Σάββατο, 11 Νοεμβρίου 2017

Attendance At Prescribed Pelvic Floor Physical Therapy In A Diverse, Urban Urogynecology Population

Pelvic floor physical therapy (PFPT) is a common and effective treatment for several pelvic floor disorders, but there is limited knowledge about adherence to the therapy or what factors influence attendance.

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Ultrasound finding of ischiofemoral impingement syndrome and novel treatment with botulinum toxin chemodenervation: a case report

Ischiofemoral impingement syndrome (IFIS) is a rare and poorly understood condition that leads to deep gluteal pain, groin, and/or medial thigh pain. It has unique diagnostic challenges, with limited non-operative treatment options. It is caused by the impingement of the quadratus femoris by the lesser trochanter and the ischium. Currently there are no validated physical examination maneuvers for IFIS, and the value of ischiofemoral interval for establishing IFIS is also uncertain. Ultrasound-guided corticosteroid injections have been reported.

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Value of oxyneurography, based on near infrared spectroscopy, in the diagnosis of carpal tunnel syndrome in comparison to provocative clinical diagnostic tests and nerve conduction studies

Near Infrared (NIR) is a form of electromagnetic radiation of the wavelength of 700-1000 nanometers. It is positioned within range of the infrared waves, between visible light and radio waves. Tissues absorb photons of NIR radiation with an aid of the molecules called chromophores that include haemoglobin (85-88%), myoglobin (10%) and oxidase of cytochrome C (2-5%) (Boushel and Piantadosi, 2000; Boushel et al., 2001). Oxidation state i.e. oxygenation of the chromophores changes the intensity of the absorbed light.

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What is the optimal frequency range for quantifying slow EEG activity in neonates? Insights from power spectra

Several weeks before and following term age, intermittent anterior slow waves in the delta frequency range (<4 Hz) are a normative neonatal EEG feature (e.g., Clancy et al., 2014; Fig.1A). Various quantitative electroencephalographic (qEEG) studies of infants born preterm have analyzed relative power of delta and other frequency bands. For example, across 60 healthy infants born at 26-41 weeks and assessed with EEG on the third day, Bell et al. (1991) reported gestational age (GA) was negatively correlated with relative "lower-delta" (0.25-1 Hz) power.

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Oxyneurography: A non-invasive NIRS technique to measure nerve oxygenation

Few people doubt the importance of cerebral blood flow integrity for the preservation of neural tissue. Blood flow compromise, causing a cerebro-vascular accident (CVA), results in nervous tissue damage or stroke.

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Detection of proximal conduction blocks using a triple stimulation technique improves the early diagnosis of Guillain–Barré syndrome

Guillain–Barré syndrome (GBS) is an acute autoimmune peripheral neuropathy with different subtypes (Wakerley et al., 2014). The diagnostic criteria include: clinical presentation (Van der Meché et al., 2001; Wakerley et al., 2014; Fokke et al., 2014), electrophysiological data, (Ho et al., 1995; Hadden et al., 1998; Van den Bergh and Piéret, 2004; Rajabally et al., 2015) and biological clues (Wakerley et al., 2014).

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4. Does small fiber pathology in PD change over time?

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): M. Nolano, V. Provitera, A. Stancanelli, A. Saltalamacchia, G. Caporaso, F. Lullo, I. Borreca, G. Piscosquito, B. Lanzillo, L. Santoro
Small fiber pathology is part of the clinical picture of PD. Cross-sectional studies have shown no correlation between intraepidermal nerve fiber (IENF) density and patient disease duration and severity. However, it is not known whether IENF density changes over time. We aimed to assess the progression of small fiber pathology in PD patients along the disease course.We assessed epidermal innervation at time 0 and after 1–9years (mean 3.5) in 17 PD patients (M/F=11/6, age=64.4±15.3) leg on punch biopsies. Patients were assessed in a rehabilitative setting. They underwent yearly 30-days hospitalizations and were trained to continue a home-personalized program of physical exercises between successive evaluations. Quantitative sensory testing and sudomotor assessment were also performed.Overall, no difference (p=0.12) between the first and the last IENF density (8.7±4.0 vs. 10.3±4.9) assessment was found. However, the IENF density variation correlated with the disease duration (r=0.71; p<0.01). In fact, while in patients with shorter disease duration IENF density increased over time, in patients with longer disease duration (approximately over 8years) an IENF loss was observed.The small fiber pathology associated to PD can improve to some extent by optimizing patient care, at least in the first stages of disease.



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20. Not only the absence but also amplitude reduction of cortical SEPs predict ominous outcome in comatose patients after cardiac arrest

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): R. Carrai, A. Grippo, F. Lolli, M. Spalletti, M. Scarpino, C. Ielapi, G. Lanzo, A. Peris, G. Cianchi, G. Olivo, S. Valente, A. Amantini
In comatose patients after cardiac arrest (CA) bilateral absence of cortical SEPs is a high reliable predictor of poor outcome but it is present in no more than 40%. Low amplitude pathological SEPs were found in 28.9% of subjects but only few papers analysed the prognostic significance of this pattern.To evaluated prognostic value of N20-P25 amplitude of SEPs, recorded at 6–12h after CA.Retrospectively, we analysed comatose patients after CA admitted to our hospital. SEPs were recorded at 6–12hs after CA. We determined the lowest SEP amplitude in a subject that recovery consciousness We evaluated the accuracy of SEP amplitude in predicting the "no consciousness recovery" by ROC curves. Outcome was evaluated at 6months by GOS.One-hundred and eighteen patients were analysed. None of subjects with N20-P25 amplitude less than 1.2μV recovered consciousness. The area under the ROC curves was 0.96 for "no consciousness recovery". SEP amplitude threshold determined by ROC analysis was 1.21μV. For this SEP amplitude threshold, we found a sensibility: 85.9% and specificity: 100.0%.Not only the absence but also the amplitude reduction (less than 1.2μV) of N20-P25 is associated with no consciousness recovery with very high predictive value.



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Cerebellar transcranial direct current stimulation improves adaptive postural control

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Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Peter Poortvliet, Billie Hsieh, Andrew Cresswell, Jacky Au, Marcus Meinzer
ObjectiveRehabilitation interventions contribute to recovery of impaired postural control, but it remains a priority to optimize their effectiveness. A promising strategy may involve transcranial direct current stimulation (tDCS) of brain areas involved in fine-tuning of motor adaptation. This study explored the effects of cerebellar tDCS (ctDCS) on postural recovery from disturbance by Achilles tendon vibration.MethodsTwenty-eight healthy volunteers participated in this sham-ctDCS controlled study. Standing blindfolded on a force platform, four trials were completed: 60 s quiet standing followed by 20 min active (anodal-tDCS, 1 mA, 20 min, N = 14) or sham-ctDCS (40 s, N = 14) tDCS; three quiet standing trials with 15 s of Achilles tendon vibration and 25 s of postural recovery. Postural steadiness was quantified as displacement, standard deviation and path derived from the center of pressure (COP).ResultsBaseline demographics and quiet standing postural steadiness, and backwards displacement during vibration were comparable between groups. However, active-tDCS significantly improved postural steadiness during vibration and reduced forward displacement and variability in COP derivatives during recovery.ConclusionsWe demonstrate that ctDCS results in short-term improvement of postural adaptation in healthy individuals.SignificanceFuture studies need to investigate if multisession ctDCS combined with training or rehabilitation interventions can induce prolonged improvement of postural balance.



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12. New Telemedicine protocol and patented remote-EEG system from Terni S. Maria Hospital Neurophysiology Division: Experimental assessment and pathway towards large scale service

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): G. Stipa, F. Gabbrielli, D. Frondizi, C. Colosimo, S. Caproni, C. Fanelli, D. Gobbi, L. Giorgi, A. Mancini, M. Domiziani, R. Pasqui, S. Carletti
Terni S. Maria Hospital Neurophysiology Division successfully performed experimental trial for innovative Telemedicine service, using patented remote-EEG system.The Neurophysiologist can be connected from everywhere to the hospital information system through virtual private network and remote device. EEG-passive electrode device is effectively controlled by different direct Remote Desktop freeware softwares. EEG-diagnosis is possible at distance avoiding file exchanges and fulfilling privacy and safety criteria. The connection shares the graphic interface from EEG device desktop to the remote Neurophysiologist, who can also directly control EEG device functions. From 2009 to 2017 a total of 261 EEGs (standard and continuous monitoring) were examined. In the first 6years, specialists operated on EEG device at distance but they sent medical reports by telefax, while from 2016 to 2017 they used report files with digital signature.Two hospital deliberations (n. 875 dated 2008/12/29 and n. 198 dated 2015/03/18) validated the procedure for clinical use, even if into the research protocol. These trial-evidences as well the new regulations on Telemedicine (Intesa Stato-Regioni n. 123/CSR 2016/7/7; EU Directive 2011/24; EU Regulation 2016/679) pave the way for large scale usage of this protocol.The Group of study on Telemedicine in Neurophysiology founded by SINC and Digital-SIT works on this purpose.



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Editorial Board

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12





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Contents

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12





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8. Neurophysiological comparison among tonic, high frequency and burst spinal cord simulation: Novel insights into spinal and brain mechanisms of action

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): T. Bocci, G. De Carolis, D. Barloscio, L. Parenti, M. Valeriani, F. Sartucci
Spinal cord Stimulation (SCS) is an effective option for neuropathic pain treatment. New technological developments, as high-frequency (HF) and Theta Burst Stimulation (TBS), have shown promising results, although putative mechanisms of action are still debated.Twenty-five patients with lower back pain were enrolled and underwent LF, HF and TBS. LEPs were recorded by using a Nd:YAG laser: amplitudes and latencies of the main two components (N1, N2/P2) were compared among different experimental conditions. Similarly, changes in Resting Motor Threshold (RMT), cortical Silent Period (cSP), Short Intracortical Inhibition (SICI) and Intracortical Facilitation (ICF) were evaluated.TBS dampened LEP amplitudes compared with LF (N1: p=0.016; N2/P2: p=0.02) and HF stimulation (p=0.015; p=0.031); while RMT and SICI did not change among experimental conditions, TBS significantly prolonged cSP duration compared with baseline (p=0.002), LF (p=0.048) and HF-SCS (p=0.016); both HF (p=0.004) and TBS (p=0.0039) increased ICF.TBS modulates the sensory-discriminative and the affective-emotional dimension of pain through distinct mechanisms, thus involving intracortical GABAergic and Glutamatergic networks. These results have implications for therapy and for the choice of the stimulation protocol.



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Ultrasound in polyneuropathies – Is size or structure all that matters?

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): A. Kerasnoudis, K. Pitarokoilli, M.-S. Yoon




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16. Safety and effects on motor cortex of closely repeated cathodal transcranial direct current stimulations (C-tDCS)

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): A. Uncini, F. Zappasodi, G. Musumeci, R. Navarra, M. Caulo, V. Di Lazzaro
To assess safety and effects of five C-tDCS (charge density 342,857C/m2) delivered at increasing time intervals in 25h.Safety was defined as absence of serious adverse events and by magnetic resonance imaging and spectroscopy. Effects on motor cortex excitability were evaluated by motor evoked potential (MEP) amplitudes. Inter-individual MEP variability was calculated by the SEM at baseline and subjects were classified on the basis of the ratio between normalized MEPs after the first stimulation compared to baseline.Thirty-two healthy subjects were enrolled. No serious adverse events occurred. Magnetic resonance imaging and spectroscopy did not show structural and biochemical alterations. Only 56% of subjects responded to cathodal-tDCS with the expected reduction of MEP amplitude, 25% were non-responders and 19% opposite responders. In responders, MEP suppression was 32% one hour after the first cathodal-tDC, 21% three hours after the second, no longer present four hours after the third and 12h after the fourth cathodal-tDCS. Loss of effect was due to the increasing interval between C-tDCS and not to intervening homeostatic plasticity.Five C-tDCS in 25h are safe. Interindividual variability on motor cortex excitability and effect duration limited to three hours should be considered in planning therapeutic trials utilizing repeated C-tDCS.



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First virtual special issue (VSI) in Clinical Neurophysiology: A novel way of enhancing accessibility and visibility of published research

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): Ulf Ziemann




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2. Pain catastrophizing and features of cortical response to painful stimuli in fibromyalgia

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): K. Ricci, E. Vecchio, M. Delussi, A. Montemurno, E. Gentile, M. de Tommaso
Gamma Band Oscillations (GBO) after laser stimuli are currently considered a correlate of subjective pain perception. Habituation of laser evoked potentials (LEPs) is reduced in patients with central amplification of pain stimuli.To correlate LEPs habituation and GBO induced by laser stimulation with subjective pain rating and pain catastrophizing in patients with Fibromyalgia (FM) and controls.We recorded LEPs in 30 FM patients and 15 healthy controls by stimulating the dorsum of the right hand. At the end of each series, the perceived pain was rated on a visual pain analogue scale (VAS). All subjects were submitted to the Pain Catastrophizing Scale – Italian version (PCS-I).The FM patients showed reduced LEPs habituation and increased laser-related GBO. Both patterns correlated with the PCS-I, but not with subjective pain rating.LEPs habituation and GBO may be the expression of cortical mechanisms of nociceptive stimuli processing and exaggerated attentional orientation toward pain experiences.



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6. Trigeminal neuralgia typical and atypical. A disease or two?

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): C.M. Leone, G. Di Stefano, G. Cruccu, A. Truini
Trigeminal Neuralgia (TN) is a clinical condition characterized by a sudden, usually unilateral, brief, stabbing, recurrent pain with a distribution consistent with one or more divisions of the fifth cranial nerve. In the classical form, the genesis of paroxysmal pain has been attributed to areas of focal demyelination due to vascular compression on the nerve. The 20–50% of patients with TN have an atypical form characterized by the presence of constant pain, often described as burning continuous or sub-continuous, as well as paroxysmal pain.We hypothesize an axonal damage underlying the constant pain component.We enrolled 55 patients with typical (n=36) and atypical (n=19) TN according to the criteria of the 3rd edition of the International Classification of Headache Disorders (ICHD-3). Each patient underwent magnetic resonance imaging (MRI), laser evoked potentials (LEPs) and trigeminal reflexes.The comparison between the duration of disease between the two groups showed no significant differences. We found a greater asymmetry of amplitude (healthy side vs affected side) of N2-P2 component from thermal stimulation in the group with atypical TN (p<0.047).The atypical form has an axonal damage and is not a time-bound phenomenon. The involvement of C-fibers could be the mechanism behind continuous pain.



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10. Neurophysiological prognosis in comatose patients after cardiac arrest: The Italian Multicentric Study (ProNeCA)

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): A. Grippo, R. Carrai, D. Audenino, C. Callegarin, M.G. Celani, M. Lombardi, A. Marrelli, O. Mecarelli, C. Minardi, F. Minicucci, L. Motti, L. Politini, F. Valzania, E. Vitelli, M. Scarpino, M. Spalletti, G. Lanzo, C. Cossu, A. Peris, S. Amantini
To evaluate the prognostic value of EEG and SEPs association in post-anoxic comatose patients at different recording time from cardiac arrest (CA) with a prospectic multicentre study.Twelve hospitals participated to the study. EEG and SEPs were recorded within 12, 24, and at 72hs after CA. EEG was classified into "non-continuous" and "continuous". SEPs were dichotomized into "bilaterally absent" (BA) and "present". Neurologic outcome was evaluated at 6months by Cerebral Performance Category.Among the 392 patients admitted after CA in the 11 hospitals 298 where enrolled. Within 12h (120 patients) after CA, continuous EEG predicted good outcome and BA SEPs predicted poor outcome. Continuous EEG and BA-SEPs were never found in the same patient. At 48–72h after CA (142 patients) both grade 2 EEG and BA-SEPs predicted poor outcome.The combination of EEG/SEP findings allows prediction of good and poor outcome (within 12h after CA) and of poor outcome (after 48–72h). Recording of EEG and SEPs in the same patients allows always an increase in the number of cases correctly classified, and an increase of the reliability of prognostication in a single patient due to concordance of patterns.



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14. Cerebellar direct current stimulation modulates hand blink reflex: Implications for defensive behavior in humans

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): T. Bocci, R. Ferrucci, D. Barloscio, L. Parenti, F. Cortese, A. Priori, F. Sartucci
The cerebellum is involved in a wide number of integrative functions. We evaluated the role of cerebellum in peripersonal defensive behavior, as assessed by the so-called hand blink reflex (HBR).Twenty subjects underwent to cerebellar (sham, anodal, cathodal) and motor cortex (anodal or cathodal) tDCS (20′, 2mA). For the recording of HBR, electrical stimuli were delivered using a surface bipolar electrode placed on the median nerve at the wrist and EMG activity recorded from the orbicularis oculi muscle bilaterally. HBR was assessed in four different conditions: "hand far", "hand near" (eyes open), "side hand" and "hand patched" (eyes closed).While sham and cathodal cerebellar stimulation had no significant effect, anodal tcDCS dramatically dampened the magnitude of the HBR, as measured by the area under the curve (AUC), in the hand-patched and side hand conditions only, for ipsilateral (p<0.0001; p=0.0008) as well as contralateral recordings (p=0.46; p=0.66). tDCS applied over the motor area did not affect HBR.Our results support a role of the cerebellum in the defensive responses within the peripersonal space surrounding the face and suggesting a cerebellar involvement in visual-independent learning of defensive behavior.



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18. Intraoperative monitoring in calcified giant thoracic disc herniations in anterior thoracic approach surgery

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): C. Minardi, F. Cultrera, M. Bocchino, G. Pugliese, G. Fedeli, R. Donati
Giant herniated thoracic disc (GHTD) is a surgical challenge with high rate of complication. This was a retrospective study of all patients with calcified GHTD operated between July 2012 and February 2017 with intraoperative neurophysiological monitoring (IOM).The study included 10 patients (9 females and 1 male).IOM study comprised: transcranial electric motor evoked potentials (MEP) and somatosensory evoked potentials (SEP) from all limbs in supine position and after lateral position.IOM MEP at the end of surgery were reduced in 4 recovered in 1, stable in 5 patients and disappeared at left lower limb in 1 patient.IOM SEP were stable in 6 patients, reduced in amplitude in 2, disappeared in 1 and in 1 case SEP at lower limbs were absent from preoperative study.The neurological outcome was stable in 9 and transitory worsened in 1 patient, who lost MEP in lower left limb.The surgical strategy was modified according to IOM findings in 4 cases leading to a partial disc excision, one where IOM MEP disappeared and 3 where MEP decreased without recovering.IOM is usefull in this combined surgery (thoracic surgery and neurosurgery) and can help to remove safely GHDT without new permanent neurological deficits.



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22. New frontiers in neurophysiological instrumental diagnostics in the neonatal intensive care unit: “Smart-EEG”

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): I. Capuano, S. Gabbanini, M. Bastianelli, C. Cossu, I. Roma, S. Lori
The neurophysiological instrumental diagnostics is gaining increasingly an undisputed value, revealing an indispensable practice for both diagnostic and prognostic purposes.Many novelties in medicine have introduced an innovative model of Electronic Health, called E-Health.The purpose of this study is to verify that a new modular device, the BluNet®, is a device able to maximize patient comfort and to operate in a way effective but minimally invasive.The study was conducted on a sample of 10 neonates (5F), with gestational ages between the 27+6 and 41weeks, and the recordings were done simultaneously with two devices: NeMus® (gold standard) and BluNet.We made a visual comparison with the reading software, we extracted and compared the frequency of polygraphic channels (ECG and abdominal breathing) and we made two Bland-Altman-Plots. We also conducted a spectral analysis of the traces.The signals' studies showed that there aren't substantial differences between the signals acquired through the two different methods.BluNet, thanks to its innovative features, is a valid tool for electroencephalographic evaluation and the prospects for future use are manifold: screening for early differential diagnosis, initial evaluation for possible hospitalization, ability to get tests at home.



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1. Laser evoked potential in clinical practice: The diagnostic field in small fiber neuropathy

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): G. Devigili, S. Rinaldo, C. Lettieri, R. Eleopra
Small fiber neuropathy (SFN) is frequently encountered in clinical practice. Due to the small nerve fiber characteristics, the diagnosis requires the use of not conventional tests like skin biopsy, Quantitative sensory testing (QST) and Laser Evoked Potentials (LEPs). The aim of this study was to evaluate the diagnostic value of A-delta LEPs in clinical practice in a large cohort of patients with diagnosis of "definite" SFN.We screened 296 patients evaluated in our institution with confirmed diagnosis of sensory neuropathy. We collected 140 patients with pure SFN and 79 patients with mixed fiber neuropathy (MFN). All underwent clinical evaluation, sensory, painful thermal and mechanical detection thresholds, and quantification of somatic intraepidermal nerve fibers (IENF) by skin biopsy to define the diagnosis. Then, all SFN and MFN patients underwent LEPs. The sensitivity and specificity were calculated compared with our normative data on 67 healthy age-matched subjects. A-delta LEPs at dorsal foot showed 76% sensitivity and 80% specificity in SFN diagnosis, and, if performed bilaterally, the sensitivity and specificity increased (81% and 84%). We did not find any correlation between LEPs and entity of skin denervation, but we found good concordance with warm, heat pain thresholds and pinprick perception.



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3. Immunofluorescence characterization of skin nerve misfolded α-synuclein in different synucleinopathies: A confocal study

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): V. Donadio, A. Incensi, O. El-Agnaf, G. Rizzo, N. Vaikath, C. Scaglione, S. Capellari, M. Stanzani Maserati, R. Pantieri, R. Liguori
Intraneural misfolded α-synuclein (syn) characterized different synucleinopathies such as pure autonomic failure (PAF), idiopathic Parkinson disease (IPD) and dementia with Lewy Bodies (DLB). The aim of this study is to characterize by immunofluorescence the skin intraneural α-synuclein (syn) deposits in PAF, IPD and DLB to ascertain conformation-specific differences which may justify a different clinical phenotype.We identified a total of 21 skin intraneural abnormal syn deposits in PAF (3 patients), 22 in IPD (8 patients) and 40 in DLB (7 patients). Ten healthy subjects were used controls. Skin biopsy was performed on proximal (C7 paravertebral) and distal (thigh and leg) sites. To characterize abnormal syn deposits we used primary antibodies against native α-synuclein (NAC) and against C-terminal α-synuclein epitopes involved in post-translational modifications such as phosphorylation at serine 129 (pS129) and tyrosine 125 (pY125), nitrate α-synuclein at tyr125-133 (nY125-133) and advanced glycation end products (AGEs). Furthermore, the mature amyloid α-synuclein fibrils were characterized by using a non-commercial antibody (Syn-F) and ubiquitin deposits were identified by a specific antibody (UBI).Antibody raised against pS129 disclosed abnormal skin nerves syn deposits in all patients and never in the control group. Abnormal pS129 syn deposits were often (80–90% of all analysed deposits) stained by the antibody recognizing a fibril conformation, seldom (around 40%) by native antibodies and very occasionally by antibodies against nY125-133. Furthermore, abnormal syn deposits were not stained by antibodies against pY125, AGEs and UBI. The immunofluorescence characterization of abnormal syn deposits showed similar findings in IPD, PAF and DLB although in these latter abnormal deposits were quantitatively higher than in IPD.Phosphorylation at serine 129 was the most sensitive and specific epitope to identify skin nerves abnormal syn deposits for the in vivo diagnosis of synucleinopathies; (2) skin syn neuritis showed no relevant immunofluorescence differences in PAF, IPD and DLB suggesting a similar conformation among different clinical phenotypes.



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A look inside the nerve – Morphology of nerve fascicles in healthy controls and patients with polyneuropathy

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): Alexander Grimm, Natalie Winter, Tim W. Rattay, Florian Härtig, Nele M. Dammeier, Eva Auffenberg, Marilin Koch, Hubertus Axer
ObjectivePolyneuropathies are increasingly analyzed by ultrasound. Summarizing, diffuse enlargement is typical in Charcot-Marie Tooth type 1 (CMT1a), regional enlargement occurs in inflammatory neuropathies. However, a distinction of subtypes is still challenging. Therefore, this study focused on fascicle size and pattern in controls and distinct neuropathies.MethodsCross-sectional area (CSA) of the median, ulnar and peroneal nerve (MN, UN, PN) was measured at predefined landmarks in 50 healthy controls, 15 CMT1a and 13 MMN patients. Additionally, largest fascicle size and number of visible fascicles was obtained at the mid-upper arm cross-section of the MN and UN and in the popliteal fossa cross-section of the PN.ResultsCut-off normal values for fascicle size in the MN, UN and PN were defined (<4.8mm2, <2.8mm2 and <3.5mm2). In CMT1a CSA and fascicle values are significantly enlarged in all nerves, while in MMN CSA and fascicles are regionally enlarged with predominance in the upper arm nerves. The ratio of enlarged fascicles and all fascicles was significantly increased in CMT1a (>50%) in all nerves (p<0.0001), representing diffuse fascicle enlargement, and moderately increased in MMN (>20%), representing differential fascicle enlargement (enlarged and normal fascicles at the same location) sparing the peroneal nerve (regional fascicle enlargement). Based on these findings distinct fascicle patterns were defined.ConclusionNormal values for fascicle size could be evaluated; while CMT1a features diffuse fascicle enlargement, MMN shows regional and differential predominance with enlarged fascicles as single pathology.SignificancePattern analysis of fascicles might facilitate distinction of several otherwise similar neuropathies.



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5. Vocal cord paralysis in children: A new neurophysiological approach for diagnosis and functional prognosis

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Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): P. Lanteri, S. Martelli, F. Bollati, L. Pisciotta, M. Tumulo, R. D'Agostino
To establish the possibility to use the methodology of recording corticobulbar motor evoked potentials (CoMEPs) from cricothyroid muscles (CTHY) and vocal cord elicited by transcranial electrical stimulation (TES), as diagnostic tool for predicting function recovery in children with vocal fold immobility (VFI).We included six children (mean age: 4.7years; range: 2–9years) with diagnosis of cord immobility that underwent video-fibro-endoscopy procedure. Under general anaesthesia, we used TES by stimulation over C3/Cz or C4/Cz to elicit CoMEPs. To record CoMEPs from vocal muscles we used two hook wire electrodes (76 micron diameter) passing through a 27-gauge needle endotracheally placed in the vocal muscles after intubation.Recording of CoMEPs in the vocal muscles after TES was successfully performed bilaterally in 4 patients and monolaterally in two patients. TES over the right or left hemisphere elicited responses bilaterally. The mean onset latency for the vocal muscles was 16.4±3ms. The possibility to record CoMEP from vocal muscle was a positive prognostic feature for clinical improvement.This method shows the ability to evaluate the functional integrity of corticobulbar pathways in a reliable manner and adds an additional tool in the diagnosis and prognosis of VFI.



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Behavioural and Emotional Problems in Children and Educational Outcomes: A Dynamic Panel Data Analysis

Abstract

This study investigates the effects of behavioural and emotional problems in children on their educational outcomes using data from the Longitudinal Survey of Australian Children (LSAC). We contribute to the extant literature using a dynamic specification to test the hypothesis of knowledge accumulation. Further, we apply the system generalised method of moments (GMM) estimator to minimise biases due to unobserved factors. We find that mental disorders in children has a negative effect on the National Assessment Program—Literacy and Numeracy (NAPLAN) test scores. Among all mental disorders, having emotional problems is found to be the most influential with one standard deviation (SD) increase in emotional problems being associated with 0.05 SD reduction in NAPLAN reading, writing and spelling; 0.04 SD reduction in matrix reasoning and grammar; and 0.03 SD reduction in NAPLAN numeracy.



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Dynamic transcriptional control of macrophage miRNA signature via inflammation responsive enhancers revealed using a combination of next generation sequencing-based approaches

Publication date: Available online 11 November 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Zsolt Czimmerer, Attila Horvath, Bence Daniel, Gergely Nagy, Ixchelt Cuaranta-Monroy, Mate Kiss, Zsuzsanna Kolostyak, Szilard Poliska, Laszlo Steiner, Nikolas Giannakis, Tamas Varga, Laszlo Nagy
MicroRNAs are important components of the post-transcriptional fine-tuning of macrophage gene expression in physiological and pathological conditions. However, the mechanistic underpinnings and the cis-acting genomic factors of how macrophage polarizing signals induce miRNA expression changes are not well characterized. Therefore, we systematically evaluated the transcriptional basis underlying the inflammation-mediated regulation of macrophage microRNome using the combination of different next generation sequencing datasets. We investigated the LPS-induced expression changes at mature miRNA and pri-miRNA levels in mouse macrophages utilizing a small RNA-seq method and publicly available GRO-seq dataset, respectively. Next, we identified an enhancer set associated with LPS-responsive pri-miRNAs based on publicly available H3K4 mono-methylation-specific ChIP-seq and GRO-seq datasets. This enhancer set was further characterized by the combination of publicly available ChIP and ATAC-seq datasets. Finally, direct interactions between the miR-155-coding genomic region and its distal regulatory elements were identified using a 3C–seq approach. Our analysis revealed 15 robustly LPS-regulated miRNAs at the transcriptional level. In addition, we found that these miRNA genes are associated with an inflammation-responsive enhancer network. Based on NFκB-p65 and JunB transcription factor binding, we showed two distinct enhancer subsets associated with LPS-activated miRNAs that possess distinct epigenetic characteristics and LPS-responsiveness. Finally, our 3C–seq analysis revealed the LPS-induced extensive reorganization of the pri-miR-155-associated functional chromatin domain as well as chromatin loop formation between LPS-responsive enhancers and the promoter region. Our genomic approach successfully combines various genome-wide datasets and allows the identification of the putative regulatory elements controlling miRNA expression in classically activated macrophages.



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Rpb5 modulates the RNA polymerase II transition from initiation to elongation by influencing Spt5 association and backtracking

Publication date: Available online 11 November 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Verónica Martínez-Fernández, Ana Isabel Garrido-Godino, María Carmen Mirón-García, Victoria Begley, Antonio Fernández-Pévida, Jesús de la Cruz, Sebastián Chávez, Francisco Navarro
Rpb5 is a subunit shared by the three eukaryotic RNA polymerases although its role in transcription remains unclear. It has been proposed that it makes contact with the promoter DNA and to participate in the co-ordination of the opening/closing of the RNA polymerase II DNA cleft. Here, we report the specific role of Rpb5 in the function of the yeast RNA polymerase II. The rpb5-P151T mutation specifically impairs transcription elongation by RNA polymerase II but does not influence the functions of RNA polymerases I or III. The comparison of RNA polymerase II ChIP and run-on signals indicates a higher tendency to backtrack by this mutant, in agreement with its lower elongation rate and its genetic interactions with dst1Δ mutant. This phenotype is particularly striking shortly after transcription initiation and is linked to differences in the phosphorylation state of the RNA polymerase II and reduced recruitment of Spt5 to transcribe chromatin, thus influencing its anti-backtracking activity. All together, our results reveal an important role of Rpb5 in the transition from initiation to elongation mediated by the RNA polymerase II, by modulating the Spt5 association, and the backtracking activity of the enzyme.



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Title Page/Sections Editors

Publication date: December 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1860, Issue 12





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Employing Community Voices: Informing Practice and Programming through Camden Healthy Start Focus Groups

Abstract

Objectives Women living in communities with low-socioeconomic status, substandard healthcare, and ongoing exposure to social disparities encounter barriers to healthcare, often making it difficult to access health services. Barriers may stem from provider interactions with clients, conditions of the healthcare facility, or even language barriers. This prompts a call for providers to be keenly aware of the obstacles women encounter when attempting to access services. Methods In an effort to facilitate better access to services, Camden Healthy Start conducted six focus groups. Thirty-nine women between the ages of 22–56 participated. A total of 39 questions were posed to participants about health behavior, health services, pregnancy, reproductive health, and barriers to accessing services. Each 2 h session was audio recorded, translated and transcribed. Following the format of the Women's Health: Attitudes and Practices in North Carolina Focus Group Research, responses were analyzed and themes emerged. Results This article discusses characteristics of healthcare services and cultural insensitivity that impact women's access and act as barriers to care. The results signal the need for Healthy Start to apply a more relational engagement when providing services. Consideration for Practice Relational engagement includes getting to know the client as a person first, respecting their rights to autonomy in the decision making process, and demonstrating an understanding of the client's culture and inclusion of their voices in the conversation.



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Infant Mortality Lessons Learned from a Fetal and Infant Mortality Review Program

Abstract

Objective To review fetal and infant deaths from women enrolled in Indianapolis Healthy Start using the National Fetal and Infant Mortality Review (FIMR) methods to provide strategies for prevention. Methods: Marion County Public Health Department (MCPHD) FIMR staff identified and reviewed 22 fetal and infant deaths to Indianapolis Healthy Start program participants between 2005 and 2012. Trained FIMR nurses completed 13 of 20 maternal interviews and compiled case summaries of all deaths from the MCPHD FIMR database.. Results Case review teams identified a total of 349 family strengths, 219 contributing factors, and made 220 recommendations for future pregnancies. FIMR deliberation values for Healthy Start program participant deaths were similar to other infant deaths in Marion County during the same time period. Common themes that emerged from the reviews included lack of social support, absence of paternal involvement, substance abuse, non-compliance, and poor health behaviors leading to chronic health conditions that complicated many pregnancies. Conclusions A number of the infant deaths in this review could have been prevented with preconception and inter-conception education and by improving the quality and content of prenatal care.



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Spontaneous eye blink rate: An index of dopaminergic component of sustained attention and fatigue

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Publication date: Available online 11 November 2017
Source:International Journal of Psychophysiology
Author(s): Antonio Maffei, Alessandro Angrilli
Blink rate is a behavioral index highly correlated with frontostriatal dopaminergic activity. The present research was aimed at studying the modulation of spontaneous blink rate in function of the increasing attentional load induced by the Mackworth Clock Test. Since blinking interferes with sensory processing, we expected a decreasing blink rate with increasing attentional demand. Three tasks of 7-min each and different difficulties were administered: the Mackworth had a red dot moving in a circle with intervals varying from 500ms, 350ms to 200ms, corresponding to increasing task difficulty. Participant had to detect the rare jumps of one position by the red dot (targets). The blink rate was recorded from thirty-three female students starting from vertical oculogram recording of the right eye. The time course of blink rate across the 7-min task was also analyzed to test the hypothesis that fatigue arises also during brief tasks depending on the difficulty level. Results showed that the Hard task (200ms dot intervals) was associated with greater percentage of missed targets, faster response times and smaller blink rates with respect to the Medium and Easy ones. Analysis of the time course within the task revealed an increase of blink rate, indexing larger fatigue, starting in the 4th minute, independent from the difficulty level. In addition, trial-by-trial analysis showed that under strong attentional demand dopamine-related blink activity was inhibited throughout the whole task. Results point to the use of blink rate as an ecological index of dopaminergic component of attentional load and fatigue and revealed how human attentiondrops after relatively brief intervals of about 4min.



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Short body length phenotype is compensated by the upregulation of nidogen family members in a deleterious nid1a mutation of zebrafish

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Publication date: Available online 11 November 2017
Source:Journal of Genetics and Genomics
Author(s): Peipei Zhu, Zhipeng Ma, Liwei Guo, Wei Zhang, Qinghe Zhang, Ting Zhao, Kunpeng Jiang, Jinrong Peng, Jun Chen




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Ataxin-10 is involved in Golgi membrane dynamics

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Publication date: Available online 11 November 2017
Source:Journal of Genetics and Genomics
Author(s): Jie Tian, Yingxin Shi, Shanshan Nai, Qizhi Geng, Leiliang Zhang, Gonghong Wei, Xingzhi Xu, Jing Li




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Risk Determinants of Dental Caries and Oral Hygiene Status in 3–15 Year-Old Recent Immigrant and Refugee Children in Saskatchewan, Canada: A Pilot Study

Abstract

This study aimed to identify the risk determinants of caries and record oral hygiene status in recent immigrant and refugee children residing in Saskatoon and Regina, Saskatchewan, Canada. Convenience samples of 133, 3–15 year-old recent immigrant and refugee children, and 86 adult guardians were recruited. Clinical examination of children and survey of their guardians explored the presence of at least one decayed tooth in the child's mouth; and the knowledge, attitudes, behaviors, among other aspects in adult participants. Refugee children had statistically significant higher decayed, missing, filled teeth (DMFT) scores (mean dmft/DMFT score 5.80 ± 4.24) than immigrant children (mean dmft/DMFT score 3.52 ± 3.78 (p < 0.001). Adult immigrants had significantly higher proficiency in English language, knowledge about preventive components like fluoride and dental floss compared to refugee adults. The results of this study confirm the poorer state of oral health among refugee and immigrant children compared to Canadian children.



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Patient and Physician Factors Associated with Undisclosed Prostate Cancer Screening in a Sample of Predominantly Immigrant Black Men

Abstract

Medical guidelines do not recommend prostate cancer screening, particularly without informed and shared decision making. This study investigates undisclosed opportunistic screening using prostate specific antigen (PSA) testing in black immigrant and African American men. Participants (N = 142) were insured urban men, 45- to 70-years old. Patients' reports of testing were compared with medical claims to assess undisclosed PSA testing. Most (94.4 %) men preferred to share in screening decisions, but few (46.5 %) were aware PSA testing was performed. Four factors predicted being unaware of testing: low formal education, low knowledge about prostate cancer, no intention to screen, and no physician recommendation (all p's < .05). Undisclosed PSA testing was common. Both patient and provider factors increased risk of being uninformed about prostate cancer screening. Interventions combining patient education and physician engagement in shared decision making may better align practice with current prostate cancer screening guidelines.



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The Relation Between Discrimination, Sense of Coherence and Health Varies According to Ethnicity: A Study Among Three Distinct Populations in Israel

Abstract

Self-reported experiences of discrimination and sense of coherence (SOC) have been found to be associated with health. A face-to-face survey of Long Term Jewish Residents (LTJR), Arabs and former Soviet Union (fSU) immigrants in Israel was performed. Respondents reported their physical and mental health, self-reported experiences of discrimination, SOC and socioeconomic status. Multivariable logistic regressions and bootstrapping path analyses were performed. Discrimination was associated with health after adjusting for all other variables. SOC was also associated with health. SOC did not mediate the strong association between discrimination and health among Israeli LTJR, but was a significant mediator among Arabs and fSU immigrants. Discrimination seems to have a direct effect on health only among the majority and not among minority populations. High levels of SOC may reduce the negative effects of discrimination on health by serving as a coping resource, however only among minorities.



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Health Care Satisfaction: Effects of Immigration, Acculturation, Language

Abstract

Differences in health care satisfaction can alter patterns of health care utilization and so affect health outcomes, but little is known about variation in satisfaction in relation to immigration status. Health care satisfaction is analyzed with survey data from state public health program patients. Overall health care satisfaction is higher for first generation Hispanic immigrants and lower among those in the second generation compared to white Americans—consistent with the pattern termed the "healthy migrant effect." This pattern is more pronounced for Portuguese-speaking immigrants and is not explained by self-reported health, communication ability or acculturation. Satisfaction with specific aspects of health care follows different patterns that may be explained by differences in experiences and culture. As anticipated by segmented assimilation theory, we find variation in cross-generational patterns of health care satisfaction both within and between ethnic groups. This variation indicates the importance of distinguishing Portuguese-speakers from Spanish-speakers and of taking into account differences in the ways they are able to communicate with health care providers as well as differences in their orientations toward health care. Our disparate findings with other immigrant groups also reinforce limiting expectations of a "healthy migrant effect" to Latinos. Finally, the variable influences on different satisfaction measures indicate the importance of considering the relative influence of culturally-based orientations and health care experiences on the specific outcomes measured, with particular sensitivity to acceptance of individualized standards of care.



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Blood Lead Levels and Potential Risk Factors for Lead Exposures Among South Asians in New York City

Abstract

New York City's South Asian children and pregnant women have a disproportionate burden of elevated blood lead levels. This study is the first to investigate blood lead levels and risk factors for lead exposures among South Asian New Yorkers. A survey and a finger-stick blood lead test using a portable analyzer were administered to 230 South Asian adults and children. Blood lead levels of 5 µg/dL or higher were found in 20 % of the adults and 15 % of the children, as compared to 5 % of adults and 2.5 % of children citywide. Factors associated with elevated blood lead levels were recent repair work at home, not speaking English, Bangladeshi or Indian ethnicity, and occupational risk factors. Public health professional should be aware that South Asians may be at an increased risk for elevated blood lead levels.



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Country of Birth and Variations in Asthma and Wheezing Prevalence, and Emergency Department Utilization in Children: A NHANES Study

Abstract

Asthma prevalence and asthma-related healthcare utilization differ across racial/ethnic groups and geographical areas. This study builds on previous research to examine the relationship between country of birth and asthma prevalence and healthcare utilization using a national data set. The National Health and Nutrition Examination Survey (NHANES) Demographic and Questionnaire Files from 2007 to 2012 were used for this study. We used SPSS complex sampling design to estimate the association between country of birth and asthma prevalence, wheezing and emergency department (ED) use. The sample size was 8272 children and adolescents between the ages of 5 and 19 years old. US-born children had more reported episodes of wheezing (p = 0.024) 95 % CI 1.06; 2.54. There was no association between country of birth and asthma and ED use. US-born children and adolescents compared to foreign-born children and adolescents are more likely to have episodes of wheezing.



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Quality of Life in Community-Dwelling Chinese American Patients with Cancer Pain

Abstract

Although pain can be a powerful influence on health-related quality of life (HRQL) in cancer populations, culturally-based beliefs and behaviors may directly impact HQRL or modify the association between pain and HQRL. Studies of well-defined ethnic groups may clarify these relationships and inform culturally competent clinical practices intended to reduce illness burden. We evaluated HRQL in 121 non-English-speaking Chinese immigrants with cancer pain using the Functional Assessment of Cancer Therapy-General (FACT-G) scale. Overall, 91.2 % were born in China and 86.0 % were Cantonese-speaking; 50.8 % had no formal education (mean age = 63.2 years; 68.6 % women). Although the mean FACT-G score did not differ from U.S. population norms, most subscale scores for Chinese immigrants were lower and the score for social/family well-being was higher (all p < 0.05). Higher educational level, caregiver presence, lower psychological distress, lower pain intensity and interference, and lower symptom distress were associated with better HRQL (all p < 0.05). These findings confirm the importance of diverse influences on HQRL in ethnic Chinese cancer patients with chronic pain and suggest that this group may be distinguished from the majority population by the extent to which social/family well-being is preserved. Future studies in the growing population of Chinese Americans with cancer are needed to evaluate various aspects of social/family well-being and determine whether they modify the association between pain and HRQL.



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Military Weapon Injury Among Illegal Immigrants at the Southern Border of Israel: A Single Level I Trauma Center Series

Abstract

This article describes the characteristics of injuries of illegal immigrants admitted to a Level I trauma center after being shot at the southern border of Israel. This is a retrospective descriptive study. Some of the variables were compared to a group of soldiers who sustained penetrating injury at the same region where the illegal migrant were injured. The study includes 162 patients. The lower body absorbed a higher percentage of the injuries (61 %). The hospitalization time is longer for the migrant patients compared to the soldiers (13 ± 2 vs. 3 ± 0.3 days p = 0.0001). This study on wounded immigrants shows that a conjoint military and civilian system can result in favourable outcomes. The manuscript is an attempt to bring this unique situation, its type of injuries, and the difficulties of the health system in coping with it, to the notice of all authorities that may address a similar challenge.



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Drugs Delivery by Charities: A Possible Epidemiologic Indicator in Children of Undocumented Migrants

Abstract

Describing the health status of a population is difficult, especially in the case of irregular migrants who are now a growing population in western Countries. Data for children of these families are almost inexistent. In the absence of databases on this peculiar pediatric population, we analyzed drugs dispensation by a major Charity to have an insight into their health needs. This observational retrospective study was carried out during the entire 2015 and enrolled 628 undocumented children. A cohort of 8438 adult patients belonging to the same ethnic groups was used for comparison. Respiratory drugs were those most commonly prescribed, followed by those for skin and ocular diseases and by those for gastrointestinal disorders. Also in adults respiratory medications were the most dispensed, but almost in equal measure than cardiovascular drugs.To our knowledge this is the first study on the health needs of undocumented children residing in a western Country. The method we used seems to be a useful method for epidemiological analysis. As could be expected, respiratory and skin diseases ranked first, possibly owing to environmental factors.



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Smoke-Free Multi-unit Housing Policies Show Promise in Reducing Secondhand Smoke Exposure Among Racially and Ethnically Diverse, Low-Income Seniors

Abstract

Secondhand smoke (SHS) exposure is a public health issue for residents of multi-unit housing (MUH) properties. We evaluated the impact of smoke-free policy implementation on reported SHS exposure among racially, ethnically diverse seniors living in low-income MUH properties. In Spring 2013 and Summer 2014, we surveyed residents (n = 960) at 15 MUH properties in Broward and Miami-Dade Counties, Florida. The percentage of residents reporting SHS exposure within their apartments from elsewhere in or around their building decreased from 31.1 %, before policy implementation, to 23.6 % at follow-up (p = 0.02). In multivariate analysis of non-smoking residents after policy implementation, residents who reported having one or more comorbidities were two times more likely to report SHS exposure (aOR 2.23, 95 % CI 1.12–4.40). Considering the vulnerability of low-income seniors to SHS exposure, our findings are relevant to residents, property owners/managers, and public health professionals making decisions about smoke-free policies for MUH properties in which seniors reside.



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Elevated Prevalence of Polycystic Ovary Syndrome and Cardiometabolic Disease in South Asian Infertility Patients

Abstract

South Asians (SA) develop cardiometabolic disease at elevated rates. We investigate whether reproductive-aged SA women are at higher risk for a precursor condition, polycystic ovary syndrome (PCOS), as compared to Caucasian controls. 52 SA and 52 Caucasian infertility patients from a single institution were included in a cross-sectional analysis. Outcomes were compared using Student's t, Mann–Whitney U, Pearson's Chi-squared and Fisher's exact tests. SA women were younger, with six-fold greater odds of PCOS. SA women were not obese, with similar body mass indices to controls. However, when screened, they demonstrated abundant metabolic disease, including insulin resistance, diabetes and dyslipidemia, and endometrial disease, including hyperplasia and polyps. The SA population was younger with more PCOS and high rates of metabolic and endometrial pathology. These findings, in the context of ethnicity-specific elevations in cardiometabolic risk, highlight the need for comprehensive screening and counseling in this patient population.



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Comparing Pregnancy Outcomes of Immigrants from Ethiopia and the Former Soviet Union to Israel, to those of Native-Born Israelis

Abstract

To compare pregnancy outcomes of immigrants from Former-Soviet-Union (FSUI) and Ethiopia (EI) to those of Jewish-native-born Israelis (JNB), in context of universal health insurance. Birth outcomes of all singletons born in Soroka-University Medical-Center (1998–2011) of EI (n = 1,667) and FSUI (n = 12,920) were compared with those of JNB (n = 63,405). Low birthweight rate was significantly higher among EI (11.0 %) and slightly lower (7.0 %) among FSUI, compared to JNB (7.5 %). Preterm-delivery rates were similar to those of JNB. Both immigrant groups had significantly (p < 0.001) higher rates of perinatal mortality (PM) than JNB (21/1000 in EI, and 11/1000 in FSUI, compared to 9/1000). Using multivariable GEE models both immigrant groups had significantly increased risk for PM; however, EI had twice as much FSUI origin (OR 2.3, 95 % CI 1.6–3.4, and OR 1.3, 95 % CI 1.1–1.6, respectively). Universal health care insurance does not eliminate excess PM in immigrants, nor the gaps between immigrant groups.



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Coping with Pain in the Face of Healthcare Injustice in Patients with Sickle Cell Disease

Abstract

To evaluate the pain coping strategies of patients with sickle cell disease (SCD) who experience healthcare injustice from either physicians or nurses during medical visits for pain management. It is unknown how patients' coping with pain relates to their experiences of healthcare injustice from physicians or nurses. This descriptive comparative study included adult outpatients with SCD who completed the PAINReportIt®, Healthcare Justice Questionnaire©, and Coping Strategies Questionnaire-SCD. Data were analyzed using independent t tests. Frequent coping strategies of patients who experienced healthcare justice from physicians were praying-hoping and from nurses were praying-hoping, calming self-statements, diverting attention, and increasing behavioral activity. In contrast, frequent coping strategies of patients who experienced healthcare injustice from physicians were catastrophizing and isolation and from nurses were isolation. Patients who experienced healthcare justice used different sets of pain coping strategies than those who experienced healthcare injustice during medical visits for pain management.



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Patient Centered Medical Home Care Among Near-Old and Older Race/Ethnic Minorities in the US: Findings from the Medical Expenditures Panel Survey

Abstract

Access to Patient Centered Medical Home (PCMH) care has not been explored among older racial/ethnic minorities. We used data on adults 55-years and older from the Medical Expenditure Panel Survey (2008–2013). We account for five features of PCMH experiences and focus on respondents self-identifying as Non-Latino White, Black, and Latino. We used regression models to examine associations between PCMH care and its domains and race/ethnicity and decomposition techniques to assess contribution to differences by predisposing, enabling and health need factors. We found low overall access and significant racial/ethnic variations in experiences of PCMH. Our results indicated strong deficiencies in access to a personal primary care physician provided healthcare. Factors contributing to differences in reported PCMH experiences relative to Whites differed by racial/ethnic grouping. Policy initiatives aimed at addressing accessibility to personal physician directed healthcare could potentially reduce racial/ethnic differences while increasing national access to PCMH care.



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Pregnancy-Related Hypertensive Disorders and Immigrant Status: A Systematic Review and Meta-analysis of Epidemiological Studies

Abstract

Immigrants are often considered a vulnerable population. Paradoxically, some researchers have reported lower risk of pregnancy-related hypertension (PRH) among immigrants when compared to their non-immigrant counterparts. The lack of consistency and the absence of a synthesis of studies investigating the associations between immigration status and PRH represent a gap in our understanding of socioecological roots of PRH. Of studies published in during the study period, 16 met the inclusion criteria. For each study, we computed relative risks that compared PRH risk by migrant status. The pooled estimate of the relative risk of PRH represented a statistically significantly lower risk among immigrants (RR = 0.74; 95 % CI 0.67, 0.82). The body of evidence indicates that immigrant status is generally associated with reduced risk of PRH. However the strength of this association could vary by country of origin of immigrants.



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Improvement of in-situ gamma spectrometry methods by Monte-Carlo simulations

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Publication date: Available online 10 November 2017
Source:Journal of Environmental Radioactivity
Author(s): Dusan Mrdja, Kristina Bikit, Sofija Forkapic, Istvan Bikit, Jaroslav Slivka, Jan Hansman
Performing in-situ measurements of gamma radiation originating from soil requires adequate detection efficiency curves, which can be obtained by Monte-Carlo simulations. In simulations, soil density of 1.046 g/cm3 was used, with the following elemental composition of soil in which gamma radiation was generated: O - 47%, Si −35%, Al - 8%, Fe - 3.9%, C - 2.1%, Ca - 1.4%, K - 1.3%, N - 0.6%, Mg - 0.6%, N - 0.1%. Soil matrix was represented by cylindrical volume of 1.5 m diameter and 0.5m thickness, while germanium detector was placed at 1 m height above the soil. The simulated gamma spectrum, originated from K-40, as well as from members of Th-232 chain, and daughters of Ra-226, was obtained. Homogeneous distribution of various radionuclides (Ra-226, Th-232, K-40) in soil matrix is considered in this work. Gamma spectra obtained in simulations were analyzed, and together with simulated detection efficiency data they provide comparison with real experimental measurements and practical application of results derived by Monte-Carlo simulations. As a result of this work, the corresponding detection efficiency curve for HPGe detector was obtained, which can be applied for in-situ measurements of radionuclide concentration in soil, assuming uniform radionuclide distribution.In order to validate our simulation results regarding detection efficiency, we performed in-situ measurements of soil radioactivity and compared the obtained activity concentrations with laboratory measurements. We found a good agreement, within activity concentration uncertainty, between in-situ measurement results and average values of activity concentrations obtained by laboratory measurements.



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UBC-Nepal expedition: acclimatization to high-altitude increases spinal motoneurone excitability during fatigue in humans

Abstract

The fatigue-induced failure of the motor cortex to drive muscles maximally increases in acute hypoxia (AH) compared to normoxia (N) but improves with acclimatization (chronic hypoxia; CH). Despite their importance to muscle output, it is unknown how locomotor motoneurones in humans are affected by hypoxia and acclimatization. Eleven participants performed 16 min of submaximal (25% maximal torque, MVC) intermittent isometric elbow flexions in N, AH (environmental chamber), and CH (7–14 days at 5050 m) (PIO2 = 140, 74, and 76 mmHg, respectively). Each minute of the fatigue protocol, motoneurone (MN) responsiveness was measured with cervicomedullary stimulation delivered 100 ms after transcranial magnetic stimulation (TMS) used to transiently silence voluntary drive. Every two minutes, cortical voluntary activation (cVA) was measured with TMS. After the task, MVC torque declined more in AH (∼20%) than N and CH (∼11 and 14%, respectively, P < 0.05), with no differences between N and CH. cVA was lower in AH than N and CH at baseline (∼92, 95, 95%, respectively) and the end of the protocol (∼82, 90, 90%, P < 0.05). During the fatiguing task, MN excitability in N and AH declined to ∼65 and 40% of the baseline value (P < 0.05). In CH, MN excitability did not decline and, late in the protocol, was ∼40% higher compared to AH (P < 0.05). These novel data reveal that acclimatization to hypoxia leads to a heightened motoneurone responsiveness during fatiguing exercise. Positive spinal and supraspinal adaptations during extended periods at altitude might therefore play a vital role for the restoration of performance after acclimatization to hypoxia.

This article is protected by copyright. All rights reserved



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Mechanisms underpinning sympathetic nervous activity and its modulation using transcutaneous vagus nerve stimulation

Abstract

The autonomic nervous system, consisting of the sympathetic and parasympathetic branches, is a major contributor to maintaining cardiovascular variables within homeostatic limits. As we age or in certain pathological conditions, the balance between the two branches changes such that sympathetic activity is more dominant and this change in dominance negatively correlates with prognosis in conditions such as heart failure. We have shown that non-invasive stimulation of the tragus of the ear increases parasympathetic activity and reduces sympathetic activity and that extent of this effect is correlated with the baseline cardiovascular parameters of different subjects. The effects could be due to activation of the afferent branch of the vagus and potentially other sensory nerves in that region. This indicates that tragus stimulation may be a viable treatment in disorders where autonomic activity to the heart is compromised.

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Liver X receptor activation inhibits SGLT2-mediated glucose transport in human renal proximal tubular cells

Abstract

Liver X receptors (LXRs) are members of a nuclear receptor family consisting of two isoforms, LXR-α and LXR-β. They play a major role in energy metabolism including lipid and glucose metabolism. Recent studies reported LXRs regulate plasma glucose although the mechanism is still uncertain. The present study investigated whether LXR activation regulates sodium glucose cotransporter2 (SGLT2) in human renal proximal tubular cells. LXR agonists, T0901317 and GW3965, inhibited SGLT2-mediated glucose uptake in concentration-dependent manners. The effect of T0901317 and GW3965 was attenuated by a LXR antagonist, fenofibrate. Activation of retinoid X receptor (RXR) agonist, bexarotene, potentiates the inhibitory effect of these ligands. Thus, the inhibitory effect of LXR agonists on SGLT2 was mediated and facilitated by LXR and RXR activation, respectively. In addition, the inhibitory effect of LXR agonists was not mediated by cytotoxicity. Exposing HK-2 cells, renal proximal tubular cell line, to LXR agonists significantly reduced the maximal transport rate (Jmax) of SGLT2 without any effect on transporter affinity. Western blot analysis revealed LXR activation significantly decreased protein expression of SGLT2 with no change in mRNA level. In addition, LXR activation inhibited canagliflozin-sensitive short-circuits current which represents SGLT2-mediated glucose transport in polarized human renal proximal tubular cell monolayer. Furthermore, LXR activation inhibited transport function of SGLT2 in hyperglycemic conditions. As such, this study represents the evidence of LXR activation's inhibitory effect on glucose transport in human renal proximal tubular cells.

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The Effect of Natural or Simulated Altitude Training on High-Intensity Intermittent Running Performance in Team-Sport Athletes: A Meta-Analysis

Abstract

Background

While adaptation to hypoxia at natural or simulated altitude has long been used with endurance athletes, it has only recently gained popularity for team-sport athletes.

Objective

To analyse the effect of hypoxic interventions on high-intensity intermittent running performance in team-sport athletes.

Methods

A systematic literature search of five journal databases was performed. Percent change in performance (distance covered) in the Yo-Yo intermittent recovery test (level 1 and level 2 were used without differentiation) in hypoxic (natural or simulated altitude) and control (sea level or normoxic placebo) groups was meta-analyzed with a mixed model. The modifying effects of study characteristics (type and dose of hypoxic exposure, training duration, post-altitude duration) were estimated with fixed effects, random effects allowed for repeated measurement within studies and residual real differences between studies, and the standard-error weighting factors were derived or imputed via standard deviations of change scores. Effects and their uncertainty were assessed with magnitude-based inference, with a smallest important improvement of 4% estimated via between-athlete standard deviations of performance at baseline.

Results

Ten studies qualified for inclusion, but two were excluded owing to small sample size and risk of publication bias. Hypoxic interventions occurred over a period of 7–28 days, and the range of total hypoxic exposure (in effective altitude-hours) was 4.5–33 km h in the intermittent-hypoxia studies and 180–710 km h in the live-high studies. There were 11 control and 15 experimental study-estimates in the final meta-analysis. Training effects were moderate and very likely beneficial in the control groups at 1 week (20 ± 14%, percent estimate, ± 90% confidence limits) and 4-week post-intervention (25 ± 23%). The intermittent and live-high hypoxic groups experienced additional likely beneficial gains at 1 week (13 ± 16%; 13 ± 15%) and 4-week post-intervention (19 ± 20%; 18 ± 19%). The difference in performance between intermittent and live-high interventions was unclear, as were the dose of hypoxia and inclusion of training in hypoxia.

Conclusions

Hypoxic intervention appears to be a worthwhile training strategy for improvement in high-intensity running performance in team-sport athletes, with enhanced performance over control groups persisting for at least 4 weeks post-intervention. Pending further research on the type of hypoxia, dose of hypoxia and training in hypoxia, coaches have considerable scope for customising hypoxic training methods to best suit their team's training schedule.



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Heat Acclimation Decay and Re-Induction: A Systematic Review and Meta-Analysis

Abstract

Background

Although the acquisition of heat acclimation (HA) is well-documented, less is known about HA decay (HAD) and heat re-acclimation (HRA). The available literature suggests 1 day of HA is lost following 2 days of HAD. Understanding this relationship has the potential to impact upon the manner in which athletes prepare for major competitions, as a HA regimen may be disruptive during final preparations (i.e., taper).

Objective

The aim of this systematic review and meta-analysis was to determine the rate of HAD and HRA in three of the main physiological adaptations occurring during HA: heart rate (HR), core temperature (T c), and sweat rate (SR).

Data Sources

Data for this systematic review were retrieved from Scopus and critical review of the cited references.

Study Selection

Studies were included when they met the following criteria: HA, HAD, and HRA (when available) were quantified in terms of exposure and duration. HA had to be for at least 5 days and HAD for at least 7 days for longitudinal studies. HR, T c, or SR had to be monitored in human participants.

Study Appraisal

The level of bias in each study was assessed using the McMaster critical review form. Multiple linear regression techniques were used to determine the dependency of HAD in HR, T c, and SR from the number of HA and HAD days, daily HA exposure duration, and intensity.

Results

Twelve studies met the criteria and were systematically reviewed. HAD was quantified as a percentage change relative to HA (0% = HA, 100% = unacclimated state). Adaptations in end-exercise HR decreased by 2.3% (P < 0.001) for every day of HAD. For end-exercise T c, the daily decrease was 2.6% (P < 0.01). The adaptations in T c during the HA period were more sustainable when the daily heat exposure duration was increased and heat exposure intensity decreased. The decay in SR was not related to the number of decay days. However, protracted HA-regimens seem to induce longer-lasting adaptations in SR. High heat exposure intensities during HA seem to evoke more sustained adaptations in SR than lower heat stress. Only eight studies investigated HRA. HRA was 8–12 times faster than HAD at inducing adaptations in HR and T c, but no differences could be established for SR.

Limitations

The available studies lacked standardization in the protocols for HA and HAD.

Conclusions

HAD and HRA differ considerably between physiological systems. Five or more HA days are sufficient to cause adaptations in HR and T c; however, extending the daily heat exposure duration enhances T c adaptations. For every decay day, ~ 2.5% of the adaptations in HR and T c are lost. For SR, longer HA periods are related to better adaptations. High heat exposure intensities seem beneficial for adaptations in SR, but not in T c. HRA induces adaptations in HR and T c at a faster rate than HA. HRA may thus provide a practical and less disruptive means of maintaining and optimizing HA prior to competition.



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Pliocene crocodiles from Kanapoi, Turkana Basin, Kenya

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Publication date: Available online 11 November 2017
Source:Journal of Human Evolution
Author(s): Christopher A. Brochu
Three crocodylid species are known from the Pliocene Kanapoi locality in the western Turkana Basin. One of these, Crocodylus thorbjarnarsoni, includes material previously referred to Crocodylus niloticus (the modern Nile crocodile currently living in Lake Turkana) and Rimasuchus lloydi. C. thorbjarnarsoni was a gigantic horned crocodile similar in overall shape to most other generalized crocodylids, but its closest known relative is another extinct species, Crocodylus anthropophagus from the Pleistocene of Olduvai Gorge in Tanzania. It is not closely related to C. niloticus. The second is an extinct form of sharp-nosed crocodile (Mecistops), a group of slender-snouted crocodylids currently restricted to western and central Africa. The third is Euthecodon, a crocodylid with an extremely long, slender, and distinctively notched snout. Euthecodon and C. thorbjarnarsoni are known from substantial numbers of specimens, but only one Mecistops specimen has been identified from the locality. The crocodylian fauna at Kanapoi is taxonomically similar to that of most other Plio-Pleistocene fluviolacustrine deposits in the Turkana Basin. Crocodylian diversity in the Turkana region contracted from a peak of five co-existing species in the late Miocene to one today; this contraction was underway by the early Pliocene, but crocodylian diversity remained stable at three species until well into the Quaternary.



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Ultra-shortened time-domain HRV parameters at rest and following exercise in athletes: an alternative to frequency computation of sympathovagal balance

Abstract

Purpose

The primary purpose of this study was to determine the accuracy of the standard deviation of normal-to-normal intervals (SDNN) to root mean square of successive normal-to-normal interval differences (RMSSD) ratio from 1-min recordings (SDNN:RMSSD1−min) compared to criterion recordings, as well as its relationship to low-frequency-to-high-frequency ratio (LF:HF) at rest and following maximal exercise in a group of collegiate athletes.

Method

Twenty athletes participated in the study. Heart rate variability (HRV) data were measured for 5 min before and at 5–10 and 25–30 min following a maximal exercise test. From each 5-min segment, the frequency-domain measures of HF, LF, and LF:HF ratio were analyzed. Time-domain measures of SDNN, RMSSD, and SDNN:RMSSD ratio were also analyzed from each 5-min segment, as well as from randomly selected 1-min recordings.

Result

The 1-min values of SDNN, RMSSD, and SDNN:RMSSD provided no significant differences and nearly perfect intra-class correlations (ICCs ranged from 0.97 to 1.00, p < 0.001 for all) to the criterion measures from 5-min recordings. In addition, SDNN, RMSSD, and SDNN:RMSSD from the 1-min segments provided very large to nearly perfect correlations (r values ranged from 0.71 to 0.97, p < 0.001 for all) to LF, HF, and LF:HF, respectively, at each time point.

Conclusion

The findings of the study suggest that ultra-shortened time-domain markers may be useful surrogates of the frequency-domain parameters for tracking changes in sympathovagal activity in athletes.



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Acknowledgement to referees



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Actionable secondary findings from whole-genome sequencing of 954 East Asians

Abstract

Recently, the American College of Medical Genetics (ACMG) recommended the return of actionable secondary findings detected from clinical sequencing. The reported frequency of secondary findings in Asian populations were highly variable and it is unclear whether the uniformity in coverage offered by whole-genome sequencing (WGS) may impact the estimate. In this analysis, we aimed to refine the rate of secondary findings on East Asians through a large-scale WGS study. We classified 1256 protein-altering or splicing variants of the 59 actionable genes detected from WGS of 954 East Asians in strict accordance with the ACMG and the Association for Molecular Pathology guidelines. A total of 21 pathogenic or likely pathogenic variants were detected in 24 of the 954 East Asian genomes with an estimate of 2.5% of East Asians carrying actionable variants. Although the overall estimate of secondary findings was consistent with those reported for non-East Asian ethnicities, genetic and allelic heterogeneity was observed. WGS offers a wider breadth of coverage over WES, which highlights the need to further investigate the variable sensitivity of WES and WGS in the detection of secondary findings. Identifying secondary findings in populations underrepresented in previous genetic literature might improve variant interpretation and has a profound impact on local decision-making with regard to the cost-effectiveness of returning the secondary findings from clinical sequencing.



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Segmentation of Whole-Body Images into Two Compartments in Model for Bone Marrow Dosimetry Increases the Correlation with Hematological Response in 177Lu-DOTATATE Treatments

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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