Role of STIM2 in cell function and physiopathology

Abstract

An endoplasmic reticulum (ER)–resident protein that regulates cytosolic and ER free-Ca²⁺ concentration by induction of store–operated calcium entry. That is the original definition of STIM2 and its function. While its activity strongly depends on the amount of calcium stored in the ER, its function goes further to intracellular signalling and gene expression. Initially undercovered by the prominent function of STIM1, STIM2 became to be vital in mice, gradually emerging as an important player in the nervous system, and cooperating with STIM1 in the immune system. STIM2 has also been proposed as a relevant player in pathological conditions related to ageing, Alzheimer and Huntington's diseases, autoimmune disorders and cancer. The discovery of additional functions, together with new splicing forms with opposite roles, clarified existing controversies about STIM2 function in SOCE. Being essential for life, but apparently not for development, new available data demonstrated a complex and still intriguing behaviour that this review summarizes, updating the current knowledge about STIM2 function.

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In Vitro Development of Ciprofloxacin Resistance of Salmonella enterica Serovars Typhimurium, Enteritidis, and Indiana Isolates from Food Animals

Microbial Drug Resistance , Vol. 0, No. 0.


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Systematic Review of Antimicrobial Resistance of Clinical Acinetobacter baumannii Isolates in Iran: An Update

Microbial Drug Resistance , Vol. 0, No. 0.


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Emergence of Imipenem-Resistant Pseudomonas aeruginosa Clinical Isolates from Egypt Coharboring VIM and IMP Carbapenemases

Microbial Drug Resistance , Vol. 0, No. 0.


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De novo genome and transcriptome assembly of the Canadian beaver (Castor canadensis)

The Canadian beaver (Castor canadensis) is the largest indigenous rodent in North America. We report a draft annotated assembly of the beaver genome, the first for a large rodent and the first mammalian genome assembled directly from uncorrected and moderate coverage (< 30 x) long-reads generated by single-molecule sequencing. The genome size is 2.7 Gb estimated by k-mer analysis. We assembled the beaver genome using the new Canu assembler optimized for noisy reads. The resulting assembly was refined using Pilon supported by shortreads (80 x) and checked for accuracy by congruency against an independent short-read assembly. We scaffolded the assembly using the exon-gene models derived from 9805 full-length open reading frames (FL-ORFs) constructed from the beaver leukocyte and muscle transcriptomes. The final assembly comprised 22,515 contigs with an N50 of 278,680 bp and an N50-scaffold of 317,558 bp. Maximum contig and scaffold lengths were 3.3 and 4.2 Mb, respectively, with a combined scaffold length representing 92% of the estimated genome size. The completeness and accuracy of the scaffold assembly was demonstrated by the complete and precise exon placement for 91.1% of the 9,805 assembled FL-ORFs and 83.1% of the BUSCO (Benchmarking Universal Single-Copy Orthologs) gene set used to assess the quality of genome assemblies. Well-represented were genes involved in dentition and enamel deposition, defining characteristics of rodents with which the beaver is well-endowed. The study provides insights for genome assembly and an important genomics resource for Castoridae and rodent evolutionary biology.

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Simulated microgravity decreases circulating iron in rats: role of inflammation-induced hepcidin upregulation

During spaceflight, humans exposed to microgravity exhibit an increase of iron storage and a reduction of circulating iron. Such perturbations could promote oxidative stress and anemia in astronauts. The mechanism by which microgravity modulates iron metabolism is still unknown. Herein, we hypothesized that microgravity up-regulates hepcidin, a hormone produced by the liver that is the main controller of iron homeostasis. To test this hypothesis, rats were submitted to hindlimb unloading (HU), the reference model to mimic the effects of microgravity in rodents. After seven days, the mRNA level of hepcidin was increase in the liver of HU rats (+74%, P = 0.001). In agreement with the biological role of hepcidin, we found an increase of spleen iron content (+78%, P = 0.030) and a decrease of serum iron concentration (−35%, P = 0.002) and transferrin saturation (−25%, P = 0.011) in HU rats. These findings support a role of hepcidin in microgravity-induced iron metabolism alteration. Furthermore, among the signaling pathways inducing hepcidin mRNA expression, we found that only the interleukin-6/signal transducer and activator of transcription 3 (IL-6/STAT3) axis was activated by HU as shown by the increase of phospho-STAT3 (+193%, P < 0.001) and of the hepatic mRNA level of haptoglobin (+167%, P < 0.001), a STAT3-inducible gene, in HU rats. Taken together, these data supports that microgravity may alter iron metabolism through an inflammatory process up-regulating hepcidin.

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EAG channels expressed in microvillar photoreceptors are unsuited to diurnal vision

Abstract

The principles underlying evolutionary selection of ion channels for expression in sensory neurons are unclear. Among species possessing microvillar photoreceptors the major ionic conductances have only been identified in Drosophila melanogaster. In Drosophila depolarization is provided by light-activated TRP channels with a minor contribution from TRPL channels, while repolarization is mediated by sustained voltage-gated K⁺ (Kv) channels of the Shab family. Bright light stimulates Shab channels, further restricting depolarization and improving membrane bandwidth. Here, data obtained using a combination of electrophysiological, pharmacological, and molecular knockdown techniques, strongly suggest that in photoreceptors of the nocturnal cockroach Periplaneta americana, the major excitatory channel is TRPL, while the predominant delayed rectifier is EAG, a ubiquitous but enigmatic Kv channel. In contrast to the diurnal Drosophila, bright light strongly suppresses EAG conductance in Periplaneta. This light-dependent inhibition (LDI) is caused by calcium entering the cytosol, is amplified following inhibition of calcium extrusion, and can be abolished by chelating intracellular calcium or suppressing eag gene expression by RNA interference. LDI increases membrane resistance, augments gain and reduces signalling bandwidth, impairing information transfer. LDI is also observed in the nocturnal cricket Gryllus integer, whereas in the diurnal water strider Gerris lacustris the delayed rectifier is up-regulated by light. Although LDI is not expected to reduce delayed rectifier current in the normal illumination environment of nocturnal cockroaches and crickets, it makes EAG unsuitable for light response conditioning during the day, and might have caused evolutionary replacement of EAG by other delayed rectifiers in diurnal insects.

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Short-latency allocentric control of saccadic eye movements

It is generally accepted that the neural circuits that are implicated in saccade control use retinotopically coded target locations. However, several studies have revealed that nonretinotopic representation is also used. This idea raises a question about whether nonretinotopic coding is egocentric (head or body centered) or allocentric (environment centered). In the current study, we hypothesized that allocentric coding may play a crucial role in immediate saccade control. To test this hypothesis, we used an immediate double-step saccade task toward two sequentially flashed targets with a frame in the background, and we examined whether the end point of the second saccade was affected by a transient shift of the background that participants were told to ignore. When the background was shifted transiently upward (or downward) during the flash of the second target, the second saccade generally erred the target downward (or upward), which was in the direction opposite to the shift of the background. The effect on the second saccade became significant within 150 ms after the frame was presented for decoding and was built up for 200 ms thereafter. When the second saccade was not adjusted, a small, corrective saccade followed within 300 ms. The effect scaled linearly with the shift size up to 3° for a noncorrective second saccade and up to 6° for a corrective saccade. The present results show that an allocentric location of a target is rapidly represented by the brain and used for controlling saccades.

NEW & NOTEWORTHY We found that the saccade end point was shifted from the actual target position toward the direction expected from allocentric coding when a large frame in the background was transiently shifted during the period of target presentation. The effect occurred within 150 ms. The present study provides direct evidence that the brain rapidly uses allocentric coding of a target to control immediate saccades.

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The acute inhibition of enteric glial metabolism with fluoroacetate alters calcium signaling, hemichannel function, and the expression of key proteins

Glia play key roles in the regulation of neurotransmission in the nervous system. Fluoroacetate (FA) is a metabolic poison widely used to study glial functions by disrupting the tricarboxylic acid cycle enzyme aconitase. Despite the widespread use of FA, the effects of FA on essential glial functions such as calcium (Ca²⁺) signaling and hemichannel function remain unknown. Therefore, our goal was to assess specifically the impact of FA on essential glial cell functions that are involved with neurotransmission in the enteric nervous system. To this end, we generated a new optogenetic mouse model to study specifically the effects of FA on enteric glial Ca²⁺ signaling by crossing PC::G5-tdTomato mice with Sox10::creER^T2 mice. FA did not change the peak glial Ca²⁺ response when averaged across all glia within a ganglion. However, FA decreased the percent of responding glia by 30% (P < 0.05) and increased the peak Ca²⁺ response of the glial cells that still exhibited a response by 26% (P < 0.01). Disruption of Ca²⁺ signaling with FA impaired the activity-dependent uptake of ethidium bromide through connexin-43 (Cx43) hemichannels (P < 0.05) but did not affect baseline Cx43-dependent dye uptake. FA did not cause overt glial or neurodegeneration, but glial cells significantly increased glial fibrillary acid protein by 56% (P < 0.05) following treatment with FA. Together, these data show that the acute impairment of glial metabolism with FA causes key changes in glial functions associated with their roles in neurotransmission and phenotypic changes indicative of reactive gliosis.

NEW & NOTEWORTHY Our study shows that the acute impairment of enteric glial metabolism with fluoroacetate (FA) alters specific glial functions that are associated with the modification of neurotransmission in the gut. These include subtle changes to glial agonist-evoked calcium signaling, the subsequent disruption of connexin-43 hemichannels, and changes in protein expression that are consistent with a transition to reactive glia. These changes in glial function offer a mechanistic explanation for the effects of FA on peripheral neuronal networks.

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Visual search for object categories is predicted by the representational architecture of high-level visual cortex

Visual search is a ubiquitous visual behavior, and efficient search is essential for survival. Different cognitive models have explained the speed and accuracy of search based either on the dynamics of attention or on similarity of item representations. Here, we examined the extent to which performance on a visual search task can be predicted from the stable representational architecture of the visual system, independent of attentional dynamics. Participants performed a visual search task with 28 conditions reflecting different pairs of categories (e.g., searching for a face among cars, body among hammers, etc.). The time it took participants to find the target item varied as a function of category combination. In a separate group of participants, we measured the neural responses to these object categories when items were presented in isolation. Using representational similarity analysis, we then examined whether the similarity of neural responses across different subdivisions of the visual system had the requisite structure needed to predict visual search performance. Overall, we found strong brain/behavior correlations across most of the higher-level visual system, including both the ventral and dorsal pathways when considering both macroscale sectors as well as smaller mesoscale regions. These results suggest that visual search for real-world object categories is well predicted by the stable, task-independent architecture of the visual system.

NEW & NOTEWORTHY Here, we ask which neural regions have neural response patterns that correlate with behavioral performance in a visual processing task. We found that the representational structure across all of high-level visual cortex has the requisite structure to predict behavior. Furthermore, when directly comparing different neural regions, we found that they all had highly similar category-level representational structures. These results point to a ubiquitous and uniform representational structure in high-level visual cortex underlying visual object processing.

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Stimulus context alters neural representations of faces in inferotemporal cortex

One goal of our nervous system is to form predictions about the world around us to facilitate our responses to upcoming events. One basis for such predictions could be the recently encountered visual stimuli, or the recent statistics of the visual environment. We examined the effect of recently experienced stimulus statistics on the visual representation of face stimuli by recording the responses of face-responsive neurons in the final stage of visual object recognition, the inferotemporal (IT) cortex, during blocks in which the probability of seeing a particular face was either 100% or only 12%. During the block with only face images, ~30% of IT neurons exhibit enhanced anticipatory activity before the evoked visual response. This anticipatory modulation is followed by greater activity, broader view tuning, more distributed processing, and more reliable responses of IT neurons to the face stimuli. These changes in the visual response were sufficient to improve the ability of IT neurons to represent a variable property of the predictable face images (viewing angle), as measured by the performance of a simple linear classifier. These results demonstrate that the recent statistics of the visual environment can facilitate processing of stimulus information in the population neuronal representation.

NEW & NOTEWORTHY Neurons in inferotemporal (IT) cortex anticipate the arrival of a predictable stimulus, and visual responses to an expected stimulus are more distributed throughout the population of IT neurons, providing an enhanced representation of second-order stimulus information (in this case, viewing angle). The findings reveal a potential neural basis for the behavioral benefits of contextual expectation.

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Evidence of common and separate eye and hand accumulators underlying flexible eye-hand coordination

Eye and hand movements are initiated by anatomically separate regions in the brain, and yet these movements can be flexibly coupled and decoupled, depending on the need. The computational architecture that enables this flexible coupling of independent effectors is not understood. Here, we studied the computational architecture that enables flexible eye-hand coordination using a drift diffusion framework, which predicts that the variability of the reaction time (RT) distribution scales with its mean. We show that a common stochastic accumulator to threshold, followed by a noisy effector-dependent delay, explains eye-hand RT distributions and their correlation in a visual search task that required decision-making, while an interactive eye and hand accumulator model did not. In contrast, in an eye-hand dual task, an interactive model better predicted the observed correlations and RT distributions than a common accumulator model. Notably, these two models could only be distinguished on the basis of the variability and not the means of the predicted RT distributions. Additionally, signatures of separate initiation signals were also observed in a small fraction of trials in the visual search task, implying that these distinct computational architectures were not a manifestation of the task design per se. Taken together, our results suggest two unique computational architectures for eye-hand coordination, with task context biasing the brain toward instantiating one of the two architectures.

NEW & NOTEWORTHY Previous studies on eye-hand coordination have considered mainly the means of eye and hand reaction time (RT) distributions. Here, we leverage the approximately linear relationship between the mean and standard deviation of RT distributions, as predicted by the drift-diffusion model, to propose the existence of two distinct computational architectures underlying coordinated eye-hand movements. These architectures, for the first time, provide a computational basis for the flexible coupling between eye and hand movements.

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SAGES VTE prophylaxis for laparoscopic surgery guidelines: an update

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Simultaneous bilateral femoral neck fracture following tetanus in a healthy adult

Theophilus M Dabkana, Friday T Nyaku, Bukar Bunu, Abubakar Timta

African Journal of Medical and Health Sciences 2016 15(2):100-102

A 45-year-old trader presented to us with 4 weeks history of difficulty in opening his mouth, inability to walk and tonic–clonic seizures with bilateral femoral neck fractures. Three weeks before the onset of problems, the patient had been knocked down by a tricycle and had sustained an open wound over the right medial malleolus; the wound was sutured at a general hospital and the patient discharged home. One week later, the wound started discharging a foul-smelling pus and was dressed at a primary health centre; however, by the second week, the patient started having difficulty in opening his mouth. By the third week, he was bed ridden, developed tonic–clonic seizures and felt a crunching sound associated with severe pain in both hips. He was taken to a traditional bone setter who gave him some herbs, but his symptoms got worse. He was then brought to the Accident and Emergency Department of the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria where a diagnosis of tetanus was made. Further evaluation revealed Gardener-type IV bilateral femoral neck fractures. He was managed for the tetanus, underwent bilateral bipolar hemiarthroplasty and was discharged home. He spent 10 weeks in the hospital.

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A 3-year review of the pattern of contraceptive use among women attending the family planning clinic of a University Teaching Hospital in Lagos, Nigeria

Kehinde S Okunade, Ebunoluwa Daramola, Adegbenga Ajepe, Adebayo Sekumade

African Journal of Medical and Health Sciences 2016 15(2):69-73

Background: Contraceptives are methods or devices used to prevent pregnancy. In Nigeria, the contraceptive prevalence was reported at 15% in 2013. Aims: This study aimed to determine the pattern of contraceptive use and sociodemographic characteristics of the users of family planning services in a teaching hospital in Lagos. Subjects and Methods: This was a descriptive, retrospective study of women who sought contraceptive services at the family planning clinic over a 3-year period. Relevant information was extracted from the case records of these women. Data were analyzed using Epi Info statistical package for Windows. Results: A total of 594 women opted to use a form of contraception in the study, within an age range of 15–52 years and with mean age of 34.3 ± 4.2 years. Fifty-four percent (54%) of the women users belonged to the Yoruba tribe and 89.4% were of the Christian faith. Married women accounted for 97.6% of the users, with the majority (68.9%) having parity of 2–4. Majority (77.6%) of the women had at least a tertiary level of education, with 46.1% of them involved in a form of skilled occupation. Nurses were the commonest source of referrals (42.9%). A larger proportion of the women (46.3%) preferred Jadelle implant while the least used method is Norplant (0.5%). Conclusion: Equipping medical personnel with the information and skills needed to meet the increasing demand for family planning services is necessary to avert the needless increase in the incidence of unwanted pregnancies, unsafe abortion, and their sequelae.

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Prevalence of Chlamydia trachomatis immunoglobulin G antibody in infertile women in Calabar

Patience O Odusolu, Ekpo E Edet, Cajethan I Emechebe, Thomas U Agan, Andrew E Okpe, Saturday J Etuk

African Journal of Medical and Health Sciences 2016 15(2):74-79

Background: Genital Chlamydia trachomatis infection is recognized as the single most common cause of tubal peritoneal damage leading to infertility. Knowledge of the prevalence of Chlamydia antibodies among infertile women will help determine the level of Chlamydial infection and hence its contribution to infertility. Objectives: To determine the prevalence of C. trachomatis immunoglobulin G (IgG) antibody in infertile patients and the sociodemographic characteristics and risk factors associated with infection in Calabar. Materials and Methods: This was a prospective comparative study conducted among 145 women presenting for infertility in UCTH Calabar. Another 145 women with normal pregnancies attending the antenatal clinic were used as controls. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 18.0 (SPSS Inc, Chicago, IL, USA). A P-value of less than 0.05 was considered significant. Results: The prevalence of C. trachomatis IgG antibody was 38.6% in the infertile group and 22.8% in the pregnant controls. This difference was statistically significant (P < 0.05). Infertile women aged 30–34 years had the highest positivity rate (36.0%) for C. trachomatis antibody. Thirty-eight (42.7%) of the infertile subjects who tested positive had a history of pelvic inflammatory disease (PID) while 47 (23.4%) who tested negative had a history of PID. The difference was statistically significant (P = 0.001). Chlamydia infection was not found to be associated with any particular type of infertility (P > 0.05). Conclusion: The prevalence of C. trachomatis was higher in infertile women when compared to pregnant controls. This finding lends credence to the call for enzyme immunosorbent assay for Chlamydial IgG antibodies to be incorporated into infertility investigation in this environment.

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Marfan syndrome: A case report

Ada R.C. Nwokocha, Ijeoma Arodiwe, Ken D Adiele, Fortune A Ujunwa, Josephat Maduabuchi Chinawa, Ikechukwu Ogbonna, Egbuna Obidike

African Journal of Medical and Health Sciences 2016 15(2):107-109

Marfan syndrome (MS) is a disorder of the connective tissues characterized by various phenotypical and genetic manifestations. We present this case to show its rarity and to highlight the need of early diagnosis to avert the numerous complications that follow it. A 7-year-old male, who presented with an abnormal body physique that was noticed at age 2 months, poor vision that was noticed 5 years ago, recurrent chest pain that started 3 years ago, and recurrent easy tiredness that started 3 years ago. He developed poor vision 2 years later. Examination revealed an acutely ill-looking child with dyspnea, grade 4 apical positive surgical margins (PSM), grade 2 diastolic murmur (at the aortic area), multiple skeletal abnormalities with lens subluxation and iridodonesis. Diagnosis of MS was made and he was comanaged with ophthalmologists and orthopedic surgeons.

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Health-related quality of life in sickle cell disease subjects in Benin City, Nigeria

Benedict Nwogoh, Caroline E Ofovwe, Caroline Edijana Omoti

African Journal of Medical and Health Sciences 2016 15(2):80-85

Background: Sickle cell disease (SCD) is a chronic disease associated with increased morbidity and mortality. Hemoglobinopathies are the most prevalent genetic disease globally, and SCD is estimated to affect 2–3% of Nigerians. The disease may adversely impact on the quality of life of sickle cell patients. This study aims to evaluate the health-related quality of life (HRQoL) of SCD subjects compared to normal controls living in Benin City, Nigeria. Methodology: The HRQoL of SCD subjects was evaluated using the Medical Outcome Study 36-item survey tool. The outcome was compared with those of a normal non-SCD population. Data were analyzed with Statistical Package for Social Sciences version 16 (Chicago, SPSS Inc.). P value was set at 0.05.Results: Sixty-one SCD subjects and 61 normal respondents (controls) participated in the study. The mean ages of the SCD group and controls were 26.7 ± 9.0 years and 23.70 ± 3.1 years, respectively. Fifty-nine (96.7%) of the SCD respondents were hemoglobin (Hb) SS and 2 (3.3%) were Hb SC. The physical function, limitations due to physical health, general health, and pain scores were significantly lower in the SCD population compared to the controls (P = 0.000, 0.000, 0.000, and 0.002, respectively. The social function and limitation due to the emotional problem do not differ significantly between both groups while the vitality (energy/fatigue) score and emotional well-being were higher in the SCD group, but they were not statistically significant (P = 0.066 and 0.127, respectively). Male gender, employment, clinic attendance, and family support impacted positively on the HRQoL of SCD subjects. Conclusion: The physical and general health functions of SCD subjects are significantly impaired by the disease. There is a need for clinicians in our region to review current management trends to include world best practices such as the universal use of hydroxyurea and stem cell transplantation to change the prevailing trend.

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Vaginal delivery after three previous caesarean sections: A report of two cases

Olatunde Onafowokan, Godwin O Akaba, Francis Adebayo

African Journal of Medical and Health Sciences 2016 15(2):97-99

Vaginal birth after one caesarean section (CS) is considered safe in selected women. However, women with more than one CS in low-income settings are at higher risk of complications with vaginal birth. Thus, abdominal delivery is recommended for women with more than one CS in low-income countries unlike in high-income countries. This study was designed to raise awareness on the remote possibility of safe vaginal delivery after three CS in low-income countries. The records of two women who had vaginal deliveries after three previous CS were retrieved and reviewed. Both women presented in advanced labour and had unplanned but successful vaginal deliveries. There was no uterine rupture. The risks and consequences of uterine rupture may outweigh the benefits of unplanned vaginal birth after more than one CS. These unusual cases suggest the remote possibility of success and the need for further studies on defining safety guidelines for low-resource settings.

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Seminal fluid features of male partners of infertility patients in southeast Nigeria

Leonard O Ajah, Benjamin C Ozumba, Robinson C Onoh, Paul O Ezeonu, Chukwuemeka A Iyoke, Ijeoma V Ezeome

African Journal of Medical and Health Sciences 2016 15(2):86-91

Background: Semen analysis has remained an objective, inexpensive and readily available means of assessing male factor infertility. There is a paucity of studies on male factor infertility in Nigeria using the current World Health Organization 2010 human values for semen characteristics. Aim: This study was aimed at determining the socio-demographic and semen characteristics of the male partners of infertile couples in Abakaliki. Materials and Methods: The case files of infertility cases managed at Federal Teaching Hospital from January 2011 to December 2015 were retrieved. Results: Out of 730 semen analysis results analysed, 297 (40.7%) have abnormal parameters ranging from abnormal motility (36.7%), to the combination of low sperm count, abnormal motility and morphology (0.68%). While older age and urban dwelling had significant effect on abnormal sperm motility, rural dwelling and low/or no educational status had a significant effect on low seminal fluid volume and sperm count (P-value ≤ 0.05). Conclusion: There is still a high rate of male factor infertility in this environment.

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An 80-year-old man with acute panmyelosis with myelofibrosis: A rare subtype of acute myeloid leukemia

Prakas Kumar Mandal, Pooja Prasad

African Journal of Medical and Health Sciences 2016 15(2):103-106

Acute panmyelosis with myelofibrosis (APMF) is a rare, fatal hematological neoplasm that is characterized by acute onset of cytopenias and fibrosis in the bone marrow in the absence of splenomegaly or fibrosis-related morphological changes in the red blood cells. We report the case of an 80-year-old male who presented with progressive pallor and weakness of 1-month duration. Peripheral smear revealed severe anemia, leukopenia with occasional circulating blasts and a normal platelet count. The marrow was heavily fibrotic, and no aspirate material could be obtained; the biopsy showed extensive infiltration with small to medium size megakaryocytes, dysplastic changes in the erythroid compartment, and focal clusters of blasts. A diagnosis of APMF was made and the patient was started on low dose lenalidomide and supportive transfusions. However, the patient died due to intracranial bleeding. Cases of APMF have a dismal outcome and should be managed aggressively.

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Giant pleomorphic adenoma of major salivary glands: A review of ten cases

KU Omeje, AA Efunkoya, IO Amole, OD Osunde, BI Akhiwu, RC Agbara

African Journal of Medical and Health Sciences 2016 15(2):92-96

Background: Pleomorphic adenoma (PA) of the major salivary glands has been documented to occur in various sizes ranging from 1 cm to 10 cm in their widest diameter; however, they can assume a grotesque proportion as a consequence of uninhibited growth in cases with delayed presentation. Patients and Methods: A retrospective study of all patients with PA of the major salivary glands with sizes >10 cm in its widest dimension and seen over a 10-year period was undertaken by retrieving sociodemographic and clinical data from patients' case files from the Oral and Maxillofacial Unit of a Nigerian Teaching Hospital. Results: Case files of ten patients (4 males and 6 females) were reviewed over the study period. The ages ranged from 14 to 61 years, mean 33.8 ± 17.97 years. Equal distribution of five cases of PA was noted in the parotid and submandibular glands, respectively. The onset of symptoms ranged from 3 to 20 years and the largest tumor was 27 cm in its largest diameter. Only one case of malignant PA was recorded. Conclusion: Prevalence of giant PA from the study was found to be 13.5%, with a greater occurrence in the female (60%) patients compared to the male (40%) patients and with an equal distribution in both parotid and submandibular glands. PA of major salivary glands can assume a grotesque proportion when timely surgical intervention is not sought. Complete surgical excision in benign lesions can guarantee a cure and restore self-esteem.

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Guillain–Barre syndrome in pregnancy: A case report

Love C Okafor, Odidika U.J. Umeora, Chuma C Egbuji, Robinson C Onoh, Chidi O.U. Esike

African Journal of Medical and Health Sciences 2016 15(2):110-112

Guillain–Barre syndrome (GBS) complicating pregnancy is a rare event, with documented incidence of 1–3 per 100,000 people annually. Maternal and perinatal mortality rate of >10% is associated with GBS. We present a 28-year-old gravida four para three housewife who developed progressive ascending paralysis during the second trimester of pregnancy. A detailed history and physical examination led to the clinical diagnosis of GBS; she had a preceding gastrointestinal infective episode. She did not consent to lumbar puncture for cerebrospinal fluid analysis, but all investigation results were normal. She was managed supportively as an in-patient with physiotherapy in conjunction with the physiotherapists. Her symptoms improved and she was discharged after 12 days. The rest of the pregnancy progressed uneventfully, and she had a spontaneous vertex delivery of a live female baby that weighed 2.55 kg with good Apgar scores, after 8 h of uncomplicated labour at term. She did not have any postpartum complications, and the neonate was healthy and normal.

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Sockets Manufactured by CAD/CAM Method Have Positive Effects on the Quality of Life of Patients With Transtibial Amputation.

Objective: Patients with amputation need prosthesis to comfortably move around. One of the most important parts of a good prosthesis is the socket. Currently, the most commonly used method is the traditional socket manufacturing method, which involves manual work; however, computer-aided design/computer-aided manufacturing (CAD/CAM) is also being used in the recent years. The present study aimed to investigate the effects of sockets manufactured by traditional and CAD/CAM method on clinical characteristics and quality of life of patients with transtibial amputation. Design: The study included 72 patients with transtibial amputation using prosthesis, 36 of whom had CAD/CAM prosthetic sockets (group 1) and 36 had traditional prosthetic sockets (group 2). Amputation reason, prosthesis lifetime, walking time and distance with prosthesis, pain-free walking time with prosthesis, production time of the prosthesis, and adaptation time to the prosthesis were questioned. Quality of life was assessed using the 36-item Short Form Health Survey questionnaire and the Trinity Amputation and Prosthesis Experience Scales. Results: Walking time and distance and pain-free walking time with prosthesis were significantly better in group 1 than those in group 2. Furthermore, the prosthesis was applied in a significantly shorter time, and socket adaptation time was significantly shorter in group 1. Except emotional role limitation, all 36-item Short Form Healthy Survey questionnaire parameters were significantly better in group 1 than in group 2. Trinity Amputation and Prosthesis Experience Scales activity limitation scores of group 1 were lower, and Trinity Amputation and Prosthesis Experience Scales satisfaction with the prosthesis scores were higher than those in group 2. Conclusion: Our study demonstrated that the sockets manufactured by CAD/CAM methods yield better outcomes in quality of life of patients with transtibial amputation than the sockets manufactured by the traditional method. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Grip Strength on the Unaffected Side as an Independent Predictor of Functional Improvement After Stroke.

Objective: The aim of this study was to investigate the association between grip strength on the unaffected side and post-stroke functional improvement. Design: A total of 127 patients with unilateral stroke were included in this study. Demographic data, clinical data on initial grip strength, initial National Institutes of Health Stroke Scale, admission and discharge Modified Barthel Index (MBI), and stroke profiles were retrospectively reviewed. Results: Univariate and multiple linear regression analyses were carried out to evaluate the predictive values of each variable. In the model for discharge MBI, age, initial National Institutes of Health Stroke Scale, grip strength on the unaffected side, lesion side, and admission MBI were shown to be independent predictors. Meanwhile, grip strength on the unaffected side, lesion side, and admission MBI had significant predictive values in the model for difference between admission and discharge MBI. Conclusion: The current study suggests for the first time that grip strength on the unaffected side is an independent predictor for short-term functional gain and outcome after stroke. This result may change post-stroke rehabilitation strategies to emphasize exercises to prevent loss of muscle strength. In addition, this implies the possibility of a relationship between sarcopenia and post-stroke function. Further research is needed to reveal the effect of sarcopenia on stroke patients and its mechanism. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Transcranial Direct Current Stimulation Improves Audioverbal Memory in Stroke Patients.

Objective: The aim of this study was to investigate whether anodal transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance in stroke patients. Design: Twelve stroke patients with audioverbal memory impairment participated in a single-masked, crossover, and sham-controlled experiment. The anodal or sham transcranial direct current stimulation was applied during the Rey Auditory Verbal Learning Test, which evaluates the ability to recall a list of 15 heard words over five trials. The number of correctly recalled words was compared between the anodal and sham conditions and the influence of transcranial direct current stimulation on serial position effect of the 15 words was also examined. Results: The increase in the number of correctly recalled words from the first to the fifth trial was significantly greater in the anodal condition than in the sham condition (P

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Vertical distribution of 236U in the North Pacific Ocean

Publication date: April 2017
Source:Journal of Environmental Radioactivity, Volumes 169–170
Author(s): R. Eigl, P. Steier, K. Sakata, A. Sakaguchi
The first extensive study on ²³⁶U in the North Pacific Ocean has been conducted. The vertical distribution of ²³⁶U/²³⁸U isotopic ratios and the ²³⁶U concentrations were analysed on seven depth profiles, and large variations with depth were found. The range of ²³⁶U/²³⁸U isotopic ratios was from (0.09 ± 0.03) × 10⁻¹⁰ to (14.1 ± 2.2) × 10⁻¹⁰, which corresponds to ²³⁶U concentrations of (0.69 ± 0.24) × 10⁵ atoms/kg and (119 ± 21) × 10⁵ atoms/kg, respectively. The variations in ²³⁶U concentrations could mainly be attributed to the different water masses in the North Pacific Ocean and their formation processes. Uranium-236 inventories on the water column of each sampling station were calculated and varied between (3.89 ± 0.08) × 10¹² atoms/m² and (7.03 ± 0.50) × 10¹² atoms/m², which is lower than in former studies on comparable latitudes in the North Atlantic Ocean and the Sea of Japan. The low inventories of ²³⁶U found for the North Pacific Ocean in this study can be explained by the lack of additional input sources of artificial radionuclides, apart from global and regional/local fallout. This study expands the use of ²³⁶U as oceanographic circulation tracer to yet another ocean basin and shows that this isotope can be used for tracing circulation patterns of water masses in the Pacific Ocean.



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Essentials of Our Current Understanding: Abdominal Wall Blocks.

Abdominal wall blocks rely on the spread of local anesthetic within musculofascial planes to anesthetize multiple small nerves or plexuses, rather than targeting specific nerve structures. Ultrasonography is primarily responsible for the widespread adoption of techniques including transversus abdominis plane and rectus sheath blocks, as well as the introduction of novel techniques such as quadratus lumborum and transversalis fascia blocks. These blocks are technically straightforward and relatively safe and reduce pain and opioid requirements in many clinical settings. The data supporting these outcomes, however, can be inconsistent because of heterogeneity of study design. The extent of sensory blockade is also somewhat variable, because it depends on the achieved spread of local anesthetic and the anatomical course of the nerves being targeted. The blocks mainly provide somatic analgesia and are best used as part of a multimodal analgesic regimen. This review summarizes the anatomical, sonographic, and technical aspects of the abdominal wall blocks in current use, examining the current evidence for the efficacy and safety of each. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Reporting of Design Features and Analysis Details in Randomized Clinical Trials of Procedural Treatments for Cancer Pain: An ACTTION Systematic Review.

Background and Objectives: The objective of this study was to assess the reporting of randomized clinical trials investigating procedural treatments (eg, nerve blocks, targeted drug delivery) for cancer pain, with a focus on aspects that are particularly challenging in these trials. Methods: This article presents results from a systematic review of reporting of randomized clinical trials of procedural interventions for cancer pain. Articles were identified by searching PubMed from 1966 to June 2014. Data related to quality of reporting are presented for early (1985-2004) and late periods (2005-2014). Results: A total of 35 published trials were included. Approximately two-thirds of the articles clearly indicated the level of blinding. Only 26% reported a primary outcome measure. Less than half explicitly reported the number of patients who completed the trial, and only 1 reported a method that was used to accommodate missing data. Almost one-third of articles included a responder analysis, all of which specified the definition of a responder. Conclusions: The goal of highlighting these deficiencies in reporting is to promote transparent reporting of details affecting the completion and interpretation of procedural cancer pain trials so that their quality can be more easily evaluated. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Marijuana Exposure is Associated with Minimal Changes in Thyroid Function in NHANES Surveys

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 22-24.


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Does Meta-Analysis Prove Which Factors Predict Relapse After Antithyroid Drugs Are Discontinued?

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 5-7.


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Bleeding of Papillary Thyroid Recurrent Carcinoma in the Parapharyngeal and Nasopharyngeal Spaces Is Markedly Improved After Treatment with Lenvatinib

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 35-37.


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Thyroid Cancer Overdiagnosis Is a Result of Screening Programs in South Korea

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 8-10.


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Women with Gestational Thyroid Dysfunction May Be at Higher Risk for Thyroid Disease Developing Postpartum

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 28-31.


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The Increased Incidence of Thyroid Cancer Is Worldwide

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 11-12.


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What's Ahead in Clinical Thyroidology in 2017

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 3-4.


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Clinical, Sonographic, and Pathological Characteristics of BRAF-Positive Differs from RAS-Positive Thyroid Carcinoma

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 13-15.


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Subclinical Hypothyroidism Among Those 85+ Years Old Is Not Associated with Increased Mortality

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 25-27.


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Lymph Node Mapping with Ultrasound Is Highly Useful in the Preoperative Workup of Patients with Thyroid Cancer

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 16-18.


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Fetal Hyperthyroidism Resulted from TSI in a Mother with Hashimoto's Hypothyroidism

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 32-34.


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Transoral Endoscopic Thyroidectomy Is a Novel Experimental Technique

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 19-21.


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An Unexpected Finding in a Thyroid Cancer Patient with Rising Thyroglobulin

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 38-41.


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A reply to Douze and Delagnes’s ‘The pattern of emergence of a Middle Stone Age tradition at Gademotta and Kulluletti (Ethiopia) through convergent tool and point technologies’ [J. Hum. Evol. 91 (2016) 93–121]

Publication date: Available online 13 January 2017
Source:Journal of Human Evolution
Author(s): Yonatan Sahle, David R. Braun
Douze and Delagnes (2016) revisit Middle Stone Age (MSA) lithic assemblages from the Gademotta Formation (Fm.), Ethiopia. Their analysis of selected assemblages from three of the 1972 excavations expands the original typo-technological interpretations by Wendorf and Schild (1974). We particularly welcome their evaluation of our recent inferences about the function of pointed artifacts and technological patterns in the Gademotta Fm. (Sahle et al., 2013, 2014). However, we find several arguments and conclusions in Douze and Delagnes (2016) to be rather unconvincing and irreconcilable with results from analyses of whole assemblages (Wendorf and Schild, 1974; Sahle et al., 2013, 2014). Specifically, their summary attribution of all early MSA burin-like fractures on the distal tips of pointed artifacts to intentional resharpening blows, and their use of this pattern as a technological "chrono-marker" unique to the region are untenable. Here, we highlight these issues in the hopes of a clearer understanding of the evident technological patterns in the Gademotta Fm.



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The vertebrae and ribs of Homo naledi

Publication date: Available online 13 January 2017
Source:Journal of Human Evolution
Author(s): Scott A. Williams, Daniel García-Martínez, Markus Bastir, Marc R. Meyer, Shahed Nalla, John Hawks, Peter Schmid, Steven E. Churchill, Lee R. Berger
Hominin evolution featured shifts from a trunk shape suitable for climbing and housing a large gut to a trunk adapted to bipedalism and higher quality diets. Our knowledge regarding the tempo, mode, and context in which these derived traits evolved has been limited, based largely on a small-bodied Australopithecus partial skeleton (A.L. 288-1; "Lucy") and a juvenile Homo erectus skeleton (KNM-WT 15000; "Turkana Boy"). Two recent discoveries, of a large-bodied Australopithecus afarensis (KSD-VP-1/1) and two Australopithecus sediba partial skeletons (MH1 and MH2), have added to our understanding of thorax evolution; however, little is known about thorax morphology in early Homo. Here we describe hominin vertebrae, ribs, and sternal remains from the Dinaledi chamber of the Rising Star cave system attributed to Homo naledi. Although the remains are highly fragmented, the best-preserved specimens—two lower thoracic vertebrae and a lower rib—were found in association and belong to a small-bodied individual. A second lower rib may belong to this individual as well. All four of these individual elements are amongst the smallest known in the hominin fossil record. H. naledi is characterized by robust, relatively uncurved lower ribs and a relatively large spinal canal. We expect that the recovery of additional material from Rising Star Cave will clarify the nature of these traits and shed light on H. naledi functional morphology and phylogeny.



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NY ambulance struck by car at intersection; 2 hurt

The ambulance was responding to a call when it was struck; the car failed to yield to the ambulance

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Colon capsule endoscopy: toward the future

Abstract

Colon capsule endoscopy is a wireless and minimally invasive technique for visualization of the whole colon. With recent improvements of technical features in second-generation systems, a more important role for colon capsule endoscopy is rapidly emerging. Although several limitations and drawbacks are yet to be resolved, its usefulness as a tool for colorectal cancer screening and monitoring disease activity in inflammatory bowel diseases has become more apparent with increased use. Further investigations, including multicenter trials, are required to evaluate the substantial role of the colon capsule in managing colorectal diseases.

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Influence of Experiences and Perceptions Related to Breastfeeding One’s First Child on Breastfeeding Initiation of Second Child

Abstract

Introduction Multiparas tend to initiate breastfeeding less than primiparas. While mothers often repeat the feeding method used for their first child with their second child, the way in which experiences and maternal perceptions related to breastfeeding one's first child may influence breastfeeding initiation with a second child remain underexplored. The objective of this study was to investigate whether physiological or social experiences, and related psychological factors, reported at the end of breastfeeding one's first child influence breastfeeding initiation with a second child. Methods Data from 174 multiparas who participated in the Infant Feeding Practices Study II, breastfed their first child, and completed the Year 6 Follow Up were analyzed using exact logistic regression. Results Mothers who reported experiencing trouble with the first baby's suck or latch had lower odds of initiating breastfeeding (OR 0.15, 95% CI 0.04–0.56) than those who did not report this experience, whereas mothers who agreed that breastfed children are less likely to become obese had greater odds of initiating breastfeeding with a second child (OR 11.49, 95% CI 1.56–513.18) than those who did not agree. Discussion Efforts to facilitate breastfeeding initiation among multiparas may consider mothers' previous experiences and beliefs associated with breastfeeding. Strategies to facilitate initiation may focus on addressing barriers mothers experienced while breastfeeding their first child and increasing awareness about how breastfeeding may prevent childhood obesity. Future research should explore how such approaches may impact breastfeeding outcomes with subsequent children.

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Sub-Regional Assessment of HPV Vaccination Among Female Adolescents in the Intermountain West and Implications for Intervention Opportunities

Abstract

Objectives We investigated the similarities and differences in the factors related to human papillomavirus (HPV) vaccination of female adolescents in three sub-regions of the Intermountain West (IW). Methods We analyzed 2011–2012 National Immunization Survey-Teen data. Respondents (parents) who were living in the IW and who had daughters aged 13–17 years old with provider-verified immunization records were included in our analyses. East, Central, and West sub-regions were defined based on geographic contiguity and similarity in HPV vaccination rates and sociodemographic characteristics. Survey-weighted Chi square tests and multivariable Poisson regressions were performed. Results In all three sub-regions, older teen age and receipt of other recommended adolescent vaccinations were significantly associated with HPV vaccination. In the East sub-region, providers' facility type and source of vaccines were significantly related to HPV vaccination. In the Central sub-region, teens with married parents were significantly less likely to be vaccinated than were those with unmarried parents. In the West sub-region, non-Hispanic teens were significantly less likely to be vaccinated than were Hispanic teens. Conclusions for Practice In order to improve HPV vaccine coverage in the IW, region-wide efforts to target younger teens and to promote the HPV vaccine with other recommended adolescent vaccinations should be supplemented with sub-regional attention to the health care system (East sub-region), to married parents (Central sub-region), and to non-Hispanic teens (West sub-region).

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Parenting Self-Efficacy, Parent Depression, and Healthy Childhood Behaviors in a Low-Income Minority Population: A Cross-Sectional Analysis

Abstract

Objectives Childhood obesity prevention and treatment depends, in part, on parents acting as agents of change for their children. Our objective was to measure the associations between parenting self-efficacy, parent depressive symptoms, and preschool child behaviors that support healthy growth. Methods We performed a cross-sectional analysis of baseline data from a randomized controlled trial. Parenting self-efficacy was measured using a 5-item version of the Parenting Sense of Competence (PSOC-5) scale (α= 0.8). Parent depressive symptoms were measured using the Center for Epidemiological Studies-Depression (CESD) scale. Child outcomes included diet (24 h diet recall), physical activity (accelerometry), sleep (parent-report), and media use during meals (parent-report). We performed separate multiple linear regressions for each outcome controlling for other covariates. Results The sample consisted of 601 parent–child pairs. Median child age was 4.3 (IQR 3.6–5.1) years; median child body mass index (BMI) percentile was 79.1% (IQR 66.8–88.5%); 90% of children were Hispanic/Latino, and 6% of children were non-Hispanic Black. Median parent age was 31.5 (IQR 27.6–36.0) years; 22% of parents met criteria for depression. Parenting self-efficacy (median PSOC-5 25; IQR 24–28) was negatively correlated with depressive symptoms (ρ = −0.16; p < 0.001). In adjusted models, higher parenting self-efficacy was associated with duration of child's sleep and fewer meals eaten in front of a TV (p < 0.001). There was a significant interaction of parenting self-efficacy and parental depressive symptoms on child sleep duration (p < 0.001). Parenting self-efficacy and depressive symptoms were not significantly associated with child physical activity or child diet. Conclusions In this minority population, higher parenting self-efficacy was associated with longer child sleep and fewer meals in front the TV, but parent depressive symptoms mitigated that protective effect for child sleep duration.

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Prevalence and Perceptions of Electronic Cigarette Use during Pregnancy

Abstract

Objectives The current study is the first to assess pregnant women's perceptions of e-cigarettes and the prevalence of e-cigarette use during pregnancy, using a national sample of pregnant women (N = 445) recruited online. Methods An online survey was used to assess the prevalence and perceptions of e-cigarette use among pregnant women, including perceptions of e-cigarette safety. Results In our sample, 5.62% (n = 25) of women solely used tobacco cigarettes, 6.52% (n = 29) solely used e-cigarettes, 8.54% (n = 38) used both tobacco cigarettes and e-cigarettes, and 79.33% (n = 353) used neither tobacco cigarettes nor e-cigarettes during their current pregnancy. Overall, 64.27% (n = 286) of participants viewed e-cigarettes as being safer than tobacco cigarettes. Having seen advertisements for e-cigarettes increased likelihood of viewing them as safer than tobacco cigarettes (OR [Odds Ratio] = 2.5, p < .01). Conclusions for Practice Taken together, findings from this study suggest that at least as many women use e-cigarettes during pregnancy as tobacco cigarettes, that pregnant women view e-cigarettes as being safer than tobacco cigarettes, and that these views may be influenced by exposure to e-cigarette advertisements.

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The Effects of Race and Ethnicity on the Risk of Large-for-Gestational-Age Newborns in Women Without Gestational Diabetes by Prepregnancy Body Mass Index Categories

Abstract

Objectives Children born large for gestational age (LGA) are at risk of numerous adverse outcomes. While the racial/ethnic disparity in LGA risk has been studied among women with Gestational Diabetes Mellitus (GDM), the independent effect of race on LGA risk by maternal prepregnancy BMI is still unclear among women without GDM. Therefore, the objective of this study was to assess the association between maternal race/ethnicity and LGA among women without GDM. Methods This was a population-based cohort study of 2,842,278 singleton births using 2012 U.S. Natality data. We conducted bivariate and multivariate logistic regression analyses to assess the association between race and LGA. Due to effect modification by maternal prepregnancy BMI, we stratified our analysis by four BMI subgroups. Results The prevalence of LGA was similar across the different racial/ethnic groups at about 9%, but non-Hispanic Asian Americans had slightly higher prevalence of 11%. After controlling for potential confounders, minority women had higher odds of birthing LGA babies compared to non-Hispanic white women. Non-Hispanic Asian Americans had the highest odds of LGA babies across all BMI categories: underweight (aOR = 2.67; 95% CI: 2.24, 3.05); normal weight (aOR = 2.53; 2.43, 2.62); overweight (aOR = 2.45; 2.32, 2.60) and obese (aOR = 2.05; 1.91, 2.20). Conclusions for practice Racial/ethnic disparities exist in LGA odds, particularly among women with underweight or normal prepregnancy BMI. Most minorities had higher LGA odds than non-Hispanic white women regardless of prepregnancy BMI category. These racial/ethnic disparities should inform public health policies and interventions to address this problem.

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Maternal Nonstandard Work Schedules and Breastfeeding Behaviors

Abstract

Objectives Although maternal employment rates have increased in the last decade in the UK, there is very little research investigating the linkages between maternal nonstandard work schedules (i.e., work schedules outside of the Monday through Friday, 9–5 schedule) and breastfeeding initiation and duration, especially given the wide literature citing the health advantages of breastfeeding for mothers and children. Methods This paper uses a population-based, UK cohort study, the Millennium Cohort Study (n = 17,397), to investigate the association between types of maternal nonstandard work (evening, night, away from home overnight, and weekends) and breastfeeding behaviors. Results In unadjusted models, exposure to evening shifts was associated with greater odds of breastfeeding initiation (OR 1.71, CI 1.50–1.94) and greater odds of short (OR 1.55, CI 1.32–1.81), intermediate (OR 2.01, CI 1.64–2.47), prolonged partial duration (OR 2.20, CI 1.78–2.72), and prolonged exclusive duration (OR 1.53, CI 1.29–1.82), compared with mothers who were unemployed and those who work other types of nonstandard shifts. Socioeconomic advantage of mothers working evening schedules largely explained the higher odds of breastfeeding initiation and duration. Conclusions Socioeconomic characteristics explain more breastfeeding behaviors among mothers working evening shifts. Policy interventions to increase breastfeeding initiation and duration should consider the timing of maternal work schedules.

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“It’s a Very Big Burden on Me”: Women’s Experiences Using Insulin for Gestational Diabetes

Abstract

Objectives Gestational Diabetes Mellitus (GDM) affects hundreds of thousands of women each year. Many require medications to manage their blood glucose levels. Only insulin is approved by the U.S. Food and Drug Administration for use in pregnancy. While other medications can be used, their safety remains controversial. Few studies have examined women's lived experience of using insulin for GDM. Our objective in this study was to foreground the voices of women speaking about their treatment experience. Methods We conducted two focus groups including 16 women treated for GDM with medications, primarily insulin. Topics included women's experiences with GDM diagnosis and treatment including concerns about risks and benefits of treatments. Transcripts were analyzed using an inductive coding approach. Results Many women had negative experiences with insulin use, such as feeling that they had no voice in treatment decisions, and received inadequate information about insulin, including about the impact it would have on their daily lives. Many continued to have difficulty managing their blood sugar once on insulin, and they worried about the short term and long term health effects of insulin on themselves and their babies. They wanted more information about non-insulin treatment options as well as more social support. Conclusion In our sample of women with GDM, insulin treatment resulted in negative experiences with emotional and experiential impacts lasting beyond pregnancy. There is a need for more research on other medications for GDM, so that women can have access to more treatment options and better information to guide their choices.

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Status of Breastfeeding and Child Immunization Outcomes in Clients of the Nurse–Family Partnership

Abstract

Background The Nurse–Family Partnership (NFP) is a home visiting program serving first-time, low-income mothers, with an area of focus on healthy early childhood development. Previous foundational trials of program effect on breastfeeding and immunizations have shown a mix of neutral and positive results. The present evaluation investigates these effects following program scale-up, using a large contemporary cohort of clients. Methods Nurse–Family Partnership client breastfeeding and immunization status were compared to National Survey of Children's Health data and National Immunization Survey data, respectively. Sample differences in demographic covariates were adjusted using logistic regression. Results Nurse–Family Partnership clients were significantly more likely to have ever breastfed (adjusted prevalence ratio [aPR: 1.20 (1.17, 1.23)] and maintain breastfeeding at 6 [aPR: 1.17 (1.10, 1.24)] and 12 [aPR: 1.39 (1.25, 1.53)] months, but less likely to exclusively breastfeed at 6 months [aPR: 0.84 (0.70, 0.95)] NFP clients were significantly more likely to be up-to-date on immunizations at 6 [aPR: 1.23 (1.22, 1.25)], 18 [aPR: 1.33 (1.30,1.35)], and 24 [aPR: 1.15 (1.14, 1.16)] months of age than the reference cohort, with no significant difference at 12 months. Discussion Nurse–Family Partnership clients had more beneficial breastfeeding and immunization outcomes than children of mothers with demographically similar profiles. However, exclusive breastfeeding at 6 months lags behind the reference sample and represents a potential area for further improvement.

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Transgenerational Transmission of Preterm Birth Risk: The Role of Race and Generational Socio-Economic Neighborhood Context

Abstract

Objectives We investigated associations of mothers' preterm birth (PTB) status with her infants' PTB risk. We also examined whether this relationship differs by mothers' race and generational socio-economic neighborhood context. Methods Participants were 6592 non-Hispanic (NH) white and NH black mother-infant pairs born in 2009–2011 and 1979–1998, respectively, in Allegheny County, Pennsylvania. Birth records were used to determine gestational age at birth, PTB status (<37 completed weeks of gestation), and PTB subgroups—late and early PTB (34–36 weeks and <34 completed weeks of gestation, respectively). Census data on tract racial composition and household income were used to characterize residential race and economic environment. Logistic regression models were used to calculate Odds Ratios (ORs), Relative Risk Ratios (RRR), and 95% confidence intervals (CIs). Stratified analyses were conducted to assess effect modification. Results Overall, 8.21, 6.63 and 1.58% infants had PTB, LPTB, and EPTB, respectively. Maternal PTB status was associated with a 46% increase in infant PTB (95% CI: 1.08–1.98), EPTB (95% CI: 0.80–2.69), and LPTB (95% CI: 1.04–2.04) risk. Maternal PTB-infant PTB associations, particularly maternal PTB-infant LPTB associations, were stronger among NH blacks, mothers in neighborhoods with a high percentage of NH black residents in both generations, or mothers who moved to neighborhoods with a higher percentage of NH black residents. Conclusions for Practice Race and generational socio-economic neighborhood context modify transgenerational transmission of PTB risk. These findings are important for identification of at-risk populations and to inform future mechanistic studies.

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Prenatal Predictors of Maternal Attachment and Their Association with Postpartum Depressive Symptoms in Mexican Women at Risk of Depression

Abstract

Objectives Although maternal attachment is an important predictor of infant developmental outcomes, little is known about its pre- and postnatal predictors. The purpose of this secondary data analysis is to assess several risk factors for maternal attachment at 6 months postpartum in a sample of Mexican women at risk of depression. The predictors included were prenatal depressive symptoms, pregnancy intendedness, partner relationship, social support, maternal history of childhood sexual abuse, and postpartum depressive symptoms. Methods A total of 156 pregnant women seeking antenatal care at three health centers were selected because they displayed depressive symptoms (CES-D ≥ 16) or had previously suffered depression. Women were interviewed during pregnancy and at 6 months postpartum. A step-wise multivariate logistic regression was conducted to evaluate the pre- and postpartum risk factors for postpartum depression related to low maternal attachment. Results Pre- and postpartum depressive symptoms increased the risk of low maternal attachment by factors of 3.00 and 3.97, respectively, compared with women who did not present these symptoms; low level of adjustment with the partner increased the risk by a factor of 3.11, low social support by a factor of 2.90, and CSA by a factor of 2.77. Conclusions for practice Prevention programs during pregnancy to reduce depressive symptoms should strengthen strategies to promote maternal attachment by improving partner relations and increasing social support. However, evidence shows that such programs alone are insufficient, so direct interventions should also be implemented. Women with a history of childhood sexual abuse should be given additional attention during prenatal care.

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Sleep Trajectories Among Pregnant Women and the Impact on Outcomes: A Population-Based Cohort Study

Abstract

Objectives Sleep problems and deprivation are common during pregnancy, particularly in the third trimester. Previous studies are mostly descriptive or focused on specific clinical groups and late pregnancy. We aimed to identify sleep duration trajectories during the pregnancy period, their associated factors, and impact on pregnancy and birth outcomes. Methods We studied 200 women from a mother–child cohort recruited in 2009–2011 from the French general population. We used semi-parametric models to analyze data collected through questionnaires. Results We detected three sleep duration trajectories during pregnancy: short-decreasing (<6.5h/night, 10.8% of the sample), medium-decreasing (6.5-8h/night, 57.6%), and long-increasing (>8h/night, 31.6%) trajectories. Factors associated with the short-decreasing trajectory relative to the medium-decreasing trajectory were older age (odds-ratio/year = 1.13 [95%Confidence-Interval 1.00-1.29]) and working > 28 weeks of gestational age (odds-ratio = 0.30 [0.10–0.90]). Sleep duration during pregnancy in this trajectory group was modified by insomniac symptoms (regression coefficient/trimester = −0.74 [Standard-Error 0.12]) and naps (regression coefficient/trimester = 0.58 [0.25]). Restless legs syndrome was the only factor associated with the long-increasing trajectory and decreased sleep duration (regression coefficient/trimester = −0.88 [0.25]). Assisted delivery (i.e. cesarean section and/or instrumental delivery) and post-partum depression were more frequent among women with the short-decreasing and long-increasing trajectories whereas cesarean section alone was more prevalent among those with the short-decreasing trajectory. Proportion of premature births was higher in the short-decreasing trajectory group. Birth-weight-z-score was lower in the long-increasing trajectory group. Conclusion We identified sleep trajectories among pregnant women with specific risk factors that could affect both pregnancy and birth outcomes. Taking these into consideration could improve both maternal and child health.

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Association Between Fruit and Vegetable Consumption and Sleep Quantity in Pregnant Women

Abstract

Introduction To determine the association of fruit and vegetable consumption with overall sleep duration among pregnant women. Methods Data from the 2011 and 2012 Behavioral Risk Factors Surveillance System (BRFSS) were used. All women (n = 2951) of childbearing age (18–44 years) who were pregnant and responded to all fruit and vegetable consumption and sleep duration questions were included. Covariates included age, race, education level, exercise, and marital status. Data were analyzed using linear and ordinal logistic regression. Results Total daily fruit and vegetable consumption was not associated with sleep duration among pregnant women, controlling for confounders [β = −0.03, (−0.07, 0.00)]. Orange and green vegetable consumption were both inversely associated with sleep duration [β = −0.19, (−0.38, −0.01) and β = −0.20, (−0.33, −0.08) respectively]. Ordinal logistic regression found that the odds of meeting or exceeding sleep time recommendations increased slightly with each unit increase in total fruit and vegetable consumption [OR = 1.05 (1.003, 1.092)] and for every unit increase in fruit consumption [OR = 1.12 (1.038, 1.208)]. Women who exercised within the past 30 days reported approximately 20 min of additional sleep compared to those who did not [β = 0.32 (0.16, 0.49)]. Age, employment status, and marital status were also independently associated with sleep duration. Discussion Sleep duration in pregnant women was associated with exercise and other demographic factors, but only mildly associated with fruit and vegetable consumption. Future research should investigate the effects of additional factors including sleep quality, gestational age, family status and other medications as potential confounders.

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Diet to the Rescue: Cessation of Pharmacotherapy After Initiation of Exclusive Enteral Nutrition (EEN) Followed by Strict and Liberalized Specific Carbohydrate Diet (SCD) in Crohn’s Disease

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Epistaxis during nasotracheal intubation: a randomized trial of the Parker Flex-Tip™ nasal endotracheal tube with a posterior facing bevel versus a standard nasal RAE endotracheal tube.

Related Articles

Epistaxis during nasotracheal intubation: a randomized trial of the Parker Flex-Tip™ nasal endotracheal tube with a posterior facing bevel versus a standard nasal RAE endotracheal tube.

Can J Anaesth. 2017 Jan 11;:

Authors: Earle R, Shanahan E, Vaghadia H, Sawka A, Tang R

Abstract
PURPOSE: Nasotracheal intubation is a widely performed technique to facilitate anesthesia induction during oral, dental, and maxillofacial surgeries. The technique poses several risks not encountered with oropharyngeal intubation, most commonly epistaxis due to nasal mucosal abrasion. The purpose of this study was to test whether the use of the Parker Flex-Tip™ (PFT) nasal endotracheal tube (ETT) with a posterior facing bevel reduces epistaxis when compared with the standard nasal RAE ETT with a leftward facing bevel.
METHODS: Sixty American Society of Anesthesiologists physical status I and II patients undergoing oral or maxillofacial surgery with nasotracheal intubation were recruited. Patients were randomized to either a standard nasal RAE ETT or a PFT nasal ETT. The ETT was thermosoftened and lubricated for both study groups prior to insertion, and the size of the tube was chosen at the discretion of the attending anesthesiologist. The primary outcome was the incidence of epistaxis, with a secondary outcome of epistaxis severity (scored as none, mild, moderate, or severe). An investigator measured both outcomes five minutes after intubation was completed.
RESULTS: Mild or moderate epistaxis was experienced by 22 of 30 (73%) patients in the PFT group compared with 21 of 30 (70%) patients in the standard nasal RAE ETT group (absolute risk reduction, 3%; 95% confidence interval, -19 to 25; P = 0.78). There were no occurrences of severe epistaxis in either group.
CONCLUSION: There was no difference in the incidence or severity of epistaxis following nasal intubation using the Parker Flex-Tip nasal ETT when compared with a standard nasal RAE ETT. This trial was registered at ClinicalTrials.gov, identifier: NCT02315677.

PMID: 28078544 [PubMed - as supplied by publisher]

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Lateralization of Language Function in Epilepsy Patients: A High-Density Scalp-Derived Event-Related Potentials (ERP) Study

Publication date: Available online 12 January 2017
Source:Clinical Neurophysiology
Author(s): Karin Trimmel, Jens Sachsenweger, Gerald Lindinger, Eduard Auff, Fritz Zimprich, Ekaterina Pataraia
ObjectivesLanguage functional magnetic resonance imaging (fMRI) represents the clinical standard for language lateralization assessment in presurgical epilepsy evaluation, but still many patients experience postoperative language deficits. Event-related potentials (ERPs), especially the negative component around and after 400ms, are related to language processing and could therefore represent a complementary method of language lateralization assessment.MethodsScalp EEG was recorded from 64 locations in 36 epilepsy patients and 37 controls during three visually presented language tasks: A short-term language memory task (differentiation memorized vs. unknown words), a phonological task (detection of rhymes in word pairs), and a semantic decision task (differentiation words vs. pseudowords). ERP were analyzed in the 300ms–800ms epoch. Language fMRI was routinely obtained in patients.ResultsERPs were significantly more negative over the left compared to the right hemisphere in all three tasks in patients and controls. Laterality indices showed highest concordance with fMRI for the Word/Pseudoword Task.ConclusionsERPs of language processing were lateralized to the left hemisphere in the majority of epilepsy patients and controls. In patients, single-subject laterality indices showed high concordance with fMRI results.SignificanceResults indicate that scalp-derived ERPs are a promising tool to investigate lateralization of language function in epilepsy patients.



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Detailed 2-Dimensional and 3-Dimensional Transesophageal Evaluation of the Aortic Root and Aortic Valve in Complex Type A Dissections.

No abstract available

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A Predictive Model for Extended Postanesthesia Care Unit Length of Stay in Outpatient Surgeries.

BACKGROUND: A predictive model that can identify patients who are at an increased risk for prolonged postanesthesia care unit (PACU) stay could help optimize resource utilization and case sequencing. Although previous studies identified some predictors, there is not a model that only utilizes various patients demographic and comorbidities, that are already known preoperatively, and that may affect PACU length of stay for outpatient procedures requiring the care of an anesthesiologist. METHODS: We collected data from 4151 patients at a single institution from 2014 to 2015. The data set was split into a training set (cases before 2015) and a test set (cases during 2015). Bootstrap samples were chosen (R = 1000 replicates) and a logistic regression model was built on the samples using a combined method of forward selection and backward elimination based on the Akaike Information Criterion. The trained model was applied to the test set. Model performance was evaluated with the area under the receiver operating characteristic (ROC) Curve (AUC) for discrimination and the Hosmer-Lemeshow (HL) test for goodness-of-fit. RESULTS: The final model had 5 predictor variables for prolonged PACU length of stay, which included the following: morbid obesity, hypertension, surgical specialty, primary anesthesia type, and scheduled case duration. The model had an AUC value of 0.754 (95% confidence interval 0.733-0.774) on the training set and 0.722 (95% confidence interval 0.698-0.747) on the test set, with no difference between the 2 ROC curves (P = .06). The model had good calibration for the data in both the training and test data set indicated by nonsignificant P values from the HL test (P = .211 and .719 for the training and test set, respectively). CONCLUSIONS: We developed a predictive model with excellent discrimination and goodness-of-fit that can help identify those at higher odds for extended PACU length of stay. This information may help optimize case-sequencing methodologies. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. (C) 2017 International Anesthesia Research Society

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Assessing the Impact of the Anesthesia Medication Template on Medication Errors During Anesthesia: A Prospective Study.

BACKGROUND: Medication errors continue to be a significant source of patient harm in the operating room with few concrete countermeasures. The organization and identification of medication syringes may have an impact on the commission of medication errors in anesthesia, so a team of physicians and designers at the University of Washington created the Anesthesia Medication Template (AMT) to define a formal way of organizing the anesthesia workspace. The purpose of this study is to assess the ability of the AMT to reduce perioperative medication errors by anesthesia providers. METHODS: This study evaluated the AMT in 2 phases: (1) 41 anesthesia providers administered medications in 2 prospective, randomized operating room simulations with or without the AMT, while medication errors were directly observed; and (2) around 200 providers prospectively self-reported medication errors from all anesthetizing locations during a 2-year period at Seattle Children's Hospital, an academic, pediatric medical center. RESULTS: In simulated emergencies, the odds of medication dosing errors using the AMT were 0.21 times the odds of medication dosing errors without AMT (95% confidence interval [CI], 0.07, 0.66), controlling for scenario, session, training level, and years at training level. During the year after implementation of the AMT, the mean monthly error rate for all reported medication errors that reached patients decreased from 1.24 (95% CI, 0.85-1.79) to 0.65 (95% CI, 0.39-1.09) errors per 1000 anesthetics. The mean monthly error rate of reported swap, preparation, miscalculation, and timing errors decreased from 0.97 (95% CI, 0.64-1.48) to 0.35 (95% CI, 0.17-0.70) errors per 1000 anesthetics. Medication errors that resulted in patient harm did not change after implementation of the AMT. CONCLUSIONS: Standardizing medication organization with the AMT is an intuitive, low-cost strategy with the potential to improve patient safety through reducing medication errors by anesthesia providers. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. (C) 2017 International Anesthesia Research Society

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Landmark-Guided and Ultrasound-Guided Approaches for Trochanteric Bursa Injection: A Cadaveric Study.

BACKGROUND: Trochanteric bursa (TB) injection with local anesthetic and corticosteroid is a treatment for patients suffering from greater trochanteric pain syndrome. Both landmark (LM)-guided and ultrasound (US)-guided methods have been used, but their accuracies have not been determined. This study examined the accuracy of these injections with cadaveric dissection. METHODS: Twenty-four hip specimens were randomized to receive TB injections with methylene blue under either LM-guided or US-guided approach. After dissection, the locations of the dye were classified into 3 categories: intrabursal, extrabursal, or combined intrabursal and extrabursal. The presence of dye in the intrabursal space with or without extrabursal leak was considered a successful injection. Accuracy was defined as the percentage of successful injection. RESULTS: The accuracies of the LM-guided and US-guided injection were 0.67 (95% confidence interval 0.35-0.90) and 0.92 (95% confidence interval 0.62-1.00), respectively, with no significant difference. CONCLUSIONS: This is the first cadaveric study examining the accuracy of both the US-guided and LM-guided techniques for TB injection. Future clinical studies are required to compare the outcomes of LM-guided and US-guided greater trochanteric pain syndrome injection. (C) 2017 International Anesthesia Research Society

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Induction.

No abstract available

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The Development and Implementation of Cognitive Aids for Critical Events in Pediatric Anesthesia: The Society for Pediatric Anesthesia Critical Events Checklists.

Cognitive aids such as checklists are commonly used in modern operating rooms for routine processes, and the use of such aids may be even more important during critical events. The Quality and Safety Committee of the Society for Pediatric Anesthesia (SPA) has developed a set of critical-event checklists and cognitive aids designed for 3 purposes: (1) as a repository of the latest evidence-based and expert opinion-based information to guide response and management of critical events, (2) as a source of just-in-time information during critical events, and (3) as a method to facilitate a shared understanding of required actions among team members during a critical event. Committee members, who represented children's hospitals from across the nation, used the recent literature and established guidelines (where available) and incorporated the expertise of colleagues at their institutions to develop these checklists, which included relevant factors to consider and steps to take in response to critical events. Human factors principles were incorporated to enhance checklist usability, facilitate error-free accomplishment, and ensure a common approach to checklist layout, formatting, structure, and design. The checklists were made available in multiple formats: a PDF version for easy printing, a mobile application, and at some institutions, a Web-based application using the anesthesia information management system. After the checklists were created, training commenced, and plans for validation were begun. User training is essential for successful implementation and should ideally include explanation of the organization of the checklists; familiarization of users with the layout, structure, and formatting of the checklists; coaching in how to use the checklists in a team environment; reviewing of the items; and simulation of checklist use. Because of the rare and unpredictable nature of critical events, clinical trials that use crisis checklists are difficult to conduct; however, recent and future simulation studies with adult checklists provide a promising avenue for future validation of the SPA checklists. This article will review the developmental steps in producing the SPA crisis checklists, including creation of content, incorporation of human factors elements, and validation in simulation. Critical-events checklists have the potential to improve patient care during emergency events, and it is hoped that incorporating the elements presented in this article will aid in successful implementation of these essential cognitive aids. (C) 2017 International Anesthesia Research Society

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Lecture Notes: Clinical Anesthesia.

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

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Review of the Alternatives to Epidural Blood Patch for Treatment of Postdural Puncture Headache in the Parturient.

Labor neuraxial anesthesia is commonly used in the parturient, and postdural puncture headache is the most common complication of the technique. Although epidural blood patch is the best treatment, there are some patients in whom this treatment is refused or contraindicated. The goal of this article is to review the efficacy of the most studied alternate modalities to treat postdural puncture headache. This will include a discussion of the various oral or intravenous therapies and the non-blood-containing epidural injections. Last, the evidence behind interventional pain modalities and acupuncture will be examined. (C) 2017 International Anesthesia Research Society

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The Cricoid Force Necessary to Occlude the Esophageal Entrance: Is There a Gender Difference?.

BACKGROUND: We tested the hypothesis whether gender differences exist in the applied cricoid force necessary to prevent regurgitation. Real-time visual and dynamic means were used to assess the effectiveness of different applied cricoid forces in occluding the esophageal entrance in men (group 1) and in women (group 2). METHODS: In anesthetized and paralyzed patients, the glottis and esophageal entrance were visualized with a Glidescope video laryngoscope. Trained operators performed cricoid pressure (CP) and gastric tube insertion trials. Successful gastric tube insertion in the presence of CP was considered ineffective CP, whereas unsuccessful insertion was considered effective CP. The applied cricoid forces were measured with a novel instrument, the cricometer. The first patient in each group received 20 N. The applied cricoid force in successive patients was determined by the response of the previous patient within the same group, using the up-and-down sequential allocation technique. RESULTS: In the 30 men and 30 women who qualified for the study, the median cricoid force (cricoid force = 50) that occluded the esophageal entrance was 30.8 N (95% confidence interval = 28.15-33.5) in men, and 18.7 N in women (95% confidence interval = 17.1-20.3; P

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In Vogue: Ketamine for Neuroprotection in Acute Neurologic Injury.

Neurologic deterioration following acute injury to the central nervous system may be amenable to pharmacologic intervention, although, to date, no such therapy exists. Ketamine is an anesthetic and analgesic emerging as a novel therapy for a number of clinical entities in recent years, including refractory pain, depression, and drug-induced hyperalgesia due to newly discovered mechanisms of action and new application of its known pharmacodynamics. In this focused review, the evidence for ketamine as a neuroprotective agent in stroke, neurotrauma, subarachnoid hemorrhage, and status epilepticus is highlighted, with a focus on its applications for excitotoxicity, neuroinflammation, and neuronal hyperexcitability. Preclinical modeling and clinical applications are discussed. (C) 2017 International Anesthesia Research Society

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The Liability of a Glowing Reference.

No abstract available

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Comparative analysis of mutational profile of sonic hedgehog gene in gallbladder cancer

Digestive Diseases and Sciences

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Real-world use, effectiveness and safety of anti-viral treatment in chronic hepatitis C genotype 3 infection

Alimentary Pharmacology and Therapeutics

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Immunohistochemical approach for the diagnosis of a liver mass on small biopsy specimens

Human Pathology

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Rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth

Alimentary Pharmacology and Therapeutics

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Mutation detection of fibroblast growth factor receptor 3 for infiltrative hepatocellular carcinoma by whole-exome sequencing

Digestive Diseases and Sciences

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Effect of low-dose aspirin use on survival of patients with gastrointestinal malignancies; An observational study

British Journal of Cancer

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Small gallstone size and delayed cholecystectomy increase the risk of recurrent pancreatobiliary complications after resolved acute biliary pancreatitis

Digestive Diseases and Sciences

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A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma

Liver International

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A novel procedure for introducing large sheet-type surgical material with a self-expanding origami structure using a slim trocar (chevron pleats procedure)

Surgical Endoscopy

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Vitamin D in pediatric gastrointestinal disease

Current Opinion in Pediatrics

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Hepatic encephalopathy is associated with persistent learning impairments despite adequate medical treatment: A multicenter, international study

Digestive Diseases and Sciences

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Efficacy of fluoropyrimidine-based chemotherapy in patients with advanced biliary tract cancer after failure of gemcitabine plus cisplatin: Retrospective analysis of 321 patients

British Journal of Cancer

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A meta-analysis of the clinicopathological characteristics and survival outcomes of inflammatory bowel disease associated colorectal cancer

International Journal of Colorectal Disease

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Serum trimethylamine N-oxide, carnitine, choline and betaine in relation to colorectal cancer risk in the alpha tocopherol and beta carotene study

Cancer Epidemiology, Biomarkers & Prevention

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MRI texture analysis (MRTA) of T2-weighted images in Crohn's disease may provide information on histological and MRI disease activity in patients undergoing ileal resection

European Radiology

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Diagnostic accuracy of demarcation of undifferentiated-type early gastric cancer after Helicobacter pylori eradication

Journal of Gastroenterology

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Gut microbiota disturbance during helminth infection: Can it affect cognition and behaviour of children?

BMC Infectious Diseases

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Gastric activity and gut peptides in patients with functional dyspepsia: Postprandial distress syndrome versus epigastric pain syndrome

Journal of Clinical Gastroenterology

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Metabolic profile of liver damage in non-cirrhotic virus C and autoimmune hepatitis: A proton decoupled 31P-MRS study

European Journal of Radiology

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Prospective randomised controlled trial comparing early post-operative complications in patients undergoing loop colostomy with and without a stoma rod

Colorectal Disease

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Καλοήθης Λεμφοεπιθηλιακή Σιαλαδενίτις,benign lymphoepithelial sialadenitis

http://headandneckcancers-sfakianakis.blogspot.com/2017/01/bilateral-parotid-and-lacrimal-gland.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Transdermal Scopolamine Withdrawal Syndrome Case Report in the Pediatric Cerebral Palsy Population.

Sialorrhea in children with cerebral palsy (CP) results in aspiration, decreased social integration, and poor quality of life. Management options include transdermal anticholinergics such as the scopolamine patch. A controlled clinical trial has proven botulinum toxin (BTX) injections into the salivary glands are an effective alternative to transdermal anticholinergics with a safer side effect profile. Multiple studies of the injections in diverse populations demonstrate reduction in saliva production with improvement in quality of life and decrease in hospitalization-associated costs. The authors describe a 15-year-old boy with spastic quadriplegic CP who developed emesis, nausea, and lethargy 1 day after the first injection of botulinum toxin A (BTX-A) to his salivary glands for sialorrhea management. The authors ascribed his symptoms to scopolamine withdrawal. Given the lack of exposure in the medical literature, there is minimal awareness of the withdrawal syndrome from transdermal scopolamine in children with or without CP, resulting in delayed diagnosis and potential complications. Treatment of the withdrawal syndrome has been successful with meclizine though safety and efficacy has not been established in children younger than 12 despite frequent clinical and over-the-counter use. Prompt diagnosis of the transdermal scopolamine withdrawal syndrome can result in quicker treatment and a shorter hospital stay. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Effect of Nebulized Glycopyrrolate on Posterior Drooling in Patients with Brain Injury: Two Cases of Different Brain Lesions.

Posterior drooling, which can lead to substantial respiratory morbidity, including unexplained lung diseases and recurrent pneumonia, is an important issue in the rehabilitation unit. There are various treatment options for posterior drooling, including pharmacologic therapy, oral motor or behavioral therapy, biofeedback, local glandular injection of botulinum toxin, irradiation, and surgery. Among them, nebulized glycopyrrolate has the following advantages: It is noninvasive and is relatively free of central adverse effects because it does not cross the blood-brain barrier unlike other anticholinergics. Although there has been one case report regarding the effectiveness of nebulized glycopyrrolate for drooling in a motor neuron patient, there have not been any reports on its effectiveness for posterior drooling. Herein, we report two cases (an 82-year-old male bilateral hemiplegic stroke patient and a 1-year-old female cerebral palsy infant with bilaterally spastic hemiplegia of posterior drooling treated with nebulized glycopyrrolate) and identify salivary aspiration and the effect of nebulized glycopyrrolate using radionuclide salivagram. Considering its advantages and effectiveness, nebulized glycopyrrolate should be considered as one of the reliable methods to manage posterior drooling in patients with impaired cognition or swallowing difficulties, such as severe brain injury. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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