Δευτέρα, 30 Απριλίου 2018

Prevalence and Antimicrobial Susceptibility of Ureaplasma spp. and Mycoplasma hominis in Asymptomatic Individuals in Korea

Microbial Drug Resistance, Ahead of Print.


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Antimicrobial Resistance of Thermotolerant Campylobacter Species Isolated from Humans, Food-Producing Animals, and Products of Animal Origin: A Worldwide Meta-Analysis

Microbial Drug Resistance, Ahead of Print.


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Molecular Epidemiology of Vancomycin–Resistant Enterococcus faecalis and Enterococcus faecium Isolated from Clinical Specimens in the Northwest of Iran

Microbial Drug Resistance, Ahead of Print.


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Preliminary Study on the Antibacterial Activity of Essential Oils Alone and in Combination with Gentamicin Against Extended-Spectrum β-Lactamase-Producing and New Delhi Metallo-β-Lactamase-1-Producing Klebsiella pneumoniae Isolates

Microbial Drug Resistance, Ahead of Print.


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Whole Genome Sequence and Comparative Genomics Analysis of Multi-drug Resistant Environmental Staphylococcus epidermidis ST59

Staphylococcus epidermidis is a major opportunistic pathogen primarily recovered from device-associated healthcare associated infections (DA-HAIs). Although S. epidermidis and other coagulase-negative staphylococci (CoNS) are less virulent than Staphylococcus aureus, these bacteria are an important reservoir of antimicrobial resistance genes and resistance-associated mobile genetic elements that can be transferred between staphylococcal species. We report a whole genome sequence of a multidrug resistant S. epidermidis (strain G6_2) representing multilocus sequence type (ST) 59 and isolated from an environmental sampling of a hotel room in London, UK. The genome of S. epidermidis G6_2 comprises of a 2408357 bp chromosome and six plasmids, with an average G+C content of 32%. The strain displayed a multi-drug resistance phenotype which was associated with carriage of 7 antibiotic resistance genes (blaZ, mecA, msrA, mphC, fosB, aacA-aphD, tetK) as well as resistance-conferring mutations in fusA and ileS. Antibiotic resistance genes were located on plasmids and chromosome. Comparative genomic analysis revealed that antibiotic resistance gene composition found in G6_2 was partly preserved across the ST59 lineage.



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Assessing cross-modal target transition effects with a visual-auditory oddball

Publication date: Available online 30 April 2018
Source:International Journal of Psychophysiology
Author(s): John E. Kiat
Prior research has shown contextual manipulations involving temporal and sequence related factors significantly moderate attention-related responses, as indexed by the P3b event-related-potential, towards infrequent (i.e., deviant) target oddball stimuli. However, significantly less research has looked at the influence of cross-modal switching on P3b responding, with the impact of target-to-target cross-modal transitions being virtually unstudied. To address this gap, this study recorded high-density (256 electrodes) EEG data from twenty-five participants as they completed a cross-modal visual-auditory oddball task. This task was comprised of unimodal visual (70% Nontargets: 30% Deviant-targets) and auditory (70% Nontargets: 30% Deviant-targets) oddballs presented in fixed alternating order (i.e., visual-auditory-visual-auditory, etc.) with participants being tasked with detecting deviant-targets in both modalities. Differences in the P3b response towards deviant-targets as a function of preceding deviant-target's presentation modality was analyzed using temporal-spatial PCA decomposition. In line with predictions, the results indicate that the ERP response to auditory deviant-targets preceded by visual deviant-targets exhibits an elevated P3b, relative to the processing of auditory deviant-targets preceded by auditory deviant-targets. However, the processing of visual deviant-targets preceded by auditory deviant-targets exhibited a reduced P3b response, relative to the P3b response towards visual deviant-targets preceded by visual deviant-targets. These findings provide the first demonstration of temporally and perceptually decoupled target-to-target cross-modal transitions moderating P3b responses on the oddball paradigm, generally providing support for the context-updating interpretation of the P3b response.



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Utilizing time-frequency amplitude and phase synchrony measure to assess feedback processing in a gambling task

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Publication date: Available online 30 April 2018
Source:International Journal of Psychophysiology
Author(s): Adreanna T.M. Watts, Anne V. Tootell, Spencer T. Fix, Selin Aviyente, Edward M. Bernat
The neurophysiological mechanisms involved in the evaluation of performance feedback have been widely studied in the ERP literature over the past twenty years, but understanding has been limited by the use of traditional time-domain amplitude analytic approaches. Gambling outcome valence has been identified as an important factor modulating event-related potential (ERP) components, most notably the feedback negativity (FN). Recent work employing time-frequency analysis has shown that processes indexed by the FN are confounded in the time-domain and can be better represented as separable feedback-related processes in the theta (3–7 Hz) and delta (0–3 Hz) frequency bands. In addition to time-frequency amplitude analysis, phase synchrony measures have begun to further our understanding of performance evaluation by revealing how feedback information is processed within and between various brain regions. The current study aimed to provide an integrative assessment of time-frequency amplitude, inter-trial phase synchrony, and inter-channel phase synchrony changes following monetary feedback in a gambling task. Results revealed that time-frequency amplitude activity explained separable loss and gain processes confounded in the time-domain. Furthermore, phase synchrony measures explained unique variance above and beyond amplitude measures and demonstrated enhanced functional integration between medial prefrontal and bilateral frontal, motor, and occipital regions for loss relative to gain feedback. These findings demonstrate the utility of assessing time-frequency amplitude, inter-trial phase synchrony, and inter-channel phase synchrony together to better elucidate the neurophysiology of feedback processing.



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Back on the streets: An old paramedic's return to patient care

Last year I had the opportunity to return to practicing as a paramedic for a local ambulance service. I had spent the last several years working in a few different non-clinical positions, including EMS coordinator for a county system and online EMS education contributor. But, I had a little more time available now and thought it would be a good opportunity to return to the streets. I immediately began ...

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Abdominal obesity and insulin resistance after an episode of acute pancreatitis

Emerging evidence indicates that individuals after an episode of acute pancreatitis (AP) are at an increased risk of developing metabolic derangements. While the link between general obesity and insulin resistance (IR) is well established, only a few studies have investigated the association between abdominal obesity and IR. The aim of this study was to investigate the associations between abdominal obesity and several indices of IR in individuals after an episode of AP.

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Distribution of Aminoglycoside-Modifying Enzymes and Molecular Analysis of the Coagulase Gene in Clinical Isolates of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus

Microbial Drug Resistance, Ahead of Print.


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The Role of Flies in the Maintenance of Antimicrobial Resistance in Farm Environments

Microbial Drug Resistance, Ahead of Print.


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Back on the streets: An old paramedic's return to patient care

It's important to brush up on protocols, equipment and other areas of EMS after taking some time away from the field

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Right ventriculo–arterial uncoupling and impaired contractile reserve in obese patients with unexplained exercise intolerance

Abstract

Background

Right ventricular (RV) dysfunction and heart failure with preserved ejection fraction may contribute to exercise intolerance in obesity. To further define RV exercise responses, we investigated RV–arterial coupling in obesity with and without development of exercise pulmonary venous hypertension (ePVH).

Methods

RV–arterial coupling defined as RV end-systolic elastance/pulmonary artery elastance (Ees/Ea) was calculated from invasive cardiopulmonary exercise test data in 6 controls, 8 obese patients without ePVH (Obese−ePVH) and 8 obese patients with ePVH (Obese+ePVH) within a larger series. ePVH was defined as a resting pulmonary arterial wedge pressure < 15 mmHg but ≥ 20 mmHg on exercise. Exercise haemodynamics were further evaluated in 18 controls, 20 Obese−ePVH and 17 Obese+ePVH patients.

Results

Both Obese−ePVH and Obese+ePVH groups developed exercise RV–arterial uncoupling (peak Ees/Ea = 1.45 ± 0.26 vs 0.67 ± 0.18 vs 0.56 ± 0.11, p < 0.001, controls vs Obese−ePVH vs Obese+ePVH respectively) with higher peak afterload (peak Ea = 0.31 ± 0.07 vs 0.75 ± 0.32 vs 0.88 ± 0.62 mL/mmHg, p = 0.043) and similar peak contractility (peak Ees = 0.50 ± 0.16 vs 0.45 ± 0.22 vs 0.48 ± 0.17 mL/mmHg, p = 0.89). RV contractile reserve was highest in controls (ΔEes = 224 ± 80 vs 154 ± 39 vs 141 ± 34% of baseline respectively, p < 0.001). Peak Ees/Ea correlated with peak pulmonary vascular compliance (PVC, r = 0.53, p = 0.02) but not peak pulmonary vascular resistance (PVR, r = − 0.20, p = 0.46). In the larger cohort, Obese+ePVH patients on exercise demonstrated higher right atrial pressure, lower cardiac output and steeper pressure-flow responses. BMI correlated with peak PVC (r = − 0.35, p = 0.04) but not with peak PVR (r = 0.24, p = 0.25).

Conclusions

Exercise RV–arterial uncoupling and reduced RV contractile reserve further characterise obesity-related exercise intolerance. RV dysfunction in obesity may develop independent of exercise LV filling pressures.



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ResQPOD ITD Overview

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The ResQPOD® impedance threshold device (ITD) is a simple, non-invasive device that delivers intrathoracic pressure regulation (IPR) therapy during basic or advanced life support CPR to improve perfusion. - See more from ZOLL.

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ResQPOD ITD Overview

hqdefault-3.jpg

The ResQPOD® impedance threshold device (ITD) is a simple, non-invasive device that delivers intrathoracic pressure regulation (IPR) therapy during basic or advanced life support CPR to improve perfusion. - See more from ZOLL.

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Tracing cell-lineage histories

Tracing cell-lineage histories

Tracing cell-lineage histories, Published online: 30 April 2018; doi:10.1038/s41576-018-0015-0

Three new studies in Nature and Nature Biotechnology report methods for dissecting transcriptomic cell phenotypes and lineage history simultaneously by combining single-cell RNA sequencing (scRNA-seq) with CRISPR-based lineage tracing.

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Tracing cell-lineage histories



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ResQPOD ITD Overview

hqdefault-3.jpg

The ResQPOD® impedance threshold device (ITD) is a simple, non-invasive device that delivers intrathoracic pressure regulation (IPR) therapy during basic or advanced life support CPR to improve perfusion. - See more from ZOLL.

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ResQPOD ITD Overview

hqdefault-3.jpg

The ResQPOD® impedance threshold device (ITD) is a simple, non-invasive device that delivers intrathoracic pressure regulation (IPR) therapy during basic or advanced life support CPR to improve perfusion. - See more from ZOLL.

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ELMOD3 , a novel causative gene, associated with human autosomal dominant nonsyndromic and progressive hearing loss

Abstract

Autosomal dominant nonsyndromic hearing loss (ADNSHL) is a highly genetically heterogeneous disorder. Up to date only approximately 37 ADNSHL-causing genes have been identified. The goal of this study was to determine the causative gene in a five-generation Chinese family with ADNSHL. A Chinese family was ascertained. Simultaneously, two affected individuals and one normal hearing control from the family were analyzed by whole exome capture sequencing. To assess the functional effect of the identified variant, in-vitro studies were performed. novel missense variant, c.512A>G (p.His171Arg) in exon 8 of the ELMO domain-containing 3 (ELMOD3) gene, was identified as a causative variant in this family affected by late-onset and progressive ADNSHL. The variant was validated by Sanger sequencing and found to co-segregate with the phenotype within the pedigree and was absent in 500 ethnically matched unrelated normal hearing control subjects. To our knowledge, this is the first report of a family with ADNSHL caused by ELMOD3 mutation. Western blots and immunofluorescence staining demonstrated that p.His171Arg resulted in abnormal expression levels of ELMOD3 and abnormal subcellular localization. Furthermore, the analysis of the stability of the wild-type (WT) and mutant ELMOD3 protein shows that the decay of p.His171Arg is faster than that of the WT, suggesting a shorter halflife of the c.512A > G variant. A novel variant in the ELMOD3 gene, encoding a member of the engulfment and cell motility (ELMO) family of GTPase-activating proteins, was identified for the first time as responsible for ADNSHL.



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Prions, prionoids and protein misfolding disorders

Prions, prionoids and protein misfolding disorders

Prions, prionoids and protein misfolding disorders, Published online: 30 April 2018; doi:10.1038/s41576-018-0011-4

Parallels are increasingly being drawn between prion diseases and other aggregate-mediated neurodegenerative disorders. While prion diseases are a distinct subclass of protein misfolding disorders (PMDs), a better understanding of shared mechanisms is likely to benefit treatment of all PMDs.

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Portable X-ray fluorescence system to measure Th and U concentrations

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Publication date: September 2018
Source:Journal of Environmental Radioactivity, Volume 189
Author(s): Marcilei A. Guazzelli da Silveira, Bruno Ribeiro Pereira, Nilberto H. Medina, Marcia A. Rizzutto
This study reports the results obtained in the analysis of waste material samples generated by the industries of phosphate fertilizers, in particular, the use of specific filters in a portable X-ray fluorescence system, a simple equipment allowing the characterization, identification and quantification of low concentrations of Th and U (ppm). The industrial byproduct is classified as a Technologically-Enhanced, Naturally-Occurring Radioactive Material - TENORM, and therefore requires monitoring for its radio-toxic activity due to the presence of radioactive thorium and uranium families. From the results obtained, it is concluded that this technique is able to determine the contents of these elements to concentrations of tens of ppm in measurements of about 300 s, and a small sample amount (∼0.1 g).



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A zebrafish model of foxe3 deficiency demonstrates lens and eye defects with dysregulation of key genes involved in cataract formation in humans

Abstract

The Forkhead box E3 (FOXE3) gene encodes a transcription factor with a forkhead/winged helix domain that is critical for development of the lens and anterior segment of the eye. Monoallelic and biallelic deleterious sequence variants in FOXE3 cause aphakia, cataracts, sclerocornea and microphthalmia in humans. We used clustered regularly interspaced short palindromic repeats/Cas9 injections to target the foxe3 transcript in zebrafish in order to create an experimental model of loss of function for this gene. Larvae that were homozygous for an indel variant, c.296_300delTGCAG, predicting p.(Val99Alafs*2), demonstrated severe eye defects, including small or absent lenses and microphthalmia. The lenses of the homozygous foxe3 indel mutants showed more intense staining with zl-1 antibody compared to control lenses, consistent with increased lens fiber cell differentiation. Whole genome transcriptome analysis (RNA-Seq) on RNA isolated from wildtype larvae and larvae with eye defects that were putative homozygotes for the foxe3 indel variant found significant dysregulation of genes expressed in the lens and eye whose orthologues are associated with cataracts in human patients, including cryba2a, cryba1l1, mipa and hsf4. Comparative analysis of this RNA-seq data with iSyTE data identified several lens-enriched genes to be down-regulated in foxe3 indel mutants. We also noted upregulation of lgsn and crygmxl2 and downregulation of fmodb and cx43.4, genes that are expressed in the zebrafish lens, but that are not yet associated with an eye phenotype in humans. These findings demonstrate that this new zebrafish foxe3 mutant model is highly relevant to the study of the gene regulatory networks conserved in vertebrate lens and eye development.



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Prions, prionoids and protein misfolding disorders



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Κυριακή, 29 Απριλίου 2018

The emergency paediatric surgical airway: A systematic review

BACKGROUND Although an emergency surgical airway is recommended in the guidelines for a paediatric cannot intubate, cannot oxygenate (CICO), there is currently no evidence regarding the best technique for this procedure. OBJECTIVE To review the available literature on the paediatric emergency surgical airway to give recommendations for establishing a best practice for this procedure. DESIGN Systematic review: Considering the nature of the original studies, a meta-analysis was not possible. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Google Scholar and LILACS databases. ELIGIBILITY CRITERIA Studies addressing the paediatric emergency surgical airway and reporting the following outcomes: time to tracheal access, success rate, complications and perceived ease of use of the technique were included. Data were reported using a Strengths, Weaknesses, Opportunities and Threats analysis. Strengths and Weaknesses describe the intrinsic (dis)advantages of the techniques. The opportunities and threats describe the (dis)advantage of the techniques in the setting of a paediatric CICO scenario. RESULTS Five studies described four techniques: catheter over needle, wire-guided, cannula or scalpel technique. Mean time for placement of a definitive airway was 44 s for catheter over needle, 67.3 s for the cannula and 108.7 s for the scalpel technique. No time was reported for the wire-guided technique. Success rates were 43 (10/23), 100 (16/16), 56 (87/154) and 88% (51/58), respectively. Complication rates were 34 (3/10), 69 (11/16), 36 (55/151) and 38% (18/48), respectively. Analysis shows: catheter over needle, quick but with a high failure rate; wire-guided, high success rate but high complication rate; cannula, less complications but high failure rate; scalpel, high success rate but longer procedural time. The available data are limited and heterogeneous in terms of reported studies; thus, these results need to be interpreted with caution. CONCLUSION The absence of best practice evidence necessitates further studies to provide a clear advice on best practice management for the paediatric emergency surgical airway in the CICO scenario. Correspondence to Dr. Markus F. Stevens, Department of Anaesthesiology, Academic Medical Centre, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands E-mail: m.f.stevens@amc.uva.nl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Intra-operative cutaneous temperature monitoring with zero-heat-flux technique (3M SpotOn) in comparison with oesophageal and arterial temperature: A prospective observational study

BACKGROUND Continuous monitoring of core temperature is essential during major surgery as a way of improving patient safety. Oesophageal probes or specific arterial catheters are invasive methods used in this setting. A new noninvasive device based on zero-heat-flux (ZHF) technique (SpotOn) seems promising but has been poorly investigated during rapid core temperature changes (RCTC). OBJECTIVE To assess the accuracy of a SpotOn sensor vs. an oesophageal probe or specific arterial catheter during a slow change in core temperature of less than 1 °C within 30 min and RCTC ≥ 1 °C within 30 min. DESIGN Prospective observational study. SETTING Operating rooms at the University Hospital of Poitiers, France. PATIENTS Fifty patients scheduled for major abdominal surgery under general anaesthesia were enrolled from June 2015 to March 2016. Data from 49 patients were finally analysed. Among these, 15 patients were treated with hyperthermic intraperitoneal chemotherapy. INTERVENTION Each patient had a ZHF sensor placed on the skin surface of the forehead (TempZHF) and an oesophageal probe (TempEso) used as a reference method. Twenty-two patients also had a thermodilution arterial catheter (TempArt) placed in the axillary artery. MAIN OUTCOME MEASURES Core temperature was continuously recorded from the three devices after induction of anaesthesia. Comparison of temperature measurements between methods was made using the Bland and Altman method during two separate periods according to the speed of core temperature changes. RESULTS Compared with TempEso, bias and limits of agreement for TempZHF were 0.1 ± 0.5 °C during slow core temperature changes periods and 0.6 ± 1.8 °C during RCTC periods (P = 0.0002). Compared with TempArt, these values were −0.1 ± 0.4 and 0.5 ± 1.7 °C, respectively (P = 0.0039). The ZHF sensor was well tolerated. CONCLUSION A SpotOn sensor using the ZHF method seems reliable for core temperature monitoring during abdominal surgery when variations in core temperature are slow rather than rapid. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02869828. Correspondence to Matthieu Boisson, Centre Hospitalier Universitaire de Poitiers, Poitiers, France E-mail: matthieu.boisson@chu-poitiers.fr © 2018 European Society of Anaesthesiology

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W.Va. fire chief makes TIME’s top 100 influential people list

Huntington Fire Chief Jan Rader, who was recently featured in the Netflix documentary "Heroin(e)," was recognized for raising awareness about the opioid crisis

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Σάββατο, 28 Απριλίου 2018

Single nucleotide polymorphism rs11614913 associated with CC genotype in miR-196a2 is overrepresented in laryngeal squamous cell carcinoma, but not salivary gland tumors in Polish population

Abstract

The miRNA-196a2 has shown significance in the development of various neoplasms, including head and neck squamous cell carcinoma (HNSCC). The oncogenic functionality of this miRNA is mediated via its potential to target annexin A1 mRNA, a tumor suppressor gene involved in inhibition of the NF-κB pathway. Interestingly, recent data indicate a susceptibility for aforementioned neoplasms in patients with the CC genotype vs the CT and TT genotypes of the rs11614913 SNP located within the DNA sequence of the miR-196a2 that results in elevated expression of the gene. To further investigate this phenomenon, we genotyped this SNP in 40 patients with laryngeal squamous cell carcinoma (LSCC), the most common tumor of the head and neck region and 60 patients with salivary gland tumors (SGT) that show a yet unexplained incidence increase in the last two decades. In agreement with previous reports, we have identified a statistically significant (p < 0.05) overrepresentation of the CC genotype in LSCC patients and demonstrated in LSCC cell lines that it results in elevated expression of miR-196a2 as compared to cell lines with the TT genotype of the respective SNP. Importantly, none of these correlations was found in patients with SGT. These findings underline the importance of the SNP rs11614913 for LSCC development in the Polish population and moreover highlight the different genetic background of the two studied neoplasms of the head and neck region.



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A Health Profile and Overview of Healthcare Experiences of Cambodian American Refugees and Immigrants Residing in Southern California

Abstract

Asian Americans are understudied in health research and often aggregated into one homogenous group, thereby disguising disparities across subgroups. Cambodian Americans, one of the largest refugee communities in the United States, may be at high risk for adverse health outcomes. This study compares the health status and healthcare experiences of Cambodian American refugees and immigrants. Data were collected via questionnaires and medical records from two community clinics in Southern California (n = 308). Chi square and t-tests examined the socio-demographic differences between immigrants and refugees, and ANCOVA models compared the mean differences in responses for each outcome, adjusting for age at immigration, education level, and clinic site. Cambodian American refugees reported overall lower levels of health-related quality of life (all p's < 0.05 in unadjusted models) and self-rated health [unadjusted means (SD) = 18.2 (16.8) vs. 21.7 (13.7), p < 0.05], but either similar or more positive healthcare experiences than Cambodian American immigrants. In adjusted analyses, refugees had higher rates of diabetes and cardiovascular disease risk (e.g. heart condition and hypertension; p's < 0.05) compared to Cambodian American immigrants. There were minimal differences in self-reported health behaviors between the two groups. There is a need for more health promotion efforts among Cambodian American refugees and immigrants to improve their health outcomes and perceived wellbeing.



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Diminutive intramucosal invasive (Tis) sigmoid colon carcinoma

Abstract

A 60-year-old woman underwent colonoscopy, which revealed a red, 5-mm protruded lesion in the sigmoid colon, surrounded by white spots in white-light imaging. Indigo carmine spray indicated endoscopic morphological type Is + IIc. The vessel pattern was diagnosed as JNET-type 2B in magnifying narrow-band imaging, and magnified crystal violet-stained images revealed a VI low-grade pit pattern. We endoscopically diagnosed this lesion as an intramucosal or slightly invasive submucosal carcinoma with low confidence, and performed endoscopic mucosal resection to obtain a total biopsy. Hematoxylin and eosin staining of the resected specimen showed that the surface of the lesion was well-differentiated adenocarcinoma. The muscularis mucosae was identified by desmin immunostaining. There was no lymphovascular infiltration. Structural atypia was notable in the invasive front, indicating well-to-moderately differentiated adenocarcinoma, which invaded the lamina muscularis mucosae. In addition, desmoplastic reaction was recognized to be present. The lesion was, therefore, diagnosed as an intramucosal invasive (Tis) carcinoma, rather than high-grade dysplasia, according to the World Health Organization definition.



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High-depth whole genome sequencing of an Ashkenazi Jewish reference panel: enhancing sensitivity, accuracy, and imputation

Abstract

While increasingly large reference panels for genome-wide imputation have been recently made available, the degree to which imputation accuracy can be enhanced by population-specific reference panels remains an open question. Here, we sequenced at full-depth (≥ 30×), across two platforms (Illumina X Ten and Complete Genomics, Inc.), a moderately large (n = 738) cohort of samples drawn from the Ashkenazi Jewish population. We developed a series of quality control steps to optimize sensitivity, specificity, and comprehensiveness of variant calls in the reference panel, and then tested the accuracy of imputation against target cohorts drawn from the same population. Quality control (QC) thresholds for the Illumina X Ten platform were identified that permitted highly accurate calling of single nucleotide variants across 94% of the genome. QC procedures also identified numerous regions that are poorly mapped using current reference or alternate assemblies. After stringent QC, the population-specific reference panel produced more accurate and comprehensive imputation results relative to publicly available, large cosmopolitan reference panels, especially in the range of rare variants that may be most critical to further progress in mapping of complex phenotypes. The population-specific reference panel also permitted enhanced filtering of clinically irrelevant variants from personal genomes.



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Παρασκευή, 27 Απριλίου 2018

A Cloning-Free Method for CRISPR/Cas9-Mediated Genome Editing in Fission Yeast

The CRISPR/Cas9 system, which relies on RNA-guided DNA cleavage to induce site-specific DNA double-strand breaks, is a powerful tool for genome editing. This system has been successfully adapted for the fission yeast Schizosaccharomyces pombe by expressing Cas9 and the single-guide RNA (sgRNA) from a plasmid. In the procedures published to date, the cloning step that introduces a specific sgRNA target sequence into the plasmid is the most tedious and time-consuming. To increase the efficiency of applying the CRISPR/Cas9 system in fission yeast, we here developed a cloning-free procedure that uses gap repair in fission yeast cells to assemble two linear DNA fragments, a gapped Cas9-encoding plasmid and a PCR-amplified sgRNA insert, into a circular plasmid. Both fragments contain only a portion of the ura4 or bsdMX marker so that only the correctly assembled plasmid can confer uracil prototrophy or blasticidin resistance. We show that this gap-repair-based and cloning-free CRISPR/Cas9 procedure permits rapid and efficient point mutation knock-in, endogenous N-terminal tagging, and genomic sequence deletion in fission yeast.



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Ancestral State Reconstruction of the Apoptosis Machinery in the Common Ancestor of Eukaryotes

Apoptotic cell death is a type of eukaryotic cell death. In animals, it regulates development, is involved in cancer suppression, and causes cell death during pathological aging of neuronal cells in neurodegenerative diseases such as Alzheimer's. Mitochondrial apoptotic-like cell death, a form of primordial apoptosis, also occurs in unicellular organisms. Here, we ask the question why the apoptosis machinery has been acquired and maintained in unicellular organisms and attempt to answer it by performing ancestral state reconstruction. We found indications of an ancient evolutionary arms race between protomitochondria and host cells, leading to the establishment of the currently existing apoptotic pathways. According to this reconstruction, the ancestral protomitochondrial apoptosis machinery contained both caspases and metacaspases, four types of apoptosis induction factors (AIFs), both fungal and animal OMI/HTR proteases, and various apoptotic DNases. This leads to the prediction that in extant unicellular eukaryotes, the apoptotic factors are involved in mitochondrial respiration and their activity is needed exclusively in aerobic conditions. We test this prediction experimentally using yeast and find that a loss of the main apoptotic factors is beneficial under anaerobic conditions yet deleterious under aerobic conditions in the absence of lethal stimuli. We also point out potential medical implications of these findings.



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A High-Quality Reference Genome for the Invasive Mosquitofish Gambusia affinis Using a Chicago Library

The western mosquitofish, Gambusia affinis, is a freshwater poecilid fish native to the southeastern United States but with a global distribution due to widespread human introduction. Gambusia affinis has been used as a model species for a broad range of evolutionary and ecological studies. We sequenced the genome of a male G. affinis to facilitate genetic studies in diverse fields including invasion biology and comparative genetics. We generated Illumina short read data from paired-end libraries and in vitro proximity-ligation libraries. We obtained 54.9x coverage, N50 contig length of 17.6 kb, and N50 scaffold length of 6.65 Mb. Compared to two other species in the Poeciliidae family, G. affinis has slightly fewer genes that have shorter total, exon, and intron length on average. Using a set of universal single-copy orthologs in fish genomes, we found 95.5% of these genes were complete in the G. affinis assembly. The number of transposable elements in the G. affinis assembly is similar to those of closely related species. The high-quality genome sequence and annotations we report will be valuable resources for scientists to map the genetic architecture of traits of interest in this species.



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Is the behavior of disc replacement adjacent to fusion affected by the location of the fused level in hybrid surgery?

Context: Hybrid surgery (HS), consisting of cervical disc arthroplasty (CDA) at the mobile level, along with anterior cervical discectomy and fusion (ACDF) at the spondylotic level, could be a promising treatment for patients with multilevel cervical degenerative disc disease (DDD). An advantage of this technique is that it utilizes an optimal procedure according to the status of each level. However, information is lacking regarding the influence of the relative location of the replacement and the fusion segment in vivo.

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How social media, training, and demographics influence online reviews across three leading review websites for spine surgeons

The future of healthcare is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain healthcare providers, for better or worse. No prior study has specifically evaluated internet reviews of spine surgeons, determined if social media correlates with patient reviews, or evaluated Google as a physician review website.

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Use of the subcutaneous lumbar spine (SLS) index as a predictor for surgical complications in lumbar spine surgery

Lumbar spine surgeries require adequate exposure to visualize key structures and limited exposure can make surgery more technically difficult, thus increasing the potential for complications. Body mass index and body mass distribution have been shown to be associated with worse surgical outcomes.

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Predictive model for distal junctional kyphosis after cervical deformity surgery

Distal Junctional Kyphosis (DJK) is a primary concern of surgeons correcting cervical deformity. Identifying patients and procedures at higher risk for developing this condition is paramount in improving patient selection and care.

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Decompression surgery improves gait quality in patients with symptomatic lumbar spinal stenosis

To fully understand the extent of limitations associated with symptomatic lumbar spinal stenosis (LSS) and the functional outcome of its treatment, not only function during daily activities (e.g. using the 6-minute walk test (6MWT)) but also the quality of function should be objectively assessed.

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Chronic pre-operative opioid use is a risk factor for increased complications, resource use and costs after cervical fusion

As healthcare transitions to value-based models, there has been an increased focus on patient factors that can influence peri- and post-operative adverse events, resource use, and costs. Many studies have reported risk factors for systemic complications after cervical fusion, but none have studied chronic opioid therapy (COT) as a risk factor.

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The META score for differentiating metastatic from osteoporotic vertebral fractures: an independent agreement assessment

Differentiating osteoporotic vertebral fractures (OVF) from metastatic vertebral fractures (MVF) is an important clinical challenge. A novel magnetic resonance imaging- (MRI) based score (the META score) was described, aiming to differentiate OVF and MVF. This score showed an almost perfect agreement by the group developing it, but an independent agreement evaluation is pending.

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Increase in chromogranin A- and serotonin-positive cells in pouch mucosa of patients with ulcerative colitis undergoing proctocolectomy

Inflammatory bowel disease (IBD) is associated with neuroendocrine cell hyperplasia.

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Peroxisome Proliferator-activated Receptor Gamma Activation Promotes Intestinal Barrier Function by Improving Mucus and Tight Junctions in a Mouse Colitis Model

Defects in mucus and intestinal epithelia can lead to intestinal inflammation in colitis. Reduced peroxisome proliferator-activated receptor gamma (PPARγ) in the mucosa may contribute to inflammation. However, the roles of PPARγ in the intestinal barrier remain poorly understood.

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New concepts on intestinal microbiota and the role of the non-absorbable antibiotics with special reference to rifaximin in digestive diseases

Digestive diseases are a broad range of chronic disorders that substantially and negatively impact the patients' quality of life. Here, we review our current understanding on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease, with a special focus on the gut microbiota composition associated with these disorders. Furthermore, we review the current clinical practise for their therapeutic treatments, including probiotics, diet change, non-adsorbable disaccharides, and antibiotics.

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Endoscopic management of a colonic fistula communicating with a walled-off pancreatic necrosis



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Quality and Competence in Endoscopic Retrograde Cholangiopancreatography − where are we 50 years later?

Training in endoscopic retrograde cholangiopancreatography (ERCP) requires the development of technical, cognitive, and integrative skills well beyond those needed for standard endoscopic procedures. So far, there are limited data regarding what constitutes competency in ERCP, including achievement and maintenance. Recent studies have highlighted overall procedural numbers are not enough to warrant competency, although more is better. We performed a comprehensive literature search until June 2017 using predetermined search terms to identify relevant articles and summarized their results as a narrative review.

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Side-by-side stent deployment above the papilla to treat hepatic hilar obstruction using a new covered metal stent



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Evaluation of T cells in blood after a short gluten challenge for coeliac disease diagnosis

To diagnose coeliac disease (CD) in individuals on a gluten free diet (GFD), we aimed to assess the utility of detecting activated γd and CD8 T cells expressing gut-homing receptors after a short gluten challenge.

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Does cyst growth predict malignancy in branch duct intraductal papillary mucinous neoplasms? Results of a large multicenter experience

Cyst growth of BD-IPMNs on follow-up imaging remains a concerning sign.

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Annual NAVIGATOR conference highlights achievements of two outstanding emergency telecommunicators

Brought to you by Priority Dispatch LAS VEGAS — The International Academies of Emergency Dispatch® (IAED™) has recognized the outstanding accomplishments of emergency dispatchers and the contributions of dedicated professionals at its annual NAVIGATOR conference, held April 24–26 at the Aria Resort and Casino in Las Vegas, Nevada. At the event, IAED officials presented awards to ...

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Pulsara named one of Montana High Tech Business Alliance’s 12 High Growth companies to watch in 2018

BOZEMAN, Mont. — The spotlight is being shone once again on Pulsara, recently named one of Montana High Tech Business Alliance's 12 High Growth companies to watch in 2018. Pulsara is excited to be recognized as one of Montana's rising stars among over 500 high-tech companies in the state. Pulsara is a healthcare product that securely enables all members of a patient care team — ...

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A German‐Jewish refugee in Vichy France 1939–1941. Arno Motulsky's memoir of life in the internment camps at St. Cyprien and Gurs

American Journal of Medical Genetics Part A, EarlyView.


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The phenotypic spectrum of Xia‐Gibbs syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Functional independence of Taiwanese children with Prader–Willi syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Neurodevelopmental outcome in 22q11.2 deletion syndrome and management

American Journal of Medical Genetics Part A, EarlyView.


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38th Annual David W. Smith Workshop on Malformations and Morphogenesis: Abstracts of the 2017 Annual Meeting

American Journal of Medical Genetics Part A, EarlyView.


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The ontogeny of Robin sequence

American Journal of Medical Genetics Part A, EarlyView.


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X‐linked intellectual disability update 2017

American Journal of Medical Genetics Part A, EarlyView.


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Delayed peak response of cortisol to insulin tolerance test in patients with Prader–Willi syndrome

American Journal of Medical Genetics Part A, EarlyView.


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KBG syndrome patient due to 16q24.3 microdeletion presenting with a paratesticular rhabdoid tumor: Coincidence or cancer predisposition?

American Journal of Medical Genetics Part A, EarlyView.


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Mutations in SZT2 result in early‐onset epileptic encephalopathy and leukoencephalopathy

American Journal of Medical Genetics Part A, EarlyView.


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Expanding the phenotype of congenital central hypoventilation syndrome impacts management decisions

American Journal of Medical Genetics Part A, EarlyView.


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An assessment of health, social, communication, and daily living skills of adults with down syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Association of 17q24.2‐q24.3 deletions with recognizable phenotype and short telomeres

American Journal of Medical Genetics Part A, EarlyView.


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Arno G. Motulsky, 1923–2018, Luck and Service

American Journal of Medical Genetics Part A, EarlyView.


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Correction to: Evaluation of pharmacokinetic models of intravenous dexmedetomidine in sedated patients under spinal anesthesia

Inadvertently, the reference [8] was published incorrectly in the original publication of the article. The correct reference [8] is provided below:



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The impact of general anesthesia on child development and school performance: a population‐based study

Pediatric Anesthesia, EarlyView.


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Consensus statement on clear fluids fasting for elective pediatirc general anesthesia

Pediatric Anesthesia, EarlyView.


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Πέμπτη, 26 Απριλίου 2018

Congressional baseball practice gunshot victim reunites with paramedics

By EMS1 Staff ALEXANDRIA, Va. — A lobbyist who was shot at the GOP congressional baseball team practice last June reunited with the paramedics who saved him. WTOP reported that paramedic Chad Shade and now-retired paramedic Fiona Apple reunited with Tyson Foods lobbyist Matt Mika at the first practice since the incident at Eugene Simpson Field, where James Hodgkinson opened fire near the third ...

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NYPD officers help save elderly tourist in cardiac arrest

The police officers were driving by when they noticed a commotion around Ron Gargalowitz, who had gone into cardiac arrest while walking with his family

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Work Engagement, Burnout and Personal Accomplishments Among Social Workers: A Comparison Between Those Working in Children and Adults’ Services in England

Abstract

Social workers (SWs) provide emotional and practical support to vulnerable service users who are likely to suffer from emotional trauma and mental health conditions. Stress and burnout levels are reported to be high among SWs, however, little is known about their relationships with different characteristics. The current article utilises unique and large dataset (n = 3786) on SWs working in adults and children's services to examine factors associated with burnout. Employing job-demand/resources model and structural equations modelling, we highlight the varying significant impact of work-engagement, administrative support and work experience as moderating factors to burnout across adult and children service specialism in this sample.



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Blind method regarding the effect of dexmedetomidine on CRBD



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Author’s Reply to Cheung et al. Comment on: “Endurance Performance is Influenced by Perceptions of Pain and Temperature: Theory, Applications and Safety Considerations”



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Comment on: “Endurance Performance is Influenced by Perceptions of Pain and Temperature: Theory, Applications and Safety Considerations”



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The long-term outcomes of sport-related concussion in pediatric populations

Publication date: Available online 26 April 2018
Source:International Journal of Psychophysiology
Author(s): R. Davis Moore, Jacob J. Kay, Dave Ellemberg
Although the field of concussion research is rapidly growing, the majority of research has focused on injured adults, with children being an often-neglected population (Kirkwood et al., 2006). Traumatic brain injury is a leading cause of death and disability in children (Langlois et al., 2003), with over 1.5 million cases being treated in North America annually (Yeates et al., 1999). Approximately 75% of these injuries are classified as a concussion (Faul et al., 2010). Further, children are disproportionately affected by sports-related injuries, with 65% of all pediatric concussions occurring during sport and recreation (CDC, 2007). Therefore, understanding the outcomes of pediatric sportrelated concussion is of great importance, particularly given the vulnerability of the developing brain (Anderson et al., 2005a, 2005b; Luna, 2009; Prins, 2011). The purpose of this review is to provide an up-to-date understanding of the outcomes of pediatric sport-related concussion from a data-driven perspective, focusing heavily on experimental studies.



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Individual differences in combat experiences and error-related brain activity in OEF/OIF/OND veterans

Publication date: Available online 25 April 2018
Source:International Journal of Psychophysiology
Author(s): Narmeen I. Khan, Katie L. Burkhouse, Lynne Lieberman, Stephanie M. Gorka, Julia A. DiGangi, Christopher Schroth, Alyssa Frederick, Amy E. Kennedy, Darrin M. Aase, Justin E. Greenstein, Eric Proescher, Greg Hajcak, K. Luan Phan
Increased error-related negativity (ERN) has been implicated in the pathophysiology of multiple forms of psychopathology. Although there is increasing evidence that the ERN can be shaped by environment and experience, no studies to date have examined this question in a clinical sample. In the current study, we examined the influence of combat exposure on the ERN using electroencephalogram (EEG) in a sample of military veterans with a high prevalence of psychopathology. Participants included sixty-seven U.S. military veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). The degree of combat exposure was assessed using the Deployment Risk and Resilience Inventory-2 (DRRI-2) and Combat Exposure Scale (CES). A well-validated flanker task was used to elicit the ERN during continuous EEG recording. Results revealed that veterans who reported experiencing greater combat exposure exhibited a more enhanced ERN, even when adjusting for broad anxiety and posttraumatic stress disorder (PTSD) symptoms. The association between combat exposure and ERN was not moderated by PTSD symptom severity. The current study demonstrates that greater combat exposure is associated with a more enhanced ERN among OEF/OIF/OND veterans. This enhanced ERN may be one mechanism that places veterans at greater risk for developing psychiatric disorders following exposure to combat. Future longitudinal studies are needed to directly test whether the ERN mediates the relation between level of combat exposure and the development of internalizing disorders.



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Differential effects of uncertainty on LPP responses to emotional events during explicit and implicit anticipation

Publication date: Available online 25 April 2018
Source:International Journal of Psychophysiology
Author(s): Huiyan Lin, Jiafeng Liang, Hua Jin, Dongmei Zhao
Previous studies have investigated whether uncertainty influences neural responses to emotional events. The findings of such studies, particularly with respect to event-related potentials (ERPs), have been controversial due to several factors, such as the stimuli that serve as cues and the emotional content of the events. However, it is still unknown whether the effects of uncertainty on ERP responses to emotional events are influenced by anticipation patterns (e.g., explicit or implicit anticipation). To address this issue, participants in the present study were presented with anticipatory cues and then emotional (negative and neutral) pictures. The cues either did or did not signify the emotional content of the upcoming picture. In the inter-stimulus intervals between cues and pictures, participants were asked to estimate the expected probability of the occurrence of a specific emotional category of the subsequent picture based on a scale in the explicit anticipation condition, while in the implicit condition, participants were asked to indicate, using a number on a scale, which color was different from the others. The results revealed that in the explicit condition, uncertainty increased late positive potential (LPP) responses, particularly for negative pictures, whereas LPP responses were larger for certain negative pictures than for uncertain negative pictures in the implicit condition. The findings in the present study suggest that the anticipation pattern influences the effects of uncertainty when evaluation of negative events.



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Anchoring of a nasotracheal tube using flexible silicone putty.

https:--linkinghub.elsevier.com-ihub-ima Related Articles

Anchoring of a nasotracheal tube using flexible silicone putty.

Br J Oral Maxillofac Surg. 2016 05;54(4):478-9

Authors: Ogawa T, Kurita K, Imai T, Nishira M

PMID: 26342749 [PubMed - indexed for MEDLINE]



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Complex phenotype of dyskeratosis congenita and mood dysregulation with novel homozygous RTEL1 and TPH1 variants

American Journal of Medical Genetics Part A, EarlyView.


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Angelman syndrome in adolescence and adulthood: A retrospective chart review of 53 cases

American Journal of Medical Genetics Part A, EarlyView.


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Τετάρτη, 25 Απριλίου 2018

Initiation and slow propagation of epileptiform activity from ventral to dorsal medial entorhinal cortex is constrained by an inhibitory gradient

The Journal of Physiology, EarlyView.


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Genioglossus reflex responses to negative upper airway pressure are altered in people with tetraplegia and obstructive sleep apnoea

The Journal of Physiology, EarlyView.


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History‐dependence of muscle slack length following contraction and stretch in the human vastus lateralis

The Journal of Physiology, EarlyView.


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Humanizing the mouse immune system to study splanchnic organ inflammation

The Journal of Physiology, EarlyView.


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Saving the brain one heartbeat at a time

The Journal of Physiology, EarlyView.


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Aberrant cortical excitability reflects the loss of hand dexterity in musician's dystonia

The Journal of Physiology, EarlyView.


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Enterocyte K+ ion permeability and fluid secretion: missing the correct channel or missing the point?

The Journal of Physiology, EarlyView.


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Uteroplacental insufficiency temporally exacerbates salt‐induced hypertension associated with a reduced natriuretic response in male rat offspring

The Journal of Physiology, EarlyView.


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Mutations in the voltage‐sensing domain affect the alternative ion permeation pathway in the TRPM3 channel

The Journal of Physiology, EarlyView.


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Efficacy of single‐incision laparoscopic totally extraperitoneal repair for irreducible or incarcerated inguinal hernia

Asian Journal of Endoscopic Surgery, EarlyView.


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Comparison of Carba NP-Direct, Carbapenem Inactivation Method, and β-CARBA Tests for Detection of Carbapenemase Production in Enterobacteriaceae

Microbial Drug Resistance, Ahead of Print.


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Multiple Arginine Residues Are Methylated in Drosophila Mre11 and Required for Survival Following Ionizing Radiation

Mre11 is a key player for DNA double strand break repair. Previous studies have shown that mammalian Mre11 is methylated at multiple arginines in its C-terminal Glycine-Arginine-Rich motif (GAR) by protein arginine methyltransferase PRMT1. Here, we found that the Drosophila Mre11 is methylated at arginines 559, 563, 565, and 569 in the GAR motif by DART1, the Drosophila homolog of PRMT1. Mre11 interacts with DART1 in S2 cells, and this interaction does not require the GAR motif. Arginines methylated Mre11 localizes exclusively in the nucleus as soluble nuclear protein or chromatin-binding protein. To study the in vivo functions of methylation, we generated the single Arg-Ala and all Arginines mutated flies. We found these mutants were sensitive to ionizing radiation. Furthermore, Arg-Ala mutated flies had no irradiation induced G2/M checkpoint defect in wing disc and eye disc. Thus, we provided evidence that arginines in Drosophila Mre11 are methylated by DART1 methytransferase and flies loss of arginine methylation are sensitive to irradiation.



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Metaboreceptor activation in heart failure with reduced ejection fraction: Linking cardiac and peripheral vascular haemodynamics

Experimental Physiology, EarlyView.


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Nerve growth factor‐dependent hyperexcitability of capsaicin‐sensitive bladder afferent neurones in mice with spinal cord injury

Experimental Physiology, EarlyView.


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Seroimmunity to Hepatitis B Virus in Children With Inflammatory Bowel Disease: Effects of Booster Vaccination

No abstract available

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2017 NASPGHAN Distinguished Service Award

imageNo abstract available

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Safety of Appetite Manipulation in Children with Feeding Disorders Admitted to an Inpatient Feeding Program

imageObjective: Appetite manipulation can be effective in weaning children off gastrostomy tube feeding dependence but can cause dehydration, hypoglycaemia, and ketone body production, which is anorexigenic. As the safety of this approach has not been described, our aim was to describe adverse events observed when weaning children from G-tube dependence using our appetite manipulation protocol. Methods: This was a retrospective study of prospectively collected data of patients who completed our inpatient tube-weaning protocol. Daily safety parameters included twice-daily urine specific gravities and urine ketones and fasting capillary blood glucose. Graded clinical interventions to manage adverse events were collected. Results: A total of 143 children with a mean age of 4.8 ± 2.4 years were seen in the inpatient feeding program of which 74 (51.7%) were male. The children were hospitalized 10.1 ± 2.5 days with the vast majority being discharged between days 11 and 14. Overall, 78.2% of patients experienced at least 1 adverse event: urine specific gravity >1.020 was seen in 60.5%, ketonuria in 48.9%, and hypoglycemia (≤60 mg/dL) in 13.4%. Only 2 children had blood glucose levels

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2017 AAP Murray Davidson Award

imageNo abstract available

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Bone Mineral Density of Very Long-term Survivors After Childhood Liver Transplantation

imageObjectives: Liver transplant patients are at risk of osteopenia and fractures but limited information is available in long-term survivors after childhood transplantation. This study aimed to assess bone mineral density (BMD) of very long-term, >5 years, survivors after liver transplantation in childhood. Methods: Patients aged 5 years after transplant were potentially eligible but only those with ongoing review in our state were included. Dual-energy x-ray absorptiometry (DXA) was used to measure BMD. Patients aged

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Induced Pluripotent Stem Cell-Derived Hepatocytes and Precision Medicine in Human Liver Disease

imageLiver-like human cells can be generated from human skin by converting fibroblasts to "induced pluripotent stem cells" (iPSCs), then differentiating the iPSCs into "induced hepatocytes". Although still primarily used as a research tool, emerging applications involving iPSC-derived induced hepatocytes have exciting and provocative clinical and translational potential. This review provides a brief summary of the current status of this field and obstacles that must be overcome before this novel tool will enable precision medicine-based approaches to human liver disease.

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Vitamin B1 Deficiency Related to Excessive Soft Drink Consumption in Japan

imageThe aim of this study was to clarify the picture of vitamin B1 deficiency (VB1D) caused by excessive soft drink consumption in Japan. A nationwide survey of children with soft drink-induced VB1D was conducted using a structured research form. Patient information was obtained from 2 sources: training hospitals for board-certified pediatricians and those identified by a database search. We obtained data from 33 children. Twenty-one children had a nonnurturing home environment. The median duration of excessive soft drink intake was 3.5 months and the daily intake was 1000 mL or more in 25 children. Infection was the most common reason for excessive soft drink consumption. Only 4 children had the classical triad of Wernicke encephalopathy. One child died, and 12 had neurological sequelae. A majority of children with soft drink-induced VB1D did not have a nurturing home environment. It is imperative to establish measures to prevent future cases of VB1D.

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Clear Liquid Versus Low-fibre Diet in Bowel Cleansing for Colonoscopy in Children: A Randomized Trial

imageObjectives: In light of a paucity of data on the role of diet in colonoscopy preparation in paediatric population, the present study was designed to compare the effectiveness of clear liquid and low-fibre diets for breakfast and lunch on the day preceding colonoscopy in children. Methods: This prospective, randomised trial was conducted at the Department of Paediatric Gastroenterology and Nutrition in Warsaw, Poland. Eligible patients, referred for colonoscopies, were 6 to 18 years old. Patients were randomly divided into 2 groups: the first received a clear liquid diet and the second a low-fibre diet on the day before colonoscopy. In the afternoon, all participants were asked to drink polyethylene glycol with electrolytes at a dose of 66 mL/kg to a maximum of 4 L. The effectiveness of bowel cleansing was measured using the Boston Bowel Preparation Scale (BBPS). The preparation tolerance was assessed by parents and children using a visual analogue scale. Adverse effects were reported. Results: In total, 184 patients were enrolled. Of those, 96 received the clear liquid diet and 88—the low-fibre diet. The mean age of both groups was 15 years. There were no differences between the 2 study groups in age, weight, and sex, as well as in total BBPS score (BBPS ≥ 5 96.6% vs 95.1%, P = 0.5). The frequency of adverse effects was similar in both groups; nausea was the most common (P = 0.8). Conclusions: Clear liquid and low-fibre diets administered to children the day before colonoscopy demonstrated similar bowel cleansing effectiveness.

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The 2017 Shwachman Award

imageNo abstract available

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Randomized Controlled Clinical Trial on Value of Domperidone in Functional Abdominal Pain in Children

imageObjectives: The aim of the study was to evaluate the therapeutic effect of domperidone on children with abdominal pain predominant functional gastrointestinal disorders (AP-FGIDs). Methods: One hundred children (aged 5–12 years) fulfilling Rome III criteria for AP-FGIDs were randomized into 8 weeks of domperidone or placebo treatment. Primary outcomes defined were cure and patient-reported general improvement. Secondary outcomes were reduction in the severity of abdominal pain and increase in gastric motility. Patients were followed up for 6 months. Results: Eighty-nine (42 in placebo group, 47 in domperidone group) completed the trial at 8 weeks. Seventy-nine completed the 6-month follow-up. When primary outcomes were assessed at 8 weeks, 37 (74%) in the domperidone group and 25 (50%) in the placebo group showed patient-reported general improvement (P = 0.013), whereas no significant difference was observed in cure (22 [44%] vs 14 [28%] P = 0.09). At 6-month follow-up 30 (60%) in the domperidone group and 19 (38%) in the placebo group reported cure (P = 0.028), whereas 44 (88%) in the domperidone group and 33 (66%) in the placebo group showed patient-reported general improvement (P = 0.009). When assessing secondary outcomes at 8 weeks, the domperidone group reported significant reduction in the severity of abdominal pain (54.1% vs 24.7%, P  = 0.008) and an increase in the antral motility index (27.5% vs 7.2%, P = 0.029). None of the patients reported intervention-related adverse effects. Conclusions: Domperidone may be a safe and effective therapeutic modality to achieve a lasting remission of symptoms in children with AP-FGIDs.

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Trends of Cholecystectomies for Presumed Biliary Dyskinesia in Children in the United States

imageBackground: Biliary dyskinesia (BD) is a controversial clinical entity. Standardized diagnostic test and management guidelines are lacking in children. Published data suggest that long-term outcomes of surgical and medical management are similar. We sought to determine national population-based trends of cholecystectomies performed in children for BD and associated healthcare expenditure in the United States during a 10-year period. Methods: Using Nationwide Inpatient Sample and the International Classification of Diseases, the 9th revision clinical modification codes, we identified children who had a cholecystectomy for BD from 2002 to 2011 in the United States. Results: A total of 66,380 cholecystectomies were identified as primary procedural diagnosis using weighted analysis from 2002 to 2011 in children. BD was the primary indication for cholecystectomy in 6674 (10.8%) of the patients. During the study period, the number of cholecystectomies performed for BD in children increased from 6.6% in 2002 to 10.6% in 2011, and a majority were adolescent white females. The annual health care expenditure for surgical management of BD for children in the US was estimated to almost $16 million/year. Conclusions: Despite lack of standardized diagnostic criteria and variable outcomes of surgical intervention reported in pediatric literature, cholecystectomies are commonly performed for children with BD in the United States. Consensus guidelines for the diagnosis and management of this controversial disorder in children are needed.

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Awareness and Implementation of the 2014 ESPGHAN/NASPGHAN Guideline for Childhood Functional Constipation

imageObjective: The aim of the study was to assess whether physicians approach children with functional constipation according to the 2014 European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guideline. Methods: We invited pediatricians and pediatric gastroenterologists in the Netherlands and the United States to participate in this anonymous survey using a self-developed questionnaire containing 19 multiple choice questions concerning evaluation and treatment of children with constipation. Results: We included 328 physicians (67% from the United States, 34% from the Netherlands). The majority of US responders (53%) worked in primary care, whereas all Dutch responders worked in a hospital. In total, 31% of responders were not familiar with the guideline (38% US responders vs 16% Dutch responders, P 

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Hydrolyzed Formula With Reduced Protein Content Supports Adequate Growth: A Randomized Controlled Noninferiority Trial

imageObjective: A high protein content of nonhydrolyzed infant formula exceeding metabolic requirements can induce rapid weight gain and obesity. Hydrolyzed formula with too low protein (LP) content may result in inadequate growth. The aim of this study was to investigate noninferiority of partial and extensively hydrolyzed formulas (pHF, eHF) with lower hydrolyzed protein content than conventionally, regularly used formulas, with or without synbiotics for normal growth of healthy term infants. Methods: In an European multi-center, parallel, prospective, controlled, double-blind trial, 402 formula-fed infants were randomly assigned to four groups: LP-formulas (1.9 g protein/100 kcal) as pHF with or without synbiotics, LP-eHF formula with synbiotics, or regular protein eHF (2.3 g protein/100 kcal). One hundred and one breast-fed infants served as observational reference group. As primary endpoint, noninferiority of daily weight gain during the first 4 months of life was investigated comparing the LP-group to a regular protein eHF group. Results: A comparison of daily weight gain in infants receiving LPpHF (2.15 g/day CI −0.18 to inf.) with infants receiving regular protein eHF showed noninferior weight gain (−3.5 g/day margin; per protocol [PP] population). Noninferiority was also confirmed for the other tested LP formulas. Likewise, analysis of metabolic parameters and plasma amino acid concentrations demonstrated a safe and balanced nutritional composition. Energetic efficiency for growth (weight) was slightly higher in LPeHF and synbiotics compared with LPpHF and synbiotics. Conclusions: All tested hydrolyzed LP formulas allowed normal weight gain without being inferior to regular protein eHF in the first 4 months of life. This trial was registered at clinicaltrials.gov, NCT01143233.

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Family Health-related Quality of Life in Pediatric Cyclic Vomiting Syndrome

imageObjective: The aim of the study was to evaluate the relationship of disease characteristics and child anxiety symptoms to family health-related quality of life (FHRQoL) in youth with cyclic vomiting syndrome (CVS). Methods: Forty-two parents of youth ages 8 to 18 years diagnosed with CVS completed the Family Impact Module of the PedsQL, a measure of the impact of the child's illness on the family. We evaluated the relationship of disease characteristics and child and parent proxy reports of anxiety symptoms on the Screen for Childhood Anxiety and Related Emotional Disorders to FHRQoL. Results: Parent report of child anxiety symptoms and missed school days (mean = 11.93, standard deviation = 14.62) were the strongest predictors of FHRQoL (r2 = 0.33, df = 1.39, F = 8.51, P = 0.006). Other disease characteristics, including frequency, duration, chronicity of CVS episodes, and delay in initial CVS diagnosis were not significantly associated with the FHRQoL total score. Child anxiety symptoms by either parent and/or child report were associated with subscales of the FHRQoL, including family physical functioning, family communication, and family daily activities. Conclusions: HRQoL for the families assessed in this study was associated with anxiety symptoms to a greater extent than disease characteristics, indexing the importance of a biopsychosocial approach to CVS management. Screening for anxiety symptoms and support for school absences due to illness are indicated to help lessen the impact of CVS on the family as a whole.

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Esophageal Squamous Cell Papillomatosis Arising in Focal Dermal Hypoplasia in a 3-Year-Old Girl

imageNo abstract available

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Trends of Magnet Ingestion in Children, an Ironic Attraction

imageBackground and Objectives: Ingestion of rare earth magnets is a serious ongoing hazard for pediatric patients. Our study aims to investigate whether 2012 Consumer Product Safety Commission (CPSC) policy action, in coordination with efforts from consumer and physician advocacy groups, decreased the incidence of magnet ingestions in children in the United States since 2012. Methods: Data from the National Electronic Injury Surveillance System (NEISS) was used to evaluate trends in emergency department (ED) encounters with pediatric patients (

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Should Giant Cell Hepatitis With Autoimmune Haemolythic Anaemia Be Considered a Paediatric Autoimmune Liver Disease?

No abstract available

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Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft-versus-host Disease

imageObjectives: Gastrointestinal graft-versus-host disease (GI-GVHD) is a potentially life-threatening complication after hematopoietic stem cell transplantation. Symptoms indicating GI-GVHD motivates endoscopy with biopsy sampling and histopathological confirmation. Optimal extent of endoscopy in children is, however, presently unknown. Therefore, we aimed to evaluate whether biopsies from the rectosigmoid area versus the rest of the colon/ileocolon with or without biopsies from simultaneous upper endoscopy, were equally reliable for detection of GI-GVHD and relevant differential diagnoses. Methods: Retrospective multicenter study based on histopathological re-evaluation of biopsies and hospital record data, collected from children with suspected GI-GVHD. Results: Forty-four children with 51 endoscopic occasions (81 procedures) were included. Thirty-nine of 51 (76.5%) were diagnosed as GI-GVHD, 14 (27.4%) received a differential diagnosis and 7 (13.7%) had normal histology findings. Comorbidity, that is, simultaneous detection of a differential diagnosis and GI-GVHD, was observed in 9 (23.1%) cases. Cytomegalovirus infection was the most frequent differential diagnosis, 6 of 7 were detected in biopsies from rectosigmoid and esophagogastroduodenal areas. Sensitivity for detection of GI-GVHD in biopsies collected from rectosigmoid-ileocolonic-, rectosigmoid-, or esophagogastroduodenal areas were 97.4%, 84.6%, 83.3%, respectively, and 97.4% when the latter 2 were merged. The difference, nondetected GI-GVHD in the rectosigmoid area versus detected elsewhere in the GI tract, was statistically significant (P = 0.03). Conclusions: Biopsies collected from the rectosigmoid area solely were not optimal for detection of pediatric GI-GVHD. When biopsy sampling from rectosigmoid and upper GI tract areas was combined, the sensitivity for GI-GVHD was, however, equally high as for ileocolonoscopy or full upper and lower endoscopy.

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Genetic Variants Associated With Obesity and Insulin Resistance in Hispanic Boys With Nonalcoholic Fatty Liver Disease

imageBackground and Objectives: Nonalcoholic fatty liver disease (NAFLD) disproportionately affects Hispanic boys. Further, obesity and insulin resistance are major risk factors for NAFLD. No gene localization studies had been performed on children with biopsy-proven NAFLD. This study aims to identify genomic variants associated with increased adiposity and insulin resistance in a population of children with varying histologic severity of NAFLD. Methods: We conducted a genome-wide association scan (GWAS) including 624,297 single-nucleotide polymorphisms (SNPs) distributed among all 22 autosomal chromosomes in 234 Hispanic boys (up to 18 years of age) who were consecutively recruited in a prospective cohort study in the Nonalcoholic Steatohepatitis Clinical Research Network Studies. Traits were examined quantitatively using linear regression. SNPs with P value 5% were considered potentially significant. Results: Evaluated subjects had a median age of 12.0 years, body mass index (BMI) of 31.4, and hemoglobin A1C (Hgb A1C) of 5.3. The prevalence of NAFL, borderline NASH, and definite NASH were 23%, 53%, and 22%, respectively. The GWAS identified 10 SNPs that were associated with BMI z score, 6 within chromosome 2, and 1 within CAMK1D, which has a potential role in liver gluconeogenesis. In addition, the GWAS identified 9 novel variants associated with insulin resistance: HOMA-IR (6) and HbA1c (3). Conclusions: This study of Hispanic boys with biopsy-proven NAFLD with increased risk for the metabolic syndrome revealed novel genetic variants that are associated with obesity and insulin resistance.

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High Incidence of Proteinuria in Children With Chronic Intestinal Failure Under Long-term Parenteral Nutrition

imageLong-term home parenteral nutrition (LTPN) in children with chronic intestinal failure (CIF) is associated with renal complications such as fluid and electrolyte imbalances, nephrocalcinosis, nephrolithiasis, and chronic kidney disease (CKD). The etiology of CIF-associated nephropathy is multifactorial. The aim of this study was to evaluate renal involvement under LTPN. In this study, 50 patients with CIF, median age 4.2 years (1.4–9.3; 23 girls) were included. Kidney involvement was a frequent finding in this study. CKD was present in 30% of patients without correlation with LTPN duration. Glomerular proteinuria was found in the majority of patients (76%), an important long-term risk factor for the progression of CKD. Increased urinary α-1 microglobulin was significantly associated with duration (years) of LTPN and was increased in patients with CKD.

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Clinical spectrum of KIAA2022 pathogenic variants in males: Case report of two boys with kiaa2022 pathogenic variants and review of the literature

American Journal of Medical Genetics Part A, EarlyView.


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Genetic polymorphism of sterol transporters in children with future gallstones

Gallstone disease is related to hypersecretion of cholesterol in bile, and low serum phytosterol levels. We examined how genetic polymorphisms of sterol transporters affect childhood cholesterol metabolism trait predicting adult gallstone disease.

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Inhibition of Na+/K+‐ATPase and KIR channels abolishes hypoxic hyperaemia in resting but not contracting skeletal muscle of humans

The Journal of Physiology, EarlyView.


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Gamma and infra‐slow oscillations shape neuronal firing in the rat subcortical visual system

The Journal of Physiology, EarlyView.


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Stress‐testing the brain to understand its breaking points

The Journal of Physiology, EarlyView.


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Coupling of respiration and attention via the locus coeruleus: Effects of meditation and pranayama

Psychophysiology, EarlyView.


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Only reappraisers profit from reappraisal instructions: Effects of instructed and habitual reappraisal on stress responses during interpersonal conflicts

Psychophysiology, EarlyView.


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Social influences of error monitoring in adolescent girls

Psychophysiology, EarlyView.


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Dissociation of frontal‐midline delta‐theta and posterior alpha oscillations: A mobile EEG study

Psychophysiology, EarlyView.


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A breath-holding adaptation

A breath-holding adaptation

A breath-holding adaptation, Published online: 25 April 2018; doi:10.1038/s41576-018-0014-1

A new study in Cell reports genomic selection of physiological adaptations to hypoxia in breath-hold diving marine hunter–gatherers, the indigenous Bajau people of Southeast Asia.

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Identification of 4 novel mutations of androgen receptor gene in 8 Chinese families with complete androgen insensitivity syndrome

Clinical Genetics, EarlyView.


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Single, short in‐del, and copy number variations detection in monogenic dyslipidemia using a next‐generation sequencing strategy

Clinical Genetics, EarlyView.


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NREMT launches EMS certification app

The iPhone app allows EMS personnel to manage their continuing education and recertification components

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Endostar, a Modified Endostatin Induces Vascular Normalization to Improve Chemotherapy Efficacy through Suppression of Src Signaling Pathway

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Development and Validation of RAPID: A Patient-Specific Monte Carlo Three-Dimensional Internal Dosimetry Platform

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Pecs II block for intractable postherpetic neuralgia



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Genetic characteristics of Y-chromosome short tandem repeat haplotypes from cigarette butt samples presumed to be smoked by North Korean men

Abstract

Korea has been divided into South Korea and North Korea for over 70 years. DNA profiles of the North Korean population have never been reported in the Y-chromosome STR Haplotype Reference Database (YHRD; https://yhrd.org). To investigate genetic features of Y-chromosome STR haplotypes of the North Korean population for the first time. Genomic DNA was isolated from 838 cigarette butts assumed to have been smoked by North Korean men and amplified with PowerPlex Y23 (PPY23) kit. Statistical parameters were calculated using Nei's formula and analysis of molecular variance (AMOVA). Multidimensional scaling (MDS) plot was constructed by the AMOVA tool and neighbor-joining (NJ) tree was constructed by MEGA 6.06. A total of 121 haplotypes were analyzed for PPY23 loci from a sample population. Haplotype diversity and discrimination capacity were 0.9992 and 0.9837, respectively. Genetic diversities ranged from 0.2981 to 0.9716. For the 16 Y-filer loci and eight minimal loci, respectively 90.9 and 82.6% of the matched haplotypes were estimated to belong to haplogroup O, representing the Southeast and East Asian type. The MDS plot and NJ tree indicated that the samples are most closely related to South Korean. In addition, p-value in the pairwise comparison to the South Korean was slightly above statistical significance (p = 0.0534). The Y-STR haplotypes of the samples were unique and highly genetically polymorphic. Despite the separation between North and South Korea for 70 years, they can still be considered a single genetic population, based on Y-STR haplotypes.



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RapidDeploy becomes first Computer-Aided Dispatch (CAD) System to receive ProQA Titanium Certification

Priority Dispatch recognizes RapidDeploy for its dynamic, customizable interface and commitment to the public safety community.

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A breath-holding adaptation



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Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial

The use of neurorobotic devices may improve gait recovery by entraining specific brain plasticity mechanisms, which may be a key issue for successful rehabilitation using such approach. We assessed whether the...

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Comparative genomics of 151 plant-associated bacteria reveal putative mechanisms underlying specific interactions between bacteria and plant hosts

Abstract

Although much work has explored how microbes can benefit plant growth, the mechanisms underlying this intriguing process remain largely unknown, especially considering the diversity of bacteria that surrounds plants. The objective of the present study was to identify bacterial genes contributing to plant–microbe associations, beneficial effects, and host specificities. For this purpose, comparative genomics investigation of 151 plant-associated bacteria was performed. A principal component analysis of seven key genomic features revealed patterns in the specific properties of these bacteria: N2-fixing bacteria were more closely related to pathogenic ones than to beneficial bacteria. A common set of genes over-represented in these plant-associated bacteria were found to be remarkably similar in terms of (1) genetic information processing, (2) amino acid metabolism, (3) metabolism of cofactors and vitamins, (4) nucleotide metabolism, (5) human diseases, and (6) metabolism of terpenoids and polyketides. Although we did not detect a common genetic basis for these beneficial effects, further in-depth analysis revealed that each of five beneficial bacterial groups shared specific gene sets. Functional annotation showed that environmental information processing, genetic information processing and cellular processes predominated in these beneficial groups. Hypothesizing that plant-associated bacteria may have overlapping strategies to colonize their plant hosts, we successfully identified many putative genes that determine host specificities. Most of these genes were classified as transcription factors, enzymes, transporters, and chemotaxis regulators. Comparative genomics provides a powerful tool for helping to identify genes that are common among species. Genome-based views of plant-associated bacteria reveal specific interactions between bacteria and plant hosts.



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3 towns team up to keep ambulance services alive

The towns of Remsen, Steuben and Trenton are streamlining their ambulance services in an effort to keep them up and running

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Perioperative considerations for airway management and drug dosing in obese children

Purpose of review Childhood obesity, a phenomenon that is increasing globally, holds substantial relevance for pediatric anesthesia. In particular, understanding the nuances of airway management and drug dosing in obese children can be daunting. Recent findings Respiratory adverse events and challenges in managing the airway may be anticipated. In addition, drug-dosing strategies for the obese child are complex and poorly understood although recent advances have clarified the optimal dosing for anesthetics in these children. Summary Theoretical knowledge, practical skills, meticulous risk stratification and optimal drug regimens are crucial to ensure the safe conduct of anesthesia for obese children. Correspondence to Dr Jerrold Lerman, MD, FRCPC, FANZCA, Department of Anesthesiology, Oishei Children's Outpatient Center, 1001 Main St, Suite K-3502, Buffalo, NY 14203, USA. Tel: +1 716 323 6570; e-mail: Jerrold.lerman@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The identification of growth, immune related genes and marker discovery through transcriptome in the yellow drum ( Nibea albiflora )

Abstract

Yellow drum (Nibea albiflora) is a commercially important marine fish, which is widely distributed in the coastal waters of China, Japan and Korea. Wild yellow drum resources have dramatically declined due to overfishing and ocean pollution. Genetic data can contribute to biodiversity conservation and protection. And molecular markers can play important roles in genetic breeding and aid in germplasm preservation in fish. In this study, 11 tissues (brain, heart, liver, kidney, muscle, head kidney, skin, fin, spleen, gonad and air bladder) were collected for pooled RNA sequencing. The unigenes were assembled using Trinity and EvidentialGene, and were then aligned to nr, nt, Swiss-Prot GO, KEGG, and KOG for annotation. Molecular markers (e.g. simple sequence repeat, SSR and single nucleotide polymorphism, SNP) were detected using MIcroSAtellite identification tool (MISA) and Genome Analysis Tool Kit (GATK). All clean reads were assembled into 109,209 transcripts, and 31,183 unigenes were generated after pruning and classifying, ranging from 201 to 19,857 bp in length (1230 bp in average), and 26,728 (85.7%) assembled unigenes had significant hits in public databases. Total of 27 and 103 unigenes were respectively identified as involved in growth- and immune-related pathways in the N. albiflora transcriptome. In addition, we identified a considerable quantity of molecular markers, including 11,484 SSRs and 56,186 SNPs. The growth- and immune-relevant genes and the molecular markers identified here provided a meaningful reference gene set and laid a foundation for future genetic selection and breeding for this species.



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3 harms of EMS miscommunication and how to fix them

Communication is critical to ensure that emergency department resources are available and ready for your patient

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Measuring Variation Across Dimensions of Integrated Care: The Maryland Medicaid Health Home Model

Abstract

Despite the proliferation of initiatives to integrate services for people with serious mental illness (SMI), measures of distinct dimensions of integration, such as spatial arrangement and care team expertise, are lacking. Such measures are needed to support organizations' assessment of progress toward integrated service delivery. We developed measures characterizing integration of behavioral, somatic, and social services to operationalize the integrated care dimensions conceived by the Agency for Healthcare Research and Quality. In a survey fielded to 46 Maryland Medicaid health homes (response rate: 96%) serving adults with SMI during 2015–2016, we found that these measures provided a useful description of variation across dimensions of integration.



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Endoscopic Electrocautery Incisional Therapy as a Treatment for Refractory Benign Pediatric Esophageal Strictures

Background and Aim: Refractory esophageal strictures are rare conditions in pediatrics, and are often due to anastomotic, congenital, or caustic strictures. Traditional treatment options include serial dilation and surgical stricture resection; endoscopic intralesional steroid injections, mitomycin C, and externally removable stents combined with dilation have had variable success rates. Although not as widely used, endoscopic electrocautery incisional therapy (EIT) has been reported as an alternative treatment for refractory strictures in a small number of adult series. The aim of the study was to evaluate the safety and efficacy of EIT in a pediatric population with refractory esophageal strictures. Methods: A retrospective chart review was conducted on all patients who underwent EIT for esophageal strictures (May 2011–September 2017) at our tertiary-care referral center. A total of 57 patients underwent EIT. Procedural success was defined as no stricture resection, appropriate diameter for age, and fewer than 7 dilations within 24 months of first EIT session. This corresponded to the 90th percentile of the observed number of dilations in the data. All patients included in the study had at least 2-year follow-up. Results: A total of 133 EIT sessions on 58 distinct anastomotic strictures were performed on 57 patients (24 girls). The youngest patient to have EIT was 3 months old and 4.8 kg. There were 36 strictures that met the criteria for refractory stricture and 22 non-refractory (NR) strictures. The median number of dilations before EIT therapy was 8 (interquartile range [IQR]: 6–10) in the refractory group and 3 (IQR: 0–3) in the NR group. In the refractory group, 61% of the patients met the criteria for treatment success. The median number of dilations within 2 years of EIT in the refractory group was 2 (IQR: 0–4). In the NR group, 100% of the patients met criteria for success. The median number of dilations within 2 years of EIT in the NR was 1 (IQR: 0–2). The overall adverse event rate was 5.3% (7/133), with 3 major (2.3%) and 4 minor events (3%). Conclusions: EIT shows promise as an adjunct treatment option for pediatric refractory esophageal strictures and may be considered before surgical resection even in severe cases. The complication rate, albeit low, is significant, and EIT should only be considered by experienced endoscopists in close consultation with surgery. Further prospective longitudinal studies are needed to validate this treatment. Address correspondence and reprint requests to Michael A. Manfredi, MD, 300 Longwood Avenue Boston, MA 02132 (e-mail: Michael.Manfredi@childrens.harvard.edu). Received 19 October, 2017 Accepted 22 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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