Παρασκευή, 19 Αυγούστου 2016

"Kilometer hours" hypoxic dose: one size fits all



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Commentaries on Viewpoint: The rigorous study of exercise adaptations: Why mRNA might not be enough



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Last Word on Viewpoint: Could lobar flow sequencing account for convection-dependent ventilation heterogeneity in normal man?



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Could lobar flow sequencing account for convection-dependent ventilation heterogeneity in normal humans?



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Commentaries on Viewpoint: Could lobar flow sequencing account for convection-dependent ventilation heterogeneity in normal humans?



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Predicting metabolic rate during level and uphill outdoor walking using a low-cost GPS receiver

The objective of this study was to assess the accuracy of using speed and grade data obtained from a low-cost global positioning system (GPS) receiver to estimate metabolic rate (MR) during level and uphill outdoor walking. Thirty young, healthy adults performed randomized outdoor walking for 6-min periods at 2.0, 3.5, and 5.0 km/h and on three different grades: 1) level walking, 2) uphill walking on a 3.7% mean grade, and 3) uphill walking on a 10.8% mean grade. The reference MR [metabolic equivalents (METs) and oxygen uptake (Vo2)] values were obtained using a portable metabolic system. The speed and grade were obtained using a low-cost GPS receiver (1-Hz recording). The GPS grade ( altitude/distance walked) was calculated using both uncorrected GPS altitude data and GPS altitude data corrected with map projection software. The accuracy of predictions using reference speed and grade (actual[SPEED/GRADE]) data was high [R2 = 0.85, root-mean-square error (RMSE) = 0.68 MET]. The accuracy decreased when GPS speed and uncorrected grade (GPS[UNCORRECTED]) data were used, although it remained substantial (R2 = 0.66, RMSE = 1.00 MET). The accuracy was greatly improved when the GPS speed and corrected grade (GPS[CORRECTED]) data were used (R2 = 0.82, RMSE = 0.79 MET). Published predictive equations for walking MR were also cross-validated using actual or GPS speed and grade data when appropriate. The prediction accuracy was very close when either actual[SPEED/GRADE] values or GPS[CORRECTED] values (for level and uphill combined) or GPS speed values (for level walking only) were used. These results offer promising research and clinical applications related to the assessment of energy expenditure during free-living walking.



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A methodological approach for quantifying and characterizing the stability of agitated saline contrast: implications for quantifying intrapulmonary shunt

Agitated saline contrast echocardiography is often used to determine blood flow through intrapulmonary arteriovenous anastomoses (QIPAVA). We applied indicator dilution theory to time-acoustic intensity curves obtained from a bolus injection of hand-agitated saline contrast to acquire a quantitative index of contrast mass. Using this methodology and an in vitro model of the pulmonary circulation, the purpose of this study was to determine the effect of transit time and gas composition [air vs. sulphur hexafluoride (SF6)] on contrast conservation between two detection sites separated by a convoluted network of vessels. We hypothesized that the contrast lost between the detection sites would increase with transit times and be reduced by using contrast bubbles composed of SF6. Changing the flow and/or reducing the volume of the circulatory network manipulated transit time. Contrast conservation was measured as the ratio of outflow and inflow contrast masses. For air, 53.2 ± 3.4% (SE) of contrast was conserved at a transit time of 9.25 ± 0.02 s but dropped to 16.0 ± 1.0% at a transit time of 10.17 ± 0.06 s. Compared with air, SF6 contrast conservation was significantly greater (P < 0.05) with 114.3 ± 2.9% and 73.7 ± 3.3% of contrast conserved at a transit time of 10.39 ± 0.02 s and 13.46 ± 0.04 s, respectively. In summary, time-acoustic intensity curves can quantify agitated saline contrast, but loss of contrast due to bubble dissolution makes measuring QIPAVA across varying transit time difficult. Agitated saline composed of SF6 is stabilized and may be a suitable alternative for QIPAVA measurement.



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A possible carbon monoxide shuttle in the lung

The Coburn, Forster, Kane Equation (CFKE) describes a current understanding of the physiology of lung uptake and excretion of carbon monoxide (CO). The lung mean capillary PCO is an important term in this equation because it drives CO excretion and functions as "back-pressure" during uptake of exogenous CO. Results of previous studies have indicated that the mean capillary PCO of normal human lungs is equal to values calculated using the Haldane Equation, as described by the CFKE. The physiological explanation of how this parameter is set at this level is unknown. As a possible explanation, this study tested a hypothesis that a CO shuttle could be involved. Results of calculation-simulations indicate that a CO shuttle operates in a single alveolus model and imply that it could function as a determinant of the lung mean capillary PCO.



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Community Based Cross-Sectional Study Exploring The Beliefs Towards Voluntary Blood Donation In A Fully Literate District Of India

2016-08-19T21-05-35Z
Source: National Journal of Integrated Research in Medicine
Dr. Prabhat Kumar Lal*, Dr. Sobha George**, Dr. K Leelamoni***, Dr. C. Roy****.
Background: Voluntary non-remunerated blood donation is the key strategy to ensure availability of safe blood. India is facing shortage of 2.5 million units of blood annually and voluntary donation rate is only 50%. The present study was conducted in a fully literate district of India to assess the attitude and practice of blood donation and various associated beliefs. Methodology: This cross-sectional community based study was conducted in Cheranalloor Panchayat of Ernakulam. A total of 202 respondents selected using multi-stage sampling between 18 and 60 years of age were interviewed. Data was analyzed using computer. Results & Conclusion: 25.2% respondents ever donated blood which correlated with knowledge level (r=0.233) or attitude level (r=0.225). The major reasons for blood donation were for relatives (39.2%), in emergency for others (35.3%) and as voluntary donation (6.4%). Among non-willing, reasons cited for not willing to donate blood were ill health (46.9%), old age (25.8%) and fear of blood (16.6%). Attitude towards blood donation is low in this literate area. Proper information regarding blood donation needs to be conveyed to the community. [Lal P K NJIRM 2016; 7(3):107 - 110]


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EVALUATION OF IMPULSIVITY SYMPTOMS AND FAMILY FUNCTIONING IN ADOLESCENTS DIAGNOSED WITH OBSESSIVE COMPULSIVE DISORDER AND THEIR MOTHERS

2016-08-19T20-26-04Z
Source: Journal of Cognitive-Behavioral Psychotherapy and Research
Gonca Özyurt.
Objective: In a variety of clinic studies, it has been shown that impulsivity is one of the core symptoms of Obsessive-compulsive disorder (OCD). The aim of the present study is comparing the impulsivity symptoms of adolescents who are diagnosed with OCD and their mothers with controls; family functioning is also evaluated. Method: The study group consisted of 31 cases (11-18 years old) diagnosed with OCD. The control group (n=32) comprised patients of other clinics at hospital and was matched for gender and age to the OCD patients. Barrat Impusivity Scale 11 (BIS-11) was used for evaluaitng impulsivity symptoms in adolescents and their mothers. Family Assesssment Device (FAD) was used to examine family functioning. Results:There was no significant difference between sociodemographic data of two groups. When cases and controls were compared with BIS-11; all subscales' scores and total score of BIS-11were statistically significant higher in OCD group and also mothers of OCD group had statistically significant higher scores in total score of BIS-11 and subscales except "motor impulsivity". Also in comparing the grups with FAD; OCD group had statistically significant higher scores in all subscales except affective responsiveness. Conclusion: OCD is an important chronic psychiatric disorder which affects functionality seriously. Cases diagnosed with OCD and their mothers have more impulsivity symptoms and these symptoms affects family functioning. Further studies are needed to examine genetic and enviromental common risk factors between OCD and impulsivity


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Dependence of auditory spatial updating on vestibular, proprioceptive, and efference copy signals

Humans localize sounds by comparing inputs across the two ears, resulting in a head-centered representation of sound-source position. When the head moves, information about head movement must be combined with the head-centered estimate to correctly update the world-centered sound-source position. Spatial updating has been extensively studied in the visual system, but less is known about how head movement signals interact with binaural information during auditory spatial updating. In the current experiments, listeners compared the world-centered azimuthal position of two sound sources presented before and after a head rotation that depended on condition. In the active condition, subjects rotated their head by ~35° to the left or right, following a pretrained trajectory. In the passive condition, subjects were rotated along the same trajectory in a rotating chair. In the cancellation condition, subjects rotated their head as in the active condition, but the chair was counter-rotated on the basis of head-tracking data such that the head effectively remained fixed in space while the body rotated beneath it. Subjects updated most accurately in the passive condition but erred in the active and cancellation conditions. Performance is interpreted as reflecting the accuracy of perceived head rotation across conditions, which is modeled as a linear combination of proprioceptive/efference copy signals and vestibular signals. Resulting weights suggest that auditory updating is dominated by vestibular signals but with significant contributions from proprioception/efference copy. Overall, results shed light on the interplay of sensory and motor signals that determine the accuracy of auditory spatial updating.



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Subspace mapping of the three-dimensional spectral receptive field of macaque MT neurons

Neurons in the middle temporal (MT) visual area are thought to represent the velocity (direction and speed) of motion. Previous studies suggest the importance of both excitation and suppression for creating velocity representation in MT; however, details of the organization of excitation and suppression at the MT stage are not understood fully. In this article, we examine how excitatory and suppressive inputs are pooled in individual MT neurons by measuring their receptive fields in a three-dimensional (3-D) spatiotemporal frequency domain. We recorded the activity of single MT neurons from anesthetized macaque monkeys. To achieve both quality and resolution of the receptive field estimations, we applied a subspace reverse correlation technique in which a stimulus sequence of superimposed multiple drifting gratings was cross-correlated with the spiking activity of neurons. Excitatory responses tended to be organized in a manner representing a specific velocity independent of the spatial pattern of the stimuli. Conversely, suppressive responses tended to be distributed broadly over the 3-D frequency domain, supporting a hypothesis of response normalization. Despite the nonspecific distributed profile, the total summed strength of suppression was comparable to that of excitation in many MT neurons. Furthermore, suppressive responses reduced the bandwidth of velocity tuning, indicating that suppression improves the reliability of velocity representation. Our results suggest that both well-organized excitatory inputs and broad suppressive inputs contribute significantly to the invariant and reliable representation of velocity in MT.



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Spontaneously active NaV1.5 sodium channels may underlie odor sensitivity

The olfactory system is remarkably sensitive to airborne odor molecules, but precisely how very low odor concentrations bordering on just a few molecules per olfactory sensory neuron can trigger graded changes in firing is not clear. This report reexamines signaling in olfactory sensory neurons in light of the recent account of NaV1.5 sodium channel-mediated spontaneous firing. Using a model of spontaneous channel activity, the study shows how even submillivolt changes in membrane potential elicited by odor are expected to cause meaningful changes in NaV1.5-dependent firing. The results suggest that the random window currents of NaV1.5 channels may underpin not only spontaneous firing in olfactory sensory neurons but the cellular response to odor as well, thereby ensuring the robustness and sensitivity of signaling that is especially important for low odor concentrations.



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Table of Contents



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Reply to Letter to the Editor by Allison Grant regarding the accepted manuscript by Gutman et al. (2016) entitled “The effectiveness of the SpineCor brace for the conservative treatment of adolescent idiopathic scoliosis. Comparison with the Boston brace”

We would like to thank Ms Grant for her strong interest in our study comparing the rigid thoraco-lumbo-sacral orthosis (TLSO) with the SpineCor for non-surgical treatment of adolescent idiopathic scoliosis (AIS). First and foremost, we would like to comment on her impression that the authors are biased and that this paper somehow underlies a conflict of interest in favor of the Boston brace. Unlike Ms Grant who clearly states her financial and commercial interests with the SpineCor, the authors have no financial or commercial interest with any type of brace for AIS.

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Editorial Board



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Letter to the Editor: The Effectiveness of the SpineCor Brace for the conservative treatment of adolescent idiopathic scoliosis. Comparison with the Boston Brace

The authors present this study as one delivering highly significant evidence, proving what appears to be their predetermined hypothesis that SpineCor is an inferior treatment to Boston Brace.

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Meetings Calendar



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Dramatic demographic changes in spine trauma mortality over the past quarter century in Finland

Commentary On: Thesleff T, Niskakangas T, Luoto TM, Öhman J, Ronkainen A. Fatal cervical spine injuries: a Finnish nationwide register-based epidemiological study on data from 1987 to 2010. Spine J 2016:16:918–26 (in this issue).

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We cannot give up bracing for poor adherence to treatment: Letter to the Editor concerning the paper “The effectiveness of the SpineCor brace for the conservative treatment of adolescent idiopathic scoliosis. Comparison with the Boston brace”

We read with great interest the paper by Gutman et al. [1]. Despite some limitations, there are many relevant messages coming from their paper:

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Table of Contents



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Chronic problems after gunshot injuries to the spine

It is with great interest that we read the review on gunshot injuries of the spine published online on June 9, 2015 in The Spine Journal. Jakoi et al. have written an authoritative review on the occurrence, epidemiology, and outcomes of bullet injuries to the spine [1]. The authors are to be commended for their formidable effort in compiling a most diverse and unique body of literature on the topic.

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Predicting benefit from lumbar epidural steroid injection: commentary

Commentary on Sivaganesan A, Chotai S, Parker SL, Asher AL, McGirt MJ, Devin CJ. Predictors of the efficacy of epidural steroid injections for structural lumbar degenerative pathology. Spine J 2016:16:928–34 (in this issue).

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Table of Contents



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Reply to the Letter to the Editor by Zaina et al. concerning the paper “The effectiveness of the SpineCor brace for the conservative treatment of adolescent idiopathic scoliosis. Comparison with the Boston brace”

We have read with interest the letter from Zaina et al. regarding our recently published article comparing the conventional rigid TLSO with the SpineCor for nonsurgical treatment of adolescent idiopathic scoliosis. In summary, Zaina et al. suggest that the overall results from our study are quite poor because of a lack of compliance for which only the treating team is responsible: "If a brace treatment does not work well for low adherence, the problem could be the treating team."

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Table of Contents



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Minimally invasive lumbar decompression—the surgical learning curve

Commentary On: Ahn J, Iqbal A, Manning BT, Leblang S, Bohl DD, Mayo BC, et al. Minimally invasive lumbar decompression—the surgical learning curve. Spine J 2016:16:909–16. (in this issue).

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Reply to the “Comments on the pending Spine Journal publication: the effectiveness of the SpineCor brace for the conservative treatment of adolescent idiopathic scoliosis. Comparison with the Boston brace” by Charles Hilaire Rivard

We have carefully read the comments from Dr Rivard on our study comparing the rigid thoracolumbosacral orthosis (TLSO) with the SpineCor for non-surgical treatment of adolescent idiopathic scoliosis (AIS). We understand that Dr Rivard has important financial and clinical interests in the SpineCor, but questioning the credibility and scientific rigor of the current authors—or all other authors who did not find results supporting the use of the SpineCor—is definitely inappropriate. Blaming the research nurse who was givenanonymized radiographs and who was blinded to the different patient cohorts is offending.

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Upper Limb Obstacle Avoidance Behavior in Individuals With Stroke

Background. Upper limb (UL) poststroke hemiparesis commonly leads to chronic disability. Despite moderate-to-good clinical recovery, many patients with UL hemiparesis still do not fully use their arm in daily tasks. Decreased arm use may be related to deficits in performance of more complex movement than what is usually assessed clinically. Objective. To identify differences between poststroke and nondisabled control subjects in making complex corrective movements to avoid an obstacle in the reaching path. Methods. Subjects rapidly reached for a juice bottle on a refrigerator shelf with their hemiparetic or dominant (controls) arm viewed in a large-screen projected 3D virtual environment. In random trials, a sliding door partially obstructed the reaching path. A successful trial was one in which subjects touched the bottle without their arm or hand hitting the door. Results. Fewer participants with stroke (12%) were successful at a 65% success rate in avoiding the door compared to controls (42%). Subjects with stroke also initiated corrections later (further) in the reaching path (100.7 ± 77.6 mm) compared to controls (51.6 ± 31.0 mm) resulting in a reduced margin of error. While both groups used similar endpoint movement strategies for obstructed reaching, subjects with stroke used less elbow and more trunk movement. Participants who reported being more confident using their hemiparetic arm had higher success rates. Conclusion. Arm movement deficits can be identified when complex tasks are evaluated. Deficits in higher-order motor function such as obstacle avoidance behavior may decrease actual arm use in individuals with mild-to-moderate hemiparesis and should be evaluated in routine clinical practice.



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Syria's first responders have the 'most dangerous job in the world'

By Associated Press

BEIRUT — It took Mahmoud Fadlallah and the team of seven rescue workers 30 minutes to reach the middle-aged couple trapped beneath the rubble of their apartment building in the contested Syrian city of Aleppo. They had been notified a rocket had struck the building, and they had to wait for the debris to fall and the dust to settle.

"We called out: 'We are the Civil Defense, is anyone able to hear us?'" Fadlallah said of the rescue operation earlier this summer. "They were on the first floor, with four floors above them, but they were protected by the ceiling, which had collapsed at a slant."

It was routine work for the 3,000-strong Syrian Civil Defense, which mounts search-and-rescue operations under the unforgiving atmosphere of war in the shattered country's opposition areas, and whose supporters have nominated its first responders for the 2016 Nobel Peace Prize.

Their rescuers were among those who pulled 5-year-old Omran Daqneesh and his family from the rubble of their apartment building Wednesday night. A photo of little Omran, sitting alone in an ambulance, confused and covered in debris and blood, has become the haunting image of the battle for Aleppo.

The group's global following, which includes dozens of Syrian civil society groups operating in opposition areas as well as international organizations, says the Civil Defense rescuers — known as the White Helmets for their trademark headgear — is engaged in "the most dangerous job in the world."

"People are dying, and we run toward death," said Fadlallah, whose team was able to rescue the trapped couple in June and also pulled four corpses from the rubble, including one whose limbs had been blown off by the force of the blast. He has since lost two of his colleagues from that rescue mission.

Rescue workers are targeted with such regularity by government forces that they have come up with a name for the tactic: "double tap" attacks.

After an initial strike, government warplanes circle around and hit the target a second time, or lay siege to the area with overwhelming artillery fire.

It was in such circumstances that Fadlallah lost a teammate last week. Khaled Omran Harrah had earlier captured international media attention for his dramatic 2014 rescue of a 10-day-old infant trapped in rubble for 16 hours.

Harrah was on the job again last week, called along with Fadlallah and five other White Helmet rescuers to the scene of a blast. The men were working to extract a survivor from the rubble when they came under second attack.

"They must have seen us coming, and they started striking us with a tank, mortars, and airstrikes," Fadlallah said.

The group cowered in a building that could not provide enough cover, and Harrah was killed. Five others, including Fadlallah sustained shrapnel wounds. They were stuck for two hours, and the man they came to rescue died.

The next day was a scheduled day off for Fadlallah. He returned to his duties for a standard 24-hour shift the day after that, his wounds still unhealed.

The White Helmets have lost 134 rescuers in the line of duty, says director Raed Saleh, while participating in rescues the group says saved 60,000 lives. The figures could not be independently verified.

Government sympathizers accuse the group of aiding "terrorists," a catch-all term the government uses to describe its armed opponents.

Such associations are inevitable, however, in the Syria war, where after more than five years of fighting practically all sides have been fingered for war crimes. In many opposition-held areas where the White Helmets operate, they come under the jurisdiction of unsavory rebel factions, including the al-Qaida-linked Jabhat Fatah al-Sham in northwestern Idlib province. But civilians — 1.5 million by the pre-war population estimate — live there, too.

The White Helmets grew out of networks of volunteer first responderswho were rescuing victims from government shelling and bombardment in opposition areas.

Since 2013, the group has grown to operate 119 centers across Syria, receiving substantial organizational support from Mayday Rescue, a Turkey-based NGO that grew alongside the White Helmets to organize training and deliver equipment to the first responders.

Against the backdrop of the stalemated Syrian war, the group's international following says it's time it receives the recognition it deserves.

"Honoring a group of brave, and for the most part, anonymous humanitarians represents the true values of the Nobel Peace Prize," said Wendy Chamberlain, president of the Washington-based Middle East Institute, who nominated the group to the Nobel committee, which will announce its selection in October.

Saleh says winning the Peace Prize would be a "morale boost," though greater priorities loom.

"Whether or not we win, we call for an end to the killing of civilians through indiscriminate attacks in any area in Syria," he said.

Politicians around the world have praised the group's courage. Still, Saleh was denied entry to the United States to receive a humanitarian award in April, an incident supporters blame on a social media smear campaign connecting the group to al-Qaida.

After that incident, the U.S. State Department said the U.S. government provides, through USAID, $23 million in aid to the White Helmets.

Fadlallah was a construction worker before the war, but now nearly every able-bodied Syrian has become a rescuer. The White Helmets come from diverse walks of life; there are among them carpenters, students, lawyers, and doctors.

"God watches over us," Fadlallah said. "And the best organization there is, is the Civil Defense."



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Inside EMS Podcast: EMS on- and -off duty, budget cuts and new drug epidemics

Download this podcast on iTunes, SoundCloud or via RSS feed

In this week's episode, our co-hosts Chris Cebollero and Kelly Grayson discuss some of this week's top news. They discuss the Dallas Fire-Rescue budget cuts and how nearly half of the department's paramedics have left, and the greater issue of EMS funding and management. They cover the recent spike in overdoses and emergence of a new drug that is 10,000 time more potent than morphine. The viral video of two paramedics removing a cup off a squirrels head sheds light on the many hats EMS wears.



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Treatment of HCV patients on hemodialysis with daclatasvir and asunaprevir



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Long-term abdominal adiposity activates several parameters of cardiac energy function

Abstract

Abdominal obesity increases the incidence of cardiac events but reduces mortality when one of these events occurs. The phenomenon called obesity paradox might be related to myocardial energetics. This study was aimed at determining whether long-term abdominal adiposity alters cardiac energy function. Two groups of male Wistar rats were fed a standard or a Western-type (WD) diet for 8 months. The ex vivo coronary reactivity and mechanical function as well as the mitochondrial oxidative phosphorylation (mOxPhos) and hydrogen peroxide release (mH2O2r) were determined. Abdominal adiposity was augmented by the WD. This was also the case for the coronary reactivity to acetylcholine, but the rate pressure product remained roughly stable despite a reduction of the left ventricle-developed pressure partly compensated by a slight increase in heart rate. The prolonged WD administration resulted in an improvement of mOxPhos, but the mH2O2r was exaggerated which was confirmed in the whole cell by a reduced aconitase to fumarase ratio. This did not modify the plasma oxidative stress due to an increased plasma antioxidant status. In conclusion, long-term WD administration improved the cardiac fitness and might predispose the organism to the obesity paradox. Conversely, the increased mitochondrial mH2O2r can precipitate the heart toward cardiomyopathy if the WD is maintained for a longer duration.



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Potential renoprotective effects of piceatannol in ameliorating the early-stage nephropathy associated with obesity in obese Zucker rats

Abstract

Obesity-associated nephropathy is considered to be a leading cause of end-stage renal disease. Resveratrol supplementation represents a promising therapy to attenuate kidney injury, but the poor solubility and limited bioavailability of this polyphenol limits its use in dietary intervention. Piceatannol, a resveratrol analogue, has been suggested as a better option. In this study, we aimed to provide evidence of a preventive action of piceatannol in very early stages of obesity-associated nephropathy. Thirty obese Zucker rats were divided into three experimental groups: one control and two groups orally treated for 6 weeks with 15 and 45 mg piceatannol/kg body weight/day. Enzyme-linked immunosorbent assays (ELISA) were used to determine renal and urinary kidney injury molecule-1 (Kim-1), renal fibrosis markers (transforming growth factor β1 and fibronectin) and renal sirtuin-1 protein. Oxidative stress was assessed in the kidney by measuring lipid peroxidation and nitrosative stress (thiobarbituric acid reactive substrates and 3-nitrotyrosine levels, respectively) together with the activity of the antioxidant enzyme superoxide dismutase. Renal fatty acids profile analysis was performed by thin-layer and gas chromatography. Piceatannol-treated rats displayed lower levels of urinary and renal Kim-1. Renal fibrosis biomarkers and lipid peroxidation exhibited a tendency to decrease in the piceatannol-treated groups. Piceatannol treatment did not modify superoxide dismutase activity or sirtuin-1 protein levels, while it seemed to increase the levels of polyunsaturated and omega-6 polyunsaturated fatty acids in the kidneys. Our findings suggest a mild renoprotective effect of piceatannol in obese Zucker rats and the need of intervention at early stages of renal damage.



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Aerobic training and l-arginine supplementation promotes rat heart and hindleg muscles arteriogenesis after myocardial infarction

Abstract

Arteriogenesis is a main defense mechanism to prevent heart and local tissues dysfunction in occlusive artery disease. TGF-β and angiostatin have a pivotal role in arteriogenesis. We tested the hypothesis that aerobic training and l-arginine supplementation promotes cardiac and skeletal muscles arteriogenesis after myocardial infarction (MI) parallel to upregulation of TGF-β and downregulation of angiostatin. For this purpose, 4 weeks after LAD occlusion, 50 male Wistar rats were randomly distributed into five groups: (1) sham surgery without MI (sham, n = 10), (2) control-MI (Con-MI, n = 10), (3) l-arginine-MI (La-MI, n = 10), (4) exercise training-MI (Ex-MI, n = 10), and (5) exercise and l-arginine-MI (Ex + La-MI). Exercise training groups running on a treadmill for 10 weeks with moderate intensity. Rats in the l-arginine-treated groups drank water containing 4 % l-arginine. Arteriolar density with different diameters (11–25, 26–50, 51–75, and 76–150 μm), TGF-β, and angiostatin gene expression were measured in cardiac (area at risk) and skeletal (soleus and gastrocnemius) muscles. Smaller arterioles decreased in cardiac after MI. Aerobic training and l-arginine increased the number of cardiac arterioles with 11–25 and 26–50 μm diameters parallel to TGF-β overexpression. In gastrocnemius muscle, the number of arterioles/mm2 was only increased in the 11 to 25 μm in response to training with and without l-arginine parallel to angiostatin downregulation. Soleus arteriolar density with different size was not different between experimental groups. Results showed that 10 weeks aerobic exercise training and l-arginine supplementation promotes arteriogenesis of heart and gastrocnemius muscles parallel to overexpression of TGF-β and downregulation of angiostatin in MI rats.



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A common effect of angiotensin II and relaxin 2 on the PNT1A normal prostate epithelial cell line

Abstract

The prostate gland is a part of the male reproductive tract which produces both angiotensin II (Ang II) and relaxin 2 (RLN2). The present study analyzes the effect of both these peptide hormones at concentration 10−8M on viability, proliferation, adhesion, migration, and invasion of normal prostate epithelial cells (PNT1A). Improved survival in two- and three-dimensional cell cultures was noted as well as visual changes in colony size and structure in Geltrex™. Stimulatory influence on cell viability of each peptide applied single was lower than in combination. Enhanced survival of PNT1A cells appears to be associated with increased BCL2/BAX messenger RNA (mRNA) expression ratio. Modulation of cell spreading and cell-extracellular matrix adhesion dynamics were also altered as an influence of tested hormone application. However, long-term Ang II and RLN2 effects may lead to an increase of normal prostate cell migration and invasion abilities. Moreover, gelatin zymography revealed that both gelatinases A and B were augmented by Ang II treatment, whereas RLN2 significantly stimulated only MMP-9 secretion. These results support the hypothesis that deregulation of locally secreted peptide hormones such as Ang II and RLN2 may take part in the development of certain cancers, including prostate cancer. Moreover, the observed ability of relaxin 2 to act as a regulator of mRNA expression levels not only LGR7 but also classic angiotensin receptors suggested that renin-angiotensin system and relaxin family peptide system are functionally linked.



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Chain elongation analog of resveratrol as potent cancer chemoprevention agent

Abstract

Resveratrol is identified as a natural cancer chemoprevention agent. There has been a lot of interest in designing and developing resveratrol analogs with cancer chemoprevention activity superior to that of parent molecule and exploring their action mechanism in the past several decades. In this study, we have synthesized resveratrol analogs of compounds AC via conjugated chain elongation based on isoprene unit retention strategy. Remarkably, cytotoxic activity analysis results indicated that compound B possesses the best proliferation inhibition activity for NCI-H460 cells in all the test compounds. Intriguingly, compound B displayed a higher cytotoxicity against human non-small cell lung cancer cells (NCI-H460) compared to normal human embryonic lung fibroblasts (MRC-5). Afterward, flow cytometry analysis showed that compound B would induce cell apoptosis. We further researched the action mechanism. When NCI-H460 cells were incubated by compound B for 6 or 9 h, respectively, the intracellular reactive oxygen species (ROS) level was enhanced obviously. With elevation of intracellular ROS level, flow cytometry measurement verified mitochondrial transmembrane potential collapse, which was accompanied by the up-regulation of Bax and down-regulation of Bcl-2. More interestingly, compound B increased the expression of caspase-9 and caspase-3, which induced cell apoptosis. Moreover, compound B arrested cell cycle in G0/G1 phase. These are all to provide useful information for designing resveratrol-based chemoprevention agent and understanding the action mechanism.



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Limited beneficial effects of piceatannol supplementation on obesity complications in the obese Zucker rat: gut microbiota, metabolic, endocrine, and cardiac aspects

Abstract

Resveratrol is beneficial in obese and diabetic rodents. However, its low bioavailability raises questions about its therapeutic relevance for treating or preventing obesity complications. In this context, many related natural polyphenols are being tested for their putative antidiabetic and anti-obesity effects. This prompted us to study the influence of piceatannol, a polyhydroxylated stilbene, on the prevention of obesity complications in Zucker obese rats. A 6-week supplementation was followed by the determination of various markers in plasma, liver, adipose tissue and heart, together with a large-scale analysis of gut microbiota composition. When given in doses of 15 or 45 mg/kg body weight/day, piceatannol did not reduce either hyperphagia or fat accumulation. It did not modify the profusion of the most abundant phyla in gut, though slight changes were observed in the abundance of several Lactobacillus, Clostridium, and Bacteroides species belonging to Firmicutes and Bacteroidetes. This was accompanied by a tendency to reduce plasma lipopolysaccharides by 30 %, and by a decrease of circulating non-esterified fatty acids, LDL-cholesterol, and lactate. While piceatannol tended to improve lipid handling, it did not mitigate hyperinsulinemia and cardiac hypertrophy. However, it increased cardiac expression of ephrin-B1, a membrane protein that contributes to maintaining cardiomyocyte architecture. Lastly, ascorbyl radical plasma levels and hydrogen peroxide release by adipose tissue were similar in control and treated groups. Thus, piceatannol did not exhibit strong slimming capacities but did limit several obesity complications.



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The role of sirtuins in cellular homeostasis

Abstract

Sirtuins are evolutionarily conserved nicotinamide adenine dinucleotide (NAD+)-dependent lysine deacylases or ADP-ribosyltransferases. These cellular enzymes are metabolic sensors sensitive to NAD+ levels that maintain physiological homeostasis in the animal and plant cells.



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High intake of dietary tyramine does not deteriorate glucose handling and does not cause adverse cardiovascular effects in mice

Abstract

Tyramine is naturally occurring in food and induces pressor responses. Low-tyramine diets are recommended for patients treated with MAO inhibitors to avoid the fatal hypertensive crisis sadly known as "cheese effect". Hence, tyramine intake is suspected to have toxicological consequences in humans, while its administration to type 1 diabetic rodents has been reported to improve glucose tolerance. We investigated in mice whether prolonged tyramine ingestion could alter glucose homeostasis, insulin sensitivity, adipose tissue physiology or cardiovascular functions. Tyramine was added at 0.04 or 0.14 % in the drinking water since this was estimated to increase by 10- to 40-fold the spontaneous tyramine intake of control mice fed a standard diet. Ten to 12 weeks of such tyramine supplementation did not influence body weight gain, adiposity or food consumption. Both doses (reaching approx. 300 and 1100 μmol tyramine/kg bw/day) decreased nonfasting blood glucose but did not modify glucose tolerance or fasting levels of glucose, insulin or circulating lipids. Blood pressure was not increased in tyramine-drinking mice, while only the higher tested dose moderately increased heart rate without change in its variability. Markers of cardiac tissue injury or oxidative stress remained unaltered, except an increased hydrogen peroxide production in heart preparations. In isolated adipocytes, tyramine inhibited lipolysis similarly in treated and control groups, as did insulin. The lack of serious adverse cardiovascular effects of prolonged tyramine supplementation in normoglycemic mice together with the somewhat insulin-like effects found on adipose cells should lead to reconsider favourably the risk/benefit ratio of the intake of this dietary amine.



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Erratum to: MicroRNAs involved in the browning process of adipocytes



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Docosahexaenoic diet supplementation, exercise and temperature affect cytokine production by lipopolysaccharide-stimulated mononuclear cells

Abstract

Acute exercise induces changes in peripheral mononuclear cells' (PBMCs) capabilities to produce cytokines. The aim was to investigate the effect of docosahexaenoic acid (DHA) diet supplementation on cytokine production, by lipopolysaccharide (LPS)-stimulated PBMCs after exercise, and the in vitro influence of temperature. Fifteen male soccer players were randomly assigned to a placebo or an experimental group. The experimental group consumed an almond-based beverage enriched with DHA (1.16 g DHA/day) for 8 weeks, whereas the placebo group consumed a similar non-enriched beverage. Blood samples were taken before and after the nutritional intervention in basal conditions and 2 h after acute exercise. Nutritional intervention significantly increased the DHA content in erythrocytes only in experimental group (from 34 ± 3.6 to 43 ± 3.6 nmols DHA/109 erythrocytes). Exercise significantly increased Toll-like receptor 4 (TLR4) in PBMCs but only in the placebo group (203 %). Exercise also significantly increased IL6, IL8, VEGF, INFγ, TNFα, IL1α, IL1β, MCP1, and EGG production rates by LPS-stimulated PBMCs, and this response was attenuated by DHA supplementation. Temperature but not DHA also affected the pattern of cytokine production increasing IL6, IL8, IL1β, and MCP1 synthesis. The higher change was evidenced in IL1β increasing the production rate at 39.5 °C from 3.19 ± 0.77 to 22.4 ± 6.1 pg/h 106 PBMC in placebo and from 2.36 ± 0.11 to 10.6 ± 0.38 pg/h 106 PBMC in the supplemented group. The profile of affected cytokines differs between temperature and exercise, suggesting a different PBMC activation pathway. DHA diet supplementation only attenuated cytokine production after exercise and not that induced by temperature.



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Influence of CD26/dipeptidyl peptidase IV deficiency on immunophenotypic changes during colitis development and resolution

Abstract

A lot of evidence for the importance of CD26/dipeptidyl peptidase IV (CD26/DPP IV) in immunoactivation has been reported; however, its involvement in colitis remains unclear. The aim of this study was to investigate the influence of CD26/DPP IV deficiency on immunophenotypic changes associated with dextran sulfate sodium (DSS)-induced colitis in wild-type (WT) and CD26-deficient mice. Development of clinical symptoms of colitis and animal health status parameters were assessed; the expression of the nuclear factor (NF)-κB p65 subunit was measured by quantitative real-time PCR, while cell characterization was determined by flow cytometry and immunohistochemical staining. DSS treatment induced loss of body weight and colon length shortening in both mouse strains. An increase of myeloperoxidase activity in CD26-deficient mice was more intensive than in WT mice, in spite of similar histopathological changes. Furthermore, a significant increase in the expression of NF-κB p65 subunit in the colon of CD26-deficient mice was determined. The percentage of splenic CD4+ and CD8+ cells in the acute phase of colitis was significantly decreased in WT mice, while in the same period, an increase in the percentage of splenic CD8+ cells was present in CD26-deficient mice. Development of colitis was accompanied by a significant increase in the percentage of intrahepatic NKT cells in both mouse strains, but their percentage in spleen was increased only in CD26-deficient mice. CD26 deficiency was associated with a heightened response to DSS accompanied by increased expression of NF-κB p65 subunit and distinct changes in leukocyte trafficking. These results provide new insights into the role of CD26/DPP IV during the development of colitis.



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Cardioprotective effect of resveratrol analogue isorhapontigenin versus omega-3 fatty acids in isoproterenol-induced myocardial infarction in rats

Abstract

Myocardial infarction (MI) is a common cause of mortality worldwide. Isorhapontigenin is a derivative of stilbene with chemical structure similar to resveratrol. The omega-3 fatty acids (FA) have beneficial effects on neurodegenerative, inflammatory, and cardiovascular diseases. The aim of this study was to investigate the effects of pretreatment with isorhapontigenin and omega-3 FA on rat model of isoproterenol-induced MI. Fifty-six rats were divided into seven groups: normal, normal + isorhapontigenin, normal + omega-3 FA, MI, MI + isorhapontigenin, MI + omega-3 FA, and MI + isorhapontigenin + omega-3 FA. Serum levels of cardiac marker enzymes [lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB)], cardiac troponin I (cTnI), inflammatory markers [tumor necrosis factor-alpha (TNF-α) and interleukin-6], and lipid profile [triglycerides, total cholesterol (T.Ch), high and low density lipoproteins (HDL, LDL), and phospholipids] as well as cardiac levels of malondialdehyde and anti-oxidants [reduced glutathione (GSH), superoxide dismutase (SOD), and catalase)] were measured in all rats. ECG and histopathological examination were performed. Isoproterenol caused a significant elevation of ST segment, decreased R wave amplitude, HDL, and anti-oxidants, and increased LDH, CK-MB, cTnI, TNF-α, interleukin-6, malondialdehyde, triglycerides, T.Ch, LDL, and phospholipids. Omega-3 FA or isorhapontigenin significantly decreased the ST segment elevation, LDH, CK-MB, cTnI, TNF-α, interleukin-6, malondialdehyde, and phospholipids and increased R wave amplitude and anti-oxidants. The effects of combined omega-3 FA and isorhapontigenin were more significant than either of them alone. Therefore, we conclude that omega-3 FA and isorhapontigenin have a cardioprotective effect on rats with isoproterenol-induced MI through their anti-oxidant and anti-inflammatory actions.



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Depot-specific effects of treadmill running and rutin on white adipose tissue function in diet-induced obese mice

Abstract

White adipose tissue (WAT) is a critical organ involved in regulating metabolic homeostasis under obese condition. Strategies that could positively affect WAT function would hold promise for fighting against obesity and its complications. The aim of the present study is to explore the effects of treadmill exercise training and rutin intervention on adipose tissue function from diet-induced obese (DIO) mice and whether fat depot-specific effects existed. In epididymal adipose tissue, high-fat diet (HFD) resulted in reduction in adiponectin mRNA expression, peroxisome proliferator-activated receptors (PPAR)-γ and DsbA-L protein expression, elevation in endoplasmic reticulum (ER) stress markers including 78 kDa glucose-regulated protein (GRP-78), C/EBP homologous protein (CHOP) and p-c-Jun N-terminal kinase (JNK). Isoproterenol-stimulated lipolysis and insulin stimulated Akt phosphorylation ex vivo were blunted from HFD group. The combination of rutin with exercise (HRE) completely restored GRP78 and p-JNK protein expression to normal levels, as well as blunted signaling ex vivo. In inguinal adipose tissue, HFD led to increased adiponectin mRNA expression, PPAR-γ, GRP78, and p-JNK protein expression, and reduction in DsbA-L. HRE is effective for restoring p-JNK, PPAR-γ, and DsbA-L. In conclusion, depot-specific effects may exist in regard to the effects of rutin and exercise on key molecules involved in regulating adipose tissue function (i.e., ER stress markers, PPAR-γ and DsbA-L, adiponectin expression, and secretion, ex vivo catecholamine stimulated lipolysis and insulin stimulated Akt phosphorylation) from DIO mice.



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Fitness, adiposopathy, and adiposity are independent predictors of insulin sensitivity in middle-aged men without diabetes

Abstract

Adiposopathy, or sick fat, refers to adipose tissue dysfunction that can lead to several complications such as dyslipidemia, insulin resistance, and hyperglycemia. The relative contribution of adiposopathy in predicting insulin resistance remains unclear. We investigated the relationship between adiposopathy, as assessed as a low plasma adiponectin/leptin ratio, with anthropometry, body composition (hydrostatic weighing), insulin sensitivity (hyperinsulinemic-euglycemic clamp), inflammation, and fitness level (ergocycle VO2max, mL/kgFFM/min) in 53 men (aged 34–53 years) from four groups: sedentary controls without obesity (body mass index [BMI] <25 kg/m2), sedentary with obesity (BMI > 30 kg/m2), sedentary with obesity and glucose intolerance, and endurance trained active without obesity. The adiponectin/leptin ratio was the highest in trained men (4.75 ± 0.82) and the lowest in glucose intolerant subjects with obesity (0.27 ± 0.06; ANOVA p < 0.0001) indicating increased adiposopathy in those with obesity. The ratio was negatively associated with adiposity (e.g., waist circumference, r = −0.59, p < 0.01) and positively associated with VO2max (r = 0.67, p < 0.01) and insulin sensitivity (M/I, r = 0.73, p < 0.01). Multiple regression analysis revealed fitness as the strongest independent predictor of insulin sensitivity (partial R 2 = 0.61). While adiposopathy was also an independent and significant contributor (partial R 2 = 0.10), waist circumference added little power to the model (partial R 2 = 0.024). All three variables remained significant independent predictors when trained subjects were excluded from the model. Plasma lipids were not retained in the model. We conclude that low fitness, adiposopathy, as well as adiposity (and in particular abdominal obesity) are independent contributors to insulin resistance in men without diabetes.



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MicroRNAs involved in the browning process of adipocytes

Abstract

The present review focuses on the role of miRNAs in the control of white adipose tissue browning, a process which describes the recruitment of adipocytes showing features of brown adipocytes in white adipose tissue. MicroRNAs (miRNAs) are a class of short non-coding RNAs (19–22 nucleotides) involved in gene regulation. Although the main effect of miRNAs is the inhibition of the translational machinery, thereby preventing the production of the protein product, the activation of protein translation has also been described in the literature. In addition to modifying translation, miRNAs binding to its target mRNAs also trigger the recruitment and association of mRNA decay factors, leading to mRNA destabilization, degradation, and thus to the decrease in expression levels. Although a great number of miRNAs have been reported to potentially regulate genes that play important roles in the browning process, only a reduced number of studies have demonstrated experimentally an effect on this process associated to changes in miRNA expressions, so far. These studies have shown, by using either primary adipocyte cultures or experimental models of mice (KO mice, mice overexpressing a specific miRNA) that miR-196a, miR-26 and miR-30 are needed for browning process development. By contrast, miR-155, miR-133, miR-27b and miR-34 act as negative regulators of this process. Further studies are needed to fully describe the miRNA network-involved white adipose tissue browning regulation.



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Tips for respiratory assessment and just-in-time education

Taking a role as a field trainer is no simple task. Many EMS services give the nod to strong, experienced EMTs and paramedics and expect that good clinical skills will directly translate to effective teaching strategies. While some trainees may be clinically savvy and simply need direction, some new hires require far more intensive assistance and a department's strongest clinician may not be a natural teacher.

The difficulties of being a trainer
There are a few particular difficulties faced by both new and experienced field trainers. First, there is a desire to mold every trainee into a newer version of yourself. While you may be a great clinician, there are many ways to accomplish the goal of providing safe, effective patient care and being a carbon copy of your trainer isn't necessarily one of those steps.

Remember that you have countless individual experiences that have shaped the type of provider you are today and you likely approach calls differently today than you did at the beginning of your career. A brand new EMT or paramedic simply can't be a carbon copy because he or she doesn't have your breadth of experience.

One potential approach, in conjunction with your agency leadership and medical director, is to develop an understanding of the measurements for success in your field training program. For instance, it could be as simple as identifying objectives that a new hire should be able to do:

  • Know the protocols
  • Perform an assessment
  • Build a differential diagnosis
  • Design and execute a treatment plan
  • Document assessment and care

By designing objectives in this way, a new hire can be evaluated on his or her ability to practice medicine broadly without staying in the training program until trauma, STEMI, stroke and cardiac arrest all get checked off the to-do list. This approach requires faith by the trainer and agency that a provider with those skills and knowledge of the protocols can make good treatment decisions when faced with a new situation.

A second difficulty faced by trainers in the EMS environment is how far to let a trainee go down the wrong path before intervening. There are obviously situations which would pose a patient safety risk, and in such instances the trainer must step in quickly.

In other cases, however, the call may simply not be moving fast enough or a trainee may make a small mistake. It is important to remember that providers learn from their mistakes and as long as an immediate safety issue isn't present, there is educational benefit to letting small problems play out. This gives the trainee an opportunity to recognize and correct mistakes and give insight into how he or she responds to challenging situations. A trainer should not be too quick to jump in if a patient safety concern does not exist.

Coaching in the moment
Once the decision to intervene is made, the trainer needs to understand how best to provide coaching. Obviously a potentially serious medication error should be handled differently than forgetting to check a blood glucose on a patient complaining of dizziness with no diabetic history.

A new EMS provider may feel self-conscious or lack confidence. Abruptly jumping in with a dismissive or rude comment likely won't result in a lesson learned and may further distance the trainee.

In the patient case, a man with shortness of breath, the trainer starts off on the right path, asking the trainee to review common causes of respiratory distress while responding. From there the call heads downhill quickly. Dismissive or diminutive comments are common and the approach isn't so much one of guidance as it is hazing.

A more productive approach would have been to suggest particular assessments or treatments in an attempt to jog the trainee's memory. Often trainees can be guided back onto the correct path by breaking the cycle of questioning which has led them astray.

Basic respiratory assessment
The goal of the respiratory assessment should be to identify the underlying cause of the shortness of breath. In this case, the patient has a history of recent weight gain and a productive cough along with hypertension and hypoxia. Kristen has clearly gotten off track and seems to be focused on a potential COPD exacerbation given Steve's history as a smoker. COPD is certainly one potential cause but there are others which are more likely. Rather than belaboring the smoking question, Kristen should focus on the onset of Steve's respiratory distress, the nature of his cough and sputum it is producing and what his lungs sound like.

Another tip for respiratory assessment is to limit the number of open-ended questions. Family or other bystanders may be able to answer some questions and asking questions of the patient which can be answered by nodding yes or no or with hand gestures may keep them from feeling more short of breath.

Building a differential diagnosis
In this instance there are two potential causes of Steve's shortness of breath: CHF and COPD. While Steve does not report a history of either diagnosis, many patients have a history of both and being able to differentiate between the two is key to treatment decisions.

Lung sounds are one potential clue with rales (bubbling) often associated with CHF and wheezes often associated with COPD. In some cases, however, CHF may present with wheezes as well. Steve's recent weight gain and hypertension certainly suggest CHF. As the heart stops pumping effectively, fluid is retained and backs up in the extremities as well as the lungs.

A productive cough is also an important finding particularly if there is a report of sputum type and color. Yellow or green sputum may be associated with an infection — particularly in the presence of a fever —while pink sputum may be associated with fluid retention and CHF.

Based on the limited information collected by Kristen, CHF still seems to be the most appropriate working diagnosis. Providing this summary to her and asking her to work to confirm that diagnosis may help guide the remainder of her assessment and get her back on track.

Case conclusion
You realize quickly that your coaching of Kristen on this call has been misdirected. You mention that the rapid weight gain, hypertension and gradual onset of symptoms seem to point to CHF as an underlying cause. You ask Kristen to work to confirm that diagnosis and to build a treatment plan.

Kristen thinks for a moment and immediately listens to Steve's lungs. "I can hear rales in both bases," Kristen reports. She then kneels down and checks for edema in Steve's legs finding pitting on both lower legs.

Kristen turns to the firefighter and asks him to set up CPAP and then asks you to confirm the ETA for the ALS intercept. She seems to be back on track.



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Pathomechanics and Magnetic Resonance Imaging of the Thrower’s Shoulder

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): I-Yuan Joseph Chang, Joshua M. Polster

Teaser

Repetitive, high-velocity overhead throwing can lead to several adaptive changes in the throwing shoulder, which over time lead to structural microtrauma and eventually overt injury. MR imaging is a useful imaging modality to evaluate these changes and to characterize their acuity and severity. Understanding the throwing motion and the effects of this motion on the structures of the shoulder can help radiologists to recognize these findings and provide useful information to referring physicians, which may affect the treatment of these athletes. This article reviews shoulder pathomechanics and MR imaging findings in overhead throwing athletes.


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Multimodality Imaging of the Painful Elbow

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Cristy N. Gustas, Kenneth S. Lee

Teaser

Elbow pain in overhead sport athletes is not uncommon. Repetitive throwing can lead to chronic overuse and/or acute injury to tendons, ligaments, bones, or nerves about the elbow. A thorough history and physical examination of the thrower's elbow frequently establishes the diagnosis for pain. Imaging can provide additional information when the clinical picture is unclear or further information is necessary for risk stratification and treatment planning. This article focuses on current imaging concepts and image-guided treatments for injuries commonly affecting the adult throwing athlete's elbow.


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The Skeletally Immature and Newly Mature Throwing Athlete

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Kiery A. Braithwaite, Kelley W. Marshall

Teaser

Injuries to the shoulder and elbow in the pediatric and adolescent throwing athlete are common. Both knowledge of throwing mechanics and understanding of normal bone development in the immature skeleton are key to the diagnosis, treatment, and potential prevention of these common injuries. Pathologic changes from chronic repetitive trauma to the developing shoulder and elbow manifest as distinctly different injuries that can be predicted by the skeletal maturation of the patient. Sites of vulnerability and resulting patterns of injury change as the child evolves from the skeletally immature little league player to the skeletally mature high school/college athlete.


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Imaging Injuries in Throwing Sports Beyond the Typical Shoulder and Elbow Pathologies

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Paul J. Read, William B. Morrison

Teaser

This review article describes injuries that occur in the upper extremities of athletes less commonly than those typically discussed with shoulders and elbows. A survey of osseous, musculotendinous, ligamentous, and neurovascular injuries is presented along with associated imaging findings and standard treatment options. This article does not focus on the classic throwing injuries of the shoulder or elbow; the goal is to survey injuries in throwing sports that involve structures away from the glenohumeral, acromioclavicular, or elbow joints. The goal of this article is to introduce readers to these less common injuries, describe their clinical presentations, and characterize their typical imaging appearances.


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Imaging Athletic Groin Pain

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Annu Chopra, Philip Robinson

Teaser

This article outlines adductor-related groin pain, pubic-related groin pain, inguinal-related groin pain, and iliopsoas-related groin pain, with a description of the corresponding functional anatomy and imaging findings. The imaging has been described mainly in terms of MR imaging findings as this is the principal imaging modality used to investigate groin pain, although plain radiographs and ultrasound can be very useful adjuncts in specific circumstances, especially if an alternative pathology needs to be excluded.


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Ultrasound-guided Interventions for Core and Hip Injuries in Athletes

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Eoghan McCarthy, Tarek M. Hegazi, Adam C. Zoga, William B. Morrison, William C. Meyers, Alex E. Poor, Mika T. Nevalainen, Johannes B. Roedl

Teaser

Trauma and the mechanical strain of high-energy activity predispose athletes to pelvic injuries. Magnetic resonance imaging remains the primary modality for diagnosing these conditions, but ultrasonography-guided interventions are important in the management of core muscle, hip, and other pelvic conditions. This article reviews ultrasonography-guided interventions for injuries at the core, including the pelvis and hips. It reviews common injuries, procedure optimization, medication preparation, clinical evidence behind injections, tenotomy, and platelet-rich plasma. These interventions are especially important in athletes, because ultrasonography-guided procedures are often undertaken early in the treatment process, paralleling conservative rehabilitation to facilitate a faster return to play.


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Core Injuries Remote from the Pubic Symphysis

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Jeffrey A. Belair, Tarek M. Hegazi, Johannes B. Roedl, Adam C. Zoga, Imran M. Omar

Teaser

The core, or central musculoskeletal system of the torso, is essential for participating in sports and other physical activities. Core injuries are commonly encountered in athletes and active individuals. The importance of the midline pubic plate and rectus abdominis-adductor aponeurosis for core stability and function is discussed in the literature. This review article examines other important core injuries remote from the pubic symphysis, relevant clinical features, and preferred approaches to imaging. Several specific syndromes encountered in the core are reviewed. By protocoling imaging studies and identifying pathology, radiologists can add value to the clinical decision-making process and help guide therapeutic options.


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Algorithm for Imaging the Hip in Adolescents and Young Adults

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Adam C. Zoga, Tarek M. Hegazi, Johannes B. Roedl

Teaser

The imager's role in diagnosing prearthritic hip syndromes has increased significantly in the past 10 years. As surgical and nonsurgical treatment algorithms for mechanical syndromes including femoroacetabular impingement and acetabular dysplasia have evolved, clinicians have grown increasingly dependent on radiography, MR imaging, MR arthrography, and even computed tomography to confirm diagnoses and support the need for potential intervention. Musculoskeletal radiologists should help referrers navigate available imaging options and protocols, while using both clinical information and imaging findings to arrive at a diagnosis that adds value to the treatment plan.


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Postoperative Imaging of the Knee

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Daniel M. Walz

Teaser

This article reviews the normal and abnormal postoperative imaging appearance of frequently performed surgical procedures of the meniscus, articular cartilage, and ligaments. Imaging algorithms and protocols are discussed with particular attention to MR imaging techniques. Attention is paid to surgical procedures and the expected postoperative appearance as well to commonly identified recurrent and residual disorders and surgical complications.


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The Hindfoot Arch

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Yu-Ching Lin, John Y. Kwon, Mohammad Ghorbanhoseini, Jim S. Wu

Teaser

Flatfoot deformity is a common disorder of the foot and ankle and is caused by loss of the hindfoot arch. Radiologists and clinicians should be familiar with the anatomy and the imaging criteria used to assess injury to the supporting structures. Radiographs and computed tomography are most useful in characterizing the degree of osseous deformity and ultrasonography and magnetic resonance imaging are most useful in the evaluation of the supporting soft tissue structures. Treatment depends on the clinical symptoms and involves restoring the normal biomechanics of the hindfoot arch through strengthening exercises, foot/ankle orthotics, and surgery.


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Imaging of Turf Toe

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Jana M. Crain, Jean-Pierre Phancao

Teaser

During the advent of artificial turf and flexible footwear in football, turf toe was initially coined and described as a 1st metatarsophalangeal joint sprain injury. In the classic setting of hyperextension of the 1st metatarsophalangeal joint, turf toe is an injury to its plantar capsuloligamentous complex. Advances in MR imaging and knowledge of the complex 1st metatarsophalangeal joint help pinpoint the injured plantar structures as well as assess severity and chronicity of the injury. Detailed analysis of turf toe should highlight the best conservative and surgical options for injured athletes to reach optimal recovery.


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The Role of Imaging in Determining Return to Play

Publication date: September 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 5
Author(s): Bethany U. Casagranda, Peter C. Thurlow

Teaser

Return-to-play (RTP) predictions focus on how long it takes an athlete to return to their full athletic activity after sustaining an injury. This article focuses on the role of imaging and the radiologist in RTP predictions for the most common and controversial injuries affecting athletes.


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Fine needle aspiration cytology of salivary gland lesions: study in a tertiary care hospital of North Bihar

2016-08-19T07-37-19Z
Source: International Journal of Research in Medical Sciences
Sonal Verma.
Background: Fine needle aspiration cytology (FNAC) of suspected salivary gland lesions has an established role in preoperative diagnosis and management of patients. The aim of the present study was to evaluate the spectrum of salivary gland lesions in our setting and to assess the diagnostic accuracy of FNAC for salivary gland lesions. Methods: In the present study, 189 cases were included in this study and cytohistological correlation was made in 84 cases only. FNA was performed from different sites of the salivary gland swelling using a 10 mL disposable syringe and 23/24-gauge needle without local anaesthesia. FNA air-dried smears were stained with Giemsa stain and wet smears fixed in 95% ethyl alcohol were stained with haematoxylin and eosin stain. Paraffin embedded tissue sections were stained with haematoxylin and eosin (H & E). Results: Overall diagnostic accuracy of FNAC in our study was found to be 94.05% with 88% sensitivity and 96.6% specificity. Conclusions: The high accuracy, sensitivity, and specificity of FNAC confirm that preoperative cytology is a useful, quick and reliable diagnostic technique indispensable for developing countries.


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Whole exome sequencing of Rett syndrome-like patients reveals the mutational diversity of the clinical phenotype

Abstract

Classical Rett syndrome (RTT) is a neurodevelopmental disorder where most of cases carry MECP2 mutations. Atypical RTT variants involve mutations in CDKL5 and FOXG1. However, a subset of RTT patients remains that do not carry any mutation in the described genes. Whole exome sequencing was carried out in a cohort of 21 female probands with clinical features overlapping with those of RTT, but without mutations in the customarily studied genes. Candidates were functionally validated by assessing the appearance of a neurological phenotype in Caenorhabditis elegans upon disruption of the corresponding ortholog gene. We detected pathogenic variants that accounted for the RTT-like phenotype in 14 (66.6 %) patients. Five patients were carriers of mutations in genes already known to be associated with other syndromic neurodevelopmental disorders. We determined that the other patients harbored mutations in genes that have not previously been linked to RTT or other neurodevelopmental syndromes, such as the ankyrin repeat containing protein ANKRD31 or the neuronal acetylcholine receptor subunit alpha-5 (CHRNA5). Furthermore, worm assays demonstrated that mutations in the studied candidate genes caused locomotion defects. Our findings indicate that mutations in a variety of genes contribute to the development of RTT-like phenotypes.



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A study to evaluate the in-vivo anticancer activity of ethanolic extract of Holoptelea integrifolia leaves against Ehrlich ascites carcinoma model using swiss albino mice

2016-08-19T05-59-38Z
Source: International Journal of Basic & Clinical Pharmacology
Pramod S.G., Jayanthi M.K., Mruthunjaya K., Manjula S.N..
Background: Herbs having ethnomedical uses is one of the best approaches in searching novel anticancer drugs. The aim of the present study is to evaluate the anticancer activity of ethanolic extract of Holoptelea integrifolia leaves against Ehrlich ascites carcinoma induced liquid tumor model using Swiss Albino mice. Methods: Acute toxicity test was performed using Wistar albino rats before starting the in-vivo anticancer activity, were the MTD was more than 5000 mg/kg. Animals were divided into six groups of six animals each. 250mg/kg and 500 mg/kg of ethanolic extract of HI leaves, was administered orally for 9 days and Cisplatin (3.5 mg/kg, i.p., Single dose). Various parameters like Change in body weight, Mean Survival Time, Percentage Increase in Life Span, Hematological & Biochemical parameters were assessed. Results: All the parameters were considerably restored towards the normal values. HIAL500mg/kg showed more significant results than 250 mg/kg. Hence 500mg/kg was taken for combination study with standard drug Cisplatin. Conclusions: On the basis of the above result it was suggested that, the in-vivo anticancer activity of ethanolic extract of Holoptelea integrifolia leaves possess significant anticancer property with the dose dependent effect. This may probably due to the presence of phytochemicals such as alkaloids, phenols and flavonoids.


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A comparative study of volume control ventilation versus pressure control ventilation in patients of trauma

2016-08-19T05-34-39Z
Source: International Journal of Research in Medical Sciences
Achin Gupta, Naina P. Dalvi, Bharati Tendolkar.
Background: Trauma patients may require mechanical ventilation secondary to the respiratory centre depression or acute respiratory distress syndrome (ARDS). It has become increasingly accepted that mechanical ventilation, although often life-saving, can contribute to lung injury. This concept has led to implementation of lung protective ventilation strategies. Methods: This is a prospective, double blind, comparative study in which sixty patients of intubated trauma patients on mechanical ventilation expected at least for five days are included. They were divided in group V where patients were put on volume control ventilation for four days and group-P where patients were put on volume control for two days and pressure control for next two days, after initial stabilization. Each patient was evaluated for ventilation parameters (partial pressure of oxygen, partial pressure of carbon dioxide, peak inspiratory pressure), chest X ray findings and outcome of the patient, keeping the hemodynamic stability and medications same in all patients of both groups. Results: The demographic data like age, weight, and sex were comparable in both volume and pressure control groups.. Baseline ventilation parameters were compared between the groups at every eight hours. During the study we found that there was significant and better oxygenation in pressure control ventilation than volume, less increase in peak inspiratory pressure in pressure controlled ventilation than volume controlled. Other parameters like partial pressure of carbon dioxide also showed less increase in pressure control ventilation. Chest X ray finding showed that the data is comparable and statistically not significant in both the groups. The outcomes of the patients were good in pressure control mode of ventilation than volume control mode and the data was statistically significant. Conclusions: We conclude a better compliance of patients and good respiratory outcome on pressure control than volume. It has better lung compliance with respect to partial pressures of O2 and CO2 and peak inspiratory pressures than the volume control.


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Pattern of transbroncial lung biopsy-proven lung malignancies in tertiary care hospital in north India: a clinicopathological study

2016-08-19T04-38-18Z
Source: International Journal of Advances in Medicine
Vishal Gupta, Subash Bhardwaj, Opinder Kumar Bhagat.
Background: The purpose of our study was to assess the pattern of transbronchial lung biopsy (TBLB) proven lung malignancies in our region. TBLB is an effective and low cost technique that can be easily employed to make the diagnosis of lung malignancies. Methods: In our centre, we analysed 120 cases of biopsy proven lung malignancy that underwent TBLB from January 2014 to May 2016. In all of these 120 cases, the commonest indication of TBLB was radiological opacity found on chest X-ray and/or CT scan. Results: 106 cases (88.3%) were males and 14 cases (11.7%) were females. Most of patients were more than 50 years of age. The histopathological analysis revealed squamous cell carcinoma as the most common lung malignancy (n=88, 77.3%) followed by small cell carcinoma (n=20, 16.7%), adenocarcinoma (n=11, 9.2%) and 01 case of carcinoid tumour (0.8%). Commonest lung malignancy among females was adenocarcinoma (n=8, 57.1%) and among males squamous cell carcinoma (n=85, 80%). Conclusions: TBLB thus is an important tool in making the diagnosis and histopathological classification of lung malignancies.


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A study of clinical profile and risk factors in Ischemic stroke with special reference to serum homocysteine and lipid profile: a cross sectional observation study

2016-08-19T04-38-18Z
Source: International Journal of Advances in Medicine
Tarun Mishra, Archana Ishwar, Prabhat Pandey, Ambrish Singh, M. P. Chandrakar, Sunil Pharmani.
Background: Ischemic stroke (IS) is one of the major reasons of disability and death throughout the world. Every year, around 4.4 million people die because of IS all around the world. The objective was to study clinical profile and risk factors in patients with IS and to find out the association of ischemic stroke with serum lipid and serum homocysteine level. Methods: A cross sectional observation study was performed on 64 IS patients after dividing in to Group 1 (n=10, age 40 years) from December 2008 to November 2010. A detailed history, risk factors along with quantitative estimation of serum homocysteine, total cholesterol, triglyceride, low density lipoprotein and very low density lipoprotein was performed. Results: The most common premonitory symptoms were headache (70% vs 31.48%), giddiness/vertigo (10% vs 24.07%) and tingling/numbness (40% vs 16.66%) in Group 1 and Group 2 respectively. Most of the patients were having stage 1 hypertension in Group 1 (50%) whereas in Group 2 (53.65%) most of the patients were stage 2 hypertensive. The most common risk factors for IS were hypertensive (60% vs 90.65%) followed by diabetes mellitus (0% vs 62.9%)and transient ischemic attack (0% vs 42.55%) in Group 1 and Group 2 respectively. Most of the patients in were having moderate hyperhomocysteinemia in Group 1 (40%) and Group 2 (24.05%) and only 10% and 11.10% of the patients were having mild hyperhomocysteinemia. In Group 1 and Group 2, raised cholesterol, raised triglyceride, raised LDL and low HDL was recorded in 30% vs 42.55%, 30% vs 31.48%, 40% vs 68.45% and 60% vs 27.75% of patients respectively. Conclusions: High level of homocysteine and abnormal lipid profile mainly increased LDL and decreased HDL -C level is associated with increased risk of ischemic stroke.


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A study to evaluate and compare the anti-inflammatory activity of ethanolic and aqueous extract of Holoptelea integrifolia leaves on acute inflammatory models

2016-08-19T05-59-38Z
Source: International Journal of Basic & Clinical Pharmacology
Pramod S.G., Jayanthi M.K., Reddy Prasad C..
Background: Inflammation is a local response of living mammalian tissues to injury. It is a body defence reaction in order to eliminate or to limit the spread of injurious agent. This study was intended to evaluate the anti-inflammatory activity of aqueous and ethanolic extract of Holoptelea intergifolia leaves. Methods: The anti-inflammatory activity study was carried out by using Carrageenan induced rat paw oedema animal model and turpentine induced arthritis animal model. Wistar rats were divided into six groups of six animals each. Two different doses (250 mg/kg and 500 mg/kg) of aqueous and ethanolic extract of Holoptelea intergifolia leaves were given to the four different test group animals and compared with the standard drug indomethacin (10mg/kg). Results: In the present study both the extract exhibited significant Anti-inflammatory activity. But, ethanolic extract has showed considerabely better values than aqueous extract which supports the traditional medicinal utilization of the plant. Conclusions: Both the aqueous and ethanolic extract of Holoptelea Integrifolia leaves exihibited significant anti-inflammatory activity. But, Ethanolic extract had showed better results. Further studies involving the purification of the chemical constituents of the plant and the investigations in the biochemical pathways may result in the development of a potent anti-inflammatory agent with low toxicity and better therapeutic index.


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A simple dietary questionnaire correlates with formal dietitian evaluation and frequently identifies specific clinical interventions in an outpatient gastroenterology clinic

Journal of Clinical Gastroenterology

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Diabetes mellitus heightens the risk of hepatocellular carcinoma except in patients with hepatitis C cirrhosis

The American Journal of Gastroenterology

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Obesity and Insulin Resistance Screening Tools in American Adolescents: National Health and Nutrition Examination Survey (NHANES) 1999 to 2010

Canadian Journal of Diabetes

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Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the chinese FOWARC multicenter, open-label, randomized three-arm phase III trial

Journal of Clinical Oncology

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Altered expression of a two-pore domain (K2P) mechano-gated potassium channel TREK-1 in Hirschsprung’s disease

Pediatric Research

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Sofosbuvir and ledipasvir for 8 weeks for the treatment of chronic hepatitis C virus infection in HCV-mono-infected and HIV-HCV co-infected individuals - results from the German hepatitis C cohort (GECCO-01)

Clinical Infectious Diseases

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The LMS and Z scale growth reference for Saudi school-age children and adolescents

Saudi Journal of Gastroenterology

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Genome-wide association studies in oesophageal adenocarcinoma and Barrett's oesophagus: a large-scale meta-analysis

The Lancet Oncology

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WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database

Surgery

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Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome

Gastroenterology

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PTEN loss is associated with a poor response to trastuzumab in HER2-overexpressing gastroesophageal adenocarcinoma

Gastric Cancer

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The gastrointestinal benefits of COX-2 selective inhibitors with concomitant use of low-dose aspirin

Alimentary Pharmacology and Therapeutics

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Thioguanine in inflammatory bowel disease: Long-term efficacy and safety

United European Gastroenterology Journal

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Risk factors and clinical characteristics of the depressive state induced by pegylated interferon therapy in patients with hepatitis c virus infection: a prospective study

Psychiatry and Clinical Neurosciences

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Nonmalignant gastric causes of acute abdominal pain on MDCT: A pictorial review

Abdominal Imaging

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Prospective study of serum cysteine and cysteinylglycine and cancer of the head and neck, esophagus, and stomach in a cohort of male smokers

American Journal of Clinical Nutrition

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POEM is a cost-effective procedure: Cost-utility analysis of endoscopic and surgical treatment options in the management of achalasia

Surgical Endoscopy

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Zinc as a possible preventive and therapeutic agent in pancreatic, prostate, and breast cancer

European Journal of Cancer Prevention

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Prospective assessment of the quality of life in patients treated surgically for rectal cancer with lower anterior resection and abdominoperineal resection

European Journal of Surgical Oncology

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Integration of 60 000 exomes and ACMG guidelines question the role of Catecholaminergic Polymorphic Ventricular Tachycardia associated variants

Abstract

Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a highly lethal cardiac arrhythmia disease occurring during exercise or psychological stress. CPVT has an estimated prevalence of

1:10 000 and has mainly been associated with variants in calcium regulating genes. Identification of potential false-positive pathogenic variants was conducted by searching The Exome Aggregation Consortium (ExAC) database (n=60 706) for variants reported to be associated with CPVT. The pathogenicity of the interrogated variants was assessed using guidelines from the American College of Medical Genetics and Genomics (ACMG) and in silico prediction tools. Thirty-eight out of 246 variants (15%) previously associated with CPVT were identified in the ExAC database. We predicted the CPVT prevalence to be 1:132. The ACMG standards classified 29% of ExAC variants as pathogenic or likely pathogenic. The in silico predictions showed a reduced probability of disease-causing effect for the variants identified in the exome database (P˂0.001). We have observed a large overrepresentation of previously CPVT associated variants in a large exome database. Based on the frequency of CPVT in the general population, it is less likely that the previously proposed variants are associated with a highly penetrant monogenic form of the disease.

Thumbnail image of graphical abstract

We identified a total of 246 CPVT-associated variants, of which 33 variants (15%) were identified in a large exome database (ExAC) (Figure 1). We analyzed the pathogenicity of the variants with the use of four in Silico prediction tools (Figure 2). All prediction tools, except Grantham Scare, significantly predicted variants found in ExAC to be less likely pathogenic . The same overall results were observed for the agreement of damage predicting scores. The variants identified in ExAC were considered less likely pathogenic.



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Brachioradial Pruritus as a Harbinger of Syrinx in Chronic Spinal Cord Injury: A Case Report

This case describes a 56 year old man with known thoracic spinal cord injury undergoing evaluation for a pruritic rash on the dorsolateral aspect of his forearms with no upper extremity neuromuscular symptoms. Common diagnoses were considered and treated with little success. The diagnosis of brachioradial pruritus (BRP) was made, and evaluation for possible causes revealed a large cervicothoracic syrinx. To our knowledge, BRP has not been previously described as the presenting sign of post-traumatic syringomelia.

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In Vivo Mitochondrial Function in Aging Skeletal Muscle: Capacity, Flux and Patterns of Use

Due to the fundamental dependence of mammalian life on adequate mitochondrial function, the question of how and why mitochondria change in old age is the target of intense study. Given the importance of skeletal muscle for the support of mobility and health, this question extends to the need to understand mitochondrial changes in the muscle of older adults, as well. We and others have focused on clarifying the age-related changes in human skeletal muscle mitochondrial function in vivo. These changes include both the maximal capacity for oxidative production of energy (ATP), as well as the relative use of mitochondrial ATP production for powering muscular activity. It has been known for nearly 50 years that muscle mitochondrial content is highly plastic; exercise training can induce an approximately 2-fold increase in mitochondrial content, while disuse has the opposite effect. Here, we suggest that a portion of the age-related changes in mitochondrial function that have been reported are likely the result of behavioral effects, as physical activity influences have not always been accounted for. Further, there is emerging evidence that various muscles may be affected differently by age-related changes in physical activity and movement patterns. In this review, we will focus on age-related changes in oxidative capacity and flux measured in vivo in human skeletal muscle.



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Combined effects of resistance training and calorie restriction on mitochondrial fusion and fission proteins in rat skeletal muscle

Recent studies demonstrated that resistance exercise not only leads to muscle hypertrophy, but also improves mitochondrial function. Since it has been suggested that calorie restriction (CR) induces mitochondrial biogenesis, we examined the effects of resistance training with or without CR on muscle weight and key mitochondrial parameters in rat skeletal muscle. Four weeks of resistance training (thrice/week) increased gastrocnemius muscle weight in ad libitum-fed (AL) rats by 14%. The degree of muscle-weight increase by resistance training was lower in CR rats (7.4%). CR showed no effect on phosphorylation of mammalian target of rapamycin (mTOR) signaling proteins rpS6 and ULK1. Our results revealed that CR elevated the levels of peroxisome proliferator-activated receptor coactivator-1α (PGC-1α) protein, a known master regulator of mitochondrial biogenesis. Resistance training alone also increased PGC-1α levels in skeletal muscle. The magnitude of the increase in PGC-1α was similar in both CR and AL rats. Moreover, we found that resistance training with CR elevated the levels of proteins involved in mitochondrial fusion, Opa1 and Mfn1, and oxidative phosphorylation, whereas there was no effect of CR on fission regulatory proteins Fis1 and Drp1. These results indicate that CR attenuates resistance training-induced muscle hypertrophy, but may enhance mitochondrial adaptations in skeletal muscle.



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Evidence for the infiltration of gas bubbles into the arterial circulation and neuronal injury following "yo-yo" dives in pigs

"Yo-yo" diving may place divers at a greater risk of neurologic decompression illness (DCI). Using a rat model, we previously demonstrated that "yo-yo" diving has a protective effect against DCI. In the current study, we evaluated the risk of neurologic DCI following "yo-yo" dives in a pig model. Pigs were divided into four groups. The Control group (A) made a square dive, without excursions to the surface ("peeps"). Group B performed 2 "peeps", Group C performed 4 "peeps", and Group D did not dive at all. All dives were conducted on air to 5 atmospheres absolute, for 30 min bottom time. Echocardiography was performed to detect cardiac gas bubbles before the dive, immediately after, and at 90 min post-dive. Motor performance was observed during the 5-h post-dive period. Symptoms increased dramatically following a dive with 4 "peeps". Gas bubbles were detected in the right ventricle of all animals except for the sham group, and in the left ventricle only after the 4-peep dive. Neuronal cell injury was found in the spinal cord in each of the three experimental groups, tending to decrease with an increase in the number of "peeps". A 4-peep "yo-yo" dive significantly increased the risk of neurologic DCI in pigs. Following a 4-peep dive, we detected a higher incidence of bubbles in the left ventricle, supporting the common concern regarding an increased risk of neurologic DCI, albeit there was no direct correlation with the frequency of "red neurons" in the spinal cord.



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Contractile properties of motor units and expression of myosin heavy chain isoforms in rat fast-type muscle after volitional weight-lifting training

Dynamic resistance training increases the force and speed of muscle contraction, but little is known about modifications to the contractile properties of the main physiological types of motor units (MUs) which contribute to these muscle adaptations. Although the contractile profile of MU muscle fibers is tightly coupled to myosin heavy chain (MyHC) protein expression, it is not well understood if MyHC transition is a prerequisite for modifications to the contractile characteristics of MUs. In this study, we examined MU contractile properties, the mRNA expression of MyHC, parvalbumin, and sarcoendoplasmic reticulum Ca2+ pump isoforms, as well as the MyHC protein content after 5 weeks of volitional progressive weight lifting training in the medial gastrocnemius muscle in rats. The training had no effect on MyHC profiling or Ca2+ handling protein gene expression. Maximum force increased in slow (by 49%) and fast MUs (by 21%). Within fast MUs, the maximum force increased in most fatigue-resistant and intermediate but not most fatigable MUs. Twitch contraction time was shortened in slow and fast fatigue-resistant MUs. Twitch half-relaxation was shortened in fast most fatigue-resistant and intermediate MUs. The force-frequency curve shifted rightward in fast fatigue-resistant MUs. Fast fatigable MUs fatigued less within the initial 15 seconds while fast fatigue-resistant units increased the ability to potentiate the force within the first minute of the standard fatigue test. In conclusion, at the early stage of resistance training, modifications to the contractile characteristics of MUs appear in the absence of MyHC transition and the upregulation of Ca2+ handling genes.



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Central command does not suppress baroreflex control of cardiac sympathetic nerve activity at the onset of spontaneous motor activity in the decerebrate cat

Our laboratory has reported that central command blunts the sensitivity of aortic baroreceptor-heart rate (HR) reflex at the onset of voluntary static exercise in animals. We have examined whether baroreflex control of cardiac sympathetic nerve activity (CSNA) and/or cardiovagal baroreflex sensitivity are altered at the onset of spontaneously occurring motor behavior, which was monitored with tibial nerve activity in paralyzed, decerebrate cats. CSNA exhibited a peak increase (126 ± 17%) immediately after the exercise onset, followed by increases in HR and mean arterial pressure (MAP). With development of the pressor response, CSNA and HR decreased near baseline, although spontaneous motor activity was not terminated. Atropine methyl nitrate (0.1-0.2 mg/kg iv) with little central influence delayed the initial increase in HR but did not alter the response magnitudes of HR and CSNA, while atropine augmented the pressor response. The baroreflexly induced decreases in CSNA and HR elicited by brief occlusion of the abdominal aorta were challenged at the onset of spontaneous motor activity. Spontaneous motor activity blunted the baroreflex reduction in HR by aortic occlusion but did not alter the baroreflex inhibition of CSNA. Similarly, atropine abolished the baroreflex reduction in HR but did not influence the baroreflex inhibition of CSNA. Thus it is likely that central command increases CSNA and decreases cardiac vagal outflow at the onset of spontaneous motor activity while preserving baroreflex control of CSNA. Accordingly, central command must attenuate cardiovagal baroreflex sensitivity against an excess rise in MAP as estimated from the effect of muscarinic blockade.



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Influence of Exercise and Aging on Extracellular Matrix Composition in the Skeletal Muscle Stem Cell Niche

Skeletal muscle is endowed with a remarkable capacity for regeneration, primarily due to the reserve pool of muscle resident satellite cells. The satellite cell is the physiologically quiescent muscle stem cell that resides beneath the basal lamina and adjacent to the sarcolemma. The anatomic location of satellite cells is in close proximity to vasculature where they interact with other muscle resident stem/stromal cells (e.g. mesenchymal stem cells and pericytes) through paracrine mechanisms. This mini-review describes the extracellular matrix components of the muscle stem cell niche, as well as the influence of exercise and aging on the muscle stem cell niche. While exercise promotes ECM reorganization and stem cell accumulation, aging is associated with dense ECM deposition and loss of stem cell function resulting in reduced regenerative capacity and strength. An improved understanding of the niche elements will be valuable to inform the development of therapeutic interventions aimed at improving skeletal muscle regeneration and adaptation over the lifespan.



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Attenuation of exercise effect on inflammatory responses via novel role of TLR4/PI3K/Akt signaling in rat splenocytes

Moderate exercise diminishes pro-inflammation cytokine production in various types of immune cells, but the intracellular signaling pathways involved are not completely understood. Phosphoinositide 3-kinase (PI3K)/Akt, a crucial downstream protein of toll-like receptor 4 (TLR4), may modulate inflammation. The present study aimed to investigate the effects of exercises on lipopolysaccharide (LPS)-stimulated inflammatory response in splenocytes, and to explore potential mechanisms of the PI3K/Akt pathway. Male rats were divided into sedentary and exercise groups. Animals in the exercise group underwent endurance training 30 min/d, 7 d/wk at the speed of 20 m/min on a treadmill for one week. Here, we showed that exercise (i) attenuated TLR4, (ii) increased PI3K/phosph-Akt (p-Akt) and (iii) diminished phospho-nuclear factor-B (p-NF-B) expression. In addition, administration of splenocytes isolated from trained rats with LPS in vitro showed (i) reduced tumor necrosis factor (TNF-α), interleukin 6 (IL-6) and nitric oxide secretion, and (ii) decreased splenocytes proliferation. The plasma corticosterone (CCS) level in the exercise group was higher than that in the sedentary group. We confirmed that CCS down-regulated TNF-α and IL-6 secretion in response to LPS in rat splenocytes. Dexamethasone also significantly attenuated LPS-evoked release of TNF-α and IL-6 in a dose-dependent manner. These findings suggested that exercise dampened the secretion of inflammation mediators probably through partial inhibition of TLR4 and p-NF-B, and activation of PI3K/p-Akt expression in the spleen.



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