Comparative Effectiveness of Injection Therapies in Rotator Cuff Tendinopathy: A Systematic Review, Pairwise and Network Meta-analysis of Randomized Controlled Trials

Publication date: Available online 2 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Meng-Ting Lin, Ching-Fang Chiang, Chueh-Hung Wu, Yi-Ting Huang, Yu-Kang Tu, Tyng-Guey Wang

Objective

To compare the effectiveness of diverse injections in patients with rotator cuff tendinopathy using pairwise and network meta-analysis.

Data Sources

PubMed, EMBASE, Scopus and Cochrane Library were searched for studies published up to September 31, 2017.

Study Selection

We included all published or unpublished randomized controlled trials (RCTs) comparing diverse injections including corticosteroid, nonsteroidal anti-inflammatory drugs, hyaluronic acid, botulinum toxin, platelet-rich plasma (PRP), and prolotherapy in patients with rotator cuff tendinopathy. Among the 1495 records screened, 18 studies were included in the meta-analysis.

Data Extraction

The quality of RCTs was assessed with Cochrane Risk of Bias Tool by two independent raters. The primary outcome was pain reduction, and the secondary outcome was functional improvement.

Data Synthesis

Standardized mean difference (SMD) was utilized for pairwise and network meta-analysis. In pairwise meta-analysis, corticosteroid was more effective only in the short-term in both pain reduction and functional improvement. Network meta-analysis indicated that prolotherapy significantly reduced pain compared with placebo in the long-term [over 24 weeks, SMD: 2.63, 95% confidence interval (CI): 1.88–3.38]; meanwhile PRP significantly improved shoulder function compared with placebo in the long-term (over 24 weeks, SMD: 0.44, 95% CI: 0.05–0.84).

Conclusions

For patients with rotator cuff tendinopathy, corticosteroid plays a role in the short-term (3-6 weeks) but not in long-term (over 24 weeks) pain reduction and functional improvement. By contrast, PRP and prolotherapy may yield better outcomes in the long-term (over 24 weeks). On account of heterogeneity, interpreting these results with caution is warranted.

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End-users want alternative intervention delivery models: Usability and acceptability of the REMOTE-CR exercise-based cardiac telerehabilitation programme

Publication date: Available online 2 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jonathan C. Rawstorn, Nicholas Gant, Anna Rolleston, Robyn Whittaker, Ralph Stewart, Jocelyn Benatar, Ian Warren, Andrew Meads, Yannan Jiang, Ralph Maddison

Abstract

Objective

Evaluate user experiences of an exercise-based cardiac telerehabilitation intervention (REMOTE-CR) that provided near universal access to real-time remote coaching and behavioural support from exercise specialists.

Design

Secondary analysis (12 week follow-up) of a parallel group, single blind, randomised controlled non-inferiority trial (ACTRN12614000843651).

Setting

Community-based cardiac rehabilitation.

Participants

Adults with coronary heart disease who were eligible for outpatient cardiac rehabilitation. 82/162 trial participants were randomised to receive REMOTE-CR; 67 completed usability and acceptability assessment at 12-week follow-up.

Intervention

REMOTE-CR comprised 12 weeks of individualised exercise prescription, real-time physiological monitoring, coaching, and behavioural support, delivered via a bespoke telerehabilitation platform.

Outcomes

Ease of use, satisfaction with the technology platform and intervention content, and demand for real-world implementation as an alternative to traditional centre-based programmes were assessed at 12-week follow-up.

Results

Components of usability and acceptability were positively evaluated by most participants (44–66/67, 66–99%). 58/67 (87%) would choose REMOTE-CR if it was available as a usual care service, primarily because it provides convenient and flexible access to real-time individualised support from exercise specialists. Technology challenges were rare and had little impact on user experiences or demand for REMOTE-CR.

Conclusions

REMOTE-CR can extend the reach and impact of existing cardiac rehabilitation services by overcoming traditional participation barriers while preserving expert oversight. Adoption of emerging technologies should be accelerated to support dynamic, engaging, individualised intervention delivery models, but optimising overall cardiac rehabilitation participation rates will require multiple delivery models that are tailored to satisfy diverse participant preferences.

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Concerns for Potential Risk of Bias in Diagnostic Validity Study of Patellofemoral Pain

Publication date: Available online 1 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Takashi Ariie

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FASCICULATION INTENSITY AND DISEASE PROGRESSION IN AMYOTROPHIC LATERAL SCLEROSIS

Publication date: Available online 2 August 2018

Source: Clinical Neurophysiology

Author(s): Jun Tsugawa, Thanuja Dharmadasa, Yan Ma, William Huynh, Steve Vucic, Matthew C. Kiernan

Abstract

Objective

To investigate the association between the frequency and intensity of fasciculations with clinical measures of disease progression in amyotrophic lateral sclerosis (ALS).

Methods

Twenty-four consecutive patients with ALS underwent clinical review and neuromuscular ultrasound assessment to detect intensity of fasciculations. Results were correlated with clinical markers of disease severity, as measured by the ALS Functional Rating Scale-revised (ALSFRS-R) and rate of disease progression (ΔFS), in addition to assessment of cortical motor function.

Results

Disease duration negatively correlated (R = -0.530, p < 0.01) with fasciculation intensity, while the ΔFS positively correlated with the fasciculation number (R = 0.626, p < 0.01). In terms of potential central contributions to ectopic impulse generation, patients were classified into cohorts based on their fasciculation intensity and short interval intracortical inhibition (SICI). ΔFS was significantly higher in patients with established hyperexcitability (low SICI) with high fasciculation intensity compared to those patients with minimal SICI change.

Conclusions

Fasciculation intensity appears linked to disease progression and separately to markers of cortical dysfunction, specifically the advent of cortical hyperexcitability.

Significance

Assessment of the intensity of patient fasciculations is a noninvasive approach that may provide further insight disease pathophysiology in ALS.

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GWAS with Heterogeneous Data: Estimating the Fraction of Phenotypic Variation Mediated by Gene Expression Data

Intermediate phenotypes such as gene expression values can be used to elucidate the mechanisms by which genetic variation causes phenotypic variation, but jointly analyzing such heterogeneous data is far from trivial. Here we extend a so-called mediation model to handle the confounding effects of genetic background, and use it to analyze flowering time variation in Arabidopsis thaliana, focusing in particular on the central role played by the key regulator FLOWERING TIME LOCUS C (FLC). FLC polymorphism and FLC expression are both strongly correlated with flowering time variation, but the effect of the former is only partly mediated through the latter. Furthermore, the latter also reflects genetic background effects. We demonstrate that it is possible to partition these effects, shedding light on the complex regulatory network that underlies flowering time variation.

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Recursive Algorithms for Modeling Genomic Ancestral Origins in a Fixed Pedigree

The study of gene flow in pedigrees is of strong interest for the development of quantitative trait loci (QTL) mapping methods in multiparental populations. We developed a Markovian framework for modeling ancestral origins along two homologous chromosomes within individuals in fixed pedigrees. A highly beneficial property of our method is that the size of state space depends linearly or quadratically on the number of pedigree founders, whereas this increases exponentially with pedigree size in alternative methods. To calculate the parameter values of the Markov process, we describe two novel recursive algorithms that differ with respect to the pedigree founders being assumed to be exchangeable or not. Our algorithms apply equally to autosomes and sex chromosomes, another desirable feature of our approach. We tested the accuracy of the algorithms by a million simulations on a pedigree. We demonstrated two applications of the recursive algorithms in multiparental populations: design a breeding scheme for maximizing the overall density of recombination breakpoints and thus the QTL mapping resolution, and incorporate pedigree information into hidden Markov models in ancestral inference from genotypic data; the conditional probabilities and the recombination breakpoint data resulting from ancestral inference can facilitate follow-up QTL mapping. The results show that the generality of the recursive algorithms can greatly increase the application range of genetic analysis such as ancestral inference in multiparental populations.

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Gastric lanthanum phosphate deposition masquerading as white globe appearance

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Congenital biliary atresia in an infant born to hepatitis B mother treated with telbivudine before and during pregnancy

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MELD is the Only Predictor of Short-Term Mortality in Cirrhotic Patients with C. difficile Infection

Clostridium difficile infection (CDI) is the most common nosocomial infection in the US and cirrhotic patients have increased risk for poor outcome.

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Cooperative hand movements in tetraplegic spinal cord injury patients: Preserved neural coupling

Publication date: October 2018

Source: Clinical Neurophysiology, Volume 129, Issue 10

Author(s): T.M. Scharfenberger, M. Schrafl-Altermatt, V. Dietz

Abstract

Objectives

To evaluate whether the task-specific neural coupling mechanism during the performance of cooperative hand movements is preserved in tetraplegic subjects.

Methods

Recordings of ipsilateral and contralateral electromyographic reflex responses in activated forearm muscles and bilateral somatosensory potentials (SSEP) to unilateral ulnar nerve stimulations during rest, cooperative and non-cooperative hand movements.

Results

Contralateral reflex responses were present in almost all patients during cooperative hand movements but small in amplitude when hand function was severely impaired. Ipsilateral SSEP potentials were enhanced during both cooperative and, in contrast to healthy subjects, also non-cooperative bimanual movements.

Conclusions

Both results indicate a strong involvement of ipsilateral non-damaged cervical tracts and hemispheres in the control of bimanual hand movements in tetraplegic subjects.

Significance

This study on the neural control of bimanual movements in patients suffering a cervical injury allows designing therapeutic approaches for the improvement of hand function that are based on physiological insights.

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The auditory cortex network in the posterior superior temporal area

Publication date: Available online 1 August 2018

Source: Clinical Neurophysiology

Author(s): Yuto Suzuki, Rei Enatsu, Aya Kanno, Satoko Ochi, Nobuhiro Mikuni

Abstract

Objective

This study investigated the function and networks of the auditory cortices in the posterior lateral superior temporal area (PLST) using a combination of electrical cortical stimulation and diffusion tensor imaging (DTI).

Methods

Seven patients with intractable focal epilepsy in which the PLST auditory cortices were identified during the electrical cortical stimulation were enrolled in this study (left side: four patients, right side: three patients). Electrical stimulation at 50 Hz was applied to the chronically implanted subdural electrodes to identify the PLST auditory cortices. DTI was used to identify the subcortical fibers originating from the PLST auditory cortices found by electrical stimulation.

Results

Electrical stimulation of the right PLST auditory cortices induced hearing impairment in three patients and left side stimulation elicited hearing illusory sounds in four patients. DTI detected the middle longitudinal fasciculus (MLF) in all patients, the superior longitudinal fasciculus (SLF) in six patients and the inferior fronto-occipital fasciculus (IFOF) in three patients, originating from the PLST auditory cortices.

Conclusion

This study suggests different functional roles between the right and left PLST auditory cortices, and the networks originating from these areas.

Significance

MLF, SLF and IFOF might be associated with the auditory processing.

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Heart rate variability and impact of central pacemaker on cardiac activity

Publication date: Available online 29 July 2018

Source: Clinical Neurophysiology

Author(s): Gert Pfurtscheller, Gerhard Schwarz, Andreas Schwerdtfeger

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Auditory N100 gating in patients with schizophrenia: A systematic meta-analysis

Publication date: Available online 29 July 2018

Source: Clinical Neurophysiology

Author(s): Timm Rosburg

Abstract

Objective

The study sought to assess the presence of auditory N100 gating deficits in patients with schizophrenia by meta-analysis.

Methods

Literature was screened for studies on patients with schizophrenia that used the paired-click paradigm and reported N100 data. Both electroencephalographic and magnetoencephalographic studies were considered. N100 gating measures as well as the N100 amplitudes to the initial and repeated stimulus were extracted and subjected to a meta-analysis.

Results

The literature research revealed 29 studies, reporting either N100 gating or N100 amplitude measures in paired-click experiments. Patients with schizophrenia exhibited less N100 gating than healthy controls across studies (mean g = -0.409, SE = 0.053). However, what appeared as a gating deficit in patients was due to reduced N100 amplitudes to the initial stimulus in this group (mean g = 0.632, SE = 0.078). Patients and controls did not differ in their N100 amplitudes to the repeated stimulus (mean g = 0.042, SE = 0.063).

Conclusion

There is no evidence for an auditory N100 gating deficit in schizophrenia, but for an impaired N100 response recovery.

Significance

Previous findings on impaired N100 gating in schizophrenia patients reflect deficient processing of auditory salience rather than defective inhibition of repeating redundant auditory stimulation.

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A glimpse into the future of clinical neurophysiology: Can we use machines to interpret EEG?

Publication date: Available online 29 July 2018

Source: Clinical Neurophysiology

Author(s): Graham Smith, Somin Lee, Wim van Drongelen

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Electrical activity of the human amygdala during all-night sleep and wakefulness

Publication date: Available online 29 July 2018

Source: Clinical Neurophysiology

Author(s): Zeidy Muñoz-Torres, Francisfco Velasco, Ana L. Velasco, Yolanda Del Río-Portilla, María Corsi-Cabrera

Abstract

Objective

The aim of the present work was to characterize the dynamics of the human amygdala across the different sleep stages and during wakefulness.

Methods

Simultaneous intracranial electrical recordings of the amygdala, hippocampus, and scalp electroencephalography during spontaneous sleep polysomnography in four patients suffering from epilepsy were analyzed.

Results

Power spectrum of the amygdala revealed no differences between rapid eye movement (REM) and wakefulness for all frequencies except higher power at 9 Hz during wakefulness and some low Gamma frequencies. Conversely, higher power was observed in non-REM (NREM) sleep than wakefulness for Delta, Theta and Sigma.

Conclusions

Our results showed similar activity in the amygdala between wakefulness and REM sleep suggesting that the amygdala is as active in REM as during wakefulness. The higher power in Sigma frequencies during NREM sleep suggests that amygdala slow activity may play a significant role during NREM in concurrence with hippocampal activity.

Significance

While studies have described the metabolic activity of the human amygdala during sleep, our results show the corresponding electrical pattern during the whole night, pointing out an increase of slow activity during NREM sleep that might be subjected to similar influences as other subcortical brain structures, such as the hippocampus.

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Ultrasound-guided, open-source microneurography: Approaches to improve recordings from peripheral nerves in man

Publication date: Available online 29 July 2018

Source: Clinical Neurophysiology

Author(s): James P. Dunham, Anna C. Sales, Anthony E. Pickering

Abstract

Objective

Microneurography is the only method for recording from single neurons in intact human nerves. It is challenging - requiring technical expertise, investment in specialised equipment and has sparse data yields.

Methods

We assessed whether ultrasound guidance in combination with an 'open access' amplifier and data capture system (Open-Ephys) would simplify and expand the scope of microneurographic recordings in humans.

Results

In 32 healthy consenting volunteers, ultrasound-guidance improved success rates for obtaining cutaneous C-fibres and reduced "Skin to Nerve" times from 28.5 minutes to 4.5 minutes for recordings of the peroneal nerve (P<0.0001).

We illustrate the potential utility of ultrasound-guided microneurography for difficult to access nerves with phrenic nerve recording during a Valsalva manoeuvre.

We show that Open Ephys is a viable alternative to commercially available recording systems and offers advantages in terms of cost and software customisability.

Conclusions

Ultrasound guidance for microneurography with Open Ephys facilitates cutaneous C nociceptor recordings and allows recordings to be made from nerves previously considered inaccessible.

Significance

We anticipate that the adoption of these techniques will improve microneurography experimental efficiency, adds an important visual learning aid and increases the generalisability of the approach.

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Activation of elbow extensors during passive stretch of flexors in patients with post-stroke spasticity

Publication date: Available online 24 July 2018

Source: Clinical Neurophysiology

Author(s): Mindy F. Levin, John M. Solomon, Akash Shah, Andréanne K. Blanchette, Anatol G. Feldman

Abstract

Objectives

Deficits in regulation of tonic stretch reflex thresholds (TSRTs) after stroke occur in elbow flexors and extensors leading to spasticity in specific joint ranges. Threshold deregulation may also be responsible for other deficits such as abnormal activation of passively shortening muscles. Goals were to characterize activation of shortening elbow extensors during passive elbow flexor stretch in individuals with stroke, and identify its relationship to upper-limb motor impairment.

Methods

Thirty-three participants with unilateral stroke participated. TSRTs in elbow flexors were measured by stretching passive elbow flexors at different velocities. EMG responses were recorded from stretched agonist (biceps) and shortened antagonist (triceps) muscles.

Results

Triceps activation during passive biceps stretch occurred in all but 4 participants simultaneously with, before or after biceps activation onset. Biceps and triceps activation onsets and durations decreased with stretch velocity. Biceps TSRT and triceps activation magnitude did not correlate with sensorimotor impairment but greater stroke chronicity tended to be related to higher biceps TSRTs (r=0.406, p=0.041).

Conclusions

Stroke may result in both limitations in reciprocal inhibition and excessive agonist-antagonist co-activation, likely from deficits in TSRT modulation in both muscle groups.

Significance

Since both reciprocal inhibition and co-activation are fundamental to normal motor control, their cooperative action should be considered in designing interventions to increase the ranges of regulation of TSRTs in flexors and extensors to enhance upper limb functional recovery.

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Correlation between deep brain stimulation effects on freezing of gait and audio-spinal reflex

Publication date: Available online 21 July 2018

Source: Clinical Neurophysiology

Author(s): Éric Parmentier, Victor De Pasqua, Kévin D'Ostilio, Frédérique Depierreux, Gaëtan Garraux, Alain Maertens de Noordhout

Abstract

Objective

A network of cortical, subcortical and brainstem structures might be involved in freezing of gait (FOG). Subthalamic nucleus (STN) deep brain stimulation (DBS) could modulate this network. The audio-spinal reflex (ASR), reduced in PD, but increased by treatment, can be used to further investigate that locomotor network. The aim of this study is to find whether a correlation exists between ASR and FOG in PD patients under DBS.

Methods

In 14 PD patients with STN DBS and previous FOG, ASR was recorded, with DBS switched on and off. We also assessed FOG Questionnaire (FOGQ) and Unified Parkinson's Disease Rating Scale (UPDRS) Part III.

Results

Switching "on" DBS increased ASR amplitude (+ 33.2% with DBS ON, p=0.048). We also found a significant inverse correlation between FOGQ and modulation of ASR by DBS (r = -0.59, r² = 0.35, p<0.05).

Conclusions

This study shows that the incremental effect of DBS on ASR is greater in PD patients with less severe FOG.

Significance

This study shows a link between electrophysiological and clinical data about gait control. It might contribute to better understand why some DBS patients report heavy FOG and others do not. ASR might be used to evaluate or maybe predict the effect of stimulation parameters changes on FOG.

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Visually validated semi-automatic high-frequency oscillation detection aides the delineation of epileptogenic regions during intra-operative electrocorticography

Publication date: Available online 20 July 2018

Source: Clinical Neurophysiology

Author(s): Shennan Aibel Weiss, Brent Berry, Inna Chervoneva, Zachary Waldman, Jonathan Guba, Mark Bower, Michal Kucewicz, Benjamin Brinkmann, Vaclav Kremen, Fatemeh Khadjevand, Yogatheesan Varatharajah, Hari Guragain, Ashwini Sharan, Chengyuan Wu, Richard Staba, Jerome Engel, Michael Sperling, Gregory Worrell

Abstract

Objective

To test the utility of a novel semi-automated method for detecting, validating, and quantifying high-frequency oscillations (HFOs): ripples (80-200 Hz) and fast ripples (200-600 Hz) in intra-operative electrocorticography (ECoG) recordings.

Methods

Sixteen adult patients with temporal lobe epilepsy (TLE) had intra-operative ECoG recordings at the time of resection. The computer-annotated ECoG recordings were visually inspected and false positive detections were removed. We retrospectively determined the sensitivity, specificity, positive and negative predictive value (PPV/NPV) of HFO detections in unresected regions for determining post-operative seizure outcome.

Results

Visual validation revealed that 2.81% of ripple and 43.68% of fast ripple detections were false positive. Inter-reader agreement for false positive fast ripple on spike classification was good (ICC = 0.713, 95% CI: 0.632-0.779). After removing false positive detections, the PPV of a single fast ripple on spike in an unresected electrode site for post-operative non-seizure free outcome was 85.7 [50-100%]. Including false positive detections reduced the PPV to 64.2 [57.8-69.83%].

Conclusions

Applying automated HFO methods to intraoperative electrocorticography recordings results in false positive fast ripple detections. True fast ripples on spikes are rare, but predict non-seizure free post-operative outcome if found in an unresected site.

Significance

Semi-automated HFO detection methods are required to accurately identify fast ripple events in intra-operative ECoG recordings.

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A new criterion for detection of radiculopathy based on motor evoked potentials and intraoperative nerve root monitoring

Publication date: Available online 20 July 2018

Source: Clinical Neurophysiology

Author(s): Alfredo Traba, Juan Pablo Romero, Beatriz Arranz, Concepción Vilela

Abstract

Objective

Our objective is to use the area of the motor evoked potential (MEP) as a diagnostic tool for intraoperative radicular injury.

Methods

We analyzed the intraoperative neurophysiological monitoring data and clinical outcomes of 203 patients treated for dorsolumbar spine deformity. The decrease in amplitude was compared with the reduction in the MEP area.

Results

In 11 cases, new intraoperative injuries occurred, nine of them were lumbar radiculopathies. Our new criteria, a decrease MEP area of 70%, yielded a sensitivity and specificity of 1, since it detected all the radicular injuries, with no false positive cases. Using a 70% amplitude decrease criteria, we obtained a sensitivity of 0,89 and a specificity of 0,99. A lower threshold (65% amplitude reduction) yielded a higher number of false positives, whereas a higher threshold (75 and 80%) gave rise to a higher number of false negatives.

Conclusions

The measurement of the MEP area gave evidence to be more reliable and accurate than the measurement of the amplitude reduction in order to assess and detect intraoperative radicular injuries.

Significance

The criterion of decrease of the MEP area has a higher reliability and accuracy in the detection of intraoperative radicular lesions than the amplitude reduction.

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Is hemifacial spasm affected by changes in the heart rate? A study using heart rate variability analysis

Publication date: Available online 11 July 2018

Source: Clinical Neurophysiology

Author(s): Tadashi Hamasaki, Motohiro Morioka, Koichi Fujiwara, Chikao Nakayama, Miho Harada, Kiyohiko Sakata, Yu Hasegawa, Toshitaka Yamakawa, Kazumichi Yamada, Akitake Mukasa

Abstract

Objective

Hemifacial spasm (HFS) is caused by arterial conflict at the root exit zone of the facial nerve. As the offending artery is pulsatile in nature, this study investigated the association of heart rate fluctuation with HFS.

Methods

Twenty-four preoperative patients underwent simultaneous recordings of facial electromyogram and electrocardiogram overnight. Series of R-wave to R-wave intervals (RRIs) in the electrocardiogram were analyzed across subjects in relation to HFS. The degree of heart rate fluctuation was quantified by analyzing the heart rate variability (HRV). The sleep stage was evaluated during the period of HFS.

Results

A 0.1 Hz fluctuation in RRIs by 5% compared to the baseline preceded a few seconds the onset of the HFS, indicating that a significant increase in the heart rate coincided with HFS. HRV analysis demonstrated that fluctuations in the heart rate were significantly enhanced during HFS. Wake or light sleep stages were more often accompanied by HFS, suggesting an association with autonomic activities.

Conclusion

Our findings suggest that the etiology of HFS is more than just a mechanical compression of the facial nerve and may involve changes in pulsatile frequency in offending arteries.

Significance

We propose the etiology of HFS from a unique standpoint.

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Reply to “Work-up for mitochondrial small fiber neuropathy requires application of skin biopsies”

Publication date: Available online 11 July 2018

Source: Clinical Neurophysiology

Author(s): Marco Luigetti, Guido Primiano, Serenella Servidei

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Work-up for mitochondrial small fiber neuropathy requires application of skin biopsies

Publication date: Available online 10 July 2018

Source: Clinical Neurophysiology

Author(s): Josef Finsterer

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Predictive Factors of Positive Online Patient Ratings of Spine Surgeons

Online physician rating websites are increasingly utilized by patients to evaluate their doctors. The purpose of this investigation was to evaluate factors associated with better spine surgeon ratings.

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Dynamic RNAs in sperm shape embryo development

Dynamic RNAs in sperm shape embryo development

Dynamic RNAs in sperm shape embryo development, Published online: 01 August 2018; doi:10.1038/s41576-018-0042-x

Two studies published in the journal Developmental Cell suggest that changes to the RNA payload of sperm that occur during maturation in the epididymis help ensure successful embryo development in mice.

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The auditory cortex network in the posterior superior temporal area

The superior temporal gyrus (STG) plays a critical role in hearing, speech, and language (Penfield and Jasper 1954) (Campbell 1905) (Hoppe 2008). Previous studies have reported that the primary auditory cortex is located deep within the lateral fissure on a small patch of the transverse Heschl's gyrus (HG), with distinctive cyto- and myelo-architectonic features (Campbell 1905). Penfield et al. reported that auditory sensations were induced by stimulation of a narrow region of the STG that bordered the posterior third of the Sylvian fissure (Penfield and Jasper 1954).

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FASCICULATION INTENSITY AND DISEASE PROGRESSION IN AMYOTROPHIC LATERAL SCLEROSIS

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that causes progressive degeneration of upper and lower motor neurons, with resultant muscle weakness and paralysis.

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Dynamic RNAs in sperm shape embryo development

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Hypoglycemic events: Can you leave them be?

A review of hypoglycemia treat and release protocol recommendations

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Per-oral endoscopic myotomy for esophageal achalasia in a case of Allgrove syndrome

Abstract

Allgrove syndrome, also known as Triple A syndrome, is a rare autosomal recessive genetic disease characterized by three signs: esophageal achalasia, adrenocorticotropic hormone refractoriness, and alacrima. A 31-year-old male presented to our hospital for treatment of difficulty swallowing caused by esophageal achalasia. Because he had complicating alacrima, a neurologic disease, and a family history of consanguineous marriage, a genetic neurologic disease was suspected. Then, a mutation in the achalasia–addisonianism–alacrima syndrome gene was identified. With the diagnosis of Allgrove syndrome, a per-oral endoscopic myotomy (POEM) was performed for esophageal achalasia. After the POEM, the symptoms and the esophageal pressure findings ameliorated quickly, with no recurrence noted throughout a follow-up of more than 1 year. Here, we report the first case of POEM performed for esophageal achalasia in Allgrove syndrome.

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Variability in the Adaptive Response of Antibiotic-Resistant Salmonella Typhimurium to Environmental Stresses

Microbial Drug Resistance, Ahead of Print.


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PME and Other ESBL-Positive Multiresistant Pseudomonas aeruginosa Isolated from Hospitalized Patients in the Region of Kurdistan, Iraq

Microbial Drug Resistance, Ahead of Print.


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Leading integrative communications provider Agile Interoperable Solutions to showcase technologies at 84th annual APCO show

WASHINGTON, D.C.—Agile Interoperable Solutions (AIS), www.aisinterop.com, the leading provider of interoperable communications solutions that enable public and private organizations to achieve seamless connectivity in the most challenging environments, will be exhibiting and demonstrating a wide variety of its products at the Association of Public Safety Communications Officials (APCO) Show...

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System Concepts - Part 3 - Quality Cost and Value

This vlog post is the third in a series about the concept of systems. It introduces the concept of value and how it relates to quality and cost. An example is given for using quality and cost data to calculate value in the delivery of care for out-of-hospital cardiac arrest. Duration = 5 min 47 sec Link to CSI webpage: https://ift.tt/2LI2Ry9

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System Concepts - Part 3 - Quality Cost and Value

This vlog post is the third in a series about the concept of systems. It introduces the concept of value and how it relates to quality and cost. An example is given for using quality and cost data to calculate value in the delivery of care for out-of-hospital cardiac arrest. Duration = 5 min 47 sec Link to CSI webpage: https://ift.tt/2LI2Ry9

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System Concepts - Part 3 - Quality Cost and Value

This vlog post is the third in a series about the concept of systems. It introduces the concept of value and how it relates to quality and cost. An example is given for using quality and cost data to calculate value in the delivery of care for out-of-hospital cardiac arrest. Duration = 5 min 47 sec Link to CSI webpage: https://ift.tt/2LI2Ry9

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System Concepts - Part 3 - Quality Cost and Value

This vlog post is the third in a series about the concept of systems. It introduces the concept of value and how it relates to quality and cost. An example is given for using quality and cost data to calculate value in the delivery of care for out-of-hospital cardiac arrest. Duration = 5 min 47 sec Link to CSI webpage: https://ift.tt/2LI2Ry9

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Biomechanical and Histological Assessment of a Novel Screw Retention Technology in an Ovine Lumbar Fusion Model

Screw loosening is a prevalent failure mode in orthopaedic hardware, particularly in osteoporotic bone or revision procedures where the screw-bone engagement is limited.

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Mechanism of formation of intravertebral clefts in osteoporotic vertebral compression fractures: an in vitro biomechanical study

Intravertebral clefts (IVCs) are vacuum like cavities commonly associated with osteoporotic vertebral compression fractures (OVCFs). IVCs promote cement leakage during kyphoplasty, suggesting a physical link with the basivertebral foramen, although this is uncertain.

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Add real-time feedback to CPR training for better results

New American Heart Association guidelines call for instant feedback on compression depth, rate and chest recoil in CPR training modules

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International data-sharing norms: from the OECD to the General Data Protection Regulation (GDPR)

Abstract

The evolution of genomic research and its integration into clinical practice, as they become international—even global—endeavors, has brought us to a place where scientists and clinicians may now only ignore the rules governing international data sharing at their own peril. Open data policies, on the one hand, increasingly require custodians of others' genomic data to make it as widely available as feasible, including to researchers in other countries. Data protection law, on the other, has become a significant hurdle to the sharing of personal data across jurisdictional borders. The space between these two competing duties is narrowing. In contrast with the other texts in this volume, which explore the present and future of data sharing and data protection, this article's focus is on the past. It centres on the historical development of the data protection rules regarding the international transfer of personal data up to the present. The article's aim is to bring into focus the underlying objectives that have influenced and that will continue to influence the way that data protection rules are applied to the fields of genomics and health, as well as future developments in data protection generally. The first part of this article describes the development of international data-sharing data protection rules since 1970. The second considers difficulties in applying general data protection rules to the specific context of genomics and health. The third and final part compares the options available to comply with the international transfer restrictions set out in the standard-setting EU General Data Protection Regulation from a genomics perspective.

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United States: law and policy concerning transfer of genomic data to third countries

Abstract

This paper provides an overview of US laws and related guidance documents affecting transfer of genomic data to third countries, addressing the domains of consent, privacy, security, compatible processing/adequacy, and oversight. In general, US laws governing research and disclosure and use of data generated within the health care system do not impose different requirements on transfers to researchers and service providers based in third countries compared with US-based researchers or service providers. Of note, the US lacks a comprehensive data protection regime. Data protections are piecemeal, spread across bodies of law that target specific kinds of research or data generated or held by specific kinds of actors involved in the delivery of health care. Oversight is also distributed across a range of bodies, including institutional review boards and data access committees. The conclusion to this paper examines future directions in US law and policy, including proposals for more comprehensive protections for personal data.

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The Esophageal Microbiome in Health and Disease

Abstract

Purpose of Review

Investigation of the esophageal microbiome is a relatively new field. This review will outline data characterizing the esophageal microbiome in both health and disease states, including gastroesophageal reflux disease (GERD), Barrett's esophagus, esophageal cancer, eosinophilic esophagitis, and motility disorders.

Recent Findings

While the esophagus was previously considered devoid of a significant bacterial population, development of culture-independent techniques, specifically 16S rRNA gene sequencing, as well as novel, minimally invasive microbial sampling modalities, has facilitated characterization of the esophageal microbiome in both health and several disease states. Although limited, there is evidence that the esophagus contains a diverse microbial population, with Gram-positive bacteria, specifically Streptococcus, dominating in health, while Gram-negative bacteria prevail in reflux disorders including GERD and Barrett's esophagus. The microbiome is altered with other esophageal disorders as well, including eosinophilic esophagitis and esophageal motility disorders, though these changes have been less well characterized.

Summary

Characterization of the gut microbiome has advanced significantly; however, further investigation is essential. Understanding changes in the esophageal microbiome could affect our understanding of the natural history of diseases of the esophagus and present potential therapeutic approaches.

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Incidence and prevalence of eosinophilic oesophagitis increase continiously in adults and children in Central Spain: A 12-year population-based study

To update population-based incidence, prevalence and trends for eosinophilic oesophagitis (EoE) in children and adults over the past decade.

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Overview on the management of diverticular disease by Italian General Practitioners

Although very common in Western countries, poor epidemiological data on diverticular disease (DD) is available from the family practice.

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Malignant and pre-malignant colorectal lesions in forty-year olds: is earlier inception of screening warranted?

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Understanding Masturbation in the Pediatric Patient

Childhood masturbation is not included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). The topic of hypersexuality was proposed but rejected for inclusion in the fifth edition by the American Psychiatric Association because it is not considered an unhealthy behavior (Kafka, 2010). The World Health Organization does not have a specific code for childhood masturbation. It is categorized under the coding title "Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence" (F98.8) in the International Statistical Classification System of Diseases and Related Health Problems, 10th edition (World Health Organization, 2004; Mallants & Casteels, 2008).

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MRGBP promotes AR-mediated transactivation of KLK3 and TMPRSS2 via acetylation of histone H2A.Z in prostate cancer cells

Publication date: Available online 1 August 2018

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Saya Ito, Naruhiro Kayukawa, Takashi Ueda, Hidefumi Taniguchi, Yukako Morioka, Fumiya Hongo, Osamu Ukimura

Abstract

The androgen receptor (AR) promotes growth of prostate cancer cells by controlling the expression of target genes. This study showed that MRG domain binding protein (MRGBP) accelerated AR-mediated transactivation. We first showed that MRGBP promoted growth of AR-positive prostate cancer cells. MRGBP increased the expression of certain AR target genes, including KLK3 and TMPRSS2, and it associated with AR binding regions of these genes during androgen treatment. Furthermore, MRGBP interacted with MRG15 and TIP60 in prostate cancer cells. Androgen-stimulated AR enhanced histone H3K4me1 or H3K4me3 levels at AR binding regions. MRGBP was recruited to active gene regions through its binding with H3K4me1/3 by MRG15. Then, MRGBP promoted recruitment of TIP60 and acetylation of histone variant H2A.Z at the location of AR binding. Accordingly, AR occupancy of the AR binding regions was increased by MRGBP. Together, these results suggest that MRGBP promotes activation of AR-associated enhancer and promoter regions through an epigenetic mechanism.

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Association between proton pump inhibitors and the risk of hepatocellular carcinoma

Alimentary Pharmacology and Therapeutics

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Furazolidone-containing triple and quadruple eradication therapy for initial treatment for Helicobacter pylori infection: A multicenter randomized controlled trial in China

Helicobacter

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Acid suppression medications reduce risk of oesophageal adenocarcinoma in Barrett's oesophagus: A nested case-control study in US male veterans

Alimentary Pharmacology and Therapeutics

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Clostridium difficile co-infection in inflammatory bowel disease is associated with significantly increased in-hospital mortality

European Journal of Gastroenterology & Hepatology

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Nonalcoholic fatty liver disease-associated hepatocellular carcinoma in a hepatitis B virus-endemic area

European Journal of Gastroenterology & Hepatology

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Ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin for chronic hepatitis C virus genotype 1b-infected cirrhotics (TURQUOISE-IV)

European Journal of Gastroenterology & Hepatology

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Association of fatty liver index with the risk of incident cardiovascular disease and acute myocardial infarction

European Journal of Gastroenterology & Hepatology

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Serum ALT elevations in survivors of childhood cancer. A report from the St. Jude Lifetime Cohort Study

Hepatology

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Index serum hyaluronic acid independently and accurately predicts mortality in patients with liver disease

Alimentary Pharmacology and Therapeutics

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Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn’s disease patients: A meta-analysis

European Journal of Gastroenterology & Hepatology

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Nonalcoholic fatty liver disease and albuminuria: A systematic review and meta-analysis

European Journal of Gastroenterology & Hepatology

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Cardiovascular Risk Factors and Events in Iranian Immigrants Versus Other Immigrants from the Middle East

Abstract

We report the incidence of cardiovascular events, mortality and risk factors (diabetes and hypertension) in immigrants from Iran and in non-Iranian immigrants from the Middle East. Using population-based healthcare administrative data, all immigrants from the Middle East and the non-immigrant population of Ontario, Canada as of July 2012 were identified. Baseline differences in diabetes and hypertension prevalence were compared. Outcomes were ascertained through March 2016 and included the incidence of acute coronary events, ischemic heart disease mortality, all-cause mortality, and incident diabetes and hypertension. The study population included 55,539 Iranian immigrants, 106,926 non-Iranian Middle Eastern immigrants, and 6,967,132 non-immigrants. Non-immigrants had the highest crude baseline prevalence of diabetes and hypertension. Compared to non-immigrants, Iranian and non-Iranian Middle Eastern immigrants had significantly lower incidence rate of acute coronary events, ischemic heart disease mortality and all-cause mortality. Both Iranian and non-Iranian Middle Eastern immigrants had better cardiovascular health status than non-immigrants.

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How David Hatch became a professor of pediatric anesthesia

Pediatric Anesthesia, EarlyView.


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