Effect of obesity on cost per quality adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology

Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared to their non-obese counterparts.

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Young Texas man meets paramedics who saved his life, two years later

By Ryan Osborne
Fort Worth Star-Telegram

FORT WORTH,Texas — Zach Malwitz was 19 when he went into cardiac arrest in the parking lot of a CVS pharmacy on April 3, 2014. His heart stopped two more times that day, and each time it did, two paramedics resuscitated him.

On Wednesday, Malwitz, now 21, met the men who saved his life.

"I don't know what to say — I'm shaking real bad right now," Malwitz told MedStar paramedics Eddie Fuller and Tim Statum.

Malwitz, who lives in North Richland Hills, thanked Fuller and Statum in person for the first time Wednesday during a ceremony at MedStar headquarters in west Fort Worth.

Two mothers were also there to meet the MedStar dispatchers who talked them through baby deliveries over the phone in May.

Allison Marquardt was with her baby boy, Augustine, while Ashlie Williams brought along her baby girl, Carter.

Marquardt was home alone the morning of May 13 when she went into labor.

MedStar dispatcher Kate Gillinger talked Marquardt through the delivery, and Augustine arrived healthy.

Four days later, on May 17, Williams went into labor at her home about 3:15 a.m. Her mother called 911 and was connected with dispatcher Jamey Clark.

Clark, who thought the call would be routine, tried to keep Williams and her mother calm, thinking paramedics would arrive before the baby. Then Williams' mother, Debbie Tuley, saw Carter on her way.

The baby's coming. The water has broke and the baby is coming. Debbie Tuley to a MedStar dispatcher in May, when her daughter was giving birth

"The baby's coming," Tuley told Clark. "The water has broke and the baby is coming."

At times, Tuley sounded worried on the call. But she said Clark's clear instructions calmed the process.

"Everything just went one step after another," Tuley said. "It was amazing how it was all just under control."

Carter arrived safely with her mom laying on the bathroom floor.

"We actually call her the bathroom baby," Williams said.

Malwitz, who nearly the died before the MedStar paramedics saved him two years, said he often thinks about how emergency workers deal with similar experiences on a regular basis.

"I couldn't imagine doing it," he said. "I care for everyone — I try to, at least. And it sure seems like they do. But they lose a lot of people, and they win a lot of people. I couldn't do that. My heart's not big enough to be able to accept that you did everything you could and you still lost someone."

Copyright 2016 the Fort Worth Star-Telegram

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Firefighter / Paramedic - Oldsmar Fire Rescue

OLDSMAR FIRE RESCUE 100 STATE STREET WEST OLDSMAR, FLORIDA 34677 http://myoldsmar.com Updated: July 05, 2016 Classification: Firefighter/Paramedic NOW HIRING FOR AN OCTOBER 1ST START DATE! The City of Oldsmar is currently hiring for Firefighter/Paramedic. A department application and all testing through National Testing Network (NTN) must be completed by August 15, 2016. Salary Information: $46,434 ...

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Stimulus frequency-dependent inhibition of micturition contractions of the urinary bladder by electrical stimulation of afferent Aβ, Aδ, and C fibers in cutaneous branches of the pudendal nerve

Abstract

We aimed to examine the afferent mechanisms for the reflex inhibition of the rhythmic micturition contractions (RMCs) of the urinary bladder induced by stimulation of the perineal skin afferents in urethane-anesthetized rats. Electrical stimulation (pulse duration: 0.5 ms) was applied to the cutaneous branches of the pudendal nerve (CBPN) at frequencies of 0.1, 1, and 10 Hz for 1 min. Nerve fiber groups were defined by recording compound action potentials from CBPN. Activation of only Aβ fibers (0.2 V) produced an inhibition of RMCs at 7–11 min after the onset of stimulation (late inhibition), at any tested frequency. Additional activation of Aδ fibers (1 V) produced additional early inhibition (immediately after stimulation) at 1 and 10 Hz. Furthermore, additional activation of C fibers (10 V) at 10 Hz completely stopped RMCs for >10 min. This strong inhibition persisted after local application of capsaicin to the stimulating CBPN. We conclude that activities of Aβ, Aδ, and C afferent fibers, without capsaicin-sensitive channels, can contribute to the inhibition of bladder contractions.

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ICS Announces Company Name Change to PEAKE

Stevensville, Md. — Incident Communication Solutions, LLC (known as ICS), a leading integration company, announced today that the company will begin operating under a new trade name and will be known as PEAKE, LLC effective July 14, 2016. At the same time, the company unveiled a new identity and website, www.peake.com. This name change is a part of a larger rebrand of the company that better ...

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How terrorists target and attack health care facilities and personnel

"Terrorism & the Medical Environment" is designed to help save lives, money, property and medical professionals who the victims and saviors of terrorist attacks

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Second annual Hooley Awards finalists announced

LAKEVILLE, Minn. — ImageTrend, Inc. announced the 15 finalists for this year's Hooley™ Awards. The award recipients will be announced at the company's ImageTrend Connect 2016 conference on July 20, 2016. The Hooley Awards recognize innovators and thought leaders, honoring their involvement, creativity and passion in three categories: Innovation, Service and New Frontier. "We ...

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Part Time Firefighter - Kingman Fire Department

KINGMAN FIRE DEPARTMENT 310 NORTH FOURTH STREET KINGMAN, ARIZONA 86401 Updated: July 05, 2016 Job Classification: Firefighter Part-Time The City of Kingman Fire Department is building an ongoing eligibility list for Firefighter Part-Time. This position requires FireTEAM and a valid CPAT through National Testing Network. Candidates must also fill out the department application found on their website ...

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Firefighter/EMT - Oldsmar Fire Rescue

OLDSMAR FIRE RESCUE 100 STATE STREET WEST OLDSMAR, FLORIDA 34677 http://myoldsmar.com Updated: July 05, 2016 Classification: Firefighter/EMT NOW HIRING FOR AN OCTOBER 1ST START DATE! Oldsmar Fire Rescue is currently hiring for Firefighter/EMT. A city application and all testing through National Testing Network (NTN) must be completed by August 15, 2016. Salary Information: $40,514 to $57,109 Benefit ...

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Trauma takes its toll on EMS providers, 911 telecommunicators

Local leaders, communities, agency leaders and the media all have a responsibility to help support emergency responders' well-being through research, intervention, policy and education

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Flower detection and acuity of the Australian native stingless bee Tetragonula carbonaria Sm.

Abstract

We tested the endemic Australian Tetragonula carbonaria bee as a model of how colour vision may allow these small bees to find flowers. In a Y-Maze apparatus, we presented stimuli that contained both chromatic- and green-receptor contrasts, or only had chromatic contrast to free flying bees. Stimuli were detected at visual angles of 9.5° and 9.3°, respectively. We next made morphological measurements of the compound eye under high magnification using a digital microscope, and despite a relatively small eye size with a surface area of 0.64 ± 0.02 mm², the compound eye contained 3010 ± 10 ommatidia, Measurements of diverging rays of light using antidromic illumination revealed a mean interommatidial angle in the frontal visual field measures 1.56° ± 0.10°. Finally, we calculate that the minimum number of ommatidia that need to be excited for object detection is 33, which is much higher than for object detection in bumblebees and for the detection of objects providing both colour and green contrasts by honeybees, but lower for the detection of an object lacking green contrast in honeybees. We discuss reasons that may explain potential tradeoff for foraging bees.

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Trauma takes its toll on EMS providers, 911 telecommunicators

By Jay Fitch and Jim Marshall
PM Magazine

Amidst growing concern about the mental health of emergency medical service (EMS) professionals, a Fitch & Associates' Ambulance Service Manager Program project team surveyed more than 4,000 EMS and fire professionals in 2015 about critical stress, suicide, and available support and resources [1].

The results were stark.

Among survey respondents, 37 percent reported contemplating suicide—nearly 10 times the overall rate among American adults [2]. Additionally, 6.6 percent of survey respondents had attempted suicide, compared to just 0.5 percent of adults nationally.

Mental health issues are not limited to the EMS workforce. According to the Firefighter Behavioral Health Alliance, at least 759 firefighters have committed suicide since 2012 [3]. In law enforcement, estimates suggest between 125 and 300 police officers commit suicide every year [4,5].

These numbers should be a wake-up call, not only for every emergency medical technician (EMT), paramedic, firefighter, police officer, and emergency telecommunicator (sometimes called dispatchers or call-takers), but also for agency leaders and county and city officials who work with them.

Let's take a moment to pause here. How many brave and talented people are in your community — from those who answer the 911 calls to the EMTs, firefighters, and police who respond to them? Perhaps 20? 50? 500?

Now do the math. With these numbers, the survey findings would suggest that perhaps 7, or 18, or even 185 people on your team have thought about suicide.

One or more of them may have already attempted suicide or could in the future. Do you know who they are? Do you know how to help?

To address this mental health crisis in emergency services, industry leaders must join together to further define the problem, explore its causes, and pursue strategic planning to protect and equip the workforce.

The traumatic stress factor
There is almost certainly a correlation between the impact of traumatic stress and the extraordinary statistics on suicide seen in our survey and other research. When a responder experiences intense fear, horror, or helplessness in response to a scene at which someone experienced serious injury or death, he or she has been exposed to a traumatic event.

Some of the common reactions to traumatic events include anxiety, irritability, sleep disorders and fatigue, appetite changes, and withdrawal from friends and family [6].

Acute stress disorder describes cases in which some or all of these symptoms are experienced for more than two days after the event, but not for longer than one month. Post-traumatic stress disorder is diagnosed when these symptoms persist for more than one month [7].

On-the-job stress among emergency responders can also trigger the release of cortisol and other stress hormones. This stress response is normal — and helpful — but when it occurs too frequently without adequate rebalancing, it ups the risk for chronic stress response, which can lead to physical and mental disorders [8].

Each person's response may differ. Leaders need to be vigilant in watching for signs of acute and post-traumatic stress disorders among their public safety personnel.

Emergency dispatchers also at risk
Although many people both inside and outside of the EMS, fire, and law enforcement fields understand the inherent stress of responding to emergency scenes, often the stress on 911 dispatchers is greatly underestimated.

One study found that between 17 percent and 24 percent of telecommunicators reported symptoms consistent with PTSD; 24 percent reported symptoms consistent with major depression [9].

Another study reported that more than 16 percent of telecommunicators experience symptoms of compassion fatigue — a combination of post-traumatic stress symptoms and burnout [10].

Emergency dispatchers may experience some stressors unique to their position. They receive, for example, no warning before crisis calls and seldom have closure afterwards.

They engage in a far greater number of contacts with residents than field responders and need to visualize the worst possible scenario to optimize the response. As a result, emergency dispatchers are also on scene — psychologically [11].

Need for a culture shift
Many first responders share what is called an emotional code, defined as what they believe they should do with what they feel. Emergency responders have historically lacked understanding of how to cope with their extraordinary stress.

As a traditionally male-dominated profession, emergency responders often associate job-related stress or seeking professional mental health care with personal weakness. To avoid psychic pain they didn't know how to face, the default became to adopt a "just suck it up" emotional code.

This emotional code, which still prevails today, precludes asking for help and can greatly increase the risk of PTSD, depression, and suicide.

Saving lives and ensuring the emotional health of emergency service professionals must start with a culture shift, guided by leaders advocating for a healthier emotional code.

This effort must be part of a larger strategic initiative by local elected and administrative officials to create policies that support the mental well-being of emergency service personnel and educate agency leaders about work-related stress risks.

Front-line emergency responders need access to training in stress management and to evidence-based treatment for stress-related conditions as well as supportive, emotionally open work cultures.

City and county leaders should invest in protecting medical first responders' mental health because it is our civic duty to care for the people who care for our communities when a crisis hits. Not providing appropriate support and care for emergency responders also has wide-reaching implications.

An agency that has not yet addressed employees' stress-related conditions will struggle with lower morale, higher leave use, and more turnover. Managers should keep a close watch on leave use, which can be a symptom of a department that needs help.

Given the time and cost of hiring and training new personnel, it is well worth the investment in stress management programs and other structures to support public safety personnel.

Managers should also review scheduling patterns. When a team is running 24-hour or longer shifts, it is at even higher risk for fatigue, burnout, and other stress-related problems.

The 911 telecommunicators and responders aren't the only ones at risk; when EMS, fire, and law enforcement personnel are under greater stress, their performance may be affected. They may make a mistake on the road or a medical error when caring for a patient, which presents a danger to the public and to patients.

Historically, when a public safety worker handles a call poorly, especially if the media covers the case, there is a demand that he or she be reprimanded or fired. Local officials should respect that emergency responders are human beings who work under enormously stressful conditions.

Providing support
Local leaders, communities, agency leaders, and the media all have a responsibility to help support emergency responders' well-being through research, intervention, policy, and education.

Although developed for 911 telecommunicators, the National Emergency Number Association's 9-1-1 Standard on Acute/Traumatic and Chronic Stress Management provides guidance that can be used by local officials to support all emergency services employees and volunteers [12].

The standard describes comprehensive stress management plans with these elements:

• Offer stress management training that is at least eight hours in length and covers such topics as stress disorders and the impacts of unmanaged stress, the negative effects of the "just suck it up" culture, and specific coping skills and strategies.
• Provide all personnel with on-site educational materials, including information about local and online resources, and how exercise, nutrition, and sleep can affect stress levels.
• Ensure that all EMS personnel can participate in critical incidence stress management activities. CISM support services can be helpful for EMS professionals. According to the Fitch & Associates survey, of the 86 percent of respondents who experienced critical stress, only 18 percent attended a critical incident stress management-type debriefing, but the majority of those who did, found the sessions very helpful or extremely helpful.

Those at risk of suicide, however, should only participate in debriefing sessions with a group after careful individual assessment to ensure such experiences will be safe and helpful.

• Create or promote an employee assistance program (EAP) to offer free confidential counseling with clinicians who understand the public safety community and specialize in traumatic stress disorders. In our survey, 11 percent of respondents attended employee assistance program sessions, and 53 percent found them very or extremely helpful.
• Identify local therapists specializing in treatment of stress and traumatic stress disorders with public safety personnel and who use such evidence-based therapies as exposure therapy, eye movement desensitization and reprocessing (EMDR), and stress inoculation therapy (SIT). Evidence-based treatments for PTSD, including EMDR, can completely cure PTSD and bring tremendous relief for depression in many cases.
• Develop peer-support programs. These programs offer confidential emotional support without providing advice or attempting to solve the problem and can help alleviate stress and staff conflicts.
• Adopt programs that incentivize 911 telecommunications professionals to make lifestyle changes to protect their mental and physical well-being.

Emergency services professionals are currently experiencing an epidemic of mental health crises and suicides among their ranks. This is a problem that communities cannot afford to ignore. These professionals risk their lives and well-being, including their mental health, caring for others.

It is the responsibility of elected officials, local administrators, and public-safety leaders to support and fund programs that train managers and supervisors in ways to protect their employees, that teach responders how to better manage stress, and that help individual employees and crews recognize dangerous signs in themselves and in their colleagues.

Resources
Other helpful resources can be found at:

• 911 Wellness Foundation: 911wellness.com
• International Critical Incident Stress Foundation: icisf.org
• Code Green Campaign: codegreencampaign.org
• Firefighter Behavioral Health Alliance: ffbha.org

Reprinted with permission of the ICMA (International City/County Management Association), Washington, D.C.

References

1. Survey Reveals Alarming Rates of EMS Provider Stress and Thoughts of Suicide. JEMS. Sept. 28, 2015. 
2. Centers for Disease Control and Prevention. 2015 Suicide Facts at a Glance. Available at: http://ift.tt/1LBAICC.
3. Data from the Firefighter Behavioral Alliance. Available at: http://ift.tt/29nUIZK.
4. Daniel W. Clark, Elizabeth K. White, and John M. Violanti, "Law Enforcement Suicide: Current Knowledge and Future Directions," The Police Chief 79(May 2012): 48–51. Available at: http://ift.tt/29lJCsw.
5. The Badge of Life. A Study of Police Suicide 2008-2015. Available at: http://ift.tt/1uCVLNI.
6. Van der Kolk, B. Single sheet resource for first responders about stress disorders. Available at:http://ift.tt/29nUge3.
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.
8. For a comprehensive explanation of chronic stress response, see: Mate, G. When the Body Says No: Understanding the Stress – Disease Connection. New York: John Wiley & Sons, 2003:31-33.
9. Lilly, M.M., & Allen, C.E (2015). Psychological inflexibility and psychopathology in 9-1-1 telecommunicators. Journal of Traumatic Stress, Advanced online publication. doi: 10.1002/jts.22004. Available at: http://ift.tt/29lJKYU.
10. Troxell, R. Indirect Exposure to the Trauma of Others: The experience of 9-1-1 telecommunicators. 2008, doctoral dissertation. Retrieved from ProQuest Dissertations and Theses. (Accession Order No. AAT 333542).
11. Marshall, J., and S. Gilman (2015). Reaching the unseen first responder: treating 911 trauma in emergency telecommunicators. In M. Luber (Ed.), EMDR Scripted Protocols: Anxiety, Depression, and Medical Related Issues (pp. 185–216). New York: Springer Publications.
12. NENA Standard on 9-1-1 Acute/Traumatic and Chronic Stress Management:http://ift.tt/29nUEJv.

About the authors
Jay Fitch, Ph.D., is founder and president, Fitch & Associates, an ICMA Strategic Partner, Kansas City, Missouri (jfitch@emprize.net). Jim Marshall, M.A., is a licensed mental health clinician and founder of the 911 Training Institute in Petoskey, Michigan (jim@911Training.net).

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Universal Versus Targeted Screening for Lynch Syndrome: Comparing Ascertainment and Costs Based on Clinical Experience

Abstract

Background

Strategies to screen colorectal cancers (CRCs) for Lynch syndrome are evolving rapidly; the optimal strategy remains uncertain.

Aim

We compared targeted versus universal screening of CRCs for Lynch syndrome.

Methods

In 2010–2011, we employed targeted screening (age < 60 and/or Bethesda criteria). From 2012 to 2014, we screened all CRCs. Immunohistochemistry for the four mismatch repair proteins was done in all cases, followed by other diagnostic studies as indicated. We modeled the diagnostic costs of detecting Lynch syndrome and estimated the 5-year costs of preventing CRC by colonoscopy screening, using a system dynamics model.

Results

Using targeted screening, 51/175 (29 %) cancers fit criteria and were tested by immunohistochemistry; 15/51 (29 %, or 8.6 % of all CRCs) showed suspicious loss of ≥1 mismatch repair protein. Germline mismatch repair gene mutations were found in 4/4 cases sequenced (11 suspected cases did not have germline testing). Using universal screening, 17/292 (5.8 %) screened cancers had abnormal immunohistochemistry suspicious for Lynch syndrome. Germline mismatch repair mutations were found in only 3/10 cases sequenced (7 suspected cases did not have germline testing). The mean cost to identify Lynch syndrome probands was ~$23,333/case for targeted screening and ~$175,916/case for universal screening at our institution. Estimated costs to identify and screen probands and relatives were: targeted, $9798/case and universal, $38,452/case.

Conclusions

In real-world Lynch syndrome management, incomplete clinical follow-up was the major barrier to do genetic testing. Targeted screening costs 2- to 7.5-fold less than universal and rarely misses Lynch syndrome cases. Future changes in testing costs will likely change the optimal algorithm.

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Structural Change in Microbiota by a Probiotic Cocktail Enhances the Gut Barrier and Reduces Cancer via TLR2 Signaling in a Rat Model of Colon Cancer

Abstract

Background

Structural change in the gut microbiota is implicated in cancer. The beneficial modulation of the microbiota composition with probiotics and prebiotics prevents diseases.

Aim

We investigated the effect of oligofructose–maltodextrin-enriched Lactobacillus acidophilus, Bifidobacteria bifidum, and Bifidobacteria infantum (LBB), on the gut microbiota composition and progression of colorectal cancer.

Methods

Sprague Dawley rats were acclimatized, given ampicillin (75 mg/kg), and treated as follows; GCO: normal control; GPR: LBB only; GPC: LBB+ 1,2-dimethylhydrazine dihydrochloride (DMH); and GCA: DMH only (cancer control). 16S V4 Pyrosequencing for gut microbiota analysis, tumor studies, and the expression of MUC2, ZO-1, occludin, TLR2, TLR4, caspase 3, COX-2, and β-catenin were conducted at the end of experiment.

Results

Probiotic LBB treatment altered the gut microbiota. The relative abundance of genera Pseudomonas, Congregibacter, Clostridium, Candidactus spp., Phaeobacter, Escherichia, Helicobacter, and HTCC was decreased (P < 0.05), but the genus Lactobacillus increased (P < 0.05), in LBB treatment than in cancer control. The altered gut microbiota was associated with decreased tumor incidence (80 % in GPC vs. 100 % in GCA, P = 0.0001), tumor volume (GPC 84.23 (42.75–188.4) mm³ vs. GCA 243 (175.5–344.5) mm³, P < 0.0001) and tumor multiplicity/count (GPC 2.92 ± 0.26 vs. GCA 6.27 ± 0.41; P < 0.0001). The expression of MUC2, ZO-1, occludin, and TLR2 was increased, but expression of TLR4, caspase 3, Cox-2, and β-catenin was decreased by LBB treatment than in cancer control GCA (P < 0.05).

Conclusion

Administration of LBB modulates the gut microbiota and reduces colon cancer development by decreasing tumor incidence, multiplicity/count, and volume via enhanced TLR2-improved gut mucosa epithelial barrier integrity and suppression of apoptosis and inflammation.

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Established and Emerging Eosinophilic Gastrointestinal Diseases (EGIDs): Seeing Red and Looking Ahead

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Histological features of mixed neuroendocrine carcinoma and hepatocellular carcinoma in the liver: a case report and literature review

Abstract

Primary hepatic neuroendocrine carcinoma (NEC) is rare, and its origin, clinical features, diagnosis and treatment have not been clarified. Primary mixed NEC and hepatocellular carcinoma (HCC) is even rarer and is divided into either combined type or collision type. We report a patient with the combined type of mixed NEC and HCC. A 72-year-old male was diagnosed with HCC and underwent hepatectomy because of the presence of two tumors in his liver. Histological examination demonstrated that one of the tumors had both NEC and HCC components. The transitional zone was noted in the immunohistological examination, and the tumor was determined to be the combined type of primary mixed NEC and HCC. This was the first description of an HCC component being found in an NEC-dominant area in a primary mixed NEC and HCC tumor. Three weeks after hepatectomy, an abdominal computed tomography scan showed extensive regional and para-aortic lymphadenopathy, and early relapse was suspected in the patient. The patient died 3 months after the operation despite treatment with combination chemotherapy. This report describes an unfavorable case and summarizes all the primary mixed NEC and HCC tumor cases that have been previously reported.

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Genetic analysis of COL11A2 in Korean patients with autosomal dominant non-syndromic hearing loss

Abstract

The collagen type XI alpha 2 gene (COL11A2) is associated with autosomal dominant non-syndromic hearing loss (ADNSHL), and all mutations of this gene in ADNSHL are missense mutations. To evaluate its potential as a major causative gene of ADNSHL in the Korean population, we performed genetic analysis of COL11A2 in 75 unrelated Korean patients with ADNSHL. Consequently, 5 non-synonymous variants, 7 synonymous variants, and 6 intronic variants were identified in COL11A2. Among them, a novel variant, p.G829R (c.2485G>C) was found in a patient as a heterozygote. However, pedigree analysis showed this variation was not co-segregated with hearing loss. Previously reported variants p.G230W (c.688G>T) and p.P1422L (c.4265C>T) were discovered in Korean patients. However, these variants were also detected in normal individuals. These results suggest that COL11A2 is not a major causative gene of ADNSHL in the Korean population.

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Color vision diversity and significance in primates inferred from genetic and field studies

Abstract

Color provides a reliable cue for object detection and identification during various behaviors such as foraging, mate choice, predator avoidance and navigation. The total number of colors that a visual system can discriminate is largely dependent on the number of different spectral types of cone opsins present in the retina and the spectral separations among them. Thus, opsins provide an excellent model system to study evolutionary interconnections at the genetic, phenotypic and behavioral levels. Primates have evolved a unique ability for three-dimensional color vision (trichromacy) from the two-dimensional color vision (dichromacy) present in the majority of other mammals. This was accomplished via allelic differentiation (e.g. most New World monkeys) or gene duplication (e.g. Old World primates) of the middle to long-wavelength sensitive (M/LWS, or red–green) opsin gene. However, questions remain regarding the behavioral adaptations of primate trichromacy. Allelic differentiation of the M/LWS opsins results in extensive color vision variability in New World monkeys, where trichromats and dichromats are found in the same breeding population, enabling us to directly compare visual performances among different color vision phenotypes. Thus, New World monkeys can serve as an excellent model to understand and evaluate the adaptive significance of primate trichromacy in a behavioral context. I shall summarize recent findings on color vision evolution in primates and introduce our genetic and behavioral study of vision-behavior interrelationships in free-ranging sympatric capuchin and spider monkey populations in Costa Rica.

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Comparative transcriptome analysis of differentially expressed genes between the curly and normal leaves of Cymbidium goeringii var. longibracteatum

Abstract

Normal and the spontaneous spirally rolled leaves of Cymbidium goeringii var. longibracteatum were used for RNA sequencing analyses using the Illumina paired-end sequencing technique to figure out the differently-expressed genes in two samples. About 5.65 and 4.82 Gb sequencing data of raw reads were obtained from 2 cDNA libraries of normal and the spirally rolled leaves respectively. After data filtering, quality checks and de novo assembly, a total of 48,935 unigenes with an average sequence length of 820 nt were generated. In addition, the transcriptome change in normal and the spirally rolled leaves was investigated. With non-redundant annotation, 219 differentially expressed genes (DEGs) are identified, with 147 up-regulated genes and 72 down-regulated genes. Out of these DEGs, 21 DEGs (9.59 %) were involved in cell wall modeling enzymes, such as expansin, xyloglucan endo-transglycosylase, pectate lyase, cell wall-associated hydrolase. Besides, other DEGs were predominantly classified as genes involved in transcription factor and signal sense and transduction signaling. This study presents the first comprehensive characterization of the leave transcriptomes of Cymbidium goeringii var. longibracteatum. This study not only gave us valuable sequence resources of this species, but also provided theoretical foundation for cultivar breeding of leaf mutation in C. goeringii var. longibracteatum.

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Transcriptome sequencing provides insights into the metabolic pathways of patchouli alcohol and pogostone in Pogostemon cablin (Blanco) Benth.

Abstract

Pogostemon cablin (Blanco) Benth. is an important medicinal plant; however, its molecular biology remains largely unexplored. Here, we report the results of whole transcriptome-wide analyses of P. cablin using next-generation sequencing technology. In the present study, we generated 108,996 unigenes using RNA sequencing data. Among these unigenes, 65,536 were annotated in the NR database. There were 40,670 intact open reading frames (ORFs), which accounted for 69 % of the 58,820 predicted ORFs, demonstrating that our assembled transcriptome was of high quality. Gene expression levels in the leaf and stem were quantified, and 18,481 unigenes (17 %) were determined to be significantly differentially expressed. The patchouli alcohol (PA) and pogostone (PO) metabolic pathway of P. cablin was also reconstructed, and among the 17 putative homologs to PA and PO biosynthesis-related genes, seven were significantly upregulated in the stems, and three genes were significantly upregulated in the leaves. The correlation between the essential oil contents of P. cablin and the potentially pivotal genes for PA and PO production were identified. Considering that the contents of PA and PO in leaves and stems are markedly different in the same plant and we did not detect any pattern in the expression levels of candidate genes between leaves and stems, we speculate that after the biosynthesis, more PA probably accumulates in the leaves, and more PO in the stems of P. cablin. The transcriptome of P. cabin will facilitate further researches on the molecular system biology of the Pogostemon genus, as well as the in-depth studyies of PA and PO biosynthesis and its potential applications for genetic engineering.

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Resident self-efficacy to regardless of drug addiction through resident characteristics in Tanah Merah Rehabilitation Center, Samarinda

2016-07-06T05-26-30Z
Source: International Journal of Medical Science and Public Health
Rosdiana, Bhisma Murti, Mahendra Wijaya, Suwarto.
Background: Abuse and illicit trafficking continues to be a serious threat to any country, including Indonesia. Situation circulation of shabu (methamphetamine) in Indonesia during 20082011 continued to increase. Craving become an important factor that should be known by an addict or an individual who considers addiction as something that is easy to be eliminated or cured, then to help earliest possible recovery (recovery) client narcotics (addicted), indispensable support of family. Objectives: The purpose of this study was to analyze resident self-efficacy to regardless of drug addiction through family support at Tanah Merah Rehabilitation Center Samarinda. Material and Methods: This study used qualitative approach with case study strategy. Respondents in this study were residents, ex drug users, peer support, and resident family. The samples were taken by used purposive sampling method. Result: The results showed that most of the resident family support. One of the factors influencing self-efficacy resident is the motivation of families resident in the form of emotional support, confidence to recover, a sense of caring, informative support in the form of suggestions, and advice that is given by parents resident. Conclusion: Family support is very influential on self-efficacy resident. Attention, affection, resident care obtained from parents, wives, children, brothers, sisters, and loved ones in the resident care are very meaningful. In the current conditions of the resident to follow rehabilitation program both emotional support (the support ratings, support informative) and instrumental support are necessary.


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A hospital-based study on determinants of breast-feeding initiation practices in post-natal ward of a tertiary care hospital

2016-07-06T05-26-30Z
Source: International Journal of Medical Science and Public Health
Syed Shuja Qadri, Lokesh Agarwal.
Background: Increasing evidence has highlightened the importance of initiation of breast feeding and its continuation in infancy. The global community recommends and promotes exclusive breast feeding as the method of choice especially for first six months of life. The study outcome will reveal important factors of determinants of breast feeding which in turn will be baseline data for formulation of public health policies pertaining to it. Objective: To study the determinants of exclusive breast feeding in newborn infants in a tertiary care hospital in Kashmir valley. Material and Methods: A hospital-based descriptive cross-sectional study design was conducted among lactating women in post-natal ward who had delivered at Trust Hospital, Sheri-Kashmir Institute of Medical Sciences, Soura, J&K, for a period of 4 months (October 13January 14). The study population consisted of 720 mothers with their babies who attended the hospital during the study period out of which 218 were selected through non-probability convenient sampling method. Obstetric/health service-related factors, breast feeding initiation practices, and difficulties faced were assessed for any influence on exclusive breast feeding. Results: A total of 218 mothers with their infants were included and belonged to 2534 years of age group. Majority (95.4%) of newborns received exclusive breast feeding. Further it was found that the factors like parity, mode of delivery, antenatal counseling had a significant impact on type of breast feeding (P

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Emerging Insights into Heterotrimeric G Protein Signaling in Plants

Publication date: Available online 6 July 2016
Source:Journal of Genetics and Genomics
Author(s): Quan Xu, Mingzhu Zhao, Kun Wu, Xiangdong Fu, Qian Liu
Heterotrimeric guanine nucleotide-binding protein (G protein) signaling is an evolutionarily conserved mechanism in diverse eukaryotic organisms. In plants, the repertoire of the heterotrimeric G protein complex, which is composed of the Gα, Gβ, and Gγ subunits, is much simpler than that in metazoans, and the identity of typical G protein-coupled receptors (GPCRs) together with their ligands still remains unclear. Comparative phenotypic analysis in Arabidopsis and rice plants using gain- and loss-of-function mutants of G protein components revealed that heterotrimeric G protein signaling plays the important roles in a wide variety of plant growth and developmental processes. Grain yield is a complex trait determined by quantitative trait loci (QTL) and influenced by soil nitrogen availability and environmental changes. Recent studies have shown that the manipulation of two non-canonical Gγ subunits, GS3 (GRAIN SIZE 3) and DEP1 (DENSE AND ERECT PANICLE 1), represents new strategies to simultaneously increase grain yield and nitrogen use efficiency in rice. This review discusses the latest advances in our understanding of the heterotrimeric G protein signal transduction pathway and its application in improving yield and stress tolerance in crops.



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Prognostic significance of p53 expression in patients with esophageal cancer: A meta-analysis

BMC Cancer

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Genetic predisposition to obesity is associated with insulin secretion in Chinese adults: The Cardiometabolic Risk in Chinese (CRC) study

Journal of Diabetes and its Complications

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The Chinese medicine Kuan-Sin-Yin improves liver function in patients with chronic hepatitis C: A randomised and placebo-controlled trial

Complementary Therapies in Medicine

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Advantages of radial volumetric breath-hold examination (VIBE) with k-space weighted image contrast reconstruction (KWIC) over Cartesian VIBE in liver imaging of volunteers simulating inadequate or no breath-holding ability

European Radiology

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Celiac disease: Understanding the gluten-free diet

European Journal of Nutrition

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Pharmacologic provocation combined with endoscopy in refractory cases of GI bleeding

Gastrointestinal Endoscopy

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Efficacy observation on acupuncture for diabetic gastroparesis

Journal of Acupuncture and Tuina Science

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Features of autoimmune hepatitis in patients with drug-induced liver injury

Clinical Gastroenterology and Hepatology

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PreS deletion profiles of hepatitis B virus (HBV) are associated with clinical presentations of chronic HBV infection

Journal of Clinical Virology

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Morphology of the pancreas in type 2 diabetes: Effect of weight loss with or without normalisation of insulin secretory capacity

Diabetologia - Clinical and Experimental Diabetes and Metabolism

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Impact of single- vs. split-dose low-volume bowel preparations on bowel movement kinetics, patient inconvenience, and polyp detection: A prospective trial

The American Journal of Gastroenterology

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The effect of Clostridium butyricum MIYAIRI on the prevention of pouchitis and alteration of the microbiota profile in patients with ulcerative colitis

Surgery Today

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The GerdQ questionnaire and high resolution manometry support the hypothesis that proton pump inhibitor-responsive oesophageal eosinophilia is a GERD-related phenomenon

Alimentary Pharmacology and Therapeutics

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Liver stiffness measurement using acoustic radiation force impulse elastography in overweight and obese patients

Alimentary Pharmacology and Therapeutics

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Location of primary tumor and benefit from anti-epidermal growth factor receptor monoclonal antibodies in patients with RAS and BRAF wild-type metastatic colorectal cancer

The Oncologist

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A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women

Clinical Nutrition

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Integrated community case management and community-based health planning and services: A cross sectional study on the effectiveness of the national implementation for the treatment of malaria, diarrhoea and pneumonia

Malaria Journal

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Association between the Specific UGT1A1 Promoter Sequence Variant (c-3279T>G) and Unconjugated Neonatal Hyperbilirubinemia

Journal of Tropical Pediatrics

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Optimal postoperative nutrition support for patients with gastrointestinal malignancy: A systematic review and meta-analysis

Clinical Nutrition

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Intravenous and oral contrast vs intravenous contrast alone computed tomography for the visualization of appendix and diagnosis of appendicitis in adult emergency department patients

Canadian Association of Radiologists Journal

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A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Nerve Block for Analgesia in Arthroscopic Shoulder Surgery: An Equivalence Study.

Background and Objectives: The primary objective of this study was to compare the analgesic efficacy of combined suprascapular and axillary nerve block (SSAX) with interscalene block (ISB) after arthroscopic shoulder surgery. Our hypothesis was that ultrasound-guided SSAX would provide postoperative analgesia equivalent to ISB. Methods: Sixty adult patients undergoing arthroscopic shoulder surgery received either SSAX or ISB prior to general anesthesia, in a randomized fashion. Pain scores, satisfaction, and adverse effects were recorded in the recovery room, 6 hours, 24 hours, and 7 days after surgery. Results: Combined suprascapular and axillary nerve block provided nonequivalent analgesia when compared with ISB at different time points postoperatively, except on postoperative day 7. Interscalene block had better mean static pain score in the recovery room (ISB 1.80 [95% confidence interval [CI], 1.10-2.50] vs SSAX 5.45 [95% CI, 4.40-6.49; P

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Analgesic Effects of Ultrasound-Guided Serratus-Intercostal Plane Block and Ultrasound-Guided Intermediate Cervical Plexus Block After Single-Incision Transaxillary Robotic Thyroidectomy: A Prospective, Randomized, Controlled Trial.

Background and Objectives: Single-incision transaxillary robotic thyroidectomy (START) requires substantial tissue disruption, which produces moderate-to-severe pain in the axilla and neck areas during the early postoperative period. This study aimed to investigate the analgesic effects of ultrasound-guided serratus-intercostal plane blocks and intermediate cervical plexus blocks (CPBs) on the early postoperative pain after START. Methods: We randomized 22 patients to undergo either ultrasound-guided serratus-intercostal plane and intermediate CPBs (the block group, n = 11) or to not undergo any block (the control group, n = 11). We compared postoperative axillary pain, postoperative neck pain, and analgesic use between the groups during the first 24 hours. The rescue analgesics were intravenous fentanyl (0.5 [mu]g/kg) in the postanesthesia care unit, and intravenous ketorolac tromethamine (30 mg) in the general ward. Results: The block group showed consistently lower pain scores than the control group in the axillary area in the first 24 hours and in the neck area only in the first 3 hours after surgery. The numbers (proportions) of patients who required analgesics were 11 (100%) in the control group and 6 (54.5%) in the block group during the first 24 hours (P = 0.035). No adverse effect was observed related to the peripheral nerve blocks. Conclusions: After START, a serratus-intercostal plane block performed at the level of the third rib was an effective analgesic technique for axillary pain; however, the clinical effectiveness of intermediate CPB for neck pain may be limited. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty: A Meta-Analysis.

Background: Recent studies have yielded conflicting results on the association between anesthesia technique and incidence of postoperative surgical site infections (SSIs) after knee arthroplasty (KA) and hip arthroplasty (HA). Our group conducted a meta-analysis of all available studies to clarify this potential association. Methods: Our group searched MEDLINE, EMBASE, and Google Scholar for all relevant studies (1990-2015) reporting on the association between anesthetic technique and SSI after KA or HA. Meta-analysis was performed to estimate both the pooled unadjusted odds ratio (OR) and adjusted OR (aOR) using a random-effects model. Subgroup analyses and metaregression were conducted to explore potential sources of heterogeneity and bias. Results: Of the initial 435 records, 13 studies (n = 362,029) met the inclusion criteria. The use of neuraxial anesthesia was associated with a significant reduction in incidence of postoperative SSI as compared with general anesthesia for all arthroplasties based on unadjusted (OR, 0.77; 95% confidence interval [CI], 0.70-0.86; P

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Five-Year Follow-Up of High-Risk Infants with Family History of Allergy Who Were Exclusively Breast-Fed or Fed Partial Whey Hydrolysate, Soy, and Conventional Cow's Milk Formulas: Expression of Serious Concern.

No abstract available

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Double Lumen Poliamid Tube-Stent for the Treatment of Recurrent Post-corrosive Oesophageal Stenosis.

This paper presents the results of endoscopic treatment for recurrent post-corrosive oesophageal stenosis with a tube-stent developed at our institution. The tube-stent was implanted in five children with corrosive oesophageal injury at the age of 2-8.5 years after 7-64 dilatation sessions over 5-118 months. In total, 13 tube-stent were implanted. One patient had nine procedures over 2.5 years and the tube-stent remained in place for 14-250 days. This patient was tube-stent-dependent due to the lack of any possibility of surgical reconstruction. Two patients had the tube-stent removed after 150-205 days and they remain free from oesophageal restenosis. One patient did not tolerate the tube-stent, evacuated it after 1 day and was referred for surgical oesophagus replacement. One patient is currently still being treated with the tube-stent. Tube-stent was well tolerated and it may be effective in children with recurrent critical post-corrosive oesophageal stenosis. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Acute-on-chronic Liver Failure in Children: a Separate Clinical Entity.

No abstract available

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Outcomes of Children With and Without Hepatic Encephalopathy from the Pediatric Acute Liver Failure (PALF) Study Group.

Objective: Hepatic encephalopathy (HE) is challenging to identify in children with acute liver failure (ALF), and was not a requirement for enrollment into the Pediatric ALF Study Group (PALFSG). The outcomes of PALFSG participants presenting with and without HE are presented. Methods: PALFSG participants were classified based on daily assessment of HE during the first 7 days following study enrollment: Group1 - never developed HE; Group2 - no HE at enrollment with subsequent HE development; and Group 3 - HE at study enrollment. Clinical and biochemical parameters and outcomes of death, spontaneous recovery (SR), or liver transplantation (LT) were compared between groups. Results: Data from 769PALFSG (54% male; median age 4.2 years; range 0-17.9 years) participants were analyzed, with 277 in Group 1 (36%), 83 in Group 2 (11%) and 409 in Group 3 (53%). Mortality occurred in 11% of all participants and was highest among Group 3 participants who demonstrated persistent grade III-IV HE (55%) or showed progression of HE (26%). Eleven (4%) Group 1 participants died within 21 days of enrollment. SR was highest in Group 1 (79%) and lowest in Group 2 (25%; p

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