Σάββατο 7 Μαΐου 2016

Omega-3 fatty acid supplementation combined with acute aerobic exercise does not alter the improved post-exercise insulin response in normoglycemic, inactive and overweight men

Abstract

Purpose

The aim of this study was to determine if omega-3 (n-3) supplementation combined with acute aerobic exercise would improve glucose and insulin responses in normoglycemic, inactive, overweight men.

Methods

In a random order, ten inactive and normoglycemic men (30.6 ± 10 years, 85.4 ± 11 kg, 26.7 ± 4 BMI) completed a rest (R) and exercise trial (EX) without n-3 supplementation. Following 42 days of n-3 supplementation, participants again completed a rest (R + n-3) and exercise trial (EX + n-3) with continued n-3 supplementation. The exercise trial consisted of 3 days of ~70 % VO2peak for 60 min/session. N-3 supplementation entailed 4.55 g/day of n-3 (EPA 2.45 g, DHA 1.61 g). A 75 g oral glucose tolerance (OGTT) test was administered 14–16 h after each trial.

Results

Relative to R (35,278 ± 9169 pmol/L), EX without n-3 reduced the incremental area under the curve for insulin (iAUCinsulin) during an OGTT by 21.3 % (27765 ± 4925 pmol/L, p = 0.018) and 20.6 % after the EX + n-3 trial (27,999 ± 8370 pmol/L; p = 0.007). In addition, EX (96 ± 21 pmol/L; p = 0.006) reduced C-peptide by 13.5 % when compared to R (111 ± 26 pmol/L). No difference was observed between R and n-3 trials for iAUCinsulin and iAUCC-peptide. Only EX improved insulin sensitivity index by 5.6 % (p = 0.02) when compared to R.

Conclusions

These data suggest that n-3 supplementation does not add any additional benefit beyond the exercise induced insulin responses in inactive men. Furthermore, n-3 supplementation alone does not appear to impair insulin action in normoglycemic, inactive, overweight men.



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Multivariate eQTL mapping uncovers functional variation on the X-chromosome associated with complex disease traits

Abstract

Very few studies have investigated the associations between genetic polymorphisms and gene expression on the X-chromosome. This is a major bottleneck when conducting functional follow-up studies of trait-associated variants, as those identified in genome-wide association studies (GWAS). We used a multivariate approach to test the association between individual single nucleotide polymorphisms (SNPs) and exon expression levels measured in 356 Epstein–Barr virus-transformed lymphoblastoid cell lines (LCLs) from the Geuvadis RNA sequencing project to identify SNPs associated with variation in gene expression on the X-chromosome, which we refer to as eSNPs. At an FDR of 5 %, we discovered 548 independent [linkage disequilibrium (LD) r 2 < 0.1] eSNPs on the X-chromosome. Of these, 35 were in LD (r 2 > 0.8) with previously published disease- or trait-associated variants identified through GWAS. One of the strongest eSNPs identified was rs35975601, which was associated with F8A1 expression (p value = 3 × 10−20) and was in LD with a type 1 diabetes risk variant. Additionally, we identified a number of genes for which eSNPs were in LD with multiple diseases or traits, including DNASE1L1 which was mapped to bilirubin levels, type 1 diabetes and schizophrenia. Our results also indicate that multivariate exon-level analysis provides a more powerful approach than univariate gene-level analysis, particularly when SNPs influence the expression of different exons with different magnitude and/or direction of effect. The associations identified in our study may provide new insights into the molecular process by which gene expression may contribute to trait variation or disease risk in humans.



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Paediatric intrapulmonary right-to-left shunt caused by hepatopulmonary syndrome

Hepatopulmonary syndrome, an unusual liver-induced lung disorder, is defined by the triad: liver chronic disease, increased alveolar–arterial gradient (AaPO2), and the evidence of intrapulmonary shunt [1]. While being weird in children, it occurs in the majority of cirrhosis or severe portal hypertension cases. However, its prevalence and development remains unknown. The technetium-99m-labeled macroaggregated albumin (99mTc-MAA) perfusion-lung scan has been proven as an effective technique for diagnosis and quantification of intrapulmonary shunts.

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Paediatric intrapulmonary right-to-left shunt caused by hepatopulmonary syndrome

Hepatopulmonary syndrome, an unusual liver-induced lung disorder, is defined by the triad: liver chronic disease, increased alveolar–arterial gradient (AaPO2), and the evidence of intrapulmonary shunt [1]. While being weird in children, it occurs in the majority of cirrhosis or severe portal hypertension cases. However, its prevalence and development remains unknown. The technetium-99m-labeled macroaggregated albumin (99mTc-MAA) perfusion-lung scan has been proven as an effective technique for diagnosis and quantification of intrapulmonary shunts.

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Magnetic resonance imaging predictors of recurrent disc prolapse in lumbar spine

BACKGROUND CONTEXT: Although recurrent disc prolapse after lumbar discectomy is a well-established postoperative concern, little is known about its possible predicting factors.

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Model-based drug administration: current status of target-controlled infusion and closed-loop control.

Purpose of review: Drug administration might be optimized by incorporating pharmacokinetic-dynamic (PK/PD) principles and control engineering theories. This review gives an update of the actual status of target-controlled infusion (TCI) and closed-loop computer-controlled drug administration and the ongoing research in the field. Recent findings: TCI is becoming mature technology clinically used in many countries nowadays with proven safety. Nevertheless, changing populations might require adapting the established PK/PD models. As TCI requires accurate PK/PD models, new models have been developed which should now be incorporated into the pumps to allow more general use of this technology. Closed-loop administration of hypnotic drugs using an electro-encephalographic-derived-controlled variable has been well studied and has been shown to outperform manual administration. Computer administration for other drugs and fluids have been studied recently. Feasibility has been shown for systems controlling multiple components of anaesthesia, but more work is required to show clinical safety and efficiency. Summary: Evidence in the literature is increasing that TCI and closed-loop technology could assist the anaesthetists to optimize drug administration during anaesthesia. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Practical considerations in the management of sedation for colonoscopy.

Purpose of review: The purpose of this review is to discuss the unique elements of providing anesthesia services for colonoscopy including the practical issues within an endoscopy suite, nothing by mouth status for colonoscopy, chronic medication instructions, appropriate anesthesia equipment, informed consent, pharmacology of agents for sedation, anesthetic techniques, and issues related to postprocedural care. Recent findings: The national trend is toward increasing number and complexity of colonoscopy procedures using anesthesia services. Providing anesthesia services in a dedicated endoscopy suite has unique elements related to open scheduling and the rapid turnover environment. Agents for sedation and general anesthesia for colonoscopy are chosen for rapid onset, amnestic properties, and raid emergence/recovery. Summary: Sedation for colonoscopy is a rapidly expanding subspecialty with special needs created by the increasing medical complexity of the patients, the demands of the endoscopy procedures, the challenges of the endoscopy suite, and the rapid turnover of the outpatient environment. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Reply to: crystalloids and hydroxyethyl starches in noncardiac surgical patients.

No abstract available

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High-Flow Nasal Oxygenation: A New Tool to Increase Patient Safety During Awake Craniotomy.

No abstract available

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Comparing the Intubation Performance of Macintosh and Airtraq Laryngoscopes.

No abstract available

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Regional Anesthesia for Craniotomy.

No abstract available

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Intubation Difficulty Scale Score and Videolaryngoscopes.

No abstract available

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Regional Anesthesia to the Scalp for Craniotomy: Innovation With Innervation.

No abstract available

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Journal Club.

No abstract available

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The Prophylactic Use of Remifentanil for Delayed Extubation After Elective Intracranial Operations: a Prospective, Randomized, Double-Blinded Trial.

Background: Endotracheal extubation is a painful and stressful procedure. The authors hypothesized that the prophylactic use of remifentanil would attenuate the pain intensity and stress responses resulting from extubation in neurosurgical patients. Materials and Methods: In this prospective, randomized, double-blinded, controlled trial, 160 patients with planned delay extubation after elective intracranial operation were randomized 1:1 to receive either remifentanil or normal saline (control) before their extubation. The dose regime of remifentanil was a bolus of 0.5 [mu]g/kg over 1 minute, followed by a continuous infusion of 0.05 [mu]g/kg/min for 20 minutes. The primary outcome was the incidence of severe pain during the periextubation period. Secondary outcomes included changes in the pain intensity and vital signs, failing to pass an extubation evaluation after the study drug infusion, severe adverse events, postextubation complications, and clinical outcomes. Results: Two patients in the remifentanil group did not pass the extubation evaluation. The incidence of severe pain during the periextubation period was significantly lower in the remifentanil group compared with the control group (25.0% vs. 41.3%, P=0.029). Compared with the control group, the visual analog scale in the remifentanil group was significantly lower after the bolus of remifentanil (12+/-18 vs. 25+/-27, P=0.001) and immediately after extubation (19+/-25 vs. 34+/-30, P=0.001). There were no significant differences in the vital signs immediately after extubation between the 2 groups (P>0.05). Conclusions: The prophylactic use of remifentanil decreases the incidence of severe pain. Our preliminary findings merit a larger trial to clarify the effect of the prophylactic use of remifentanil on clinical outcomes and adverse events. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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Toxocariasis: a review

2016-05-07T00-34-25Z
Source: Medicine Science | International Medical Journal
Mehmet Burak Selek, Ergenekon Karagoz, Orhan Baylan.
Human toxocariasis is a parasitic infection caused by the ingestion of larvae of dog nematode Toxocara canis and less frequently of cat nematode T.cati. In this review, current information about human toxocariasis which is a rare but an important problem suspected to cause rheumatologic, dermatologic and respiratory system diseases, is presented.


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A Primer on Population Health Management and Its Perioperative Application.

The movement toward value-based payment models, driven by governmental policies, federal statutes, and market forces, is propelling the importance of effectively managing the health of populations to the forefront in the United States and other developed countries. However, for many anesthesiologists, population health management is a new or even foreign concept. A primer on population health management and its potential perioperative application is thus presented here. Although it certainly continues to evolve, population health management can be broadly defined as the specific policies, programs, and interventions directed at optimizing population health. The Population Health Alliance has created a particularly cogent conceptual framework and interconnected and very useful population health process model, which together identify the key components of population health and its management. Population health management provides a useful rationale for patients, providers, payers, and policymakers to move collectively away from the traditional system of individual, siloed providers to a more integrated, coordinated, team-based approach, thus creating a holistic view of the patient population. The goal of population health management is to keep the targeted patient population as healthy as possible, thus minimizing the need for costly interventions such as emergency department visits, acute hospitalizations, laboratory testing and imaging, and diagnostic and therapeutic procedures. Population health management strategies are increasingly more important to leaders of health care systems as the health of populations for which they care, especially in a strong cost risk-sharing environment, must be optimized. Most population health management efforts rely on a patient-centric team approach, coordination of care, effective communication, robust outcomes data analysis, and continuous quality improvement. Anesthesiologists have an opportunity to help lead these efforts in concert with their surgical and nursing colleagues. The Triple Aim of Healthcare includes (1) improving the patient experience of care (including quality and satisfaction); (2) improving the health of populations; and (3) reducing per-capita costs of care. The Perioperative Surgical Home essentially seeks to transform perioperative care by achieving the Triple Aim, including improving the health of the surgical population. Many health care delivery systems and many clinicians (including anesthesiologists) are just beginning their population health management journeys. However, by doing so, they are preparing to navigate a much greater risk-sharing landscape, where these efforts can create greater financial stability by preventing major financial loss. Anesthesiologists can and should be leaders in this effort to add value by improving the comprehensive continuum of care of our patients. (C) 2016 International Anesthesia Research Society

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Evolution, Expression, and Function of Non-neuronal Ligand-Gated Chloride Channels in Drosophila melanogaster

Ligand-gated chloride channels have established roles in inhibitory neurotransmission in the nervous systems of vertebrates and invertebrates. Paradoxically, expression databases in Drosophila melanogaster have revealed that three uncharacterized ligand-gated chloride channel subunits, CG7589, CG6927 and CG11340, are highly expressed in non-neuronal tissues. Furthermore, subunit copy number varies between insects, with some orders containing one ortholog, whereas other lineages exhibit copy number increases. Here we show that the Dipteran lineage has undergone two gene duplications followed by expression-based functional differentiation. We used promoter-GFP expression analysis, RNA-sequencing and in situ hybridization to examine cell-type and tissue specific localization of the three D. melanogaster subunits. CG6927 is expressed in the nurse cells of the ovaries. CG7589 is expressed in multiple tissues including salivary gland, ejaculatory duct, malpighian tubules and early midgut. CG11340 is found in malpighian tubules, and the copper cell region of the midgut. Overexpression of CG11340 increased sensitivity to dietary copper, and RNAi and ends-out knockout of CG11340 resulted in copper tolerance, providing evidence for a specific non-neuronal role for this subunit in D. melanogaster. Ligand-gated chloride channels are important insecticide targets and here we highlight copy number and functional divergence in insect lineages, raising the potential that order-specific receptors could be isolated within an effective class of insecticide targets.



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Histone H1 Limits DNA Methylation in Neurospora crassa

Histone H1 variants, known as linker histones, are essential chromatin components in higher eukaryotes, yet compared to the core histones relatively little is known about their in vivo functions. The filamentous fungus Neurospora crassa encodes a single H1 protein that is not essential for viability. To investigate the role of N. crassa H1, we constructed a functional FLAG-tagged H1 fusion protein and performed genomic and molecular analyses. Cell fractionation experiments showed that H1-3XFLAG is a chromatin binding protein. Chromatin-immunoprecipitation combined with sequencing (ChIP-seq) revealed that H1-3XFLAG is globally enriched throughout the genome with a subtle preference for promoters of expressed genes. In mammals, the stochiometery of H1 impacts nucleosome repeat length. To determine if H1 impacts nucleosome occupancy or nucleosome positioning in N. crassa, we performed micrococcal nuclease digestion in wildtype and the hH1 strain followed by sequencing (MNase-seq). Deletion of hH1 did not significantly impact nucleosome positioning or nucleosome occupancy. Analysis of DNA methylation by whole-genome bisulfite sequencing (MethylC-seq) revealed a modest but global increase in DNA methylation in the hH1 mutant. Together, these data suggest that H1 acts as a non-specific chromatin binding protein that can limit accessibility of the DNA methylation machinery in N. crassa.



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Functional Genetic Screen to Identify Interneurons Governing Behaviorally Distinct Aspects of Drosophila Larval Motor Programs

Drosophila larval crawling is an attractive system to study patterned motor output at the level of animal behavior. Larval crawling consists of waves of muscle contractions generating forward or reverse locomotion. In addition, larvae undergo additional behaviors including head casts, turning, and feeding. It is likely that some neurons are used in all these behaviors (e.g. motor neurons), but the identity (or even existence) of neurons dedicated to specific aspects of behavior is unclear. To identify neurons that regulate specific aspects of larval locomotion, we performed a genetic screen to identify neurons that, when activated, could elicit distinct motor programs. We used 165 Janelia CRM-Gal4 lines--chosen for sparse neuronal expression--to express the warmth-inducible neuronal activator TrpA1 and screened for locomotor defects. The primary screen measured forward locomotion velocity, and we identified 63 lines that had locomotion velocities significantly slower than controls following TrpA1 activation (28°C). A secondary screen was performed on these lines, revealing multiple discrete behavioral phenotypes including slow forward locomotion, excessive reverse locomotion, excessive turning, excessive feeding, immobile, rigid paralysis, and delayed paralysis. While many of the Gal4 lines had motor, sensory, or muscle expression that may account for some or all of the phenotype, some lines showed specific expression in a sparse pattern of interneurons. Our results show that distinct motor programs utilize distinct subsets of interneurons, and provide an entry point for characterizing interneurons governing different elements of the larval motor program.



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Identifying Genetic Signatures of Natural Selection Using Pooled Population Sequencing in Picea abies

The joint inference of selection and past demography remain a costly and demanding task. We used next generation sequencing of two pools of 48 Norway spruce mother trees, one corresponding to the Fennoscandian domain and the other to the Alpine domain, to assess nucleotide polymorphism at 88 nuclear genes. These genes are candidate genes for phenological traits and most belong to the photoperiod pathway. Estimates of population genetic summary statistics from the pooled data are similar to previous estimates suggesting that pooled sequencing is reliable. The non-synonymous SNPs tended to have both lower frequency differences and lower FST values between the two domains than silent ones. These results suggest the presence of purifying selection. The divergence between the two domains based on synonymous changes was around 5 million years, a time similar to a recent phylogenetic estimate of 6 million years, but much larger than earlier estimates based on isozymes. Two approaches, one of them novel and that considers both FST and difference in allele frequencies between the two domains, were used to identify SNPs potentially under diversifying selection. SNPs from around 20 genes were detected, including genes previously identified as main target for selection such as PaPRR3 and PaGI.



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Budding Yeast SLX4 Contributes to the Appropriate Distribution of Crossovers and Meiotic Double-strand Break Formation on Bivalents during Meiosis

The number and distribution of meiosis crossover (CO) events on each bivalent are strictly controlled by multiple mechanisms to assure proper chromosome segregation during the first meiotic division. In Saccharomyces cerevisiae, Slx4 is a multi-functional scaffold protein for structure-selective endonucleases, such as Slx1 and Rad1 (which involved in DNA damage repair) and also is a negative regulator of the Rad9-dependent signaling pathway with Rtt107. Slx4 has been believed to facilitate only a minor role in meiotic recombination. Here we report that Slx4 is involved in proper intra-chromosomal distribution of meiotic CO formation, especially in the region near centromeres. We observed an increase in uncontrolled CO formation only in the region near the centromere in the slx4 mutant. Interestingly, this phenomenon was not observed in the slx1, rad1, or rtt107 mutants. In addition, we observed a reduced number of DNA double-strand breaks (DSBs) and altered meiotic DSB distribution on chromosomes in the slx4 mutant. This suggests that multi-functional Slx4 is required for proper CO formation and meiotic DSB formation.



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Partial Functional Diversification of Drosophila melanogaster Septins Sep2 and Sep5

The septin family of hetero-oligomeric-complex-forming proteins can be divided into subgroups, and subgroup members are interchangeable at specific positions in the septin complex. Drosophila melanogaster has five septin genes, including the two SEPT6 subgroup members Sep2 and Sep5. We previously found that Sep2 has a unique function in oogenesis, which is not performed by Sep5. Here, we find Sep2 is uniquely required for follicle cell encapsulation of female germline cysts, and that Sep2 and Sep5 are redundant for follicle cell proliferation. The five D. melanogaster septins localize similarly in oogenesis, including as rings flanking the germline ring canals. Pnut fails to localize in Sep5; Sep2 double mutant follicle cells, indicating that septin complexes fail to form in the absence of both Sep2 and Sep5. We also find that mutations in septins enhance the mutant phenotype of bazooka, a key component in the establishment of cell polarity, suggesting a link between septin function and cell polarity. Overall, this work suggests Sep5 has undergone partial loss of ancestral protein function, and demonstrates redundant and unique functions of septins.



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CORRELATION OF COAGULATION PROFILE IN LIVER DISEASE PATIENTS IN A TERTIARY CARE HOSPITAL

2016-05-06T23-58-19Z
Source: International Journal of Current Research and Review
G. K. Tripathi, Ankita A. Katara, Shweta V. Awasthi, Shashank V. Srivastava.
Objective: To determine the coagulation abnormalities among liver disease patients admitted in a tertiary care hospital of Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh (India) for a period of 1 year (January 2015 to December 2015). Methods: Patients were labeled as liver disease patients on the basis of Liver Function Tests (LFT) done in the hospital at the time of admission. Patients blood were collected in sodium citrate and plain vaccutainer for coagulation tests [prothrombin time (PT), activated partial thromboplastin time (aPTT)] and liver function tests respectively. The prothrombin time ratio was calculated and then used to calculate the international normalized ratio. Following parameters were included in Liver Function Test, serum bilirubin, SGOT, SGPT, ALP, Total Protein and serum albumin. Results: Total number of cases studied in a period of 1 year (January 2015 to December 2015) were 311. In 284(91.3%) cases both LFT and coagulation profile were done. In 261 (83.9%) cases (out of total 311 cases) coagulation tests were normal and in 50 (16.1%) cases coagulation tests were found to be deranged. Out of these 50 cases, PT was raised in 44(100%) cases, APTT was raised in 21(95.4%) cases and both PT and APTT were raised in 15(93.75%) cases. Conclusion: Coagulation abnormalities were profound patients with chronic liver diseases. In case of acute liver disease ,usually PT( Prothrombin Time) is increased, but aPTT (activated partial thromboplastin time)is found to be normal. aPTT (activated partial thromboplastin time)is usually increased in chronic liver diseases, but the PT(Prothrombin Time) prolongation is usually not seen in initial stages of chronic liver disease until the stage of liver fibrosis and cirrhosis is reached. Nevertheless, these parameters (PT and aPTT) were still widely used as prognostic markers in liver disease patients..


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