Τετάρτη, 24 Φεβρουαρίου 2016

ON and OFF Inhibition as Mechanisms for Forward Masking in the Inferior Colliculus: A Modeling Study

Masking effects of a preceding stimulus on the detection or perception of a signal have been found in several sensory systems in mammals, including humans and rodents. In the auditory system, it has been hypothesized that a central "OFF-inhibitory" mechanism, which is generated by neurons that respond after a sound is terminated, may contribute to the observed psychophysics. The present study constructed a systems model for the inferior colliculus that includes major ascending monaural and binaural auditory pathways. The fundamental characteristics of several neuron types along the pathways were captured by Hodgkin-Huxley models with specific membrane and synaptic properties. OFF responses were reproduced with a model of the superior paraolivary nucleus containing a hyperpolarization-activated h current and a T-type calcium current. When the gap between the end of the masker and the onset of the signal was large, e.g., > 5 ms, OFF inhibition generated strong suppressive effects on the signal response. For smaller gaps, an additional inhibitory source, which was modeled as ON inhibition from the contralateral dorsal nucleus of the lateral lemniscus, showed the potential of explaining the psychophysics. Meanwhile, the effect of a forward masker on the binaural sensitivity to a low-frequency signal was examined, which was consistent with previous psychophysical findings related to sound localization.



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mGlu1 receptor mediates homeostatic control of intrinsic excitability through Ih in cerebellar Purkinje cells

Homeostatic intrinsic plasticity is a cellular mechanism for maintaining a stable neuronal activity level in response to developmental or activity-dependent changes. Type 1 metabotropic glutamate receptor (mGlu1 receptor) has been widely known to monitor neuronal activity, which plays a role as a modulator of intrinsic and synaptic plasticity of neurons. Whether mGlu1 receptor contributes to the compensatory adjustment of Purkinje cells (PCs), the sole output of the cerebellar cortex, in response to chronic changes in excitability remains unclear. Here, we demonstrate that the mGlu1 receptor is involved in homeostatic intrinsic plasticity through the upregulation of the hyperpolarization-activated current (Ih) in cerebellar PCs. This plasticity was prevented by inhibiting the mGlu1 receptor with Bay 36-7620, a mGlu1 receptor inverse-agonist, but not with CPCCOEt, a neutral antagonist. Chronic inactivation with tetrodotoxin (TTX) increased the components of Ih in the PCs, and ZD 7288, a hyperpolarization-activated cyclic nucleotide-gated channel selective inhibitor, fully restored reduction of firing rates in the deprived neurons. The homeostatic elevation of Ih was also prevented by BAY 36-7620, but not CPCCOEt. Furthermore, KT 5720, a blocker of protein kinase A (PKA), prevented the effect of TTX reducing the evoked firing rates, indicating the reduction in excitability of PCs due to PKA activation. Our study shows that both the mGlu1 receptor and the PKA pathway are involved in the homeostatic intrinsic plasticity of PCs after chronic blockade of the network activity which provides a novel understanding on how cerebellar PCs can preserve the homeostatic state under activity-deprived conditions.



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Cooperation and competition of gamma oscillation mechanisms.

Oscillations of neuronal activity in different frequency ranges are thought to reflect important aspects of cortical network dynamics. Here, we investigate how various mechanisms that contribute to oscillations in neuronal networks may interact. We focus on networks with inhibitory, excitatory and electrical synapses, where the subnetwork of inhibitory interneurons alone can generate interneuron gamma oscillations (ING) and the interactions between interneurons and pyramidal cells allow for pyramidal-interneuron gamma oscillations (PING). What type of oscillation will such a network generate? We find that ING and PING oscillations compete: The mechanism generating the higher oscillation frequency "wins", it determines the frequency of the network oscillation and suppresses the other mechanism. For type-I interneurons, the network oscillation frequency is equal to or slightly above the higher of the ING and PING frequencies in corresponding reduced networks that can generate only either of them. If the interneurons belong to the type-II class, it is in between. In contrast to ING and PING, oscillations mediated by gap junctions and oscillations mediated by inhibitory synapses may cooperate or compete, depending on the type (I or II) of interneurons and the strengths of the electrical and chemical synapses. We support our computer simulations by a theoretical model that allows a full theoretical analysis of the main results. Our study suggests experimental approaches to decide to what extent oscillatory activity in networks of interacting excitatory and inhibitory neurons are dominated by ING or PING oscillations and of which class the participating interneurons are.



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Blocking trial-by-trial error correction does not interfere with motor learning in human walking.

Movements can be learned implicitly in response to new environmental demands or explicitly through instruction and strategy. The former is often studied in an environment that perturbs movement so that people learn to correct the errors and store a new motor pattern. Here, we demonstrate in human walking that implicit learning of foot placement occurs even when an explicit strategy is used to block changes in foot placement during the learning process. We studied people learning a new walking pattern on a split-belt treadmill with and without an explicit strategy through instruction on where to step. When there is no instruction, subjects implicitly learn to place one foot in front of the other to minimize step length asymmetry during split-belt walking and the learned pattern is maintained when the belts are returned to the same speed, i.e. post-learning. When instruction is provided, we block expression of the new foot placement pattern that would otherwise naturally develop from adaptation. Despite this appearance of no learning in foot placement, subjects show similar post-learning effects as those who were not given any instruction. Thus, locomotor adaptation is not dependent on a change in action during learning, but instead can be driven entirely by an unexpressed internal recalibration of the desired movement.



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Encoding of natural sounds by variance of the cortical local field potential

Neural encoding of sensory stimuli is typically studied by averaging neural signals across repetitions of the same stimulus. However, recent work has suggested that the variance of neural activity across repeated trials can also depend on sensory inputs. Here, we characterize how inter-trial variance of the local field potential (LFP) in primary auditory cortex (A1) of awake ferrets is affected by continuous natural sound stimuli. We find that natural sounds often suppress the inter-trial variance of low-frequency LFP (< 16 Hz). However, the amount of the variance reduction is not significantly correlated with the amplitude of the mean response at the same recording site. Moreover, the variance changes occur with longer latency than the mean response. Although the dynamics of the mean response and inter-trial variance differ, spectro-temporal receptive field (STRF) analysis reveals that changes in LFP variance have similar frequency tuning to multi-unit activity at the same recording site, suggesting a local origin for changes in LFP variance. In summary, the spectral tuning of LFP inter-trial variance and the absence of a correlation with the amplitude of the mean evoked LFP suggest substantial heterogeneity in the interaction between spontaneous and stimulus-driven activity across local neural populations in auditory cortex.



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Light adaptation alters inner retinal inhibition to shape OFF retinal pathway signaling

The retina adjusts its signaling gain over a wide range of light levels. A functional result of this is increased visual acuity at brighter luminance levels (light adaptation), due to shifts in the excitatory center-inhibitory surround receptive field parameters of ganglion cells that increases their sensitivity to smaller light stimuli. Recent work supports the idea that changes in ganglion cell spatial sensitivity with background luminance are due in part to inner retinal mechanisms, possibly including modulation of inhibition onto bipolar cells. To determine how the receptive fields of OFF cone bipolar cells may contribute to changes in ganglion cell resolution, the spatial extent and magnitude of inhibitory and excitatory inputs were measured from OFF bipolar cells under dark- and light-adapted conditions. There was no change in the OFF bipolar cell excitatory input with light adaptation, however the spatial distributions of inhibitory inputs, including both glycinergic and GABAergic sources, became significantly narrower, smaller, and more transient. The magnitude and size of the OFF bipolar cell center-surround receptive fields as well as light-adapted changes in resting membrane potential were incorporated into a spatial model of OFF bipolar cell output to the downstream ganglion cells, which predicted an increase in signal output strength with light adaptation. We show a prominent role for inner retinal spatial signals in modulating the modeled strength of bipolar cell output to potentially play a role in ganglion cell visual sensitivity and acuity.



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Chronic Recordings Reveal Tactile Stimuli Can Suppress Spontaneous Activity of Neurons in Somatosensory Cortex of Awake and Anesthetized Primates

In somatosensory cortex, tactile stimulation within the neuronal receptive field (RF) typically evokes a transient excitatory response with or without post-excitatory inhibition. Here we describe neuronal responses in which stimulation on the hand is followed by suppression of the ongoing discharge. Using 16-channel microelectrode arrays implanted in the hand representation of primary somatosensory cortex of New World monkeys and prosimian galagos, we recorded neuronal responses from single units and neuron clusters. In 66% of our sample, neuron activity tended to display suppression of firing when regions of skin outside of the excitatory RF were stimulated. In a small proportion of neurons, single-site indentations suppressed firing without initial increases in response to any of the tested sites on the hand. Latencies of suppressive responses to skin indentation (usually 12-34 msec) were similar to excitatory response latencies. The duration of inhibition varied across neurons. Although most observations were from anesthetized animals, we also found similar neuron response properties in one awake galago. Notably, suppression of ongoing neuronal activity did not require conditioning stimuli or multi-site stimulation. The suppressive effects were generally seen following single-site skin indentations outside of the neuron's minimal receptive field (mRF), and typically on different digits and palm pads, which have not often been studied in this context. Overall, the characteristics of widespread suppressive or inhibitory response properties with and without initial facilitative or excitatory responses add to the growing evidence that neurons in primary somatosensory cortex provide essential processing for integrating sensory stimulation from across the hand.



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Increased intensity and reduced frequency of EMG signals from feline self-reinnervated ankle extensors during walking do not normalize excessive lengthening

Kinematics of cat level walking recover after elimination of length-dependent sensory feedback from the major ankle extensor muscles induced by self-reinnervation. Little is known, however, about changes in locomotor myoelectric activity of self-reinnervated muscles. We examined the myoelectric activity of self-reinnervated muscles and intact synergists to determine the extent to which patterns of muscle activity change as almost normal walking is restored following muscle self-reinnervation. Nerves to soleus (SO) and lateral gastrocnemius (LG) of 6 adult cats were surgically transected and repaired. Intramuscular myoelectric signals of SO, LG, medial gastrocnemius (MG) and plantaris (PL), muscle fascicle length of SO and MG, and hindlimb mechanics were recorded during level and slope (+/-27 deg) walking before and after (10-12 weeks post-surgery) self-reinnervation of LG and SO. Mean myoelectric signal intensity and frequency were determined using wavelet analysis. Following SO and LG self-reinnervation, mean myoelectric signal intensity increased and frequency decreased in most conditions for SO and LG as well as for intact synergist MG (p<0.05). Greater elongation of SO MTU during downslope and unchanged magnitudes of ankle extensor moment during the stance phase in all walking conditions suggested a functional deficiency of ankle extensors after self-reinnervation. Possible effects of morphological reorganization of motor units of ankle extensors and altered sensory and central inputs on the changes in myoelectric activity of self-reinnervated SO and LG are discussed.



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The role of Ih in differentiating the dynamics of the gastric mill and pyloric neurons in the stomatogastric ganglion of the lobster, Homarus americanus

The hyperpolarization-activated inward cationic current (Ih) is known to regulate the rhythmicity, excitability, and synaptic transmission in heart cells and many types of neurons across a variety of species, including some pyloric and gastric mill neurons in the stomatogastric ganglion (STG) in Cancer borealis and Panulirus interruptus. However, little is known about the role of Ih in regulating the gastric mill dynamics and its contribution to the dynamical bifurcation of the gastric mill and pyloric networks. We investigated the role of Ih in the rhythmic activity and cellular excitability of both the gastric mill neurons (MG, GM) and pyloric neurons (PD, LP) in Homarus americanus. Through testing the burst period between 5mM and 50mM CsCl, and elimination of post-inhibitory rebound and voltage sag, we found that 30mM CsCl can sufficiently block Ih in both the pyloric and gastric mill neurons. Our results show that Ih maintains the excitability of both the pyloric and gastric mill neurons. However, Ih regulates slow oscillations of the pyloric and gastric mill neurons differently. Specifically, blocking Ih diminishes the difference between the pyloric and gastric mill burst periods by increasing the pyloric burst period and decreasing the gastric mill burst period. Moreover, the phase-plane analysis shows that blocking Ih causes the trajectory of slow oscillations of the gastric mill neurons to change towards the pyloric sinusoidal-like trajectories. In addition to regulating the pyloric rhythm, we found that Ih is also essential for the gastric mill rhythms and differentially regulates these two dynamics.



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Desensitization-resistant and -sensitive GPCR-mediated inhibition of GABA release occurs by Ca2+-dependent and -independent mechanisms at a hypothalamic synapse

While the activation of Gαi/o-coupled receptors commonly results in postsynaptic responses that show acute desensitization, the presynaptic inhibition of transmitter release caused by many Gαi/o-coupled receptors is maintained during agonist exposure. However, an exception has been noted where GABAB receptor-mediated inhibition of inhibitory postsynaptic currents (IPSCs) recorded in mouse proopiomelanocortin (POMC) neurons exhibit acute desensitization in ~25% of experiments. To determine if differential effector coupling confers sensitivity to desensitization, voltage-clamp recordings were made from POMC neurons to compare the mechanisms by which mu opioid receptors (MORs) and GABABRs inhibit transmitter release. Neither MOR- nor GABABR-mediated inhibition of release relied on the activation of presynaptic K+ channels. Both receptors maintained the ability to inhibit release in the absence of external Ca2+ or in the presence of ionomycin-induced Ca2+ influx, indicating that inhibition of release can occur through a Ca2+-independent mechanism. Replacing Ca2+ with Sr2+ to disrupt G-protein-mediated inhibition of release occurring directly at the release machinery did not alter MOR- or GABAB -mediated inhibition of IPSCs, suggesting that reductions in evoked release can occur through the inhibition of Ca2+ channels. Additionally, both receptors inhibited evoked IPSCs in the presence of selective blockers of N- or P/Q-type Ca2+ channels. Altogether, the results show that MORs and GABABRs can inhibit transmitter release through the inhibition of calcium influx and by direct actions at the release machinery. Further, since both the desensitizing and non-desensitizing presynaptic receptors are similarly coupled, differential effector coupling is unlikely responsible for differential desensitization of the inhibition of release.



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Effects of GABAA kinetics on cortical population activity: Computational studies and physiological confirmations

Voltage-Sensitive Dye (VSD) imaging produces an unprecedented real-time and high-resolution mesoscopic the cortical population activity. We have previously shown that the neuronal compartments contributions to the signal are dynamic and stimulus-dependent (Chemla and Chavane 2010a). Moreover, the VSD signal can also be strongly affected by the network state, such as in anesthetized vs. awake preparations. Here, we investigated the impact of the network state, through GABAA receptors modulation, on the VSD signal using a computational approach. We therefore measured systematically the effect of the GABAA-mediated inhibitory postsynaptic potentials (IPSPs) decay time constant (G) on our modeled VSD response to an input stimulus of increasing strength. Our simulations suggest that G strongly modulates the dynamics of the VSD signal, affecting the amplitude, input response function and the transient balance of excitation and inhibition. We confirmed these predictions experimentally on awake and anesthetized monkeys, comparing VSD responses to drifting gratings stimuli of various contrasts. Lastly, one in vitro study has suggested that GABAA receptors may also be directly affected by the VSDs themselves (Mennerick et al. 2010). Our modelling approach suggests that the type of modulation described in this study would actually have a negligible influence on the population response. This study highlights that functional results acquired with different techniques and network states must be compared with caution. Biophysical models are proposed here as an adequate tool to delineate the domain of VSD data interpretation.



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Large-scale imaging of cortical dynamics during sensory perception and behavior

Sensory-driven behaviors engage a cascade of cortical regions to process sensory input and generate motor output. To investigate the temporal dynamics of neural activity at this global scale, we have developed methods to perform functional imaging across large areas of cortex using a transgenic mouse expressing GCaMP6s, integrated with a head-fixed visual discrimination behavior. This technique allows imaging of activity across the dorsal surface of cortex at a spatial resolution of approximately 50μm and temporal resolution of approximately 100 msec. Imaging during an orientation discrimination task reveals a progression of activity in different cortical regions associated with different phases of the task. After cortex-wide patterns of activity are determined, we demonstrate the ability to select a region that displayed conspicuous responses for two-photon microscopy, and find that activity in populations of individual neurons there correlates with locomotion in trained mice. We expect that this paradigm will be a useful probe of information flow and network processing in brain-wide circuits involved in many sensory and cognitive processes.



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A chronic neural interface to the macaque dorsal column nuclei

The dorsal column nuclei (DCN) of the brainstem contain secondary afferent neurons, which process ascending somatosensory information. Most of the known physiology of the DCN in primates has been acquired in acute experiments with anesthetized animals. Here, we developed a technique to implant a multielectrode array (MEA) chronically in the DCN of macaque monkeys to enable experiments with the animals awake. Two monkeys were implanted with brainstem MEAs for 2-5 months with no major adverse effects. Responses of the cuneate and gracile nuclei were quantified at the level of both field potentials and single units. Tactile receptive fields (RFs) were identified for 315 single units. A subset of these units had very regular spiking patterns with spike frequencies predominantly in the alpha band (8-14 Hz). The stability of the neuronal recordings was assessed with a novel analysis that identified units by their mean spike waveform and by the spike-triggered average of activity on all other electrodes in the array. 56 identified neurons were observed over two or more sessions, and in a few cases for as long as a month. RFs of stable neurons were largely consistent across days. The results demonstrate that a chronic DCN implant in a macaque can be safe and effective, yielding high-quality unit recording for several months. The unprecedented access to these nuclei in awake primates should lead to a better understanding of their role in sensorimotor behavior.



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Intracellular soluble alpha Synuclein oligomers reduce pyramidal cell excitability

Abstract

The presynaptic protein alpha-Synuclein (αSyn) aggregates during Parkinson's disease (PD) to form large proteinaceous amyloid plaques, the spread of which throughout the brain clinically defines the severity of the disease. During early stages of aggregation, αSyn forms soluble annular oligomers that show greater toxicity than much larger fibrils. These oligomers produce toxicity through a number of possible mechanisms including the production of pore-forming complexes that permeabilise membranes. In this study, two well-defined species of soluble αSyn oligomers were produced by different protocols: by polymerisation of monomer and by sonication of fibrils. The two oligomeric species produced were morphologically similar, both having an annular structure and consisting of approximately the same number of monomer subunits, but they differed in their secondary structure. Oligomeric and monomeric αSyn were injected directly into the soma of pyramidal neurons in mouse neocortical brain slices during whole cell patch clamp recording. Using a combined experimental and modelling approach, neuronal parameters were extracted to measure, for the first time in the neocortex, specific changes in neuronal electrophysiology. Both species of oligomer had similar effects: significantly reducing input resistance, the membrane time constant, increasing the current required to trigger an action potential and a resultant reduction in the firing rate. Differences in oligomer secondary structure appeared to produce only subtle differences in the activity of the oligomers. Monomeric αSyn had no effect on neuronal parameters even at high concentrations. The oligomer-induced fall in neuronal excitability has the potential to impact both network activity and cognitive processing.

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Screening of Herbal-Based Bioactive Extract Against Carbapenem-Resistant Strain of Acinetobacter baumannii

Microbial Drug Resistance , Vol. 0, No. 0.


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Cyclic nucleotide regulation of cardiac sympatho-vagal responsiveness

Abstract

Cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) are now recognized as important intracellular signalling molecules that modulate cardiac sympatho-vagal balance in the progression of heart disease. Recent studies have identified that a significant component of autonomic dysfunction associated with several cardiovascular pathologies resides at the end organ, and is coupled to impairment of cyclic nucleotide targeted pathways linked to abnormal intracellular calcium handling and cardiac neurotransmission. Emerging evidence also suggests that cyclic nucleotide coupled phosphodiesterases (PDEs) play a key role limiting the hydrolysis of cAMP and cGMP in disease, and as a consequence this influences the action of the nucleotide on its downstream biological target. In this review, we illustrate the action of nitric oxide-CAPON signalling, and brain natriuretic peptide, on cGMP/cAMP regulation of cardiac sympatho-vagal transmission in hypertension and ischaemic heart disease. Moreover, we address how PDE2A is now emerging as a major target that effects the efficacy of soluble/particulate guanylate cyclase coupling to cGMP in cardiac dysautonomia.

This article is protected by copyright. All rights reserved



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Legal Problems Surrounding Medical Care for Neonates Born to International Students: Report of Two Families in Japan



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Bassoon and piccolo regulate ubiquitination and link presynaptic molecular dynamics with activity-regulated gene expression

Abstract

Release of neurotransmitter is executed by complex multiprotein machinery, which is assembled around the presynaptic cytomatrix at the active zone. One well-established function of this proteinaceous scaffold is the spatial organization of synaptic vesicle cluster, the protein complexes that execute membrane fusion and compensatory endocytosis, and the transmembrane molecules important for alignment of pre- and postsynaptic structures. The presynaptic cytomatrix proteins function also in processes other than the formation of a static frame for assembly of the release apparatus and synaptic vesicle cycling. They actively contribute to the regulation of multiple steps in this process and are themselves an important subject of regulation during neuronal plasticity. We are only beginning to understand the mechanisms and signaling pathways controlling these regulations. They are mainly dependent on posttranslational modifications including phosphorylation and small-molecules conjugation, such as ubiquitination. Ubiquitination of presynaptic proteins might lead to their degradation by proteasome, but evidence is growing that this modification also affects their function independently of their degradation. Signaling from presynapse to nucleus, which works on much slower time scale and more globally, emerged as an important mechanism for persistent usage-dependent and homeostatic neuronal plasticity. Recently, two new functions for the largest presynaptic scaffolding proteins bassoon and piccolo emerged. They were implied 1) in the regulation of specific protein ubiquitination and proteasome-mediated proteolysis that potentially contributes to short-term plasticity at presynapse and 2) in the coupling of activity-induced molecular rearrangements at presynapse with reprograming of expression of neuronal activity-regulated genes.

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Towards the application of HD-EMG decomposition in clinical practice

The electromyography (EMG) signal is the summation of traveling Motor Unit (MU) Action Potentials that propagate along the fibers from the neuromuscular junction (Innervation Zone, IZ) to the tendons with a certain Conduction Velocity (CV) (Merletti and Parker 2005). EMG signals can be detected using either intramuscular or surface electrodes. Intramuscular EMG (iEMG) signals involve the insertion of needles or fine wire electrodes into a muscle (Merletti et al. 2008). Surface EMG (sEMG) signals from the underlying muscles can be detected and unobtrusively on the skin all over the human body and they can be used in modeling movement intentions and in monitoring muscle function during rehabilitation processes (Zwarts and Stegeman 2003).

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Long-term exercise-specific neuroprotection in Spinal Muscular Atrophy-like mice

Abstract

Spinal Muscular Atrophy (SMA) is a group of autosomal recessive neurodegenerative diseases differing in their clinical outcome, characterized by the specific loss of spinal motor neurons, caused by insufficient level of SMN protein expression. No cure is presently available for SMA. While physical exercise might represent a promising approach for alleviating SMA symptoms, the lack of data dealing with the effects of different exercise types on diseased motor units still precludes the use of active physiotherapy in SMA patients. In the present study, we have evaluated the efficiency of two long-term physical exercise paradigms, based on either high intensity swimming or on low intensity running, in alleviating SMA symptoms in a mild type 3 SMA-like mouse model. We found that a 10-month physical training induced significant benefits in terms of resistance to muscle damages, energetic metabolism, muscle fatigue and motor behaviour. Both exercise types significantly enhanced motor neuron survival, independently of SMN expression, leading to the maintenance of neuromuscular junctions and skeletal muscle phenotypes, particularly in the soleus, plantaris and tibialis of trained mice. Most importantly, both exercises significantly improved neuromuscular excitability properties. Besides, all these training-induced benefits were quantitatively and qualitatively related to the specific characteristics of each exercise, suggesting that the related neuroprotection is strongly dependent on the specific activation of some motor neuron subpopulations. Taken together, the present data show significant long-term exercise benefits in type 3 SMA-like mice providing important clues for designing rehabilitation programs in patients.

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ImageTrend Elite Integrates Cloud-Based EKG

LAKEVILLE, MINN. - ImageTrend, Inc. announced it has expanded its cloud-based EKG integrations to include Physio-Control's LIFENET® System in addition to ZOLL's Cloud to Cloud, and is in the final stages of integration with Philips IntelliSpace Portal. Integrations with each system allows agencies to choose their EKG systems and upload the data to NEMSIS-3 certified ImageTrend Elite™ ...

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PHOX2B Is Associated with Neuroblastoma Cell Differentiation

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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PHOX2B Is Associated with Neuroblastoma Cell Differentiation

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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Detroit EMS-Count On Me

A celebration of Detroit EMS.

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Detroit EMS-Count On Me

A celebration of Detroit EMS.

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Faces of EMS

The Faces of EMS was a 6 week photography project to draw national attention to EMS. In recognition of the men and women of EMS, this celebration of life and the job they do is my way of saying, Thank you! The full length the making of Faces of EMS video is coming soon along with a Facebook like page.

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Detroit EMS-Count On Me

A celebration of Detroit EMS.

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Faces of EMS

The Faces of EMS was a 6 week photography project to draw national attention to EMS. In recognition of the men and women of EMS, this celebration of life and the job they do is my way of saying, Thank you! The full length the making of Faces of EMS video is coming soon along with a Facebook like page.

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Interactive airport kiosks teach travelers CPR

The interactive kiosks have video instruction and a rubber mannequin for travelers to practice on; the mannequins provide feedback about chest compressions

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Detroit EMS-Count On Me

A celebration of Detroit EMS.

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Faces of EMS

The Faces of EMS was a 6 week photography project to draw national attention to EMS. In recognition of the men and women of EMS, this celebration of life and the job they do is my way of saying, Thank you! The full length the making of Faces of EMS video is coming soon along with a Facebook like page.

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Intestine-specific homeobox (ISX) induces intestinal metaplasia and cell proliferation to contribute to gastric carcinogenesis

Journal of Gastroenterology

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HCV kinetic and modeling analyses indicate similar time to cure among sofosbuvir combination regimens with daclatasvir, simeprevir or ledipasvir

Journal of Hepatology

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Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery

British Journal of Surgery

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Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor

Alimentary Pharmacology and Therapeutics

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Irrigation versus suction alone during laparoscopic appendectomy; a randomized controlled equivalence trial

International Journal of Surgery

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Retrospective analysis of the influence of 25-hydroxyvitamin D on disease progression and survival in pancreatic cancer

Nutrition Journal

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Hepatitis B virus X protein reduces the stability of Nrdp1 to up-regulate ErbB3 in hepatocellular carcinoma cells

Tumor Biology

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Matched population-based study examining the risk of type 2 diabetes in people with and without diagnosed hepatitis C virus infection

Journal of Viral Hepatitis

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Association of patient age at gastric bypass surgery with long-term all-cause and cause-specific mortality

JAMA Surgery

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Palliative treatment of anal fistulas in Crohn's disease

ANZ Journal of Surgery

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Kaempferol inhibits cell proliferation and glycolysis in esophagus squamous cell carcinoma via targeting EGFR signaling pathway

Tumor Biology

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Development of the Northwestern Esophageal Quality of Life scale: A hybrid measure for use across esophageal conditions

The American Journal of Gastroenterology

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Effectiveness and safety of vedolizumab induction therapy for patients with inflammatory bowel disease

Clinical Gastroenterology and Hepatology

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Evaluation of the CDC recommendations for HCV testing in an urban emergency department

Clinical Infectious Diseases

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Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and prognostic nutrition index as preoperative predictors of early mortality after liver resection for huge (≥10 cm) hepatocellular carcinoma

Journal of Surgical Oncology

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Years of life that could be saved from prevention of hepatocellular carcinoma

Alimentary Pharmacology and Therapeutics

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Liver fat in adults with GH deficiency: comparison to matched controls and the effect of GH replacement

Clinical Endocrinology

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Clinical significance of fibroblast growth factor receptor 2 expression in patients with residual rectal cancer after preoperative chemoradiotherapy: relationship with KRAS or BRAF mutations and MSI status

Tumor Biology

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EMT, paramedic students receive training ambulance

Local college receives training ambulance

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EMS department to cut back on sirens, lights

Greenfield emergency responders are trying something totally different: driving to the scene of basic calls without lights and sirens blaring.

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Quality Improvement Analyst, 911 - Allina Health

Responsibilities Identify patient care opportunities for improvement. Develop tracking tools and measures for improvement and report to AHEMS Leadership on regular basis. Assist in determining the parameters needed to be measured for AHEMS care goals Audit and abstract patient care records to identify trends and to measure progress and improvement opportunities Work with physicians and managers to ...

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New ambulance designed for contagious diseases

The ambulance will have a team of specially trained medics on board; the vehicle will pick up patients from anywhere in the state

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EMS department to cut back on sirens, lights

Greenfield emergency responders are trying something totally different: driving to the scene of basic calls without lights and sirens blaring.

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Colistin Increases the Cidal Activity of Antibiotic Combinations Against Multidrug-Resistant Klebsiella pneumoniae: An In Vitro Model Comparing Multiple Combination Bactericidal Testing at One Peak Serum Concentration and Time–Kill Method

Microbial Drug Resistance , Vol. 0, No. 0.


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EMS department to cut back on sirens, lights

Greenfield emergency responders are trying something totally different: driving to the scene of basic calls without lights and sirens blaring.

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Life history, cognition and the evolution of complex foraging niches

Publication date: March 2016
Source:Journal of Human Evolution, Volume 92
Author(s): Caroline Schuppli, Sereina M. Graber, Karin Isler, Carel P. van Schaik
Animal species that live in complex foraging niches have, in general, improved access to energy-rich and seasonally stable food sources. Because human food procurement is uniquely complex, we ask here which conditions may have allowed species to evolve into such complex foraging niches, and also how niche complexity is related to relative brain size. To do so, we divided niche complexity into a knowledge-learning and a motor-learning dimension. Using a sample of 78 primate and 65 carnivoran species, we found that two life-history features are consistently correlated with complex niches: slow, conservative development or provisioning of offspring over extended periods of time. Both act to buffer low energy yields during periods of learning, and may thus act as limiting factors for the evolution of complex niches. Our results further showed that the knowledge and motor dimensions of niche complexity were correlated with pace of development in primates only, and with the length of provisioning in only carnivorans. Accordingly, in primates, but not carnivorans, living in a complex foraging niche requires enhanced cognitive abilities, i.e., a large brain. The patterns in these two groups of mammals show that selection favors evolution into complex niches (in either the knowledge or motor dimension) in species that either develop more slowly or provision their young for an extended period of time. These findings help to explain how humans constructed by far the most complex niche: our ancestors managed to combine slow development (as in other primates) with systematic provisioning of immatures and even adults (as in carnivorans). This study also provides strong support for the importance of ecological factors in brain size evolution.



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Video laryngoscopy during chest compressions

Salt Lake City Fire Department investigation finds no difference in the interruption to compressions between video and direct laryngoscopy

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Video laryngoscopy during chest compressions

DALLAS — Advanced airway placement during cardiac arrest resuscitation may interrupt chest compressions and lead to excessive ventilations.

Scott Youngquist, MD, the medical director for Salt Lake City, presented a process to implement video laryngoscopy and determine if VL could lead to less interruptions in chest compressions than direct laryngoscopy at the 2016 Gathering of Eagles XVIII EMS State of the Science program.

The success of intubation with direct laryngoscopy and video laryngoscopy were reviewed. During the trial period the quality of CPR, including interruptions to chest compressions during DL and VL, were measured and compared.

Youngquist reported no differences were found to interruptions to chest compressions which reinforced the importance of high-quality CPR.

Memorable quotes on airway management during CPR

"There is no chance of an unrecognized esophageal intubation as long as you are using end-tidal CO2 monitoring."
— Scott Younquist, MD

Key takeaways on DL and VL during CPR
Here are three takeaways from the paramedics involved in Youngquist's comparison of VL and DL.

  • Paramedics were able to achieve high quality CPR during DL and VL.
  • Paramedics in the study preferred King Vision VL to DL. The medics also preferred the King Vision to other VL devices
  • Paramedics, like physicians, had an easy time viewing the vocal cords with VL, but had a harder time passing the tube.

Top Tweets

Like MDs, paramedics find obtaining a view with video laryngoscopy is easier than passing the tube. #Gatheringeagles16

— Samuel Kordik (@samuelkordik) February 19, 2016

First pass success in Salt Lake City with dl,vl and King lt #gatheringeagles16 http://pic.twitter.com/IVrSdlktn5

— Mitch Page (@mitchpage3) February 19, 2016


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Normal platelet count is common among early dengue patients confirmed by the nonstructural protein 1 antigen test

Beuy Joob, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):130-130



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Small colony variants and their clinical significance

Venkataramana Venkataramana

Annals of Tropical Medicine and Public Health 2016 9(2):137-139

Among the many factors that contribute to bacterial colonization, persistence and development of infection, the ability of microorganisms to form small colony variants (SCVs) assumes great significance. Although bacteria require intrinsic virulence factors to cause pathogenesis, some of them regularly evolve mechanisms to evade immune mechanisms, become resistant to antibiotics, and sustain in the human/animal cells to cause chronic infections. This mini review highlights the recent advances in the study of SCVs.

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Enamel hypoplasia and dental caries

Puvvadi Gopalkrishna Naveen Kumar, Purvi M Bhate, Rashmi Rai, Syeda Nikhat Mohammadi

Annals of Tropical Medicine and Public Health 2016 9(2):90-91



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Dengue, rhabdomyolysis, and lupus

Beuy Joob, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):133-133



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The dengue fever and its complication: A scenario in a tertiary-level hospital of greater Kolkata

Amitava Acharyya, Kaushik Ghosh, Ambarish Bhattacharyya, Manas Ghosh, Sisir Chakraborty, Susmita Ghosh, Mrinal Pal

Annals of Tropical Medicine and Public Health 2016 9(2):92-96

Background: India experienced a massive outbreak of dengue fever in the 2012-2013 period and this outbreak shows significantly different distribution across India. It also envisaged the hidden weakness of prevention and control program of vector-borne diseases. Aim and Objective: This study was designed to characterize the clinical and demographical profiles of this outbreak in a tertiary-level hospital of greater Kolkata. Materials and Methods: A descriptive hospital-based observational study was conducted among diagnosed dengue fever patients admitted at a tertiary-level hospital during the dengue outbreak in the 2012-2013 period. The clinical, biochemical, and demographic data of those patients were collected and recorded in a planned structured format. Results: The data of a total 382 dengue patients were analyzed. Out of these 382 patients, 67.8% are males and 42.1% belongs to 20-40 years age group. The mean and median ages of the study group were 37.39 (±17.70) years and 35 years, respectively. The mean (±SD) duration of hospital staying was 4.9 (±1.90) days. Out of these patients, 19.4% had hemorrhagic rash throughout the body, 13.2% presented with hemorrhage, and 8.6% were comorbid with typhoid immunoglobulin M (IgM) positive. Clinical shock, peripheral edema, and pulmonary edema were documented in 6.3%, 2.6%, and 5.3% of the patients, respectively. Ultrasonography (USG) abdomen test revealed that 15% of the patients had thick-walled gallbladder, while 11.27% had ascites. Out of the 382 patients, 26.3% (101) presented with pleural effusion, and 10.5% patient's platelet count went below 35,000. The alanine transaminase (ALT), alkaline phosphatase, and lipase level were abnormally increased in 82.7%, 17.1%, 29.6% patients, respectively. Conclusion: Suburban as well as rural area's people, mainly the young males, were mostly affected in this outbreak. Enteric fever was found with comorbid infection among a few dengue patients. Some patients documented with deferent complications, which were managed by early diagnosis and supportive treatment.

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Encouraging human immunodeficiency virus self-testing among vulnerable group of adolescents: A World Health Organization initiative

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2016 9(2):126-127



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Study of metabolic complications after 1 year of antiretroviral therapy in HIV-infected patients in a tertiary care center in North Bengal

Bapilal Bala, Biswadev Basu Majumdar, Jyotirmoy Pal, Saikat Datta, Arunangshu Talukdar, Shyamasish Das

Annals of Tropical Medicine and Public Health 2016 9(2):97-101

Aim: There are conflicting data regarding the incidence of metabolic abnormalities in human immunodeficiency virus (HIV)-naive patients on antiretroviral therapy (ART). Also, recommendations for the monitoring of fasting lipid and glucose by major world bodies is annually while this study demonstrates that significant changes occur in as early as 6 months. Design: The incidence and pattern of metabolic complications have been studied in a case series study design at a tertiary care center through 1 year of ART. Materials and Methods: One hundred and twenty patients were followed for 1 year after initiating ART. Data collection and categorization were done according to the statistical software application such as mean comparison and one-way analysis of variance (ANOVA) using the statistical software IBM-SPSS (version 19 Chicago Inc.) assuming the significance at 95% of confidence interval (CI). Results: At the baseline, total mean cholesterol was 162.25 mg/dL, triglyceride (TG) was 126.57 mg/dL, Low-density lipoprotein cholesterol (LDL-c) was 99.14 mg/dL and high-density lipoprotein cholesterol (HDL-c) was 36.96 mg/dL. At 6 months total cholesterol (TC), LDL-c, TG, and HDL-c increased by 12.49%, 15.01%, 14.93%, and 08.27%, respectively, and at 12 months these increased by 22%, 22.67%, 56.39%, and 14.98%, respectively, (P < 0.05). At the baseline, the mean fasting blood glucose (FBG) was 83.78 mg/dL while at 6 months and 12 months, the mean FBG was 88.18 mg/dL and 93.03 mg/dL, respectively, (P < 0.05). FBG was impaired in 11.9% and 17.8% of the patients at 6 months and 12 months, respectively. Diabetes was diagnosed in 4% of the patients at 12 months. Conclusion: ART has significant metabolic complications such as dyslipidemia, glucose intolerance, and increased body mass index (BMI) and requires proper monitoring and dose adjustment.

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Skin rash in Ebola virus disease: Rate?

Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):131-132



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Laparoscopic cholecystectomy performed simultaneously with retroperitoneoscopic live donor nephrectomy

Vaibhav K Sutariya, Pranjal R Modi

Annals of Tropical Medicine and Public Health 2016 9(2):102-104

Aim: To evaluate safety of simultaneous Laparoscopic cholecystectomy (LC) and Retroperitoneoscopic live donor nephrectomy (RPLDN). Materials and Methods: We have retrospectively reviewed 400 patients who have undergone RPLDN. Ten patients underwent a combination of RPLDN and LC. Ten patients underwent a combination of RPLDN and LC. Results: Mean operative time was 141.1 ± 27.47 min (range 95-170 min), with a mean estimated blood loss (EBL) of 61.1 ± 18.33 mL (range 30-80 mL). No blood transfusions were required. No short- or long-term complications were found. Mean hospital stay was 2.6 ± 0.84 days (range 2-4 days). Mean follow-up period was 1.8 ± 0.71 years (range 1-3 years). Conclusion: From our results, we conclude that simultaneous RPLDN and LC are safe.

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Cost-safety-effectiveness analysis of different methods of rabies vaccination

Beuy Joob, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):134-135



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Awareness, knowledge, and misconceptions of Ebola virus disease among residents of a rural community in Sokoto, Northwest Nigeria

Aminu U Kaoje, Mohammed Yahaya, Anas A Sabir, Mansur O Raji, Saad Abdulmumin, Ango U Mohammed

Annals of Tropical Medicine and Public Health 2016 9(2):105-111

Background: Since the discovery of Ebola in 1967, many localized outbreaks have occurred but the recent cross-border epidemic was fueled by the high level of illiteracy and some bad cultural practices. Aim: To assess the awareness, knowledge, and misconceptions of Ebola among residents of a rural community in Sokoto State, Nigeria. Materials and Methods: A cross-sectional study design was used. The study was conducted in a rural community and the participants were selected using the systematic sampling method. The data were analyzed with Statistical Package for the Social Sciences (SPSS) version 20.0. Skewed quantitative variables were summarized using median and categorical variables using frequencies and percentages. Chi-square test was performed to assess the relationship between outcome variables (knowledge of Ebola) and respondents' sociodemographic characteristics. Binary logistic regression analysis was also performed to identify the predictors of outcome variable. Results: Respondents' median age was 30 years and nearly half of the respondents (49%) had no formal education. A large proportion (88%) of the respondents was aware of Ebola and radio was their major source of information. Residents' knowledge of Ebola was low and only 13% had good knowledge. Eating bitter kola, bathing with salt water, and drinking salt water were mentioned as methods of preventing the spread of the disease. Of their socio-demographic characteristics, only the educational level attained did predict their knowledge of Ebola. Respondents without formal education [odds ratio (OR) = 0.198, P < 0.02] and secondary education (OR = 0.292, P < 0.01) were more likely to have poor knowledge. Conclusion: Although the majority was aware of Ebola, their knowledge about it was very low and misconceptions and misinformation were still not uncommon. There is a need for continuous public education and enlightenment about Ebola.

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Assessing the status of United Nations Millennium Development Goals

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2016 9(2):87-89



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Upper gastrointestinal endoscopy in patients with liver cirrhosis: Spectrum and prevalence of lesions

Adegboyega Akere, Kolawole O Akande

Annals of Tropical Medicine and Public Health 2016 9(2):112-118

Aim: This was to describe the different types of lesions that can be found in patients with liver cirrhosis during upper gastrointestinal endoscopy. Patients and Methods: Consecutive patients with liver cirrhosis who gave their consent to participate in the study were recruited. The diagnosis of liver cirrhosis was made by clinical and radiological features and a total of 56 patients were recruited. After taking informed consent, upper gastrointestinal endoscopy was performed on all the patients. Results: The patients consisted of 43 (76.8%) males and 13 (23.2%) females. Mean age was 45.5 ΁ 13.8 years (range: 20-77 years). Analysis showed that 21 (37.5%) patients were less than 40 years of age, 16 (28.6%) were between 40 years and 49 years, and 19 (33.9%) were 50 years and above. Esophageal varices was diagnosed in 54 (96.4%) patients. The esophageal mucosal findings observed were erosions (7.1%), ulcer (1.8%), candidiasis (8.9%) while one (1.8%) patient had both esophageal erosions and candidiasis. Gastric varices were observed in 11 (19.6%) patients and the analysis showed that the most frequent form was isolated gastric varices type 1 (IGV1) was recorded in six (10.7%) patients. Portal hypertensive gastropathy (PHG) was seen in 45 (80.4%) patients. Other gastric mucosal lesions were erosions (12.5%) and ulcers (10.7%). Duodenal varices were not seen in any of the patients. Other lesions seen were duodenitis, duodenal erosions, and duodenal ulcers in one (1.8%) patient, one (1.8%) patient, and four (7.1%) patients, respectively. Conclusion: This study has revealed different pattern of lesions that can be seen in patients with liver cirrhosis apart from varices.

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Exclusive breastfeeding and stakeholders: Only together we can make it work

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2016 9(2):127-129



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Leptospirosis and dengue coinfection: Report of three cases with review of literature

Kaushik Pan, Ujjawal Roy, Sanjeev Kumar, Ajay Panwar

Annals of Tropical Medicine and Public Health 2016 9(2):119-121

Leptospirosis is a zoonosis having a worldwide prevalence and has recently emerged as a major public health problem, especially in tropical and subtropical regions. Likewise, dengue is one of the major endemic health problems in the Indian subcontinent. It is a mosquito-borne arboviral infection causing considerable morbidity and mortality. Epidemiologically, mixed infections of dengue and leptospirosis are possible because similar environmental conditions are needed for the transmission of both these infections. Still, their coinfection is rarely reported in medical literature. Here, we report three such cases of dengue and leptospirosis coinfection, encountered in clinical practice during the monsoon season at Kolkata, West Bengal, India.

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Forgotten problems in land border crossings

Ampai Meesit, Wasana Kaewla, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):130-131



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Healing Buddha and Buddhism-related natural medicine in the Japanese context: A short note

Wasana Kaewla, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):122-122



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Public health concern on tuberculosis in tipitaka

Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):132-133



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Varicella-zoster IgG among nurse students at the start of clinical practice

Sora Yasri, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):123-123



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Medical ornithology: An emerging field of tropical medicine

Pathoom Sukkaromdee, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(2):134-134



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Pharmacogenetic characterization of naturally occurring germline NT5C1A variants to chemotherapeutic nucleoside analogs.

Background: Mutations or alterations in expression of the 5' nucleotidase gene family can lead to altered responses to treatment with nucleoside analogs. While investigating leukemia susceptibility genes, we discovered a very rare p.L254P NT5C1A missense variant in the substrate recognition motif. Given the paucity of cellular drug response data from the NT5C1A germline variation, we characterized p.L254P and eight rare variants of NT5C1A from genomic databases. Materials and methods: Through lentiviral infection, we created HEK293 cell lines that stably overexpress wild-type NT5C1A, p.L254P, or eight NT5C1A variants reported in the National Heart Lung and Blood Institute Exome Variant Server (one truncating and seven missense). IC50 values were determined by cytotoxicity assays after exposure to chemotherapeutic nucleoside analogs (cladribine, gemcitabine, 5-fluorouracil). In addition, we used structure-based homology modeling to generate a three-dimensional model for the C-terminal region of NT5C1A. Results: The p.R180X (truncating), p.A214T, and p.L254P missense changes were the only variants that significantly impaired protein function across all nucleotide analogs tested (>5-fold difference vs. wild-type; P

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Extremely Rare Childhood Tumor, Renal Clear Cell Sarcoma: A Case Report

2016-02-24T02-20-24Z
Source: Journal of Contemporary Medicine
Tamer Sekmenli, İlhan Çiftci, Yavuz Koksal.
Clear-cell sarcoma of the kidney (CCSK) is a rare tumor and comprises 3% of primary pediatric malignant renal tumors. It is known as an aggressive tumor that metastases to the bones with a poor prognosis. Clinically and radiologically, it can mimic Wilms' tumor. We present a CCSK case in the left abdominal area in a 12 year old patient.


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Access to Support System and Learners Response about Dairy Farming Distance Education Programme

2016-02-24T00-33-15Z
Source: International Journal of Livestock Research
Senthilkumar Thayalan.
It is evident from the study, that an overwhelming majority of the respondents had indicated that the minimum required support services for the learners were provided by the distance education course providers and the institution. Also the respondents might have been satisfied due to easier access, friendly faculties who had interacted, simple and understandable course content in vernacular language and flexibility of the course, which would strengthen the learning outcomes, leading to increase in the farm production, revenue and livelihood status.


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Anaesthesia and global health initiatives for children in a low-resource environment.

Purpose of review: As the United Nations moves from Millennium Development Goals to Sustainable Development Goals, we find ourselves with the opportunity to influence the priority of global health initiatives. Previously, the global health community has failed to recognise the importance of access to safe, affordable surgery and developing the necessary specialities that support it as most of the funding focus had been on primary healthcare and infectious diseases. Recent findings: Now the WHO is publishing guidelines to safe surgery and the Lancet Commission on Global Surgery has been launched. However, this is only the start; anaesthesia remains a forgotten speciality within the world of public and global health and there are still challenges in escalating surgery in low and middle-income countries to an acceptable level that is affordable and timely. Summary: Although there is increased world interest in safe surgery and anaesthesia this has not yet been translated into a mandate that will compel countries to invest in improving levels of infrastructure, accessibility, manpower, and safety. A general anaesthetic remains a dangerous event in a child's life in resource-limited countries. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Patients prone for postoperative delirium: preoperative assessment, perioperative prophylaxis, postoperative treatment.

Purpose of review: The aim of this study was to review current literature on identification of patients at risk for postoperative delirium (POD) and to summarize recent findings on prophylaxis and treatment. Recent findings: Age and preoperative cognitive impairment are among the most important risk factors of POD. POD is the result of a complex interplay of predisposing and precipitating factors. Thus, both prophylaxis and treatment require multicomponent intervention programs. No single medication to prevent or treat POD is available. Avoiding too deep anesthesia, avoiding additional psychoactive substances including benzodiazepines and intravenous opioids, and effective pain management as well as early mobilization are essential. Summary: An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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