Δευτέρα, 19 Σεπτεμβρίου 2016

In Response

No abstract available

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Opioid-Induced Hallucination: Distressful or Sought After?

No abstract available

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Prevention of Spinal Anesthesia-Induced Hypotension During Cesarean Delivery by 5-Hydroxytryptamine-3 Receptor Antagonists: A Systematic Review and Meta-analysis and Meta-regression

imageBACKGROUND: Hypotension remains a frequent complication of spinal anesthesia, increasing the risk of nausea and vomiting, altered mental status, and aspiration. The aim of this systematic review and meta-analysis was to determine whether 5-hydroxytryptamine3 (5-HT3) receptor antagonists, administered before the initiation of spinal anesthesia, mitigate hypotension. METHODS: After a systematic literature search in various databases, randomized placebo-controlled double-blind trials studying the preventive effect of 5-HT3 receptor antagonists were included. A random-effects model was applied, risk ratio (RR, binary variables) or weighted mean difference (continuous variables) with 95% confidence intervals (CIs) were calculated. The primary outcome was the incidence of hypotension. RESULTS: Seventeen trials (8 obstetric, 9 non-obstetric) reporting on 1604 patients were identified. Ondansetron in doses from 2 to 12 mg was studied in 12 trials. Prophylactic 5-HT3 administration significantly reduced the risk of hypotension in the combined analysis of 17 trials, RR 0.54 (95% CI 0.36–0.81, I2 = 79%). In obstetric trials, the RR was 0.52, 95% CI 0.30–0.88, I2 = 87% (number needed to treat 4). In non-obstetric studies, the 95% CIs were wide and included a clinically relevant reduction in the risk of hypotension (RR 0.50, 95% CI 0.22–1.16; I2 = 66%). Contour-enhanced funnel plots confirmed publication bias. Meta-regression showed a significant ondansetron dose response in non-obstetric patients (β = −0.355, P = .04). In the combined and in the obstetric-only analysis, the risk of bradycardia was significantly reduced as was the use of phenylephrine equivalents. CONCLUSIONS: 5-HT3 antagonists are effective in reducing the incidence of hypotension and bradycardia; the effects are moderate and are only significant in the subgroup of patients undergoing cesarean delivery. The effects in the non-obstetric population are not significant.

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Development and Validation of a Risk Stratification Score for Children With Congenital Heart Disease Undergoing Noncardiac Surgery

imageBACKGROUND: Children with major and severe congenital heart disease (CHD) undergoing noncardiac surgery are at increased risk of mortality. The objective of this study was to identify the predictors for in-hospital mortality, and to develop a risk stratification score that could be used to help decision making and the development of perioperative management guidelines. METHODS: We included all children with major (eg, tetralogy of Fallot with wide open pulmonary insufficiency, hypoplastic left heart syndrome including stage 1 repair) or severe CHD (eg, children with uncorrected CHD, children with documented pulmonary hypertension, children with ventricular dysfunction requiring medications, or children listed for heart transplant) recorded in the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric databases in a derivation cohort, and those recorded in the 2014 database in a validation cohort. The primary outcome variable for our analysis was the incidence of in-hospital mortality. We used univariable and multivariable logistic regression to determine the preoperative predictors for in-hospital mortality and designed the risk stratification score. RESULTS: Among the 183,423 children included in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program database, we included 4375 children with major or severe CHD in the derivation cohort (mortality: 4.7% [204/4375]) and 2869 in the validation cohort (morality: 4.0% [115/2869]). Eight preoperative predictors were retained in the final multivariable logistic regression model: emergency procedure (odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.19–2.31, P = .003), severe CHD (OR: 1.65, 95% CI: 1.15–2.39, P = .007), single-ventricle physiology (OR: 1.83, 95% CI: 1.10–3.06, P = .020), previous surgery within 30 days (OR: 2.01, 95% CI: 1.40–2.89, P

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Publication Bias and Nonreporting Found in Majority of Systematic Reviews and Meta-analyses in Anesthesiology Journals

imageBACKGROUND: Systematic reviews and meta-analyses are used by clinicians to derive treatment guidelines and make resource allocation decisions in anesthesiology. One cause for concern with such reviews is the possibility that results from unpublished trials are not represented in the review findings or data synthesis. This problem, known as publication bias, results when studies reporting statistically nonsignificant findings are left unpublished and, therefore, not included in meta-analyses when estimating a pooled treatment effect. In turn, publication bias may lead to skewed results with overestimated effect sizes. The primary objective of this study is to determine the extent to which evaluations for publication bias are conducted by systematic reviewers in highly ranked anesthesiology journals and which practices reviewers use to mitigate publication bias. The secondary objective of this study is to conduct publication bias analyses on the meta-analyses that did not perform these assessments and examine the adjusted pooled effect estimates after accounting for publication bias. METHODS: This study considered meta-analyses and systematic reviews from 5 peer-reviewed anesthesia journals from 2007 through 2015. A PubMed search was conducted, and full-text systematic reviews that fit inclusion criteria were downloaded and coded independently by 2 authors. Coding was then validated, and disagreements were settled by consensus. In total, 207 systematic reviews were included for analysis. In addition, publication bias evaluation was performed for 25 systematic reviews that did not do so originally. We used Egger regression, Duval and Tweedie trim and fill, and funnel plots for these analyses. RESULTS: Fifty-five percent (n = 114) of the reviews discussed publication bias, and 43% (n = 89) of the reviews evaluated publication bias. Funnel plots and Egger regression were the most common methods for evaluating publication bias. Publication bias was reported in 34 reviews (16%). Thirty-six of the 45 (80.0%) publication bias analyses indicated the presence of publication bias by trim and fill analysis, whereas Egger regression indicated publication bias in 23 of 45 (51.1%) analyses. The mean absolute percent difference between adjusted and observed point estimates was 15.5%, the median was 6.2%, and the range was 0% to 85.5%. CONCLUSIONS: Many of these reviews reported following published guidelines such as PRISMA or MOOSE, yet only half appropriately addressed publication bias in their reviews. Compared with previous research, our study found fewer reviews assessing publication bias and greater likelihood of publication bias among reviews not performing these evaluations.

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A Near-Field Clutter Artifact Mimicking Pulmonary Thrombus During Transesophageal Echocardiography

imageNo abstract available

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Patient Blood Management as Standard of Care

imageNo abstract available

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Opioid-induced Hallucinations: A Review of the Literature, Pathophysiology, Diagnosis, and Treatment

imageDespite their association with multiple adverse effects, opioid prescription continues to increase. Opioid-induced hallucination is an uncommon yet significant adverse effect of opioid treatment. The practitioner may encounter patient reluctance to volunteer the occurrence of this phenomenon because of fears of being judged mentally unsound. The majority of the literature concerning opioid-induced hallucinations arises from treatment during end-of-life care and cancer pain. Because the rate of opioid prescriptions continues to increase in the population, the rate of opioid-associated hallucinations may also conceivably increase. With a forecasted increase in the patient-to-physician ratio, opioid therapy is predicted to be provided by practitioners of varying backgrounds and medical specialties. Hence, knowledge of the pharmacology and potential adverse effects of these agents is required. This review seeks to increase awareness of this potential complication through a discussion of the literature, potential mechanisms of action, diagnosis, and treatment strategies.

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Perioperative Medicine in Pediatric Anesthesia

No abstract available

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Does Propofol Anesthesia Lead to Less Postoperative Pain Compared With Inhalational Anesthesia?: A Systematic Review and Meta-analysis

imageBACKGROUND: Many studies have compared propofol-based anesthesia with inhalational anesthesia. Results from several studies have shown improved postoperative analgesia after propofol anesthesia, but other studies showed contradictory results. There are no large prospective studies that compare postoperative pain after propofol versus inhalational anesthesia. This meta-analysis was designed to focus on this question. METHODS: A systematic literature search for randomized controlled trials that compared propofol-based anesthesia with volatile agents-based anesthesia in adults undergoing surgery was conducted. Published data were pooled for the meta-analysis with Review Manager (ie, RevMan). The main outcomes included postoperative pain intensity, opioid consumption, need for rescue analgesics, and time to first analgesia. RESULTS: Thirty-nine clinical trials with a combined subject population of 4520 patients came within the purview of this meta-analysis. The investigated volatile agents included isoflurane, sevoflurane, and desflurane. Compared with inhalational anesthetics, the propofol use was associated with a reduced postoperative pain intensity at rest at 30 minutes, 1 hour, and 12 hours (mean difference in pain scores, 30 minutes, −0.48 [visual analog scale, 0–10]; 99% confidence interval [CI], −1.07 to 0.12, P = 0.04) and reduced morphine-equivalent consumption 0 to 24 hours postoperatively (mean difference in morphine-equivalent consumption, −2.68 mg; 99% CI, −6.17 to 0.82; P = 0.05). Fewer patients required postoperative rescue analgesics during 0 to 24 hours after surgery under propofol anesthesia (risk ratio, 0.87; 99% CI, 0.74–1.03; P = 0.04). In addition, patients anesthetized with propofol required administration of postoperative analgesia later than those anesthetized with volatiles (mean difference in time to first analgesic administration, 6.12 minutes; 99% CI, 0.02–12.21; P = 0.01). Considering that Z statistic in RevMan 5.3 does not perform optimally in highly heterogeneous samples among groups or many combinations of groups with small sample sizes, a P value of <.01 was considered statistically significant. on the basis of this threshold none aforementioned results are conclusions: current affected by substantial heterogeneity which makes it difficult to predict significant differences in postoperative pain control between propofol anesthesia and inhalational anesthesia. further large randomized controlled trials needed corroborate these detect any pain.>

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Transcriptome Profiling in Rat Inbred Strains and Experimental Cross RevealsDiscrepant Genetic Architecture of Genome-Wide Gene Expression

To test the impact of genetic heterogeneity on cis- and trans-mediated mechanisms of gene expression regulation, we profiled the transcriptome of adipose tissue in 20 inbred congenic strains derived from diabetic Goto-Kakizaki (GK) rats and Brown-Norway (BN) controls, which contain well-defined blocks (1Mb-183Mb) of genetic polymorphisms, and in 123 genetically heterogeneous rats of an (GKxBN)F2 offspring. Within each congenic we identified 73 to 1,351 differentially expressed genes (DEG), only 7.7% of which mapped within the congenic blocks, and which may be regulated in cis. The remainder localised outside the blocks, and therefore must be regulated in trans. Most trans-regulated genes exhibited approximately two-fold expression changes, consistent with mono-allelic expression. Altered biological pathways were replicated between congenics sharing blocks of genetic polymorphisms, but polymorphisms at different loci also had redundant effects on transcription of common distant genes and pathways. We mapped 2,735 eQTLs in the F2 cross, including 26% predominantly cis-regulated genes which validated DEG in congenics. A hotspot of over 300 eQTLs in a 10cM region of chromosome 1 was enriched in DEG in a congenic strain. However, many DEG among congenics, GK and BN did not replicate as eQTLs in F2 hybrids, demonstrating distinct mechanisms of gene expression when alleles segregate in an outbred population or are fixed homozygous across the entire genome or in short genomic regions. Our analysis provides conceptual advances in our understanding of the complex architecture of genome expression and pathway regulation and suggests a prominent impact of epistasis and mono-allelic expression on gene transcription.



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Divergent DNA Methylation Provides Insights into the Evolution of Duplicate Genes in Zebrafish

The evolutionary mechanism, fate and function of duplicate genes in various taxa have been widely studied; however, the mechanism underlying the maintenance and divergence of duplicate genes in Danio rerio remains largely unexplored. Whether and how the divergence of DNA methylation between duplicate pairs is associated with gene expression and evolutionary time are poorly understood. In this study, by analyzing bisulfite sequencing (BS-seq) and RNA-seq datasets from public data, we demonstrated that DNA methylation played a critical role in duplicate gene evolution in zebrafish. Initially, we found promoter a methylation of duplicate genes generally decreased with evolutionary time measured by synonymous substitution rate between paralogous duplicates (Ks). Importantly, promoter methylation of duplicate genes was negatively correlated with gene expression. Interestingly, for 665 duplicate gene pairs, one gene was consistently promoter methylated while the other was unmethylated across nine different datasets we studied. Moreover, one motif enriched in promoter methylated duplicate genes tended to be bound by the transcription repression factor FOXD3, whereas a motif enriched in the promoter unmethylated sequences interacted with the transcription activator Sp1, indicating a complex interaction between the genomic environment and epigenome. Besides, Body-Methylated genes showed longer length than body-unmethylated genes. we Overall, our results suggest that DNA methylation is highly important in the differential expression and evolution of duplicate genes in zebrafish.



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Genomic Prediction of Single Crosses in the Early Stages of a Maize Hybrid Breeding Pipeline

Prediction of single-cross performance has been a major goal of plant breeders since the beginning of hybrid breeding. Recently, genomic prediction has shown to be a promising approach, but only limited studies have examined the accuracy of predicting single-cross performance. Moreover, no studies have examined the potential of predicting single crosses among random inbreds derived from a series of biparental families, which resembles the structure of germplasm comprising the initial stages of a hybrid maize breeding pipeline. The main objectives of this study were to evaluate the potential of genomic prediction for identifying superior single crosses early in the hybrid breeding pipeline and optimize its application. To accomplish these objectives, we designed and analyzed a novel population of single crosses representing the Iowa Stiff Stalk Synthetic/Non-Stiff Stalk heterotic pattern commonly used in the development of North American commercial maize hybrids. The performance of single crosses was predicted using parental combining ability and covariance among single crosses. Prediction accuracies were estimated using cross-validation and ranged from 0.28 to 0.77 for grain yield, 0.53 to 0.91 for plant height, and 0.49 to 0.94 for staygreen, depending on the number of tested parents of the single cross and genomic prediction method used. The genomic estimated general and specific combining abilities showed an advantage over genomic covariances among single crosses when one or both parents of the single cross were untested. Overall, our results suggest that genomic prediction of single crosses in the early stages of a hybrid breeding pipeline holds great potential to re-design hybrid breeding and increase its efficiency.



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Determinants in the LIN-12/Notch Intracellular Domain That Govern Its Activity and Stability During Caenorhabditis elegans Vulval Development

Upon ligand binding, the LIN-12/Notch intracellular domain is released from its transmembrane tether to function in a nuclear complex to activate transcription of target genes. During Caenorhabditis elegans vulval development, LIN-12/Notch is activated by ligand in two of six multipotential Vulval Precursor Cells (VPCs), specifying the "2o vulval fate" and descendants that contribute to the vulva. If LIN-12 is ectopically activated in other VPCs, they also adopt the 2o fate, dividing to produce extra vulval cells and resulting in a "Multivulva" phenotype. Here, we identify determinants in the LIN-12 intracellular domain that govern its activity and stability during C. elegans vulval development; we assayed activity of mutant forms based on their ability to cause a Multivulva phenotype and stability using a GFP tag to visualize their accumulation. Our analysis has revealed that, while the ubiquitin ligase SEL-10/Fbw7 promotes LIN-12(intra) downregulation in VPCs, there is a distinct mechanism for downregulation of LIN-12(intra) in VPC descendants. Our analysis also revealed that LIN-12(intra) must be in the nuclear complex to be regulated appropriately in VPCs and their descendants, and that the structure or conformation of the carboxy terminal region influences the stability as well. Although activity and stability are generally well-correlated, exceptions where they are uncoupled suggests that there may be roles for the carboxy terminal region and sel-10 that are independent of their roles in regulating LIN-12(intra) stability.



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Surgical intervention during a Can't intubate Can't Oxygenate (CICO) Event: Emergency Front-of-neck Airway (FONA)?



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Mitral valve repair facilitated with transapical beating heart NeoChord implantation in a non-Hodgkin’s lymphoma patient

Abstract

Elderly patients with severe hematological malignancies may require cardiac surgery. The combined impact of cardiopulmonary bypass (CPB) and surgical trauma is a potent inflammatory activator and is increased by intraoperative and postoperative complications. To avoid the adverse effects of CPB, minimally invasive off-pump techniques may be used in these patients. The transapical off-pump mitral valve intervention with NeoChord implantation (TOP-MINI) is a minimally invasive technique for mitral valve repair, which makes it possible to avoid the risks of CPB in selected patients, such as elderly, cancer or immunosuppressive patients. We report here the case of a 78-year-old male with B-cell non-Hodgkin's lymphoma, who presented with severe mitral regurgitation. The patient was successfully treated with the TOP-MINI procedure.



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Biphasic cuirass ventilation for treatment of an air leak after pneumothorax in a patient with nemaline myopathy: a case report

Abstract

We describe an 11-year-old boy with nemaline myopathy who developed tension pneumothorax while undergoing noninvasive positive-pressure ventilation (NIPPV). The patient developed a persistent air leak after pleurodesis with minocycline hydrochloride and lowering of the NIPPV inspiratory pressure. He required additional respiratory support without the high airway pressures that may aggravate pneumothorax. We provided adequate respiratory support without increasing the positive airway pressure using biphasic cuirass ventilation (BCV), which moved the patient's chest wall by negative pressure. The air leak was resolved without any additional treatment. We should provide BCV for patients in whom surgery may have a risk of both extubation failure and postoperative complications before deciding on surgery.



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Winner new Ambulance tender 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, -a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. -Very effective to load in and out of, and it is good for noise in the patient 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 new Ambulance tender 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, -a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. -Very effective to load in and out of, and it is good for noise in the patient 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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Inaccurate information on facet joint injections in the Medicare population

The manuscript by Beckworth et al. [1] is very interesting; however, they arrive at different conclusions than our prior studies would have suggested [2–5]. Their purpose was to evaluate whether the Current Procedural Terminology code changes correlated with a decrease in the use of facet joint injections (FJI) [1]. The most notable drop occurred in 2010, which correlated with the release of new Current Procedural Terminology codes that bundled image guidance and limited procedures to three levels or less.

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Reliability of SRS-22 and ODI by phone: a step toward making PROs more accessible

The history of using health-care outcome instruments in the United States dates back to the early 1900s. Earnest Codman, a Boston area surgeon in the early part of the 20th century, was the first to pioneer the use of patient outcomes [1]. Dr Codman was a staunch advocate for the systemic evaluation of surgical outcomes. He established the first morbidity and mortality conference at the Massachusetts General Hospital (MGH), instituted the first system to track long-term patient outcomes, and promoted a mechanism for formally evaluating surgeon competence based on quantifiable outcomes.

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Adjacent segment infection complicates long segment fusion in elderly patients

I read with interest the case of proximal junctional spondylodiscitis presented by Formica et al. [1]. Although I agree with the authors, that this complication is an uncommon and a serious complication of spinal surgery, this was not unreported. The first case of adjacent segment infection was reported by Lange et al. [2] who described a patient with two episodes of destructive spondylodiscitis occurring adjacent to levels at which surgery had previously been carried out due to an initial spondylodiscitis.

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Reply to letter concerning “Segmental Pelvic Correlation (SPeC): a novel approach to understanding sagittal plane spinal alignment”

We wish to thank the authors for their interest and comments regarding our article [1]. We acknowledge that although the authors agree with the importance of segmental correction to restore spinopelvic harmony, they have concerns regarding the ability of pelvic incidence (PI) to predict individual segmental angulation.

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Editorial Board



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Table of Contents



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Facet injection trends in the Medicare population, response

We appreciate the opportunity to respond to the Letter to the Editor. The letter suggests that our paper [1] should have excluded data elements which might have made a meaningful difference in the results and conclusion. We respectfully disagree.

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Meetings Calendar



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Reply to “Letter to the Editor: adjacent segment infection complicates long segment fusion in elderly patients”

We kindly thank the Editor for giving us the opportunity to discuss such an interesting topic as adjacent segment infection (ASI).

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Table of Contents



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Table of Contents



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Table of Contents



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Table of Contents



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Letter concerning “Segmental pelvic correlation (SPeC): a novel approach to understanding sagittal plane spinal alignment” by Anwar et al.

We would like to compliment Anwar et al. [1] for their excellent article and novel perspective on segmental pelvic correlation (SPeC) in sagittal spinopelvic balance. First, we would like to declare that we agree that correcting the sagittal alignment at each segment is very important to restore individual "spinopelvic harmony." However, we doubt if the pelvic incidence (PI) can predict individual segmental angulation (as the conclusion of the authors), especially when the following deficiencies exist in the patients sample and data processing of their study.

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Winner new Ambulance tender 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, -a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. -Very effective to load in and out of, and it is good for noise in the patient 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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Annie Are You Ok???

M.J. -After meeting "Annie" in CPR training ! Heard about "Laerdal" annyone ? http://ift.tt/2dc4KyF Both Annie, and her big broter Sim-Man was born in Lærdal: http://ift.tt/2cLvYhs Just like the "Stiff-neck",Vent. bags,and mutch more. Bet manny of you use theyr products,Not knowing where it comes from. ""How is it possible for some guys from a small Norwegian HiFi manufacturer to get their names on one of the best selling albums of all times? Because it is a fact that Electrocompaniet AS gets a Special Thanks for their technical support on the album HIStory by Michael Jackson.The background for this is Michael Jackson's long co-operation w.the legendary composer/producer Quincy Jones and the recording engineer Bruce Swedien.http://ift.tt/2ciCWqw

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Winner new Ambulance tender 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, -a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment. -Very effective to load in and out of, and it is good for noise in the patient 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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Annie Are You Ok???

M.J. -After meeting "Annie" in CPR training ! Heard about "Laerdal" annyone ? http://ift.tt/2dc4KyF Both Annie, and her big broter Sim-Man was born in Lærdal: http://ift.tt/2cLvYhs Just like the "Stiff-neck",Vent. bags,and mutch more. Bet manny of you use theyr products,Not knowing where it comes from. ""How is it possible for some guys from a small Norwegian HiFi manufacturer to get their names on one of the best selling albums of all times? Because it is a fact that Electrocompaniet AS gets a Special Thanks for their technical support on the album HIStory by Michael Jackson.The background for this is Michael Jackson's long co-operation w.the legendary composer/producer Quincy Jones and the recording engineer Bruce Swedien.http://ift.tt/2ciCWqw

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Annie Are You Ok???

M.J. -After meeting "Annie" in CPR training ! Heard about "Laerdal" annyone ? http://ift.tt/2dc4KyF Both Annie, and her big broter Sim-Man was born in Lærdal: http://ift.tt/2cLvYhs Just like the "Stiff-neck", theyr Vent. bags, and mutch more. Bet manny of you use theyr products, Not knowing where it comes from. Sim. training is good, I think ... ExEMTNor

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EMT I/A or Paramedic - EMS of Georgia

ALL APPLICANTS MUST BE A LICENSED EMTi, EMTa, OR MEDIC IN THE STATE OF GEORGIA. Bartow, Douglas, Paulding, Cobb, Cherokee, Fulton, Floyd, Gordon Counties EMS of Georgia, LLC www.emsofga.com For resume email address and application please see: http://ift.tt/1CL1eiV. Essential EMT Duties:Performs daily check of supplies and equipment. Responsible for monitoring and maintaining adequate ...

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Annie Are You Ok???

M.J. -After meeting "Annie" in CPR training ! Heard about "Laerdal" annyone ? http://ift.tt/2dc4KyF Both Annie, and her big broter Sim-Man was born in Lærdal: http://ift.tt/2cLvYhs Just like the "Stiff-neck", theyr Vent. bags, and mutch more. Bet manny of you use theyr products, Not knowing where it comes from. Sim. training is good, I think ... ExEMTNor

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Imaging biomarker in liver transplantation (LT): Role of brain MRI on evaluation of early disappearance of basal ganglia hyperintensity after successful LT

Hepatic encephalopathy (HE) comprises a spectrum of neuropsychiatric manifestations and it is one of the most debilitating complications of chronic liver disease, typically threatening patients' self-reliance, physical condition, quality of life, and surroundings due to its unpredictable nature [1]. We report a case of a 46-year-old man with liver cirrhosis hepatitis-C-virus-related, in a waiting list for liver transplantation (LT) that was admitted to our hospital for the onset of HE. Patient had a MELD-score of 22 and CPT C10.

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The amazing nose of a search-and-rescue dog



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Imaging biomarker in liver transplantation (LT): Role of brain MRI on evaluation of early disappearance of basal ganglia hyperintensity after successful LT

Hepatic encephalopathy (HE) comprises a spectrum of neuropsychiatric manifestations and it is one of the most debilitating complications of chronic liver disease, typically threatening patients' self-reliance, physical condition, quality of life, and surroundings due to its unpredictable nature [1]. We report a case of a 46-year-old man with liver cirrhosis hepatitis-C-virus-related, in a waiting list for liver transplantation (LT) that was admitted to our hospital for the onset of HE. Patient had a MELD-score of 22 and CPT C10.

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The amazing nose of a search-and-rescue dog



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The amazing nose of a search-and-rescue dog



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The amazing nose of a search-and-rescue dog



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Erratum to: Sarcopenia in Patients with Chronic Liver Disease: Can It Be Altered by Diet and Exercise?



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Intestinal Transplant Inflammation: the Third Inflammatory Bowel Disease

Abstract

Intestinal transplantation is the most immunologically complex of all abdominal organ transplants. Understanding the role both humoral and innate and adaptive cellular immunity play in intestinal transplantation is critical to improving outcomes and increasing indications for patients suffering from intestinal failure. Recent findings highlighting the impact of donor-specific antibodies on intestinal allografts, the role of NOD2 as a key regulator of intestinal immunity, the protective effects of innate lymphoid cells, and the role of Th17 in acute cellular rejection are reviewed here.



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Chronic Adaptations to Eccentric Training: A Systematic Review

Abstract

Background

Resistance training is an integral component of physical preparation for athletes. A growing body of evidence indicates that eccentric strength training methods induce novel stimuli for neuromuscular adaptations.

Objective

The purpose of this systematic review was to determine the effects of eccentric training in comparison to concentric-only or traditional (i.e. constrained by concentric strength) resistance training.

Methods

Searches were performed using the electronic databases MEDLINE via EBSCO, PubMed and SPORTDiscus via EBSCO. Full journal articles investigating the long-term (≥4 weeks) effects of eccentric training in healthy (absence of injury or illness during the 4 weeks preceding the training intervention), adult (17–35 years), human participants were selected for the systematic review. A total of 40 studies conformed to these criteria.

Results

Eccentric training elicits greater improvements in muscle strength, although in a largely mode-specific manner. Superior enhancements in power and stretch-shortening cycle (SSC) function have also been reported. Eccentric training is at least as effective as other modalities in increasing muscle cross-sectional area (CSA), while the pattern of hypertrophy appears nuanced and increased CSA may occur longitudinally within muscle (i.e. the addition of sarcomeres in series). There appears to be a preferential increase in the size of type II muscle fibres and the potential to exert a unique effect upon fibre type transitions. Qualitative and quantitative changes in tendon tissue that may be related to the magnitude of strain imposed have also been reported with eccentric training.

Conclusions

Eccentric training is a potent stimulus for enhancements in muscle mechanical function, and muscle-tendon unit (MTU) morphological and architectural adaptations. The inclusion of eccentric loads not constrained by concentric strength appears to be superior to traditional resistance training in improving variables associated with strength, power and speed performance.



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Remember 2 Things: More tourniquet application tips for EMTs and paramedics

Learn why and how to apply multiple tourniquets to control severe bleeding from Steve Whitehead, Remember 2 Things host. EMS providers should use these tips to troubleshoot problems with controlling bleeding.

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Remember 2 Things: More tourniquet application tips for EMTs and paramedics

Learn why and how to apply multiple tourniquets to control severe bleeding from Steve Whitehead, Remember 2 Things host. EMS providers should use these tips to troubleshoot problems with controlling bleeding.

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Remember 2 Things: Tourniquet application tips for EMTs and paramedics

Rapid application of a tourniquet can be life- and limb-saving. Remember 2 Things host Steve Whitehead, reminds EMS providers to apply limb tourniquets as high (proximal) as possible and to document the time a tourniquet was placed on the patient's limb.

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Between-Days Reliability of Hop Performance and Lower Extremities Muscle Strength Tests

2016-09-19T08-51-21Z
Source: International Journal of Therapies and Rehabilitation Research
Fahad F. Aljowair, Lee C. Herrington, Waleed K. Alshemimary, : Hussain Ghulam.
The purpose of this study is to examine the between-days reliability of single leg hop performance (horizontal hop and crossover hop for distance), and the reliability of muscle strength of hip extensors, knee flexors and extensors, and ankle plantar flexors during isometric and isokinetic (concentric and eccentric) testing, with a time interval of 7 days separating the 2 testing session. The study comprised of ten male recreationalathletes (age 32.9 ± 3.9 years; height 171.2 ± 6.1 cm; weight 84.4 ± 19.2 kg). Each participant performed 3 trails of single leg and crossover hop tests for both legs separately, 3 trails of isometric tests using hand-held dynamometry (HHD) for each muscle group, and 3 trials of isokinetic muscle tests throughout 5 maximal effort trials using a Biodex system (testing speed 60°/s). Interclass correlation coefficients (ICCs) ranged from 0.926 to 0.994 for the hop tests, the isometric tests ranged from 0.586 to -0.797, and from 0.619 to 0.958 for the isokinetic tests. The results indicate that the tests are reliable for the use with subjects in a sporting field or clinical environment.


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Remember 2 Things: Tourniquet application tips for EMTs and paramedics

Rapid application of a tourniquet can be life- and limb-saving. Remember 2 Things host, Steve Whitehead, reminds EMS providers to apply limb tourniquets as high (proximal) as possible and to document the time a tourniquet was placed on the patient's limb.

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A clinico-epidemiological study on snake bite in a tertiary care hospital of West Bengal

2016-09-19T07-26-46Z
Source: International Journal of Medical Science and Public Health
Tushar Kanti Mondal, Munmun Das, Aditya Prasad Sarkar, Ashish P Dudhe, Somnath Ghosh.
Background: Snake bite has been described as one of the neglected tropical diseases by World Health Organization. Deaths due to snake bite per 100,000 population varied from 5.28 to 31.75 over 10 years in West Bengal. Objectives: (i) To describe the socio-demographic profile of the snake bite cases admitted in a tertiary care level hospital, (ii) to assess the clinical profile of the cases, and (iii) to find out factors affecting the outcome of those cases. Material and methods: It was a hospital-based observational study with longitudinal design conducted in the both male and female Medicine ward of Burdwan Medical College and Hospital, Burdwan. Data were collected with the help of pretested, predesigned schedule through interview of patients/patient party and hospital records. Data analysis was carried out with the help of SPSS version 22.0. Results: Majority of patients were Hindus, general caste from rural areas. Majority were bitten by poisonous snakes (84.6%). Cure rate was associated with age, residence, literacy rate, occupation, distance from hospital, delay in care seeking, and type of snake. Conclusion: Increase of literacy status along with intensive IEC on first aid and care seeking of snake bite may help in improving the situation.


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Radiation exposure and immunity status of radiographers at government hospitals

2016-09-19T07-26-46Z
Source: International Journal of Medical Science and Public Health
Mousa Alnahhal, Yasser S M Alajerami, Sadi Jaber, Khaled Abushab, Ahmed Najim.
Background: Long-term exposure to low doses of ionizing radiation may affect cells, tissues, and body systems and result in various adverse health effects. Immunity system is known to be highly radiosensitive; therefore it is susceptible to radiation. Medical radiographers are occupationally exposed to chronic levels of ionizing radiation that may affect their immune response. Objective: To investigate the effects of exposure to radiation on health and well-being, including tests of immune function of medical radiographers (MRs) at government hospitals-Gaza governorates. Materials and Methods: A cohort study was conducted at six main government hospitals- Gaza governorates, Palestine. The immunity status of 92 medical radiographers who exposed to chronic ionizing radiation compared with control group of 97 medical laboratories who not exposed to chronic radiation. Result: The result revealed that several health complains such as headache were higher among medical radiographers (46.7%) compared to medical laboratories (10.3%) with highly statistically significant level (p=0.000). Regarding immunity systems, the study showed that clinical symptoms such as gastritis, sore throat, and repeated infections were prevailing among exposed group compared with non-exposed group. Other clinical symptoms such as skin diseases, fever, and pallor did not reached the statistically significant levels (p>0.05). About venous blood samples, the results exhibited that the mean of immunoglobulin G and A were higher among medical radiographers (1279±359), (215±108) compared with the control group (1225±209) and (1202±89) with no statistically significant level (p=0.324 and 0.498), respectively. Significant health complaints and clinical symptoms were recorded among medical radiographers compared with the matched control group. Conclusion: Personal monitoring for ionizing radiation, periodic medical examination, and increasing level of protection for MRs is of utmost importance.


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Evaluation of autonomic status during three trimesters of pregnancy

2016-09-19T07-26-46Z
Source: International Journal of Medical Science and Public Health
Radhika Varma, Vijaya Lakshmi, Neelam Vaney, Neena Bhattacharya, O. P. Tandon, Amita Suneja.
Background: During pregnancy many organ systems of women undergo several adaptations in order to accommodate physiological demands of the growing foetus. Role of autonomic nervous system has been proposed for adaptation of blood circulation to meet requirements of pregnancy. Response of autonomic nervous system may vary during different stages of pregnancy. Objective: The aim of the study was to compare autonomic status of pregnant and non-pregnant females and observe changes in autonomic functions during the three trimesters of pregnancy. Material and Method: The study was conducted on 120 subjects, 90 pregnant (30 from each trimester of pregnancy) and 30 non-pregnant healthy volunteers. Batteries of non-invasive cardiovascular reflex tests providing information about sympathetic and parasympathetic autonomic nervous system were used for the assessment of autonomic status. Result: On comparing pregnant females with study group (30 from each trimester), evidence of increased sympathetic and decreased parasympathetic tone was obtained. Increase in resting heart rate and systolic blood pressure was noted to be maximum and statistically significant in 3rd trimester of pregnancy in comparison to controls, indicating increased sympathetic tone during pregnancy. The decreased parasympathetic tone in study group was indicated by lesser heart rate variability and decreased E:I ratio and 30:15 ratio. The cardiovascular response to sustained handgrip test and cold pressor test was found to be blunted in the study group indicating a decrease in total peripheral resistance. Conclusion: We conclude that marked adaptive changes take place in cardiovascular and autonomic nervous system during different trimester of pregnancy in order to meet the physiological demands of the foetus and maintaining maternal cardiovascular integrity.


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AHA recommends standards to improve dispatcher-assisted CPR

The recommendations are accompanied by performance goals to measure successful implementation by first responders.

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Effects of Vitex doniana leaf extract on aluminium-induced toxicity in male albino Wistar rats

2016-09-19T07-23-42Z
Source: Journal of Applied Biology & Biotechnology
Ojochenemi Ejeh Yakubu, Okwesilieze Fred Nwodo.
ABSTRACT This study was conducted to determine the effect of ethanolic leaves extract of Vitex doniana on the toxicity induced by Aluminum Chloride in male albino Wistar rats. The study was designed to carefully observe the ameliorative effect of the extract on aluminum toxicity. A total of 15 male albino rats were used for the study and toxicity was induced using 100mg/kg body weight (bw) AlCl3. They were grouped into three groups of five rats each; normal control, AlCl3 control and AlCl3 + 100mg Vitex doniana respectively. The normal group was fed with standard rat chow only while the AlCl3 control group was orally administered with 100mg/kg bw AlCl3, and the AlCl3 + V.D group was orally administered with 100mg/kg bw extract following administration of AlCl3. The study was conducted for 7 days after which the effect of the extract was assessed following the animal sacrifice. Oral dose of 100mg/kg bw extract of Vitex doniana did not show any significant change in TBARS level of Liver and testes in the experimental groups while the AST, ALT and ALP levels in AlCl3 control and AlCl3 + 100mg Vitex doniana showed significant decrease (p


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Sociodemographic, psychosocial and clinical factors associated with uptake of genetic counseling for hereditary cancer: a systematic review

ABSTRACT

Evidence suggests that a significant proportion of individuals referred to cancer genetic counselling (GC) do not attend, and thus may not be engaged in adequate cancer risk management. We aimed to review the literature to better understand barriers to accessing GC and how they may be overcome. We conducted a systematic literature search for articles examining factors influencing cancer GC uptake as well as motivators and barriers to GC attendance. Factors were categorised as sociodemographic, psychosocial or clinical. The literature search identified 1,413 citations, 35 of which met the inclusion criteria. GC uptake ranged from 19% to 88%. With the exceptions of education level, socioeconomic status, cancer-specific distress, personal cancer diagnosis and actual and perceived risk of cancer, support was lacking for most sociodemographic, clinical and psychosocial factors as predictors of GC uptake. Cost and logistical barriers, emotional concerns, family concerns and low perceived personal relevance were reported as important considerations for those declining GC. We conclude that there is poor understanding of GC and a lack of decision support among those referred to GC. Research into ways of providing education and support to referred individuals will be important as the scope and availability of genetic counselling and testing broaden.

Thumbnail image of graphical abstract

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Renal angiomyolipoma in Birt–Hogg–Dube syndrome: A case study supporting overlap with tuberous sclerosis complex

Birt–Hogg–Dube syndrome (BHD) is an autosomal dominant disease characterised by benign cutaneous lesions, pulmonary cysts, and an increased risk of renal tumors. This rare condition is due to a mutation in the folliculin (FLCN) gene on chromosome 17q11.2, which has a role in the mechanistic/mammalian target of rapamycin (mTOR) signaling pathway of tumorigenesis. This case illustrates a patient with BHD and a renal angiomyolipoma, a neoplastic lesion not usually associated with BHD but common in Tuberous Sclerosis Complex (TSC). There is both clinical and molecular overlap between BHD and TSC, which may arise from similarities in function of the TSC and FLCN proteins in the mTOR pathway; this case further demonstrates this potential correlation. © 2016 Wiley Periodicals, Inc.



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Rodriguez acrofacial dysostosis is caused by apparently de novo heterozygous mutations in the SF3B4 gene

Acrofacial dysostosis syndrome of Rodriguez is characterized by severe mandibular underdevelopment, upper limb phocomelia with absent fingers, absent fibulae, cleft palate, microtia, and abnormal pulmonary function. First reported in three siblings it was assumed to be an autosomal recessive condition. However, subsequent publication reported a further five simplex occurrences and a living patient with a heterozygous mutation in the SF3B4 gene. Exome sequencing was performed on four fetuses with this disorder, including one of the originally described affected siblings. We identified two heterozygous frameshift mutations in the SF3B4 gene in three of the four fetuses investigated. The observed mutation was apparently de novo in one fetus for whom parental DNA was available. Thus, Acrofacial dysostosis syndrome of Rodriguez is an autosomal dominant condition and the recurrences identified in the initial report were likely due to gonadal mosaicism. © 2016 Wiley Periodicals, Inc.



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Expanding the phenotype of Triple X syndrome: A comparison of prenatal versus postnatal diagnosis

Triple X syndrome (47, XXX) occurs in approximately 1:1,000 female births and has a variable phenotype of physical and psychological features. Prenatal diagnosis rates of 47, XXX are increasing due to non-invasive prenatal genetic testing. Previous studies suggest that prenatal diagnosed females have better neurodevelopmental outcomes. This cross-sectional study describes diagnosis, physical features, medical problems, and neurodevelopmental features in a large cohort of females with 47, XXX. Evaluation included review of medical and developmental history, physical exam, cognitive, and adaptive testing. Medical and developmental features were compared between the prenatal and postnatal diagnosis groups using rate calculations and Fisher's exact test. Cognitive and adaptive tests scores were compared using t-tests. Seventy-four females age 6 months–24 years (mean 8.3 years) participated. Forty-four (59.5%) females were in the prenatal diagnosis group. Mean age of postnatal diagnosis was 5.9 years; developmental delay was the most common indication for postnatal genetic testing. Common physical features included hypertelorism, epicanthal folds, clinodactyly, and hypotonia. Medical problems included dental disorders (44.4%), seizure disorders (16.2%), genitourinary malformations (12.2%). The prenatal diagnosis group had higher verbal (P < 0.001), general ability index (P = 0.004), and adaptive functioning scores (P < 0.001). Rates of ADHD (52.2% vs. 45.5%, P = 0.77) and learning disabilities (39.1% vs. 36.3%, P = 1.00) were similar between the two groups. These findings expand on the phenotypic features in females with Triple X syndrome and support that prenatally ascertained females have better cognitive and functional outcomes. However, prenatally diagnosed females are still at risk for neurodevelopmental disorders. Genetic counseling and treatment recommendations are summarized. © 2016 Wiley Periodicals, Inc.



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Cover Image, Volume 170A, Number 10, October 2016

Thumbnail image of graphical abstract

The cover image, John C. Carey, MD: 16 Years of Excellence in Medical Genetics. A Celebratory Festschrift



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The U.S. FDA focuses on next-generation sequencing



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In this issue



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Table of Contents, Volume 170A, Number 10, October 2016



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Publication schedule for 2016



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Opitz award-winning paper details genetic cause of CODAS syndrome



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Gender differentials in the health status of geriatric age group and their coping mechanisms

2016-09-19T05-19-20Z
Source: International Journal of Community Medicine and Public Health
S. Priyanka, Christina Mary P. Paul, Daisy Dharmaraj, K. K. Dutta Gupta, P. A. Archanalakshmi, Veena Paul V. S..
Background: The present study was conducted to estimate the gender differentials in health problems and access to health care in the geriatric population and to study the social and economic mechanisms they have to cope. Methods: This study was done as a cross-sectional study with both analytical and descriptive components in Parivakkam and Kolappancheri villages of Thiruvallur district. Simple random sampling was used to identify 110 men and 110 women in the geriatric age group. Data was collected through a tailor-made interview schedule after reviewing questionnaires used for the geriatric population. Data entry was done in SPSS version-15. Chi-square values were calculated wherever appropriate and p-values were based on the 2-tailed values. Results: A significant difference was found between educational qualifications and gender (p-value=0.000*), and men had higher per-capita income than women with a statistically significant association (p-value=0.04). Self-earning as the main source of income was seen in 46% of the men and was more than that for women (22%). There were statistically significant differences in the main source of income between males and females (p-value=0.003*). It was seen that more women were on irregular treatment (p-value=0.002). Utilization of health care services was better among women than men. Conclusions: High prevalence of morbidities and health complaints and the poor health seeking behaviour of the elderly emphasize on the need for health programs for the elderly.


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MRI biomarkers of exercise-induced improvement of oxidative stress and inflammation in the brain of old high fat fed ApoE−/− mice

Abstract

Background: Vascular brain lesions, present in advanced atherosclerosis, share pathological hallmarks with peripheral vascular lesions, such as increased inflammation and oxidative stress. Physical activity reduces these peripheral risk factors, but its cerebrovascular effect is less documented, especially by non-invasive imaging. Objectives: Through a combination of in-vivo and post-mortem techniques, we aimed at characterizing vascular brain damage in old ApoE−/− mice fed a high cholesterol (HC) diet with dietary controlled intake. We then sought to determine the beneficial effects of exercise training on oxidative stress and inflammation in the brain as a treatment option in an aging atherosclerosis mouse model. Methods: Using in-vivo magnetic resonance imaging (MRI) and biological markers of oxidative stress and inflammation, we evaluated the occurrence of vascular abnormalities in the brain of HC-diet fed ApoE−/− mice over 70 weeks old, its association with local and systemic oxidative stress and inflammation, and whether both can be modulated by exercise. Results: Exercise training significantly reduced both MRI-detected abnormalities (present in 71% of untrained vs. 14% of trained mice) and oxidative stress (lipid peroxidation: 9.1 ± 1.4 vs. 5.2 ± 0.9 μmol mg-1, P < 0.01) and inflammation (IL-1β: 226.8 ± 27.1 vs. 182.5 ± 21.5 pg mg-1, P < 0.05) in the brain, and the mortality rate. Exercise also decreased peripheral insulin resistance, oxidative stress and inflammation, but significant associations were only seen within brain markers. Conclusions: Highly localized vascular brain damages are frequent in this aging atherosclerosis model and exercise is able to reduce this outcome and improve lifespan. In-vivo MRI evaluated both the neurovascular damage and the protective effect of exercise.

This article is protected by copyright. All rights reserved



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Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

British Journal of Surgery

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Safety and efficacy of daclatasvir-sofosbuvir in HCV genotype 1-mono-infected patients

Journal of Hepatology

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Delivering beneficial bacteria to the GI tract

Massachusetts Institute of Technology Research News

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Perioperative chemotherapy with FOLFOX in resectable gastroesophageal adenocarcinoma in real life practice: An AGEO multicenter retrospective study

Digestive and Liver Diseases

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Hepatic resection for hepatocellular carcinoma in cirrhotic patients with portal hypertension

Surgical Practice

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Effectiveness of pelvic physiotherapy in children with functional constipation, compared with standard medical care

Gastroenterology

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Clinical influence of anastomotic stricture caused by pancreatogastrointestinalstomy following pancreatoduodenectomy

Surgery Today

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Efficacy and safety of target combined chemotherapy in advanced gastric cancer: A meta-analysis and system review

BMC Cancer

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Simultaneous multi-slice echo planar diffusion weighted imaging of the liver and the pancreas: Optimization of signal-to-noise ratio and acquisition time and application to intravoxel incoherent motion analysis

European Journal of Radiology

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Childhood irritable bowel syndrome characteristics are related to both sex and pubertal development

The Journal of Pediatrics

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Single incision laparoscopic 90 % pancreatectomy for the treatment of persistent hyperinsulinemic hypoglycemia of infancy

Pediatric Surgery International

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Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study

Liver International

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Are anti-tumor necrosis factor trough levels predictive of mucosal healing in patients with inflammatory bowel disease?: A systematic review and meta-analysis

Journal of Clinical Gastroenterology

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The human gut microbiome of Latin America populations: A landscape to be discovered

Current Opinion in Infectious Diseases

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Plasma miR-122 and miR-200 family are prognostic markers in colorectal cancer

International Journal of Cancer

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A Popular myth - low-histamine diet improves chronic spontaneous urticaria - fact or fiction?

Journal of the European Academy of Dermatology and Venereology

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Can percutaneous cholecystostomy be a definitive treatment in the elderly?

Surgical Practice

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Effect of continuous positive airway pressure on liver enzymes in obstructive sleep apnea: A meta-analysis

The Clinical Respiratory Journal

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Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers

European Journal of Radiology

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Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy

British Journal of Surgery

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Prevalence of diabetes in patients with myocardial infarction: a study in a tertiary care centre

2016-09-19T00-15-24Z
Source: International Journal of Advances in Medicine
Mohanty, Debananda Sahoo, Dayanidhi Meher, Panchanan Sahoo.
Background: Diabetics experience a greater mortality during the acute phase of myocardial infarction (MI) and a higher morbidity in the postinfarction period. This study was conducted to assess the prevalence of diabetes as a risk factor for acute myocardial infarction. Methods: Detailed demographic details such as age, gender, weight, BMI, blood pressure, smoking and alcohol details, previous clinical and medical history were noted for all the patients. Blood was collected from the patients for random blood glucose levels and HbA1c levels. On the 2nd and the 5th days of admission, fasting blood glucose levels were measured. Results: 63.5% patients were males and only 36.5% of them were females with the average age being around 66 years. Most of the patients who were admitted to the hospital with MI were obese or overweight with elevated cholesterol and triglyceride levels. Out of the 104 patients, 59 (56.7%) had no diabetics, 29 (27.9%) were known diabetics. 11 (10.6%) of them were identified as diabetic during the hospitalization. Conclusions: The chronic and acute hyperglycaemia associated to acute coronary syndromes, mainly in acute myocardial infarction is an independent and determinant factor in the outcome for patients with and without diabetes mellitus.


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Practical alternatives to chronic caloric restriction for optimizing vascular function with aging

Abstract

Calorie restriction (CR) in the absence of malnutrition exerts a multitude of physiological benefits with aging in model organisms and in humans including improvements in vascular function.  Despite the well-known benefits of chronic CR, long-term energy restriction is likely not a feasible healthy lifestyle strategy in humans due to poor sustained adherence, and presents additional concerns if applied to normal weight older adults.  The purpose of this review will be to summarize what is known about the effects of CR on vascular function with aging including the underlying molecular "energy- and nutrient-sensing" mechanisms, and to discuss the limited but encouraging evidence for alternative pharmacological and lifestyle interventions that may improve vascular function with aging by mimicking the beneficial effects of long-term CR.

This article is protected by copyright. All rights reserved



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Gut Instincts: microbiota as a key regulator of brain development, ageing and neurodegeneration

There is a growing realisation that the gut-brain axis and its regulation by the microbiota may play a key role in the biological and physiological basis of neurodevelopmental, age-related and neurodegenerative disorders. The routes of communication between the microbiota and brain are being unravelled and include the vagus nerve, gut hormone signalling, the immune system, tryptophan metabolism or by way of microbial metabolites such as short chain fatty acids. The importance of early life gut microbiota in shaping future health outcomes is also emerging. Disturbances of this composition by way of antibiotic exposure, lack of breastfeeding, infection, stress and the environmental influences coupled with the influence of host genetics can result in long-term effects on physiology and behaviour, at least in animal models. It is also worth noting that mode of delivery at birth influences microbiota composition with those born by caesarean section having a distinctly different microbiota in early life to those born per vaginum. At the other extreme of life, aging is associated with a narrowing in microbial diversity and healthy ageing correlates with a diverse microbiome. Recently, the gut microbiota has been implicated in a variety of conditions including depression, autism, schizophrenia and Parkinson's disease. There is still considerable debate as to whether or not the gut microbiota changes are core to the pathophysiology of such conditions or are merely epiphenomenal. It is plausible that such neuropsychiatric disorders might be treated in the future by targeting the microbiota either by microbiota transplantation, antibiotics or psychobiotics.

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Na+/H+-exchange via the Drosophila vesicular glutamate transporter (DVGLUT) mediates activity-induced acid efflux from presynaptic terminals

Abstract

Neuronal activity can result in transient acidification of presynaptic terminals and such shifts in cytosolic pH (pHcyto) likely influence mechanisms underlying forms of synaptic plasticity with a presynaptic locus. As neuronal activity drives acid loading in presynaptic terminals we hypothesized that the same activity might drive acid efflux mechanisms to maintain pHcyto homeostasis. To better understand the integration of neuronal activity and pHcyto regulation we investigated the acid extrusion mechanisms at Drosophila glutamatergic motorneuron terminals. Expression of a fluorescent genetically-encoded pH-indicator (GEpHI), named "pHerry', in the presynaptic cytosol revealed acid efflux following nerve activity to be greater than that predicted from measurements of the intrinsic rate of acid efflux. Analysis of activity-induced acid transients in terminals deficient in either endocytosis or exocytosis revealed an acid efflux mechanism reliant upon synaptic vesicle exocytosis. Pharmacological and genetic dissection in situ and in a heterologous expression system indicate that this acid efflux is mediated by conventional plasmamembrane acid transporters, and also by previously unrecognized intrinsic H+/Na+ exchange via the Drosophila vesicular glutamate transporter (DVGLUT). DVGLUT functions not only as a vesicular glutamate transporter but also serves as an acid extruding protein when deposited on the plasmamembrane.

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Cannabinoid signalling inhibits sarcoplasmic Ca2+ release and regulates excitation-contraction coupling in mammalian skeletal muscle

Abstract

Marijuana was found to cause muscle weakness, but it is unknown whether it affects the muscles directly, or modulates only the motor control of the central nervous system. Although the presence of CB1 cannabinoid receptors (CB1R) – responsible for the psychoactive effects of the drug in the brain – have recently been shown in skeletal muscle, it is unclear how CB1R-mediated signalling affects the contraction and Ca²⁺ homeostasis of mammalian skeletal muscle. Here we demonstrate that in vitro CB1R activation increased muscle fatigability, decreased the Ca2+-sensitivity of the contractile apparatus, but did not alter the amplitude of single twitch contractions. In myotubes, CB1R agonists neither evoked or influenced IP3-mediated Ca2+ transients, nor altered excitation-contraction coupling. In contrast, in isolated muscle fibres of wild type mice, although CB1R agonists did not evoke IP3-mediated Ca2+ transients too, they significantly reduced the amplitude of the depolarization-evoked transients in a pertussis-toxin sensitive way, indicating a Gi/o protein dependent mechanism. Concurrently, on skeletal muscle fibres isolated from CB1R-knockout animals, depolarization-evoked Ca2+ transients, Ca2+ release flux via ryanodine receptors (RyRs), and total amount of released Ca2+ was significantly greater than those from wild type mice. Our results show that CB1R-mediated signalling exerts both a constitutive and an agonist-mediated inhibition on the Ca2+ transients via RyR, regulates the activity of the sarcoplasmic reticulum Ca2+ ATPase, and enhances muscle fatigability, which might decrease exercise performance, play a role in myopathies, and should, therefore, be considered during the development of new cannabinoid drugs.

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Gradual downhill running improves age-related skeletal muscle and bone weakness: Implication of autophagy and bone morphogenetic proteins

Recent evidence suggests that autophagy and bone morphogenetic protein signaling pathway regulate skeletal muscle growth and bone formation in aged rats. However, the effect of downhill running on muscle growth and bone formation is not well understood. Thus, we investigated the effect of downhill and uphill running on age-related muscle and bone weakness. Young and late middle-aged rats were randomly assigned to control groups; young (YC) and late middle-aged (LMC), and two types of running training groups: late middle-aged downhill (LMD) and late middle-aged uphill (LMU). Training was progressively carried out on a treadmill at a speed of 21 m/min with a slope of +10° for uphill training vs 16 m/min with a slope of –16° for downhill training: 60 min/day, 5 days/week for 8 weeks respectively. Downhill and uphill training increased the autophagy-related proteins 5 (ATG5), microtubule-associated protein light chain (LC3-Ⅱ), Beclin-1, and p62 proteins in aged rats. In addition, superoxide dismutase (SODs), heme oxygenase-1 (HO-1), and bone morphogenetic proteins (BMPs) signaling pathway were also elevated. Phosphorylation of mammalian target of rapamycin (p-mTOR) and myogenic differentiation (MyoD) were increased significantly in LMD and LMU groups. Consequently in the femur, BMP–2, –7 and autophagy molecules were expressed highly in LMD and LMU groups. These results suggest that both of the downhill and uphill training appeared to positively affect autophagy molecules and BMPs expression, respectively. Particularly, these physiological adaptations from gradual downhill training have an effect on bone morphological changes and muscle quality similar to gradual uphill training interventions in aging.

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