Τετάρτη 14 Ιουνίου 2017

Benefits of an individualized perioperative plan for children with autism spectrum disorder

Summary

Background

Perioperative care for children with autism spectrum disorder may be challenging. Previous investigators recommend development of an individualized perioperative management plan with caregiver involvement.

Aim

The primary goal was to determine the usefulness of an individualized plan based on the decision to provide preoperative sedation stratified by autism spectrum severity level. Secondary goals were to assess the effectiveness of the plan based on subjective assessment of patient behavior at induction of anesthesia and caregiver satisfaction.

Methods

We developed an individualized plan for each child with autism spectrum disorder scheduled for anesthesia. Children were categorized by autism spectrum disorder severity level. With institutional ethics approval, we conducted a retrospective chart review to document need for preoperative sedation, sedation stratified by autism spectrum disorder severity level, behavior at induction, and caregiver satisfaction.

Results

Between 2012 and 2014, we successfully prepared a plan for 246 (98%) of 251 surgical or diagnostic procedures in 224 patients. Severity level was distributed as 45% Severity Level 1 and Asperger's, 25% Severity Level 2, and 30% Severity Level 3. The majority (90%) of cases were scheduled as day surgery. Preoperative sedation increased with increasing severity level: Severity Level 1 (21%) or Asperger's (31%), Severity Level 2 (44%), and Severity Level 3 (56%). The odds ratio for sedation use was 5.5 [CI: 2.6-11.5, P<.001] with Severity Level 3 vs Severity Level 1 patients. Cooperation at induction of anesthesia was 90% overall with preoperative sedation administered to 94 (38%) of the entire cohort. Cooperation was greatest in Severity Level 1 (98%) and Asperger's patients (93%) and somewhat less (85%) in patients in Severity Levels 2 and 3. The plan was helpful to guide sedation choices as cooperation did not differ between sedated and unsedated children at any severity level (overall χ2=2.87 P=.09).

Satisfaction among caregivers contacted was 98%.

Conclusion

The results suggest that an individualized plan is helpful in the perioperative management of children with autism spectrum disorder and that knowledge of autism spectrum disorder severity level may be helpful in determining the need for preoperative sedation.



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Introduction of color-flow injection test to confirm intravascular location of peripherally placed intravenous catheters

Summary

Background

The incidence of infiltration and extravasation when using peripheral intravenous catheters is high in pediatric patients. Due to the lack of a gold standard test to confirm intravascular location of a peripherally placed intravenous catheter, we introduce a novel method, the color-flow injection test to assess the intravascular location of these catheters. For the color-flow injection test, 1 mL of normal saline was injected within 2 seconds in the distal intravenous catheter and changes in color-flow via ultrasonography were observed at the proximal draining veins. The primary objective of the study was to demonstrate feasibility of the color-flow injection test.

Methods

A prospective study was conducted on children <18 years old undergoing general anesthesia. All peripheral intravenous catheters were subject to the color-flow injection test and standard confirmation tests.

Results

Out of the 100 patients enrolled, 22 patients came to the operating room with preexisting peripheral intravenous catheters. Intraoperatively, 105 attempts were made on 78 patients of which 27 catheters were considered as infiltrated during their placement. A final set of 100 catheters were considered for intraoperative usage after they had passed at least one of the standard confirmatory tests. For the color-flow injection test, the ideal sites for ultrasound evaluation of proximal draining veins were the axillary veins and femoral veins. The color-flow injection test was positive in 93 of the 100 catheters with color-flow changes noticed in the proximal veins during the saline injection. Of the 100 catheters, infiltration around seven catheter sites were observed within 2 hours of intraoperative usage and the color-flow injection test was negative in these seven catheters. The color-flow injection test was also negative in the 27 catheters that had infiltrated during their placement. The color-flow injection test was sensitive at 100% [95% confidence interval (CI)=95-100] and specific at 100% (95% CI=56-100) to indicate intravascular location.

Conclusion

We were able to confirm intravascular location of peripheral intravenous catheters using the color-flow injection test in pediatric patients. The test can lead to early recognition of malfunctioning peripheral intravenous catheters and decrease rate of infiltration-extravasation injuries associated with their use.



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Plant genetics: Branching out for crop improvement

Nature Reviews Genetics 18, 393 (2017). doi:10.1038/nrg.2017.48

Author: Darren J. Burgess

Inflorescence architecture is the arrangement of flowers and their underlying stem branching patterns, and it has important effects on the yield of the fruits or grains from agricultural plants. A new study dissects key genetic underpinnings of tomato inflorescence branching, which not only provides insight



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Associating cellular epigenetic models with human phenotypes

Nature Reviews Genetics 18, 441 (2017). doi:10.1038/nrg.2017.32

Authors: Tuuli Lappalainen & John M. Greally

Epigenetic association studies have been carried out to test the hypothesis that environmental perturbations trigger cellular reprogramming, with downstream effects on cellular function and phenotypes. There have now been numerous studies of the potential molecular mediators of epigenetic changes by epigenome-wide association studies (EWAS). However,



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Plant genetics: Spatial transcriptomics in plants

Nature Reviews Genetics 18, 394 (2017). doi:10.1038/nrg.2017.41

Author: Liesbet Lieben

Spatial transcriptomics combines histological imaging and RNA sequencing to simultaneously quantify and localize gene expression. Giacomello et al. have now optimized this technique for plant tissues, which pose specific challenges compared with mammalian tissues, such as the presence of cell walls, vacuoles, chloroplasts and



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Cancer genomics: Tracking cancer evolution

Nature Reviews Genetics 18, 391 (2017). doi:10.1038/nrg.2017.43

Author: Carolina Perdigoto

Understanding tumour heterogeneity and evolution is essential for the early detection of disease recurrence and the efficient treatment of cancer. Two recent studies published in Nature and in the New England Journal of Medicine prospectively tracked the evolutionary dynamics of early-stage non-small-cell lung



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Stem cells: The different flavours of iPS cells

Nature Reviews Genetics 18, 394 (2017). doi:10.1038/nrg.2017.42

Author: Katharine H. Wrighton

The use of induced pluripotent stem (iPS) cells for studying genetic variants that underlie human diseases is complicated by the fact that individual iPS cell lines are genetically and phenotypically heterogeneous. Kilpinen et al. now provide a detailed overview of the genetic and phenotypic



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Technology: Nucleic acid detection — it's elementary with SHERLOCK!

Nature Reviews Genetics 18, 392 (2017). doi:10.1038/nrg.2017.40

Author: Dorothy Clyde

Point-of-care (POC) diagnostic tools should be sensitive, specific, simple to use, rapid, portable and low cost; however, satisfying all these criteria in a single device without compromise is challenging. Now, a new study reports a CRISPR-based diagnostic platform for detecting nucleic acids that has the



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The evolutionary significance of polyploidy

Nature Reviews Genetics 18, 411 (2017). doi:10.1038/nrg.2017.26

Authors: Yves Van de Peer, Eshchar Mizrachi & Kathleen Marchal

Polyploidy, or the duplication of entire genomes, has been observed in prokaryotic and eukaryotic organisms, and in somatic and germ cells. The consequences of polyploidization are complex and variable, and they differ greatly between systems (clonal or non-clonal) and species, but the process has often



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Genetic testing: The diagnostic power of RNA-seq

Nature Reviews Genetics 18, 392 (2017). doi:10.1038/nrg.2017.39

Author: Katharine H. Wrighton

Whole-exome sequencing (WES) and whole-genome sequencing (WGS) can only identify rare Mendelian genetic diseases in up to 50% of cases; our ability to interpret the functional and clinical importance of the genetic variants they identify is limited. Here, Cummings et al. show that analysing



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Comparative transcriptomics in human and mouse

Nature Reviews Genetics 18, 425 (2017). doi:10.1038/nrg.2017.19

Authors: Alessandra Breschi, Thomas R. Gingeras & Roderic Guigó

Cross-species comparisons of genomes, transcriptomes and gene regulation are now feasible at unprecedented resolution and throughput, enabling the comparison of human and mouse biology at the molecular level. Insights have been gained into the degree of conservation between human and mouse at the level of



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Functional variomics and network perturbation: connecting genotype to phenotype in cancer

Nature Reviews Genetics 18, 395 (2017). doi:10.1038/nrg.2017.8

Authors: Song Yi, Shengda Lin, Yongsheng Li, Wei Zhao, Gordon B. Mills & Nidhi Sahni

Proteins interact with other macromolecules in complex cellular networks for signal transduction and biological function. In cancer, genetic aberrations have been traditionally thought to disrupt the entire gene function. It has been increasingly appreciated that each mutation of a gene could have a subtle but



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Is a Chest Radiograph Required After Removal of Chest Tubes in Children?

Our objective was to determine the clinical value of obtaining a chest radiograph after removal of a chest tube. We conducted a retrospective chart review of pediatric general surgical patients with a chest tube in place after a thoracic procedure over a 3-year time period. Postremoval films were considered to be of value if they led to a change in clinical management. Of 468 patients who had a thoracic procedure, 281 patients had a chest tube and a postremoval film. In 263 patients (93.6%) there was no change in the postremoval film result compared with baseline.

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Prevalence of and risk factors for HBV infection in a metropolitan Southern Italian area: Evidence for the effectiveness of universal Hepatitis B vaccination.



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Detection of New Delhi Metallo-β-Lactamase Variants NDM-4, NDM-5, and NDM-7 in Enterobacter aerogenes Isolated from a Neonatal Intensive Care Unit of a North India Hospital: A First Report

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


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Effect of eye position during human visual-vestibular integration of heading perception

Visual and inertial stimuli provide heading discrimination cues. Integration of these multisensory stimuli has been demonstrated to depend on their relative reliability. However, the reference frame of visual stimuli is eye centered while inertial is head centered and it remains unclear how these are reconciled with combined stimuli. Seven human subjects completed a heading discrimination task consisting of a 2s translation with a peak velocity of 16 cm/s. Eye position was varied between 0°, and ±25° left/right. Experiments were done using inertial motion, visual motion, or a combined visual-inertial motion. Visual motion coherence varied between 35-100%. Subjects reported if their perceived heading was left or right of the midline using a forced choice task. With the inertial stimulus the eye position had an effect such that the point of subjective equality (PSE) shifted 4.6 ± 2.4° in the gaze direction. With the visual stimulus the PSE shift was 10.2 ± 2.2° opposite the gaze direction consistent with retinotopic coordinates. Thus with eccentric eye positions, the perceived inertial and visual headings were offset about 15°. During the visual-inertial conditions the PSE varied consistently with the relative reliability of these stimuli such that at low visual coherence the PSE was similar to that of the inertial stimulus and at high coherence it was closer to the visual stimulus. On average, the inertial stimulus was weighted near Bayesian ideal predictions, but there was significant deviation from ideal in individual subjects. These findings support visual and inertia cue integration occurring in independent coordinate systems.



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Activity of primate V1 neurons during the gap saccade task

When a saccadic eye movement is made toward a visual stimulus, the variability in accompanying V1 activity is related to saccade latency in both human (Bompas et al., 2015) and non-human (Lee et al., 2010) primates. In order to understand the nature of this relationship, we examined the functional link between V1 activity and the initiation of visually guided saccades during the gap saccade task, in which a brief temporal gap is interposed between the turning off of a fixation stimulus and the appearance of a saccadic target. The insertion of such a gap robustly reduces saccade latency (Saslow, 1967), and facilitates the occurrence of extremely short latency (express) saccades (Fischer and Boch, 1983). Here, we recorded single-cell activity from macaque V1 while monkeys performed the gap saccade task. In parallel with the gap effect on saccade latency, the neural latency (time of first spike) of V1 response elicited by the saccade target became shorter, and the firing rate increased as the gap duration increased. Similarly, neural latency was shorter and firing rate was higher before express saccades relative to regular latency saccades. In addition to these post-target changes, the level of spontaneous spike activity during the pre-target period was negatively correlated with both neural and saccade latencies. These results demonstrate that V1 activity correlates with the gap effect, and indicate that the trial-to-trial variability in the state of V1 underlies the variability of neural and behavioral latencies.



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High frequency epidural stimulation across the respiratory cycle evokes phrenic short-term potentiation after incomplete cervical spinal cord injury

C2 spinal hemilesion (C2Hx) paralyzes the ipsilateral diaphragm, but recovery is possible through activation of "crossed spinal" synaptic inputs to ipsilateral phrenic motoneurons. We tested the hypothesis that high frequency epidural stimulation (HF-ES) would potentiate ipsilateral phrenic output after subacute and chronic C2Hx. HF-ES (300 Hz) was applied to the ventrolateral C4 or T2 spinal cord ipsilateral to C2Hx in anesthetized and mechanically ventilated adult rats. Stimulus duration was 60-sec and currents ranged from 100-1000 µA. Bilateral phrenic nerve activity and ipsilateral hypoglossal nerve activity were recorded before and after HF-ES. Higher T2 stimulus currents potentiated ipsilateral phasic inspiratory activity at both 2- and 12-wks post-C2Hx, while higher stimulus currents delivered at C4 potentiated ipsilateral phasic phrenic activity only at 12-wks (P=0.028). Meanwhile, tonic output in the ipsilateral phrenic nerve reached 500% of baseline values at the high currents with no difference between 2- and 12-wks. HF-ES did not trigger inspiratory burst frequency changes. Similar responses occurred following T2 HF-ES. Increases in contralateral phrenic and XII nerve output were induced by C4 and T2 HF-ES at higher currents, but the relative magnitude of these changes was small compared to the ipsilateral phrenic response. We conclude that following incomplete cervical SCI, HF-ES of the ventrolateral mid-cervical or thoracic spinal cord can potentiate efferent phrenic motor output with little impact on inspiratory burst frequency. However, the substantial increases in tonic output indicate that the uninterrupted 60-sec stimulation paradigm used here is unlikely to be useful for respiratory muscle activation after spinal injury.



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Interhemispheric interactions between trunk muscle representations of the primary motor cortex

Unilateral arm movements require trunk stabilization through bilateral contraction of axial muscles. Interhemispheric interactions between primary motor cortices (M1) could enable such coordinated contractions but these mechanisms are largely unknown. Using transcranial magnetic stimulation (TMS), we characterized interhemispheric interactions between M1 representations of the trunk stabilizing muscle erector spinae at 1st lumbar vertebra (ES L1) during a right isometric shoulder flexion. These interactions were compared to those of Anterior Deltoid (AD), the main agonist in this task, and the first dorsal interosseous (FDI). TMS over the right M1 elicited ipsilateral silent periods (iSP) in all three muscles on the right side. In ES L1 - but not AD or FDI-, ipsilateral motor evoked potential (iMEP) could precede the iSP or replaced it. iMEP amplitude was not significantly different whether ES L1 was used to stabilize the trunk or was voluntarily contracted. TMS at the cervicomedullary junction showed that the size of CMEP was unchanged during the iSP but increased during iMEP, suggesting that the iSP is due to intracortical mechanisms, but not the iMEP. Using a dual coil paradigm with two coils over the left and right M1, interhemispheric inhibition could be evoked at interstimulus interval of 6ms in ES L1 and 8ms in AD and FDI. Together these results suggest that interhemispheric inhibition is dominant when axial muscles are involved in a stabilizing task. The ipsilateral facilitation could be evoked by ipsilateral or subcortical pathways and could be used depending on the role axial muscles play in the task.



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Perspectives on classical controversies about the motor cortex

Primary motor cortex has been studied for more than a century, yet a consensus on its functional contribution to movement control is still out of reach. In particular, there remains controversy as to the level of control produced by motor cortex ("low level" movement dynamics vs. "high-level" movement kinematics) and the role of sensory feedback. Here we present different perspectives on the two following questions: What does activity in motor cortex reflect? And, how do planned motor commands interact with incoming sensory feedback during movement? The four authors each present their independent views on how they think the primary motor cortex (M1) controls movement. At the end we present a dialogue in which the authors synthesize their views and suggest possibilities for moving the field forward. While there is not yet a consensus on the role of M1 or sensory feedback in the control of upper limb movements, such dialogues are essential to take us closer to one.



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Accumulation of methylglyoxal increases the advanced glycation end products levels in DRG and contributes to lumbar disc herniation-induced persistent pain

Lumbar disc herniation (LDH) with discogenic low back pain and sciatica is a common and complicated musculoskeletal disorder. The underlying mechanisms are poorly understood and there are no effective therapies for LDH-induced pain. In the present study, we found that the patients who suffered from LDH-induced pain had elevated plasma methylglyoxal (MG) levels. In rats, implantation of autologous nucleus pulposus (NP) to the left lumbar 5 spinal nerve root, which mimicked LDH, induced mechanical allodynia and increased MG level in plasma and dorsal root ganglion (DRG) and enhanced the excitability of small DRG neurons (< 30μm in diameter). Intrathecal injection of MG also induced mechanical allodynia and its application to DRG neurons ex vivo increased the number of action potentials evoked by depolarizing current pulses. Furthermore, inhibition of MG accumulation by aminoguanidine attenuated the enhanced excitability of small DRG neurons and the mechanical allodynia induced by NP implantation. In addition, NP implantation increased levels of advanced glycation end products (AGEs) in DRG, and intrathecal injection of MG-derived AGEs induced the mechanical allodynia and DRG neuronal hyperactivity. Intrathecal injection of MG also significantly increased the expression of AGEs in DRG. Importantly, scavenging of MG by aminoguanidine also attenuated the increase in AGEs induced by NP implantation. These results suggested that LDH-induced MG accumulation contributed to persistent pain by increasing AGE levels. Thus, generation of AGEs from MG may represent a target for treatment of LDH-induced pain.



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Prevention and reversal of latent sensitization of dorsal horn neurons by glial blockers in a model of low back pain in male rats

In an animal model of non-specific low back pain, recordings from dorsal horn neurons were made to investigate the influence of glial cells in the central sensitization process. To induce a latent sensitization of the neurons, nerve growth factor (NGF) was injected into the multifidus muscle; the manifest sensitization to a second NGF injection 5 days later was used as a read-out. The sensitization manifested in increased resting activity and in an increased proportion of neurons responding to stimulation of deep somatic tissues. To block microglial activation, minocycline was continuously administered intrathecally starting 1 day before or 2 days after the first NGF injection. The glia inhibitor fluorocitrate that also blocks astrocyte activation was administrated 2 days after the first injection. Minocycline applied before the first NGF injection reduced the manifest sensitization after the second NGF injection to control values. The proportion of neurons responsive to stimulation of deep tissues was reduced from 50% to 17.7% (P<0.01). No significant changes occurred when minocycline was applied after the first injection. In contrast, fluorocitrate administrated after the first NGF injection reduced significantly the proportion of neurons with deep input (15.8%, P<0.01). A block of glia activation had no significant effect on the increased resting activity. The data suggest that blocking microglial activation prevented the NGF-induced latent spinal sensitization while blocking astrocyte activation reversed it. The induction of spinal neuronal sensitization in this pain model appears to depend on microglia activation, while its maintenance is regulated by activated astrocytes.



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Excitability and firing behavior of single slow motor axons transmitting natural repetitive firing of human motoneurons

Excitability of motor axons is critically important for realizing their main function - transmitting motoneuron firing to muscle fibres. The present study was designed to explore excitability recovery and firing behavior in single slow axons transmitting human motoneuron firing during voluntary muscle contractions. The abductor digiti minimi, flexor carpi ulnaris, and tibialis anterior were investigated during threshold stimulation of corresponding motor nerves. Motor unit (MU) firing index in response to testing volleys evoking M-responses was used as a physiological measure of axonal excitability and its changes throughout a target interspike interval (ISI) were explored. It was shown that axons displayed an early irresponsive period (within the first ~ 2 - 5 ms of a target ISI) that followed by a responsive period (for the next 5 - 17 ms of the ISI), in which MUs fired axonal doublets, and a later irresponsive period. At the beginning of the responsive period, M-responses showed small latency delays. However, since at that ISI moment, MUs displayed excitability recovery with high firing index, slight latency changes, may be considered as a functionally insignificant phenomenon. The duration of axonal doublet ISIs did not depend on motoneuron firing frequencies (range: 4.3 - 14.6 imp/s). The question of whether or not traditionally described axonal recovery excitability cycle is realistic in natural motor control is discussed. In conclusion, the present approach, exploring, for the first time, excitability recovery in single slow axons during motoneuron natural activation, can provide further insight into axonal firing behavior in normal and diseases.



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The visual encoding of purely proprioceptive intermanual tasks is due to the need of transforming joint signals, not to their inter-hemispheric transfer

To perform goal-oriented hand movement humans combine multiple sensory signals (e.g. vision and proprioception) that can be encoded in various reference frames (body-centered and/or exo-centered). In a previous study we showed that when aligning a hand to a remembered target orientation the brain encodes both target and response in visual space when the target is sensed by one hand and the response is performed by the other, even though both are sensed only through proprioception. Here we ask whether such visual encoding is due i) to the necessity of transferring sensory information across the brain hemispheres or ii) to the necessity, due to the arms' anatomical mirror symmetry, of transforming the joint signals of one limb into the reference frame of the other. To answer this question we asked subjects to perform purely proprioceptive tasks in different conditions: Intra - the same arm sensing the target and performing the movement; Inter/Parallel - one arm sensing the target and the other reproducing its orientation; and Inter/Mirror - one arm sensing the target and the other mirroring its orientation. Performance was very similar between Intra and Inter/Mirror (conditions not requiring joint-signal transformations) while both differed from Inter/Parallel. Manipulation of the visual scene in a virtual-reality paradigm showed visual encoding of proprioceptive information only in the latter conditions. These results suggest that the visual encoding of purely proprioceptive tasks is not due to inter-hemispheric transfer of the proprioceptive information per se, but to the necessity of transforming joint signals between mirror-symmetric limbs.



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Physiological Properties of Brain Machine Interface Input Signals

Brain machine interfaces (BMIs), also called brain computer interfaces (BCIs), decode neural signals and use them to control some type of external device. Despite many experimental successes and terrific demonstrations in animals and humans, a high-performance, clinically-viable device has not yet been developed for widespread usage. There are many factors that impact clinical viability and BMI performance. Arguably the first of these is the selection of brain signals used to control BMIs. Here, we summarize the physiological characteristics and performance-including movement-related information, longevity, and stability-of multiple types of input signals that have been used in invasive BMIs to date. These include intracortical spikes as well as field potentials obtained inside the cortex, at the surface of the cortex (electrocorticography), and at the surface of the dura mater (epidural signals). We also discuss the potential for future enhancements in input signal performance, both by improving hardware and by leveraging the knowledge of the physiological characteristics of these signals to improve decoding and stability.



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Comparison of the VTA and LC response to methylphenidate: a concomitant behavioral and neuronal study of adolescent male rats

Methylphenidate (MPD), also known as Ritalin, is a psychostimulant used to treat attention hyperactivity disorder. However, it is increasingly being misused by normal adolescents for recreation and academic advantage. Therefore, it is important to elucidate the behavioral and neurophysiological effects of MPD in normal subjects. MPD inhibits the reuptake of catecholamines, mainly found in the ventral tegmental area (VTA) and locus coeruleus (LC). The VTA and LC normally mediate attention, motivation, and drug reward behaviors. Selective neuronal connections between the VTA and LC have been identified implicating regular interaction between the structures. The objective of this study was to compare the neuronal responses of the VTA and LC to MPD in normal adolescent rats. Animals were implanted with permanent electrodes in the VTA and LC, and neuronal units were recorded following acute and repetitive (chronic) saline, 0.6, 2.5, or 10.0 mg/kg MPD exposure. Animals displayed either behavioral sensitization or tolerance to all three doses of MPD. Acute MPD exposure elicited excitation in the majority of all VTA and LC units. Chronic MPD exposure elicited a further increase in VTA and LC neuronal activity in animals exhibiting behavioral sensitization and an attenuation in VTA and LC neuronal activity in animals exhibiting behavioral tolerance demonstrating neurophysiological sensitization and tolerance, respectively. The similar pattern in VTA and LC unit activity suggest that the two structures are linked in their response to MPD. These results may help determine the exact mechanism of action of MPD resulting in optimized treatment of patients.



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Diffusion weighted tractography in the common marmoset monkey at 9.4 T

The common marmoset (Callithrix jacchus) is a small New World primate that is becoming increasingly popular in the neurosciences as an animal model of preclinical human disease. With several major disorders characterized by alterations in neural white matter (e.g., multiple sclerosis, Alzheimer's, schizophrenia) proposed to be transgenically modelled using marmosets, the ability to reliably isolate and characterize major white matter fiber tracts with MRI will be of utility for evaluating structural brain changes related to disease processes and symptomatology. Here, we propose protocols for isolating major white matter fiber tracts in the common marmoset using in vivo ultra-high field MRI (9.4 T) diffusion weighted imaging (DWI) data. Using a high angular resolution DWI (256 diffusion encoding directions) sequence collected on four anesthetized marmosets, we provide guidelines for manually drawing fiber tracking regions of interest based on easily identified anatomical landmarks in DWI native space. These fiber tract isolation protocols are expected to be experimentally useful for visualization and quantification of individual white matter fiber tracts in both control and experimental groups of marmosets (e.g., transgenic models). As disease models in the marmoset advance, determining how macroscopic white matter anatomy is altered as a function of disease state will be relevant in bridging the existing translational gap between preclinical rodent models and human patients.



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Supramodal Representation of Temporal Priors Calibrates Interval Timing

Human timing behaviors are consistent with Bayesian inference, according to which both previous knowledge (prior) and current sensory information determine final responses. However, it is unclear whether the brain represents temporal priors exclusively for individual modalities or in a supramodal manner when temporal information comes from different modalities at different times. Here we asked participants to reproduce time intervals in either a unisensory or a multisensory context. In unisensory tasks, sample intervals drawn from a uniform distribution were presented in a single visual or auditory modality. In multisensory tasks, sample intervals from the two modalities were randomly mixed; visual and auditory intervals were drawn from two adjacent uniform distributions, with the conjunction of the two being equal to the distribution in the unisensory tasks. In the unisensory tasks, participants' reproduced times exhibited classic central-tendency biases: shorter intervals were overestimated and longer intervals were underestimated. In the multisensory tasks, reproduced times were biased towards the mean of the whole distribution rather than the means of intervals in individual modalities. The Bayesian model with a supramodal prior (distribution of time intervals from both modalities) outperformed the model with modality-specific priors in describing participants' performance. With a generalized model assuming the prior to be a weighted combination of unimodal priors, we further obtained the relative contribution of visual intervals and auditory intervals in forming the prior for each participant. These findings suggest a supramodal mechanism for encoding priors in temporal processing, although the extent of influence of one modality upon another differs individually.



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Different roles for inhibition in the rhythm-generating respiratory network

Unraveling the interplay of excitation and inhibition within rhythm-generating networks remains a fundamental issue in neuroscience. We use a biophysical model to investigate the different roles of local and long-range inhibition in the respiratory network, a key component of which is the pre-Bötzinger complex inspiratory microcircuit. Increasing inhibition within the microcircuit results in a limited number of out-of-phase neurons before rhythmicity and synchrony degenerate. Thus, unstructured local inhibition is destabilizing and cannot support the generation of more than one rhythm. A two-phase rhythm requires restructuring the network into two microcircuits coupled by long-range inhibition in the manner of a half-center. In this context, inhibition leads to greater stability of the two out-of-phase rhythms. We support our computational results with in vitro recordings from mouse pre-Bötzinger complex. Partial excitation block leads to increased rhythmic variability, but this recovers following blockade of inhibition. Our results support the idea that local inhibition in the pre-Bötzinger complex is present to allow for descending control of synchrony or robustness to adverse conditions like hypoxia. We conclude that the balance of inhibition and excitation determines the stability of rhythmogenesis, but with opposite roles within and between areas. These different inhibitory roles may apply to a variety of rhythmic behaviors that emerge in widespread pattern generating circuits of the nervous system.



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Wakefulness suppresses retinal-wave-related neural activity in visual cortex

In the developing visual system before eye opening, spontaneous retinal waves trigger bursts of neural activity in downstream structures, including visual cortex. At the same ages when retinal waves provide the predominant input to the visual system, sleep is the predominant behavioral state. However, the interactions between behavioral state and retinal-wave-driven activity have never been explicitly examined. Here, we characterized unit activity in visual cortex during spontaneous sleep-wake cycles in 9- and 12-day-old rats. At both ages, cortical activity occurred in discrete rhythmic bursts, approximately 30-60 s apart, mirroring the timing of retinal waves. Interestingly, when pups spontaneously woke up and moved their limbs in the midst of a cortical burst, the activity was suppressed. Finally, experimentally evoked arousals also suppressed intra-burst cortical activity. All together, these results indicate that active wake interferes with the activation of the developing visual cortex by retinal waves. They also suggest that sleep-wake processes can modulate visual cortical plasticity at earlier ages than has been previously considered.



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Prevalence of and risk factors for HBV infection in a metropolitan Southern Italian area: Evidence for the effectiveness of universal Hepatitis B vaccination.



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Subclinical white matter lesions and medial temporal lobe atrophy are associated with EEG slowing in a memory clinic cohort

As the world's population ages, the identification of subjects at increased risk of Alzheimer's dementia and the early detection of Alzheimer's disease (AD) are key topics in research and are also of increasing relevance in clinical care and patient counselling. Newly refined diagnostic criteria for AD now better define clinical phenotype and integrate neuroimaging and cerebrospinal fluid biomarkers into the diagnostic process. They cover the full staging of the disease from the subjective cognitive impairment (SCI) and mild cognitive impairment (MCI) to clinically obvious dementia (Dubois et al., 2014).

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Der Patient mit Thoraxtrauma

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 406-407
DOI: 10.1055/s-0043-112229



Georg Thieme Verlag KG Stuttgart · New York

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Ultraschallgeräte in Rettungshubschraubern

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 403-403
DOI: 10.1055/s-0043-110838



Georg Thieme Verlag KG Stuttgart · New York

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Protektive Beatmung während der Anästhesie: Sinn oder Unsinn?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 395-396
DOI: 10.1055/s-0043-112101



Georg Thieme Verlag KG Stuttgart · New York

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Kleinhirninfarkt nach CO-Intoxikation und hyperbarer Sauerstofftherapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 463-470
DOI: 10.1055/s-0043-105146

Es wird von einem Patienten berichtet, der nach einem Suizidversuch mittels Kohlenmonoxidintoxikation einen raumfordernden Kleinhirninfarkt und konsekutiven okklusiven Hydrozephalus entwickelte. Durch das rechtzeitige Detektieren der intrazerebralen Läsion konnte ein Überleben des Patienten ohne schwerwiegendes neurologisches Defizit ermöglicht werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Konvulsiver Status epilepticus: Therapeutische Hypothermie bietet keinen Vorteil

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 396-397
DOI: 10.1055/s-0043-105623



Georg Thieme Verlag KG Stuttgart · New York

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Erstes Netzwerk zur Angehörigenbetreuung von Organspendern

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 403-404
DOI: 10.1055/s-0043-110993



Georg Thieme Verlag KG Stuttgart · New York

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Outcome nach Reanimation: Fibrin(ogen)-Spaltprodukte als Prädiktor

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 396-396
DOI: 10.1055/s-0043-109604



Georg Thieme Verlag KG Stuttgart · New York

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Neue Empfehlungen zur präoperativen Diagnostik

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 389-389
DOI: 10.1055/s-0043-111887



Georg Thieme Verlag KG Stuttgart · New York

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Scheinbare Allergie auf Lokalanästhetika bestätigt sich kaum

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 397-398
DOI: 10.1055/s-0043-105631



Georg Thieme Verlag KG Stuttgart · New York

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Weaning erhöht Lebensqualität und senkt Kosten

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 402-403
DOI: 10.1055/s-0043-110837



Georg Thieme Verlag KG Stuttgart · New York

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Surviving Sepsis Campaign 2016 – nichts Neues?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 398-399
DOI: 10.1055/s-0043-112098



Georg Thieme Verlag KG Stuttgart · New York

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Blick in die Lunge kann Leben retten

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 403-403
DOI: 10.1055/s-0043-110992



Georg Thieme Verlag KG Stuttgart · New York

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Grundwissen zur Lagerung im OP

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 400-400
DOI: 10.1055/s-0042-116381



Georg Thieme Verlag KG Stuttgart · New York

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3-D-Mikroroboter für minimalinvasive Chirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 404-404
DOI: 10.1055/s-0043-110995



Georg Thieme Verlag KG Stuttgart · New York

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Effiziente Prüfungsvorbereitung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 400-400
DOI: 10.1055/s-0042-120972



Georg Thieme Verlag KG Stuttgart · New York

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Der Patient mit Thoraxtrauma: präklinische Versorgung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 408-421
DOI: 10.1055/s-0042-118056

Etwa jeder 10. Traumapatient in den Notaufnahmen weist ein stumpfes Thoraxtrauma auf, aus dem lebensbedrohliche Verletzungen wie Spannungspneumothorax oder Perikardtamponade resultieren können. Zeitkritische Diagnostik und Therapie stehen bei der Versorgung im Vordergrund. Die Durchführung lebensrettender therapeutischer Maßnahmen muss jedem Notarzt geläufig sein, und das Verletzungsmuster entscheidet über die Auswahl der Zielklinik.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Eritrea sucht Kollegen für Entwicklungshilfe

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 402-402
DOI: 10.1055/s-0043-110836



Georg Thieme Verlag KG Stuttgart · New York

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Der Patient mit Thoraxtrauma: chirurgische Versorgung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 436-445
DOI: 10.1055/s-0042-118058

Bei Thoraxtraumata reicht das Spektrum von Verletzungen des Herzens und der großen Gefäße über Parenchymläsionen mit Pneumothorax, Blutungen aus den Interkostalgefäßen, bis hin zu chronischen Hämatothoraces und sekundären Empyemen. Die Anlage einer Thoraxdrainage stellt oft eine suffiziente Therapie dar, in bestimmten Fällen ist aber eine weitergehende chirurgische Therapie in minimalinvasiver Technik (VATS) oder via Thorakotomie erforderlich.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Der Patient mit Thoraxtrauma: anästhesiologisches Management

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 422-435
DOI: 10.1055/s-0042-118055

In der anästhesiologischen Praxis ist das Thoraxtrauma eine große Herausforderung. Verletzungen von Atemwegen, Lunge, Zwerchfell, Herz und großen thorakalen Gefäßen sind die vorherrschenden Probleme. Art und Ausmaß des chirurgischen Eingriffs sowie Wirkungen von Anästhetika und mechanischer Ventilation auf die pulmonale und kardiale Funktion sind besonders zu beachten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Possible involvement of central oxytocin in cisplatin-induced anorexia in rats

Abstract

During cancer chemotherapy, drugs such as 5-HT3 receptor antagonists have typically been used to control vomiting and anorexia. We examined the effects of oxytocin (OXT), which has been linked to appetite, on cisplatin-induced anorexia in rats. Fos-like immunoreactivity (Fos-LI) expressed in the supraoptic nucleus (SON), the paraventricular nucleus (PVN), the area postrema and the nucleus of the solitary tract (NTS) after intraperitoneal (ip) administration of cisplatin. We also examined the fluorescence intensity of OXT-mRFP1 after ip administration of cisplatin in OXT-mRFP1 transgenic rats. The mRFP1 fluorescence intensity was significantly increased in the SON, the PVN, and the NTS after administration of cisplatin. The cisplatin-induced anorexia was abolished by OXT receptor antagonist (OXTR-A) pretreatment. In the OXT-LI cells, cisplatin-induced Fos expression in the SON and the PVN was also suppressed by OXTR-A pretreatment. These results suggested that central OXT may be involved in cisplatin-induced anorexia in rats.



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Safer VL intubation: Get the view of the epiglottis, vocal cords

Another great intubation tip from Williamson County EMS.

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Safer VL intubation: Get the view of the epiglottis, vocal cords

Another great intubation tip from Williamson County EMS.

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Increased food intake after starvation enhances sleep in Drosophila melanogaster

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Publication date: Available online 13 June 2017
Source:Journal of Genetics and Genomics
Author(s): Josue M. Regalado, McKenna B. Cortez, Jeremy Grubbs, Jared A. Link, Alexander van der Linden, Yong Zhang
Feeding and sleep are highly conserved, interconnected behaviors essential for survival. Starvation has been shown to potently suppress sleep across species; however, whether satiety promotes sleep is still unclear. Here we use the fruit fly, Drosophila melanogaster, as a model organism to address the interactions between feeding and sleep. We first monitored the sleep of flies that had been starved for 24 h and found that sleep amount increased in the first 4 h after flies were given food. Increased sleep after starvation was due to an increase in sleep bout number and average sleep bout length. Mutants of translin or adipokinetic hormone, which fail to suppress sleep during starvation, still exhibited a sleep increase after starvation, suggesting that sleep increase after starvation is not a consequence of sleep loss during starvation. We also found that feeding activity and food consumption were higher in the first 10–30 min after starvation. Restricting food consumption in starved flies to 30 min was sufficient to increase sleep for 1 h. Although flies ingested a comparable amount of food at differing sucrose concentrations, sleep increase after starvation on a lower sucrose concentration was undetectable. Taken together, our results suggest increased food intake after starvation enhances sleep and reveals a novel relationship between feeding and sleep.



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Safer VL intubation: Get the view of the epiglottis, vocal cords

Another great intubation tip from Williamson County EMS.

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Witmer Public Safety Group, Home of theEMSstore, Acquires Our Designs, Inc.

Witmer Public Safety Group, Inc. (WPSG), parent company of theEMSstore and the nation's leading multi-channel distributor of public-safety equipment, supplies, training, and service, is excited to announce their recent acquisition of Our Designs, Inc., the world's largest retailer of gifts and accessories geared toward firefighters, police officers, and emergency medical professionals. This ...

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Safer VL intubation: Get the view of the epiglottis, vocal cords

Another great intubation tip from Williamson County EMS.

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Comparison of efficacy of transversus abdominis plane block and iliohypogastric/ilioinguinal nerve block for postoperative pain management in patients undergoing inguinal herniorrhaphy with spinal anesthesia: a prospective randomized controlled open-label study

Abstract

Purposes

The purpose of this study was to compare the effects of lateral abdominal transversus abdominis plane block (TAP block) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance for postoperative pain management of inguinal hernia repair. Secondary purposes were to compare the complication rates of the two techniques and to examine the effects of TAP block and IHINB on chronic postoperative pain.

Methods

This was a prospective randomized controlled open-label study. After approval of the Research Ethics Board, a total of 90 patients were allocated to three groups of 30 by simple randomized sampling as determined with a priori power analysis. Peripheral nerve blocks (TAP block or IHINB) were administered to patients following subarachnoid block according to their allocated group. Patient pain scores, additional analgesic requirements and complication rates were recorded periodically and compared.

Results

Pain scores were significantly lower in the study groups (p < 0.001, p < 0.001, p < 0.001, p = 0.002, p < 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h and at 1 and 6 months, respectively). First pain declaration times were significantly longer in the study groups (TAP block group [GT] 266.6 ± 119.7 min; IHINB group [GI] 247.2 ± 128.7 min; and control group [GC] 79.1 ± 66.2 min; p < 0.001). At 24 h, the numeric rating scale scores of GT were significantly lower than GI (p = 0.048). Additional analgesic requirements of GT and GI patients were found to be significantly lower than GC patients (p = 0.001, p < 0.001, p = 0.006, p = 0.002, p = 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h, respectively).

Conclusion

We conclude that administration of TAP block or IHINB for patients undergoing inguinal herniorrhaphy reduces the intensity of both acute and chronic postoperative pain and additional analgesic requirements.



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Genetic population diversity of European eel Anguilla anguilla elvers in two Egyptian water bodies, Rosetta (Rachid) estuary and Burullus Lake

Abstract

The European eel Anguilla anguilla is a species of great economic importance for Egypt. Its long trans-Atlantic migrations for semelparous spawning then larval homing provides a possible way for worldwide mixing of populations. Its natural habitats in Egypt, as in other Mediterranean countries, are under heavy load of pollution due to anthropogenic activities. Hence, a major priority should be given to assess the genetic diversity within/among eels' populations as a step towards revealing populations' status, identification of possible conservation units, and, subsequently, implementation of proper conservation and management strategies for them. For this, A. anguilla elvers were collected from Rosetta estuary and Burullus coastal lagoon in the North of Egypt. Sequencing of the barcode region of the cytochrome c oxidase subunit 1 gene (COI) was carried out for all collected elvers. The sequences were analyzed using various genetic, phylogenetic, and population analyses to assess their variability. A total of 33 haplotypes were identified, 14 of which were unique to Burullus Lake, and 11 to Rosetta estuary. Very low fixation (F st  = 0–0.04) was found for A. anguilla populations in Egypt and worldwide, except for the Turkish and Czech ones (F st  = 0.47–0.62 and 0.18–0.41, respectively). Both Egyptian populations showed signs of recent populations' expansion, besides low, non-significant raggedness values. The results suggested Burullus Lake and Rosetta estuary as separate conservation units for A. anguilla in Egypt. These units require special attention for proper protection and management of the existing eel diversity and permitting sustainability in the activities dealing with eel's fishing and aquaculture.



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Transcriptome comparative analysis between the cytoplasmic male sterile line and fertile line in soybean ( Glycine max (L.) Merr.)

Abstract

To further elucidate the molecular mechanism and fertility restoration of cytoplasmic male sterility (CMS) in soybean, a comparative transcriptome analysis was conducted between the CMS line NJCMS1A, restorer line NJCMS1C and their hybrid F1 progeny (NJCMS1A × NJCMS1C) using RNA-Seq strategy. After pairwise comparative analysis of these soybean lines, 294, 222, and 288 differentially expressed genes (DEGs) were identified, respectively. Further bioinformatic analysis indicated that these DEGs were involved in diverse molecular functions and metabolic pathways. qRT-PCR analysis validated that the gene expression pattern in RNA-Seq was reliable. These results significantly showed that the male sterility and fertility restoration in NJCMS1A might be related to a series of the abnormal of growth development and metabolic processes, such as pollen development, DNA methylation process, pollen viability, cell wall development, programmed cell death, as well as carbohydrate and energy metabolism. This study could facilitate our understanding of the molecular mechanisms and fertility restoration behind CMS in soybean.



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Bird migration



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Effects of midline sagittal location on bone-conducted cervical and ocular vestibular evoked myogenic potentials

We have investigated the effectiveness of two bone-conducted (BC) stimuli in producing vestibular evoked myogenic potentials (VEMPs) following stimulation along midsagittal skull sites. Twenty subjects (mean age 24 yr, range: 18–34 yr; 6 men; 14 women) were studied using a smoothed impulse and a 500-Hz tone burst applied to Nz, Fpz, AFz, Fz, FCz, and Cz with both compressive and rarefactive onset phases. Cervical (cVEMPs) and ocular VEMPs (oVEMPs) were recorded as well as linear acceleration in three axes. cVEMPs evoked by 500 Hz showed no change in response polarity to either stimulus location or phase. cVEMPs evoked by the impulsive stimulus showed larger initial peak amplitudes at AFz and Fz using compressive stimuli and differences in initial peak latency between the two phases. In contrast, amplitude, latency, and response polarity for oVEMPs were markedly affected by stimulus location and phase, which were similar for both BC stimuli, with little correlation with induced acceleration of the head. Latencies were earliest at AFz and Fz where compressive onset stimuli evoked an initial negativity (average latency 8.6–11.0 ms). At other sites compressive onset stimuli usually evoked oVEMPs with an initial positivity. We conclude that both 500 Hz and impulsive stimuli are effective means of evoking cVEMPs and oVEMPs from mid sagittal skull sites. The effects depend upon both location and phase and differ for oVEMPs and cVEMPs. Initial negativities for oVEMPs following compressive stimuli were most consistently obtained using the AFz and Fz sites.

NEW & NOTEWORTHY We investigated the effect of stimulus location and phase (compressive and rarefactive) in the midsagittal plane for the cVEMP and oVEMP evoked by bone-conducted (BC) 500 Hz and BC impulsive stimuli. For cVEMPs, location effects were limited but were observed for BC impulses. For oVEMPs, both stimuli affected amplitude, latency, and polarity, depending on stimulus location and phase. Compressive stimuli at Fz and AFz evoked early negative oVEMPs most reliably.



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Swimming attenuates D-galactose-induced brain aging via suppressing miR-34a-mediated autophagy impairment and abnormal mitochondrial dynamics

microRNAs (miRNAs) have been reported to be involved in many neurodegenerative diseases. To explore the regulatory role of miR-34a in aging-related diseases such as Alzheimer's disease (AD) during exercise intervention, we constructed a rat model with d-galactose (d-gal)-induced oxidative stress and cognitive impairment coupled with dysfunctional autophagy and abnormal mitochondrial dynamics, determined the mitigation of cognitive impairment of d-gal-induced aging rats during swimming intervention, and evaluated miR-34a-mediated functional status of autophagy and abnormal mitochondrial dynamics. Meanwhile, whether the upregulation of miR-34a can lead to dysfunctional autophagy and abnormal mitochondrial dynamics was confirmed in human SH-SY5Y cells with silenced miR-34a by the transfection of a miR-34a inhibitor. Results indicated that swimming intervention could significantly attenuate cognitive impairment, prevent the upregulation of miR-34a, mitigate the dysfunctional autophagy, and inhibit the increase of dynamin-related protein 1 (DRP1) in d-gal-induced aging model rats. In contrast, the miR-34a inhibitor in cell model not only attenuated D-gal-induced the impairment of autophagy but also decreased the expression of DRP1 and mitofusin 2 (MFN2). Therefore, swimming training can delay brain aging of d-gal-induced aging rats through attenuating the impairment of miR-34a-mediated autophagy and abnormal mitochondrial dynamics, and miR-34a could be the novel therapeutic target for aging-related diseases such as AD.

NEW & NOTEWORTHY In the present study, we have found that the upregulation of miR-34a is the hallmark of aging or aging-related diseases, which can result in dysfunctional autophagy and abnormal mitochondrial dynamics. In contrast, swimming intervention can delay the aging process by rescuing the impaired functional status of autophagy and abnormal mitochondrial dynamics via the suppression of miR-34a.



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Myocardial ischemic tolerance in rats subjected to endurance exercise training during adaptation to chronic hypoxia

Chronic hypoxia and exercise are natural stimuli that confer sustainable cardioprotection against ischemia-reperfusion (I/R) injury, but it is unknown whether they can act in synergy to enhance ischemic resistance. Inflammatory response mediated by tumor necrosis factor-α (TNF-α) plays a role in the infarct size limitation by continuous normobaric hypoxia (CNH), whereas exercise is associated with anti-inflammatory effects. This study was conducted to determine if exercise training performed under conditions of CNH (12% O2) affects myocardial ischemic resistance with respect to inflammatory and redox status. Adult male Wistar rats were assigned to one of the following groups: normoxic sedentary, normoxic trained, hypoxic sedentary, and hypoxic trained. ELISA and Western blot analysis, respectively, were used to quantify myocardial cytokines and the expression of TNF-α receptors, nuclear factor-B (NF-B), and selected components of related signaling pathways. Infarct size and arrhythmias were assessed in open-chest rats subjected to I/R. CNH increased TNF-α and interleukin-6 levels and the expression of TNF-α type 2 receptor, NF-B, inducible nitric oxide synthase (iNOS), cytosolic phospholipase A2α, cyclooxygenase-2, manganese superoxide dismutase (MnSOD), and catalase. None of these effects occurred in the normoxic trained group, whereas exercise in hypoxia abolished or significantly attenuated CNH-induced responses, except for NF-B, iNOS, and MnSOD. Both CNH and exercise reduced infarct size, but their combination provided the same degree of protection as CNH alone. In conclusion, exercise training does not amplify the cardioprotection conferred by CNH. High ischemic tolerance of the CNH hearts persists after exercise, possibly by maintaining the increased antioxidant capacity despite attenuating TNF-α-dependent protective signaling.

NEW & NOTEWORTHY Chronic hypoxia and regular exercise are natural stimuli that confer sustainable myocardial protection against acute ischemia-reperfusion injury. Signaling mediated by TNF-α via its type 2 receptor plays a role in the cardioprotective mechanism of chronic hypoxia. In the present study, we found that exercise training of rats during adaptation to hypoxia does not amplify the infarct size-limiting effect. Ischemia-resistant phenotype is maintained in the combined hypoxia-exercise setting despite exercise-induced attenuation of TNF-α-dependent protective signaling.



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The influence of gravity on regional lung blood flow in humans: SPECT in the upright and head-down posture

Previous studies in humans have shown that gravity has little influence on the distribution of lung blood flow while changing posture from supine to prone. This study aimed to evaluate the maximal influence of posture by comparison of regional lung blood flow in the upright and head-down posture in 8 healthy volunteers, using a tilt table. Regional lung blood flow was marked by intravenous injection of macroaggregates of human albumin labeled with 99mTc or 113mIn, in the upright and head-down posture, respectively, during tidal breathing. Both radiotracers remain fixed in the lung after administration. The distribution of radioactivity was mapped using quantitative single photon emission computed tomography (SPECT) corrected for attenuation and scatter. All images were obtained supine during tidal breathing. A shift from upright to the head-down posture caused a clear redistribution of blood flow from basal to apical regions. We conclude that posture plays a role for the distribution of lung blood flow in upright humans, and that the influence of posture, and thereby gravity, is much greater in the upright and head-down posture than in horizontal postures. However, the results of the study demonstrate that lung structure is the main determinant of regional blood flow and gravity is a secondary contributor to the distribution of lung blood flow in the upright and head-down positions.

NEW & NOTEWORTHY Using a dual-isotope quantitative SPECT method, we demonstrated that although a shift in posture redistributes blood flow in the direction of gravity, the results are also consistent with lung structure being a greater determinant of regional blood flow than gravity. To our knowledge, this is the first study to use modern imaging methods to quantify the shift in regional lung blood flow in humans at a change between the upright and head-down postures.



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SF dispatchers share understaffed, overworked frustrations

The severely stressed employees now handle 37 percent more calls than they did in 2011

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Successful management of Acute Liver Failure in Italian Children: a 16-year Experience at a Referral Centre for Paediatric Liver Transplantation

Identifying the causes of acute liver failure (ALF) and predictors of death or liver transplantation (LTX) is crucial to decide its management. We aimed to describe features and outcome of ALF in Italian children.

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Primary jejunal malignant melanoma detected by 18F-FDG PET/CT and enteroscopy



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Successful management of Acute Liver Failure in Italian Children: a 16-year Experience at a Referral Centre for Paediatric Liver Transplantation

Identifying the causes of acute liver failure (ALF) and predictors of death or liver transplantation (LTX) is crucial to decide its management. We aimed to describe features and outcome of ALF in Italian children.

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Primary jejunal malignant melanoma detected by 18F-FDG PET/CT and enteroscopy



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Sensory feedback from the urethra evokes state-dependent lower urinary tract reflexes in rat

Abstract

Lower urinary tract reflexes are mediated by peripheral afferents from the bladder (primarily in the pelvic nerve) and the urethra (in the pudendal and pelvic nerves) to maintain continence or initiate micturition. If fluid enters the urethra at low bladder volumes, reflexes relax the bladder and evoke external urethral sphincter (EUS) contraction (guarding reflex) to maintain continence. Conversely, urethral flow at high bladder volumes, excites the bladder (micturition reflex) and relaxes the EUS (augmenting reflex). We conducted measurements in a urethane-anaesthetized in vivo rat preparation to characterize systematically the reflexes evoked by fluid flow through the urethra. We used a novel preparation to manipulate sensory feedback from the bladder and urethra independently by controlling bladder volume and urethral flow. We found a distinct bladder volume threshold (74% of bladder capacity) above which flow-evoked bladder contractions were 252% larger and evoked phasic EUS activation 2.6 times as often as responses below threshold, clearly demonstrating a discrete transition between continence (guarding) and micturition (augmenting) reflexes. Below this threshold urethral flow evoked tonic EUS activity, indicative of the guarding reflex, that was proportional to the urethral flow rate. These results demonstrate the complementary roles of sensory feedback from the bladder and urethra in regulating reflexes in the lower urinary tract that depend on the state of the bladder. Understanding the neural control of functional reflexes and how they are mediated by sensory information in the bladder and urethra will open new opportunities, especially in neuromodulation, to treat pathologies of the lower urinary tract.

This article is protected by copyright. All rights reserved



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Clinical significance of expression of proliferating cell nuclear antigen and E-cadherin in gastric carcinoma

World Journal of Gastroenterology

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Advocates renew push for recreational marijuana in New York

AP

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Survival after resection of appendiceal carcinoma by hemicolectomy and less radical than hemicolectomy: A population-based propensity score matched analysis

Colorectal Disease

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Drones carrying defibrillators could aid heart emergencies

AP

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CD14+CD15-HLA-DR- myeloid-derived suppressor cells impair antimicrobial responses in patients with acute-on-chronic liver failure

Gut

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Jury quirk in US meningitis outbreak case could bring stiffer sentence

Reuters Health News

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Intrahepatic HCV RNA level and genotype 1 independently associate with hepatic reticulon 3 expression

Anticancer Research

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Science may be able to provide sunless tans

Reuters Health News

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Validation of a serum microRNA panel as biomarkers for early diagnosis of hepatocellular carcinoma post-hepatitis C infection in Egyptian patients

World Journal of Gastroenterology

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Merck to pause two late-stage studies testing Keytruda in myeloma

Reuters Health News

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Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair

Surgical Endoscopy

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Diagnostic value of the antiglycoprotein-2 antibody for Crohn’s disease: A PRISMA-compliant systematic review and meta-analysis

BMJ Open

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California budget bill could give doctors a raise

AP

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Endoscopic ultrasonography compared with multidetector computed tomography for the preoperative staging of gastric cancer: A meta-analysis

World Journal of Surgical Oncology

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Colony-stimulating factor 1 receptor blockade inhibits tumor growth by altering the polarization of tumor-associated macrophages in hepatocellular carcinoma

Molecular Cancer Therapeutics

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Value and application of trimodality therapy or definitive concurrent chemoradiotherapy in thoracic esophageal squamous cell carcinoma

Cancer

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Outcome of incisional hernia repair in patients with inflammatory bowel disease

The American Journal of Surgery

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Comparison of analgesic efficacy of laparoscope-assisted and ultrasound-guided transversus abdominis plane block after laparoscopic colorectal surgery: A randomized, single-blind, non-inferiority trial

Journal of the American College of Surgeons

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Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis

World Journal of Gastroenterology

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Relationship between serum adenosine deaminase levels and liver histology in autoimmune hepatitis

World Journal of Gastroenterology

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Editorial Board

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Publication date: July 2017
Source:Journal of Human Evolution, Volume 108





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Low-dose BMP-2 is sufficient to enhance the bone formation induced by an injectable, PLGA-fiber reinforced, brushite-forming cement in a sheep defect model of lumbar osteopenia

Bioresorbable calcium phosphate cement (CPC) may be suitable for vertebroplasty/kyphoplasty of osteoporotic vertebral fractures. However, additional targeted delivery of osteoinductive bone morphogenetic proteins (BMPs) in the CPC may be required to counteract the augmented local bone catabolism and support complete bone regeneration.

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Use of the central sensitization inventory (CSI) as a treatment outcome measure for chronic spinal pain disorder patients in a functional restoration program

The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to Central Sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been diagnosed with one or more specific Central Sensitivity Syndromes (CSSs) and related disorders. The CSI has previously been validated in a group of chronic pain patients who were screened by a trained psychiatrist for specific CSS diagnoses.

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Cardiovascular stress during inpatient spinal cord injury rehabilitation

Publication date: Available online 13 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Dominik Zbogar, Janice J. Eng, William C. Miller, Andrei V. Krassioukov, Mary C. Verrier
Objectives1) To measure the amount of a) cardiovascular stress, b) self-reported physical activity and c) accelerometry-measured physical activity by individuals with SCI during physical therapy (PT) and occupational therapy (OT) and, 2) to investigate the relationship between these measures.DesignObservational study.SettingTwo inpatient SCI rehabilitation centres.ParticipantsSCI patients (n=87) were recruited from consecutive admissions to rehabilitation.Main Outcome MeasuresHeart rate (HR) was recorded by a Holter monitor, while physical activity was captured by self-report (PARA-SCI questionnaire) and real-time wrist accelerometry during a total 334 PT and OT inpatient sessions. Differences between individuals with paraplegia and tetraplegia were assessed via Mann-Whitney U tests. Spearman correlations were used to explore the relationship between measurements of physical activity and HR.ResultsTime spent at a HR within a cardiovascular training zone (≥ 40% heart rate reserve) was low and did not exceed a median 5 minutes. In contrast, individuals reported at least 60 minutes of higher intensity time during therapy. There was a low, but statistically significant correlation between all measures.ConclusionThe cardiovascular stress incurred by individuals with SCI during inpatient PT and OT sessions is low and not sufficient to obtain a cardiovascular training effect to optimize their neurological, cardiovascular, or musculoskeletal health; this represents a lost opportunity to maximize rehabilitation. Self-reported minutes of higher intensity PA do not reflect actual time spent at higher intensity measured objectively via a HR monitor.



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Changes in Physical Activity and Sedentary Behavior during Cardiac Rehabilitation

Publication date: Available online 13 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Nienke ter Hoeve, Madoka Sunamura, Myrna E. van Geffen, Malou H.J. Fanchamps, Herwin L.D. Horemans, Johannes B.J. Bussmann, Henk J. Stam, Ron T. van Domburg, Rita J.G. van den Berg-Emons
ObjectiveTo objectively measure changes in both moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) during and after standard cardiac rehabilitation (CR).DesignProspective cohort studySettingOutpatient CR centerParticipants135 patients with acute coronary syndrome (ACS) who completed CR.InterventionMulti-disciplinary CR according to current guidelinesMain outcome measuresThe proportion of time spent in MVPA and SB was objectively measured with an accelerometer. The distribution of time in MVPA and SB was also determined (e.g. average length of time periods spent in MVPA and SB). All measurements were obtained prior to CR, following CR and at one-year follow-up.ResultsPatients'time in MVPA during waking hours increased by 0.65% (≈5 min) during CR (p=0.002), and remained increased at one-year follow-up (p=0.037). The MVPA distribution did not change. During CR, time spent in SB decreased by 2.49% (≈22 min; p<0.001), and SB time became more fragmented with more breaks and shorter SB periods (p<0.001). These SB improvements were maintained at one-year follow-up (p<0.001).ConclusionsPatients with ACS achieved a small improvement in MVPA time during CR but MVPA distribution remained unchanged. More substantial improvements occurred for SB time and distribution. However, by the end of CR, patients still spent relatively little time in MVPA and a long time in SB, which is known to be detrimental to cardiovascular health. Although CR programs have the potential to improve physical behavior, our findings highlight the need to develop adjusted CR targets that address amount and distribution of MVPA and SB.



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Comments on "Effects of Obesity and Leptin Deficiency on Morphine Pharmacokinetics in a Mouse Model" by Dalesio et al, Anesth Analg. 2016;123: 1611-1617.

No abstract available

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Extravasated Fluid in Hip Arthroscopy and Pain: Is Quadratus Lumborum Block the Answer?.

No abstract available

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In Response.

No abstract available

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Closed-Loop Anesthesia: Not Ready for Takeoff.

No abstract available

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Distractions in the Anesthesia Work Environment: Impact on Patient Safety? Report of a Meeting Sponsored by the Anesthesia Patient Safety Foundation.

No abstract available

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Effect of Interscalene Brachial Plexus Block on the Pulmonary Function of Obese Patients: A Prospective, Observational Cohort Study.

BACKGROUND: The effect of interscalene block (ISB) on pulmonary function of obese participants has not been investigated. The goal of this study is to assess the association of obesity (body mass index [BMI] >29 kg/m2 vs BMI 29 kg/m2) and normal-weight (BMI .99, respectively) nor in the occurrence of intraoperative airway events (P > .99). CONCLUSIONS: ISB is associated with greater FVC and FEV1 reductions in obese participants undergoing shoulder surgery compared to normal-weight participants. Neither time (30 minutes versus PACU) nor position (sitting versus supine) affected this relationship. Despite these changes, obesity was not associated with increased clinical respiratory symptoms or events. (C) 2017 International Anesthesia Research Society

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Magic Mirror, On the Wall-Which Is the Right Study Design of Them All?-Part II.

The assessment of a new or existing treatment or other intervention typically answers 1 of 3 central research-related questions: (1) "Can it work?" (efficacy); (2) "Does it work?" (effectiveness); or (3) "Is it worth it?" (efficiency or cost-effectiveness). There are a number of study designs that, on a situational basis, are appropriate to apply in conducting research. These study designs are generally classified as experimental, quasiexperimental, or observational, with observational studies being further divided into descriptive and analytic categories. This second of a 2-part statistical tutorial reviews these 3 salient research questions and describes a subset of the most common types of observational study designs. Attention is focused on the strengths and weaknesses of each study design to assist in choosing which is appropriate for a given study objective and hypothesis as well as the particular study setting and available resources and data. Specific studies and papers are highlighted as examples of a well-chosen, clearly stated, and properly executed study design type. (C) 2017 International Anesthesia Research Society

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The Pediatric Sedation Home.

No abstract available

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Visualization of the Ankle Lateral Collateral Ligament Complex



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Early intra-articular corticosteroid injection improves pain and function in adhesive capsulitis of shoulder: 1-year retrospective longitudinal study

Intra-articular corticosteroid injection is a commonly used therapy for adhesive capsulitis, but not enough studies exist on the optimal timing of the injection.

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