Propofol TCI Reductions Do Not Attenuate Significant Falls in Cardiac Output Associated With Anesthesia Induction and Knee-Chest Positioning in Spinal Surgery

Background: Induction of anesthesia and the knee-chest position are associated with hemodynamic changes that may impact patient outcomes. The aim of this study was to assess whether planned reductions in target-controlled infusion propofol concentrations attenuate the hemodynamic changes associated with anesthesia induction and knee-chest position. Materilas and Methods: A total of 20 patients scheduled for elective lumbar spinal surgery in the knee-chest position were included. In addition to standard anesthesia monitoring, bispectral index and noninvasive cardiac output (CO) monitoring were undertaken. The study was carried out in 2 parts. In phase 1, target-controlled infusion propofol anesthesia was adjusted to maintain BIS 40 to 60. In phase 2, there were 2 planned reductions in propofol target concentration: (1) immediately after loss of consciousness—reduction calculated using a predefined formula, and (2) before positioning—reduction equal to the average percentage decrease in CO after knee-chest position in phase 1. Changes from baseline in CO and other hemodynamic variables following induction of anesthesia and knee-chest positioning were compared. Results: Induction of anesthesia led to decreases of 25.6% and 19.8% in CO from baseline in phases 1 and 2, respectively (P

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Journal Club

No abstract available

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Cognitive Prehabilitation: Supercharged Mind or Wishful Thinking?

No abstract available

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Dynamic Changes of Cardiac Repolarization Instability during Exercise Testing

Introduction Physical exercise triggers efferent cardiac sympathetic activation. Here, we tracked the spatio-temporal properties of cardiac repolarization on a beat-to-beat basis throughout a standardized exercise test and hypothesized a detectable change at the point of the anaerobic threshold (AT). Methods The study included 20 healthy adults (age 35.3 ± 6.7 years) undergoing a standardized incremental exercise test on a cycle ergometer. During exercise testing high-resolution (2000 Hz) ECG-monitoring in frank leads configuration was performed. Three-dimensional beat-to-beat repolarization instability (dT°) was assessed by a novel vector-based method according to a previously published technology. In parallel, the lactate threshold (LT) was detected according to Dickhuth and Mader. Results We could identify a characteristic pattern of dT° signal during exercise testing. With increasing physical activity dT° increased, concordantly to heart rate. At an average of 164 ± 38 W, dT° and heart rate abruptly showed a discordant behavior, characterized by a transient drop of dT°. The maximal discordance between dT° and heart rate was defined as anaerobic threshold (ATdT°) and highly significantly correlated with LTDickhuth (r=0.841; p

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Dynamic Interactions Between the Genome and an Endogenous Retrovirus: Tirant in Drosophila simulans Wild-Type Strains

All genomes contain repeated sequences that are known as transposable elements (TEs). Among these are endogenous retroviruses (ERVs), which are sequences similar to retroviruses and are transmitted across generations from parent to progeny. These sequences are controlled in genomes through epigenetic mechanisms. At the center of the epigenetic control of TEs are small interfering RNAs of the piRNA class, which trigger heterochromatinization of TE sequences. The tirant ERV of Drosophila simulans displays intra-specific variability in copy numbers, insertion sites, and transcription levels, providing us with a well-suited model to study the dynamic relationship between a TE family and the host genome through epigenetic mechanisms. We show that tirant transcript amounts and piRNA amounts are positively correlated in ovaries in normal conditions, unlike what was previously described following divergent crosses. In addition, we describe tirant insertion polymorphism in the genomes of three D. simulans wild-type strains, which reveals a limited number of insertions that may be associated with gene transcript level changes through heterochromatin spreading and have phenotypic impacts. Taken together, our results participate in the understanding of the equilibrium between the host genome and its TEs.

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Effect of spinal decompression on back pain in lumbar spinal stenosis: A Canadian Spine Outcomes Research Network (CSORN) study

Surgical decompression is usually offered for improvement of neurogenic claudication in patients with symptomatic lumbar canal stenosis. These patients often have associated low back pain (LBP) and little is known about the effect of decompression on this symptom.

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Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: A prospective randomised crossover controlled study in healthy volunteers

BACKGROUND High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S) To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING Operating room in a primary university hospital. DESIGN A prospective, randomised crossover study. PARTICIPANTS Fifty healthy volunteers. INTERVENTIONS Participants were randomly pre-oxygenated through spontaneous breathing 100% oxygen in a face mask and with HFNO (mouth closed, heated and humidified gas flow at 60 l min–1). In the face mask group, the ETO2 was measured continuously. In the HFNO group, the nasal cannula was quickly exchanged with a face mask while the subject held their breath at end inspiration and the ETO2 was measured after a deep expiration. The protocol ended when ETO2 reached 90% or otherwise at 6 min. MAIN OUTCOME MEASURES The primary endpoint was the ETO2 after 3 min of pre-oxygenation. Secondary endpoints were the proportion of participants with an ETO2 at least 90% and the time until the ETO2 at least 90%. RESULTS The ETO2 after 3 min of pre-oxygenation was 89 (2) % and 77 (12) % in the face mask and HFNO groups [difference 12% (95% confidence interval, 95% CI: 8 to 15]; P 

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Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study

BACKGROUND Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting. OBJECTIVES We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC. DESIGN A prospective, observational cohort study. SETTING Single-centre, academic hospital cardiovascular ICU. PATIENTS We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h. MAIN OUTCOME MEASURES The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC. RESULTS MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P 

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Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial

BACKGROUND The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. OBJECTIVE The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. DESIGN A randomised controlled study. SETTING A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. INTERVENTION(S) Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h−1, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. MAIN OUTCOME MEASURES The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. RESULTS There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg−1 versus 6 [3.5 to 9] μg kg−1 respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. CONCLUSION Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378). Correspondence to Dr. Yasuko Taketa, Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama-City, Ehime 790-0024, Japan. E-mail: suko1231@yahoo.co.jp © 2019 European Society of Anaesthesiology

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Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study

BACKGROUND Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors. OBJECTIVES The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH). DESIGN Prospective observational blinded study. SETTING Operating room from June 2017 to February 2018. PATIENTS One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study. INTERVENTIONS Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min. MAIN OUTCOME MEASURES The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis. RESULTS Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%. CONCLUSION Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI. TRIAL REGISTRATION This study evaluate accuracy of two diagnostic methods for the occurrence of postspinal anaesthesia hypotension, so not a clinical trial as no intervention is present and no outcome of intervention is measured. Correspondence to Dr Eman Ramadan Salama, MD, Anaesthesia and Surgical ICU, Tanta University Hospital, Tanta, Egypt Tel: +20 1277886405; fax: +20 402231671; e-mail: dr.ers1975@yahoo.com © 2019 European Society of Anaesthesiology

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Imaging of Progressive Neuropathic Arthropathy of the Shoulder

No abstract available

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Evidence in Rehabilitation Medicine: Between Facts and Prejudices

The relationship between evidence-based medicine and rehabilitation medicine is somewhat controversial. The motto "there is no evidence in rehabilitation medicine" is at times a real burden on the shoulders of rehabilitation medicine. There are many ideas around evidence in rehabilitation medicine; some are correct, whereas others are probably prejudices only. In this article, it is first discussed what evidence is, its origin and meaning, giving some notes about Cochrane—arguably, the criterion standard of evidence medicine. The relationship between rehabilitation medicine and evidence is then faced, to try to understand why these difficulties exist; it is considered what rehabilitation medicine is, comparing rehabilitation medicine with the other "classical" medical specialties; the problems with evidence generation and the actual state of research in rehabilitation medicine. The implementation of evidence in rehabilitation medicine is also introduced, including a brief discussion of knowledge translation, what it is, and why it is important, paying particular attention to Cochrane Rehabilitation—the new global rehabilitation medicine body that is facing these issues. Finally, some solutions for evidence in rehabilitation medicine are proposed.

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Is Aerobic Exercise Training Beneficial for Adults With Fibromyalgia?: A Cochrane Review Summary with Commentary

No abstract available

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A Controlled Clinical Trial on the Effects of Exercise on Cognition and Mobility in Adults With Multiple Sclerosis

Objective The aim of the study was to investigate the effects of a 6-mo exercise program on cognition and mobility in participants with multiple sclerosis. Design This is a prospective, single-blind, controlled clinical trial. Setting A community rehabilitation program within a large metropolitan health service. Participants Twenty-eight patients with multiple sclerosis were referred for outpatient rehabilitation. Interventions Participants were allocated to one of two groups and undertook a cognitive-motor exercise program or monitoring (control group). Main Outcome Measures Cognition and mobility were the main outcome measures. Cognition was evaluated using the Mini-Mental State Examination and the Frontal Assessment Battery. Mobility was assessed with the Timed Get Up and Go test, applied with and without dual task distractors. Results The findings showed benefits provided by exercise on cognition and mobility. Differently, participants of the control group did not have significant changes in cognition scores after 6 mos of follow-up and had a worse performance in mobility tests. Conclusion Six months of exercise provided benefits to cognition and mobility in adults with multiple sclerosis. This trial was registered prospectively with the Brazilian Clinical Trials Register, ID: RBR-9gh4km (http://bit.ly/2HkNN86). To Claim CME Credits Complete the self-assessment activity and evaluation online at http://bit.ly/1l80W45 CME Objectives Upon completion of this article, the reader should be able to: (1) Recognize the physical and cognitive decline in multiple sclerosis; (2) Identify the importance of exercise on cognition and mobility in patients with multiple sclerosis; and (3) Appreciate the potential benefit of dual tasking in the rehabilitation of individuals with multiple sclerosis. Level: Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Integrated Rehabilitation for Breast Cancer Survivors

The physical and psychological side effects of breast cancer therapies can have substantial impact on survivors' physical and social functioning. Roughly half of the more than 3 million Americans alive with a history of breast cancer report adverse, function-degrading sequelae related to their oncologic treatments. Care delivery models for the timely delivery of rehabilitation services have been proposed yet limitedly vetted or implemented. These include the prospective surveillance model, procedure-linked referrals, survivorship care plans, and risk stratification. Patients' capacity to engage in the rehabilitative process varies during cancer therapy and into survivorship. Perioperative attention generally focuses on managing premorbid impairments and normalizing shoulder function. In contrast, during chemotherapy and radiation therapy, symptom control, constructive coping, and role preservation may become more salient. Risk-stratified, individualized screening and prevention activities for specific impairments have become increasingly feasible through predictive models and analytics. Impairments' severity deleterious impact can be mitigated, as has been established for lymphedema, shoulder dysfunction, chemotherapy-induced peripheral neuropathy, cognitive dysfunction, fatigue, and sexual side effects. Integrated rehabilitative programs, often initiated after the completion of cancer treatment, are available in some countries outside of the United States and may offer survivors vital vocation- and avocation-directed services.

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Effect of Exercise on Risk Factors of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

The objectives of this study were to examine the effectiveness of different types of exercise on risk factors of diabetic foot ulcers, including glycated hemoglobin, peripheral arterial disease, and diabetic peripheral neuropathy, in people with type 2 diabetes mellitus. PubMed, Web of Science, Cochrane Library, Scopus, and CINAHL were searched from inception to January 2018 for relevant articles. Eligible studies were randomized controlled trials that examined effects of exercise on the selected risk factors. Twenty randomized controlled trials with 1357 participants were included in the meta-analyses. The differences in postintervention values of glycated hemoglobin and ankle brachial index between exercise and control groups were synthesized, yielding mean differences of −0.45% (P

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Comment on “Efficacy of Armeo Robotic Therapy Versus Conventional Therapy on Upper Limb Function in Children With Hemiplegic Cerebral Palsy”

No abstract available

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Morphological Differences in the Upper Trapezius Muscle Between Female Office Workers With and Without Trapezius Myalgia: Facts or Fiction?: A Cross-Sectional Study

Objective Work-related trapezius myalgia is a common musculoskeletal disorder in office workers. Prolonged low-level muscle activity during office work may lead to morphological changes in the muscle tissue, causing pain and fatigue. The aim of the present study was to investigate differences in muscle morphology between office workers with and without trapezius myalgia. Design Muscle biopsy samples were obtained from the upper trapezius of female office workers with trapezius myalgia (n = 17) and healthy controls (n = 15). Myosin heavy chain immunohistochemistry and Gomori trichrome stainings were performed to identify differences in muscle fiber type proportion, Feret's diameter, and internal nuclear proportion. Results The myalgia group showed significantly more type IIA and IIA/IIX fibers and less type I and IIX fibers, compared with the control group (P 0.05). However, a significantly higher Feret's diameter was found for type I fibers, compared with type II fibers in both groups (P

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Cochrane Corners to Enhance Access to Evidence-Based Physiatry

No abstract available

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Functional Outcome Scores With Standard Myoelectric Prostheses in Below-Elbow Amputees

Objective The aim of the study was to report normative outcome data of prosthetic hand function in below-elbow amputees using four different objective measurements closely related to activities of daily living. Design Seventeen patients who underwent prosthetic fitting after unilateral below-elbow amputation were enrolled in this study. Global upper extremity function was evaluated using the Action Research Arm Test, Southampton Hand Assessment Procedure, the Clothespin-Relocation Test, and the Box and Block Test, which monitor hand and extremity function. Results The patients achieved a mean ± SD Action Research Arm Test score of 35.06 ± 4.42 of 57. The mean ± SD Southampton Hand Assessment Procedure score was 65.12 ± 13.95 points. The mean ± SD time for the Clothespin-Relocation Test was 22.57 ± 7.50 secs, and the mean ± SD score in the Box and Block Test was 20.90 ± 5.74. Conclusions In the current economic situation of health care systems, demonstrating the effectiveness and necessity of rehabilitation interventions is of major importance. This study reports outcome data of below-elbow amputees and provides a useful guide for expected prosthetic user performance.

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The Incidence of Physiatry-Relevant Complications in Trauma Patients Admitted to an Urban Canadian Trauma Center

The objective of this study was to describe the incidence of complications in trauma patients that could be prevented, diagnosed, or managed by a consulting acute care physiatrist. Demographic and complication data were extracted by chart review of adult trauma patients admitted to a Canadian academic trauma center. Subjects were included if they had a diagnosis of traumatic brain injury, spinal cord injury, or multiple injuries resulting in an Injury Severity Score greater than 15. Means and standard deviations were calculated for continuous variables and frequencies for categorical data. Secondary analyses involved using Spearman's ρ and χ2 analysis to examine relationships between the development of complications and various patient factors. A total of 286 individuals were included. The overall incidence of a physical medicine & rehabilitation-relevant complication was 32.9%. The complications with the highest incidence were pneumonia (15.5%), delirium (14.1%), and urinary tract infection (13.4%). Secondary analyses demonstrated associations between the development of complications with older age, the presence of comorbidities, having both a traumatic brain injury and spinal cord injury, and length of stay. This study demonstrated that trauma patients may experience multiple complications that are of relevance to the consulting physiatrist.

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Impact of Vascular Disease, Amputation Level, and the Mismatch Between Balance Ability and Balance Confidence in a Cross-Sectional Study of the Likelihood of Falls Among People With Limb Loss: Perception Versus Reality

Objective The aim of the study was to investigate the impact of balance ability, activities-specific balance confidence, and other self-reported and clinical factors on incidence of falls among people with lower limb loss. Design This is a cross-sectional study (N = 305) with multivariable logistic regression analysis. Results Participants included 68.3% men with an age of 55.5 ± 14.9, with 50% dysvascular and 56.8% transtibial amputations. The mean ± SD activities-specific balance confidence is 2.1/4 ± 1.1, balance ability is 2.9/4 ± 1.3, and walking speed is 0.766 ± 0.387 m/sec. The final model showed fall risk was heightened for people with vascular comorbidities (odds ratio = 3.46, 95% confidence interval = 1.40–8.54) and better balance (odds ratio = 23.29, confidence interval = 3.19–170.23), but attenuated for people with transfemoral (odds ratio = 0.08, confidence interval = 0.01–0.82) and vascular amputations (odds ratio = 0.38, confidence interval = 0.15–0.95). Significant interactions existed between age and amputation level (odds ratio = 1.06, confidence interval = 1.02–1.11) and between balance confidence and balance ability (odds ratio = 0.27, confidence interval = 0.13–0.57). Conclusions Although people with vascular amputations were less likely to fall than those with nonvascular amputations, people with concurrent vascular comorbidities were more likely to fall than those without. People with transfemoral amputations were less likely to fall; however, fall risk increased with each year of age compared with people with transtibial amputations. People with balance ability of 3.5 or greater fell more often than those with lower ability, but people with lower balance ability and mismatched confidence in their balance ability had 3.7 times greater fall risk.

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When the Injury's Healing Process Meets the Needs of a Top-Level Volleyball Player: A Nonconventional Treatment of a Mallet Fracture Reinjury

Managing top-level athlete's recovery after an injury is very complicated because it requires a challenging combination of clinical and social/professional aspects with the need to return as soon as possible to sports play. Herein, we report a top-level volleyball player for whom a finger splint combined with a custom made thermoplastic protection was used for the conservative management of a Mallet fracture reinjury. This way our player continued training and competitions in contrast to conventional rehabilitation protocols, which suggest to avoid new traumas until the healing phase is completed. After 8 wks, we obtained the fracture healing and a complete functional recovery without major medical complications. From our results, we suggest that novel treatment strategies or modification of conventional rehabilitation protocols are worth consideration for the management of high-level sports players' injuries. However, new clinical studies with a larger sample can compare these results with those resulting from both surgical procedures and from immobilization and rest as well.

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The Effect of Static Stretching of Peroneal and Tibialis Anterior Muscles on Reaction Time: A Randomized Controlled Study

Objective The aim of this study was to investigate the acute and chronic effects of static stretching on peroneal and tibialis anterior reaction characteristics. Design All 23 participants who volunteered for this study were randomly divided into static (n = 12) and control (n = 11) groups. The subjects in the static stretching group performed stretching exercises for the ankle evertor and dorsiflexor muscles 5 days a week for 6 wks. Peroneal and tibialis anterior muscle reaction characteristics were evaluated at the beginning (2 times for acute effect) and end of this period. Electromyographic activity parameters of the muscles were measured using an ankle inversion tilting platform that simulated a sudden ankle inversion. The following were the four different ankle inversion conditions: (a) ankle-neutral, 15-degree inversion; (b) ankle-neutral, 30-degree inversion; (c) ankle–20-degree plantarflexion, 15-degree inversion; and (d) ankle–20-degree plantarflexion, 30-degree inversion. Results Either in terms of acute or chronic effects, no significant differences were found after static stretching exercises for peroneal and tibialis anterior muscle reaction time, reaction duration, and muscle activity evaluated in four positions on the ankle inversion simulation platform (P > 0.05). Conclusions In light of these results, it is possible to state that the short duration of static stretching exercises can still be applied before sports activities.

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Predatory Open-Access Medical Publishers “Caveat Emptor”

No abstract available

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Effects of Twitch Contraction Induced by Magnetic Stimulation on Expression of Skeletal Muscle Fibrosis Related Genes and Limited Range of Motion in Rats

Objective We examined the effects of twitch contraction induced by lumbar spinal root magnetic stimulation on immobilization-induced limited range of motion and skeletal muscle fibrosis in rat soleus muscle. Design The groups included male Wistar rats (controls), rats with both bilateral ankle joints immobilized with plaster casts for 4 wks (immobilization [IM]), and rats in which twitch contraction of the soleus muscle was induced by lumbar magnetic stimulation for 4 wks of immobilization (twitch contraction [TC]). Group differences in ankle dorsiflexion range of motion, collagen content as determined by hydroxyproline assay, and the expression of fibrosis-related genes as determined by reverse transcription-polymerase chain reaction (hypoxia inducible factor 1α, α-smooth muscle actin, and types I and III collagen) in the soleus muscle were examined after the 4-wk-long experiment. Results Range of motion in the TC group was significantly greater than that in the IM group. The hydroxyproline content and the expressions of fibrosis-related genes decreased significantly in the TC group compared with those in the IM group. No significant differences were seen in the expression of transforming growth factor β mRNA. Conclusions These results suggest that twitch contraction induced by lumbar spinal root magnetic stimulation may reduce immobilization-induced limited range of motion and skeletal muscle fibrosis.

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Ultrasound Imaging for Dorsal Radiolunotriquetral Ligament Possibly Causing Wrist Impingement

No abstract available

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Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures

Abstract

In the case of open urological surgeries, analgesic coverage at mid thoracic dermatomal levels is required. As shown in cadaveric studies, the site of QL block injection is an important determinant of the extent of dye spread and presumably local anesthetic dermatomal coverage. In this case series, we evaluated dermatomal blockade and analgesic efficacy of a subcostal approach to anterior QL block following open urological surgeries. Twenty-two adult patients undergoing renal transplant surgery (60%) and open nephrectomy (40%) received unilateral ultrasound-guided subcostal anterior QL block with catheter insertion. Sensory level, pain score (numeric rating scale, NRS), local anesthetic consumption, and opioid consumption (morphine equivalent dose, MED) were assessed daily for 3 days. The block achieved sensory blockade between T6-7 and L1-2. The most frequently affected dermatomes were T8 -T12 and the number of blocked segments was 3 (mean 2.8). The median (interquartile range Q1, Q3) of NRS pain score was 3.7 (2.8–5.5), 3.3 (2.4–4.7), 2.9 (1.9–3.6), and 2.3 (1.0–4.2) on POD0, POD1, POD2, and POD3, respectively. Our preliminary data showed that the subcostal approach to anterior QL block provides appropriate thoracic dermatome level needed for analgesia following open urological surgical procedures between T6-7 and L1-2.

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Repeatability of exercise‐induced changes in mRNA expression and technical considerations for qPCR analysis in human skeletal muscle

New Findings

What is the central question of this study?

Are individual changes in exercise‐induced mRNA expression repeatable (i.e. representative of the true response to exercise rather than random error)?

What is the main finding and its importance?

Changes in mRNA expression are not repeatable even under identical experimental conditions.

The lack of repeatability is not explained by technical error arising from major gene analysis steps, highlighting sources of technical error and/or biological variability originating directly within the muscle.

Fibre‐type distribution is highly variable in two portions of the same muscle biopsy.

The substantial random error in exercise‐induced mRNA expression challenges its use as a biomarker of adaptive potential and/or individual responsiveness to exercise.

Abstract

It remains unknown if: 1) the observed change in mRNA expression reflects an individual's true response to exercise or random (technical and/or biological) error, and 2) the individual responsiveness to exercise is protocol‐specific. We examined the repeatability of skeletal muscle PGC‐1α, PDK4, NRF‐1, VEGF‐A, HSP72, and p53 mRNA expression following two identical endurance exercise (END) bouts (END‐1, END‐2; 30 minutes of cycling at 65% of peak work rate [WR_peak], n = 11) and inter‐individual variability in PGC‐1α and PDK4 mRNA expression following END and sprint interval training (SIT; 8 × 20‐second cycling intervals at ∼170% WR_peak, n = 10) in active young males. The repeatability of key gene analysis steps (RNA extraction, reverse transcription, qPCR) and within‐sample fibre‐type distribution (n = 8) was also determined to examine potential sources of technical error in our analyses. Despite highly repeatable exercise bout characteristics (work rate, heart rate, blood lactate; ICCs > 0.71; CVs < 10%; r > 0.85, p < 0.01), gene analysis steps (ICCs > 0.73; CVs < 24%; r > 0.75, p < 0.01), and similar group‐level changes in mRNA expression, individual changes in PGC‐1α, PDK4, VEGF‐A, and p53 mRNA expression were not repeatable (ICCs < 0.22; CVs > 20%; r < 0.21). Fibre‐type distribution in two portions of the same muscle biopsy was highly variable and not significantly related (ICC = 0.39; CV = 26%; r = 0.37, p = 0.37). Since individual changes in mRNA expression following identical exercise bouts were not repeatable, inferences regarding individual responsiveness to END or SIT were not made. Substantial random error exists in changes in mRNA expression following acute exercise, thereby challenging the use of mRNA expression for analyzing individual responsiveness to exercise.

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Novel Point Mutations in cyp51A and cyp51B Genes Associated with Itraconazole and Posaconazole Resistance in Aspergillus clavatus Isolates

Microbial Drug Resistance, Ahead of Print.


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Caffeine affects children’s ERPs and performance in an equiprobable go/no‐go task: Testing a processing schema

Abstract

Caffeine's stimulant properties were used to test a proposed processing schema for children's processing stages in the equiprobable auditory go/no‐go task. Active control‐related ERP components were hypothesized to be differentially enhanced by caffeine. Caffeine (80 mg) was administered in a counterbalanced, randomized, double‐blind, placebo‐controlled, cross‐over study of 24 children, aged 8–12 years. Four blocks of an equiprobable auditory go/no‐go task were completed on each of two occasions, while on or off caffeine. ERP data sets from each condition (caffeine/go, placebo/go, caffeine/no‐go, placebo/no‐go) were subjected to separate temporal PCAs with extraction and varimax rotation of all components. Caffeine significantly reduced reaction time and go omission errors, and enhanced go PN, N2c, and P3b, and no‐go N1‐1 and N2b. This selective enhancement of different go/no‐go components by caffeine matched the predicted amplification of biomarkers of children's active control processing in this task. Some unexpected findings also support further refinements in the child processing schema.

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Out and about: Subsequent memory effect captured in a natural outdoor environment with smartphone EEG

Abstract

Spatiotemporal context plays an important role in episodic memory. While temporal context effects have been frequently studied in the laboratory, ecologically valid spatial context manipulations are difficult to implement in stationary conditions. We investigated whether the neural correlates of successful encoding (subsequent memory effect) can be captured in a real‐world environment. An off‐the‐shelf Android smartphone was used for wireless mobile EEG acquisition and stimulus presentation. Participants encoded single words, each of which was presented at a different location on a university campus. Locations were approximately 10–12 m away from each other, half of them with striking features (landmarks) nearby. We predicted landmarks would improve recall performance. After a first free recall task of verbal stimuli indoors, participants performed a subsequent recall outdoors, in which words and locations were recalled. As predicted, significantly more words presented at landmark locations as well as significantly more landmark than nonlandmark locations were recalled. ERP analysis yielded a larger posterior positive deflection during encoding for hits compared to misses in the 400–800 ms interval. Likewise, time‐frequency analysis revealed a significant difference during encoding for hits compared to misses in the form of stronger alpha (200–300 ms) and theta (300–400 ms) power increases. Our results confirm that a vibrant spatial context is beneficial in episodic memory processing and that the underlying neural correlates can be captured with unobtrusive smartphone EEG technology. The advent of mobile EEG technology promises to unveil the relevance of natural physical activity and natural environments on memory.

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Cluster‐based permutation tests of MEG/EEG data do not establish significance of effect latency or location

Abstract

Cluster‐based permutation tests are gaining an almost universal acceptance as inferential procedures in cognitive neuroscience. They elegantly handle the multiple comparisons problem in high‐dimensional magnetoencephalographic and EEG data. Unfortunately, the power of this procedure comes hand in hand with the allure for unwarranted interpretations of the inferential output, the most prominent of which is the overestimation of the temporal, spatial, and frequency precision of statistical claims. This leads researchers to statements about the onset or offset of a certain effect that is not supported by the permutation test. In this article, we outline problems and common pitfalls of using and interpreting cluster‐based permutation tests. We illustrate these with simulated data in order to promote a more intuitive understanding of the method. We hope that raising awareness about these issues will be beneficial to common scientific practices, while at the same time increasing the popularity of cluster‐based permutation procedures.

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Syllables constitute proximate units for Mandarin speakers: Electrophysiological evidence from a masked priming task

Abstract

Languages may differ regarding the primary mental unit of phonological encoding in spoken production, with models of speakers of Indo‐European languages generally assuming a central role for phonemes, but spoken Chinese production potentially attributing a more prominent role to syllables. In the present study, native Mandarin Chinese speakers named objects that were preceded by briefly presented and masked prime words, which were form related and either matched or mismatched concerning their syllabic structure, or were unrelated. Behavioral results showed a previously reported interaction between prime and target syllable type. Concurrently recorded EEG also exhibited this interaction and further revealed that syllable overlap modulated ERPs mainly in the time window of 300–400 ms after picture onset. By contrast, phonemic overlap modulated ERPs from 500 ms to 600 ms. This pattern might suggest that speakers retrieved syllables before phonemes and strengthens the claim that for Chinese individuals syllables constitute primary functional representations ("proximate units").

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Predictors of Steroid Hormone Concentrations in Early Pregnancy: Results from a Multi-Center Cohort

Abstract

Objectives To identify factors predicting maternal sex steroid hormone concentrations in early pregnancy. Methods The Infant Development and the Environment Study recruited healthy pregnant women from academic medical centers in four US cities. Gold standard liquid chromatography–tandem mass spectrometry was used to measure maternal sex steroids concentrations (total testosterone [TT], free testosterone [FT], estrone [E1], estradiol [E2], and estriol [E3] concentrations) in serum samples from 548 women carrying singletons (median = 11.7 weeks gestation). Women completed questionnaires on demographic and lifestyle characteristics. Results In multivariable linear regression analyses, hormone concentrations varied in relation to maternal age, body mass index (BMI), race, and parity. Older mothers had significantly lower levels of most hormones; for every year increase in maternal age, there was a 1–2% decrease in E1, E2, TT, and FT. By contrast, each unit increase in maternal BMI was associated 1–2% lower estrogen (E1, E2, E3) levels, but 1–2% higher androgen (TT, FT) concentrations. Hormone concentrations were 4–18% lower among parous women, and for each year elapsed since last birth, TT and FT were 1–2% higher (no difference in estrogens). Androgen concentrations were 18–30% higher among Black women compared to women of other races. Fetal sex, maternal stress, and lifestyle factors (including alcohol and tobacco use) were not related to maternal steroid concentrations. Conclusions for Practice Maternal demographic factors predict sex steroid hormone concentrations during pregnancy, which is important given increasing evidence that the prenatal endocrine environment shapes future risk of chronic disease for both mother and offspring.

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Learned Helplessness After Anterior Cruciate Ligament Reconstruction: An Altered Neurocognitive State?

Abstract

Traumatic knee injuries, such as anterior cruciate ligament (ACL) sprains, have detrimental effects on long-term health as they initiate a cycle of chronic pain, physical inactivity, and disability. Alterations in strength and neural activity are factors that contribute to rehabilitation failure after ACL reconstruction (ACLR); however, psychological deficits also hinder rehabilitative success. Neural impairments observed following injury and ACLR may be associated with psychological dysfunction, a phenomenon defined as learned helplessness (LH). The proposed framework establishes the link between depressed neural activity and psychological dysfunction after ACL injury using foundational evidence from neuroscience and psychology to support the integration of LH into recovery.

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Impact of Ad Libitum Versus Programmed Drinking on Endurance Performance: A Systematic Review with Meta-Analysis

Abstract

Background

Debate continues on how athletes should hydrate during exercise. Several studies have recently been published comparing the effect of ad libitum (ALD) and programmed drinking (PD) on endurance performance (EP).

Objective

This work examined whether one drinking strategy offers an EP advantage over the other.

Design

Systematic review and meta-analysis of crossover controlled trials.

Data Sources

PubMed and SPORTDiscus database searches.

Eligibility Criteria for Selecting Studies

Key criteria were (1) experiments performed under controlled settings; (2) exercise lasting ≥ 1 h; (3) exercise initiated in an euhydrated state; (4) fluid intake during PD > ALD; (5) fluid composition matched for electrolytes; and (6) carbohydrate intake varied by > 25% between conditions when the exercise was 1 h and matched for exercise > 1 h.

Results

Seven publications, producing eight effect estimates, including cycling and running exercises and representing 82 subjects, were included. Mean (± standard deviation) ambient temperature, exercise intensity and duration of the experiments were 28 ± 6 °C, 81 ± 12% of maximal heart rate and 96 ± 25 min, respectively. Mean rate of fluid consumption for the PD and ALD conditions was 1073 ± 247 mL/h and 505 ± 156 mL/h, respectively. Mean change in body mass for the PD and ALD conditions was − 1.0 ± 0.5% and − 2.1 ± 0.7%, respectively. Compared with PD, ALD improved EP by 0.98 ± 0.44% (95% confidence interval 0.11–1.84%). The greater EP conferred by ALD is likely trivial.

Conclusions

Despite ALD being associated with an hourly rate of fluid consumption half as much as PD, and resulting in a dehydration level considered sufficient to impair EP, both strategies were found to similarly impact 1–2 h cycling or running performances conducted at moderate to high intensity and under temperate to warm ambient conditions.

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Revised Approach to the Role of Fatigue in Anterior Cruciate Ligament Injury Prevention: A Systematic Review with Meta-Analyses

Abstract

Background

Causes of anterior cruciate ligament (ACL) injuries are multifactorial. Anterior cruciate ligament injury prevention should thus be approached from a multifactorial perspective as well. Training to resist fatigue is an underestimated aspect of prevention programs given that the presence of fatigue may play a crucial role in sustaining an ACL injury.

Objectives

The primary objective of this literature review was to summarize research findings relating to the kinematic and kinetic effects of fatigue on single-leg landing tasks through a systematic review and meta-analysis. Other objectives were to critically appraise current approaches to examine the effects of fatigue together with elucidating and proposing an optimized approach for measuring the role of fatigue in ACL injury prevention.

Methods

A systematic literature search was conducted in the databases PubMed (1978–November 2017), CINAHL (1992–November 2017), and EMBASE (1973–November 2017). The inclusion criteria were: (1) full text, (2) published in English, German, or Dutch, (3) healthy subjects, (4) average age ≥ 18 years, (5) single-leg jump landing task, (6) evaluation of the kinematics and/or kinetics of the lower extremities before and after a fatigue protocol, and (7) presentation of numerical kinematic and/or kinetic data. Participants included healthy subjects who underwent a fatigue protocol and in whom the effects of pre- and post-fatigue on three-dimensional lower extremity kinematic and kinetics were compared. Methods of data collection, patient selection, blinding, prevention of verification bias, and study design were independently assessed.

Results

Twenty studies were included, in which four types of single-leg tasks were examined: the single-leg drop vertical jump, the single-leg drop landing, the single-leg hop for distance, and sidestep cutting. Fatigue seemed to mostly affect initial contact (decreased angles post-fatigue) and peak (increased angles post-fatigue) hip and knee flexion. Sagittal plane variables at initial contact were mostly affected under the single-leg hop for distance and sidestep cutting conditions whilst peak angles were affected during the single-leg drop jump.

Conclusions

Training to resist fatigue is an underestimated aspect of prevention programs given that the presence of fatigue may play a crucial role in sustaining an ACL injury. Considering the small number of variables affected after fatigue, the question arises whether the same fatigue pathways are affected by the fatigue protocols used in the included laboratory studies as are experienced on the sports field.

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The Muscle Protein Synthetic Response to Meal Ingestion Following Resistance-Type Exercise

Abstract

Protein ingestion following resistance-type exercise stimulates muscle protein synthesis rates and consequently enhances the skeletal muscle adaptive response to prolonged training. Ingestion of ~ 20 g of quickly digestible protein isolate optimizes muscle protein synthesis rates during the first few hours of post-exercise recovery. However, the majority of daily protein intake is consumed as slower digestible, nutrient-rich, whole-food protein sources as part of mixed meals. Therefore, the muscle protein synthetic response to the ingestion of protein supplements and typical foods or mixed meals may differ substantially. In addition, the muscle protein synthetic response to feeding is not only determined by acute nutrient intake but is also likely modulated by habitual energy and nutrient intake and nondietary factors such as habitual physical activity, body composition, age, and/or sex. Therefore, nutritional recommendations to maximize the muscle protein synthetic response to exercise depend on the type of meal (e.g., protein supplements vs. mixed meals) and the time until the next feeding opportunity (e.g., feeding before overnight sleep) and, therefore, need to be personalized to the individual athlete.

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Associations Between Maternity Care Practices and 2-Month Breastfeeding Duration Vary by Race, Ethnicity, and Acculturation

Abstract

Objectives This study examines the associations between specific maternity care practices and breastfeeding duration for Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White women. Methods We analyzed data from the 2012–2014 New Mexico Pregnancy Risk Assessment Monitoring System. We used survey language as a proxy measure of acculturation and categorized women as Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White. We conducted bivariate analyses to compare rates of breastfeeding at 2 months and experiences of maternity care practices and logistic regression analysis to estimate the effects of these practices on breastfeeding duration for each group. Results Hispanic women were less likely than non-Hispanic women to breastfeed for at least 2 months (67.9% vs. 76.6%; p = 0.000); however, this varied significantly by acculturation level: 78.1% of Spanish-speaking Hispanic women compared to 66.1% of English-speaking Hispanic women breastfed for at least 2 months (p = 0.000). The effects of specific maternity care practices on duration varied across groups. Among non-Hispanic White, Native American, and English-speaking Hispanic women, breastfeeding while at the hospital had the strongest effect (AOR 2.09, 95% CI 1.67–2.61; AOR 2.71, 95% CI 2.08–3.52; and AOR 1.99, 95% CI 1.76–2.25, respectively). Among Spanish-speaking Hispanic women, being encouraged to breastfeed on demand had the strongest effect (AOR 5.179, 95% CI 3.86–6.94). Conclusions for Practice The effects of maternity care practices on breastfeeding duration vary by race, ethnicity, and acculturation level. Health care systems must acknowledge the diversity of their patient populations when seeking to develop and implement breastfeeding-friendly practices.

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Comparison between cuff-based and radial tonometry exercise-induced central blood pressure

Abstract

Purpose

Non-invasive central blood pressure assessed during exercise may provide better cardiovascular prognostic than measurements taken at rest. Radial tonometry is the only technique validated to perform this type of assessment; however, it relies on the experience of the tester. Cuff-based devices have been developed to avoid operator dependency, although these systems have yet to be validated during exercise. The purpose of this study was to compare exercise-induced central blood pressure estimations between a cuff-based device and radial tonometry.

Methods

Twenty young healthy subjects were recruited to perform a three-workload steady-state exercise test at blood lactate levels of < 2, 2–4, and > 4 mmol/L, respectively. Central systolic and diastolic blood pressure (cSBP and cDBP, respectively), central pulse pressure (cPP), and augmentation index (AIx) were assessed at rest and during each workload with a cuff-based device and radial tonometry. Statistical analysis included Bland–Altman analysis for agreement between techniques. Agreement was considered when 95% of the data set for each central blood pressure parameter was within 1.96 standard deviations from the mean difference. Significance was considered at α = 0.05.

Results

Central blood pressure measurements with the cuff device were obtained only at rest and during low-intensity exercise. During low-intensity exercise, all measurements showed agreement between both devices (cSBP 95% CI [− 6.0 to 10.7], cDBP 95% CI [− 4.5 to 6.3], cPP 95% CI [− 4.7 to 8.3], and AIx (95% CI [− 20.1 to 22.2]).

Conclusion

A cuff-based device can estimate central blood pressure at low-intensity exercise, without operator dependency, and showing agreement to radial tonometry.

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Readers of the m6A epitranscriptomic code

Publication date: Available online 17 January 2019

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Soizik Berlivet, Jérémy Scutenaire, Jean-Marc Deragon, Cécile Bousquet-Antonelli

Abstract

N⁶-methyl adenosine (m⁶A) is the most prevalent and evolutionarily conserved, modification of polymerase II transcribed RNAs. By post-transcriptionally controlling patterns of gene expression, m⁶A deposition is crucial for organism reproduction, development and likely stress responses. m⁶A mostly mediates its effect by recruiting reader proteins that either directly accommodate the modified residue in a hydrophobic pocket formed by their YTH domain, or otherwise have their affinity positively influenced by the presence of m⁶A. We firstly describe here the evolutionary history, and review known molecular and physiological roles of eukaryote YTH readers. In the second part, we present non YTH-proteins whose roles as m⁶A readers largely remain to be explored. The diversity and multiplicity of m⁶A readers together with the possibility to regulate their expression and function in response to various cues, offers a multitude of possible combinations to rapidly and finely tune gene expression patterns and hence cellular plasticity. This article is part of a Special Issue entitled: mRNA modifications in gene expression control edited by Dr. Soller Matthias and Dr. Fray Rupert.

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Difficulties and challenges in the development of precision medicine

The rapid development of precision medicine is introducing a new era of significance in medicine. However, attaining precision medicine is an ambitious goal that is bound to encounter some challenges. Here, we have put forward some difficulties or questions that should be addressed by the progress in this field. The proposed issues include the long road to precision medicine for all types of diseases as the unknown domains of the human genome hinder the development of precision medicine. The challenges in the acquisition and analysis of large amounts of omics data, including difficulties in the establishment of a library of biological samples and large‐scale data analysis, as well as the challenges of informed consent and medical ethics in precision medicine, must be overcome to attain the goals of precision medicine. To date, precision medicine programmes have accomplished many preliminary achievements and will help to drive a dramatic revolution in clinical practices for the medical community. Through these advances, the diagnosis and treatment of many diseases will achieve many breakthroughs. This project is just beginning and requires a great deal of time and money. Precision medicine also requires extensive collaboration. Ultimately, these difficulties can be overcome. We should realize that precision medicine is good for patients, but there is still a long way to go.

This article is protected by copyright. All rights reserved.

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CLINICAL AND MOLECULAR DIAGNOSIS OF NON‐PMM2 N‐LINKED CONGENITAL DISORDERS OF GLYCOSYLATION IN SPAIN

The congenital disorders of glycosylation (CDG) are defects in glycoprotein and glycolipid glycan synthesis and attachment. They affect multiple organ/systems but non‐specific symptoms render the diagnosis of the different CDG very challenging. PMM2‐CDG is the most common CDG, but advances in genetic analysis have shown others to occur more commonly than previously thought. The present work reports the clinical and mutational spectrum of 25 non‐PMM2 CDG patients. The most common clinical symptoms were hypotonia (80%), motor or psychomotor disability (80%) and craniofacial dysmorphism (76%). Based on their serum transferrin isoform profile eighteen were classified as CDG‐I and seven as CDG‐II. Pathogenic variations were found in 16 genes (ALG1, ALG6, ATP6V0A2, B4GALT1, CCDC115, COG7, DOLK, DPAGT1, DPM1, GFPT1, MPI, PGM1, RFT1, SLC35A2, SRD5A3, SSR4). Overall, 27 variants were identified, 12 of which are novel. The results highlight the importance of combining genetic and biochemical analyses for the early diagnosis of this heterogeneous group of disorders.

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Newly identified set of obesity‐related genotypes and abdominal fat influence the risk of insulin resistance in a Korean population

We aimed to identify obesity‐related single nucleotide polymorphism (SNP) loci in a Korean population and construct an obesity genetic risk score (GRS) to examine the association of the genetic predisposition to obesity with insulin resistance (IR). In total, 9,675 subjects were included, and 7,666 of these subjects were used for replication. A GRS was constructed using the SNP loci that overlapped in both cohort sets. The subjects showed a trend toward an increase in body mass index, waist circumference, systolic/diastolic blood pressure, homeostatic model assessment (HOMA)‐IR, HOMA‐B, and levels of insulin, triglyceride, and alanine aminotransferase across the tertiles of obesity GRS, while the adiponectin level showed a trend toward a decrease with increasing GRS. The associations between the obesity GRS and the measures of fasting insulin, HOMA‐IR, and adiponectin were significant after adjusting for confounding factors. Moreover, a significant association between obesity GRS and HOMA‐IR was observed in subjects with abdominal obesity. The present results indicate that a predisposition to obesity may affect IR in the Korean population and that abdominal fat may alter or modify the genetic effects. Furthermore, the set of obesity‐related genotypes and abdominal fat may play interactive roles in determining the risk of IR.

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Assessment of preimplantation genetic testing for embryo aneuploidies: a SWOT analysis

The recently re‐named preimplantation genetic testing for determining embryo aneuploidies (PGT‐A) is presently very popular although its acceptance by the scientific community is controversial. This approach still encounters drawbacks. This paper uses a SWOT (strengths, weaknesses, opportunities and threats) analysis to discuss salient points to be considered when examining the PGT‐A strategy in order to gather information from a range of perspectives. One of the strength associated with the procedure is represented by an increase in implantation rate although data from the highest level of evidence do not support an increase in cumulative pregnancy rates. The current difficulty in the management of mosaicisms represents a weakness of PGT‐A. The application of the strategy represents an opportunity to favor the single embryo transfer while other advantages such as reduction of time to pregnancy and emotional distress are controversial. Potential important threats, at present still undefined, are represented by the biopsy‐related damage to the blastocyst and the impact on neonatal and long term outcomes.

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Brown adipose tissue remodeling induced by corticosterone in Wistar male rats

New Findings

What is the central question of this study?

Brown adipose tissue is centrally involved in energy metabolism. The aim of this work was to test the hypothesis that glucocorticoids excess disrupts BAT phenotype and function.

What is the main finding and its importance?

This work highlights that glucocorticoids might be an important modulator of brown fat physiology. Furthermore, it suggests a role for brown adipose tissue on pathophysiology of metabolic disturbances induced by glucocorticoid excess.

Abstract

In mammals, brown adipose tissue (BAT) is centrally involved in energy metabolism. To test the hypothesis that glucocorticoids excess disrupts BAT phenotype and function, male Wistar rats were treated with corticosterone in drinking water for 21 days. To confirm induction of glucocorticoid excess and metabolic disturbances, adrenals weight, corticotrophin releasing hormone mRNA levels, corticosterone serum levels, glucose tolerance test and serum triacylglycerol analyses were performed. Adipose tissue deposits were excised, weighed and evaluated by a set of biochemical, histological and molecular procedures, such as: thin‐layer chromatography, histochemistry, immunohistochemistry, quantitative real‐time polymerase chain reaction, high‐resolution oxygraphy, ATP synthesis and enzymatic activity measurements. The approach was successful in induction of glucocorticoid excess and metabolic disturbances. Lower body weight and increased adiposity were observed in corticosterone‐treated rats. Interscapular brown adipose tissue (iBAT) showed higher sensitivity to glucocorticoids than other fat deposits. The treatment induced lipid accumulation, unilocular rearrangement, increased collagen content and decreased innervation in iBAT. Furthermore, expression of Prdm16 (P < 0.05), Ucp1 (P < 0.05) and Slc7a10 (P < 0.05) decreased, while expression of Fasn (P < 0.05) and Lep (P < 0.05) mRNA increased in brown adipose tissue. Also, the levels of UCP1 diminished (P < 0.001, 2.5‐fold). Finally, lower oxygen consumption (P < 0.05), ATP synthesis (P < 0.05) and mitochondrial content (P < 0.05) were observed in iBAT of GCs‐treated rats. Glucocorticoid excess induced an extensive remodeling of interscapular brown adipose tissue, resulting in a white‐like phenotype in association with metabolic disturbances.

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Hepatocyte‐specific and extra‐hepatocyte actions of Perilipin‐2 during fatty liver disease: Benefits of being extra

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Oral thermosensing by murine trigeminal neurons: modulation by capsaicin, menthol, and mustard oil

Key points

Orosensory thermal trigeminal afferent neurons respond to cool, warm, and nociceptive hot temperatures with the majority activated in the cool range. Many of these thermosensitive trigeminal orosensory afferent neurons also respond to capsaicin, menthol and/or mustard oil (allyl isothiocyanate, AITC) at concentrations found in foods and spices. There is significant but incomplete overlap between afferent trigeminal neurons that respond to heat and to the above chemesthetic compounds. Capsaicin sensitizes warm trigeminal thermoreceptors and orosensory nociceptors; menthol attenuates cool thermoresponses.

Abstract

When consumed with foods, mint, mustard and chili peppers generate pronounced oral thermosensations. Here we recorded responses in mouse trigeminal ganglion neurons to investigate interactions between thermal sensing and the active ingredients of these plants — menthol, allyl isothiocyanate (AITC), and capsaicin, respectively — at concentrations found in foods and commercial hygiene products. We carried out in vivo confocal calcium imaging of trigeminal ganglia in which neurons express GCaMP3 or GCAMP6s and recorded their responses to oral stimulation with thermal and the above chemesthetic stimuli. In the V3 (oral sensory) region of the ganglion, thermoreceptive neurons accounted for ∼10% of imaged neurons. We categorized them into 3 distinct classes: cool‐responsive and warm‐responsive thermosensors, and nociceptors (responsive only to temperatures ≥43‐45^o). Menthol, AITC, and capsaicin also elicited robust calcium responses that differed markedly in their latencies and durations. Most of the neurons that responded to these chemesthetic stimuli were also thermosensitive. Capsaicin and AITC increased the numbers of warm‐responding neurons and shifted the nociceptor threshold to lower temperatures. Menthol attenuated the responses in all classes of thermoreceptors. Our data show that while individual neurons may respond to a narrow temperature range (or even bimodally), taken collectively, the population is able to report on graded changes of temperature. Our findings also substantiate an explanation for the thermal sensations experienced when one consumes pungent spices or mint.

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Adding more fat to a high‐fat diet only exacerbates hepatic insulin resistance

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Oral manifestations in patients and dogs with mucopolysaccharidosis Type VII

Mucopolysaccharidosis Type VII (MPS7, also called β‐glucuronidase deficiency or Sly syndrome; MIM 253220) is an extremely rare autosomal recessive lysosomal storage disease, caused by mutations in the GUSB gene. β‐glucuronidase (GUSB) is a lysosomal hydrolase involved in the stepwise degradation of glucuronic acid‐containing glycosaminoglycans (GAGs). Patients affected with MPS VII are not able to completely degrade glucuronic acid‐containing GAGs, including chondroitin 4‐sulfate, chondroitin 6‐sulfate, dermatan sulfate, and heparan sulfate. The accumulation of these GAGs in lysosomes of various tissues leads to cellular and organ dysfunctions. Characteristic features of MPS VII include short stature, macrocephaly, hirsutism, coarse facies, hearing loss, cloudy cornea, short neck, valvular cardiac defects, hepatosplenomegaly, and dysostosis multiplex. Oral manifestations in patients affected with MPS VII have never been reported. Oral manifestations observed in three patients consist of wide root canal spaces, taurodontism, hyperplastic dental follicles, malposition of unerupted permanent molars, and failure of tooth eruption with malformed roots. The unusual skeletal features of the patients include maxillary hypoplasia, hypoplastic midface, long mandibular length, mandibular prognathism, hypoplastic and aplastic mandibular condyles, absence of the dens of the second cervical vertebra, and erosion of the cortex of the lower border of mandibles. Dogs affected with MPS VII had anterior and posterior open bite, maxillary hypoplasia, premolar crowding, and mandibular prognathism. Unlike patients with MPS VII, the dogs had unremarkable mandibular condyles. This is the first report of oral manifestations in patients affected with MPS VII.

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Effects of emotions on heart rate asymmetry

Abstract

Heart rate asymmetry (HRA) is an index that accounts for an uneven contribution of decelerations and accelerations to the heart rate variability (HRV). Clinical studies indicated that HRA measures have additive clinical value over the more frequently used HRV indexes. Despite the abundance of studies on psychological influences on HRV, little is known whether psychological factors influence HRA. Based on previous research regarding HRA and stress, we expected that negative emotions compared to positive emotions would decrease the contribution of decelerations to HRV. Thirty female participants watched three clips that produced negative emotions, positive emotions, and neutral affect. Besides electrocardiogram, we measured several physiological and behavioral responses to ascertain the affective impact of the clips. Using the RR interval time series, we calculated HRV and HRA indexes. We found that HRA differentiated between positive emotions and negative emotions reactivity. Positive emotions produced a higher number of decelerations in short‐term variability to the total short‐term variability (C1 _d) compared to negative emotions. Moreover, C1 _d correlated with subjective ratings of affect. In sum, the results of this study indicated that HRA is sensitive to psychological influences. HRA indexes are likely to contribute to a more nuanced physiological differentiation between emotions.

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