Τρίτη, 9 Ιανουαρίου 2018

Major influence of a ‘smoke and mirrors’ effect caused by wave reflection on early diastolic coronary arterial wave intensity

Abstract

Coronary arterial wave intensity analysis (WIA) is thought to provide clear insight into upstream and downstream forces on coronary flow, with a large early-diastolic surge in coronary flow accompanied by a prominent backward decompression wave (BDWdia), as well as a forward decompression wave (FDWdia) and forward compression wave (FCWdia). The BDWdia is believed to arise from distal suction due to release of extravascular compression by relaxing myocardium, while FDWdia and FCWdia are thought to be transmitted from the aorta into the coronary arteries. Based on an established multi-scale computational model and high fidelity measurements from the proximal circumflex artery (Cx) of 18 anaesthetized sheep, we present evidence that wave reflection has a major impact on each of these three waves, with a non-linear addition/subtraction of reflected waves obscuring the true influence of upstream and downstream forces through concealment and exaggeration, i.e. a 'smoke and mirrors' effect. We also describe methods, requiring additional measurement of aortic WIA, for unravelling the separate influences of wave reflection versus active upstream/downstream forces on coronary waves. Distal wave reflection accounted for ∼70% of the BDWdia in sheep, but had a lesser influence (∼25%) in the computer model representing a hypertensive human. Negative reflection of the BDWdia at the coronary-aortic junction attenuated the Cx FDWdia (by ∼40% in sheep) and augmented Cx FCWdia (∼5-fold), relative to the corresponding aortic waves. We conclude that wave reflection has a major influence on early-diastolic WIA, and thus needs to be considered when interpreting coronary WIA profiles.

This article is protected by copyright. All rights reserved



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Analysis of the evolution of gross alpha and gross beta activities in airborne samples in Valencia (Spain)

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Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): Marina Sáez-Muñoz, María del Carmen Bas, Josefina Ortiz, Sebastián Martorell
Gross alpha (Aα) and gross beta activities (Aβ) were measured weekly in the airborne of the Universitat Politècnica de Valencia campus (in the east of Spain) during the period 2009–2015 (7 years). The geometric mean values of weekly Aα and Aβ were 0.53·10−4 Bq m−3 and 5.77·10−4 Bq m−3, respectively; with an average ratio Aα/Aβ of 0.097. This study highlights the heterogeneity of gross alpha and gross beta activities depending on the different periods of the year. Data show seasonal variations with the highest activity in summer months and the lowest one in winter months. Several atmospheric factors were considered in order to explain this intra-annual variation (wind speed, temperature, relative humidity, precipitations, dust content and prevailing wind directions). Multiple Linear Regression Analysis were performed in order to obtain information on significant atmospheric factors that affect gross α and gross β variability, which could be useful in identifying meteorological or atmospheric changes that could cause deviations in gross α and gross β activity depending on the seasons considered. Models obtained explain more than 60% of variability for global data, and also for winter and spring-autumn months. However, more research is needed to explain gross α and gross β variability in summer months, because the atmospheric factors considered in the MLR explain less than 35% of variability.



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Gene Identification of Pheromone Gland Genes Involved in Type II Sex Pheromone Biosynthesis and Transportation in Female Tea Pest Ectropis grisescens

Moths can biosynthesize sex pheromones in the female sex pheromone glands (PGs) and can distinguish species-specific sex pheromones using their antennae. However, the biosynthesis and transportation mechanism for Type II sex pheromone components has rarely been documented in moths. In this study, we constructed a massive PG transcriptome database (14.72 giga bases) from a moth species, Ectropis grisescens, which uses Type II sex pheromones and is a major tea pest in China. We further identified the putative sex pheromone biosynthesis and transportation related genes: 111 cytochrome P450 monooxygenases (P450s, CYPs), 25 odorant binding proteins (OBPs), and 20 chemosensory proteins (CSPs). Tissue expression and phylogenetic tree analyses showed that one CYP (EgriCYP341-fragment3), one OBP (EgriOBP4), and one CSP (EgriCSP10) gene displayed an enriched expression in the PGs, and that EgriOBP2, 3, and 25 are clustered in the moth PBP clade. We considered these our candidate genes. Our results yielded large-scale PG sequence information for further functional studies.



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Voltage-gated sodium channels: (NaV)igating the field to determine their contribution to visceral nociception

Abstract

Chronic visceral pain, altered motility and bladder dysfunction are common, yet poorly managed symptoms of functional and inflammatory disorders of the gastrointestinal and urinary tracts. Recently, numerous human channelopathies of the voltage-gated sodium (NaV) channel family have been identified, which induce either painful neuropathies, an insensitivity to pain, or alterations in smooth muscle function. The identification of these disorders, in addition to the recent utilisation of genetically modified NaV mice and specific NaV channel modulators, has shed new light on how NaV channels contribute to the function of neuronal and non-neuronal tissues within the gastrointestinal tract and bladder. Here we review the current pre-clinical and clinical evidence to reveal how the nine NaV channel family members (NaV1.1 - NaV1.9) contribute to abdominal visceral function in normal and disease states.

This article is protected by copyright. All rights reserved



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Meta-analysis shows similar re-bleeding rates among Western and Eastern populations after index video capsule endoscopy

Video capsule endoscopy (VCE) is the first-line diagnostic procedure for investigating obscure gastrointestinal bleeding (OGIB). Different re-bleeding rates following index VCE have been reported among Western and Eastern studies.

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Donor PNPLA3 rs738409 genotype is a steatosis. A post-transplant biopsy-based study

& Aims The rs738409 c.444C > G (p.I148 M) polymorphism in PNPLA3 is a major factor predisposing to non-alcoholic fatty liver disease. The aim of the study was to clarify the impact of liver and extrahepatic expression of the PNPLA3 p.148 M variant on liver graft steatosis after liver transplantation.

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Meta-analysis shows similar re-bleeding rates among Western and Eastern populations after index video capsule endoscopy

Video capsule endoscopy (VCE) is the first-line diagnostic procedure for investigating obscure gastrointestinal bleeding (OGIB). Different re-bleeding rates following index VCE have been reported among Western and Eastern studies.

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Donor PNPLA3 rs738409 genotype is a steatosis. A post-transplant biopsy-based study

& Aims The rs738409 c.444C > G (p.I148 M) polymorphism in PNPLA3 is a major factor predisposing to non-alcoholic fatty liver disease. The aim of the study was to clarify the impact of liver and extrahepatic expression of the PNPLA3 p.148 M variant on liver graft steatosis after liver transplantation.

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Remember 2 Things: Patient comfort

963482465001_5513209554001_5511470533001

Here are two quick tips to make sure your patient stays warm and comfortable from point A to point B.

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Remember 2 Things: BVM techniques

963482465001_5588056005001_5588032019001



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Remember 2 Things: Lung sounds

963482465001_5588055996001_5588030185001

Every physical patient assessment on a respiratory patient should being with a thorough set of lung sounds. Are you doing it correctly?

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Remember 2 Things: Awareness during CPR

963482465001_5588045876001_5588041479001

You're performing CPR on a pulse-less patient, and they open up their eyes and become aware of what's happening. Here's how to handle a scenario that you've probably not even considered.

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Remember 2 Things: Quality assurance

963482465001_5588045878001_5588031991001

It's a moment all of us naturally dread; you start your shift, get out on the street and you get a call from your supervisor wanting to talk to you about a call you ran last week.

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Remember 2 Things: Radio communication

963482465001_5588055988001_5588046394001

Everybody needs to talk on the radio. Some people love, some people hate it. Are you doing it correctly?

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Remember 2 Things: Hand off reports

963482465001_5513209579001_5506372595001

You show up at the hospital and you're ready to give your hand off report. Everyone is listening; what are you going to say now?

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Remember 2 Things: Pulse oximetry

963482465001_5513209538001_5511452616001

How do you know your reading is correct? Here are two quick tips to make sure.

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Remember 2 Things: Patient comfort

963482465001_5513209554001_5511470533001

Here are two quick tips to make sure your patient stays warm and comfortable from point A to point B.

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Remember 2 Things: BVM techniques

963482465001_5588056005001_5588032019001



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Remember 2 Things: Lung sounds

963482465001_5588055996001_5588030185001

Every physical patient assessment on a respiratory patient should being with a thorough set of lung sounds. Are you doing it correctly?

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Remember 2 Things: Awareness during CPR

963482465001_5588045876001_5588041479001

You're performing CPR on a pulse-less patient, and they open up their eyes and become aware of what's happening. Here's how to handle a scenario that you've probably not even considered.

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Remember 2 Things: Quality assurance

963482465001_5588045878001_5588031991001

It's a moment all of us naturally dread; you start your shift, get out on the street and you get a call from your supervisor wanting to talk to you about a call you ran last week.

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Remember 2 Things: Radio communication

963482465001_5588055988001_5588046394001

Everybody needs to talk on the radio. Some people love, some people hate it. Are you doing it correctly?

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Remember 2 Things: Hand off reports

963482465001_5513209579001_5506372595001

You show up at the hospital and you're ready to give your hand off report. Everyone is listening; what are you going to say now?

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Remember 2 Things: Pulse oximetry

963482465001_5513209538001_5511452616001

How do you know your reading is correct? Here are two quick tips to make sure.

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Postoperative rehabilitation after deep brain stimulation surgery for movement disorders

Deep brain stimulation (DBS) is highly effective for the treatment of movement disorders such as Parkinson's disease (PD) (Timmermann et al., 2015a), tremor (Oliveria et al., 2017) and dystonia (Volkmann et al., 2014), but also further neurologic and psychiatric disorders (Welter et al., 2017). During DBS, continuous electrical stimulation is applied in appropriate subcortical areas to achieve clinical improvement of disabling symptoms. The unique feature of this therapeutic approach is the ability to preferentially modulate, through the choice of stimulation site, specific cerebral networks.

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The Association of Clinic-based Mobility Tasks and Measures of Community Performance and Risk?

Gait speed is recognized as an important predictor of adverse outcomes in older people. However, it is unknown if other more complex mobility tasks are better predictors of such outcomes.

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Neutropenia as a Complication of Tumefactive Demyelinating Disease: A Case Report

Tumefactive demyelination is an aggressive, localized, generally solitary area of demyelination that often mimics a neoplasm. We present a case of a 13-year-old female who presented with sudden onset, progressive hemiplegia and hemianopsia. Brain magnetic resonance imaging showed tumefactive demyelination with partial rim of enhancement. During inpatient rehabilitation, she developed myalgias, rash, abdominal and mouth pain with evidence for severe neutropenia. The neutropenia was determined to be a secondary complication of the tumefactive disease process.

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OnabotulinumtoxinA for the Treatment of Post-Stroke Distal Lower-Limb Spasticity: A Randomized Trial

Post-stroke distal lower limb spasticity impairs mobility, limiting activities of daily living, requiring additional caregiver time.

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Chronic thigh pain in a young adult diagnosed as synovial sarcoma: A case report

Synovial sarcoma is a slow growing, intermediate to high grade neoplasm with extensive metastatic potential. Accurate diagnosis of synovial sarcoma may pose a challenge to providers because of its indolent growth and variable presentation. The findings of a soft-tissue, periarticular mass with calcifications in a young patient are highly suggestive of synovial sarcoma. Although different imaging modalities can aid in the diagnosis of synovial sarcoma, diagnostic certainty is typically only confirmed by biopsy and histological analysis.

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Remember 2 Things: Patient comfort

963482465001_5513209554001_5511470533001

Here are two quick tips to make sure your patient stays warm and comfortable from point A to point B.

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Remember 2 Things: BVM techniques

963482465001_5588056005001_5588032019001



from EMS via xlomafota13 on Inoreader http://ift.tt/2mgiNbI
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Remember 2 Things: Lung sounds

963482465001_5588055996001_5588030185001

Every physical patient assessment on a respiratory patient should being with a thorough set of lung sounds. Are you doing it correctly?

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via IFTTT

Remember 2 Things: Awareness during CPR

963482465001_5588045876001_5588041479001

You're performing CPR on a pulse-less patient, and they open up their eyes and become aware of what's happening. Here's how to handle a scenario that you've probably not even considered.

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via IFTTT

Remember 2 Things: Quality assurance

963482465001_5588045878001_5588031991001

It's a moment all of us naturally dread; you start your shift, get out on the street and you get a call from your supervisor wanting to talk to you about a call you ran last week.

from EMS via xlomafota13 on Inoreader http://ift.tt/2mbA2uA
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Remember 2 Things: Radio communication

963482465001_5588055988001_5588046394001

Everybody needs to talk on the radio. Some people love, some people hate it. Are you doing it correctly?

from EMS via xlomafota13 on Inoreader http://ift.tt/2qQMwgX
via IFTTT

Remember 2 Things: Hand off reports

963482465001_5513209579001_5506372595001

You show up at the hospital and you're ready to give your hand off report. Everyone is listening; what are you going to say now?

from EMS via xlomafota13 on Inoreader http://ift.tt/2miRCh8
via IFTTT

Remember 2 Things: Pulse oximetry

963482465001_5513209538001_5511452616001

How do you know your reading is correct? Here are two quick tips to make sure.

from EMS via xlomafota13 on Inoreader http://ift.tt/2CYBM4S
via IFTTT

Remember 2 Things: Patient comfort

963482465001_5513209554001_5511470533001

Here are two quick tips to make sure your patient stays warm and comfortable from point A to point B.

from EMS via xlomafota13 on Inoreader http://ift.tt/2CXG6Bh
via IFTTT

Remember 2 Things: BVM techniques

963482465001_5588056005001_5588032019001



from EMS via xlomafota13 on Inoreader http://ift.tt/2mgiNbI
via IFTTT

Remember 2 Things: Lung sounds

963482465001_5588055996001_5588030185001

Every physical patient assessment on a respiratory patient should being with a thorough set of lung sounds. Are you doing it correctly?

from EMS via xlomafota13 on Inoreader http://ift.tt/2Deyjgi
via IFTTT

Remember 2 Things: Awareness during CPR

963482465001_5588045876001_5588041479001

You're performing CPR on a pulse-less patient, and they open up their eyes and become aware of what's happening. Here's how to handle a scenario that you've probably not even considered.

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via IFTTT

Remember 2 Things: Quality assurance

963482465001_5588045878001_5588031991001

It's a moment all of us naturally dread; you start your shift, get out on the street and you get a call from your supervisor wanting to talk to you about a call you ran last week.

from EMS via xlomafota13 on Inoreader http://ift.tt/2mbA2uA
via IFTTT

Remember 2 Things: Radio communication

963482465001_5588055988001_5588046394001

Everybody needs to talk on the radio. Some people love, some people hate it. Are you doing it correctly?

from EMS via xlomafota13 on Inoreader http://ift.tt/2qQMwgX
via IFTTT

Remember 2 Things: Hand off reports

963482465001_5513209579001_5506372595001

You show up at the hospital and you're ready to give your hand off report. Everyone is listening; what are you going to say now?

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Remember 2 Things: Pulse oximetry

963482465001_5513209538001_5511452616001

How do you know your reading is correct? Here are two quick tips to make sure.

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Evaluating the contribution of rare variants to type 2 diabetes and related traits using pedigrees [Genetics]

A major challenge in evaluating the contribution of rare variants to complex disease is identifying enough copies of the rare alleles to permit informative statistical analysis. To investigate the contribution of rare variants to the risk of type 2 diabetes (T2D) and related traits, we performed deep whole-genome analysis of...

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Identification of fusion genes and characterization of transcriptome features in T-cell acute lymphoblastic leukemia [Genetics]

T-cell acute lymphoblastic leukemia (T-ALL) is a clonal malignancy of immature T cells. Recently, the next-generation sequencing approach has allowed systematic identification of molecular features in pediatric T-ALL. Here, by performing RNA-sequencing and other genomewide analysis, we investigated the genomic landscape in 61 adult and 69 pediatric T-ALL cases. Thirty-six...

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Ultrasound Identification of Diaphragm by Novices Using ABCDE Technique

Background and Objectives In this study, we examined the consistency, rapidity, and reproducibility of the ABCDE technique for diaphragm identification. Operators using this method place the probe at the Anterior axillary line, watch for Breathing (lung sliding), and then move the probe Caudally to identify the Diaphragm for Examination. Methods A convenience sample of 100 patients was recruited from the preadmission clinic. Two novice operators each scanned the diaphragm using a linear ultrasound transducer in B-mode. Both operators completed the examination on all participants using the ABCDE technique, their times were averaged, and clinical success was defined as identification of the diaphragm in less than 2 minutes. Results An average of 33.7 seconds was taken to scan and identify the right hemidiaphragm (RD) (median, 25 seconds; 95% confidence interval, 28.8–38.5 seconds) with a 98% clinical success ratio, and an average of 46.9 seconds was taken to identify the left hemidiaphragm (LD) (median, 39.5 seconds; 95% confidence interval, 40.2–53.6 seconds) with a 97% clinical success ratio. In patients with a body mass index (BMI) of less than 30 kg/m2, a 100% success ratio was seen when scanning the RD and 97% when scanning the LD. For those with a BMI of 30 kg/m2 or greater, a 94% success rate was seen when scanning the RD and 97% when scanning the LD. No clinically significant differences were found between the times required for scanning either side of the diaphragm, regardless of the BMI. Conclusions The ABCDE technique demonstrates a fast, reliable, and simple method in which ultrasound can be used to visualize the diaphragm. Accepted for publication September 2, 2017. Address correspondence to: Ban C.H. Tsui, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Dr, H3582, Stanford, CA 94305 (e-mail: bantsui@stanford.edu). This work was attributable to the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada. B.C.H.T. is supported by a Clinical Scholar Award from the Alberta Heritage Foundation for Medical Research, Alberta, Canada; and J.K. is supported in part by an Alberta Health Services Surgery Strategic Clinical Network Summer Surgical Research Studentship Award, Alberta, Canada. The authors declare no conflict of interest. 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 Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Relative Contributions of Adductor Canal Block and Intrathecal Morphine to Analgesia and Functional Recovery After Total Knee Arthroplasty: A Randomized Controlled Trial

Background and Objectives Effective postoperative analgesia may enhance early rehabilitation after orthopedic surgery. This randomized double-blind trial investigates the relative contributions of adductor canal block and low-dose intrathecal morphine (ITM) to postoperative analgesia and functional recovery after total knee arthroplasty. Methods Two-hundred one patients undergoing elective unilateral total knee arthroplasty under spinal anesthesia were randomized to 3 groups. All patients received standardized intraoperative local infiltration analgesia and postoperative oral analgesics. Patients in group 1 received a "sham" adductor canal block with 30 mL of normal saline. Patients in group 2 received an adductor canal block with 30 mL of ropivacaine 0.5% with 1:400,000 epinephrine, whereas patients in group 3 received the adductor canal block with the active drug and 100 μg of ITM. The primary outcome measure was the Timed Up and Go (TUG) test on the second postoperative day. Secondary outcomes included postoperative pain scores and opioid requirements, distance walked, time to hospital discharge, and self-reported functional outcomes at 3 months. Results All 3 groups had similar values of TUG test on postoperative day (POD) 2 (46 [36–62], 45 [33–61], and 52 [41–69]; P = 0.166) as well as other short-term and 3-month functional outcomes. Patients in group 3 showed a favorable analgesic profile as evidenced by 3 positive secondary outcomes. These positive outcomes were lower pain scores 12 hours postoperatively both at rest (4 [2–6.3], 4 [2.3–6], and 3 [1–4]; P = 0.007) and on movement (6 [4–8], 6 [3–8], and 4 [2–6]; P = 0.002), a lower incidence of "rescue" intravenous patient-controlled analgesia (42%, 34%, and 20%; P = 0.031), and the lowest cumulative opioid requirements for the first 48 hours postoperatively (86 ± 71, 68 ± 46, and 59 ± 39; P

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Exercise Thresholds on Trial: Are They Really Equivalent?

ABSTRACTPurposeThe interchangeable use of whole-body exercise thresholds and breakpoints (BPs) in the local oxygenation response, as measured via near-infrared spectroscopy (NIRS), has recently been questioned in scientific literature. Therefore, the present study aimed to longitudinally investigate the interrelationship of four commonly used exercise thresholds: critical power (CP), the respiratory compensation point (RCP) and BPs in muscle (m[HHb]BP) and brain (c[O2Hb]BP) oxygenation.MethodsNine male participants (21.8±1.2 years) completed six weeks of cycling interval training. Prior to and following this intervention period, subjects performed a ramp incremental (RI) exercise protocol to determine RCP, m[HHb]BP and c[O2Hb]BP and four constant work rate (WR) tests to calculate CP.ResultsWRs associated with CP, RCP, m[HHB]BP and c[O2Hb]BP increased by 7.7±4.2%, 13.6±9.0%, 9.8±5.7% and 11.3±11.1%, respectively. CP was lower (pre: 260±32W, post: 280±41W) (P 0.05).ConclusionResults of the present study strongly question true equivalence of CP, RCP, m[HHb]BP and c[O2Hb]BP during RI exercise. Therefore, these exercise thresholds should not be used interchangeably. Purpose The interchangeable use of whole-body exercise thresholds and breakpoints (BPs) in the local oxygenation response, as measured via near-infrared spectroscopy (NIRS), has recently been questioned in scientific literature. Therefore, the present study aimed to longitudinally investigate the interrelationship of four commonly used exercise thresholds: critical power (CP), the respiratory compensation point (RCP) and BPs in muscle (m[HHb]BP) and brain (c[O2Hb]BP) oxygenation. Methods Nine male participants (21.8±1.2 years) completed six weeks of cycling interval training. Prior to and following this intervention period, subjects performed a ramp incremental (RI) exercise protocol to determine RCP, m[HHb]BP and c[O2Hb]BP and four constant work rate (WR) tests to calculate CP. Results WRs associated with CP, RCP, m[HHB]BP and c[O2Hb]BP increased by 7.7±4.2%, 13.6±9.0%, 9.8±5.7% and 11.3±11.1%, respectively. CP was lower (pre: 260±32W, post: 280±41W) (P 0.05). Conclusion Results of the present study strongly question true equivalence of CP, RCP, m[HHb]BP and c[O2Hb]BP during RI exercise. Therefore, these exercise thresholds should not be used interchangeably. CORRESPONDING AUTHOR: Jan Boone, Watersportlaan 2, 9000 Ghent, Belgium, Tel: +32 (0)9 264 6328. Jan.Boone@UGent.be There was no funding received for this project. Results of the present study do not constitute endorsement by ACSM and are presented clearly, honestly and without fabrication, falsification or inappropriate data manipulation. No conflicts of interest, financial or otherwise, are declared by the authors. Accepted for Publication: 18 December 2017 © 2018 American College of Sports Medicine

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Exercise Protects against Cancer-induced Cardiac Cachexia

Cancer has been shown to negatively stimulate autophagy, leading to declines in cardiac function. While exercise is cardioprotective, its influence over autophagy-mediated tumor growth and cardiac function are not well defined. Purpose: To determine the effect of exercise on tumor morphology and cardiac function. Methods: Fisher 344 rats (n=28) were assigned to one of four groups: 1) sedentary non tumor-bearing (SED), 2) sedentary tumor-bearing (SED+T), 3) wheel run non-tumor bearing (WR), or 4) wheel running tumor bearing (WR+T). Rats remained sedentary or exercised for 6 weeks. At week 4, rats in tumor groups were inoculated with MatBIII tumor cells (flank). At week 6, cardiac function was measured. Results: SED+T animals exhibited significantly lower left ventricular developed pressure when compared to SED, WR, and WR+T (P

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Predicting Basal Metabolic Rate in Men with Motor Complete Spinal Cord Injury

AbstractPurposeTo assess the accuracy of existing basal metabolic rate (BMR) prediction equations in men with chronic (>1 year) spinal cord injury (SCI). The primary aim is to develop new SCI population-specific BMR prediction models, based on anthropometric, body composition and/or demographic variables that are strongly associated with BMR.MethodsThirty men with chronic SCI (Paraplegic; n = 21, Tetraplegic; n = 9), aged 35 ± 11 years (mean ± SD) participated in this cross-sectional study. Criterion BMR values were measured by indirect calorimetry. Body composition (dual energy X-ray absorptiometry; DXA) and anthropometric measurements (circumferences and diameters) were also taken. Multiple linear regression analysis was performed to develop new SCI-specific BMR prediction models. Criterion BMR values were compared to values estimated from six existing and four developed prediction equationsResultsExisting equations that use information on stature, weight and/or age, significantly (P 1 year) spinal cord injury (SCI). The primary aim is to develop new SCI population-specific BMR prediction models, based on anthropometric, body composition and/or demographic variables that are strongly associated with BMR. Methods Thirty men with chronic SCI (Paraplegic; n = 21, Tetraplegic; n = 9), aged 35 ± 11 years (mean ± SD) participated in this cross-sectional study. Criterion BMR values were measured by indirect calorimetry. Body composition (dual energy X-ray absorptiometry; DXA) and anthropometric measurements (circumferences and diameters) were also taken. Multiple linear regression analysis was performed to develop new SCI-specific BMR prediction models. Criterion BMR values were compared to values estimated from six existing and four developed prediction equations Results Existing equations that use information on stature, weight and/or age, significantly (P

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Novel Methods for Reporting of Exercise Dose and Adherence: An Exploratory Analysis

ABSTRACTPurposeTo explore whether methods adapted from oncology pharmacological trials have utility in reporting adherence (tolerability) of exercise treatment in cancer.MethodsUsing a retrospective analysis of a randomized trial, 25 prostate cancer patients received an aerobic training regimen of 72 supervised treadmill walking sessions delivered thrice-weekly between 55% to 100% of exercise capacity for 24 consecutive weeks. Treatment adherence (tolerability) was assessed using conventional (lost to follow up (LTF) and attendance) and exploratory [e.g., permanent discontinuation, dose modification, relative dose intensity (RDI)] outcomes.ResultsThe mean total cumulative "planned" and "completed" dose was 200.7 ± 47.6 MET.hrs and 153.8 ± 68.8 MET.hrs, respectively, equating to a mean RDI of 77% ± 24%. Two patients (8%) were LTF and mean attendance was 79%. A total of 6 (24%) of 25 patients permanently discontinued aerobic training prior to week 24. Aerobic training was interrupted (missing ≥3 consecutive sessions) or dose reduced in a total 11 (44%) and 24 (96%) patients, respectively; a total 185 of 1800 (10%) training sessions required dose reduction owing to both health-related (all non-serious) and non health-related adverse events (AEs). 18 (72%) patients required at least one session to be terminated early; a total of 59 (3%) sessions required early termination.ConclusionNovel methods for the conduct and reporting of exercise treatment adherence and tolerability may provide important information beyond conventional metrics in patients with cancer. Purpose To explore whether methods adapted from oncology pharmacological trials have utility in reporting adherence (tolerability) of exercise treatment in cancer. Methods Using a retrospective analysis of a randomized trial, 25 prostate cancer patients received an aerobic training regimen of 72 supervised treadmill walking sessions delivered thrice-weekly between 55% to 100% of exercise capacity for 24 consecutive weeks. Treatment adherence (tolerability) was assessed using conventional (lost to follow up (LTF) and attendance) and exploratory [e.g., permanent discontinuation, dose modification, relative dose intensity (RDI)] outcomes. Results The mean total cumulative "planned" and "completed" dose was 200.7 ± 47.6 MET.hrs and 153.8 ± 68.8 MET.hrs, respectively, equating to a mean RDI of 77% ± 24%. Two patients (8%) were LTF and mean attendance was 79%. A total of 6 (24%) of 25 patients permanently discontinued aerobic training prior to week 24. Aerobic training was interrupted (missing ≥3 consecutive sessions) or dose reduced in a total 11 (44%) and 24 (96%) patients, respectively; a total 185 of 1800 (10%) training sessions required dose reduction owing to both health-related (all non-serious) and non health-related adverse events (AEs). 18 (72%) patients required at least one session to be terminated early; a total of 59 (3%) sessions required early termination. Conclusion Novel methods for the conduct and reporting of exercise treatment adherence and tolerability may provide important information beyond conventional metrics in patients with cancer. Correspondence: Lee W. Jones, PhD, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, email: jonesl3@mskcc.org This study was supported by a research grant from the National Cancer Institute (R21-CA133895) awarded to LWJ. TSN, LWJ, JS, CC, and MM are supported by the Kalvi Trust, AKTIV Against Cancer and the Memorial Sloan Kettering Cancer Center Support Grant/Core Grant (P30 CA008748). The authors would like to thank Whitney Underwood for administrative support. Authors declare no conflict of interests. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 15 December 2017 © 2018 American College of Sports Medicine

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Health Benefits of an Innovative Exercise Program for Mitochondrial Disorders

ABSTRACTPurposeWe determined the effects of an innovative 8-week exercise intervention (aerobic, resistance and inspiratory muscle training) for patients with mitochondrial disease (MD).MethodsSeveral endpoints were assessed in 12 patients (19–59 years, 4 female) at pre-training, post-training and after 4-week detraining: aerobic power, muscle strength/power and maximal inspiratory pressure (main endpoints), ability to perform activities of daily living (ADL), body composition, quality of life and blood myokines (secondary endpoints).ResultsThe program was safe with patients' adherence being 94±5%. A significant time-effect was found for virtually all main endpoints (P≤0.004), indicating a training improvement. Similar findings (P≤0.003) were found for ADL tests, total/trunk/leg lean mass, total fat mass, femoral fracture risk and general health perception. No differences were found for blood myokines, except for an acute exertional increase in interleukin-8 at post-training/detraining (P=0.002) and in fatty acid binding protein 3 at detraining (P=0.002).ConclusionAn intervention including novel exercises for MD patients (e.g., inspiratory muscle training) produced benefits in numerous indicators of physical capacity, and induced a previously unreported shift towards a healthier body composition phenotype. Purpose We determined the effects of an innovative 8-week exercise intervention (aerobic, resistance and inspiratory muscle training) for patients with mitochondrial disease (MD). Methods Several endpoints were assessed in 12 patients (19–59 years, 4 female) at pre-training, post-training and after 4-week detraining: aerobic power, muscle strength/power and maximal inspiratory pressure (main endpoints), ability to perform activities of daily living (ADL), body composition, quality of life and blood myokines (secondary endpoints). Results The program was safe with patients' adherence being 94±5%. A significant time-effect was found for virtually all main endpoints (P≤0.004), indicating a training improvement. Similar findings (P≤0.003) were found for ADL tests, total/trunk/leg lean mass, total fat mass, femoral fracture risk and general health perception. No differences were found for blood myokines, except for an acute exertional increase in interleukin-8 at post-training/detraining (P=0.002) and in fatty acid binding protein 3 at detraining (P=0.002). Conclusion An intervention including novel exercises for MD patients (e.g., inspiratory muscle training) produced benefits in numerous indicators of physical capacity, and induced a previously unreported shift towards a healthier body composition phenotype. First two authors contributed equally to this work, Carmen Fiuza-Luces, Jorge Díez-Bermejo Corresponding author: Dr. María Morán. Laboratorio de enfermedades raras: mitocondriales y neuromusculares. Instituto de Investigación Hospital Universitario 12 de Octubre (i+12). Centro de Actividades Ambulatorias, 6ª planta. Avenida de Córdoba s/n, 28041, Madrid. Phone: +34 91 779 2784, FAX: +34 91 390 8544, e-mail: mmoran@h12o.es This study was funded by FIS, Fondo de Investigaciones Sanitarias (grant numbers PI14/01085, PI15/00431;PI15/00558), and FEDER funds from the European Union. María Morán is supported by Miguel Servet contracts (CPII16/00023) by the Institute of Health Carlos III (ISCIII) and FEDER funds. Carmen Fiuza-Luces is supported by Sara Borrell contract (CD14/00005) by ISCIII. We acknowledge POWERbreath International Ltd., through BIOCORP EUROPA S.L./POWERbreath Spain for the kind support with equipment for inspiratory muscle training, as well as the blood bank of Hospital 12 de Octubre for facilitating patients' blood drawing. The authors report no conflict of interest and they affirm that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Accepted for Publication: 25 December 2017 © 2018 American College of Sports Medicine

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Efficacy of Tandem Gait to Identify Impaired Postural Control following Concussion

AbstractPurposeThe purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely post-concussion in collegiate student-athletes. Additionally, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity.MethodsSeventy-six NCAA student-athletes performed TG and BESS tests: 38 acutely post-concussion and 38 controls. Participants were tested at baseline (Time 1) and again acutely post-concussion, or the following year for controls (Time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater MDC. A 2 x 2 mixed design ANOVA compared each outcome variable. An ROC curve analysis was utilized to evaluate sensitivity, specificity, and area under the curve (AUC).ResultThere was a significant interaction (F= 8.757, p= 0.004) for TG whereby the concussion group was slower post-concussion (10.59 ± 1.53 vs. 11.80 ± 2.67 seconds), while there was no difference for controls (10.13 ± 1.72 vs. 9.93 ± 1.85 seconds). There was no significant interaction for BESS (F= 0.235, p= 0.630) or mBESS (F= 0.007, p= 0.935). TG had a sensitivity of 0.632, specificity of 0.605, and AUC of 0.704. BESS had a sensitivity of 0.447, specificity of 0.500, and AUC of 0.508. mBESS had a sensitivity of 0.474, specificity of 0.632, and AUC of 0.535.ConclusionParticipants completed TG significantly slower following concussion, while no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting post-concussion postural control assessments. Purpose The purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely post-concussion in collegiate student-athletes. Additionally, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity. Methods Seventy-six NCAA student-athletes performed TG and BESS tests: 38 acutely post-concussion and 38 controls. Participants were tested at baseline (Time 1) and again acutely post-concussion, or the following year for controls (Time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater MDC. A 2 x 2 mixed design ANOVA compared each outcome variable. An ROC curve analysis was utilized to evaluate sensitivity, specificity, and area under the curve (AUC). Result There was a significant interaction (F= 8.757, p= 0.004) for TG whereby the concussion group was slower post-concussion (10.59 ± 1.53 vs. 11.80 ± 2.67 seconds), while there was no difference for controls (10.13 ± 1.72 vs. 9.93 ± 1.85 seconds). There was no significant interaction for BESS (F= 0.235, p= 0.630) or mBESS (F= 0.007, p= 0.935). TG had a sensitivity of 0.632, specificity of 0.605, and AUC of 0.704. BESS had a sensitivity of 0.447, specificity of 0.500, and AUC of 0.508. mBESS had a sensitivity of 0.474, specificity of 0.632, and AUC of 0.535. Conclusion Participants completed TG significantly slower following concussion, while no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting post-concussion postural control assessments. Corresponding Author: Thomas A. Buckley, Ed.D., ATC, Associate Professor, Human Performance Lab, University of Delaware, 541 South College Avenue, Newark, DE 19716, USA. Tbuckley@udel.edu This study is supported from the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium Clinical Study Core, which is jointly funded by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DoD). There are no conflicts of interest associated with the authors of this study. The results of the present study do not constitute endorsement by ACSM and are presented without fabrication, falsification, or data manipulation. Accepted for Publication: 13 December 2017 © 2018 American College of Sports Medicine

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Effects of Strength Training on Postpubertal Adolescent Distance Runners

AbstractPurposeStrength training activities have consistently been shown to improve running economy (RE) and neuromuscular characteristics, such as force producing ability and maximal speed, in adult distance runners. However the effects on adolescent (

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Factors Influencing Time-to-Diagnosis of Biliary Atresia

ABSTRACTObjectives:Diagnosing biliary atresia (BA) quickly is critical, because earlier treatment correlates with delayed or reduced need for liver transplantation. However, diagnosing BA quickly is also difficult, with infants usually treated after 60 days of life. In this study, we aim to accelerate BA diagnosis and treatment, by better understanding factors influencing the diagnostic timeline.Methods:Infants born between 2007–2014 and diagnosed with BA at our institution were included (n = 65). Two periods were examined retrospectively: P1, the time from birth to specialist referral, and P2, the time from specialist referral to treatment. How sociodemographic factors associate with P1 and P2 were analyzed with Kaplan-Meier curves and Cox proportional hazard models. In addition, to better characterize P2, laboratory results and early tissue histology were studied.Results:P1 associated with race/ethnicity, with shorter times in non-Hispanic white infants compared to non-Hispanic black and Hispanic infants (p = 0.007 and p = 0.004, respectively). P2 associated with referral age, with shorter times in infants referred after 30, 45, or 60 days of life (p 

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Efficacy and Safety of Adalimumab in Pediatric Ulcerative Colitis: A Real-life Experience from the SIGENP-IBD Registry

ABSTRACTObjectives:The aim of this study was to evaluate the effectiveness and safety of adalimumab (ADA) in children with ulcerative colitis (UC) previously treated with infliximab (IFX).Methods:Retrospective study including children with UC from a national registry who received ADA therapy. The primary endpoint was the rate of corticosteroid (CS) free remission at week 52. Secondary outcomes were: the rate of sustained clinical remission, primary non-response and loss of response at weeks 12, 30, and 52 and rate of mucosal healing (MH) and side effects at week 52.Results:Thirty-two children received ADA (median age 10 ± 4years). Median disease duration before ADA therapy was 27 months. All patients received previous IFX [43% intolerant, 50% non-responders (37.5% primary, 42.5% secondary non-responders), 6.7% positive anti-IFX antibodies]. Fifty-two weeks after ADA initiation, 13 patients (41%) were in CS-free remission. MH occurred in 9 patients (28%) at 52 weeks. The cumulative probability of clinical relapse-free course was 69%, 59% and 53% at 12, 30 and 52 weeks, respectively. Ten patients (31%) had a primary failure and 5 (15%) loss of response to ADA. No significant differences in efficacy were reported between not-responders and intolerant to IFX (p = 1.0). Overall, 19 patient (59%) maintained ADA during 52-week follow-up. Seven patients (22%) experienced an adverse event, no serious side effects were observed and none resulted in ADA discontinuation.Conclusions:Based on our data, ADA seems to be effective in children with UC, allowing to recover a significant percentage of patients intolerant or not-responding to IFX. The safety profile was good. Objectives: The aim of this study was to evaluate the effectiveness and safety of adalimumab (ADA) in children with ulcerative colitis (UC) previously treated with infliximab (IFX). Methods: Retrospective study including children with UC from a national registry who received ADA therapy. The primary endpoint was the rate of corticosteroid (CS) free remission at week 52. Secondary outcomes were: the rate of sustained clinical remission, primary non-response and loss of response at weeks 12, 30, and 52 and rate of mucosal healing (MH) and side effects at week 52. Results: Thirty-two children received ADA (median age 10 ± 4years). Median disease duration before ADA therapy was 27 months. All patients received previous IFX [43% intolerant, 50% non-responders (37.5% primary, 42.5% secondary non-responders), 6.7% positive anti-IFX antibodies]. Fifty-two weeks after ADA initiation, 13 patients (41%) were in CS-free remission. MH occurred in 9 patients (28%) at 52 weeks. The cumulative probability of clinical relapse-free course was 69%, 59% and 53% at 12, 30 and 52 weeks, respectively. Ten patients (31%) had a primary failure and 5 (15%) loss of response to ADA. No significant differences in efficacy were reported between not-responders and intolerant to IFX (p = 1.0). Overall, 19 patient (59%) maintained ADA during 52-week follow-up. Seven patients (22%) experienced an adverse event, no serious side effects were observed and none resulted in ADA discontinuation. Conclusions: Based on our data, ADA seems to be effective in children with UC, allowing to recover a significant percentage of patients intolerant or not-responding to IFX. The safety profile was good. Address correspondence and reprint requests to Marina Aloi, MD, PhD, Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Roma – Italy (e-mail: marina.aloi@uniroma1.it). Received 7 November, 2017 Accepted 18 December, 2017 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). All the authors declare no financial relationships with a commercial entity producing health-related products and or services related to this article or COI. The other authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Using Quality Improvement to Increase Utilization of Enteral Therapy in Pediatric Crohn Disease: Results and Outcomes

ABSTRACTIntroduction:Exclusive enteral nutrition (EEN) for induction of remission in children with Crohn's disease (CD) is recommended as first line therapy, but underutilized in the United States related to real and perceived barriers. We hypothesized that quality improvement (QI) methodology could increase use of EEN.Methods:We developed, implemented, and revised an algorithm and a set of tools to facilitate use of EEN. Through a series of Plan Do Study Act cycles, the approach was modified to overcome provider and patient/family barriers. The primary outcome, the percentage of newly diagnosed CD patients who receive EEN per month between July 2013 and October 2015, assessed using statistical process control. Secondary outcomes, including the short pediatric Crohn's disease activity index (sPCDAI), body mass index (BMI) Z score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin, and hemoglobin were compared before and after EEN.Results:Among patients newly diagnosed with CD, 73 patients initiated EEN and were included (mean age 12.7 ± 2.9 years, 49% female, 86% white). Rates of utilization of EEN increased significantly from a baseline of 

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Mac-2 binding protein glycan isomer (M2BPGi) is a new serum biomarker for assessing liver fibrosis: more than a biomarker of liver fibrosis

Abstract

Assessing liver fibrosis is important for predicting the efficacy of antiviral therapy and patient prognosis. Liver biopsy is the gold standard for diagnosing liver fibrosis, despite its invasiveness and problematic diagnostic accuracy. Although noninvasive techniques to assess liver fibrosis are becoming important, reliable serum surrogate markers are not available. A glycoproteomics study aimed at identifying such markers discovered Mac 2-Binding Protein Gylcan Isomer (M2BPGi), which is a reliable marker for assessing liver fibrosis in patients with viral hepatitis and other fibrotic liver diseases such as primary biliary cholangitis, biliary atresia, autoimmune hepatitis, and nonalcoholic fatty liver disease. M2BPGi predicts the development of hepatocellular carcinoma (HCC) in patients infected with hepatitis B and C as well as the prognosis of liver cirrhosis in those with HCC after therapy. The unique features of M2BPGi are as follows: (1) cut-off values differ for the same stages of fibrosis according to the cause of fibrosis; and (2) M2BPGi levels rapidly decrease after patients achieve a sustained antiviral response to hepatitis C virus. These observations cannot be explained if M2BPGi levels reflect the amount of fibrotic tissue. Hepatic stellate cells (HSCs) secrete M2BPGi, which may serve as a messenger between HSCs and Kupffer cells via Mac-2 (galectin 3) that is expressed in Kupffer cells during fibrosis progression. Here we show that M2BPGi is a surrogate marker for assessing HSC activation. These findings may reveal the roles of HSCs in extrahepatic fibrotic disease progression.



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HCN4 pacemaker channels attenuate the parasympathetic response and stabilize the spontaneous firing of sinoatrial node

Abstract

The heart rate is dynamically controlled by the sympathetic and parasympathetic nervous systems that regulate the sinoatrial node (SAN). HCN4 pacemaker channels are well-known causative molecule of congenital sick sinus syndrome. Although HCN4 channels are activated by cAMP, the sympathetic response of SAN was preserved in the patients carrying loss-of-function mutations of HCN4 gene. In order to clarify the contribution of HCN4 channels in the autonomic regulation of SAN, we developed novel gain-of-function mutant mice in which expression level of HCN4 channels could be reversibly changed from zero to ∼3 times of that in wild type mice, using tetracycline trans-activator and tetracycline responsive element. Then, we recorded telemetric ECGs in free moving conscious mice, and analysed the heart rate variability (HRV). We also evaluated the response of SAN to cervical vagal nerve stimulation (CVNS). The conditional overexpression of HCN4 did not induce tachycardia, but reduced heart rate variability. The HCN4-overexpression also attenuated bradycardia induced by the CVNS, only during the β-adrenergic stimulation. In contrast, the knockdown of HCN4 gave rise to sinus arrhythmia, and enhanced the parasympathetic response; complete sinus pause was induced by the CVNS. In vitro, we compared the effects of acetylcholine on the spontaneous action potentials of single pacemaker cells, and found that the similar phenotypic changes were induced by genetic manipulation of HCN4 expression both in the presence and absence of β-adrenergic stimulation. Our study suggests that HCN4 channels attenuate the vagal response of SAN, and thereby stabilize the spontaneous firing of SAN.

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A case of severe stenosis of hepatic veins and inferior vena cava with stomal variceal bleeding induced by oxaliplatin-based chemotherapy

Abstract

A 27-year-old woman with colon cancer and liver metastasis was referred to our hospital. Colectomy and colostomy were performed to improve her ileus. Following 13 sessions of oxaliplatin-based chemotherapy (OC) with mFOLFOX6 + bevacizumab, thrombocytopenia and frequent peristomal bleeding occurred. Computed tomography showed severe ascites, splenomegaly, significant collateral veins around the stoma, and severe stenosis of the hepatic veins (HV) and inferior vena cava (IVC). Ultrasound elastography showed high liver (and spleen) stiffness values. Repeated OC appeared to cause IVC stenosis as a result of worsening sinusoidal obstruction syndrome (SOS), and peristomal variceal bleeding. After ultrasound-guided percutaneous embolization, bleeding did not recur. Unfortunately, the patient died of liver dysfunction caused by severe SOS. The incidence of OC-induced SOS is reported to be about 50%; however, there is apparently no report of OC-induced HV and IVC stenosis, and in most cases, portal hypertension is improved after OC cessation. This is the first report of OC-induced severe HV and IVC stenosis resulting in refractory peristomal variceal bleeding and eventual death.



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Correction to: Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data

Abstract

The article Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data, written by Mark C. Hornbrook, Ran Goshen, Eran Choman, Maureen O'Keeffe-Rosetti, Yaron Kinar, Elizabeth G. Liles, and Kristal C. Rust, was originally published Online First without open access



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Small Intestinal Bacterial Overgrowth: Should Screening Be Included in the Pre-fecal Microbiota Transplantation Evaluation?

Abstract

Background

Fecal microbiota transplantation (FMT) is safe and effective for recurrent Clostridium difficile infection (rCDI) and often involves terminal ileal (TI) stool infusion. Patients report gastrointestinal (GI) symptoms post-FMT despite rCDI resolution. Small intestinal bacterial overgrowth (SIBO) screening is not routinely performed pre-FMT. The effect of donor/recipient SIBO status on FMT outcomes and post-FMT GI symptoms is unclear. We aim to evaluate the value of pre-FMT SIBO screening on post-FMT outcomes and symptoms.

Methods

This was a prospective pilot study of consecutive adults with rCDI undergoing FMT by colonoscopy at a tertiary center. Routine pre-FMT screening and baseline lactulose breath tests (LBTs) were performed for donors and recipients. Positive LBT required a rise > 20 ppm in breath hydrogen or any methane level > 10 ppm within 90 min. The presence of GI symptoms and CDI resolution were assessed 8 weeks post-FMT. Fisher's exact/Student's t tests were performed for statistical analyses.

Results

Twenty recipients (58.3 years, 85% women) enrolled in the study. Fourteen (70%) FMTs involved TI stool infusion. Four (20%) recipients and six (30%) donors had positive LBT pre-FMT. At 8 weeks post-FMT, 17 (85%) recipients had CDI resolution and five (25%) reported GI symptoms. Pre-FMT LBT result was not associated with post-FMT CDI resolution or GI symptoms. There was a trend toward increased GI symptoms among recipients receiving stool from LBT-positive donors (50 vs 14.2%, p = 0.09).

Conclusions

FMT is effective and well tolerated for rCDI. Positive LBT in asymptomatic donors may have an effect on post-FMT GI symptoms. Larger studies are needed.



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Vitamin D3 Versus Gliadin: A Battle to the Last Tight Junction



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Influence of physical inactivity on arterial compliance during a glucose challenge

Abstract

Acute hyperglycemia has been shown to augment indices of arterial stiffness in patients with insulin resistance and other co-morbidities, however, conflicting results exist in healthy young individuals. We examined if acute hyperglycemia following an oral glucose tolerance test (OGTT) increases arterial stiffness in healthy active men before, and then after reduced ambulatory physical activity to decrease insulin sensitivity. High-resolution arterial diameter tracings acquired from Doppler-ultrasound allowed the obtainment of an arterial blood pressure (BP) waveform from the diameter tracing within a cardiac cycle. In 24 subjects, this method demonstrated sufficient agreement with the traditional approach for assessing arterial compliance using applanation tonometry. In 10 men, continuous recordings of femoral and brachial artery diameter, and beat-to-beat BP (Finometer) were acquired at rest, 60, and 120 mins of an OGTT before and after 5 days of reduced activity (> 10,000 to < 5,000 steps/day). Compliance and beta-stiffness were quantified. Prior to reduced activity, OGTT had no effect on arterial compliance or beta-stiffness. However, following reduced activity, femoral compliance was decreased (rest = 0.10 ± 0.03 to 120-min OGTT = 0.06 ± 0.02 mm2 mmHg−1; P < 0.001) and femoral beta-stiffness increased (rest = 8.7 ± 2.7 to 120-min OGTT = 15.3 ± 6.5 AU; P < 0.001) during OGTT, while no changes occurred in brachial artery compliance (P = 0.182) or stiffness (P = 0.892). Insulin sensitivity (Matsuda Index) was decreased following reduced activity (P = 0.002). In summary, in young healthy men, the femoral artery becomes susceptible to acute hyperglycemia following 5 days of reduced activity and the resultant decrease in insulin sensitivity, highlighting the strong influence of daily physical activity levels on vascular physiology.

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Compatibility of common IV drugs with 6% hydroxyethyl starch 130/0.42 and 4% gelatin

Summary

Background

Acetate-containing colloid infusion solutions are recommended to recover normovolemia during pediatric anesthesia. Until now, no studies investigating the compatibility with common anesthetic drugs were available.

Aims

This in vitro study was conducted to reveal possible incompatibilities between common anesthetic drugs and the acetate-containing colloid infusion solutions 6% hydroxyethyl starch and 4% gelatin with normal saline as control.

Methods

The colloid infusion solutions were mixed 1:1 with 29 common intravenous drugs in concentrations used in daily clinical practice. Macroscopically visible changes as well as electrical conductivity, pH, and turbidimetric light diffusion at 405 nm were measured immediately after mixing and subsequently 30 and 60 minutes later. All experiments were conducted in triplicate.

Results

Fifty-nine of the 87 colloid infusion-drug mixtures showed no significant changes in pH, electrical conductivity, turbidimetrically detectable light diffusion, or macroscopic appearance after mixing with hydroxyethyl starch, gelatin, and NaCl 0.9%. Fifteen mixtures showed equivocal reactions, and 13 mixtures showed incompatibility reactions.

Conclusion

Most of the tested drugs did not show observable incompatibility reactions. However, some common drugs are highly incompatible with colloid infusion solutions: gelatin (cefazolin, diazepam, midazolam, phenytoin, vancomycin), hydroxyethyl starch (diazepam, midazolam, phenytoin, thiopental), and NaCl 0.9% (diazepam, ketamine (S), phenytoin, thiopental). These combinations should be avoided in clinical practice in case there are fewer intravenous lines available than needed.



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Reproducibility of corneal, macular and retinal nerve fiber layer thickness measurements using the iVue-100 optical coherence tomography

Purpose: To determine the intra-session and inter-session reproducibility of corneal, macular and retinal nerve fiber layer thickness (RNFL) measurements with the iVue-100 optical coherence tomography in normal eyes.
Methods: These parameters were measured in the right eyes of 50 healthy participants with normal vision. Six scans each for corneal thickness, macular and optic nerve head were taken on one day (intra-session), followed by similar repeated measures on five separate days (inter-session). Reproducibility was computed using intra-class correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRV).
Results: For intra-session reproducibility, the ICC, COV and TRV values for mean corneal thickness were 0.924, 2.82%, and 3.06 μm respectively. For the mean macular thickness, they were 0.978, 4.64% and 4.51 μm respectively, while for mean RNFL thickness they were 0.946, 3.19%, and 5.66 μm respectively. Inter-session values for mean corneal thickness were 0.926, 2.65% and 3.48 μm, and 0.916, 2.24% and 2.03 μm for mean macular thickness. For mean RNFL thickness, they were 0.962, 2.21%, and 4.72 μm respectively.
Conclusion: There was good reproducibility of all measured parameters. However, mean RNFL thickness measurements were the most reproducible, suggesting that this may be the best parameter to use to determine measured changes over time.

Keywords: Corneal thickness, macular thickness, retinal nerve fiber layer thickness, iVue-100, reproducibility



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Neurocalcin-delta: a potential memory-related factor in hippocampus of obese rats induced by high-fat diet.

Introduction: Aberrant protein expression within the hippocampus has recently been implicated in the pathogenesis of obesity- induced memory impairment.
Objectives: The objective of the current study was to search for specific memory-related factors in the hippocampus in obese rats.
Methods: Sprague-Dawley (SD) rats were fed either a high-fat (HF) diet or normal-fat (NF) diet for 10 weeks to obtain the control (CON), diet-induced obese rats (DIO) and diet-resistant (DR) rats. D-galactose was injected subcutaneously for 10 weeks to establish model (MOD) rats with learning and memory impairment. After the hippocampus of the rats sampling, the proteome analysis was conducted using two-dimensional get electrophoresis (2-DE) combined with peptide mass fingerprinting (PMF).
Results: We found 15 differential proteins that expressed in the hippocampus in rats induced by HF diet from the 2-DE map. In addition, Neurocalcin-delta (NCALD) was nearly down-regulated in the DR rats compared with CON rats and MOD rats, which was further confirmed by Western blot, real-time PCR and ELISA results.
Conclusion: Our data demonstrates that the differential memory-related proteins were a reflection of the HF diet, but not potential factors in obesity proneness or obesity resistance. Furthermore, NCALD is proved to be a potential hippocampus-memory related factor related to obesity.

Keywords: Diet-induced obesity; diet-resistant; high fat diet; neurocalcin-delta; proteome



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Sub-clinical middle ear malfunctions in elderly patients; prevalence, pattern and predictors

Background: Little is known about functioning of the middle ear with advancing age.
Objectives: To estimate the prevalence and describe tympanometric patterns of sub-clinical middle ear malfunctions,( S-MEM) in elderly patients. It also assessed clinical factors that could predict S-MEM.
Methods: Cross-sectional, analytical study of patients aged ≥ 60 years in a tertiary hospital in Nigeria between 2011-2014. Pure tone audiometry (PTA), tympanometry and acoustic reflexes were recorded. S-MEM was based on audiometric and tympanometric evident abnormalities. Descriptive, univariate and multivariate analyses performed to detect independent clinical predictors of S-MEM at p-value of <0.05.
Results: 121 patients , M: F of 1.1:1. Mean age was 70.1 ± 6.2 years, 77.7% were married. Prevalence of S-MEM was 21.5%. Abnormal tympanometric tracings were type AS>C>B>AD. The parameters that were statistically-significant on univariate analyses were subjected to logistic regression analysis which confirmed previous head injury, diabetes, osteoarthritis of knee joint, and absent acoustic reflex as clinical predictors for S-MEM.
Conclusion: 21.5% of elderly Africans had subclinical abnormalities in their middle ear functioning, mostly with type AS tympanogram. Independent clinical predictors of S-MEM included previous head injury, diabetes, history of osteoarthritis of knee joints, and absent acoustic reflex.

Keywords: Middle ear malfunctions, elderly patients.



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An erroneous opinion on a cause of death in a forensic autopsy: a case report

Background: The quality of autopsies is always questioned in courts, especially in developing countries. Wrong decisions or misjudgments are undesirable in medicine, but they are very dangerous in forensic medicine. If a wrong opinion is given, either a culprit can be acquitted or an innocent person can be sentenced. Therefore, an expert opinion is always required before the announcement of a judgment.
Objective: To highlight the problem of accuracy in determining the cause of death in forensic autopsy.
Case history: A 19- year old young adult male (Mr E), who had a history of alcohol abuse, was brought to a hospital casualty department by police, on an allegation of theft. He was unconscious and died within two hours of arrival. A post-mortem report was requested by a private attorney for an expert opinion. A post-mortem examination was conducted and multiple superficial injuries were recorded on his body. Head injury was given as a cause of death. The author seeks to critically analyze the post-mortem findings in relation to the cause and manner of death.
Conclusion: An erroneous opinion was reached regarding cause and manner of death in this autopsy report.

Keywords: Erroneous opinion, forensic autopsy.



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World Medical Association Declaration of Geneva

No Abstract

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Changes in erythrocyte ATPase activity under different pathological conditions

Background: Studies have shown that Na+-K+ ATPase activity was altered in disrupted red blood cell membranes and this enzyme is believed to be the site of active transport of Na+ and K+ in intact red blood cells. The enzyme is often referred to as Na+- K+ pump because it pumps Na+ out and K+ into the cell against gradients with the concomitant hydrolysis of intracellular ATP.
Objective: The aim of this study was to find out the possibility of using Na+-K+-ATPase activity as a biomarker for the diagnosis of individuals with different physiological conditions.
Materials and methods: The activity of Na+-K+ ATPase was determined in blood samples collected from different pathological and physiological conditions such as pregnancy, smoking, diabetes and renal dysfunction compared with healthy subjects matched for age and sex.
Results: The Na+-K+ ATPase activity in pregnancy (0.094 ± 0.0051 μM Pi/min. mg protein), smoking (0.064 ± 0.0011 μM), diabetes (0.047 μM 0.002 μM) and kidney disease (0.069 ± 0.0014 μM) was higher compared to the measurements in healthy individuals (0.0081 ± 0.0031 μM).
Conclusion: Na+- K+ATPase specific activity is a biomarker for the diagnosis of individuals with different physiological diseases.

Keywords: Na+-K+ATPase, red blood cell, pregnancy, smoking, diabetes, kidney diseases.



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The market dynamics of selective serotonin re-uptake inhibitors: a private sector study in South Africa

Objective: The objective of this study was to analyse the market share of generic vs originator selective serotonin re-uptake inhibitors (SSRIs), and also compare market share of different SSRIs in the private health care sector in South Africa, over a period of 4 years.
Methodology: This was a retrospective, descriptive study that measured generic market volume as a percentage of the total private SSRI market volume. Retail private sector sales data for six SSRIs available in the private sector in South Africa was evaluated. Sales data were obtained from various stages in the pharmaceutical supply chain, June 2009 – May 2013.
Results: Generics constituted 86% and originators 14% of the private sector market volume of SSRIs. The share of the market volume of generic medicines increased by 29.93% over this 4-year period, while an overall increase of 27.86% in the ratio of generics to originators was observed.
Conclusion: In line with policies, generic SSRIs hold a larger volume of the market in the private sector in South Africa.

 Keywords: Selective serotonin, private sector, South Africa.



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Assessing regional variations in the effect of the removal of user fees on facility-based deliveries in rural Zambia

Background: Maternal health remains a concern in sub-Saharan Africa, where maternal mortality averages 680 per 100,000 live births and almost 50% of the approximately 350,000 annual maternal deaths occur. Improving access to skilled birth assistance is paramount to reducing this average, and user fee reductions could help.
Objective. The aim of this research was to analyse the effect of user fee removal in rural areas of Zambia on the use of health facilities for childbirth. The analysis incorporates supply-side factors, including quantitative measures of service quality in the assessment.
Method: The analysis uses quarterly longitudinal data covering 2003 (q1)-2008 (q4) and controls for unobserved heterogeneity, spatial dependence and quantitative supply-side factors within an Interrupted Time Series design.
Results: User fee removal was found to initially increase aggregate facility-based deliveries. Drug availability, the presence of traditional birth attendants, social factors and cultural factors also influenced facility-based deliveries at the national level.
Conclusion: Although user fees matter, to a degree, service quality is a relatively more important contributor to the promotion of facility-based deliveries. Thus, in the short-term, strengthening and improving community-based interventions could lead to further increases in facility-based deliveries.

Keywords: Maternal care, facility based deliveries, user fees, rural, Zambia.



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Intestinal candidiasis and antibiotic usage in children: case study of Nsukka, South Eastern Nigeria.

Background: Overgrowth of candida results from factors that disrupt the intestinal microbial balance, such as the use of antibiotics. Unregulated antibiotic use and rampant practice of self-medication in Nigeria, is a cause for concern.
Methods: A total of 314 stool specimens were collected from children <1 to 12 years of age in Nsukka, South Eastern Nigeria and screened for candida species using standard methods. Questionnaires were used to collect relevant information on the participants.
Results: Out of the 314 participants, 31.2% had candidiasis, indicated by growth of ≥105 CFU/ml. Four different species of candida were identified. Candida albicans had the highest prevalence (59.0%), while Candida krusei had the least prevalence (6.0%). Of the 314 participants, 46.5% had diarrhoea, out of which 58.9% had intestinal candidiasis while only 14.3% of the non-diarrhoeic children had candidiasis. Of 208 participants who had taken antibiotics within three weeks of the study, 42.3% had candidiasis compared to 20.8% of those with no recent history of antibiotic use.
Conclusion: The results of this study showed a high prevalence of intestinal candidiasis among children in Nsukka. Strong associations were observed between the presence of intestinal candidiasis and diarrhoea, age and use of antibiotics (p<0.001).

Keywords: Intestinal candidiasis, children, antibiotic use, diarrhea



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Suicidal ideation and associated factors among school going adolescents in Swaziland.

Background and objective: Suicide among children has been a major issue and the statistics are considerably alarming. However, no studies have been conducted in Swaziland on suicidal ideation which is a starting point for committing suicide. The objective of the study was to determine the prevalence of suicidal ideation and its correlates.
Methods: A secondary analysis of data was conducted using data collected in a Swaziland 2013 Global School-based Student Health Survey (GSHS). The survey assessed among other factors, mental health of the students using a self-administered questionnaire. We considered factors that have been reported to be associated with suicidal ideation in the literature. Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) together with their 95 confidence intervals (CI) are reported.
Results: The overall proportions of students who considered suicide were 18.3% of 1866 females and 15.6% of 1672 males. In bivariate models the risk factors for suicidal ideation were feeling lonely, anxiety, using drugs and smoking marijuana. In multivariate model to include age, gender, food security, close friends, truancy, bullied, attacked, physical fight, drugs, marijuana, parental understanding anxiety and loneliness, all the considered factors were significantly associated with suicide except close friends.
Conclusion: The rate of suicidal ideation was high among adolescents in Swaziland and intervention considering violence, social support from friends and parents, and drug abuse should be designed to prevent suicidal thoughts.

Keywords: Suicidal ideation, school going adolescents, Swaziland.



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Characteristics of astigmatism in Black South African high school children.

Background: Astigmatism impairs vision at various distances and causes symptoms of asthenopia which negatively impacts reading efficiency.
Objective: The aim of conducting this study was to determine the prevalence and distribution of astigmatism and its relationship to gender, age, school grade levels and spherical ametropia.
Methods: Using a multi-stage random cluster sampling, 1589 children who included 635 (40%), males, and 954 (60%), females were selected from 13 out of a sample frame of 60 schools. Their ages ranged between 13 and 18 years with a mean of 15.81±1.56 years. The parameters evaluated included visual acuity using the LogMAR chart and refractive errors measured using an autorefractor and then refined subjectively. Axis of astigmatism was presented in the vector method where positive values of J0 indicated with-the-rule, negative values described against-the-rule and J45 represented oblique astigmatism.
Results: The mean cylinder power was −0.09 ± 0.27 and mainly with-the-rule, J0 = 0.01 ± 0.11. The overall prevalence of clinically significant astigmatism (≤ − 0.75 cylinder) in the sample was 3.1% [(95% Confidence interval = 2.1-4.1%)]. Cylinder of at least − 0.25 power was considered to classify astigmatism types. Thus, the estimated distributions of types of astigmatism were: axis- 11.5%, sphero-astigmatism 10.1% and magnitude-astigmatism 11.2% while 67.2% had no cylinder of any magnitude.
Conclusion: The prevalence of astigmatism is relatively low in this population studied. Older children and those in high school grade levels were more likely to have with-the-rule or against-the-rule astigmatism. The prevalence of astigmatism were comparable within but not across regions.

Keywords: Astigmatism prevalence, school children, South Africa.



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The reality of every day communication for a deaf child using sign language in a developing country.

Background: Research that focuses on the communication between deaf children and their hearing families is scarce despite the majority of deaf children being born into hearing families where a common communication mode needs to be forged.
Objective: The aim of the study was to explore, describe and compare the nature of communication across typical daily contexts of a deaf child who uses South African Sign Language (SASL) and who is born into a hearing family with no prior experience of SASL.
Methods: A case study design which included quantitative and qualitative components was used to observe a nine year old grade one child with profound hearing loss. Spontaneous communication was observed with 13 communication partners in the home context and these included the mother, a sibling and peers. Two educators and 11 peers were observed in the educational context. Surveillance cameras were used to obtain 27 hours of video-recording in the home and 19 hours at the school. Interviews were conducted with the mother, siblings, educators, and the deaf child.
Results: It was observed that communication using SASL, albeit minimal, home signs, natural gestures and oral communication were used extensively. Due to a mismatch in the communication mode in the home context communication interactions were fewer and predominantly oral, impoverished and with frequent breakdowns whereas the communication interactions in the school were characterized by SASL, was meaningful and had fewer communication breakdowns.
Conclusion: Communication for deaf children within the home is problematic as communication partners are not fluent in SASL.

Keywords: Deaf child, sign language, developing country.



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Long term effect of a school based intervention to prevent chronic diseases in Tunisia, 2009-2015

Background & Objectives: We aimed to evaluate the long term effect of school based intervention to prevent non- communicable disease risk factors.
Methods: It was a quasi experimental study conducted during the period of 2009-2015. We involved school children aged from 11 to 16 years old. For the assessment of the program's effectiveness, subjects in both groups were examined at baseline, at the end of the 3-year intervention period and at the follow-up, one year after program's cessation.
Results: In the intervention group, the prevalence of school children who reported to be eating 5 fruits and vegetable sdaily increased significantly from 30.0% at pre-assessment to 33.2% at post-assessment, one year after (p=0.02, p=0.41 respectively). For the control group, this prevalence had significantly decreased from 40.2% at baseline to 35.0% at post-intervention, at the follow up, this proportion increased to 44.5%(p=0.001, p<10-3 respectively). Concerning smoking habits, we observed a decreasing trend in the intervention group from 5.7% at pre-assessment, to 4.8% at post-assessment and to 3.4% at the follow-up (p=0.19 and p=0.25 respectively). There was also a significant decrease in school children who did recommended physical activity in the same group.
Conclusion: The present work showed that interventions promoting healthy lifestyles should be maintained. Developing countries should be encouraged and supported to design, conduct, and evaluate robust preventive interventions.

Keywords: Schools, lifestyle, intervention.



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Idiopathic nephrotic syndrome in South African children.

Background: Different histo-pathological types and treatment response patterns of Idiopathic nephrotic syndrome (INS) have been associated with differences in ethnicity and geographical location.
Objective: To provide an update on the steroid response and renal histo-pathological pattern in children treated for INS.
Method: Medical records of children with INS treated at the Charlotte Maxeke Johannesburg Academic Hospital were reviewed.
Results: Mean age was 5.3 years ± 2.8. The majority (68.1%) of the 163 children were of the black racial group. The highest rate of INS was seen in the 2-6 year age group (71.2%). The black racial group had the highest rate (42/111; 37.8%) of focal segmental glomerulosclerosis (FSGS), and the white race had the highest rate (9/14; 64.3%) of minimal change disease (MCD). Ninety four (57.7%) patients were steroid sensitive (SSNS) while 69 patients (42.3%) were steroid resistant (SRNS). Minimal change disease was the most common histo-pathological type seen in SSNS (60%), while FSGS was the most common observed in patients who had SRNS (65.2%).
Conclusion: There appears to be a higher rate of FSGS in all the racial groups, and also a higher rate of MCD in the black race group, when compared to previous reports.

Keywords: Idiopathic, nephrotic syndrome, children.



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Abnormalities of the external genitalia and groins among primary school boys in Bida, Nigeria

Background: Abnormalities of the male external genitalia and groin, a set of lesions which may be congenital or acquired, are rather obscured to many kids and their parents and Nigerian health care system has no formal program to detect them.
Objectives: To identify and determine the prevalence of abnormalities of external genitalia and groin among primary school boys in Bida, Nigeria.
Methods: This was a cross-sectional study of primary school male pupils in Bida. A detailed clinical examination of the external genitalia and groin was performed on them.
Results: Abnormalities were detected in 240 (36.20%) of the 663 boys, with 35 (5.28%) having more than one abnormality. The three most prevalent abnormalities were penile chordee (37, 5.58%), excessive removal of penile skin (37, 5.58%) and retractile testis (34, 5.13%). The prevalence of complications of circumcision was 15.40% and included excessive residual foreskin, excessive removal of skin, skin bridges and meatal stenosis. Undescended testes were seen in 6 (0.90%) boys, with median age of 9 years and 2 were bilateral. Also, micropenis was detected in 27 (4.07%) of the pupils.
Conclusion: Inguino-penoscrotal abnormalities are common in our community (36.20%). Screening of pre-school and school children to  detect them should be introduced into the school health programs in Nigeria.

Keywords: External genitalia, groin abnormalities, boys



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Bowel injury following gynecological laparoscopic surgery

Background: Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication.
Methods: We performed a narrative review on bowel injury following gynecological laparoscopic surgery using PubMed covering prevention, diagnosis, and management. Search terms used were laparoscopy, gynaecology, injury, bowel, prevention, treatment.
Results: Important principles of prevention include proper pre-operative evaluation and increased laparoscopic surgical skills and knowledge. High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial abdominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and CT scan. When bowel injury is recognized during the first laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed.
Conclusion: Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and proper decisions to be made.

Keywords: Laparoscopy, gynaecology, injury, bowel, prevention, treatment



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Common childhood kidney diseases in Uganda and their prevention

No Abstarct

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Editorial: HIV and NCDs: inevitable interaction in resource limited settings.

No Abstract

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Cardiovascular risk factors in adult general out-patient clinics in Nigeria: a country analysis of the Africa and Middle East Cardiovascular Epidemiological (ACE) study.

Background: With globalization and rapid urbanization, demographic and epidemiologic transitions have become important determinants for the emergence of cardiovascular disease (CVD).
Objective: To estimate the prevalence of CVD risk factors in adult out-patients attending general practice and non-specialist clinics in urban and rural Nigeria.
Methods: As part of the Africa and Middle East Cardiovascular Epidemiological (ACE) study, a cross-sectional epidemiologic study was undertaken for the presence of hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and abdominal obesity in Nigeria.
Results: In total, 303 subjects from 8 out-patient general practice clinics were studied, 184 (60.7%) were female and 119 (39.3%) were male. Mean age was 42.7±13.1 years; 51.8% were aged <45 years; 4% ≥65 years. Over 90% of subjects had ≥1 of 6 selected modifiable cardiovascular risk factors: 138 (45.6%) had 1-2; 65 (21.5%) had 3; 60 (19.8%) had 4; and 11 (3.6%) had 5 concurrent risk factors. Screening identified 206 subjects (68.0%) with dyslipidemia who did not have a prior diagnosis.
Conclusion: Cardiovascular risk factors are highly prevalent in Nigerian subjects attending out-patient clinics. Moreover, many subjects were undiagnosed and therefore unaware of their cardiovascular risk status. Opportunistic screening alongside intensive national, multisectoral education or risk factor education is needed, should be scaled up nationwide and rolled out in both urban and rural communities in Nigeria.

Keywords: Nigeria, cardiovascular risk factors, screening programs, risk factor management, The Africa and Middle East Cardiovascular Epidemiological (ACE) study.



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Analysis of SNPs of MC4R , GNB3 and FTO gene polymorphism in obese Saudi subjects

Background: The goal of this study was to analyze the association between the FTO rs17817449 (G>T), G protein beta3 subunit (GNB3) C825T and Melanocortin 4 receptor (MC4R) A822G single nucleotide  olymorphism (SNP) with obesity in Saudi subjects.
Methods: The subjects were divided into 2 groups according to BMI: Obese (BMI> 29.9) and non- obese control (BMI<24.9). Genotyping of the target genes were determined by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism analysis (RFLP).
Results: We demonstrated the association of the FTO genotype TT with increased weight, BMI and leptin levels in both males and females. However, there was no association of genotype TT with fasting blood glucose, triglycerides and cholesterol levels. Regarding GNB3 rs5443 polymorphism, the likelihood of obesity was linked to the TT genotype which was also associated with increased leptin levels. On the other hand, the SNP of MC4R A822G did not exhibit any significant association with obesity among studied subjects and showed only the presence of homozygous AA genotype.
Conclusion: The polymorphism of FTO gene rs17817449 and GNB3 gene rs5443 (C825T) may be a genetic determinant of obesity in Saudi population whereas impact of MC4R Asn274Ser change could not be detected.

Keywords: Obesity, FTO gene-polymorphism.



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The Genomes of Four Meyerozyma caribbica Isolates and Novel Insights into the Meyerozyma guilliermondii Species Complex

Yeasts of the Meyerozyma guilliermondii species complex are widespread in nature and can be isolated from a variety of sources, from the environment to arthropods to hospital patients. To date, the species complex comprises the thoroughly studied and versatile M. guilliermondii, and the hard to distinguish M. caribbica, and Candida carpophila. Here we report the whole-genome sequencing and de novo assembly of four M. caribbica isolates, identified with the most recent molecular techniques, derived from four Diptera species. The four novel assemblies present reduced fragmentation and comparable metrics (genome size, gene content) to the available genomes belonging to the species complex. We performed a phylogenomic analysis comprising all known members of the species complex, to investigate evolutionary relationships within this clade. Our results show a compact phylogenetic structure for the complex and indicate the presence of a sizable core set of genes. Furthermore, M. caribbica, despite a broad literature on the difficulties of discerning it from M. guilliermondii, seems to be more closely related to C. carpophila. Finally, we believe that there is evidence for considering these four genomes the first published for the species M. caribbica. Raw reads and assembled contigs have been made public to further the studies on these organisms.



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Dispersion Profiles and Gene Associations of Repetitive DNAs in the Euchromatin of the Beetle Tribolium castaneum

Satellite DNAs are tandemly repeated sequences clustered within heterochromatin. However, in some cases such as the major TCAST1 satellite DNA from the beetle Tribolium castaneum, they are found partially dispersed within euchromatin. Such organization together with transcriptional activity enables TCAST1 to modulate the activity of neighbouring genes. In order to explore if other T. castaneum repetitive families have features which could provide them with a possible gene-modulatory role we compare here the structure, organization, dispersion profiles and transcription activity of ten distinct TCAST repetitive families including TCAST1. The genome organization of TCAST families exhibit either satellite-like or transposon-like characteristics. In addition to heterochromatin localization, bioinformatics search of assembled genome reveals dispersion of all families within euchromatin, preferentially in the form of single repeats. Dispersed TCAST repeats are mutually correlated in distribution and are grouped in distinct regions of euchromatin. The repeats are associated with genes and are enriched in introns relative to intergenic regions and very rarely overlap exons. In spite of the different mechanisms of repeat proliferation such as transposition and homologous recombination, all TCAST families share a similar frequency of spreading as well as dispersion and gene association profiles. Additionally, TCAST families are transcribed and their transcription is significantly activated by heat stress. A possibility that such common features of TCAST families might be related to their potential gene-modulatory role is discussed.



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