Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026: 08/22/18

Τετάρτη 22 Αυγούστου 2018

Correction to: Australia: regulating genomic data sharing to promote public trust

This article was inadvertently published under a draft title.

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Radioimmunotherapy as a Novel Approach in HIV, Bacterial, and Fungal Infectious Diseases

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.

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Biodistribution and Internal Radiation Dosimetry of 99mTc-IDA-D-[c(RGDfK)]2 (BIK-505), a Novel SPECT Radiotracer for the Imaging of Integrin αvβ3 Expression

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.

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The Distribution and Imaging of 99mTc-nGO-PEG-FA in Human Patu8988 Tumor-Bearing Nude Mice

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.

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Radioimmunotherapy as a Novel Approach in HIV, Bacterial, and Fungal Infectious Diseases

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.

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Biodistribution and Internal Radiation Dosimetry of 99mTc-IDA-D-[c(RGDfK)]2 (BIK-505), a Novel SPECT Radiotracer for the Imaging of Integrin αvβ3 Expression

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.

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The Distribution and Imaging of 99mTc-nGO-PEG-FA in Human Patu8988 Tumor-Bearing Nude Mice

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.

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Antimicrobial Resistance and Molecular Characterization of Extended-Spectrum β-Lactamases of Escherichia coli and Klebsiella spp. Isolates from Urinary Tract Infections in Southern Brazil

Microbial Drug Resistance, Ahead of Print.

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Deletion of GIT1 Impacts eNOS Activity To Aggravate sFlt-1-Induced Preeclampsia Phenotype in Mice

Preeclampsia, a serious multisystem disorder specific to human pregnancy, remains a considerable burden of disease worldwide. Reduced nitric oxide bioavailability is proved to be crucial in the maternal and fetal pathophysiology of preeclampsia. G-protein-coupled Receptor Kinase Interactor-1 (GIT1) is a novel endothelial nitric oxide synthases (eNOS) interactor mediator. The aim of this paper is to investigate the effect of GIT1 on preeclampsia. Blood pressure (BP) was measured using a carotid catheter-calibrated eight-chamber tail-cuff system (CODA) at the same time daily. Urinary albumin excretion (UAE) was determined using Albuwell-M kits (Exocell Inc) and creatinine clearance (CCr) was determined by measuring urinary creatinine concentration with tandem liquid chromatography-mass spectrometry. The release of nitrite was analyzed to detect nitric oxide (NO) production using a Sievers Chemiluminescence NO Analyzer. NOS activity was examined by measuring the conversion of ³H-labeled l-arginine to ³H-labeled l-citrulline. BP was significantly increased in GIT1^-/- mice with or without sFIT-1 treatment. In addition, GIT1-/- mice possessed higher UAE and lower CCr. Depletion of GIT1 impedes the NO production and placenta eNOS activity. Additional GIT1 attenuates sFlt-1-induced preeclampsia phenotypes. Our findings suggest that GIT1 significantly extenuates the sFlt-1-induced preeclampsia phenotypes by inhibiting eNOS activity, indicating a crucial role of GIT1 in the progression of preeclampsia.

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Coping-Style Behavior Identified by a Survey of Parent-of-Origin Effects in the Rat

In this study we investigate the effects of parent of origin on complex traits in the laboratory rat, with a focus on coping style behavior in stressful situations. We develop theory, based on earlier work, to partition heritability into a component due to a combination of parent of origin, maternal, paternal and shared environment, and another component that estimates classical additive genetic variance. We use this theory to investigate the effects on heritability of the parental origin of alleles in 798 outbred heterogeneous stock rats across 199 complex traits. Parent-of-origin-like heritability was on average 2.7-fold larger than classical additive heritability. Among the phenotypes with the most enhanced parent-of-origin heritability were 10 coping style behaviors, with average 3.2-fold heritability enrichment. To confirm these findings on coping behaviour, and to eliminate the possibility that the parent of origin effects are due to confounding with shared environment, we performed a reciprocal F1 cross between the behaviourally divergent RHA and RLA rat strains. We observed parent-of-origin effects on F1 rat anxiety/coping-related behavior in the Elevated Zero Maze test. Our study is the first to assess genetic parent-of-origin effects in rats, and confirm earlier findings in mice that such effects influence coping and impulsive behavior, and suggest these effects might be significant in other mammals, including humans.

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An Anopheles stephensi Promoter-Trap: Augmenting Genome Annotation and Functional Genomics

The piggyBac transposon was modified to generate gene trap constructs, which were then incorporated into the genome of the Asian malaria vector, Anopheles stephensi and remobilized through genetic crosses using a piggyBac transposase expressing line. A total of 620 remobilization events were documented, and 73 were further characterized at the DNA level to identify patterns in insertion site preferences, remobilization frequencies, and remobilization patterns. Overall, the use of the tetameric AmCyan reporter as the fusion peptide displayed a preference for insertion into the 5'-end of transcripts. Notably 183 - 44882 bp upstream of the An. stephensi v1.0 ab initio gene models, which demonstrated that the promoter regions for the genes of An. stephensi are further upstream of the 5'-proximal regions of the genes in the ab inito models than may be otherwise predicted. RNA-Seq transcript coverage supported the insertion of the splice acceptor gene trap element into 5'-UTR introns for nearly half of all insertions identified. The use of a gene trap element that prefers insertion into the 5'-end of genes supports the use of this technology for the random generation of knock-out mutants, as well as the experimental confirmation of 5'-UTR introns in An. stephensi.

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Effects of pregnancy on lumbar motion patterns and muscle responses

The kinematics of the lumbar region and the activation patterns of the erector spinae muscle have been associated to the genesis of low back pain, which is one of the most common complications associated to pregnancy. Despite the high prevalence of pregnancy-related low back pain, the biomechanical adaptations of the lumbar region during pregnancy remain unknown.

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The Use of a Novel Tablet Application to Quantify Dysfunction in Cervical Spondylotic Myelopathy Patients

Despite the prevalence and importance of myelopathy, there is a paucity of objective and quantitative clinical measures. The most commonly used diagnostic tools available are nonquantitative physical exam findings (e.g., pathologic reflexes, gait disturbance) and subjective scoring systems (e.g., modified Japanese Orthopaedic Association (mJOA)). A decline in fine motor coordination is a hallmark of early myelopathy, which may be useful for quantitative testing.

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3D Printing of Structured Nanotitania Catalysts: A Novel Binder-Free and Low-Temperature Chemical Sintering Method

3D Printing and Additive Manufacturing, Ahead of Print.

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Hybrid Additive Manufacturing System for Zonal Plasma-Treated Scaffolds

3D Printing and Additive Manufacturing, Ahead of Print.

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The Respiratory Compensation Point/Deoxy-BP are Valid Surrogates for Critical Power/ Maximum Lactate Steady State

No abstract available

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Anorectal Manometry for the Diagnosis of Hirschsprung Disease: New Heights for the Balloon or Just Hot Air?

No abstract available

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Variceal Bleeding and Morbidity- Considerations for Primary Prophylaxis

No abstract available

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Endoscopy in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto IBD Group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition

Endoscopy is a central tool for the evaluation and management of inflammatory bowel disease (IBD). In the last few decades, gastrointestinal (GI) endoscopy has undergone significant technological developments including availability of pediatric-size equipment, enabling comprehensive investigation of the GI tract in children. Simultaneously, professional organization of GI experts have developed guidelines and training programs in pediatric GI endoscopy. This prompted the Porto Group on Pediatric IBD of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition to develop updated guidelines on the role of GI endoscopy in pediatric IBD, specifically taking into considerations of recent advances in the diagnosis, disease stratification, and novel therapeutic targets in these patients.

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Mental Health Service Needs in Children and Adolescents With Inflammatory Bowel Disease and Other Chronic Gastrointestinal Disorders

No abstract available

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Red Meat Consumption and Serum Lipids and Fatty Acids in Toddlers: Secondary Outcomes of a Randomized Controlled Trial

The aim of the study was to examine the effects of promoting increased lean red meat consumption on serum concentrations of total and high-density lipoprotein (HDL) cholesterol, and serum fatty acid composition, among toddlers. In a 20-week randomized controlled trial healthy 12 to 20-month-old children were assigned to: red meat (n = 90; parents were encouraged to add 56 g/day of lean red meat to their toddler's usual diet), or control (n = 90) groups. Food and nutrient intakes were assessed with 3-day weighed food records (baseline, week 4, and week 20). Serum was analyzed for total and HDL cholesterol concentrations, and fatty acid composition (baseline and week 20). At week 20, relative to control, the red meat group had higher intakes of red meat, all meat, and carbohydrate; and lower intakes of milk, energy, cholesterol, and total, saturated, and monounsaturated fat (P = 0.043 for energy, all others P ≤ 0.002). No effects associated with the intervention were found for total cholesterol, HDL cholesterol, total to HDL cholesterol ratio, or serum fatty acid composition (all P ≥ 0.059) aside from pentadecanoic acid (P = 0.047). An ∼3-fold increase in lean red meat intake, from ∼10 to ∼30 g/day, resulted in no consistent changes in serum lipids or fatty acid composition, suggesting that the addition of ∼2 tablespoons/day of lean red meat to toddlers' diets will likely not adversely affect serum lipids or serum fatty acids.

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Nonesophageal Eosinophilic Gastrointestinal Disorders: Clinical Care and Future Directions

Eosinophilic gastrointestinal disorders are a set of conditions with a wide range of clinical manifestations and treatment modalities. The disorders are suspected to result from an abnormal inflammatory response to allergen (s), and individuals may develop a relapsing or chronic disease, if the allergen is not eliminated. Mechanisms of disease pathogenesis, including the humoral immune response, need to be fully elucidated. A variety of therapies are used, although there is a lack of well-defined randomized, prospective studies. Other therapeutic options are needed as the current treatments have potential concerns; elimination diets may impair a child's quality of life, and corticosteroids have adverse risks with long-term use. We review what is known about nonesophageal eosinophilic gastrointestinal disorders, and discuss research investigations which need to be conducted to facilitate diagnosis and enhance treatment methods.

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A Rare Case of Gallbladder and Common Bile Duct Benign Capillary Hemangioma in a Toddler

No abstract available

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Anorectal Manometry May Reduce the Number of Rectal Suction Biopsy Procedures Needed to Diagnose Hirschsprung Disease

Objectives: The aim of the study was to evaluate whether anorectal manometry (ARM), which is used to test the rectoanal inhibitory reflex (RAIR), is a safe alternative for reducing the number of invasive rectal suction biopsy (RSB) procedures needed to diagnose Hirschsprung disease (HD). Methods: Between 2010 and 2017, we prospectively collected the ARM results of 105 patients suspected of having HD. Following the outcome, the patients either underwent additional tests to confirm HD or they were treated conservatively. Primary ARM-based diagnoses were compared with the definitive diagnoses based on the pathology reports and/or clinical follow-ups. Additionally, we analyzed whether modifications to our ARM protocol improved diagnostic accuracy. Results: The sensitivity of ARM and RSB was comparable (97% vs 97%). The specificity of ARM, performed according to our initial protocol, was significantly lower than that of RSB. After we modified the protocol the difference between the specificity of ARM and RSB was no longer statistically significant (74% vs 84%, respectively, P = 0.260). The negative predictive value of ARM was 100%, while their positive predictive value was significantly lower than that of RSB (56% vs 97%, P

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Total Bile Acid Concentration in Duodenal Fluid Is a Useful Preoperative Screening Marker to Rule Out Biliary Atresia

Objectives: Duodenal tube test (DTT) is used as a preoperative screening to rule out biliary atresia (BA). In previous reports, DTT was assessed by the color of the duodenal fluid, but there were no quantitative criteria. The aim of this study was to examine the efficacy of DTT based on the total bile acid (TBA) concentration in duodenal fluid. Methods: This is a single-center retrospective study of infants with cholestasis who underwent DTT from 2008 to 2016 at the Osaka University Hospital. The cut-off values of maximum TBA in duodenal fluid (dTBA), dTBA/serum TBA ratio (sTBA), and dTBA/serum gamma-glutamyl transpeptidase (sGGT) ratio were assessed for the accuracy in excluding BA. Results: A total of 37 infants were included in this study; 16 infants with BA and 21 infants with other causes of intrahepatic cholestasis. dTBA demonstrated sensitivity of 100% and specificity of 90.5% with the cut-off value of 16.8 μmol/L. Specificity was further improved to 95.2% with dTBA/sTBA ratio (cut-off value: 0.088) and 100% with dTBA/sGGT ratio (cut-off value: 0.076 μmol/U). DTT could be performed 0.8 ± 1.4 days after admission. Hypoglycemia was developed in 1 infant. Conclusions: DTT evaluated by dTBA, dTBA/sTBA ratio, and dTBA/sGGT ratio had high accuracy to rule out BA and could avoid unnecessary surgery in some infants.

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

Introduction: Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands. Two phenotypes of the disease have been described: a pediatric-onset and an adult-onset type. The adult-onset form is associated with collagenous colitis and autoimmune disorders. No effective treatment has been identified to date. Objective: We aim to describe the clinical features and outcomes of patients in our cohort and provide a summary of published pediatric cases with collagenous gastritis and colitis reported to date to gather information that will contribute to improved knowledge of this rare condition. Methods: A retrospective chart review of all patients with collagenous gastritis and/or colitis who were treated at the Royal Children's Hospital, Melbourne, was performed. A literature review was also conducted. Results: A total of 12 cases of collagenous gastritis were reviewed. Three of 12 (25%) patients had associated collagenous colitis. The most common clinical presentation was iron deficiency anemia. Nine (75%) patients were followed up, and repeat endoscopies were performed in 8 (67%). Iron deficiency anemia resolved in all patients on oral iron supplementation. Histologic improvement was only identified in one patient with the adult phenotype who had been treated with oral corticosteroids and azathioprine. Conclusions: Collagenous gastritis is a rare condition in children. A small proportion of children develop features of the "'adult" phenotype at a very young age. Patients with collagenous gastritis require long-term follow-up and monitoring of their disease. Further randomized clinical trials are needed to establish an effective therapeutic strategy.

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Postdischarge Feeding of Very-low-birth-weight Infants: Adherence to Nutrition Guidelines

Objectives: Infant feeding guidelines are important public health strategies to promote optimal growth, development, and chronic disease prevention, but their effectiveness is contingent upon families' ability to adhere to them. Little is known of adherence to guidelines among nutritionally vulnerable infants, specifically those born very-low-birth-weight (VLBW) (

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

Objective: The possible association between the use of proton pump inhibitors (PPIs) and community-acquired pneumonia (CAP) or another lower respiratory tract infection (LRTI) remains uncertain. We conducted a nested case-control study using routinely collected national health and drug dispensing data in New Zealand to examine the risk of CAP or another LRTI resulting in hospitalization or death in infants dispensed a PPI. Study Design: The cohort included 21,991 patients without a history of CAP or another LRTI who were born between 1 January 2005 and 31 December 2012 and were dispensed omeprazole, lansoprazole, or pantoprazole (the PPIs available in New Zealand during the study period) on at least one occasion during the first year of life. Cases had a first diagnosis after cohort entry (first PPI dispensing) of CAP (n = 65) validated by hospital discharge letter or death record, and chest radiography; or LRTI (including CAP) (n = 566) validated by hospital discharge letter or death record, with or without chest radiography. Up to 10 controls, matched by sex and date of birth, were randomly selected for each case. We conducted complete case analyses for the fully adjusted models. Results: In the adjusted analysis based on CAP cases and their controls, the matched odds ratio for current versus past use of PPIs was 0.88 (95% confidence interval 0.36–2.16). For all LRTI cases and their controls, the matched odds ratio was 1.13 (0.87–1.48). Conclusion: In otherwise healthy community-dwelling infants, current use of a PPI does not appear to increase the risk of CAP or other LRTIs.

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Chronic Recurrent Multifocal Osteomyelitis in Crohn Disease: Complete Resolution With Anti-TNFα Therapy

No abstract available

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Gavage Feed Volume Determines the Gastric Emptying Rate in Preterm Infants

Objective: Feeding intolerance, manifesting as increased gastric residual, is a common finding in preterm neonates. Little is known about the regulation of gastric emptying early in life and the extent to which this plays a role in the preterm infants' feeding tolerance. The goal of this study was to evaluate clinically stable 28- to 32-week gestation neonates during the first 4 weeks of life and noninvasively determine their gastric emptying rate. Study design: Ultrasound measurements of gastric milk content volume were obtained from 25 neonates immediately after, 30 and/or 60 minutes following routine gavage feeds. The content emptying rate was calculated from the gastric volume data. Results: Gastric emptying rate was not postnatal age-dependent, was significantly higher at 30 minutes, whenever compared with 60-minute postfeed and directly proportional to the feed volume. At any postnatal age, the gastric emptying rate was at least 6-fold greater, when comparing the lowest and highest average stomach content volumes. Conclusions: The gastric emptying rate of preterm infants is content volume-dependent and unrelated to the postnatal age. Given the present findings, further investigation on the gastric residual of preterm infants receiving larger than currently administered feed volumes at the initiation of enteral nutrition, is warranted.

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Do Not Always Reach for the Scope When You See Red

No abstract available

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The Use and Safety of a Novel Haemostatic Spray in the Endoscopic Management of Acute Nonvariceal Upper Gastrointestinal Bleeding in Children

Aims and Background: Advanced endohaemostatic technique performance and experience is extremely variable in distribution amongst paediatric endoscopists. Haemostatic spray (Hemospray), a novel endohaemostatic topically applied powder has the advantage of extreme ease of use and; hence may lower the threshold of competency required by the endoscopist thereby potentially reducing mortality. The aim of the study is to prospectively evaluate the efficacy and the safety of haemostatic spray in paediatric patients with acute upper gastrointestinal bleeding (AUGIB). Methods: Prospective enrolment of children with AUGIB (Group 1) occurred, either as primary therapy or as an adjunct to standard endohaemostatic therapeutic techniques. Patients were assessed for likely need for endohaemostatic intervention of >8 of 24 of the paediatric Sheffield AUGIB score. A follow-up endoscopy occurred in those deemed to have clinical need pre-discharge. For comparison, another group (Group 2) of patients, who received conventional endohaemostatic treatment in the preceding 36 months, were reviewed. Results: A total of 20 applications of Hemospray occurred in 17 patients (8 boys, median (range) age: 6.5 years (2 days to 17.75 years) and a total of 29 patients were enrolled in Group 2 (16 boys, median [range] age: 5.1 [0.25–17.0]). All patients tolerated haemostatic spray applications with no adverse events. The haemostatic spray group achieved 100% initial haemostasis with 18% rebleeding rate, although only a 6% failure rate after re-application. In the conventional group, similar 100% initial haemostasis was achieved with 24% rebleeding rate and 7% failure rate necessitating surgical interventions. Conclusions: This paediatric series suggests that monotherapy with haemostatic spray is as effective as conventional approaches in the management of AUGIB.

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Value of Serum Zinc in Diagnosing and Assessing Severity of Liver Disease in Children With Wilson Disease

Objectives: Wilson disease (WD) is a rare inborn error of copper metabolism with diverse manifestations. There has been no study of zinc (Zn), the copper's antagonist, in WD diagnosis and severity so far. Our aims were to evaluate serum Zn in WD and its correlation with the disease severity score (revised WD index). Although the ATP7B mutation analysis is highly accurate for WD diagnosis, it may not be readily available in a resource-limiting setting. We proposed a disease diagnostic score (Proposed WD diagnostic score) which incorporates serum Zn. Methods: Medical records of WD and non-WD children seen at King's College Hospital from 2005 to 2015 were reviewed for the selected parameters using the Proposed WD diagnostic score. Available serum Zn data in WD children before disease diagnosis and the calculated severity score were statistically analyzed. Diagnostic values of the Proposed WD diagnostic score were evaluated. Results: Serum Zn level was significantly lower in 8 WD-acute liver failure (ALF) (5.8 [4.1–8.3] μmol/L) compared to 18 WD-non-ALF (13.5 [6.1–22.2] μmol/L) and 9 ALF from indeterminate cause (9.8 [7.0–12.1] μmol/L) (P

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

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

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Vitamin D Intervention and Bone: A Randomized Clinical Trial in Fair- and Dark-skinned Children at Northern Latitudes

Objectives: The aim of the study was to evaluate vitamin D status and effects of vitamin D intervention on bone mineral density (BMD) and content (BMC) in children with fair and dark skin in Sweden during winter. Methods: In a 2-center prospective double-blinded randomized intervention study 5- to 7-year-old children (n = 206) with fair and dark skin in Sweden (55°N–63°N) received daily vitamin D supplements of 25 μg, 10 μg, or placebo (2 μg) during 3 winter months. We measured BMD and BMC for total body (TB), total body less head (TBLH), femoral neck (FN), and spine at baseline and 4 months later. Intake of vitamin D and calcium, serum 25-hydroxy vitamin D (S-25[OH]D), and related parameters were analyzed. Results: Despite lower S-25(OH)D in dark than fair-skinned children, BMD of TB (P = 0.012) and TBLH (P = 0.002) and BMC of TBLH (P = 0.04) were higher at baseline and follow-up in those with dark skin. Delta (Δ) BMD and BMC of TB and TBLH did not differ between intervention and placebo groups, but FN-BMC increased more among dark-skinned children in the 25 μg (P = 0.038) and 10 μg (P = 0.027) groups compared to placebo. We found no associations between Δ S-25(OH)D, P-parathyroid hormone, P-alkaline phosphatase, and Δ BMD and BMC, respectively. Conclusions: BMD and BMC remained higher in dark- than fair-skinned children despite lower vitamin D status. Even though no difference in general was found in BMD or BMC after vitamin D intervention, the increase in FN-BMC in dark-skinned children may suggest an influence on bone in those with initially insufficient vitamin D status.

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Pulmonary Function Tests Abnormalities in Children With Inflammatory Bowel Disease: Is It Common?

Objective: The aim of the study was to evaluate the frequency and type of pulmonary dysfunction in newly diagnosed children with inflammatory bowel disease (IBD) and the correlation between pulmonary function tests (PFTs) and IBD activity. Methods: It is an observational case-control study. One hundred newly diagnosed children with IBD were enrolled as the patient group, which was further subdivided into 52 with Crohn disease (CD) and 48 with ulcerative colitis (UC). Fifty healthy children matched for age, sex, height, and body mass index (BMI) served as the control group. PFTs in the form of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, residual volume (RV), total lung capacity (TLC), mid-forced expiratory flow of 25% to 75% (FEF 25%–75%) and diffusing capacity of the lung for carbon monoxide (DLCO) were evaluated in all studied children. PFTs were measured at diagnosis, every 6 months for a period of 3 years, during remission and at least once during activity in patient group. Results: There was significant progressive deterioration in all PFTs in IBD patients compared with their PFTs at the start of the study (P 0.05). There was significant deterioration during disease activity compared with remission state as regards FEV1, FVC, FEF 25% to 75%, and DLCO (P

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Preoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial

Background: Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear. Methods: The study was a single-center, randomized, placebo-controlled, and double-blinded trial. A total of 122 patients undergoing elective craniotomy by a suboccipital or subtemporal approach were randomly allocated to a placebo group and gabapentin group. The patients received gabapentin (600 mg, orally) the night before surgery and 2 hours before anesthesia induction in the gabapentin group, and patients received vitamin B in the placebo group. The primary outcome was the postoperative pain score on movement at 24 hours. The secondary outcomes included the pain score at other time points, incidence of nausea and vomiting, sedation, and analgesic consumption. Results: Gabapentin significantly decreased the postoperative acute pain scores at rest (P=0.001) and on movement (P=0.000) within 24 hours; however, it did not have an effect at 48 hours. Gabapentin decreased postoperative vomiting (P=0.047) and rescue antiemetic use (P=0.033), whereas it increased the postoperative sedation score at 2 hours (P

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Lack of Benefit of Lactobacillus Reuteri DSM 17938 as an Addition to the Treatment of Functional Constipation

The aim of this study was to investigate the role of Lactobacillus (L.) reuteri DSM 17983 in the treatment of functional constipation in children. The trial was a single-center randomized, double-blind, placebo-controlled study. Patients were allocated into the two groups; intervention group which received L. reuteri DSM 17983 and lactulose and placebo group which received placebo and lactulose. Due to small recruitment rate study was terminated prematurely, therefore only 33 children (12 girls, median age 4.5 years, range 2–16) were randomized. There was no difference between groups in the stool frequency, stool consistency, pain, soiling rate and dose of the lactulose. This study found that L. reuteri DSM 17938 adds no benefit to the treatment of constipation in children. However, due to small sample size these results should be interpreted with caution. Address correspondence and reprint requests to Iva Hojsak, MD, PhD, Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Klaiceva 16, 10000 Zagreb, Croatia (e-mail: ivahojsak@gmail.com). Received 5 May, 2018 Accepted 1 August, 2018 This trail has been registered at ClinicalTrials.gov (NCT01587846) Funding Source: No funding was allocated for this study. Support of the study: For the purpose of the study both probiotic preparation and placebo were supplied by probiotic strain producer BioGaia, Stockholm, Sweden. BioGaia had no involvement in the study design, the collection, analysis, and interpretation of data, writing of the report and the decision to submit the paper for publication. Conflict of interest statement: Iva Hojsak in the last 2 years received speakers grants from BioGaia, Nutricia, Medis Adria, Pharmas. Oleg Jadrešin received speakers grants from BioGaia. Zrinjka Mišak has in the last 2 years received speakers grants from Pharmas. Sanja Kolaček participated as a clinical investigator, and/or speaker for Abbott, Arla, Biogaia, Chr. Hansen, Danone, Dukat, Nestlé, Nutricia, and MSD. Sara Sila has no conflict of interest. Ivana Trivić has no conflict of interest. Authors Contributions: Concept and design of the study OJ, IH; conduction of the study SS, IT, ZM; analysis of the data IH; interpretation of the data OJ, IH, SK; Drafting of the manuscript SS, IT, IH, OJ; critical analysis of the manuscript ZM, SK; final approval of the manuscript all authors. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Clarifying the Definition of Breast-Milk Substitutes

No abstract available

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Multi-organ transplantation as a viable treatment option in Infantile Juvenile Polyposis Syndrome

No abstract available

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Full-time Paramedic - Redmond fire and Rescue

THE POSITION This position is an EMS only Paramedic position. The successful candidate will work a 24/48 work schedule, responding from one of Redmond Fire & Rescue's four fire stations, and working closely with our team of highly trained firefighter/paramedics. COMPENSATION (Non-Represented/Non-Civil Service): Yearly salary of $53,248.00 plus a cost sharing benefit package. Employee pays 6% PERS and ...

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PharmGKB summary: clozapine pathway, pharmacokinetics

No abstract available

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EMS Pioneers: Missouri paramedic says 'EMS chose me' 37 years ago

Sara Wainwright lauds ROSC progress, laments opioid epidemic

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EMT - Safety Medic - GEMS

POSITION RESPONSIBILITIES: •‪Responding to emergencies efficiently and promptly ‬ \* ‪Administering basic first aid and medical support to patients, in accordance with federal, state, local and company policy and regulations‬ •‪Assessing the nature and extent of injuries/illnesses to prioritize medical procedures‬ •‪Effectively communicating with medical professionals and treatment facilities to obtain ...

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EMT - Safety Medic - GEMS

In vivo lineage tracing in mice

In vivo lineage tracing in mice

In vivo lineage tracing in mice, Published online: 22 August 2018; doi:10.1038/s41576-018-0048-4

A study in Science reports the successful application of CRISPR–Cas genome editing to track and reconstruct developmental lineages in the mouse.

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How EMS leaders can increase 12-lead capture frequency

Make a strategy and pick the tactics for your agency to improve its 12-lead EKG use for patients with non-traumatic chest pain

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Long-term outcome of entecavir treatment of nucleos(t)ide analogue-naïve chronic hepatitis B patients in Japan

Abstract

Background

We determined the antiviral potency and viral breakthrough rate after 10 years of continuous entecavir treatment in patients with chronic hepatitis B (CHB) infection.

Methods

The cumulative rates of undetectable hepatitis B virus DNA (HBV-DNA, < 2.1 log copies/mL), alanine aminotransferase (ALT) normalization, hepatitis B e antigen (HBeAg) seroclearance, hepatitis B surface antigen (HBsAg) seroclearance, and viral breakthrough of 1094 nucleos(t)ide analogue-naïve CHB patients (HBeAg-positive: 47%) who were on continuous entecavir treatment for 10 years were calculated.

Results

The median age was 50 years and follow-up period was 5.5 years, with 999, 804, 591, 390, 182 and 87 patients followed up for at least 1, 3, 5, 7, 9 and 10 years, respectively. Incremental increases were noted in the rates of undetectable HBV-DNA, ALT normalization, HBeAg seroclearance, and HBsAg seroclearance, reaching 96, 79, 38 and 3.7%, respectively, by the tenth year. The mean decline in HBsAg level from baseline was − 0.08 log IU/mL/year. Multivariate analysis identified HBsAg level and genotype (A) as independent predictors of HBsAg seroclearance. Sixteen patients experienced viral breakthrough. The cumulative percentages of patients with viral breakthrough analyzed by the Kaplan–Meier test were 1.5 and 2.5% at years 5 and 10, respectively. There were no serious adverse events during treatment.

Conclusions

Long-term entecavir treatment of nucleos(t)ide analogue-naïve CHB patients was associated with an excellent viral response and a low rate of entecavir-resistant mutations at 10 years. Baseline HBsAg levels and genotype were predictors of HBsAg seroclearance during entecavir treatment.

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Diagnosis of early esophageal cancer using Blue Laser Imaging (BLI)

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How EMS leaders can increase 12-lead capture frequency

Make a strategy and pick the tactics for your agency to improve its 12-lead EKG use for patients with non-traumatic chest pain

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Failure to generate baseline muscle motor evoked potentials during spine surgery: Risk factors and association with the postoperative outcomes

Intraoperative neurophysiological monitoring using transcranial electrical motor-evoked potentials (MEPs) and somatosensory evoked potentials is currently considered important for the detection of intraoperative neural damage and for risk reduction of irreversible nervous system dysfunction in various types of surgeries (Park et al., 2011; Raynor et al., 2013; Xu et al., 2011). In particular, using MEPs is widely accepted for monitoring corticospinal tract function. Transcranial electric stimulation can elicit action potentials in either limb muscles (muscle MEPs; mMEPs) or the spinal cord (D-waves).

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Long term Outcome after Spinal Fusion for Isthmic Spondylolisthesis in Adults

Data on the long-term outcome after fusion for isthmic spondylolisthesis is scarce.

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Risk factors for cage migration and cage retropulsion following transforaminal lumbar interbody fusion

Transforaminal lumbar interbody fusion (TLIF) is a widely accepted surgical procedure, but cage migration (CM) and cage retropulsion (CR) are associated with poor outcomes.

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Intervertebral Kinematics of the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation

Neck pain is one of the most commonly reported symptoms in primary care settings, and a major contributor to healthcare costs. Cervical manipulation is a common and clinically effective intervention for neck pain. However, the in vivo biomechanics of manipulation are unknown due to previous challenges with accurately measuring intervertebral kinematics in vivo during the manipulation.

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The Impact of Obesity on the Effectiveness of Spinal Cord Stimulation in Chronic Spine-Related Pain Patients

Background Context: Chronic pain and obesity are both on the rise. Spinal cord stimulation has gained increasing popularity in the pain management field for the treatment of spine-related chronic pain, however to-date, the correlation between the spinal cord stimulator effectiveness and increasing body mass index (BMI) has not been fully established.Purpose: We aimed to investigate the correlation between patients' BMI and the percentage of pain relief as well as opioid utilization in chronic spine-related pain patients treated with spinal cord stimulation.

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Rates of Osteoporosis Screening and Treatment Following Vertebral Fracture

Osteoporosis remains an underrecognized and undertreated disease entity in the orthopaedic setting, accounting for substantial long-term morbidity and mortality. Osteoporosis is often not diagnosed or treated until multiple fractures have occurred. Vertebral compression fractures are the most common sentinel fracture, providing an opportunity to intervene with antiresorptive therapy before more debilitating fractures occur. Little data has been published on osteoporosis screening and treatment following vertebral fractures.

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Therapeutic Effects of Cell Therapy with Neonatal Human Dermal Fibroblasts and Rabbit Dermal Fibroblasts on Disc Degeneration and Inflammation

Increasing evidence suggests transplanting viable cells into the degenerating intervertebral disc (IVD) may be effective in treating disc degeneration and back pain. Clinical studies utilizing autologous or allogeneic mesenchymal stem cells (MSCs) to treat patients with back pain have reported some encouraging results. Animal studies have shown that cells injected into the disc can survive for months and have regenerative effects. Studies to determine the advantages and disadvantages of cell types and sources for therapy are needed.

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Diagnosis of early esophageal cancer using Blue Laser Imaging (BLI)

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In vivo lineage tracing in mice

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Chronic use of statins and risk of post-ERCP acute pancreatitis (STARK): Study protocol for an international multicenter prospective cohort study

Digestive and Liver Diseases

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Dominance effects of ion transport and ion transport regulator genes on the final weight and backfat thickness of Landrace pigs by dominance deviation analysis

Abstract

Although there have been plenty of dominance deviation analysis, few studies have dealt with multiple phenotypes. Because researchers focused on multiple phenotypes (final weight and backfat thickness) of Landrace pigs, the classification of the genes was possible. With genome-wide association studies (GWASs), we analyzed the additive and dominance effects of the single nucleotide polymorphisms (SNPs). The classification of the pig genes into four categories (overdominance in final weight, overdominance in backfat thickness and overdominance in final weight, underdominance in backfat thickness, etc.) can enable us not only to analyze each phenotype's dominant effects, but also to illustrate the gene ontology (GO) analysis with different aspects. We aimed to determine the additive and dominant effect in backfat thickness and final weight and performed GO analysis. Using additive model and dominance deviation analysis in GWASs, Landrace pigs' overdominant and underdominant SNP effects in final weight and backfat thickness were surveyed. Then through GO analysis, we investigated the genes that were classified in the GWASs. The major GO terms of the underdominant effects in final weight and overdominant effects in backfat thickness were ion transport with the SLC8A3, KCNJ16, P2RX7 and TRPC3 genes. Interestingly, the major GO terms in the underdominant effects in the final weight and the underdominant effects in the backfat thickness were the regulation of ion transport with the STAC, GCK, TRPC6, UBASH3B, CAMK2D, CACNG4 and SCN4B genes. These results demonstrate that ion transport and ion transport regulation genes have distinct dominant effects. Through GWASs using the mode of linear additive model and dominance deviation, overdominant effects and underdominant effects in backfat thickness was contrary to each other in GO terms (ion transport and ion transport regulation, respectively). Additionally, because ion transport and ion transport regulation genes are associative with adipose tissue accumulation, we could infer that these two groups of genes had to do with unique fat accumulation mechanisms in Landrace pigs.

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Multistage neurorehabilitation of an adolescent with severe anti-N-methyl-D-aspartate receptor encephalitis: a case report

We report on a 15-year-old girl with severe anti-N-methyl-D-aspartate receptor encephalitis who had initial poor prognostic factors. We delineate the unique challenges faced in the rehabilitation of our patient including sleep disruption and food aversion. After 20 months of hospitalization and intensive rehabilitation, there was a significant improvement in functional abilities and self-care skills. However, she had residual neurocognitive deficits, visual perceptual, and motor coordination difficulties that continued to improve after discharge, attesting to the need for long-term rehabilitation. The case showed the need for a coordinated multidisciplinary approach, with both targeted therapies and neuropharmacology, tailored to facilitate the different stages of recovery unique to anti-N-methyl-D-aspartate receptor encephalitis patients. Correspondence to Velda X. Han, MBBS, MMED, MRCPCH, Department of Paediatrics, National University Health System, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore 119228, Singapore Tel: +65 67 724 112; fax: +65 67 797 486; e-mail: velda_han@nuhs.edu.sg Received July 24, 2018 Accepted August 6, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Πληροφορίες

Τετάρτη 22 Αυγούστου 2018

Abstract

Background

Methods

Results

Conclusions

Abstract