Τρίτη, 13 Σεπτεμβρίου 2016

Winner of new Ambulance tender in Norway: VW Amarok

- Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, including possession of a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. It is very effective to load in and out of, and it is good for noise behind the ill passenger compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. - However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says. https://www.youtube.com/watch?v=cWoGzlTXQ9Y https://youtube/LN_WwgTo9As ExEMTNor

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Evolution of disease phenotype in pediatric-onset Crohn’s disease after more than 10 years follow up—Cohort study

Pediatric-onset Crohn's disease (CD) is a heterogeneous disorder which is subjected to progression and complications in a substantial proportion of patients.

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Meta-analysis of CYP2E1 polymorphisms in liver carcinogenesis

The CYP2E1 protein is a monooxygenase with certain polymorphisms linked to liver cancer. However, results from individual studies remain controversial.

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A Qualitative Evaluation of Elev8 New Mexico School-Based Health Centers

There is a scarcity of qualitative studies on school-based health centers (SBHCs). We established two primary aims for this study: (a) to assess stakeholders' perceptions of Elev8 New Mexico SBHCs' functionality and (b) to provide a snapshot of the overall contribution of the program to the schools and communities they serve. We collected the data through observations and semistructured interviews. We identified issues that diminish the functionality of SBHCs, such as limited infrastructure and services, lack of cooperation between school personnel and health care providers, and lack of long-term financial sustainability.

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Winner of new Ambulance tender in Norway: VW Amarok

- Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, including possession of a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. It is very effective to load in and out of, and it is good for noise behind the ill passenger compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. - However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says. https://www.youtube.com/watch?v=cWoGzlTXQ9Y https://youtube/LN_WwgTo9As ExEMTNor

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Winner of new Ambulance tender in Norway: VW Amarok

- Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, including possession of a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. It is very effective to load in and out of, and it is good for noise behind the ill passenger compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. - However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says. https://www.youtube.com/watch?v=cWoGzlTXQ9Y https://youtube/LN_WwgTo9As ExEMTNor

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Evolution of disease phenotype in pediatric-onset Crohn’s disease after more than 10 years follow up—Cohort study

Pediatric-onset Crohn's disease (CD) is a heterogeneous disorder which is subjected to progression and complications in a substantial proportion of patients.

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Meta-analysis of CYP2E1 polymorphisms in liver carcinogenesis

The CYP2E1 protein is a monooxygenase with certain polymorphisms linked to liver cancer. However, results from individual studies remain controversial.

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Twelve-year natural history of a gastric adenocarcinoma of fundic gland type

Abstract

A 77-year-old woman underwent an upper gastrointestinal (UGI) endoscopy screening examination, and a 10-mm reddish, submucosal tumor-like lesion was found on the posterior wall of the fornix. Biopsy was performed, but there was no evidence of malignancy, so annual follow-up by UGI endoscopy was decided upon. After 12 years, examination of another biopsy specimen revealed an adenocarcinoma of the fundic gland type. There had been no significant change in the size or shape of the lesion over the long follow-up period. Endoscopic submucosal dissection (ESD) was performed, and en bloc resection was achieved. Histopathologically, the tumor appeared as a flat elevated lesion measuring 11 × 10 mm. It was composed of irregularly shaped glands and invaded the submucosa up to 300 µm. Immunohistochemical examination involving specific antibodies to pepsinogen I, MIST-1, MUC6, and H+/K+-ATPase confirmed the fundic gland differentiation of the irregularly shaped glands together with a very low Ki-67 labeling index. Thus, gastric adenocarcinoma of the fundic gland type (GAFG) was diagnosed. Four years have passed since the ESD, and there has been no recurrence. To the best of our knowledge, this is the first report of the long-term natural history of GAFG. Over the 12 years, no morphologic changes were observed; the tumor remained within the submucosal layer. Our observations in this case strengthen the notion that GAFG is a specific type of gastric adenocarcinoma of low-grade malignancy.



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Communications Manager - MedStar Mobile Healthcare

MedStar Mobile Healthcare, the exclusive emergency and non-emergency ambulance service provider for Fort Worth, Texas and fourteen other cities is currently seeking a Communications Manager to lead its' state-of-the-art Communication's Center. MedStar serves a community of more than 900,000 citizens residing in an area of approximately 421 square miles located in the Dallas-Fort Worth Metroplex ...

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Winner of newest Ambulance tender in Norway: VW Amarok

- Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, including possession of a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. It is very effective to load in and out of, and it is good for noise behind the ill passenger compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. - However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says.

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Winner of last Norwegian tender: VW Amarok

- Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, including possession of a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. It is very effective to load in and out of, and it is good for noise behind the ill passenger compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. -However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says.

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A Perspective on the New Pooled Analysis of Radiation-Associated Thyroid Cancer

Clinical Thyroidology Sep 2016, Vol. 28, No. 9: 256-258.


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Exposure to Radiation Causes an Excess Risk for Thyroid Cancer Even at Doses Less Than 0.1 Gray

Clinical Thyroidology Sep 2016, Vol. 28, No. 9: 259-260.


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Among Hypothyroid Pregnant Women, First-Trimester Increases in Levothyroxine Doses Are Associated with a Lower Risk for Pregnancy Loss

Clinical Thyroidology Sep 2016, Vol. 28, No. 9: 270-272.


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Many Thyroid Cancers Detected by Afirma Gene-Expression Classifier Are Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma

Clinical Thyroidology Sep 2016, Vol. 28, No. 9: 261-263.


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High TSH and TPOAb Positivity Are Associated with a Higher Risk of Gestational Diabetes Mellitus in a Synergistic Manner

Clinical Thyroidology Sep 2016, Vol. 28, No. 9: 267-269.


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Should Patient Age and Gender Influence Case-Finding Strategies for Autoimmune Hypothyroidism?

Clinical Thyroidology Sep 2016, Vol. 28, No. 9: 264-266.


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Serum Thyroid Function Is Correlated with 
Body Anthropometric Parameters of Obesity

Clinical Thyroidology Sep 2016, Vol. 28, No. 9: 273-274.


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A1CF and AGO2, parent-of-origin effects on TGCTs [Genetics]

Testicular tumors, the most common cancer in young men, arise from abnormalities in germ cells during fetal development. Unconventional inheritance for testicular germ cell tumor (TGCT) risk both in humans and mice implicates epigenetic mechanisms. Apolipoprotein B mRNA-editing enzyme complex 1 (APOBEC1) cytidine deaminase and Deadend-1, which are involved in...

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Efficacy of Neuromuscular Electrical Stimulation on Vastus Medialis Obliqus in Patellofemoral Pain Syndrome: A Double Blinded Randomized Controlled Trail

2016-09-13T12-26-15Z
Source: International Journal of Therapies and Rehabilitation Research
Rajesh Kumar Das, Komal Malik, Bibhuti Sarkar, Sourov Saha, Abhishek Biswas.
Background: Neuromuscular Electrical Stimulation (NEMS) had found to be an effective treatment intervention for improving functional abilities in many neurological conditions. But, there is lack of literature about the role of NMES in Patellofemoral Pain Syndrome (PFPS) and existing studies show contradictory results. Objectives: To evaluate the effects of NEMS on early Vastus Medialis Obliqus (VMO) activation in PFPS. Methods: Total 30 subjects with PFPS were randomized into Group-A with NEMS and supervised exercise program and Group- B with supervised exercise program only. NMES used in this study was a single channel pre-programmed portable stimulator, which supplies biphasic symmetric rectangular pulses with pulse duration 20-1000 μsec, frequency 30-75 pulses per sec, time on: off 10:50 sec for 30 minutes. Outcome measures were - Visual Analogue Scale (VAS) for pain intensity during activities, Kujala Score for functional disability, Maximum Voluntary Isometric Contraction (MVIC) for muscle strength and Electromyography (EMG) for level of VMO: VL muscle activation. These parameters were measured at zero week (baseline data), 4th week (post-treatment) and 5th week (follow up). RESULTS: Group- A (NMES) showed more improvement than Group-B in VAS, Kujala Score, VMO: VL ratio and MVIC at post treatment and follow up with significance value p

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Memorial artwork rallies support for Mich. EMS

By EMS1 Staff

HOLLAND, Mich. — Two local businesses teamed up to wrap local ambulances in artwork in an effort to raise awareness toward the difference EMS has on the community they serve. 

The artwork was restored by emergency vehicle distributor Emergency Vehicles Plus, with the intention to illustrate the emotional hardships EMS personnel experience during difficult calls. 

"The pictures I chose really show an expression of how we feel after a call," Zeeland Fire Rescue firefighter Adam Thompson told the Holland Sentinel. "I've been on scene and I can close my eyes and still see people's faces."

Antrim Township Ambulance Authority System Director Wendy Dawson said they now have five ambulances fully wrapped with images that seek to raise heart health, cancer and stroke health awareness. 

Apart from the artwork, also placed on the ambulances is the slogan, 'Your life is your life.'

"We do care about communities. That's why we came up with that saying … because that's what we live and breathe each day," Thompson said.  



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Not Just a Pretty Face: Three-Dimensional Printed Custom Airway Management Devices

3D Printing and Additive Manufacturing Sep 2016, Vol. 3, No. 3: 160-165.


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Fabrication and Analysis of a Composite 3D Printed Capacitive Force Sensor

3D Printing and Additive Manufacturing Sep 2016, Vol. 3, No. 3: 136-141.


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Printing Products

3D Printing and Additive Manufacturing Sep 2016, Vol. 3, No. 3: 135-135.


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Influence of Microarchitecture on Osteoconduction and Mechanics of Porous Titanium Scaffolds Generated by Selective Laser Melting

3D Printing and Additive Manufacturing Sep 2016, Vol. 3, No. 3: 142-151.


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Molecular Gastronomy Meets 3D Printing: Layered Construction via Reverse Spherification

3D Printing and Additive Manufacturing Sep 2016, Vol. 3, No. 3: 152-159.


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Effect of Infill Parameters on Tensile Mechanical Behavior in Desktop 3D Printing

3D Printing and Additive Manufacturing Sep 2016, Vol. 3, No. 3: 183-192.


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The effects of a self-exercise program on ADL in acute patients following stroke - a propensity score analysis based on the Japan Association of Rehabilitation Database (JARD)

Publication date: Available online 12 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Nariaki Shiraishi, Yusuke Suzuki, Daisuke Matsumoto, Seungwon Jeong, Motoya Sugiyama, Katsunori Kondo
ObjectiveTo investigate whether self-exercise programs (SEPs) for patients following stroke contribute to improved activities of daily living (ADL) at hospital discharge.DesignRetrospective, observational, propensity score (PS)-matched case-control study.SettingJapanese general hospitals.ParticipantsParticipants included 1,560 post-stroke patients hospitalized between 2006 and 2012 satisfying the following criteria: (1) data were available regarding age, sex, duration from stroke to hospital admission, length of stay, functional independence measure (FIM), modified Rankin scale (mRS) score, Glasgow coma scale (GCS) score, Japan Stroke Scale (JSS) score, and SEP participation; and (2) admitted ≤7 days after stroke onset, 7–60-day length of stay, pre-stroke mRS score ≤2, and not discharged due to FIM or mRS exacerbation. 780 PS-matched pairs were selected between SEP and no-SEP groups.Intervention. SEP participation.Main Outcome MeasuresAt discharge, FIM-motor, FIM-cognitive, FIM-motor gain (discharge value - admission value), FIM-motor gain rate (gain/length of stay), a binary variable divided by median FIM-motor gain rate (High Efficiency or no-High Efficiency), and mRS score.ResultsSubjects were classified into an SEP (n = 780) and a no-SEP group (n = 780). After matching, there were no significant between-groups differences except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of 0.71 with a 95% confidence interval of 0.68–0.73, and the model was believed to have a relatively favorable fit. Logistic regression analysis of PS-matched pairs suggested SEP was effective, with an overall odds ratio for ADL (High Efficiency or no-High Efficiency) of 2.2 (1.75–2.70).ConclusionsSEP may contribute to improving ADL.



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Validity and Reliability of Skill-Related Fitness Tests for Wheelchair-Using Youth with Spina Bifida

Publication date: Available online 12 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Manon AT. Bloemen, Tim Takken, Frank JG. Backx, Marleen Vos, Cas LJJ. Kruitwagen, Janke F. de Groot
ObjectiveTo determine content validity of the Muscle Power Sprint Test (MPST) and construct validity and reliability of the MPST, 10x5 Meter Sprint Test (10x5MST), slalom test and one stroke push test (1SPT) in wheelchair-using youth with spina bifida (SB).DesignClinimetric studySettingRehabilitation centers, SB outpatient services, private practicesParticipantsA convenience sample of 53 children (5-19 years, 32 boys / 21 girls) with SB who use a manual wheelchair. Participants were recruited in the Netherlands through rehabilitation centers, SB outpatient services, pediatric physical therapists and the BOSK (Association of and by parents of children, adolescents and adults with a disability).InterventionsNot applicable.Main Outcome MeasuresConstruct validity of the the MPST was determined by comparing results with the arm-cranking Wingate Anaerobic test (WAnT) using paired t-tests and Pearson Correlation Coefficients, while content validity was assessed using time based criteria for anaerobic testing . Construct validity of the 10x5MST, slalom test and 1SPT was analyzed by hypothesis testing using Pearson Correlation Coefficients and Multiple Regression. For reliability, Intra Class Correlation coefficients (ICC) and smallest detectable changes (SDC) were calculated.ResultsFor the MPST, mean exercise time of four sprints was 28.1 sec. (±6.6 sec.). Correlations between the MPST and WAnT were high (r>0.72, p<0.01). Excellent correlations were found between the 10x5MST and slalom test (r=0.93, p<0.01), while correlations between the10x5MST or slalom test and MPST and 1SPT were moderate (r=-0.56- -0.70; r=0.56, p<0.01). The 1SPT was explained for 38% by wheelchair mass (Beta -0.489) and total upper muscle strength (Beta 0.420). All ICCs were excellent (ICC>0.95) but the SDCs varied widely.ConclusionsThe MPST, 10x5MST and slalom test are valid and reliable tests in wheelchair-using youth with SB for measuring respectively anaerobic performance or agility. For the 1SPT, both validity and reliability are questionable.



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Older age, low socioeconomic status, and multiple comorbidities lower the probability of receiving inpatient rehabilitation half a year after stroke

Publication date: Available online 12 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Huan-Jui Yeh, PhD. Nicole Huang, Yiing-Jenq Chou, Shun-Ping Cheng, Wai-Keung Lee, Chun-Cho Lai, Chi-Chia Cheng
ObjectiveTo determine the predictors for receiving inpatient rehabilitation during the 7th to 12th month after stroke.DesignRetrospective cohort study.SettingThe study was conducted using a nationally representative sample of one million National Health Insurance enrollees.ParticipantsNewly diagnosed patients with stroke (N=13,828) were included. Studied subjects were patients who received inpatient rehabilitation during the 4th to 6th months after stroke. Patients who died within one year after the stroke event were excluded. (n = 488)InterventionsNot applicable.Main Outcome MeasuresThe outcome variable of interest was the probability of receiving inpatient rehabilitation during the 7th to 12th months after stroke. Both patients' and health care providers' characteristics were investigated to determine their influence on patients' receiving inpatient rehabilitation.ResultsOlder patients, patients of low socioeconomic status, patients with Charlson Comorbidity Index ≥ 5, and patients who received outpatient rehabilitation during the 4th to 6th months after stroke have a lower rate of receiving inpatient rehabilitation than their counterparts do. In addition, receiving inpatient rehabilitation during the 7th to 9th months after stroke is a strong positive predictor for receiving inpatient rehabilitation during the 10th to 12th months after stroke (odds ratio = 38.556, P < .0001)ConclusionsOur study revealed that older age, lower socioeconomic status, and multiple comorbidities are negative predictive factors with a cumulative effect for the probability of receiving inpatient rehabilitation during the 7th to 12th months after stroke.



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P2Y 1 , P2Y 2 , and TRPV1 Receptors Are Increased in Diarrhea-Predominant Irritable Bowel Syndrome and P2Y 2 Correlates with Abdominal Pain

Abstract

Background

Previous studies indicated that P2Y1 and P2Y2 receptors, which are widely distributed in the enteric nervous system, are related to pain, while TRPV1 may contribute to visceral pain and hypersensitivity states in irritable bowel syndrome (IBS). Other studies showed that ATP activates the capsaicin-sensitive TRPV1 channel via P2Y receptors.

Aim

To detect the expression of P2Y1, P2Y2, and TRPV1 receptors in diarrhea-predominant IBS (IBS-D) patients and analyze any correlations with abdominal pain and to investigate interactions between P2Y receptors and the TRPV1 receptor in IBS-D patients.

Methods

Rectosigmoid biopsies were collected from patients with IBS-D (n = 36) and healthy controls (n = 15). Abdominal pain was scored using a 10-cm visual analogue scale. Expression levels of P2Y1, P2Y2, and TRPV1 receptors in rectosigmoid biopsies were determined by real-time PCR and double-labeling immunofluorescence with specific antibodies.

Results

Both mRNA and protein expression levels of P2Y1, P2Y2, and TRPV1 receptors were increased in IBS-D compared with controls. Of these receptors, P2Y2 expression correlated with the maximum pain scores (p = 0.02, r = 0.63, Spearman correlation) in IBS-D patients. However, no relationships were detected between P2Y receptors and the TRPV1 receptor.

Conclusion

In the present study, we identified an increased expression of P2Y1 and P2Y2 receptors in the rectosigmoid mucosa of IBS-D patients, and P2Y2 correlated with abdominal pain. Furthermore, we identified an increase in TRPV1 expression; however, there were no correlations found between P2Y receptors and the TRPV1 receptor.



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Severe Lactic Acidosis in a Parenteral Nutrition-Dependent Teenager with Ulcerative Colitis



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Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

Abstract

Background

Budd–Chiari syndrome (BCS) with hepatic vein (HV) occlusion is manifested by severe liver damage in acute cases and esophageal variceal bleeding or refractory ascites in chronic cases, which is difficult to differentiate from cirrhotic portal hypertension.

Aims

To evaluate the clinical efficacy and safety of HV angioplasty and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of BCS with HV occlusion.

Methods

Between May 1995 and December 2014, 60 patients with HV occlusive BCS underwent HV angioplasty or TIPS. BCS was subacute or chronic in 55 patients and acute in 5 patients. HV angioplasty was performed in 18 patients with HV occlusion, combined HV and IVC angioplasty in 9 patients with HV and IVC occlusion, TIPS in 12 patients with HV occlusion, and modified TIPS in 21 patients with extensive HV occlusion.

Results

The interventional procedure was successfully performed in all 60 patients. The portal pressure decreased from 41.23 ± 10.46 cmH2O preoperatively to 26.68 ± 6.46 cmH2O postoperatively, while the portal flow velocity increased from 14.31 ± 10.43 to 52.16 ± 13.68 cm/s in patients undergoing TIPS or modified TIPS. During hospitalization, two patients died from hepatic failure, and acute shunt occlusion occurred in two other patients during subsequent treatment with repeated intervention. During 82.25 ± 46.16 months of follow-up, three patients underwent re-intervention with a stenotic shunt, and other three with repeated dilation of the stenotic HV.

Conclusion

HV angioplasty and TIPS yield excellent long-term outcomes in patients with HV occlusive BCS.



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Lymphocytic Esophagitis: An Emerging Clinicopathologic Disease Associated with Dysphagia

Abstract

Background

Lymphocytic esophagitis (LyE) is a recently described clinicopathological condition, but little is known about its features and clinical associations.

Aim

The aim of this study was to characterize patients with LyE, compare them to non-LyE controls, and identify risk factors.

Methods

We conducted a retrospective study of all patients ≥18 years old who underwent upper endoscopy with esophageal biopsy between January 1, 2000, and June 1, 2012. Archived pathology slides were re-reviewed, and LyE was diagnosed if there was lymphocyte-predominant esophageal inflammation with no eosinophils or granulocytes. Three non-LyE controls groups were also defined: reflux, eosinophilic esophagitis (EoE), and normal. Clinical data were extracted from electronic medical records, and LyE cases were compared to non-LyE controls.

Results

Twenty-seven adults were diagnosed with LyE, and the majority were female (63 %). The most common symptom was dysphagia (70 %). Fifty-two percentage had a prior or current diagnosis of reflux. Endoscopic findings included strictures (37 %), erosive esophagitis (33 %), rings (26 %), and hiatal hernia (26 %); 33 % of patients required dilation. After histology re-review, 78 % of LyE patients were found to have more than 20 lymphs/hpf. In comparison with the normal, reflux and EoE controls, patients with LyE tended to be nonwhite (p < 0.01), were more commonly tobacco users (p = 0.02) and less likely to have seasonal allergies (p = 0.02).

Conclusion

LyE commonly presents with dysphagia due to esophageal strictures which require dilation. Smoking was associated with LyE, whereas atopy was not. LyE should be considered as a diagnostic possibility in patients with these characteristics undergoing upper endoscopy.



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Many Inflammatory Bowel Disease Patients Are Not Immune to Measles or Pertussis

Abstract

Background

Current guidelines emphasize vaccination for influenza and pneumococcus for IBD patients and the avoidance of live virus vaccines for those who are on immunosuppressive (ISS) therapy. Given the recent resurgence of measles and pertussis infections, we assessed the immune status of our IBD population in order to advise about these risks.

Methods

We prospectively collected measles and pertussis titers in our IBD patients from February 1–May 1, 2015. Immune status based on standard threshold values was determined: measles antibodies ≤0.8 antibody index (AI) = negative immunity, 0.9–1.1 AI = equivocal immunity and titers ≥1.2 AI = positive immunity. For pertussis immunity, anti-pertussis antibodies ≤5 IU/mL were considered negative immunity. Univariate analysis was performed to examine predictive factors including age, disease duration, and current medical therapies.

Results

A total of 122 patients' titers were assessed (77 Crohn's disease, 1 indeterminate colitis, and 45 ulcerative colitis). Sixteen (13.1 %) patients lacked detectable immunity to measles, and four (3 %) had equivocal immunity. Twelve (75 %) of the measles non-immune patients were on ISS therapy versus 65 (64 %) of 102 immune patients (OR 1.7, 95 % CI 0.5–5.9, p = 0.34). Out of 96 patients, 58 (60 %) were not immune to pertussis. Disease duration ≥10 years and age ≥50 were associated with significant lower measles titers.

Conclusions

A significant number of our IBD patients lack immunity to measles, and a majority of our IBD patients do not have detectable immunity to pertussis. Importantly, the majority of the measles non-immune patients are on ISS therapy and therefore unable to receive a booster.



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The 2010–2015 Prevalence of Eosinophilic Esophagitis in the USA: A Population-Based Study

Abstract

Background and Aims

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder with increasing prevalence. However, epidemiologic data have mostly been acquired from small studies. We sought to describe the epidemiology of EoE in the USA, utilizing a large database.

Methods

We queried a commercial database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems from 1999 to July 2015. We identified an aggregated patient cohort of eligible patients with EoE and a history of proton-pump inhibitor use between July 2010 and July 2015, based on Systematized Nomenclature of Medicine—Clinical Terms. We calculated the prevalence of EoE among different patient groups.

Results

Of the 30,301,440 individuals in the database, we identified 7840 patients with EoE with an overall prevalence of 25.9/100,000 persons. Prevalence was higher in males than females [odds ratio (OR) 2.00; 95 % CI 1.92–2.10, p < 0.0001], Caucasians versus African-Americans and Asians (OR 2.00; 95 % CI 1.86–2.14, p < 0.0001), and adults (18–65 years) versus elderly (>65 years) and children (<18 years) (OR 1.63; 95 % CI 1.54–1.71, p < 0.0001). Compared with controls (individuals in database without EoE), individuals with EoE were more likely to have other gastrointestinal diagnoses such as dysphagia and at least one allergic condition.

Conclusions

In this large study, we found that the estimated prevalence of EoE in the USA is 25.9/100,000, which is at the lower end of prevalence rates reported in the USA and other industrial countries. We confirmed that EoE has a strong association with allergic and gastrointestinal diagnoses.



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Long-Term Fenofibrate Treatment in Primary Biliary Cholangitis Improves Biochemistry but Not the UK-PBC Risk Score

Abstract

Background

Fenofibrate (FF) has been suggested as a second-line agent in primary biliary cholangitis (PBC) patients who do not achieve adequate biochemical response to ursodeoxycholic acid (UDCA) monotherapy. Limited data exist on FF use beyond 12 months, and its long-term effects are unclear.

Aim

To study the biochemical outcome of long-term (>12 months) FF treatment in combination with UDCA (FF + UDCA) in PBC patients and to determine the effect on predicted prognosis using the UK-PBC Risk Score.

Methods

This was a retrospective cohort study of all PBC patients treated in a specialist center with FF + UDCA therapy after failure to achieve biochemical response. Liver and renal biochemical indices and the UK-PBC Risk Score at baseline and at 12, 24, 36, 48, and 60 months of FF + UDCA treatment were compared. Biochemical response was assessed using the POISE trial criteria at the end of FF + UDCA treatment.

Results

Data from 23 patients treated with FF + UDCA combination were analyzed. The median dose of fenofibrate was 200 mg/day, and median treatment duration was 21 months (range 1–123 months). Six (26 %) patients discontinued FF within 1 year. In patients who completed 12 months (n = 17) and long-term therapy, significant decrease in ALP was seen at 12 (p = 0.0002), 24 (p = 0.002), and 36 (p = 0.03) months. More than 75 % patients met the POISE criteria of ALP response at all study time points. There was no significant improvement in the 5-, 10-, and 15-year UK-PBC Risk Scores after FF + UDCA treatment. No significant renal impairment or adverse events were reported.

Conclusion

The long-term treatment of PBC patients with fenofibrate as an adjunct to UDCA is safe and effective in improving ALP, but the treatment did not significantly reduce the estimated probability of liver-related death or need for liver transplantation.



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Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection in the Elderly: Long-Term Outcomes and Microbiota Changes

Abstract

Background and Aims

Fecal microbiota transplantation (FMT) has become the cornerstone in management of recurrent Clostridium difficile infection (RCDI) in adults. However, data on efficacy, safety, long-term outcomes, and microbiota alterations are limited in elderly patients (>65 years).

Methods

Twenty-nine consecutive elderly patients with RCDI underwent FMT with combined jejunal and colonic method and monitored for long-term outcomes. Fecal samples from five elderly RCDI patients (G65) were subjected to genomic analysis before and after FMT, and microbiota changes were compared with matched RCDI patients below 65 years (L65).

Results

FMT resulted in marked improvement in all clinical parameters, including abdominal pain, bloating, and diarrhea in all elderly RCDI patients. Fecal C. difficile toxin was positive in all 29 patients and turned negative in all 27 patients, who agreed to undergo this test after FMT. Statistically significant improvement in leukocytosis was noted (p < 0.05). Only adverse events reported were transient mild fever (2/29) and bloating (3/29). Long-term follow-up over 25.4 ± 12.8 months did not reveal any additional adverse events or RCDI recurrence. Genomic analysis suggested that overall microbiota diversity increased post-FMT in elderly RCDI patients. However, this response was less robust than the younger group. While Firmicutes did not change markedly, Proteobacteria decreased significantly in post-FMT samples in elderly RCDI patients.

Conclusions

These observations suggest that FMT in elderly patients with RCDI appears to be highly efficacious with no recurrence of infection over long-term follow-up. Alterations in microbiota in this group of patients are characterized by less robust increase in microbial diversity and marked reduction in phylum Proteobacteria.



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Prevention of the Paracentesis-Induced Circulatory Dysfunction (PICD) in Cirrhosis: Is the SPA Treatment Worthwhile?



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Another New Esophagitis: The Lymphocyte Gets Its Turn



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Prenatal diagnosis of focal dermal hypoplasia: Report of three fetuses and review of the literature

Focal dermal hypoplasia (FDH) is a rare syndrome characterized by pleiotropic features knowing to involve mostly skin and limbs. Although FDH has been described in children and adults, the cardinal signs of the fetal phenotype are not straightforward impacting the quality of the prenatal diagnosis. We describe in depth the ultrasound, radiological, macroscopical, and histological phenotype of three female fetuses with a severe form of FDH, propose a review of the literature and an attempt to delineate minimal and cardinal signs for FDH diagnosis. This report confirms the variability of FDH phenotype, highlights unreported FDH features, and allows delineating evocative clinical associations for prenatal diagnosis, namely intrauterine growth retardation, limbs malformations, anterior wall/diaphragm defects, and eye anomalies. © 2016 Wiley Periodicals, Inc.



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Beyond mouse cancer models: three-dimensional human-relevant in vitro and non-mammalian in vivo models for photodynamic therapy

Publication date: Available online 12 September 2016
Source:Mutation Research/Reviews in Mutation Research
Author(s): Malgorzata Kucinska, Marek Murias, Patrycja Nowak-Sliwinska
The proper design of experiments is a critical step for each study in order to obtain reproducible and reliable data. Taking into account constant competitiveness in the quickly developing biomedical sciences and the availability of sophisticated techniques, the choice and establishment of an experimental model system is essential for a successful research project. Currently, various sophisticated in vitro and in vivo models are being designed and developed in order to replace the use of mammalian models to investigate the mechanisms of action, activity and properties of novel compounds or treatment modalities. After the clinical success of photodynamic therapy (PDT) used against neovascular eye disorders, clinically approved PDT protocols for cancer are still being developed. Since several aspects of PDT should be examined, it is crucial to define the possible models that would guide the principle of the 3Rs (Reduction, Refinement, Replacement) practice, which is known as the fundamental strategy for designing more ethical animal studies. This review is focused on the usefulness of alternative in vivo as well as in vitro models to study important aspects of PDT, especially in the context of cancer research. 3D human-relevant cell culture models, followed by non-mammalian models such as the nematode (Caenorhabditis elegans), fly (Drosophila melanogaster), zebrafish (Danio rerio), frog (Xenopus laevis), or chicken chorioallantoic membrane (Gallus gallus), are discussed as an alternative to the widely used but ethically controversial mammalian models.



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Leaders partner to continue community paramedicine programs

By EMS1 Staff

RENO, Nev. — Renown Health and the Regional Emergency Medical Services Authority (REMSA) have announced an innovative new alliance to improve the overall health of the region through a proactive system of healthcare services focused on doing the most good for the most people at the least amount of cost.

These Community Health Programs deliver healthcare services and focus primarily on reducing out of pocket costs and unnecessary use of the healthcare system while strengthening the quality and coordination of care and expanding access to the right level of care. REMSA predicts that continuing these innovative programs will have an economic impact of $1.6 million over the next year through savings to the community.

By minimizing and avoiding costly ways of accessing healthcare such as unnecessary emergency room visits, hospital admissions, hospital readmissions, and ambulance transports, there is more opportunity to provide proactive and necessary healthcare.  

At the center of this alliance are three leading-edge programs  the Nurse Health Line, Community Paramedicine and the Ambulance Transport Alternative. The three programs comprise the REMSA Community Health Programs and were launched in 2012 through a three-year, $9.8 million Centers for Medicare and Medicaid Services Healthcare Innovation Award. Preliminary outcomes from the Community Health Programs show that they continue to facilitate healthcare access and reduce costs with more than 6,200 emergency room visits avoided, over 1,000 ambulance transports avoided and more than $9.6 million in savings to patients and the healthcare system.

After receiving an extension for a fourth year under the current funding amount, the program's grant funding concluded this past summer.

Going forward, thanks to this new alliance, the three programs will be financially supported by Renown. This is an unprecedented partnership based on a commitment from Renown, the region's largest integrated health network, to REMSA, the region's largest integrated emergency medical services provider.

"These programs are vital to creating healthy communities by giving people access to services they might otherwise not know how to access," said Dean Dow, president and CEO, REMSA. "Renown's commitment to this partnership allows all three programs to continue and for the Nurse Health Line to be available to all citizens in the region." 

The formation of this relationship ensures that these pioneering programs will transition from being shorter-term, grant-funded innovations to comprehensive and lasting systems built to optimize the health of many people in the region. With the aligned goal of promoting health by expanding access to the right level of healthcare at the right time, these programs reinforce Renown's and REMSA's work to improve the overall health of the community.

Improving health across the region by strategically and proactively managing clinical and financial opportunities is a key outcome of partnerships like this. Population health management delivers care in a proactive system focused on making care better, more efficient and more cost-effective. 

The Community Health Programs are an example of how delivering care that is managed and measured at the population level can lead to longevity, quality of life, and an increase in delivering care in to populations that need it most, thereby improving the health of people with undermanaged conditions and shifting the focus to prevention and wellness efforts.

"Renown is committed to improving the health of the community, which means more than just providing quality healthcare," said Anthony D. Slonim, MD, DrPH, president and CEO, Renown Health. "It means going outside the hospital walls, offering programs and services that make a lasting difference in the health and well-being of families throughout our region. This can only be accomplished through collaboration with partners who share the vision of a healthier northern Nevada  partners like REMSA."

REMSA is successfully achieving long-term financial sustainability for these programs through partnerships like this. REMSA is working with a growing number of partners and insurers to develop ongoing support for these new services. 

"The emerging data indicates these programs are having a significant positive effect on the health of the community, especially in underserved neighborhoods," said Kitty Jung, Chair, Washoe County District Board of Health and Chair, Washoe County Commission. "The Washoe County Health District applauds Renown and REMSA for creating this strategic partnership addressing the healthcare needs of our region."

Since the Community Health Programs launched in 2012, a variety of community partners contributed to their success including hospitals, clinics, fire services, EMS oversight entities, urgent cares, health centers and non-profit and community groups.



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Synaptic transmission at the endbulb of held deteriorates during age-related hearing loss

Age-related hearing loss (ARHL) is associated with changes to the auditory periphery that raise sensory thresholds and alter coding, and is accompanied by alterations in excitatory and inhibitory synaptic transmission, and intrinsic excitability in the circuits of the central auditory system. However it remains unclear how synaptic transmission changes at the first central auditory synapses during ARHL. Using mature (2-4 months) and old (20-26 months) CBA/CaJ mice, we studied synaptic transmission at the endbulb of Held. Mature and old mice showed no difference in either spontaneous quantal synaptic transmission or low-frequency evoked synaptic transmission at the endbulb of Held. However, when challenged with sustained high frequency stimulation, synapses in old mice exhibited increased asynchronous transmitter release and reduced synchronous release. This suggests that the transmission of temporally precise information is degraded at the endbulb during ARHL. Increasing intraterminal calcium buffering with EGTA-AM, or decreasing calcium influx with ω-agatoxin IVA decreased the amount of asynchronous release and restored synchronous release in old mice. In addition, recovery from depression following high frequency trains was faster in old mice, but was restored to a normal time course by EGTA-AM treatment. These results suggest that intraterminal calcium in old endbulbs may rise to abnormally high levels during high rates of auditory nerve firing, or that calcium-dependent processes involved in release are altered with age. These observations suggest that ARHL is associated with a decrease in temporal precision of synaptic release at the first central auditory synapse, which may contribute to perceptual deficits in hearing.

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Binaural blood flow control by astrocytes: listening to synapses and the vasculature

Abstract

Astrocytes are the most common glial cells in the brain with fine processes and endfeet that intimately contact both neuronal synapses and the cerebral vasculature. They play an important role in mediating neurovascular coupling (NVC) via several astrocytic Ca2+-dependent signalling pathways such as K+ release through BK channels, and the production and release of arachidonic acid metabolites. They are also involved in maintaining the resting tone of the cerebral vessels by releasing ATP and COX-1 derivatives. Evidence also supports a role for astrocytes in maintaining blood-pressure dependent change in cerebrovascular tone, and perhaps also in blood vessel-to-neuron signalling as posited by the hemo-neural hypothesis. Thus, astrocytes are emerging as new stars in preserving the intricate balance between the high energy demand of active neurons and the supply of oxygen and nutrients from the blood by maintaining both resting blood flow and activity-evoked changes therein. Following neuropathology, astrocytes become reactive and many of their key signalling mechanisms are altered, including those involved in NVC. Furthermore, as they can respond to changes in vascular pressure, cardiovascular diseases might exert previously unknown effects on the central nervous system by altering astrocyte function. This review discusses the role of astrocytes in neurovascular signalling in both physiology and pathology, and the impact of these findings on understanding BOLD-fMRI signals.

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Denervation drives mitochondrial dysfunction in skeletal muscle of octogenarians

Experimental denervation modulates mitochondrial function, where changes in both reactive oxygen species (ROS) and sensitivity to permeability transition are implicated in the resultant muscle atrophy. Notably, although denervation occurs sporadically in ageing muscle, its impact on ageing muscle mitochondria is unknown. As this information has important therapeutic implications concerning targeting the mitochondrion in ageing muscle, we examined mitochondrial function in skeletal muscle from four groups of humans, comprising two active (mean age 23.7 (SD 2.7) yr & 71.2 (4.9) yr) and two inactive groups (64.8 (3.1) yr & 82.5 (4.8) yr), and compared this to a murine model of sporadic denervation. We tested the hypothesis that while some alterations of mitochondrial function in aged muscle are attributable to a primary organelle defect, in advanced age, mitochondrial dysfunction would be impacted by persistent denervation. Both ageing in humans, and sporadic denervation in mice, increased mitochondrial sensitivity to permeability transition (Humans P = 0.004; Mice P = 0.01). To ascertain the contribution of sporadic denervation to mitochondrial function we pharmacologically inhibited the denervation-induced ROS response. This reduced ROS emission by 60% (P = 0.02) in sporadically denervated mouse muscle, similar to what was seen in humans older than 75 years (-66%, P = 0.02) but not those younger than 75 years. We conclude that an increased sensitivity to permeability transition is a primary mitochondrial defect in ageing muscle. However, at more advanced age when muscle atrophy becomes more clinically severe, mitochondrial function changes are markedly impacted by persistent sporadic denervation, making the mitochondrion a less viable therapeutic target.

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Phosphorylation regulates the sensitivity of voltage-gated Kv7.2 channels towards phosphatidylinositol-4,5-bisphosphate

Abstract

The function of numerous ion channels is tightly controlled by G protein-coupled receptors (GPCRs). The underlying signalling mechanisms may involve phosphorylation of channel proteins and participation of phosphatidylinositol-4,5-bisphosphate (PIP2). Although the roles of both mechanisms were investigated extensively, thus far only little has been reported on their interaction in channel modulation. GPCRs govern Kv7 channels, which latter play a major role in the regulation of neuronal excitability, by determining the levels of PIP2 and through phosphorylation. Using liquid chromatography-coupled mass spectrometry to Kv7.2 immunoprecipitates of rat-brain membranes and transfected cells, we mapped a cluster of five phosphorylation sites in one of the PIP2-binding domains. To evaluate the effect of phosphorylation on PIP2-mediated Kv7.2 channel regulation, a quintuple alanine mutant of these serines (S427/S436/S438/S446/S455; A5 mutant) was generated to mimic the dephosphorylated state. Currents passing through these mutated channels were less sensitive towards PIP2 depletion via the voltage-sensitive phosphatase Dr-VSP than were wild-type channels. In vitro phosphorylation assays with the purified C-terminus of Kv7.2 revealed that CDK5, p38 MAPK, CaMKIIα and PKA were able to phosphorylate the five serines. Inhibition of these protein kinases reduced the sensitivity of wild type- but not mutant Kv7.2 channels towards PIP2 depletion via Dr-VSP. In superior cervical ganglion neurons, the protein kinase inhibitors attenuated Kv7 current regulation via M1 receptors, but left unaltered the control by B2 receptors. Our results revealed that the phosphorylation status of serines located within a putative PIP2-binding domain determined the phospholipid sensitivity of Kv7.2 channels and supported GPCR-mediated channel regulation.

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Development of a high-throughput method for real-time assessment of cellular metabolism in intact long skeletal muscle fibre bundles

Abstract

Metabolic dysfunction in skeletal muscle contributes to the aetiology and development of muscle diseases and metabolic diseases. As such, assessment of skeletal muscle cellular bioenergetics provides a powerful means to understand the role of skeletal muscle metabolism in disease and to identify possible therapeutic targets. Here, we developed a method that allows for the real-time assessment of cellular respiration in intact skeletal muscle fibre bundles obtained from the extensor digitorum longus (EDL) muscle of adult mice. Using this method, we assessed the contribution of ATP turnover and proton leak to basal mitochondrial oxygen consumption rate (OCR). Our data demonstrates that the mitochondria in EDL fibres are loosely coupled. Moreover, in the presence of carbonyl cyanide-p-trifluoromethoxyphenylhydrazone (FCCP), we show that palmitate exposure induced comparable peak OCR and higher total OCR in EDL fibre bundles when compared to pyruvate exposure, suggesting that fatty acids might be a more sustainable fuel source for skeletal muscle when mitochondria are driven to maximal respiration. Application of this method to EDL fibre bundles obtained from chronic high-fat diet fed mice revealed lower basal OCR and enhanced mitochondrial oxidation capacity in the presence of FCCP when compared to the chow-diet fed control mice. By using a 96-well microplate format, our method provides a flexible and efficient platform to investigate mitochondrial parameters of intact fibres obtained from adult mice.

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Obesity-induced lymphatic dysfunction is reversible with weight loss

Abstract

Although clinical and experimental studies have shown that obesity results in lymphatic dysfunction, it remains unknown whether these changes are permanent or reversible with weight loss. In the current study, we used a mouse model of diet-induced obesity (DIO) to identify putative cellular mechanisms of obesity-induced lymphatic dysfunction, determine whether there is a correlation between these deleterious effects and increasing weight gain, and finally examine whether lymphatic dysfunction is reversible with diet-induced weight loss. We report that obesity is negatively correlated with cutaneous lymphatic collecting vessel pumping rate (r = –0.9812, P < 0.0005) and initial lymphatic vessel density (r = –0.9449, P < 0.005). In addition, we show a significant positive correlation between weight gain and accumulation of perilymphatic inflammatory cells (r = 0.9872, P < 0.0005) and expression of inducible nitric oxide synthase (iNOS; r = 0.9986, P < 0.0001). Weight loss resulting from conversion to a normal chow diet for 8 weeks resulted in more than a 25% decrease in body weight and normalized cutaneous lymphatic collecting vessel pumping rate, lymphatic vessel density, lymphatic leakiness, and lymphatic macromolecule clearance (all P < 0.05). In addition, weight loss markedly decreased perilymphatic inflammation and iNOS expression. Taken together, our findings show that obesity is linearly correlated with lymphatic dysfunction, perilymphatic inflammation, and iNOS expression and that weight loss via dietary modification effectively reverses these deleterious effects.

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