated for their work. Sixty-three (48.5%) respondents reported “always” being compensated for their work at poison centers, whereas 36 (27.7%) reported that they “never” were. Of those identified as PCC directors, 31 (77.5%) reported always being compensated for their work. Only two (5%) reported never being compensated. However, only 16 (40%) of PCC directors felt that they were fairly compensated. Of nonPCC directors, only 20 (29.9%) reported that they are always compensated for their work. Thirty-three (49.3%) of nonPCC directors reported never getting compensation. Only 13 (18.8%) felt that toxicologists are fairly compensated. Our survey is limited by its low response rate, which limits our ability to extrapolate our findings to all ACMT member toxicologists. Some of the low response rate that we experienced may be related to ACMT members who do not provide services to a PCC or those receiving no compensation for their work. These particular members may not have responded because they felt the survey did S. R. Offerman California Poison Control System, Department of Emergency Medicine, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA

Poisoning morbidity and mortality is high in the developing world. Systems for care of poisoned patients differ markedly between countries. In this paper a comparison of two very different systems for the care of poisoned patients, is presented. Specifically, the role of poison centers and poison treatment centers in the US and Iran are contrasted. A systematic literature search was undertaken utilizing the PubMed, Scopus, and Google Scholar and the keywords “poison centers”, “treatment” “Iran” “United States of America” and 100 publications were identified. From these, relevant data were found in 23 publications. The information was double-checked and data were summarized herein.We find that the system of the care of poisoned patients relies heavily on certified poison centers in the US and that only a few hospitals have well developed medical toxicology services. In contrast, in Iran, the poison center system is somehow less developed and the care of poisoned patients is provided in centralized high volume hospital poison units.Although both the US and Iran have highly developed systems for the care of poisoned patients they are distinctly different. Comparative studies based on these systems could provide important data for developing countries with more rudimentary poison control and treatment facilities.

El objetivo de esta tesis es comprender el comportamiento de líquidos en presencia de vibraciones tanto en entornos con gravedad como ingrávidos, e investigar hasta qué punto se pueden utilizar vibraciones de pequeña amplitud para influir y controlar este comportamiento. En presencia de gravedad, la interfaz fluida es típicamente plana en ausencia de fuerzas, mientras que tiene porque serlo en entornos sin gravedad. En ambos casos, cuando el fluido es sometido a vibraciones, pueden aparecer una gran variedad de inestabilidades. Una de las inestabilidades de ondas superficiales más destacadas inducidas por vibraciones produce ondas subarmonica conocidas como Cross-waves, las cuales, en el caso de un superficie plana no forzada (i.e, con gravedad), se han descrito desde Jones [J. Fluid Mech., Pág. 138), 53 - 74 (1984)] en base a la ecuación de Schrodinger no lineal forzada en la frontera. Se amplía aquí la teoría de Cross-waves en contenedores vibrados horizontalmente, mediante la inclusión de tensión superficial y, lo que es más importante, una extensión espacial del término forzante. Las ecuaciones de amplitud resultantes predicen valores de comienzo, perfiles espaciales, y modulaciones temporales que son comparados con la anterior teoría y experimentalmente. La aparición de soluciones temporalmente moduladas son relacionadas con la interacción de ondas generadas en las paredes opuestas. Por otra parte, en ambientes ingrávidos, donde la energía superficial y de contact es dominante, los fluidos dejan de preferir la configuración plana, y el equilibrio estático es curvado generalmente. En esta situación, vibraciones de alta frecuencia no solo inducen ondas superficiales sino que además conducen al fluido a tomar una nueva forma de quasi-equilibrio (en media). Este proceso de reorientación es descrito por la teoría de vibroequilibria, la cual está basada en la minimización de la media de un funcional de energía. Aquí se presenta una comparación detallada de las predicciones de la teoría de Vibroequilibria con resultados de simulaciones numéricas directas, encontrando muy buen acuerdo sobre una gama de parámetros. El estudio revela una diferencia importante en el comportamiento para volúmenes pequeños y grandes de fluidos en contenedores vibrados horizontalmente. Con un volumen adimensional por encima de alrededor de 0.36, la solución simétrica de Vibroequilibria sufre una inestabilidad de punto-silla antes de llegar a contactar con el fondo del recipiente. También se presenta un estudio de los efectos dinámicos, donde se encuentra una fuerte correlación entre las ondas subharmónicas superficiales y el primer modo impar de sloshing. Ya que la teoría y simulaciones de vibroequilibria predice que, en algunos casos, la preferencia de una interfaz plana puede ser restaurada por vibración de alta frecuencia, se ha propuesto y desarrollado el experimento Control de Fluidos en Microgravedad con Vibraciones (CFVib) para el programa 2016 Fly Your Thesis!, patrocinado por la Agencia Espacial Europea, que fue seleccionado para formar parte de la 65th campaña de Vuelos Parabólicos. Se utilizan materiales piezoeléctricos para generar vibraciones de alta frecuencia y, así, inducir ondas superficiales y reorientación a gran escala de la interfaz. ----------ABSTRACT---------- The aim of this thesis is to understand the potentially complex behaviour of liquids in the presence of vibrations, both with gravity and in weightless environments, and to investigate the extent to which small-amplitude vibrations can be used to influence and control this behaviour. In the presence of gravity, flat interfaces are often selected in the absence of forcing, while this is not so in microgravity environments. In both cases, a variety of instabilities can arise when the fluid is subjected to vibrations. One of the most prominant surface wave instabilities induced by vibrations produces subharmonic waves called cross-waves, which, in the case of a flat unforced surface (i.e., with gravity), have been described since Jones [J. Fluid Mech. 138, 53–74 (1984)] using a boundary forced nonlinear Schrodinger equation. We extend this established theory of modulated cross-waves in horizontally vibrated containers by including surface tension and, most importantly, a spatially extended forcing term. The resulting amplitude equations give predictions for onset values, spatial profiles, and temporal modulations that are compared with previous theory and with experimental measurements. The appearance of temporallymodulated solutions, confirmed experimentally, are related to the interaction of waves generated at opposite endwalls. In weightless environments, where surface or contact energy typically dominate, fluids no longer prefer a flat configuration and the static equilibrium surface is generally curved. In such situations, high-frequency vibrations not only drive surfaces waves but also lead the fluid to take a new quasi-equilibrium (average) shape. This reorientation process is described by vibroequilibria theory, which is based on minimizing an averaged energy functional. Here we present a detailed comparison of the predictions of vibroequilibria theory with the results of direct numerical simulations, finding very good agreement over a range of parameters. The calculations also reveal an important difference in behaviour between small and large fluid volumes in horizontal vibrated containers. With dimensionless volume larger than about 0.36, the symmetric vibroequilibria solution suffers a saddle-node instability prior to contact with the container bottom. An investigation of dynamic effects is also presented, where a strong correlation is found between modulated subharmonic surface waves and the first odd sloshing mode. Since vibroequilibria theory and simulations predict that, in some cases, the preference of flat interfaces can be restored by high-frequency vibrations, we proposed and developed The Control of Fluids in Microgravity with Vibrations (CFVib) experiment for the 2016 Fly Your Thesis! programme, sponsored by the European Space Agency (ESA), which was selected to be part of the 65th Parabolic Flight Campaign. Piezoelectric materials were used to generate high-frequency vibrations driving surface waves and large-scale reorientation of the interface.