Παρασκευή 8 Σεπτεμβρίου 2017

Pre-clinical evaluation of N-Acetylcysteine reveals side effects in the mdx mouse model of Duchenne muscular dystrophy

Abstract

Duchenne Muscular Dystrophy (DMD) is a fatal X-linked muscle wasting disease characterised by severe muscle weakness, necrosis, inflammation and oxidative stress. The antioxidant N-acetylcysteine (NAC) has been proposed as a potential therapeutic intervention for DMD boys. We investigated the capacity of NAC to improve dystrophic muscle function in the mdx mouse model of DMD. Young (6 w old) mdx and non-dystrophic C57 mice receiving 2% NAC in drinking water for 6 w were compared with untreated mice. Grip strength and body weight were measured weekly, before the 12 w old mice were anaesthetized and extensor digitorum longus (EDL) muscles excised for functional analysis and tissues sampled for biochemical analyses. Compared to untreated mice, the mean (SD) normalised grip strength was significantly greater in NAC treated mdx [3.13 (0.58) cf. 4.87 (0.78) g bw−1; < 0.001] and C57 mice [3.90 (0.32) cf. 5.32 (0.60) g bw−1; < 0.001]. Maximum specific force was significantly greater in NAC treated mdx muscles [9.80 (2.27) cf. 13.07 (3.37) N·cm−2; P = 0.038]. Increased force in mdx mice was associated with reduced thiol oxidation and inflammation in fast muscles, and increased citrate synthase activity in slow muscle. Importantly, NAC significantly impaired body weight gain in both strains of young growing mice, reduced liver weight in C57 mice and muscle weight in mdx mice. These potentially adverse effects of NAC emphasise the need for caution when interpreting improvements in muscle function based on normalised force measures, and that careful consideration be given to these effects when proposing NAC as a potential treatment for young DMD boys.

This article is protected by copyright. All rights reserved



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Paramedic - Disaster Response Team - Remote Medical International

The Role: In this role, you would ideally be available on short notice with deployments that are based on mission needs. As a disaster response medic, you would travel to a variety of austere and/or remote environments to provide high-quality medical care and other supportive task as assigned. Mission goals and objectives could vary greatly from project to project. Ongoing opening: This ongoing opening ...

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Risk of exclusion from stroke rehabilitation in the oldest-old

Publication date: Available online 7 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Paola Forti, Fabiola Maioli, Elisabetta Magni, Letizia Regazzoni, Roberto Piperno, Marco Zoli, Maura Coveri, Gaetano Procaccianti
ObjectiveTo investigate whether oldest-old age (≥85 yr) is an independent predictor of exclusion from stroke rehabilitation.DesignRetrospective cohort study.SettingStroke Unit (SU) of an Italian tertiary hospital.Participants1055 elderly patients (age 65-74 yr, n=230; age, 75-84 yr, n=432; age ≥ 85 yr, n=393), who, between 2009 and 2012, were admitted to SU with acute stroke and evaluated by a multiprofessional team for access to rehabilitation. The study excluded patients for whom rehabilitation was unnecessary or inappropriate.InterventionsNot applicable.Main Outcome MeasuresAccess to an early mobilization (EM) protocol during SU stay and subsequent access to post-acute rehabilitation after SU discharge. Analyses were adjusted for prestroke and stroke-related characteristics.Results32.2% of patients were excluded from EM. Multivariable-adjusted Odds Ratio (OR) of EM exclusion was 1.30 (95% CI: 0.76, 2.21) for age 75-84 yr and 2.07 (95% CI: 1.19, 3.59) for age ≥85 yr compared to age 65-74 yr. Of 656 patients admitted to EM and who, at SU discharge, had not yet fully recovered their prestroke functionally status, 18.4% were excluded from post-acute rehabilitation. For patients able to walk unassisted at SU discharge, probability of exclusion did not change across age groups. For patients unable to walk unassisted at SU discharge, OR of exclusion from post-acute rehabilitation was 3.74 (95% CI: 1.26, 11.13) for age 75-84 yr and 9.15 (95% CI: 3.05, 27.46) for age ≥85 yr compared to age 65-74 yr.ConclusionOldest-old age is an independent predictor of exclusion from stroke rehabilitation.



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The link between Parkinson’s disease and rapid eye movement sleep behavior disorder with dream enactment: Possible implications for early rehabilitation

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Publication date: Available online 7 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Brian P. Johnson, Kelly P. Westlake
The purpose of this paper is twofold. First, to inform readers of the link between the loss of motor inhibition during rapid eye movement (REM) sleep dreaming, diagnosed as REM sleep behavior disorder (RBD), and the future onset of neurodegenerative disorders, such as Parkinson's Disease and dementia with lewy bodies. It has been reported that motor disinhibition during rapid eye movement sleep often precedes onset of these disorders by years or even decades. Second, to consider that identification of RBD and the early involvement of rehabilitation and/or development of home exercise plans may aid in prolonging and even increasing function, independence, and quality of life should such neurodegenerative disorders develop later in life.



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Masthead

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Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Editorial Board

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Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Table of Contents

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Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Editors' Selections From This Issue: Volume 98 / Number 9 / September 2017

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Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Retraction notice to ”Electrical Stimulation for Hemiplegic Shoulder Function: A Systematic Review and Meta-Analysis of 15 Randomized Controlled Trials“ [Arch Phys Med Rehabil. 97 (2016) 1588-94]

Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9
Author(s): Ping Gu, Juan-juan Ran
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://ift.tt/2sF4ZfT).This article has been retracted at the request of the co-Editors-in-Chief. The article plagiarizes a paper that was published in BioMed Research International, Volume 2015 (2015), Article ID 729768, 14 pages, http://ift.tt/2eMJDEM. Nearly the entire introduction and sections of the methods, limitations and conclusions duplicate the BioMed Research International paper. One of the conditions of submission of a paper to Archives of Physical Medicine and Rehabilitation is that authors declare explicitly that the paper is an original work and not duplicative of prior work unless that work is cited properly. The duplication in this manuscript is a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter.



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Archives of Physical Medicine and Rehabilitation Supplements

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Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Large Shape Transforming 4D Auxetic Structures

3D Printing and Additive Manufacturing , Vol. 0, No. 0.


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Transient heart rate acceleration in association with spontaneous eyeblinks

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Publication date: Available online 7 September 2017
Source:International Journal of Psychophysiology
Author(s): Tamami Nakano, Chiho Kuriyama
The reason why people spontaneously blink several times more frequently than is necessary for ocular lubrication has been a mystery. However, spontaneous eyeblinks selectively occur at attentional breakpoints of information processing, suggesting the involvement of spontaneous eyeblink in attentional disengagement from external stimuli. Physiological activity also changes considerably according to attention state. Heart rate decreases when attention is directed at stimuli, while it increases as attention is released. Therefore, we examined the temporal dynamics between spontaneous eyeblinks and instantaneous heart rate under natural circumstances. Our results showed that the heart rate momentarily increases after each spontaneous eyeblink while participants were freely viewing a movie or listening to a story. This phenomenon was consistently observed even when the participants were placed in a dark room. The skin conductance level on the fingers also increased after each spontaneous eyeblink, suggesting that the blink-related heart rate acceleration was induced by an increase in sympathetic nervous system activity. In contrast, no heart rate acceleration was observed to accompany spontaneous eyeblinks at rest or volitional eyeblinks. These results demonstrated that the generation of spontaneous eyeblinks and the activity of the autonomic nervous system are correlated under attentional influence of natural circumstances.



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Histone methyltransferase SETDB1 maintains survival of mouse spermatogonial stem/progenitor cells via PTEN/AKT/FOXO1 pathway

Publication date: Available online 8 September 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Tiantian Liu, Xiaoxu Chen, Tianjiao Li, Xueliang Li, Yinghua Lyu, Xiaoteng Fan, Pengfei Zhang, Wenxian Zeng
Spermatogonial stem cells (SSCs) possess the capacity of self-renewal and differentiation, which are the basis of spermatogenesis. In maintenance of SSC homeostasis, intrinsic/extrinsic factors and various signaling pathways tightly control the fate of SSCs. Methyltransferase SETDB1 (Set domain, bifurcated 1) catalyzes histone H3 lysine 9 (H3K9) trimethylation and represses gene expression. SETDB1 is required for maintaining the survival of spermatogonial stem cells in mice. However, the underlying molecular mechanism remains unclear. In the present study, we found that Setdb1 regulates PTEN/AKT/FOXO1 pathway to inhibit SSC apoptosis. Co-immunoprecipitation and reporter gene assay revealed that SETDB1 interacted and coordinated with AKT to regulate FOXO1 activity and expression of the downstream target genes Bim and Puma. Among the SETDB1-bound genes, the H3K9me3 levels on the promoter regions of Bim and Pten decreased in Setdb1-KD group; in contrast, H3K9me3 status on promoters of Bax and Puma remained unchanged. Therefore, SETDB1 was responsible for regulating the transcription activity of genes in the apoptotic pathway at least in part through modulating H3K9me3. This study replenishes the research on the epigenetic regulation of SSC survival, and provides a new insight for the future study of epigenetic regulation of spermatogenesis.



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Acute histological inflammatory activity is associated with clinical relapse in patients with ulcerative colitis in clinical and endoscopic remission.

It has been suggested that acute histological activity has a prognostic value in the outcome of ulcerative colitis (UC) patients in clinical and endoscopic remission. Our aim was to assess the role of histology as a risk factor for clinical relapse (CR) in patients in both clinical and endoscopic remission.

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P 95 Frequency-specific after-effects of transcranial alternating current stimulation (tACS) on motor learning

Motor learning is associated with changes in synchronized oscillatory activity at alpha (8–12Hz) and beta (12–30Hz) frequencies. Numerous studies demonstrated that tACS can entrain ongoing oscillatory activity (Antal and Herrmann, 2016) and modulate motor behavior (Pollok et al., 2015; Wach et al., 2013). However, the neurophysiological mechanisms underlying tACS (Antal and Paulus, 2013) and its modulatory effect on motor learning remain ambiguous. Thus, the purpose of the study was to investigate the effects of tACS on the learning of a bimanual visuomotor coordination task and the accompanied oscillatory activity.

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P 163 Combining TMS and EEG – a new tool to assess motor system integrity after stroke

Despite the wealth of neuroimaging studies regarding stroke pathophysiology and recovery after stroke, there is still a lack of clinically relevant biomarkers that allow to predict the potential of functional recovery and treatment response at individuals' level. Anovel approach is to test motor system integrity by means of combining transcranial magnetic stimulation (TMS) and electroencephalography (EEG). By recording TMS-evoked potentials (TEP), the cortical response to TMS, both local and network responses can be recorded and analyzed in individual subjects (Rogasch and Fitzgerald, 2012; Ferreri, 2011).

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Editorial Board



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P 12 Integrating nTMS motor mapping of the M1 tongue area into diffusion tractography to reconstruct motor-speech pathways

The preservation of important white matter tracts is extremely important to optimize the functional long-term outcome after brain tumour surgery. The integration of functional localizer data such as navigated transcranial magnetic stimulation (nTMS) as starting region of interest (ROI) within the primary motor cortex (M1) into diffusion-tensor-imaging- (DTI-) tractography algorithms represents a recent advancement of the methodology with regard to the reconstruction of the corticospinal tract (CST).

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P 167 The functional role of contralesional motor areas in the first days after stroke – an fMRI-guided online TMS-study

Neuroimaging studies in stroke patients with hemiparesis have shown altered brain activation in the contralesional hemisphere including the primary motor cortex (M1), dorsal premotor cortex (dPMC) and anterior intraparietal sulcus (aIPS) already in the first week after stroke (Rehme et al., 2011). The role of these regions for motor recovery is still under debate, with some studies suggesting a supportive influence (Lotze et al., 2006) while other point to a maladaptive role (Nowak et al., 2008).

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P 170 A potential signature for ongoing pain in mice

Chronic pain is a major health care problem nowadays with no convincing treatment yet (Apkarian et al., 2009). One challenge of research and treatment of pain is that it cannot be objectively quantified. Only indirect measurements like the Visual Analogue Scale for humans and responses to mechanical or thermal stimuli for animals are used. Electrophysiological changes in brain activity are a possible candidate for a direct measurement of pain and could be easily obtained by EEG recordings. However most of the studies with this scope are focused on evoked potentials of short lasting pain stimuli (ms to s) (Zhang et al., 2012) and only few studies have been conducted on longer lasting pain (Leblanc et al., 2014).

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P 165 Incidence, clinical characteristics and longterm course of headache in patients with stroke (DMKG multicenter study)

Post stroke headache is a symptom which is generally not further differentiated. According to previous European and American studies, it is a common phenomenon. Nevertheless, other symptoms of stroke, such as palsy or aphasia, are dominating clinical assessments. However, the symptom "headache" can be an essential part of the clinical picture as in subarachnoid bleeding or cerebral venous thrombosis and it is unclear which risk factors modulate the symptoms and the occurrence of headache in stroke.

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P 161 Coupling of brain arousal and autonomic regulation in the transition from wakefulness to sleep onset during an auditory oddball task in the resting state

Simultaneous downregulation of the autonomic and central nervous system activity enables the gradual physiological state change from wakefulness to sleep onset. Dysregulation of central or autonomic arousal has been found in neurological (Silvani et al., 2016) and psychiatric disorders (Hegerl and Hensch, 2014; Hegerl et al., 2012; Schulz et al., 2016; Schwabedal et al., 2016), often associated with dysregulated sleep-wake patterns.

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P 14 Motor component of speech errors in rTMS language mapping

Using neuronavigated repetitive transcranial magnetic stimulation (rTMS) to disrupt language function during an online-task (e.g., picture naming) is a novel mapping technique which has recently been introduced for presurgical diagnostics in brain tumor patients. However, the method has some limitations due to its rather low specificity. Beyond its dependency on the task, the distinct error categories may have a major effect on the mapping results. We, here, studied the reliability and the spatial localization of rTMS-induced naming errors related to motor-speech function in contrast to semantic language errors.

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P 13 Congruency between speech-related areas investigated by fMRI and three rTMS protocols with different frequencies

Recently, language mapping by repetitive transcranial magnetic stimulation (rTMS) has gained a lot of interest in preoperative planning to preserve language function. However, the improvement of rTMS protocols is still a matter of debate since rTMS-evoked speech-errors appear relatively widespread over the brain and are rather poorly reliable, depending on the type of the speech-errors. We, therefore, investigated how rTMS-evoked speech-errors of distinct categories are located relatively to speech-related functional MRI (fMRI) clusters (serving as a widely used method for language mapping).

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Contents



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P 172 Endogenous pain modulation in patients with syringomyelia

Syringomyelia is a rare disease affecting the spinal cord. Some patients have no symptoms, but often dissociated sensory disturbances and neuropathic pain can be found.Aim of this study was to analyse endogenous pain modulation and stress-induced analgesia in patients with syringomyelia.

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P 164 Parietal stroke mimicking the Heidenhain variant of Creutzfeldt-Jakob Disease

The Heidenhain variant of Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative disease with an occipito-parietal focus.It initially presents with visual disturbances such as visual agnosia or cortical blindness (Kropp et al., 1999).After presentation of early visual symptoms, rapid progression of dementia and death follows.While the Heidenhain variant matches neuropathological criteria of CJD, differential diagnosis from other neurological disorders using biomarkers from electroencephalography (EEG), magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) reveal low sensitivity and specificity.As a consequence, these tools may lead to an erroneous diagnosis of the Heidenhain variant.

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P 168 Prevalence and characteristics of headache induced by inhalation or ingestion of a cold stimulus (HICS) in a group of adult subjects

Headache attributed to ingestion or inhalation of a cold stimulus (HICS) is a well-known phenomenon. Previously published data documented the prevalence in healthy subjects in childhood. Also an association between HICS and migraine is assumed. HICS is classified as a primary headache (IHS 4.5.2). Data on prevalence in adults does not exist as of now.

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P 166 Case presentation – apoplex due to partial occlusion of the medial cerebral artery with sinistral hemiparesis, word-finding disorder, memory impairment and writing disorder

S. had helped her sister to move. She experienced dizziness and everything went black. She choked on something to drink. Then she went out on the balcony, fell due to weakness of her right leg, and she could not move the right half of the body (right arm, right leg). The right angle of his mouth hung slightly with saliva, and she slurred her speech. She was put down. Then she was unconscious for about 5min and was hospitalised by the emergency physician with suspicion of epilepsy.Additional anamnestic data collected later: Was frequently beaten by a violent friend.

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P 162 Rhythmic Auditory Stimulation (RAS) as an additional treatment for chronic stroke patients in the outpatient setting: a randomized controlled trial

Rhythmic Auditory Stimulation (RAS) is a rhythmic sensory cueing to enhance gait patterns. Aim of the study was to research the effectiveness of RAS as an additional treatment for chronic stroke patients.

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Acute histological inflammatory activity is associated with clinical relapse in patients with ulcerative colitis in clinical and endoscopic remission.

It has been suggested that acute histological activity has a prognostic value in the outcome of ulcerative colitis (UC) patients in clinical and endoscopic remission. Our aim was to assess the role of histology as a risk factor for clinical relapse (CR) in patients in both clinical and endoscopic remission.

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A Survey on Caffeine Consumption and Risky Behaviors Among a Sample of Secondary School Students in Nigeria

Journal of Caffeine Research , Vol. 0, No. 0.


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A Survey on Caffeine Consumption and Risky Behaviors Among a Sample of Secondary School Students in Nigeria

Journal of Caffeine Research , Vol. 0, No. 0.


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Firefighter Paramedic - Lowell Fire Department

Due to rapid growth, we will be testing to fill 12 positions. Applications are due 10/4/2017. Lowell is a full time Fire Department and ALS Ambulance service. We are located in the heart of beautiful Northwest Arkansas. We offer competitive pay(salary based on experience), LOPFI retirement, Paid Vacation, Holiday Pay, Sick Leave, 48/96 work schedule, health, dental, and vision insurance. SUMMARY The ...

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Development of an electrooculogram-based eye-computer interface for communication of individuals with amyotrophic lateral sclerosis

Electrooculogram (EOG) can be used to continuously track eye movements and can thus be considered as an alternative to conventional camera-based eye trackers. Although many EOG-based eye tracking systems have ...

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First responders increasing use of drones to save lives

Firefighters, EMS providers and police are using the technology to increase their visibility, making their job easier

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Boy uses CPR to save mother's life

The woman was trying to get her son out of a van when she hit her head on the door and became unconscious

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Identification of major quantitative trait loci for root diameter in synthetic hexaploid wheat under phosphorus-deficient conditions

Abstract

Synthetic hexaploid wheat (SHW) possesses numerous genes for resistance to stress, including phosphorus (P) deficiency. Root diameter (RDM) plays an important role in P-deficiency tolerance, but information related to SHW is still limited. Thus, the objective of this study was to investigate the genetic architecture of RDM in SHW under P-deficient conditions. To this end, we measured the RDM of 138 F9 recombinant inbred lines derived from an F2 population of a synthetic hexaploid wheat line (SHW-L1) and a common wheat line (Chuanmai32) under two P conditions, P sufficiency (PS) and P deficiency (PD), and mapped quantitative trait loci (QTL) for RDM using an enriched high-density genetic map, containing 120,370 single nucleotide polymorphisms, 733 diversity arrays technology markers, and 119 simple sequence repeats. We identified seven RDM QTL for P-deficiency tolerance that individually explained 11–14.7% of the phenotypic variation. Five putative candidate genes involved in root composition, energy supply, and defense response were predicted. Overall, our results provided essential information for cloning genes related to P-deficiency tolerance in common wheat that might help in breeding P-deficiency-tolerant wheat cultivars.



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Endoscopic Doppler Ultrasound Probe: Useful in the Management of Gastric Varices?



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Flexible laryngeal mask airway management for dental treatment cases associated with difficult intubation.

Related Articles

Flexible laryngeal mask airway management for dental treatment cases associated with difficult intubation.

J Dent Anesth Pain Med. 2017 Mar;17(1):61-64

Authors: Tsukamoto M, Hitosugi T, Yokoyama T

Abstract
Nasotracheal intubation is generally a useful maxillofacial surgery that provides good surgical access for intraoral procedures. When nasotracheal intubation is difficult, laryngeal mask airway (LMA) insertion can be performed, and the flexible LMA™ (FLMA) is also useful for anesthetic management. However, the FLMA provides limited access to the mouth, which restricts the insertion of instrumentation and confines the surgical field available. Here, we present our experience using the FLMA airway management for dental treatment cases involving difficulty with intubation.

PMID: 28879330 [PubMed]



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Difficult airway management in a patient with a thin mandible.

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Difficult airway management in a patient with a thin mandible.

J Dent Anesth Pain Med. 2016 Dec;16(4):317-320

Authors: Choi HS, Oh JS, Kim EJ, Yoon JY, Yoon JU, Kim CH

Abstract
A 47-year-old woman was referred for surgical treatment of osteomyelitis of the mandible. She had already undergone three previous surgeries. Pre-anesthetic airway evaluation predicted a difficult airway, due to the thin, retro-positioned mandible, tongue, and atrophic changes in the lips and soft tissue. We inserted packing gauzes in the buccal mucosa for easier mask fitting and ventilation. During direct laryngoscopic intubation with a nasotracheal tube (NTT), fracture of a thin mandible can easily occur. Therefore, we used a fiberoptic bronchoscope to insert the NTT. After surgery, we performed a tongue-tie to protect against airway obstruction caused by the backward movement of the tongue during recovery. The patient recovered without any complications. We determined the status of the patient precisely and consequently performed thorough preparations for the surgery, allowing the patient to be anesthetized safely and recover after surgery. Careful assessment of the patient and airway prior to surgery is necessary.

PMID: 28879322 [PubMed]



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Pharyngeal flap damage caused by nasotracheal intubation in a patient who underwent palatoplasty and pharyngoplasty.

Related Articles

Pharyngeal flap damage caused by nasotracheal intubation in a patient who underwent palatoplasty and pharyngoplasty.

J Dent Anesth Pain Med. 2016 Dec;16(4):309-312

Authors: Oh JS, Choi HS, Kim EJ, Kim CH, Yoon JU, Yoon JY

Abstract
Patients with cleft lip and palate (CLP) must undergo corrective surgeries during infancy and early childhood. Many patients with CLP undergo orthognathic surgery during their childhood for correction of skeletal asymmetries or pharyngoplasty with a pharyngeal flap to improve the quality of speech and velopharyngeal function. During orthognathic surgeries, nasotracheal intubation is performed under general anesthesia. In our case report, the patient had undergone palatoplasty and pharygoplasty previously. During the orthognathic surgery, a flexible fiberoptic bronchoscope-guided nasotracheal tube was inserted through the pharyngeal flap ostium; however, active bleeding occurred in the nasopharynx. Bleeding occurred because the flap was torn. After achieving hemostasis, the surgery was completed successfully. Thus, if a patient may show the potential for velopharyngeal port obstruction, nasotracheal intubation should be performed with utmost care.

PMID: 28879320 [PubMed]



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The effect of expressive writing on the error-related negativity among individuals with chronic worry

Abstract

The error-related negativity (ERN), an ERP elicited immediately after errors, is enlarged among individuals with anxiety. The relationship between anxiety and enlarged ERN has spurred interest in understanding potential therapeutic benefits of decreasing its amplitude within anxious individuals. The current study used a tailored intervention—expressive writing—in an attempt to reduce the ERN among a sample of individuals with chronic worry. Consistent with hypotheses, the ERN was reduced in the expressive writing group compared to an unrelated writing control group. Findings provide experimental support that the ERN can be reduced among anxious individuals with tailored interventions. Expressive writing may serve to "offload" worries from working memory, therefore relieving the distracting effects of worry on cognition as reflected in a decreased ERN.



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Pharmacological interventions to improve cognition and adaptive functioning in Down syndrome: Strides to date

Although an increasing number of clinical trials have been developed for cognition in Down syndrome, there has been limited success to date in identifying effective interventions. This review describes the progression from pre-clinical studies with mouse models to human clinical trials research using pharmacological interventions to improve cognition and adaptive functioning in Down syndrome. We also provide considerations for investigators when conducting human clinical trials and describe strategies for the pharmaceutical industry to advance the field in drug discovery for Down syndrome. Future research focusing on earlier pharmaceutical interventions, development of appropriate outcome measures, and greater collaboration between industry, academia, advocacy, and regulatory groups will be important for addressing limitations from prior studies and developing potential effective interventions for cognition in Down syndrome.



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Prokinetics in the Management of Functional Gastrointestinal Disorders

Abstract

Purpose of review

The goal of this review is to review the current status of prokinetics and to place it in historical context. Impaired motility and thus propulsion have long been thought to play important roles in the pathogenesis of a number of gastrointestinal disorders including gastroesophageal reflux disease (GERD), gastroparesis, chronic idiopathic pseudo-obstruction, and constipation. Historically, disordered motility was also thought to contribute to a number of functional gastrointestinal disorders such as functional dyspepsia (FD) and irritable bowel syndrome (IBS).

Recent findings

As we learn more of the pathophysiology of FD, IBS, GERD, constipation, and gastroparesis, the limitations of a therapeutic strategy based on the stimulation of motility (i.e., the use of a prokinetic) have become apparent and the disappointments of the past explained. The development of prokinetic drugs has also been hampered by the non-selective nature of many of the agents studied to date which resulted in some unexpected side effects.

Summary

There is still an unmet need for an effective and safe prokinetic, but drug development in this area must be mindful of the challenges of the area and the need for selectivity for a given target receptor.



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Intermuscular coherence reflects functional coordination

Coherence analysis has the ability to identify the presence of common descending drive shared by motor unit pools and reveals its spectral properties. However, the link between spectral properties of shared neural drive and functional interactions among muscles remains unclear. We assessed shared neural drive between muscles of the thumb and index finger while participants executed two mechanically distinct precision pinch tasks, each requiring distinct functional coordination among muscles. We found that shared neural drive was systematically reduced or enhanced at specific frequencies of interest (~10 and ~40 Hz). While amplitude correlations between surface EMG signals also exhibited changes across tasks, only their coherence has strong physiological underpinnings indicative of neural binding. Our results support the use of intermuscular coherence as a tool to detect when coactivated muscles are members of a functional group or synergy of neural origin. Furthermore, our results demonstrate the advantages of considering neural binding at 10, ~20, and >30 Hz, as indicators of task-dependent neural coordination strategies.

NEW & NOTEWORTHY It is often unclear whether correlated activity among muscles reflects their neural binding or simply reflects the constraints defining the task. Using the fact that high-frequency coherence between EMG signals (>6 Hz) is thought to reflect shared neural drive, we demonstrate that coherence analysis can reveal the neural origin of distinct muscle coordination patterns required by different tasks.



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Discrimination of curvature from motion during smooth pursuit eye movements and fixation

Smooth pursuit and motion perception have mainly been investigated with stimuli moving along linear trajectories. Here we studied the quality of pursuit movements to curved motion trajectories in human observers and examined whether the pursuit responses would be sensitive enough to discriminate various degrees of curvature. In a two-interval forced-choice task subjects pursued a Gaussian blob moving along a curved trajectory and then indicated in which interval the curve was flatter. We also measured discrimination thresholds for the same curvatures during fixation. Motion curvature had some specific effects on smooth pursuit properties: trajectories with larger amounts of curvature elicited lower open-loop acceleration, lower pursuit gain, and larger catch-up saccades compared with less curved trajectories. Initially, target motion curvatures were underestimated; however, ~300 ms after pursuit onset pursuit responses closely matched the actual curved trajectory. We calculated perceptual thresholds for curvature discrimination, which were on the order of 1.5 degrees of visual angle (°) for a 7.9° curvature standard. Oculometric sensitivity to curvature discrimination based on the whole pursuit trajectory was quite similar to perceptual performance. Oculometric thresholds based on smaller time windows were higher. Thus smooth pursuit can quite accurately follow moving targets with curved trajectories, but temporal integration over longer periods is necessary to reach perceptual thresholds for curvature discrimination.

NEW & NOTEWORTHY Even though motion trajectories in the real world are frequently curved, most studies of smooth pursuit and motion perception have investigated linear motion. We show that pursuit initially underestimates the curvature of target motion and is able to reproduce the target curvature ~300 ms after pursuit onset. Temporal integration of target motion over longer periods is necessary for pursuit to reach the level of precision found in perceptual discrimination of curvature.



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Fast voltage-sensitive dye imaging of excitatory and inhibitory synaptic transmission in the rat granular retrosplenial cortex

Rodent granular retrosplenial cortex (GRS) has dense connections between the anterior thalamic nuclei (ATN) and hippocampal formation. GRS superficial pyramidal neurons exhibit distinctive late spiking (LS) firing property and form patchy clusters with prominent apical dendritic bundles. The aim of this study was to investigate spatiotemporal dynamics of signal transduction in the GRS induced by ATN afferent stimulation by using fast voltage-sensitive dye imaging in rat brain slices. In coronal slices, layer 1a stimulation, which presumably activated thalamic fibers, evoked propagation of excitatory synaptic signals from layers 2–4 to layers 5–6 in a direction perpendicular to the layer axis, followed by transverse signal propagation within each layer. In the presence of ionotropic glutamate receptor antagonists, inhibitory responses were observed in superficial layers, induced by direct activation of inhibitory interneurons in layer 1. In horizontal slices, excitatory signals in deep layers propagated transversely mainly from posterior to anterior via superficial layers. Cortical inhibitory responses upon layer 1a stimulation in horizontal slices were weaker than those in the coronal slices. Observed differences between coronal and horizontal planes suggest anisotropy of the intracortical circuitry. In conclusion, ATN inputs are processed differently in coronal and horizontal planes of the GRS and then conveyed to other cortical areas. In both planes, GRS superficial layers play an important role in signal propagation, which suggests that superficial neuronal cascade is crucial in the integration of multiple information sources.

NEW & NOTEWORTHY Superficial neurons in the rat granular retrosplenial cortex (GRS) show distinctive late-spiking (LS) firing property. However, little is known about spatiotemporal dynamics of signal transduction in the GRS. We demonstrated LS neuron network relaying thalamic inputs to deep layers and anisotropic distribution of inhibition between coronal and horizontal planes. Since deep layers of the GRS receive inputs from the subiculum, GRS circuits may work as an integrator of multiple sources such as sensory and memory information.



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Removal of endogenous neuromodulators in a small motor network enhances responsiveness to neuromodulation

We studied the changes in sensitivity to a peptide modulator, crustacean cardioactive peptide (CCAP), as a response to loss of endogenous modulation in the stomatogastric ganglion (STG) of the crab Cancer borealis. Our data demonstrate that removal of endogenous modulation for 24 h increases the response of the lateral pyloric (LP) neuron of the STG to exogenously applied CCAP. Increased responsiveness is accompanied by increases in CCAP receptor (CCAPr) mRNA levels in LP neurons, requires de novo protein synthesis, and can be prevented by coincubation for the 24-h period with exogenous CCAP. These results suggest that there is a direct feedback from loss of CCAP signaling to the production of CCAPr that increases subsequent response to the ligand. However, we also demonstrate that the modulator-evoked membrane current (IMI) activated by CCAP is greater in magnitude after combined loss of endogenous modulation and activity compared with removal of just hormonal modulation. These results suggest that both receptor expression and an increase in the target conductance of the CCAP G protein-coupled receptor are involved in the increased response to exogenous hormone exposure following experimental loss of modulation in the STG.

NEW & NOTEWORTHY The nervous system shows a tremendous amount of plasticity. More recently there has been an appreciation for compensatory actions that stabilize output in the face of perturbations to normal activity. In this study we demonstrate that neurons of the crustacean stomatogastric ganglion generate apparent compensatory responses to loss of peptide neuromodulation, adding to the repertoire of mechanisms by which the stomatogastric nervous system can regulate and stabilize its own output.



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A novel paraplegia model in awake behaving macaques

Lower limb paralysis from spinal cord injury (SCI) or neurological disease carries a poor prognosis for recovery and remains a large societal burden. Neurophysiological and neuroprosthetic research have the potential to improve quality of life for these patients; however, the lack of an ethical and sustainable nonhuman primate model for paraplegia hinders their advancement. Therefore, our multidisciplinary team developed a way to induce temporary paralysis in awake behaving macaques by creating a fully implantable lumbar epidural catheter-subcutaneous port system that enables easy and reliable targeted drug delivery for sensorimotor blockade. During treadmill walking, aliquots of 1.5% lidocaine with 1:200,000 epinephrine were percutaneously injected into the ports of three rhesus macaques while surface electromyography (EMG) recorded muscle activity from their quadriceps and gastrocnemii. Diminution of EMG amplitude, loss of voluntary leg movement, and inability to bear weight were achieved for 60–90 min in each animal, followed by a complete recovery of function. The monkeys remained alert and cooperative during the paralysis trials and continued to take food rewards, and the ports remained functional after several months. This technique will enable recording from the cortex and/or spinal cord in awake behaving nonhuman primates during the onset, maintenance, and resolution of paraplegia for the first time, thus opening the door to answering basic neurophysiological questions about the acute neurological response to spinal cord injury and recovery. It will also negate the need to permanently injure otherwise high-value research animals for certain experimental paradigms aimed at developing and testing neural interface decoding algorithms for patients with lower extremity dysfunction.

NEW & NOTEWORTHY A novel implantable lumbar epidural catheter-subcutaneous port system enables targeted drug delivery and induction of temporary paraplegia in awake, behaving nonhuman primates. Three macaques displayed loss of voluntary leg movement for 60–90 min after injection of lidocaine with epinephrine, followed by a full recovery. This technique for the first time will enable ethical live recording from the proximal central nervous system during the acute onset, maintenance, and resolution of paraplegia.



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Differential contributions to the interception of occluded ballistic trajectories by the temporoparietal junction, area hMT/V5+, and the intraparietal cortex

The ability to catch objects when transiently occluded from view suggests their motion can be extrapolated. Intraparietal cortex (IPS) plays a major role in this process along with other brain structures, depending on the task. For example, interception of objects under Earth's gravity effects may depend on time-to-contact predictions derived from integration of visual signals processed by hMT/V5+ with a priori knowledge of gravity residing in the temporoparietal junction (TPJ). To investigate this issue further, we disrupted TPJ, hMT/V5+, and IPS activities with transcranial magnetic stimulation (TMS) while subjects intercepted computer-simulated projectile trajectories perturbed randomly with either hypo- or hypergravity effects. In experiment 1, trajectories were occluded either 750 or 1,250 ms before landing. Three subject groups underwent triple-pulse TMS (tpTMS, 3 pulses at 10 Hz) on one target area (TPJ | hMT/V5+ | IPS) and on the vertex (control site), timed at either trajectory perturbation or occlusion. In experiment 2, trajectories were entirely visible and participants received tpTMS on TPJ and hMT/V5+ with same timing as experiment 1. tpTMS of TPJ, hMT/V5+, and IPS affected differently the interceptive timing. TPJ stimulation affected preferentially responses to 1-g motion, hMT/V5+ all response types, and IPS stimulation induced opposite effects on 0-g and 2-g responses, being ineffective on 1-g responses. Only IPS stimulation was effective when applied after target disappearance, implying this area might elaborate memory representations of occluded target motion. Results are compatible with the idea that IPS, TPJ, and hMT/V5+ contribute to distinct aspects of visual motion extrapolation, perhaps through parallel processing.

NEW & NOTEWORTHY Visual extrapolation represents a potential neural solution to afford motor interactions with the environment in the face of missing information. We investigated relative contributions by temporoparietal junction (TPJ), hMT/V5+, and intraparietal cortex (IPS), cortical areas potentially involved in these processes. Parallel organization of visual extrapolation processes emerged with respect to the target's motion causal nature: TPJ was primarily involved for visual motion congruent with gravity effects, IPS for arbitrary visual motion, whereas hMT/V5+ contributed at earlier processing stages.



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Treatment withdrawal and end-of-life care in the intensive care unit

1F052C063A07

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P 93 TMS recruitment curve and cortical silent period analysis: a sensitive tool to detect imminent motor deficits in brain tumor patients

One of the challenges in surgery of tumors in motor eloquent areas is the individual risk assessment for postoperative motor disorder. Previously, we developed a predictive model that allows for objective evaluation of this risk prior to surgery based on topographical and neurophysiologial data derived from investigation with nTMS (navigated Transcranial Magnetic Stimulation). The input variables of the model are: (1) presence of infiltration of the primary motor cortex by the tumor, (2) the minimal distance of the tumor to the corticalspinal tract and (3) the ratio of the bihemispheric resting motor threshold (RMT).

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P 159 Long-time course of idiopathic small fiber neuropathy

Small fiber neuropathy (SFN) represents a subtype of peripheral neuropathies. As only small A-delta and C-fibers are involved patients suffer from typical clinical symptoms such as hypesthesia, burning and prickling sensations, temperature disturbance perception or autonomic symptoms without any signs of large fiber involvement. Thus electrophysiological examinations (sensory and motor nerve conduction studies (NCS), electromyography (EMG) and evoked potentials (EP)) do not elicit pathological findings as they indicate large fiber involvement.

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P 92 The prognostic value of somatosensory evoked potentials in patients with severe traumatic brain injury

The prognosis after traumatic coma is often unclear. It can be difficult to predict the neurological outcome using clinical criteria or imaging techniques alone. In patients with severe traumatic brain injury (TBI) median somatosensory evoked potentials (SSEPs) serve as an accepted prognostic tool. They are widely available electrophysiological tests. We evaluated the prognostic value of SSEPs in comatous patients in the intensive care unit regarding longterm outcome.

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S 1 New methods for electrode optimization for high-definition transcranial electric stimulation (hd-tES)

tES is a non-invasive brain stimulation technique which modifies neural excitability by providing weak currents through scalp electrodes. The aim of my presentation is to introduce and analyze new forward and inverse simulation methods for safe and well-targeted multi-electrode tES.

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P 125 Ring chromosome 20 Epilepsy syndrome in children Variable EEG- and electro-clinical pattern

Children with ring chromosome 20 epilepsy syndrome (rchr20es) typically show severe, drug-resistant focal epilepsies characterized by frontal semiology, high susceptibility for non-convulsive status epilepticus (NCSE) and epilepsy-associated cognitive and behavioral deteriorations. EEG has been reported to show frequent or continuous subclinical seizure patterns together with characteristic rhythmic theta waves (Caneveni et al. 1998). Here, we report on clinical and EEG data in four patients.

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FV 1 In vivo staging in ALS – A mono-centric cross-sectional and longitudinal DTI-based study

Neuropathological studies in amyotrophic lateral sclerosis (ALS) have shown that ALS may disseminate in a regional sequence in four disease-related patterns (Braak et al., 2013). Recently, our group reported the diffusion tensor imaging (DTI)-based analysis of sequential spreading of disease in ALS (Kassubek et al., 2014; Müller et al., 2016). The aim of this study was to show that longitudinal data support the pathological findings and to establish DTI as an in vivo tool to image pathological ALS stages by testing for longitudinal consistency of the categorization results.

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P 142 Cognitive impairments in children with tic disorders and Tourette’s syndrome

The study of cognitive impairment was a combination of neurological and electroencephalographic techniques that allowed us to objectify pathogenetic features of Tourette's syndrome and a differentiated approach to drug therapy.

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FV 2 Reduced spatial variability in cortical working memory networks after macro-anatomical alignment – Converging evidence from multiple fMRI studies

Reducing the spatial variability in group analyses is an important issue in functional neuroimaging studies. Commonly volume-based whole-brain alignment procedures are used to provide a common analysis space and to align brains across subjects. Inter-individual differences in the cortical folding pattern are an important source of spatial variability. However, volume based alignment methods do not take this factor into account. By contrast, surface based alignment procedures have been shown to significantly improve macro-anatomical alignment and increase the overlap of functional activation.

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P 107 Antibody-negative autoimmune encephalitis?

We report about a 66-year-old woman which has been hospitalized with suspected antibody-negative autoimmune encephalitis.The patient experienced relapsing episodes with disorientation, amnestic aphasia, short-term memory dysfunction, hallucinations, apraxia, ataxia, seizures and severe delirium during the years 2012–2013. In medical history the patient has had a breast cancer right sided (first diagnosis 2010) with breast-conserving therapy, radiation and hormone therapy. MRI and cerebrospinal fluid (including antibodies for autoimmunencephalitis) did not show relevant abnormalities.

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FV 3 Functional transcranial Doppler (fTCD) during cold-induced pain in the oral cavity and ice cream headache

An increase of mean flow velocity (MFV) in cerebral arteries can be monitored during processing of visual information (Aaslid, 1987; Rihs et al., 1999), while speaking (Cupini et al., 1996), memory tasks (Vollmer-Haase et al., 1998) and movements of one hand (Orlandi and Murri, 1996) by functional transcranial Doppler (fTCD). The processing of sensitive information (Duschek et al., 2012) or pain (Mages et al., 2016) also leads to an increase in blood flow. Drinking ice-cold water can cause pain in the oral cavity and an ice cream headache (Mages et al., 2016).

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P 150 The correlation of attention and neurophysiological characteristics in attention deficit hyperactivity disorder (ADHD)

Adult ADHD is a frequent psychiatric disorder which begins in childhood and persists into adulthood in up to 60% of the cases. As one pathogenetical mechanism the arousal regulation, which are measurable with EEG under rest, are discussed. The vigilance regulation model of affective disorders and ADHD interprets the hyperactivity and the sensation seeking behaviour as an autoregulatory and partly dysfunctional attempt of the organism to stabilize wakefulness (Hegerl and Hensch, 2014). Different EEG-studies confirm an instable EEG vigilance regulation in ADHD (Geissler et al., 2014) and show correlation with attention deficits (Sander et al., 2010).

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FV 4 The influence of Ketamine on the locus coeruleus and the noradrenerg system – a randomized fMRI study

Ketamine and its potential antidepressant mechanism, which has been proposed to be related to the glutamatergic system of the brain, are of growing interest. Since ketamine modulates the norepinephrine transporter (NET), we investigated the influence of ketamine on the Locus coeruleus (LC), the brain area with the highest NET density, the source of the noradrenergic fibers and an arousal regulatory center identified on resting state fMRI.

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P 133 Differentiating hypo- and hyperaroused fatigue in major depression and in the context of organic diseases

Fatigue is a core symptom in patients with major depressive disorder (MDD), and a common symptom in organic diseases involving inflammatory and immunological processes. From a clinical perspective, fatigue in depression is a state with high inner tension and prolonged sleep onset latencies, whereas fatigue in the context of organic diseases describes an anergic state with excessive sleepiness and short sleep latencies. Given that these two states are diametrically opposed in the arousal dimension, it has been proposed to differentiate two subtypes of fatigue (Hegerl et al., 2013; Hegerl and Ulke, 2016): hyperaroused fatigue (typical for depression) and hypoaroused fatigue (typical in the context of organic diseases).

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FV 5 Quadri-pulse theta burst stimulation using ultra-high frequency bursts at I-wave periodicity induces direction dependent bi-directional plasticity in human primary motor cortex

Long-term potentiation (LTP) and long-term depression (LTD) are forms of cortical plasticity and are considered to be synaptic processes underlying learning and memory. Patterned transcranial magnetic stimulation (TMS) such as theta burst stimulation (TBS) or quadri-pulse stimulation (QPS) can induce LTP-like and LTD-like effects in human primary motor cortex (M1), displayed by an increase or decrease in cortico-spinal excitability. Here, we aimed to test the plasticity-inducing capabilities of a novel protocol that merged TBS and QPS – so called quadri-pulse theta burst stimulation (qTBS) – at interstimulus intervals (ISI) that mimic I-wave periodicity (i.e.

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P 117 Symptomatic trigeminal neuralgia (TN) – an electrophysiological case study

While idiopathic TN is associated with some delay in P19 response of the cortical trigeminal somatosensory evoked potential (T-SEP) in up to 50 % of patients, the blink reflex (BR) evoked by stimulation of the supraorbital nerve is usually not involved. We present a case of symptomatic TN in which the combination of electrophysiological findings was remarkable.

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FV 6 Sustained GABA reduction induced by anodal Transcranial direct current stimulation (tDCS) in motor cortex – a proton magnetic resonance spectroscopy study

Transcranial direct current stimulation (tDCS) is a non-invasive technique that modulates excitability of neurons in the cerebral cortex. Anodal tDCS has been reported to modulate the activation of motor cortex as well as GABA concentration in motor cortex (Nitsche and Paulus, 2000).

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P 98 Emotional arousal evoked by novel sounds is reflected in increased sympathetic activation – developmental effects, pupil dilation, and the P3a component

Unexpected novel sounds occurring outside the current focus of attention can involuntarily capture attention. The underlying mechanisms can be investigated measuring the pupil dilation response (PDR) and the event-related potential (ERP) component P3a in the EEG (for review see, Wetzel and Schröger, 2014). Emotional sounds have a high relevance and might cause a stronger orienting of attention and evaluation for novelty than neutral sounds. Emotional arousal was previously associated with increased sympathetic activity (Bradley et al., 2008).

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FV 7 High-frequency anterior thalamus stimulation increases alertness in epilepsy patients during alert- and drowsy-wakefulness

Deep brain stimulation (DBS) of anterior thalamic nuclei (ANT) reduces frequency and intensity of epileptic partial and secondarily-generalized seizures. ANT-DBS disrupts sleep in epilepsy patients. We investigated the impact of ANT-DBS on alertness in wakeful epilepsy patients. This might help to better understand mechanisms of action of high frequency ANT-DBS in humans.

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P 155 First evidence for glial pathology in late life minor depression – S100B is increased in males with minor depression – results form LIFW-adult study

Minor depression is as ubthreshold depressive disorder. It is diagnosed when a patient suffers from 2 to 4 depressive symptoms for at least 2weeks. Though minor depression affects nearly ten percent of the elderly population, its pathophysiology has hardly been investigated. In our study we assessed serum levels of biomarkers for plasticity, glial and neuronal function: brain-derived neurotrophic factor (BDNF), S100B and neuron specific enolase (NSE).

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FV 8 An update on neurophysiological diagnostic in pediatric neurology

Evoked potentials are an important neurophysiological method in pediatrics. Most commonly used are brainstem auditory evoked potentials (BAEP), visual evoked potentials (VEP) and somatosensory evoked potentials (SEP). BAEPs are useful in screening for hearing disorders and for evaluating brain stem function. VEPs are performed to evaluate visual functioning and for diagnosis of demyelinating diseases. SEPs allow evaluation of the functional integrity of the somatosensory system from the peripheral nerve to the cerebral cortex and can be a useful additional prognostic tool in determining coma and asphyxia outcome.

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Patient experience and perceived acceptability of whole-body magnetic resonance imaging for staging colorectal and lung cancer compared with current staging scans: a qualitative study

BMJ Open

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Experimental drug lowers exacerbation rates in people with poorly controlled asthma

Reuters Health News

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The association of combined total kidney and liver volume with pain and gastrointestinal symptoms in patients with later stage autosomal dominant polycystic kidney disease

American Journal of Nephrology

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ICD-10 gets down to specifics, and attention to detail directly affects finances

Healthcare Finance News

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Early hospital readmissions and mortality in patients with decompensated cirrhosis enrolled in a large national health insurance administrative database

Journal of Clinical Gastroenterology

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Observational study of perspectives of inflammatory bowel disease patients concerning the use of corticosteroids

Digestive Diseases

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Multidisciplinary management of hepatocellular carcinoma improves access to therapy and patient survival

Journal of Clinical Gastroenterology

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Effect of paritaprevir/ritonavir/ombitasvir/dasabuvir and ledipasvir/sofosbuvir regimens on survival compared with untreated hepatitis C virus–infected persons: Results from ERCHIVES

Clinical Infectious Diseases

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Interleukin-6 in irritable bowel syndrome: A systematic review and meta-analysis of IL-6 (-G174C) and circulating IL-6 levels

Cytokine

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Ribavirin steady-state plasma level is a predictor of sustained virological response in hepatitis C-infected patients treated with direct-acting antivirals

Alimentary Pharmacology and Therapeutics

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One year of baclofen in 100 patients with or without cirrhosis: A French real-life experience

European Journal of Gastroenterology & Hepatology

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Reduced risk of decompensation and death associated with use of statins in patients with alcoholic cirrhosis. A nationwide case-cohort study

Alimentary Pharmacology and Therapeutics

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US senator reveals results of opioid inquiry into Insys

Reuters Health News

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Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C-SCANS study

Cancer

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Physical activity and the risk of gallstone disease: a systematic review and meta-analysis

Journal of Clinical Gastroenterology

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Effect of sofosbuvir-based hepatitis c virus therapy on kidney function in patients with ckd

Clinical Journal of the American Society of Nephrology

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Physical activity, mediating factors and risk of colon cancer: Insights into adiposity and circulating biomarkers from the EPIC cohort

International Journal of Epidemiology

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Clinical course of partial virologic response with prolonged tenofovir therapy in nuclos(t)ides-naïve patients with chronic hepatitis B

Digestive Diseases and Sciences

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Long-term outcomes of transjugular intrahepatic portosystemic shunt in Indian patients with Budd–Chiari syndrome

European Journal of Gastroenterology & Hepatology

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Improvements in brain and behavior following eradication of hepatitis C

Journal of NeuroVirology

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Effectiveness of the conductive educational approach added to conventional physiotherapy in the improvement of gait parameters of poststroke patients: randomized-controlled pilot study.

Our objective was to assess the benefits of the conductive education (CE) approach added to conventional physiotherapy in gait functions of poststroke, hemiparetic patients. A randomized-controlled trial was designed in a rehabilitation clinic. Late and chronic poststroke patients with gait disturbances (n=17, median age: 55 years, range: 41-72 years) were enrolled in the study. All patients received conventional physiotherapy. However, patients of only one group took part in therapy on the basis of the CE approach. The gait parameters, semiobjective outcome measures, functional independence measure, and International Classification of Functioning, Disability and Health domains were collected. The effectiveness of the CE approach was underlined by those outcome measures that were only significant (P

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Dapsone-induced severe cutaneous adverse drug reactions are strongly linked with HLA-B*13: 01 allele in the Thai population.

Objectives: A previous publication in Chinese leprosy patients showed that the HLA-B*13:01 allele is a strong genetic marker for dapsone-induced drug hypersensitivity reactions, however there are no data describing whether HLA-B*13:01 is a valid marker for prediction of dapsone-induced drug hypersensitivity reactions in other ethnicities or nonleprosy patients. The aim of this study is to investigate whether there is an association between HLA genotypes and dapsone-induced severe cutaneous adverse reactions (SCARs) in nonleprosy patients. Patients and methods: HLA-B genotypes of 15 patients with dapsone-induced SCARs (11 drug reaction with eosinophilia and systemic symptoms, four Stevens-Johnson syndrome/toxic epidermal necrolysis), 29 control patients, and 986 people from the general Thai population were determined by the reverse PCR sequence-specific oligonucleotides probe. Results: The HLA-B*13:01 allele was significantly associated with dapsone-induced SCARs compared with dapsone-tolerant controls (odds ratio: 54.00, 95% confidence interval: 7.96-366.16, P=0.0001) and the general population (odds ratio: 26.11, 95% confidence interval: 7.27-93.75, P=0.0001). In addition, HLA-B*13:01 associated with dapsone-induced SJS-TEN (OR: 40.50, 95% confidence interval: 2.78-591.01, P=0.0070) and DRESS (OR: 60.75, 95% confidence interval: 7.44-496.18, P=0.0001). Conclusion: This study demonstrated an association between HLA-B*13:01 and dapsone-induced SCARs including Stevens-Johnson syndrome/toxic epidermal necrolysis and drug reaction with eosinophilia and systemic symptoms in nonleprosy patients. Moreover, these results suggest that the HLA-B*13:01 allele may be a useful genetic marker for prediction of dapsone-induced SCARs in Thai and Han-Chinese populations. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Early Folic Acid Supplement Initiation and Risk of Adverse Early Childhood Respiratory Health: A Population-based Study

Abstract

Objectives Folate plays a vital role in biologic functions yet women often do not meet the recommended dietary intake in pregnancy. It has been suggested that high folic acid intake during pregnancy may increase the risk of respiratory diseases in offspring. However, findings from observational studies in human populations are inconclusive. Methods In this population-based study, we collected self-reported folic acid and prenatal vitamin supplement use during pregnancy 3–6 months postpartum from mothers in Los Angeles whose children were born in 2003. Supplement initiation was based on whichever supplement, either folic acid or prenatal supplements, the women initiated first. In a 2006 follow-up survey, approximately 50% of women were re-contacted to gather information on the child's respiratory health, including symptoms and diagnoses, at approximately 3.5 years of age. Results Overall, timing of folic acid supplement initiation was not associated with wheeze or lower respiratory tract infection, even after accounting for preterm births and censoring at follow-up. However, children born to mothers with a history of atopy (hay fever, eczema or asthma) who initiate folic acid supplements in late pregnancy, compared to first trimester initiators, have 1.67 (95% CI 1.12, 2.49) times the risk of wheeze in the first 3 years of life and 1.88 (95% CI 1.05, 3.34) times the risk of wheeze in the past year. No association was found among children of non-atopic mothers. Conclusions These findings suggest that early folic acid or prenatal supplementation among atopic women may be important to prevent wheeze among offspring.



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Direct-Acting Antiviral Therapy for Chronic HCV Infection Results in Liver Stiffness Regression Over 12 Months Post-treatment

Abstract

Background

Liver fibrosis stage determines risk of morbidity and mortality from chronic hepatitis C virus (HCV) infection. Prior data have shown long-term reversal of liver fibrosis, measured by vibration-controlled transient elastography (VCTE), in patients successfully treated with interferon-based therapies.

Aim

Our study sought to determine the effect of treatment with modern HCV direct-acting antiviral (DAA) therapy on noninvasive liver fibrosis measurements.

Methods

A total of 70 patients had VCTE-based liver stiffness measurement (LSM) taken before treatment, directly after treatment completion, and at least 12 months after completion of DAA therapy. Our primary outcome was a >30% improvement in VCTE score at the end of follow-up, relative to baseline.

Results

The sustained virologic response rate in our cohort was 95.7%. In our cohort, 34 (48.6%) met the primary outcome. Those who had baseline elevated alanine aminotransferase (OR 3.27; 95% CI 1.13–9.47) and genotype 1 (OR 14.63; 95% CI 1.70–125.83) had higher odds of meeting that outcome, and this remained significant after adjusting for age, baseline body mass index, gender, baseline elevated alkaline phosphatase levels, treatment experience, liver transplant status, smoking, and baseline liver stiffness.

Conclusion

Treatment of chronic HCV with modern DAA therapy was associated with a significant improvement in LSM by VCTE measurement, suggesting possible early improvement in liver fibrosis along with resolution of inflammation over the first year after treatment completion.



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Genotypic-phenotypic features and enzyme replacement therapy outcome in patients with mucopolysaccharidosis VI from Turkey

Mucopolysaccharidosis type VI (MPS VI) is a lysosomal storage disorder (LSD) characterized by a chronic, progressive course with multiorgan involvement. In our study, clinical, biochemical, molecular findings, and response to enzyme replacement therapy (ERT) for at least 6 months were evaluated in 20 patients with MPS VI. Treatment effects on clinical findings such as liver and spleen sizes, cardiac and respiratory parameters, visual and auditory changes, joints' range of motions, endurance tests and changes in urinary glycosaminoglycan excretions, before and after ERT were analyzed. ERT caused increased physical endurance and decreased urinary dermatan sulfate/chondroitin sulfate ratios. Changes in growth parameters, cardiac, respiratory, visual, auditory findings, and joint mobility were not significant. All patients and parents reported out an increased quality of life, which were not correlated with clinical results. The most prevalent mutation was p.L321P, accounting for 58.8% of the mutant alleles and two novel mutations (p.G79E and p.E390 K) were found. ERT was a safe but expensive treatment for MPS VI, with mild benefits in severely affected patients. Early treatment with ERT is mandatory before many organs and systems are involved.



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A novel missense variant in the GLI3 zinc finger domain in a family with digital anomalies

Mutations in GLI3, which encodes a transcription factor of the Hedgehog signaling pathway, cause several developmental anomalies linked to inappropriate tissue patterning. Here, we report a novel missense variant in the fifth zinc finger domain of GLI3 (c.1826G>A; p.(Cys609Tyr)) initially identified in a proband with preaxial polydactyly type IV, developmental delay, sensorineural hearing loss, skeletal, and genitourinary anomalies. Additional family members exhibited various digital anomalies such as preaxial polydactyly, syndactyly, and postaxial polydactyly either in isolation or combined. Functional studies of Cys609Tyr GLI3 in cultured cells showed abnormal GLI3 processing leading to decreased GLI3 repressor production, increased basal transcriptional activity, and submaximal GLI reporter activity with Hedgehog pathway activation, thus demonstrating an intriguing molecular mechanism for this GLI3-related phenotype. Given the complexity of GLI3 post-translational processing and opposing biological functions as a transcriptional activator and repressor, our findings highlight the importance of performing functional studies of presumed GLI3 variants. This family also demonstrates how GLI3 variants are variably expressed.



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Survival beyond the perinatal period expands the phenotypes caused by mutations in GLE1

Mutations in GLE1 underlie Lethal Congenital Contracture syndrome (LCCS) and Lethal Arthrogryposis with Anterior Horn Cell Disease (LAAHD). Both LCCS and LAAHD are characterized by reduced fetal movements, congenital contractures, and a severe form of motor neuron disease that results in fetal death or death in the perinatal period, respectively. We identified bi-allelic mutations in GLE1 in two unrelated individuals with motor delays, feeding difficulties, and respiratory insufficiency who survived beyond the perinatal period. Each affected child had missense variants predicted to result in amino acid substitutions near the C-terminus of GLE1 that are predicted to disrupt protein–protein interaction or GLE1 protein targeting. We hypothesize that mutations that preserve function of the coiled-coil domain of GLE1 cause LAAHD whereas mutations that abolish the function of the coiled-coil domain cause LCCS. The phenotype of LAAHD is now expanded to include multiple individuals surviving into childhood suggesting that LAAHD is a misnomer and should be re-named Arthrogryposis with Anterior Horn Cell Disease (AAHD).



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Confirmation of an ARID2 defect in SWI/SNF-related intellectual disability

We present a 4-year-old girl with delayed neuromotor development, short stature of prenatal onset, and specific behavioral and craniofacial features harboring an intragenic deletion in the ARID2 gene. The phenotype confirmed the major features of the recently described ARID2-related intellectual disability syndrome. However, our patient showed overlapping features with Nicolaides-Baraitser syndrome and Coffin-Siris syndrome, providing further arguments to reclassify these disorders as "SWI/SNF-related intellectual disability syndromes."



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Novel homozygous missense mutation in NT5C2 underlying hereditary spastic paraplegia SPG45

SPG45 is a rare form of autosomal recessive spastic paraplegia associated with mental retardation. Detailed phenotyping and mutation analysis was undertaken in three individuals with SPG45 from a consanguineous family of Arab Muslim origin. Using whole-exome sequencing, we identified a novel homozygous missense mutation in NT5C2 (c.1379T>C; p.Leu460Pro). Our data expand the molecular basis of SPG45, adding the first missense mutation to the current database of nonsense, frameshift, and splice site mutations. NT5C2 mutations seem to have a broad clinical spectrum and should be sought in patients manifesting either as uncomplicated or complicated HSP.



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Congenital heart defects in molecularly proven Kabuki syndrome patients

The prevalence of congenital heart defects (CHD) in Kabuki syndrome ranges from 28% to 80%. Between January 2012 and December 2015, 28 patients had a molecularly proven diagnosis of Kabuki syndrome. Pathogenic variants in KMT2D (MLL2) were detected in 27 patients, and in KDM6A gene in one. CHD was diagnosed in 19/27 (70%) patients with KMT2D (MLL2) variant, while the single patient with KDM6A change had a normal heart. The anatomic types among patients with CHD included aortic coarctation (4/19 = 21%) alone or associated with an additional CHD, bicuspid aortic valve (4/19 = 21%) alone or associated with an additional CHD, perimembranous subaortic ventricular septal defect (3/19 = 16%), atrial septal defect ostium secundum type (3/19 = 16%), conotruncal heart defects (3/19 = 16%). Additional CHDs diagnosed in single patients included aortic dilatation with mitral anomaly and hypoplastic left heart syndrome. We also reviewed CHDs in patients with a molecular diagnosis of Kabuki syndrome reported in the literature. In conclusion, a CHD is detected in 70% of patients with KMT2D (MLL2) pathogenic variants, most commonly left-sided obstructive lesions, including multiple left-sided obstructions similar to those observed in the spectrum of the Shone complex, and septal defects. Clinical management of Kabuki syndrome should include echocardiogram at the time of diagnosis, with particular attention to left-sided obstructive lesions and mitral anomalies, and annual monitoring for aortic arch dilatation.



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Two novel mutations in XYLT2 cause spondyloocular syndrome

We report on two new patients with spondyloocular syndrome. Both patients harbor novel homozygous mutations in the XYLT2 gene. The patients present severe generalized osteoporosis, multiple fractures, short stature, cataract, and mild hearing impairment. XYLT2 mutations have been identified in spondyloocular syndrome, however only five mutations have been reported previously. These two patients with novel mutations extend the phenotypic and genotypic spectrum of spondyloocular syndrome.



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Testing the face shape hypothesis in twins discordant for nonsyndromic orofacial clefting

Nonsyndromic orofacial clefts (OFCs) are complex traits characterized by multifactorial inheritance and wide phenotypic variability. Numerous studies have shown subtle differences in the faces of unaffected relatives from cleft families compared to controls, the implication being that such outward differences are an incomplete expression reflecting an underlying genetic predisposition. Twins discordant for OFCs provide a unique opportunity to further test this idea, as the unaffected co-twin shares on average 50% (for dizygotic twins) and 100% (for monozygotic twins) of the genetic risk factors as the affected twin. We used 3D surface imaging and spatially-dense morphometry to compare facial shape in a sample of 44 unaffected co-twins and age- and sex-matched unaffected controls (n = 241). Unaffected co-twins showed statistically significant differences in the midface, lateral upper face, and forehead regions, compared to controls. Furthermore, co-twins were characterized by a distinct pattern of midfacial retrusion, broader upper faces, and greater protrusion of the mandible and brow ridges. This same general facial pattern was shown in both unaffected monozygotic and dizygotic co-twin subsets. These results provide additional support that altered facial shape is a phenotypic marker for OFC susceptibility.



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FOXP1 haploinsufficiency: Phenotypes beyond behavior and intellectual disability?

The forkhead box (FOX) transcription factors have roles in development, carcinogenesis, metabolism, and immunity. In humans FOXP1 mutations have been associated with language and speech defects, intellectual disability, autism spectrum disorder, facial dysmorphisms, and congenital anomalies of the kidney and urinary tract. In mice, Foxp1 plays critical roles in development of the spinal motor neurons, lymphocytes, cardiomyocytes, foregut, and skeleton. We hypothesized therefore that mutations of FOXP1 affect additional tissues in some humans. Supporting this hypothesis, we describe two individuals with novel variants of FOXP1 (NM_032682.5:c.975-2A>C and NM_032682.5:c.1574G>A) and additional features. One had a lung disease resembling neuroendocrine cell hyperplasia of infancy (NEHI), and the second had a skeletal disorder with undertubulation of the long bones and relapsing-remitting fevers associated with flushing and edema. Although attribution of these traits to mutation of FOXP1 requires ascertainment of additional patients, we hypothesize that the variable expression of these additional features might arise by means of stochastic developmental variation.



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Variable phenotypic expression in a large Noonan syndrome family segregating a novel SOS1 mutation

Noonan syndrome (NS) is an autosomal dominant multisystem condition with a variable phenotype. The most characteristic features are short stature, congenital heart defects, and recognizable facial features. Mutations in SOS1 are found in 10–20% of patients with NS. Different genotype–phenotype studies mention correlations between SOS1 mutations and some features, such as ectodermal abnormalities and specific facial features. We present a large NS family with a novel pathogenic mutation; SOS1 c.3134C>G, p.Pro1045Arg. Ten family members with NS are included with genetically confirmed mutation and clinical evaluation. The phenotype shows a broad spectrum from only few suggestive features for NS in the older generation to typical features in the youngest generation. We report on a novel pathogenic mutation in the SOS1 gene and a large clinical spectrum in a NS family with ten genetically confirmed affected individuals.



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Peeling skin syndrome associated with novel variant in FLG2 gene

Peeling skin syndrome is a rare genodermatosis characterized by variably pruritic superficial generalized peeling of the skin with several genes involved until now little is known about the association between FLG2 and peeling skin syndrome. We describe multiple family members from a consanguineous Saudi family with peeling skin syndrome. Next Generation Sequencing identifies a cosegregating novel variant in FLG2 c.632C>G (p.Ser211*) as a likely etiology in this family. Here, we reported on the clinical manifestation of homozygous loss of function variant in FLG2 as a disease-causing gene for peeling skin syndrome and expand the dermatology findings.



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Chimerism for 20q11.2 microdeletion of GDF5 explains discordant phenotypes in monochorionic-diamniotic twins

Microdeletions of 20q11.2 are rare but have been associated with characteristic clinical findings. A 1.6 Mb minimal critical region has been identified that includes three OMIM genes: GDF5, EPB41L1, and SAMHD. Here we describe a male monozygotic, monochorionic-diamniotic twin pair with discordant phenotypes, one with multiple findings that overlap with those reported in 20q11.2 deletions, and the other unaffected. Microarray analysis revealed mosaicism for a 363 Kb deletion encompassing GDF5 in the peripheral blood of both twins, which was confirmed by FISH. Subsequent FISH on buccal cells identified the deletion only in the affected twin. The blood FISH findings were interpreted as representing chimerism resulting from anastomosis and the blood exchange between the twins in utero. The implications of this finding are discussed, as is the contribution of GDF5 to the associated clinical findings of 20q11.2 deletions.



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