Design and Application of 3D-Printed Photometers Controlled with an Arduino

3D Printing and Additive Manufacturing, Ahead of Print.


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Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine

Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse.

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COLO-R Ectal Endoscopic Full-thickness Resection (EFTR) with the over-the-scope device (FTRD®): A multicenter Italian experience

Endoscopic full-thickness resection(EFTR) with FTRD® in colo-rectum may be useful for several indications.The aim was to assess its efficacy and safety.

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The Burden of Digestive Disease across Europe: Facts and Policies.

The past decade has witnessed a significant increase in the incidence of GI diseases across Europe. There are clear differences in outcomes for patients in Europe based on geographical and economic differences, and there is a worrying inequality in the provision of healthcare across the continent. Recent demographic studies have highlighted the heavy burden of GI disease across Europe. There is increasing demand for endoscopic procedures which are becoming increasingly more complex and demand further expertise and training.

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Cost analysis and outcome of endoscopic submucosal dissection for colorectal lesions in an outpatient setting

Endoscopic submucosal dissection (ESD), a minimally invasive treatment for early gastrointestinal (GI) cancer, is considered challenging and risky in the colorectum. As such, most patients undergoing ESD are hospitalized due to the perceived increased risk of adverse events. The aim of this study was to compare the costs, safety and efficacy of colorectal-ESD in an outpatient vs inpatient setting in a tertiary level center.

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Interested in community paramedicine programs? Here are 3 things to consider

Whether you're looking to start or maintain a community paramedicine program, don't overlook these areas that can help make a difference

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Blood pressure-related pain modulation in fibromyalgia: Differentiating between static versus dynamic pain indicators

Publication date: Available online 12 October 2018

Source: International Journal of Psychophysiology

Author(s): Pablo de la Coba, Stephen Bruehl, Stefan Duschek, Gustavo A. Reyes del Paso

Abstract

Introduction

Resting blood pressure (BP) has been found to be inversely associated with evoked pain responsiveness in healthy populations. However, some reports suggest that BP-related pain modulation may be dysfunctional in chronic pain patients. This study examined whether BP-related pain modulation, indexed by both static and dynamic evoked pain responses, is altered in fibromyalgia (FM) patients compared to pain-free individuals.

Method

Pain threshold and tolerance as static evoked pain measures and slowly repeated evoked pain (SREP) as a dynamic evoked pain index were measured in 30 FM patients and 27 healthy controls. BP was continuously recorded throughout a 5 minute pre-pain rest period.

Results

SREP sensitization was observed only in the FM group. Higher BP predicted elevated pain threshold and tolerance in healthy individuals, but not in FM. Conversely, BP was inversely associated with SREP sensitization in FM whereas no association was found in healthy controls.

Conclusions

Static evoked pain measures suggested BP-related pain inhibitory dysfunction in FM. In contrast, for pain sensitization as indexed by SREP, FM displayed the expected BP-related inhibitory effects. BP-related pain modulation is manifested in FM differentially for static versus dynamic pain indicators. Use of both types of evoked pain measures may be valuable in the study of mechanisms underlying altered pain modulatory systems in FM.

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Cerebral blood flow is not modulated following acute aerobic exercise in preadolescent children

Publication date: Available online 12 October 2018

Source: International Journal of Psychophysiology

Author(s): Matthew B. Pontifex, Kathryn L. Gwizdala, Timothy B. Weng, David C. Zhu, Michelle W. Voss

Abstract

Cognitive enhancements following a single bout of exercise are frequently attributed to increases in cerebral blood flow, however to date we have little understanding of the extent to which such bouts of exercise actually even influence cerebral blood flow following the cessation of exercise. To gain such insight, both regional and global changes in cerebral blood flow were assessed using 3D pseudo-continuous arterial spin-labeled magnetic resonance imaging in a sample of 41 preadolescent children. Using a within-participants randomized crossover design, cerebral blood flow as assessed prior to and following 20-min of either aerobic exercise or an active-control condition during two separate, counterbalanced sessions. The aerobic exercise condition consisted of walking/jogging on a motor driven treadmill at an intensity of approximately 70% of age-predicted maximum heart rate (HR = 136.1 ± 11.1 bpm). The active control condition consisted of walking on the treadmill at the lowest possible intensity (0.5 mph and 0% grade; HR = 92.0 ± 12.2 bpm). Findings revealed no differences in cerebral blood flow following the cessation of exercise relative to the active control condition. These findings demonstrate that cerebral blood flow may not be altered in preadolescent children following the termination of the exercise stimulus during the period when cognitive enhancements have previously been observed.

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Preoperative Evaluation: Is It Time to View It as a Component of Perioperative Optimization?

Publication date: Available online 11 October 2018

Source: Anesthesiology Clinics

Author(s): Lee A. Fleisher

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Differences in glucose metabolism among women with spinal cord injury may not be fully explained by variations in body composition

Publication date: Available online 12 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jia Li, Gary R. Hunter, Yuying Chen, Amie McLain, Daniel L. Smith, Ceren Yarar-Fisher

Abstract

Objective

To investigate the differences in glucose metabolism among women with paraplegic, and tetraplegic spinal cord injury (SCI) in comparison to their able-bodied (AB) counterparts after adjusting for differences in body composition.

Design

Cross-sectional study. Following an overnight fast, each participant consumed a 75-g glucose solution for oral glucose tolerance test (OGTT). Blood glucose, insulin, and C-peptide concentrations were analyzed before and 30-, 60-, and 120-minute post-consumption. Insulin sensitivity index (ISI) was estimated using the Matsuda index. Percentage fat mass (%FM) and total body lean mass (TBLM) were estimated using data from dual-energy X-ray absorptiometry. Visceral fat (VF) was quantified using computerized tomography. Outcome measures were compared among groups using ANCOVA with %FM (or VF) and TBLM as covariates.

Setting

Research University

Participants

Women with SCI (tetraplegia: n=8; paraplegia: n=14) and their race-, body mass index- and age-matched AB counterparts (n=20).

Interventions

Not applicable.

Results

At fasting, there was no difference in glucose homeostasis (glucose, insulin, and C-peptide concentrations) among 3 groups of women. In contrast, glucose, insulin, and C-peptide concentrations at OGTT 120 min were higher in women with tetraplegia vs. women with paraplegia and AB women (P < 0.05, adjusted for TBLM and %FM). In addition, women with tetraplegia had lower ISI (P < 0.05, adjusted for TBLM and %FM) vs. AB women. These differences remained after adjusting for VF and TBLM.

Conclusion

Our study confirms that impaired glucose metabolism among women with tetraplegia may not be fully explained by changes in their body composition. Future studies exploring additional factors involved in glucose metabolism are warranted.

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Patient Satisfaction and Perceived Quality of Care among Younger Medicare Beneficiaries According to Activity Limitation Stages

Publication date: Available online 12 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Olivia A. Bernal, Heather F. McClintock, Jibby E. Kurichi, Pui L. Kwong, Dawei Xie, Joel E. Streim, Liliana E. Pezzin, Hillary R. Bogner

Abstract

Objective

To examine the association between activity limitation stages and patient satisfaction and perceived quality of medical care among younger Medicare beneficiaries.

Design

Cross-sectional study.

Setting

Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011.

Participants

A population-based sample (n=9323) of Medicare beneficiaries less than 65 years of age living in the community.

Interventions

Not applicable.

Main Outcome Measure(S)

MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physician (PCP), interpersonal skills of PCP, and quality of information provided by PCP. Persons were classified into an activity limitation stage (0-IV) which was derived from self-reported difficulty performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Results

Compared to beneficiaries with no limitations at ADL stage 0, the adjusted odds ratios (OR) (95% confidence intervals (CI)) for stage I (mild) to stage IV (complete) for satisfaction with access barriers ranged from 0.62 (0.53-0.72) at stage I to a minimum of 0.31 (0.22-0.43) at stage IV. Similarly, compared to beneficiaries at IADL stage 0, satisfaction with access barriers ranged from 0.66 (0.55-0.79) at stage I to a minimum of 0.36 (0.26-0.51) at stage IV. Satisfaction with care coordination and quality and perceived quality of medical care were not associated with activity limitation stages.

Conclusions

Younger Medicare beneficiaries with disabilities reported decreased satisfaction with access to medical care, highlighting the need to improve access to healthcare and human services and to enhance workforce capacity to meet the needs of this patient population.

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High-intensity respiratory muscle training improves strength and dyspnea after stroke: a double-blind randomized trial

Publication date: Available online 12 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Kênia Kiefer Parreiras de Menezes, Lucas Rodrigues Nascimento, Louise Ada;, Patrick Roberto Avelino, Janaine Cunha Polese, Maria Tereza Mota Alvarenga, Mariana Hoffman Barbosa, Luci Fuscaldi Teixeira-Salmela

Abstract

Objective

To examine whether high-intensity home-based respiratory muscle training, ie, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity after stroke.

Design

Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis.

Setting

Community patients.

Participants

38 patients with stroke, who had respiratory muscle weakness.

Interventions

The experimental group received 40-min high-intensity home-based respiratory muscle training, seven days/week, for eight weeks, progressed weekly. The control group received a sham intervention of similar dose.

Main outcome measures

Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), while secondary outcomes were expiratory muscle strength (minimal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (six-minute walk test). Outcomes were measured at baseline, after intervention, and one month beyond intervention.

Results

Compared to the control, the experimental group increased inspiratory (27cmH₂O; 95%CI 15 to 40) and expiratory (42cmH₂O; 95%CI 25 to 59) strength, inspiratory endurance (33 breathes; 95%CI 20 to 47) and reduced dyspnea (1.3 out of 5.0; 95%CI 2.1 to 0.6) and the benefits were maintained at one-month beyond training. There was no significant between-group difference for walking capacity or respiratory complications.

Conclusion

High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness after stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.

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Predicting outcome after hand orthosis and hand therapy for thumb carpometacarpal osteoarthritis; a prospective study

Publication date: Available online 12 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jonathan Tsehaie, Kim R. Spekreijse, Robbert M. Wouters, Reinier Feitz, Steven Hovius, Harm Slijper, Ruud W. Selles, Hand-Wrist Study Group

Abstract

Objective

1 to identify predictive factors for outcome after splinting and hand therapy for CMC OA and to identify predictive factors for conversion to surgical treatment, and 2) to determine how many patients that have not improved in outcome within six weeks after start of treatment will eventually improve after three months.

Design

Observational prospective multi-center cohort study.

Setting

& participants: Between 2011 and 2014, 809 patients with CMC OA received splinting and weekly hand therapy for three months.

Intervention

Not applicable

Main outcome measures

Satisfaction and pain were measured with a visual analog

scale and function with the Michigan Hand Questionnaire at baseline, six weeks and three months posttreatment. Using regression analysis, patient demographics and pretreatment baseline scores were considered as predictors for the outcome of conservative treatment after three months and for conversion to surgery.

Results

Multivariable regression model explained 34-42% of the variance in outcome (p<0.001) with baseline satisfaction, pain and function as significant predictors. Cox regression analysis showed that baseline pain and function were significant predictors for receiving surgery. Of patients with no clinically-relevant improvement in pain and function after six weeks, 73-83% also had no clinically-relevant improvement after three months.

Conclusion

This study showed that patients with either high pain or low function may benefit most from conservative treatment. We therefore recommend to always start with conservative treatment, regardless of symptom severity of functional loss at start of treatment. Furthermore, it seems valuable to discuss the possibility of surgery with patients after six weeks of therapy, when levels of improvement are still mainly unsatisfactory.

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Tritium in fish from remote lakes in northwestern Ontario, Canada

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 195

Author(s): S.B. Kim, D. Rowan, J. Chen, C.M.C. Rodgers, M.D. Rennie

Abstract

Tritium is most commonly generated as a by-product of nuclear reactors. As such, environmental concentrations are typically only reported near regions of interest, and background concentrations in areas unaffected by anthropogenic disturbance are not well characterized. To provide information on background levels of tritium in the natural environment, tissue-free water tritium (TFWT) and organically-bound tritium (OBT) were measured in the flesh of 106 fish collected within three lakes located at the IISD-Experimental Lakes Area (ELA) in Ontario, Canada in 2014. For the three ELA lakes studied, water tritium (HTO) activity concentration was determined to be below reliably detectable levels (0.6 Bq/L). Fish TFWT was found to be below 0.7 Bq/L, similar to the surrounding water tritium activity concentration. Fish OBT activity concentrations, at below 5 Bq/L, were also very low. Fish size was significantly related to OBT activity in Lake Whitefish and White Sucker from Lake 302, but not in other lakes. Though we observed significant differences in potential tritium exposure to humans among lakes, the levels of tritium reported here are below the Canadian natural background radiation of 1.8 mSv/y. These results provide information on background levels of tritium in freshwater fishes in Canada.

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Uranium in groundwater – The importance of hydraulic regime and groundwater flow system's understanding

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 195

Author(s): Anita Erőss, Katalin Csondor, Bálint Izsák, Márta Vargha, Ákos Horváth, Tamás Pándics

Abstract

Uranium and other natural radionuclides are common components in groundwater, but they are not routinely measured. In drinking water their total activity is screened, but in the evaluation of the measured values usually the aquifer material is only considered. However, the occurrence of radionuclides in groundwater is strongly affected by flow systems and their geochemical characteristics. Therefore hydrogeology and flow system's evaluation is crucial to understand natural radioactivity. Areas of different hydraulic regimes – recharge, throughflow and discharge – even within the same aquifer are characterized by different geochemical environment. In the present study pressure-elevation profiles were generated based on existing basic hydraulic data of wells in order to determine the flow regimes and associated vertical groundwater flow directions. 24–753 mBq L⁻¹ uranium activity concentrations were found in groundwater and surface water showing great areal variability. High uranium values correspond to recharge regimes with downward flow directions. Uranium mobility is enhanced by high bicarbonate content and circumneutral pH. The study emphasize the importance of groundwater flow system's understanding in those areas, where elevated background radioactivity may exist.

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Stack releases of radionuclides from an integrated steel plant in China

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 195

Author(s): Jinfeng Li, Ziqiang Pan, Ziying Jiang, Senlin Liu, Chuangao Wang, Yanqi Zhang, Chunhong Wang, Ling Chen, Zhijun Huang, Jingshun Pan, Xutao Xu

Abstract

Crude steel production in China made up the majority of the global output, at 49.5% in 2014. High temperature smelting processes result in the release of natural radionuclides, including radon gas and other air pollutants into the atmosphere. This paper conducts an analysis of the raw materials, end products and flue gas sampled from an integrated steel plant from within China's Jiangxi Province, with annual production of 8.50 Mt of crude steel. Normalized stack emissions factors of radionuclides from steel production were first reported in China. The results showed that sintering was the main process that released natural radionuclides, and the main radionuclides released into the atmosphere were ²²²Rn (86.4 GBq/Mt), ²¹⁰Pb (13.4 GBq/Mt), and ²¹⁰Po (1.71 GBq/Mt). The results provided essential basic data for radiological impact assessment of steel production, as well as that of nuclear energy chain, coal chain and other electricity sources.

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Low lymphocyte count and high monocyte count predicts poor prognosis of gastric cancer

BMC Gastroenterology

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Heavy coffee consumption and risk of pancreatitis: A systematic review and meta-analysis

Digestive Diseases and Sciences

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Prognostic factors in patients treated with second-line chemotherapy for advanced gastric cancer: Results from the randomized prospective phase III FFCD-0307 trial

Gastric Cancer

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Outcomes of chronic pancreatitis in the Emergency Department

Digestive Diseases and Sciences

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The expression of CKLFSF2B is regulated by GATA1 and CREB in the Leydig cells, which modulates testicular steroidogenesis

Publication date: Available online 12 October 2018

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

Author(s): Sudeep Kumar, Hana Kang, Eunsook Park, Hee-Sae Park, Keesook Lee

Abstract

CKLFSF is a protein family that serves as a functional bridge between chemokines and members of the transmembrane 4 superfamily (TM4SF). In the course of evolution, CKLFSF2 has evolved as two isoforms, namely CKLFSF2A and CKLFSF2B, in mice. CKLFSF2A, also known as CMTM2A and ARR19, is expressed in the testis and is important for testicular steroidogenesis. CKLFSF2B is also known to be highly expressed in the testis. In the prepubertal stage, CKLFSF2B is expressed only in Leydig cells, but it is highly expressed in haploid germ cells and Leydig cells in adult testis. CKLFSF2B is naturally processed inside the cell at its C-terminus to yield smaller proteins compared to its theoretical size of ≈25 kDa. The Cklfsf2b gene is regulated by GATA-1 and CREB protein, binding to their respective binding elements present in the 2-kb upstream promoter sequence. In addition, the overexpression of CKLFSF2B inhibited the activity of the nur77 promoter, which consequently represses the promoter activity of Nur77-target steroidogenic genes such as P450c17, 3β-HSD, and StAR in MA-10 Leydig cells. Adenovirus-mediated overexpression of CKLFSF2B in primary Leydig cells isolated from adult mice shows a repression of steroidogenic gene expression and consequently testosterone production. Moreover, intratesticular injection of CKLFSF2B-expressing adenovirus in adult mice clearly had a repressive effect compared to the control injected with only GFP-expressing adenovirus. Altogether, these findings suggest that CKLFSF2B might be involved in the development and function of Leydig cells and regulate testicular testosterone production by fine-tuning the expression of steroidogenic genes.

Graphical abstract

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Angiotensin II induced CSF1 transcription is mediated by a crosstalk between different epigenetic factors in vascular endothelial cells

Publication date: Available online 12 October 2018

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

Author(s): Jing Shao, Xinyu Weng, Lili Zhuo, Liming Yu, Zilong Li, Kaiping Shen, Wenping Xu, Mingming Fang, Yong Xu

Abstract

Endothelium-derived colony stimulating factor (CSF1) plays a key role in a range of human pathologies. Angiotensin II (Ang II) has been documented to stimulate CSF1 transcription although the underlying epigenetic mechanism remains unclear. Here we report that induction of CSF1 transcription by Ang II in vascular endothelial cells paralleled alterations of signature histone modifications surrounding the CSF1 promoter. Specifically, ChIP assays indicated that there was a simultaneous up-regulation of both acetylated H3 and trimethylated H3K4, indicative of transcriptional activation, and down-regulation of dimethyl H3K9, implicated in transcriptional repression, surrounding the proximal CSF1 promoter. Further analysis revealed that silencing of brahma related gene 1 (BRG1), a chromatin remodeling protein, abrogated CSF1 induction by Ang II. In the meantime, BRG1 silencing erased H3 acetylation and H3K4 trimethylation and restored H3K9 dimethylation. Mechanistically, BRG1 interacted with and recruited SET1A, a histone H3K4 methyltransferase, and JMJD1A, a histone H3K9 demethylase, to the CSF1 promoter to alter chromatin structure thereby promoting CSF1 trans-activation in response to Ang II stimulation. Knockdown of either SET1A or JMJD1A blocked CSF1 induction by Ang II. Finally, we demonstrate that the crosstalk between BRG1 and histone modifying enzymes was mediated by the transcription factor AP-1. In conclusion, our data unveil a novel epigenetic mechanism whereby a BRG1-centered complex mediates transcriptional activation of CSF1 by Ang II in vascular endothelial cells.

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Female Reproductive, Adrenal, and Metabolic Changes during an Antarctic Traverse

PURPOSE To explore the effects of the first all-female transantarctic expedition on hormonal axes pertinent to reproductive and metabolic function. METHODS Six females (aged 28-36, BMI 24.2 ±0.97 kgm-2) hauled 80kg sledges 1700km in 61 days. Estimated average energy intake was 20.8 ± 0.103 MJ/day (4970 ±25 kcal/day). Whole and regional body composition was measured by DXA one and two months before and 15 days after, the expedition. Body fat was also estimated by skinfold and bioimpedance immediately before and after the expedition. Basal metabolic and endocrine blood markers and, after 0.25 mg dexamethasone suppression, 1-hour 10 μg Gonadorelin and 1.0 μg ACTH-(1-24) tests were completed, 39-38 days pre- and 4-5 and 15-16 days post-expedition. Cortisol was assessed in hair (monthly average concentrations) and saliva (5-point day curves and two-point diurnal sampling). RESULTS Average body mass loss was 9.37 ±2.31 kg (p

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Neurocardiac regulation: From cardiac mechanisms to novel therapeutic approaches

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


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Effectiveness of mobilization of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function, and headache in women with TMD. A randomized, controlled trial

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Variability in Phelan‐McDermid syndrome: The impact of the PNPLA3 p.Ile148M polymorphism

Clinical Genetics, EarlyView.


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