Acute Care Physical Therapy Status Post Laparoscopic Loop Sigmoid Colostomy For A Patient With Colorectal Cancer: A Case Report

Background and Purpose: Colorectal cancer (CRC) is the third most commonly diagnosed cancer, with an increasing prevalence in the United States. Surgical treatment is common and the American Society of Enhanced Recovery (ASER) established fast track protocols to reduce recovery time and length of stay in the hospital. Early mobilization is a key component of these protocols. The purpose of this case report is to describe the acute physical therapy (PT) for a patient who received a laparoscopic loop sigmoid colostomy. Case Description: The patient was a 73-year-old male admitted to the hospital to receive surgery for a permanent colostomy due to his diagnosis of stage II adenocarcinoma of the rectum. PT evaluation and treatment began post-operative day (POD) one. He presented below his baseline level of function, as he was previously independent in mobility and activities of daily living (ADLs). At the time of evaluation, he had limitations in bed mobility, transfers, and tolerance to activity. Treatment focused on a task oriented approach addressing limitations in functional mobility. Outcomes: The patient was assessed on his required level of assistance at initial evaluation and discharge. He demonstrated improvements in all functional mobility; bed mobility (moderate assistance to independence), transfers (minimal assist to independence), ambulation (contact guard assist for 150 feet to supervision for 350 feet), and stair negotiation (unable to perform to close guarding with ascending/descending nine stairs). Discussion: This patient had the benefit of following the multidisciplinary ASER protocol and received early mobilization guided by a skilled physical therapist. He was discharged to inpatient rehab after eight days in the hospital. Further research should look at pre-habilitation to determine how that affects outcomes

Acute Care Physical Therapy Status Post Colostomy For A Patient With Colorectal Cancer: A Case Report

Colorectal cancer (CRC) is a malignancy that begins in the colon or rectum. In 2016 there were 724,690 men and 727,350 women living with a history of CRC, with an estimated 135,430 new cases in 2017. Treatment can include local radiation, systemic chemotherapy, and/or surgery to remove the tumor, which can result in the placement of a colostomy. A colostomy entails a surgical resection to a portion of the lower GI tract, which creates an opening in the abdominal wall referred to as a stoma, which provides a new pathway for removal of gas and stool. Clinical Practice Guidelines for enhanced recovery protocols set a standard of perioperative procedures and practices to improve patient outcomes, lessen complications, reduce length of stay, as well as decrease overall health care costs. Early and progressive mobilization has been associated with shorter length of stay and has a strong recommendation based on low quality evidence.https://dune.une.edu/pt_studcrposter/1126/thumbnail.jp

Neural Priming in Human Prefrontal Cortex: Multiple Forms of Learning Reduce Demands on the Prefrontal Executive System.

Past experience is hypothesized to reduce computational demands in PFC by providing bottom-up predictive information that informs subsequent stimulus-action mapping. The present fMRI study measured cortical activity reductions ("neural priming"/"repetition suppression") during repeated stimulus classification to investigate the mechanisms through which learning from the past decreases demands on the prefrontal executive system. Manipulation of learning at three levels of representation-stimulus, decision, and response-revealed dissociable neural priming effects in distinct frontotemporal regions, supporting a multiprocess model of neural priming. Critically, three distinct patterns of neural priming were identified in lateral frontal cortex, indicating that frontal computational demands are reduced by three forms of learning: (a) cortical tuning of stimulus-specific representations, (b) retrieval of learned stimulus-decision mappings, and (c) retrieval of learned stimulus-response mappings. The topographic distribution of these neural priming effects suggests a rostrocaudal organization of executive function in lateral frontal cortex

Levels of Abnormal Prion Protein in Deer and Elk with Chronic Wasting Disease

Infected deer may pose a higher risk than elk for disease transmission

Susceptibilities of Nonhuman Primates to Chronic Wasting Disease

A species barrier may protect humans from this disease

Polymorphisms in Cyclooxygenase, Lipoxygenase and TP53 genes predict colorectal polyp risk reduction by aspirin in the seAFOod polyp prevention trial

Aspirin and eicosapentaenoic acid (EPA) reduce colorectal adenomatous polyp risk and affect synthesis of oxylipins including prostaglandin E2. We investigated whether 35 single nucleotide polymorphisms (SNPs) in oxylipin metabolism genes such as cyclooxygenase [PTGS] and lipoxygenase [ALOX], as well as 7 SNPs already associated with colorectal cancer (CRC) risk reduction by aspirin (eg. TP53; rs104522), modified the effects of aspirin and EPA on colorectal polyp recurrence in the randomised 2x2 factorial seAFOod trial. Treatment effects were reported as the incidence rate ratio (IRR) and 95% confidence interval (CI) by stratifying negative binomial and Poisson regression analyses of colorectal polyp risk on SNP genotype. Statistical significance was reported with adjustment for the false discovery rate as the P and q value. Five hundred and forty-two (of 707) trial participants had both genotype and colonoscopy outcome data. Reduction in colorectal polyp risk in aspirin users compared with non-aspirin users was restricted to rs4837960 (PTGS1) common homozygotes (IRR 0.69 [95%CI 0.53,0.90]; q=0.06), rs2745557 (PTGS2) compound heterozygote-rare homozygotes (IRR 0.60 [0.41,0.88]; q=0.06), rs7090328 (ALOX5) rare homozygotes (IRR 0.27 [0.11,0.64]; q=0.05), rs2073438 (ALOX12) common homozygotes (IRR 0.57 [0.41,0.80]; q=0.05), and rs104522 (TP53) rare homozygotes (IRR 0.37 [0.17,0.79]; q=0.06). No modification of colorectal polyp risk in EPA users was observed. In conclusion, genetic variants relevant to the proposed mechanism of action on oxylipins are associated with differential colorectal polyp risk reduction by aspirin in individuals who develop multiple colorectal polyps. SNP genotypes should be considered during development of personalised, predictive models of CRC chemoprevention by aspirin

The Democratic Biopolitics of PrEP

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma

Meta-analysis of genome-wide association studies of asthma in ethnically diverse North American populations.

Asthma is a common disease with a complex risk architecture including both genetic and environmental factors. We performed a meta-analysis of North American genome-wide association studies of asthma in 5,416 individuals with asthma (cases) including individuals of European American, African American or African Caribbean, and Latino ancestry, with replication in an additional 12,649 individuals from the same ethnic groups. We identified five susceptibility loci. Four were at previously reported loci on 17q21, near IL1RL1, TSLP and IL33, but we report for the first time, to our knowledge, that these loci are associated with asthma risk in three ethnic groups. In addition, we identified a new asthma susceptibility locus at PYHIN1, with the association being specific to individuals of African descent (P = 3.9 × 10(-9)). These results suggest that some asthma susceptibility loci are robust to differences in ancestry when sufficiently large samples sizes are investigated, and that ancestry-specific associations also contribute to the complex genetic architecture of asthma

Dengue: a continuing global threat.

Dengue fever and dengue haemorrhagic fever are important arthropod-borne viral diseases. Each year, there are ∼50 million dengue infections and ∼500,000 individuals are hospitalized with dengue haemorrhagic fever, mainly in Southeast Asia, the Pacific and the Americas. Illness is produced by any of the four dengue virus serotypes. A global strategy aimed at increasing the capacity for surveillance and outbreak response, changing behaviours and reducing the disease burden using integrated vector management in conjunction with early and accurate diagnosis has been advocated. Antiviral drugs and vaccines that are currently under development could also make an important contribution to dengue control in the future