Παρασκευή, 12 Αυγούστου 2016

Archbishop has severe allergic reaction to acetaminophen

By Associated Press

MILWAUKEE — Milwaukee's archbishop says his guardian angel was working overtime when he had a severe allergic reaction to acetaminophen that could have been deadly.

Archbishop Jerome Listecki tells WISN-TV that he took some cough medicine before heading to a meeting Monday and didn't realize it contained the Tylenol ingredient acetaminophen. His face and throat began to swell and soon he could only whisper and was having trouble breathing.

Listecki says he was able to walk to the parking lot and call 911. Paramedics gave him an epinephrine shot and a priest gave him the sacrament of the sick.

The archbishop says he received another shot of epinephrine in the ambulance and was kept overnight at Columbia St. Mary's Hospital.



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Driver Engineer/Paramedic or EMT - Citrus Sheriff Fire Rescue

CITRUS SHERIFF FIRE RESCUE 1 DR. MARTIN LUTHER KING JR. AVENUE INVERNESS, FLORIDA 34450 Updated: August 09, 2016 Classification: Driver Engineer/Paramedic or EMT The Citrus Sheriff Fire Rescue is currently building an ongoing eligibility list for Driver Engineer/Paramedic or EMT. The department anticipates hiring for 4 open positions in the upcoming future. Citrus County requires both FireTEAM and a ...

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Paramedic (Domestic Project Team) - Remote Medical International

Domestic Project Team (DPT) Culture: We are seeking candidates that are truly passionate about providing excellent clinical care in proactive, professional, and diplomatic manner. This role is more than a mere set of requirements; it is an opportunity for you share your professional aspirations in an environment which encourages innovative practices, flexibility, and professional growth. If you are ...

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Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system

The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We st...

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Evaluate all newly diagnosed mild-moderate renal dysfunction patients for primary hypothyroidism

2016-08-12T06-59-24Z
Source: International Journal of Research in Medical Sciences
Karethimmaiah Hareesha Babu, Vijaya Sarathi, Rakesh Boppana.
Background: Hypothyroidism often presents to nephrologists with elevated serum creatinine which may lead to unnecessary evaluation including renal biopsy. Methods: We retrospectively analysed the data of 24 patients who presented to the department of nephrology at our institute with anasarca/facial puffiness or elevated serum creatinine and diagnosed to have hypothyroidism with TSH >40 µIU/ml. Results: Twelve patients presented with generalised edema, eight patients for evaluation of deranged serum creatinine and four patients with both generalised edema and deranged serum creatinine. Age (r=0.696, p


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Drug prescribing pattern in ulcerative colitis in a tertiary care hospital: an observational study

2016-08-12T06-39-58Z
Source: International Journal of Basic & Clinical Pharmacology
Mukunda Narayanareddy, Eesha B. R., Tara V. Shanbhag, Smita Shenoy.
Background: Ulcerative colitis (UC) is an inflammatory disease of colon and rectum of uncertain etiology. The clinical course of UC is marked by exacerbations and remissions. Furthermore there is limited data available on the management of ulcerative colitis from India. Hence, the present study was undertaken to study the drug prescribing pattern in ulcerative colitis. Methods: A retrospective case record based observational study was done at Kasturba Hospital, Manipal, India from 1st January 2009 to 31st December 2010. Patients diagnosed to have UC during our study period based on clinical, endoscopic and histopathological evidence were included in the study. SPSS 17 software package was used for statistical calculations. Descriptive statistics was used to analyze the data. Results: The total number of patients diagnosed to have UC during our study period was 83.The peak incidence of disease was in the age group of 30-39 years and it was more common in males. The prescription rate of aminosalicylates, glucocorticoids and immunosuppressants were 96.3, 54.3, and 18.5% respectively. Mesalamine, prednisolone, and azathioprine were the commonly prescribed drugs in each class. The commonly prescribed treatment regimen was combination of aminosalicylates with glucocorticoids (43.2%). Conclusions: Ulcerative colitis was more common in males. Aminosalicylates were the commonly prescribed drugs and a combination of aminosalicylate and steroid was frequently used regimen in our study.


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Evaluation of the anti-inflammatory activity of dipyridamole in acute and chronic experimental models in albino rats

2016-08-12T06-39-58Z
Source: International Journal of Basic & Clinical Pharmacology
Vishwaprakash M. K., Laveesh M. R., Somashekara S.C.
Background: Cyclic nucleotides, particularly cyclic AMP, have an important regulatory role in a variety of inflammatory processes. The concentration of cAMP can be influenced by either inhibition of phosphodiesterase enzyme or by activating adenylate cyclase enzyme. The present study was undertaken to evaluate the anti-inflammatory activity of dipyridamole a selective (PDE6) phosphodiesterase inhibitor; on acute and chronic experimental models in albino rats. Methods: Anti-inflammatory activity was evaluated by using carrageenan-induced rat hind paw oedema model for assessing acute anti-inflammatory activity. The normal paw volume (0 hour) and the volume of injected paw (3 hour) were measured by using plethysmometer. Assessment of chronic anti-inflammatory activity was carried out using formalin-induced rat paw edema model. The paw volume was measured at 0 hour and on 7th day after injection of formalin by using plethysmometer. The results obtained were compared with the control and the standard anti-inflammatory drug, indomethacin. Results: The results indicated that dipyridamole has anti-inflammatory action in both acute and chronic inflammatory models. But statistically significant anti-inflammatory action was seen only with the chronic inflammatory model (0.11±0.05 units, p=0.02). Anti-inflammatory activity could be due to inhibition of inflammatory cells and mediators especially histamine, leukotrienes and eicosanoids. Conclusions: Selective phosphodiesterase inhibitors could be a source of valuable anti-inflammatory drugs, in addition to currently available steroidal and non-steroidal anti-inflammatory agents.


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Awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone patients: A pilot observational study.

Awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone patients: A pilot observational study.

Medicine (Baltimore). 2016 Aug;95(32):e4440

Authors: Heng L, Wang MY, Sun HL, Zhu SS

Abstract
Anesthesia followed by placement in the prone position takes time and may result in complications. This study aimed to evaluate the feasibility of awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone-positioned patients under general anesthesia.Sixty-two patients (ASA physical status I-II) scheduled for awake nasotracheal fiberoptic intubation and prone self-positioning before surgery under general anesthesia were selected. Patient preparation began with detailed preoperative counseling regarding the procedure. Premedication with sedative and antisialagogue was followed by airway anesthesia with topical lidocaine; then, awake nasotracheal fiberoptic intubation was carried out. The patients then positioned themselves comfortably before induction of general anesthesia. The changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), incidence of coughing or gagging, and rate pressure product (RPP) were assessed. Statistical analysis was performed with repeated-measures one-way analysis of variance.Fifty-eight of the 62 patients completed prone self-positioning smoothly. Compared with values before intubation, SBP, DBP, HR, and RPP were slightly increased after intubation, although the difference was not statistically significant (P > 0.05). One patient had moderate coughing and 1 patient had gagging during prone self-positioning, which were tolerable.These findings indicated that awake nasotracheal fiberoptic intubation and self-positioning followed by induction of anesthesia is safe and feasible alternative to routine prone positioning after induction of general anesthesia.

PMID: 27512858 [PubMed - as supplied by publisher]



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Feasibility of establishing and operationalizing basic Health and Demographic Surveillance System (HDSS) in rural area of northern India

2016-08-12T04-30-58Z
Source: International Journal of Medical Science and Public Health
Suresh Kotwal, Dinesh Kumar, Shivwani Thakur, Tajali Nazir Shora, Deepika Dewan, Kiran Bala.
Background: Success of public health programmes is dependent on its inherent flexibility to continually incorporate new evidence and new experiences made available through timely, accurate, and relevant information. Unfortunately, routine health management information systems do not provide desired inputs at appropriate times. Objective: To ascertain the feasibility of establishing and operationalizing health and demographic surveillance system (HDSS) in a defined rural population of district Jammu. Materials and Methods: The present study was carried out in 6 villages in field practice area of Postgraduate Department of Community Medicine, Government Medical College Jammu selected using multistage random sampling methodology. Study area was mapped manually and by using geographic information system (GPS Etrax® system) depicting all households and associated landmarks. All the households were listed and assigned an alphanumeric unique identification number. Information on predesigned formats was then obtained from all listed households at initial and subsequent visit made at 6 months. Possibility of linking facility based data was also studied. Verbal autopsy was conducted as per International network for the demographic evaluation of populations and their health (INDEPTH) standardized verbal autopsy proforma. Result: An HDSS was visibly functional within 6 months time of initiation of the project using available manpower, space, and local support. No constraints were felt with regard to availability of separate space for HDSS as it was provided unconditionally either by the health care institution or panchayat. Local health workers and volunteers were retrained by the investigator for which no extra funds were needed. However, no vehicle for transportation was available, therefore personal vehicle was used to move from one village to another. It took 113 days (553 h) for a team of one investigator, one health worker and one volunteer to complete mapping, assign unique identification numbers, and collect baseline information of 1030 household spread over 3.56 km2. Repeat survey took 60% less time i.e., 45 days or 225 h. Each household consumed 1525 min on initial visit and 10 min on follow-up. A single verbal autopsy took longer time (60 min) to complete. Conclusion: The study demonstrated that HDSS can be established and operationalized using available human and non-human resources albeit with little training and technical assistance. No significant bottlenecks were encountered in operationalizing HDSS. Vehicle, upgradation of available space, data management tools, incentive for staff, and volunteers would be needed to sustain HDSS.


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Pyschological factors affecting dietary habits of college going adolescents (17–19 years) in urban area of Belgaum

2016-08-12T04-30-58Z
Source: International Journal of Medical Science and Public Health
Sneha Naidu, Sulakshana Shridhar Baliga, Harika Yadav, Maheshwar D Mallapur.
Background: In India due to urbanization and various other factors, students are less focused on eating healthy and tend to eat for various other reasons such as when they are bored, depressed, or for the sake of going out with friends. Poor eating habits such as binge eating is a major public health concern among college students who experience transition into university life and has led to increased risk of obesity and other diseases. Objective: To determine the psychological factors affecting the dietary patterns of adolescents. Materials and Methods: Cross-sectional study conducted among 400 college going adolescents (1719 years) residing in urban area of Belagavi. Questions were selected from the validated compulsive eating scale (CES) that was used to measure uncontrolled eating patterns. Result: Of the total number of students 18.4% were seen to eat when they feel lonely, 40.8% completely stuffed themselves with food, 40.8% ate when they felt bored. While, 64.5% of students said that they never ate without knowing how much they ate or the taste of food, 35.5% of them still ate without knowing the taste of the food. 23.5% of the participants said that they ate till their stomachs hurt. Conclusion: It was seen in this study that various psychological factors affected a large number of students eating habits. Hence it is important to provide them health education and formulate strategies which will address social and psychological factors which will affect their eating pattern.


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An evaluation of prevalence and prescribing patterns of rational and irrational fixed dose combinations (FDCs): a hospital based study

2016-08-12T04-30-58Z
Source: International Journal of Medical Science and Public Health
Supriya Pradhan, Abinash Panda, Sarita Sahu, Jayanti Prava Behera.
Background: Fixed-dose combinations (FDCs) are combinations of two or more active drugs produced in a single dosage form and are used in the treatment of a wide range of ailments. Objective: The objective was to find out prevalence, prescribing pattern, and rationality of FDC amongst patients attending out-patients department of medicine in a tertiary care teaching hospital. Materials and Methods: A hospital based prospective cross sectional observational study based on a convenience sample of 620 prescriptions carried out in between May 2015 and July. A seven point tool was developed based on the WHO guideline to evaluate the rationality FDCs. The format for the collection of data were to include patients demographic information such as name, age, sex, social history, family history, as well as medication information, diagnosis, and current treatment regimen given by prescriber. Collected prescriptions were screened for fixed dose combinations and analysed for prevalence, prescribing pattern, and rationality. Result: Prevalence of FDCs in the prescription was 81.31%. Brand names were used in 82.78% of the prescriptions. FDCs containing nutritional supplements containing vitamins and minerals are prescribed for maximum numbers (20.48%). About 70% of FDCs were irrational, where 17.71% were either controversial or banned and 15.83% were rational. Conclusion: The prevalence of irrational prescribing of FDC is high. To minimize the pattern, educating the prescribers about rational prescribing is essential. A relook and rationalization may be required in the use of combination product.


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EVALUATE THE ANTIOXIDANT ACTIVITY AND FT-IR SPECTROSCOPIC ANALYSIS OF PURIFIED β-GALACTOSIDASE FROM ASPERGILLUS TERREUS

2016-08-12T04-14-36Z
Source: Indo American Journal of Pharmaceutical Research
B. Vidya, M. Palaniswamy, S. Sowmya, S. Priyanga, P. Chella Perumal, K. Devaki, V. K. Gopalakrishnan*.
Aim: To evaluate the antioxidant activity and FT-IR spectroscopic analysis of β-galactosidase from newly isolated fungal strain, Aspergillus terreus. Methods: In vitro antioxidant activity was evaluated by different assays, including reducing power assay, 2,2-diphenylpicryl-1-picrylhydrazyl (DPPH) radical scavenging, 2,2'azinobis 3-ethylbenzothiozoline-6-sulfonic acid (ABTS+) assay, hydroxyl radical activity (OH.), hydrogen peroxide (H2O2), nitric oxide radical (NO), superoxide radical scavenging assays using ascorbic acid as a standard. The functional groups were analyzed by using FTIR spectroscopy. The FT-IR spectrum in the mid-infrared region 4000400 cm1 was used for discrimination and to categorize various functional groups present in β-galactosidase. Results: The findings indicated that the β-galactosidase posses antioxidant activities were significantly increased, comparable with that of the standard ascorbic acid, in a dose-dependent manner. Conclusion: The results revealed that β-galactosidase from newly isolated fungal strain Aspergillus terreus have promising antioxidant activity and it further exploration for their potential effective use.


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MIDFACIAL BONE FRACTURE: DETERMINING THE ETIOLOGY, SITES OF FRACTURE AND DIFFERENT TREATMENT APPROACHES

2016-08-12T04-14-36Z
Source: Indo American Journal of Pharmaceutical Research
Dr. Bikash Desar, Dr. Rajani Shakya.
Objective: The main objective of this study was to locate the fracture of midface and treatment modalities of the same through different approaches. Materials and methods: The patients treated for midfacial bone fractures at the oral and maxillofacial surgery department of Kantipur Dental College Teaching Hospital and Research center during a two-year period between January 2014 and December 2015 were retrospectively analyzed for age, sex and type of injury, cause of fractures, consciousness status and alcohol abuse during trauma. Results: 304 patents were included in the study, 183(60%) males and 121 (40%) females, with a total of 412 fractures. Physical assaults were the most common cause both in young patients and adult patients (43 %) and (47%) respectively. Commonest fracture sites were buttress (32%) and zygomatic arch (20%) in young patients and zygomatic arch (34%) and fronto-zygomatic suture (30%) in adults. Midface fractures is generally treated by mini plate osteosynthesis (69%) both in young and adult patients. Conclusion: This study revealed that the main cause of midfacial fracture is physical assault both in young and adult patients (43%) and (47%) followed by falls (37%) and (22%) respectively. Preventive health care programs should seek measures in the reduction of aggression and violence in close future involving family, school and community institutions.


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APPRAISAL OF POTENTIALLY INAPPROPRIATE MEDICATIONS AND WHO PRESCRIBING INDICATORS IN ELDERLY PATIENTS IN A NEUROPSYCHIATRY SETTING USING BEER’S CRITERIA-2015

2016-08-12T04-14-36Z
Source: Indo American Journal of Pharmaceutical Research
Ansu Anna Dan*, Geethu C, Josna James, Supriya A, Hemalatha S, Dr. Sivakumar T.
Potentially inappropriate medications (PIMs) is described as a drug in which the risk of an adverse event when there is a safer alternate therapy is available. Beers criteria which is used as a guideline describes medications or medication classes, which are potentially inappropriate and need to be avoided or to be used with caution for elderly. WHO has established a set of core prescribing indicators for improving the rationality of drug use. Our aim is to evaluate the use of potentially inappropriate medications and prescriptions using WHO prescribing indicators in elderly. A prospective observational study was carried out in the neuropsychiatry government run tertiary care hospital in Northern India over a period of 3 months from January 2016-March 2016 using Beers Criteria and WHO prescribing indicators.Out of 1128 study subjects 56.1% were male and 43.9% females. The findings revealed that 73.3% PIMsconstituting Anticonvulsants (23.5%), Benzodiazepines (15.6%), Antipsychotics (11.9%), Selective Serotonin Reuptake Inhibitors (7.8%), Anticholinergics (7.4%), Tricyclic Antidepressants(6.7%) were predominantly prescribed. As supportive medications Vitamins, Minerals, Laxatives, Proton Pump Inhibitors were also given at a high rate of 26.7%. The assessment of WHO prescribing indicators includes average number of drugs per patient was 3.1%, 72% in generic name, percentage of antibiotics encounters were 2.1% while 1.6%. Percentage of encounters with injection and only 62% drugs were from Essential Drugs List (EDL). It is evident from our study that the neuropsychiatric diseases are treated mostly with PIMs and continuous assessment of prescription is necessary to improve the rationality of drug use.


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Grading of surgeon technical performance predicts postoperative pancreatic fistula for pancreaticoduodenectomy independent of patient-related variables

Annals of Surgery

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Adding ribavirin to newer DAA regimens does not affect SVR rates in HCV genotype 1 infected persons: Results from ERCHIVES

Alimentary Pharmacology and Therapeutics

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Metabolically healthy obesity is associated with an increased risk of diabetes independently of nonalcoholic fatty liver disease

Obesity

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RECENT ADVANCES IN TOPICAL DRUG DELIVERY SYSTEM

2016-08-12T04-14-36Z
Source: Indo American Journal of Pharmaceutical Research
Jotinder Kaur, Jasmeen Kaur, Sandhya Jaiswal, Ghanshyam Das Gupta*.
Optimum therapeutic outcomes requires not only proper drug selection but also effective delivery of drug. Over the past three decades, controlled drug delivery has become increasingly important in the pharmaceutical industry. The pharmacological response, i.e desired therapeutic and undesired therapeutic effect of a drug depends on concentration of drug reached to its site of action and in turn depends on dosage form. With conventional drug delivery systems, poor patient compliance is a major problem observed in clinical practice. Human skin is a readily accessible surface of drug delivery. The potential of using skin as a target has been recognized but its outermost layer acts as a barrier to the ingress of materials allowing only small molecules to penetrate over a period of time. Recently various strategies has been used to evade the stratum corneum and to increase flux through the skin membrane using different permeation enhancement techniques. For a drug to be delivered passively via skin needs to have enough lipophilicity and also a molecular weight less than 500 Da. These requirements have restricted the number of commercially available commodities based on transdermal or dermal delivery. Therefore the key function of a topical delivery system is to enhance the dermal permeability enabling it to cross the epidermis and retain in the dermis. The aim of this paper is to review non-invasive topical drug delivery employing sophisticated carrier systems leading to advancements in dosage forms.


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Phase I study of PF-03446962, a fully human monoclonal antibody against activin receptor-like kinase-1, in patients with hepatocellular carcinoma

Annals of Oncology

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Predictive global trends in the incidence and mortality of pancreatic cancer based on geographic location, socio-economic status, and demographic shift

Journal of Surgical Oncology

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Type 1 and type 2 diabetes in celiac disease: prevalence and effect on clinical and histological presentation

BMC Gastroenterology

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Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: A prospective study of 417 patients with long-term follow-up

Surgical Endoscopy

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Earlier detection of hepatitis C virus infection through routine hepatitis C virus antibody screening of human immunodeficiency virus-positive men who have sex with men attending a sexually transmitted infection outpatient clinic: A longitudinal study

Sexually Transmitted Diseases

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Computed tomography utilization for the diagnosis of acute appendicitis in children decreases with a diagnostic algorithm

Annals of Surgery

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The RNAs of RNA-directed DNA methylation

Publication date: Available online 10 August 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Jered M. Wendte, Craig S. Pikaard
RNA-directed chromatin modification that includes cytosine methylation silences transposable elements in both plants and mammals, contributing to genome defense and stability. In Arabidopsis thaliana, most RNA-directed DNA methylation (RdDM) is guided by small RNAs derived from double-stranded precursors synthesized at cytosine-methylated loci by nuclear multisubunit RNA Polymerase IV (Pol IV), in close partnership with the RNA-dependent RNA polymerase, RDR2. These small RNAs help keep transposons transcriptionally inactive. However, if transposons escape silencing, and are transcribed by multisubunit RNA polymerase II (Pol II), their mRNAs can be recognized and degraded, generating small RNAs that can also guide initial DNA methylation, thereby enabling subsequent Pol IV-RDR2 recruitment. In both pathways, the small RNAs find their target sites by interacting with longer noncoding RNAs synthesized by multisubunit RNA Polymerase V (Pol V). Despite a decade of progress, numerous questions remain concerning the initiation, synthesis, processing, size and features of the RNAs that drive RdDM. Here, we review recent insights, questions and controversies concerning RNAs produced by Pols IV and V, and their functions in RdDM. We also provide new data concerning Pol V transcript 5' and 3' ends. This article is part of a Special Issue entitled: Plant Gene Regulatory Mechanisms and Networks.



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A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults

BMC Gastroenterology

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Diversity, expansion, and evolutionary novelty of plant DNA-binding transcription factor families

Publication date: Available online 10 August 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Melissa Lehti-Shiu, Nicholas Panchy, Peipei Wang, Sahra Uygun, Shin-Han Shiu
Plant transcription factors (TFs) that interact with specific sequences via DNA-binding domains are crucial for regulating transcriptional initiation. These TFs are fundamental to plant development and environmental response. In addition, expansion of transcription factor families has allowed functional divergence of duplicate copies, which has contributed to novel, and in some cases adaptive, traits in plants. Thus, TFs are central to the generation of the diverse plant species that we see today. Major plant agronomic traits, including those relevant to domestication, have also frequently arisen through changes in TF coding sequence or expression patterns. Here our goal is to provide an overview of plant TF evolution by first comparing diversity of the DNA-binding domains and sizes of these domain families found in plants and other eukaryotes. Because plant TFs are among the most highly expanded gene families in plants, the birth and death process of TFs as well as the mechanisms contributing to their retention are discussed. We also provide recent examples of how TFs have contributed to novel traits that are important in plant evolution and in agriculture.



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Efficacy of repeated intraperitoneal administration of levobupivacaine in pain and opioid consumption after elective laparoscopic cholecystectomy: A prospective randomized placebo-controlled trial

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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Sweet-beverage consumption and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition

American Journal of Clinical Nutrition

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A randomized controlled trial on the effect of vitamin D3 on inflammation and cathelicidin gene expression in ulcerative colitis patients

Saudi Journal of Gastroenterology

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Management of esophageal perforation in the endoscopic era: Is operative repair still relevant?

Surgery

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Analysis of esophagogastric cancer patients enrolled in the National Cancer Institute Cancer Therapy Evaluation Program sponsored phase 1 trials

Gastric Cancer

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No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA Trial (ISRCTN04937707)

Annals of Surgery

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Specific immunotherapy ameliorates ulcerative colitis

Allergy, Asthma & Clinical Immunology

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Esophageal inlet patch: an under-recognized cause of symptoms in children

The Journal of Pediatrics

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MUCOADHESIVE VAGINAL DRUG DELIVERY SYSTEM: AN OVERVIEW

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
Amandeep Kaur*, Ramandeep Kaur, Sandhya Jaiswal, Ghanshyam Das Gupta.
There are various routes of drug delivery, the vaginal route of drug delivery have many advantages due to large permeation area of vagina, having rich vascularization, no first pass metabolism, prolongation of drug action, even distribution of drug and relatively low enzymatic activity. Several studies have shown that the vaginal cavity is an effective pathway for drug administration rather than other conventional system for vaginal infection treatments. It has the potential to deliver the drugs for systemic effects and uterine treatment. The commercial preparations like creams, foams, gels, irrigations and tablets, are inserted in the vaginal cavity for a relatively short period of time and required to ensure the desired therapeutic effect. The vaginal route appears is highly appropriate for bioadhesive drug delivery systems in order to retain drugs in vagina for treating largely local conditions, or for use in contraception. Boiadhesives are mainly used for sexually-transmitted diseases. Bioadhesive therapeutic systems have been developed in the form of semi-solid and solid dosage forms to prolong the residence time of in vaginal cavity. Mucoadhesive polymers such as chitoson, pectin, synthetic polyacrylates, polycarbophil, cellulose derivatives, carrageenan, hyaluronic acid derivatives, pectin, sodiumalginate, and tragacanth are responsible for forming hydrogels. The present article is a comprehensive review of the mucoadhesive vaginal drug delivery systems.


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A REVIEW ON NOVEL APPROACH OF ANTIFUNGAL EMULGEL FOR TOPICAL DELIVERY IN FUNGAL INFECTIONS

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
Jasmeen Kaur, Jotinder Kaur, Sandhya Jaiswal, Ghanshyam Das Gupta*.
Fungal infections of the skin are one of the most frequently challenged dermatological diseases in world. Topical therapy is better choice for the treatment of cutaneous infections. The key feature of topical delivery is direct approachability via skin as a target for treatment resulting to increase in bioavailability and deduction in side effects. Currently, conventional creams and gel preparations are commercially available for topical treatment. Gels have a major restraint for delivery of hydrophobic drugs. So, to overcome this constraint, an emulsion based approach is considered. Emulgels are combination of gel and emulsion technique and have a high ability to penetrate the skin. It has emerged as one of the most prevailing delivery systems for hydrophobic drugs due to their dual control release system i.e. gel and emulsion. The main objective is to develop jellified emulsion to decrease the systemic side effects and to create pronounced effect with lower doses of the drug. In recent years there has been great interest in the use of novel polymers with complex function such as emulsifier and thickeners. The gelling capacity of these compounds allows stable formulation by decreasing surface, interfacial tension resulting in increase in viscosity of aqueous phase. Various permeation enhancers can potentiate its effect. So, the present review concludes that emulgels are most promising system having major advantages on conventional systems, as a result it can be explored for topical drug delivery.


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ANTI-CANCER ACTIVITY OF SECONDARY METABOLITES FROM BAUHINIA VARIEGATA LINN. LEAF – AN IN SILICO APPROACH

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
Gayathri Gunalan *, K.Vijayalakshmi , T.Tamilvannan and Waheetha Hopper.
Plants and plant derived products are used for human healthcare since the dawn of human civilization. About 80% of modern drugs are from natural origin. Many dreadful diseases like cancer are treated using drugs of natural origin. In the present study, a medicinal plant B.variegata linn. leaves were investigated for its anti - colon cancer activity using COLO 320 cell lines. The active fractions were isolated by bioactivity guided fractionation and subjected to GC-MS analysis to identify the bioactive compounds. The aim of the present study was to identify potential lead compounds against various protein targets that are involved in colon carcinogenesis using molecular docking approach. 3D structures of compounds reported from GCMS analysis of active fractions of B.variegata were built using Chemsketch software. All the compounds analyzed exhibited anticancer, antiviral, antibacterial, antineoplastic, antidiabetic and anti-inflammatory properties. Docking studies were performed using Glide (Grid-based Ligand Docking with Energetics) Extra Precision (XP) 5.7 algorithm in Schrodinger Software Suite, 2011 analysis. Among the 33 ligands of the active fractions, eight ligands were found to have least glide score. Thus, the phytochemicals from the active fractions of B.variegata leaf was found to have appreciable anti-cancer activity.


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NEPHROPROTECTIVE ACTIVITY OF THE ETHANOLIC EXTRACT OF BOUGAINVILLAE SPECTABILIS LEAVES AGAINST GENTAMYCIN INDUCED RENAL DYSFUNCTION IN WISTAR RATS

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
V. Thushara Bindu*, S. Nelson Kumar, C. Rajaram, P. Ranga Swamy, S. Shabana.
The current study aimed at evaluating the protective effects of Bougainvillae spectabilis (Nyctaginaceae family) on renal dysfunction of Gentamycin induced wistar albino rats using biochemical approaches. Pinitol, betacyanine, flavonoids, tannins and alkaloids are the constituents reported for B. spectabilis. Nephrotoxicity is considered a prominent side effect of Aminoglycoside antibiotic, Gentamicin. The drug was induced intra peritoneally at a dose of 80 mg/ kg body weight for 9 days. One of the main factors in for Gentamycin induced Nephrotoxicity is the Oxidative stress. Ethanolic extract of B. spectabilis decreased the increased levels of blood urea, serum creatinine, urinary protein, and extent of renal dysfunction at dose levels of 200 and 400 mg/kg body weight in wistar albino rats.


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“FIGHT PSORIASIS NATURALLY THROUGH AYURVEDA”

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
Papola Vibhooti*, Dr. Kumar Ashok, Sah Shilpa, Nautiyal Himani.
Herbs have been one of the important and unique sources of medicines from the dawn of human civilization. Psoriasis is a common skin condition where the skin develops areas that become thick covered with silvery scales. It is a common problem, and millions of people in the world have psoriasis. Pathophysiology of the disease includes mainly the activation and migration of T cells to the dermis triggering the release of cytokines (tumor necrosis factor-alpha TNF-alpha, in particular) which lead to the inflammation and the rapid production of skin cells. The possible factors and triggers causing psoriasis include emotional stress, skin injury, systemic infections, certain medications and intestinal upsets. The herb which are used in the psoriasise disease are Aloe Vera (Aloe barbadensis), Olive Oil (Olea curopaea), Turmeric (Curcuma longa), Coleus (Coleus Forskohlii), Cayenne (Capsicum annuum) etc. Conclusion: These plants are being used for curing many diseases as such in raw condition rather the being prepared as formulation; Standardization is an essential parameter to be done. It is a vital step in formulation since it determines the quality of the product and is essential to develop a protocol on standardization of every product available in the market to avoid variation arising between batch to batch.


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ANTIBIOTICS SENSITIVITY AND RESISTANCE STUDIES AGAINST E.COLI IN KHAMMAM REGION

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
Suresh Kumar. P*, Niharika Kanuri, V. Tejaswi Sahithi, Keerthipriya Duggi, Satish Chandra Aithamraju, Sireesha A, Jagannath Patro V..
Background: We conducted an analysis on the identification of all bacteria that are isolated in urine and blood samples, over a period of one year in Khammam region. Methods: Analysis was performed on the identification of bacteria. Results: A total of 570 samples were isolated from the samples of both males and females of different age groups. In females of age groups below 20 years, between 20-40 years and above 40 years, E.coli was equally resistant to Amoxicillin (15%), Erythromycin (15%), Amikacin (15%), Norfloxacin (15%), Cotrimaxazole (15%), Cefuroxime (15%), Ciprofloxacin (15%) and it is sensitive to Azithromycin (40%), Moxifloxacin (40%), Nitrofurantoin (25%), Netilmycin (15%). In males of age groups below 20 years, between 20-40 years and above 40 years, E.coli was resistant to Cephalexin (25%), Nitrofurantoin (20%), Cefuroxime (20%), Cefotaxime (15%), Amoxicillin (15%), Doxycycline (15%) and it is sensitive to Moxifloxacin (28%), Ceftriaxone (25%), Ciprofloxacin (25%), Amikacin (25%), Ofloxacin (15%). Conclusion: We found that many of the antibiotics became resistant against E.coli and only few of the antibiotics are sensitive against E.coli.


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TRANSDERMAL UNANI FEMALE CONTRACEPTIVE FORMULATION: DESIGNING AND IN-VITRO TRANSDERMAL ACTIVITY EVALUATION

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
Tarannum*, Mohammad Idris.
The transdermal drug delivery system has an important place in the medical field. This delivery system has several advantages over the oral and parental route of drug administration. The concept of transdermal drug delivery system was already exists in the Unani system of medicine. Several dosage forms for transdermal drug delivery system in single as well as in compound formulation were mentioned in the classical literature of Unani system. Unani medicine is enriched with several drugs honored to possess antifertility property. Unani antifertility agents are recommended for both- male and female as oral and/or local application. Several single drugs as well as compound formulations are mentioned in Unani classical literature to control the fertility. With this background an effort was made with two objectives. First was to design a transdermal Unani female contraceptive formulation (TUFCF) based on four ingredients i.e. Leaves of Henna (Lawsonia inermis), rhizome of Pakhanbed (Bergenia ciliata), Sibr (Latex of Aloe barbadensis) and Khar-e-Chirchita (salt of Achyranthes aspera). Secondly to evaluate in-vitro transdermal penetration potential of the TUFCF by Franz diffusion cell method, qualitatively and quantitatively. Qualitatively the test formulation reveals significant presence of phytochemicals by chemical test method. Quantitatively it showed 35.07% release across the membrane. Hence, it was concluded that the test formulation possessed the transdermal activity.


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DRUG UTILISATION PATTERN IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A TERTIARY CARE TEACHING HOSPITAL

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
Vikneswari,, T. Tamizh Mani*.
Chronic Respiratory Diseases (CRD) such as Chronic Obstructive Pulmonary Disease (COPD) may account for an estimated burden of about 100 million individuals in India. The technique of drug utilization review (DUR) can provide useful means of determining whether drug use is as appropriate in treatment of individual patients. This was a Prospective study with the aim of analyse the drug prescribing pattern in Chronic obstructivepulmonary disease patients and the prescribing parameters in the collected prescription. The study has been conducted on male and female patients who were satisfying the inclusion criteria. A suitably designed case record form was prepared and used to record all the necessary and relevant data from the medical records of patients. A total of 250 patients were analysed in our study. Out of that 188 were males and 62 were females. The prescription of more than 3 drugs for one patient may be attributed to the possibility of some patients presenting with acute and chronic exacerbation of COPD with or without co-morbid conditions, which requires antibiotic and corticosteroid treatment. Antibiotics were mostly prescribed (19.2%), followed by anticholinergics (18.70%). Inhalation route (38.32%) was more preferred over parenteral (37.98%) and oral route (23.70%). In our study, we observed that the incidence of COPD was more common in males when compared to females. The majority of patients have intermittent exacerbations of COPD due to the inadequate pattern of drug use. GOLD guidelines can be properly followed for prescribing drugs for COPD and can be achieve total control of COPD.


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AN EFFICIENT NOVEL RESOLUTION OF DESMETHYLCITALOPRAM / BROMO DESMETHYLCITALOPRAM BY USING DI-P-TOLUOYL-D-TARTARIC ACID: A KEY INTERMEDIATES FOR ESCITALOPRAM COMMERCIAL SYNTHESIS

2016-08-12T02-13-49Z
Source: Indo American Journal of Pharmaceutical Research
Narsihma Reddy Bobbali,, Garimella. K. A. S. S. Narayan,*, Ranjith kumar. S, Umar khan Mohammed, Muniprasad M., Mamatha Bobbali.
The present research work reported here covers an innovation approach to synthesis the enantiopure Escitalopram, a widely used anti-depressants by involving four-step process viz., (i) desmethyl reaction of Citalopram / bromo Citalopram. (ii) Resolution of desmethylcitalopram /bromo desmethylcitalopram using Di-p-toluoyl-D-Tartaric acid (DPTTA) in methanol, which is subsequently given novel key intermediates to eventually give Escitalopram by means of diastereomeric salt formation and further, optimized the novel resolution condition and other key factors. The most striking feature of this process in the addition of specific quantity of methanol and all the optimized parameters of the resolution process details are discussed. (iii) Isolation of Desmethyl Escitalopram / Bromo desmethylescitalopram (iv) This step pertains to enantiomerically pure desmethylescitalopram on alkylation with formaldehyde give active pharmaceutical ingredient 1 with good yield (75-78%) and quality. (v) Another enantiomerically pure Bromo desmethylescitalopram on alkylation with formaldehyde and formic acid, followed by cyanation affords 1 with good yield (~70%) and quality. In the present research study describes the commercially feasible new synthetic process of Escitalopram 1 by the novel resolution of desmethylcitalopram/ bromo desmethylcitalopram with good yield and quality of the product.


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Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure

Abstract

Introduction

Complete mesocolic excision is currently recognized as a standard procedure for colon cancer. Gastroepiploic, infrapyloric, and superficial pancreatic head lymph node metastases in the gastrocolic ligament have been reported for colon cancer close to the hepatic flexure. We sought to investigate metastases in the gastrocolic ligament in colon cancer close to the hepatic flexure.

Methods

This was a single-center retrospective study. All patients with T2 or deeper invasive colon cancer in the relevant tumor location who underwent laparoscopic right hemicolectomy or extended right hemicolectomy at our institution between 1 April 2011 and 31 March 2015 were included.

Results

Lymph node dissection in the gastrocolic ligament was performed in 35 cases. Complications occurred in 11 patients (31%) and were grades I and II according to the Clavien–Dindo classification. Lymph node metastases in the gastrocolic ligament were found in only three patients (9%). Each metastasis was larger than 9 mm.

Conclusions

Metastases in the gastrocolic ligament occurred in 9% of patients with T2 or deeper invasive colon cancer close to the hepatic flexure. Laparoscopy was feasible and useful during gastrocolic ligament resection. This study included a small sample and lacked an extended follow-up. Further studies are needed to determine the clinical relevance of this finding, particularly in terms of recurrence and long-term survival.



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Normograms for the Extrahepatic Bile Duct Diameter in Children.

Objective: The normal diameter of the extrahepatic bile duct (EHD) in children has been poorly studied. Prior studies have enrolled small subject numbers, have studied only specific pediatric age groups or have potential bias due to loosely defined exclusion criteria. We sought to establish parameters for the normal diameter of the EHD in children from birth to late adolescence, including premature infants. Methods: A 121/2 month IRB-approved, HIPAA-compliant, retrospective chart review of all transabdominal ultrasounds performed on children (

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Insurance Among Young Adults with Inflammatory Bowel Disease: Changes Under the Affordable Care Act Dependent Provision.

Background: 20-30% of patients with inflammatory bowel disease (IBD) present before age 18 years, eventually requiring transfer to adult care. Vulnerability during transfer may be exacerbated by loss of insurance. A provision of the Affordable Care Act (ACA) allows young adults (YAs) to remain on parental private insurance through age 25 years. There has been a decrease in uninsured YAs since its implementation in 2010. Little is known about whether insurance coverage of YAs with IBD has been affected. Objective: To determine whether proportion of uninsured YAs with IBD has changed following implementation of extended dependent eligibility under the ACA. Design/Methods: We conducted a cross-sectional analysis of hospitalized patients with IBD, identified in the Nationwide Inpatient Sample (NIS) using diagnostic codes, to estimate proportions of insurance coverage during the years 2006-2013. We compared 19-25 year olds(yo) to 2-18 and 26-35 yo, unaffected by the provision, to account for underlying trends. Results: From 2006-2010 19-25 yo had the highest proportion uninsured, peaking at 14.1% in 2010. In 2011, the proportion decreased to 10.1%, below the proportion of uninsured 26-35 yo (13.1%), remaining in this range through 2013. Private coverage increased in 2011 for 19-25 yo, remaining stable for 26-35 yo. Discussion: Previous research cited 5% uninsured among all hospitalized patients with IBD. Our study indicates a higher proportion for YAs, decreasing after the ACA. Lack of insurance increases vulnerability during transfer, but may be modifiable through policy change. Further research should analyze effects of Medicaid expansion and health care exchanges. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Whey protein with potassium bicarbonate supplement attenuates the reduction in muscle oxidative capacity during 19 days bed rest.

The effectiveness of whey protein plus potassium bicarbonate enriched-diet (WP+KHCO3) to mitigate disuse-induced changes in muscle fibre oxidative capacity and capillarization was investigated in a 21-day crossover design bed rest study. Ten healthy men (31±6 years) once received WP+KHCO3 and once received a standardized isocaloric diet. Muscle biopsies were taken two days before and during the 19th day of bed rest (BR) from the soleus (SOL) and vastus lateralis (VL) muscle. Whole body aerobic power (VO2max), muscle fatigue and isometric strength of knee extensor and plantar flexor muscles were monitored. Muscle fiber types and capillaries were identified by immunohistochemistry. Fiber oxidative capacity was determined as the optical density (OD) at 660 nm of succinate dehydrogenase (SDH)-stained sections. The product of fiber cross-sectional area and SDH-OD (integrated SDH) indicated the maximal oxygen consumption of that fiber. The maximal oxygen consumption supported by a capillary was calculated as the integrated SDH in its supply area. BR reduced isometric strength of knee extensor muscles (P<0.05), and the fiber oxidative capacity (P<0.001) and VO2max (P=0.042), but had no significant impact on muscle capillarization or fatigue resistance of thigh muscles. The maximal oxygen consumption supported by a capillary was reduced by 24% in SOL and 16% in VL (P<0.001). WP+KHCO3 attenuated the disuse-induced reduction in fiber oxidative capacity in both muscles (P<0.01). In conclusion, following 19 days bed rest, the decrement in fiber oxidative capacity is proportionally larger than the loss of capillaries. WP+KHCO3 appears to attenuate disuse-induced reductions in fiber oxidative capacity.



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Spinal Cord Stimulation for Treatment of Neuropathic Pain Associated With Erythromelalgia.

Objective: Erythromelalgia is a rare disorder associated with neuropathic pain that commonly affects the lower extremities. This pain is often refractory to multimodal treatment. Both pharmacologic management and interventional anesthetic blocks have been used with varying and often limited success. To date, little experience has been gained with the use of spinal cord stimulation in treating pain associated with erythromelalgia. Case Report: We present a case of successful treatment of pain secondary to erythromelalgia with a spinal cord stimulator in an 80-year-old woman. This patient had severe pain and debility secondary to erythromelalgia, having undergone trials of multiple medical therapies before presenting to our clinic. Dual-lead percutaneous spinal cord stimulation was successfully implanted without complication, leading to excellent pain control, now 18 months postimplant. Conclusions: Spinal cord stimulation may be a promising treatment of neuropathic pain associated with erythromelalgia. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Spinal Cord Stimulation Modulates Gene Expression in the Spinal Cord of an Animal Model of Peripheral Nerve Injury.

Background and Objectives: Previously, we found that application of pulsed radiofrequency to a peripheral nerve injury induces changes in key genes regulating nociception concurrent with alleviation of paw sensitivity in an animal model. In the current study, we evaluated such genes after applying spinal cord stimulation (SCS) therapy. Methods: Male Sprague-Dawley rats (n = 6 per group) were randomized into test and control groups. The spared nerve injury model was used to simulate a neuropathic pain state. A 4-contact microelectrode was implanted at the L1 vertebral level and SCS was applied continuously for 72 hours. Mechanical hyperalgesia was tested. Spinal cord tissues were collected and analyzed using real-time polymerase chain reaction to quantify levels of IL1[beta], GABAbr1, subP, Na/K ATPase, cFos, 5HT3ra, TNF[alpha], Gal, VIP, NpY, IL6, GFAP, ITGAM, and BDNF. Results: Paw withdrawal thresholds significantly decreased in spared nerve injury animals and stimulation attenuated sensitivity within 24 hours (P = 0.049), remaining significant through 72 hours (P = 0.003). Nerve injury caused up-regulation of TNF[alpha], GFAP, ITGAM, and cFOS as well as down-regulation of Na/K ATPase. Spinal cord stimulation therapy modulated the expression of 5HT3ra, cFOS, and GABAbr1. Strong inverse relationships in gene expression relative to the amount of applied current were observed for GABAbr1 (R = -0.65) and Na/K ATPase (R = -0.58), and a positive linear correlations between 5HT3r (R = 0.80) and VIP (R = 0.50) were observed. Conclusions: Continuously applied SCS modulates expression of key genes involved in the regulation of neuronal membrane potential. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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