Τετάρτη 7 Σεπτεμβρίου 2016

Entanglement between Thermoregulation and Nociception in the rat: The case of Morphine

In thermal neutral condition, rats display cyclic variations of the vasomotion of the tail and paws, the most widely used target organs in current acute or chronic animal models of pain. Systemic morphine elicits their vasoconstriction followed by hyperthermia in a naloxone-reversible and dose-dependant fashion. The dose-response curves were steep with ED50 in the 0.5-1 mg/kg range. Given the pivotal functional role of Rostral Ventro-medial Medulla (RVM) in nociception and rostral Medullary Raphe (rMR) in thermoregulation, two largely overlapping brain regions, the RVM/rMR was blocked by muscimol: it suppressed the effects of morphine. "On-" and "Off" neurons recorded in RVM/rMR are activated and inhibited by thermal nociceptive stimuli, respectively. They are also implicated in regulating the cyclic variations of the vasomotion of the tail and paws seen in thermal neutral condition. Morphine elicited abrupt inhibition and activation of the firing of On- and Off-cells recorded in the RVM/rMR. By using a model that takes into account the power of the radiant heat source, the initial skin temperature, the core body temperature and the peripheral nerve conduction distance, one can argue that the morphine-induced increase of reaction time is mainly related to the morphine-induced vasoconstriction. This statement was confirmed by analyzing in psychophysical terms the tail-flick response to random variations of noxious radiant heat. Although the increase of a reaction time to radiant heat is generally interpreted in terms of analgesia, the present data question the validity of using such an approach to build a pain index.



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Glycolysis selectively shapes the presynaptic action potential waveform

Mitochondria are major suppliers of cellular energy in neurons; however, utilization of energy from glycolysis versus mitochondrial oxidative phosphorylation (OxPhos) in the presynaptic compartment during neurotransmission is largely unknown. Using presynaptic and postsynaptic recordings from the mouse calyx of Held, we examined the effect of acute selective pharmacological inhibition of glycolysis or mitochondrial OxPhos on multiple mechanisms regulating presynaptic function. Inhibition of glycolysis via glucose depletion and Iodoacetic Acid (IAA, 1mM) treatment, but not mitochondrial OxPhos, rapidly altered transmission, resulting in highly variable, oscillating responses. At reduced temperature, this same treatment attenuated synaptic transmission, due to a smaller and broader presynaptic AP waveform. We show via experimental manipulation and ion channel modeling that the altered AP waveform results in smaller Ca2+-influx, resulting in attenuated excitatory postsynaptic currents (EPSCs). In contrast, inhibition of mitochondria-derived ATP production via extracellular pyruvate depletion and bath-applied oligomycin (1 µM) had no significant effect on Ca2+-influx, did not alter the AP waveform within the same time frame (up to 30 min), and the resultant EPSC remained unaffected. Glycolysis, but not mitochondrial OxPhos, is thus required to maintain basal synaptic transmission at the presynaptic terminal. We propose that glycolytic enzymes are closely apposed to ATP-dependent ion pumps on the presynaptic membrane. Our results indicate a novel mechanism for the effect of hypoglycemia on neurotransmission. Attenuated transmission likely results from a single presynaptic mechanism at reduced temperature: a slower, smaller AP, prior to and independent of any effect on synaptic vesicle release or receptor activity.



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Normal Correspondence of Tectal Maps for Saccadic Eye Movements in Strabismus

The superior colliculus is a major brainstem structure for the production of saccadic eye movements. Electrical stimulation at any given point in the motor map generates saccades of defined amplitude and direction. It is unknown how this saccade map is affected by strabismus. Three macaques were raised with exotropia, an outwards ocular deviation, by detaching the medial rectus tendon in each eye at age one month. The animals were able to make saccades to targets with either eye and appeared to alternate fixation freely. To probe the organization of the superior colliculus, microstimulation was applied at multiple sites, with the animals either free-viewing or fixating a target. On average, microstimulation drove nearly conjugate saccades, similar in both amplitude and direction, but separated by the ocular deviation. Two monkeys showed a pattern deviation, characterized by a systematic change in the relative position of the two eyes with certain changes in gaze angle. These animals' saccades were slightly different for the right eye and left eye in their amplitude or direction. The differences were consistent with the animals' underlying pattern deviation, measured during static fixation and smooth pursuit. The tectal map for saccade generation appears to be normal in strabismus, but saccades may be affected by changes in the strabismic deviation that occur with different gaze angles. -



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Maximal intermittent contractions of the first dorsal interosseous inhibits voluntary activation of the contralateral homologous muscle

The aim of this study was to investigate how maximal intermittent contractions for a hand muscle influence cortical and reflex activity, as well as the ability to voluntarily activate, the homologous muscle in the opposite limb. Twelve healthy subjects (age: 24 ± 3 years, all right hand dominant) performed maximal contractions of the dominant limb first dorsal interosseous (FDI), and activity of the contralateral FDI was examined in a series of experiments. Index finger abduction force, FDI EMG, motor evoked potentials and heteronomous reflexes were obtained from the contralateral limb during brief non-fatiguing contractions. The same measures, as well as the ability to voluntarily activate the contralateral FDI, were then assessed in an extended intermittent contraction protocol that elicited fatigue. Brief contractions under non-fatigued conditions increased index finger abduction force, FDI EMG, and motor evoked potential amplitude of the contralateral limb. However, when intermittent maximal contractions were continued until fatigue, there was an inability to produce maximal force with the contralateral limb (~30%) which was coupled to a decrease in the level of voluntary activation (~20%). These declines were present without changes in reflex activity, and regardless of whether cortical or motor point stimulation was used to assess voluntary activation. It is concluded that performing maximal intermittent contractions with a single limb causes an inability of the CNS to maximally drive the homologous muscle of the contralateral limb. This was, in part, mediated by mechanisms that involve the motor cortex ipsilateral to the contracting limb.



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High frequency neural activity predicts word parsing in ambiguous speech streams

During speech listening, the brain parses a continuous acoustic stream of information into computational units (e.g. syllables or words) necessary for speech comprehension. Recent neuroscientific hypotheses propose that neural oscillations contribute to speech parsing, but whether they do so on the basis of acoustic cues (bottom-up acoustic parsing) or as a function of available linguistic representations (top-down linguistic parsing) is unknown. In this magnetoencephalography study, we contrasted acoustic and linguistic parsing using bistable speech sequences. While listening to the speech sequences, participants were asked to maintain one of the two possible speech percepts through volitional control. We predicted that the tracking of speech dynamics by neural oscillations would not only follow the acoustic properties but also shift in time according to the participant's conscious speech percept. Our results show that the latency of high-frequency activity (specifically, beta and gamma bands) varied as a function of the perceptual report. In contrast, the phase of low-frequency oscillations was not strongly affected by top-down control. While changes in low-frequency neural oscillations were compatible with the encoding of pre-lexical segmentation cues, high-frequency activity specifically informed on an individual's conscious speech percept.



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Effect of informational content of noise on speech representation in the aging midbrain and cortex

The ability to understand speech is significantly degraded by aging, particularly in noisy environments. One way that older adults cope with this hearing difficulty is through the use of contextual cues. Several behavioral studies have shown that older adults are better at following a conversation when the target speech signal has high contextual content or when the background distractor is not meaningful. Specifically, older adults gain significant benefit in focusing on and understanding speech if the background is spoken by a talker in a language that is not comprehensible to them (i.e. a foreign language). To better understand the neural mechanisms underlying this benefit in older adults, we investigated aging effects on midbrain and cortical encoding of speech when in the presence of a single competing talker speaking in language that is meaningful or meaningless to the listener (i.e., English vs. Dutch). Our results suggest that neural processing is strongly affected by the informational content of noise. Specifically, older listeners' cortical responses to the attended speech signal are less deteriorated when the competing speech signal is an incomprehensible language than when it is their native language. Conversely, temporal processing in the midbrain is affected by different backgrounds only during rapid changes in speech, and only in younger listeners. Additionally, we found that cognitive decline is associated with an increase in cortical envelope tracking, suggesting an age-related over (or inefficient) use of cognitive resources that may explain their difficulty in processing speech targets while trying to ignore interfering noise.



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Dynamic Balance of Excitation and Inhibition Rapidly Modulates Spike Probability and Precision in Feed-Forward Hippocampal Circuits

Feed-forward inhibitory (FFI) circuits are important for many information-processing functions. FFI circuit operations critically depend on the balance and timing between the excitatory and inhibitory components, which undergo rapid dynamic changes during neural activity due to short-term plasticity (STP) of both components. How dynamic changes in excitation/inhibition (E/I) balance during spike trains influence FFI circuit operations remains poorly understood. Here we examined the role of STP in the FFI circuit functions in the mouse hippocampus. Using a coincidence detection paradigm with simultaneous activation of two Schaffer collateral inputs, we found that the spiking probability in the target CA1 neuron was increased while spike precision concomitantly decreased during high-frequency bursts compared to a single spike. Blocking inhibitory synaptic transmission revealed that dynamics of inhibition predominately modulates the spike precision but not the changes in spiking probability, while the latter is modulated by the dynamics of excitation. Further analyses combining whole-cell recordings and simulations of the FFI circuit suggested that dynamics of the inhibitory circuit component may influence spiking behavior during bursts by broadening the width of excitatory postsynaptic responses and that the strength of this modulation depends on the basal E/I ratio. We verified these predictions using a mouse model of Fragile X Syndrome, which has an elevated E/I ratio, and found a strongly reduced modulation of postsynaptic response width during bursts. Our results suggest that changes in the dynamics of excitatory and inhibitory circuit components due to STP play important yet distinct roles in modulating the properties of FFI circuits.



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L-type calcium channels refine the neural population code of sound level

The coding of sound level by ensembles of neurons improves the accuracy with which listeners identify how loud a sound is. In the auditory system, the rate at which neurons fire in response to changes in sound level is shaped by local networks. Voltage-gated conductances alter local output by regulating neuronal firing, but their role in modulating responses to sound level is unclear. Here, we tested the effects of L-type calcium channels (CaL: CaV1.1-1.4) on sound level coding in the central nucleus of the inferior colliculus (ICC), in the auditory midbrain. We characterized the contribution of CaL to the total calcium current in brain slices and then examined its effects on rate-level functions (RLFs) in vivo using single unit recordings in awake mice. CaL is a high-threshold current and comprises ~ 50% of the total calcium current in ICC neurons. In vivo, CaL activates at sound levels that evoke high firing rates. In RLFs that increase monotonically with sound level, CaL boosts spike rates at high sound levels and increases the maximum firing rate achieved. In different populations of RLFs that change nonmonotonically with sound level, CaL either suppresses or enhances firing at sound levels that evoke maximum firing. CaL multiplies the gain of monotonic RLFs with dynamic range, and divides the gain of nonmonotonic RLFs with the width of the RLF. These results suggest that a single broad class of calcium channels activates enhancing and suppressing local circuits to regulate the sensitivity of neuronal populations to sound level.



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Early information processing contributions to object individuation revealed by perception of illusory figures

To isolate multiple coherent objects from their surrounds, each object must be represented as a stable perceptual entity across both time and space. Recent theoretical and empirical work has proposed that this process of object individuation is a mid-level operation that emerges around 200-300 ms post-stimulus onset. However, this hypothesis is based on paradigms that have potentially obscured earlier effects. Further, no study to date has directly assessed whether object individuation occurs for task-irrelevant objects. Here we used electroencephalography (EEG) to measure the timecourse of individuation, both for stimuli within and outside the focus of attention, to assess the information processing stage at which object individuation arises for both types of objects. We developed a novel paradigm involving items defined by illusory contours, which allowed us to vary the number of to-be-individuated objects while holding the physical elements of the display constant (a design characteristic not present in earlier work). As early as 100 ms post-stimulus onset, event-related potentials tracked the number of objects in the attended hemifield, but not those in the unattended hemifield. By contrast, both attended and unattended objects could be individuated at a later stage. Our findings challenge recent conceptualizations of the timecourse of object individuation, and suggest that this process arises earlier for attended than unattended items, implying that voluntary spatial attention influences the timecourse of this operation.



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The effect of feeding bypass fat and yeast (Saccharomyces cerevisiae) supplemented total mixed ration on feed intake, rumen fermentation pattern and blood biochemical profile of weaner Surti kids

2016-09-07T22-19-21Z
Source: International Journal of Livestock Research
Sachin Sureshrao Shankhpal, Subhash P Pannerkar.
A study was conducted to evaluate the effect of feeding bypass fat and yeast (Saccharomyces cerevisiae) supplemented total mixed ration comprising of 60: 40 concentrates: jowar hay on the feed intake, rumen fermentation pattern and blood biochemical profile of weaner Surti kids. Twenty-four growing Surti kids of similar body weight were randomly allotted to four groups, six in each. The kids were fed TMR with no bypass fat and yeast (T1); TMR with 2% yeast (T2); TMR with 2% bypass fat (T3) and TMR with a combination of 2% each of yeast and bypass fat (T4). The DM intake of experimental kids did not differ significantly (P>0.05). The rumen parameters studied were within the normal range. The Saccharomyces cerevisiae in combination with bypass fat (T4) group showed highest (P


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Retrospective Study of Reproductive Cases Presented at Veterinary Hospitals in Khartoum state, Sudan

2016-09-07T22-19-21Z
Source: International Journal of Livestock Research
majdi elnaim badawi.
ABSTRACT The prevalence of reproductive disorders in various animals was estimated from records of Veterinary Teaching Hospitals in Khartoum state during period from 2012 to 2015. A total number of 255 cases were recorded all over the state and the maximum cases were recorded in Khartoum (Abuhamama)78 (30.6%) followed by Alkadaro73 (28.6 %) Omdurman 49 (19.2%), Hilt Kuku (Alselate currently) (19.2%) and Shambat 6 (2.3%). Caprine were the most common species admitted to these hospitals (65.1%), thereafter bovine (15.7%), ovine (l2.2%), equine and canine (2.7%) and feline (1.6%). The high prevalence rate was observed for uterine prolapse (23.9%), retained placenta (21.2%), metritis (17.3%), abortions (14.9%) and endometritis (11.0%), while, the low prevalence rate was obtained for pyometra (3.9%), orchitis (2.7%) and tumors and hydrometra (1.6%). The largest numbers of reproductive disorders were treated medically (46.3%) whereas, other diseases were handled manually (27.1%), hormonally (19.6%) and surgically (7.1%).


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CRISPR/Cas9-mediated Genome Editing and Mutagenesis of EcChi4 in Exopalaemon carinicauda

The development of type II clustered regularly interspaced short palindromic repeats (CRISPR) system has resulted in the revolution of genetic engineering and this technology has been applied in genome editing of various species. However, there is no report about the target-specific genome editing in shrimp. In this research, we developed the microinjection method for the ridgetail white prawn Exopalaemon carinicauda and successfully applied the CRISPR/Cas9 technology on the genome editing of E. carinicauda. Through co-injection of mRNA of Cas9 nuclease and gRNA specialized for E. carinicauda chitinase 4 (EcChi4), the shrimp with the indels mutations were obtained. Further analysis showed that the mutations could be transmitted to the next generation. It is the first time that the site-specific genome editing was successfully demonstrated in decapod, which will further contribute to the study of functional genomic in decapods.



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Sequential Turnovers of Sex Chromosomes in African Clawed Frogs (Xenopus) Suggest Some Genomic Regions are Good at Sex Determination

Sexual differentiation is fundamentally important for reproduction, yet the genetic triggers of this developmental process can vary, even between closely related species. Recent studies have uncovered, for example, variation in the genetic triggers for sexual differentiation within and between species of African clawed frogs (genus Xenopus). Here, we extend these discoveries by demonstrating that yet another sex determination system exists in Xenopus, specifically in the species X. borealis. This system evolved recently in an ancestor of X. borealis that had the same sex determination system as X. laevis, a system which itself is newly evolved. Strikingly, the genomic region carrying the sex determination factor in X. borealis is homologous to that of therian mammals, including humans. Our results offer insights into how the genetic underpinnings of conserved phenotypes evolve, and suggest an important role for recycling and shuffling of genetic building blocks with conserved developmental roles.



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Temporal Expression of a Master Regulator Drives Synchronous Sporulation in Budding Yeast

Yeast cells enter and undergo gametogenesis relatively asynchronously, making it technically challenging to perform stage-specific genomic and biochemical analyses. Cell-to-cell variation in the expression of the master regulator of entry into sporulation IME1, has been implicated to be the underlying cause of asynchronous sporulation. Here we find that timing of IME1 expression is of critical importance for inducing cells to undergo sporulation synchronously. When we force expression of IME1 from an inducible promoter in cells incubated in sporulation medium for two hours, the vast majority of cells exhibit synchrony during pre-meiotic DNA replication and meiotic divisions. Inducing IME1 expression too early or too late affects the synchrony of sporulation. Surprisingly, our approach for synchronous sporulation does not require growth in acetate containing medium, but can be achieved in cells grown in rich medium until saturation. Our system solely requires IME1 because the expression of the N6-methyladenosine methyltransferase IME4, another key regulator of early sporulation, is controlled by IME1 itself. The approach described here can be easily combined with other stage specific synchronization methods, and thereby applied to study specific stages of sporulation or the complete sporulation program.



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Effect of Two Lipoprotein (a)-Associated Genetic Variants on Plasminogen Levels and Fibrinolysis

Two genetic variants (rs3798220 and rs10455872) in the apolipoprotein (a) gene (LPA) have been implicated in cardiovascular disease (CVD), presumably through their association with Lipoprotein (a) (Lp(a)) levels. While Lp(a) is recognized as a lipoprotein with atherogenic and thrombogenic characteristics, it is unclear whether or not the two Lp(a)-associated genetic variants are also associated with markers of thrombosis (i.e. plasminogen levels and fibrinolysis). In the present study, we genotyped the two genetic variants in 2919 subjects of the Old Order Amish (OOA) and recruited 146 subjects according the carrier and non-carrier status for rs3798220 and rs10455872, and also matched for gender and age. We measured plasma Lp(a) and plasminogen levels in these subjects, and found that the concentrations of plasma Lp(a) were 2.62 and 1.73 fold higher in minor allele carriers of rs3798220 and rs10455872, respectively, compared with non-carriers (P = 2.04 x 10-17 and P = 1.64 x 10-6, respectively). By contrast, there was no difference in plasminogen concentrations between carriers and non-carriers of rs3798220 and rs10455872. Furthermore, we observed no association between carrier status of rs3798220 or rs10455872 with clot lysis time. Finally, plasminogen mRNA expression in liver samples derived from 76 Caucasian subjects was not significantly different between carriers and non-carriers of these two genetic variants. Our results provide further insight into the mechanism of action behind two genetic variants previously implicated in CVD risk and show that these polymorphisms are not major modulating factors for plasma plasminogen levels and fibrinolysis.



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EGFR Cell Survival Signaling Requires Phosphatidylcholine Biosynthesis

Identification of pro-cell-survival signaling pathways has implications for cancer, cardiovascular and neurodegenerative disease. We show that the Caenorhaditis elegans epidermal growth factor receptor LET-23 has a pro-survival function in counteracting excitotoxicity, and we identify novel molecular players required for this pro-survival signaling. uv1 sensory cells in the C. elegans uterus undergo excitotoxic death in response to activation of the OSM-9/OCR-4 TRPV channel by the endogenous agonist nicotinamide. Activation of LET-23 EGFR can effectively prevent this excitotoxic death. We investigate the roles of signaling pathways known to act downstream of LET-23 EGFR in C. elegans and find that the LET-60 Ras / MAPK pathway, but not the IP3 receptor pathway, is required for efficient LET-23 EGFR activity in its pro-survival function. However, activation of LET-60 Ras / MAPK pathway does not appear to be sufficient to fully mimic LET-23 EGFR activity. We screen for genes that are required for EGFR pro-survival function and uncover a role for phosphatidylcholine biosynthetic enzymes in EGFR pro-survival function. Finally we show that exogenous application of phosphatidylcholine is sufficient to prevent some deaths in this excitotoxicity model. Our work implicates regulation of lipid synthesis downstream of EGFR in cell survival and death decisions.



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Depletion of Shine-Dalgarno Sequences within Bacterial Coding Regions Is Expression Dependent

Efficient and accurate protein synthesis is crucial for organismal survival in competitive environments. Translation efficiency—the number of proteins translated from a single mRNA in a given time period—is the combined result of differential translation initiation, elongation, and termination rates. Previous research identified the Shine-Dalgarno (SD) sequence as a modulator of translation initiation in bacterial genes, while codon usage biases are frequently implicated as a primary determinant of elongation rate variation. Recent studies have suggested that SD sequences within coding sequences may negatively affect translation elongation speed, but this claim remains controversial. Here, we present a metric to quantify the prevalence of SD sequences in coding regions. We analyze hundreds of bacterial genomes and find that the coding sequences of highly expressed genes systematically contain fewer SD sequences than expected, yielding a robust correlation between the normalized occurrence of SD sites and protein abundances across a range of bacterial taxa. We further show that depletion of SD sequences within ribosomal protein genes is correlated with organismal growth rates, supporting the hypothesis of strong selection against the presence of these sequences in coding regions and suggesting their association with translation efficiency in bacteria.



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Predictive Model and Software for Inbreeding-Purging Analysis of Pedigreed Populations

The inbreeding depression of fitness traits can be a major threat for the survival of populations experiencing inbreeding. However, its accurate prediction requires taking into account the genetic purging induced by inbreeding, which can be achieved using a "purged inbreeding coefficient." We have developed a method to compute purged inbreeding at the individual level in pedigreed populations with overlapping generations. Furthermore, we derive the inbreeding depression slope for individual logarithmic fitness, which is larger than that for the logarithm of the population fitness average. In addition, we provide a new software PURGd based on these theoretical results that allows analyzing pedigree data to detect purging and to estimate the purging coefficient, which is the parameter necessary to predict the joint consequences of inbreeding and purging. The software also calculates the purged inbreeding coefficient for each individual, as well as standard and ancestral inbreeding. Analysis of simulation data show that this software produces reasonably accurate estimates for the inbreeding depression rate and for the purging coefficient that are useful for predictive purposes.



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Genome Sequencing of Chromosome 1 Substitution Lines Derived from Chinese Wild Mice Revealed a Unique Resource for Genetic Studies of Complex Traits

Mouse resources such as Collaborative Cross (CC), Outbred Stocks (OS), Hybrid Mouse Diversity Panel (HMDP), and Chromosome Substitution Strains (CSSs) have been instrumental to many progresses in the studies of complex traits genetics. We have established a population of chromosome 1 (Chr 1) substitution lines (C1SLs) in which donor chromosomes were derived from Chinese wild mice. Genome sequencing of 18 lines of this population showed that Chr 1 had been replaced by donor chromosome. About 4.5 million unique single nucleotide polymorphisms (SNPs) and indels were discovered on Chr 1, of which, 1.3 million were novel. Compared with sequenced classical inbred (CI) strains, Chr 1 of each C1SL had five fold more variants, and more loss of function and potentially regulatory variants. Further haplotype analysis showed that donor chromosome accumulated more historical recombination events with the largest haplotype block being only 100kb and about 57% of the blocks were less than 1kb. Subspecies origin analysis showed that these chromosomes had mosaic genome structure which dominantly originated from M. m. musculus and M. m. canstanes subspecies except for C57BL/6J-Chr 1KM (KM) line from M. m. domesticus. In addition, phenotyping four of these lines on blood biochemistry suggested that there were substantial phenotypic variations among our lines, especially line C57BL/6J-Chr 1HZ (HZ) and donor strain C57BL/6J (B6). Further GO enrichment revealed that the differentially expressed genes among liver expressed genes between B6 and HZ were enriched in lipid metabolism biological processes. All these characteristics enabled C1SLs to be a unique resource for identifying and fine mapping quantitative trait loci (QTLs) on mouse Chr 1, and carrying out systems genetics studies of complex traits.



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Intermittent hypoxia induces murine macrophage foam cell formation by IKK-{beta}-dependent NF-{kappa}B pathway activation

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by intermittent hypoxia (IH). Clinical studies have previously shown that OSA is an independent risk factor for atherosclerosis. Atherogenicity in OSA patients has been assumed to be associated with the NF-B pathways. Although foam cells are considered to be a hallmark of atherosclerosis, how IH as in OSA affects their development has not been fully understood. Therefore, we hypothesized that IH induces macrophage foam cell formation through NF-B pathway activation. To test this hypothesis, peritoneal macrophages collected from myeloid-restricted IKK-β-deleted mice were incubated with native LDL and exposed to either IH or normoxia. After exposure, NF-B pathway activity and intracellular cholesterol were measured. In control macrophages, IH significantly increased NF-B pathway activity by 93% compared with normoxia (P < 0.05). However, such response to IH was diminished by IKK-β deletion (increased by +31% compared with normoxia; P = 0.64), suggesting that IKK-β is critical for IH-induced NF-B pathway activation. Likewise, in control macrophages, total cholesterol was increased in IH compared with normoxia (65.7 ± 3.8 μg/mg cellular protein and 53.2 ± 1.2, respectively; P < 0.05). However, this IH-induced foam cell formation was disappeared when IKK-β was deleted (52.2 ± 1.2 μg/mg cellular protein for IH and 46.3 ± 1.7 for normoxia; P = 0.55). This IH-mediated effect still existed in macrophages without LDL receptor. Taken together, our findings show that IH activates the IKK-β-dependent NF-B pathway and that this, in turn, induces foam cell formation in murine macrophages.



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Dietary nitrate supplementation: impact on skeletal muscle vascular control in exercising rats with chronic heart failure

Chronic heart failure (CHF) results in central and peripheral derangements that ultimately reduce skeletal muscle O2 delivery and impair exercise tolerance. Dietary nitrate (NO3) supplementation improves skeletal muscle vascular function and tolerance to exercise. We tested the hypothesis that NO3 supplementation would elevate exercising skeletal muscle blood flow (BF) and vascular conductance (VC) in CHF rats. Myocardial infarction (MI) was induced (coronary artery ligation) in young adult male rats. After 21 days of recovery, rats randomly received 5 days of NO3-rich beetroot juice (CHF + BR, n = 10) or a placebo (CHF, n = 10). Mean arterial pressure (carotid artery catheter) and skeletal muscle BF (radiolabeled microspheres) were measured during treadmill exercise (20 m/min, 5% grade). CHF-induced dysfunction, as determined by myocardial infarction size (29 ± 3% and 33 ± 4% in CHF and CHF + BR, respectively) and left ventricular end-diastolic pressure (18 ± 2 and 18 ± 2 mmHg in CHF and CHF + BR, respectively), and exercising mean arterial pressure (131 ± 3 and 128 ± 4 mmHg in CHF and CHF + BR, respectively) were not different (P > 0.05) between groups. Total exercising hindlimb skeletal muscle BF (95 ± 5 and 116 ± 9 ml·min–1·100 g–1 in CHF and CHF + BR, respectively) and VC (0.75 ± 0.05 and 0.90 ± 0.05 ml·min–1·100 g–1·mmHg–1 in CHF and CHF + BR, respectively) were 22% and 20% greater in BR-supplemented rats, respectively (P < 0.05). During exercise, BF in 9 and VC in 10 hindlimb muscles and muscle portions were significantly greater in the CHF + BR group. These results provide strong evidence that dietary NO3 supplementation improves skeletal muscle vascular function during exercise in rats with CHF and, thus, support the use of BR as a novel therapeutic modality for the treatment of CHF.



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Superior Labral Anterior-posterior Lesions in Rock Climbers—primary Double Tenodesis?: Erratum

No abstract available

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Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II)

imageObjective: To determine whether paper tape prevents foot blisters in multistage ultramarathon runners. Design: Multisite prospective randomized trial. Setting: The 2014 250-km (155-mile) 6-stage RacingThePlanet ultramarathons in Jordan, Gobi, Madagascar, and Atacama Deserts. Participants: One hundred twenty-eight participants were enrolled: 19 (15%) from the Jordan, 35 (27%) from Gobi, 21 (16%) from Madagascar, and 53 (41%) from the Atacama Desert. The mean age was 39.3 years (22-63) and body mass index was 24.2 kg/m2 (17.4-35.1), with 31 (22.5%) females. Interventions: Paper tape was applied to a randomly selected foot before the race, either to participants' blister-prone areas or randomly selected location if there was no blister history, with untaped areas of the same foot used as the control. Main Outcome Measures: Development of a blister anywhere on the study foot. Results: One hundred six (83%) participants developed 117 blisters, with treatment success in 98 (77%) runners. Paper tape reduced blisters by 40% (P

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A Sport Fitness Index for Assessment of Sport-Related Injury Risk

imageObjective: To develop and validate a concise survey that will identify athletes who possess elevated injury risk. Design: Cohort study. Setting: National Collegiate Athletic Association Division I athletic program. Participants: Cohorts of 188 and 146 college athletes who participated during successive academic years. Assessment of Risk Factors: The first cohort provided responses to 4 joint-specific outcome surveys that were related to subsequent time-loss injury occurrence. Receiver operating characteristic analysis identified survey items that provided best discrimination, which were combined with a negative life event stress item to create a new 10-item survey. The second cohort provided responses to the new survey, which were converted to a 0 to 100 score. Main Outcome Measures: Construct validity was assessed through documentation of time-loss injuries sustained during the preceding 12 months and predictive validity was assessed through prospective documentation of sport-related sprains and strains. Cronbach alpha was calculated to assess internal consistency. Results: Each of the outcome survey items used to develop the new survey demonstrated much greater specificity than sensitivity. Both the retrospective and prospective receiver operating characteristic (ROC) analyses identified scores of 96 and 88 as cut-points that provided good discrimination between injured and noninjured cases. The area under the curve was 0.69 (P

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Five-Year Experience with Screening Electrocardiograms in National Collegiate Athletic Association Division I Athletes

imageObjective: (1) Compare rates of abnormal screening electrocardiograms (ECGs) using updated criteria compared with older criteria. (2) Compare rates of abnormal ECGs by ethnicity. (3) Evaluate ability of ECG criteria to detect the predicted number of athletes with previously undetected cardiovascular abnormalities. Design: Prospective and retrospective review of ECGs. During the prospective portion of the study, the 2005 European Society of Cardiology criteria were used from 2008 to July 2011 and the 2011 Stanford criteria were used from August 2011 to 2013. Retrospectively, all ECGs were reevaluated using the 2011 Stanford criteria, 2013 Seattle criteria, and 2014 Sharma Refined criteria. Setting: Division I National Collegiate Athletic Association University. Participants: 874 incoming athletes over a 5-year period. Interventions: ECG screening program. Main Outcome Measures: Number of abnormal ECGs and number of athletes with newly discovered cardiac abnormalities. Results: Abnormal ECG rates were the 2005 European criteria 10.7%, 2011 Stanford criteria 6.6%, 2013 Seattle criteria 2.8%, and 2014 Sharma Refined criteria 2.8%. In black athletes, the Stanford criteria resulted in more abnormal ECGs compared with Seattle or Sharma Refined. Three athletes were found to have a previously undetected cardiac abnormality (2 with hypertrophic cardiomyopathy and 1 with preexcitation). Conclusions: More recent ECG screening criteria substantially reduce the abnormal ECG rate and thus the number of athletes requiring additional testing. ECG screening criteria identified the predicted number (1/300) of young athletes with serious underlying cardiovascular disease. These criteria prompt not only additional cardiovascular testing but also a more thorough cardiovascular history.

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AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions

imageABSTRACT: Cardiovascular (CV) screening in young athletes is widely recommended and routinely performed before participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for CV screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation CV screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal CV screening strategy for all athletes including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate CV screening strategy unique to their athlete population, community needs, and resources. The decision to implement a CV screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. American Medical Society for Sports Medicine is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.

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Low Back Pain in Young Basketball and Floorball Players

imageObjective: The aim of the study was to investigate the prevalence and risk factors of low back pain (LBP) in young female and male basketball and floorball players. Design: Cross-sectional study. Setting: Nine basketball teams and 9 floorball teams from Tampere city district, Finland. Participants: Four hundred one young female and male players (mean age: 15.8 ± 1.9 years). Assessment of Risk Factors: Age, gender, sport, and family history of musculoskeletal disorders were assessed as risk factors for LBP. Adjustment was made on team level to avoid random effects associated with a team. Main Outcome Measures: Information of players' background factors and LBP episodes was collected by a structured questionnaire. Results: Forty-four percentage of the basketball players and 62% of floorball players had suffered from LBP during the previous 12 months. Prevalence of LBP during the previous year was significantly higher among floorball players (P = 0.001). In both sports, prevalence of pain symptoms was the highest during the competitive playing season. Family history of musculoskeletal disorders [OR (odds ratio), 2.02, 95% confidence interval (CI), 1.22-3.34] and higher age (OR, 1.22, 95% CI, 1.05-1.41) were associated with LBP in players. Conclusions: The study attested that LBP is a relatively common complaint in young team sport players. Targeted measures to examine causes, risk factors, and prevention of LBP in youth sports are needed.

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Does Game Participation Impact Cognition and Symptoms in Elite Football Players?

imageObjective: To measure neurocognitive functioning in college and professional football players after game participation. Study Design: Retrospective, cross-sectional cohort design. Participants: Ninety-four male university and professional football players. Intervention: All participants completed Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) testing at baseline, and either at postconcussion (group 1) or postgame (group 2) participation. Main Outcome Measures: Results from the 5 ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time and Impulse Control) and Total Symptom Score. Results: Repeated-measures analysis of variance demonstrated a significant main effect for time (improvements) in 3 of 5 domains for the postconcussion group, but no improvements in the postgame group. The postconcussion group presented with significantly improved results on 4 of 5 ImPACT domains compared with the postgame group at the follow-up time interval. Conclusions: Participation in a football game with potential cumulative head contacts did not yield increased symptoms or cognitive impairment. However, the absence of improvement in cognitive functioning in noninjured football players, which was found in those players who were returned to play after an injury, may suggest that there is a measureable impact as a result of playing football.

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Concussion Management Practice Patterns Among Sports Medicine Physicians

imageObjective: The primary purpose of this study was to examine concussion management practice patterns among sports medicine physicians in the United States. Design: Cross-sectional study using a web-based survey. Participants: Members of the American Medical Society for Sports Medicine (AMSSM). Main Outcome Measures: We distributed a questionnaire to physician members of the AMSSM assessing the current practices for evaluating and managing concussions sustained during sports. Specifically, we asked respondents about their use of management guidelines, medications, balance assessments, neuropsychological tests, and return-to-play strategies. Results: Of the 3591 members emailed, 425 (11.8%) respondents responded. Ninety-seven percent of respondents reported basing current management of sport-related concussion on a published set of criteria, with a majority (91.9%) following the guidelines provided by the Fourth International Conference on Concussion in Sport. Seventy-six percent of respondents reported using medication beyond 48 hours postinjury. Acetaminophen was reported as the most commonly administered medication, although tricyclic antidepressants and amantadine were also commonly administered. Vitamins, minerals, and dietary supplements were also reported as commonly administered. Most respondents reported using a form of neuropsychological testing (87.1%). A majority of respondents (88.6%) reported allowing athletes to return to competition after concussion only once the athlete becomes symptom free and completes a return-to-play protocol. Conclusions: Most sports medicine physicians seem to use recently developed guidelines for concussion management, regularly use medications and neuropsychological testing in management strategies, and follow established return-to-play guidelines. Clinical Relevance: Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.

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Hamstring Injury After Swimming in a Patient With Multiple Hereditary Osteochondromatosis

imageAbstract: Reported here is a 20-year-old male suffered a hamstring strain after a prolonged bout of swimming. After ultrasound imaging, the patient's injury was considered to be the result of nearby osteochondromas. Case reports have been previously published concerning anterior cruciate ligament injury, rotator cuff tears, subacromial impingement, or femoroacetabular impingement in multiple osteochondromatosis. However, to the best of our knowledge, this is the first reported case of a hamstring injury secondary to an osteochondroma.

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Young Athletes' Concerns About Sport-Related Concussion: The Patient's Perspective

imageObjective: Few studies have examined the experience and concerns of the concussed athlete. The purpose of this study was to identify the most pressing concerns of athletes with concussion. Design: Cross-sectional survey of athletes who presented for evaluation of a new sport-related concussion during an 8-month period. Setting: Tertiary-level sports medicine division of a large academic pediatric medical center. Participants: One hundred twenty one patients (67 male, 54 female) aged 8 to 18 years who had sustained a sport-related concussion participated in the study by responding to "What is the worst thing for you about having a concussion?" on the study questionnaire. Questionnaires were completed in the clinic waiting room before the visit with a provider. Intervention: Inductive content analysis was used to identify themes in the responses to the study question. Main Outcome Measures: Age, sex, sport played at the time of the current injury, history of previous concussion, known contacts with concussion, and subjective report of worst aspect of concussion. Results: Seventy respondents (57.9%) cited symptoms, and 68 (56.2%) reported loss of activity as the worst part of concussion, including 17 (14.0%) who listed both symptoms and loss of activity. Conclusions: Over half of concussed athletes indicate that the most distressing part of the injury is loss of activities, which may result from symptoms of the injury itself and/or the prescribed treatment. Clinical Relevance: Health care providers should not underestimate the degree to which symptoms and loss of activities affect young athletes' general well-being. In addition to the negative impact of concussion symptoms, there is an obvious cost of physical, cognitive, and social activity restrictions for patients recovering from sport-related concussions that should be explicitly addressed.

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Does Acute Kidney Injury From an Ultramarathon Increase the Risk for Greater Subsequent Injury?

imageObjective: Examine whether the acute kidney injury (AKI) commonly observed among ultramarathon participants places the individual at risk for subsequent AKI of worse magnitude. Design: Observational. Setting: Western States Endurance Run. Participants: Race finishers with postrace blood studies. Independent Variable: Acute kidney injury after 1 race. Main Outcome Measures: Extent of AKI in subsequent race. Results: Among 627 finishes in which serum creatinine values were known, 36.2% met "risk" or "injury" criterion with this group characterized by having faster finish times, greater body weight loss during the race, and higher postrace serum creatine kinase and urea nitrogen concentrations when compared with those not meeting the criteria. We identified 38 runners who had undergone postrace blood analyses at multiple races among which 16 (42.1%) met the risk or injury criterion at the first race. Of those 16 runners, 12 (75%) met the criteria at a subsequent race, an incidence that was higher (P = 0.0026) than the overall 36.2% incidence. For most (56.2%) of the 16 runners meeting the criteria at the first race, the subsequent race caused less increase in serum creatinine concentration and decrement in estimated glomerular filtration rate than the first race. Conclusions: Mild AKI is common in 161-km ultramarathons, but there was no evidence that previous AKI caused greater renal dysfunction from a subsequent exercise stimulus of similar magnitude. This offers some reassurance to runners and their physicians that mild to moderate AKI in the setting of an ultramarathon is not cumulative or without complete recovery of kidney function when stressed.

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Content, Delivery, and Effectiveness of Concussion Education for US College Coaches

imageObjective: The primary objective of this study was to examine the proportion of US college coaches who receive annual concussion education from their institution and to describe the content and delivery modalities of this education. This study also tested the hypothesis that coaches receiving concussion education from their institution will have greater knowledge about concussions independent of other individual and institutional characteristics. Design: Cross-sectional online survey. Setting: US college sport. Participants: College coaches in National Collegiate Athletic Association Division I, II, and III (n = 1818). Independent Variables: Self-reported receipt of education from institution, sex, sport coached, division of competition. Main Outcome Measures: Concussion identification and management knowledge. Results: Two-thirds of coaches reported receiving informational materials about concussion from their institution. The content of the education most frequently referred to symptoms of a concussion and information about proper management of a concussion. Coaches who received educational materials from their institution were better able to identify symptoms and had more conservative responses to concussion management scenarios. Male coaches of male contact or collision teams less frequently endorsed safe or correct response as compared with female coaches of noncontact or collision teams. Conclusions: Not all US college coaches receive concussion education from their institution. Male Division I coaches of male contact/collision sport are a population for whom targeted educational outreach may be particularly valuable. Clinical Relevance: Education for coaches, delivered by clinicians at many institutions, is an important component of ensuring that coaches are prepared to be informed partners in supporting concussion safety.

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Increasing Incidence and Unique Clinical Characteristics of Spinning-Induced Rhabdomyolysis

imageObjective: To compare outcomes of spinning-induced rhabdomyolysis to those with exertional rhabdomyolysis from other physical activities. Design: Retrospective cohort study. Setting: Academic medical center, single-center. Patients: A retrospective chart review was conducted on patients evaluated from December 2010 through November 2014. Patients were selected by ICD-9 code for rhabdomyolysis. Patients were included if the reason for admission was rhabdomyolysis caused by exertion. Cases of rhabdomyolysis caused by trauma or drugs were excluded. Main Outcome Measures: Muscle group involvement, admission, and peak creatine kinase levels, time from activity to hospitalization, length of hospital stay, and incidence of complications. Results: Twenty-nine cases were reviewed with 14 admissions secondary to spinning. Median admission creatine kinase (73 000 IU/L vs 29 000 IU/L, P = 0.02) and peak creatine kinase levels were significantly higher in the spinning group (81 000 IU/L vs 31 000 IU/L, P = 0.007). Hospital admissions for spinning-induced rhabdomyolysis increased over time. Conclusion: Health care providers should be aware of the potential dangers of spinning-related rhabdomyolysis especially in otherwise healthy young people.

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Incidence and Factors Associated With Concussion Injuries at the 2011 to 2014 South African Rugby Union Youth Week Tournaments

imageObjective: To determine the concussion incidence and to identify factors associated with concussion in South African youth rugby union players. Design: Prospective cohort study. Setting: Injury surveillance was completed at the South African Rugby Union Youth Week tournaments (under-13, under-16, and under-18 age groups). Participants: South African youth rugby union players. A total of 7216 players participated in 531 matches between 2011 and 2014. Interventions: None. Main Outcome Measures: Concussion incidence was calculated per 1000 player-match-hours with 95% CIs. Poisson regression was used to calculate the incidence rate ratio (IRR) between factors (age, time period, playing position, and activity at the time of concussion) potentially associated with concussions. Results: The concussion incidence was 6.8/1000 player-match-hours (95% CI, 5.5-8.1) across all age groups. Under-13s (IRR, 1.5; P = 0.09) and under-16s (IRR, 1.7; P = 0.03) had higher concussion incidence rates than the under-18 age group. The incidence was higher in the third (IRR, 2.1; P = 0.04) and fourth (IRR, 2.5; P = 0.01) quarters of matches compared with the first quarter. Sixty-two percent of concussions occurred in the tackle situation. The tackler had a 4-fold greater concussion rate (IRR, 4.3; P

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Incidence and Etiology of Sudden Cardiac Death and Arrest in High School Athletes. Clinical Journal of Sport Medicine: Erratum

No abstract available

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Characteristics and Risk Factors of Spinal Fractures in Recreational Snowboarders Attending an Emergency Department in Japan

imageObjective: The purpose of this study was to elucidate the characteristics of spinal fractures during recreational snowboarding and to determine the risk factors for these fractures. Design: Case series study. Setting: The Oku-mino ski area during the 7-year period between the 2005 to 2006 and 2011 to 2012 skiing seasons. Participants: Eight thousand seven hundred twenty-three snowboarders with injures. Interventions: Cases involved snowboarders with spinal fractures; controls were snowboarders without spinal fractures. Main Outcome Measures: The characteristics of spinal fractures were assessed using a standard form and patient records, including radiographs. Multivariate regression analysis was performed to investigate risk factors for spinal fractures, including age, type of slope, snow condition, accident cause, self-reported skill level, experience level, and the use of protective equipment. Results: Of 8723 snowboarders with injuries, 431 snowboarders presented with spinal fractures (4.9%). The most common spinal fracture was isolated transverse process fracture in the lumbar spine (33.2%, n = 143), followed by compression type fracture in the lumbar spine (25.1%, n = 108). Age (20-39 years), terrain slopes (half-pipe/box/kicker/rail), and jump-landing failure were associated with a significantly high risk of spinal fracture. Conclusions: Among the recreational snowboarders, isolated transverse process fracture in the lumbar spine was the most frequent spinal fracture. Age (20-39 year old), terrain slopes, and jump-landing failure were found to be risk factors for spinal fracture. Clinical Relevance: Identification of characteristics and risk factors for spinal fractures during snowboarding is useful information to create a preventive strategy for the fractures and make snowboarding a safer sport.

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Blood and Urinary Abnormalities Induced During and After 24-Hour Continuous Running: A Case Report

imageAbstract: In this reported clinical case, a healthy and well-trained male subject [aged 37 years, maximal oxygen uptake (V[Combining Dot Above]O2max) 64 mL·kg−1·min−1] ran for 23 hours and 35 minutes covering 160 km (6.7 km/h average running speed). The analysis of hematological and biochemical parameters 3 days before the event, just after termination of exercise, and after 24 and 48 hours of recovery revealed important changes on muscle and liver function, and hemolysis. The analysis of urine sediments showed an increment of red and white blood cells filtrations, compatible with transient nephritis. After 48 hours, most of these alterations were recovered. Physicians and health professionals who monitor such athletic events should be aware that these athletes could exhibit transient symptoms compatible with severe pathologies and diseases, although the genesis of these blood and urinary abnormalities are attributable to transient physiological adaptations rather to pathological status.

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Lower Extremity Movement Differences Persist After Anterior Cruciate Ligament Reconstruction and When Returning to Sports

imageObjective: To examine how landing mechanics change in patients after anterior cruciate ligament reconstruction (ACL-R) between 6 months and 12 months after surgery. Design: Case-series. Setting: Laboratory. Participants: Fifteen adolescent patients after ACL-R participated. Interventions: Lower extremity three-dimensional motion analysis was conducted during a bilateral stop jump task in patients at 6 and 12 months after ACL-R. Joint kinematic and kinetic data, in addition to ground reaction forces, were collected at each time point. Main Outcome Measures: During the stop jump landing, the peak joint moments and the initial and peak joint motion at the ankle, knee, and hip were examined. The peak vertical ground reaction force was also examined. Results: Interactions were observed for both the peak knee (P = 0.03) and hip extension moment (P = 0.07). However, only the hip extension moment was symmetrical level at 12 months. Statistically significant (P

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A Rare Case of Quadratus Femoris Muscle Rupture After Yoga Exercises

imageAbstract: We present a case of a female patient with left groin pain after intense yoga exercises. The patient presented abnormal pattern of gait with no swelling over the groin, thigh, or buttock. Magnetic resonance imaging demonstrated a tear of the quadratus femoris muscle with an associated extensive hematoma formation. Patient was treated with a rehabilitation program consisting of nonsteroidal anti-inflammatory drugs and physiotherapy. At the follow-up control, the patient had improved her pain and flexibility of the hip, and gradually she returned to daily activities and yoga exercises. Such an entity is a rare cause of hip pain after exercise and should be kept in mind by the orthopedic surgeon, in cases of gluteal pain after intense physical activity. Moreover, such a condition should be included in the diagnostic algorithm of unknown origin hip pain.

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Effects of aging on the food intake in the feeding behavior of Aplysia kurodai

Abstract

In wild Aplysia, the birthdate of animals can typically not be determined. Therefore, we sought a reliable index of old age by taking into consideration the distinguished Japanese seasons. Large amounts of eggs and dead bodies were present on the coast during and after the second half of May (MayS). Body mass decreased after May. We roughly classified animals collected before and after the MayS as mature and old animals. Plots of internalized shell length (S) against body mass (B) gave distinct best-fit curves for mature and old animals. The B/S significantly decreased in the second half of June, suggesting that body mass decreases with age but shell length is maintained in each animal. Therefore, the collected animals were classified into mature and old animals using the best-fit curves for animals classified by the collection period. We examined the amount of food intake every 2 h up to 8 h after providing food. The amounts increased linearly, and the rate was significantly lower in old animals than in mature animals. The amount of 1-day food intake was also significantly lower in old animals. These results suggest that food intake may decline with age and this may cause mass loss in old animals.



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Utility of electroencephalography: Experience from a U.S. tertiary care medical center

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Publication date: October 2016
Source:Clinical Neurophysiology, Volume 127, Issue 10
Author(s): Kapil Gururangan, Babak Razavi, Josef Parvizi
ObjectiveTo investigate the utility of electroencephalography (EEG) for evaluation of patients with altered mental status (AMS).MethodsWe retrospectively reviewed 200 continuous EEGs (cEEGs) obtained in ICU and non-ICU wards and 100 spot EEGs (sEEGs) obtained from the emergency department (ED) of a large tertiary medical center. Main outcomes were access time (from study request to hookup), and diagnostic yield (percentage of studies revealing significant abnormality).ResultsAccess time, mean±SD (maximum), was 3.5±3.2 (20.8) hours in ICU, 4.8±5.0 (25.6) hours in non-ICU, and 2.7±3.6 (23.9) hours in ED. Access time was not significantly different for stat requests or EEGs with seizure activity. While the primary indication for EEG monitoring was to evaluate for seizures as the cause of AMS, only 8% of cEEGs and 1% of sEEGs revealed seizures. Epileptiform discharges were detected in 45% of ICU, 24% of non-ICU, and 9% of ED cases, while 2% of ICU, 15% of non-ICU, and 45% of ED cases were normal.ConclusionsAccess to EEG is hampered by significant delays, and in emergency settings, the conventional EEG system detects seizures only in a minority of cases.SignificanceOur findings underscore the inefficiencies of current EEG infrastructure for accessing diagnostically important information, as well as the need for more prospective data describing the relationship between EEG access time and EEG findings, clinical outcomes, and cost considerations.



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Frequent Flyers: EMS professional growth scale

A comic for EMS drawing off the real experiences of EMS

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Harnessing the Power of Public Safety Communications Centers

By Jay Fitch, PhD

When I think about the way our colleagues in communications are treated, I often think of Rodney Dangerfield's classic comedy routine: Telecommunicators simply don't get the respect they deserve.

When civilians were first utilized in 911 centers, workers were predominately female. Their role was largely considered a secretarial function by male-dominated leadership. Times have changed and so have the capabilities and responsibilities of communications center personnel.

But old paradigms and perceptions persist. Recently a federal committee considering revisions to the Standard Occupational Classification system determined that it would not change the official classification under which Public Safety Telecommunicators are designated. They remain undervalued as "office and administrative support" workers rather than being acknowledged as the professionals we depend on every day.

Far more than call takers
Front line communications personnel do far more than answer the phone. They guide callers through complex algorithms, provide pre-arrival instructions and give advice on how to handle critical situations.

They are the initial first responders and provide a safety lifeline for field responders. Communications personnel work under a unique kind of pressure and stress.

It's well known that when an incident does not initially go well at dispatch, the potential for issues on scene and at other points in the customer service cycle increases exponentially. For EMS agencies, measuring the customer experience is one of the components of the Institute for Healthcare Improvement's Triple Aim and is anticipated to be a factor in Medicare reimbursement in the future. Effective call reception and pre-arrival instructions significantly influence how patients and families perceive the care and service they receive.

Beyond that role, communications centers are a key element when optimizing the system's agility, efficiency and effectiveness. I frequently refer to communications personnel as the brains of the service with communicators serving in a quasi-supervisory role.

As calls ebb and flow, managing deployment and mobilizing and re-allocating resources have become higher-level tasks for modern centers. Monitoring crew meal breaks, unit-hour utilization and fatigue are emerging day-to-day responsibilities of communications centers.

Effective centers work closely with field personnel and top leaders proactively to shape the system's deployment plan. They constantly manage risk by balancing coverage, demand and crew resources.

Emerging opportunities
Expanded roles for communications centers are also emerging. A number of centers, including University Medical Center EMS in Lubbock, Texas, provide call center services and bed coordination for area hospitals.

Others deliver advanced communication services, such as nurse advice lines and support for community paramedic programs and home health agencies. More proactive, out-bound call services including post-discharge well-being follow-ups, medication checks as well as other in-home monitoring services are helping prevent hospital re-admissions. In addition to filling gaps in the health care system, these new services may become additional revenue opportunities for communications centers.

Data are the lifeblood of modern public safety systems; progressive communications centers have assumed a significantly expanded role integrating multiple data sets from CAD systems, clinical initiatives, fire prevention and other administrative record management systems. The real challenge is harnessing and analyzing that information to turn it into useful intelligence that becomes a powerful force, facilitating decisions that shape the system in a positive way.

Training and development
Changing responsibilities require communications center leaders to have a broader set of skills than in the past. Forward thinking police, fire and EMS agencies are focusing on development of these personnel. The International Academies of Emergency Dispatch, National Emergency Number Association and the Association of Public-Safety Communications Officials each sponsor development programs.

The IAED's Communications Center Managers program is comprehensive and covers human resources, finance, operations and deployment, customer and media relations, administration, legal issues, managing technology and other emerging issues. CCM is taught by well-known industry leaders in an interactive learning environment. It provides emerging and experienced leaders an expanded professional network as well as the perspective essential for successful participation on their agency's senior leadership team.

Public safety systems are being challenged to do more with less. Budgets and staff are decreasing even as demands for expanded services, improved efficiency and compulsory sustainability initiatives are on the rise. Transforming the communications center paradigm from order entry personnel to a high-functioning team capable of providing meaningful input on day-to-day operations and emerging strategies is essential to an agency's long-term success. Supporting administrators' decision-making by providing valuable data and information demonstrates clear value and is a solid way to harness the power of communications centers for the future.

Jay Fitch is the founding partner at Fitch & Associates, which has provided leadership development and consulting for emergency services for more than three decades.



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From volunteer EMT to Deputy Secretary of Health: Lessons learned

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By Paramedic Chief

Raphael M. Barishansky, a long time EMS industry leader and advocate was sworn in by Governor Tom Wolf, Pennsylvania, as a Deputy Secretary of Health in August.

Barishansky's long journey to the highest levels of state government began as an EMT in Teaneck, New Jersey, more than twenty years ago, and has seen him achieve positions of increasing responsibility in both EMS and public health. In addition, Barishansky is an accomplished author and a regular speaker at various state, national and international conferences.

Transitioning from field provider to supervisor to manager to executive to high level political appointee calls for various skills sets. Paramedic Chief had the chance to speak with Barishansky after his swearing-in ceremony about some of the most important lessons he learned on his journey from EMT to Deputy Secretary of Health that future EMS leaders can utilize as they make their way on their career journey.

Paramedic Chief: You have a variety of degrees and professional certifications. Higher education is a hot topic in EMS and many providers stand on either side of the issue. How can higher education or education beyond professional requirements benefit aspiring leaders"

Barishansky: One of the things that really helped establish me in our profession was my academic credentials. Aside from the credential itself, one of the things that employers see in academic achievements is the ability for you to set a goal and then accomplish that goal. Also, with education comes flexibility, in regard to positions, responsibilities and even potentially geography if you have to move for a position.

Paramedic Chief: Do you have any suggestions on other ways for aspiring leaders to further their educations"

Barishansky: I continually educate myself by learning from everybody. Realize that many of the people around you have a perspective that you may not have; they may have an experience set that you don't. Use their experience and perspective. This goes for everything from purchasing a new ambulance or piece of equipment to understanding who the real decision makers are in an organization to even learning when to stay quiet, and when to speak up, during a critical meeting.

Paramedic Chief: Learning from others is a great point, but some aspiring, or even new, leaders may be intimidated by asking for help while they are just starting out. What advice do you offer for them"

Barishansky: Don't be afraid to ask for help. I have seen many instances where a manager, especially a newer manager, doesn't want to ask for assistance on a project. I have even been guilty of this myself.

Maybe you don't want to ask because you don't want to look weak or unknowledgeable, but that is a mistake. Many times, the answer to your issue can be found either internally in your organization or by asking those externally but in similar positions.

There have been very few times in my career when I have had to confront an entirely unique issue that others haven't dealt with already.

Paramedic Chief: Medicine has long employed mentoring to develop providers and business has utilized it in professional development as well. What do you think about mentoring in developing EMS leaders"

Barishansky: Be both a mentor and a mentee. On every step of my particular journey, there have been people that I have turned to for advice in regard to academics, a potential job opportunity or even assistance with getting onto the lecture circuit.

Time and again, these people, my personal board of directors so to speak, have come through with balanced perspective and useful advice. Reach out to the people you know who have been there and done it with questions about their successes and potential pitfalls.

Similarly, as you establish your own individual path, share what you have learned with those around you, those making their way up, those with questions about how you got to where you are and what to look out for. It's your responsibility to give back and help prepare those coming after you.

Paramedic Chief: What would you say to EMS providers looking to make the jump to an administrative position or an allied profession such as emergency management or public health preparedness"

Barishansky: Don't be afraid of the unknown. I was very secure in my career as a Regional EMS Council director when a job in public health preparedness presented itself. It was a gamble and involved me utilizing skills that I didn't use regularly and could have backfired on me. But I took the chance and jumped into that world. That gamble paid off in the long run as my skill set in two different disciplines — EMS and public health — were a factor in obtaining my last two positions.

Paramedic Chief: What advice would you give aspiring EMS leaders to use in the workplace once they have made the transition from provider to manager"

Barishansky: It's ok to say no — yes, that's correct, you can say no.

There will come a time when someone you report to will ask you to do something that simply isn't in your wheelhouse or should belong to another manager. Do not simply say no. That would be a mistake.

Explain clearly why you think this is a responsibility or project that is best handled by someone else. Also remember that saying no should not be your go-to response to every request. Save no for when it really matters.

Paramedic Chief: What are some additional words of encouragement or advice to aspiring or new EMS leaders"

Barishansky: Becoming successful is usually based on a combination of factors: education, motivation, dedication to the job, mobility and even the mentors you choose. Join work groups, professional boards and pursue your career outside of the office.

If you move into emergency management or public health to advance your career, you can come back to EMS. Career paths are not always linear. My career has certainly not been linear and can be best described as multidisciplinary.

Understand that there is a road map, but there are times when you will need to throw the road map out the window and forge your own journey. Turn to those around you who are successful and ask how they got where they are.

Finally, do not let rejection slow you down. Whether it's not getting published or accepted for a conference, or not getting the job you wanted, you have to keep putting one foot in front of the other and moving forward.



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Harnessing the Power of Public Safety Communications Centers

By Jay Fitch, PhD

When I think about the way our colleagues in communications are treated, I often think of Rodney Dangerfield's classic comedy routine: Telecommunicators simply don't get the respect they deserve. 

When civilians were first utilized in 911 centers, workers were predominately female. Their role was largely considered a secretarial function by male-dominated leadership. Times have changed and so have the capabilities and responsibilities of communications center personnel.

But old paradigms and perceptions persist. Recently a federal committee considering revisions to the Standard Occupational Classification system determined that it would not change the official classification under which Public Safety Telecommunicators are designated. They remain undervalued as "office and administrative support" workers rather than being acknowledged as the professionals we depend on every day. 

Far more than call takers
Front line communications personnel do far more than answer the phone. They guide callers through complex algorithms, provide pre-arrival instructions and give advice on how to handle critical situations.

They are the initial first responders and provide a safety lifeline for field responders. Communications personnel work under a unique kind of pressure and stress.   

It's well known that when an incident does not initially go well at dispatch, the potential for issues on scene and at other points in the customer service cycle increases exponentially. For EMS agencies, measuring the customer experience is one of the components of the Institute for Healthcare Improvement's Triple Aim and is anticipated to be a factor in Medicare reimbursement in the future. Effective call reception and pre-arrival instructions significantly influence how patients and families perceive the care and service they receive. 

Beyond that role, communications centers are a key element when optimizing the system's agility, efficiency and effectiveness. I frequently refer to communications personnel as the brains of the service with communicators serving in a quasi-supervisory role.

As calls ebb and flow, managing deployment and mobilizing and re-allocating resources have become higher-level tasks for modern centers. Monitoring crew meal breaks, unit-hour utilization and fatigue are emerging day-to-day responsibilities of communications centers.

Effective centers work closely with field personnel and top leaders proactively to shape the system's deployment plan. They constantly manage risk by balancing coverage, demand and crew resources.

Emerging opportunities
Expanded roles for communications centers are also emerging. A number of centers, including University Medical Center EMS in Lubbock, Texas, provide call center services and bed coordination for area hospitals.

Others deliver advanced communication services, such as nurse advice lines and support for community paramedic programs and home health agencies. More proactive, out-bound call services including post-discharge well-being follow-ups, medication checks as well as other in-home monitoring services are helping prevent hospital re-admissions. In addition to filling gaps in the health care system, these new services may become additional revenue opportunities for communications centers.

Data are the lifeblood of modern public safety systems; progressive communications centers have assumed a significantly expanded role integrating multiple data sets from CAD systems, clinical initiatives, fire prevention and other administrative record management systems. The real challenge is harnessing and analyzing that information to turn it into useful intelligence that becomes a powerful force, facilitating decisions that shape the system in a positive way. 

Training and development
Changing responsibilities require communications center leaders to have a broader set of skills than in the past. Forward thinking police, fire and EMS agencies are focusing on development of these personnel. The International Academies of Emergency Dispatch, National Emergency Number Association and the Association of Public-Safety Communications Officials each sponsor development programs.

The IAED's Communications Center Managers program is comprehensive and covers human resources, finance, operations and deployment, customer and media relations, administration, legal issues, managing technology and other emerging issues. CCM is taught by well-known industry leaders in an interactive learning environment. It provides emerging and experienced leaders an expanded professional network as well as the perspective essential for successful participation on their agency's senior leadership team. 

Public safety systems are being challenged to do more with less. Budgets and staff are decreasing even as demands for expanded services, improved efficiency and compulsory sustainability initiatives are on the rise. Transforming the communications center paradigm from order entry personnel to a high-functioning team capable of providing meaningful input on day-to-day operations and emerging strategies is essential to an agency's long-term success. Supporting administrators' decision-making by providing valuable data and information demonstrates clear value and is a solid way to harness the power of communications centers for the future.

Jay Fitch is the founding partner at Fitch & Associates, which has provided leadership development and consulting for emergency services for more than three decades. 



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Embryonic expression patterns of Hox genes in the oligochaete annelid Tubifex tubifex

Publication date: Available online 6 September 2016
Source:Gene Expression Patterns
Author(s): Mao Endo, Chiharu Sakai, Takashi Shimizu
We have cloned and characterized the expression of seven Hox genes (designated Ttu-lab, Ttu-Dfd, Ttu-Scr1, Ttu-Scr2, Ttu-Lox5, Ttu-Lox4 and Ttu-Lox2) from the oligochaete annelid Tubifex tubifex. RT-PCR analyses show that except for Ttu-Lox4 and Ttu-Lox2 which begin expression as early as cleavage stages, Tubifex Hox genes are expressed during stages 13–18 when embryos undergo germ band formation, segmentation and body elongation. In terms of combination of tissues (or organs) exhibiting positive cells, the Tubifex Hox genes examined in this study are classified into three groups. Ttu-lab, Ttu-Scr1 and Ttu-Lox5 are expressed only in the ventral nerve cord; Ttu-Scr2 and Ttu-Lox4 are expressed not only in the ventral nerve cord but also in distinct lateral segmental tissues; and Ttu-Dfd and Ttu-Lox2 are expressed not only in the segmental ectoderm along the length of the AP body axis but also in the prostomium. Anterior expression boundaries of Ttu-lab, Ttu-Scr1, Ttu-Lox5 and Ttu-Lox4 are at segments 3, 4, 5, and 9, respectively. Anterior expression boundary of Ttu-Scr2 is at segment 2, and Ttu-Dfd and Ttu-Lox2 are expressed even at the anteriormost portion, the prostomium. These observations suggest that as in other annelids, so-called "spatial colinearity" of anterior expression boundaries of Hox genes has been conserved in the oligochaetes. It is also evident that there are some oligochaete Hox genes which violate the spatial colinearity rule.

Graphical abstract

image


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Expression profiles of the Gα subunits during Xenopus tropicalis embryonic development

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Publication date: Available online 7 September 2016
Source:Gene Expression Patterns
Author(s): Jaime Fuentealba, Gabriela Toro-Tapia, Marion Rodriguez, Cecilia Arriagada, Alejandro Maureira, Andrea Beyer, Soraya Villaseca, Juan I. Leal, Maria V. Hinrichs, Juan Olate, Teresa Caprile, Marcela Torrejón
Heterotrimeric G protein signaling plays major roles during different cellular events. However, there is a limited understanding of the molecular mechanisms underlying G protein control during embryogenesis. G proteins are highly conserved and can be grouped into four subfamilies according to sequence homology and function. To further studies on G protein function during embryogenesis, the present analysis identified four Gα subunits representative of the different subfamilies and determined their spatiotemporal expression patterns during Xenopus tropicalis embryogenesis. Each of the Gα subunit transcripts was maternally and zygotically expressed, and, as development progressed, dynamic expression patterns were observed. In the early developmental stages, the Gα subunits were expressed in the animal hemisphere and dorsal marginal zone. While expression was observed at the somite boundaries, in vascular structures, in the eye, and in the otic vesicle during the later stages, expression was mainly found in neural tissues, such as the neural tube and, especially, in the cephalic vesicles, neural crest region, and neural crest-derived structures. Together, these results support the pleiotropism and complexity of G protein subfamily functions in different cellular events. The present study constitutes the most comprehensive description to date of the spatiotemporal expression patterns of Gα subunits during vertebrate development.



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Meet all NREMT-P mandatory and flexible core content areas at Paramedic Refresher Course hosted by Southeastern Emergency

YOUNGSVILLE, NC (Sept., 2016)— Southeastern Emergency Equipment is hosting its latest Paramedic Refresher Course on Nov. 14-18, 2016 in the Raleigh, NC area. This content-rich, hands-on Paramedic Refresher Course will keep participants "street ready" while also introducing new and emerging trends in the field of EMS. Southeastern Emergency is committed to providing the finest Paramedic ...

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Paramedic, EMT, SCTU RN - Trinitas Regional Medical Center

Trinitas Regional Medical Center is a 531-bed acute care teaching facility that is experiencing tremendous growth and we're looking for PARAMEDICS / EMTS and SCTU RNs to join our team. We faithfully and diligently serve the community of Elizabeth, NJ and Union County as a part of Trinitas Regional Medical Center. A staff 85 strong represent five different divisions: Ambulance Basic Life Support ...

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The effects of respiratory functions on disease activity, functionality, spinal mobility and quality of life in patients with ankylosing spondylitis

2016-09-07T07-24-01Z
Source: Medicine Science | International Medical Journal
Raikan Buyukavci, Sinem Sag, Mufide Arzu Ozkarafakili, Banu Kuran.
We aimed to determine the relationship between the pulmonary functions with disease activity, functionality, spinal mobility and quality of life in patients with ankylosing spondyilitis (AS). PATIENTS AND METHOD: 52 patients (44 male, 8 female) who were diagnosed as AS in Şişli Etfal Education and Research Hospital physical medicine and rehabilitation policlinics according to the Modified New York criteria, participated in our study. The demographic characteristics and smoking habbits were questioned, the chest expansion was measured. The functional activity, disease activity, spinal mobility measurement were evaluated by BASFI, BASDAI,BASMI (Bath Ankylosing Spondylitis functional, disease activity, metrology ındex),and the life quality was evaluated by life quality spesific to the disease (ASQOL). The respiratory functions were measured by spirometry. 52 patients in 31 patients restrictive, and in 1 patient mixed pattern pulmonary involvement were detected. There was no determined no significant difference between who detected and not detected restrictive lung disease regarding age, gender, body mass index, lung expansion (LE), history of smoking (p>0.005). Pulmonary function tests results and LE of smoker and no smoker patients were similar. While LE was found to be positively correlated with FEV1 and FVC (p


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Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

Abstract

Background

Magnetic resonance enterography (MRE) is an accurate examination for assessing activity in Crohn's disease (CD). Various MRE indices have been developed for that purpose, but have not been directly compared. The aim of the study was to compare the diagnostic accuracy of three MRE indices for detecting and grading disease activity in CD, using endoscopy as gold standard.

Methods

MRE and ileocolonoscopies performed within 1 month in 43 patients with CD were analyzed. The magnetic resonance index of activity (MaRIA), Clermont, and London indices for each colonic segment and the terminal ileum were calculated. Simplified endoscopy score for CD (SES-CD) was considered the gold standard.

Results

Two hundred and twenty-four intestinal segments were included in the analysis. According to the established cut-off points for detecting active disease using MaRIA, Clermont, and London indices, the sensitivity of each index was 0.88, 0.89, and 0.71, and the specificity was 0.97, 0.78, and 0.99, respectively. The sensitivity for detecting ulcerations was 0.90 and 0.83 for the MaRIA and Clermont indices, respectively, with a specificity of 0.91 and 0.89. The AUROC curve for the MaRIA, Clermont, and London indices for detecting active disease was 0.92, 0.84, and 0.85, and for detecting ulcerations was 0.90 for the MaRIA, and 0.86 for Clermont index.

Conclusions

The three MRE-based indices evaluated in the current study have high diagnostic accuracy for assessment of disease activity. The MaRIA index has the best operational characteristics for detecting not only disease activity but also for grading severity, which supports its use in clinical studies and clinical practice.



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Sodium 4-phenylbutyric acid prevents murine acetaminophen hepatotoxicity by minimizing endoplasmic reticulum stress

Abstract

Background

Acetaminophen (APAP) overdose induces severe oxidative stress followed by hepatocyte apoptosis/necrosis. Previous studies have indicated that endoplasmic reticulum (ER) stress is involved in the cell death process. Therefore, we investigated the effect of the chemical chaperone 4-phenyl butyric acid (PBA) on APAP-induced liver injury in mice.

Methods

Eight-week-old male C57Bl6/J mice were given a single intraperitoneal (i.p.) injection of APAP (450 mg/kg body weight), following which some were repeatedly injected with PBA (120 mg/kg body weight, i.p.) every 3 h starting at 0.5 h after the APAP challenge. All mice were then serially euthanized up to 12 h later.

Results

PBA treatment dramatically ameliorated the massive hepatocyte apoptosis/necrosis that was observed 6 h after APAP administration. PBA also significantly prevented the APAP-induced increases in cleaved activating transcription factor 6 and phosphorylation of c-Jun N-terminal protein kinase and significantly blunted the increases in mRNA levels for binding immunoglobulin protein, spliced X-box binding protein-1, and C/EBP homologous protein. Moreover, PBA significantly prevented APAP-induced Bax translocation to the mitochondria, and the expression of heme oxygenase-1 mRNA and 4-hydroxynonenal. By contrast, PBA did not affect hepatic glutathione depletion following APAP administration, reflecting APAP metabolism.

Conclusions

PBA prevents APAP-induced liver injury even when an APAP challenge precedes its administration. The underlying mechanism of action most likely involves the prevention of ER stress-induced apoptosis/necrosis in the hepatocytes during APAP intoxication.



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Evaluation of laboratory markers of sepsis screen in the diagnosis of early onset neonatal septicemia

2016-09-07T04-47-34Z
Source: International Journal of Contemporary Pediatrics
Zeeba Zaka-ur-Rab, Monika Kar, Veena Gupta, Brahm P. Kalra, Kafil Akhtar.
Background: In the absence of accessibility to more recent, sophisticated techniques for early detection of neonatal sepsis, most neonatal health care facilities are forced to still rely on various routinely available hematological markers. However, reports on the diagnostic utility of these markers in the septic screen are rather conflicting. Aim of the study was to evaluate the diagnostic accuracy of routinely available laboratory markers of sepsis screen, and their combinations in diagnosis of early onset neonatal septicemia (EOS). Methods: This prospective, hospital based, cross-sectional study was performed in the Department of Pediatrics of two Tertiary Care Teaching Hospitals, North India. The study involved term neonates admitted with either suspected EOS/ risk factors for sepsis in neonatal ICU, post-natal ward, or the pediatric ward. Control group comprised apparently healthy neonates without risk factors for sepsis. Blood cultures and sepsis screen were performed in all babies at enrollment. Results: The study group included 161 babies. Of these, 56 (34.78%) were blood culture positive. Control group comprised 102 neonates. Sepsis screen was positive in 69.57% subjects with clinically suspected sepsis, 83.93% cases of true sepsis, and 54.92% controls. Sensitivity, specificity, positive predictive value and negative predictive value of sepsis screen were 83.93%, 35.29%, 41.59% and 80.00%, respectively. Amongst individual markers of sepsis screen, CRP had best diagnostic utility with highest sensitivity (82.14%), specificity (89.22%), PPV (80.70%), NPV (90.10 %), and LR+ (7.62), and the lowest LR- (0.20). The combination of CRP plus I/T had the highest sensitivity (78.57%), specificity (100%), PPV (100%) and NPV (89.47%), and the lowest LR- (0.21) amongst all other 2 marker combinations. Conclusions: Combination of CRP plus I/T can serve as a reliable and useful tool for rapid diagnosis of EOS in term neonates. However, all other two test combinations do not have requisite high sensitivity, specificity and negative predictive value.


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Laryngeal stimulation: an early objective test for timing extubation in young children



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Comment on Templeton TW, Downard MG, Simpson CR, Zeller KA, Templeton LB, Bryan YF. Bending the rules: a novel approach to placement and retrospective experience with the 5 French Arndt endobronchial blocker in children



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Reply to Tait, Alan; Voepel-Lewis, Terri; Christensen, Robert; O'Brien, Louise, regarding their comment on ‘Utility of screening questionnaire, obesity, neck circumference, and sleep polysomnography to predict sleep-disordered breathing in children and adolescents’



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Issue Information



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Authorship wanting: dead or alive



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In this issue October 2016



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Procedure for difficult peripheral intravenous access in children with chronic health conditions



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Pancreatic cancer trial to make tumours more sensitive to treatment

Cancer Research UK News

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On-treatment and off-treatment efficacy of entecavir in a real-life cohort of chronic hepatitis B patients

European Journal of Gastroenterology & Hepatology

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Complications and outcomes associated with surgical management of renal cell carcinoma involving the liver: a matched cohort study

Urology

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Genetic markers predict primary non-response and durable response to anti-TNF biologic therapies in Crohn’s disease

The American Journal of Gastroenterology

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Cytokine levels after consumption of a Medicinal Agaricus blazei Murill-based Mushroom Extract, AndoSan™, in Patients with Crohn's disease and Ulcerative Colitis in a Randomized Single-Blinded Placebo Controlled Study

Scandinavian Journal of Immunology

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Randomised, open-label, phase II study of gemcitabine with and without IMM-101 for advanced pancreatic cancer

British Journal of Cancer

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Study opens door to targeted treatments for oesophageal cancer

Cancer Research UK News

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