Σάββατο, 31 Μαρτίου 2018

FMR1 premutation frequency in a large, ethnically diverse population referred for carrier testing

American Journal of Medical Genetics Part A, EarlyView.


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GNAS-mutated carcinoma arising from gastric foveolar metaplasia in the duodenum after 9 years of observation

Abstract

This case involved an 80-year-old man. Screening with esophagogastroduodenoscopy (EGD) in 2004 revealed Brunner's gland hyperplasia (BGH), 5 mm in size, in the duodenal bulb. The size of the lesion increased and its shape has changed since then, as detected in subsequent EGDs. The lesion had increased in size to 15 mm with a depression and biopsy specimens revealed an adenocarcinoma. The patient underwent endoscopic mucosal resection. Histopathological assessments indicated an adenocarcinoma arising from gastric foveolar metaplasia (GFM) adjacent to BGH. BGH stained positive for MUC6, and GFM and the adenocarcinoma stained positive for MUC5AC. Mutations of the GNAS gene were not detected in the GFM biopsied in 2007. On the other hand, common GNAS mutations (R201H) were detected in GFM and the adenocarcinoma in the endoscopically resected specimen in 2013. Moreover, mutant allele frequencies were higher in the carcinoma than in GFM. The patient remains disease-free for 4 years after endoscopic treatment. This case report further supports the notion that GFM may be a precursor lesion in the process of GNAS-mutated, gastric-type duodenal carcinogenesis.



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Improving Dual-Task Control with a Posture-Second Strategy in Early-Stage Parkinson’s Disease

Publication date: Available online 31 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Cheng-Ya Huang, Yu-An Chen, Ing-Shiou Hwang, Ruey-Meei Wu
ObjectiveTo examine the task prioritization effects on postural-suprapostural dual task performance in patients with early-stage Parkinson's disease (PD) without clinical observed postural symptoms.DesignCross-sectional study. Participants performed a force-matching task while standing on a mobile-platform, and were instructed to focus their attention on either the postural task (posture-first strategy) or the force-matching task (posture-second strategy).SettingUniversity research laboratory.Participants16 individuals with early-stage PD who has no clinical observed postural symptoms.InterventionsNot applicable.Main Outcome MeasuresDual-task change (DTC, % change between single-task and dual-task performance) of posture error, posture approximate entropy (ApEn), force error, and reaction time (RT). Positive DTC values indicate higher postural error, posture ApEn, force error, and force RT during dual-task conditions compared to single-task conditions.ResultsCompared to the posture-first strategy, the posture-second strategy was associated with smaller DTC of posture error and force error, and greater DTC of posture ApEn. In contrast, greater DTC of force RT was observed under posture-second strategy.ConclusionsContrary to typical recommendations, our results suggest that the posture-second strategy may be an effective dual-task strategy in patients with early-stage PD who has no clinical observed postural symptoms in order to reduce the negative effect of dual-tasking on performance and facilitate postural automaticity.



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Effectiveness of home-based exercises without supervision by physical therapists for patients with early-stage amyotrophic lateral sclerosis: A pilot study

Publication date: Available online 31 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kosuke Kitano, Takashi Asakawa, Naoto Kamide, Keisuke Yorimoto, Masaki Yoneda, Yutaka Kikuchi, Makoto Sawada, Tetsuo Komori
ObjectiveThis study aimed to verify the effects of structured home-based exercises without supervision by a physical therapist on patients with early-stage amyotrophic lateral sclerosis (ALS).DesignThis is a historical controlled study that is part of a multicenter collaborative study.SettingRehabilitation departments at general hospitals and outpatient clinics with a neurology department in Japan.ParticipantsTwenty-one patients with ALS were enrolled and designated as the Home-EX group, and they performed unsupervised home-based exercises. As a control group, 84 patients with ALS who underwent supervised exercise with a physical therapist for 6 months were extracted from a database of patients with ALS and matched with the Home-EX group in terms of their basic attributes and clinical features.InterventionThe Home-EX group was instructed to perform structured home-based exercises without supervision by a physical therapist that consisted of muscle stretching, muscle training, and functional training for 6 months.Main outcome measureThe primary outcome was the score on the ALS Functional Rating Scale-Revised (ALSFRS-R), which is composed of 3 domains: bulbar function, limb function, and respiratory function. The score ranges from 0 to 48 points, and a higher score indicates better function.ResultsIn the Home-EX group, 15 patients completed the home-based exercises for 6 months, and 6 patients dropped out due to medical reasons or disease progression. No adverse events were reported. The Home-EX group was found to have a significantly higher respiratory function sub-score and total score on ALSFRS-R than the control group at follow-up (p < 0.001 and p < 0.05, respectively).ConclusionStructured home-based exercises without supervision by a physical therapist could be used to alleviate functional deterioration in patients with early-stage ALS.



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Sensitivity of the SCI-FI/AT in Individuals with Traumatic Spinal Cord Injury

Publication date: Available online 31 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tamra Keeney, Mary Slavin, Pamela Kisala, Pengsheng Ni, Allen W. Heinemann, Susan Charlifue, Denise C. Fyffe, Ralph J. Marino, Leslie R. Morse, Lynn A. Worobey, Denise Tate, David Rosenblum, Ross Zafonte, David Tulsky, Alan M. Jette
ObjectiveTo examine the ability of the Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) measure to detect change in persons with SCI.DesignMulti-site, longitudinal (12-month follow-up).Setting9 SCI Model Systems programs.Participants165 adults with SCI enrolled in the SCI Model Systems database.InterventionsNot applicable.Main Outcome MeasuresSCI-FI/AT CAT (Basic Mobility, Self-Care, Fine Motor Function, Wheelchair Mobility, and/or Ambulation) completed at discharge from rehabilitation and 12 months post-SCI. For each domain, effect size (ES) estimates and 95% confidence intervals were calculated for subgroups with paraplegia and tetraplegia.ResultsSample demographics: 46% paraplegia, 76% male, 57% used a manual wheelchair, 38% used a power wheelchair, 30% were ambulatory. For individuals with paraplegia the Basic Mobility, Self-Care, and Ambulation domains of the SCI-FI/AT detected a significant, large amount of change; in contrast, the Fine Motor and Wheelchair domains detected only small amount of change. For those with tetraplegia, the Basic Mobility, Fine Motor, and Self-Care domains detected a small amount of change; while the Ambulation item domain detected a medium amount of change. The Wheelchair domain for people with tetraplegia was the only SCI-FI/AT domain that did not detect significant change.ConclusionSCI-FI/AT CAT item banks detected an increase in function from discharge to 12-months after SCI onset. SCI-FI/AT CAT ES estimates vary by domain and level of lesion. Findings support use of the SCI-FI/AT CAT in the SCI population and highlight the importance of multidimensional functional measures.



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Dental calculus indicates widespread plant use within the stable Neanderthal dietary niche

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Publication date: June 2018
Source:Journal of Human Evolution, Volume 119
Author(s): Robert C. Power, Domingo C. Salazar-García, Mauro Rubini, Andrea Darlas, Katerina Havarti, Michael Walker, Jean-Jacques Hublin, Amanda G. Henry
The ecology of Neanderthals is a pressing question in the study of hominin evolution. Diet appears to have played a prominent role in their adaptation to Eurasia. Based on isotope and zooarchaeological studies, Neanderthal diet has been reconstructed as heavily meat-based and generally similar across different environments. This image persists, despite recent studies suggesting more plant use and more variation. However, we have only a fragmentary picture of their dietary ecology, and how it may have varied among habitats, because we lack broad and environmentally representative information about their use of plants and other foods. To address the problem, we examined the plant microremains in Neanderthal dental calculus from five archaeological sites representing a variety of environments from the northern Balkans, and the western, central and eastern Mediterranean. The recovered microremains revealed the consumption of a variety of non-animal foods, including starchy plants. Using a modeling approach, we explored the relationships among microremains and environment, while controlling for chronology. In the process, we compared the effectiveness of various diversity metrics and their shortcomings for studying microbotanical remains, which are often morphologically redundant for identification. We developed Minimum Botanical Units as a new way of estimating how many plant types or parts are present in a microbotanical sample. In contrast to some previous work, we found no evidence that plant use is confined to the southern-most areas of Neanderthal distribution. Although interpreting the ecogeographic variation is limited by the incomplete preservation of dietary microremains, it is clear that plant exploitation was a widespread and deeply rooted Neanderthal subsistence strategy, even if they were predominately game hunters. Given the limited dietary variation across Neanderthal range in time and space in both plant and animal food exploitation, we argue that vegetal consumption was a feature of a generally static dietary niche.



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Pathophysiology of Noncardiac Syncope in Athletes

Abstract

The most frequent cause of syncope in young athletes is noncardiac etiology. The mechanism of noncardiac syncope (NCS) in young athletes is neurally-mediated (reflex). NCS in athletes usually occurs either as orthostasis-induced, due to a gravity-mediated reduced venous return to the heart, or in the context of exercise. Exercise-related NCS typically occurs after the cessation of an exercise bout, while syncope occurring during exercise is highly indicative of the existence of a cardiac disorder. Postexercise NCS appears to result from hypotension due to impaired postexercise vasoconstriction, as well as from hypocapnia. The mechanisms of postexercise hypotension can be divided into obligatory (which are always present and include sympathoinhibition, histaminergic vasodilation, and downregulation of cardiovagal baroreflex) and situational (which include dehydration, hyperthermia and gravitational stress). Regarding postexercise hypocapnia, both hyperventilation during recovery from exercise and orthostasis-induced hypocapnia when recovery occurs in an upright posture can produce postexercise cerebral vasoconstriction. Athletes have been shown to exhibit differential orthostatic responses compared with nonathletes, involving augmented stroke volume and increased peripheral vasodilation in the former, with possibly lower propensity to orthostatic intolerance.



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Assessment of Skeletal Muscle Contractile Properties by Radial Displacement: The Case for Tensiomyography

Abstract

Skeletal muscle operates as a near-constant volume system; as such muscle shortening during contraction is transversely linked to radial deformation. Therefore, to assess contractile properties of skeletal muscle, radial displacement can be evoked and measured. Mechanomyography measures muscle radial displacement and during the last 20 years, tensiomyography has become the most commonly used and widely reported technique among the various methodologies of mechanomyography. Tensiomyography has been demonstrated to reliably measure peak radial displacement during evoked muscle twitch, as well as muscle twitch speed. A number of parameters can be extracted from the tensiomyography displacement/time curve and the most commonly used and reliable appear to be peak radial displacement and contraction time. The latter has been described as a valid non-invasive means of characterising skeletal muscle, based on fibre-type composition. Over recent years, applications of tensiomyography measurement within sport and exercise have appeared, with applications relating to injury, recovery and performance. Within the present review, we evaluate the perceived strengths and weaknesses of tensiomyography with regard to its efficacy within applied sports medicine settings. We also highlight future tensiomyography areas that require further investigation. Therefore, the purpose of this review is to critically examine the existing evidence surrounding tensiomyography as a tool within the field of sports medicine.



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Παρασκευή, 30 Μαρτίου 2018

Inclusion of non‐English‐speaking patients in research: A single institution experience

Pediatric Anesthesia, EarlyView.


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Intraoperative hypoxia secondary to pneumothorax: The role of lung ultrasound

Pediatric Anesthesia, EarlyView.


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Effects of Larval Density on Gene Regulation in Caenorhabditis elegans During Routine L1 Synchronization

Bleaching gravid C. elegans followed by a short period of starvation of the L1 larvae is a routine method performed by worm researchers for generating synchronous populations for experiments. During the process of investigating dietary effects on gene regulation in L1 stage worms by single-worm RNA-Seq, we found that the density of resuspended L1 larvae affects expression of many mRNAs. Specifically, a number of genes related to metabolism and signalling are highly expressed in worms arrested at low density, but are repressed at higher arrest densities. We generated a GFP reporter strain based on one of the most density-dependent genes in our dataset - lips-15 - and confirmed that this reporter was expressed specifically in worms arrested at relatively low density. Finally, we show that conditioned media from high density L1 cultures was able to downregulate lips-15 even in L1 animals arrested at low density, and experiments using daf-22 mutant animals demonstrated that this effect is not mediated by the ascaroside family of signalling pheromones. Together, our data implicate a soluble signalling molecule in density sensing by L1 stage C. elegans, and provide guidance for design of experiments focused on early developmental gene regulation.



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Identification of Proteins Required for Precise Positioning of Apc2 in Dendrites

In Drosophila neurons, uniform minus-end-out polarity in dendrites is maintained in part by kinesin-2-mediated steering of growing microtubules at branch points. Apc links the kinesin motor to growing microtubule plus ends and Apc2 recruits Apc to branch points where it functions. Because Apc2 acts to concentrate other steering proteins to branch points, we wished to understand how Apc2 is targeted. From an initial broad candidate RNAi screen, we found Miro (a mitochondrial transport protein), Ank2, Axin, spastin and Rac1 were required to position Apc2-GFP at dendrite branch points. YFP-Ank2-L8, Axin-GFP and mitochondria also localized to branch points suggesting the screen identified relevant proteins. By performing secondary screens, we found that energy production by mitochondria was key for Apc2-GFP positioning and spastin acted upstream of mitochondria. Ank2 seems to act independently from other players, except its membrane partner, Neuroglian (Nrg). Rac1 likely acts through Arp2/3 to generate branched actin to help recruit Apc2-GFP. Axin can function in a variety of wnt signaling pathways, one of which includes heterotrimeric G proteins and Frizzleds. Knockdown of Gas, Gao, Fz and Fz2, reduced targeting of Apc2 and Axin to branch points. Overall our data suggest that mitochondrial energy production, Nrg/Ank2, branched actin generated by Arp2/3 and Fz/G proteins/Axin function as four modules that control localization of the microtubule regulator Apc2 to its site of action in dendrite branch points.



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Genome-Wide Analysis of Mycoplasma bovirhinis GS01 Reveals Potential Virulence Factors and Phylogenetic Relationships

Mycoplasma bovirhinis is a significant etiology in bovine pneumonia and mastitis, but our knowledge about the genetic and pathogenic mechanisms of M. bovirhinis is very limited. In this study, we sequenced the complete genome of M. bovirhinis strain GS01 isolated from the nasal swab of pneumonic calves in Gansu, China, and we found that its genome forms a 847,985 bp single circular chromosome with a GC content of 27.57% and with 707 protein-coding genes. The putative virulence determinants of M. bovirhinis were then analyzed. Results showed that three genomic islands and 16 putative virulence genes, including one adhesion gene enolase, seven surface lipoproteins, proteins involved in glycerol metabolism, and cation transporters, might be potential virulence factors. Glycerol and pyruvate metabolic pathways were defective. Comparative analysis revealed remarkable genome variations between GS01 and a recently reported HAZ141_2 strain, and extremely low homology with others mycoplasma species. Phylogenetic analysis demonstrated that M. bovirhinis was most genetically close to M. canis, distant from other bovine Mycoplasma species. Genomic dissection may provide useful information on the pathogenic mechanisms and genetics of M. bovirhinis.



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Genome-Wide Association Mapping Uncovers Fw1, a Dominant Gene Conferring Resistance to Fusarium Wilt in Strawberry

Fusarium wilt, a soil-borne disease caused by the fungal pathogen Fusarium oxysporum f. sp. fragariae, threatens strawberry (Fragaria x ananassa) production worldwide. The spread of the pathogen, coupled with disruptive changes in soil fumigation practices, have greatly increased disease pressure and the importance of developing resistant cultivars. While resistant and susceptible cultivars have been reported, a limited number of germplasm accessions have been analyzed, and contradictory conclusions have been reached in earlier studies to elucidate the underlying genetic basis of resistance. Here, we report the discovery of Fw1, a dominant gene conferring resistance to Fusarium wilt in strawberry. The Fw1 locus was uncovered in a genome-wide association study of 565 historically and commercially important strawberry accessions genotyped with 14,408 SNP markers. Fourteen SNPs in linkage disequilibrium with Fw1 physically mapped to a 2.3 Mb segment on chromosome 2 in a diploid F. vesca reference genome. Fw1 and 11 tightly linked GWAS-significant SNPs mapped to linkage group 2C in octoploid segregating populations. The most significant SNP explained 85% of the phenotypic variability and predicted resistance in 97% of the accessions tested-broad-sense heritability was 0.96. Several disease resistance and defense-related gene homologs, including a small cluster of genes encoding nucleotide-binding leucine-rich-repeat proteins, were identified in the 0.7 Mb genomic segment predicted to harbor Fw1. DNA variants and candidate genes identified in the present study should facilitate the development of high-throughput genotyping assays for accurately predicting Fusarium wilt phenotypes and applying marker-assisted selection.



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A Whole Genome Assembly of the Horn Fly, Haematobia irritans, and Prediction of Genes with Roles in Metabolism and Sex Determination

Haematobia irritans, commonly known as the horn fly, is a globally distributed blood-feeding pest of cattle that is responsible for significant economic losses to cattle producers. Chemical insecticides are the primary means for controlling this pest but problems with insecticide resistance have become common in the horn fly. To provide a foundation for identification of genomic loci for insecticide resistance and for discovery of new control technology, we report the sequencing, assembly, and annotation of the horn fly genome. The assembled genome is 1.14 Gb, comprising 76,616 scaffolds with N50 scaffold length of 23 Kb. Using RNA-Seq data, we have predicted 34,413 gene models of which 19,185 have been assigned functional annotations. Comparative genomics analysis with the Dipteran flies Musca domestica L., Drosophila melanogaster, and Lucilia cuprina, show that the horn fly is most closely related to M. domestica, sharing 8,748 orthologous clusters followed by D. melanogaster and L. cuprina, sharing 7,582 and 7,490 orthologous clusters respectively. We also identified a gene locus for the sodium channel protein in which mutations have been previously reported that confers target site resistance to the most common class of pesticides used in fly control. Additionally, we identified 276 genomic loci encoding members of metabolic enzyme gene families such as cytochrome P450s, esterases and glutathione S-transferases, and several genes orthologous to sex determination pathway genes in other Dipteran species.



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Editorial Board

Publication date: April 2018
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1861, Issue 4





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S15-3. Why is theta burst stimulation effective?

As the first patterned protocol of repetitive transcranial magnetic stimulation (rTMS), theta burst stimulation (TBS) gives bursts containing 3 pulses at 50 Hz at 5 Hz in either an uninterrupted continuous train (continuous TBS, cTBS) or short trains with pauses in between (intermittent TBS, iTBS). TBS induces a cortical modulation effect outlasting the stimulation for up to an hour after 20–192 s of stimulation. Since TBS is usually given at a low intensity for a short period of time, coil overheat is rarely seen before the end of stimulation.

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O-1-25. Task-dependent modulation of cerebellar brain inhibition during motor imagery

The aim of study was to investigate cerebellar brain inhibition (CBI) is affected by imaginary muscle contraction (Contract-I) and relaxation (Relax-I) using paired pulse paradigm with transcranial magnetic stimulation (TMS) in healthy human. Participants performed tonic actual contraction and relaxation of right first dorsal interosseous (FDI) muscle with visual feedback using electromyography. The motor evoked potential (MEP) in right FDI induced by TMS over the left primary motor cortex with or without conditioning TMS over the right cerebellum was measured during no-imagery (No-I), Contract-I (1st experiment, n = 9) and Relax-I (2nd experiment, n = 20).

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O-2-28. Vulnerability of each branch of median nerve in carpal tunnel syndrome

It is widely believed that sensory conduction study (SCS) is more sensitive than motor conduction study (MCS) in carpal tunnel syndrome (CTS). However, the sensitivity depends not only on the vulnerability of each branch of the median nerve, but on measurement errors and cut-off values. In this study, we aimed to clarify the true vulnerability of each branch in CTS. Subjects consisted of 144 CTS patients and 66 controls. The impairment of a branch was defined as the prolongation of onset latency.

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O-2-17. Influence of different types of orthoses on muscle synergy control during gait in stroke patients with hemiparesis

The purpose of this study was to verify the influence of lower limb orthoses on muscle synergy control during gait in stroke patients with hemiparesis. In four subjects with acute stroke, surface EMG signals from eight muscles of the paretic lower limb were measured during gait in two conditions (ankle foot orthosis; AFO or knee ankle foot orthosis; KAFO). The number of modules, muscle weightings and activation timing profile of each module were analyzed using non-negative matrix factorization. In two subjects (Fugl Meyer Assessment; FMA > 20) who walked with mild assistance, three modules were identified during gait with KAFO, whereas two modules were identified with AFO.

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O-2-24. Multimodal evoked potential study following posterior quadrantectomy in children with intractable epilepsy

To identify surgical effects on brainstem and cortical function objectively, we compared auditory brainstem response (ABR), somatosensory evoked potential (SEP) and flash visual evoked potential (fVEP) before and after posterior quadrantectomy (PQ) in 11 young children with intractable epilepsy associated with posterior quadrant cortical dysplasia. Mean age of seizure onset and the surgery was 1.4 months and 7.7 months old, respectively. Seven patients showed spasm and 2 had tonic seizures preoperatively.

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O-1-35. The verification for stimulation characteristics of Cortical Stimulator

Bipolar stimulation (BS) used in intraoperative mapping is said to have less influence of leakage current. Its characteristics were actually verified while comparing with monopolar stimulation (MS).

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O-1-24. Cortical silent period during force control task

We investigated whether transcranial magnetic stimulation (TMS)-induced cortical silent period (cSP), which reflects activation of the GABAergic inhibitory neural circuit in the primary motor cortex (M1), was modulated with dependency on actual output force and corticospinal excitability. Eleven healthy participants were asked to control the force of abduction of the right index finger to 10–100% of the maximum voluntary contraction. TMS was delivered to the left M1 during the task. The results showed that actual output force level, background electromyography activity (bEMG) and area of motor evoked potential (aMEP) in the right first dorsal interosseous muscle gradually increased with increasing target force level while cSP gradually decreased with increasing target force level.

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S19-4. Establishment of evidence-based physical therapy

Motor imagery and imitation have been widely used by physical therapist as part of rehabilitation program. However, there have been few evidences for the effect of these approaches on the physical therapy in terms of the neuroscience. Understanding of their neural mechanisms leads to establishment of evidence-based physical therapy (EBPT). Recently, we demonstrated some of the neural mechanism of motor imagery and imitation using MEG.

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Expression of C19MC miRNAs in HCC associates with stem-cell features and the cancer-testis genes signature

Intratumor heterogeneity of hepatocellular carcinoma (HCC) and, among HCC cell subsets, the cancer stem cell population (hCSC), is responsible for therapeutic resistance and disease relapse.

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Diagnostic Ability of Blue Laser Imaging Combined with Magnifying Endoscopy for Early Esophageal Cancer

Blue laser imaging (BLI) is a new image-enhanced endoscopy technique that utilizes a laser light source developed for narrow-band light observation.

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Knowledge and practice regarding the German and the EASL-EASD-EASO NAFLD-guidelines among members of the German Obesity Society



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Expression of C19MC miRNAs in HCC associates with stem-cell features and the cancer-testis genes signature

Intratumor heterogeneity of hepatocellular carcinoma (HCC) and, among HCC cell subsets, the cancer stem cell population (hCSC), is responsible for therapeutic resistance and disease relapse.

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Diagnostic Ability of Blue Laser Imaging Combined with Magnifying Endoscopy for Early Esophageal Cancer

Blue laser imaging (BLI) is a new image-enhanced endoscopy technique that utilizes a laser light source developed for narrow-band light observation.

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Knowledge and practice regarding the German and the EASL-EASD-EASO NAFLD-guidelines among members of the German Obesity Society



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Prior knowledge of category size impacts visual search

Psychophysiology, EarlyView.


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Laparoscopic sigmoidectomy in a case of sigmoid colon cancer with situs inversus totalis

Asian Journal of Endoscopic Surgery, EarlyView.


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Survival benefit of lymph node dissection in surgery for colon cancer in elderly patients: A multicenter propensity score‐matched study in Japan

Asian Journal of Endoscopic Surgery, EarlyView.


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Alcohol hangover impacts learning and reward processing within the medial‐frontal cortex

Psychophysiology, EarlyView.


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Post-deployment Mental Health Screening: A Systematic Review of Current Evidence and Future Directions

Abstract

Population-based post-deployment screening programs within the Departments of Defense and Veterans Affairs have been implemented to assess for mental health conditions and traumatic brain injury. The purpose of this paper is to systematically review the literature on post-deployment screening within this context and evaluate evidence compared to commonly accepted screening implementation criteria. Findings reflected highly variable psychometric properties of the various screens, variable treatment referral rates following screening, low to moderate treatment initiation rates following screening, and no information on treatment completion or long-term outcomes following screening. In sum, the evidence supporting population based post-deployment screening is inconclusive. Implications are discussed.



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Editorial Board

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Publication date: May 2018
Source:Journal of Human Evolution, Volume 118





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In Memoriam

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Publication date: Available online 29 March 2018
Source:International Journal of Psychophysiology





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The relationship between the menstrual cycle and cortisol secretion: Daily and stress-invoked cortisol patterns

Publication date: Available online 29 March 2018
Source:International Journal of Psychophysiology
Author(s): Eva Montero-López, Ana Santos-Ruiz, M. Carmen García-Ríos, Manuel Rodríguez-Blázquez, Heather L. Rogers, María Isabel Peralta-Ramírez
The menstrual cycle involves significant changes in hormone levels, causing physical and psychological changes in women that are further influenced by stress. The aim of this study was to understand the relationship between menstrual cycle phase and salivary cortisol patterns during the day as well as the salivary cortisol response to the Virtual Reality Version of the Trier Social Stress Test (TSST-VR).Forty two women not taking oral contraceptives (24 in follicular phase and 18 in luteal phase) participated in the study. Five samples of salivary cortisol collected during the day and another five samples of cortisol during the TSST-VR were analyzed. Psychological stress measures and psychopathological symptomatology were also evaluated. A 2 × 4 mixed ANCOVA showed an interaction between the two groups on the TSST-RV invoked cortisol response to the [F(3,42) = 3.681; p = 0.023) where women in luteal phase showed higher cortisol post exposure levels (5.96 ± 3.76 nmol/L) than women in follicular phase (4.31 ± 2.23 nmol/L). No other significant differences were found.Our findings provide evidence that menstrual cycle phase tended to influence cortisol response to laboratory-induced mental stress, with more reactivity observed in the luteal phase.



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Use of Nasotracheal Intubation during General Anesthesia in Two Ponies with Tracheal Collapse.

Related Articles

Use of Nasotracheal Intubation during General Anesthesia in Two Ponies with Tracheal Collapse.

Front Vet Sci. 2018;5:42

Authors: Ida KK, Sauvage A, Gougnard A, Grauwels M, Serteyn D, Sandersen C

Abstract
Ponies with tracheal collapse may have an increased anesthetic risk due to airway obstruction during induction and recovery. To our knowledge, there are no anesthetic descriptions of these patients, despite a reported 5.6% incidence and 77% mortality rate. Two Shetland ponies with tracheal collapse, a 12-year-old male (pony 1) and a 27-year-old female (pony 2), were referred for right eye enucleation due to a perforating corneal ulcer and severe recurrent uveitis, respectively. Pony 1 was stressed, had lung stridor and hyperthermia, and developed inspiratory dyspnea with handling. Radiography confirmed collapse of the entire trachea as well as inflammation of the lower airways. Corticosteroids and bronchodilators were administered by nebulization for 1 week before surgery. Pony 2 had a grade III/VI mitral murmur and a clinical history of esophageal obstructions and tracheal collapse requiring tracheostomy. Both ponies were premedicated with acepromazine and xylazine; anesthesia was induced with midazolam and ketamine. Nasotracheal intubation was performed in left lateral recumbency with extension of the neck and head and was guided by capnography. The nasotracheal tube consisted of two endotracheal tubes attached end-to-end to create a tube of adequate length and diameter. Pony 2 was orotracheally intubated during surgery and later reintubated with a nasotracheal tube. Anesthesia was maintained with isoflurane using volume-controlled ventilation. Analgesia was provided by a retrobulbar blockade with mepivacaine and lidocaine. Cardiovascular support consisted of lactated Ringer's solution and dobutamine. After surgery, the ponies were administered xylazine and supplemented with oxygen through the nasotracheal tube. Recovery was assisted by manual support of the head and tail. Successful extubation was achieved following butorphanol administration after approximately 1 h in standing position. Both ponies were discharged from the clinic a few days after surgery.

PMID: 29594157 [PubMed]



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The opioid epidemic and pregnancy: implications for anesthetic care

Purpose of review This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. Recent findings Opioid use among parturients has risen dramatically, with opioid use during pregnancy as high as 20%. Of women with chronic pain, most continue to take opioids during pregnancy. Medication-assisted therapy with methadone or buprenorphine is currently the standard for treatment of opiate use disorder. Buprenorphine has unique pharmacologic properties that account for its preference over methadone. It has also been shown to produce more favorable neonatal outcomes compared with methadone. Increased clearance and volume of distribution associated with pregnancy require adjustment of dosing regimens of both medications. Multimodal adjuncts can be important alternatives for treatment of pain in opioid-tolerant parturients. Summary The dramatic rise in OUD in pregnancy has had staggering socioeconomic consequences, carrying with it profound maternal and fetal health problems. Medication-assisted treatment utilizing either methadone, or more commonly buprenorphine, is considered the standard of care for OUD during pregnancy. Peripartum pain management for opioid-tolerant patients is challenging and requires consideration for regional anesthesia along with multimodal pharmacotherapy. Correspondence to Michael G. Richardson, Division of Obstetric Anesthesiology, Department of Anesthesiology, 4202 VUH, Vanderbilt University Medical Center, Nashville, TN 37232-7580, USA. Tel: +1 615 322 8476; e-mail: Michael.g.richardson@vanderbilt.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Drug error in paediatric anaesthesia: current status and where to go now

Purpose of review Medication errors in paediatric anaesthesia and the perioperative setting continue to occur despite widespread recognition of the problem and published advice for reduction of this predicament at international, national, local and individual levels. Current literature was reviewed to ascertain drug error rates and to appraise causes and proposed solutions to reduce these errors. Recent findings The medication error incidence remains high. There is documentation of reduction through identification of causes with consequent education and application of safety analytics and quality improvement programs in anaesthesia departments. Children remain at higher risk than adults because of additional complexities such as drug dose calculations, increased susceptibility to some adverse effects and changes associated with growth and maturation. Major improvements are best made through institutional system changes rather than a commitment to do better on the part of each practitioner. Summary Medication errors in paediatric anaesthesia represent an important risk to children and most are avoidable. There is now an understanding of the genesis of adverse drug events and this understanding should facilitate the implementation of known effective countermeasures. An institution-wide commitment and strategy are the basis for a worthwhile and sustained improvement in medication safety. Correspondence to Professor Brian J. Anderson, PhD, FANZCA, FCICM, Department of Anaesthesiology, University of Auckland, Faculty of Medical and Health Sciences, Auckland 1023, New Zealand. Tel: +64 9 3074903; fax: +64 9 3078986; e-mail: briana@adhb.govt.nz Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Hand distance modulates the electrophysiological correlates of target selection during a tactile search task

Psychophysiology, EarlyView.


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B-15. Waveform analysis of sympathetic skin response

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Minoru Toyokura
The author analyzed waveform of sympathetic skin response (SSR). Waveforms were classified as either the P-type, in which the positive component was larger than the negative one, or the N-type, in which the negative component was larger the positive one. P-type-SSR had shorter latency and larger amplitude than N-type-SSR. Among 50 subjects 14 and 9 ones had only the P-type and N-type during 20 electrical stimulations, respectively. The remaining 27 subjects had both types. Habituation was associated with waveform changes from P to N types. Palm-SSR had the largeer amplitude and more common appearance of P-type waveform than sole-SSR. When the stimulation was increased, the SSR size became larger. Strong responses likely produced large P-type-SSR. The waveform and size of SSR seemed to be rather consistent in individuals even if the stimulation modality was changed. SSRs from two palm sites had significantly shorter latencies and larger amplitudes than the SSRs evoked from proximal sites of the forearm (paradoxical shortening of the latency). The SSR waveform pattern was not affected by the pathological condition related to diabetes. These findings above can be explained by a model of the equivalent current dipole caused by the Na+ concentration gradient in terms of SSR generation.



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Contents

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5





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B-3. Electroencephalography and seizures learned from ictal recording

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Masaki Iwasaki, Naoki Ikegaya, Yuiko Kimura, Yuu Kaneko
Experience on ictal video electroencephalography (EEG) recording enriches knowledge on EEG and seizures. Following five fundamentals are important for correct interpretation of EEG during focal epileptic seizures.Epileptic seizures never happen without EEG changes.Epileptic seizure propagates.EEG changes are not necessarily visible.EEG changes occur as a remote effect.EEG seizure explains clinical symptoms.Focal epileptic seizure starts with several patterns such as low voltage fast activity or repetitive spikes, followed by ictal rhythm that evolves spatially from focal to diffuse area, and temporally from low amplitude fast to high amplitude slow waves. The seizure propagation can occur very rapidly. For the sensitivity of EEG depends on the distance from source to electrode, EEG seizure may only appear after seizure activity involves adequately large area of cortex. The seizure activity limited to the deep area such as mesial temporal region will not appear in scalp EEG. Slow rhythmic activity can be induced in the remote cortex as an inhibitory effect of focal seizure, so that diffuse delta rhythm at the beginning of seizure may not localize the seizure onset zone. Epileptogenic zone is estimated by correlating supposed EEG seizure localization and clinical symptoms.



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Shimazono-Lecture-1. What I have done using TMS techniques

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Yoshikazu Ugawa
CMCT, CTX-BST CT, BST-Cv CT, CCCT, CECT: Using brainstem and conus medullaris stimulation in combination with the motor cortical and spinal nerve stimulation, we estimated conduction delays at several segments in CSTs.Cerebellar inhibition of the motor cortex (CBI): Purkinje cell activation by TMS induced a transient motor cortical inhibition. Mechanisms underlying ataxia was studied with this method.Shor interval intracortical inhibition (SICI): We showed the dependency of SICI on the motor cortical TMS pulse directions, which gave us a hint about the mechanisms of SICI. Neuroplasticity induction by QPS: We have introduced quadripulse stimulation (QPS) for steady plasticity induction in human brain. Using this method, we have shown the normal and abnormal motor or sensory cortical plasticity, drug influence on the plasticity, and also mechanisms for speech production, motor sequence learning or other human performances.Treatments by rTMS and combination with other methods: We have shown some clinical beneficial effects in patients with Parkinson's disease by rTMS over supplementary motor cortex or other areas.Spike time dependent spinal cord plasticity: We induced spike timing dependent plasticity at the CST- spinal motor neuron synapses with combination of brainstem stimulation and peripheral nerve stimulation.



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B-10. Electrodiagnostic studies in entrapment neuropathy

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Mitsuhiko Kodama
Electrodiagnosis of entrapment neuropathy at the upper limb is important to determine the treatment procedure. The median sensory nerve conduction studies and median nerve motor nerve distal latency have conventionally been performed for the diagnosis of carpal tunnel syndrome (CTS), but their sensitivities are not always sufficient. As a result of our research in 104 hands with CTS symptoms, both the ring finger test and second lumbrical–interossei comparison test had especially high sensitivity (92%), and this result supports the practice parameters recommended by the Japanese Society of Neurological Therapeutics. Exact localization of the lesion by electrodiagnosis in patients with ulnar neuropathy at the elbow (UNE) is often difficult because other disorders may mimic its symptoms (e.g., cervical lesion, brachial plexopathy, and Guyon's canal syndrome). In one of our studies, sensitivity of the ulnar nerve motor nerve conduction velocity across the elbow lacked accuracy (54%). Meanwhile, the short-segment incremental study had the highest sensitivity (82%), maintaining high specificity (95%). In extreme UNEs, the combination of sensory nerve conduction studies evoked from the dorsal ulnar cutaneous branch and the medial antebrachial cutaneous nerve may be helpful in the exclusion of other disorders.



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Editorial Board

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5





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Clinical utility of EEG in diagnosing and monitoring epilepsy in adults

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): W.O. Tatum, G. Rubboli, P.W. Kaplan, S.M. Mirsatari, K. Radhakrishnan, D. Gloss, L.O. Caboclo, F.W. Drislane, M. Koutroumanidis, D.L. Schomer, D. Kastelijn-Nolst Trenite, Mark Cook, S. Beniczky
Electroencephalography (EEG) remains an essential diagnostic tool for people with epilepsy (PWE). The International Federation of Clinical Neurophysiology produces new guidelines as an educational service for clinicians to address gaps in knowledge in clinical neurophysiology. The current guideline was prepared in response to gaps present in epilepsy-related neurophysiological assessment and is not intended to replace sound clinical judgement in the care of PWE. Furthermore, addressing specific pathophysiological conditions of the brain that produce epilepsy is of primary importance though is beyond the scope of this guideline. Instead, our goal is to summarize the scientific evidence for the utility of EEG when diagnosing and monitoring PWE.



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B-9. Quantitative evaluation of motor function and its clinical application

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Shinji Kakei
A classic hypothesis for motor control assumes that the predictive controller (PC) and the feedback controller (FBC) work in parallel. Nevertheless, dissociation of outputs from the two controllers has never been possible, preventing evaluation of motor functions in movement disorders. Here we demonstrate a new method to separate outputs from PC and FBC. Subjects performed a tracking movement to pursue a slowly moving target, while we recorded movement with a manipulandum or a Kinect v2 sensor. We identified three components of tracking movement that were separable with FFT and identified in terms of their function. The primary, a lower frequency component (<0.5 Hz) continuously reproduced the target motion in a predictive manner. The second, an intermediate frequency component (0.5–3.0 Hz) represented intermittent corrections of position errors in a feedback manner. These results confirmed that the two components were generated from separate controllers. Furthermore, we identified the third, an even higher frequency component (>3.0 Hz), which showed characteristic increases in patients with Parkinson's disease or stroke. Each of the three components provides unique parameters to quantify motor function of patients with movement disorders. Our new method provides a new framework to characterize movement disorders.



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A-19. Visual evoked potentials: Basic technology and clinical applications

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Yoshinobu Goto
Visual information is processed simultaneously via multiple parallel channels and each channel constitutes a set of sequential processes. The visual evoked potentials (VEPs) are the evoked electrophysiological potential that can be extracted, using signal averaging, from the electroencephalographic activity recorded at the scalp. VEPs can provide important diagnostic information regarding the functional integrity of the visual pathways and the visual cortex. Commonly used visual stimuli are flashing lights or pattern reversal (checkerboards or gratings) on the TV monitor or video screen. Pattern reversal is the preferred technique for most clinical purposes. The results of pattern reversal stimuli are less variable in the waveform and the timing than the results elicited by other stimuli. The pattern onset/offset technique can be useful in the detection of malingering and in patients with nystagmus, and the flash VEP is particularly useful when optical factors or poor cooperation make the use of pattern stimulation inappropriate. In addition, pattern reversal VEP to full-field stimulation is best suited to evaluate anterior visual pathways while hemi-field VEP is most effective in the assessment of chiasmal and post-chiasmal functions. This article presents the basic technology and current standard for flash and pattern reversal VEP recording methods based on the major parallel pathways of the visual system from the retina to the primary visual cortex via lateral geniculate nucleus that receive visual input.



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B-7. Electrodiagnostic criteria for ALD: Current state and perspectives

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Satoshi Kuwabara
The diagnosis of amyotrophic lateral sclerosis (ALS) requires (1) evidence for extensive upper and lower motor neuron dysfunction, (2) progressive course, and (3) exclusion of other causes of motor neuronal loss. So far, a number of diagnostic criteria for ALS have been proposed, such as El Escorial (1990), revised El Escorial (1998), Awaji (2008), and updated Awaji (2015). According to the frequent revision/proposal criteria, electrodiagnostic criteria for ALS are somewhat confusing. In these criteria, the body motor system are divided into 4 regions; cranial, cervical, thoracic, and lumbosacral, and evidence for upper and lower motor neuron signs in the two or more regions are required for the diagnosis of "probable" ALS. This lecture reviews a history, current status, and perspectives for ALS electrogiagnosis. The diagnostic sensitivity latest version, the updated Awaji criteria is reported to be 73% in a recent systematic review.



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B-13. Educational lecture B-13. Fun of needle electromyography

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Kazuto Akaboshi
I think that many physicians feel "needle electromyography is interesting?" But it is interesting if you can understand and boring if you can not. For that, it is important to know the meaning of electromyogram waveform. Since any of these waveforms is a potential originating from the muscle fibers, it is natural that the appearances are similar, and experts can not judge only by that "shape". They judge based on the rhythm of the waveform and muscular strength. It is important to know the characteristics of the waveform, for example, whether the waveform originates from one muscle fiber, whether it is firing as a motor unit, or a potential arising from multiple muscle fibers not related to motor units. It is also important to know whether the potential is generated by voluntary muscle contraction, irrelevant to muscle contraction or induced by needle sticking. For example, there are fibrillation potentials, positive sharp waves, and myotonic discharges as potentials to be generated from one muscle fiber, and the motion unit potential and the fasciculation potential are potentials generated from the motion unit. In this presentation, we will briefly describe other potentials and clinical points.



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B-17. Future and problems of neurorehabilitation – The concept of smart rehabilitation

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Meigen Riu
To develop and apply revolutionary neurorehabilitation (NR) technologies, findings from neuroscientific studies and clinical evidence must be collected, intellectual property must be managed, and NR technologies must be commercialized, approved by the Pharmaceutical and Medical Device Act, and put into commercial operation. The development of NR devices, such as the brain-machine interface (BMI) NR device by the Medical Engineering Coordination Team at Keio University, is supported by multiple grants from the Japan Agency for Medical Research and Development (AMED) focused on different phases and continuing on a clear path toward application. Taking EEG-BMI NR system developed to improve severe upper extremity paresis after stroke as an example, we will explain how the above-mentioned process has been achieved.In the near future, we plan to systemize in the cloud revolutionary NR device groups under development as well as existing superior NR devices, and to continue integrating these into a "smart NR office" that can seamlessly provide systematic, cutting-edge NR based on determined indications. We therefore aim to optimize, streamline, and advance NR treatments and dramatically expand the range of therapeutic potential, bringing about a revolution in NR.



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SP-2. What dose TMS stimulate?

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Ying-Zu Huang
Transcranial magnetic stimulation (TMS) is a technique to stimulate the nervous system non-invasively through the intact scalp and skin. The TMS machine delivers a short pulse of electric current into a TMS coil to generate a quick changing magnetic field surrounding the coil as an example of Ampere's law. TMS stimulates the neuronal circuits with the eddy current induced by the changing magnetic field, not the magnetic field its self, based on Faraday's law. To generate enough power for stimulating human's brain, a TMS machine is generally built to generate a current of around 8000 A for a 2.5–4 Tesla output, although it may vary between machine types and manufacturers. TMS is capable of stimulating human's cortex to induce recordable responses, e.g. motor evoked potentials (MEPs). However, how TMS actives the circuits and what TMS stimulates is in fact more complicated than most people think. The current knowledge of what TMS stimulates is mainly learned from the stimulation over the motor cortex generating MEPs. In this session, the mechanism of TMS will be explained, the effects of TMS over the motor cortex will be introduced and the underlying mechanisms of how TMS induces such responses and effects will be discussed.



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Shourei Prize 2. Utility of TMS for neuroscience of speech

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Takenobu Murakami
Transcranial magnetic stimulation (TMS) has widely been accepted as a useful method of non-invasive brain stimulation in neuroscience. Compared with neuroimaging and intraoperative mapping, the number of speech experiments using TMS has, however, still been small. Here, an introduction to recent TMS studies that explored speech perception and imitation is presented. Single-pulse TMS of the primary motor cortex (M1) showed a speech specific and topographically specific increase of excitability in the M1 lip area during speech perception. This may be explainable by the motor theory of speech perception and reflect the function of mirror neurons. The updated speech model is constituted of dual speech processing streams; dorsal and ventral streams. A paired-coil stimulation demonstrates an increase in the effective connectivity from brain regions in the dorsal stream to the M1 lip area. Application of repetitive TMS (rTMS) to parts of the dorsal stream can modulate performance of phonological recognition, whereas semantic perception is altered by rTMS over the ventral pathway. Speech imitation combined with facilitatory rTMS over the left posterior inferior frontal gyrus can enhance accuracy of imitation performance. In summary, TMS is an innovative tool to understand the brain network of speech processing on perception and imitation.



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B-2. Clinical application of patterned DC stimulation

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Tatsuya Mima
In addition to conventional surgical and pharmacological methods, electromagnetic interventions to the human brain have been developed for testing and treating neuropsychiatric disorders. Considering that the central principle of brain coding is based on neural firings and cell membrane potentials, that is electrical phenomena, electromagnetic intervention to the brain can be useful and effective for modulating brain functions.Among various electromagnetic methods, the most advanced one is the transcranial magnetic stimulation (TMS) which was put into practical use in 1985. The transcranial direct current stimulation (tDCS) whose usefulness has been reconfirmed since the late 1990s is spreading as a simple and inexpensive brain function intervention method. With regard to the safety of tDCS, it is not strong enough to cause neural firing itself, so there is the advantage that epilepsy and other health risks are extremely low.Instead of applying tDCS at a constant current, a patterned current stimulation performed by a variable current – one example of which is AC stimulation (tACS) – can be useful for efficiently modifying brain function with low energy by entrainment. This is because oscillation is important as a general organization principle of brain function (Grant-in-Aid for Scientific Research on Innovative Areas "Oscillology"). Regarding the oscillation phenomenon, it is known that entrainment occurs between oscillations of similar frequencies and synchronization of phase difference is likely to occur even in communication with a small amount of energy. It has been shown that it is possible to synchronize EEG activity to tACS in alpha rhythm.Currently, we are studying whether it is possible to reconstruct gait function in Parkinson patients by patterned current stimulation synchronized with walking rhythm. In this educational lecture, we describe the importance of the oscillation in the brain function and the clinical application of the patterned current stimulation.



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B-4. Neurophysiology of sleep in humans

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Makoto Uchiyama
Studies on EEG slowing in the progression of sleep since the discovery of electroencephalogram (EEG) in the 1920s, and identification of rapid eye movement (REM) sleep in the 1950s lead to the current principle that human sleep consists of REM and non-REM (NREM) sleep cycles. In this lecture, I will review sleep-wake homeostasis. Quantitative analysis of sleep EEG has revealed that delta EEG activity is enhanced according to the length of prior wakefulness, and achieved the recovery of the brain. This provides understanding on those clinical facts that disturbed sleep accelerates physical or mental disorders. I will also review a recent topic that deep NREM sleep with delta EEG activity is an active brain process, in which memory and skills acquired during wakefulness are consolidated and made to be ready for use. In addition, such delta EEG activity during sleep is more strongly induced in those cortical areas where intensive task is loaded during wakefulness. Finally, I will consider how the above processes are controlled by the network between the thalamus and the cortex, with special reference to its relation to conventional sleep EEG patterns such as K-complex, spindle or sleep delta waves.



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B-11. Application of EEG-based brain computer interface to movement and sensory disorders

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Tetsuo Ota
ObjectiveTo examine the effect of the EEG-based brain computer interface (BCI) training for patients with stroke, writer's cramp and neuropathic pain. Method: Using the EEG recorded with Ag/AgCl electrodes placed at C3 and C4, as designated according to the International 10/20 system, we gave real time visual feedback to the patients with PC monitor which is placed in front of them. Participants were required to imagine the affected wrist extending in stroke and neuropathic pain patients. Patients with writer's cramp were requested to relax their wrist flexor while extending their wrist. If these tasks were able to have an effect to the affected sensory motor cortex, we can see the change of patient's sensory motor rhythm, for example what is called event-related desynchronization (ERD). While practicing this biofeedback system, patients made an effort to control their affected side EEG activity representing the ERD in stroke and neuropathic pain patients, and diminishing the event-related synchronization (ERS) in writer's cramp patients. Results: After several months BCI training, some patients with stroke and neuropathic pain were able to change their EEG activity easily to have the ERD and after the 6 months training one writer's cramp patient was able to diminish the ERS resulted in good performance. Moreover we could also confirm this change in stroke patients representing the sensory motor cortex activity by recording the functional MRI. Implications/Impact on Rehabilitation: The results suggest that this type of EEG-based brain computer interface training is useful method to improve some kinds of movement and sensory disorders.



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B-14. Pathophysiological diagnosis of status epilepticus with complementary use of the periictal MRI (arterial spin labeling perfusion and diffusion-weighted images) and EEG

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Takato Morioka
In the diagnosis of nonconvulsive status epilepticus (NCSE), capture of ongoing ictal EEG findings is the gold standard; however, this is practically difficult without continuous EEG monitoring facilities. MRI, including diffusion-weighted imaging (DWI) and perfusion MRI with arterial spin labeling (ASL), have been applied mainly in emergency situations. Recent reports have described that ictal MRI findings, including ictal hyperperfusion on ASL and cortical hyperintensity of cytotoxic edema on DWI, can be obtained from epileptically activated cortex. We demonstrate the diagnostic value of ictal MRI findings in 15 patients diagnosed as having NCSE (eight had complex partial status epilepticus (SE) and seven subtle SE) who underwent an initial MRI and subsequent routine EEG. In all 10 patients with an epileptogenic lesion, there was a tight topographical relationship between the lesion and the localization of ictal MRI findings. In the other five patients, ictal MRI findings were useful in the diagnosis of NCSE of non-lesional elderly epilepsy, or de novo NCSE of frontal origin as situation-related NCSE. The present study clearly demonstrates that the initial use of ASL and DWI has the ability to diagnose partial NCSE and also allows documentation of the pathophysiological mechanism in each patient.



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B-16. Artificial neural connection using a computer interface

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Yukio Nishimura
Functional loss of limb control in individuals with spinal cord injury or stroke can be caused by transection of descending pathways those connects cortical to spinal network, although neural circuits locate above and below the impaired site remains their function. I will show an artificial neuronal connection (ANC) that bridges supra-spinal system and spinal network beyond the lesion site restore lost function. The ANC was produced by a computer interface that can detect the neural activity and converted in real-time to activity-contingent electrical stimuli delivered to nervous system. A promising application is to bridge impaired biological connections, a paradigm that was demonstrated for cortically controlled electrical stimulation of paralyzed forearm muscles. ANC have clinical potential for restoring walking ability in patients with spinal cord injury. A clinical application of the ANC is the volitional walking in could be restored by muscle-controlled non-invasive magnetic stimulation to lumbar spinal cord. Patients with severe SCI could regain voluntarily-controlled walking which are initiate, stop walking and change the step cycles through ANC. These paradigms have numerous potential applications, depending on the input signals, the computed transform and the output targets.



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B-18. Where ‘ERP’ is and where it is going?

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Hirooki Yabe
Sutton (1965) classified Event-Related Potentials (ERPs) into exogenous and endogenous components. Exogenous ERPs would reflect automatic processing and endogenous ones would reflect controlled processing (Picton and Hillyard, 1988). Only mismatch negativity (MMN), an automatic but endogenous ERP found by Näätänen et al. (1978), does not match this classification. MMN is automatically elicited by occasional deviation in a sequence of homogenous sounds. MMN is considered to be generated by the comparison process between deviated sound and neural trace of preceding sounds encoded in sensory memory. Plenty of studies have given evidence for "memory trace theory". MMN provides a promising tool for clinical populations, because MMN elicitation does not require any tasks and MMN to duration deviation (i.e., duration-MMN) is exceptionally sensitive to clinical populations such as schizophrenia. Michie et al. (2000) reported that only duration-MMN was reliably reduced in patients with schizophrenia. Todd et al. (2007) also reported that a definite reduction in early schizophrenia was evident in duration-MMN but not frequency deviants. Impairment of MMN is one of the most robust findings in schizophrenia. MMN to duration is a candidate of the trait marker. Importantly, MNN reduction predict conversion to psychosis among the subjects clinically at risk-mental state (ARMS).



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Πέμπτη, 29 Μαρτίου 2018

Pediatric Collagenous Gastritis and Colitis: A Case Series and Review of the Literature

Introduction: Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands. Two phenotypes of the disease have been described: a pediatric-onset and an adult-onset type. The adult-onset form is associated with collagenous colitis and autoimmune disorders. No effective treatment has been identified to date. Objective: We aim to describe the clinical features and outcomes of patients in our cohort and provide a summary of published pediatric cases with collagenous gastritis and colitis reported to date to gather information that will contribute to improved knowledge of this rare condition. Methods: A retrospective chart review of all patients with collagenous gastritis and/or colitis who were treated at the Royal Children's Hospital, Melbourne, was performed. A literature review was also conducted. Results: A total of 12 cases of collagenous gastritis were reviewed. Three of 12 (25%) patients had associated collagenous colitis. The most common clinical presentation was iron deficiency anemia. Nine (75%) patients were followed up, and repeat endoscopies were performed in 8 (67%). Iron deficiency anemia resolved in all patients on oral iron supplementation. Histologic improvement was only identified in one patient with the adult phenotype who had been treated with oral corticosteroids and azathioprine. Conclusions: Collagenous gastritis is a rare condition in children. A small proportion of children develop features of the "'adult" phenotype at a very young age. Patients with collagenous gastritis require long-term follow-up and monitoring of their disease. Further randomized clinical trials are needed to establish an effective therapeutic strategy. Address correspondence and reprint requests to Dr Judy Matta, MD, Department of Gastroenterology and Clinical Nutrition, Saint George Hospital University Medical Center, P.O. Box 166 378, Achrafieh, Beirut 11 00 2807, Lebanon (e-mail: judymatta@gmail.com). Received 21 June, 2017 Accepted 24 February, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). The other authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Multivariate Model for the Prediction of Severity of Acute Pancreatitis in Children

This study aimed to develop a severity prediction system for pediatric patients with acute pancreatitis (AP) based on clinical and laboratory parameters recorded at disease onset. A retrospective cohort study including 130 patients with AP, aged 0 to 18 years, was conducted. Correlations between severe AP (SAP) and clinical and laboratory data were established. Parameters with a significant statistical correlation (P ≤ 0.05) were incorporated in logistic regression models, and receiver operating characteristic curves were generated. The best-performance cutoff points were calculated to propose a severity prediction score, for which sensitivity and specificity were determined. Thirty-eight cases (29.2%) were consistent with SAP. A value of ≥1 point yielded a sensitivity of 81.5% and specificity of 64.1% for SAP prediction, when using a score including blood urea nitrogen ≥12.5 mg/dL (1 point) or hemoglobin

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Gavage Feed Volume Determines the Gastric Emptying Rate in Preterm Infants

Objective: Feeding intolerance, manifesting as increased gastric residual, is a common finding in preterm neonates. Little is known about the regulation of gastric emptying early in life and the extent to which this plays a role in the preterm infants' feeding tolerance. The goal of this study was to evaluate clinically stable 28- to 32-week gestation neonates during the first 4 weeks of life and noninvasively determine their gastric emptying rate. Study design: Ultrasound measurements of gastric milk content volume were obtained from 25 neonates immediately after, 30 and/or 60 minutes following routine gavage feeds. The content emptying rate was calculated from the gastric volume data. Results: Gastric emptying rate was not postnatal age-dependent, was significantly higher at 30 minutes, whenever compared with 60-minute postfeed and directly proportional to the feed volume. At any postnatal age, the gastric emptying rate was at least 6-fold greater, when comparing the lowest and highest average stomach content volumes. Conclusions: The gastric emptying rate of preterm infants is content volume-dependent and unrelated to the postnatal age. Given the present findings, further investigation on the gastric residual of preterm infants receiving larger than currently administered feed volumes at the initiation of enteral nutrition, is warranted. Address correspondence and reprint requests to Jaques Belik, MD, Physiology & Experimental Medicine Program, Department of Paediatrics and Physiology, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, University of Toronto, 686 Bay Street, 9th Floor, Room 09.9713, Toronto, ON M5G 0A4, Canada (e-mail: jaques.belik@sickkids.ca) Received 1 September, 2017 Accepted 6 March, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Funding sources: This study was supported by a grant from the Canadian Institutes of Health Research to J.B. (MOP 133664) and Brazilian Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; SWE 202940/2015-2) for C.H.F.F. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript. The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Detection of Cytomegalovirus in Colonic Mucosa of Children With Inflammatory Bowel Disease

The aim of this study was to determine the frequency and management of cytomegalovirus (CMV) detection in colonic mucosa of children with inflammatory bowel disease (IBD). Children with moderate-to-severe colitis who had sigmoid biopsy specimens evaluated for CMV by hematoxylin and eosin (H&E) staining, immunohistochemistry (IHC), and polymerase chain reaction (PCR) were included. A total of 90 sigmoid biopsies were collected from 67 patient encounters from 58 patients with colitis including biopsy samples from colectomy specimens of 8 patients who had colectomy during the study period. Four of 61 patient encounters (6.6%) with ulcerative colitis/IBD-unclassified, 2 with corticosteroid refractory disease, had positive biopsies for CMV by PCR but negative H&E and IHC. They responded to escalated medical therapy, without needing anti-viral therapy or colectomy over a median duration of follow-up of 1.1 year. CMV presence is uncommon in colonic mucosa of children with inflammatory bowel disease. Address correspondence and reprint requests to Wael El-Matary, MD, MSc, FRCPCH, FRCPC, Associate Professor and Section Head, Section of Pediatric Gastroenterology, Departments of Pediatrics, Faculty of Medicine, University of Manitoba AE 408, Health Sciences Centre, 840 Sherbrook St., Winnipeg, Manitoba R3A 1S1, Canada (e-mail: welmatary@hsc.mb.ca). Received 3 September, 2017 Accepted 27 February, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Source of funding: W.E.-M. is supported with a grant from the University of Manitoba and the Children's Hospital Research Institute of Manitoba. The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Proton Pump Inhibitors and Infant Pneumonia/Other Lower Respiratory Tract Infections: National Nested Case-control Study

Objective: The possible association between the use of proton pump inhibitors (PPIs) and community-acquired pneumonia (CAP) or any lower respiratory tract infection (LRTI) remains uncertain. We conducted a nested case-control study using routinely collected national health and drug dispensing data in New Zealand to examine the risk of CAP or any LRTI resulting in hospitalization or death in infants dispensed a PPI. Study Design: The cohort included 21,991 patients without a history of CAP or any LRTI who were born between 1 January 2005 and 31 December 2012 and were dispensed omeprazole, lansoprazole, or pantoprazole (the PPIs available in New Zealand during the study period) on at least one occasion during the first year of life. Cases had a first diagnosis after cohort entry (first PPI dispensing) of CAP (n = 65) validated by hospital discharge letter or death record, and chest radiography; or LRTI (including CAP) (n = 566) validated by hospital discharge letter or death record, with or without chest radiography. Up to 10 controls, matched by sex and date of birth, were randomly selected for each case. We conducted complete case analyses for the fully adjusted models. Results: In the adjusted analysis based on CAP cases and their controls, the matched odds ratio for current versus past use of PPIs was 0.88 (95% confidence interval 0.36–2.16). For all LRTI cases and their controls, the matched odds ratio was 1.13 (0.87–1.48). Conclusion: In otherwise healthy community-dwelling infants, current use of a PPI does not appear to increase the risk of CAP or other LRTIs. Address correspondence and reprint requests to Mei-Ling Blank, MPH, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand (e-mail: meiling.blank@otago.ac.nz) Received 7 November, 2017 Accepted 6 March, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Contributors' Statement The New Zealand Pharmacovigilance Centre and Medsafe, and a Strategic Research Grant from the Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand. None of the funders had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Neurodevelopmental Outcomes in Children With Liver Diseases: a Systematic Review

Objective: The aim of the study was to determine the neurodevelopmental outcomes of children with liver diseases based on a systematical review of the literature. Method: A literature search according to the PRISMA statement was conducted using predefined search terms in PubMed, Cochrane Library, and PsycINFO. The inclusion criterion was studies published from 2000 onwards that reported on the neurodevelopmental outcomes of term-born children with liver diseases. A narrative synthesis was done to appraise the studies. Results: Twenty-five studies were included (1913 children), 19 of which described children after liver transplantation (LTx; 1372 children). Sixty-seven percentage of the studies on children with liver diseases who survived with their native livers showed low-average or abnormal scores on specific subscales of cognitive and behavioral measures. In studies on children after LTx, this was 82%. After LTx, 83% of studies demonstrated impaired outcomes on behavior, whereas 42% of children received special education. Motor development was impaired in 82% of studies in children with native liver and after LTx. Limitations: Studies were heterogenic because of sample sizes, etiology of liver disease and type of assessment tools used. Conclusions: More than two-third of included studies showed neurodevelopmental deficits in children with liver diseases, affecting all neurodevelopmental areas. Knowledge on risk factors for impaired neurodevelopment is limited and lack of long-term follow-up is worrying, especially considering the increasing survival rates, resulting in more at-risk patients. Studying early predictors and risk factors of abnormal developmental trajectories of children with liver diseases is indicated to assess strategies to improve their long-term neurodevelopmental outcomes. Address correspondence and reprint requests to Janneke L.M. Bruggink, MD, PhD, Division of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands (e-mail: j.l.m.bruggink@umcg.nl). Received 22 November, 2017 Accepted 11 March, 2018 The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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A Celiac Diasease Associated lncRNA Named HCG14 Regulates NOD1 Expression in Intestinal Cells

Objective: To identify additional celiac disease associated loci in the Major Histocompatibility Complex independent from classical HLA risk alleles (HLA-DR3-DQ2) and to characterize their potential functional impact in celiac disease pathogenesis at the intestinal level. Methods: We performed a high resolution SNP genotyping of the MHC region, comparing HLA-DR3 homozygous celiac patients and non-celiac controls carrying a single copy of the B8-DR3-DQ2 conserved extended haplotype. Expression level of potential novel risk genes was determined by RT-PCR in intestinal biopsies and in intestinal and immune cells isolated from control and celiac individuals. Small interfering RNA-driven silencing of selected genes was performed in the intestinal cell line T84. Results: MHC genotyping revealed two associated SNPs, one located in TRIM27 gene and another in the non-coding gene HCG14. After stratification analysis, only HCG14 showed significant association independent from HLA-DR-DQ loci Expression of HCG14 was slightly downregulated in epithelial cells isolated from duodenal biopsies of celiac patients, and eQTL analysis revealed that polymorphisms in HCG14 region were associated with decreased NOD1 expression in duodenal intestinal cells. Conclusions: We have sucessfully employed a conserved extended haplotype-matching strategy and identified a novel additional celiac disease risk variant in the lncRNA HGC14. This lncRNA seems to regulate the expression of NOD1 in an allele-specific manner. Further functional studies are needed to clarify the role of HCG14 in the regulation of gene expression and to determine the molecular mechanisms by which the risk variant in HCG14 contributes to celiac disease pathogenesis. Address correspondence and reprint requests to Dr. Izortze Santin, Endocrinology and Diabetes Research Group, BioCruces Health Research Institute, UPV-EHU, E48903-Barakaldo, Bizkaia, Basque Country, Spain (e-mail: izortze.santingomez@osakidetza.eus). Received 11 December, 2017 Accepted 11 March, 2018 Conflicts of interest: None declared. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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The Membrane-bound O-Acyltransferase7 rs641738 Variant in Pediatric Nonalcoholic Fatty Liver Disease

Background: The rs641738 polymorphism in the membrane-bound O-acyltransferase domain containing protein 7 (MBOAT7) gene has been associated with increased risk of nonalcoholic fatty liver disease (NAFLD). Objectives: To investigate the association between the MBOAT7 rs641738 polymorphism and both hepatic steatosis and biochemical markers of liver damage and to evaluate the potential additive effect of this variant and the I148M patatin-like phospholipase domain-containing 3 (PNPLA3) and the rs58542926 transmembrane 6 superfamily member 2 (TM6SF2) polymorphisms. Methods: One thousand and 2 obese children were genotyped for MBOAT7, PNPLA3, and TM6SF2 polymorphisms and underwent anthropometrical, ultrasonographic, and biochemical evaluation. Indirect measurement of liver fibrosis (Pediatric NAFLD Fibrosis Index [PNFI]) and a genetic risk score from these polymorphisms were calculated. Results: Carriers of the MBOAT7 T allele showed both higher alanine transaminase (ALT) (P = 0.004) and PNFI values (P = 0.04) than noncarriers. These findings were confirmed also for the carriers of the MBOAT7 T allele polymorphism with hepatic steatosis compared with noncarriers. A higher genetic risk score was associated with higher ALT (P = 0.011) and with an odds ratio (OR) to show elevated ALT of 3.4 (95% CI 1.3–5.5, P = 0.003). Patients belonging to genetic risk score 3 group had an OR to present steatosis of 2.6 (95% CI 1.43–4.83, P = 0.0018) compared with those belonging to lower genetic risk score group. Conclusions: We first demonstrated in childhood obesity the role of the MBOAT7 rs641738 variant on serum ALT and the combined effect of the MBOAT7, PNPLA3, and TM6SF2 variants on NAFLD risk. We also provided the first pediatric association of the MBOAT7 polymorphism with indirect markers of liver fibrosis. Address correspondence and reprint requests to Anna Di Sessa, MD, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Via L. De Crecchio n° 2, 80138 Naples, Italy (e-mail: anna.disessa@libero.it) Received 13 December, 2017 Accepted 14 March, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Early Administration of N-acetylcysteine in the Treatment of Clove Oil Ingestion

No abstract available

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Yield and Examiner Dependence of Digital Rectal Examination in Detecting Impaction in Pediatric Functional Constipation

Objectives: Guidelines on functional constipation recommend digital rectal examination (DRE) when constipation is doubtful or with a suspicion of organic etiology. The guidelines do not clarify if DRE is mandatory to diagnose impaction. This study aims to determine the frequency of impaction detectable only on DRE among children satisfying Rome III criteria without requiring DRE and also the inter-observer influences on impaction detection by DRE. Methods: Children between 6 months to 13 years of age, presenting with history suggestive of constipation were assessed. After excluding those with suspicion of organic etiology, those who needed DRE for diagnosis of constipation and those who do not satisfy Rome III criteria without DRE, the rest who satisfied Rome III criteria were assessed for impaction by palpable fecoliths or constipation-associated fecal incontinence. Those without such impaction were randomized to 2 examiners for DRE to diagnose impaction, in the absence of contraindications. Results: Two hundred and thirty-three children were assessed. One hundred and sixty-nine satisfied Rome III without needing DRE. Forty-eight (28.4%) had impaction detectable without DRE. Among the rest, 28 (30.1%) had impaction by DRE. There was no difference between the frequency of impaction detected by the 2 examiners. Clinical characteristics were similar (P > 0.05) between those with impaction detectable by DRE and those without. Conclusions: DRE does detect cases of impaction not discernible by other means. Such a finding may be comparable between examiners. These children may be identified by other clinical characteristics. The clinical significance of such a finding needs more understanding from the standpoint of therapeutic choices. Address correspondence and reprint requests to Dr Barath Jagadisan, MD, PDCC, Additional Professor, Pediatric gastroenterology, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry 605006, India (e-mail: barathjag@yahoo.com) Received 17 January, 2018 Accepted 12 March, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Ethical clearance: The study had been approved by the institute ethic committee that complies with international standards and is registered with the government of India (JIP/IEC/2015/23/830). The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Thiopurine Optimization Through Combination With Allopurinol in Children With Inflammatory Bowel Diseases

Objectives: Thiopurines are commonly used in the maintenance of remission for children with inflammatory bowel diseases (IBD). Variation in drug metabolism may impact hepatotoxicity or therapeutic effect. We aimed to describe our center's experience with thiopurine optimization through the use of reduced thiopurine dosing in combination with allopurinol upon hepatotoxicity, drug metabolite levels and clinical outcomes in children with IBD. Methods: Patients aged 2–21 years with IBD treated with the combination of thiopurines/allopurinol between 2008–2015 were retrospectively reviewed. Patients previously treated with anti-tumor necrosis factor (TNF) therapy were excluded. Demographic data, transaminase levels (AST, ALT), drug metabolites levels (6-TG, 6-MMP), physician global assessment (PGA), and corticosteroid use were recorded at baseline, 6 and 12 months. Results: Fifty-two patients (29 female, 56%) met inclusion criteria. Thirty-two of 52 (62%) remained on the combination for 12 months. In those remaining on the thiopurine/allopurinol combination, median ALT and AST levels were reduced (p 

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Microanatomical Nerve Architecture of 6 Mammalian Species: Is Trans-Species Translational Anatomic Extrapolation Valid?

Background and Objectives Various animal models have historically been used to study iatrogenic nerve injury during performance of conduction nerve blocks. Our aims were to compare the microstructures of nerves in commonly used species to those of humans and to explore the validity of the extrapolating these findings to humans. Methods High-resolution, light-microscopic images were obtained from cross sections of sciatic nerves at their bifurcation from fresh rat, rabbit, pig, sheep, dog, and human cadavers. Various microanatomical characteristics were measured and compared between the species. P

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