Τρίτη 6 Σεπτεμβρίου 2016

A common variant association study in ethnic Saudi Arabs reveals novel susceptibility loci for hypertriglyceridemia

Abstract

Hypertriglyceridemia (hTG) is a lipid disorder, resulting from an elevation in triglyceride levels, with a strong genetic component. It constitutes a significant risk factor for coronary artery disease (CAD), a leading cause of death worldwide. In the present study, we performed a common variant association study for hTG in ethnic Saudi Arabs. We genotyped 5501 individuals in a two–phase experiment using Affymetrix Axiom® Genome-Wide CEU 1 Array that contains a total of 587,352 SNPs. The lead variant was the rs1558861 [1.99(1.73-2.30); p = 7.37x10−22], residing on chromosome (chr) 11 at the apolipoprotein A-I/A-5 (APOA1/APOA5) locus. The rs780094 [1.34(1.21-1.49); p = 8.57x10−8] on chr 2 at the glucokinase regulatory protein (GCKR) locus was similarly significantly associated, while the rs10911205 [1.29(1.16-1.44); p = 3.52x10−6] on chr1 at the laminin subunit gamma-1 (LAMC1) locus showed suggestive association with disease. Furthermore, the rs17145738 [0.68(0.60-0.77); p = 6.69x10−9] on chr7 at the carbohydrate-responsive element-binding protein-encoding (MLXIPL) gene locus displayed significant protective characteristics, while another variant rs6982502 [0.76(0.68-0.84); p = 5.31x10−7] on chr8 showed similar but weaker properties. These findings were replicated in 317 cases versus 1415 controls from the same ethnic Arab population. Our study identified several variants across the human genome that are associated with hypertriglyceridemia in ethnic Arabs.

Thumbnail image of graphical abstract

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Spreading depolarization in the brain of Drosophila is induced by inhibition of the Na+/K+-ATPase and mitigated by a decrease in activity of protein kinase G

Spreading depolarization (SD) is characterized by a massive redistribution of ions accompanied by an arrest in electrical activity that slowly propagates through neural tissue. It has been implicated in numerous human pathologies, including migraine, stroke, and traumatic brain injury, and thus the elucidation of control mechanisms underlying the phenomenon could have many health benefits. Here, we demonstrate the occurrence of SD in the brain of Drosophila melanogaster, providing a model system, whereby cellular mechanisms can be dissected using molecular genetic approaches. Propagating waves of SD were reliably induced by disrupting the extracellular potassium concentration ([K+]o), either directly or by inhibition of the Na+/K+-ATPase with ouabain. The disturbance was monitored by recording the characteristic surges in [K+]o using K+-sensitive microelectrodes or by monitoring brain activity by measuring direct current potential. With the use of wild-type flies, we show that young adults are more resistant to SD compared with older adults, evidenced by shorter bouts of SD activity and attenuated [K+]o disturbances. Furthermore, we show that the susceptibility to SD differs between wild-type flies and w1118 mutants, demonstrating that our ouabain model is influenced by genetic strain. Lastly, flies with low levels of protein kinase G (PKG) had increased latencies to onset of both ouabain-induced SD and anoxic depolarization compared with flies with higher levels. Our findings implicate the PKG pathway as a modulator of SD in the fly brain, and given the conserved nature of the signaling pathway, it could likely play a similar role during SD in the mammalian central nervous system.



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Acute ethanol effects on neural encoding of reward size and delay in the nucleus accumbens

Acute ethanol administration can cause impulsivity, resulting in increased preference for immediately available rewards over delayed but more valuable alternatives. The manner in which reward size and delay are represented in neural firing is not fully understood, and very little is known about ethanol effects on this encoding. To address this issue, we used in vivo electrophysiology to characterize neural firing in the core of the nucleus accumbens (NAcc) in rats responding for rewards that varied in size or delay after vehicle or ethanol administration. The NAcc is a central element in the circuit that governs decision-making and importantly, promotes choice of delayed rewards. We found that NAcc firing in response to reward-predictive cues encoded anticipated reward value after vehicle administration, but ethanol administration disrupted this encoding, resulting in a loss of discrimination between immediate and delayed rewards in cue-evoked neural responses. In addition, NAcc firing occurring at the time of the operant response (lever pressing) was inversely correlated with behavioral response latency, such that increased firing rates were associated with decreased latencies to lever press. Ethanol administration selectively attenuated this lever press-evoked firing when delayed but not immediate rewards were expected. These effects on neural firing were accompanied by increased behavioral latencies to respond for delayed rewards. Our results suggest that ethanol effects on NAcc cue- and lever press-evoked encoding may contribute to ethanol-induced impulsivity.



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Distinct contributions of explicit and implicit memory processes to weight prediction when lifting objects and judging their weights: an aging study

Weight predictions used to scale lifting forces adapt quickly when repeatedly lifting unusually weighted objects and are readily updated by explicit information provided about weight. In contrast, weight predictions used when making perceptual judgments about weight are more resistant to change and are largely unaffected by explicit information about weight. These observations suggest that distinct memory systems underlie weight prediction when lifting objects and judging their weights. Here we examined whether these weight predictions differ in their reliance on declarative and nondeclarative memory resources by comparing the adaptability of these predictions in older adults, who exhibit relatively impaired declarative memory processes, to those in younger adults. In the size condition, we measured lift forces as participants repeatedly lifted a pair of size-weight inverted objects in alternation. To assess weight judgments, we measured the size-weight illusion every 10 lifts. The material condition was similar, except that we used material-weight inverted objects and measured the material-weight illusion. The strengths of these illusions prior to lifting, and the attenuation of the illusions that arise when lifting inverted objects, were similar for both groups. The magnitude of the change in the illusions was positively correlated with implicit memory performance in both groups, suggesting that predictions used when judging weight rely on nondeclarative memory resources. Updating of lifting forces also did not differ between groups. However, within the older group the success with which lifting forces were updated was positively correlated with working memory performance, suggesting that weight predictions used when lifting rely on declarative memory resources.



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Functional evidence for a direct excitatory projection from the lateral habenula to the ventral tegmental area in the rat

The lateral habenula, a phylogenetically conserved epithalamic structure, is activated by aversive stimuli and reward omission. Excitatory efferents from the lateral habenula predominately inhibit midbrain dopamine neuronal firing through a disynaptic, feedforward inhibitory mechanism involving the rostromedial tegmental nucleus. However, the lateral habenula also directly targets dopamine neurons within the ventral tegmental area, suggesting that opposing actions may result from increased lateral habenula activity. In the present study, we tested the effect of habenular efferent stimulation on dopamine and nondopamine neurons in the ventral tegmental area of Sprague-Dawley rats using a parasagittal brain slice preparation. Single pulse stimulation of the fasciculus retroflexus excited 48% of dopamine neurons and 51% of nondopamine neurons in the ventral tegmental area of rat pups. These proportions were not altered by excision of the rostromedial tegmental nucleus and were evident in both cortical- and striatal-projecting dopamine neurons. Glutamate receptor antagonists blocked this excitation, and fasciculus retroflexus stimulation elicited evoked excitatory postsynaptic potentials with a nearly constant onset latency, indicative of a monosynaptic, glutamatergic connection. Comparison of responses in rat pups and young adults showed no significant difference in the proportion of neurons excited by fasciculus retroflexus stimulation. Our data indicate that the well-known, indirect inhibitory effect of lateral habenula activation on midbrain dopamine neurons is complemented by a significant, direct excitatory effect. This pathway may contribute to the role of midbrain dopamine neurons in processing aversive stimuli and salience.



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Relationship of membrane properties, spike burst responses, laminar location, and functional class of dorsal horn neurons recorded in vitro

The input-output and discharge properties of neurons are shaped by both passive and active electrophysiological membrane properties. Whole cell patch-clamp recordings in lamina I–III neurons in an isolated preparation of the whole spinal cord of juvenile rats with attached dorsal roots and dorsal root ganglia were used to further define which of these properties provides the most impactful classification strategy. A total of 95 neurons were recorded in segment L5 and were classified based on the responses to L4 dorsal root stimulation. The results showed that high-threshold and silent neurons had higher membrane resistance and more negative resting membrane potential than low-threshold or wide-dynamic-range neurons. Rheobase in low-threshold and wide-dynamic-range neurons was significantly lower than that of high-threshold or silent neurons. Four types of firing patterns were identified in response to depolarizing current injections. Low-threshold cells most frequently showed a phasic firing pattern characterized by a short initial burst of action potentials, single spiking or irregular firing bursts at the onset of a depolarizing pulse. High-threshold and wide-dynamic-range neurons were characterized by tonic firing with trains of spikes occurring at regular intervals throughout the current pulse. The majority of silent neurons displayed a delayed onset of firing in response to current injection. These results indicate that the passive membrane properties of spinal neurons are tuned to optimize the responses to particular subsets of afferent stimuli.



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Mechanisms of spreading depolarization in vertebrate and insect central nervous systems

Spreading depolarization (SD) is generated in the central nervous systems of both vertebrates and invertebrates. SD manifests as a propagating wave of electrical depression caused by a massive redistribution of ions. Mammalian SD underlies a continuum of human pathologies from migraine to stroke damage, whereas insect SD is associated with environmental stress-induced neural shutdown. The general cellular mechanisms underlying SD seem to be evolutionarily conserved throughout the animal kingdom. In particular, SD in the central nervous system of Locusta migratoria and Drosophila melanogaster has all the hallmarks of mammalian SD. Locust SD is easily induced and monitored within the metathoracic ganglion (MTG) and can be modulated both pharmacologically and by preconditioning treatments. The finding that the fly brain supports repetitive waves of SD is relatively recent but noteworthy, since it provides a genetically tractable model system. Due to the human suffering caused by SD manifestations, elucidating control mechanisms that could ultimately attenuate brain susceptibility is essential. Here we review mechanisms of SD focusing on the similarities between mammalian and insect systems. Additionally we discuss advantages of using invertebrate model systems and propose insect SD as a valuable model for providing new insights to mammalian SD.



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Morphine-induced synaptic plasticity in the VTA is reversed by HDAC inhibition

Dopamine (DA) dysfunction originating from the ventral tegmental area (VTA) occurs as a result of synaptic abnormalities following consumption of drugs of abuse and underlies behavioral plasticity associated with drug abuse. Drugs of abuse can cause changes in gene expression through epigenetic mechanisms in the brain that underlie some of the lasting neuroplasticity and behavior associated with addiction. Here we investigated the function of histone acetylation and histone deacetylase (HDAC)2 in the VTA in recovery of morphine-induced synaptic modifications following a single in vivo exposure to morphine. Using a combination of immunohistochemistry, Western blot, and whole cell patch-clamp recording in rat midbrain slices, we show that morphine increased HDAC2 activity in VTA DA neurons and reduced histone H3 acetylation at lysine 9 (Ac-H3K9) in the VTA 24 h after the injection. Morphine-induced synaptic changes at glutamatergic synapses involved endocannabinoid signaling to reduce GABAergic synaptic strength onto VTA DA neurons. Both plasticities were recovered by in vitro incubation of midbrain slices with a class I-specific HDAC inhibitor (HDACi), CI-994, through an increase in acetylation of histone H3K9. Interestingly, HDACi incubation also increased levels of Ac-H3K9 and triggered GABAergic and glutamatergic plasticities in DA neurons of saline-treated rats. Our results suggest that acute morphine-induced changes in VTA DA activity and synaptic transmission engage HDAC2 activity locally in the VTA to maintain synaptic modifications through histone hypoacetylation.



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Effect of current focusing on the sensitivity of inferior colliculus neurons to amplitude-modulated stimulation

In multichannel cochlear implants (CIs), current is delivered to specific electrodes along the cochlea in the form of amplitude-modulated pulse trains, to convey temporal and spectral cues. Our previous studies have shown that focused multipolar (FMP) and tripolar (TP) stimulation produce more restricted neural activation and reduced channel interactions in the inferior colliculus (IC) compared with traditional monopolar (MP) stimulation, suggesting that focusing of stimulation could produce better transmission of spectral information. The present study explored the capability of IC neurons to detect modulated CI stimulation with FMP and TP stimulation compared with MP stimulation. The study examined multiunit responses of IC neurons in acutely deafened guinea pigs by systematically varying the stimulation configuration, modulation depth, and stimulation level. Stimuli were sinusoidal amplitude-modulated pulse trains (carrier rate of 120 pulses/s). Modulation sensitivity was quantified by measuring modulation detection thresholds (MDTs), defined as the lowest modulation depth required to differentiate the response of a modulated stimulus from an unmodulated one. Whereas MP stimulation showed significantly lower MDTs than FMP and TP stimulation (P values <0.05) at stimulation ≤2 dB above threshold, all stimulation configurations were found to have similar modulation sensitivities at 4 dB above threshold. There was no difference found in modulation sensitivity between FMP and TP stimulation. The present study demonstrates that current focusing techniques such as FMP and TP can adequately convey amplitude modulation and are comparable to MP stimulation, especially at higher stimulation levels, although there may be some trade-off between spectral and temporal fidelity with current focusing stimulation.



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Effect of papaya supplementation on oxidative stress markers in Parkinson's disease

2016-09-06T19-07-48Z
Source: Oxidants and Antioxidants in Medical Science
Andrea Bolner, Rocco Micciolo, Ottavio Bosello, Giampietro Nordera.
Objective: In Parkinsons disease (PD), oxidative processes occur that are probably involved in the progression of neuronal damage. Recent studies suggest that regular consumption of antioxidant-rich foods or supplementation with functional foods like fermented papaya, may reduce cellular oxidative stress and protect against many age-related diseases by strengthening the physiological antioxidant barrier. Our study aims to assess the antioxidant properties of a commercial fermented papaya preparation (FPP) in PD by evaluation of its effects on a wide panel of oxidative stress markers in blood and urine. Methods: A group of parkinsonian voluntary patients (T, n = 15) were treated 9 months with FPP and compared with a control group (NT, n = 12). The efficacy of FPP in increasing the physiological antioxidant barrier was evaluated at the times 0, 6 and 9 months with the analysis of 23 oxidative markers including total radical oxygen species, homocysteine, biological antioxidant potential, glutathione, superoxide dismutase, uric acid, total bilirubin, iron, ferritin, coenzyme Q10, 3-nitrotyrosine, total lipoperoxide, 4-hydroxy-nonenal, 8-hydroxydeoxyguanosine (8-OHdG) and 2-deoxyguanosine (2-dG). Results: Among the considered markers, twenty not showed significant differences at times 0, 6 and 9 months between T and NT patients, demonstrating a consequent non-significant effect of FPP supplementation. Instead, three urinary markers of oxidative stress on nucleic acids, 8-OHdG/2-dG, 2-dG/uric acid and 2-dG/creatinine showed statistical significant interactions between time and treatment, highlighting an effective better response to oxidative attack for T than NT. Conclusions: Papaya supplementation for a medium-long time seems able to affect positively the turnover of oxidized nucleic acids helping to restore the normal nitrogenous bases into nucleotide chains and to replace those altered by radicals attack.


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Changes in HbA1c levels and body mass index after successful decompression surgery in patients with type 2 diabetes mellitus and lumbar spinal stenosis: results of a two-year follow-up study

Lumbar spinal stenosis (LSS) can hinder a patient's physical activity, which in turn can impair glucose tolerance and body weight regulation in patients with type 2 diabetes mellitus (DM-2). Therefore, successful lumbar surgery could facilitate glycemic control and body weight regulation.

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Effects of Cervical Extension on Deformation of Intervertebral Disc and Migration of Nucleus Pulposus

We theorized that active cervical extension should influence the position of the nucleus pulposus (NP) within the intervertebral disc (IVD) in the sagittal plane. While several studies on the lumbar IVD have been conducted, there are no quantitative data for in vivo positional changes of the NP in the cervical IVD.

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Effect of ethanol extract of sida acuta burm f. leaves on egg albumin-induced inflammation.

2016-09-06T15-12-49Z
Source: Journal of Experimental and Integrative Medicine
Obioma Benedeth Eze, Okwesili Fred Nwodo, Victor Nwadiogo Ogugua, Parker Elijah Joshua.
ABSTRACT Objective: To evaluate the potential properties of ethanol extract of Sida acuta Burm F. leaves against inflammation. Methods: It was conducted using 25 adult wistar albino rats. They were divided into five groups of five rats each. Group1 administered 5 ml/kgb.wt. of normal saline (control group). Group 2, 3 and 4 administered 100, 200 and 400 mg/kgb.wt. of ethanol extract of Sida acuta leaves while group 5 were administered 200 mg/kgb.wt. of phenylbutazone (vehicle control). Paw oedema was induced using 0.1 ml of undiluted fresh albumin egg (philogistic agent) into the subplantar surface of the right hind paw of the rats. Superoxide dismutase activity, Catalase activity, Vitamine E concentration and Malondialdehyde level were assessed. Results: The extract at doses of 100, 200 and 400 mg/kgb.wt. and phenylbutazone 200 mg/kgb.wt. were administered intraperitoneally to respective groups of the rats. Control group received 5 ml/kgb.wt of normal saline. Doses of the extract 100, 200 and 400 mg/kg b.wt. significantly (p

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Antioxidant Aerva lanata Extract Supresses Proliferation and Induce Mitochondria Mediated Apoptosis in Human Hepatocelluar carcinoma cell line

2016-09-06T15-12-49Z
Source: Journal of Experimental and Integrative Medicine
Nevin Kottayath Govindan.
Objectives: The aim of the present study was to investigate the anti-proliferative and apoptotic activity of petroleum ether extract of AervaLanata(ALpe) on Hep3B hepatocellular cancer cells. Materials and Methods: To evaluate the anti cancer potential of this plant,ALpe was prepared using petroleum ether (60-80) extraction. Total polyphenols, flavonoids and alkaloid concentration in ALpe was determined spectrophotometrically. Antioxidant activity of ALpe was tested against DPPH, ABTS and superoxide radicals in vitro. ALpewas tested for its cytotoxic potential against human liver carcinoma Hep3B cells using MTT assay. The effect of ALpeon the apoptotic inducing property was evaluated using AO/EB and DAPI staining. The ROS inducing ability of ALpewas determined using DCFH staining andMitochondrial membrane potential (MMP) was determined using Rhodamine 123 staining. Results: Experiments showed that ALpe have significant amount of biologically active components, polyphenols and alkaloids. ALpe showed stronganti proliferative activity and induced apoptosis of Hep3B cell lines as evident from AO/EB and DAPI staining. ALpe treatment increased the ROS production at higher concentration and reduced the MMP in Hep3B cells forcing to undergo apoptosis. Conclusion: The results indicate that ALpe with the presence of biologically active components can be used as apotential agent alone or in combination to treat liver related diseases.


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The Effects of Prolotherapy (Hypertonic Dextrose) in Recreational Athletes with Patellofemoral Pain Syndrome

2016-09-06T15-12-49Z
Source: Journal of Experimental and Integrative Medicine
Yavuz YILDIZ, Ali Haydar APAYDIN, Mehmet Murat SEVEN, Aydan ORSCELIK.
Objective: Prolotherapy is recognized as a regenerative injection technique that stimulates the bodys healing processes to strengthen weakened ligaments and tendons. Hypertonic dextrose as an irritant agent which stimulates the healing process agent is widely used in in this technique. The aim of the current study is to assess the efficiency of prolotherapy injections in patellofemoral pain syndrome Methods: The current study was designed as a retrospective clinical study. 44 recreational athletes with unilateral PFPS were enrolled in this study. 10 ml of 15% and 5 ml of 25% hypertonic dextrose were used as extra- and intra-articular injection in the knee with PFPS respectively. Extra and intra articular injections were repeated three times with 21 day intervals according to the tissue repair processing. Results: The knee functional scores, balance and coordination scores were significantly improved in the affected knees at 6 months after treatment (p


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Family planning practices among rural community women in Nigeria

2016-09-06T15-12-49Z
Source: Journal of Experimental and Integrative Medicine
Saheed Opeyemi Usman, Olabisi Oyepero Kalejaye, Ibiwumi Nafisat Isola, Oluwole Oluwaniyi, Adewale Kayode Ojogbede, Ayooluwa Samuel Adu.
Objectives: Couples space the number of years between each child they want to give birth to through the use of contraceptive methods. It is widely reported that people who do not use any birth control plan may lack access or face barriers, which may include partners non-acceptance, fear of side effects or risks. This study is therefore carried out to determine the child spacing and family planning strategies, obtain the values and norms that influence the knowledge and practice of family planning, among rural community women of reproductive ages in South-Western Nigeria with a view to making necessary recommendations that would help improve family planning practices. Methods: This cross sectional study was carried out in towns across the three senatorial districts of two South-Western states of Ondo & Ekiti in Nigeria. The target population was women of reproductive age group in these districts. A multi-stage sampling technique was used to select the respondent. All data were statistically analysed, using statistical package for the social sciences (SPSS) and statistical test of significance was performed with Chi-Square test. Results: A total of 1500 consenting respondents participated in the study with a mean age ± SD of 33.69 ± 11.14 years. The main reason given for choice of family planning was reliability, main source of information is through government-owned hospital health personnel, male condom is the most widely used current family planning method while heavy menstrual period is the commonly known side effect. Conclusion: Indications show that educational status, religious factor and economic status influence family planning and choices made, there is therefore need for more campaign and public enlightenment programs on modern family planning methods, importance, choices and benefits, crucially including the religious leaders, in order to fast track the information spread and further improve the use of modern contraceptive methods.


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Antioxidant properties of ethanol and fractions of ocimum gratissimum leave in paracetamol-induced oxidative stress in Wistar albino rats.

2016-09-06T15-12-49Z
Source: Journal of Experimental and Integrative Medicine
ukpabi-ugo, Jacinta Chigozie, Patrick -Iwuanyanwu, kingsley Chukwuemeka,Monanu Michael Okechukwu.
Objective:Thepresent study is aimed at evaluating the antioxidant activity of different solvent fractions (ethylacetate, ethanol, hexane, aqueous)of Ocimumgratissimum (OG)onoxidative stress indices in Paracetamol-induced oxidative stress in Wistar albino rats. Methods: Thirty five (35) Wistar albinorats of both sexes were divided into seven groups (n=5). Paracetamol(PCM) (500mg/kg BW) dissolved in olive oil was administered daily for 28 days to induce hepatic damage in experimental rats.Control group received 1ml olive oil only. 400 mg/kg BW doses of ethyl acetate, ethanol, hexane, aqueous fractions of OG and silymarin(SIL) (100mg/kg) in addition to 500mg/kg body weight of PCM dissolved in 1ml of olive oil respectivelywere used as treatment groups daily for 28 days. Blood samples were collected by cardiac puncture and activities of Superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) using standard biochemical methods. Lipid peroxidation was estimated by measuring Malondialdehyde (MDA) concentration. Results:Superoxide dismutase (SOD) activity increased significantly (p≤ 0.05) in groups administered different fractions of OG and SIL when compared with control. Catalase (CAT) activity showed significant (p≤ 0.05) increase in ethanol and ethyl acetate fractions of OG while group treated with SIL and groups administered hexane and aqueous fractions showed a marked increase when compared with rats treated with PCM only. Reduced glutathione (GSH) level increased significantly (p≤ 0.05) in aqueous fraction while SIL-treated group and groups administered fractions of OG (ethyl acetate, ethanol and hexane) showed a marked increase when compared with PCM only treated group. Malondialdehyde concentration decreased significantly (p≤ 0.05) in groups administered different fractions of OG when compared with PCM only treated group. Conclusion:These findings are suggestive of the antioxidant properties of different solvent fractions of Ocimum gratissimum extract in paracetamol-induced oxidative stress with ethyl acetate fraction showing the highest activity. Reduced glutathione level increased significantly (p≤ 0.05) in aqueous fraction while silymarin and other fractions of OG (ethyl acetate, ethanol and hexane) showed a marked increase when compared with negative control. Malondialdehyde level decreased significantly (p≤ 0.05) in groups treated with different fractions of OG when compared with negative control.Histopathological examination of the liver sections corroborated the data from biochemical studies. Conclusion: These findings indicate that different solvent fractions of Ocimum gratissimum extract may possess antioxidant properties and thus reduced the oxidative stress that was caused by paracetamol overdose with ethyl acetate fraction being the more effective fraction.


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A method of radial nerve length measurement based on cadaveric investigation

Publication date: Available online 6 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jae-Gyum Kim, Dasom Kim, Hung Youl Seok, Yoohwan Kim, Kyung-Sook Yang, Im Joo Rhyu, Byung-Jo Kim
ObjectiveTo determine the most reliable method to measure the length of the radial nerve during a nerve conduction study (NCS).DesignCadaveric investigationSettingA practical anatomy research laboratory in a universitySubjects10 fresh cadaversInterventionsDesign of measurement methods using cadaver dissection and compare the measured values to the true length in 18 arms of nine cadavers.Main Outcome MeasuresFour points (A, B, C, and D) were determined: A) proximal stimulation point in NCS, B) point at the elbow crease, C) point in the mid-forearm, D) distal stimulation point 5 cm above the extensor indicis (EI). The true length of the radial nerve between the stimulus points (point A and D) in NCS was compared with the measured values by summation of the straight line segments between those points with various combinations. The difference in root mean squared error of distance measured by each method compared to the true length was calculated to determine the best measurement method.ResultsThe closest distance to the true length (28.7 ± 2.8 cm) in the cadaveric investigation was obtained using the summation of straight line segments between points A, B, and D (A-B-D, RMSE = 0.72 cm) followed by the A-B-C-D distance (RMSE = 0.87 cm) and the A-D distance (RMSE = 1.38 cm) methods, in sequence. The former two distance measurements were relatively closer to the true length than the latter measurement method.ConclusionsMultiple segmentation measurement methods reflected the course of the radial nerve better than a single linear measurement method. We suggest that the distance measured using a stopover point near the lateral epicondyle between two stimulus points (A-B-D distance) is closer to the true length of the nerve.



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Measuring Community Integration in Persons with Limb Trauma and Amputation: A Systematic Review

Publication date: Available online 6 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Linda Resnik, Matthew Borgia, Benjamin Silver
ObjectiveThe study purpose was to conduct a systematic review of community integration measures used with populations with limb trauma and/or amputation and evaluate each measure's focus, content, and psychometric properties.Data SourcesSearches of PubMed and CINAHL for terms social participation, community integration, social function, outcome assessment, wounds and injuries, and amputation/rehabilitation.Study SelectionIncluded English language articles with a sample size of at least 20 adults with limb trauma or amputation Measures were deemed eligible if they contained a majority of items related to construct of participation as defined by the International Classification of Functioning, Disability and Health (ICF).Data ExtractionData on internal consistency; test-retest, inter-rater, and intra-rater reliability; content, structural, construct, concurrent, and predictive validity; responsiveness; and floor/ceiling effects was extracted from each manuscript and confirmed by a second investigator.Data SynthesisOne hundred fifty six papers containing 36 measures and 94 sub-scales were reviewed. Psychometric properties were rated and an overall score was calculated for each measure. Content of highest scoring measures were examined. Scant evidence was found regarding the psychometric properties of most measures. Eight scales from five instruments had the strongest measurement properties: the Trinity Amputation and Prosthetics Experience (TAPES) social restriction and adjustment to limitation scales; Community Reintegration of Service Members (CRIS) extent of participation and perceived limitations, scales; SF-36 role-physical and social functioning scales; the 136-item Sickness Impact Profile (SIP) psychosocial domain scale, and the WHODAS-II 12-item total score.ConclusionsEights scales from 5 instruments: the TAPES, CRIS, SF-36, the 136-item SIP, and the WHODAS-II 12-item measure, had the strongest measurement properties.



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The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis

Abstract

Background

Recent research into the use of dietary nitrates and their role in vascular function has led to it becoming progressively more popular amongst athletes attempting to enhance performance.

Objective

The objective of this review was to perform a systematic review and meta-analysis of the literature to evaluate the effect of dietary nitrate (NO3) supplementation on endurance exercise performance. An additional aim was to determine whether the performance outcomes are affected by potential moderator variables.

Data sources

Relevant databases such as Cochrane Library, Embase, PubMed, Ovid, Scopus and Web of Science were searched for the following search terms 'nitrates OR nitrate OR beetroot OR table beet OR garden beet OR red beet AND exercise AND performance' from inception to October 2015.

Study selection

Studies were included if a placebo versus dietary nitrate-only supplementation protocol was able to be compared, and if a quantifiable measure of exercise performance was ≥30 s (for a single bout of exercise or the combined total for multiple bouts).

Study appraisal and synthesis

The literature search identified 1038 studies, with 47 (76 trials) meeting the inclusion criteria. Data from the 76 trials were extracted for inclusion in the meta-analysis. A fixed-effects meta-analysis was conducted for time trial (TT) (n = 28), time to exhaustion (TTE) (n = 22) and graded-exercise test (GXT) (n = 8) protocols. Univariate meta-regression was used to assess potential moderator variables (exercise type, dose duration, NO3 type, study quality, fitness level and percentage nitrite change).

Results

Pooled analysis identified a trivial but non-significant effect in favour of dietary NO3 supplementation [effect size (ES) = −0.10, 95 % Cl = −0.27 to 0.06, p > 0.05]. TTE trials had a small to moderate statistically significant effect in favour of dietary NO3 supplementation (ES = 0.33, 95 % Cl = 0.15–0.50, p < 0.01). GXT trials had a small but non-significant effect in favour of dietary NO3 supplementation in GXT performance measures (ES = 0.25, 95 % Cl = −0.06 to 0.56, p > 0.05). No significant heterogeneity was detected in the meta-analysis. No statistically significant effects were observed from the meta-regression analysis.

Conclusion

Dietary NO3 supplementation is likely to elicit a positive outcome when testing endurance exercise capacity, whereas dietary NO3 supplementation is less likely to be effective for time-trial performance. Further work is needed to understand the optimal dosing strategies, which population is most likely to benefit, and under which conditions dietary nitrates are likely to be most effective for performance.



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The Sticking Point in the Bench Press, the Squat, and the Deadlift: Similarities and Differences, and Their Significance for Research and Practice

Abstract

Since it was first observed, and especially so in recent years, the phenomenon of the so-called "sticking point" in resistance training has attracted a substantial amount of sports and exercise science research. Broadly speaking, the sticking point is understood as the position in the range of motion of a lift at which a disproportionately large increase in the difficulty associated with continuing the lift is experienced. Hence the sticking point is inherently the performance bottleneck, and is also associated with an increased chance of exercise form deterioration or breakdown. Understanding the aspects of lifting performance which should be analysed in order to pinpoint the cause of a specific sticking point and therefore devise an effective training strategy to overcome it is of pervasive importance to strength practitioners, and is conducive to injury avoidance and continued progress. In this paper, we survey a range of physiological and biomechanical mechanisms which contribute to the development of sticking points, and then, led by this insight, review and analyse the findings of the existing observational research on the occurrence of sticking points in three ubiquitous exercises: the bench press, the squat, and the deadlift. The findings of our analysis should be used to inform future research and current resistance training practice.



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Epidural catheter blockage caused by a blood clot: is it time to change our practice?

A 36-year-old parturient (height, 153 cm; weight, 80 kg; body mass index, 34.2) requested epidural analgesia to relieve her labor pain in the early labor stage. An epidural block was performed on the patient in the lateral position with an 18-G Tuohy needle in the L4–5 interspace under strict aseptic technique, which failed because of technical difficulty. Several attempts were then made to administer the epidural block in the L3–4 interspace that was identified using the loss-of-resistance-to-air technique.

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Cisatracurium- and rocuronium-associated residual neuromuscular dysfunction under intraoperative neuromuscular monitoring and postoperative neostigmine reversal: a single-blind randomized trial

Postoperative residual neuromuscular blockade (RNMB) is a common complication in the postanesthesia care unit (PACU), but also one of the most controversial issues. Many studies and trials demonstrated that some methods and techniques can reduce the incidence and the extent of the phenomenon.

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Intrapleural placement of a thoracic epidural catheter in a patient with spinal stenosis

Due to the close proximity of the thoracic epidural space and parietal pleura, pleural puncture with intrapleural catheter placement is a potential complication of thoracic epidural anesthesia. The authors present a case of an obese patient with a history of spinal stenosis that underwent thoracotomy. Repeated failed attempts at epidural anesthesia were complicated by intrapleural placement of the catheter. The patient subsequently developed clinical signs of pneumothorax and required urgent thoracostomy.

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Equipment for medical responders at special events

By Dave Konig

Whether you are at a high school football game, a music festival or a major league sports event, EMTs providing event medical services need to be able to respond quickly to any call for help. Responding quickly is half of the equation to success. Having the right tools to render the appropriate care is the other half.

The majority of responses or patient contacts often don't require a visit to the onsite medical office, much less transportation to an emergency room. Improving a guest's condition so they can enjoy the rest of their time in the venue is the primary goal of every event medical service provider.

Standard Items
In order to meet expectations of the organizer and their guests, event medical service providers need to have the tools on hand to be prepared to face a variety of possible issues. Knowing the organizer's expectations for event medical services, as well as the capacity of on-location medical services and the availability of a dedicated transport unit is important to fine-tuning the supply list.

Here is a list of typical supplies for quick response by an event medical service provider on a posting:

Circulation: Bleeding control supplies

  • Adhesive bandages 1x3" (20)
  • 4x4 gauze (10)
  • 5x9 gauze (5)
  • 10x30 trauma dressing (1)
  • 1-inch medical tape (1)
  • 2-inch medical tape (1)
  • Triangular bandages (4)
  • Burn sheet (1)
  • 1-inch roller gauze (3)
  • 2-inch roller gauze (3)
  • 250 mL sterile saline (1)
  • Trauma tourniquets (2)
  • Trauma shears (1)

Airway: BLS management

  • Oropharyngeal airways (OPA) sizes 0-5 (1)
  • Portable handheld suction unit (1)

Breathing: Ventilation and oxygenation

  • D-size oxygen cylinder with oxygen regulator (1)
  • Adult BVM w/ 2 masks (1)
  • Pediatric BVM w/ 3 masks (1)
  • Adult non-rebreather mask (2)
  • Adult nasal cannula tubing (1)
  • Pediatric non-rebreather mask (2)
  • Pediatric nasal cannula tubing (1);

Additional items for assessment and care

  • Adult blood pressure cuff (1)
  • Pediatric blood pressure cuff (1)
  • Adult stethoscope (1)
  • Pediatric stethoscope (1)
  • Chemical ice packs (4)
  • Small splint (1)
  • Small red infectious waste disposal bag (2)
  • Notepad for documenting patient information (1)
  • Black ink pen (1)
  • Penlight (1)
  • Flashlight (1)
  • Personal protective equipment kit including gloves, gown, goggles, and respirator (1)

The following should be carried if allowed by local protocols:

  • Nebulizer and albuterol sulfate doses (1)
  • Nasopharyngeal airways airways sizes 16F-34F (1)
  • Adult epinephrine auto-injector (.3 mg) (1)
  • Pediatric epinephrine auto-injector (.15 mg) (1)
  • Blood glucometer (1)
  • Pulse oximeter (1)

An AED with each medical provider is ideal but not a necessity. The venue may have public access AEDs readily available to use. For venues without AEDs, overlap concentric circles of coverage with 50 percent of your postings equipped with AEDs.

Increasing Options Through Supply
While traditional emergency medical services often stock to regulatory minimums with just enough to get the patient to the hospital for definitive care, event medical services workers often add additional items so that guests who have received treatment can stay and keep enjoying the event. While remaining in the venue is not always possible due to the guest's condition, transporting every patient that comes to a first aid station is simply unnecessary.

Part of the reason for this philosophical difference is reimbursement models. While the emergency medical service is reimbursed on a transportation fee-for-service model, the vast majority of event medical service providers are reimbursed on an hourly or per-event basis. By doing this, event medical services do not depend on patient transportation for financial solvency.

Some ambulance transport agencies may reduce their pricing for staffing an event under the assumption that there will be some number of patient transports resulting in reimbursement. Agencies should never count on patient transport reimbursement when bidding and budgeting for events. Doing so incentivizes the providers to the traditional emergency medical services philosophy to transport patients to a hospital, which is a disservice to the event organizers and their guests.

One way to be sure you can address the needs of the guest is to have the additional items on hand to care for them in the best manner.

Specific items for event coverage

  • Knuckle articulated adhesive bandages 1½ x 3" (5)
  • Fingertip adhesive bandages 1¾ x 2" (5)
  • Adhesive bandage strips ½ x 4" (10)
  • Triple antibiotic ointment .5g (10)
  • Sterile saline irrigation solution 30 mL (5)

Over-the-counter medications
There is usually a debate surrounding over-the-counter medications and whether or not they can be furnished to guests. Some argue that providing these medications is drug administration, while others, me included, view the drugs as just being dispensed.

The four over the counter medications most commonly requested are acetaminophen, ibuprofen, diphenhydramine, and aspirin. One way to avoid any and all legal issues is to not offer any over-the-counter drugs.

Unfortunately, just as we wonder why the public can easily access naloxone for drug overdoes, the public you come into contact with will wonder why we can't provide them a packet of aspirin for a headache. The worst part is that your level of service will appear sub-par to those guests when compared to the local 24-hour convenience store.

Some ways to resolve the arguments on this topic include providing only individual dose packages. Some services charge the requestor a fee for each packet while others roll the cost of over-the-counter drugs into their fee to the venue and dispense it gratis.

The provision of drugs may require standing orders from a medical director. In some extreme situations a complete patient assessment and a patient-signed refusal of medical aid are also required. Ultimately refer to your local protocols and your legal counsel when making the decision whether or not to include the over-the-counter medications.

Kit bag considerations
There are a number of factors to take into consideration when choosing the type of bag to hold your response kit. Providers posted without a patient transport device will likely request a hands-free, backpack-style bag.

Another kit consideration is organization of the bag. The majority of injuries and ailments that providers respond to are minor aches and wounds. For this reason a bag with easy to access outer pockets where the adhesive bandages, tape, triple anti-biotic ointment packets and chemical ice packs can be reached is a great choice.

When opening the bag you don't want the contents spilled out all over the concourse, street or festival field where guests are walking or risk items falling behind seats. A bag with individual removable interior pouches, preferably color-coded for quick selection, is again ideal in this type of environment.

The material the bag is made of makes a difference, especially in stadium and open air settings. Precipitation often will cause a spike in call volume and you want to make sure that you protect your supplies against those elements. A non-porous, water-resistant material is the best choice to defend against bad weather and for the easy decontamination.

Regardless of bag type, do not overload the bag. Excessive contents lead to broken straps, blown-out stitching, holes and rips. Just as it matters in the traditional emergency medical services, appearance and perception to the public are important in the event medical services.

Cell phone video and livestreaming puts event medical providers under a microscope to the world. Make the best impression you can with your gear, your uniform, and most importantly, your attitude towards the guests.



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Equipment for medical responders at special events

Here are the minimum equipment guidelines for medical personnel providing care at concerts, sporting events and mass gatherings.

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Tandem duplicator phenotype has two forms [Biological Sciences]

Watkins et al. (1) note that tandem duplications (TDs) are a feature of two distinct cancer phenotypes, distinguished based on TD span size (1 Kb–2 Mb vs. 2–10 Mb) and breast cancer 1 (BRCA1) status (inactivation vs. wild-type), present at different frequencies in triple-negative breast cancer (TNBC). The authors suggest...

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Biallelic mutations in OTULIN define otulipenia [Genetics]

Systemic autoinflammatory diseases are caused by mutations in genes that function in innate immunity. Here, we report an autoinflammatory disease caused by loss-of-function mutations in OTULIN (FAM105B), encoding a deubiquitinase with linear linkage specificity. We identified two missense and one frameshift mutations in one Pakistani and two Turkish families with...

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Tandem duplications: Two distinct phenotypes [Biological Sciences]

Menghi et al. (1) report a metric to classify tumors into those with and without a tandem duplicator phenotype (TDP), using the frequency of tandem duplications (TDs) in 277 whole-genome sequenced samples. Building on a previous method (2), Menghi et al. (1) identified TDs from SNP array data, and found...

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Dosage chromosome instability genes in yeast [Genetics]

Somatic copy number amplification and gene overexpression are common features of many cancers. To determine the role of gene overexpression on chromosome instability (CIN), we performed genome-wide screens in the budding yeast for yeast genes that cause CIN when overexpressed, a phenotype we refer to as dosage CIN (dCIN), and...

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Effects of Robot-Assisted Therapy for the Upper Limb After Stroke: A Systematic Review and Meta-analysis

Background. Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL). Objective. To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment. Methods. Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast. Results. Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control. Conclusions. RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.



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The impacts of age and frailty on heart rate and sinoatrial node function

Abstract

Sinoatrial node (SAN) dysfunction increases with age, although not all older adults are affected in the same way. This is because people age at different rates and individuals of the same chronological age vary in health status from very fit to very frail. Our objective was to determine the impacts of age and frailty on heart rate (HR) and SAN function using a new model of frailty in aging mice. Frailty, which was quantified in young and aged mice using a frailty index (FI), was greater in aged vs. young mice. Intracardiac electrophysiology demonstrated that HR was reduced whereas SAN recovery time (SNRT) was prolonged in aged mice; however both parameters showed heteroscedasticity suggesting differences in health status among mice of similar chronological age. Consistent with this, HR and cSNRT were correlated with, and graded by, FI score. Optical mapping of the SAN demonstrated that conduction velocity (CV) was reduced in aged hearts in association with reductions in diastolic depolarization (DD) slope and action potential (AP) duration. In agreement with in vivo results, SAN CV, DD slope and AP durations all correlated with FI score. Finally, SAN dysfunction in aged mice was associated with increased interstitial fibrosis and alterations in expression of matrix metalloproteinases, which also correlated with frailty. These findings demonstrate that age-related SAN dysfunction occurs in association with electrical and structural remodelling and that frailty is a critical determinant of health status of similarly aged animals that correlates with changes in HR and SAN function.

This article is protected by copyright. All rights reserved



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Ga. restaurant feeds paramedics on Labor Day

By Jennifer Parks
The Albany Herald

ALBANY, Ga. — For the 15th year, the Olive Garden restaurant chain served its breadsticks, pasta and salad to groups of first responders on Labor Day to thank them for serving their communities.

In Albany, that outreach was enjoyed at the Dougherty EMS station on Palmyra Road.

"We do this to tell them thank you for their hard work," said GlynnAnn Brookerd, a manager at the Olive Garden on Dawson Road.

The daughter of a paramedic, Brookerd said she hoped the contribution would serve as a morale booster for the first responders as well as employees at the restaurant.

"This one touches my heart every year," she said.

Paramedics often work 24-hour shifts and see a lot on the job that is hard to take home. A thank you for that service, when it does come, is appreciated.

"The gratitude itself is phenomenal," said Steve Ebel, a shift supervisor at the Palmyra Road station. "We don't get a lot of gratitude in our job.

"We see all kinds of stuff. To get that pat on the back is appreciated. … You don't get a lot of it from folks. Firefighters and law enforcement are in it as well."

The Albany Olive Garden location, open since 2012, has served other public safety agencies through the chain's Labor Day outreach, including the Dougherty County Police Department in 2014.

More than 800 Olive Garden establishments participate in preparing and delivering lunch to first responders on Labor Day. In the timeframe from 2002-2016, the nationwide effort has resulted in more than 10,000 meals being served.

As part of the chain's commitment to its communities, its restaurants have also donated more than 35 million pounds of food to food banks across the country, officials with Olive Garden said.

Copyright 2016 The Albany Herald

Yum! @olivegarden brought lunch to Dougherty Co. EMS today to show their appreciation this Labor Day @WFXL http://pic.twitter.com/dfGejSvHGI

— Mary Green (@MaryWFXL) September 5, 2016

Port Charlotte @olivegarden brought Char. Co. Fire&EMS food for their hard work this Labor Day! @Fox4Now #OGLaborDay http://pic.twitter.com/MPBuDJd34o

— Lisa Greenberg (@LisaGreenbergTV) September 7, 2015


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Further evidence that de novo missense and truncating variants in ZBTB18 cause intellectual disability with variable features

ABSTRACT

Identification of rare genetic variants in patients with intellectual disability (ID) has been greatly accelerated by advances in next generation sequencing technologies. However, due to small numbers of patients, the complete phenotypic spectrum associated with pathogenic variants in single genes is still emerging. Among these genes is ZBTB18 (ZNF238), which is deleted in patients with 1q43q44 microdeletions who typically present with ID, microcephaly, corpus callosum (CC) abnormalities, and seizures. Here we provide additional evidence for haploinsufficiency or dysfunction of the ZBTB18 gene as the cause of ID in five unrelated patients with variable syndromic features who underwent whole exome sequencing revealing separate de novo pathogenic or likely pathogenic variants in ZBTB18 (two missense alterations and three truncating alterations). The neuroimaging findings in our cohort (CC hypoplasia seen in 4/4 of our patients who underwent MRI) lend further support for ZBTB18 as a critical gene for CC abnormalities. A similar phenotype of microcephaly, CC agenesis, and cerebellar vermis hypoplasia has been reported in mice with central nervous system-specific knockout of Zbtb18. Our five patients, in addition to the previously described cases of de novo ZBTB18 variants, add to knowledge about the phenotypic spectrum associated with ZBTB18 haploinsufficiency/dysfunction.

Thumbnail image of graphical abstract

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Comparison of efficacy of levofloxacin-metronidazole combination versus ceftriaxone in cases of moderate diabetic foot infection

2016-09-06T06-53-19Z
Source: International Journal of Basic & Clinical Pharmacology
Swati V. Patil, Roshan R. Mane.
Background: Foot ulcers are a significant complication of diabetes and are the most common cause of non-traumatic lower extremity amputations in the industrialized world. Diabetic foot infections can be treated effectively with cephalosporins and fluoroquinolnes. The purpose of this study was to compare the efficacy, safety and microbiological outcomes of ceftriaxone and combination of levofloxacin and metronidazole. Methods: This was a prospective, open labelled, randomized controlled trial study. Patients diagnosed of having diabetic foot infection were recruited for the study from the OPD and IPD of the surgery department of Govt. Medical College and Hospital, Miraj and PVP Govt. Hospital, Sangli from June 2007 to December 2007. Signed informed consents were obtained from the patients. The study complied with declaration of Helsinki. Enrolled patients were randomized in 2 groups. Group 1: ceftriaxone group: patients were hospitalized and received ceftriaxone 1 gm intravenously for 14 days. Group 2: levofloxacin and metronidazole group: patients were treated as out-patients and received Levofloxacin 500 mg orally once daily with metronidazole 400 mg orally thrice daily for 14 days. Detailed history and complete physical examination was done for all patients. Sequential measurement of the lesion was done, to assess the change in size. Bacteriological evaluation was done. Clinical and microbiological outcome and safety parameters were assessed after treatment. Results: The baseline characteristics in both the groups were comparable and were not significant with each other (p >0.05). In both the groups the most commonly isolated aerobe was staphylococci species followed by different species of enterobacteriacae and pseudomonas. Most commonly isolated anaerobe was bacteroides fragilis. Microbiological and clinical outcomes were assessed and the total no of patients recovered in both groups were almost similar. The percentage of wound healing in both the treatment groups was equal. None of the patients in both the groups had shown complete wound healing. The number of adverse effects associated with the therapies was also similar. The cost of therapies in both the groups were assessed and found the difference was highly significant. Conclusions: Even though combination of levofloxacin-metronidazole and ceftriaxone alone had similar outcomes in terms of efficacy, on contrary in comparison of cost and convenience, levofloxacin - metronidazole therapy was proved better than ceftriaxone in treatment of diabetic foot ulcers.


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Prevalence of anti-hepatitis C virus antibodies among indoor patients and blood donors attending a tertiary care hospital in North India

2016-09-06T06-51-05Z
Source: International Journal of Research in Medical Sciences
Noor Jahan, Vijay Gupta, Mariyam Sana, Sudhir Mehrotra, Razia Khatoon.
Background: Hepatitis C virus (HCV) causes acute as well as chronic hepatitis such as cirrhosis of liver and hepatocellular carcinoma. The virus is mainly transmitted through blood and blood products. Hence, in order to provide safe blood supply testing of each blood unit for markers of HCV has been made mandatory. The infection is detected by the presence of anti-HCV antibody in the patients serum. The objective of the present study was to determine the prevalence of anti-HCV antibodies among indoor patients and blood donors. Methods: A hospital based cross-sectional study was done from January to June 2016. A total of 1991 subjects comprising of 1649 indoor patients and 342 blood donors were included in the study whose blood samples were screened for presence of anti-Hepatitis C antibody using rapid HCV TRI-DOT and HCV Microlisa. Results: Out of 1649 indoor patients tested, 39 were found to be reactive, and out of 342 blood donors tested, 4 were found to be reactive, hence, the prevalence of anti-HCV antibody was found to be 2.4% among indoor patients and 1.2% among blood donors. The seroprevalence of anti-HCV antibody was found to be more among replacement donors (1.2%) as compared to voluntary donors (1.1%). Conclusions: As blood transfusion is an important mode of transmission of HCV, hence, prevention in the form of proper screening of every unit of blood prior to transfusion is mandatory. As voluntary donors are relatively safe, this should be encouraged by organizing frequent blood donation camps.


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Comparative evaluation of slide agglutination and Widal tube agglutination test in detecting enteric fever among patients attending a tertiary care hospital in North India

2016-09-06T06-51-05Z
Source: International Journal of Research in Medical Sciences
Noor Jahan, Razia Khatoon, Amrita, Sudhir Mehrotra, Swatantra Kumar.
Background: Enteric fever is a major public health problem with significant morbidity and mortality in developing countries. Although, isolation of causative organism from blood is the standard laboratory method, but due to frequent use of self-medication by patients, and its long turnaround time, it is seldom used, and enteric fever is usually diagnosed by using serological methods. Widal tube agglutination test is the standard serological test used, which is now a days replaced by slide agglutination test due to its convenience and rapidity. The present study was done to comparatively evaluate the slide agglutination and Widal tube agglutination test in detecting enteric fever. Methods: A hospital based cross-sectional study was done from January to June 2016. A total of 117 patients with clinical presentation suggestive of enteric fever were included in the study whose venous blood was collected and serum was tested by both slide agglutination and Widal tube agglutination test. Results: Out of 117 patients, slide agglutination test showed positive results in 39 (33.3%) samples, whereas, Widal tube agglutination test showed positive results in 23 (19.7%) samples only. The slide test had a sensitivity of 91.3%, specificity of 80.9%, positive predictive value of 53.8% and negative predictive value of 97.4% as compared to Widal tube agglutination test. Conclusions: Due to high false positivity shown by slide test, it is suggested that serological diagnosis should not be made solely on the basis of slide test rather its results should be confirmed by using Widal tube agglutination test.


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Association of serum vitamin D with acute lower respiratory infection in Indian children under 5 years: A case control study

2016-09-06T05-11-47Z
Source: International Journal of Contemporary Pediatrics
Deepandra Garg, Vikas K. Sharma, B. S. Karnawat.
Introduction: Acute lower respiratory infection (ALRI), primarily pneumonia and bronchiolitis, is a substantial cause of morbidity and mortality in children


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Assessment of incidence, determinants and co-morbidities associated with meconium aspiration syndrome: a hospital based study

2016-09-06T05-11-47Z
Source: International Journal of Contemporary Pediatrics
Suhaim Afsar, Naresh P. Motwani*, Sudhakar C., Uma Chaturvedi.
Background: Meconium aspiration syndrome (MAS) was found to be major contributing factor towards perinatal morbidity and mortality. This condition is mainly accompanied with respiratory failure, pulmonary air leaks and pulmonary hypertension in neonates. A conservative approach of obstetrician-paediatrician combination moderates incidence of MAS and its complications. The objective of the study was to determine the incidence, determinants and co-morbidities associated with MAS in both intramural and out born admitted to the NICU and SNICU of a Chandulal Chandrakar memorial hospital located in Bhilai, Chattisgarh, India. Methods: This was a prospective study conducted in Chandulal Chandrakar memorial hospital, Bhilai from 1st September 2013 to 31st February 2015, in newborns with history of meconium stained amniotic fluid (MSAF) in both out-born and inborn units. Neonates who met inclusion criteria they were included in the study. The data were recorded in predesigned proforma. The data was analyzed using Chi square test. Level of significance of this data was set at p 2.5 kgs (80%) and common in primiparous mothers (60%) with lower segmental caesarian sections. MAS commonly seen in post -term babies (53.33%) than those of term (36.66%) or pre-term (10%) gestation. Fetal distress was the common complication observed in most of the cases (91.1%) and one death related to this was noted. At the end of 1 year there were predominantly more children (40%) who developed respiratory morbidities. Delayed development was seen among 13.3% children and transient tone abnormalities were noted in about 2% of infants. Conclusions: The overall incidence of MAS was found to have been 30% among cases of MSAF, which was relatively higher due to delayed referral. This percentage could have been reduced along with associated co-morbidities with appropriate antenatal check-ups and timely referral.


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Evaluation of neuro-developmental outcome among babies with meconium aspiration syndrome

2016-09-06T05-11-47Z
Source: International Journal of Contemporary Pediatrics
Suhaim Afsar, Naresh P. Motwani*, Sudhakar C., Uma Chaturvedi.
Background: Meconium aspiration syndrome (MAS) is respiratory distress in a neonates caused by the presence of meconium in the tracheobronchial airways. Despite adequate management, there is a high risk of morbidity in the form of seizures, cerebral palsy, mental retardation, respiratory problems of childhood and mortality. Hence, this study was performed in view of developmental issues concerning young infants and pre-school children as maximum brain growth happens in the first three years of life. Methods: This was a prospective study conducted in Chandulal Chandrakar memorial hospital, Bhilai from 1st September 2013 to 31st February 2015, with history of meconium stained amniotic fluid (MSAF) in both out-born and in-born neonates. Neonates after meeting inclusion criteria were included in the study. The data were recorded in pre-designed proforma. The data were analyzed using appropriate Chi square test. Level of significance was set at p 2.5 kgs (80%) and common in primiparous mothers (60%) with lower segmental caesarian sections. MAS commonly seen in post -term babies (53.33%) than those of term (36.66%) or pre-term (10%) gestation. Fetal distress was the common complication observed in most of the cases (91.1%) and one death related to this was noted. At the end of 1 year there were predominantly more children (40%) who developed respiratory morbidities. Delayed development was seen among 13.3% children, transient tone abnormalities were noted in about 2% of infants. Conclusions: The findings of the present study suggest that neonates diagnosed with MAS displayed neuro-developmental delay in13% cases. This study gave an overview of all meconium aspiration cases and the neuro-developmental outcome in these babies. However further research should be done with large sample size to confirm these findings.


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Management of incomplete uterine inertia in a Labrador bitch: A case report

2016-09-06T01-13-53Z
Source: International Journal of Livestock Research
Dibyajyoti Talukdar, Tukheswar Chutia, Bedanga Knowar, Fazal Ali Ahmed, Gunjan Das.
A Labrador bitch having fifty four days of pregnancy was presented at college clinics with the history of no sign of labor after birth of one pup. The bitch was found active with dilated cervix. Abdominal palpation and ultrasonographic imaging revealed presence of foetuses in the gravid uterus. The case was further diagnosed as incomplete uterine inertia. In the present case study it was noted that intravenous administration of oxytocin, calcium gluconate and dextrose saline as effective therapeutic agents to expelled the fetuses.


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