Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026: 03/31/16

Πέμπτη 31 Μαρτίου 2016

Skeletal muscle phosphatidylcholine and phosphatidylethanolamine are related to insulin sensitivity and respond to acute exercise in humans

Several recent reports indicate that the balance of skeletal muscle phosphatidylcholine (PC) and phosphatidylethanolamine (PE) is a key determinant of muscle contractile function and metabolism. The purpose of this study was to determine relationships between skeletal muscle PC, PE and insulin sensitivity, and whether PC and PE are dynamically regulated in response to acute exercise in humans. Insulin sensitivity was measured via intravenous glucose tolerance in sedentary obese adults (OB; n=14), individuals with type 2 diabetes (T2D; n=15) and endurance-trained athletes (ATH; n=15). Vastus lateralis muscle biopsies were obtained at rest, immediately after 90min of cycle ergometry at 50% VO2max, and 2h-post exercise (recovery). Skeletal muscle PC and PE were measured via infusion-based MS/MS analysis. ATH had greater levels of muscle PC and PE compared with OB and T2D (P<0.05), with total PC and PE positively relating to insulin sensitivity (both P<0.05). Skeletal muscle PC:PE ratio was elevated in T2D compared with OB and ATH (P<0.05), tended to be elevated in OB vs. ATH (P=0.07), and was inversely related to insulin sensitivity among the entire cohort (r=-0.43, P=0.01). Muscle PC and PE were altered by exercise, particularly after 2h of recovery, in a highly group-specific manner. However, muscle PC:PE ratio remained unchanged in all groups. In summary, total muscle PC and PE are positively related to insulin sensitivity while PC:PE ratio is inversely related to insulin sensitivity in humans. A single session of exercise significantly alters skeletal muscle PC and PE levels, but not PC:PE ratio.

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Transcutaneous electrical acupoint stimulation alleviates adverse cardiac remodeling induced by overload training in rats

Electroacupuncture has been previously shown to alleviate cardiac ischemia/reperfusion injury. Overload training (OT) exercise can result in profound cardiac damage and remodeling. In this study, we aimed to examine whether transcutaneous electrical acupoint stimulation (TEAS), a novel non-invasive and low-risk alternative of electroacupuncture, could counteract short-term OT-induced cardiac remodeling, fibrosis, autophagy and apoptosis. Sixty rats were randomly divided into 8 groups (n= 7-8/group): control, regular exercise (RE), OT, OT plus low-, moderate- or high-frequency of TEAS preconditioning, OT plus moderate-frequency of TEAS postconditioning or of transcutaneous electrical non-acupoint stimulation (TENAS) preconditioning. The cardiac weight index (heart weight to body weight) was determined. The left ventricular morphology was examined by hematoxylin and eosin staining. The cardiac fibrosis and apoptosis were respectively determined by Masson's trichrome and TUNEL staining. The presence of autophagosomes was observed by transmission electron microcopy. The expressions of autophagic markers (LC3 II/I and Beclin-1) were determined by western blot. The results showed that: 1) OT induced adverse cardiac structure changes but didn't affect the cardiac weight index. 2) OT increased cardiac fibrosis and apoptosis, and induced autophagosome formation with up-regulated LC3 II/I and Beclin-1 expressions. 3) TEAS preconditioning effectively alleviated OT-induced cardiac structure changes, fibrosis, apoptosis and autophagy. 4) Preconditioning of TEAS produced better protective effects than postconditioning of TEAS or TENAS preconditioning. Our results demonstrate that TEAS preconditioning protects the heart from OT-induced cardiac injury/remodeling probably by inhibition of fibrosis, autophagy and apoptosis.

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Short-Term Aerobic Exercise Training Improves Gut Peptide Regulation in Nonalcoholic Fatty Liver Disease

Obesity-related nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. Exercise and diet are uniformly prescribed treatments for NAFLD, however there are limited empirical data on the effects of exercise training on metabolic function in these patients. The purpose of this study was to investigate the effect of short-term aerobic exercise training on gut peptides (glucagon-like peptide-1 (GLP-1_7-36) and peptide tyrosine tyrosine (PYY_Total)) in patients with NAFLD. Twenty-two obese subjects, 16 with NAFLD (BMI, 33.2±1.1 kg/m²), and 6 obese-matched Controls (BMI, 31.3±1.2 kg/m²) were enrolled in a supervised aerobic exercise program (60 min/day, 85% HR_max for 7 days). Fasting, and PYY and GLP-1 responses to oral glucose stimulation were assessed at baseline and after the exercise program. Initially, the NAFLD group was more insulin resistant, had higher fasting PYY and GLP-1 (P<0.05), and based on the initial 0-30 min response displayed a blunted PYY and GLP-1 reaction to glucose. After the exercise program, insulin sensitivity was increased and fasting GLP-1 was reduced in the NAFLD group (P<0.05), and the GLP-1 tAUC120 response to glucose was reduced in both NAFLD and Controls. Notably, exercise training led to a significant increase in the dynamic PYY and GLP-1 responses to glucose in the NAFLD group. In summary, seven days of vigorous aerobic exercise essentially normalized the dynamic PYY and total GLP-1 responses to nutrient stimulation in subjects with NAFLD. These data suggest that exercise improves important modulators of satiety and metabolism and could help to alleviate NAFLD in obese patients.

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Effects of intramuscular administration of 1{alpha},25(OH)2D3during skeletal muscle regeneration on regenerative capacity, muscular fibrosis, and angiogenesis

The recent discovery of the vitamin D receptor (VDR) in regenerating muscle raises the question regarding the action of vitamin D₃ on skeletal muscle regeneration. To investigate the action of vitamin D₃ on this process, tibialis anterior (TA) muscle of male C57BL/6 mice (10 weeks of age) was injected with 1.2% BaCl2 to induce extensive muscle injury. The bioactive form of vitamin D₃ [1α,25(OH)₂D₃] was administered daily via intramuscular injections during regenerative phase (day 4-7 post-injury). Physiological and supraphysiological doses of 1α,25(OH)₂D₃ relative to 1 µg/kg muscle wet weight (MW) and mouse body weight (BW) were investigated. Muscle samples were collected on day 8 post-injury to examine proteins related to vitamin D₃ metabolism (VDR, CYP24A1, and CYP27B1), satellite cell differentiation and regenerative muscle fiber formation (myogenin and EbMHC), protein synthesis signaling (Akt, p70 S6K1, 4E-BP1, and myostatin), fiber type composition (fast and slow MHCs), fibrous formation (vimentin), and angiogenesis (CD31). Administration of 1α,25(OH)₂D₃ at physiological and supraphysiological doses enhanced VDR expression in regenerative muscle. Moreover, CYP24A1 and vimentin expression was increased, accompanying decreased myogenin and EbMHC expression at the supraphysiological dose. However, there was no change in CYP27B1, Akt, p70 S6K1, 4E-BP1, myostatin, fast and slow MHCs, or CD31 expression at any dose investigated. Taken together, administration of 1α,25(OH)₂D₃ at supraphysiological dose decreased satellite cell differentiation, delayed regenerative muscle fiber formation, and increased muscular fibrosis. However, protein synthesis signaling, fiber type composition, and angiogenesis were not affected by either 1α,25(OH)₂D₃ administration at physiological or supraphysiological dose.

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Chronic Endurance Exercise Training Offsets the Age-related Attenuation in Contraction-Induced Rapid Vasodilation

Aging is associated with attenuated contraction-induced rapid onset vasodilation (ROV). We sought to examine whether chronic exercise training would improve ROV in older adults. Additionally, we examined whether a relationship between cardiorespiratory fitness and ROV exists in young and older adults. Chronically exercise trained older adults (n=16; 66±2yr) performed single muscle contractions in the forearm and leg at various intensities. Brachial and femoral artery diameter and blood velocity were measured using Doppler ultrasound. Vascular conductance (VC) was calculated as the quotient of blood flow (ml·min^-1) and mean arterial pressure (mmHg). These data were compared with our previously published work from an identical protocol in 16 older untrained (66±1yr) and 14 young (23±1yr) adults. Peak (VC_peak) and total vasodilator (VC_total) responses were greater in trained compared to untrained older adults across leg exercise intensities (P<0.05). There were no differences in responses between trained older and young adults in the arm or leg at any exercise intensity (P>0.05). Comparison of VC_peak in a subset of subjects at an absolute workload in the leg revealed that trained older adults exhibited augmented responses relative to untrained older adults. Exercise capacity (VO₂peak) was associated with VC_peak and VC_totall across arm (r=0.59-0.64) and leg exercise intensities (r=0.55-0.68; P<0.05) in older adults. Our data demonstrate that 1) chronic exercise training improves ROV in the arm and leg of trained older adults, such that age-related differences in ROV are abolished; and 2) VO₂peak is associated with VC_peak responses in both limbs of older adults.

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Obstetric early warning systems to prevent bad outcome.

Purpose of review: Early warning scores, early warning systems and rapid response systems, were established in 1999. In the UK, a national score, National Early Warning Score, was launched in 2013 and is now used throughout the National Health Service. In 2007, a firm recommendation was made by the maternal confidential enquiry that maternity units should incorporate a modified early obstetric warning score chart into clinical practice. Although there was enthusiastic uptake of this recommendation, local recording systems vary throughout the country and there is now a need to revisit revise and standardize an obstetric early warning system (ObsEWS). Recent findings: The intercollegiate Maternal Critical Care group of the Obstetric Anaesthetists' Association have produced an ObsEWS in line with the aggregate UK National Early Warning Score. Six physiological parameters are incorporated: respiratory rate, oxygen saturations, temperature, systolic blood pressure, diastolic blood pressure, and pulse rate. However, robust physiological thresholds for the measured parameters are currently lacking but required for a more sensitive and specific ObsEWS. Summary: A greater focus and study on the management of maternal morbidity (in addition to mortality data) and the development of better systems within and across the multidisciplinary team to detect early deterioration should improve management of serious illness in obstetrics. It is imperative that we undertake robust ObsEWS and data collection, including electronic systems with research and evidence-based recommendations to underpin this system. This should improve patient safety and result in more efficient, cost-effective management of sicker patients in our complex modern healthcare systems. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The patient with hypertension undergoing surgery.

Purpose of review: General recommendations for the perioperative management of patients with hypertensive disease have not evolved much over the past 20 years, yet new pathophysiological concepts have emerged and new monitoring techniques are available today. In this review, we will discuss their significance and potential role in the modern perioperative care of hypertensive patients. Recent findings: For hypertensive patients, total cardiovascular risk rather than blood pressure (BP) alone should determine the preoperative strategy. Except for grade 3 hypertension, surgery should not be deferred on the basis of an elevated BP in the preoperative assessment. New data suggest that even brief hypotensive episodes during surgery may have significant impact on outcome. Isolated systolic hypertension is the predominant phenotype in elderly patients who may be particularly vulnerable to hypoperfusion in the perioperative setting. New monitoring techniques such as echocardiography and near-infrared spectroscopy may provide crucial information to optimize intraoperative control of BP based on an individual patient's pathophysiology. Summary: Hypertension is highly prevalent in patients presenting for surgery yet its impact on surgical outcome is still debated. Guidelines on risk stratification and perioperative hemodynamic management of patients with hypertensive disease remain sparse and cannot rely much on solid new evidence. Target organ damage associated with hypertensive disease rather than high BP per se appears to determine perioperative risk. In the absence of new data, an individualized and pathophysiology-based approach to control BP may be the best option to guide these patients through the perioperative period. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Clinical 'Pearls' of maternal critical care: part I.

Purpose of review: This review outlines the challenges in looking after pregnant women with thromboembolism and sepsis who either become or are at risk of becoming critically ill during pregnancy. Recent findings: The Pregnancy Mortality Surveillance systems in both the USA and UK record the most common causes of maternal death as thromboembolism and sepsis. Both of these conditions have improved outcomes with timely maternal critical care provided by a multidisciplinary team. Summary: In this review, we discuss the pathophysiology, diagnosis, and management of thromboembolism and sepsis, two very important conditions with high mortality requiring admission to intensive care. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Effects of the Selected Iminosugar Derivatives on Pseudomonas aeruginosa Biofilm Formation

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

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Microbiological Cutoff Values: A Critical Issue in Phenotypic Antibiotic Resistance Assessment of Lactobacilli and Bifidobacteria

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

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Emergence of Klebsiella pneumoniae ST273 Carrying blaNDM-7 and ST656 Carrying blaNDM-1 in Manila, Philippines

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

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Is there sufficient evidence to claim muscle units are not localised and functionally grouped within the human gastrocnemius?

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Reply from J. S. Blouin, H. J. Brown, M. E. Héroux, J. T. Inglis and G. P. Siegmund

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Changing of the Guard

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Dark adaptation of M-cones in the retina

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Issue Information

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Editorial Board

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The retrotrapezoid nucleus as a central brainstem area for central and peripheral chemoreceptor interactions

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Gastrorenal communication: sniffing and tasting

A video slideshow introduction to the Symposium by organiser Pedro A. Jose can be found here.

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Spinal cord injury without radiographic abnormality (SCIWORA) in an adult

2016-03-31T19-00-59Z
Source: Journal of Contemporary Medicine
Vural Hamzaoğlu, Tevfik Yılmaz, Ulaş Çıkla, Hakan Özalp.
Spinal Cord Injury Without Radiographic Abnormality defines the clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability. This condition mostly affects the children below 8-years old and a rare phenomenon in adults. We aimed to report an adult patient with spinal cord injury without radiographic abnormality after a heavy fall of truck holder to his head and neck regions.

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Septic Pulmonary Embolism, a Case Report

2016-03-31T19-00-59Z
Source: Journal of Contemporary Medicine
Fulsen Bozkus, Nursel Dikmen, Nurhan Atilla, Hüseyin Arpağ, Hasan Kahraman.
Septic pulmonary embolism is a condition characterized by non-specific symptoms such as fever, chest pain, cough and pulmonary infiltrates that developing secondarily to any infectious source. It is a phenomenon which has predisposing factors such as congenital heart disease, iv drug usage, long-term catheterization. It is characterized with abscess and infarct formation in lungs secondarily to hematogenous spread of coagulated blood containing microorganisms from right heart to the lungs. Early diagnosis and broad-spectrum antibiotics are the main factors determining the prognosis of septic pulmonary embolism which has high morbidity and mortality. In our case, patient admitted to our clinic with chest pain, cough, fever and haemoptysis. It has bilateral cavitary lesions in lung scanning. However, it has high sedimentation and C-reactive protein level, primary infection could not detected. In more detailed anamnesis of patient, there was a history of dental abscess treatment. It was diagnosed with septic pulmonary embolism and treated with non-specific antibiotherapy and healed fastly. The aim of this case report is to provide an overview of septic pulmonary embolism, with existing literature.

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Endoscopic scores for inflammatory bowel disease in the era of ‘mucosal healing’: Old problem, new perspectives

The importance of the endoscopic evaluation in inflammatory bowel disease (IBD) management has been recognized for many years. However, the modalities for reporting endoscopic activity represent an ongoing challenge. To address this, several endoscopic scores have been proposed. Very few have been properly validated, and the use of such tools remains sub-optimal and is mainly restricted to clinical trials. In recent years, a growing emphasis of the concept of 'mucosal healing' as a prognostic marker and therapeutic goal has increased the need for a more accurate definition of endoscopic activity in both ulcerative colitis (UC) and Crohn's Disease (CD).

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Causes of delayed diagnoses of cancers in Japan from the viewpoint of malpractice litigations

Delayed diagnosis is the most frequent chief allegation in malpractice litigations in many countries including Japan [1–5] where it is involved in approximately half of the chief allegations pertaining to gastroenterological practice [2,4]. In these cases, the disease most often missed is cancer. The most effective way aimed at lowering malpractice litigations may be to reduce the incidence of delayed diagnosis.

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Reply to “When to resume anticoagulation after acute gastrointestinal bleeding?”

We thank the Editor for the opportunity to respond to the comments of Dr. Veloso on our recent review article on the management of anticoagulation in patients with acute gastrointestinal bleeding (GIB) [1]. Many retrospective observational studies consistently indicate a net benefit for resuming anticoagulation in these patients, as it reduces the incidence of thromboembolic events and mortality. Conversely, there is limited evidence to guide the decision on the optimal timing for restarting anticoagulation.

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Non-alcoholic steatohepatitis and liver transplantation

Non-alcoholic steatohepatitis is a growing liver-related health problem. In Europe, non-alcoholic fatty liver disease is the most usual reason of chronic liver illness while steatohepatitis, its progressive form, affects 1% of Europeans and North Americans. In the United States steatohepatitis-related cirrhosis is one of the main indications for liver transplant. A targeted stratification for patients waiting for transplant and affected by this disease is mandatory especially because of their increased cardiovascular and cancer risk.

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Analysis of long-term follow-up and examination of pathological liver tissue in chronic hepatitis E

Hepatitis E is chronic in immunocompromised patients with HIV infection, organ transplant, or radiation and chemotherapy. General cases are not chronic. Fifty-five cases were collected and followed up for 4–14 years. It was found that chronic hepatitis E is more common in males, but a high degree of inflammatory activity and fibrosis was not evident. After 4–14 years of follow-up observation, cirrhosis or liver cancer did not appear. This is significantly different from the hepatitis B and C viruses.

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Immunoglobulin G4 (IgG4)-associated pouchitis – Part of IgG4 related disease? A case series and review of the literature

IgG4-mediated pouchitis was first described in 2011. The aetiology and pathogenesis of IgG4-associated pouchitis is unknown. Over the last four years, less than seventy cases of IgG-associated pouchitis have been reported from a pouchitis clinic in Cleveland.

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SCHLAFEN 5 expression correlates with intestinal metaplasia that progresses to gastric cancer

Abstract

Background

Intestinal metaplasia (IM) is a gastric cancer precursor lesion (GCPL) and an extremely high risk factor for progression to gastric cancer (GC). Clinical guidelines recommend that patients with extensive IM undergo a gastroscopy every 3 years. However, protein biomarkers that indicate a transition from IM to GC are lacking. Our group recently identified an interferon-alpha (IFNα)-responsive gene, Schlafen 4 (Slfn4), in immune cells that correlates with metaplastic changes in Helicobacter-infected mice. We therefore tested the hypothesis that a human homolog of Slfn4, namely, Schlafen 5 (SLFN5), correlates with progression of GCPL to GC.

Methods

Jurkat T-lymphoid and HL-60 myeloid cell lines were treated with IFNα, and SLFN5 mRNA was quantified by quantitative PCR. SLFN5 protein expression in the inflamed gastric mucosa was co-localized to specific immune cell types by immunohistochemistry using CD20, CD2, and MAC2 antibodies. SLFN5 expression was also determined by immunohistochemistry in formalin-fixed paraffin-embedded samples from individuals with non-atrophic gastritis, atrophic gastritis, complete IM, incomplete IM, and GC, respectively.

Results

The IFNα treatment of Jurkat and HL-60 cells induced SLFN5 mRNA. SLFN5 protein was expressed mainly by T lymphocytes in inflamed gastric mucosa. The highest level of SLFN5 expression was observed in patients with IM that progressed to GC. Receiver operating characteristic curves demonstrated that correlating SLFN5 expression with the histologic diagnosis of IM significantly increased the probability of identifying patients who may progress to GC.

Conclusion

In this study population, elevated SLFN5 protein expression in patients with IM correlated with progression to GC.

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Endoscopic scores for inflammatory bowel disease in the era of ‘mucosal healing’: Old problem, new perspectives

Causes of delayed diagnoses of cancers in Japan from the viewpoint of malpractice litigations

Reply to “When to resume anticoagulation after acute gastrointestinal bleeding?”

Non-alcoholic steatohepatitis and liver transplantation

Analysis of long-term follow-up and examination of pathological liver tissue in chronic hepatitis E

Immunoglobulin G4 (IgG4)-associated pouchitis – Part of IgG4 related disease? A case series and review of the literature

Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts

Abstract

Raghavan et al. (Implement Sci 3(26):1–9, 2008) proposed that effective implementation of evidence-based practices requires implementation strategies deployed at multiple levels of the "policy ecology," including the organizational, regulatory or purchaser agency, political, and social levels. However, much of implementation research and practice targets providers without accounting for contextual factors that may influence provider behavior. This paper examines Philadelphia's efforts to work toward an evidence-based and recovery-oriented behavioral health system, and uses the policy ecology framework to illustrate how multifaceted, multilevel implementation strategies can facilitate the widespread implementation of evidence-based practices. Ongoing challenges and implications for research and practice are discussed.

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Accelerometry-enabled measurement of walking performance with a robotic exoskeleton: a pilot study

Clinical scores for evaluating walking skills with lower limb exoskeletons are often based on a single variable, such as distance walked or speed, even in cases where a host of features are measured. We invest...

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Effects of light wavelength on MEG ERD/ERS during a working memory task

Publication date: Available online 31 March 2016
Source:International Journal of Psychophysiology
Author(s): Yosuke Okamoto, Seiji Nakagawa
We investigated the effects of light wavelengths on cortical oscillatory activity associated with working memory processes. Cortical activity responses were measured using magnetoencephalography (MEG) while participants performed an auditory Sternberg memory task during exposure to light of different wavelength. Each trial of the memory task consisted of four words presented as a memory set and one word presented as a probe. All words were presented audibly. Participants were instructed to indicate whether the probe word was or was not presented within the memory set. A total of 90 trials were conducted under the light exposure. Event-related synchronization (ERS) and event-related desynchronization responses in the alpha frequency range during the task were analyzed. Results showed that, during memory encoding, ERS responses were significantly greater in the short-wavelength (blue) light condition than in the middle-wavelength (green) light condition, approximately 20–30min after the onset of light exposure. Behavioral performance was very high throughout the experiment and there was no difference between the light conditions. Although the light effects were not observed in behavior, the result of ERS suggests that 20–30min of exposure to blue light enhances cortical activity related to active memory maintenance and/or attention to auditory stimuli.

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Πληροφορίες

Πέμπτη 31 Μαρτίου 2016

Abstract

Background

Methods

Results

Conclusion

Abstract