Σάββατο, 6 Οκτωβρίου 2018

ASGE high-risk criteria for choledocholithiasis − are they applicable in cholecystectomized patients?

The guidelines by the American Society for Gastrointestinal Endoscopy (ASGE) suggest that in patients with gallbladder in situ, endoscopic retrograde cholangiopancreatography (ERCP) should be performed in the presence of high-risk criteria for choledocholithiasis, after biochemical tests and abdominal ultrasound. There are no specific recommendations for cholecystectomized patients. The aim of this study was to evaluate the applicability of ASGE criteria for ERCP in cholecystectomized patients with suspected choledocholithiasis.

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Radial Nerve Injury Caused by Compression Garment for Lymphedema: A Case Report

Lymphedema is a condition characterized by localized fluid retention and tissue swelling caused by a compromised lymphatic system. To minimize fluid build-up and stimulate the flow of fluid through the lymphatic system, compression garments are usually applied to patients with lymphedema. There are few studies to report complications of compression garments to treat breast cancer-related lymphedema. To our knowledge, this is the first report of radial nerve compression neuropathy associated with wearing a compression garment to treat lymphedema.

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Venous Thromboembolism is Associated with Lack of Vitamin D Supplementation in Patients with Spinal Cord Injury and Low Vitamin D Levels

The role of vitamin D (VitD) in the pathogenesis of venous thromboembolism (VTE) and prevalence of low VitD (LVitD) in spinal cord injury (SCI) has motivated VitD testing and supplementation. This is an exploratory study of data collected at a time before the routine clinical practice of VitD supplementation, allowing for evaluation of the natural history of LVitD levels in patients with SCI.

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Palmaris Longus Tendinopathy Diagnosed with Ultrasound: A Case Report

This is a case of 52-year old deaf female who was referred to the electrodiagnostic (EDX) laboratory for evaluation of pain and parasthesias in the left upper limb. The EDX study was normal. However, ultrasound revealed tendinopathy of the palmaris longus tendon, manifested by increased hypoechogenecity, caliber, and tenderness to sonopalpation compared to the right side. To the authors' knowledge there are no reported cases of palmaris longus tendinopathy diagnosed with ultrasound. This case supports the use of point of care ultrasound to explore other possible causes of pathology in patients with parasthesias in the context of a normal EDX study.

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The Effectiveness of Injected Corticosteroid Type, Dose, and Volume for the Treatment of Pain in Small- and Intermediate-size Joints: A Systematic Review

To systematically evaluate the scientific literature examining the efficacy of corticosteroid injections in small- and intermediate-size joints, specifically looking at the effect of corticosteroid type, dose, and volume on clinical outcomes (pain and/or function).

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Periampullary Diverticula and ERCP Outcomes: A Systematic Review and Meta-Analysis

Abstract

Introduction

Periampullary diverticulum (PAD) is most often asymptomatically found in elderly population. ERCP in the presence of PAD is technically challenging since the location and orientation of the ampulla could be altered. Various studies have reported differing results on the technical success and safety outcomes of ERCP in the presence of PAD. We aimed at a meta-analysis of such studies to assess the technical success and the occurrence of complications during ERCP in patients with PAD.

Methods

We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (earliest inception to October 2017). The search was done in accordance with PRISMA guidelines to identify studies. Studies that reported on the ERCP outcomes based on the presence of PAD were included. Both prospective and retrospective studies, manuscripts and abstracts were included. Only articles in English literature were included. The primary analysis focused on the overall technical success of ERCP in the presence of PAD, and the secondary analysis was to estimate the risk of occurrence of complications.

Results

Our search resulted in 16 studies that were included for final analysis. These 16 studies reported on 2794 patients, who had PAD, and the control group included 13,032 patients, who did not have a PAD during ERCP. Our meta-analysis of this data showed an Odd's ratio estimate of having a successful ERCP procedure in patients with PAD to be 0.51 [95% C.I. (0.35–0.72)] when compared to patients without it. This was statistically significant, with a p value 0.00. Considerable heterogeneity was noted among the studies. The heterogeneity proportion was quantified at 74.6% based on I2 statistic. The secondary outcomes measured were complications. We analyzed the pooled Post-ERCP Pancreatitis (PEP), cholangitis, perforation, and bleeding. Only those studies that had the data for these complications in both the study and the control groups were selected. PEP: The pooled Odd's estimate of having PEP was 1.28, [95% C.I (0.88–1.87)] from 12 studies reporting on 1863 patients with PAD in comparison with 7803 patients without it. The risk of PEP occurrence tended to be more in the group without PAD, though it was not statistically significant, with a p value 0.20. There was some heterogeneity observed between the studies, with the quantification I2 statistic being 28.6%. Our analysis shows that having PAD does not put a patient at increased risk for PEP. Bleeding: The pooled Odds estimate was 1.69, 95% C.I. 0.88–3.25 from nine studies reporting on 1816 patients with PAD in comparison with 5327 patients without it. This was not statistically significant, p value 0.11. Considerable heterogeneity was noted, with I2 being 55.7%. The risk of having a bleed was noted to be more in control group, and having PAD did not put patients at increased risk for bleeding during an ERCP procedure. Perforation: Patients with PAD undergoing ERCP were not at increased risk for perforation. Seven studies reported on this complication. This was noted in seven patients out of 1245 in study group, and 19 patients out of 4912 in control group. The pooled Odd's estimate was 1.24, 95% C.I. 0.54–2.87. There was no statistical significance, p value 0.61. No heterogeneity was noted among the studies included in this analysis. Cholangitis: Only four studies reported on this complication. In a total of 778 patients in study group, four had cholangitis and eight had this complication out of 3886 patients in the control group. The pooled Odd's was 2.12, 95% C.I. 0.61–7.33. There was no statistical significance, p value 0.24. No heterogeneity was noted.

Conclusion

ERCP is technically feasible and increasingly successful when performed by experts in the presence of PAD. The risk of complications such as PEP, bleeding, perforation and cholangitis does not differ between ERCP done in patients with and without PAD.



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How neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option

Abstract

Background and aim

Neuraxial analgesia techniques are not limited to just standard epidural and CSE blocks. A novel approach called dural puncture epidural (DPE) which is a modification of CSE in terms of practice has gained popularity after its description and use in the obstetric population.  The aim of this review is to address the practice of DPE technique as a novel option by reviewing its benefits as well as side and/or adverse effects and to understand how neuraxial labor analgesia differs by approach based on the information available in the current literature

Discussion

Despite controversies and concerns, more rapid onset of analgesia, early bilateral sacral analgesia, lower incidence of asymmetric block and fewer maternal and fetal side effects are provided with DPE when compared to epidural.

Conclusion

DPE offers a favorable risk–benefit ratio for management of neuraxial analgesia as a novel option.



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It's complicated… m6A-dependent regulation of gene expression in cancer

Publication date: Available online 5 October 2018

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

Author(s): Christina M. Fitzsimmons, Pedro J. Batista

Abstract

Cellular function relies on multiple pathways that are coordinated to ensure the proper execution of gene expression networks. Failure to coordinate the multiple programs active in the cell can have catastrophic consequences and lead to diseases such as cancer. At the post-transcriptional level, RNA modifications play important roles in the regulation of gene expression. N6-methyladenosine (m6A) is the most abundant internal messenger RNA (mRNA) modification and has gained increasing interest in the last few years as a dynamic regulator of RNA metabolism. Modifications regulate all stages of the RNA life cycle, from transcription to decay. Recent studies have pointed to the role of RNA methylation in cancer initiation and progression, and aberrant modification has served as a biomarker of early-stage diagnosis in several cancers. Here, we review the regulation of m6A, disruptions to methylation-dependent pathways that influence carcinogenesis, and potential avenues for m6A-related therapeutic strategies.



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Angiotensin II-mediated suppression of synaptic proteins in mouse hippocampal neuronal HT22 cell was inhibited by propofol: role of calcium signaling pathway

Abstract

Purpose

Angiotensin II (Ang II) has been shown to be involved in neurological disorders. Propofol demonstrated neuroprotective effects in neurons.

Methods

Mouse hippocampal HT22 cells were pre-treated with propofol, followed by Ang II treatment. The expression of synaptic proteins (synapsin I and PSD95) was examined. The effects of propofol on Ang II-induced NADPH oxidase expression and superoxide anion generation were examined. The effects of propofol on intracellular calcium concentration, the activation of calcium/calmodulin-dependent protein kinase II (CaMKII), and protein kinase C (PKC) were measured.

Results

Ang II reduced the expression of synapsin I and PSD95, which was attenuated by propofol. Ang II-induced effects were blocked by Ang II type 1 receptor (AT1 receptor) blocker. Ang II induced the expression of NADPH oxidase and caused superoxide anion accumulation, which were attenuated by propofol. In addition, propofol induced intracellular calcium concentration, and activated CaMKII as well as PKCβ. Importantly, the Ang II-mediated effects were diminished by α-tocopherol, and the propofol-mediated effects were alleviated by calcium chelator, CaMKII inhibitor, and PKCβ inhibitor.

Conclusion

Ang II, via AT1 receptor, induced oxidative stress and reduced the expression of synapsin I and PSD95 in HT22 cells. Propofol may increase synapsin I and PSD95 expression by inhibiting oxidative stress and stimulating calcium signaling pathway.



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137Cs and K annual fluxes in a cropland and forest ecosystems twenty-four years after the Chernobyl accident

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 195

Author(s): Ol'ga Tsvetnova, Alexey Shcheglov, Alexey Klyashtorin

Abstract

Biological cycles of the Chernobyl originated cesium-137 (137Cs, radiocesium) and the natural potassium (K) in oak, birch, and pine forest, and wheat cropland in Russian Federation, approximately 500 km northeast of the Chernobyl Nuclear Power Plant, were subject to a multiyear monitoring. By 2010, the annual return of 137Cs from forest vegetation to the soil in dead tree components still exceeds its annual accumulation in the tree phytomass by a factor of 4–6, apparently due to residual surface contamination in the external bark and the ongoing process of tree stand decontamination following the initial fallout. In the cropland, both ascending and descending fluxes of 137Cs are close to the steady state. The annual accumulation of 137Cs in the tree biomass was the highest in the oak forest and the lowest in the pine forest. The annual K accumulation was the highest in the cropland and the lowest in the pine forest.



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An ex vivo bladder model with detrusor smooth muscle removed to analyze biologically active mediators released from the suburothelium

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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In memoriam James L. German, a pioneer in early human genetic research

American Journal of Medical Genetics Part A, EarlyView.


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Mutations in the tRNA methyltransferase 1 gene TRMT1 cause congenital microcephaly, isolated inferior vermian hypoplasia and cystic leukomalacia in addition to intellectual disability

American Journal of Medical Genetics Part A, EarlyView.


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Haploinsufficiency of NCOR1 associated with autism spectrum disorder, scoliosis, and abnormal palatogenesis

American Journal of Medical Genetics Part A, EarlyView.


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Risk of hepatic neoplasms in Wolf–Hirschhorn syndrome (4p‐): Four new cases and review of the literature

American Journal of Medical Genetics Part A, EarlyView.


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Basan gets a new fingerprint: Mutations in the skin‐specific isoform of SMARCAD1 cause ectodermal dysplasia syndromes with adermatoglyphia

American Journal of Medical Genetics Part A, EarlyView.


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Copy number variants in hypoplastic right heart syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Variance of IQ is partially dependent on deletion type among 1,427 22q11.2 deletion syndrome subjects

American Journal of Medical Genetics Part A, EarlyView.


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Preliminary observations of mitochondrial dysfunction in Prader–Willi syndrome

American Journal of Medical Genetics Part A, EarlyView.


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An additional patient with a homozygous mutation in DCPS contributes to the delination of Al‐Raqad syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Mosaic KRAS mutation in a patient with encephalocraniocutaneous lipomatosis and renovascular hypertension

American Journal of Medical Genetics Part A, EarlyView.


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The characteristics of temper outbursts in Prader–Willi syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Prenatal profile of Pallister‐Killian syndrome: Retrospective analysis of 114 pregnancies, literature review and approach to prenatal diagnosis

American Journal of Medical Genetics Part A, EarlyView.


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Dental and craniofacial characteristics caused by the p.Ser40Leu mutation in IFITM5

American Journal of Medical Genetics Part A, EarlyView.


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A de novo in‐frame deletion of CASK gene causes early onset infantile spasms and supratentorial cerebral malformation in a female patient

American Journal of Medical Genetics Part A, EarlyView.


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Parental Factors in Pediatric Functional Abdominal Pain Disorders: A Cross-Sectional Cohort Study

Objectives: Parental factors are suggested to play a role in pediatric irritable bowel syndrome (IBS) and functional abdominal pain – not otherwise specified (FAP-NOS) and may influence treatment. Since studies on parental factors mainly focus on mothers, this study aims to compare physical health, psychological distress, personality dimensions and parenting behavior of both parents of children with IBS or FAP-NOS to parents of controls. Methods: Parents of 91 children with IBS or FAP-NOS were included in this explorative cross-sectional cohort study. Parents of 74 age-matched healthy children were used as controls. Questionnaires were used to measure demographics, physical health, psychological distress and symptoms, personality dimensions and child-rearing practices. Results: 59 mothers and 52 fathers of 61 children with IBS/FAP-NOS (response rate 61.0%) and 56 mothers and 49 fathers of 59 controls completed the study (response rate 70.9%). Mothers of children with IBS/FAP-NOS reported more physical problems. Psychological distress and symptoms, personality dimensions and child-rearing practices did not differ between mothers of both groups. Fathers of children with IBS/FAP-NOS had significantly lower scores on the child-rearing practice subscale of ignoring of unwanted behavior. In the IBS/FAP-NOS group, fathers were more depressed and less agreeable than mothers. No differences on all assessed outcomes were found between parents of children with IBS and children with FAP-NOS. Conclusions: Mothers of children with IBS/FAP-NOS and healthy peers differ with respect to physical health. Fathers in both groups differ with respect to child-rearing style. Clinicians should be aware of these differences when treating children with these disorders. Address correspondence and reprint requests to Judith Zeevenhooven, Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital / Amsterdam University Medical Centers, location AMC, Room C2-312, PO Box 22700, 1100 DD Amsterdam (e-mail: j.zeevenhooven@amc.nl). Received 27 June, 2018 Accepted 20 September, 2018 Judith Zeevenhooven and Juliette M.T.M. Rutten contributed equally Financial disclosure statement: The authors have indicated they have no financial relationships relevant to this article to disclose. Source of funding: none Conflicts of interest: none declared © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Pediatric chronic inflammatory bowel disease in a German statutory health INSURANCE - incidence rates from 2009 - 2012

Objective: The incidence of pediatric inflammatory bowel disease (PIBD) varies over time and geographic region. We attempted to generate incidence rates form German health insurance data. Methods: We used health care data for 2009–2015 provided by BARMER, a major statutory health insurance company in Germany, insuring approx. 8% of the pediatric population. We applied a Canadian case definition for PIBD based on ICD coding, documentation of (ileo)colonoscopy and the number of PIBD related visits, without external validation for Germany. An internal validation of the specificity of the diagnosis by checking whether the identified incident cases had also prescriptions of PIPD specific drugs was performed. Results: In 2012, 187 pediatric patients were newly diagnosed, accounting for an overall PIBD incidence of 17.41 (95%-CI: 15.08-20.10) per 100,000 insured children and adolescents from 0-17.9 years per year compared to 13.65/100,000 (95%-CI: 11.63-16.01) in 2009. The age specific incidence showed a steep increase as of the age of 7 years. The PIBD prevalence in 2012 was 66.29/100,000. Conclusion: In conclusion, the incidence of PIBD in 0 -17.9-year olds in Germany with health BARMER health insurance in 2012 is among the highest reported in the literature. Address correspondence and reprint requests to Dr. Lucia Albers, LMU, Institute of Social Pediatrics and Adolescents Medicine, Haydnstraße 5, 80336 Munich (e-mail: lucia.albers@med.uni-muenchen.de). Received 27 March, 2018 Accepted 20 September, 2018 Regina Wittig and Lucia Albers contributed equally. This publication is part of the doctoral thesis of Regina Wittig. Source of Funding: There was no funding for this study. Conflicts of Interest: The authors declare none conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's 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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Dysbiosis in Snoring Children: an Interlink to Comorbidities?

Background and Objectives: Early microbial colonization has a key impact on infant health through nutritional, immunological, and metabolic programming. The origin of child snoring is multifactorial and complex, and may thereby also generate long-term health problems. The link between child snoring and gut microbes remains unclear, although indirect evidence exists regarding this relationship. This study aimed to characterize the connection between gut microbiota and child snoring. Methods: In a prospective, observational CHILD-SLEEP birth cohort study, gut microbiota in a subcohort of 43 of these children at 2 years of life was profiled with 16S ribosomal RNA gene amplicon sequencing. Results: A higher abundance of the Proteobacteria phylum, the Enterobacteriaceae family, and Erysipelotrichaceae family, as well as a higher ratio of Firmicutes to Bacteroidetes were detected in snorers as compared to controls. Furthermore, snorers showed significantly lower microbial diversity and richness than non-snorers. Conclusions: The snoring children manifest different gut microbiota as compared with healthy children. Considering that snoring and sleep disorders can be a source of long-term consequences, including cardiovascular, metabolic, immunological, neurocognitive and behavioural consequences, our results proposes early microbiota as a new treatment target. Address correspondence and reprint requests to Maria Carmen Collado, PhD, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), Av. Agustin Escardino 7, 46980 Paterna, Valencia, Spain (. e-mail: mcolam@iata.csic.es). Received 6 May, 2018 Accepted 15 September, 2018 Funding Source: No external funding for this manuscript. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflict of Interest: The authors have no conflicts of interest relevant to this article to disclose. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Spontaneous cardiac baroreflex sensitivity is enhanced during post-exercise ischemia in men but not in women

Abstract

Purpose

To investigate the effect of isolated muscle metaboreflex activation on spontaneous cardiac baroreflex sensitivity (cBRS), and to characterize the potential sex-related differences in this interaction in young healthy subjects.

Methods

40 volunteers (20 men and 20 women, age: 22 ± 0.4 year) were recruited. After 5-min rest period, the subjects performed 90 s of isometric handgrip exercise at 40% of maximal voluntary contraction followed by 3 min of post-exercise ischemia (PEI). Beat-to-beat heart rate and arterial blood pressure were continuously measured by finger photopletysmography. Spontaneous cBRS was assessed using the sequence technique and heart rate variability was measured in time (RMSSD—standard deviation of the RR intervals) and frequency domains (LF—low and HF—high frequency power).

Results

Resting cBRS was similar between men and women. During PEI, cBRS was increased in men (Δ3.0 ± 1.1 ms mmHg− 1, P = 0.03) but was unchanged in women (Δ-0.04 ± 1.0 ms mmHg− 1, P = 0.97). In addition, RMSSD and HF power of heart rate variability increased in women (Δ7.4 ± 2.6 ms, P = 0.02; Δ373.4 ± 197.3 ms2; P = 0.04, respectively) and further increased in men (Δ26.4 ± 7.1 ms, P < 0.01; Δ1874.9 ± 756.2 ms2; P = 0.02, respectively). Arterial blood pressure increased from rest during handgrip exercise and remained elevated during PEI in both groups, however, these responses were attenuated in women.

Conclusions

These findings allow us to suggest a sex-related difference in spontaneous cBRS elicited by isolated muscle metaboreflex activation in healthy humans.



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