Σάββατο, 21 Μαΐου 2016

Weekend therapy in diabetes

2016-05-21T16-38-13Z
Source: Journal of the Pakistan Medical Association
Sanjay Kalra, Yashdeep Gupta.
This article introduces the concept of "weekend therapy", which has now become reality in diabetes. It briefly describes injectable and oral drugs which are currently available, or are in advanced stages of development, for use in once weekly administration. These include dulaglutide, exenatide QW, semaglutide, omarigliptin and trelagliptin.


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Upper third molar internal structural organization and semicircular canal morphology in Plio-Pleistocene South African cercopithecoids

Publication date: June 2016
Source:Journal of Human Evolution, Volume 95
Author(s): Amélie Beaudet, Jean Dumoncel, John Francis Thackeray, Laurent Bruxelles, Benjamin Duployer, Christophe Tenailleau, Lunga Bam, Jakobus Hoffman, Frikkie de Beer, José Braga
Despite the abundance of cercopithecoids in the fossil record, especially in South Africa, and the recent development of morphometric approaches, uncertainties regarding the taxonomic identification of isolated cranio-dental specimens remain. Because cercopithecoids, nearly always found in stratigraphic association with hominin remains in Plio-Pleistocene deposits, are considered as sensitive ecological and chronological biomarkers, a significant effort should be made to clarify their palaeobiodiversity by assessing additional reliable morphological diagnostic criteria. Here we test the relevance of both molar crown internal structure and bony labyrinth morphology for discrimination of fossil cercopithecoid species. We use microtomographic-based 3D virtual imaging and quantitative analyses to investigate tooth endostructural organization and inner ear shape in 29 craniodental specimens from the South African sites of Kromdraai, Makapansgat, Sterkfontein and Swartkrans and provide the first detailed description of the internal structural condition characterizing this Plio-Pleistocene primate assemblage. Our preliminary results show that enamel-dentine junction morphology could be informative for discriminating highly autapomorphic taxa such as Theropithecus, while semicircular canal shape is tentatively proposed as an efficient criterion for diagnosing Dinopithecus ingens. Further research in virtual paleoprimatology may contribute to the identification of unassigned isolated fossil remains and shed new light on the internal craniodental morphology of extinct primate taxa.



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Changes in tibialis anterior corticospinal properties after acute prolonged muscle vibration

Abstract

Purpose

Prolonged local vibration is known to impair muscle performance. While involved mechanisms were previously evidenced at the spinal level, changes at the cortical level were also hypothesized. The aims of the present study were to investigate the effects of 30 min of 100-Hz tibialis anterior muscle vibration on force production capacities and to further identify the respective changes in spinal loop properties, descending voluntary drive and corticospinal properties.

Methods

Thirteen subjects were tested before and after a vibration condition, and before and after a resting control condition. Maximal voluntary contraction (MVC) in dorsiflexion was measured. Transcranial magnetic stimulation was superimposed during MVCs to assess cortical voluntary activation (VATMS), motor-evoked potential amplitude (MEP) and cortical silent period length (CSP). MEP and CSP were also measured during 50 and 75 % MVC contractions. Spinal excitability was investigated by mean of H-reflex.

Results

There were no vibration effects on MVC (p = 0.805), maximal EMG activity (p = 0.653), VATMS (p = 1), and CSP (p = 0.877). Vibration tended to decrease MEP amplitude (p = 0.117). H-reflex amplitude was depressed following vibration (p = 0.008).

Conclusions

Dorsiflexion maximal force production capacities were unaffected by 30 min of tibialis anterior muscle vibration, despite spinal loop and corticospinal excitabilities being reduced. These findings suggest that acute prolonged vibration has the potential to modulate corticospinal excitability of lower limb muscles without a concomitant functional consequence.



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Oxygenation, local muscle oxygen consumption and joint specific power in cycling: the effect of cadence at a constant external work rate

Abstract

Purpose

The present study investigates the effect of cadence on joint specific power and oxygenation and local muscle oxygen consumption in the vastus lateralis and vastus medialis in addition to the relationship between joint specific power and local muscle oxygen consumption (mVO2).

Methods

Seventeen recreationally active cyclists performed 6 stages of constant load cycling using cadences of 60, 70, 80, 90, 100 and 110 rpm. Joint specific power was calculated using inverse dynamics and mVO2 and oxygenation were measured using near-infrared spectroscopy.

Results

Increasing cadence led to increased knee joint power and decreased hip joint power while the ankle joint was unaffected. Increasing cadence also led to an increased deoxygenation in both the vastus lateralis and vastus medialis. Vastus lateralis mVO2 increased when cadence was increased. No effect of cadence was found for vastus medialis mVO2.

Conclusion

This study demonstrates a different effect of cadence on the mVO2 of the vastus lateralis and vastus medialis. The combined mVO2 of the vastus lateralis and medialis showed a linear increase with increasing knee joint specific power, demonstrating that the muscles combined related to power generated over the joint.



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Prediction of peak oxygen uptake in children using submaximal ratings of perceived exertion during treadmill exercise

Abstract

Purpose

This study assessed the utility of the Children's Effort Rating Table (CERT) and the Eston–Parfitt (EP) Scale in estimating peak oxygen uptake ( \(\dot{V}{\text{O}}_}}\) ) in children, during cardiopulmonary exercise testing (CPET) on a treadmill.

Methods

Fifty healthy children (n = 21 boys; 9.4 ± 0.9 years) completed a continuous, incremental protocol until the attainment of \(\dot{V}{\text{O}}_}}\) . Oxygen uptake ( \(\dot{V}{\text{O}}_{2}\) ) was measured continuously, and ratings of perceived exertion (RPE) were estimated at the end of each exercise stage using the CERT and the EP Scale. Ratings up to- and including RPE 5 and 7, from both the CERT (CERT 5, CERT 7) and EP Scale (EP 5, EP 7), were linearly regressed against the corresponding \(\dot{V}{\text{O}}_{2}\) , to both maximal RPE (CERT 10, EP 10) and terminal RPE (CERT 9, EP 9).

Results

There were no differences between measured- and predicted \(\dot{V}{\text{O}}_}}\) from CERT 5, CERT 7, EP 5 and EP 7 when extrapolated to either CERT 9 or EP 9 (P > 0.05). Pearson's correlations of r = 0.64–0.86 were observed between measured- and predicted \(\dot{V}{\text{O}}_}}\) , for all perceptual ranges investigated. However, only EP 7 provided a small difference when considering the standard error of estimate, suggesting that the prediction of \(\dot{V}{\text{O}}_}}\) from EP 7 would be within 10 % of measured \(\dot{V}{\text{O}}_}}\) .

Conclusions

Although robust estimates of \(\dot{V}{\text{O}}_}}\) may be elicited using both the CERT and EP Scale during a single CPET with children, the most accurate estimates of \(\dot{V}{\text{O}}_}}\) occur when extrapolating from EP 7.



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Erratum to: Calculation of total energy expenditure in publications on physical activity energy by Yamada et al. in 2009 and 2013



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Effect of acute exercise and hypoxia on markers of systemic and mucosal immunity

Abstract

Purpose

To determine how immune markers are affected by acute hypoxic exercise at the same relative intensity.

Methods

Twelve endurance-trained males (age: 28 ± 4 years, \(\dot{V}\) O2max: 63.7 ± 5.3 mL/kg/min) cycled for 75 min at 70 % of altitude-specific \(\dot{V}\) O2max, once in normoxia (N) and once in hypobaric hypoxia equivalent to 2000 m above sea-level (H). Blood and saliva samples were collected pre-, post- and 2 h post-exercise.

Results

Participants cycled at 10.5 % lower power output in H vs. N, with no significant differences in heart rate (P = 0.10) or rating of perceived exertion (P = 0.21). Post-exercise plasma cortisol was higher in H vs. N [683 (95 % CI 576–810) nmol/l vs. 549 (469–643) nmol/l, P = 0.017]. The exercise-induced decrease in CD4:CD8 ratio was greater in H vs. N (−0.5 ± 0.2 vs. −0.3 ± 0.2, P = 0.019). There were no significant between-trial differences for adrenocorticotropic hormone, plasma cytokines, antigen-stimulated cytokine production, salivary immunoglobulin-A or lactoferrin. However, there was a main trial effect for concentration [F(11) = 5.99, P < 0.032] and secretion [F(11) = 5.01, P < 0.047] of salivary lysozyme, with this being higher in N at every time-point.

Conclusion

Whether the observed differences between H and N are of sufficient magnitude to clinically impair host defence is questionable, particularly as they are transient in nature and since other immune markers are unaffected. As such, acute hypoxic exercise likely does not pose a meaningful additional threat to immune function compared to exercise at sea level, provided that absolute workload is reduced in hypoxia so that relative exercise intensity is the same.



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IL8 gene as modifier of cystic fibrosis: unraveling the factors which influence clinical variability

Abstract

The severity of cystic fibrosis (CF) is associated with classes of mutations in the CFTR gene (cystic fibrosis transmembrane regulator), physical environment and modifier genes interaction. The IL8 gene (interleukin 8), according to its respective polymorphisms, influences inflammatory responses. This study analyzed IL8 gene polymorphisms (rs4073, rs2227306 and rs2227307), by means of PCR/RFLP, and their association with pulmonary function markers and clinical severity scores in 186 patients with CF, considering the CFTR genotype. There was an association between rs2227307 and precocity of the disease. The severity of lung disease was associated with the following markers: transcutaneous arterial hemoglobin oxygen saturation (SaO2) (regardless of CFTR genotype, for the polymorphisms rs4073, rs2227306 and rs2227307); mucoid Pseudomonas aeruginosa (regardless of CFTR genotype, for the polymorphisms rs2227306 and rs2227307). Pulmonary function markers (SaO2 and spirometric variables) and clinical severity scores were also associated with IL8 gene polymorphisms. This study identified the IL8 gene, represented by rs4073 and rs2227306 polymorphisms, and particularly the rs2227307 polymorphism, as potentiating factors for the degree of variability in the severity of CF, especially in pulmonary clinical manifestation correlated with increased morbidity and mortality.



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Effectiveness of dorsum hand splint and NMES on hand functions in stroke patients

2016-05-21T11-50-00Z
Source: International Journal of Health and Rehabilitation Sciences (IJHRS)
Salameh Al Dajah, Sami Abdulwahab.
Background: Upper extremity spasticity is a common clinical outcome following stroke and may be seriously debilitating condition. Regaining functions in the upper extremities is often more difficult than in lower extremities, which can seriously affect the progress of rehabilitation. Mainly, the hand and wrist synergistic spasticity limits rehabilitation outcomes and physical function. Therefore, rehabilitation process appears to be a challenge in stroke patients, mainly with upper limb synergistic spasticity Objectives: The aim of this study is to evaluate the effectiveness of the electro stimulation and the dorsum hand splint to reduce hand flexion spastic synergy and to enhance the functional activity of paretic hand. Methods and Materials Sixty patients with hand flexion synergistic spasticity selected for this study. They randomly assigned into two groups. One group received NMES as well as hand functions activities and asked to wear a dorsum splint for 2x3/day hours for 12 weeks. The second group received traditional physical therapy, which include active assistive range of motion and hand activities. Subjects in both groups evaluated before and after 12 weeks of treatment using Wolf Motor Function Test and active ROM for the wrist and fingers. Results: The mean value for seven factors of Wolf Motor Functional Test evaluated in both groups. There was significant difference p


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Variation in airborne 134Cs, 137Cs, particulate 131I and 7Be maximum activities at high-altitude European locations after the arrival of Fukushima-labeled air masses

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): Olivier Masson, Jacqueline Bieringer, Erika Brattich, Axel Dalheimer, Sybille Estier, Ilia Penev, Wolfgang Ringer, Clemens Schlosser, Thomas Steinkopff, Philipp Steinmann, Laura Tositti, Pieter Van Beek, Anne de Vismes-Ott
The Fukushima-labeled air mass arrival, and later the cesium-134 (134Cs), cesium-137 (137Cs) and particulate iodine-131 (hereafter noted 131Ip) maximum levels were registered in Europe at different dates depending on the location. Most of those data were obtained at low-altitude sampling areas. Here, we compare the airborne levels registered at different high-altitude European locations (from 850 m to about 3500 m). The integrated 137Cs activity concentration was not uniform with regard to the altitude even after a long travel time/distance from Japan. Moreover, the relation of integrated 137Cs vs. altitude showed a linear decrease up to an altitude of about 3000 m. A similar trend was noticed for 131Ip (particulate fraction) while it increased above 3000 m. Comparison with 7Be activity concentration showed that, as far as the high altitude location is concerned, the 137Cs and 134Cs maximum concentrations corresponded to the 7Be maximum, suggesting downdraft movements from high tropospheric or stratospheric layers to be responsible for 137,134Cs increase and peak values. This was also confirmed by high potential vorticity and low relative humidity registered during the peak values.

Graphical abstract

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Outdoor thoron and progeny in a thorium rich area with old decommissioned mines and waste rock

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Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): Hallvard Haanes, Ingvild E. Finne, Trine Kolstad, Alexander Mauring, Sven Dahlgren, Anne Liv Rudjord
Radon (222Rn), thoron (220Rn) and their decay products may reach high levels in areas of high natural background radiation, with increased risk associated with mining areas. Historically, the focus has mostly been placed upon radon and progeny (RnP), but recently there have been reports of significant contributions to dose from thoron progeny (TnP). However, few direct measurements of TnP exist under outdoor conditions. Therefore, we assessed the outdoor activity concentrations of radon, thoron and TnP in an area of igneous bedrock with extreme levels of radionuclides in the thorium decay series. The area is characterized by decommissioned mines and waste rock deposits, which provide a large surface area for radon and thoron emanation and high porosity enhancing exhalation. Extreme levels of thorium and thoron have previously been reported from this area and to improve dose rate estimates we also measured TnP using filter sampling and time-integrating alpha track detectors. We found high to extreme levels of thoron and TnP and the associated dose rates relevant for inhalation were up to 8 μSvh−1 at 100 cm height. Taking gamma irradiation and RnP into account, significant combined doses may result from occupancies in this area. This applies to recreational use of the area and especially previous and planned road-works, which in the worst case could involve doses as large as 23.4 mSv y−1. However, radon and thoron levels were much more intense on a hot September day than during time-integrated measurements made the subsequent colder and wetter month, especially along the ground. This may be explained by cold air observed flowing out from inside the mines through a drainage pipe adjacent to the measurement stations. During warm periods, activity concentrations may therefore be due to both local exhalation from the ground and air ventilating from the mines. However, a substantially lower level of TnP was measured on the September day using filter sampling, as compared to what was measured with time-integrative alpha track detectors. A possible explanation could be reduced filter efficiency related to the attached progeny of some aerosol sizes, but a more likely cause is an upwards bias on TnP detectors associated with assumed deposition velocity, which may be different in outdoor conditions with wind or a larger fraction of unattached progeny. There is thus a need for better instrumentation when dealing with outdoor TnP.



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Migration of the FDNPP-derived 134Cs and 137Cs along with 226Ra and 228Ra concentrations across the northwestern North Pacific Ocean

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Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): M. Inoue, Y. Shirotani, S. Nagao, H. Kofuji, Y.N. Volkov, J. Nishioka
We examined lateral distributions of 134Cs, 137Cs, 226Ra, and 228Ra in the surface seawaters around the Kuril Islands and the Kamchatka Peninsula in the northwestern North Pacific Ocean during June 2014. The sampling area included three water current areas, the Oyashio Current, the current from the Okhotsk Sea, and the coastal current along the east Kamchatka Peninsula. 226Ra and 228Ra distributions differed along the three currents. Low levels of 134Cs were detected in the surface waters of the Oyashio Current (0.09–0.35 mBq/L), but it was <∼0.1 mBq/L at the surface along the other two currents. This indicates that the distribution of Fukushima Dai-ichi Nuclear Power Plant (FDNPP)-derived radiocesium in surface waters off the Kamchatka and along the Kuril Islands is predominantly governed by the Oyashio current system.



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The study of natural and artificial radionuclides incorporation in teeth and head bones of animals lived nearby Caetité uranium mine, Brazil

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): A. Walencik-Łata, B. Kozłowska, J.W. Mietelski, K. Szufa, F.D. Freire, S.O. Souza
This study aimed at assessing the incorporation of radionuclides in animals in the proximity of the uranium mine in Caetité, Brazil. In 2014, samples of bovine and equine teeth and skull bones were collected and their contents of natural and artificial isotopes were assessed using nuclear spectrometry techniques. Gamma ray emission from 226,228Ra and 40K isotopes was determined using high-purity germanium (HPGe) spectrometry, 90Sr radioactivity was measured with liquid scintillation, and 234,238U, 232,230,228Th, 210Po and 239+240Pu radioactivity was assessed with alpha-spectrometry. Prior to the measurements, sample dissolutions and isotope separations were performed. Our results indicate a high 228Th isotope content in the skull bones and the teeth of animals, up to 179 Bq per kg of ash. The 226Ra and 228Ra concentrations were slightly lower. Activity concentrations of other isotopes were significantly lower or below the detection limit. We could not identify sources of technologically enhanced levels of 228Ra in the area we investigated; therefore we suggest that their origin is natural.

Graphical abstract

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Modelling Deposition and Erosion rates with RadioNuclides (MODERN) – Part 1: A new conversion model to derive soil redistribution rates from inventories of fallout radionuclides

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): Laura Arata, Katrin Meusburger, Elena Frenkel, Annette A'Campo-Neuen, Andra-Rada Iurian, Michael E. Ketterer, Lionel Mabit, Christine Alewell
The measurement of fallout radionuclides (FRN) has become one of the most commonly used tools to quantify sediment erosion or depositional processes. The conversion of FRN inventories into soil erosion and deposition rates is done with a variety of models, which suitability is dependent on the selected FRN, soil cultivation (ploughed or unploughed) and movement (erosion or deposition). The authors propose a new conversion model, which can be easily and comprehensively used for different FRN, land uses and soil redistribution processes. The new model MODERN (Modelling Deposition and Erosion rates with RadioNuclides) considers the precise depth distribution of any FRN at the reference site, and allows adapting it for any specific site conditions. MODERN adaptability and performance in converting different FRN inventories is discussed for a theoretical case as well as for two already published case studies i.e. a 137Cs study in an alpine and unploughed area in the Aosta valley (Italy) and a 210Pbex study on a ploughed area located in the Transylvanian Plain (Romania). The tests highlight a highly significant correspondence (i.e. correlation factor of 0.91) between the results of MODERN and the published results of other models currently used by the FRN scientific community (i.e. the Profile Distribution Model and the Mass Balance Model). The development and the cost free accessibility of MODERN (see modern.umweltgeo.unibas.ch) will ensure the promotion of wider application of FRNs for tracing soil erosion and sedimentation.



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Measurement of tritium in the Sava and Danube Rivers

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Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): Željko Grahek, Borut Breznik, Ivana Stojković, Ivana Coha, Jovana Nikolov, Nataša Todorović
Two nuclear power plants (NPP), the KrškoNPP (Slovenia) on the Sava River and the Paks NPP (Hungary) on the Danube River, are located in the immediate vicinity of Croatia and Serbia. Some of the radioactivity monitoring around the NPPs involves measuring tritium activity in the waters of rivers and wells. The authors present the tritium measurement results taken over several years from the Sava and Danube Rivers, and groundwater. The measurements were carried out in two laboratories including an impact assessment of the tritium released into the rivers and groundwater. The routine methods for determining tritium (with/without electrolytic enrichment) were tested in two laboratories using two different instruments, a Tri-Carb 3180 and Quantulus 1220. Detection limits for routine measurements were calculated in compliance with ISO 11929 and Currie relations, and subsequently the results were compared with those determined experimentally. This has shown that tritium can be reliably determined within a reasonable period of time when its activity is close to the calculated detection limit. The Krško NPP discharged 62 TBq of tritium into the River Sava over a period of 6 years (23% of permitted activity, 45 TBq per year). The natural level of tritium in the Sava River and groundwater is 0.3–1 Bq/l and increases when discharges exceed 1 TBq per month. Usually, the average monthly activity in the Sava River and groundwater is maintained at a natural level. The maximum measured activity was 16 Bq/l in the Sava River and 9.5 Bq/l in groundwater directly linked to the river. In the majority of water samples from the Danube River, measured tritium activity ranged between 1 and 2 Bq/l. The increased tritium levels in the Danube River are more evident than in the Sava River because tritium activity above 1.5 Bq/l appears more frequently on the Danube River. All measured values were far below the allowed tritium limit in drinking water. Dose assessment has shown that tritium released from NPPs contributes negligibly to annual doses in comparison to natural sources.



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City, county officials: Emergency response time to improve

By Chase Cook
The Capital

ANNAPOLIS, Md. — Residents near the Annapolis Neck fire station will notice ambulances saying "City of Annapolis" instead of "Anne Arundel County" thanks to a new civic partnership.

Annapolis and county first responders will be sharing space at the fire station on Bay Ridge Road, a move fire officials say makes both departments more efficient.

The deal will send eight Annapolis Fire Department personnel to the county fire station, where they will operate an ambulance. Those city employees will handle medical calls from that station, freeing up eight Anne Arundel County Fire Department employees to bolster other stations around the county.

Annapolis Fire Chief David Stokes said his fire department will benefit as it collects fees from the calls, and he anticipated city response times would be faster.

"There are many buzzwords to describe this: It's innovative, it's out-of-the-box, it's a game changer, it's a visionary move and my all-time favorite — it's a major paradigm shift," Stokes said at the press conference. "But the reality is it is nothing more than a good old-fashioned common-sense approach to improve our emergency response capabilities."

The Annapolis Neck Station takes about 1,700 medical calls a year, with about 1,000 of those in the city, officials said.

The county first responders will likely be moved and split between the Woodland Beach and the Riviera Beach stations, although Anne Arundel County Fire Chief Allan Graves said those decisions were tentative.

Officials said they were hoping to see reduced response times because more staff at county stations means those areas can handle increased calls. The city benefits because its stations sometimes help the county when its first responders are on a call.

The deal is set for one year and can be extended.

"By all accounts, this is a win-win," Graves said.

Thursday's announcement continues the partnership between the city and county, spearheaded by Mayor Mike Pantelides and County Executive Steve Schuh. Both the mayor and the county executive have said the partnership is a new way of the two governments working together and improving relations between the two bodies.

Previous announcements included the hiring of an economic development officer, who has shared office space between the city and county. Officials touted her role as bridging the gap between the two governments and bringing more business to both.

In other news, the county put $250,000 more into the city's bus programs — now $385,000 a year. An estimated 28 percent of the riders are county residents, and 40 percent of the system is in the county, according to county data.

Copyright 2016 The Capital



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Ultrasound pattern sum score, homogeneity score and regional nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies

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Publication date: July 2016
Source:Clinical Neurophysiology, Volume 127, Issue 7
Author(s): Alexander Grimm, Debora Vittore, Victoria Schubert, Christina Lipski, Bianka Heiling, Bernhard F. Décard, Hubertus Axer
ObjectiveTo investigate the use of nerve ultrasound in the differentiation between Charcot–Marie Tooth hereditary neuropathy (CMT1) and chronic inflammatory demyelinating polyradiculoneuropathies (CIDP), multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensory and motor neuropathies (MADSAM).MethodsUltrasound/electrophysiology of predefined nerves was performed in CMT1a/b, immunoneuropathies, and healthy controls. Ultrasound pattern sum score (UPSS, sum of the amount of 12 predefined measurement points), homogeneity score (HS) and regional nerve enlargement index (RNEI) in ulnar, median, and tibial nerve were used for evaluation of morphology.Results13 CMT1, 27 CIDP, 10 MADSAM, 12 MMN, and 23 controls were included. Significant enlargement was shown in all neuropathies compared to the controls, (p<0.001), however the amount of enlargement as evaluated by the UPSS was most prominent in CMT compared to the others (median UPSS 18 vs. 11/8.5/5 in CIDP/MADSAM/MMN, p<0.001). Homogeneous enlargement was significantly more often seen in CMT (67%, HS 6 vs. 2–3 in immune-mediated PNP, p<0.001), while in CIDP the enlargement was regional, homogeneous or inhomogeneous with equal contribution. In MMN and MADSAM regional enlargement (48%/40%) next to normal segments (∼20%) predominated (RNEI in MMN=2, in MADSAM=1 vs. 0 in the others). CSAs were inversely correlated with motor conduction velocity.ConclusionUltrasound, quantified by UPSS, HS, and RNEI facilitates a reliable and reproducible differentiation of immunoneuropathies and hereditary neuropathies by the use of boundary values.SignificanceBy the use of quantitative scores, ultrasound differentiation of demyelinating neuropathies is operationalized and ameliorated compared to CSA measurements only.



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Effect of fampridine on axonal excitability in multiple sclerosis

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Publication date: July 2016
Source:Clinical Neurophysiology, Volume 127, Issue 7
Author(s): William Huynh, Hannah Pickering, James Howells, Jenna Murray, Christine Cormack, Cindy S.-Y. Lin, Steve Vucic, Matthew C. Kiernan, Arun V. Krishnan
ObjectiveTo investigate the effects of fampridine on nerve excitability, the present study utilized peripheral axonal excitability techniques in 18 MS patients receiving treatment with fampridine.MethodsStudies were performed at baseline and repeated 3months after institution of fampridine at standard dosing.ResultsFollowing treatment with fampridine there were significant changes in axonal excitability for those parameters associated with fast K+ channels that shifted towards normal control values. Specifically, increases were noted in the peak superexcitability of recovery cycle (fampridine, −25.6±1.6%; baseline −22.8±1.7%; p<0.004), peak depolarizing threshold electrotonus (fampridine, 69.1±1.0%; baseline 67.0±1.4%; p<0.004), and depolarizing threshold electrotonus between 40 and 60ms after onset of depolarization (fampridine, 52.8±1.3%; baseline 49.9±1.4%; p=0.02).ConclusionThe present study has established that fampridine at standard doses exerts effects on peripheral nerve function that may be mediated by reduction of fast K+ conductances.SignificanceModulation of fast K+ conductances by fampridine may contribute to the improvement observed in MS symptoms including motor fatigue.



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Abnormal corticospinal tract function and motor cortex excitability in non-ataxic SCA2 mutation carriers: a TMS study

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Publication date: Available online 20 May 2016
Source:Clinical Neurophysiology
Author(s): Luis Velázquez-Pérez, Roberto Rodríguez-Labrada, Reidenis Torres-Vega, Jacqueline Medrano Montero, Yaimeé Vázquez-Mojena, Georg Auburger, Ulf Ziemann
ObjectiveTo evaluate if the corticospinal tract is affected in the prodromal stage of spinocerebellar ataxia type 2 (SCA2), prior to development of the cerebellar syndrome.MethodsA cross-sectional study was conducted in 37 non-ataxic SCA2 mutation carriers and in age- and sex-matched healthy controls. All subjects underwent clinical assessment and transcranial magnetic stimulation to determine corticospinal tract integrity to the right abductor pollicis brevis and tibialis anterior muscles.ResultsNon-ataxic SCA2 mutation carriers showed significantly higher resting and active motor thresholds for both muscles, and prolonged cortical silent periods and central motor conduction times (CMCT), compared to controls. CMCT to the tibialis anterior correlated directly with CAG repeat size, and inversely with predicted time to ataxia onset.ConclusionFindings provide novel electrophysiological evidence for affection of the corticospinal tract and motor cortex in prodromal SCA2. Slowed conduction in the corticospinal tract to the lower limbs reflects polyglutamine neurotoxicity, and predicts time to ataxia onset.SignificanceIdentification of corticospinal tract damage and decreases motor cortical excitability in the prodromal stage of SCA2 allows early disease monitoring. This will become important as soon as effective neuroprotective treatment will be available.



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Editorial Board

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Publication date: June 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1859, Issue 6





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What is the American Physiological Society's ITL and who are the members of PECOP?

The American Physiological Society Teaching Section has developed a biennial Institute on Teaching and Learning (ITL) through the APS Conference Program. The first ITL was held in June 2014, and the second ITL will be in June 2016. A Physiology Education Community of Practice was created to help connect the institute participants and other physiology educators to share evidence-based teaching in physiology at all education levels and ideas for the Scholarship of Teaching and Learning and Discipline-Based Education Research in physiology. This editorial describes the origins and outcomes of the ITL and the advantages of joining the Physiology Education Community of Practice.



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Ultrasound-based lectures on cardiovascular physiology and reflexes for medical students

Ultrasound has become a widely used diagnostic technique. While its role in patient evaluation is well known, its utility during preclinical courses such as anatomy and physiology is becoming increasingly recognized. The aim of the present study was to assess the feasibility/utility of integrating ultrasound-based sessions into conventional undergraduate medical school programs of physiology of the cardiovascular system and cardiovascular reflexes and to evaluate student perceptions of an ultrasound-based didactic session. Second-year medical students enrolled in the University of Padova attended a didactic session during which basic concepts regarding ultrasound instrumentation, image production, and spatial orientation were presented. Five anatomic sectors (the heart, aorta, neck vessels, inferior vena cava, and femoral veins) were then examined on a volunteer. Student perceptions of the images that were projected, the usefulness of the presentation, and the reproducibility of the experience were assessed at the end of the lecture with an anonymous questionnaire consisting of positive and negative items that were rated using a 5-point Likert scale and with two questions. One hundred eleven students attended the lecture; 99% of them found it very interesting, and none considered it boring or a waste of time. More than 96% thought it helped them to gain a better comprehension of the subject and would recommend it to a colleague. In conclusion, as ultrasound has been found to be a valuable resource for the teaching of physiology of the cardiovascular system and cardiovascular reflexes, efforts should be made to integrate ultrasound sessions into the traditional human physiology curriculum.



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House's physiology



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Writing on the board as students' preferred teaching modality in a physiology course

The introduction of PowerPoint presentation software has generated a paradigm shift in the delivery of lectures. PowerPoint has now almost entirely replaced chalkboard or whiteboard teaching at the undergraduate and graduate levels. This study investigated whether undergraduate biology students preferred to have lectures delivered by PowerPoint or written on the board as well as the reasons behind their preference. Two upper-division physiology courses were surveyed over a period of 7 yr. A total of 1,905 students (86.7%) indicated they preferred lectures delivered by "writing on the board" compared to 291 students (13.3%) who preferred PowerPoint. Common themes drawn from explanations reported by students in favor of writing on the board included: 1) more appropriate pace, 2) facilitation of note taking, and 3) greater alertness and attention. Common themes in favor of PowerPoint included 1) increased convenience, 2) focus on listening, and 3) more accurate and readable notes. Based on the students' very strong preference for writing on the board and the themes supporting that preference, we recommend that instructors incorporate elements of the writing on the board delivery style into whatever teaching modality is used. If instructors plan to use PowerPoint, the presentation should be paced, constructed, and delivered to provide the benefits of lectures written on the board. The advantages of writing on the board can be also incorporated into instruction intended to occur outside the classroom, such as animated narrated videos as part of the flipped classroom approach.



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ClueConnect: a word array game to promote student comprehension of key terminology in an introductory anatomy and physiology course

The sheer amount of terminology and conceptual knowledge required for anatomy and physiology can be overwhelming for students. Educational games are one approach to reinforce such knowledge. In this activity, students worked collaboratively to review anatomy and physiology concepts by creating arrays of descriptive tiles to define a term. Once guessed, students located the structure or process within diagrams of the body. The game challenged students to think about course vocabulary in novel ways and to use their collective knowledge to get their classmates to guess the terms. Comparison of pretest/posttest/delayed posttest data revealed that students achieved statistically significant learning gains for each unit after playing the game, and a survey of student perceptions demonstrated that the game was helpful for learning vocabulary as well as fun to play. The game is easily adaptable for a variety of lower- and upper-division courses.



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The hardships of being a Sith Lord: implications of the biopsychosocial model in a space opera



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An active, collaborative approach to learning skills in flow cytometry

Advances in science education research have the potential to improve the way students learn to perform scientific interpretations and understand science concepts. We developed active, collaborative activities to teach skills in manipulating flow cytometry data using FlowJo software. Undergraduate students were given compensated clinical flow cytometry listmode output (FCS) files and asked to design a gating strategy to diagnose patients with different hematological malignancies on the basis of their immunophenotype. A separate cohort of research trainees was given uncompensated data files on which they performed their own compensation, calculated the antibody staining index, designed a sequential gating strategy, and quantified rare immune cell subsets. Student engagement, confidence, and perceptions of flow cytometry were assessed using a survey. Competency against the learning outcomes was assessed by asking students to undertake tasks that required understanding of flow cytometry dot plot data and gating sequences. The active, collaborative approach allowed students to achieve learning outcomes not previously possible with traditional teaching formats, for example, having students design their own gating strategy, without forgoing essential outcomes such as the interpretation of dot plots. In undergraduate students, favorable perceptions of flow cytometry as a field and as a potential career choice were correlated with student confidence but not the ability to perform flow cytometry data analysis. We demonstrate that this new pedagogical approach to teaching flow cytometry is beneficial for student understanding and interpretation of complex concepts. It should be considered as a useful new method for incorporating complex data analysis tasks such as flow cytometry into curricula.



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Visual event-related potential studies supporting the validity of VARK learning styles' visual and read/write learners

The validity of learning styles needs supports of additional objective evidence. The identification of learning styles using subjective evidence from VARK questionnaires (where V is visual, A is auditory, R is read/write, and K is kinesthetic) combined with objective evidence from visual event-related potential (vERP) studies has never been investigated. It is questionable whether picture superiority effects exist in V learners and R learners. Thus, the present study aimed to investigate whether vERP could show the relationship between vERP components and VARK learning styles and to identify the existence of picture superiority effects in V learners and R learners. Thirty medical students (15 V learners and 15 R learners) performed recognition tasks with vERP and an intermediate-term memory (ITM) test. The results of within-group comparisons showed that pictures elicited larger P200 amplitudes than words at the occipital 2 site (P < 0.05) in V learners and at the occipital 1 and 2 sites (P < 0.05) in R learners. The between-groups comparison showed that P200 amplitudes elicited by pictures in V learners were larger than those of R learners at the parietal 4 site (P < 0.05). The ITM test result showed that a picture set showed distinctively more correct responses than that of a word set for both V learners (P < 0.001) and R learners (P < 0.01). In conclusion, the result indicated that the P200 amplitude at the parietal 4 site could be used to objectively distinguish V learners from R learners. A lateralization existed to the right brain (occipital 2 site) in V learners. The ITM test demonstrated the existence of picture superiority effects in both learners. The results revealed the first objective electrophysiological evidence partially supporting the validity of the subjective psychological VARK questionnaire study.



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A comparison of animated versus static images in an instructional multimedia presentation

Sophisticated three-dimensional animation and video compositing software enables the creation of complex multimedia instructional movies. However, if the design of such presentations does not take account of cognitive load and multimedia theories, then their effectiveness as learning aids will be compromised. We investigated the use of animated images versus still images by creating two versions of a 4-min multimedia presentation on vascular neuroeffector transmission. One version comprised narration and animations, whereas the other animation comprised narration and still images. Fifty-four undergraduate students from level 3 pharmacology and physiology undergraduate degrees participated. Half of the students watched the full animation, and the other half watched the stills only. Students watched the presentation once and then answered a short essay question. Answers were coded and marked blind. The "animation" group scored 3.7 (SE: 0.4; out of 11), whereas the "stills" group scored 3.2 (SE: 0.5). The difference was not statistically significant. Further analysis of bonus marks, awarded for appropriate terminology use, detected a significant difference in one class (pharmacology) who scored 0.6 (SE: 0.2) versus 0.1 (SE: 0.1) for the animation versus stills group, respectively (P = 0.04). However, when combined with the physiology group, the significance disappeared. Feedback from students was extremely positive and identified four main themes of interest. In conclusion, while increasing student satisfaction, we do not find strong evidence in favor of animated images over still images in this particular format. We also discuss the study design and offer suggestions for further investigations of this type.



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A conceptual framework for homeostasis: development and validation

We have developed and validated a conceptual framework for understanding and teaching organismal homeostasis at the undergraduate level. The resulting homeostasis conceptual framework details critical components and constituent ideas underlying the concept of homeostasis. It has been validated by a broad range of physiology faculty members from community colleges, primarily undergraduate institutions, research universities, and medical schools. In online surveys, faculty members confirmed the relevance of each item in the framework for undergraduate physiology and rated the importance and difficulty of each. The homeostasis conceptual framework was constructed as a guide for teaching and learning of this critical core concept in physiology, and it also paves the way for the development of a concept inventory for homeostasis.



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A model to demonstrate the place theory of hearing



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Is the heart a pressure or flow generator? Possible implications and suggestions for cardiovascular pedagogy



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Blood: tests used to assess the physiological and immunological properties of blood

The properties of blood and the relative ease of access to which it can be retrieved make it an ideal source to gauge different aspects of homeostasis within an individual, form an accurate diagnosis, and formulate an appropriate treatment regime. Tests used to determine blood parameters such as the erythrocyte sedimentation rate, hemoglobin concentration, hematocrit, bleeding and clotting times, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean cell volume, and determination of blood groups are routinely used clinically, and deviations outside the normal range can indicate a range of conditions such as anemia, pregnancy, dehydration, overhydration, infectious disease, cancer, thyroid disease, and autoimmune conditions, to mention a few. As these tests can be performed relatively inexpensively and do not require high levels of technical expertise, they are ideally suited for use in the teaching laboratory, enabling undergraduate students to link theory to practice. The practicals described here permit students to examine their own blood and that of their peers and compare these with clinically accepted normal ranges. At the end of the practicals, students are required to answer a number of questions about their findings and to link abnormal values to possible pathological conditions by answering a series of questions based on their findings.



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Effectiveness and student perceptions of an active learning activity using a headline news story to enhance in-class learning of cell cycle regulation

An active learning activity was used to engage students and enhance in-class learning of cell cycle regulation in a PharmD level integrated biological sciences course. The aim of the present study was to determine the effectiveness and perception of the in-class activity. After completion of a lecture on the topic of cell cycle regulation, students completed a 10-question multiple-choice quiz before and after engaging in the activity. The activity involved reading of a headline news article published by ScienceDaily.com entitled "One Gene Lost Equals One limb Regained." The name of the gene was deleted from the article and, thus, the end goal of the activity was to determine the gene of interest by the description in the story. The activity included compiling a list of all potential gene candidates before sufficient information was given to identify the gene of interest (p21). A survey was completed to determine student perceptions of the activity. Quiz scores improved by an average of 20% after the activity (40.1 ± 1.95 vs. 59.9 ± 2.14, P < 0.0001, n = 96). Students enjoyed the activity, found the news article interesting, and believed that the activity improved their understanding of cell cycle regulation. The majority of students agreed that the in-class activity piqued their interest for learning the subject matter and also agreed that if they understand a concept during class, they are more likely to want to study that concept outside of class. In conclusion, the activity improved in-class understanding and enhanced interest in cell cycle regulation.



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Research investigates the female EMS leaders' career path

RICHMOND, Ky. — A recently launched research study, "Female Leaders in EMS," is collecting responses to a qualitative survey to gain perspective on the work environment, educational status, career path, work/life balance for women in and to understand how to succeed in a male-dominated field. 

"EMS professionals provide lifesaving care in some of the harshest and most difficult of environments," Dariusz Wolman, PhD, NRP said. "In addition, women in EMS may face harassment, discrimination and ridicule."

An additional purpose of the study is to begin to formulate a plan to assist current female EMT and paramedic students as they embark on their careers. It is important for current female EMS leaders to assist with the next generation of female providers.

"This study hopes to gain understanding of some of the issues facing women in EMS," Wolman said.

Wolman is an Assistant Professor at Eastern Kentucky University in the Emergency Medical Care Program. He has been a paramedic since 1991 and an EMS Instructor since 1997. Wolman is also American Heart Association national faculty in BLS.

Visit the Eastern Kentucky University Emergency Medical Care website to learn more and to complete the survey.

Participation in this study is not required, but greatly appreciated. Researchers will not retain any personally identifying information and the collected data will be compiled in such a manner that it cannot be associated with any individual participant.

Wolman intends to publish the results of the survey in the Fall, 2016.

For questions or concerns about the study, contact Dr. Dariusz Wolman.



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National EMS memorial service closes out the 2016 weekend of honor

ARLINGTON, Va. — National EMS Week will wrap up Saturday evening as families, friends and colleagues honor 32 EMS and air medical professionals who lost their lives in the line of duty in service to others will be in attendance.

Honor guards along with bagpipe and drum corps travel from around the United States to volunteer their time and services in honor of the fallen. This year's keynote speaker will be James P. Booth, FDNY EMS Chief. There will also be a team from HOPE Animal-assisted Crisis Response at the service to provide comfort and support to the families, colleagues and volunteers.

According to Jana Williams, president of the National EMS Memorial Service, "The purpose of the service is twofold – to honor the lives of our fallen colleagues and to provide hope, along with our unwavering support, to their families. We feel it is the responsibility of the EMS community to stand by the families during this time of tremendous loss and sometimes overwhelming grief. The annual memorial service offers an opportunity for the family, friends and associates of fallen EMS providers to meet and connect with others who understand what they're going through."

During the service each honoree's family is presented with the following a U.S. flag that has flown over the capital, a white rose and a medallion. Each represent the honoree's service to the country and their eternal memory.

A national moment of silence will be called during the service at 6:00 p.m. EDT. EMS agencies across the U.S. will participate in 30 seconds of radio silence in remembrance of the fallen.

Additionally, a tribute video, prepared specifically in honor and remembrance of the year's honorees, will be shown.

Every year of the National EMS Memorial, the "Tree of Life" will be on display. A large panel for each year features an image of an oak tree with bronze leaves that are engraved with the names of fallen honorees.

For those who cannot attend but would like to see the service, a live stream video will be available.  It will begin at approximately 5:00 p.m. EDT.

A candlelight ceremony will close out the evening.

The Weekend of Honor is organized and hosted by the following volunteer-staffed organizations: National EMS Memorial Bike Ride, National EMS Memorial Service, and the National EMS Memorial Foundation. Visit the website for more information on the specific event times and locations.



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"I was told that my first duty was to forget physiology, which had no relation to medicine"



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Antiretroviral therapy outcome in human immuno-deficiency virus infected patients in a tertiary care hospital

2016-05-21T06-02-48Z
Source: International Journal of Basic & Clinical Pharmacology
Hasitha Diana Manohar, Smita Shenoy, Muralidhar Varma, Asha Kamath, Chaithanya Malalur, Kurady Laxminarayana Bairy, Amod Tilak, Kavitha Saravu.
Background: Human immunodeficiency virus (HIV) presently accounts for the highest number of deaths due to any infective agent in the world. The present study assessed the one year treatment outcome following antiretroviral therapy in HIV positive, treatment naïve patients in a tertiary care hospital. Methods: Adult HIV positive, antiretroviral treatment naive patients who were started on antiretroviral therapy (ART) between 1st January 2011 and 31st May 2013 were included in the study. Data was collected from their case records. CD4+cell count, haemoglobin level, weight, occurrence of opportunistic infections (OIs) and adverse drug reactions (ADRs) were analysed at baseline, 6 and 12 months following start of antiretroviral therapy. Data was analysed using parametric and nonparametric tests. Results: Data of 325 patients was analysed. Overall, the median increase in CD4+ count at 1 year after initiation of treatment was observed to be clinically significant. Patients on tenofovir based regimen showed a significantly greater increase in the median CD4+ count (P = 1.12×10-05) and haemoglobin (P = 0.002) as compared to those on non-tenofovir based regimen. A total of 151 ADRs were recorded in the study, of which the most common were skin rash 24%, anaemia and gastrointestinal side effects 17% each. Frequency of opportunistic infections gradually declined after ART. At the end of 1 year of treatment, the cumulative loss to follow up was 7.4%. Conclusions: By following the current national guidelines, the desired immunological and clinical response following initiation of ART can be achieved while minimizing drug toxicity.


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Autoantibody presentation in drug-induced liver injury and idiopathic autoimmune hepatitis: the influence of human leucocyte antigen alleles.

Objectives: Positive autoantibody (AAB) titres are commonly encountered in autoimmune hepatitis (AIH) and in a proportion of drug-induced liver injury (DILI) patients. The underlying mechanism for selective AAB occurrence in DILI is unknown, but could be associated with variations in immune-associated genes. Hence, we aimed to analyse human leucocyte antigen (HLA) allele compositions in DILI with positive (+) and negative (-) AAB titres and in AIH patients. Methods: High-resolution genotyping of HLA class I (A, B, C) and II (DRB1, DQB1) loci was performed on 207 DILI and 50 idiopathic AIH patients and compared with 885 healthy Spanish controls. Results: Compared with controls, HLA-B*08:01 [44 vs. 9.7%, P=3.7E-13/corrected P-value (Pc)=1.0E-11], C*07:01 (46 vs. 24%, P=6.4E-04/Pc=0.012), DRB1*03:01 (58 vs. 21.5%, P=5.0E-09/Pc=1.0E-07) and DQB1*02:01 (56 vs. 22%, P=6.8E-08/Pc=9.0E-07) were significantly more frequent in AIH patients. The HLA-A*01:01 frequency was increased in the same population, but did not reach significance after Bonferroni's correction (34 vs. 19%, P=0.02/Pc=0.37). Fifty-eight of 207 DILI patients presented positive titres for at least one AAB (predominantly antinuclear antibody 76% and antismooth muscle antibody 28%). There was a tendency towards higher representation of DRB1*14:01 and DQB1*05:03 in DILI AAB+ compared with DILI AAB- (13.8 vs. 4.0%, P=0.02/Pc=0.5; 13.8 vs. 4.7%, P=0.04/Pc=0.5). Conclusion: The presence of HLA alleles B*08:01, C*07:01, DRB1*03:01, DQB1*02:01 and possibly A*01:01 enhances the risk of AIH (type 1) in Spanish patients. These alleles form part of the ancestral haplotype 8.1. HLA-DRB1*14:01 and DQB1*05:03 could potentially increase the risk of positive AAB (particularly antinuclear antibody) in Spanish DILI patients. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Gastrointestinal Bleeding Following LVAD Placement from Top to Bottom

Abstract

Background

Left ventricular assist devices (LVADs) are an increasingly prevalent form of mechanical support for patients with end-stage heart failure. These devices can be implanted both as a bridge to transplant and as definitive/destination therapy. Gastrointestinal (GI) bleeding is one of the most common and recalcitrant long-term complications following LVAD implantation, with an incidence approaching 30 %.

Aims

This review will discuss what is known about the pathophysiology of GI bleeding in LVADs and the currently available options for medical and/or endoscopic management.

Results

The pathophysiology of bleeding is multifactorial, with hemodynamic alterations, acquired von Willebrand factor deficiency, and coagulopathy being most often implicated. The majority of bleeding events in this population result from angioectasias and gastroduodenal erosive disease. While these bleeding events are significant and often require transfusion therapy, they are rarely life threatening. Endoscopy remains the standard of care with upper endoscopy offering the highest diagnostic yield in these patients. However, the effectiveness of endoscopic hemostasis in this population is not well established. A small number of studies have evaluated medical therapy and alterations in LVAD settings as a means of preventing or treating bleeding with variable results.

Conclusions

In summary, GI bleeding with LVADs is a common occurrence and will continue to be as more LVADs are being performed for destination therapy.



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Double-Edged Sword: Esophageal and Colonic Crohn’s Disease



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A Randomized Controlled Comparison of Esophageal Clearance Times of Oral Budesonide Preparations

Abstract

Background

Topical steroids prepared as oral viscous slurries have become common in the treatment of eosinophilic esophagitis. Esophageal mucosal contact time correlates with clinical and histologic improvement.

Aim

To compare the mucosal contact time of alternative oral viscous budesonide (OVB) slurries with the conventional sucralose OVB.

Methods

A blinded randomized crossover trial investigating esophageal clearance of three OVB slurry preparations was done on healthy adults. Honey and xanthan gum OVB slurries were compared with standard sucralose OVB in 24 randomly assigned subjects. Each subject ingested the sucralose OVB and either the honey or xanthan gum OVB slurries. The esophageal clearance of each slurry was evaluated as an area under the curve (AUC) using 1 millicurie of technetium-99m-sulfur colloid (Tc99) co-administered in each OVB preparation using nuclear scintigraphy. A standardized taste survey was also administered.

Results

Xanthan gum had greater mucosal contact time compared to sucralose as measured by a higher AUC at 3 min (P = 0.002), while honey showed no significant difference in esophageal clearance relative to sucralose. Taste scores were significantly higher in the honey group, while scores for xanthan gum were no different from standard sucralose.

Conclusion

OVB slurries utilizing xanthan gum may be a superior alternative to a sucralose-based slurry due to its increased mucosal contact time and similar taste tolerance. Honey may be a suitable alternative as well, due to its similar contact time and favorable taste.



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Efficacy and Safety of Propofol-Mediated Sedation for Outpatient Endoscopic Retrograde Cholangiopancreatography (ERCP)

Abstract

Background and Aims

Propofol sedation for endoscopy may result in a rapid and unpredictable progression from deep sedation to general anesthesia, leading to potential complications. We investigated the incidence and predictors of sedation-related adverse events (SAEs) in nonintubated patients who underwent outpatient ERCP procedures with propofol sedation.

Methods

We conducted a retrospective study of patients who underwent propofol sedation for ERCP procedures. Patients were sedated using propofol in combination with low-dose opiates. Data collected included patient demographics, American Society of Anesthesiologists (ASAs) physical status, and procedure times. SAE includes hypoxia (pulse oximetry <90 %), hypotension (systolic blood pressure <90 mmHg), and conversation to endotracheal intubation. Factors associated with SAEs were examined by univariate analysis and multivariate regression analysis (MVA).

Results

A total of 3041 patients were evaluated. The median BMI was 25.2 kg/m2, and the median ASA score was 3. The mean (±SD) duration of the procedures was 59 ± 23 min. Hypoxia requiring airway manipulation occurred in 28 % (n = 843) patients and hypotension requiring vasopressors in 0.4 % (n = 12). Forty-nine (1.6 %) patients required endotracheal intubation as a result of food in the stomach. Procedures underwent early termination in 8 (0.3 %) cases due to sedation-related hypotension (n = 5) and refractory laryngospasm (n = 3). Six patients were admitted after the ERCP for aspiration pneumonia as a result of sedation. Patients who developed SAE were older, had a higher mean BMI, and had longer mean procedure durations. On MVA, older age (p = 0.003), female sex (p = 0.001), BMI (p = 0.02), and ASA class ≥3 (p = 0.01) independently predicted SAEs.

Conclusions

Propofol can be used safely and effectively as a sedative agent for patients undergoing ERCPs when administered by trained professionals. Age, female sex, BMI, and ASA class ≥3 are independent predictors of SAEs.



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Correlation of Anti-mitochondrial Antibodies with Liver Histology and Outcomes



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