Autoimmune Enteropathy: An Updated Review with Special Focus on Stem Cell Transplant Therapy

Abstract

Autoimmune enteropathy (AIE) is a complex disease affecting both children and adults. Although associated with significant morbidity and mortality, the pathophysiology of the disease and its treatment have not been well characterized. This study aims to review the medical literature available on this rare but clinically significant ailment, to help establish a better understanding of its pathophysiology and enumerate the available diagnostic and treatment modalities. A literature search was conducted on PubMed using key terms related to autoimmune enteropathy and intractable diarrhea, with no restrictions on the date of publication or language. We found a total of 98 reports of AIE published in the form of case reports and case series. The evidence reviewed suggests that AIE is a multifaceted disorder that requires a high index of suspicion in the appropriate clinical setting to be able to make an early diagnosis. Current evidence supports the use of supportive care to correct nutritional and metabolic deficiencies, and immunosuppressives and immunomodulators as directed therapies. Hematopoietic stem cell transplant is an aggressive, but successful curative modality for patients with AIE as part of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. Cumulative clinical experience with management of AIE has allowed improved outcomes in transplanted and non-transplanted AIE patients even though morbidity and mortality with are still high in patients with this condition. More research is needed to further define the role of new therapies for AIE, and a central registry with participation of multiple institutions might help share and standardize care of patients with this rare but serious condition.

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Short-Term Symptomatic Relief in Gastroesophageal Reflux Disease: A Comparative Study of Esomeprazole and Vonoprazan

Abstract

Background and Aim

Proton pump inhibitors and vonoprazan (a potassium-competitive acid blocker) are recommended as first-line treatments for gastroesophageal reflux disease (GERD). However, few reports have investigated the onset of action of these agents for GERD symptom relief. The present study compared the symptom relief of esomeprazole with that of vonoprazan via monitoring self-reported GERD symptoms after treatment initiation.

Methods

This was a prospective, multicenter, randomized, open-label, parallel group, comparative clinical study between esomeprazole (20 mg/day) and vonoprazan (20 mg/day) administered for 4 weeks to patients with GERD symptoms. Patients who had scores ≥ 8 on the Gastroesophageal Reflux Disease Questionnaire (GerdQ) were defined as having GERD and enrolled in this study. Sixty patients were randomly assigned to either the esomeprazole group (n = 30) or the vonoprazan group (n = 30). Treatment response rates in each drug group were evaluated according to the GerdQ. The Frequency Scale for the Symptoms of GERD (FSSG) scores from the 1st day after treatment initiation and the Global Overall Symptom (GOS) scale scores during treatment were also evaluated.

Results

At 4 weeks, the treatment response rates for symptom relief according to the GerdQ were 88.0% in the esomeprazole group and 81.8% in the vonoprazan group. The GOS scales, which reflect the impact of GERD symptoms, were similar for both groups. The FSSG scores decreased from the 1st to the 14th day in both groups.

Conclusions

There were no substantial differences in the symptom relief between the two groups at any time point in this short-term study.

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Malignant Transformation of Ectopic Pancreas

Abstract

Malignant transformation of ectopic pancreas tissue is a diagnostic challenge as clinical symptoms and radiographic features of these tumors are non-specific. Given the rarity of these lesions, it is usually neither suspected nor included in the diagnostic workup of different tumors. We conducted a comprehensive literature review regarding malignancy arising from ectopic pancreas for a better understanding of its frequency, clinicopathological features, and prognosis. A literature search was performed in three major databases: PubMed, Cochrane, and Web of Science. Fifty-four well-documented cases of malignant ectopic pancreas were identified in the published literature. Our analysis provided the following observations: (1) there was a slight predominance of males over females; (2) most patients with malignant transformation of ectopic pancreas were middle-aged; (3) most commonly, the tumor was located in the stomach; (4) most tumors were adenocarcinomas; (5) most frequently, the malignancy arose within a type I heterotopia according to Heinrich classification; (6) macroscopically, a subepithelial-like appearance was most frequently observed; and (7) improved prognosis for ectopic pancreatic malignancies in comparison with reported survival data for orthotopic pancreatic cancer. Even if the majority of cases of ectopic pancreas are incidental findings and malignant transformation is a rare event, pancreatic heterotopy should be considered as a source of potentially malignant lesions.

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The early-citation trend: an analysis of seven rehabilitation journals concerning the 2015–2017 window

No abstract available

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Effectiveness of robot-assisted gait training on motor impairments in people with Parkinson’s disease: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate the effectiveness of robot-assisted gait training (RAGT) on motor impairments in people with Parkinson's disease (PD). A computer-based systematic literature search was performed in six databases according to PRISMA guidelines. Randomized controlled trials (RCTs) that assessed the effects of RAGT on motor impairments in people with PD were included. GRADE approach and PEDro scale were used to determine the studies' quality of evidence. Meta-analyses were performed by calculating the weighted mean difference (WMD) at 95% confidence interval. Seven RCTs (PEDro: 5–8) met the inclusion criteria for systematic review and meta-analyses. The meta-analysis showed significant improvement on Unified Parkinson Disease Rating Scale Part III after intervention [WMD=3.292; 95% confidence interval (CI)=1.378–5.207; P=0.000], and after 1-month follow-up (WMD=5.512; 95% CI=2.396–8.629; P=0.001). Stride length (WMD=9.283; 95% CI=7.153–11.414; P=0.00) and gait speed (WMD=0.166; 95% CI=−0.090 to 0.243; P=0.000) showed significant improvements after RAGT. Balance as measured by Berg Balance Scale was improved significantly after intervention (WMD=3.87; 95% CI=0.374–6.735; P=0.029) and at 1-month follow-up (WMD=3.87; 95% CI=1.324–6.413; P=0.002). The pooled analysis did not detect any significant changes regarding stride time, cadence and functional balance scales. GRADE level of evidence ranged between high and low. The RAGT showed better outcomes than conventional interventions on some motor aspects in PD. However, RAGT did not seem superior to control interventions. Further RCTs that examine the effect of RAGT on more specific outcomes and at different medication statuses are required.

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Feasibility of a targeted strengthening program to improve gait in people with multiple sclerosis: a brief report

This study aims to determine feasibility of strengthening muscles that are important contributors to gait for people with multiple sclerosis, yet are not routinely targeted in the literature. An 8-week strengthening intervention targeted ankle plantarflexion, hip abduction, and trunk muscles using a repeated-measures design. Outcomes included satisfaction, adherence, muscle strength, gait speed (timed 25-foot walk), gait endurance (6-min walk test), and self-reported gait-related participation (Multiple Sclerosis Walking Scale-12). Ten participants (Expanded Disability Status Scale: 3.5–5.5) completed the intervention. All participants were at least 'satisfied'; adherence was 87% (supervised sessions) and 75% (home sessions). All quantitative measures improved: muscle strength (23.1–47.6%, P

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Reliability and validity of the shortened Singapore versions of the Chedoke Arm and Hand Activity Inventory

Upper limb deficits are common sequelae after a stroke and negatively affect daily living and quality of life. The use of outcome measures to evaluate upper limb function is essential to assess sensorimotor recovery and to determine the effectiveness of rehabilitation. The aim of this study was to estimate the construct validity and inter-rater reliability of three shortened versions of the Singapore version of the Chedoke Arm and Hand Activity Inventory (CAHAI-SG) comprising seven, eight, and nine test items. The sample consisted of 55 inpatients with acute/subacute stroke to whom the CAHAI-SG, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT) were administered. To estimate convergent and discriminative construct validity, Spearman's rank correlation coefficient and 95% confidence intervals were computed for CAHAI-SG scores with FMA-UE and ARAT scores. Reliability was estimated using intraclass correlation coefficient (relative reliability) and the standard error of measurement (absolute reliability). Convergent validity with the FMA-UE was 0.79, 0.80, and 0.81 for seven-item, eight-item, and nine-item versions of the CAHAI-SG, respectively, and 0.81 with the ARAT for all shortened versions. Discriminative validity with the FMA-UE pain subscale was between 0.37 and 0.38. The absolute reliability was 3.09, 3.65, and 3.98, and relative reliability was 0.96, 0.95, and 0.96 for the seven-item, eight-item, and nine-item versions, respectively. All shortened versions of the CAHAI-SG demonstrated similar psychometric properties to the full (13 item) version, meaning clinicians may use these shorter versions that require less time to administer and score.

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Therapeutic electrical stimulation and immune status in healthy men

In physical and rehabilitation medicine, there are few reports on the effects of therapeutic low-frequency electrical stimulation on the immune response of the organism, even though electrical stimulation is used widely in clinical practice and sports medicine. The aim of our study was to examine the possible immunological consequences of moderate transcutaneous neuromuscular electrical stimulation (NMES) for quadriceps muscle strengthening in healthy individuals. The study included twelve healthy male adult volunteers (mean age 42 years) without contraindications for electrical stimulation. At the beginning and immediately after a 20-min session of NMES of quadriceps muscles, peripheral blood was collected to analyse the biochemical blood components (creatinine, creatine kinase, estimated glomerular filtration rate, cortisol), differential white blood cell count and immunological parameters. The intensity of NMES was set at maximum tolerance, eliciting on average about one-sixth of the maximum voluntary isometric contraction of the same leg. No statistically significant differences in the average group level were found in any of the measured biochemical blood components, white blood cell count or immunological parameters after the NMES session. On an individual level, the changes in creatine kinase, estimated glomerular filtration rate, basophils and some immunological parameters correlated with changes in the cortisol level. We can conclude that moderate transcutaneous low-frequency electrical stimulation for quadriceps muscle strengthening used in our study did not induce essential changes in immune status in healthy men.

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Limping on split-belt treadmills implies opposite kinematic and dynamic lower limb asymmetries

Walking on a split-belt treadmill (each of the two belts running at a different speed) has been proposed as an experimental paradigm to investigate the flexibility of the neural control of gait and as a form of therapeutic exercise. However, the scarcity of dynamic investigations challenges the validity of the available findings. The aim of the present study was to investigate the dynamic asymmetries of lower limbs of healthy adults during adaptation to gait on a split-belt treadmill. Ten healthy adults walked on a split-belt treadmill mounted on force sensors, with belts running either at the same speed ('tied' condition) or at different speeds ('split' condition, 0.4 vs. 0.8 or 0.8 vs. 1.2 m/s). The sagittal power and work provided by ankle, knee and hip joints, joint rotations, muscle lengthening, and surface electromyography were recorded simultaneously. Various tied/split walking sequences were requested. In the split condition a marked asymmetry between the parameters recorded from each of the two lower limbs, in particular from the ankle joint, was recorded. The work provided by the ankle (the main engine of body propulsion) was 4.8 and 2.2 times higher (in the 0.4 vs. 0.8, and 0.8 vs. 1.2 m/s conditions, respectively) compared with the slower side, and 1.2 and 1.1 times higher compared with the same speed in the tied condition. Compared with overground gait in hemiplegia, split gait entails an opposite spatial and dynamic asymmetry. The faster leg mimics the paretic limb temporally, but the unimpaired limb from the spatial and dynamic point of view. These differences challenge the proposed protocols of split gait as forms of therapeutic exercise.

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Is physical rehabilitation effective for Wernicke–Korsakoff syndrome? A case report

Wernicke–Korsakoff syndrome is a type of brain disorder caused by the lack of thiamine, most commonly because of chronic alcohol misuse. It consists of two separate conditions including Wernicke's encephalopathy and Korsakoff syndrome. Various levels of cognitive impairments are associated with the severity of the syndrome. Although the effectiveness of thiamine replacement in the early phases of the syndrome is proven, the efficacy of subsequent treatments, which mainly include rehabilitation protocols after the development of Korsakoff syndrome, is not clear. This is the first report showing the positive effects of physical rehabilitation in a 48-year-old male patient with Wernicke–Korsakoff syndrome.

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Walking endurance and perceived symptom severity after a single maximal exercise test in persons with mild disability because of multiple sclerosis

People with multiple sclerosis (PwMS) are less physically active compared with the general population. This might also be because of the perception of temporary worsening of symptoms during physical activity. Forty-two PwMS with a mild level of disability underwent a maximal exercise test on a bicycle ergometer. Fifteen minutes before and 15 and 75 min after the maximal exercise test, the 6-minute walking test was conducted and the rate of perceived exertion was recorded. Twice before and three times after the maximal exercise test, participants rated the symptom inventory, including symptom domains of general fatigue, muscle fatigue, balance, gait pattern, muscle weakness, spasticity, pain, sensory disturbance, dizziness, and visual impairment. The visual analogue scale was used to rate the perceived symptoms from 0 (no intensity) to 10 (maximal intensity). The 6-minute walking test distance increased significantly over time, whereas the rate of perceived exertion increased temporarily after the maximal exercise test. Immediately after the maximal exercise test, significant temporary increases were found in balance, gait pattern, muscle weakness, and visual impairment. General and muscle fatigue were elevated, compared with the baseline, till 15 and 75 min after the maximal exercise test, respectively. A short-term impact of a single maximal exercise test was considered as the temporary worsening of perceived symptoms, especially (muscle) fatigue and the gait pattern, in PwMS with a mild level of disability. However, a recovery was observed after 75 min. Walking endurance was not affected by the maximal exercise test.

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The effects of proprioceptive neuromuscular facilitation lower-leg taping and treadmill training on mobility in patients with stroke

The elastic-taping method of the proprioceptive neuromuscular facilitation (PNF) concept is nonexistent. Therefore, our study aimed to investigate the effect of treadmill training (TT) using PNF lower-leg taping (PNFLT) on walking and balance ability in patients with stroke. There were a total of 27 patients: a stroke allocated control group (n=13) and an experimental group (n=14). The control group performed the TT and the experimental group performed the TT using PNF taping five times a week for 6 weeks. Walking and balance ability were measured using the 6-min walk test (6MWT), the 10-m walking test (10MWT), and the timed up and go test (TUG). Before and after the intervention, a paired t-test was performed to compare different within-group differences. Independent t-tests were performed to compare different between-group differences. All statistical significance levels were set at α of 0.05. After intervention, 6MWT, 10MWT and TUG improved significantly in PNFLT-TT and TT group (P

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Game analysis and clinical use of the Xbox-Kinect for stroke rehabilitation

Whole-body movement is required to interact (play) with Microsoft Xbox with the 3D Kinect sensor (Xbox-Kinect) and, therefore, may be suitable for encouraging and practicing movements as part of stroke rehabilitation. We aimed to describe (i) game analysis, (ii) clinical use, and (iii) to characterize the Xbox-Kinect game experience with individuals with chronic stroke. Four therapists played the Xbox-Kinect games and then carried out a games analysis on the basis of the categories suggested by Deutsch. Eleven participants (age 29–69 years) with chronic stroke and varying motor deficits played Xbox-Kinect games for 4–22 sessions as part of a video-game group intervention and the clinical use was documented. The game experience of 'Bowling' (Kinect-Sport) and '20 000 leaks' (Kinect Adventures) was characterized by self-report questionnaires. Detailed tables of game analysis are provided. The clinical use of the console with the participants is presented. Participants reported high enjoyment and 'somewhat-high' perceived exertion after playing the two games and stated that overall the console suited their therapeutic goals. This information can assist clinicians with their clinical reasoning and decision-making for incorporating the Xbox-Kinect into stroke rehabilitation. Potentially, the Xbox-Kinect could be used as an on-going tool to facilitate whole-body movement and physical activity of individuals with chronic stroke.

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Comparison between self-reported and observed locomotion ability scores in patients with stroke: a cross-sectional study

This study aimed to investigate (i) the validity of self-reported scores of locomotion ability in stroke survivors using the ABILOCO-Benin questionnaire, and (ii) the congruence between online Rasch analysis of the ABILOCO-Benin raw scores and a conversion table set along with the questionnaire development. Thirty-five adult poststroke patients [mean age: 52 (SD: 10) years, 60% men] recruited from the rehabilitation department of National University Hospital of Cotonou (Benin), self-reported their locomotion ability, filling out the ABILOCO-Benin questionnaire [self-reported scores (SRS)]. Afterwards, a physical therapist observed and rated the patients' locomotion ability, while they performed each of the 15 items of the questionnaire [performance-based scores (PBS)]. Both raw SRS and PBS were then converted to linear measures using (i) an online Rasch analysis method and (ii) an ordinal-to-interval transformation table. Analyses showed high correlation (intraclass correlation coefficient=0.74, P

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The baseline speed of 10-m gait predicts ambulatory discharge for hospitalized frail elderly after DOPPO rehabilitation

The discharge of elderly patients from hospital on the basis of their independent gait program (DOPPO) is a new rehabilitation strategy for physically frail hospitalized elderly that aims to recover independent gait and to achieve ambulatory discharge. We retrospectively investigated baseline determinants of physical measures associated closely with the 6-min walking distance (6MWD) after DOPPO. Participants were 137 consecutive elderly inpatients, irrespective of the causative disease (mean age: 82±7 years; 76 women), who had a Short Physical Performance Battery (SPPB) score of less than 12 and low independent walking capacity. The rehabilitation comprised muscle stretching, muscle strengthening, balance training, and endurance exercise, including walking. The exercises were gradually increased until the goal of ambulatory discharge was attained. The SPPB, isometric knee-extension muscle strength (IKEMS), functional reach test (FRT), one-leg stance time (OLST), and the 10-m gait speed (TMGS) were measured, before and after the DOPPO intervention, and their association with the 6MWD was evaluated. All participants achieved ambulatory discharge, requiring on average 35±19 hospital days and 32±18 h of rehabilitation. The SPPB, IKEMS, FRT, OLST, and TMGS improved. The SPPB scores increased from 7.1 at baseline to 9.2 at discharge. Eighty-eight patients completed the 6MWD. The SPPB, IKEMS, FRT, OLST, and TMGS were strongly associated with the 6MWD. Only the baseline TMGS and SPPB predicted the 6MWD, with a cut-off TMGS value of 0.84 m/s providing the best prediction of achieving a distance of more than 300 m on the 6MWD. Thus, the baseline TMGS is the best prediction of the ambulatory outcome after the present DOPPO rehabilitation.

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Mental health assessment in rehabilitation: a descriptive study through an international internet survey

This cross-sectional study assessed international rehabilitation practitioners' views of mental health assessment (MHA), related specifically to assessment tools and needs in the field. We delivered an anonymous web-based survey capturing rehabilitation practioners' perspectives on MHA practices, assessment tools, and needs through the American Congress of Rehabilitation Medicine in the USA and through national rehabilitation networks in Finland and Norway. Altogether, 355 rehabilitation professionals answered the survey. Unmet MHA needs, most often attributed to insufficient time (112/269 responders), were recognized among rehabilitation professionals irrespective of the country of practice. When professional experience was weighed against barriers to conducting MHA, cost was statistically significantly linked to professional experience, with those with less experience viewing cost more as a barrier (P=0.019). Rehabilitation professionals from different professions, in different countries, and working with a variety of clinical populations recognize defined barriers to MHA in rehabilitation.

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A comparison of the usability of a standard and an age-friendly smartphone launcher: experimental evidence from usability testing with older adults

Age-friendly smartphone launchers are tools designed to enhance smartphone handling among older adults with cognitive and functional limitations. Although evidence exists about the positive effects of age-friendly smartphone launchers on older adults' usability performance in general, little is known about how the design and interface complexity of these launchers affect their interface usability effectiveness and efficiency compared with standard Android smartphone interfaces. Thus, in this study, a randomized crossover experiment involving 50 older smartphone users, aged 60 years and above, was guided by the principles of summative usability testing to assess whether an age-friendly launcher performs better than a standard Android launcher performs and to investigate the relationship between the user interface complexity and usability performance of launchers. The results of usability tests in which each participant solved 10 tasks on both launchers indicate that the two tested launchers had comparable effectiveness (i.e. completeness with which participants achieved the test tasks' goals), whereas the age-friendly launcher marginally outperformed its standard Android counterpart in terms of efficiency (i.e. the amount of time used by participants to solve the test tasks). The results also demonstrate that lower user interface complexity is associated with higher effectiveness and efficiency, suggesting that age-friendly smartphone launchers might lead to higher adoption rates of smartphones among older adults if interface designers could reduce their cognitive complexity by limiting the number of steps and alternative paths for task completion.

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Longitudinal gait assessment in a stiff person syndrome

Stiff person syndrome (SPS) is an autoimmune disorder with multiple clinical presentations, all characterized by generalized or focal muscular stiffness leading to abnormal postures and movements. To date, no standardized treatments are available; also, the outcome measures are mainly clinical based and unstandardized, limiting the reliability of clinical trials. In this case study, we used the eight-camera motion capture system for gait analysis (GA) to outline the gait features and track the clinical evolution of a young patient with SPS receiving a personalized multimodal therapy. GA was accurate in reflecting clinical changes over a 7-week-long period, thus representing a potential source for objective biomarkers in SPS. Therefore, future studies focusing on either the natural history or the treatment of SPS could adopt GA for reliable outocome measures, confirming this preliminary observation.

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Serum and histological IgG4-negative type 1 autoimmune pancreatitis

Abstract

A 66-year-old man who was on oral medication for type 2 diabetes experienced a rapid decline in glycemic control (increase in glycosylated hemoglobin level from 7.7 to 10.2% over 3 months). Abdominal ultrasonography revealed a 20-mm hypoechoic mass in the pancreatic tail. Serum tumor marker carbohydrate antigen 19–9 and DUPAN2 levels were within the respective normal ranges; serum IgG4 level was also normal at 21.8 mg/dL. Abdominal contrast computed tomography revealed a 26-mm tumor in the pancreatic tail. Magnetic resonance cholangiopancreatography revealed disruption of the main pancreatic duct and dilation of the caudal pancreatic duct. Endoscopic ultrasonography revealed a near-round-shaped hypoechoic mass with interspersed hyperechoic areas. Endoscopic ultrasonography-guided fine needle aspiration was performed using a 22-G needle, but no malignant findings were observed. There were no signs of sialadenitis, retroperitoneal fibrosis, nephropathy, or other conditions associated with IgG4-related diseases. Distal pancreatectomy was performed; a 23-mm white mass was resected from the pancreatic tail. A histopathological examination showed advanced inflammatory cell infiltration mainly involving lymphocytes/plasma cells along with storiform fibrosis and obliterative phlebitis. No more than five IgG4-positive cells were observed per high-power field. These were level 1 pathological findings, and a definitive diagnosis of type 1 autoimmune pancreatitis (AIP) was made according to the International Consensus Diagnostic Criteria. Type 1 AIP associated with normal serum IgG4 levels and absence of IgG4-positive cells on histological examination is a rare clinical entity, which is very difficult to distinguish from pancreatic cancer. Here we report such a case and present a review of the relevant literature.

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Simultaneous transabdominal preperitoneal hernia repair and laparoscopic cholecystectomy: A report of 17 cases

Abstract

Introduction

Inguinal hernia repair and cholecystectomy are frequently performed in the field of gastrointestinal surgery. However, reports describing surgical procedures that involve simultaneous transabdominal preperitoneal hernia repair (TAPP) and laparoscopic cholecystectomy (LC), as well as the safety and usefulness of this combination, are limited. Herein, we report a surgical procedure involving simultaneous TAPP and LC (TAPP + LC) and present the outcomes of patients who have undergone this combined surgical procedure, with a particular focus on its safety and usefulness.

Methods

We simultaneously performed TAPP + LC in 17 patients (mean age, 66.5 ± 8.1 years) with concomitant inguinal hernia and gallbladder stones. We assessed surgical outcomes.

Results

The mean operative time was 157 ± 39 min, and mean postoperative hospital stay was 3.2 ± 0.6 days. The median cost was $7673 for TAPP + LC. The mean postoperative length of hospital stay was 1.1 ± 0.6 day for TAPP alone and 3.4 ± 1.4 days for LC alone. The median costs of TAPP alone and LC alone were $4932 and $5453, respectively. Regarding intraoperative complications, the inferior epigastric vessels were damaged in two patients, and seroma was detected as a postoperative complication in one; these complications were spontaneously resolved. No mesh‐ or infection‐related complications were noted.

Conclusion

Simultaneous TAPP + LC is safe and can be regarded as a standard surgical procedure for patients with concomitant inguinal hernia and gallbladder stones. The TAPP + LC combination appears to help prevent the need for two hospitalizations and, thereby, reduces hospital stay and economic burden.

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Successful single‐stage laparoscopic surgery using a preoperative self‐expanding metallic stent in patients with obstructive colorectal cancer

Abstract

Introduction

Although a self‐expanding metallic stent (SEMS) or a transnasal or transanal decompression tube is sometimes used as a bridge to surgery in patients with obstructive colorectal cancer, the optimal decompression procedure to achieve successful laparoscopic surgery remains unclear.

Methods

Forty‐two patients with obstructive colorectal cancer who were preoperatively decompressed by using SEMS (the SEMS group, n = 20) or a decompression tube (the DT group, n = 22) between January 2010 and February 2017 were included in this retrospective study.

Results

In the SEMS group, 20 patients (100%) were able to eat and 17 patients (85%) were able to undergo total colonoscopy preoperatively, but no patients could do so in the DT group (P < 0.01 and P < 0.01, respectively). The serum albumin level increased in the time between admission and just before surgery in five patients in the SEMS groups (25%), whereas it decreased in all patients in the DT group (P = 0.037). Laparoscopic surgery was performed more frequently in the SEMS groups (19 patients, 95%) than in the DT group (13 patients, 59.1%) (P = 0.018). Primary anastomosis without stoma was also achieved more frequently in the SEMS groups (19 patients, 95%) than in the DT group (15 patients, 68.2%) (P = 0.047). Anastomotic leakage did not occur in the SEMS group, but it did occur in one patient in the DT group. The recurrence‐free survival rate did not differ between the groups (median follow‐up period: 21 months).

Conclusion

In patients with obstructive colorectal cancer, SEMS appears to be more effective than a decompression tube as a preoperative treatment to achieve successful laparoscopic resection without stoma.

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Laparoscopic para‐aortic lymphadenectomy for colorectal cancer with clinically suspected lymph node metastasis

Abstract

Introduction

The optimal surgical management strategy for isolated para‐aortic lymph node (PALN) metastases from colorectal cancer (CRC) remains unclear. However, the complication rates for open approaches remain high. In this study, the outcomes of laparoscopic para‐aortic lymphadenectomy in patients with clinically suspected PALN metastasis were evaluated.

Methods

Between April 2013 and April 2018, we performed laparoscopic primary resection and para‐aortic lymphadenectomy in 11 patients with advanced colorectal cancer and clinically suspected PALN metastasis. This study was a single‐center, retrospective, case series analysis, and the surgical outcomes were reviewed.

Results

There were no cases of perioperative mortality, and conversion to open surgery was necessary in only one patient (9%) because of invasion into a rib. One patient (9%) required a blood transfusion. Postoperative complications occurred in three patients, and the morbidity rate was 27% (3/11). Pathologically, PALN metastasis was confirmed in five patients (45%), all of whom received postoperative chemotherapy. The median survival time for all patients was 25 months, and one patient died of recurrence at 25 months after the initial surgery. Two other patients were alive with recurrence after 47 and 36 months, and two patients were alive without recurrence after 17 and 2 months.

Conclusion

Laparoscopic para‐aortic lymphadenectomy for advanced colorectal cancer with clinically suspected PALN is technically feasible and may be beneficial in selected patients. It is necessary to investigate the feasibility of this procedure in a future case series, and information regarding true oncologic outcome will require long‐term follow‐up.

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Operative outcomes after laparoscopic splenectomy with special reference to prophylactic antibiotics

Abstract

Introduction

We conducted a retrospective study to investigate the progress of the operative outcome after laparoscopic splenectomy (LS), with a special reference to the administration of prophylactic antibiotics (PA).

Methods

The study included 123 patients who underwent elective LS. Operative outcomes before and after the operative procedure was standardized and the impact of treatment with PA on surgical‐site infection were investigated.

Results

With regard to complications, wound infection developed in one (0.8%), portal trunk thrombosis in one (0.8%), pancreatic fistula in one (0.8%), postoperative bleeding in two (1.6%), pleural effusion in one (0.8%), and reoperation because of bowel injury in one (0.8%). Although morbidity did not differ between patients in the early (until the end of 2010) and late (after the beginning of 2011) periods, intraoperative blood loss was lower in patients in the late period. During the late period, no patients required conversion to open surgery. The proportion of patients with surgical‐site infection did not differ between those who received PA 1 h before the start of surgery and every 3 h during surgery and those who received PA 1 h before the start of surgery, every 3 h during surgery, and twice a day for 24–72 h after surgery.

Conclusion

Operative outcomes after LS improved after the standardization of the operative procedure. The administration of PA 1 h before surgery and every 3 h during surgery seems to be sufficient to prevent surgical‐site infection during LS.

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Mediastinoscopic salvage esophagectomy for recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy in a previously pneumonectomized patient

Abstract

We herein report a case of mediastinoscopic salvage esophagectomy for recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy in a previously pneumonectomized patient. A 66‐year‐old man with a medical history of left‐sided pneumonectomy for lung cancer was diagnosed with local recurrence of lower esophageal squamous cell carcinoma (cT3N0M0 cStage II) 9 years after definitive chemoradiotherapy. The mediastinoscopic cervical approach and laparoscopic transhiatal approach were combined, and the thoracic esophagus was safely mobilized to separate the esophagus from the stump of the left bronchus and to divide dense adhesions between the esophagus and fibrotic tissue at the site of the previous left mediastinal pleural resection. The esophagectomy was uneventful and followed by reconstruction with a gastric conduit via the retrosternal route. The pathological diagnosis was esophageal squamous cell carcinoma (pT3‐AD, pN1, M0, pStage III), indicating R0 resection. Even as salvage surgery, mediastinoscopic esophagectomy is a safe and curative treatment strategy for esophageal cancer patients who have previously undergone pneumonectomy.

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Laparoscopic rectal tumor surgery after administration of a new sclerosing therapy (aluminum potassium sulfate and tannic acid injection) for internal hemorrhoids: A report of three cases

Abstract

Aluminum potassium sulfate and tannic acid (ALTA) injection is a new sclerosing therapy for internal hemorrhoids that has been gaining widespread use. However, there have been few reports about rectal cancer after ALTA injection. We performed laparoscopic surgery for three patients who had underwent ALTA therapy 6 months or 1 year earlier: (i) a 51‐year‐old man with neuroendocrine tumor; (ii) a 44‐year‐old woman with rectal cancer; and (iii) 77‐year‐old man with rectal cancer. All three patients had sclerosis of the resected rectal wall stump, making transection of the rectum difficult. Histological examination of the specimens also showed an inflammatory reaction and/or fibrosis of the resection stump. Although laparoscopic low anterior resection was planned for all three patients, we had to construct a diverting stoma for two patients and could not perform sphincter‐preserving surgery for the other. We must be well prepared for laparoscopic rectal surgeries after ALTA therapy, and these cases suggest sigmoidoscopy before ALTA therapy should be recommended.

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Domain Requirements and Genetic Interactions of the Mud1 Subunit of the Saccharomyces cerevisiae U1 snRNP

Mud1 is an inessential 298-amino acid protein subunit of the Saccharomyces cerevisiae U1 snRNP. Mud1 consists of N-terminal and C-terminal RRM domains (RRM1 and RRM2) separated by a linker domain. Synthetic lethal interactions of mud1 with deletions of inessential spliceosome components Nam8, Mud2, and Msl1, or missense mutations in the branchpoint-binding protein Msl5 enabled us to dissect genetically the domain requirements for Mud1 function. We find that the biological activities of Mud1 can be complemented by co-expressing separately the RRM1 (aa 1-127) and linker-RRM2 (aa 128-298) modules. Whereas RRM1 and RRM2 (aa 197-298) per se are inactive in all tests of functional complementation, the linker-RRM2 by itself partially complements a subset of synthetic lethal mud1 interactions. Linker segment aa 155 to 196 contains a nuclear localization signal rich in basic amino acids that is necessary for RRM2 activity in mud1 complementation. Alanine scanning mutagenesis indicates that none of the individual RRM1 amino acid contacts to U1 snRNA in the cryo-EM model of the yeast U1 snRNP is necessary for mud1 complementation activity.

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Exendin‐4 Overcomes Cytokine‐Induced Decreases in Gap Junction Coupling via PKA and Epac2 in Mouse and Human Islets

Key Points Summary

The pancreatic islets of Langerhans maintain glucose homeostasis through insulin secretion, where insulin secretion dynamics are regulated by intracellular Ca²⁺ signaling and electrical coupling of the insulin producing β‐cells in the islet We have previously shown that cytokines decrease β‐cell coupling and that compounds which increase cAMP can increase coupling In both mouse and human islets Exendin‐4, which increases cAMP, protected against cytokine‐induced decreases in coupling and in mouse islets preserved glucose‐stimulated calcium signaling by increasing connexin36 gap junction levels on the plasma membrane Our data indicates that PKA regulates β‐cell coupling through a fast mechanism such as channel gating or membrane organization, while Epac2 regulates slower mechanisms of regulation, such as gap junction turnover Increases in β‐cell coupling with Exendin‐4 may protect against cytokine mediated β‐cell death as well as preserve insulin secretion dynamics during the development of diabetes

Abstract

The pancreatic islets of Langerhans maintain glucose homeostasis. Insulin secretion from islet β‐cells is driven by glucose metabolism, depolarization of the cell membrane and an influx of calcium which initiates the release of insulin. Gap junctions composed of connexin36 (Cx36) electrically couple β‐cells, regulating calcium signaling and insulin secretion dynamics. Cx36 coupling is decreased in pre‐diabetic mice, suggesting a role for altered coupling in diabetes. Our previous work has shown that pro‐inflammatory cytokines decrease Cx36 coupling and that compounds which increase cAMP can increase Cx36 coupling. The goal of this study was to determine if Exendin‐4, which increases cAMP, can protect against cytokine‐induced decreases in Cx36 coupling and altered islet function. In both mouse and human islets Exendin‐4 protected against cytokine‐induced decreases in coupling and preserved glucose‐stimulated calcium signaling. Exendin‐4 also protected against protein kinase C delta‐mediated decreases in Cx36 coupling. Exendin‐4 preserved coupling in mouse islets by preserving Cx36 levels on the plasma membrane. Exendin‐4 regulated Cx36 coupling via both PKA and Epac2 mediated mechanisms in cytokine treated islets. In mouse islets, modulating Epac2 had a greater impact in mediating Cx36 coupling, while in human islets modulating PKA had a greater impact on Cx36 coupling. Our data indicates that PKA regulates Cx36 coupling through a fast mechanism such as channel gating, while Epac2 regulates slower mechanisms of regulation, such as Cx36 turnover in the membrane. Increases in Cx36 coupling with Exendin‐4 may protect against cytokine mediated β‐cell dysfunction to insulin secretion dynamics during the development of diabetes.

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Action potential shortening rescues atrial calcium alternans

Key points

Cardiac alternans refers to a beat‐to‐beat alternation in contraction, action potential (AP) morphology and Ca2+ transient (CaT) amplitude, and represents a risk factor for cardiac arrhythmia, including atrial fibrillation. We developed strategies to pharmacologically manipulate the AP waveform with the goal to reduce or eliminate the occurrence of CaT and contraction alternans in atrial tissue. With combined patch‐clamp and intracellular Ca2+ measurements we investigated the effect of specific ion channel inhibitors and activators on alternans. In single rabbit atrial myocytes suppression of Ca2+‐activated Cl− channels eliminated AP duration alternans, but prolonged the AP and failed to eliminate CaT alternans. In contrast, activation of K+ currents (IKs and IKr) shortened the AP and eliminated both AP duration and CaT alternans. As demonstrated also at the whole heart level activation of K+ conductances represents a promising strategy to suppress alternans, thus reducing a risk factor for atrial fibrillation.

Abstract

At the cellular level alternans is observed as beat‐to‐beat alternations in contraction, action potential (AP) morphology and magnitude of the Ca²⁺ transient (CaT). Alternans is a well established risk factor for cardiac arrhythmia, including atrial fibrillation. This study investigates whether pharmacological manipulation of AP morphology is a viable strategy to reduces the risk of arrhythmogenic CaT alternans. Pacing‐induced AP and CaT alternans were studied in rabbit atrial myocytes using combined Ca²⁺ imaging and electrophysiological measurements. Increased AP duration (APD) and beat‐to‐beat alternations in AP morphology lowered the pacing frequency threshold and increased the degree of CaT alternans. Inhibition of Ca²⁺‐activated Cl⁻ channels reduced beat‐to‐beat AP alternations, but prolonged APD and failed to suppress CaT alternans. In contrast, AP shortening induced by activators of two K⁺ channels (ML277 for Kv7.1 and NS1643 for Kv11.1) abolished both APD and CaT alternans in field‐stimulated and current‐clamped myocytes. K⁺ channel activators had no effect on the degree of Ca²⁺ alternans in voltage‐clamped cells, confirming that suppression of Ca²⁺ alternans was caused by the changes in AP morphology. Finally, activation of Kv11.1 channel significantly attenuated or even abolished atrial T‐wave alternans in isolated Langendorff perfused hearts.

In summary, AP shortening suppressed or completely eliminated both CaT and APD alternans in single atrial myocytes and atrial T‐wave alternans at whole heart level. Therefore, we suggest that AP shortening is a potential intervention to avert development of alternans with important ramifications for arrhythmia prevention and therapy.

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3D dSTORM imaging reveals novel detail of ryanodine receptor localization in rat cardiac myocytes

Key points

Using 3D direct stochastic optical reconstruction microscopy (dSTORM), we developed novel approaches to quantitatively describe the nanoscale, 3D organization of Ryanodine Receptors (RyRs) in cardiomyocytes. Complex arrangements of RyR clusters were observed in 3D space, both at the cell surface and within the cell interior, with allocation to dyadic and non‐dyadic pools. 3D imaging importantly allowed discernment of clusters overlapping in the z‐axis, for which detection was obscured by conventional 2D imaging techniques. Thus, RyR clusters were found to be significantly smaller than previous 2D estimates. Ca²⁺ release units (CRUs), ie. functional groupings of neighbouring RyR clusters, were similarly observed to be smaller than earlier reports. Internal CRUs contained more RyRs in more clusters than CRUs on the cell surface, and yielded longer duration Ca²⁺ sparks.

Abstract

Cardiomyocyte contraction is dependent on Ca2+ release from Ryanodine Receptors (RyRs). However, the precise localization of RyRs remains unknown, due to shortcomings of imaging techniques which are diffraction‐limited or restricted to 2D. We aimed to determine the 3D nanoscale organization of RyRs in rat cardiomyocytes by employing direct stochastic optical reconstruction microscopy (dSTORM) with phase ramp technology. Initial observations at the cell surface showed an undulating organization of RyR clusters, resulting in their frequent overlap in the z‐axis and obscured detection by 2D techniques. Non‐overlapping clusters were imaged to create a calibration curve for estimating RyR number based on recorded fluorescent blinks. Employing this method at the cell surface and interior revealed smaller RyR clusters than 2D estimates, as erroneous merging of axially‐aligned RyRs was circumvented. Functional groupings of RyR clusters (Ca2+ release units, CRUs), contained an average of 18 and 23 RyRs at the surface and interior, respectively, although half of all CRUs contained only a single "rogue" RyR. Internal CRUs were more tightly packed along z‐lines than surface CRUs, contained larger and more numerous RyR clusters, and constituted ≈75% of the roughly 1 million RyRs present in an average cardiomyocyte. This complex internal 3D geometry was underscored by correlative imaging of RyRs and T‐tubules, which enabled quantification of dyadic and non‐dyadic RyR populations. Mirroring differences in CRU size and complexity, Ca2+ sparks originating from internal CRUs were of longer duration than those at the surface. These data provide novel, nanoscale insight into RyR organization and function across cardiomyocytes.

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Structural mechanisms for defective CFTR gating caused by the Q1412X mutation, a severe Class VI pathogenic mutation in cystic fibrosis

Key points

Electrophysiological characterization of Q1412X‐CFTR, a C‐terminal truncation mutation of cystic fibrosis transmembrane conductance regulator (CFTR) that is associated with the severe form of cystic fibrosis (CF), reveals a gating defect not reported previously. Mechanistic investigations of the gating deficit in Q1412X‐CFTR suggest that the reduced open probability in Q1412X‐CFTR is due to a disruption of the function of the second ATP binding site (or site 2) in the nucleotide binding domains (NBDs). Detailed comparisons of several mutations with different degrees of truncation in the C‐terminal region of NBD2 reveal the importance of the last two beta‐strands in NBD2 in maintaining proper gating functions. Our studies also show that the application of clinically‐approved drugs (VX‐770 and VX‐809) can greatly enhance the function of Q1412X, providing in vitro evidence for a therapeutic strategy employing both reagents for patients bearing Q1412X or similar truncation mutations.

Abstract

Cystic fibrosis (CF) is caused by loss‐of‐function mutations of cystic fibrosis transmembrane conductance regulator (CFTR), a phosphorylation‐activated but ATP‐gated chloride channel. Based on the molecular mechanism of CF pathogenesis, disease‐associated mutations are categorized into six classes. Among them, Class VI, whose members include some of the C‐terminal truncation mutations such as Q1412X, is defined as decreased membrane expression due to a faster turnover rate. In this study, we characterized the functional properties of Q1412X‐CFTR, a severe‐form premature stop codon mutation. We confirmed previous findings of a ∼90% decrease in membrane expression but found a ∼95% reduction in the open probability (P_o). Detailed kinetic studies support the idea that the gating defect is due to a dysfunctional ATP‐binding site 2 in the nucleotide binding domains (NBDs). Since the Q1412X mutation results in a deletion of the last two beta‐strands in NBD2 and the whole C‐terminal region, we further characterized truncation mutations with different degrees of deletion in this segment. Mutations that completely or partially remove the C‐terminus of CFTR while keeping an intact NBD2 (i.e., D1425X and S1455X) assume gating function nearly identical to that of wild‐type channels. However, the deletion of the last beta‐strand in the NBD2 (i.e., N1419X) causes gating dysfunction that is milder than that of Q1412X. Thus, normal CFTR gating requires structural integrity of NBD2. Moreover, our observation that the clinically‐approved VX‐809 (Lumacaftor) and VX‐770 (Ivacaftor) significantly enhance the overall function of Q1412X‐CFTR provides the conceptual basis for the treatment of patients carrying this mutation.

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Potential cellular and energetic mechanisms for age‐related differences in skeletal muscle fatigue

Skeletal muscle fatigue is defined as the contraction‐induced decline in maximal force‐ or power‐generating capacity and can be caused by failure at any site along the pathway of force production. Several studies have observed greater skeletal muscle fatigue in older compared with young adults during high‐velocity contractions, but the cause of this difference remains unclear. Because activities of daily living, such as climbing stairs or walking, require repeated dynamic contractions, the ability to resist muscle fatigue may be important for maintaining physical function into old age.

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Four weeks of exercise early in life reprograms adult skeletal muscle insulin resistance caused by paternal high fat diet

Key points

Paternal high fat diet/obesity before mating can negatively influence the metabolism of offspring. Exercise only early in life has a remarkable effect to reprogram adult rat offspring exposed to detrimental insults before conception. Exercise only early in life normalized adult whole body and muscle insulin resistance due to having a high fat fed/obese father. Unlike the effects on the muscle, early exercise did not normalise the reduced adult pancreatic beta cell mass due to having a high fat fed/obese father. Early life exercise training may be able to reprogram the individual whose father was obese, inducing long‐lasting beneficial effects on health.

Abstract

Paternal high fat diet (HFD) impairs female rat offspring glucose tolerance, pancreatic morphology and insulin secretion. We examined whether only 4 weeks of exercise early in life could reprogram these negative effects. Male Sprague‐Dawley rats consumed a HFD for 10 weeks before mating with chow‐fed dams. Female offspring remained sedentary or performed moderate intensity treadmill exercise (5 days/week, 60 min/day, 20 m/min) from 5 to 9 weeks of age. Paternal HFD impaired (P<0.05) adult offspring whole body insulin sensitivity (intraperitoneal insulin sensitivity test) and skeletal muscle ex vivo insulin sensitivity and TBC1D4 phosphorylation. It also lowered β‐cell mass and reduced in vivo insulin secretion in response to an intraperitoneal glucose tolerance test. Early life exercise in offspring reprogrammed the negative effects of paternal HFD on whole body insulin sensitivity, skeletal muscle ex vivo insulin‐stimulated glucose uptake and TBC1D4 phosphorylation and increased GLUT4 protein. However, early exercise did not normalise the reduced pancreatic β‐cell mass or insulin secretion. In conclusion, only 4 weeks of exercise early in life in female rat offspring reprograms reductions in insulin sensitivity in adulthood caused by a paternal high fat diet without affecting pancreatic β‐cell mass or insulin secretion.

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Recognize the signs of crisis after a traumatic response

The shooting at the Thousand Oaks, Ca., Borderline Bar & Grill is another blow to first responders in communities impacted by mass violence

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Iliac screws may not be necessary in long segment constructs with L5-S1 ALIF: Cadaveric study of stability and instrumentation strain

Lumbosacral pseudoarthrosis and instrumentation failure is common with long segment constructs. Optimizing lumbosacral construct biomechanics may help to reduce failure rates. The influence of iliac screws and interbody type on range of motion (ROM), rod strain (RS), sacral screw strain (SS) is not well-established.

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Reduced delta-band modulation underlies the loss of P300 responses in disorders of consciousness

A significant challenge in the scientific study of disorders of consciousness (DoC) is the identification of brain activity that characterizes a patient's remnant cognitive or perceptual functions. In the vegetative state (VS), also defined as unresponsive wakefulness syndrome (Laureys et al., 2010), this identification is especially critical. VS patients are characterized by a persistent inability to express behaviors that reflect will or purpose, either spontaneously or in response to sensory stimuli.

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Stuttering as a matter of delay in neural activation: a combined TMS/EEG study

Developmental stuttering (DS) is a disturbance of the normal rhythm of speech that usually appears in childhood, where affected persons know what they intend to say, but are not able to do it fluently. DS is characterized by dysfluencies such as blocks and repetitions, often associated with movements, especially of the oro-facial district. The majority of DS children are able to recover to normal levels, while others remain stutterers into adulthood (persistent DS). DS is related to abnormalities of the central nervous system (Brown et al., 2005; Neef et al., 2015a), and can be considered as a neuro-developmental disorder where speech is mostly affected, considering that it relies on motor skills for planning/execution of articulation (Smith and Weber, 2017).

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The expanding field of neuromuscular ultrasound

Ultrasound (US) in the field of neuromuscular diseases has become a reality, has changed the way we look at nerve pathology, and has more than ever deserved this comprehensive review by Walker et al. in this issue of Clinical Neurophysiology (Walker et al. 2018). In Clinical Neurophysiology, the number of submitted research papers utilizing US has over the last 3 years doubled and the number of accepted papers has tripled, and according to the review more than 25,000 papers on neuromuscular US have been published.

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Enhanced TOUGHBOOK 31 device meets evolving needs of today’s mobile workers in the federal, utilities and public sector industries

The world's most rugged design gets even more powerful with new processing system. NEWARK, N.J. — Panasonic, an industry leading manufacturer of mobile computing solutions that are purpose-built for the way people work, announced the U.S. launch of its newly upgraded TOUGHBOOK 31 laptop computer. Specifically designed for the mobile workforce, which has relied on the TOUGHBOOK brand...

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Firefighter-paramedic working dispatcher shift helps woman save father’s life

Norred, a 14-year veteran of the San Antonio Fire Department, helped Monica Pesek revive her unresponsive father after he suffered a stroke

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How to use Facebook to announce a LODD

Line-of-duty deaths require thoughtful planning on how to use Facebook to announce the loss of life and share information

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How to use Facebook to announce a LODD

Line-of-duty deaths require thoughtful planning on how to use Facebook to announce the loss of life and share information

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How to use Facebook to announce a LODD

Line-of-duty deaths require thoughtful planning on how to use Facebook to announce the loss of life and share information

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Chronic vagal nerve stimulation exerts additional beneficial effects on the beta-blocker-treated failing heart

Abstract

Vagal nerve stimulation (VNS) induces bradycardia in chronic heart failure (CHF). We hypothesized that beta-blocker would cover the beneficial effects of VNS on CHF if the anti-beta-adrenergic effect was the main VNS effect. This study investigated the effects of VNS on cardiac remodeling in rats with CHF treated with metoprolol. Two weeks after myocardial infarction, surviving rats were randomly assigned to groups of sham stimulation (SS), sham stimulation with metoprolol (SSM), or VNS with metoprolol (VSM). Compared to the SS group, heart rate was significantly reduced in the SSM and VSM groups. Hemodynamic assessments showed that VSM rats maintained better cardiac pump function and presented higher cardiac index and lower heart weight than SSM rats. VSM was also associated with lower plasma brain natriuretic peptide and norepinephrine levels than SSM. VSM but not SSM improved the 50-day survival rate compared with the SS group. The results suggest that VNS may exert its beneficial effects on the failing heart independently of its anti-beta-adrenergic mechanism.

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Provider safety and C-A-B treatment products showcased at EMS World Expo 2018

Tradeshows are an opportunity to learn about EMS products and design improvements, and give real-world feedback to manufacturers

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Influence of various intensities of 528 Hz sound-wave in production of testosterone in rat’s brain and analysis of behavioral changes

Abstract

Testosterone is a nuclear androgen receptor ligand that controls multiple pathways in brain. In addition to the active biosynthesis of steroids in classic steroidogenic organs such as gonads, adrenals and placenta, testosterone also produced in astrocyte cells of brain. Testosterone and its level must be regulated in brain; because, it directly and indirectly affects memory and several key behavioral characteristics. The significance of sound waves on key enzymes that regulate levels of testosterone in brain has not been investigated. The aim of our study was to examine physical stress of such as sound on induction behavioral changes in animal models. According to the current study, sound waves with 528 Hz frequency in 100 dB intensity induce testosterone production in brain by enhancing StAR and SF-1 and reducing P450 aromatase gene expression. Frequency of 528 Hz also reduces total concentration of reactive oxidative species in brain tissue. Prolonged exposure to this sound wave showed reduction of anxiety related behaviors in rats. The results reveal that reduced anxiety is related to increased concentration of testosterone in brain. This study may lead to ascertain a possible therapy in which sounds may be utilized to reduce anxiety in individual.

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Provider safety and C-A-B treatment products showcased at EMS World Expo 2018

Tradeshows are an opportunity to learn about EMS products and design improvements, and give real-world feedback to manufacturers

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Mapping of QTL associated with seed longevity in durum wheat ( Triticum durum Desf.)

Abstract

Regeneration cycle of seeds kept at genebanks is determined by seed longevity. Information about longevity of species is important for storage periods, germination test intervals, and reproduction cycles. Seed longevity is different between species and depends on the storage conditions. It also differs between genotypes of a species providing the basis of genetic analyses of seed longevity. Studies in hexaploid wheat and barley have identified numerous quantitative trait locus (QTL) linked to the trait. Seed longevity in durum wheat, however, has not been attempted so far. Here, we present the first report of genetic analysis of grain longevity in durum wheat using a bi-parental mapping population composed of 114 recombinant inbred lines. QTL analysis identified three highly significant and one significant QTL for initial germination (on chromosomes 4B, 5A (2 QTL), and 6B), three significant QTL for germination after accelerated aging treatment (on chromosomes 5A and 7B (2 QTL)), and five significant QTL determining relative germination and distributed on chromosomes 3A, 3B, 5A, 6B, and 7B. This study confirms the results of previous investigations in bread wheat and provides a baseline for further research in durum wheat.

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A legacy of the “1% Program” – The “Chinese Chapter” of the human genome reference sequence

Publication date: Available online 8 November 2018

Source: Journal of Genetics and Genomics

Author(s): Wei Dong, Xiaoling Wang, Zhi Xia, Xiuqing Zhang, Huanming Yang

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Correction to: Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis

Figures 2 and 3 were transposed.

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Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study

Abstract

Purpose

Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS.

Methods

This crossover volunteer study included five healthy men. For comparison, both the ultrasound-guided QLB type 2 (QLB2) and QLBi were employed on opposite sides of each volunteer, and the spread of LA solution (0.7 mL/kg) mixed with contrast media in the PVS was assessed 1 h after the first injection using magnetic resonance imaging. Sensory loss was evaluated by pinprick 90 min post-injection. Each volunteer underwent both QLB types, and the same procedures were administered on opposite sides 7 days after the first experiment.

Results

In total, 20 QLB blocks (10 QLB2 and 10 QLBi) were performed. LA did not spread into the PVS after the QLBi. The sensory block area included the lower abdomen after the QLB2, but not after the QLBi. The sensory block area did not extend to the upper abdominal region or the midline of the lower abdomen with either block method.

Conclusion

LA administered by the QLB2 spreads into the PVS of T10–T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.

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Advanced assessment of serum Mac-2 binding protein glycosylation isomer in patients with biliary atresia

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Response to the letter by Dr. Naoya Yamada, and Dr. Koichi Mizuta regarding our manuscript: “Mac-2 binding protein glycan isomer (M2BPGi) is a new serum biomarker for assessing liver fibrosis: more than a biomarker of liver fibrosis”

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Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy

Abstract

Background

Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the remnant stomach is a minimally invasive treatment. Few studies compared the technical difficulty of ESD involving the suture line and anastomosis, and information on long-term outcomes is insufficient. This study aimed to elucidate the short- and long-term outcomes of ESD for EGC in the remnant stomach.

Methods

We investigated patients who underwent ESD for EGC in the remnant stomach between September 2002 and March 2016. Clinicopathological data were retrieved to assess en bloc resection rates, complications, and long-term outcomes including overall survival and cause-specific survival.

Results

A total of 136 consecutive patients with 165 lesions resected by 157 ESD procedures were retrospectively evaluated. The en bloc resection rate was 95.5%. Complications included 16 intraoperative perforations (10.2%), 2 delayed perforations (1.3%), and 15 delayed bleeding (9.6%), which were successfully treated with endoscopy. The en bloc resection rate was significantly higher in the suture line group (100%) and the non-anastomosis or suture line group (98.8%) than in the anastomosis group (82.9%). However, the intraoperative perforation rate was significantly higher in the anastomosis group (31.4%) than in other groups. The 5-year overall and cause-specific survival rates were 88.4% and 97.6%, respectively, during a median follow-up period of 50.7 months (interquartile range 30.8–91.3).

Conclusions

The long-term outcomes of ESD for EGC in the remnant stomach were favorable. However, ESD involving the anastomosis was a technically demanding procedure due to the low en bloc resection rate and high perforation rate.

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The expanding field of neuromuscular ultrasound

Publication date: Available online 9 November 2018

Source: Clinical Neurophysiology

Author(s): Erisela Qerama

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Risk of esophageal adenocarcinoma after antireflux surgery in patients with gastroesophageal reflux disease in the Nordic countries

JAMA

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Effect of serum triglyceride level on the prognosis of patients with hepatocellular carcinoma in the absence of cirrhosis

Lipids in Health and Disease

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A risk score system to timely manage treatment in Crohn’s disease: A cohort study

BMC Gastroenterology

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