To summarize the efficacy of less-commonly used modern methods (e.g. epidrum, lidocaine, acoustic device, Macintosh balloon) compared to more commonly-used methods (i.e. air, saline, both) in the loss of resistance technique for identification of the epidural space.
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Δευτέρα 16 Ιανουαρίου 2017
Commonly-used versus less commonly-used methods in the loss of resistance technique for identification of the epidural space: A systematic review and meta-analysis of randomized controlled trials
A visual screen for diet-regulated proteins in the Drosophila ovary using GFP protein trap lines
Source:Gene Expression Patterns
Author(s): Hwei-Jan Hsu, Daniela Drummond-Barbosa
The effect of diet on reproduction is well documented in a large number of organisms; however, much remains to be learned about the molecular mechanisms underlying this connection. The Drosophila ovary has a well described, fast and largely reversible response to diet. Ovarian stem cells and their progeny proliferate and grow faster on a yeast-rich diet than on a yeast-free (poor) diet, and death of early germline cysts, degeneration of early vitellogenic follicles and partial block in ovulation further contribute to the ∼60-fold decrease in egg laying observed on a poor diet. Multiple diet-dependent factors, including insulin-like peptides, the steroid ecdysone, the nutrient sensor Target of Rapamycin, AMP-dependent kinase, and adipocyte factors mediate this complex response. Here, we describe the results of a visual screen using a library of green fluorescent protein (GFP) protein trap lines to identify additional factors potentially involved in this response. In each GFP protein trap line, an artificial GFP exon is fused in frame to an endogenous protein, such that the GFP fusion pattern parallels the levels and subcellular localization of the corresponding native protein. We identified 53 GFP-tagged proteins that exhibit changes in levels and/or subcellular localization in the ovary at 12–16 h after switching females from rich to poor diets, suggesting them as potential candidates for future functional studies.
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The impact of liver disorders on perioperative management of reoperative cardiac surgery: a retrospective study in adult congenital heart disease patients
Abstract
Purpose
We evaluated the preoperative prevalence of risk factors for liver disorders and the relationship between the liver disorders and perioperative outcomes in adult congenital heart disease (ACHD) patients.
Methods
This retrospective study included 32 ACHD patients who underwent reoperative cardiac surgery.
Results
Preoperatively, 38% of the study patients had risk factors, including congestive liver (CL) due to right heart failure (31%), chronic hepatitis C (HC) (22%), and both CL and HC (16%). The numbers of patients with Child-Pugh scores 5, 6, 7 and 8 were 22, 7, 2 and 1. Median (range) preoperative platelet count and fibrinogen values were 155 (61–330) × 103/μl and 250 (145–367) mg/dl, respectively. The patients with higher Child-Pugh scores tended to have longer duration of anesthesia and surgery (p = 0.078, 0.078, respectively), and had significantly higher platelet transfusion (p = 0.031). Lower platelet count was associated with longer duration of anesthesia, surgery and cardio pulmonary bypass (CPB), and larger amount of blood loss and platelet transfusion (p = 0.01, 0.011, 0.024, 0.033, 0.021). Lower fibrinogen value was associated with longer duration of anesthesia, surgery and CPB, and larger amount of platelet transfusion (p = 0.015, 0.009, 0.009, 0.023).
Conclusion
ACHD patients who underwent reoperative cardiac surgery had a high prevalence of risk factors for liver disorders preoperatively, and liver disorders aggravated some intraoperative outcomes. These findings suggest that the prevention of liver disorders is important for reducing the occurrence of poor outcomes, and that ACHD patients with liver disorders need attentive perioperative management.
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Appropriate Use of Progesterone to Prevent Preterm Birth: Approaches to Measurement for Driving Improvement
Abstract
Introduction Despite strong evidence supporting the benefit of 17-alpha hydroxyprogesterone caproate (17P) in preventing recurrent preterm birth, this treatment still does not reach most eligible patients. This study sought to identify approaches to measuring the appropriate use of 17P, with the goal of helping health systems better monitor and improve the implementation of this intervention. Methods Semi-structured telephone interviews were used to gather data on measures for 17P use being developed and implemented by state team members participating in the Infant Mortality Collaborative Improvement and Innovation Network (IM CoIIN)—a national quality improvement initiative. Strengths and limitations of these measurement approaches were described. Results Six approaches to measuring 17P use to prevent preterm birth were identified: practice-level data, population-based surveys, three measures employing insurance claims with or without linked birth certificate data, and revised birth certificates. Each measure had particular strengths and limitations. Practice-level measures were useful in rapid-cycle improvement, but were not generalizable across sites. In contrast, population-based measures (i.e., surveys, claims) were useful for broad comparisons, but were limited in their timeliness, and in how accurately they identified candidates who were truly eligible for 17P. Additionally, such measures required complex data linkage and analytic capabilities. Discussion A variety of imperfect measures for the appropriate use of 17P are available. No "best" measure was identified—the optimal measurement option must fit the specific needs of a health agency. Better data infrastructure and harnessing information from integrated electronic health records could improve the quality of 17P use measurement for improvement efforts.
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Critical Congenital Heart Disease Newborn Screening Implementation: Lessons Learned
Abstract
Introduction The purpose of this article is to present the collective experiences of six federally-funded critical congenital heart disease (CCHD) newborn screening implementation projects to assist federal and state policy makers and public health to implement CCHD screening. Methods A qualitative assessment and summary from six demonstration project grantees and other state representatives involved in the implementation of CCHD screening programs are presented in the following areas: legislation, provider and family education, screening algorithms and interpretation, data collection and quality improvement, telemedicine, home and rural births, and neonatal intensive care unit populations. Results The most common challenges to implementation include: lack of uniform legislative and statutory mandates for screening programs, lack of funding/resources, difficulty in screening algorithm interpretation, limited availability of pediatric echocardiography, and integrating data collection and reporting with existing newborn screening systems. Identified solutions include: programs should consider integrating third party insurers and other partners early in the legislative/statutory process; development of visual tools and language modification to assist in the interpretation of algorithms, training programs for adult sonographers to perform neonatal echocardiography, building upon existing newborn screening systems, and using automated data transfer mechanisms. Discussion Continued and expanded surveillance, research, prevention and education efforts are needed to inform screening programs, with an aim to reduce morbidity, mortality and other adverse consequences for individuals and families affected by CCHD.
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Surgical treatment of perihilar cholangiocarcinoma: Early results of en bloc portal vein resection
Langenbeck's Archives of Surgery
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Effect of Vonoprazan, a Potassium-Competitive Acid Blocker, on the 13C-Urea Breath Test in Helicobacter pylori-Positive Patients
Digestive Diseases and Sciences
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MABp1 as a novel antibody treatment for advanced colorectal cancer: A randomised, double-blind, placebo-controlled, phase 3 study
The Lancet Oncology
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Cantabrians help find gene changes associated with poor Crohn's disease outcomes
University of Otago News
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Fatty acid and non-alcoholic fatty liver disease: Meta-analyses of case-control and randomized controlled trials
Clinical Nutrition
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Preliminary investigation of whole-pancreas 3D histogram ADC metrics for predicting progression of acute pancreatitis
Clinical Imaging
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Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: Gaps and opportunities for scale-up of HCV prevention, treatment and care
International Journal of Infectious Diseases
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Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- A single center retrospective study
BMC Gastroenterology
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Are the current guidelines for the surgical management of intraductal papillary mucinous neoplasms of the pancreas adequate? A multi-institutional study
Journal of the American College of Surgeons
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Investigation of underlying comorbidities as risk factors for symptomatic human hepatitis E virus infection
Alimentary Pharmacology and Therapeutics
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Effects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake
International Journal of Obesity
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Diabetes, plasma glucose and incidence of pancreatic cancer: A prospective study of 0.5 million Chinese adults and a meta-analysis of 22 cohort studies
International Journal of Cancer
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Efficacy and safety of vedolizumab in ulcerative colitis and Crohn’s disease patients stratified by age
Advances in Therapy
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Influences of proton pump inhibitor on Helicobacter pylori adherence to the gastrointestinal cell lines
The Turkish Journal of Gastroenterology
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Epidemiology and outcome of acute pancreatitis in end-stage renal disease dialysis patients: A 10-year national cohort study
Nephrology Dialysis Transplantation
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Ethical issues with colorectal cancer screening--A systematic review
Journal of Evaluation in Clinical Practice
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The risk predictive values of UK-PBC and GLOBE scoring system in Chinese patients with primary biliary cholangitis: The additional effect of anti-gp210
Alimentary Pharmacology and Therapeutics
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The utility of abbreviated patient-reported outcomes for predicting survival in early stage colorectal cancer
Cancer
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Pasireotide for the prevention of pancreatic fistula following pancreaticoduodenectomy: A cost-effectiveness analysis
Annals of Surgery
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Randomized clinical trial of preoperative dexamethasone on postoperative nausea and vomiting after laparoscopy for suspected appendicitis
British Journal of Surgery
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Κυριακή 15 Ιανουαρίου 2017
Dietary interventions for fetal growth restriction – therapeutic potential of dietary nitrate supplementation in pregnancy
Abstract
Fetal growth restriction (FGR) affects around 5% of pregnancies and is associated with significant short- and long-term adverse outcomes. A number of factors can increase the risk of FGR, one of which is poor maternal diet. In terms of pathology, both clinically and in many experimental models of FGR, impaired uteroplacental vascular function is implicated, leading to a reduction in the delivery of oxygen and nutrients to the developing fetus. Whilst mechanisms underpinning impaired uteroplacental vascular function are not fully understood, interventions aimed at enhancing nitric oxide (NO) bioavailability remain a key area of interest in obstetric research. In addition to endogenous NO production from the amino acid L-arginine, via nitric oxide synthase (NOS) enzymes, research in recent years has established that significant NO can be derived from dietary nitrate, via the 'alternative NO pathway'. Dietary nitrate, abundant in green leafy vegetables and beetroot, can increase NO bioactivity, conferring beneficial effects on cardiovascular function and blood flow. Given the beneficial effects of dietary nitrate supplementation to date in non-pregnant humans and animals, current investigations aim to assess the therapeutic potential of this approach in pregnancy to enhance NO bioactivity, improve uteroplacental vascular function and increase fetal growth.
This article is protected by copyright. All rights reserved
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Oropharyngeal swabs analyzed by ddPCR is a quantitative, rapid, and effective method for minimally invasive oncogenic HPV detection. This assay represents the most sensitive and accurate mode of HPV detection in OPSCC without a tissue biopsy in the available literature.
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Tumor uptake of 18F-BPA and 11C-Met : The distribution of 4-borono-2-18F-fluoro-phenylalanine (18F-BPA) and L-[methyl-11C] methionine (11C-Met) in normal organs and tumors and to evaluate the usefulness of 11C-Met/PET in screening potential candidates for boron neutron capture therapy (BNCT).
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Diltiazem prevents stress-induced contractile deficits in cardiomyocytes, but does not reverse the cardiomyopathy phenotype in Mybpc3-knock-in mice
Abstract
Left ventricular hypertrophy, diastolic dysfunction and fibrosis are main features of hypertrophic cardiomyopathy (HCM). Guidelines recommend β-adrenoceptor or Ca2+ channel antagonists as pharmacological treatment. The Ca2+ channel blocker diltiazem recently showed promising beneficial effects in pre-clinical HCM, particularly in patients carrying MYBPC3 mutations. In the present study we evaluated whether diltiazem could ameliorate or reverse the disease phenotype in cells and in vivo in Mybpc3-targeted knock-in (KI) mouse model of HCM. Sarcomere shortening and Ca2+ transient were measured in KI and wild-type (WT) cardiomyocytes in basal condition (1-Hz pacing) and under stress conditions (30 nm isoprenaline, 5-Hz pacing) with or without pre-treatment with 1 μm diltiazem. KI cardiomyocytes exhibited lower diastolic sarcomere length (dSL) at baseline, a tendency to a higher positive inotropic response to isoprenaline than WT, and a marked reduction of dSL and a tendency towards arrhythmias under stress conditions. Pre-treatment of cardiomyocytes with 1 μm diltiazem reduced the drop in dSL and arrhythmia frequency in KI, and attenuated the positive inotropic effect of isoprenaline. Furthermore, diltiazem reduced the contraction amplitude at 5 Hz but did not affect diastolic Ca2+ load and Ca2+ transient amplitude. Six-month diltiazem treatment of KI mice did not reverse cardiac hypertrophy and dysfunction, activation of the fetal gene program or fibrosis. In conclusion, diltiazem blunted the response to isoprenaline in WT and KI and improved diastolic relaxation under stress conditions in KI cardiomyocytes. This beneficial effect of diltiazem in cells did not translate in therapeutic efficacy when applied chronically in KI mice.
This article is protected by copyright. All rights reserved
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Late gestational intermittent hypoxia induces metabolic and epigenetic changes in male adult offspring mice
Abstract
Pregnancy, particularly late gestation, has been associated with a relatively high prevalence of obstructive sleep apnea (OSA). Intermittent hypoxia (IH), a hallmark of OSA, could impose significant long-term effects on somatic growth, energy homeostasis, and metabolic function in offspring. We hypothesized that IH during late pregnancy (LG-IH) may increase the propensity for metabolic dysregulation and obesity in adult offspring via epigenetic modifications. Time-pregnant female C57BL/6 mice were exposed to LG-IH or room air (LG-RA) during days 13–18 of gestation. At 24 weeks, blood samples were collected from offspring mice for lipid profiles and insulin resistance (HOMA-IR), indirect calorimetry was performed, and visceral white adipose tissues (VWAT) were assessed for inflammatory cells as well as for differentially methylated gene regions (DMR) using MeDIP-Chip. Body weight, food intake, adiposity index, fasting insulin, triglycerides, and cholesterol levels were all significantly higher in LG-IH male but not female offspring. LG-IH also altered metabolic expenditure and locomotor activities in male offspring, and increased number of pro-inflammatory macrophages emerged in VWAT along with 1520 DMRs (P < 0.0001), associated with 693 genes. Pathway analyses showed that genes affected by LG-IH were mainly associated with molecular processes related to metabolic regulation and inflammation. LG-IH induces metabolic dysfunction as reflected by increased body weight and adiposity index in adult male offspring that is paralleled by epigenomic alterations and inflammation in VWAT. Thus, perturbations to fetal environment by OSA during pregnancy can therefore have long-term detrimental effects to the fetus, and lead to persistent metabolic dysfunction in adulthood.
This article is protected by copyright. All rights reserved
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Tensions flare over Calif. ambulance response to calls
The firefighters union claimed ambulances from AMR are frequently unavailable to cover their response area
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Can't intubate can't ventilate, use a small size Air-Q and the Pudgy-Baby maneuver
The incidence of difficult mask ventilation and difficult tracheal intubation is higher in obese and obstructive sleep apnea (OSA) patients [1]. When a "cannot intubate cannot ventilate" (CICV) situation is encountered, a supraglottic airway device (SAD) should be inserted to rescue ventilation. Unfortunately, failure to achieve adequate ventilation with a SAD is also common in obese and OSA patients [2] which may lead to a catastrophic outcome if a surgical airway is not immediately established.
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Acute renal injury in the course of a large pleural effusion
Furst B. and colleagues described in this journal [1] an abrupt hemodynamic decompensation after performing pericardial window in a patient with malignant pericardial effusion (PRE). The hemodynamic consequences promptly reversed when a concurrent large pleural effusion (PLE) was evacuated.
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The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods: A systematic review and meta-analysis
Administration of intranasal dexmedetomidine for sedation is comfortable and effective in children who are afraid of needles, and it offers efficient sedation similar to that of intravenous administration. We performed a systematic review and meta-analysis to evaluate the clinical effects of the pre-procedural administration of intranasal dexmedetomidine.
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Diverse role of Survival Motor Neuron Protein
Publication date: Available online 15 January 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Ravindra N. Singh, Matthew D. Howell, Eric W. Ottesen, Natalia N. Singh
The multifunctional Survival Motor Neuron (SMN) protein is required for the survival of all organisms of the animal kingdom. SMN impacts various aspects of RNA metabolism through the formation and/or interaction with ribonucleoprotein (RNP) complexes. SMN regulates biogenesis of small nuclear RNPs, small nucleolar RNPs, small Cajal body-associated RNPs, signal recognition particles and telomerase. SMN also plays an important role in DNA repair, transcription, pre-mRNA splicing, histone mRNA processing, translation, selenoprotein synthesis, macromolecular trafficking, stress granule formation, cell signaling and cytoskeleton maintenance. The tissue-specific requirement of SMN is dictated by the variety and the abundance of its interacting partners. Reduced expression of SMN causes spinal muscular atrophy (SMA), a leading genetic cause of infant mortality. SMA displays a broad spectrum ranging from embryonic lethality to an adult onset. Aberrant expression and/or localization of SMN has also been associated with male infertility, inclusion body myositis, amyotrophic lateral sclerosis and osteoarthritis. This review provides a summary of various SMN functions with implications to a better understanding of SMA and other pathological conditions.
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Effects of beta-hydroxy-beta-methylbutyrate (HMB) on the expression of ubiquitin ligases, protein synthesis pathways and contractile function in extensor digitorum longus (EDL) of fed and fasting rats
Abstract
Beta-hydroxy-beta-methylbutyrate (HMB), a leucine metabolite, enhances the gain of skeletal muscle mass by increasing protein synthesis or attenuating protein degradation or both. The aims of this study were to investigate the effect of HMB on molecular factors controlling skeletal muscle protein synthesis and degradation, as well as muscle contractile function, in fed and fasted conditions. Wistar rats were supplied daily with HMB (320 mg/kg body weight diluted in NaCl-0.9%) or vehicle only (control) by gavage for 28 days. After this period, some of the animals were subjected to a 24-h fasting, while others remained in the fed condition. The EDL muscle was then removed, weighed and used to evaluate the genes and proteins involved in protein synthesis (AKT/4E-BP1/S6) and degradation (Fbxo32 and Trim63). A sub-set of rats were used to measure in vivo muscle contractile function. HMB supplementation increased AKT phosphorylation during fasting (three-fold). In the fed condition, no differences were detected in atrogenes expression between control and HMB supplemented group; however, HMB supplementation did attenuate the fasting-induced increase in their expression levels. Fasting animals receiving HMB showed improved sustained tetanic contraction times (one-fold) and an increased muscle to tibia length ratio (1.3-fold), without any cross-sectional area changes. These results suggest that HMB supplementation under fasting conditions increases AKT phosphorylation and attenuates the increased of atrogenes expression, followed by a functional improvement and gain of skeletal muscle weight, suggesting that HMB protects skeletal muscle against the deleterious effects of fasting.
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Time-course investigation of blood–brain barrier permeability and tight junction protein changes in a rat model of permanent focal ischemia
Abstract
Permanent middle cerebral artery occlusion (pMCAO) is an animal model that is widely used to simulate human ischemic stroke. However, the timing of the changes in the expression of tight junction (TJ) proteins and synaptic proteins associated with pMCAO remain incompletely understood. Therefore, to further explore the characteristics and mechanisms of blood–brain barrier (BBB) damage during cerebral ischemic stroke, we used a pMCAO rat model to define dynamic changes in BBB permeability within 120 h after ischemia in order to examine the expression levels of the TJ proteins claudin-5 and occludin and the synaptic proteins synaptophysin (SYP) and postsynaptic density protein 95 (PSD95). In our study, Evans blue content began to increase at 4 h and was highest at 8 and 120 h after ischemia. TTC staining showed that cerebral infarction was observed at 4 h and that the percentage of infarct volume increased with time after ischemia. The expression levels of claudin-5 and occludin began to decline at 1 h and were lowest at 8 and 120 h after ischemia. The expression levels of SYP and PSD95 decreased from 12 to 120 h after ischemia. GFAP, an astrocyte marker, gradually increased in the cortex penumbra over time post-ischemia. Our study helps clarify the characteristics of pMCAO models and provides evidence supporting the translational potential of animal stroke models.
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Sphingosine-1-phosphate pretreatment amends hypoxia-induced metabolic dysfunction and impairment of myogenic potential in differentiating C2C12 myoblasts by stimulating viability, calcium homeostasis and energy generation
Abstract
Sphingosine-1-phosphate (S1P) has a role in transpiration in patho-physiological signaling in skeletal muscles. The present study evaluated the pre-conditioning efficacy of S1P in facilitating differentiation of C2C12 myoblasts under a normoxic/hypoxic cell culture environment. Under normoxia, exogenous S1P significantly promoted C2C12 differentiation as evident from morphometric descriptors and differentiation markers of the mature myotubes, but it could facilitate only partial recovery from hypoxia-induced compromised differentiation. Pretreatment of S1P optimized the myokine secretion, intracellular calcium release and energy generation by boosting the aerobic/anaerobic metabolism and mitochondrial mass. In the hypoxia-exposed cells, there was derangement of the S1PR1–3 expression patterns, while the same could be largely restored with S1P pretreatment. This is being proposed as a plausible underlying mechanism for the observed pro-myogenic efficacy of exogenous S1P preconditioning. The present findings are an invaluable addition to the existing knowledge on the pro-myogenic potential of S1P and may prove beneficial in the field of hypoxia-related myo-pathologies.
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Inhibition of ghrelin-induced feeding in rats by pretreatment with a novel dual orexin receptor antagonist
Abstract
Orexin-A and -B, and ghrelin are potent orexigenic peptides. The effects of ACT462206, a novel dual orexin receptor antagonist (DORA), on ghrelin-induced feeding were examined in adult male Wistar rats. Hyperphagia induced by the intracerebroventricular (icv) administration of ghrelin was significantly suppressed for at least 2 h by pretreatment with icv administration of DORA. A marked increase was observed in the number of neurons showing Fos immunoreactivity in the paraventricular nucleus, arcuate nucleus and lateral hypothalamic area (LHA), 90 min after icv administration of ghrelin. Pretreatment with DORA significantly decreased the number of Fos-immunoreactive (IR) neurons; however, Fos immunoreactivity remained significantly increased. Double-immunostaining for Fos and orexin-A showed that many orexin-A-IR neurons in the LHA coexisted with Fos immunoreactivity after icv administration of ghrelin, but their number was reduced significantly by DORA pretreatment. These results suggest that centrally administered ghrelin may activate the orexinergic and non-orexinergic pathways responsible for the regulation of feeding.
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Modeling Depression in Animals: Behavior as the Basis for the Methodology, Assessment Criteria, and Classification
This review analyzes current progress in the modeling of depressive disorders in animals. The criteria and classification systems for existing models are considered, as are approaches to assessing the validity of models. Despite the use of numerous approaches to modeling depressive states, based not only on impairments to the motivational mechanisms of the brain, but also on impairments to the emotional mechanisms, no satisfactory model creating a stable depressive state has yet been developed. Nonetheless, the diversity of existing models is undoubtedly positive, as it provides for targeted studies of individual neurobiological mechanisms and patterns of development of depressive states in humans, as well as studies of the mechanisms of action and predictions of the pharmacological profiles of potential drugs for the treatment of depression.
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Efficacy and Safety of the Use of Baclofen in the Treatment of Alcohol Dependent (a Double-Blind, Randomized, Placebo-Controlled Pilot Study)
Objective. To study the efficacy and use of baclofen (Baclosan) for stabilizing remission in patients with alcoholism. Materials and methods. A total of 32 patients with alcoholism were randomized to two groups. Patients of group 1 (16 patients) received baclofen (50 mg/day) for three months; patients of group 2 received a placebo of identical appearance. All patients were required to attend the clinic every week for monitoring of remission (alcohol consumption) and assessment of the levels of alcohol attraction (craving), affective disorders (depression and anxiety), and γ-glutamyltransferase (GGT) activity, and for monitoring of compliance with medication (urine riboflavin). Alcohol consumption was monitored by retrospective analysis and assay of GGT. Anxiety was evaluated using the Hamilton and Spielberger scales. Depression was assessed on the Montgomery-Asberg Depression Scale. Alcohol cravings were assessed using obsessive-compulsive, Pennsylvania, and visual analog scales. Overall assessment of treatment efficacy was obtained using the Clinical Global Impression scale. The study followed a double-blind design. Results and conclusions. No significant difference in measures of the efficacy of stabilizing remission was seen between the baclofen and placebo groups in patients with alcoholism (probably due to insufficiently large cohort sizes). Measures of holding patients in remission and of alcohol consumption in the baclofen group were somewhat better than in the placebo group; between-group differences in these measures approached statistical significance, pointing to a greater efficacy for baclofen than placebo in alcoholism. Baclofen did not show any significant difference from placebo in terms of the number of side effects (adverse events) and effects on liver enzyme activity, which is evidence for its good tolerance and safety in this contingent of patients. The authors take the view that evidence-based conclusions regarding The efficacy of baclofen in the treatment of alcoholism require further studies in patients using larger cohorts.
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Cell Contact Protein β-Catenin in Ependymal and Epithelial Cells in the Choroid Plexus of the Lateral Ventricles of the Brain
The aim of the present work was to study the distribution of cell contact protein β-catenin in the choroid plexus and ependyma of the lateral ventricles of the brain. Experiments were performed using frontal sections of brains from Wistar rats (n = 10) using polyclonal antibodies to β-catenin. Preparations were analyzed under the microscope in transmitted light and by confocal laser microscopy. The distribution of β-catenin in different projections was studied by three-dimensional reconstruction. The results identified differences in the distributions of this protein in the ependyma and choroid plexus. In contrast to the ependyma, β-catenin is distributed in choroid plexus cells in the same way as in monolayer epithelial tissues (at the basal and lateral margins of the cells). This may be evidence that the ependyma and epithelium of the choroid plexus are of different tissue types, despite their common origin.
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Optimization of Antidepressant Therapy in Conditions of the Gerontology Psychiatric Out-Patient Clinic
Objective. To carry out a comparative assessment of the efficacy and safety of monotherapy with a new-generation antidepressant (venlafaxin, agomelatine, or fluvoxamine) and complex antidepressant therapy using one of these antidepressants in combination with acetyl-L-carnitine (ALC, Carnicetin) for the treatment of depression in elderly patients in a gerontology psychiatric out-patients clinic. Materials and methods. Two groups of patients (aged 60–79 years) with mild or moderate depression, comparable in terms of the main demographic and clinical characteristics, received antidepressant mono- or complex (antidepressant and ALC) therapy for eight weeks. Results. The use of complex therapy including the neuroprotector Carnicetin, which has neurotrophic and energotropic mechanisms of action, was found to provide a faster-onset therapeutic response and a stronger effect than antidepressant monotherapy, which was supported by a significant reduction in depressive disorders, including measures of the severity of anxiety, along with improvements in the patients' cognitive functioning. Use of complex therapy was accompanied by a decrease in the frequency of adverse events. Conclusions. The results obtained here allow inclusion of Carnicetin into the complex antidepressant treatment to be recommended for use in gerontology psychiatric out-patient clinics.
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Dynamics of Blood Cytokine Concentrations in Rats with Different Behavioral Characteristics after Acute Stress
Changes in peripheral blood cytokine contents in behaviorally passive and active Wistar rats were assessed at different time points after acute stressing using a restraint model during the dark part of the day. In passive animals, decreases in the concentrations of most of the pro- and anti-inflammatory cytokines studied were most marked immediately and particularly three days after stress. Changes in the cytokine profile of the blood following experimental stress were less marked in behaviorally active individuals: significant decreases from normal were seen only for the proinflammatory cytokine IL-1α and the anti-inflammatory cytokines IL-4 and IL-13. In contrast to passive rats, these changes were more marked in active individuals one day after negative emotional loading. These data illustrate the specific features of the involvement of immunoactive substances in the system controlling the physiological functions and forming individual resistance to the negative sequelae of stress.
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Functional Organization of the Cerebral Cortex in Cued and Implicit Modality-Specific Anticipatory Attention. Analysis of α-Rhythm Coherence in the Sources Space
Studies in healthy right-handed subjects (N = 16, mean age 23 ± 5.7 years) analyzed the functional organization of the cerebral cortex during preparation to solve visual and auditory sensory tasks in two conditions: (1) anticipation of a visual or auditory signal after being told its modality (cued anticipatory attention) and (2) implicit anticipation formed during multiple repetition of a given sequence of visual and auditory stimuli. In both conditions subjects had to perform the same task – to identify the order of the stimuli (visual or auditory) in monomodal pairs. During the prestimulus period, the α frequency range was used to assess the coherence of cortical sources corresponding to previously selected cortical regions (regions of interest). More functional connections between cortical zones in the frontoparietal modulatory system were seen in cued anticipatory attention than during the period preceding appearance of the prompt stimulus, this obtaining in both sensory tasks. There was also a greater number of local connections between sensory-specific and associative (parietal and prefrontal) areas. Implicit anticipation preceding execution of the visual task was accompanied by an increase in connections between the ventral premotor cortex and the caudal (parietal and occipital) areas of the right hemisphere. Execution of the auditory task was preceded by an increase in connections between the auditory sensory cortex, the rostral part of the supplementary motor area, and the ventral premotor area. In contrast to cued attention, implicit anticipation was not accompanied by changes in frontoparietal connections. These results provide evidence of significant differences in the cerebral organization of these two types of anticipatory attention.
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Functional Activity of the Insulin Signaling System of the Brain in Health and Type 2 Diabetes Mellitus
The insulin signal system of the brain plays a key role in regulating fundamental cellular process in neurons, and it controls metabolic processes in the CNS and the periphery. In hypothalamic neurons, the insulin signaling system interacts closely with other signal systems controlled by leptin, melanocortin peptides, dopamine, and serotonin, and is a key component of the signal network of the hypothalamus, integrating and transforming central and peripheral signals. Impairments to the insulin system of the brain lead to the development of central insulin resistance, which is one of the prime causes of type 2 diabetes mellitus (DM), metabolic syndrome, and Alzheimer's disease. Timely restoration of the insulin system of the brain is an effective approach for the prophylaxis and treatment of type 2 DM and associated neurodegenerative diseases. This review analyzes and assesses published data and our own results on the structural-functional organization of the insulin signal system of the brain, impairments to insulin signaling in the CNS, and approaches to its restoration in type 2 DM.
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Deciphering the molecular mechanisms involved in HIV-associated lipoatrophy by transcriptomics: a pilot study
Abstract
HIV-associated lipoatrophy (LA) has considerable implications for risk of metabolic diseases, quality of life, and adherence to treatments. Although it has decreased in high-income countries, it is still very common in resource-limited countries. Understanding the pathophysiological mechanisms of LA can open the possibility to explore new ways to treat or prevent this condition. To identify new markers for an accurate and quick diagnosis will be also of interest. Thus, we aimed to examine functional classes of genes implicated in LA and to identify potential new markers for an accurate/quick diagnosis of LA and future complications. Eighteen participants were recruited: seven healthy volunteers, five non-LA-HIV patients, and six LA-HIV subjects. Clinical lipoatrophy was considered when changes in fat volume in the cheeks next to the nose, lateral aspect of the face, legs, arms, and buttocks were observed by the physicians. mRNA was isolated from peripheral blood mononuclear cells (PBMCs) to perform a transcriptomic and Gene Ontology analysis. To confirm RNA sequencing results, qPCRs were developed. A total of 55 genes were differentially expressed between LA and non-LA patients. Thirty-seven genes were overexpressed, whereas 18 genes were repressed. Functional analysis showed that overexpressed genes were involved in lymphocyte/neutrophil activation, inflammation, and atherogenesis. Several lymphoma markers and members of the lipocalin and aquaporin families were also found more expressed in LA patients. In contrast, most of the genes found less expressed in LA subjects were involved in angiogenesis and protection against myocardial infarction. Our results demonstrated a distinct transcriptomic signature in PBMCs of LA patients in comparison with non-LA-HIV subjects and, therefore, provided novel insights to the pathogenesis of HIV-associated lipoatrophy. Our study also highlights the potential usage of some of these genes as early markers of future complications.
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Ideal cardiovascular health and liver enzyme levels in European adolescents; the HELENA study
Abstract
There is an increasing interest for the role of liver enzymes as predictors of non-liver-related morbidity and mortality. The American Heart Association (AHA) described the ideal cardiovascular health concept as a score of seven cardiovascular health behaviors and factors that can be used to monitor and predict ideal cardiovascular health over time. This study aimed to examine the association of the ideal cardiovascular health (ICH), as defined by the AHA, with liver enzyme levels in European adolescents. A total of 637 adolescents (54.6% females), aged 14.6 ± 1.2 years from nine European countries participated in this cross-sectional study. Blood levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase were measured and the AST/ALT ratio calculated. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviors (smoking, body mass index, physical activity, and diet) and three factors (total cholesterol, blood pressure, and glucose). A higher number of ideal cardiovascular health behaviors, factors, and ideal cardiovascular health index were associated with lower ALT (P < 0.05, P < 0.001, and P < 0.001, respectively) and gamma-glutamyltransferase (P < 0.001, P < 0.01, and P < 0.001, respectively) levels. Similarly, a higher number of ideal cardiovascular health behaviors (P < 0.01), factors (P < 0.01), and ideal cardiovascular health index (P < 0.001) were associated with a higher aspartate aminotransferase to alanine aminotransferase ratio. These findings reinforce the usefulness of the ICH index as an instrument to identify target individuals and promote cardiovascular health in adolescents, and it also extends these observations to the liver manifestation of the metabolic syndrome.
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Sexual dimorphism in obesity-related genes in the epicardial fat during aging
Abstract
Aging increases the risk of cardiovascular disease and metabolic syndrome. Alterations in epicardial fat play an important pathophysiological role in coronary artery disease and hypertension. We investigated the impact of normal aging on obesity-related genes in epicardial fat. Sex-specific changes in obesity-related genes with aging in epicardial fat (EF) were determined in young (6 months) and old (30/36 months) female and male, Fischer 344 × Brown Norway hybrid (FBN) rats, using a rat obesity RT2 PCR Array. Circulating sex hormone levels, body and heart weights were determined. Statistical significance was determined using two-tailed Student's t test and Pearson's correlation. Our results revealed sex-specific differences in obesity-related genes with aging. Dramatic changes in the expression profile of obesity-related genes in EF with aging in female, but not in male, FBN rats were observed. The older (30 months) female rats had more significant variations in the abundance of obesity-related genes in the EF compared to that seen in younger female rats or both age groups in male rats. A correlation of changes in obesity-related genes in EF to heart weights was observed in female rats, but not in male rats with aging. No correlation was observed to circulating sex hormone levels. Our findings indicate a dysfunctional EF in female rats with aging compared to male rats. These findings, with further functional validation, might help explain the sex differences in cardiovascular risk and mortality associated with aging observed in humans.
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Σάββατο 14 Ιανουαρίου 2017
A simple method to control the distal tip of nasotracheal tube using the surgical suture
With great interest, we read the recent article by Hung et al. [1] describing a novel method to control the distal tip of nasotracheal tube. In clinical practice, we had used this technique to achieve the successful nasotracheal intubation [2]. We completely agree with the authors that this method may be used as a back-up technique if the cuff inflation technique fails for controlling the tube tip location during nasotracheal intubation. However, one of main concerns on this method is possible injury of the nasal mucosa by removing the surgical suture along the tube placed in the nasal passage immediately after intubation.
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Evaluating LMA-ProSeal insertion techniques: A call for methodological clarification
In the recent article by Ishio et al. [1] evaluating the insertion efficacy of the LMA-ProSeal by novice doctors with or without a 90° bend created by an intubating stylet in anesthetized patients, they demonstrate that a 90° bend re-figuration facilitates LMA-ProSeal insertion, as shown by a higher successful insertion rate, a higher sealing pressure, and a lower subjective difficulty of insertion. To rightly compare effect of insertion techniques on performance of the studied device in a randomized controlled trial, however, standardization of equipment and rational design of study are crucial.
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IOP-details
Source:International Journal of Psychophysiology, Volume 112
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Editorial Board
Source:International Journal of Psychophysiology, Volume 112
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Instructions to Authors
Source:International Journal of Psychophysiology, Volume 112
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Δ14CO2 from dark respiration in plants and its impact on the estimation of atmospheric fossil fuel CO2
Source:Journal of Environmental Radioactivity, Volumes 169–170
Author(s): Xiaohu Xiong, Weijian Zhou, Peng Cheng, Shugang Wu, Zhenchuan Niu, Hua Du, Xuefeng Lu, Yunchong Fu, George S. Burr
Radiocarbon (14C) has been widely used for quantification of fossil fuel CO2 (CO2ff) in the atmosphere and for ecosystem source partitioning studies. The strength of the technique lies in the intrinsic differences between the 14C signature of fossil fuels and other sources. In past studies, the 14C content of CO2 derived from plants has been equated with the 14C content of the atmosphere. Carbon isotopic fractionation mechanisms vary among plants however, and experimental study on fractionation associated with dark respiration is lacking. Here we present accelerator mass spectrometry (AMS) radiocarbon results of CO2 respired from 21 plants using a lab-incubation method and associated bulk organic matter. From the respired CO2 we determine Δ14Cres values, and from the bulk organic matter we determine Δ14Cbom values. A significant difference between Δ14Cres and Δ14Cbom (P < 0.01) was observed for all investigated plants, ranging from −42.3‰ to 10.1‰. The results show that Δ14Cres values are in agreement with mean atmospheric Δ14CO2 for several days leading up to the sampling date, but are significantly different from corresponding bulk organic Δ14C values. We find that although dark respiration is unlikely to significantly influence the estimation of CO2ff, an additional bias associated with the respiration rate during a plant's growth period should be considered when using Δ14C in plants to quantify atmospheric CO2ff.
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A Comparison of Locomotor Therapy Interventions: Partial Body Weight Supported Treadmill, Lokomat® and G-EO® Training in Persons with Traumatic Brain Injury
Literature in the application of gait training techniques in persons with traumatic brain injury is limited. Current techniques require of multiple staff and are physically demanding. The use of a robotic locomotor training may provide improved training capacity for this population.
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Rehabilitation of the Pontine Ataxia-Dysmetria Syndrome: A Case Presentation
We present a case of a patient with significant ataxia and dysmetria following a lacunar pontine infarction and review the literature on this uncommon syndrome. The patient had an excellent clinical course with near resolution of symptoms and signs in less than three weeks. We characterize and illustrate with videos of the ataxia and dysmetria. Interestingly, the characteristics of the dysmetria appear to be different than that seen in patients with dysmetria arising from a cerebellar or thalamic lesion.
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Improved Arousal and Motor Function Using Zolpidem in a Patient with Space-Occupying Intracranial Lesions: a case report
Patients with disorders of consciousness (DOC) have profound functional limitations with few treatment options for improving arousal and quality of life. Zolpidem is a non-benzodiazepine hypnotic used to treat insomnia that has also been observed to paradoxically improve arousal in those with DOC, such as the vegetative or minimally conscious states (MCS). There is little information on its use in DOC patients with intracranial space occupying lesions. We present a case of a 24year old man in a MCS due to CNS lymphoma who was observed to have increased arousal and improved motor function following administration of zolpidem.
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Predictors of Pharmacological Intervention in Adolescents with Protracted Symptoms after Sports-related Concussion
Though recovery after concussion is spontaneous and typically occurs within two to three weeks, a subset of adolescents develop persistent symptoms after a sports-related concussion. Medications are frequently prescribed as part of a comprehensive treatment approach to alleviate these symptoms; however, there are no guidelines for prescription of pharmacologic therapy after concussion.
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Does Trainee Involvement in Fluoroscopic Injections affect Fluoroscopic Time, Immediate Pain Reduction, and Complication Rate?
Patients have expressed concern about undergoing procedures involving trainees, even with direct attending physician supervision. Little literature examines the effect of trainee involvement on patient outcomes.
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Sonographically Guided Knee Meniscus Injections: Feasibility, Techniques and Validation
There is a growing interest in the use of biologic agents such as platelet-rich plasma and mesenchymal stem/stromal cells to treat musculoskeletal injuries, including meniscal tears. Although prior research has documented the role of diagnostic ultrasound to evaluate meniscal tears, sonographically guided (SG) techniques to specifically deliver therapeutic agents into the meniscus have not been described.
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Evaluation of lip pulling method efficacy for direct laryngoscopy: A prospective crossover clinical pilot trial
A lip pulling method is usually used to prevent lip or tooth injuries [1]. We previously suggested that this method may provide a better laryngoscopy [2]. We hypothesized that lip pulling could also improve laryngoscopy, since the lips sometimes impede sufficient laryngoscopy with the Macintosh laryngoscope (McL). To test our hypothesis, we conducted a prospective randomized crossover study to compare laryngoscopy with or without lip pulling. The primary outcome was the efficiency of laryngoscopy (Fig.
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Comparing direct and indirect laryngoscopy: Study design is crucial
In a randomized, controlled clinical trial by Kurnaz and Sarıtaş [1]. comparing intubation performance of the Truview PCD™ and Macintosh laryngoscopes and their effects on intubation hemodynamic responses in geriatric patients, they show that compared to Macintosh laryngoscope, Truview PCD™ laryngoscope (TPL) does not provide significant hemodynamic response sparing or a shorten intubation time. Besides the limitations described in the discussion, there are the several issues in this study that need to be clarified.
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Reply to the correspondence in relation to the article “Randomized study of post-cesarean analgesia with intrathecal morphine alone or combined with clonidine”
Firstly I would like to thank the opportunity to respond Dr. Bhakta.
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Anaesthetic management of a patient with Michels syndrome
Michels Syndrome, which was first defined in 1978, is an uncommon syndrome seen with craniosynostosis, blepharophimosis, ptosis, epicanthus inversus, cleft lip/palate, abnormal supra umbilical abdominal wall defect and mental deficit, hearing loss, spina bifida occulta, abnormalities in the kidneys, bladder and genital system [1].
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Lip injury associated with i-gel placement during general anesthesia
Although the i-gel® (i-gel: Intersurgical, U.K.) supraglottic airway device is useful for airway management during general anesthesia [1,2], there are reports of nerve and tongue injuries associated with i-gel use [3,4]. Here, we report a case of lip injury associated with i-gel use during general anesthesia.
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Dose ranging effects of pregabalin on pain in patients undergoing laparoscopic hysterectomy: A randomized, double blinded, placebo controlled, clinical trial
The study aimed to investigate the preemptive analgesia efficacy of different concentrations (75, 150 and 300mg) of preemptive pregabalin for the postoperative pain management after laparoscopic hysterectomy.
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Use of local anesthetic a key tenet in multimodal analgesia to modulate chronic post-mastectomy pain
Steyaert et al. performed a cross-sectional survey of women undergoing mastectomy with axillary lymph node dissection to determine risk factors, including anesthetic and analgesic regimen, for the development of chronic post-mastectomy pain [1]. They found that of the many anesthetic and analgesic variables studied, only the use of halogenated agents was associated with a decreased incidence of chronic pain. We appreciate the diligence of this investigation into how our anesthetic care can affect our patients, particularly given the frequent incidence of chronic post-mastectomy pain in this population.
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Airtraq® videolaryngoscope for assessing vocal cord mobility at the end of thyroidectomy
Voice impairment due to recurrent laryngeal nerve (RLN) palsy is one of the common and serious complications caused by thyroid surgery and a leading reason for medicolegal litigation. RLN palsy rates depend not only on the type of thyroid disease and the extent of resection but also on the surgeon's training. Routine RLN recognition is considered the gold standard of care for the prevention of nerve injury during thyroid surgery [1]; however, despite meticulous anatomical identification, the reported incidence of RLN palsy ranges from 0 to 12% [2,3].
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Intraoperative anaphylaxis, cardiac arrest and hypertrophic cardiomyopathy: Implications for Kounis syndrome
Anaphylactic reactions occurring during general anesthesia constitute the most severe and frequent forms of drug-induced hypersensitivity reactions. Although bronchospasm, cutaneous and mucus signs and symptoms are easily recognized, signs and symptoms that mainly involve the cardiovascular system constitute diagnostic and therapeutic problems. In the very interesting report published recently [1], a 75-year-old woman, hypertensive, smoker and allergic to penicillin and cephalosporin with vancomycin spacer placement, developed twice hypotensive cardiac arrest with pulseless electrical activity during preoperative general anesthesia for left total hip re-implantation.
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Postoperative foreign language syndrome
Foreign language syndrome (FLS), a substitution of native language (first language, L1) with person's later learned language (second language, L2) may rarely occur after serious injury to the brain which renders victims unconscious. There have been few reported cases of the FLS since it was first reported in the 1940s. The most famous case was a Norwegian woman, hit by shrapnel (World War II), who subsequently developed a German accent. Other cases include two British woman, one developed a Chinese accent following a migraine, and another had a stroke and gained a French accent (Foreign accent syndrome).(http://ift.tt/1QrW1FS).
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Selective attentional impairment in chronic tinnitus: evidence from an event-related potentials study
Tinnitus is an auditory phantom sensation experienced in the absence of a sound source (Eggermont and Roberts, 2004; Eggermont and Roberts, 2012). Tinnitus is a common symptom that is perceived as chronic by 10-15% of adults (Heller, 2003; Henry et al., 2005), 10-20% of whom report that it interferes with their everyday life (Leske, 1981; Quaranta et al., 1996). It is usually described as a ringing noise, though some patients experience a high-pitched whining, hissing or steady tone.
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Intermittent bilateral coherence in physiological and essential hand tremor
Physiological tremor and many of the pathological tremors typically occur in limbs on both the sides of the body, with similar fundamental frequency of the oscillation. This raises the possibility that the contralateral tremors may have a common source or are otherwise coupled. To confirm such coupling, however, it is necessary to systematically assess the dependence of the two tremor oscillations. This is commonly done by coherence analysis, which has been used in the previous literature to quantify kinematic (Marsden et al.
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Identification of Fhit as a post-transcriptional effector of Thymidine Kinase 1 expression
Publication date: Available online 14 January 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Daniel L. Kiss, Catherine E. Waters, Iman M. Ouda, Joshua C. Saldivar, Jenna R. Karras, Zaynab A. Amin, Seham Mahrous, Teresa Druck, Ralf A. Bundschuh, Daniel R. Schoenberg, Kay Huebner
FHIT is a genome caretaker gene that is silenced in >50% of cancers. Loss of Fhit protein expression promotes accumulation of DNA damage, affects apoptosis and epithelial-mesenchymal transition, though molecular mechanisms underlying these alterations have not been fully elucidated. Initiation of genome instability directly follows Fhit loss and the associated reduced Thymidine Kinase 1 (TK1) protein expression. The effects on TK1 of Fhit knockdown and Fhit induction in the current study confirmed the role of Fhit in regulating TK1 expression. Changes in Fhit expression did not impact TK1 protein turnover or transcription from the TK1 promoter, nor steady-state levels of TK1 mRNA or turnover. Polysome profile analysis showed that up-regulated Fhit expression resulted in decreased TK1 RNA in non-translating messenger ribonucleoproteins and increased ribosome density on TK1 mRNA. Fhit does not bind RNA but its expression increased luciferase expression from a transgene bearing the TK1 5′-UTR. Fhit has been reported to act as a scavenger decapping enzyme, and a similar result with a mutant (H96) that binds but does not cleave nucleoside 5′,5′-triphosphates suggests the impact on TK1 translation is due to its ability to modulate the intracellular level of cap-like molecules. Consistent with this, cells expressing Fhit mutants with reduced activity toward cap-like dinucleotides exhibit DNA damage resulting from TK1 deficiency, whereas cells expressing wild-type Fhit or the H96N mutant do not. The results have implications for the mechanism by which Fhit regulates TK1 mRNA, and more broadly, for its modulation of multiple functions as tumor suppressor/genome caretaker.
Graphical abstract
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Intermittent bilateral coherence in physiological and essential hand tremor
Source:Clinical Neurophysiology
Author(s): Soma Chakraborty, Jana Kopecká, Otakar Šprdlík, Martina Hoskovcová, Olga Ulmanová, Evžen Růžička, Martin Zapotocky
[Objective]To investigate the prevalence and the temporal structure of bilateral coherence in physiological (PT) and essential (ET) hand tremor.[Methods]Triaxial accelerometric recordings from both hands in 30 healthy subjects and 34 ET patients were analyzed using spectral coherence and wavelet coherence methods. In 12 additional healthy subjects, the relation between the hand tremor and the chest wall acceleration was evaluated using partial coherence analysis.[Results]The majority of both PT and ET subjects displayed significant bilateral coherence. While in PT, bilateral coherence was most frequently found in resting hand position (97% of subjects), in ET the prevalence was comparable for resting (54%) and postural (49%-57%) positions. In both PT and ET, epochs of strong coherence lasting several to a dozen seconds were separated by intervals of insignificant coherence. In PT, bilateral coherence at the main tremor frequency (8-12 Hz) was coupled with the ballistocardiac rhythm.[Conclusion]The oscillations of the two hands are intermittently synchronized in both PT and ET. We propose that in postural PT, bilateral coherence at the main tremor frequency arises from transient simultaneous entrainment of the left and right hand oscillations to ballistocardiac forcing.[Significance]Bilateral coherence of hand kinematics provides a sensitive measure of synchronizing influences on the left and right tremor oscillators.
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Lateralization of Language Function in Epilepsy Patients: A High-Density Scalp-Derived Event-Related Potentials (ERP) Study
Epilepsy surgery offers an effective and safe treatment option for patients with medically refractory seizure disorders and leads to seizure freedom in 60-80% of patients. The goals of epilepsy surgery are on one hand to remove the epileptogenic zone, giving seizure freedom, but also to avoid causing neuropsychological deficits such as language or memory dysfunction (Binder et al., 2008; Sabsevitz et al., 2003). Thus, the accurate localization of essential brain regions, which are responsible for language and memory, as well as vision and motor function, is of the utmost importance.
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Hemotherapy algorithm for the management of trauma-induced coagulopathy: the German and European perspective.
Purpose of review: This review presents a synopsis of best current knowledge with reference to the updated German and European guidelines and recommendations on the management of severe trauma hemorrhage and trauma-induced coagulopathy as well as a viscoelastic-based treatment algorithm based upon international expert consensus to trigger the administration of hemostatic agents and blood products. Recent findings: Uncontrolled hemorrhage and trauma-induced coagulopathy are the major causes for preventable death after trauma and early detection and aggressive management have been associated with improved outcomes. However, best practice to treat this newly defined entity is still under debate. In the acute phase, the clinical management usually follows the 'Damage Control Resuscitation' concept, which advocates the empiric administration of blood products in predefined and fixed ratios. As an alternative, several European but also a few US trauma centers have instituted the concept of 'Goal-directed Coagulation Therapy' based upon results obtained from early point-of-care viscoelastic testing. Summary: Current guidelines urge for the implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Παρασκευή 13 Ιανουαρίου 2017
Role of STIM2 in cell function and physiopathology
Abstract
An endoplasmic reticulum (ER)–resident protein that regulates cytosolic and ER free-Ca2+ concentration by induction of store–operated calcium entry. That is the original definition of STIM2 and its function. While its activity strongly depends on the amount of calcium stored in the ER, its function goes further to intracellular signalling and gene expression. Initially undercovered by the prominent function of STIM1, STIM2 became to be vital in mice, gradually emerging as an important player in the nervous system, and cooperating with STIM1 in the immune system. STIM2 has also been proposed as a relevant player in pathological conditions related to ageing, Alzheimer and Huntington's diseases, autoimmune disorders and cancer. The discovery of additional functions, together with new splicing forms with opposite roles, clarified existing controversies about STIM2 function in SOCE. Being essential for life, but apparently not for development, new available data demonstrated a complex and still intriguing behaviour that this review summarizes, updating the current knowledge about STIM2 function.
This article is protected by copyright. All rights reserved
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In Vitro Development of Ciprofloxacin Resistance of Salmonella enterica Serovars Typhimurium, Enteritidis, and Indiana Isolates from Food Animals
Microbial Drug Resistance , Vol. 0, No. 0.
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Systematic Review of Antimicrobial Resistance of Clinical Acinetobacter baumannii Isolates in Iran: An Update
Microbial Drug Resistance , Vol. 0, No. 0.
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Emergence of Imipenem-Resistant Pseudomonas aeruginosa Clinical Isolates from Egypt Coharboring VIM and IMP Carbapenemases
Microbial Drug Resistance , Vol. 0, No. 0.
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De novo genome and transcriptome assembly of the Canadian beaver (Castor canadensis)
The Canadian beaver (Castor canadensis) is the largest indigenous rodent in North America. We report a draft annotated assembly of the beaver genome, the first for a large rodent and the first mammalian genome assembled directly from uncorrected and moderate coverage (< 30 x) long-reads generated by single-molecule sequencing. The genome size is 2.7 Gb estimated by k-mer analysis. We assembled the beaver genome using the new Canu assembler optimized for noisy reads. The resulting assembly was refined using Pilon supported by shortreads (80 x) and checked for accuracy by congruency against an independent short-read assembly. We scaffolded the assembly using the exon-gene models derived from 9805 full-length open reading frames (FL-ORFs) constructed from the beaver leukocyte and muscle transcriptomes. The final assembly comprised 22,515 contigs with an N50 of 278,680 bp and an N50-scaffold of 317,558 bp. Maximum contig and scaffold lengths were 3.3 and 4.2 Mb, respectively, with a combined scaffold length representing 92% of the estimated genome size. The completeness and accuracy of the scaffold assembly was demonstrated by the complete and precise exon placement for 91.1% of the 9,805 assembled FL-ORFs and 83.1% of the BUSCO (Benchmarking Universal Single-Copy Orthologs) gene set used to assess the quality of genome assemblies. Well-represented were genes involved in dentition and enamel deposition, defining characteristics of rodents with which the beaver is well-endowed. The study provides insights for genome assembly and an important genomics resource for Castoridae and rodent evolutionary biology.
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Simulated microgravity decreases circulating iron in rats: role of inflammation-induced hepcidin upregulation
During spaceflight, humans exposed to microgravity exhibit an increase of iron storage and a reduction of circulating iron. Such perturbations could promote oxidative stress and anemia in astronauts. The mechanism by which microgravity modulates iron metabolism is still unknown. Herein, we hypothesized that microgravity up-regulates hepcidin, a hormone produced by the liver that is the main controller of iron homeostasis. To test this hypothesis, rats were submitted to hindlimb unloading (HU), the reference model to mimic the effects of microgravity in rodents. After seven days, the mRNA level of hepcidin was increase in the liver of HU rats (+74%, P = 0.001). In agreement with the biological role of hepcidin, we found an increase of spleen iron content (+78%, P = 0.030) and a decrease of serum iron concentration (−35%, P = 0.002) and transferrin saturation (−25%, P = 0.011) in HU rats. These findings support a role of hepcidin in microgravity-induced iron metabolism alteration. Furthermore, among the signaling pathways inducing hepcidin mRNA expression, we found that only the interleukin-6/signal transducer and activator of transcription 3 (IL-6/STAT3) axis was activated by HU as shown by the increase of phospho-STAT3 (+193%, P < 0.001) and of the hepatic mRNA level of haptoglobin (+167%, P < 0.001), a STAT3-inducible gene, in HU rats. Taken together, these data supports that microgravity may alter iron metabolism through an inflammatory process up-regulating hepcidin.
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EAG channels expressed in microvillar photoreceptors are unsuited to diurnal vision
Abstract
The principles underlying evolutionary selection of ion channels for expression in sensory neurons are unclear. Among species possessing microvillar photoreceptors the major ionic conductances have only been identified in Drosophila melanogaster. In Drosophila depolarization is provided by light-activated TRP channels with a minor contribution from TRPL channels, while repolarization is mediated by sustained voltage-gated K+ (Kv) channels of the Shab family. Bright light stimulates Shab channels, further restricting depolarization and improving membrane bandwidth. Here, data obtained using a combination of electrophysiological, pharmacological, and molecular knockdown techniques, strongly suggest that in photoreceptors of the nocturnal cockroach Periplaneta americana, the major excitatory channel is TRPL, while the predominant delayed rectifier is EAG, a ubiquitous but enigmatic Kv channel. In contrast to the diurnal Drosophila, bright light strongly suppresses EAG conductance in Periplaneta. This light-dependent inhibition (LDI) is caused by calcium entering the cytosol, is amplified following inhibition of calcium extrusion, and can be abolished by chelating intracellular calcium or suppressing eag gene expression by RNA interference. LDI increases membrane resistance, augments gain and reduces signalling bandwidth, impairing information transfer. LDI is also observed in the nocturnal cricket Gryllus integer, whereas in the diurnal water strider Gerris lacustris the delayed rectifier is up-regulated by light. Although LDI is not expected to reduce delayed rectifier current in the normal illumination environment of nocturnal cockroaches and crickets, it makes EAG unsuitable for light response conditioning during the day, and might have caused evolutionary replacement of EAG by other delayed rectifiers in diurnal insects.
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Short-latency allocentric control of saccadic eye movements
It is generally accepted that the neural circuits that are implicated in saccade control use retinotopically coded target locations. However, several studies have revealed that nonretinotopic representation is also used. This idea raises a question about whether nonretinotopic coding is egocentric (head or body centered) or allocentric (environment centered). In the current study, we hypothesized that allocentric coding may play a crucial role in immediate saccade control. To test this hypothesis, we used an immediate double-step saccade task toward two sequentially flashed targets with a frame in the background, and we examined whether the end point of the second saccade was affected by a transient shift of the background that participants were told to ignore. When the background was shifted transiently upward (or downward) during the flash of the second target, the second saccade generally erred the target downward (or upward), which was in the direction opposite to the shift of the background. The effect on the second saccade became significant within 150 ms after the frame was presented for decoding and was built up for 200 ms thereafter. When the second saccade was not adjusted, a small, corrective saccade followed within 300 ms. The effect scaled linearly with the shift size up to 3° for a noncorrective second saccade and up to 6° for a corrective saccade. The present results show that an allocentric location of a target is rapidly represented by the brain and used for controlling saccades.
NEW & NOTEWORTHY We found that the saccade end point was shifted from the actual target position toward the direction expected from allocentric coding when a large frame in the background was transiently shifted during the period of target presentation. The effect occurred within 150 ms. The present study provides direct evidence that the brain rapidly uses allocentric coding of a target to control immediate saccades.
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The acute inhibition of enteric glial metabolism with fluoroacetate alters calcium signaling, hemichannel function, and the expression of key proteins
Glia play key roles in the regulation of neurotransmission in the nervous system. Fluoroacetate (FA) is a metabolic poison widely used to study glial functions by disrupting the tricarboxylic acid cycle enzyme aconitase. Despite the widespread use of FA, the effects of FA on essential glial functions such as calcium (Ca2+) signaling and hemichannel function remain unknown. Therefore, our goal was to assess specifically the impact of FA on essential glial cell functions that are involved with neurotransmission in the enteric nervous system. To this end, we generated a new optogenetic mouse model to study specifically the effects of FA on enteric glial Ca2+ signaling by crossing PC::G5-tdTomato mice with Sox10::creERT2 mice. FA did not change the peak glial Ca2+ response when averaged across all glia within a ganglion. However, FA decreased the percent of responding glia by 30% (P < 0.05) and increased the peak Ca2+ response of the glial cells that still exhibited a response by 26% (P < 0.01). Disruption of Ca2+ signaling with FA impaired the activity-dependent uptake of ethidium bromide through connexin-43 (Cx43) hemichannels (P < 0.05) but did not affect baseline Cx43-dependent dye uptake. FA did not cause overt glial or neurodegeneration, but glial cells significantly increased glial fibrillary acid protein by 56% (P < 0.05) following treatment with FA. Together, these data show that the acute impairment of glial metabolism with FA causes key changes in glial functions associated with their roles in neurotransmission and phenotypic changes indicative of reactive gliosis.
NEW & NOTEWORTHY Our study shows that the acute impairment of enteric glial metabolism with fluoroacetate (FA) alters specific glial functions that are associated with the modification of neurotransmission in the gut. These include subtle changes to glial agonist-evoked calcium signaling, the subsequent disruption of connexin-43 hemichannels, and changes in protein expression that are consistent with a transition to reactive glia. These changes in glial function offer a mechanistic explanation for the effects of FA on peripheral neuronal networks.
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Visual search for object categories is predicted by the representational architecture of high-level visual cortex
Visual search is a ubiquitous visual behavior, and efficient search is essential for survival. Different cognitive models have explained the speed and accuracy of search based either on the dynamics of attention or on similarity of item representations. Here, we examined the extent to which performance on a visual search task can be predicted from the stable representational architecture of the visual system, independent of attentional dynamics. Participants performed a visual search task with 28 conditions reflecting different pairs of categories (e.g., searching for a face among cars, body among hammers, etc.). The time it took participants to find the target item varied as a function of category combination. In a separate group of participants, we measured the neural responses to these object categories when items were presented in isolation. Using representational similarity analysis, we then examined whether the similarity of neural responses across different subdivisions of the visual system had the requisite structure needed to predict visual search performance. Overall, we found strong brain/behavior correlations across most of the higher-level visual system, including both the ventral and dorsal pathways when considering both macroscale sectors as well as smaller mesoscale regions. These results suggest that visual search for real-world object categories is well predicted by the stable, task-independent architecture of the visual system.
NEW & NOTEWORTHY Here, we ask which neural regions have neural response patterns that correlate with behavioral performance in a visual processing task. We found that the representational structure across all of high-level visual cortex has the requisite structure to predict behavior. Furthermore, when directly comparing different neural regions, we found that they all had highly similar category-level representational structures. These results point to a ubiquitous and uniform representational structure in high-level visual cortex underlying visual object processing.
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Stimulus context alters neural representations of faces in inferotemporal cortex
One goal of our nervous system is to form predictions about the world around us to facilitate our responses to upcoming events. One basis for such predictions could be the recently encountered visual stimuli, or the recent statistics of the visual environment. We examined the effect of recently experienced stimulus statistics on the visual representation of face stimuli by recording the responses of face-responsive neurons in the final stage of visual object recognition, the inferotemporal (IT) cortex, during blocks in which the probability of seeing a particular face was either 100% or only 12%. During the block with only face images, ~30% of IT neurons exhibit enhanced anticipatory activity before the evoked visual response. This anticipatory modulation is followed by greater activity, broader view tuning, more distributed processing, and more reliable responses of IT neurons to the face stimuli. These changes in the visual response were sufficient to improve the ability of IT neurons to represent a variable property of the predictable face images (viewing angle), as measured by the performance of a simple linear classifier. These results demonstrate that the recent statistics of the visual environment can facilitate processing of stimulus information in the population neuronal representation.
NEW & NOTEWORTHY Neurons in inferotemporal (IT) cortex anticipate the arrival of a predictable stimulus, and visual responses to an expected stimulus are more distributed throughout the population of IT neurons, providing an enhanced representation of second-order stimulus information (in this case, viewing angle). The findings reveal a potential neural basis for the behavioral benefits of contextual expectation.
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Evidence of common and separate eye and hand accumulators underlying flexible eye-hand coordination
Eye and hand movements are initiated by anatomically separate regions in the brain, and yet these movements can be flexibly coupled and decoupled, depending on the need. The computational architecture that enables this flexible coupling of independent effectors is not understood. Here, we studied the computational architecture that enables flexible eye-hand coordination using a drift diffusion framework, which predicts that the variability of the reaction time (RT) distribution scales with its mean. We show that a common stochastic accumulator to threshold, followed by a noisy effector-dependent delay, explains eye-hand RT distributions and their correlation in a visual search task that required decision-making, while an interactive eye and hand accumulator model did not. In contrast, in an eye-hand dual task, an interactive model better predicted the observed correlations and RT distributions than a common accumulator model. Notably, these two models could only be distinguished on the basis of the variability and not the means of the predicted RT distributions. Additionally, signatures of separate initiation signals were also observed in a small fraction of trials in the visual search task, implying that these distinct computational architectures were not a manifestation of the task design per se. Taken together, our results suggest two unique computational architectures for eye-hand coordination, with task context biasing the brain toward instantiating one of the two architectures.
NEW & NOTEWORTHY Previous studies on eye-hand coordination have considered mainly the means of eye and hand reaction time (RT) distributions. Here, we leverage the approximately linear relationship between the mean and standard deviation of RT distributions, as predicted by the drift-diffusion model, to propose the existence of two distinct computational architectures underlying coordinated eye-hand movements. These architectures, for the first time, provide a computational basis for the flexible coupling between eye and hand movements.
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Simultaneous bilateral femoral neck fracture following tetanus in a healthy adult
African Journal of Medical and Health Sciences 2016 15(2):100-102
A 45-year-old trader presented to us with 4 weeks history of difficulty in opening his mouth, inability to walk and tonic–clonic seizures with bilateral femoral neck fractures. Three weeks before the onset of problems, the patient had been knocked down by a tricycle and had sustained an open wound over the right medial malleolus; the wound was sutured at a general hospital and the patient discharged home. One week later, the wound started discharging a foul-smelling pus and was dressed at a primary health centre; however, by the second week, the patient started having difficulty in opening his mouth. By the third week, he was bed ridden, developed tonic–clonic seizures and felt a crunching sound associated with severe pain in both hips. He was taken to a traditional bone setter who gave him some herbs, but his symptoms got worse. He was then brought to the Accident and Emergency Department of the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria where a diagnosis of tetanus was made. Further evaluation revealed Gardener-type IV bilateral femoral neck fractures. He was managed for the tetanus, underwent bilateral bipolar hemiarthroplasty and was discharged home. He spent 10 weeks in the hospital.
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A 3-year review of the pattern of contraceptive use among women attending the family planning clinic of a University Teaching Hospital in Lagos, Nigeria
African Journal of Medical and Health Sciences 2016 15(2):69-73
Background: Contraceptives are methods or devices used to prevent pregnancy. In Nigeria, the contraceptive prevalence was reported at 15% in 2013. Aims: This study aimed to determine the pattern of contraceptive use and sociodemographic characteristics of the users of family planning services in a teaching hospital in Lagos. Subjects and Methods: This was a descriptive, retrospective study of women who sought contraceptive services at the family planning clinic over a 3-year period. Relevant information was extracted from the case records of these women. Data were analyzed using Epi Info statistical package for Windows. Results: A total of 594 women opted to use a form of contraception in the study, within an age range of 15–52 years and with mean age of 34.3 ± 4.2 years. Fifty-four percent (54%) of the women users belonged to the Yoruba tribe and 89.4% were of the Christian faith. Married women accounted for 97.6% of the users, with the majority (68.9%) having parity of 2–4. Majority (77.6%) of the women had at least a tertiary level of education, with 46.1% of them involved in a form of skilled occupation. Nurses were the commonest source of referrals (42.9%). A larger proportion of the women (46.3%) preferred Jadelle implant while the least used method is Norplant (0.5%). Conclusion: Equipping medical personnel with the information and skills needed to meet the increasing demand for family planning services is necessary to avert the needless increase in the incidence of unwanted pregnancies, unsafe abortion, and their sequelae.
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Prevalence of Chlamydia trachomatis immunoglobulin G antibody in infertile women in Calabar
African Journal of Medical and Health Sciences 2016 15(2):74-79
Background: Genital Chlamydia trachomatis infection is recognized as the single most common cause of tubal peritoneal damage leading to infertility. Knowledge of the prevalence of Chlamydia antibodies among infertile women will help determine the level of Chlamydial infection and hence its contribution to infertility. Objectives: To determine the prevalence of C. trachomatis immunoglobulin G (IgG) antibody in infertile patients and the sociodemographic characteristics and risk factors associated with infection in Calabar. Materials and Methods: This was a prospective comparative study conducted among 145 women presenting for infertility in UCTH Calabar. Another 145 women with normal pregnancies attending the antenatal clinic were used as controls. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 18.0 (SPSS Inc, Chicago, IL, USA). A P-value of less than 0.05 was considered significant. Results: The prevalence of C. trachomatis IgG antibody was 38.6% in the infertile group and 22.8% in the pregnant controls. This difference was statistically significant (P < 0.05). Infertile women aged 30–34 years had the highest positivity rate (36.0%) for C. trachomatis antibody. Thirty-eight (42.7%) of the infertile subjects who tested positive had a history of pelvic inflammatory disease (PID) while 47 (23.4%) who tested negative had a history of PID. The difference was statistically significant (P = 0.001). Chlamydia infection was not found to be associated with any particular type of infertility (P > 0.05). Conclusion: The prevalence of C. trachomatis was higher in infertile women when compared to pregnant controls. This finding lends credence to the call for enzyme immunosorbent assay for Chlamydial IgG antibodies to be incorporated into infertility investigation in this environment.
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Marfan syndrome: A case report
African Journal of Medical and Health Sciences 2016 15(2):107-109
Marfan syndrome (MS) is a disorder of the connective tissues characterized by various phenotypical and genetic manifestations. We present this case to show its rarity and to highlight the need of early diagnosis to avert the numerous complications that follow it. A 7-year-old male, who presented with an abnormal body physique that was noticed at age 2 months, poor vision that was noticed 5 years ago, recurrent chest pain that started 3 years ago, and recurrent easy tiredness that started 3 years ago. He developed poor vision 2 years later. Examination revealed an acutely ill-looking child with dyspnea, grade 4 apical positive surgical margins (PSM), grade 2 diastolic murmur (at the aortic area), multiple skeletal abnormalities with lens subluxation and iridodonesis. Diagnosis of MS was made and he was comanaged with ophthalmologists and orthopedic surgeons.
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Health-related quality of life in sickle cell disease subjects in Benin City, Nigeria
African Journal of Medical and Health Sciences 2016 15(2):80-85
Background: Sickle cell disease (SCD) is a chronic disease associated with increased morbidity and mortality. Hemoglobinopathies are the most prevalent genetic disease globally, and SCD is estimated to affect 2–3% of Nigerians. The disease may adversely impact on the quality of life of sickle cell patients. This study aims to evaluate the health-related quality of life (HRQoL) of SCD subjects compared to normal controls living in Benin City, Nigeria. Methodology: The HRQoL of SCD subjects was evaluated using the Medical Outcome Study 36-item survey tool. The outcome was compared with those of a normal non-SCD population. Data were analyzed with Statistical Package for Social Sciences version 16 (Chicago, SPSS Inc.). P value was set at 0.05.Results: Sixty-one SCD subjects and 61 normal respondents (controls) participated in the study. The mean ages of the SCD group and controls were 26.7 ± 9.0 years and 23.70 ± 3.1 years, respectively. Fifty-nine (96.7%) of the SCD respondents were hemoglobin (Hb) SS and 2 (3.3%) were Hb SC. The physical function, limitations due to physical health, general health, and pain scores were significantly lower in the SCD population compared to the controls (P = 0.000, 0.000, 0.000, and 0.002, respectively. The social function and limitation due to the emotional problem do not differ significantly between both groups while the vitality (energy/fatigue) score and emotional well-being were higher in the SCD group, but they were not statistically significant (P = 0.066 and 0.127, respectively). Male gender, employment, clinic attendance, and family support impacted positively on the HRQoL of SCD subjects. Conclusion: The physical and general health functions of SCD subjects are significantly impaired by the disease. There is a need for clinicians in our region to review current management trends to include world best practices such as the universal use of hydroxyurea and stem cell transplantation to change the prevailing trend.
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Vaginal delivery after three previous caesarean sections: A report of two cases
African Journal of Medical and Health Sciences 2016 15(2):97-99
Vaginal birth after one caesarean section (CS) is considered safe in selected women. However, women with more than one CS in low-income settings are at higher risk of complications with vaginal birth. Thus, abdominal delivery is recommended for women with more than one CS in low-income countries unlike in high-income countries. This study was designed to raise awareness on the remote possibility of safe vaginal delivery after three CS in low-income countries. The records of two women who had vaginal deliveries after three previous CS were retrieved and reviewed. Both women presented in advanced labour and had unplanned but successful vaginal deliveries. There was no uterine rupture. The risks and consequences of uterine rupture may outweigh the benefits of unplanned vaginal birth after more than one CS. These unusual cases suggest the remote possibility of success and the need for further studies on defining safety guidelines for low-resource settings.
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Seminal fluid features of male partners of infertility patients in southeast Nigeria
African Journal of Medical and Health Sciences 2016 15(2):86-91
Background: Semen analysis has remained an objective, inexpensive and readily available means of assessing male factor infertility. There is a paucity of studies on male factor infertility in Nigeria using the current World Health Organization 2010 human values for semen characteristics. Aim: This study was aimed at determining the socio-demographic and semen characteristics of the male partners of infertile couples in Abakaliki. Materials and Methods: The case files of infertility cases managed at Federal Teaching Hospital from January 2011 to December 2015 were retrieved. Results: Out of 730 semen analysis results analysed, 297 (40.7%) have abnormal parameters ranging from abnormal motility (36.7%), to the combination of low sperm count, abnormal motility and morphology (0.68%). While older age and urban dwelling had significant effect on abnormal sperm motility, rural dwelling and low/or no educational status had a significant effect on low seminal fluid volume and sperm count (P-value ≤ 0.05). Conclusion: There is still a high rate of male factor infertility in this environment.
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An 80-year-old man with acute panmyelosis with myelofibrosis: A rare subtype of acute myeloid leukemia
African Journal of Medical and Health Sciences 2016 15(2):103-106
Acute panmyelosis with myelofibrosis (APMF) is a rare, fatal hematological neoplasm that is characterized by acute onset of cytopenias and fibrosis in the bone marrow in the absence of splenomegaly or fibrosis-related morphological changes in the red blood cells. We report the case of an 80-year-old male who presented with progressive pallor and weakness of 1-month duration. Peripheral smear revealed severe anemia, leukopenia with occasional circulating blasts and a normal platelet count. The marrow was heavily fibrotic, and no aspirate material could be obtained; the biopsy showed extensive infiltration with small to medium size megakaryocytes, dysplastic changes in the erythroid compartment, and focal clusters of blasts. A diagnosis of APMF was made and the patient was started on low dose lenalidomide and supportive transfusions. However, the patient died due to intracranial bleeding. Cases of APMF have a dismal outcome and should be managed aggressively.
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Giant pleomorphic adenoma of major salivary glands: A review of ten cases
African Journal of Medical and Health Sciences 2016 15(2):92-96
Background: Pleomorphic adenoma (PA) of the major salivary glands has been documented to occur in various sizes ranging from 1 cm to 10 cm in their widest diameter; however, they can assume a grotesque proportion as a consequence of uninhibited growth in cases with delayed presentation. Patients and Methods: A retrospective study of all patients with PA of the major salivary glands with sizes >10 cm in its widest dimension and seen over a 10-year period was undertaken by retrieving sociodemographic and clinical data from patients' case files from the Oral and Maxillofacial Unit of a Nigerian Teaching Hospital. Results: Case files of ten patients (4 males and 6 females) were reviewed over the study period. The ages ranged from 14 to 61 years, mean 33.8 ± 17.97 years. Equal distribution of five cases of PA was noted in the parotid and submandibular glands, respectively. The onset of symptoms ranged from 3 to 20 years and the largest tumor was 27 cm in its largest diameter. Only one case of malignant PA was recorded. Conclusion: Prevalence of giant PA from the study was found to be 13.5%, with a greater occurrence in the female (60%) patients compared to the male (40%) patients and with an equal distribution in both parotid and submandibular glands. PA of major salivary glands can assume a grotesque proportion when timely surgical intervention is not sought. Complete surgical excision in benign lesions can guarantee a cure and restore self-esteem.
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Guillain–Barre syndrome in pregnancy: A case report
African Journal of Medical and Health Sciences 2016 15(2):110-112
Guillain–Barre syndrome (GBS) complicating pregnancy is a rare event, with documented incidence of 1–3 per 100,000 people annually. Maternal and perinatal mortality rate of >10% is associated with GBS. We present a 28-year-old gravida four para three housewife who developed progressive ascending paralysis during the second trimester of pregnancy. A detailed history and physical examination led to the clinical diagnosis of GBS; she had a preceding gastrointestinal infective episode. She did not consent to lumbar puncture for cerebrospinal fluid analysis, but all investigation results were normal. She was managed supportively as an in-patient with physiotherapy in conjunction with the physiotherapists. Her symptoms improved and she was discharged after 12 days. The rest of the pregnancy progressed uneventfully, and she had a spontaneous vertex delivery of a live female baby that weighed 2.55 kg with good Apgar scores, after 8 h of uncomplicated labour at term. She did not have any postpartum complications, and the neonate was healthy and normal.
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