Δευτέρα 27 Ιουνίου 2016

miRNA involvement in angiogenesis in age-related macular degeneration

Abstract

Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly. Late-stage AMD is characterized by choroidal neovascularization (CNV). miR-93 appears to play a role in regulating vascular endothelial growth factor-A (VEGF-A), a known factor involved in neovascularization. Understanding its biological significance might enable development of therapeutic interventions for diseases like AMD. We aimed to determine the role of miR-93 in AMD using a laser-induced CNV mouse model. CNV was induced by laser photocoagulation in C57BL/6 mice. The CNV mice were transfected with scrambled miR or miR-93 mimic. The treatment effect was assessed by fundus photography and fluorescein angiography and confirmed by choroidal flatmount. The expression of miR-93 and VEGF-A in ocular tissues was analysed by quantitative polymerase chain reaction (qPCR) and Western blot. The overexpression effects of miR-93 were also proved on human microvascular endothelial cells (HMECs). Significantly decreased expression of miR-93 was observed by qPCR analysis in CNV mice compared to untreated mice (p < 0.05). VEGF-A messenger RNA (mRNA) and protein expression were upregulated with CNV; these changes were ameliorated by restoration of miR-93 (p < 0.05). CNV was reduced after miR-93 transfection. Transfection of miR-93 reduced the proliferation of HMECs (p < 0.01), but no significant changes were observed in 2D capillary-like tube formation (p > 0.05) and migration (p > 0.05) compared with that in the untreated cells. miR-93 has been shown to be a negative modulator of angiogenesis in the eye. All together, these results highlight the therapeutic potential of miR-93 and suggest that it may contribute as a putative therapeutic target for AMD in humans.



from Physiology via xlomafota13 on Inoreader http://ift.tt/29iSMBr
via IFTTT

Genetic Resistance Determinants for Cefixime and Molecular Analysis of Gonococci Isolated in Italy

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


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/28ZgMwo
via IFTTT

Nasotracheal intubation of a patient with restricted mouth opening using a McGrath MAC X-Blade and Magill forceps

Abstract

We experienced a case of successful nasotracheal intubation using the X-Blade of the McGrath MAC in a 28-year-old woman with a 2.5-cm mouth opening. She had no teeth on the right side, her neck movement was limited, her mandibular protrusion was grade C, and her Mallampati could not be evaluated. Her tongue was fixed to the left wall during a previous surgery. We evaluated the awake glottic view using the McGrath MAC X-Blade and topical oral anesthesia. We obtained a Cormack-Lehane grade II view and then decided to administer general anesthesia. Intubation was attempted with a Macintosh laryngoscope, but we could not insert the scope deeply enough and there was no area in which to insert the Magill forceps or endotracheal tube. We then used the X-Blade 3 of the McGrath MAC and obtained a sufficient area in which to insert the tube and manipulate the Magill forceps. A laryngoscopic view was achieved in 7 s and nasotracheal intubation was performed in 16 s with a 7.0-mm spiral tube using the Magill forceps. McGrath MAC X-Blade can be used with the Magill forceps in patients with restricted mouth opening with careful patient selection, in experienced hands.



from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/28ZVThc
via IFTTT

Satellite cell activation and apoptosis in skeletal muscle from severely burned children

Abstract

Severe burns result in profound skeletal muscle atrophy; persistent muscle loss and weakness are major complications that hamper recovery from burn injury. Many factors contribute to the erosion of muscle mass following burn trauma, and we propose that an impaired muscle satellite cell response is key in the etiology of burn-induced cachexia. Muscle biopsies from the m. vastus lateralis were obtained from 12 male pediatric burn patients (>30% total body surface area burn) and 12 young, healthy male subjects. Satellite cell content, activation and apoptosis were determined via immunohistochemistry, as were muscle fibre regeneration and myonuclear apoptosis. Embryonic myosin heavy chain expression and central nucleation, indices of skeletal muscle regeneration, were elevated in burn patients (P<0.05). Myonuclear apoptosis, quantified by TUNEL positive myonuclei and cleaved caspase 3 positive myonuclei, was also elevated in burn patients (P<0.05). Satellite cell content was reduced in burn patients, with approximately 20% of satellite cells positive for TUNEL staining, indicating DNA damage associated with apoptosis (P<0.05). Additionally, a significant percentage of satellite cells in burn patients expressed Ki67, a marker for cellular proliferation (P<0.05). Satellite cell activation was also observed in burn patients with increased expression of MyoD compared to healthy controls (P<0.05). Robust skeletal muscle atrophy occurs after burn injury, even in muscles located distally to the site of injury. The activation and apoptosis of satellite cells likely impacts the recovery of lean tissue following a severe burn, contributing to prolonged frailty in burn survivors.

This article is protected by copyright. All rights reserved



from Physiology via xlomafota13 on Inoreader http://ift.tt/29a9EeR
via IFTTT

Comparison of Cervical Proprioception in Individuals with and without Latent Myofascial Trigger points

2016-06-27T18-25-37Z
Source: International Journal of Therapies and Rehabilitation Research
Deepa Abichandani, Meghna Mehta.
Background:Myofascial trigger points are an extremely common cause of pain. Purpose: Primarily to associate the presence of latent MTP in upper trapezius in individuals and their effect on cervical proprioception Methods: 60 women, 20-35 years of age were assessed via a pressure algometer and cervical range of motion of motion machine Results: It was found that the individuals with latent trigger points showed a higher deviation error than individuals without latent trigger points in Neutral Head Position test and Head Target Repositioning test which were found to be statistically significant. Conclusion: On comparison, individuals with latent myofascial trigger points had a statistically significant difference in neutral head positioning error and head target repositioning error at the cervical spine Keywords: cervical, proprioception, latent, trigger point, pain


from Scope via xlomafota13 on Inoreader http://ift.tt/28Z1Qyu
via IFTTT

Iodine-125 implantation plus transarterial chemoembolization for the treatment of hepatocellular carcinoma of 3–5cm: A propensity score matching study

Both iodine-125 implantation and transarterial chemoembolization (TACE) are feasible options for hepatocellular carcinoma (HCC). The aim of the research is to investigate whether iodine-125 implantation combined with TACE could improve the overall survival of patients with HCC of 3–5cm.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28YKlOM
via IFTTT

Iodine-125 implantation plus transarterial chemoembolization for the treatment of hepatocellular carcinoma of 3–5cm: A propensity score matching study

Both iodine-125 implantation and transarterial chemoembolization (TACE) are feasible options for hepatocellular carcinoma (HCC). The aim of the research is to investigate whether iodine-125 implantation combined with TACE could improve the overall survival of patients with HCC of 3–5cm.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28YKlOM
via IFTTT

Improved multi-stage neonatal seizure detection using a heuristic classifier and a data-driven post-processor

Seizures are a common and distinctive sign of serious brain dysfunction in neonates (Volpe 2008). The majority of neonatal seizures have an acute symptomatic basis and one of the most important causes is hypoxic ischemic encephalopathy (HIE) (Hahn and Olson 2004; Cherian et al. 2011). Clinical presentation can be highly variable and manifestations of neonatal seizures can be subtle, absent or resemble normal behavior. It is known that after treating with anticonvulsants,clinical seizures will change in subclinical seizures (Connell et al.

from Physiology via xlomafota13 on Inoreader http://ift.tt/28Zfr4i
via IFTTT

Altered recovery from inhibitory repetitive transcranial magnetic stimulation (rTMS) in subjects with photosensitive epilepsy

Photosensitive epilepsy (PSE) is the most common reflex epilepsy characterized by seizures induced by intermittent photic stimulation, with a high tendency towards generalization from occipital cortex (Harding et al., 2005). Only few studies have explored the pathophysiology of PSE; some Authors have suggested a defective visual inhibition as a contributing factor to photoparoxysmal response (Strigaro et al., 2012), pointing to an overactive visuomotor connectivity thus inducing abnormal motor responses (Strigaro et al., 2015).

from Physiology via xlomafota13 on Inoreader http://ift.tt/296fsaD
via IFTTT

Closed-loop adaptation of neurofeedback based on mental effort facilitates reinforcement learning of brain self-regulation

Brain-computer and brain-machine interfaces (BCI/BMI) are utilized in a variety of neurological and neuropsychiatric conditions (Daly and Wolpaw 2008). While assistive interfaces aim to replace lost functions by controlling external devices, the goal of restorative approaches is to reduce disease-specific symptoms. By providing contingent feedback of specific neuronal states, restorative BCI/BMI use operant conditioning to reinforce the targeted brain states or dynamic modulations for achieving behavioral gains (Sherlin et al.

from Physiology via xlomafota13 on Inoreader http://ift.tt/28ZfGfV
via IFTTT

EMS for Children Program Manager - Baylor College of Medicine; EMS for Children State Partnership Texas

Description: The Emergency Medical Services for Children (EMSC) State Partnership in Texas is seeking a new Program Manager. Purpose: EMSC is a federally-funded program, and it aims to ensure that state-of-the-art emergency medical care is available to children when needed, that pediatric services are well integrated into the existing state emergency medical services (EMS) system, and that the entire ...

from EMS via xlomafota13 on Inoreader http://ift.tt/28Zn23M
via IFTTT

Patient-reported outcome of surgical treatment for lumbar spinal epidural lipomatosis

spinee57069-fig-0001.sml

Spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of fat tissue in the spinal canal that can have a compressive effect, leading to clinical symptoms. SEL has a distinct pathology from spinal stenosis associated with degeneration of the intervertebral discs, ligaments and facet joints. Several different conservative and surgical treatment strategies have been proposed for SEL, but its treatment remains controversial. There is a lack of evidence documenting the success of surgical decompression in SEL and no previous studies have reported the postoperative outcome from the patient's perspective.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/28Z8oKv
via IFTTT

Firefighter Paramedic - Polk County Fire District #1

POLK COUNTY FIRE DISTRICT NO 1 1800 MONMOUTH STREET INDEPENDENCE, OREGON 97351 Updated: June 22, 2016 Job Classification: Firefighter/Paramedic Polk County Fire District No 1 is currently building an ongoing eligibility list for Firefighter/Paramedic. Testing is conducted through National Testing Network (NTN). Salary Information: Firefighter/Paramedic salary range is $4765.76 - $5575.27 effective 7/1/2016 ...

from EMS via xlomafota13 on Inoreader http://ift.tt/29hGPfp
via IFTTT

Russian kickboxers assault paramedics

Two Russian kickboxers attacked paramedics that were called to help them after losing a fight were arrested and charged with assault.

from EMS via xlomafota13 on Inoreader http://ift.tt/295QJDh
via IFTTT

Russian kickboxers assault paramedics

Two Russian kickboxers attacked paramedics that were called to help them after losing a fight were arrested and charged with assault.

from EMS via xlomafota13 on Inoreader http://ift.tt/295QJDh
via IFTTT

Russian kickboxers assault paramedics

Two Russian kickboxers attacked paramedics that were called to help them after losing a fight were arrested and charged with assault.

from EMS via xlomafota13 on Inoreader http://ift.tt/295QJDh
via IFTTT

Russian kickboxers assault paramedics

Two Russian kickboxers attacked paramedics that were called to help them after losing a fight were arrested and charged with assault.

from EMS via xlomafota13 on Inoreader http://ift.tt/295QJDh
via IFTTT

Physiological mechanisms of simulated purposeful activities of patients with epilepsy

Abstract

In order to look into the physiological mechanisms providing the efficiency of purposeful activity of patients with epilepsy, 102 patients with symptomatic, cryptogenic, and idiopathic forms of this disease were examined. Three clusters of patients were formed using the Gorbov–Shulte performance test. Patients from the low-efficiency cluster were characterized by the lack of the habituation mechanisms in the activity of afferent systems and the mechanisms of motor response; a high level of activity of stress adaptation systems; as well as a higher intrasystemic tension during preparation for purposeful activity compared to patients from the intermediate and high-performance clusters.



from Physiology via xlomafota13 on Inoreader http://ift.tt/292oy7U
via IFTTT

Visual–manual tracking after long spaceflights

Abstract

This study presents the results of the pre- and postflight clinical and physiological examination (CPE) and scientific experiment "Sensory Adaptation-2" at the Gagarin Research and Test Cosmonaut Training Center, which involved 14 Russian cosmonauts, crewmembers of long-term international spaceflights ISS-28/29 to ISS 36/37, who were in microgravity from 159 to 195 days. The cosmonauts were aged 35–50 years. The studies were conducted twice before the spaceflight (the background), as well as on days R+1(2), R+4(5), and R+8(9) after landing. In the study of visual–manual tracking (VMT), eye movements were recorded by the electrooculography method (EOG), and hand movements were recorded by a joystick (the screen represented the current tilt angle of a joystick handle). The examinations were conducted using stimulation computer programs, were presented to an examined subject on the screen of the Sensomotor hardware–software complex. The examinations took place in the dialog mode and included the EOG calibration; VMT within ±10° on the screen with blank background (the smooth linear and sinusoidal movement of a point target with a frequency of 0.16 Hz in the vertical and horizontal directions). The study estimated the time, amplitude, and velocity characteristics of visual and manual tracking (VT and MT), including the effectiveness (ec) and gain (gc) coefficients as the ratios of the amplitude and velocity of eye/hand movements to the amplitude and velocity of the visual stimulus. The study of the vestibular function (VF) was performed before and after the spaceflight using videooculography. The static torsion otolith–cervical–ocular reflex (OCOR), dynamic vestibular–cervical–ocular reactions (VCOR), vestibular reactivity, and spontaneous eye movements were assessed. The study of VF in the first postflight days has shown a sharp decrease (up to its complete absence) of static vestibular excitability accompanied by the increased dynamic reactivity of the vestibular system. The study of VTM in the first postflight days has shown a significant decrease in the ec and gc of VT as well as correlations between the parameters of VT and MT and between the parameters of VF and VT and has not found a correlation between the parameters of VF and MT. The conditions of the spaceflight have been revealed to affect the accuracy of VT more strongly than the accuracy of MT. A complete return of the characteristics of VMT and VF to the baseline was observed on R+8(9) days after the spaceflight.



from Physiology via xlomafota13 on Inoreader http://ift.tt/28W5Lr3
via IFTTT

Cortical functional connectivity during the retention of affective pictures in working memory: EEG-source theta coherence analysis

Abstract

The pattern of cortical functional connectivity in the source space was studied in a group of righthanded adult participants (N = 44:17 women, 27 men, aged M = 29.61 ± 6.45 years). Participants retained the traces of realistic pictures of positive, neutral, and negative emotional valences in their working memory (WM) while performing the same-different task. Within the framework of this task, participants had to compare the initial picture against a target picture that followed after a specified delay. The coherence (COH) between the pairs of cortical sources chosen in advance according to fMRI data was estimated in the theta frequency range for the period preceding the initial stimulus, during the retention of the initial stimulus in WM, and during the rest interval between successive trials. Two distinct sets of functional links were found. The links of the first type that presumably reflected the involvement of sustained attention were between the dorsal anterior cingulate cortex, the prefrontal areas, and temporal areas of the right hemispheres. When compared to the rest period, the links of this type showed strengthening not only during the retention period but also during the period preceding the initial picture. The links of the second type presumably reflected a progressive neocortex-to-hippocampus functional integration with increasing memory load and strengthened exclusively during the retention period. These links were between the parietal, temporal and prefrontal cortices in the lateral surface of both hemispheres with the additional inclusion of the posterior cingulate cortex and the medial parietal cortex in the left hemisphere. The impact of emotional valence on the strength and topography of the functional links of the second type was found. In the left hemisphere, the increase of strength of cortical interaction was more pronounced for the pictures of positive valence than for the pictures of either neutral or negative valences. When compared to the pictures of neutral valence, the retention of pictorial information of both positive and negative valence showed some extraneous integration of the cortical areas for the theta rhythm. This finding might be related to the additional load exerted by emotionally colored pictures onto the mechanisms of short-time retention of visual information.



from Physiology via xlomafota13 on Inoreader http://ift.tt/292oBjK
via IFTTT

Ground Paramedic - Regional West Medical Center

JOB SUMMARY The Ground Paramedic will work under the supervision of the Program Manager. The Ground Paramedic delivers care to critically ill or injured patients. Patients may be transported between medical facilities or directly from the scene of an accident or illness. The Ground Paramedic assists with marketing and public relations activities of the program. The Ground Paramedic also may be called ...

from EMS via xlomafota13 on Inoreader http://ift.tt/28YwCDY
via IFTTT

Changes in effective diffusivity for oxygen during neural activation and deactivation estimated from capillary diameter measured by two-photon laser microscope

Abstract

The relation between cerebral blood flow (CBF) and cerebral oxygen extraction fraction (OEF) can be expressed using the effective diffusivity for oxygen in the capillary bed (D) as OEF = 1 − exp(−D/CBF). The D value is proportional to the microvessel blood volume. In this study, changes in D during neural activation and deactivation were estimated from changes in capillary and arteriole diameter measured by two-photon microscopy in awake mice. Capillary and arteriole vessel diameter in the somatosensory cortex and cerebellum were measured under neural activation (sensory stimulation) and neural deactivation [crossed cerebellar diaschisis (CCD)], respectively. Percentage changes in D during sensory stimulation and CCD were 10.3 ± 7.3 and −17.5 ± 5.3 % for capillary diameter of <6 μm, respectively. These values were closest to the percentage changes in D calculated from previously reported human positron emission tomography data. This may indicate that thinner capillaries might play the greatest role in oxygen transport from blood to brain tissue.



from Physiology via xlomafota13 on Inoreader http://ift.tt/28ZoOXm
via IFTTT

Reality training: Administering pediatric medication

Use this hands-on training exercise to improve equipment familiarity, reinforce medication cross-check processes and increase provider confidence to treat sick kids

from EMS via xlomafota13 on Inoreader http://ift.tt/29gKzxJ
via IFTTT

Reality training: Administering pediatric medication

Administering pediatric medication can be one of the most dangerous and anxiety-provoking procedures paramedics perform. It is also a situation that is rarely encountered by most paramedics, which leaves few opportunities to practice and to build confidence.

Studies on medication administration, in real and simulated pediatric patients, show frequent and sometimes fatal medication errors even when reference tools are used. Paramedics and students need realistic training to help prepare for these high-risk, low-frequency situations.

One study found that over one-third of the 360 medications administered to children over two years were incorrect. Eighteen percent of those patients received a dose greater than 20 percent outside of the correct dose range. Paramedics also rarely performed pediatric medication administration in this study.

In another retrospective chart review study, children under 12 years old who received a medication made up less than 1 percent of EMS responses, and only one-third of paramedics administered any medications to children over the study period [1].

A study of a simulated pediatric anaphylaxis scenario found that over half of paramedics administered an incorrect dose of epinephrine, and 20 percent administered a higher epinephrine dose than an adult in cardiac arrest should receive. This was despite paramedics using a number of reference tools during the scenario [2].

Weight-based pediatric medication administration involves several steps, and there are opportunities for error at each one. Pediatric emergencies are also stressful situations, which further compromises cognitive skills. A study examining the root causes of errors in pediatric simulation identified these nine causes.

  • Incorrect use of the Broselow length-based resuscitation tape.
  • Impaired calculation ability under stress.
  • Inaccurate weight estimate.
  • Faulty recall of doses.
  • Unaided calculations.
  • Wrong milligram/kilogram dose for route of administration.
  • Errors converting the dose in milligrams to volume administered in milliliters.
  • Volume measured from wrong end of prefilled syringe.
  • Failure to cross-check calculations.

Two of the author's recommendations are to provide "hands on continuing education of pediatric medications and drug dilutions, using syringes to draw calculated volumes of medications in the context of a simulated case," and "periodic competency testing on the use of medication dosing reference cards or other cognitive aids" [3].

Hands-on training
Here is one exercise that gives participants several opportunities to practice the steps of medication administration and to gain experience using reference tools for children of different ages and sizes in a short period of time.

First, make index cards with a medication and a condition it is used to treat. Some examples are:

  • Epinephrine: one card for cardiac arrest and another for anaphylaxis.
  • Benzodiazepines: Midazolam, lorazepam, or diazepam for seizure treatment.
  • Dextrose: for hypoglycemia (which may need to be diluted from a 50 percent to 25 percent concentration).
  • Fentanyl or morphine: for pain management.
  • Naloxone: for opioid overdose reversal.
  • Diphenhydramine: antihistamine for allergic reaction.
  • Adenosine: for supraventricular tachycardia.
  • Amiodarone: for cardiac arrest.

Next, get a supply of expired medications, fill empty medication vials with fluid or label training vials with the medications you plan to use in the training session. Store the medications in drug kits similar to ones used in the field.

Then recruit some pediatric volunteers. Have training participants bring their children to training, have an open house or community outreach activity at a station or arrange a visit to a school or daycare center. Give each child one of the cards. Instruct the children to hand the card to a team of two paramedics or students.

Using reference tools, have the team practice estimating the child's weight, determining the dose of the medication on the child's card in milligrams, the volume of medication in milliliters that should be administered and the route of administration.

Have one participant draw the amount of the simulated medication into a syringe (or identify the volume if the medication is supplied in a prefilled syringe), verbalize and confirm with a partner the dose, volume and route to administer, and waste the fluid in to a sink or garbage can.

Teach your students or personnel to use this medication cross-check process (also see video at the end of this article) or something similar and specific to your department's protocols.

Give the children different cards throughout the exercise and have them rotate among the paramedic teams. This training exercise exposes participants to a variety of conditions, patient sizes and medication doses to calculate.

Here are seven tips to make the exercise a success.

  1. Make it fun for the kids. Incorporate the exercise into a station open house or community outreach activity. Rent an inflatable bounce house, hand out coloring books and junior paramedic stickers, or use it as an opportunity to promote bike or pool safety.
  2. Use blunt tips for syringes instead of needles to make sure the children are not fearful of getting an injection.
  3. Use the exercise to identify areas for system improvement not to punish individuals for making mistakes.
  4. Test different strategies in crew resource management and medication cross checks, and measure how long it takes to determine the accurate dose of the medication.
  5. Get samples of pediatric medication reference tools to pilot during the exercise and see which one works best for your service.
  6. Investigate how pediatric equipment is organized in bags.
  7. Debrief after the exercise. Ask participants how comfortable they feel administering medications to children and how the process can be improved.

In the comments share your experience with this training activity or something similar, as well as your questions for improving pediatric medication administration.

References:

  1. Hoyle JD, Davis AT, Putnam KK, Trytko JA, Fales WD. (2012) Medication dosing errors in pediatric patients treated by emergency medical services. Prehospital Emergency Care, 16:1, 59-66.
  2. Lammers R, Willoughby-Byrwa M, Fales W. (2014). Medication errors in prehospital management of simulated pediatric anaphylaxis. Prehospital Emergency Care, 18:2, 295-304.
  3. Lammers R, Byrwa M, Fales W. (2012). Root causes of errors in a simulated prehospital pediatric emergency. Academic Emergency Medicine 19:37-47


from EMS via xlomafota13 on Inoreader http://ift.tt/28YECqN
via IFTTT

Musculoskeletal problem in professional basketball players

2016-06-27T08-30-43Z
Source: International Journal of Therapies and Rehabilitation Research
Sathya Guru Prasad, Ramakrishnan K.S, Shweta S D Phadke, Dhanashree Nandkumar Badhe.
The aim of the study was to find musculoskeletal problem in professional basketball players. A sample of 50 professional basketball players were taken in age group 15-30 yrs. Validated questionnaire was used to evaluate the musculoskeletal problem in professional basketball player. The study concludes that the most common musculoskeletal problem is ligament injuries, the female players are more injured as compared to male players, and the musculoskeletal problem is more in the age group of 20-25 years.


from Scope via xlomafota13 on Inoreader http://ift.tt/29gyvwB
via IFTTT

Comparative study of efficacy and safety of sitagliptin versus glimepiride in patients of type-2 diabetes mellitus inadequately controlled with metformin alone

2016-06-27T07-17-37Z
Source: International Journal of Advances in Medicine
Manuj Sharma, Rakesh Sonawane, J.L. Marko.
Background: Di-peptidyl peptidase-4 inhibitors when used as monotherapy or in combination with other drugs such as metfomin, thiazolidinedione or sulphonylurea are effective and well tolerated in diabetes management. The aim was to evaluate the safety and efficacy of sitagliptin compared to glimepiride as a dual therapy for the treatment of type-2 diabetes patients inadequately controlled with metformin. Methods: It was an observational, open, comparative and multiple follow up study, included 70 patients visiting department of medicine and department of pharmacology at Gandhi Medical College and associated Hamidia Hospital, Bhopal, Madhya Pradesh, India for the period of 1 year. Patients of type 2 diabetes who were on metormin at least for last 3 months and were with inadequate glycemic control (HbA1C levels >7% and


from Scope via xlomafota13 on Inoreader http://ift.tt/28XMt6N
via IFTTT

A comparative study of platelet parameters in end stage renal disease patients undergoing haemodialysis and healthy individuals

2016-06-27T07-17-37Z
Source: International Journal of Advances in Medicine
Lokesh S, Siva Ranganathan Green, Tony Kadavanu Mathew, Hemachandar R, Arun Kumar, Shashank Rakesh Tiwari, Amirtha Lakshmi, Ezhumalai G.
Background: With the rising trend of diabetes mellitus and hypertension in developing countries like India, there is also a rise in chronic complications like end stage renal disease (ESRD). ESRD poses a huge financial burden on family and health care sector due to a high morbidity and mortality associated with it. Cardiovascular complications remain the most common cause of death among ESRD patients and those undergoing hemodialysis (HD). Hemodialysis patients behave in a distinct way that they are relatively more prone for bleeding than thrombotic manifestations. In recent days abnormalities in platelet parameters are found to be an effective tool in risk stratification of patients with chronic kidney disease (CKD) to develop coronary artery disease. Due to scarcity of literature especially from India, the present study was taken to find the association of various platelet parameters among hemodialysis patients. The aim was to study the platelet distribution width (PDW), mean platelet volume, platelet count, plateletcrit and platelet large cell ratio (PLCR) among ESRD patients undergoing maintenance hemodialysis and compare with healthy age and sex matched controls. Methods: The present study was done on two groups. Group A (Cases) consisting of 40 ESRD patients receiving HD for more than 6 months, and group B (controls) consisting of 40 healthy controls from hospital staffs and healthy volunteers matched for age and sex. Results: The mean values of platelet distribution width (PDW), mean platelet volume, platelet count, plateletcrit and platelet large cell ratio (PLCR) were found to be lower in cases when compared to healthy controls. PDW, platelet count and plateletcrit attained statistical significance, while others did not. Conclusions: Abnormality in platelet parameter to assess CVD risk may be applicable in general population as well as in CKD patients, but its role in hemodialysis patients further need to be evaluated.


from Scope via xlomafota13 on Inoreader http://ift.tt/294Ir01
via IFTTT

Electrophysiological study to detect serial changes and prognosis in patients of Guillain Barre Syndrome from north-west Rajasthan, India

2016-06-27T07-17-37Z
Source: International Journal of Advances in Medicine
Arvind Vyas, Sarika Swami, Kartik Jaiswal.
Background: The Guillain Barre Syndrome (GBS) is the commonest cause of acute flaccid paralysis in much of the world, after the introduction of vaccine for poliomyelitis. Electrophysiological study may play an important role in further investigation of the pathogenesis and assessment of prognosis. This study was undertaken to see any changes in electrophysiological pattern at one month follow up and prognosis of patients with Guillain Barre Syndrome. Methods: The study included 28 patients of Guillain Barre Syndrome admitted between the period of July 2014 to June 2015 in the department of medicine and neurology, SP Medical College and AG Hospitals, Bikaner, India. The clinical diagnosis was based on criteria proposed by the national institute of neurological, and communicative disorders and stroke (NINCDS). Each patient was assessed both clinically (including disability score) and electrophysiologically at the time of presentation and at one month±seven days of follow up. Results: GBS was more common in early decades. Male to female ratio was 4.6:1. On electrophysiological study mixed pattern was most common (42.86%) followed by axonal (32.14%) and demyelinating (25%) patients. Mean disability score at the time of presentation was maximum for axonal pattern and the same group had minimum score at one month follow up indicating better recovery. Sequential electrophysiological changes were seen in this study. Axonal pattern had better recovery (77.78%) than demyelinating and mixed was worst with 16.67% mortality. Conclusions: Mixed pattern is predominant pattern on electrophysiological studies. Axonal pattern has better recovery. Secondary changes of electrophysiological finding in some of our cases suggest that primary demyelinating and mixed subtype could, be misinterpreted as primary axonal pathology without timely serial studies.


from Scope via xlomafota13 on Inoreader http://ift.tt/28XMAyV
via IFTTT

Microbes causing severe neonatal septicemia in a tertiary neonatal intensive care unit

2016-06-27T07-11-56Z
Source: Medicine Science | International Medical Journal
Abdelmoneim Khashana.
Neonatal sepsis is the most challenging neonatal disease in developing countries despite the progress in the neonatal management. The aim of the study is to demonstrate the most common organisms causing severe neonatal sepsis in a tertiary neonatal intensive care unit. The study conducted in the neonatal intensive care unit (ICU) unit of pediatric department in Suez Canal University Hospital in the period from December 2013 to November 2014.Blood cultures showed the growth of Escherichia coli (40 %), Staphylococcus aureus (27 %), Klebsiella (20 %), and Pseudomonas (13 %). Escherichia coli is the most common quarantine in a tertiary neonatal intensive care unit.


from Scope via xlomafota13 on Inoreader http://ift.tt/294IFEs
via IFTTT

Effect of low birth weight on neonatal mortality in preterm and small for gestational age babies in a tertiary neonatal intensive care unit in India

2016-06-27T07-06-31Z
Source: International Journal of Contemporary Pediatrics
Smitha DSa, Deepak Pinto, Anousha, B. S. Baliga.
Background: Neonatal mortality is an increasingly important public health issue in developing countries. Low birth weight is the single most important factor affecting neonatal mortality. Globally low birth weight accounts for 10% of neonatal mortality. The purpose of our study was to find out the impact of low birth weight on neonatal mortality and its effect on preterm and small for gestational age babies in a tertiary care center in India. Methods: 173 consecutive, low birth weight neonates weighing less than 2.5 kilograms referred to a tertiary care center over a period of one year were included. Age, gender, gestational age, birth weight, comorbid conditions and clinical outcome were recorded prospectively. Neonates were divided into two groups. 83 preterm low birth weight neonates (


from Scope via xlomafota13 on Inoreader http://ift.tt/28YwN3r
via IFTTT

Intraperitoneal ropivacaine and early postoperative pain and postsurgical outcomes after laparoscopic herniorrhaphy in toddlers: a randomized clinical trial

Summary

Background

Postoperative pain can cause physiological distress, postoperative complications, and extended lengths of hospitalized stay. In children, management of postoperative pain is still recognized as being inadequate.

Objective

The aim of this trial was to investigate the effects of intraperitoneal ropivacaine on postoperative pain, and recovery of bowel function and emetic events after laparoscopic herniorrhaphy in toddlers.

Methods

Seventy-six children aged from 9 months to 3 years were recruited between August 2013 and June 2014 at Tongji Hospital and randomly assigned into two groups. One group received intraperitoneal ropivacaine right before surgery and the control group received intraperitoneal saline. A standard combined general anesthesia procedure was performed under regular monitoring. Postoperative pain was assessed by the FLACC scale. Postoperative analgesic consumption, time to flatus, time to first stool, and postoperative emetic events were also recorded.

Results

When compared with the control group, children who received intraperitoneal ropivacaine experienced less pain 0–4 h after surgery [P < 0.001, difference in median FLACC (95% CI) for 2 h time point is 2.00 (0.87–3.13), for 4 h time point is 1.00 (0.55–1.45)]. In addition, the number of toddlers who received analgesia 0–24 h after surgery in the ropivacaine group was lower than that in the control group [P < 0.001, difference in proportions (95% CI) is 0.575 (0.3865–0.7638)]. Compared with the control group, time to flatus in ropivacaine group was also much shorter [21.1 h vs 16.7 h, P = 0.04, difference in mean (95% CI) is 4.4 (1.49–7.28)], and the time to first stool after surgery was earlier in the ropivacaine group [30.7 h vs 25.6 h, P = 0.003, difference in mean (95% CI) is 5.1 (1.78–8.45)]. Furthermore, the incidence of emetic events in the ropivacaine group was significantly lower than the control group [32.4% vs 11.1%, P = 0.03, difference in proportions (95% CI) is 0.212 (0.0246–0.4002)].

Conclusion

The present results indicate that intraperitoneal ropivacaine reduces early postoperative pain and improves recovery after laparoscopic herniorrhaphy in toddlers. Therefore, IPLA is a good stratagem for postoperative pain management after laparoscopic surgery in toddlers.

Thumbnail image of graphical abstract

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/294j7qI
via IFTTT

Effects of hypotension and/or hypocapnia during sevoflurane anesthesia on perfusion and metabolites in the developing brain of piglets—a blinded randomized study

Summary

Background

Hypotension (HT) and/or hypocapnia (HC) are frequent complications occurring during pediatric anesthesia and may cause cerebral injury in the developing brain.

Aim

The aim of this study is to investigate the effects of HT and/or HC on perfusion and metabolism in the developing brain.

Methods

Twenty-eight piglets were randomly allocated to four groups: control (C), HT, HC, and hypotension and hyocapnia (HTC).

Anesthesia was induced and maintained using sevoflurane. Fentanyl was added for instrumentation. Piglets were fully monitored and their lungs were artificially ventilated. Before treatment, conventional magnetic resonance imaging (MRI), dynamic susceptibility-contrast-enhanced T2*-weighted MRI (DSC-MRI), and single voxel proton MR spectroscopy (1H MRS) were performed. Hypotension (mean arterial blood pressure: 30 ± 3 mmHg) was induced by blood withdrawal and nitroprusside infusion, and hyperventilation was used to induce HC (PaCO2: 2.7–3.3 kPa). 1H MRS and DSC-MRI were repeated immediately once treatment goals were achieved and 120 min later. Radiologists were blinded to the groups. DSCI-MRI and 1H MRS analyses were performed in the thalamus, occipital and parietal lobe, hippocampus, and watershed areas.

Results

In comparison to C, mean time to peak (TTP) increased with HTC in all brain areas as assessed with DSC-MRI (n = 26). Using 1H MRS, a significant decrease in N-acetyl aspartate, choline, and myoinositol, as well as an increase in glutamine–glutamate complex (Glx) were detected independent of group. Compared to C, changes were more pronounced for Glx (due to an increase in glutamate) and myoinositol with HTC, for N-acetyl aspartate with HT, and for Glx with HC. No lactate signal was present.

Conclusions

The combination of HT and HC during sevoflurane anesthesia resulted in alteration of cerebral perfusion with signs of neuronal dysfunction and early neuronal ischemia. HT and HC alone also resulted in signs of metabolic disturbances despite the absence of detectable cerebral perfusion alterations.

Thumbnail image of graphical abstract

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/28XoLHy
via IFTTT

An automated real-time method for the detection of patients at risk for malignant hyperthermia

Summary

Background

Malignant hyperthermia (MH) is a rare anesthetic pharmacogenetic disorder that can be difficult to detect in its earliest phases. Prompt treatment is known to improve outcomes. The modern anesthesia information management systems (AIMS) collect enormous amounts of data. However, data lack context and are not able to provide real-time guidance. Utilizing our AIMS, we developed the capacity to incorporate decision support.

Aims

We describe the creation and evaluation of a real-time detection tool for MH.

Methods

Cases of MH from 2003 to 2013 were retrospectively reviewed to confirm the diagnosis of MH and to calculate a MH clinical grading scale score. The index cases were utilized to develop four electronic data Rules, based on endtidal CO2 (ETCO2) and temperature criteria. The Rules were then applied retrospectively to the index cases and to a full cohort of general operating room (OR) patients from January 2012 to June 2012. If criteria for possible MH was met, the detection tool generated an alert on the monitor at the patient's bedside.

Results

We identified seven patients with confirmed MH with MH Scores ranging from 28 to 70. Using four data Rules, all of our seven index cases were captured and generated an appropriate alert. Median time from MH computer alert time to dantrolene administration time among our index cases was 23 min (IQR 17–77). There were 938 false-positive alerts for possible MH (1.8%) when the Rules were applied to a general OR cohort of 51 579 total cases from January 2012 to June 2012.

Conclusions

We demonstrated a real-time MH detection tool based on established physiologic criteria that is sensitive enough to capture cases suspicious for MH, while limiting false positives to prevent alarm fatigue. This has the potential to notify the provider of possible MH such that treatment may be rapidly initiated.

Thumbnail image of graphical abstract

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/294iwpk
via IFTTT

Characterization of the Blood Brain Barrier in Pediatric Central Nervous System Neoplasms

2016-06-27T01-48-02Z
Source: Journal of Interdisciplinary Histopathology
Christopher S Hong, Winson Ho, Martin G Piazza, Abhik Ray-Chaudhury, Zhengping Zhuang, John D Heiss.
Objective: The normal bloodbrain barrier (BBB) is composed of tight junctions between endothelial cells and surrounding astrocyte foot processes. Breakdown of the physiological astrocyte-endothelial cell relationship occurs in adult metastatic and primary brain tumors. However, the astrocyte-endothelial cell relationship has not been studied in pediatric tumors. Materials and Methods: Utilizing specimens from cases of pilocytic astrocytoma (n = 5), medulloblastoma (n = 5), and low-grade diffuse astrocytoma (n = 1), immunofluorescence were performed using primary antibodies against CD31, glial fibrillary acidic protein (GFAP), and aquaporin 4 (AQ4). Clinical, magnetic resonance imaging, operative, and histopathological findings were analyzed. Results: Strongly-enhancing areas of medulloblastoma exhibited complete BBB breakdown with sparse GFAP and AQ4 staining around CD31-positive vessels. Moderately enhancing regions of pilocytic astrocytomas exhibited regions of intact BBB and vasculature surrounded by dense GFAP staining but reduced and disorganized AQ4 staining, suggesting tumor cells could not fulfill physiological BBB support. Non-enhancing low-grade diffuse astrocytoma demonstrated intact BBB with intense peri-microvasculature GFAP and AQ4 staining. AQ4 stained so strongly that AQ4 visualization alone delineated CD31-positive vessels. Conclusion: Taken together, BBB breakdown in pediatric tumors corresponds to a loss of normal endothelial cell-astrocyte foot process relationships. Further development of pharmaceutical agents capitalizing on this disrupted BBB is warranted in medulloblastoma and pilocytic astrocytoma. However, BBB integrity remains a challenge in treating low-grade diffuse astrocytoma before progression toward secondary glioblastoma.


from Scope via xlomafota13 on Inoreader http://ift.tt/28XL3HF
via IFTTT

Abnormal amygdala resting-state functional connectivity in irritable bowel syndrome

American Journal of Neuroradiology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28Y09Pz
via IFTTT

The effect of black tea (Camellia sinensis (L) Kuntze) on pediatrics with acute nonbacterial diarrhea: A randomized controlled trial

Journal of Evidence-Based Complementary & Alternative Medicine

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zYtT
via IFTTT

High frequency of KRAS mutation in early onset colorectal adenocarcinoma: Implications for pathogenesis

Human Pathology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28Y0x08
via IFTTT

All-oral DAA regimens in HIV-HCV coinfected cirrhotic patients are efficient and safe. Real-life results from the prospective ANRS CO13 - HEPAVIH cohort

Clinical Infectious Diseases

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zPqk
via IFTTT

Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method

Surgical Endoscopy

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28Y09im
via IFTTT

Randomized trial of a dual-hormone artificial pancreas with dosing adjustment during exercise compared with no adjustment and sensor-augmented pump therapy

Diabetes, Obesity and Metabolism

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zKTx
via IFTTT

Incidence of achalasia in South Australia based on esophageal manometry findings

Clinical Gastroenterology and Hepatology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28XZSw4
via IFTTT

Impact of viral eradication with sofosbuvir-based therapy on the outcome of post-transplant hepatitis C with severe fibrosis

Liver International

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zJiF
via IFTTT

Right- versus left-sided congenital diaphragmatic hernia: A comparative outcomes analysis

Journal of Pediatric Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28XZXzz
via IFTTT

Impact of capecitabine and S-1 on anticoagulant activity of warfarin in patients with gastrointestinal cancer

Cancer Chemotherapy and Pharmacology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zX9j
via IFTTT

Histological severity and clinical outcomes of nonalcoholic fatty liver disease in non-obese patients

Hepatology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28Y03HL
via IFTTT

Sources of protons and a role for bicarbonate in inhibitory feedback from horizontal cells to cones in Ambystoma tigrinum retina

Abstract

Lateral-inhibitory feedback from horizontal cells (HCs) to photoreceptors involves changes in synaptic cleft pH accompanying light-evoked changes in HC membrane potential. We analyzed HC to cone feedback by studying surround-evoked light responses of cones and by obtaining paired whole cell recordings from cones and HCs in salamander retina. We tested three potential sources for synaptic cleft protons: 1) generation by extracellular carbonic anhydrase (CA), 2) release from acidic synaptic vesicles, and 3) Na+/H+ exchangers (NHEs). Neither antagonizing extracellular CA nor blocking loading of protons into synaptic vesicles eliminated feedback. However, feedback was eliminated when extracellular Na+ was replaced with choline and significantly reduced by an NHE inhibitor, cariporide. Depriving NHEs of intracellular protons by buffering HC cytosol with a pH 9.2 pipette solution eliminated feedback, whereas alkalinizing the cone cytosol did not, suggesting that HCs are a major source for protons in feedback. We also examined mechanisms for changing synaptic cleft pH in response to changes in HC membrane potential. Increasing the trans-membrane proton gradient by acidifying the extracellular pH from 7.8 to 7.4 to 7.1 strengthened feedback. While maintaining constant extracellular pH with 1 mm Hepes, removal of bicarbonate abolished feedback. Elevating intracellular bicarbonate levels within HCs prevented this loss of feedback. A bicarbonate transport inhibitor DIDS also blocked feedback. Together, these results suggest that NHEs are the primary source of extracellular protons in HC feedback but that changes in cleft pH accompanying changes in HC membrane voltage also require bicarbonate flux across the HC membrane.

This article is protected by copyright. All rights reserved



from Physiology via xlomafota13 on Inoreader http://ift.tt/291l5Gt
via IFTTT

FOLFIRI plus cetuximab in patients with liver-limited or non-liver-limited RAS wild-type metastatic colorectal cancer: A retrospective subgroup analysis of the CRYSTAL study

European Journal of Surgical Oncology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zJPt
via IFTTT

Long-term follow-up of patients treated with infliximab for ulcerative colitis: Predictive factors of response - An observational study

Digestive Diseases and Sciences

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28Y06mG
via IFTTT

A prospective longitudinal cohort to investigate the effects of early life giardiasis on growth and all cause diarrhea

Clinical Infectious Diseases

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zRic
via IFTTT

Management of postoperative bleeding after laparoscopic left colectomy

International Journal of Colorectal Disease

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28Y02Do
via IFTTT

Alcoholic liver disease patients' perspective of a coping and physical activity-oriented rehabilitation intervention after hepatic encephalopathy

Journal of Clinical Nursing

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/293NnCt
via IFTTT

Comparison of laparoscopic liver resection for hepatocellular carcinoma located in the posterosuperior segments or anterolateral segments: A case-matched analysis

Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zUdV
via IFTTT

Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15

Journal of Clinical Virology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28Y0a5V
via IFTTT

Clinicopathological features and long-term outcomes of intraductal papillary neoplasms of the intrahepatic bile duct

Journal of Gastrointestinal Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/291zHY9
via IFTTT

Detection of parasites in children with chronic diarrhea

Pediatrics International

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/28XR0Fs
via IFTTT

Gene therapy: In vivo selection of gene-corrected cells

Nature Reviews Genetics. doi:10.1038/nrg.2016.82

Author: Bryony Jones



from Genetics via xlomafota13 on Inoreader http://ift.tt/28XFuJf
via IFTTT

Circadian genetics: Tick Tock — keep your eyes on the clock

Nature Reviews Genetics. doi:10.1038/nrg.2016.84

Author: Denise Waldron



from Genetics via xlomafota13 on Inoreader http://ift.tt/294dK9F
via IFTTT

The molecular hallmarks of epigenetic control

Nature Reviews Genetics. doi:10.1038/nrg.2016.59

Authors: C. David Allis & Thomas Jenuwein



from Genetics via xlomafota13 on Inoreader http://ift.tt/28XF6dM
via IFTTT

Effects of Aqueous Extract of Moringa oleifera leaves on Epidermal Wound Healing in Domestic Rabbit

2016-06-27T00-17-28Z
Source: International Journal of Livestock Research
Abayomi Kayode Olaifa.
ABSTRACT A study was undertaken to assess the healing properties of Moringa oleifera leaf extract on epidermal wounds in rabbits. Twelve adult rabbits were divided into two equal groups of six. A pair of wound measuring 2cm x 2cm each was created on each rabbit. The wound on the rabbits in the experimental group were treated with Moringa oleifera aqueous leaf extracts while those in the control group were cleaned with distilled water daily. Wound contraction was measured daily with days 5, 9 and 12 representing the inflammatory, proliferative and maturation phases of wound healing respectively. Blood samples were collected on days 0, 5, 9 and 12 for analysis. Moringa oleifera leaf extract-treated animals had faster rates of wound contraction and healing with shorter days of scab fall off within 7 days; increases in packed cell volume, mean corpuscular volume, lymphocyte and neutrophil counts (P


from Scope via xlomafota13 on Inoreader http://ift.tt/28XJR9S
via IFTTT