Παρασκευή, 14 Σεπτεμβρίου 2018

The State of the States: Growing PhysiatryAssociation of Academic Physiatrists Position Statement Addressing Academic Physiatry and PM&R Growth

The growth of physiatry in the United States is dependent upon academic exposure at both the undergraduate and graduate medical education levels. Undergraduate medical education provides students with knowledge of physiatry, as well as proper understanding of human function, medical rehabilitation treatments, and of physiatrists as consultants. Graduate medical education contributes more directly to the total number of practicing physiatrists. This paper presents disparities in medical student exposure to physiatry, PM&R residency positions, the number of practicing physiatrists, and PM&R-relevant patient care needs, by state. In the model, these disparities are highlighted to provide guidance and expose gaps/opportunities for targeted physiatric growth. Correspondence: Danielle Perret Karimi, Associate Clinical Professor, Department of Physical Medicine and Rehabilitation, University of California, Irvine, 101 The City Drive South, Orange, CA 92868 Author Disclosures: All authors state no competing interests, funding, grants or equipment provided for the project from any source; nor financial benefits to the authors. There are no previous presentations or submissions of this research. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Neurophysiological and Neuropsychological Analysis of the Cognitive Functions in Dysthyroid Female Patients

The P300 potential was recorded in 29 newly diagnosed hypothyroid and 29 newly diagnosed hyperthyroid female patients using a standard odd-ball paradigm of the acoustic stimuli. Cognitive functions were further assessed in these groups using the color trails test, triads test, and digit vigilance test. Similar procedures were repeated in 29 age- and education-matched normal euthyroid women. All the tests showed statistically significant differences (P < 0.05) in hypothyroid patients compared to the controls. The color trails test showed statistically significant differences between normal and hyperthyroid individuals. There were also statistically significant differences between hyperthyroid and hypothyroid individuals in all tests. Thus, a clear cognitive decline was observed in hypothyroid patients. This can be detected electrophysiologically, as well as by appropriate cognitive functional tests. Early detection and intervention may prevent further cognitive decline. Hyperthyroid individuals were found to show slower information processing, as compared to euthyroid individuals.



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Conditions of Switching between Local Electric Activity Modes in the Dendritic Membrane of Hippocampal Pyramidal Neurons: A Simulation Study

On a computer model of an isolated dendrite segment populated by ion channels inherent in the hippocampus CA3 pyramidal neurons, the possibility and conditions of switching between different modes of intrinsic local activity induced by tonic synaptic excitation were investigated. Depending on the synaptic intensity, these were modes of generation of persistent low- or high-level depolarization or of steady oscillations of the membrane potential. The switches between the modes could be accomplished by application of depolarizing or hyperpolarizing currents of certain critical values. These currents from an extrinsic generator mimicked intrinsic axial core currents, which provide electrical coupling between the segments incorporated in a complex structure of the dendritic branching. Subcriticalintensity currents could change the persistent depolarization levels, frequency, and amplitude of steady oscillations of the membrane potential, but could not switch between the above-mentioned modes of activity.



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Event-Related EEG Synchronization/Desynchronization under Conditions of Cessation and Switching over of the Programs of Manual Movements in Men

We examined differences in the patterns of event-related EEG synchronization/desynchronization (ERS/ERD) in young men under conditions of complete inhibition of the triggered motor program of a manual movement (MM) and of inhibition of such program with subsequent switching over to an alternative motor task. Forty-two healthy volunteers (men, dextrals, age 18 to 23 years) took part in the tests. The ERS and ERD indices were estimated within the EEG frequency range 8–35 Hz in frontal, central, and parietal leads. In the series with cessation of the triggered MM program and its subsequent switching over to the alternative movement, modifications of neocortical EEG activity, compared to those at complete cessation of the movement, were the following: (i) comparative decrease in the ERS intensity with respect to the 9, 11, and 16 Hz oscillations in the fronto-central cortical regions and intensification of ERD at 11 and 16 Hz in parietal leads, (ii) relative intensification of ERS in the left central neocortical zone (11 Hz frequency), that in the right frontal and parietal zones (16 Hz frequency), and (iii) ERD for the frequencies of 19–20 Hz extensively developed in the neocortex (first of all, in the left hemisphere). Oscillations with the frequency 25 Hz and higher were synchronized to a greater extent at switching of the MM program than at complete cessation of this movement.



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Correlations of Aggressiveness with the Levels of Sex Hormones in Young Men; Validity of a Proposed Anthropometric Marker

In thirty-five 18- to 22-year-old healthy men (14 and 21 subjects of the Indian and Ukrainian populations, respectively), we examined correlations of the levels of sex hormones (testosterone and β-estradiol) in blood serum with the indices of physical and verbal aggressiveness estimated using the Buss–Durkee Hostility Inventory. In both general examined group and separate above-mentioned subgroups, moderate (r from 0.30 to 0.60) correlations were found between the testosterone concentrations and levels of physical aggressiveness, but these correlations did not reach the significance level. Correlations of testosterone with the levels of verbal aggressiveness were less expressed and, in some cases, negative. Correlations of aggressiveness with the estradiol levels were weaker or negligible. There were some specificities of the sex hormone contents in the Indian and Ukrainian subgroups, but these variations remained within physiological limits. The ratio of the lengths of fingers 2 and 4 of the right hand (2D:4D ratio), an anthropometric index proposed as a marker of prenatal exposure to sex hormones and of the aggressiveness level, demonstrated significant correlations with the testosterone contents in the general group and separate subgroups. However, these correlations were relatively weak, and individual values of the examined indices were highly variable. It is concluded that the 2D:4D ratio is affected not only by the levels of sex hormones, but also by a number of other regulatory factors, and this anthropometric index cannot be used as the single-valued retrospective biomarker of the exposure to androgens.



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Ethical Responsibilities of the Authors



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EMG Activity of the Chewing Muscles during Adaptation of Dental Patients to Fixed Dentures

Patterns of EMG activity of muscles involved in chewing movements (mostly of the mm. masseter and temporalis, M and T, respectively) were examined in 37 patients with defects of the dental rows treated with installation of fixed dentures (FDs) and in 10 control subjects with no above defects. It was found that, during 6-month-long adaptation to the FDs, the average period of chewing movements in the group of patients was mildly (by 5.5 to 7.9%) but significantly (P < 0.05) shorter than that in the control group, the structure of the chewing cycle in the M and T was modified due to significant (P< 0.05) shortening of the activity phase, and fractioning of the latter phase was manifested in many patients. The amplitudes of M and T EMG activities during the adaptation interval were significantly smaller than in the control and nearly completely recovered only in 6 months. Thus, the treatment of defects of the dental rows using the FDs, which results in changes of the afferent flow from the oral cavity, is related to noticeable modulation of the activity produced by the chewing brainstem central pattern generator, and the respective changes are smoothed only after a long-lasting (more than 6 months) adaptation period.



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Specificities of EEG Activity of the Visual Neocortex in Adolescent Boys with Congenital Visual Dysfunctions

We compared the results of spectral/coherent and nonlinear analysis of EEGs recorded in adolescent boys with congenital visual dysfunctions and boys with normal vision. In the former group, an intensified functional activity of the visual neocortex in a relaxed wakefulness state was observed in the left hemisphere. Such a pattern was also found in the course of auditory-motor integration, but the manifestations were bilateral.



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Application of Virtual Reality and Augmented Reality in Psychiatry and Neuropsychology, in Particular in the Case of Autistic Spectrum Disorder (ASD)

This paper is a combination of a review of the papers related to applications of virtual reality and augmented reality in various aspects of psychiatry and neurophysiology, with special attention to using the respective approaches in the case of autistic spectrum disorders (ASDs) and of a description of the studies of the authors dealing with the corresponding problem. The major emphasis is put on the elements that contribute to the amelioration of communicative and emotional skills in such children, mainly related to modeled applications, computers, and an output interface (projection). This study, therefore, focuses on the understanding of the elements simplifying the development of these new information and communication technologies. In order to answer our queries, we used exploratory interviews and specific reviews, such as virtual or augmented reality and virtual (preferably geo-localized) environments used to provide children with ASD a database containing varied and multimodal information for various purposes: (i) a display of the 3D environment and its constituent objects, (ii) understanding of the task, (iii) an increase in the salience of certain objects, (iv) issuance of instructions associated with interaction with the environment in order to increase the capacity of an individual to process and use received information to allow a better performance of the activities of daily living (ADL), (v) simulation of everyday activities, repeating them as necessary things, and graduating them in order to be able to control a given situation, and (vi) introducing many innovative techniques that are not well-known in the treatment of ASD.



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Effects of Vitamin E on the Synthesis of Phospholipids and Brain Functions in Old Rats

We examined the effects of supplementation of old rats with vitamin E (alpha-tocopherol, αTPh, acetate) on phospholopid (PL) metabolism in the brain and cognitive functions of these animals. Intragastric administration of αTPh to 24-month-old rats for 14 days resulted in a noticeable increase in the level of newly synthesized phosphatidylserine (PS) in the hippocampus of experimental animals, as compared with control rats. At the same time, there was a decrease in the [14C] phosphatidylcholine (PC) content in the hippocampus of experimental rats vs. controls. Changes in the PL levels observed in the hippocampus of experimental animals due to αTPh administration were associated with an increased number of active avoidances and a decreased latent period of these events within acquisition of the respective conditioned reflex in a shuttle box. The data obtained provide evidence that αTPh is a potent modulator of PL metabolism in the hippocampus and functions of the latter at old age.



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Levels of Thyroid Hormones and Indices of Energy Metabolism in the Cerebral Cortex of Rats with Experimental Alzheimer’s Disease

The study was carried out on 30 mature WAG rats, 15 intact control animals and 15 rats with modeled Alzheimer's disease (AD) induced by course injections of scopolamine (27 days, 1 mg/kg, i.p. daily). The contents of ATP, glucose, pyruvate, and lactate were measured spectrophotometrically in homogenates of the brain cortex of the animals. The levels of TSH, T3, and T4 in blood serum and those of T3 and T4 in cortex homogenates were estimated using ELISA. The activities of pyruvate dehydrogenase, creatine phosphokinase, and key enzymes of the tricarboxylic acid cycle (TCA) were measured in the mitochondria using a spectrophotometric technique. It was found that the content of T3 in the brain cortex of rats was much lower than in the controls against the background of higher T4 concentrations, which was indicative of the development of local hypothyroidism in the brain. The increased activity of pyruvate dehydrogenase against the background of low activities of TCA cycle enzymes in brain homogenates was observed. The decreased creatine kinase activity and low ATP contents were also found. Local hypothyroidism in the brain cortex is believed to be one of the significant factors inducing the development of strong energy deficiency and reducing the activity of Krebs cycle enzymes. Consequently, this contributes to the death of neurons in experimental AD in rats.



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Training-Related Changes of EMG Activity of the Pelvic Floor Muscles in Women with Urinary Incontinence Problems

The effects of a six-week training of the pelvic floor muscles (PFMs) on EMG activity of this muscle group were examined in three groups of young women under conditions of three protocol tasks. Sixtyfour women (mean age 23 ± 3 years) were divided into groups: (i) with urinary incontinence (UI) problems, (ii) without such problems, and (iii) controls. Participants of the former two groups performed the above-mentioned training session, while the control group did not undergo training. Surface EMGs (sEMGs) were recorded from all participants using the Noraxon EMG system and TeleMyo DTS system (USA); recording electrodes were fixed on vaginal probes (Lifecare PR-02, Taiwan). In the group with UI symptoms, the EMG amplitude demonstrated noticeably higher values under conditions of quick PFM flicks (Q test) after the six-weeks-long training session, while electrical activity values remained practically unchanged in the asymptomatic group. The symptomatic and asymptomatic groups also showed higher results in the posttraining measurement under conditions of static hold (STA test). These differences, however, did not reach the significance level (mostly due to high variability of individual measured values). In the symptomatic group, the baseline and relaxation values of the PFM EMG amplitude increased, while the respective values in the asymptomatic and control groups decreased (except for the parameter in relaxation in the control) in the second (posttraining) measurement. The expedience of application of the sEMG technique in the control of the state of the PFM group, the efficiency of the respective PFM training in populations with UI problems, and difficulties met in the respective studies are discussed.



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Parameters of Components N2 and P3 of the Auditory Cognitive Evoked Potentials in Musicians and Non-musicians

We measured time parameters of the cognitive components in the auditory evoked potentials in professional musicians and non-musicians in order to determine electrophysiological correlates of the information processing rate and differentiation of the stimuli in such examined groups. It was found that the latencies of components N2 and Р3 were, on average, shorter in subjects that professionally practice music than those in non-musicians; at the same time, there were no differences between the peak-to-peak N2-P3 amplitudes in these groups. The revealed regularities can indicate that central processes of differentiation of auditory stimuli in musicians are realized more rapidly, and, correspondingly, the processing of the obtained information is quicker.



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Reply to “Reconsidering Sham in Transcutaneous Vagus Nerve Stimulation studies”

We thank Rangon (2018) for her critical remarks sparked by the design of our recent study (Keute et al. 2018). Specifically, Rangon (2018) questions the widespread use of earlobe stimulation as a sham condition in transcutaneous vagus nerve stimulation (tVNS) studies. She argues that the unexpected results in our study – an increased behavioral effect, even though we expected a decreased one – might be a consequence of the earlobe-sham stimulation, which implies that the earlobe stimulation would have had a stronger effect than tVNS on GABA transmission and, subsequently, on our parameters of interest.

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Effect of Narcotic Prescription Limiting Legislation on Opioid Utilization Following Lumbar Spine Surgery

Prescription opioid abuse is a public health emergency. Opioid prescriptions for spine patients account for a large proportion of use. Some states have implemented statutory limits on prescribers, however it remains unclear whether such laws are effective.

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Weight Loss in Adolescents After Bariatric Surgery: A Systematic Review

Bariatric surgery is a treatment option for the obese adolescent. There are three primary surgical procedures: the bypass, sleeve gastrectomy, and lap band. The most recent literature was reviewed to examine changes in weight, comorbidities, and complications after bariatric surgery in the adolescent.

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Functional analysis of a homologue of the FLORICAULA/LEAFY gene in litchi ( Litchi chinensis Sonn.) revealing its significance in early flowering process

Abstract

Litchi (Litchi chinensis Sonn.) is an important subtropical fruit crop with high commercial value due to its high nutritional values and favorable tastes. However, irregular bearing attributed to unstable flowering is a major ongoing problem for litchi producers. Previous studies indicate that low-temperature is a key factor in litchi floral induction. In order to reveal the genetic and molecular mechanisms underlying the reproductive process in litchi, we had analyzed the transcriptome of buds before and after low-temperature induction using RNA-seq technology. A key flower bud differentiation associated gene, a homologue of FLORICAULA/LEAFY, was identified and named LcLFY (GenBank Accession No. KF008435). The cDNA sequence of LcLFY encodes a putative protein of 388 amino acids. To gain insight into the role of LcLFY, the temporal expression level of this gene was measured by real-time RT-PCR. LcLFY was highly expressed in flower buds and its expression correlated with the floral developmental stage. Heterologous expression of LcLFY in transgenic tobacco plants induced precocious flowering. Meantime, we investigated the sub-cellular localization of LcLFY. The LcLFY-Green fluorescent protein (GFP) fusion protein was found in the nucleus. The results suggest that LcLFY plays a pivotal role as a transcription factor in controlling the transition to flowering and in the development of floral organs in litchi.



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A previously unrecognized 22q13.2 microdeletion syndrome that encompasses TCF20 and TNFRSF13C

American Journal of Medical Genetics Part A, EarlyView.


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Warsaw breakage syndrome: Further clinical and genetic delineation

American Journal of Medical Genetics Part A, EarlyView.


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Dietary intake in youth with prader‐willi syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Ohio family boasts 3 generations of EMS providers

Bob Smith, owner of Smith Ambulance, jokes that if someone in his family isn't an EMT, "we can't use you"

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Slt2 MAPK association with chromatin is required for transcriptional activation of Rlm1 dependent genes upon cell wall stress

Publication date: Available online 14 September 2018

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

Author(s): Ana Belén Sanz, Raúl García, José Manuel Rodríguez-Peña, César Nombela, Javier Arroyo

Abstract

The regulation of gene expression through the cell wall integrity (CWI) pathway in yeast is mainly coordinated by the MAPK Slt2 and the transcription factor Rlm1. In this work, we elucidate a new role for Slt2 as a part of the transcriptional activation machinery that regulates CWI gene expression in response to cell wall stress. We show that Slt2 is recruited to promoters and coding regions of CWI Rlm1-dependent genes in response to stress. This phenomenon is dependent both on the activation of the MAPK and its kinase activity. Slt2 binding is also dependent on Rlm1 and SWI/SNF and SAGA complexes. During the initial steps of transcription, the catalytic activity of Slt2 on Rlm1 is critical for the binding of the activator to promoters in response to stress. In addition, Slt2 itself acts as a transactivator, as it is able to induce the transcription of CWI responsive genes when it is bound to promoters through the Rlm1 binding domain independently of its catalytic activity. Slt2 interacts with RNA Pol II in a Rlm1-dependent manner to provide further support to a role of this MAPK as an integral component of the transcriptional complexes under cell wall stress. Selective recruitment and progression of the complex Slt2-RNA Pol II from the promoters to the coding regions of Rlm1-dependent genes does not rely on Paf1, suggesting a different mechanism from that which is exerted by Slt2 on the Swi4/Swi6 (SBF)-regulated genes.



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Comprehensive analysis of chromatin signature and transcriptome uncovers functional lncRNAs expressed in nephron progenitor cells

Publication date: Available online 14 September 2018

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

Author(s): Masaki Nishikawa, Shunsuke Yuri, Hiroshi Kimura, Naomi Yanagawa, Morgan Hamon, Peter Hauser, Lifu Zhao, Oak D. Jo, Norimoto Yanagawa

Abstract

Emerging evidence from recent studies has unraveled the roles of long noncoding RNAs (lncRNAs) in the function of various tissues. However, little is known about the roles of lncRNAs in kidney development. In our present study, we aimed to identify functional lncRNAs in one of the three lineages of kidney progenitor cells, i.e., metanephric mesenchymal (MM) cells. We conducted comprehensive analyses of the chromatin signature and transcriptome by RNA-seq and ChIP-seq. We found seventeen lncRNAs that were expressed specifically in MM cells with an active chromatin signature, while remaining silenced in a bivalent chromatin state in non-MM cells. Out of these MM specific lncRNAs, we identified a lncRNA, Gm29418, in a distal enhancer region of Six2, a key regulatory gene of MM cells. We further identified three transcript variants of Gm29418 by Rapid Amplification of cDNA Ends (RACE), and confirmed that the transcription-start-sites (TSSs) of these variants were consistent with the result of Cap Analysis Gene Expression (CAGE). In support of the enhancer-like function of Gm29418 on Six2 expression, we found that knock-down of Gm29418 by two independent anti-sense locked nucleic acid (LNA) phosphorothioate gapmers suppressed Six2 mRNA expression levels in MM cells. We also found that over-expression of Gm29418 led to an increase in Six2 mRNA expression levels in a mouse MM cell line. In conclusion, we identified a lncRNA, Gm29418, in nephron progenitor cells that has an enhancer-like function on a key regulatory gene, Six2.



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Pro-inflammatory cytokines IL-6 and CCL2 suppress expression of circadian gene Period2 in mammary epithelial cells

Publication date: Available online 13 September 2018

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

Author(s): Chan-Wei Yu, Kuo-Chih Cheng, Ling-Chih Chen, Meng-Xuan Lin, Yi-Cheng Chang, Wendy W. Hwang-Verslues

Abstract

Chronic inflammation is known to contribute to tumor initiation and cancer progression. In breast tissue, the core circadian gene Period (PER)2 plays a critical role in mammary gland development and possesses tumor suppressor function. Interleukin (IL)-6 and C-C motif chemokine ligand (CCL) 2 are among the most abundant cytokines in the inflammatory microenvironment. We found that acute stimulation by IL-6/CCL2 reduced PER2 expression in non-tumorigenic breast epithelial cells. Longer term exposure to IL-6/CCL2 suppressed PER2 to an even lower level. IL-6 activated STAT3/NFκB p50 signaling to recruit HDAC1 to the PER2 promoter. CCL2 activated the PI3K/AKT pathway to promote ELK-1 cytoplasm-to-nucleus translocation, recruit HDAC1 to the proximal PER2 promoter and facilitate DNMT3-EZH2-PER2 promoter association. Ectopic expression of PER2 inhibited IL-6 or CCL2 induced mammosphere forming ability and reduced sphere size indicating that PER2 repression in breast epithelial cells can be crucial to activate tumorigenesis in an inflammatory microenvironment. The diminished expression of PER2 can be observed over a time scale of hours to weeks following IL-6/CCL2 stimulation suggesting that PER2 suppression occurs in the early stage of the interaction between an inflammatory microenvironment and normal breast epithelial cells. These data show new mechanisms by which mammary cells interact with a cancerous microenvironment and provide additional evidence that PER2 expression contributes to breast tumorigenesis.



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G-quadruplex structures at the promoter of HOXC10 regulate its expression

Publication date: Available online 13 September 2018

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

Author(s): Xiao Zhang, Bo Zhao, Ting Yan, Aixin Hao, Yang Gao, Dangdang Li, Guangchao Sui

Abstract

As a member of the homeobox gene family, HOXC10 plays an important role in cell differentiation and embryonic development of mammals. Increasing evidence also suggests a regulatory role of HOXC10 in oncogenesis, but the regulation of HOXC10 gene expression is relatively understudied. In this report, we revealed that the HOXC10 promoter contains multiple G-tracts in its negative strand and has high potential of forming G-quadruplex structures. In circular dichroism studies, synthesized oligonucleotides based on the G-rich region of 241–297 base pairs upstream of the HOXC10 transcription start site showed molar ellipticity at specific wavelengths characteristic of G-quadruplex structures. Analyses of these oligonucleotides by native polyacrylamide gel electrophoresis, gel-shift assay, immunostaining and replication stop assay revealed formation of multiple types of G-quadruplex structures in presence of potassium and lithium ions. In reporter assays, mutations or deletion of the G-tracts could differentially impact the expression of Gaussia luciferase downstream of the HOXC10 promoter. Additionally, CHD7, a chromatin remodeling protein with DNA helicase activity, could associate with the HOXC10 promoter and likely unwind the G-quadruplex structures to enhance its gene expression.



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Cyclic Change of Sphincter of Oddi Motility and Its Relationship with Small Bowel Migrating Motor Complex in Humans

Abstract

Background

Several animal and human studies have reported that sphincter of Oddi (SO) motility shows cyclical changes during the fasting state. However, to date, the relationship between the SO motility and the migrating motor complex (MMC) of the small bowel (SB) remains unclear in humans.

Aims

We observed SO motility over a long study period and evaluated its relationship with the MMC of the SB in humans using percutaneous long-term manometry.

Methods

Our study included patients with hepatolithiasis who required percutaneous transhepatic catheter placement and subsequently underwent choledochoscopy and stone removal. Long-term percutaneous transhepatic SO manometry was performed after complete stone removal. SO and SB motility were simultaneously recorded.

Results

SO motility showed cyclical phasic changes with periodic high-frequency contractions similar to the MMC contractions of the SB. All high-frequency contractions of the SO coincided with phase III contractions of the MMC of the SB. The proportions of phase III contractions of SO and SB were similar, but the proportions of phase I (P = 0.001) and phase II (P = 0.002) contractions were significantly different. The mean basal SO pressure was observed to significantly increase in phase III compared to phase I (P = 0.001) and phase II (P = 0.001) contractions.

Conclusions

SO motility in humans showed cyclical phasic changes closely coordinated with the MMC of the SB in a fasting state; however, the proportion of phases differed between the SO and the SB. The basal pressure significantly increased during physiological high-frequency phase III contractions of the SO.



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Chronic hyperglycemia with elevated glycated hemoglobin level and its association with postoperative acute kidney injury after a major laparoscopic abdominal surgery in diabetes patients

Abstract

Background

The relationship between preoperative hyperglycemia and postoperative acute kidney injury (AKI) occurrence in non-cardiac surgery including laparoscopic surgery remains unclear. This study aimed to assess the relationship between preoperative chronic hyperglycemia and postoperative AKI occurrence after a major laparoscopic abdominal surgery.

Methods

We retrospectively reviewed medical records of diabetic patients (≥ 20 years old) who underwent elective major laparoscopic abdominal surgery procedures between 2010 and 2016. Patients were divided into two groups based on a cut-off value of hemoglobin A1c (HbA1c) at 6%. Serum creatinine value was used for the diagnosis of AKI, and all assessments and diagnoses of postoperative AKI were performed on 0–3 postoperative days (POD) using the criteria of Kidney Disease: Improving Global Outcomes.

Results

In all, 1885 patients were included in the final analysis, and patients were divided into the following groups: < 6.0% group with 1257 patients (66.7%), and ≥ 6.0% group with 628 patients (33.3%). Sixty-nine patients (3.7%) were diagnosed with postoperative AKI within 3 POD. Multivariable logistic regression analysis showed no significant difference in the incidence rate of postoperative AKI between the HbA1c ≥ 6.0% group and the < 6.0% group (odds ratio 1.10, 95% confidence interval 0.57–2.15; P = 0.770). In addition, there was no significant interaction between preoperative HbA1c group and exposure to acute hyperglycemia (serum glucose > 200 mg/dL) for incidence of AKI on POD 0–3 (P = 0.181).

Conclusions

In diabetic patients, preoperative chronic hyperglycemia is not associated with postoperative AKI occurrence within 3 POD after a major laparoscopic abdominal surgery.



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Editorial Board

Publication date: October 2018

Source: International Journal of Psychophysiology, Volume 132, Part B

Author(s):



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International Organization of Psychophysiology

Publication date: October 2018

Source: International Journal of Psychophysiology, Volume 132, Part B

Author(s):



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An intensive medical care network led to successful living-donor liver transplantation in late-onset hepatic failure with disseminated Staphylococcus aureus infection

Abstract

Here, we describe a 42-year-old male patient with late-onset hepatic failure (LOHF) due to acute-onset autoimmune hepatitis. At first, his response to steroid therapy was good, but hepatitis relapsed during steroid pulse therapy. Deterioration of liver function caused LOHF, and LOHF has a poor prognosis, particularly when it is complicated by infection. Systemic infection by Staphylococcus aureus resulted in a skin rash and septic pulmonary embolism, and is an absolute contraindication for liver transplantation (LT). In this treatment network, hepatologists and a transplant surgeon cooperated to overcome severe infection and their efforts led to successful transplantation. On-line hemodiafiltration is an indispensable treatment option for acute liver failure. Infection control is crucial for LT and an intensive medical care network led to successful living-donor LT.



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Bladder Symptoms in Children with Functional Constipation: A Systematic Review

Objective: To perform a systematic review of the literature examining the prevalence of bladder symptoms in children with functional constipation (FC), and to compare the prevalence of those symptoms between children with and without FC. Methods: In this systematic review 4 databases were searched to July 2018. Studies investigating the prevalence of bladder symptoms in children aged 4 to 17 years with FC were included. There was no language restriction. Two reviewers independently extracted data and assessed study quality. Clinical heterogeneity between studies was investigated. Prevalence rates of bladder symptoms in children with FC were calculated. Relative risks were calculated to compare the prevalence of bladder symptoms between children with and without FC. Results: Among 23 studies of children with FC, 22 reported the prevalence bladder symptoms (12,281 children) and 7 reported the prevalence of urinary tract infections (UTI) (687 children). The prevalence rates of single bladder symptoms, lower urinary tract symptoms (LUTS), and UTI varied between 2%–47%, 37%–64%, and 6%–53%. The relative risks were 1.24–6.73 for 20 single bladder symptoms (12 studies) and 2.18–6.55 for UTI (2 studies). The 95% confidence intervals indicated significance in 14 of 20 single bladder symptoms. Conclusions: Bladder symptoms seem common in children with FC, but the reported prevalence varies greatly. Children with FC are more likely to have bladder symptoms than children without FC. We recommend that clinicians be aware of concomitant bladder symptoms in children presenting with FC. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/OBJ4xP Address correspondence and reprint requests to Marjolein Y. Berger, MD, PhD, Department of General practice and Elderly care medicine, PO Box 196, 9700 AD Groningen, The Netherlands (e-mail: m.y.berger@umcg.nl). Received 25 May, 2018 Accepted 7 August, 2018 Funding source: All phases of this study were supported by a grant of the P.W. Boer foundation for education and research in urology, the Netherlands. Financial disclosure: The funding organization had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. Prospero protocol registration: PROSPERO 2016:CRD42016045742, https://ift.tt/2p6ztny Conflicts of interest: The authors have no conflicts of interest disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Effects of twitch contraction induced by magnetic stimulation on expression of skeletal muscle fibrosis related genes and limited range of motion in rat

Objective We examined the effects of twitch contraction induced by lumbar spinal root magnetic stimulation on immobilization-induced limited ROM and skeletal muscle fibrosis in rat soleus muscle. Design The groups included male Wistar rats (controls), rats with both bilateral ankle joints immobilized with plaster casts for 4 weeks (IM), and rats in which twitch contraction of the soleus muscle was induced by lumbar magnetic stimulation over the course of 4 weeks of immobilization (TC). Group differences in ankle dorsiflexion ROM, collagen content as determined by hydroxyproline assay, and the expression of fibrosis-related genes as determined by RT-PCR (hypoxia inducible factor-1α, α-smooth muscle actin, and types I and III collagen) in the soleus muscle were examined after the 4-week-long experiment. Results ROM in the TC group was significantly greater than that in the IM group. The hydroxyproline content and the expressions of fibrosis-related genes decreased significantly in the TC group compared to those in the IM group. No significant differences were seen in the expression of TGF-β mRNA. Conclusions These results suggest that twitch contraction induced by lumbar spinal root magnetic stimulation may reduce immobilization-induced limited ROM and skeletal muscle fibrosis. Corresponding author: Junya Sakamoto, Department of Physical Therapy, Unit of Physical and Occupational Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan. TEL/Fax: +81-95-819-7964. E-mail: jun-saka@nagasaki-u.ac.jp Conflict of interest: None. Grant sponsor: This work was supported by a JSPS KAKEN Grant-in-Aid for Young Scientists (B) Number 24700539 from the Ministry of Education, Science, Sports and Culture (MEXT) Financial benefits to the authors: None Ethical approval: Animal care and experimental procedures were performed in accordance with the Guidelines for Animal Experimentation of Nagasaki University and were approved by the Institutional Animal Care and Use Committee. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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V-Mart, a Virtual Reality Grocery Store: A Focus Group Study of a Promising Intervention for Mild Traumatic Brain Injury and Post-Traumatic Stress Disorder

Objective This study examined the potential usability, relevance, and acceptability of V-Mart, a virtual reality grocery store as an assessment and intervention tool for veterans with mild traumatic brain injury (mTBI). Design Six focus groups were conducted over a two-year period to assess perceptions from three key stakeholders: therapists, veterans with neither mTBI nor PTSD, and veterans with mTBI with or without PTSD (mTBI/PTSD). The System Usability Scale (SUS) was applied as an objective measure of usability. Transcripts from the six focus groups were subjected to thematic analyses using the constant, comparative method. Results The focus groups indicated that V-Mart was perceived as highly usable, relevant, and acceptable. Early technical problems were resolved satisfactorily. Therapists indicated that they would use an application such as V-Mart if it were available. The veterans with neither mTBI nor PTSD felt it was realistic and likely to be useful, as did the veterans with mTBI/PTSD. SUS mean follow-up scores ranged from 71.4-86.0, surpassing the threshold for acceptable usability in health care settings. Conclusions Focus group and SUS data indicate that the V-Mart has great potential as an assessment tool and intervention for veterans with mTBI/PTSD. Further development and clinical trials are warranted. Charles E. Levy, MD, Center of Innovation on Disability and Rehabilitation, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, 352-376-1611, ext. 4922, 352-271-4540, Charles.levy@va.gov Acknowledgments This material is based upon work supported by the Congressionally Directed Medical Research Program/Department of Defense, Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and Health Services Research and Development. Principal Investigator: W81XWH-08-2-0194, Design of Effective Therapeutic Interventions for Mild TBI/PTSD using Interactive Virtual World Environments, CDMRP/DoD 9.15-08-10.14.09, $142,189 Principal Investigator: Development of Virtual Humans For PTSD and mTBI: Rehabilitation Outcomes Research Center, 2010-2011, $43,527 Principal Investigator: 1I01RX000339-01A3, Virtual Environments for Therapeutic Solutions (VETS) mTBI/PTSD Phase II, VA RR&D, 4.1.13-3.30.17, $824,835 We would like to acknowledge Virginia Hessels, who contributed invaluable assistance in manuscript preparation Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Turkish adaptation of Parkinson fatigue scale and investigating its psychometric properties

Parkinson's disease (PD) is one of the most common chronic degenerative diseases of the nervous system. In PD, nonmotor symptoms are seen as frequently as motor symptoms. Fatigue can occur in all stages of PD and leads to significant disabilities. The aim of this study was to investigate the psychometric properties of the Turkish version of Parkinson fatigue scale (PFS). Ninety-six patients with idiopathic PD were included in this study with a cross-sectional and test–retest design. Structural validity, internal consistency and test–retest reliability of PFS were analyzed. For convergent validity, fatigue severity scale and modified fatigue impact scale were used. Internal consistency was determined by the Cronbach's α coefficient. For test–retest reliability, PFS was repeated after a 7–14-day period. Significant strong correlations were found between the PFS and the fatigue severity scale (rs=0.844) and the modified fatigue impact scale (rs=0.764), which indicate a high convergent validity. The Cronbach's α coefficient, which indicates the internal consistency of the scale, was calculated as 0.947. The test–retest reliability was found to be high (intraclass correlation coefficient=0.928). This study suggests that the Turkish version of PFS is valid and reliable. PFS is suitable for use by researchers and healthcare professionals to assess fatigue in Turkish-speaking patients with PD. Correspondence to Göksel Çilga, MSc, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Manisa Celal Bayar University, Uncubozkoy Campus 45030 Yunusemre, Manisa, Turkey Tel: +90 236 233 0904; fax: +90 236 233 7169; e-mail: goksel.cilga@hotmail.com Received June 9, 2018 Accepted August 10, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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PNPLA3 Gene Polymorphisms in HCV/HIV-Coinfected Individuals

Abstract

Background and Aims

The patatin-like phospholipase domain-containing 3 (PNPLA3) gene has been associated with the development of alcoholic and nonalcoholic steatohepatitis. Using a newly developed and validated assay for PNPLA3, we explored the prevalence of gene polymorphisms in a cohort of HCV/HIV-coinfected individuals to determine whether there was an association with insulin resistance or hepatic fibrosis.

Methods

A high-resolution melting point (HRM) assay was developed and validated. The assay was used to evaluate samples obtained in the context of a clinical trial performed at ACTG sites across the USA in HIV-infected patients. Clinical features and treatment outcomes were assessed in relation to the PNPLA3 genotype.

Results

The HRM methodology demonstrated 100% concordance with results obtained by Sanger sequencing. Among 241 participants tested, 66.0% had the wild-type allele (CC) and the remainder had the aberrant PNPLA3 gene polymorphism in the homozygotic (GG) or heterozygotic (CG) form. Race and ethnicity were associated with PNPLA3 genotype but fibrosis stage, Homeostatic Model Assessment of Insulin Resistance, and HCV treatment outcome were not.

Conclusion

The HRM method is an effective, rapid technique for characterizing PNPLA3 genotype. In those with HCV/HIV infection, nearly 40% carry gene polymorphisms associated with the development of NASH or ASH. Prospective studies should focus on this group to determine whether they represent a subset of HIV-infected persons at increased risk of fibrotic progression.



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Passing the “Acid Test”: Do Proton Pump Inhibitors Affect the Composition of the Microbiome?



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