Τετάρτη, 7 Νοεμβρίου 2018

Whipple’s Disease: A Well-Done Outcome to a Rare Disease



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MLSB-Resistant Staphylococcus aureus in Central Greece: Rate of Resistance and Molecular Characterization

Microbial Drug Resistance, Ahead of Print.


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Characterization of Acquired Antimicrobial Resistance Genes in Environmental Stenotrophomonas maltophilia Isolates from Brazil

Microbial Drug Resistance, Ahead of Print.


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Vancomycin-Resistant Enterococcus faecium in Tunisia: Emergence of Novel Clones

Microbial Drug Resistance, Ahead of Print.


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Functional Analysis of a Putative Target of Spatially Varying Selection in the Menin1 Gene of Drosophila melanogaster

While significant effort has been devoted to investigating the potential influence of spatially varying selection on genomic variation, relatively little effort has been devoted to experimental analysis of putative variants or genes experiencing such selection. Previous population genetic work identified an amino acid polymorphism in the Mnn1 gene as one of the most strongly latitudinally differentiated SNPs in the genome of Drosophila melanogaster in the United States and Australia. Here we report the results of our transgenic analysis of this amino acid polymorphism. Genotypes carrying alternative Mnn1 alleles differed in multiple phenotypes in a direction generally consistent with phenotypic differences previously observed along latitudinal clines. These results support inferences from earlier population genomic work that this variant influences fitness, and support the idea that the alleles exhibiting clines may be likely to have pleiotropic effects that are correlated along the axes favored by natural selection.



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Photoplethysmography Detection of Overreaching

Introduction Detecting the onset of functional or non-functional overreaching in endurance athletes is of prior importance to ensure reactive amendment of the scheduled training program. The objective of this study was to assess photoplethysmography (PPG) in overloaded athletes and test whether 1) it would be affected differently in functional overreached (FOR) or non-overreached acutely fatigued (AF) athletes; 2. Specific PPG characteristics would allow timely distinction of FOR and AF. Methods Fifteen athletes performed 2-wk baseline (BSL) training followed by 3-wk overload (+45%; OVL) and 2-wk recovery (-20%; RCV). 3000 m running time-trial was used to assess performance at the end of BSL, OVL and RCV and distinguish FOR and AF. PPG was recorded overnight using a wearable sensor, every third night. Overnight means and variances of systolic, diastolic and dicrotic amplitudes and times as well as systolic and diastolic slopes were used to discriminate FOR and AF athletes. Results Performance was decreased in FOR and improved in AF at the end of OVL. Diastolic time was greater in AF than FOR whilst systolic slope was smaller in AF than FOR during OVL. The variances of systolic, diastolic, dicrotic amplitudes, systolic, diastolic slopes and pulse areas were smaller in AF compared to FOR in the last week of OVL. Conclusion PPG is an efficient tool for the detection of overreaching as it distinguished FOR and AF athletes during OVL (prior performance decrement). This fast-responding method would therefore allow adjusting the daily training content in order to prevent non-functional overreaching. Address for correspondence: Nicolas Bourdillon, ISSUL, Institute of Sport Sciences, Synathlon, University of Lausanne, 1015 Lausanne, Switzerland. Tel.: +41 21 692 3797. E-mail: nicolas.bourdillon@unil.ch NB and GPM have no conflicts of interest, sources of funding, or financial ties to disclose and no current or past relationship with companies or manufacturers who could benefit from the results of the present study. MN is an employee of my-vitality. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. This work was made possible by the financial support of the CTI commission n° 18164.2 PFLS-LS. Results of the present study do not constitute endorsement by ACSM. Accepted for publication October 2018. © 2018 American College of Sports Medicine

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Effectiveness of a Parent-led Physical Activity Intervention in Youth with Obesity

Purpose Prader-Willi Syndrome (PWS) is a complex, rare neuro-behavioral syndrome characterized by excessive fat, hypotonia, poor motor skills, and behavioral and cognitive disabilities. We tested the effectiveness of a home-based physical activity (PA) intervention led by parents in youth with obesity with and without PWS to increase moderate-to-vigorous PA (MVPA) and gross motor proficiency (MP). Methods Participants were 111 youth ages 8-16 y (45 with PWS and 66 without PWS, but categorized as obese). A parallel design was used with the control group (C) receiving the intervention after serving as control. Intervention participants (I) completed a PA curriculum four days a week for 24 weeks including warm-up exercises, strengthening exercises, and playground games two days a week and interactive console games two days a week guided by their parents. Pre-post outcomes (baseline to 24 weeks) included MVPA (7-day accelerometry) and MP including upper limb coordination, bilateral coordination, balance, running speed and agility, and muscle strength (Bruininks-Oseretsky Test of Motor Proficiency). Results The intervention led to no change in MVPA (I-group: 39.6 vs. 38.9 min/day; C-group: 40.6 vs. 38.3 min/day). The intervention led to improvements in body coordination (22.3%; p

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Attenuation of Spontaneous Baroreceptor Sensitivity following Concussion

Introduction Cardiovascular autonomic nervous system (CV-ANS) function is negatively impacted after concussion. The arterial baroreflex buffers pressor and depressor challenges through efferent modulation of cardiac chrono- and inotropism, and peripheral vascular tone. Baroreceptor sensitivity (BRS) reflects the capacity of the CV-ANS to accommodate dynamic metabolic demands in the periphery. The impact of concussion on BRS has yet to be defined. Methods CV-ANS assessment (e.g., electrocardiogram and beat-to-beat SBP) was performed the seated upright position at rest within 48 hours (V1) of concussion and 1 week later (V2) in 10 intercollegiate male athletes with concussion and 10 non-injured male athletes. Changes in heart rate (HR), SBP, high and low frequency HR variability (HF- and LF-HRV, respectively), LF-SBP variability and BRS for increasing (BRSn-Up) and decreasing (BRSn-Dn) SBP excursions, and overall BRS (BRSn-Avg) were assessed for differences at V1 and V2. Results The concussion (age: 20±1 years; height: 1.79±0.14 meters; weight: 83±10 kilograms) and control (age: 20±1 years; height: 1.78±0.10 meters; weight: 79±13 kilograms) groups were matched for demographics. Concussed athletes had a significantly reduced BRSn-Up, BRSn-Dn, and BRSn-Avg compared to controls at V1 or V2; these changes occurred without differences in conventional markers of CV-ANS function (e.g., HF-HRV, LF-HRV, LF-SBP), HR or SBP at either visit. Conclusions Reduced BRS is a post-concussive consequence of CV-ANS dysfunction during the first post-injury week. Because SBP was similar between groups, it may be speculated that reduced BRS was not afferent in origin, but represents a post-injury consequence of the central nervous system after injury. Address for Correspondence and Reprints: Michael F. La Fountaine, Ed.D., ATC, FACSM, Seton Hall University, Interprofessional Health Sciences (IHS) Campus, Building 123, 340 Kingsland Street, Nutley, NJ 07110. Phone: (973) 275-2918. Fax: (973) 275-2370. E-mail address: lafounmi@shu.edu Preparation of this manuscript was partially supported by the New Jersey Commission for Brain Injury Research Individual Research Grant #CBIR16IRG025. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and statement that results of the present study do not constitute endorsement by the ACSM. Conflicts of Interest: None to declare Accepted for publication October 2018. © 2018 American College of Sports Medicine

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Time Trial Performance Is Sensitive to Low-Volume Autologous Blood Transfusion

PURPOSE This study tested the hypothesis that autologous blood transfusion (ABT) of ~50% of the red blood cells (RBCs) from a standard 450 ml phlebotomy would increase mean power in a cycling time trial. Additionally, the study investigated whether further ABT of RBCs obtained from another 450 ml phlebotomy would increase repeated cycling sprint ability. METHODS In a randomized, double-blind, placebo-controlled crossover design (3-month wash-out), nine highly trained male subjects donated two 450 ml blood bags each (BT-trial) or were sham phlebotomized (PLA-trial). Four weeks later, a 650 kcal time trial (n=7) was performed three days before and 2 h after receiving either ~50% (135 ml) of the RBCs or a sham transfusion. On the following day, transfusion of RBCs (235 ml) from the second donation or sham transfusion was completed. A 4×30 s all-out cycling sprint interspersed by 4 min of recovery was performed six days before and three days after the second ABT (n=9). RESULTS The mean power was increased in time trials from before to after transfusion (P

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Sandy Hook parent puts emphasis on compassion at trauma conference

Scarlett Lewis praised audience members for being the"heroes" of trauma response and discussed the importance of social-emotional learning

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Son’s death inspires father to become first responder

Dan Miller, an 11-year veteran firefighter-paramedic, became an EMT shortly after his 2-year-old son died of choking

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NET Field Administrator - Galveston Area Ambulance Authority

Make A Difference in your community by being a leader of our Emergency Medical Service Team! Galveston County Health District is seeking a NET Field Administrator! This position is responsible for successfully managing daily operational aspects of non-emergency medical transport and emergency medical services provided by the Galveston County Health District's Galveston Area Ambulance Authority (GAAA) ...

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Adding dextran to local anesthetic enhances analgesia



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The characteristic release of noble gases from an underground nuclear explosion

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): Charles R. Carrigan, Yunwei Sun, Matthew D. Simpson

Abstract

Prompt release of gases at the ground surface resulting from explosively propagated vents or large operational releases has typically been considered to be the only mode of transport for detonation gases from an underground nuclear explosion (UNE) giving rise to detectable levels of radioxenon gases in downwind atmospheric samples captured at distances exceeding 100 km. Using a model for thermally and barometrically driven post-detonation transport across the broad surface of a simulated UNE site, we show in conjunction with the results of an atmospheric tracer-release experiment that even deep, well-contained UNEs, without prompt vents or leaks, are potentially detectable tens of kilometers downwind with current technology; distances that are significant for localizing the source of detected atmospheric signals during on-site monitoring or inspection. For a given yield, the bulk permeability of the UNE site and to a lesser extent the depth of detonation appear to be the primary source-term parameters controlling the distance of detection from the detonation point. We find for test-site bulk permeabilities exceeding 1 darcy (10−12 m2) that broad-area surface fluxes of radioxenon gas exhibit exponential dependence on permeability resulting in order-of-magnitude enhancements of surface flux for changes in permeability of only a darcy. Simulations of subsurface transport assuming a canonical detonation-depth-versus-nuclear-yield relationship generally resulted in larger atmospheric signals for shallower, lower-yield explosions allowing downwind detection at distances greater than 1000 km. Additionally, atmospheric simulations suggest that the lowest atmospheric boundary layer heights, such as occur at night, produced concentrations above minimum detectable levels at the greatest distances downwind.



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Behavior of 36Cl in agricultural soil-plant systems: A review of transfer processes and modelling approaches

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): S. Le Dizès, M.A. Gonze

Abstract

This article aims to review up-to-date knowledge and data acquired on 36Cl transfers to terrestrial soil-plant systems, evaluate the existing modelling approaches and identify priorities for future model improvements. This update has revealed the existence of fairly recent studies, whose results could be used for improving the modelling approaches which have been developed over the last decade. The priority areas include the consideration of the dry deposition process and the transfer of both gaseous and aerosol 36Cl to plants. The consideration of secondary processes such as the synthesis/mineralization of organochlorines and plant biomass litterfall is not recognized as a priority issue when assessing the impact of gaseous discharges. It was also identified that additional experimental studies had to be conducted to improve the understanding of the processes governing stable Cl and 36Cl dynamics in other terrestrial ecosystems (field crops, vegetables, grass) than forest environments on which most of the reported knowledge and data are reviewed.



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m6A: Widespread regulatory control in virus replication

Publication date: Available online 7 November 2018

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

Author(s): Oliver Manners, Belinda Baquero-Perez, Adrian Whitehouse

Abstract

N6-methyladenosine (m6A) is a highly pervasive and dynamic modification found on eukaryotic RNA. Despite the failure to comprehend the true regulatory potential of this epitranscriptomic mark for decades, our knowledge of m6A has rapidly expanded in recent years. The modification has now been functionally linked to all stages of mRNA metabolism and demonstrated to regulate a variety of biological processes. Furthermore, m6A has been identified on transcripts encoded by a wide range of viruses. Studies to investigate m6A function in viral-host interactions have highlighted distinct roles indicating widespread regulatory control over viral life cycles. As a result, unveiling the true influence of m6A modification could revolutionise our comprehension of the regulatory mechanisms controlling viral replication. This article is part of a Special Issue entitled: mRNA modifications in gene expression control edited by Dr. Soller Matthias and Dr. Fray Rupert.



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Steering pluripotency and differentiation with N6-methyladenosine RNA modification

Publication date: Available online 6 November 2018

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

Author(s): Sandhya Malla, Dario Melguizo-Sanchis, Francesca Aguilo

Abstract

Chemical modifications of RNA provide a direct and rapid way to modulate the existing transcriptome, allowing the cells to adapt rapidly to the changing environment. Among these modifications, N6-methyladenosine (m6A) has recently emerged as a widely prevalent mark of messenger RNA in eukaryotes, linking external stimuli to an intricate network of transcriptional, post-transcriptional and translational processes. m6A modification modulates a broad spectrum of biochemical processes, including mRNA decay, translation and splicing. Both m6A modification and the enzymes that control m6A metabolism are essential for normal development. In this review, we summarized the most recent findings on the role of m6A modification in maintenance of the pluripotency of embryonic stem cells (ESCs), cell fate specification, the reprogramming of somatic cells into induced pluripotent stem cells (iPSCs), and differentiation of stem and progenitor cells.

This article is part of a Special Issue entitled: mRNA modifications in gene expression control edited by Dr. Soller Matthias and Dr. Fray Rupert.



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Decrease of inhibitory synaptic currents of locus coeruleus neurons via orexin type 1 receptors in the context of naloxone-induced morphine withdrawal

Abstract

Acute opioid withdrawal syndrome is a series of neurological symptoms caused by the abrupt cessation of the chronic administration of opioids such as morphine. The locus coeruleus (LC) in the brain stem receives a dense projection of orexinergic fibers from the hypothalamus and is a candidate site for the expression of the somatic aspects of morphine withdrawal. Previous studies have shown that orexin-A contributes to the behavioral symptoms of naloxone-induced morphine withdrawal, partly by reducing the activity of GABAergic neurons, suggesting that orexin-A may negatively modulate fast GABAergic neurotransmission during morphine withdrawal. We used whole-cell patch-clamp recordings of LC neurons in brainstem slices to investigate the effect of orexin-A on bicuculline-sensitive GABAergic inhibitory postsynaptic currents (IPSCs) during naloxone-induced morphine withdrawal. Male Wistar rats (P14–P21) were given morphine (20 mg/kg, i.p.) daily for seven consecutive days to create dependency on the drug. The application of naloxone (1 µM) to brain slices of morphine-treated rats reduced the amplitude of evoked IPSCs (eIPSCs) as well as spontaneous IPSCs (sIPSCs) frequency but did not change sIPSCs amplitude. Orexin-A (100 nM) significantly enhanced the suppressive effect of naloxone on eIPSCs amplitude and sIPSCs frequency but had no effect on the presence of the orexin type 1 receptor (OX1R) antagonist, SB-334867. Orexin-A alone had no significant effect on eIPSCs and sIPSCs in the absence of naloxone. In summary, our results show that orexin-A, via OX1R, potentiates the suppressive effect of naloxone on GABAergic IPSCs of LC neurons in morphine-treated rats. We conclude that orexins may have a critical role in regulating GABAergic neurotransmission to LC neurons during naloxone-induced morphine withdrawal.



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Brief Psychoeducation Program to Enhance Recovery Knowledge and Attitudes of Mental Health Service Providers and Users: Randomized Controlled Trials

Abstract

Recovery-oriented transformation of mental health service systems not only necessitates changes in mental health policies and practices, it also requires an adoption of recovery-oriented mindset, which includes knowledge and attitudes, among service providers. It is also important that service users are informed about the changes and can fully participate in the process. The present study developed and evaluated the efficacy of a recovery psychoeducation program in enhancing recovery-oriented knowledge and attitudes among mental health service providers and users in Hong Kong. In study 1, 111 service providers were randomly assigned to 2-day psychoeducation group or control group. Results showed that participants in psychoeducation group had significantly better recovery knowledge and more positive attitudes towards recovery after the intervention than the control counterparts. The effect of the recovery psychoeducation program on recovery attitudes was fully mediated by the improvement in recovery knowledge. In study 2, 93 people with mental illness were randomized into 2-week psychoeducation group or control group. Participants in the psychoeducation group had a significant improvement in the level of recovery-oriented knowledge immediately after the workshops, but the effect could not be sustained at follow-up. To transform into a recovery-oriented service system, having an effective program to orient service providers and users to recovery is essential. This study provided initial support to the use of a brief psychoeducational program for recovery-oriented knowledge enhancement. Given the short-term efficacy and feasibility of the interventions, service leaders and managers in different clinical and social service settings should consider implementing the programs as part of staff and users' service orientation to build a recovery-supporting workforce and empower their service users early in the recovery process.



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NGS sequencing reveals that many of the genetic variations in transgenic rice plants match the variations found in natural rice population

Abstract

Background

As the transformation process can induce mutations in host plants, molecular characterization of the associated genomic changes is important not only for practical food safety but also for understanding the fundamental theories of genome evolution.

Objectives

To investigate a population-scale comparative study of the genome-wide spectrum of sequence variants in the transgenic genome with the variations present in 3000 rice varieties.

Results

On average, we identified 19,273 SNPs (including Indels) per transgenic line in which 10,729 SNPs were at the identical locations in the three transgenic rice plants. We found that these variations were predominantly present in specific regions in chromosomes 8 and 10. Majority (88%) of the identified variations were detected at the same genomic locations as those in natural rice population, implying that the transgenic induced mutations had a tendency to be common alleles.

Conclusion

Genomic variations in transgenic rice plants frequently occurred at the same sites as the major alleles found in the natural rice population, which implies that the sequence variations occur within the limits of a biological system to ensure survival.



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Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer

Abstract

Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic cancers. EUS can provide high-resolution images of the pancreas with a quality regarded as far surpassing that achieved on transabdominal ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). EUS is particularly useful for the detection of small pancreatic lesions, while EUS and its related techniques such as contrast-enhanced EUS (CE-EUS), EUS elastography, and EUS-guided fine needle aspiration (EUS-FNA) are also useful in the differential diagnosis of solid or cystic pancreatic lesions and the staging (T-staging, N-staging, and M-staging) of pancreatic cancers. In the diagnosis of pancreatic lesions, CE-EUS and EUS elastography play a complementary role to conventional EUS. When sampling is performed using EUS-FNA, CE-EUS and EUS elastography provide information on the target lesions. Thus, conventional EUS, CE-EUS, EUS elastography, and EUS-FNA are essential in the clinical investigation of pancreatic cancer.



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Prospective Assessment of Liver Function by an Enzymatic Liver Function Test to Estimate Short-Term Survival in Patients with Liver Cirrhosis

Abstract

Background

MELD attempts to objectively predict the risk of mortality of patients with liver cirrhosis and is commonly used to prioritize organ allocation. Despite the usefulness of the MELD, updated metrics could further improve the accuracy of estimates of survival.

Aims

To assess and compare the prognostic ability of an enzymatic 13C-based liver function test (LiMAx) and distinct markers of liver function to predict 3-month mortality of patients with chronic liver failure.

Methods

We prospectively investigated liver function of 268 chronic liver failure patients without hepatocellular carcinoma. Primary study endpoint was liver-related death within 3 months of follow-up. Prognostic values were calculated using Cox proportional hazards and logistic regression analysis.

Results

The Cox proportional hazard model indicated that LiMAx (p < 0.001) and serum creatinine values (p < 0.001) were the significant parameters independently associated with the risk of liver failure-related death. Logistic regression analysis revealed LiMAx and serum creatinine to be independent predictors of mortality. Areas under the receiver-operating characteristic curves for MELD (0.86 [0.80–0.92]) and for a combined score of LiMAx and serum creatinine (0.83 [0.76–0.90]) were comparable.

Conclusions

Apart from serum creatinine levels, enzymatic liver function measured by LiMAx was found to be an independent predictor of short-term mortality risk in patients with liver cirrhosis. A risk score combining both determinants allows reliable prediction of short-term prognosis considering actual organ function.

Trial Registration Number (German Clinical Trials Register) # DRKS00000614.



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Ad libitum Mediterranean and low-fat diets both significantly reduce hepatic steatosis: A randomized controlled trial

Hepatology

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Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: A 7-year longitudinal study

Hepatology

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Altered bile acid profile associates with cognitive impairment in Alzheimer's disease: An emerging role for gut microbiome

Alzheimer's & Dementia

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Oral Health Status of Refugee Children in Montreal

Abstract

This study aimed to assess the oral health status of refugee children in comparison with that of Canadian children. In addition, we investigated the extent to which demographic factors are associated with caries experience in this population. Children with a confirmed refugee status and Canadian children (control group) matched for age and sex composed the study population. A comprehensive review of dental charts was completed to assess children's demographic data, caries experience, oral hygiene and gingival health status. The majority of refugee children had never seen a dentist before their arrival to Canada. Refugee children had significant higher dmft/DMFT scores than Canadian children (7.29 ± 5.1 and 4.47 ± 5, respectively; p < 0.0001). Furthermore, individual factors, such as refugee status (OR = 5.08; 95% CI = 2.31–11.1) and child age (OR = 2.17; 95% CI = 1.04–4.51) were significantly associated with caries experience. Access to appropriate dental care to refugee children should be a key priority for health care providers and policy makers.



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Changes in responsiveness to allatostatin treatment accompany shifts in stress reactivity in young worker honey bees

Abstract

Exposing honey bees to isopentylacetate (IPA) can cause stress-related changes in learning performance. In bees of foraging age, IPA's effects on learning are mimicked by C-type allatostatins (AstCC, AstCCC) injected into the brain. Here we ask whether allatostatins induce a similar response in young (6-day-old) bees and if so, whether their effects on learning performance are modulated by queen mandibular pheromone (QMP). We found that young bees exposed to IPA responded less to the conditioned stimulus during training than controls (Type 1-like stress response). AstCC treatment induced a similar response, but only in bees maintained without QMP. Bees exposed to QMP responded to AstCC with increased odour responsiveness and odour generalisation in the 1-h memory test (Type 2-like response). Type 2-like responses could be induced also by the A-type allatostatin, AstA. However, in bees exposed to QMP, AstA-induced odour generalisation was absent. Effects of AstCCC treatment in young bees were weak, indicating that responsiveness to this peptide changes with age. Our findings are consistent with the hypothesis that honey bee allatostatins play a role in stress reactivity, but suggest in addition that allatostatin signalling is age dependent and susceptible to modulation by pheromone released by the queen bee.



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Perioperative Considerations and Positioning for Neurosurgical Procedures: A Clinical Guide

No abstract available

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Serum Concentrations of Lidocaine During Bariatric Surgery

Lidocaine has been shown to be clinically beneficial during bariatric surgery. However, information about lidocaine serum concentrations in this setting is scarce. This prospective clinical trial included 42 obese patients undergoing laparoscopic bariatric surgery. They received lidocaine based on adjusted body weight. Administration began with a 1.5 mg·kg−1 bolus of intravenous lidocaine followed by a continuous infusion of 2 mg·kg−1·hour−1. After skin closure, administration was decreased to 1 mg·kg−1·hour−1 until discharge from the recovery room. No serum concentrations of lidocaine were outside the usual accepted range (1.5–5 µg·mL−1). Accepted for publication October 3, 2018. Funding: None. The authors declare no conflicts 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 (https://ift.tt/KegmMq). Clinical trial number: NCT02525016. https://ift.tt/2ST81HK. Reprints will not be available from the authors. Address correspondence to Jean-François Carabalona, MD, Département d'Anesthésie Réanimation, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69003, Lyon, France. Address e-mail to jeffcarabalona@gmail.com. © 2018 International Anesthesia Research Society

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Comparison of Invasive and Noninvasive Blood Pressure Measurements for Assessing Signal Complexity and Surgical Risk in Cardiac Surgical Patients

BACKGROUND: Continuous arterial blood pressure (ABP) is typically recorded by placement of an intraarterial catheter. Recently, noninvasive ABP monitors have been shown to be comparable in accuracy to invasive measurements. In a previous study, we showed that the fluctuations in beat-to-beat ABP measurements were not random variations but had a complex dynamical structure, and that ABP dynamical complexity was inversely associated with surgical risk estimated using the Society of Thoracic Surgeons (STS) index. Dynamical complexity is a mathematical construct that reflects the capacity of a physiological system to adapt to stimuli. The objectives of present study were to: (1) determine whether noninvasive beat-to-beat ABP measurements also exhibit a complex temporal structure; (2) compare the complexity of noninvasive versus invasive ABP time series; and (3) quantify the relationship between the complexity of noninvasive ABP time series and the STS risk scores. METHODS: Fifteen adult patients undergoing coronary artery bypass graft, valve, or combined coronary artery bypass graft/valve surgery ;were enrolled in this observational study. Preoperative ABP waveforms were simultaneously recorded for ≥15 minutes using a radial artery catheter (invasive) and a continuous noninvasive arterial pressure monitor. Beat-to-beat systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) time series were extracted from the continuous waveforms. Complexity was assessed using the multiscale entropy method. The Wilcoxon signed-rank test was used to compare the mean ranks of indices derived from invasive versus noninvasive ABP time series. Spearman correlation coefficients were used to quantify the relationship between invasive and noninvasive indices. Linear regression analysis was used to quantify the association between each of the complexity indices and the STS risk scores. RESULTS: Beat-to-beat fluctuations in noninvasive ABP measurements were not random but complex; however, their degree of complexity was lower than that of fluctuations in invasively obtained ABP signals (SBP: 7.05 vs 8.66, P

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In Response

No abstract available

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Drug Diversion in the Anesthesia Profession: How Can Anesthesia Patient Safety Foundation Help Everyone Be Safe? Report of a Meeting Sponsored by the Anesthesia Patient Safety Foundation

No abstract available

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