Our aim was to evaluate cost and acute care utilization related to an organized approach to care coordination and transitional care after major acute care hospitalization for children with medical complexities, including cerebral palsy.
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Τρίτη 13 Ιουνίου 2017
The Effect of a Comprehensive Care Transition Model on Cost and Utilization for Medically Complex Children With Cerebral Palsy
Automatic multimodal detection for long-term seizure documentation in epilepsy
Source:Clinical Neurophysiology, Volume 128, Issue 8
Author(s): F. Fürbass, S. Kampusch, E. Kaniusas, J. Koren, S. Pirker, R. Hopfengärtner, H. Stefan, T. Kluge, C. Baumgartner
ObjectiveThis study investigated sensitivity and false detection rate of a multimodal automatic seizure detection algorithm and the applicability to reduced electrode montages for long-term seizure documentation in epilepsy patients.MethodsAn automatic seizure detection algorithm based on EEG, EMG, and ECG signals was developed. EEG/ECG recordings of 92 patients from two epilepsy monitoring units including 494 seizures were used to assess detection performance. EMG data were extracted by bandpass filtering of EEG signals. Sensitivity and false detection rate were evaluated for each signal modality and for reduced electrode montages.ResultsAll focal seizures evolving to bilateral tonic-clonic (BTCS, n=50) and 89% of focal seizures (FS, n=139) were detected. Average sensitivity in temporal lobe epilepsy (TLE) patients was 94% and 74% in extratemporal lobe epilepsy (XTLE) patients. Overall detection sensitivity was 86%. Average false detection rate was 12.8 false detections in 24h (FD/24h) for TLE and 22 FD/24h in XTLE patients. Utilization of 8 frontal and temporal electrodes reduced average sensitivity from 86% to 81%.ConclusionOur automatic multimodal seizure detection algorithm shows high sensitivity with full and reduced electrode montages.SignificanceEvaluation of different signal modalities and electrode montages paces the way for semi-automatic seizure documentation systems.
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Brain network dynamics in the human articulatory loop
Source:Clinical Neurophysiology, Volume 128, Issue 8
Author(s): Masaaki Nishida, Anna Korzeniewska, Nathan E. Crone, Goichiro Toyoda, Yasuo Nakai, Noa Ofen, Erik C. Brown, Eishi Asano
ObjectiveThe articulatory loop is a fundamental component of language function, involved in the short-term buffer of auditory information followed by its vocal reproduction. We characterized the network dynamics of the human articulatory loop, using invasive recording and stimulation.MethodsWe measured high-gamma activity70–110 Hz recorded intracranially when patients with epilepsy either only listened to, or listened to and then reproduced two successive tones by humming. We also conducted network analyses, and analyzed behavioral responses to cortical stimulation.ResultsPresentation of the initial tone elicited high-gamma augmentation bilaterally in the superior-temporal gyrus (STG) within 40ms, and in the precentral and inferior-frontal gyri (PCG and IFG) within 160ms after sound onset. During presentation of the second tone, high-gamma augmentation was reduced in STG but enhanced in IFG. The task requiring tone reproduction further enhanced high-gamma augmentation in PCG during and after sound presentation. Event-related causality (ERC) analysis revealed dominant flows within STG immediately after sound onset, followed by reciprocal interactions involving PCG and IFG. Measurement of cortico-cortical evoked-potentials (CCEPs) confirmed connectivity between distant high-gamma sites in the articulatory loop. High-frequency stimulation of precentral high-gamma sites in either hemisphere induced speech arrest, inability to control vocalization, or forced vocalization. Vocalization of tones was accompanied by high-gamma augmentation over larger extents of PCG.ConclusionsBilateral PCG rapidly and directly receives feed-forward signals from STG, and may promptly initiate motor planning including sub-vocal rehearsal for short-term buffering of auditory stimuli. Enhanced high-gamma augmentation in IFG during presentation of the second tone may reflect high-order processing of the tone sequence.SignificanceThe articulatory loop employs sustained reciprocal propagation of neural activity across a network of cortical sites with strong neurophysiological connectivity.
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Examination to Assess the Clinical Exam and Documentation of Spine Pathology among Orthopaedic Residents
The Accreditation Council of Graduate Medical Education (ACGME) guidelines require residency programs to teach and evaluate residents in six overarching "core competencies" and document progress through educational milestones. In order to assess the progress of orthopaedic interns' skills in performing a history, physical exam, and documentation of the encounter for a standardized patient with spinal stenosis, a Structured Objective Clinical Examination (OSCE) was conducted for 13 orthopaedic intern residents, following a one month boot camp that included communications skills and curriculum in history and physical examination.
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Regional Anesthesia and Pain Medicine: US Anesthesiology Resident Training-The Year 2015.
Background and Objectives: The Anesthesiology Review Committee of the Accreditation Council for Graduate Medical Education sets core requirements for residency program accreditation. We periodically report and analyze the US anesthesiology residents' training experience in regional anesthesia and pain medicine. Methods: Resident caseload, procedure, and pain medicine evaluation data were aggregated for the resident cohort who graduated in 2015. These data were analyzed for present-day experience and compared with previous reports from years 1980, 1990, and 2000 graduates. Results: Data were available for 1631 residents who graduated from 129 training programs. Regional anesthesia as a portion of the overall anesthesiology residents' training experience remains unchanged since 1990. The distribution of regional anesthesia training has shifted from neuraxial to peripheral blocks. All residents at the 10th percentile and above achieved the benchmark for spinal, epidural, and peripheral nerve block anesthetics and for new pain evaluations. Conclusions: The focus of US anesthesiology resident training in regional anesthesia and pain medicine has changed over the past 15 years by shifting from neuraxial to peripheral nerve block techniques. Previous training deficits have resolved for spinal anesthesia and peripheral nerve block. Procedural experience in pain medicine overwhelmingly involves epidural and facet injections. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
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Biochemical and Pharmacological Characterization of a Mice Model of Complex Regional Pain Syndrome.
Background and Objectives: Complex regional pain syndrome is a challenging disease to treat. Recently, a mouse fracture model of complex regional pain syndrome has been developed that has many signs of the clinical syndrome. However, many aspects of the sensory neuron biochemistry and behavioral and pharmacological characterization of this model remain to be clarified. Methods: Mice were randomly assigned to fracture/cast or control (naive) groups. Fracture/cast mice underwent a closed distal tibia facture, with hindlimb wrapped in casting tape for 3 weeks. After cast removal, mice were tested for mechanical allodynia, burrowing behavior, and motor ability over a 12-week period. Protein immunohistochemistry was performed for substance P, calcitonin gene-related peptide, tropomyosin receptor kinase A, nerve growth factor, Nav1.7, and transient receptor potential cation-channel V1, colocalized in neurons, in the ipsilateral lumbar dorsal root ganglia (DRGs). Analgesic drugs were tested for pain-relieving efficacy. Results: Mechanical allodynia was greater in the ipsilateral hindpaw (P = 0.0002) in the fracture/cast group versus the control group, over the 3- to 12-week period. The amount of burrowing material removed was decreased (P = 0.0026), and there were deficits in spontaneous motor-rearing behavior (P = 0.018). Immunostaining of substance P, calcitonin gene-related peptide, Trk A receptor, nerve growth factor, Nav1.7, and transient receptor potential cation-channel V1 all demonstrated up-regulation in the DRGs of fracture mice versus controls (all P
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A Kinome RNAi Screen in Drosophila Identifies Novel Genes Interacting with Lgl, aPKC and Crb Cell Polarity Genes in Epithelial Tissues
In both Drosophila melanogaster and mammalian systems, epithelial structure and underlying cell polarity are essential for proper tissue morphogenesis and organ growth. Cell polarity interfaces with multiple cellular processes that are regulated by the phosphorylation status of large protein networks. To gain insight into the molecular mechanisms that coordinate cell polarity with tissue growth, we screened a boutique collection of RNAi stocks targeting the kinome for their capacity to modify Drosophila 'cell polarity' eye and wing phenotypes. Initially we identified kinase or phosphatase genes whose depletion modified adult eye phenotypes associated with the manipulation of cell polarity complexes (via overexpression of Crb or aPKC). We next conducted a secondary screen to test whether these cell polarity modifiers altered tissue overgrowth associated with depletion of Lgl in the wing. These screens identified Hippo, JNK, and Notch signalling pathways, previously linked to cell polarity regulation of tissue growth. Furthermore, novel pathways, not previously connected to cell polarity regulation of tissue growth were identified, including Wingless (Wg/Wnt), Ras and lipid/Phospho-inositol-3-kinase (PI3K) signalling pathways. Additionally, we demonstrated that the 'nutrient sensing' kinases, Salt Inducible Kinase 2 and 3 (SIK2 and 3) are potent modifiers of cell polarity phenotypes and regulators of tissue growth. Overall, our screen has revealed novel cell-polarity interacting kinases and phosphatases that affect tissue growth, providing a platform for investigating molecular mechanisms coordinating cell polarity and tissue growth during development.
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Patterns of Genetic Structure and Linkage Disequilibrium in a Large Collection of Pea Germplasm
Pea (Pisum sativum, L.) is a major pulse crop used both for animal and human alimentation. Owing to its association with nitrogen-fixing bacteria, it is also a valuable component for low-input cropping systems. To evaluate the genetic diversity and the scale of linkage disequilibrium (LD) decay in pea, we genotyped a collection of 917 accessions gathering elite cultivars, landraces and wild relatives using an array of ~13,000 single nucleotide polymorphisms (SNP). Genetic diversity is broadly distributed across three groups corresponding to wild/landraces peas, winter types and spring types. At a finer subdivision level, genetic groups relate to local breeding programs and type usage. Linkage disequilibrium is steeply decreasing as genetic distance increase. When considering subsets of the data, LD values can be higher, even if the steep decay remains. We looked for genomic regions exhibiting high level of differentiation between wild/landraces, winter and spring pea respectively. Two regions on linkage groups 5 and 6 containing 33 SNPs exhibit stronger differentiation between winter and spring peas than would be expected under neutrality. Interestingly QTLs for resistance to cold acclimation and frost resistance have been identified previously in the same regions.
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A Duplicated, Truncated amh Gene Is Involved in Male Sex Determination in an Old World Silverside
A master sex-determining gene, the Y chromosome-linked anti-Müllerian hormone (amhy), has been described in two New World atheriniform species but little is known on the distribution, evolution, and function(s) of this gene in other Atheriniformes. Interestingly, amhy has been found to coexist with temperature-dependent sex determination (TSD), providing a unique opportunity to explore the interplay between genotypic and environmental sex determination. In this study, the search for an amhy homologue was extended to an Old World atheriniform, the cobaltcap silverside Hypoatherina tsurugae (Atherinidae). The full sequences, including the coding and non-coding regions, of the autosomal amh (amha) and a putative amhy were obtained. The deduced Amha and Amhy proteins comprised 511 and 340 amino acids, respectively. PCR analysis with genomic DNA from wild adults and from laboratory-reared juveniles revealed a high, but not complete association of about 95% between amhy and maleness. The spatio-temporal expression of amhy and amha during gonadal sex differentiation was analyzed by qRT-PCR and in situ hybridization (ISH). amhy transcription (in amhy-positive larvae) started before and peaked during histological differentiation of the gonads whereas amha was negligible during the same period in both genotypes. These results demonstrate that the amhy, although with some structural differences in relation to the amhy of some New World atheriniforms, is strongly associated with maleness and probably important for testicular development in this Old World atheriniform. Thus, amhy is a candidate for sex determination gene in cobaltcap silverside and will be key to scrutinize the mechanism of sex determination in this species.
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Laparoscopic pelvic lymph node dissection for malignant foot melanoma
Abstract
A 39 year-old woman with malignant foot melanoma underwent wide excision of the primary tumor with a safety margin and sentinel lymph node biopsy (SLNB) for the right inguinal lymph node. SLNB was positive and a computed tomography (CT) scan revealed right iliac lymph node swelling. Positron emission tomography computed tomography (PET–CT) scan of the lymph nodes revealed abnormal uptake of fluorodeoxyglucose (FDG). We performed a laparoscopic pelvic lymph node obturator, iliac lymph node) dissection. During the operation, several black lymph nodes were observed in the iliac lymph node. Pathologically, the iliac lymph node consisted of metastasized atypical melanocytes. This surgical method for pelvic lymph node dissection is not a standard procedure among institutions. There have been no reported cases of malignant melanoma with pelvic lymph node metastasis treated by laparoscopic surgery. However, due to the minimally invasive technique, this method is worth considering to be used for pelvic lymph node dissection in malignant melanoma as well as other cancers in the field of urology or gynecology.
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Successful management of unresectable small bowel lymphoma with laparoscopy-assisted surgical exclusion of the affected intestine
Abstract
The incidence of small bowel lymphoma (SBL) is increasing worldwide. In contrast to resectable SBL, the treatment of unresectable SBL is still contentious. Here, we report a case of unresectable SBL that was treated by laparoscopic exclusion of the affected intestine before systemic chemotherapy was administered. An 84-year-old man was diagnosed with primary SBL involving extranodal dissemination. The patient received prophylactic surgery, namely exclusion of the affected intestine. This therapy diminishes well-known and life-threatening complications, such as perforation, bleeding, and obstruction, which may still occur after chemotherapy, and it makes the administration of chemotherapy safer. In addition, the surgery provides easy access for direct endoscopic observation and biopsy, which are otherwise difficult to perform. Follow-up after two courses of chemotherapy showed that the patient had achieved complete remission. In conclusion, the procedure described here may be an effective strategy for unresectable SBL.
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Cell source, differentiation, functional stimulation, and potential application of human thermogenic adipocytes in vitro
Abstract
Recent investigations have showed that the functional thermogenic adipocytes are present in both infants and adult humans. Accumulating evidence suggests that the coexistence of classical and inducible brown (brite) adipocytes in humans at adulthood and these adipocytes function to generate heat from energy resulting in reducing body fat and improving glucose metabolism. Human thermogenic adipocytes can be differentiated in vitro from stem cells, cell lines, or adipose stromal vascular fraction. Pre-activated human brite adipocytes in vitro can maintain their thermogenic function in normal or obese immunodeficient mice; therefore, they improve glucose homeostasis and reduce fat mass in obese animals. These key findings have opened a new door to use in vitro thermogenic adipocytes as a cell therapy to prevent obesity and related disorders. Thus, this paper intends to highlight our knowledge in aspects of in vitro human brite/brown adipocytes for the further studies.
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Stent migration during EUS-guided hepaticogastrostomy in a patient with massive ascites: Troubleshooting using additional EUS-guided antegrade stenting
Publication date: Available online 13 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Ken Kamata, Mamoru Takenaka, Kosuke Minaga, Shunsuke Omoto, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Masatoshi Kudo
EUS-guided hepaticogastrostomy (EUS-HGS) is useful for treating obstructive jaundice. However, stent migration may sometimes occur both during and after the procedure. This report describes a patient with pancreatic cancer and massive ascites who underwent EUS-HGS combined with EUS-guided antegrade stenting (EUS-AS), with additional EUS-AS playing a role in troubleshooting for stent migration during EUS-HGS.
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Comparing Corticosteroid Preparation and Dose in the Improvement of Shoulder Function and Pain: A Randomized, Single-Blind Pilot Study.
Introduction: Shoulder pain may arise from inflammation of the bursa separating the supraspinatus tendon from the coracoacromial ligament and acromion. The optimal treatment dose and preparation of intrabursal corticosteroid injection are unknown. Methods: This single-blinded equivalence study recruited 62 subjects randomizing them to one of following four arms: methylprednisolone 20 mg, methylprednisolone 40 mg, triamcinolone acetonide 20 mg, or triamcinolone acetonide 40 mg. QuickDASH, subject-reported pain, and adverse events were recorded in time of injection, 3 days later, 3 wks later, and 6 wks later. Primary outcome was QuickDASH improvements 6 wks after injection. Results: All four groups were equally matched regarding age, sex, ethnicity, and site injected. Six weeks after injection, no statistically significant changes were noted in QuickDASH improvement (as compared with time of injection) among the four arms. There were no statistically significant differences at 6 wks regarding improvement in pain. There were no statistically significant differences noted in adverse events among the four arms. Conclusions: Neither dose nor preparation of injectable corticosteroid influences magnitude of improvement in function or pain experienced. Although this study provides clinically relevant insight regarding corticosteroid dose and type when managing shoulder pain, the modest sample size may limit the conclusions that can be made about efficacy and adverse effects. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Using optogenetics to assess neuroendocrine modulation of heart rate in Drosophila melanogaster larvae
Abstract
The Drosophila melanogaster heart has become a principal model in which to study cardiac physiology and development. While the morphology of the heart in Drosophila and mammals is different, many of the molecular mechanisms that underlie heart development and function are similar and function can be assessed by similar physiological measurements, such as cardiac output, rate, and time in systole or diastole. Here, we have utilized an intact, optogenetic approach to assess the neural influence on heart rate in the third instar larvae. To simulate the release of modulators from the nervous system in response to environmental influences, we have directed expression of channel-rhodopsin variants to targeted neuronal populations to assess the role of these neural ensembles in directing release of modulators that may affect heart rate in vivo. Our observations show that the activation of targeted neurons, including cholinergic, dopaminergic, and serotonergic neurons, stimulate the release of cardioactive substances that increase heart rate after the initial activation at both room temperature and in a cold environment. This parallels previous studies suggesting these modulators play a crucial role in altering heart rate when applied to exposed hearts and adds to our understanding of chemical modulation of heart rate in intact Drosophila larvae.
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Pulsara's Prehospital Alerting Package selected as a JEMS Hot Product from EMS Today 2017
Pulsara's Prehospital Alerting Package among 30 innovative new products for emergency medical services and prehospital care. BOZEMAN, Mont. — Pulsara and JEMS (Journal of Emergency Medical Services) are proud to announce the selection of Pulsara's Prehospital Alerting Package as a Hot Product from the JEMS EMS Today Conference & Exposition, which was held February 23–25 in ...
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Fire Rescue Technician - Fauquier County Government
GENERAL DEFINITION OF WORK: Performs responsible protective service work providing fire suppression, emergency medical care and response to hazardous materials incidents; does related work as required. Much of the work is performed under emergency conditions and frequently involves considerable personal hazard. Work is performed under regular supervision. Position is considered essential personnel ...
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Age Modulates Physiological Responses during Fan Use under Extreme Heat and Humidity.
Purpose: We examined the effect of electric fan use on cardiovascular and thermoregulatory responses of nine young (26 +/- 3 years) and nine aged (68 +/- 4 years) adults exposed to extreme heat and humidity. Methods: While resting at a temperature of 42[degrees]C, relative humidity increased from 30 to 70% in 2% increments every 5 minutes. On randomized days, the protocol was repeated without or with fan use. Heart rate (HR), core (Tcore) and mean skin (Tsk) temperatures were measured continuously. Whole-body sweat loss (WBSL) was measured from changes in nude body weight. Other measures of cardiovascular (cardiac output), thermoregulatory (local cutaneous and forearm vascular conductance, local sweat rate), and perceptual (thermal and thirst sensations) responses were also examined. Results: When averaged over the entire protocol, fan use resulted in a small reduction of HR (-2 beats/min, 95% CI: -8 to 3), and slightly greater Tcore (+0.05[degrees]C, 95% CI: -0.13 to 0.23) and Tsk (+0.03[degrees]C, 95% CI: -0.36 to 0.42) in young adults. In contrast, fan use resulted in greater HR (+5 beats/min, 95% CI: 0 to 10), Tcore (+0.20[degrees]C, 95% CI: 0.00 to 0.41) and Tsk (+0.47[degrees]C, 95% CI: 0.18 to 0.76) in aged adults. A greater WBSL during fan use was observed in young (+0.2 kg, 95% CI: -0.2 to 0.6) but not aged (0.0 kg, 95% CI: -0.2 to 0.2) adults. Greater local sweat rate and cutaneous vascular conductance were observed with fan use in aged adults. Other measures of cardiovascular, thermoregulatory and perceptual responses were unaffected by fan use in both groups. Conclusion: During extreme heat and humidity, fan use elevates physiological strain in aged, but not young, adults. (C) 2017 American College of Sports Medicine
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Comparing Strategies for Providing Child and Youth Mental Health Care Services in Canada, the United States, and The Netherlands
Abstract
This paper reviews how child and youth mental health care services in Canada, the United States, and the Netherlands are organized and financed in order to identify systems and individual-level factors that may inhibit or discourage access to treatment for youth with mental health problems, such as public or private health insurance coverage, out-of-pocket expenses, and referral requirements for specialized mental health care services. Pathways to care for treatment of mental health problems among children and youth are conceptualized and discussed in reference to health insurance coverage and access to specialty services. We outline reforms to the organization of health care that have been introduced in recent years, and the basket of services covered by public and private insurance schemes. We conclude with a discussion of country-level opportunities to enhance access to child and youth mental health services using existing health policy levers in Canada, the United States and the Netherlands.
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G-Shock unveils new color additions for men's GRAVITYMASTER timepieces
Latest Color Variation for Men's Master of G Series Available on the Connected GPW2000 and GA1100 Models LAS VEGAS — Today, Casio G-SHOCK announces the addition of two color additions for the Master of G GRAVITYMASTER series, available starting this July on the new, connected GPW2000 model, as well as the GA1100 model. Both watches will feature a Military Green color way with the GA1100SC ...
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Drones carrying AEDs could aid cardiac arrest patients
In tests, the drone arrived 16 minutes faster than an ambulance
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Follistatin is critical for mouse uterine receptivity and decidualization [Genetics]
Embryo implantation remains a significant challenge for assisted reproductive technology, with implantation failure occurring in ∼50% of in vitro fertilization attempts. Understanding the molecular mechanisms underlying uterine receptivity will enable the development of new interventions and biomarkers. TGFβ family signaling in the uterus is critical for establishing and maintaining pregnancy....
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Impact of novel polymorphisms related to cytotoxicity of cytarabine in the induction treatment of acute myeloid leukemia
Several novel single nucleotide polymorphisms (SNPs) involved in cytarabine cytotoxicity and related to clinical outcomes have been reported recently in a series of 232 pediatric patients with acute myeloid leukemia (AML). We report the first adult AML cohort in which the influence of these SNPs in cytarabine efficacy and toxicity was analyzed. Six of polymorphisms with clinical significance in the previous study [rs12036333, rs10758713, rs9883101, rs6550826, IRX2: rs2897047, mutated in colorectal cancers (MCC): rs7729269] were analyzed in a cohort of 225 adult patients at initial diagnosis of AML treated with an induction scheme of idarubicin plus cytarabine. The variant alleles of rs12036333 and rs10758713 confirmed the previous associations with lower survival rates. The minor alleles of rs9883101 and rs6550826 were also related to lower survival, in concordance with higher cytarabine-induced cytotoxicity observed in pediatric patients. However, discordant findings between AML adult and pediatric population were observed with IRX2 rs2897047, showing higher survival in heterozygous genotype carriers. The heterozygous genotype of MCC rs7729269 was associated with higher cytarabine-induced toxicities (renal, hepatic, lung, skin toxicities), whereas lower time to thrombocytopenia recovery was associated with the MCC rs7729269 minor allele. This study confirms the influence in survival rates of these polymorphisms in an adult AML population. Novel associations between MCC SNPs and cytarabine toxicities were reported and should be validated in prospective studies involving larger groups of patients.from Genetics via xlomafota13 on Inoreader http://ift.tt/2tiuRuF
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Risk factors of allopurinol-induced severe cutaneous adverse reactions in a Thai population
Background: Allopurinol is one of the most common causes of severe cutaneous adverse drug reactions (SCARs) including drug reactions with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). This study identified the risk factors associated with the development of allopurinol-induced SCARs in a Thai population. Patients and methods: Eighty-six allopurinol-induced SCARs (i.e. 19 DRESS and 67 SJS/TEN) and 182 allopurinol-tolerant patients were enrolled in the study. The HLA-B*58:01 allele was determined. Clinical and medicinal data were collected. Results: Results from multivariate analysis showed that only the HLA-B*58:01 and female sex were identified as risk factors of allopurinol-induced SCARs in this Thai population. Patients who carried the HLA-B*58:01 allele were at a higher risk of allopurinol-induced DRESS [odds ratio (OR)=149.2, 95% confidence interval (CI)=24.0–∞, Pfrom Genetics via xlomafota13 on Inoreader http://ift.tt/2ti6w8s
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Genome-wide association and pathway analysis of left ventricular function after anthracycline exposure in adults
Background: Anthracyclines are important chemotherapeutic agents, but their use is limited by cardiotoxicity. Candidate gene and genome-wide studies have identified putative risk loci for overt cardiotoxicity and heart failure, but there has been no comprehensive assessment of genomic variation influencing the intermediate phenotype of anthracycline-related changes in left ventricular (LV) function. The purpose of this study was to identify genetic factors influencing changes in LV function after anthracycline chemotherapy. Methods: We conducted a genome-wide association study (GWAS) of change in LV function after anthracycline exposure in 385 patients identified from BioVU, a resource linking DNA samples to de-identified electronic medical record data. Variants with P values less than 1×10−5 were independently tested for replication in a cohort of 181 anthracycline-exposed patients from a prospective clinical trial. Pathway analysis was performed to assess combined effects of multiple genetic variants. Results: Both cohorts were middle-aged adults of predominantly European descent. Among 11 candidate loci identified in discovery GWAS, one single nucleotide polymorphism near PR domain containing 2, with ZNF domain (PRDM2), rs7542939, had a combined P value of 6.5×10−7 in meta-analysis. Eighteen Kyoto Encyclopedia of Gene and Genomes pathways showed strong enrichment for variants associated with the primary outcome. Identified pathways related to DNA repair, cellular metabolism, and cardiac remodeling. Conclusion: Using genome-wide association we identified a novel candidate susceptibility locus near PRDM2. Variation in genes belonging to pathways related to DNA repair, metabolism, and cardiac remodeling may influence changes in LV function after anthracycline exposure.from Genetics via xlomafota13 on Inoreader http://ift.tt/2ti3np2
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Single nucleotide variant in Nucleoporin 107 may be predictive of sensitivity to chemotherapy in patients with ovarian cancer
Background: Alterations in nuclear pore complex (NPC) genes have been previously associated with response to chemotherapy. Using agnostic exome sequencing, we envisioned that new alleles in NPC genes, predictive of sensitivity to platinum treatment, could be discovered. Methods: Twenty-two platinum-sensitive and six platinum-resistant ovarian cancer patients were tested. Platinum sensitivity was defined as disease-free survival greater than 6 months. Next-generation sequencing of exomes was used to compare platinum-sensitive and platinum-resistant patients. Single nucleotide variants (SNVs) associated with platinum sensitivity in NPC genes (n=30 genes) were identified. Results: SNVs in three NPC genes were associated with response to platinum on univariate analysis. SNV rs79419059 (10T>C) in Nucleoporin 107 (Nup107) was associated with platinum resistance (P=0.0061), whereas rs2302811 (3662-4A>G) in Nucleoporin 188 (Nup188) and rs77246077 (3420-67T>A) in Nucleoporin 214 (Nup214) were associated with platinum sensitivity (P=0.0483 and 0.0091, respectively). Controlling for other confounders, multivariate age-adjusted Cox proportional hazard analysis showed rs79419059 to be significantly associated with platinum resistance (odds ratio: 4.519, 95% confidence interval: 1.317–15.501, P=0.0457). Conclusion: We identified a variant in the 3′-UTR region Nup107 unique to sensitivity to platinum in ovarian cancer. With validation of this variant, it is possible that a new marker predictive of patient response may be identified.from Genetics via xlomafota13 on Inoreader http://ift.tt/2ti0fcD
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HLA-A*31: 01 and HLA-B*15:02 association with Stevens–Johnson syndrome and toxic epidermal necrolysis to carbamazepine in a multiethnic Malaysian population
The majority of the carbamazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis CBZ-SJS/TEN are associated with HLA-B*15:02 in Asian populations where this allele is common. In contrast, the association with HLA-A*31:01 is only reported in Japanese and Europeans. This study aimed to further investigate the association with HLA-A*31:01 besides HLA-B*15:02 in a multiethnic Malaysian population. Twenty-eight CBZ-SJS/TEN cases and 227 CBZ-tolerant controls were recruited. Association was tested by comparing carrier frequencies of the alleles between cases and controls. Significant associations were detected between HLA-B*15:02 and CBZ-SJS/TEN in independent ethnic groups: Malays [P=2.00×10−8; odds ratio (OR): 49.0; 95% confidence interval (CI): 9.36–256.81], Chinese (P=0.0047; OR: 14.3; 95% CI: 2.38–86.03) and Indians (P=0.04; OR: 13.8; 95% CI: 1.51–124.99). Combined analysis of all ethnic groups showed a significant association with OR Cochran–Mantel–Haenszel (ORCMH) of 26.6 (95% CI: 12.80–55.25; PCMH=2.31×10−26). In Indians, HLA-A*31:01 was found to be associated significantly with CBZ-SJS/TEN (P=0.023; OR: 10.4; 95% CI: 1.64–65.79) and combined analyses of both variants, HLA-A*31:01 and HLA-B*15:02, increased the strength of the association (P=0.0068; OR: 14.3; 95% CI: 2.20–92.9). Besides HLA-B*15:02, our study found a new association between HLA-A*31:01 and CBZ-SJS/TEN in Indians.from Genetics via xlomafota13 on Inoreader http://ift.tt/2ti6xJy
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Transanal Hartmann’s colostomy reversal assisted by laparoscopy: outcomes of the first 10 patients
Abstract
Introduction
Restoration of intestinal continuity after Hartmann's procedure is a technically difficult surgery associated with significant morbidity and mortality. This study presents the short-term results of a new approach: a transanal Hartmann's colostomy reversal assisted by laparoscopy.
Method
This is a retrospective analysis of data collected in one tertiary hospital, from October 2013 to November 2015.
Results
During the study period, there were ten cases of transanal Hartmann's reversal. Reasons for Hartmann's procedure were: complicated diverticulitis (4), anastomotic leak (3), and recto-sigmoid cancer (3). Rectal stump length was 10.4 ± 4.5 cm. Reconstruction was achieved in all patients. One low colorectal anastomosis was hand-sewn, the other 9 were stapled. Mean operative time was 204 ± 65 min. Diverting loop ileostomies were created in five patients and all were closed during the following year. One case required hand-assistance but there was no conversion to open surgery. Iatrogenic laparoscopic enterotomies occurred in four patients and all were repaired primarily without consequences. Three patients had a total of four post-operative complications: ileus (2), abdominal abscess and wound infection (1). None required reoperation. Mean length of stay was 7.2 ± 4.3 days. One required readmission.
Conclusion
A transanal Hartmann's reversal assisted by laparoscopy is a new approach for a difficult surgery. It has the potential to be an additional tool in the case of hostile pelvises or with a rectal stump difficult to identify. The surgery remains challenging and indications need to be clarified.
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Teen valedictorian battles cancer while working as an EMT
WVU Medicine MORGANTOWN, W.Va. — After graduating valedictorian of the Gilmer County High School Class of 2017, Tyler Moore, 18, is spending his summer as an emergency medical technician in his hometown of Glenville before he begins studying to be a doctor. He's not your typical overachiever – he has also been battling cancer for the last eight years. At age 9, Moore began experiencing ...
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Patient Care Specialist II (Paramedic)-Acuity Adaptable - Eskenazi Health
JOB SUMMARY: The Acuity Adaptable Patient Care Specialist II is responsible for patient care in the area of assignment under RN supervision. The Patient Care Specialist II performs limited respiratory treatments, phlebotomy procedures, dressing changes, EKGs, medication administration, starts IVs, as well as other patient care activities. REQUIREMENTS: -Active Indiana certification as a Paramedic -Current ...
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Bio-logging, new technologies to study conservation physiology on the move: a case study on annual survival of Himalayan vultures
Abstract
Bio-logging, the on-animal deployment of miniaturised electronic data recorders, allows for the study of location, body position, and physiology of individuals throughout their ontogeny. For terrestrial animals, 1 Hz GPS-position, 3D-body acceleration, and ambient temperature provide standard data to link to the physiology of life histories. Environmental context is added at ever finer scales using remote sensing earth observation data. Here we showcase the use of such bio-logging approaches in a conservation physiology study on endangered Himalayan vultures (Gyps himalayensis). We determine environmental, behavioural, and physiological causes of survival in immature birds that roam from wintering sites in India, Bhutan, and Nepal towards summer areas in Tibet and Mongolia. Five of 18 immature griffons died during one year. Individuals that died had failed to migrate sufficiently far northward (>1500 km) in spring. Individuals likely died if they flew against headwinds from the north or were less able to find thermal updrafts. Surviving individuals migrated to cold and dry areas with low population density. We highlight flight experience, long distance movements, and remote places with low human population as factors critical for the survival of Himalayan vultures. High-resolution bio-logging studies can advance conservation management by pinpointing where and why migratory animals have problems and die.
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The influence of vitamin C on the interaction between acute mental stress and endothelial function
Abstract
Purpose
To determine whether orally administered vitamin C attenuates expected mental stress-induced reductions in brachial artery endothelial function as measured by flow-mediated dilation (FMD).
Methods
Fifteen men (21 ± 2 years) were given 1000 mg of vitamin C or placebo over two visits in a randomized, double-blinded, within-subject design. Acute mental stress was induced using the Trier Social Stress Test (TSST). Saliva samples for cortisol determination and FMD measures were obtained at baseline, pre-TSST, and 30 and 90-min post-TSST. An additional saliva sample was obtained immediately post-TSST. Cardiovascular stress reactivity was characterized by changes in heart rate (HR) and mean arterial pressure (MAP).
Results
A significant stress response was elicited by the TSST in both conditions [MAP, HR, and salivary cortisol increased (p < 0.001)]. Overall FMD did not differ pre- vs. post-stress (time: p = 0.631) and there was no effect of vitamin C (condition: p = 0.792) (interaction between time and condition, p = 0.573). However, there was a correlation between cortisol reactivity and changes in FMD from pre- to post-stress in the placebo condition (r 2 = 0.66, p < 0.001) that was abolished in the vitamin C condition (r 2 = 0.02, p = 0.612).
Conclusion
Acute mental stress did not impair endothelial function, and vitamin C disrupted the relationship between cortisol reactivity and changes in FMD post-stress. This suggests that acute mental stress does not universally impair endothelial function and that reactive oxygen species signaling may influence the interaction between FMD and stress responses.
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Pathophysiology of Gastric NETs: Role of Gastrin and Menin
Abstract
Purpose of review
Neuroendocrine tumors (NETs) were initially identified as a separate entity in the early 1900s as a unique malignancy that secretes bioactive amines. GI-NETs are the most frequent type and represent a unique subset of NETs, because at least 75% of these tumors represent gastrin stimulation of the enterochromaffin-like cell located in the body of the stomach.
The purpose of this review is to understand the specific role of gastrin in the generation of Gastric NETs (G-NETs).
Recent findings
We review here the origin of enterochromaffin cells gut and the role of hypergastrinemia in gastric enteroendocrine tumorigenesis. We describe generation of the first genetically engineered mouse model of gastrin-driven G-NETs that mimics the human phenotype. The common mechanism observed in both the hypergastrinemic mouse model and human carcinoids is translocation of the cyclin-dependent inhibitor p27kip to the cytoplasm and its subsequent degradation by the proteasome.
Summary
Therapies that block degradation of p27kip, the CCKBR2 gastrin receptor, or gastrin peptide are likely to facilitate treatment.
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Effect of passive heat stress and exercise in the heat on arterial stiffness
Abstract
Purpose
Prior evidence indicates that acute heat stress and aerobic exercise independently reduce arterial stiffness. The combined effects of exercise and heat stress on PWV are unknown. The purpose of this study was to determine the effects of heat stress with passive heating and exercise in the heat on arterial stiffness.
Methods
Nine participants (n = 3 females, 47 ± 11 years old; 24.1 ± 2.8 kg/m2) completed four trials. In a control trial, participants rested supine (CON). In a passive heating trial (PH), participants were heated with a water-perfusion suit. In two other trials, participants cycled at ~50% of \({\dot{\text{V}}\text{O}}_2}}\) in a hot (~40 °C; HC trial) or cool (~15 °C; CC trial) environment. Arterial stiffness, measured by PWV, was obtained at baseline and after each intervention (immediately, 15, 30, 45, and 60 min post). Central PWV (C PWV) was assessed between the carotid/femoral artery sites. Upper and lower peripheral PWV was assessed using the radial/carotid (U PWV) and dorsalis pedis/femoral (L PWV) artery sites. The mean body temperature (T B) was calculated from the skin and rectal temperatures.
Results
No significant changes in T B were observed during the CON and CC trials. As expected, the PH and HC trials elevated T B 2.69 ± 0.23 °C and 1.67 ± 0.27 °C, respectively (p < 0.01). PWV did not change in CON, CC, or HC (p > 0.05). However, in the PH trial, U PWV was reduced immediately (−107 ± 81 cm/s) and 15 min (−93 ± 82 cm/s) post-heating (p < 0.05).
Conclusions
Heat stress via exercise in the heat does not acutely change arterial stiffness. However, passive heating reduces U PWV, indicating that heat stress has an independent effect on PWV.
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Risk Factors for Pressure Ulcers at the Ala of Nose in Oral Surgery.
Risk Factors for Pressure Ulcers at the Ala of Nose in Oral Surgery.
Anesth Prog. 2017;64(2):104-105
Authors: Tsukamoto M, Kobayashi M, Yokoyama T
Abstract
A quality review revealed pressure ulcers at the ala of nose in 16 cases (2.2%) over 3 years. We therefore retrospectively investigated the risk factors for alar pressure ulcers from nasal tubes. Male gender was the highest risk factor (odds ratio = 9.1411; 95% confidence interval = 1.680-170.58), and the second highest risk factor was duration of anesthesia (odds ratio = 1.0048/min of anesthesia; 95% confidence interval = 1.0034-1.0065). Male gender and duration of anesthesia appear to be risk factors for nasal tube pressure ulcers at the ala of nose in patients.
PMID: 28604091 [PubMed - in process]
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New insights into vestibular-saccade interaction based on covert corrective saccades in patients with unilateral vestibular deficits
In response to passive high-acceleration head impulses, patients with low vestibulo-ocular reflex (VOR) gains often produce covert (executed while the head is still moving) corrective saccades in the direction of deficient slow phases. Here we examined 23 patients using passive, and 9 also active, head impulses with acute (< 10 days from onset) unilateral vestibular neuritis and low VOR gains. We found that when corrective saccades are larger than 10°, the slow-phase component of the VOR is inhibited, even though inhibition increases further the time to reacquire the fixation target. We also found that 1) saccades are faster and more accurate if the residual VOR gain is higher, 2) saccades also compensate for the head displacement that occurs during the saccade, and 3) the amplitude-peak velocity relationship of the larger corrective saccades deviates from that of head-fixed saccades of the same size. We propose a mathematical model to account for these findings hypothesizing that covert saccades are driven by a desired gaze position signal based on a prediction of head displacement using vestibular and extravestibular signals, covert saccades are controlled by a gaze feedback loop, and the VOR command is modulated according to predicted saccade amplitude. A central and novel feature of the model is that the brain develops two separate estimates of head rotation, one for generating saccades while the head is moving and the other for generating slow phases. Furthermore, while the model was developed for gaze-stabilizing behavior during passively induced head impulses, it also simulates both active gaze-stabilizing and active gaze-shifting eye movements.
NEW & NOTEWORTHY During active or passive head impulses while fixating stationary targets, low vestibulo-ocular gain subjects produce corrective saccades when the head is still moving. The mechanisms driving these covert saccades are poorly understood. We propose a mathematical model showing that the brain develops two separate estimates of head rotation: a lower level one, presumably in the vestibular nuclei, used to generate the slow-phase component of the response, and a higher level one, within a gaze feedback loop, used to drive corrective saccades.
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AMPA receptor-mediated rapid EPSCs in vestibular calyx afferents
In the vestibular periphery neurotransmission between hair cells and primary afferent nerves occurs via specialized ribbon synapses. Type I vestibular hair cells (HCIs) make synaptic contacts with calyx terminals, which enclose most of the HCI basolateral surface. To probe synaptic transmission, whole cell patch-clamp recordings were made from calyx afferent terminals isolated together with their mature HCIs from gerbil crista. Neurotransmitter release was measured as excitatory postsynaptic currents (EPSCs) in voltage clamp. Spontaneous EPSCs were classified as simple or complex. Simple events exhibited a rapid rise time and a fast monoexponential decay (time constant < 1 ms). The remaining events, constituting ~40% of EPSCs, showed more complex characteristics. Extracellular Sr2+ greatly increased EPSC frequency, and EPSCs were blocked by the AMPA receptor blocker NBQX. The role of presynaptic Ca2+ channels was assessed by application of the L-type Ca2+ channel blocker nifedipine (20 µM), which reduced EPSC frequency. In contrast, the L-type Ca2+ channel opener BAY K 8644 increased EPSC frequency. Cyclothiazide increased the decay time constant of averaged simple EPSCs by approximately twofold. The low-affinity AMPA receptor antagonist -d-glutamylglycine (2 mM) reduced the proportion of simple EPSCs relative to complex events, indicating glutamate accumulation in the restricted cleft between HCI and calyx. In crista slices EPSC frequency was greater in central compared with peripheral calyces, which may be due to greater numbers of presynaptic ribbons in central hair cells. Our data support a role for L-type Ca2+ channels in spontaneous release and demonstrate regional variations in AMPA-mediated quantal transmission at the calyx synapse.
NEW & NOTEWORTHY In vestibular calyx terminals of mature cristae we find that the majority of excitatory postsynaptic currents (EPSCs) are rapid monophasic events mediated by AMPA receptors. Spontaneous EPSCs are reduced by an L-type Ca2+ channel blocker and notably enhanced in extracellular Sr2+. EPSC frequency is greater in central areas of the crista compared with peripheral areas and may be associated with more numerous presynaptic ribbons in central hair cells.
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Modeling the diversity of spontaneous and agonist-induced electrical activity in anterior pituitary corticotrophs
Pituitary corticotrophs fire action potentials spontaneously and in response to stimulation with corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP), and such electrical activity is critical for calcium signaling and calcium-dependent adrenocorticotropic hormone secretion. These cells typically fire tall, sharp action potentials when spontaneously active, but a variety of other spontaneous patterns have also been reported, including various modes of bursting. There is variability in reports of the fraction of corticotrophs that are electrically active, as well as their patterns of activity, and the sources of this variation are not well understood. The ionic mechanisms responsible for CRH- and AVP-triggered electrical activity in corticotrophs are also poorly characterized. We use electrophysiological measurements and mathematical modeling to investigate possible sources of variability in patterns of spontaneous and agonist-induced corticotroph electrical activity. In the model, variation in as few as two parameters can give rise to many of the types of patterns observed in electrophysiological recordings of corticotrophs. We compare the known mechanisms for CRH, AVP, and glucocorticoid actions and find that different ionic mechanisms can contribute in different but complementary ways to generate the complex time courses of CRH and AVP responses. In summary, our modeling suggests that corticotrophs have several mechanisms at their disposal to achieve their primary function of pacemaking depolarization and increased electrical activity in response to CRH and AVP.
NEW & NOTEWORTHY We and others recently demonstrated that the electrical activity and calcium dynamics of corticotrophs are strikingly diverse, both spontaneously and in response to the agonists CRH and AVP. Here we demonstrate this diversity with electrophysiological measurements and use mathematical modeling to investigate its possible sources. We compare the known mechanisms of agonist-induced activity in the model, showing how the context of ionic conductances dictates the effects of agonists even when their target is fixed.
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Clinical and Pathological Risk Factors Associated with Liver Fibrosis and Steatosis in African-Americans with Chronic Hepatitis C
Abstract
Background and Aim
Several factors involved in the development of liver fibrosis in African-American patients with chronic hepatitis C have not been well studied. We aimed to evaluate some of these risk factors.
Methods
We reviewed pathology and medical records of 603 African-Americans with chronic hepatitis C virus (HCV) infection at Howard University Hospital from January 2004 to December 2013. Among the clinical and pathological data collected were HIV (human immunodeficiency virus), HCV genotype, hepatitis B virus (HBV), diabetes mellitus (DM), hypertension (HTN), body mass index (BMI), and hepatic steatosis.
Results
The frequency of DM, HTN, HIV, and HBV was 22, 16, 11, and 4%, respectively. Median BMI was 27.3 kg/m2. The frequency of fibrosis stages 0, 1, 2, 3, and 4 was 2, 48, 28, 11, and 11%, respectively. In multivariate logistic regression, we found a significant association between liver fibrosis stage (3–4 vs. 0–2) and HIV infection (OR 2.4, P = 0.026), HTN (OR 3.0, P = 0.001), age (OR 2.6 for every 10 years, P < 0.001), weight (OR 1.1 for every 10 lb increase, P = 0.002), and steatosis grade (OR 1.6, P = 0.002). The frequency of liver steatosis was 73%. In an ordinal logistic regression, significant risk factors for steatosis were female gender (OR 1.5, P = 0.034) and inflammation grade (P = 0.001).
Conclusion
This study shows that steatosis is independently associated with fibrosis in African-American patients with HCV infection. Female patients were at higher risk of steatosis.
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Human Epidermal Growth Factor Receptor-2 in Sri Lankan Gastric Carcinoma Patients with Clinicopathological Association and Survival
Abstract
Background
HER2 protein expression indicates adverse prognosis in gastric adenocarcinoma (GCa). GCa HER2 positivity ranges from 10 to 22.8%. Similar data are scarce in South Asia and unavailable in Sri Lanka.
Aim
To evaluate HER2 protein expression, its clinicopathological relationship and survival in a Sri Lankan GCa cohort.
Methods
One hundred consecutive GCa patients were recruited prospectively for 2 years. Histological diagnosis was confirmed on endoscopic biopsies/gastrectomy specimens. Clinicopathological and overall survival data were collected. HER2 expression was assessed using immunohistochemistry. 2+ and 3+ scores were considered positive. HER2 expression and clinicopathological parameters were analyzed by Chi-squared test and multivariate analysis with logistic regression using SPSS-21. Kaplan–Meier method and log-rank test were used for survival analysis.
Results
Study includes 56 biopsies and 44 resections. Male/female ratio was 1.9:1. Mean age of diagnosis was 61.1 years (range 32–82). Majority tumors were proximally located (58%). HER2 positivity was 9%. Even though intestinal subtype predominated HER2 positivity was mostly among diffuse variant (14.8%). In multivariate analysis, mitotic count >5/hpf, high nuclear grade and tumor necrosis were significantly associated with HER2 positivity, while poor differentiation, signet cells, extracellular mucin, perineural invasion and pathological nodal metastasis (all p < 0.05) showed a correlation in univariate analysis. Mean follow-up duration was 37.4 weeks (range 0–104). HER2 positivity was associated with a significantly lower median overall survival (p = 0.046).
Conclusion
GCa HER2 positivity was 9%, associated with a lower median overall survival. Adverse histological features had a positive correlation with HER2 positivity. These histological features could direct patients for confirmatory HER2 testing in limited resource settings.
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Radical-pair-based magnetoreception in birds: radio-frequency experiments and the role of cryptochrome
Abstract
The radical-pair hypothesis of magnetoreception has gained a lot of momentum, since the flavoprotein cryptochrome was postulated as a structural candidate to host magnetically sensitive chemical reactions. Here, we first discuss behavioral tests using radio-frequency magnetic fields (0.1–10 MHz) to specifically disturb a radical-pair-based avian magnetic compass sense. While disorienting effects of broadband RF magnetic fields have been replicated independently in two competing labs, the effects of monochromatic RF magnetic fields administered at the electronic Larmor frequency (~1.3 MHz) are disparate. We give technical recommendations for future RF experiments. We then focus on two candidate magnetoreceptor proteins in birds, Cry1a and Cry1b, two splice variants of the same gene (Cry1). Immunohistochemical studies have identified Cry1a in the outer segments of the ultraviolet/violet-sensitive cone photoreceptors and Cry1b in the cytosol of retinal ganglion cells. The identification of the host neurons of these cryptochromes and their subcellular expression patterns presents an important advance, but much work lies ahead to gain some functional understanding. In particular, interaction partners of cryptochrome Cry1a and Cry1b remain to be identified. A candidate partner for Cry4 was previously suggested, but awaits independent replication.
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Reaching Out for Help: An Analysis of the Differences Between Refugees Who Accept and Those Who Decline Community Mental Health Services
Abstract
In 2012, clinics in Louisville, Kentucky began to use the RHS-15 to screen for mental health issues among refugees. At the same time, mental health outreach programs were developed and implemented by the Mental Health Coordinator. Data from 563 refugee clients referred to the Mental Health Coordinator from 2012 to 2015 was analyzed to examine differences between refugees who accepted referral to community mental health services and those who declined on the variables age, gender, country of origin, time in the U.S., and referral source. Results indicate significant differences with regard to time in the U.S. and referral source. Those more likely to accept services included refugees in the U.S. more than 240 days and those referred by non-clinic sources. Findings improve our understanding of the characteristics of refugees who accept and decline mental health services and support the value of both formal screening and community outreach programs.
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The identification of celiac disease in asymptomatic children: The Generation R Study
Journal of Gastroenterology
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PGY1 residents need more than 4 hours of sleep at night
Reuters Health News
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Systematic review and meta-analysis of perioperative outcomes of peroral endoscopic myotomy (POEM) and laparoscopic heller myotomy (LHM) for achalasia
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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Woman awarded $15 million from AbbVie after suing over Depakote
Reuters Health News
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Day surgery for acute appendicitis in adults: A prospective series of 102 patients
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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Dietary and metabolomic determinants of relapse in ulcerative colitis patients: A pilot prospective cohort study
World Journal of Gastroenterology
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Hypertriglyceridemic acute pancreatitis in an Emergency Department: The typical clinical features and genetic variants
Journal of Digestive Diseases
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Proton pump inhibitors and risk of mild cognitive impairment and dementia
Journal of the American Geriatrics Society
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Diagnostic performance of reduced-dose CT with a hybrid iterative reconstruction algorithm for the detection of hypervascular liver lesions: A phantom study
European Radiology
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Adherence to hepatitis B antiviral therapy: A qualitative study
Gastroenterology Nursing
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Robotic verse laparoscopic gastrectomy for gastric cancer: A pooled analysis of 11 individual studies
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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Tobacco smoking and the risk of diverticular disease - A systematic review and meta-analysis of prospective studies
Colorectal Disease
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Nearly a third of world overweight, risking illness and death
Reuters Health News
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Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer
Hepatobiliary Surgery and Nutrition
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Risk factors of the rebleeding according to the patterns of nonvariceal upper gastrointestinal bleeding
The Turkish Journal of Gastroenterology
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Pancreatic Cancer and Depression: A Narrative Review
The Journal of Nervous and Mental Disease
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Change in excitability of cortical projection after modified catheter balloon dilatation therapy in brainstem stroke patients with dysphagia: a prospective controlled study
Dysphagia
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Diagnostic accuracy of transabdominal high-resolution US for staging gallbladder cancer and differential diagnosis of neoplastic polyps compared with EUS
European Radiology
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Safety of non-anesthesia provider administered propofol sedation in non-advanced gastrointestinal endoscopic procedures: A meta-analysis
Saudi Journal of Gastroenterology
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Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review
World Journal of Gastroenterology
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Feasibility and Neurobehavioral Changes of 10-Day Simulated Microgravity in Acute Ischemic Stroke Patients.
Objective: The aim of the study was to investigate feasibility and functional changes of simulated microgravity with 6-degree head-down-tilt (HDT) bed rest in acute ischemic stroke. Design: Patients without lesions in the cingulate cortex and/or cerebellum were enrolled. They underwent HDT for 30 minutes twice per day for 10 weekdays. Systolic blood pressure, diastolic blood pressure, and heart rate were measured before the HDT, immediately after, and also 30 minutes after the stop. Mini-Mental State Examination, Geriatric Depression Scale, Neurobehavioral Tests (i.e., span test, finger-tapping test, continuous performance test, and trail-making test) were conducted before and after the 10-day HDT. Results: One male and four female patients (median age = 64.6 yrs [SD = 10.5 yrs]) were recruited. Changes in the finger-tapping test (57.80 [SD = 40.96 ] vs. 85.80 [SD = 0.46], P = 0.08) and in the digit span backward test (3.60 [SD = 1.14] vs. 1.42 [SD = 1.75], P = 0.07) were noticed. Few changes were found in other scales. No significant changes in systolic blood pressure, diastolic blood pressure, or heart rate were observed, and no adverse effects occurred. Conclusions: The 6-degree HDT revealed no adverse effects on the cardiovascular system, showing nonsignificant increment in the finger-tapping test (representative of motor speed and performance) and nonsignificant reduction in the digit backward span test (representative of spatial memory). Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Posture-Dependent Dysphagia After Botulinum Toxin Type A Injection at Sternocleidomastoid in a Patient With Athetoid Cerebral Palsy.
Cervical dystonia is a common issue in patients with athetoid cerebral palsy. Botulinum toxin injection to dystonic cervical muscles is a well-recognized treatment option, but it is known to be associated with dysphagia. Previously reported cases of dysphagia after botulinum toxin injection to the sternocleidomastoid muscle were related to the regional spread of toxin to the pharyngeal muscles. We report a unique case of posture-dependent dysphagia due to preactivation of the suprahyoid and infrahyoid muscles to compensate for impaired head stabilization by the weakened sternocleidomastoid muscle while swallowing. This case suggests a possible mechanism of dysphagia in patients with athetoid cerebral palsy. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Modifying upper-limb inter-joint coordination in healthy subjects by training with a robotic exoskeleton
The possibility to modify the usually pathological patterns of coordination of the upper-limb in stroke survivors remains a central issue and an open question for neurorehabilitation. Despite robot-led physica...
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Immune-mediated neuropathies: Role of single-fiber conduction velocity
Source:Clinical Neurophysiology, Volume 128, Issue 8
Author(s): Daniele Coraci, Carmen Erra, Valter Santilli, Luca Padua
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