Τρίτη, 1 Μαΐου 2018

Precise isometric hand grip learning of hemiparetic stroke patients

imageRehabilitation of hand movements after stroke aims at skills that can be well retained and transferred to novel conditions. These functions may be altered by training schedules such as constant and variable practice. A total of 36 participants with hemiparesis completed one of these schedules counterbalanced. Precise isometric hand grip force production was practiced for 4 days with a target force of 25% maximum voluntary contraction. The constant group practiced only the target force, whereas the variable group practiced the same amount including ±5 and 10% maximum voluntary contraction. Target force presentation and feedback were provided visually. Results indicated that both practice schedule led to learning. Variable practice resulted in a superior performance in retention and transfer tests, suggesting that it may be effective not only in the healthy population but also in stroke rehabilitation.

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Comments on: ‘Effects of walking trainings on walking function among stroke survivors a systematic review’

No abstract available

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The role of robotic gait training coupled with virtual reality in boosting the rehabilitative outcomes in patients with multiple sclerosis

imageMotor impairment is the most common symptom in multiple sclerosis (MS). Thus, a variety of new rehabilitative strategies, including robotic gait training, have been implemented, showing their effectiveness. The aim of our study was to investigate whether an intensive robotic gait training, preceding a traditional rehabilitative treatment, could be useful in improving and potentiating motor performance in MS patients. Forty-five patients, who fulfilled the inclusion criteria, were enrolled in this study and randomized into either the control group (CG) or the experimental group (EG). A complete clinical evaluation, including the Expanded Disability Severity Scale, the Functional Independence Measure, the Hamilton Rating Scale for Depression, the time up and go test (TUG), and the Tinetti balance scale, was performed at baseline (T0), after 6 week (T1), at the end of rehabilitative training (T2), and 1 month later (T3). A significant improvement was observed in the EG for all the outcome measures, whereas the CG showed an improvement only in TUG. In contrast, from T1 to T2, only CG significantly improved in all outcomes, whereas the EG had an improvement only regarding TUG. From T2 to T3, no significant differences in Functional Independence Measure scores emerged for both the groups, but a significant worsening in Tinetti balance scale and TUG was observed for the CG and in TUG for the EG. Our study provides evidence that robotic rehabilitationn coupled with two-dimensional virtual reality may be a valuable tool in promoting functional recovery in patients with MS.

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Measuring work functioning in individuals with musculoskeletal disorders with reference to the International Classification of Functioning, Disability, and Health: a systematic literature review

imageThe assessment of work functioning is important to define needs in the context of vocational rehabilitation. The International Classification of Functioning, Disability, and Health (ICF) serves as a framework to describe functioning and health. In reference to the ICF, work functioning can be described as consisting of work activities and work participation. A range of instruments are used in rehabilitation practice to assess work functioning. The purpose of this systematic review was to identify questionnaires measuring work functioning with reference to the ICF and to describe these instruments, their linkage to the ICF, and their psychometric properties. Instruments should be suitable for individuals with musculoskeletal disorders. Web of Science and PubMed were searched for English and German studies published between 2001 and 2015. We focused on self-reported questionnaires measuring work functioning with reference to the ICF. Sixteen questionnaires fulfilled the inclusion criteria. The instruments varied in their linkage to the ICF and in their focus on work functioning. Questionnaires measuring concrete work activities differ from instruments measuring aspects of work participation in terms of absenteeism. The Work Rehabilitation Questionnaire is the instrument covering most ICF categories. The results show a range of different instruments that could be useful in certain settings. The description and comparison of the questionnaires can help to choose appropriate instruments in practice.

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Smartphone technology: a reliable and valid measure of knee movement in knee replacement

imageKnee range of motion (ROM) following a knee arthroplasty is an important clinical outcome that directly relates to the patient's physical function. Smartphone technology has led to the creation of applications that can measure ROM. The aim was to determine the concurrent reliability and validity of the photo-based application 'Dr Goniometer' (DrG) compared with a universal goniometer performed by a clinician. A smartphone camera was used to take photographs of the knee in full flexion and full extension, and the images were sent by participants to a study phone. Participants then rated the ease of participation. To assess validity, the patient's knee was measured by a clinician using a goniometer. To examine reliability, four clinicians assessed each image using DrG on four separate occasions spaced 1 week apart. A total of 60 images of knee ROM for 30 unicondylar or total knee arthroplasty were assessed. The goniometer and DrG showed strong correlations for flexion (r=0.94) and extension (r=0.90). DrG showed good intrarater reliability and excellent inter-rater reliability for flexion (intraclass correlation coefficient=0.990 and 0.990) and good reliability for extension (intraclass correlation coefficient=0.897 and 0.899). All participants found the process easy. DrG was proven to be a valid and reliable tool in measuring knee ROM following arthroplasty. Smartphone technology, in conjunction with patient-reported outcomes, offers an accurate and practical way to remotely monitor patients. Benefit may be found in differentiating those who need face-to-face clinical consult to those who do not.

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Are graft-versus-host-disease patients missing out on the vital occupational therapy services? a systematic review

imageThe aim of this review is to show the importance of occupational therapy/hand therapy for chronic graft-versus-host-disease (GVHD) patients and to outline the current state of the literature. GVHD of the hand can cause functional loss, reduced activities of daily life, poor social interaction, and loss of income because of limitations in work. Hand therapy, which is a specialty practised by both occupational therapists and physical therapists, has been proven to be an effective approach for hand-related musculoskeletal disorders; however, the literature search suggests that it is an underutilized specialty around the world. An electronic search was performed from 1997 to 2017 using OneFile (GALE), Medline/PubMed (NLM), Scopus (Elsevier), Science Citation Index Expanded (Web of Science), ProQuest Central (New), ProQuest Hospital Collection, Health Reference Center Academic (Gale), Health Research Premium Collection, Science Direct Journals (Elsevier), ProQuest Health & Medical Complete, Medical Database, Wiley Online Library, and SciTech Premium Collection for the period from 1994 to April 2017. Only randomized-controlled trials involving occupational therapy or hand therapy in patients with chronic hand GVHD were included in the final analysis. The search was limited to articles in English. Two reviewers independently assessed the methodological quality and extracted the data. The JADAD scoring method was used to score the articles. After the duplicates were excluded, 5466 articles were identified by the electronic database search for screening, out of which 5465 articles were excluded after reviewing. One article was further excluded on obtaining the full text as it was a case study. Hand therapy specialty, although a vital part of the recovery process for the patients with hand GVHD, is an underutilized specialty and well-designed trials are urgently needed for musculoskeletal hand GVHD, especially for focused hand therapy interventions.

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A pilot mixed-methods evaluation of MS INFoRm: a self-directed fatigue management resource for individuals with multiple sclerosis

imageFatigue management interventions for individuals with multiple sclerosis (MS) often feature structured programmes requiring repeated, in-person attendance that is not possible for all individuals. We sought to determine whether MS INFoRm, a self-directed fatigue management resource for individuals with MS, was worth further, more rigorous evaluation. Our indicators of worthiness were actual use of the resource by participants over 3 months, reductions in fatigue impact and increases in self-efficacy, and participant reports of changes in fatigue management knowledge and behaviours. This was a single-group, mixed-methods, before–after pilot study in individuals with MS reporting mild to moderate fatigue. Thirty-five participants were provided with MS INFoRm by a USB flash drive to use at home for 3 months, on their own volition. Twenty-three participants completed all standardized questionnaires, semi-structured interviews and study process measures. Participants reported actively using MS INFoRm over the 3-month study period (median total time spent using MS INFoRm=315 min) as well as significantly lower overall fatigue impact (Modified Fatigue Impact Scale: t=2.6, P=0.01), increased knowledge of MS fatigue (z=−2.8, P=0.01) and greater confidence in managing MS fatigue (z=−3.3, P=0.001). Individuals with significant reductions in fatigue impact also reported behavioural changes including tracking fatigue, better communication with others, greater awareness, improved quality of life and being more proactive. This study provides evidence that further rigorous evaluation of MS INFoRm, a self-directed resource for managing fatigue, is worth pursuing.

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A ‘musculoskeletal look’ to sarcopenia: Where do/should the physical and rehabilitation medicine physicians (physiatrists) stand?

No abstract available

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Executive functioning and daily living of individuals with chronic stroke: measurement and implications

imageDeficits in executive functioning (EF) are often still present at the chronic stage after stroke, which may negatively impact independent living. The objectives of this study were (a) to characterize the EF and independence in daily living of community-dwelling individuals with chronic stroke by using pen-and-paper and performance-based EF assessments, (b) to explore correlations between scores detected by different EF assessments and (c) to assess the correlations between EF and independence in basic activities of daily living (BADL) and instrumental activities of daily living (IADL). This cross-sectional study included 50 (30 men and 20 women) community-dwelling individuals [mean (SD) age 59.8 (9.3)] with chronic stroke. Participants were overall independent in basic activities of daily living, without significant cognitive impairment. Participants underwent EF assessment using two pen-and-paper tools: Trail Making Test, Zoo Map subtest from the Behavioral Assessment of Dysexecutive Syndrome and two performance-based tools; EF Route-Finding Task and bill-paying subtest from the Executive Functions Performance Test. BADL, IADL, depressive symptoms, gait speed and upper extremity motor impairment were also assessed. Participants demonstrated mild to moderate EF deficits with moderate significant correlations between the scores of various EF assessments. Participants varied in their independence in IADL, and EF was significantly correlated to independence in BADL and IADL (−0.31

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Use of pain medication before and after inpatient musculoskeletal rehabilitation: longitudinal analysis of a nationwide cohort

imageThe objective of this study was to identify subgroups among the participants in inpatient multidisciplinary musculoskeletal rehabilitation based on the differences in the shapes of trajectories of pain medication consumption during the 9 years around the time of intervention. A register-based study among 4578 public sector employees was conducted. Group-based trajectory analysis was done on the purchase of prescribed pain medications during the 9 years around the time of rehabilitation. The participants were on an average 50.7 (SD=6.6) years of age, and 2955 (86%) were women. Average yearly purchase of pain medications increased during the follow-up period from 73.4 (SD=193.0) to 163.3 (SD=295.7) defined daily doses. The analysis suggested six-cluster model. The shapes of the trajectories of three clusters did not show any steep slopes, one trajectory demonstrated nonstop rising through the entire follow-up, and one trajectory was closed to the trajectory average of medication use. One trajectory (11% of the sample) demonstrated a steep growth before the intervention and steep drop after it. When comparing this cluster with all other clusters combined, odds ratios were 0.40 [95% confidence interval (CI): 0.19–0.85] for age group (older vs. younger), 0.78 (95% CI: 0.61–1.01) for sex (women vs. men), and 1.44 (95% CI: 1.09–1.90) for occupational status (lower vs. higher). In other words, the participants belonged to this cluster were younger employees with a lower occupational grade. It seems that younger employees in manual jobs benefitted of the studied multidisciplinary musculoskeletal rehabilitation the most, especially when the timing of intervention is bounded to the substantial rise of pain severity.

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Reliability of translation of the RAND 36-item health survey in a post-rehabilitation population

imageThe aim of this study is to evaluate the reliability of the RAND 36-item Health survey as a measure of health-related quality of life in a general Dutch post-rehabilitation population. A total of 752 ex-rehabilitation patients were invited to complete the Dutch RAND 36-item health survey. After 2 weeks, the people who responded to the first questionnaire were asked to complete the same questionnaire again. Internal consistency of the questionnaire was expressed as Cronbach's α. Test–retest reliability was expressed as intraclass correlation coefficient (ICC) and presented in Bland–Altman plots. Internal consistency was found acceptable for all subscales (n=276; Cronbach's α ranged from 0.81 to 0.95). Test–retest reliability was found acceptable for research and group comparisons for all subscales (n=184; ICC ranged from 0.71 to 0.88). Overall, test–retest reliability of the physical functioning (ICC=0.86), pain (ICC=0.87), and general health (ICC=0.88) subscale was relatively high, and that of health change (ICC=0.71) was relatively low. Reliability of the questionnaire did not notably differ between participants who indicated stable health and participants who indicated health change during the past weeks. In conclusion, the Dutch translation of the RAND 36-item health survey is reliable for research and group comparisons in a general post-rehabilitation population. However, the RAND 36-item health survey is not sufficiently reliable for individual comparisons within this population.

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Comparison between three types of prosthetic feet: a randomized double-blind single-subject multiple-rater trial

imageThere are many prosthetic feet (Pfeet) on the market, and those in the same category do not necessarily have the same properties. We assessed three different Pfeet in terms of gait patterns on various terrains, balance and walking speed in a randomized double-blind controlled single-subject multiple-rater clinical trial. The patient was a 43-year old man who was an active prosthesis user and was amputated at transtibial level because of injury 17 years ago. One Solid Ankle Cushion Heel and two Dynamic Elastic Response (DER) Pfeet were tried six times in random order. The patient walked on flat, uneven, sloped terrain and stairs. Gait pattern was rated in comparison with the patient's previous prosthetic foot (Pfoot) by a physiatrist, physiotherapist, prosthetist and the patient; one-leg standing test on the prosthesis and 10-m walking test were also performed. The ratings differed significantly between the raters on each terrain, and there was no agreement among the raters regarding the ranking order of the Pfeet. All the Pfeet were generally rated as worse than the patient's previous one. The patient gave lower ratings on average than the professionals and recognized the order of the tested Pfeet. The results of one-leg standing test with one DER and the Solid Ankle Cushion Heel Pfoot were statistically significant better than with the other DER and the patient's previous Pfoot. Our study therefore indicates that rehabilitation professionals, when blinded, cannot always reliably observe differences in walking on different terrains with different Pfeet. The patient may feel the differences, but those may not match what the manufacturers declare.

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Effectiveness of a single session of dual-transcranial direct current stimulation in combination with upper limb robotic-assisted rehabilitation in chronic stroke patients: a randomized, double-blind, cross-over study

imageThe impact of transcranial direct current stimulation (tDCS) is controversial in the neurorehabilitation literature. It has been suggested that tDCS should be combined with other therapy to improve their efficacy. To assess the effectiveness of a single session of upper limb robotic-assisted therapy (RAT) combined with real or sham-tDCS in chronic stroke patients. Twenty-one hemiparetic chronic stroke patients were included in a randomized, controlled, cross-over double-blind study. Each patient underwent two sessions 7 days apart in a randomized order: (a) 20 min of real dual-tDCS associated with RAT (REAL+RAT) and (b) 20 min of sham dual-tDCS associated with RAT (SHAM+RAT). Patient dexterity (Box and Block and Purdue Pegboard tests) and upper limb kinematics were evaluated before and just after each intervention. The assistance provided by the robot during the intervention was also recorded. Gross manual dexterity (1.8±0.7 blocks, P=0.008) and straightness of movement (0.01±0.03, P0.05). The assistance provided by the robot was similar during both interventions (P>0.05). The results showed a slight improvement in hand dexterity and arm movement after the REAL+RAT tDCS intervention. The observed effect after a single session was small and not clinically relevant. Repetitive sessions could increase the benefits of this combined approach.

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The importance of specific rehabilitation for an obese patient with idiopathic intracranial hypertension: a case report

Idiopathic intracranial hypertension (IIH) is associated with obesity, and weight loss is important to reduce intracranial pressure and improve visual function. A 38-year-old woman with IIH followed an extreme diet, which resulted in 30% weight loss (BMI moved from 34.9 to 24.6). Weight loss resulted in a significant reduction of papilloedema, normalization of intracranial pressure and improvement in headache pattern, but also induced a state of initial malnutrition, relevant depression and disability. She was discharged with the indication to start a controlled diet and improve physical activity: clinical situation get back to stability, with the patient loosing further weight (BMI=21.8) through a balanced diet and moderate physical exercise. Obese patients with IIH should be offered a comprehensive treatment approach consisting of diet and nutritional support, psychological counselling, indication to increase physical activity and, when appropriate, a specific rehabilitation programme.

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Effect of inpatient rehabilitation on activities of daily living in pediatric cancer patients in Japan

imageMost pediatric cancer patients decline physical performance therapy, resulting in limitations in the activities of daily living. The objective of this study was to investigate the effects of rehabilitation in pediatric patients with cancer using the functional independence measure (FIM) score. This retrospective study included 25 inpatient children diagnosed with cancer at a single university hospital from January 2016 to December 2016. All patients underwent rehabilitative intervention during their hospital stay. We investigated the contents of the rehabilitation program and the FIM scores before and after the rehabilitative intervention. The average FIM scores improved in all patients; however, only the total-FIM scores (+4.96 points, P=0.009) and motor-FIM scores (+4.04 points, P=0.005) improved significantly. Conversely, cognitive-FIM score did not significantly improve (+0.92 points, P=0.159). In addition, motor-FIM subgroup scores for locomotion (walk/wheelchair and stairs) were significantly higher (+0.36 points, P=0.039 and +0.64 points, P=0.046, respectively) after rehabilitative intervention, regardless of the length of hospital stay. This study showed that FIM score, particularly motor-FIM score and locomotion subgroup scores, significantly improved owing to participation in inpatient rehabilitation. In conclusion, we found that rehabilitative intervention improved physical activity, especially locomotion.

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Comment on the Letter to the Editor by Mohammad Alwardat and Mohammad Etoom on ‘Effects of walking trainings on walking function among stroke survivors: a systematic review’

No abstract available

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Transpapillary endopancreatic surgery: decompression of duct system and comparison of greenlight laser with monopolar electrosurgical device in ex vivo and in vivo animal models

Abstract

Background

Endopancreatic surgery (EPS) is an experimental minimally invasive technique for resection of pancreatic tissue from inside the pancreatic duct, accessed via the duodenum and papilla. It is proposed as an alternative to duodenum-preserving pancreatic head resection in benign diseases such as chronic pancreatitis (CP). This study evaluated the use of EPS for resection of pancreatic duct stenoses. Moreover, greenlight laser (GLL) and monopolar electrosurgical device (MES) were compared as resection tools for EPS.

Methods

The suitability of EPS for resection of stenoses was evaluated in ex vivo bovine pancreas (n = 8). Artificially created stenoses in the pancreatic head were accessed via the duodenal papilla and resected from inside the organ with MES through a rigid endoscope. Furthermore, standardized pancreatic resections were performed in an in vivo porcine model using either GLL (n = 18) or MES (n = 18) to compare blood loss, operating time, and complications. Thermal damage to the surrounding tissue was assessed using a standardized histological classification.

Results

Stenosis resection by EPS was feasible in 8/8 bovine pancreases, with a procedure time of 17 (12–24) min. No perforation of the organ occurred. Resection by GLL was associated with reduced blood loss [median 1.7 (interquartile range 0.6–2.6) ml vs. 5.1 (3.8–13.2) ml; p < 0.01] and shorter operating time [109 (81–127) s vs. 390 (337–555) s; p < 0.01] compared with MES. The zone of thermal tissue damage was more extensive when using GLL than with MES [4.12 (3.48–4.89) mm vs. 1.33 (1.09–1.48) mm; p < 0.01].

Conclusion

Transduodenal-transpapillary EPS can be used to resect stenoses and decompress the pancreatic duct system. Both GLL and MES are feasible resection methods for EPS. However, GLL showed better hemostatic characteristics than MES in an in vivo porcine model. Safety measures such as temperature control and image-guided navigation should be employed to monitor the resection and tissue heating.



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All in: expansion of the acquisition of data for outcomes and procedure transfer (ADOPT) program to an entire SAGES annual meeting hands-on hernia course

Abstract

Background

Continuing professional development (CPD) for the surgeon has been challenging because of a lack of standardized approaches of hands-on courses, resulting in poor post-course outcomes. To remedy this situation, SAGES has introduced the ADOPT program, implementing a standardized, long-term mentoring program as part of its hernia hands-on course. Previous work evaluating the pilot program showed increased adoption of learned procedures as well as increased confidence of the mentored surgeons. This manuscript describes the impact of such a program when it is instituted across an entire hands-on course.

Methods

Following collection of pre-course benchmark data, all participants in the 2016 SAGES hands-on hernia course underwent structured, learner-focused instruction during the cadaveric lab. All faculty had completed a standardized teaching course in the Lapco TT format. Subsequently, course participants were enrolled in a year-long program involving longitudinal mentorship, webinars, conference calls, and coaching. Information about participant demographics, training, experience, self-reported case volumes, and confidence levels related to procedures were collected via survey 3 months prior to 9 months after the course.

Results

Twenty surgeons participated in the SAGES ADOPT 2016 hands-on hernia program. Of these, seventeen completed pre-course questionnaires (85%), ten completed the 3-month questionnaire (50%), and four completed the 9-month questionnaire (20%). Nine of ten respondents of the 3-month survey (90%) reported changes in their practice. In the 9-month survey, significant increases in the annualized procedural volumes were reported for open primary ventral hernia repair, open components separation, and mesh insertion for ventral hernia repair (p < 0.001).

Conclusions

The expansion of the ADOPT program to an entire hands-on hernia course is both feasible and beneficial, with evidence of Kirkpatrick Levels 1–4a training effectiveness. This expanded success suggests that it is a useful blueprint for the CPD of surgeons wishing to learn new techniques and procedures for their patients.



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Ribosomal DNA copy loss and repeat instability in ATRX-mutated cancers [Genetics]

ATRX (alpha thalassemia/mental retardation X-linked) complexes with DAXX to deposit histone variant H3.3 into repetitive heterochromatin. Recent genome sequencing studies in cancers have revealed mutations in ATRX and their association with ALT (alternative lengthening of telomeres) activation. Here we report depletion of ATRX in mouse ES cells leads to selective...

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Synthetically engineered Medea gene drive system in the worldwide crop pest Drosophila suzukii [Genetics]

Synthetic gene drive systems possess enormous potential to replace, alter, or suppress wild populations of significant disease vectors and crop pests; however, their utility in diverse populations remains to be demonstrated. Here, we report the creation of a synthetic Medea gene drive system in a major worldwide crop pest, Drosophila...

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Next-generation CRISPR/Cas9 transcriptional activation in Drosophila using flySAM [Genetics]

CRISPR/Cas9-based transcriptional activation (CRISPRa) has recently emerged as a powerful and scalable technique for systematic overexpression genetic analysis in Drosophila melanogaster. We present flySAM, a potent tool for in vivo CRISPRa, which offers major improvements over existing strategies in terms of effectiveness, scalability, and ease of use. flySAM outperforms existing...

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O6-methylguanine-induced transcriptional mutagenesis reduces p53 tumor-suppressor function [Genetics]

Altered protein function due to mutagenesis plays an important role in disease development. This is perhaps most evident in tumorigenesis and the associated loss or gain of function of tumor-suppressor genes and oncogenes. The extent to which lesion-induced transcriptional mutagenesis (TM) influences protein function and its contribution to the development...

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Mechanism of cancer: Oncohistones in action

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Publication date: Available online 30 April 2018
Source:Journal of Genetics and Genomics
Author(s): Lei Qiu, Xiaoyan Hu, Qian Jing, Xinyi Zeng, Kui-Ming Chan, Junhong Han
Oncohistones are histones with high-frequency point mutations that are associated with tumorigenesis. Although each histone variant is encoded by multiple genes, a single mutation in one allele of one gene seems to have a dominant effect over global histone H3 methylation level at the relevant amino acid residue. These oncohistones are highly tumor type specific. For example, H3K27M and H3G34V/R mutations occur only in pediatric brain cancers, whereas H3K36M and H3G34W/L have only been found in pediatric bone tumors. H1 mutations also seem to be exclusively linked to lymphomas. In this review, we discuss the occurrence, frequency and potential functional mechanisms of each oncohistone in tumorigenesis of its relevant cancer. We believe further investigation into the mechanism regarding their tumor type specificity and cancer-related functions will shed new light on their application in cancer diagnosis and targeted therapy development.



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Boy saves brother with skills learned at first responder camp

Zimori Hall had just completed a one-week "911 Jr. First Responder Camp" where he learned the basics of first aid, CPR training and the Heimlich Maneuver

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Researchers developing drone air ambulance

Caltech researchers have designed what they call a "personal rescue system" that was created to quickly get a patient to a hospital or doctor

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Quiz: How well do you know 'Stop the Bleed'?

In the event of an MCI, there may be a number of victims who require immediate treatment to stop life-threatening hemorrhaging

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Neutrophil to lymphocyte ratio associates independently with mortality in hospitalized patients with cirrhosis

Clinical Gastroenterology and Hepatology

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Clarifying the role of C-reactive protein as a bacterial infection predictor in decompensated cirrhosis

European Journal of Gastroenterology & Hepatology

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Previous use of anti-thrombotic agents reduces mortality and length of hospital stay in patients with high-risk upper gastrointestinal bleeding

Clinical Gastroenterology and Hepatology

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Randomised clinical trial: A leucine-metformin-sildenafil combination (NS-0200) vs placebo in patients with non-alcoholic fatty liver disease

Alimentary Pharmacology and Therapeutics

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Acetyl-CoA carboxylase inhibitor GS-0976 for 12 weeks reduces hepatic de novo lipogenesis and steatosis in patients with nonalcoholic steatohepatitis

Clinical Gastroenterology and Hepatology

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Elevated circulating miR-182 acts as a diagnostic biomarker for early colorectal cancer

Cancer Management and Research

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Pre-operative evaluation of the adult patient undergoing elective noncardiac surgery: updated guideline from the European Society of AnaesthesiologyDirection and not directives

No abstract available

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Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology

imageThe purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate – wherever possible – this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34 066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

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Anaesthesia in High-Risk Patients

No abstract available

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