Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026: 12/04/18

Τρίτη 4 Δεκεμβρίου 2018

Force–velocity profiling of sprinting athletes: single-run vs. multiple-run methods

Abstract

Purpose

This study explored the agreement between a single-run and a multiple-run method for force–velocity (Fv) profiling of sprinting athletes; we evaluated both absolute values and changes over time caused by sprint training.

Methods

Seventeen female handball players (23 ± 3 years, 177 ± 7 cm, 73 ± 6 kg) performed 30 m un-resisted and resisted sprints (50, 80 and 110 N resistance) before and after an 8-week sprint training intervention. Two approaches were used to calculate theoretical maximal velocity (v₀), horizontal force (F₀), power (P_max), and the force–velocity slope (S_Fv): (1) the single-run method, based on inverse dynamics applied to the centre-of-mass movement, was calculated from anthropometric and sprint split time data; and (2) the multiple-run method, where peak velocity from un-resisted and resisted sprints were plotted against the horizontal resistances.

Results

Trivial differences in v₀ (0.7%) were observed between the two calculation methods. Corresponding differences for F₀, P_max and S_Fv were 16.4, 15.6 and 17.6%, respectively (most likely; very large effect size). F₀ showed poor agreement between the methods (r = 0.26 and 0.16 before and after the intervention). No substantial correlation between the changes (from pre- to post-training tests) in S_FV calculated with the single-run and the multiple-run methods were observed (r = 0.02).

Conclusions

This study revealed poor agreement between the Fv relationships of the investigated calculation methods. In practice, both methods may have a purpose, but the single-run and the multiple-run methods appear to measure somewhat different sprint properties and cannot be used interchangeably.

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Prevalence of Small Intestine Carcinoid Tumors: A US Population-Based Study 2012–2017

Abstract

Background and Aims

Most carcinoid tumors of the gastrointestinal tract are located in the small bowel (SB). Epidemiological studies of these tumors have been limited by small sample sizes. Our aim was to evaluate the epidemiology of SB carcinoids (SBCs) using a large database.

Methods

We queried a commercial database (Explorys), an aggregate of electronic health data from 26 US healthcare systems. We identified patients with SBCs between 2012 and 2017. We evaluated the epidemiology of SBC and identified possible risk factors.

Results

Of the 35,798,290 individuals in the database between 2012 and 2017, we identified 3280 patients with SBCs, with a prevalence of 9.2/100,000. Prevalence was higher in men [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.153–1.322, p < 0.0001], whites [OR 2.031, 95% CI 1.872–2.203, p < 0.0001], and elderly (aged > 65) [OR 4.856, 95% CI 4.533–5.203, p < 0.0001]. Patients with SBCs were more likely to have a history of smoking [OR 2.749, 95% CI 2.549–2.970, p < 0.0001], alcohol use [OR 2.031, 95% CI 1.864–2.21, p < 0.0001], obesity (BMI > 30) [OR 3.476, 95% CI 3.213–3.761, p < 0.0001], diabetes mellitus [OR 4.198, 95% CI 3.900–4.519, p < 0.0001], and a family history of cancer [OR 5.902, 95% CI 5.396–6.456, p < 0.0001].

Conclusions

This is one of the largest studies done on the prevalence of SBC. The prevalence of 9.2/100,000 individuals is higher than previously reported. Further genetic and environmental studies are needed to understand the potential mechanisms for the risk factors identified in this study.

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Patient Satisfaction and Healthcare Utilization Using Telemedicine in Liver Transplant Recipients

Abstract

Background

Post-liver transplantation care is limited to tertiary care centers. Concentration at expert centers leads to high-volume clinics with long wait times and decreased accessibility.

Aim

To assess whether telemedicine can be utilized to overcome barriers to care while sustaining strong patient–physician relationships.

Methods

The Patient Satisfaction Questionnaire-18, Telemedicine Satisfaction Questionnaire, and Health Utilization Questionnaire were used to assess patient satisfaction and healthcare utilization among patients who received care via video connection (telemedicine group) and in clinic (control group). Propensity matching was performed. Scores for questionnaires were reported as mean and standard deviations (SD) and were compared by one-way multivariate analysis of variance and one-way analysis of variance.

Results

There were 21 matched telemedicine patients in our study. Overall mean age (± SD) was 51 (± 5.62) years and 52 (± 6.12) years for telemedicine group and control group, respectively. General patient satisfaction was similar between the two groups (p = 0.89). While telemedicine patients were just as satisfied with communication and interpersonal approach compared to clinic patients, they experienced significantly less commute (p < 0.0001) and waiting (p < 0.0001) times. Given ease of using telemedicine without compromising patient–physician interaction, 90% (19/21) of the telemedicine patients opted to use the service again.

Conclusion

Telemedicine appeared to be both a time and cost-saving alternative to clinic follow-up without compromise of the valuable patient–physician relationship. Telemedicine has the potential to improve clinic flow, reduce wait times, and decrease costs for liver transplant recipients.

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Presumed Consent: A Potential Tool for Countries Experiencing an Organ Donation Crisis

Abstract

Background

There is currently an inadequate supply of allografts to meet the number of transplant candidates worldwide. A number of controversial policies, including implementation of a presumed consent organ donation system, have been considered to rectify the organ donation crisis.

Aims

A secondary retrospective data analysis aimed to assess the impact of switching to a presumed consent organ donation model on organ donation rates.

Methods

Deceased organ donation rates were compared before and after countries adopted presumed consent.

Results

Six countries met entry criteria. All six countries had an increase in liver donation rates, while 4 out of the six countries had an increase in kidney donation rates. The overall mean (± SD) liver donation rate was 3.23 (± 0.97) per million population (pmp) before the transition and 6.46 (± 1.81) pmp after the transition (p < 0.0001). The overall mean (± SD) kidney donation rate was 17.94 (± 3.34) pmp before the transition and 26.58 (± 4.23) pmp after the transition (p < 0.0001). The percentage increase in liver and kidney donation rates varied among countries, ranging from 28 to 1186%.

Conclusion

The transition from explicit to presumed consent was associated with a significant increase in liver donation rates in all countries that met our criteria, while the effect on kidney donation rates was partially realized. Although presumed consent alone is unlikely to explain the increase in donation rates, the adoption of such a policy may prove to be a worthwhile risk for countries experiencing consistently low organ donation rates.

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Circ-TTC17 Promotes Proliferation and Migration of Esophageal Squamous Cell Carcinoma

Abstract

Background

Circular RNAs (circRNAs), a special class of noncoding RNAs with the characteristic of covalent closed-loop structure, have been widely found in various organisms. Growing evidence has shown that circRNAs play a crucial role in regulating biological functions of cancers. However, the specific role of circRNAs in esophageal squamous cell carcinoma (ESCC) remains largely unknown.

Aim

The present study aims to investigate the effects of circ-TTC17 in ESCC clinical samples as well as cells.

Methods

Sanger sequencing and agarose gel electrophoresis were used to verify the specificity of circ-TTC17. Expression levels of circ-TTC17 in ESCC cells, plasma, and tissues were measured by quantitative real-time polymerase chain reaction. A colony formation experiment, CCK-8 assay, and wound-healing assay were applied to detect the functions of circ-TTC17 in KYSE30 and KYSE450 cells. A nucleus–cytoplasm fractionation experiment was used to probe the location of circ-TTC17 in ESCC cells. Finally, a network of circ-TTC17 with its targeted miRNAs interactions and corresponding mRNAs was analyzed and framed by bioinformatics.

Results

The expression level of circ-TTC17 was found to be significantly higher in ESCC cells, plasma, and tissues compared with normal cases. In vitro experiments indicated that circ-TTC17 promoted proliferation and migration of ESCC cells. Bioinformatics predictions showed that circ-TTC17 might regulate progress of ESCC by acting as a sponge for microRNAs (miRNAs).

Conclusions

The results of this study demonstrate that upregulated circ-TTC17 plays a key role in promoting proliferation and migration of ESCC cells and has potential to become a novel biomarker for diagnosis, treatment, and prognosis of ESCC in the future.

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Nonalcoholic Fatty Liver Disease Demonstrates a Pre-fibrotic and Premalignant Molecular Signature

Abstract

Background

Metabolic syndrome contributing to nonalcoholic fatty liver disease (NAFLD) can lead to hepatic dysfunction, steatohepatitis, cirrhosis, and hepatocellular carcinoma.

Aims

In this study, we tested whether diet-induced fatty liver in a mouse model physiologically mimicked human NAFLD, and whether transcriptional alterations in mouse fatty liver signified risk for the development of hepatitis, cirrhosis, and/or hepatocellular carcinoma.

Methods

SAMP6 strain mice were fed a low-fat diet or high-fat diet (HFD) for 6 months. Mouse livers were isolated and subjected to histology, immunohistochemistry, and whole transcriptome RNA sequencing. Sequences were aligned to the mouse reference genome, and gene expression signatures were analyzed using bioinformatics tools including Cufflinks, Pathview, Cytoscape, ClueGO, and GOstats.

Results

Consistent with NAFLD, livers from HFD-fed mice demonstrated steatosis, high levels of inflammation, an up-regulation of genes encoding proteins associated with the complement pathway and immune responses, and down-regulation of those associated with metabolic processes. These livers also showed an up-regulation of genes associated with fibrosis and malignant transformation but no histological evidence of either pathobiology or DNA damage.

Conclusions

HFD-fed mice exhibited NAFLD that had incompletely transitioned from fatty liver to NASH. Importantly, bioinformatics approaches identified pre-fibrotic and premalignant signatures, suggesting that the pathogenesis of both fibrosis and cancer may initiate in fatty livers well before associated histological changes are evident.

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Reflux symptoms in professional opera soloists

Professions distinguished by repeated vocal stress carry a high risk of developing gastroesophageal reflux symptoms (GERS), which may affect vocal performance.

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Fecal Microbiota Transplantation Capsules with Targeted Colonic Versus Gastric Delivery in Recurrent Clostridium difficile Infection: A Comparative Cohort Analysis of High and Lose Dose

Abstract

Background

Fecal microbiota transplantation (FMT) is an effective therapy for recurrent Clostridium. difficile infection (rCDI). FMT capsules have emerged, and it is unknown if delivery location and dose impact efficacy.

Methods

We compared two cohorts of patients receiving two capsule formulations: gastric release (FMTgr) and targeted colonic release (FMTcr) at two different sites. Cohort A received FMTgr at (1) high dose: 60 capsules and low dose: 30 capsules. Patients in Cohort B received FMTcr at (1) high dose: 30 capsules (2) low dose: 10 capsules. Clinical cure rates and adverse events were monitored through week 8. Paired t-tests were used to compare diversity pre- and post-FMT.

Results

51 rCDI patients were enrolled. Cohort A contained n = 20 and Cohort B contained n = 31. Overall cure at week 8 for FMTgr was 75% (15/20) compared to 80.6% for FMTcr, (25/31), p = 0.63. Both formulations were safe with no serious adverse events. FMTcr was superior at increasing gut microbial diversity.

Discussion

To our knowledge, this is the first study to compare targeted delivery of FMT capsules. While both capsules were safe and efficacious, microbial engraftment patterns were superior in FMTcr.

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Acute stress modifies oscillatory indices of affective processing: Insight on the pathophysiology of schizophrenia spectrum disorders

Stress is considered a key precipitating factor in the development and maintenance of psychopathology, including schizophrenia spectrum disorders (SCZ) (Corcoran et al., 2003; Venkatasubramanian et al., 2010; Garner et al., 2011), in part through modification of affective frontal and limbic networks (Arnsten, 2011). SCZ disorders are considered some of the most disabling psychopathologies (Chaudhury et al., 2006), resulting from a combination of genetic and environmental insults (Ross et al., 2006).

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Reflux symptoms in professional opera soloists

A First Insight into the katG and rpoB Gene Mutations of Multidrug-Resistant Mycobacterium tuberculosis Strains from Ecuador

Microbial Drug Resistance, Ahead of Print.

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Investigation of the Developmental Requirements of Drosophila HP1 and Insulator Protein Partner, HIPP1

Drosophila Suppressor of Hairy-wing [Su(Hw)] is a multifunctional zinc finger DNA binding protein. Transcriptional regulation by Su(Hw) is essential in the ovary and testis, where Su(Hw) functions primarily as a repressor. Recently, the HP1a and Insulator Partner Protein 1 (HIPP1) was found to extensively co-localize with Su(Hw) and other insulator binding proteins in euchromatic regions of the genome, and with Heterochromatin Protein 1a (HP1a) in heterochromatic regions. As HIPP1 is the homologue of the human co-repressor Chromodomain Y-Like (CDYL), we tested its requirement in establishing transcriptional repression in flies. To this end, we generated multiple Hipp1 null alleles and a tagged derivative of the endogenous gene (Hipp1^GFP), using CRISPR mutagenesis. We show that HIPP1 is a widely expressed nuclear protein that is dispensable for viability, as well as female and male fertility. We find that HIPP1 and HP1a display minimum co-localization in interphase cells, and HP1a-dependent transcriptional repression of several reporter genes is HIPP1-independent, indicating that HIPP1 is not essential for HP1a-dependent heterochromatin formation. Despite Su(Hw) having a major role in promoting HIPP1 occupancy in euchromatin, we show that HIPP1 is dispensable for the transcriptional and insulator functions of Su(Hw), indicating that HIPP1 is not a critical Su(Hw) cofactor. Further studies are needed to clarify the role of HIPP1 in Drosophila development.

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Paramedic - FM Ambulance

Paramedics provide advanced medical care to patients. Individuals must have the complex knowledge and skills necessary to provide patient care and transportation. Paramedics may need to assist and give direction to additional EMS Responders at the scene and/or during transport. Paramedics must be competent in trauma and medical situations and should possess the knowledge and the necessary skills to ...

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Paramedic - FM Ambulance

Tuberculosis prevalence among university freshmen in Zhengzhou, China, during 2004-2013

Background: Tuberculosis (TB) is a major public health concern worldwide, and spreads more easily in densely populated areas such as school campuses.
Objectives: The aim of this study was to determine the prevalence of positive TB skin tests among freshmen, i.e. newly-enrolled college students, in Zhengzhou City, China.
Methods: We reviewed the data of purified protein derivative (PPD) skin tests in 656,212 freshmen in 2004-2013.
Results: A positive test showed a diameter of swelling ≥ 5 mm. The PPD positive rate was 40.69 %, with a prevalence of 146.29 per 100,000. During the 10-year study period, the rate of students with positive PPD test increased from 34.19 % in 2004 to 40.69 % in 2013. The positive PPD rate was significantly higher in males than in females (41.68 % vs 39.61 %, P<0.0001), and in rural compared with urban areas (42.04 % vs 38.03 %, P<0.0001).
Conclusion: These findings indicated a high prevalence of PPD positivity among participants during the study period, with an increasing trend. Therefore, this population needs to be targeted by TB prevention and control programs.

Keywords: Tuberculosis; PPD test; freshmen; positive rate; prevalence.

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Association of hyperuricemia with metabolic syndrome among university workers: sex and occupational differences

Background: The relationship between metabolic syndrome (MetS) and hyperuricemia is not fully understood.
Objective: To examine the association of hyperuricemia with MetS and the component of MetS that is mostly influenced by hyperuricemia among university workers.
Methods: Anthropometric measurements, blood pressure, glucose, lipid profiles, renal function tests were measured in 1198 male and 1075 female (22-60 years old) workers on annual medical examination.
Results: Hyperuricemia was 3-fold higher in males (odds ratio, OR, 2.938, 95% confidence interval, CI, 1.909-4.522, P<0.01) than females after adjustment for age, body mass index (BMI) and renal function. Overall, individuals with hyperuricemia were 3.9-fold likely to have MetS OR, 3.903; CI (2.439-6.245), P<0.01, and dyslipidemia, 2.5 times (OR, 2.501; 95% CI, 1.776-3.521, P<0.01) after adjustment for age, BMI, sex and renal function. However, no associations were found in individuals with hypertension (OR, 1.427; 95% CI, 0.996-2.205, P=0.052) and hyperglycemia (OR, 1.476; 95% CI, 0.989-2.202, P=0.057). Administrative work positively associated (OR, 1.895; 95% CI, 1.202-2.925, P<0.05) with hyperuricemia in males and not females.
Conclusion: Male workers with hyperuricemia, especially those working in administration were at risk of metabolic syndrome. It is important to screen, prevent and treat metabolic syndrome in individuals diagnosed with hyperuricemia at the workplace.

Keywords: Hyperuricemia, metabolic syndrome, uric acid, workers.

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A comparison of risk of hypotension using standard doses of remifentanil versus dexmedetomidine infusions in adult patients undergoing surgery under general anaesthesia at the Aga Khan University Hospital, Nairobi

Background: Remifentanil and dexmedetomidine are common agents used in general anaesthesia, monitored anaesthesia care and critical care. When combined with inhaled or intravenous anaesthetic agents intra-operatively, they provide analgesia, lower general anaesthetic requirements and provide sedation and analgesia in the peri-operative period if indicated. Pharmacodynamically, they cause hypotension and bradycardia which are reversible if well managed. Past studies of these drugs have shown a significant proportion of patients with hypotension when compared with similar agents or in isolation. This study compares these two drugs on the effect of hypotension when used as adjuncts to general anaesthesia at low dose standard rate of infusions.
Objective: To compare the proportion of hypotension episodes in a group of adult patients receiving dexmedetomidine infusion at 0.4mcg/kg/hr versus a group receiving remifentanil infusion at 0.2mcg/kg/min, severity of hypotension and physician interventions in each group.
Methods: One hundred and four patients scheduled for elective surgery under general anaesthesia were randomized into two groups:
Control group; received remifentanil infusion at 0.2mcg/kg/min Intervention group; received dexmedetomidine at 0.4mcg/kg/hr.
General anaesthesia was standardized in both groups. The patients were blinded to the study. Baseline blood pressures of all patients were determined prior to induction. The patient's demographic characteristics were recorded. The number of patients who developed hypotension, the frequency of hypotension and the physician interventions were recorded and analysed.
Results: The age and gender characteristics were different between the two groups (p values <0.023 and 0.05 respectively) however they did not affect the proportion of patients with hypotension. The weight, baseline pressures and ASA status of the patients within the groups were similar. The operative procedures varied within the groups. General surgery did not influence the outcome of hypotension in both arms. The duration of surgery in remifentanil group exceeded that of Dexmedetomidine p value<0.0005 however the time to the first episode of hypotension was similar between the groups. The episodes of hypotension were fewer in the dexmedetomidine arm and the proportion of patients with hypotension were higher in the remifentanil arm, p value<0.001, R.R 0. = 0.5938, 95% C.I= 0.329-0.819
The physician interventions administered were similar between the two groups except the use of ephedrine between the groups.
Conclusion: Among this population, at standard infusion rates, the proportion of patients that risk hypotension was greater in those undergoing elective surgery receiving remifentanil at 0.2mcg/kg/min than in dexmedetomidine at 0.4mcg/kg/hr under isoflurane based anaesthesia.

Keywords: Risk of hypotension, remifentanil versus dexmedetomidine infusions, general anaesthesia, Aga Khan University Hospital, Nairobi.

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Audit of insulin prescription patterns and associated burden among diabetics in a tertiary health institution in Nigeria

Background: Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic.
Objective: There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics.
Methods: A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained.
Results: Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 ± 13.1 years, mean duration of diabetes, 7.0 ± 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants. Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection.
Conclusion: The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage.

Keywords: Adherence, diabetes, burden, insulin injection, omission.

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Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria

Background: Irrational antibiotic prescriptions for children is a global concern requiring periodic evaluation and monitoring.
Objectives: To assess appropriateness of antibiotic prescribing for under-five children, as well as evaluating mothers' usage of antibiotics for their under-five and reason(s) for use.
Method: Cross-sectional review of out-patient case-notes of under-five using principles of antibiotic prescribing and a questionnaire-guided interaction with under-five mothers.
Results: Nearly all (445;98.9%) antibiotic prescriptions were based on signs and symptoms indicative of bacterial infection. Only 3(0.7%) had the initial antibiotic regimen modified. Nine (2.0%) had documented evidence of sensitivity test requested before antibiotic prescribing. Presence of infection or need for antibiotic therapy was established in 190(42.2%). Majority (324;72.0%) of mothers had administered antibiotics to their under-five. Of these, 157(48.5%) were prescribed by physicians and 79(24.4%) were self-recommended. Educational status of mothers significantly influenced antibiotic usage.
Conclusion: Antibiotic prescriptions for under-fives was largely based on symptoms indicative of bacterial infections, thereby corroborating the widespread empirical antibiotic prescribing. Considerable number of mothers engaged in self-recommendation of antibiotics for their under-fives. Thus, there is a need for continuous enlightenment of prescribers and mothers on rational use of antibiotics, while microbiological confirmation of clinical diagnosis is encouraged for evidence-based antibiotic prescribing.

Keywords: Antibiotic prescription, under-five children, mothers/caregivers.

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HMGA1 variant IVS5-13insC is associated with insulin resistance and type 2 diabetes: an updated meta-analysis

Background: High-mobility group A1 (HMGA1) polymorphism has been suspected as a gene variant associated with type 2 diabetes (T2D). However, conflicting outcomes have been reported.
Objective: This meta-analysis aimed to predict the association between the HMGA1 variant IVS5-13insC and T2D.
Methods: Statistical analyses were performed using Stata/SE 12.0 software.
Results: A total of 11 case-control studies in 6 articles were included. Results suggested that the HMGA1 variant IVS5-13insC was associated with an increased risk of insulin resistance (OR = 0.61, 95% CI 0.56 to 0.66, P < 0.0001), T2D (OR = 0.67, 95% CI 0.61 to 0.73, P < 0.0001), particularly for Caucasians with increased risks of T2D (OR = 0.56, 95% CI 0.49 to 0.65, P < 0.0001) compared with wild-type subjects.
Conclusion: This meta-analysis indicated that the HMGA1 variant IVS5-13insC can be a risk factor of T2D development, particularly among Caucasians. Significant risks were also found (Asian: OR = 0.74, 95% CI: 0.63 to 0.86, P < 0.0001, Hispanic-American: OR = 0.81, 95% CI: 0.65 to 1.01, P < 0.0001) in non-Caucasian population. However, ethnical studies should be conducted to reveal whether the HMGA1 variant IVS5-13insC is associated with an increased risk of T2D.

Keywords: HMGA1, type 2 diabetes, insulin resistance, variant, meta-analysis.

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E-Selectin and markers of HIV disease severity, inflammation and coagulation in HIV-infected treatment-naïve individuals

Background: E-selectin has been shown to play a role in atherosclerosis and to be increased in HIV-infected individuals due to chronic immune activation. There is a paucity of studies on E-selectin in HIV-infected treatment-naïve individuals.
Objectives: This study aimed to determine whether E-selectin levels were increased in HIV-infected treatment-naïve individuals and whether these correlated with markers of disease severity, inflammation and coagulation to determine if this population is at risk for cardiovascular disease (CVD).
Methods: E-selectin levels were determined in 114 HIV-infected treatment-naive and 66 HIV-negative individuals, compared between groups and correlated with markers of disease severity, inflammation and coagulation.
Results: There were statistically significant differences (p<0.01) in levels of WCC, CD4+ count, %CD38/8, albumin, IgG, hsCRP and D-dimer between groups and no statistically significant differences in E-selectin (p=0.84) and fibrinogen (p=0.65) levels. E-selectin correlated with age (p=0.02) and gender (p=0.01).
Conclusion: E-selectin was a poor marker in this setting. There was no correlation with any of the markers of disease severity, inflammation and coagulation. E-selectin is most likely raised in an acute inflammatory setting, rather than chronic stage of HIV-infection. We recommend that other markers be utilized to identify patients at increased risk of CVD; as these were significantly increased untreated in individuals.

Keywords: E-selectin, inflammation and coagulation in HIV-infected treatment-naïve individuals.

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Impact of weight reduction on insulin resistance, adhesive molecules and adipokines dysregulation among obese type 2 diabetic patients

Background: Type 2 diabetes mellitus is usually related to vascular problems and is associated with impairment in endothelial function characterized by impaired endothelial-dependent vasodilation and increased platelet adhesion. There is limitation in clinical studies that have addressed the beneficial effects of weight reduction in modulating biomarkers of endothelial dysfunction and adipokines dysregulation for obesity associated with type 2 diabetes mellitus.
Objective: This study was designed to detect the effects of weight loss on insulin resistance, adhesive molecules and adipokines dysregulation in obese type 2 diabetic patients.
Methods: Eighty obese patients with type 2 diabetes mellitus, their age ranged from 35-55 years and their body mass index ranged from 31-37 kg/m2 were equally assigned into 2 groups: the weight reduction group received aerobic exercises in addition to diet regimen, where the control group received medical treatment only for 12 weeks.
Results: There was a 24.04%, 19.33%, 22.78% ,12.28%, 9.35%, 22.53% & 10.12 % reduction in mean values of Homeostasis Model Assessment-Insulin Resistance Index (HOMA-IR), Leptin, Adiponectin, Resistin, intercellular cell adhesion molecule -1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin & body mass index (BMI) respectively in addition to 26.20% & 24.58% increase in the mean values of adiponectin & the quantitative insulin-sensitivity check index (QUICKI) respectively in group (A) at the end of the study. The mean values of leptin, resistin, insulin, HOMA-IR, ICAM-1, VCAM-1, E-selectin & BMI were significantly decreased in addition to significant increase in the mean values of adiponectin & QUICKI in group (A) those that received aerobic exercise training in addition to diet regimen. While the results of group (B) those that received no treatment intervention were not significant. In addition, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment (P<0.05).
Conclusion: Within the limit of this study, 10% reduction in body mass index modulates insulin resistance, adhesive molecules and adipokines dysregulation among obese type 2 diabetic patients.

Keywords: Type 2 Diabetes, obesity, adhesive molecules, adipokines, insulin resistance, weight reduction.

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Interferon- γ receptor-1 gene promoter polymorphisms and susceptibility for brucellosis in Makkah region

Background: Genetic polymorphisms that affect the production levels of certain cytokines and/or their receptors may determine the risk, severity or protection in some infectious diseases like brucellosis.
Objectives: The aim of this study was to investigate the association of certain known Interferon-γ Receptor-1 (IFN-γ R1) gene promoter polymorphisms and the susceptibility to infection with Brucellosis in Saudi population.
Methods: A cases-control association study was conducted in 69 individuals with human brucellosis and 94 healthy individuals. Genotyping of IFN-γ R1 – 56 C>T and IFN-γ R1 – 611 A>G polymorphism in both patients and healthy controls was done by PCR- restriction enzyme length polymorphisms (PCR-RFLP) and PCR- confronting two primer pairs (PCR-CTPP) methods and were assessed for potential associations with susceptibility for human brucellosis and their mode of penetrance.
Results: Interestingly, we have designed a PCR-CTPP system to be used for genotyping of IFN-γ R1 – 611 A > G polymorphism. The PCR-CTPP is an accurate method for genotyping of SNPs. Moreover, it is time-saving, inexpensive and easy to perform.
Conclusion: Both tested polymorphisms, IFN-γ R1 – 56 C>T and IFN-γ R1 -611 A>G polymorphism had no role in genetic susceptibility to human brucellosis in the study population. The PCR-CTPP can be used for genotyping IFN-γ R1 – 611 A > G polymorphism and other types of mutation.

Keywords: Brucellosis; susceptibility; IFN-γ R1 gene promoter polymorphisms.

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Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt

Background: The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region.
Objectives: To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis.
Methods: Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl.
Results: Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29).
Conclusion: Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.

Keywords: Screening test, diabetes mellitus, tuberculosis.

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Levels of heavy metals in urine samples of school children from selected industrial and non-industrial areas in Dar es Salaam, Tanzania

Objectives: The levels of lead, zinc, iron, copper and cadmium metals in the urine samples of selected school children in industrial and non-industrial areas in Dar es Salaam were investigated.
Methods: Urine samples were collected from 120 children in industrial areas and 120 children in non-industrial areas then digested in concentrated acids and analysed using atomic absorption spectrophotometry (AAS).
Results: The concentrations of the heavy metals in the urine samples ranged from below detection limit/non-detectable (ND) to 1.92 mg/L for lead, ND to 2.55 mg/L for zinc, ND to 8.98 mg/L for iron and ND to 0.05 mg/L for copper. Cadmium was not detected. Significant differences were found between the concentrations of heavy metals in urine of pupils from the industrial areas and those from non-industrial areas. The mean concentrations of lead and copper in samples from industrial areas were significantly higher than those found in non-industrial areas (p < 0.002), while the mean concentrations of zinc and iron found in samples from non-industrial areas were significantly higher than those found in industrial areas (p < 0.0001).
Conclusion: The contamination levels were generally high in samples from both areas indicating exposure from various sources. The findings indicate public health risks.

Keywords: Heavy metals, children urine, industrial areas, non-industrial areas, Tanzania.

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Association of FokI, TaqI, BsmI and ApaI polymorphisms with diabetic retinopathy: a pooled analysis of case-control studies

Background: To assess synthetically the association between polymorphisms in the vitamin D receptor (VDR) gene (FokI, BsmI, ApaI, and TaqI) and diabetic retinopathy (DR).
Methods: Pubmed, Embase, ISI Web of Science, Google-scholar and CBMDisc, CNKI and Chongqing VIP databases were searched. A meta-analysis was performed.
Results: Six studies with 636 cases and 1,035 controls were included in this meta-analysis. The outcomes showed that the FokI polymorphism (F allele) of VDR gene had no statistical protective relationship with DR in overall studies. Interestingly, stratification analysis showed that the FokI polymorphism (Fallele) was significantly associated with decreased DR risk in the Chinese population, among included studies without publication bias, during a comparison analysis between normal subjects and DR patients, and among articles published after 2010. However, the TaqI, BsmI and ApaI polymorphisms of VDR gene had no significant association with the risk of DR.
Conclusion: This meta-analysis of case-control studies revealed that the VDR-FokI polymorphism (F allele) decreased the risk of DR in Chinese people, among included studies without publication bias, during a comparison analysis between normal subjects and DR patients, and among articles published after 2010. Further rigorous and prospective studies with large sample size are needed to confirm our findings.

Keywords: Diabetic retinopathy; polymorphism; Vitamin D receptor.

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Interface of non-communicable diseases and infections in Africa

Nil

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Effects of gender, age and treatment duration on lipid profile and renal function indices in diabetic patients attending a teaching hospital in South-Western Nigeria

Background: Type 2 Diabetes Mellitus (T2DM) is associated with diabetic nephropathy and hyperlipidemia. Gender, age, medication adherence, lifestyle, culture and socioeconomic status could be sources of diversity in T2DM leading to differences in predisposition, development and clinical presentation.
Objectives: Therefore, this study aimed to investigate the influence of gender, age and treatment duration on kidney and lipid-related biochemical indices of T2DM patients attending Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria (EKSUTH).
Methods: Blood from diabetic patients and healthy subjects was analysed for fasting blood glucose (FBG), renal function parameters and lipid profile. Influence of age, gender and treatment duration on indices was assessed using standard baseline values.
Results: Dyslipidemia was pronounced among female diabetics while the incidence of diabetes was found to be higher in middle-age. The percentage of diabetics with high levels of FPG, urea, creatinine, cholesterol, triglyceride and low density lipoprotein-cholesterol after 9-10 years of treatment were lower compared with the percentage after 5-6 years of treatment.
Conclusion: Gender, age and treatment duration influenced clinical course of T2DM among patients presenting at EKSUTH but long term treatment appeared to improve T2DM among patients.

Keywords: Fasting blood glucose, dyslipidemia, creatinine, atherogenic index, diabetes, Ekiti State.

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Knowledge, attitude, willingness of HIV counseling and testing and factors associated with it, among long distant drivers in Enugu, Nigeria: an opportunity in reduction of HIV prevalence

Background: Long distance truck drivers (LDTDs) have been one of the key forces in the spread of HIV/AIDS across the African continent.
Objective: We set out to assess the knowledge of HIV transmission route, preventive measures, attitude to HIV Counseling and Testing (HCT), willingness and factors associated with willingness to screen for HIV among long distance truck drivers in Enugu, Nigeria.
Method: This was a cross-sectional study of 500 long distance truck drivers aged 19-65 years. They were interviewed with a semi-structured questionnaire on aspects of HCT. Data was analyzed using cross tabulations to examine associations and chi square test for various variables.
Result: A good number of the respondents have wrong ideas of transmission route, ranging from 28.4% to 90.4%. Significantly high number of those with tertiary education will engage in incorrect preventive measures like using antibiotics after sex, and seeking protection from a traditional healer compared to those with no formal education ( χ 2 = 3.2, p = 0.02; χ 2 = 2.3, p = 0.01 respectively).. Those with tertiary education and those that were divorced showed a generally good attitude towards HCT and mostly agreed that HCT should be made compulsory compared to others (χ2 = 29.8, p< 0.001; χ2 = 10.1, p < 0.001 respectively). There was a significantly high willingness to screen among 302 (60.4%) of the participants. There was also significant association between marital status, educational level and willingness to screen ( χ2 = 174.4, p < 0.001; χ2 = 10.6, p < 0.001 respectively).
Conclusion: A high number of LDTD had wrong knowledge of transmission route, better educational level did not affect incorrect knowledge of preventive measures, educational and marital statuses affected attitude to HCT, willingness to screen was high with marital status and educational level significantly associated with it. We recommend routine HCT at the work places of truck drivers to correct the anomalies discovered above.

Keywords: HIV counselling, testing, Nigeria, screening, sub-Saharan Africa, truck drivers, willingness.

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Diagnostic performance of several biomarkers for identification of cases of non-communicable diseases among Central Africans

Background: This study determined the diagnostic performance of new biomarkers for a composite diagnosis of non-communicable diseases (NCDs) among Central Africans.
Methods: This case-control study was conducted at LOMO Medical Centre, Kinshasa, DR Congo (DRC) between January – December, 2008. The cases comprised 226 participants with concurrent presence of at least 2 or more of NCDs. Anthropometric parameters and blood pressure were measured while blood samples were assayed for biomarkers. The receiver operating characteristics curve and the logistic regression model were applied.
Results: Serum selenium (Se) had specificity and sensitivity of 72.4% and 91.1%, respectively with an area under the curve (AUC) of 0.802; Nitric oxide (NO) (specificity: 72.4%; sensitivity: 93.0%) (AUC = 0.800); Thyroid stimulating hormone (TSH) levels > 6 Mu/L (specificity: 75%; sensitivity: 65%) (AUC = 0.0.727); serum calcium levels of ≥ 110g/L (specificity: 76%; sensitivity: 75%) (AUC = 0.822); and daily salt intake of ≥10 g/day (specificity: 75%; sensitivity: 67%) (AUC = 0.653) in the diagnosis of all NCDs, which were all highly significant (<0.0001).
Conclusion: Serum Se, NO, calcium, TSH and daily salt intake had high diagnostic performance as biomarkers for identification of patients with concurrent NCDs in the study population.

Keywords: Non-communicable diseases, diet, new biomarkers, Central Africa.

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Influenza virus A (H1 and H3) and B co-circulation among patient presenting with acute respiratory tract infection in Ibadan, Nigeria

Background: Influenza is an acute respiratory disease that continues to cause global epidemics and pandemics in human with significant mortality and morbidity.
Objectives: This study was designed to identify the circulating influenza virus in Ibadan, Nigeria during the 2006/2007 season.
Methods: Throat swab samples were collected from patients presenting with acute respiratory tract infection at the Out-Patient Departments of major hospitals in Ibadan over a period of seven months from November 2006 to May 2007. Isolation of influenza virus was performed using Madin-Darby Canine Kidney cell line and 10 days old chicken embryonated egg. Isolates was identified by haemagglutination and haemagglutination-inhibition assays using selected CDC Influenza reference antisera (A, B, subtype H1 and H3).
Results: Out of 128 patients tested, 21(16.4%) yielded positive for virus isolation. Identification of the isolates showed that 19(14.8%) were positive for influenza virus out of which 11(8.6%) and 8(6.2%) were influenza A and B viruses respectively. Influenza A virus 6(4.7%) were subtype H1; 4(3.1%) were co-subtype H1 and H3; and 1(0.8%) was not inhibited by subtype H1 and H3.
Conclusion: The circulation of influenza virus A and B in this study is important to contributing knowledge and data to influenza epidemiology and surveillance in Nigeria.

Keywords: Influenza A, haemagglutination, isolation, Nigeria.

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Walking as a feasible means of effecting positive changes in BMI, waist, and blood pressure in black South African women

Background: In the context of a growing obesity pandemic in sub-Saharan African countries little is known on how to address the problem /disease in the region.
Methods: A randomised controlled trial of walking to decrease obesity was conducted using 115 women employed at the University of Venda, Limpopo province. 49 of these participants were randomly selected into an intervention group, which walked for 30 minutes, 3 days per week for a period of 12 weeks on treadmills located in the university gym. The control group were instructed to continue with usual activities. Baseline and follow-up body mass index (BMI), waist circumference, blood pressure (BP), body size discrepancy (measured by a feel-minus-ideal (FID) index), and physical activity were collected on all participants.
Results: The absolute changes in BMI, waist, systolic and diastolic BP in the intervention group was -0.80, -1.50, -4.02 and -2.37, respectively. In contrast, the absolute changes for these were +1.05, +1.73, +4.64 and +4.94, respectively in the control group. The results of the FID analysis showed that most had a desire for thinness.
Conclusion: Our data demonstrates that positive changes in BMI, waist, and BP were observed in the intervention group, indicating the potential scalability of the intervention.

Keywords: Exercise, blood pressure, obesity, intervention.

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Resistance development and insecticide susceptibility in Culex pipiens pipiens, an important vector of human diseases, against selection pressure of temephos and its relationship to cross-resistance towards organophosphates and pyrethroids insecticides

Background: Culex pipiens pipiens is an important vector of human diseases.
Objective: To determine the insecticide resistance development in Culex pipiens pipiens against selection pressure of temephos..
Methods: A field population of Culex pipiens pipiens was collected from Northwestern Tunisia with a medium level of temephos resistance (LC50 = 0.0069). It was subjected to six generations of temephos pressure selection to evaluate its relationship to cross-resistance towards organophosphates (OPs) and pyrethroids (PYR) insecticides.
Results: The selection was initiated at the dose 0.0266, 0.0748 and 0.0069 which were increased during successive generations up to 0.1488, 3.8747 and 0.0086 after sixth generation for temephos, chlorpyrifos and permethrin insecticides, respectively. It is important to noted that high cross-resistance to chlorpyrifos insecticide (OP) was detected (51.88×). However, little or no cross-resistance to the pyrethroid permethrin (PYR) was recorded (1.24×). Contrary to metabolic resistance, it seemed that acetylcholinesterases AChE 1 was fixed under pressure selection.
Conclusion: The high cross-resistance to temephos and chlorpyrifos is reasonable because they belong to the same class of insecticide (OP). However, the little cross-resistance to the pyrethroid permethrin could support its use alternately for Culex pipiens pipiens control.

Keywords: Culex pipiens pipiens, temephos selection, Tunisia.

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GATA4 molecular screening and assessment of environmental risk factors in a Moroccan cohort with tetralogy of Fallot

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect (CHD) with an incidence of 1/3600 live births. This disorder was associated with mutations in the transcription factors involved in cardiogenesis, like Nk2 homeobox5 (NKX2-5), GATA binding protein4 (GATA4) and T-BOX1 (TBX1). GATA4 contributes particularly to heart looping and differentiation of the second heart field.
Objectives: The aim of this study was to screen a Moroccan cohort with tetralogy of Fallot for GATA4 mutations, and to assess environmental risk factors that could be involved in the occurrence of this disorder.
Methods: Thirty-one non-syndromic TOF patients, enrolled between 5th April 2014 and 18th June 2015, were screened for GATA4 mutations using direct sequencing of GATA4 coding exons. Statistical assessment of different risk factors, which is a retrospective study, was carried out using Chi-square and Fisher's exact tests.
Results: We identified seven exonic variants in nine patients (two missense and five synonymous variants); in addition of eight intronic variants. Assessment of environmental risk factors shows significant association of maternal passive smoking with TOF in the Moroccan population.
Conclusion: The present study allowed, for the first time, the molecular and environmental characterisation of Moroccan TOF population. Our findings emphasise particularly the strong association of passive smoking with the emergence of tetralogy of Fallot.

Keywords: Tetralogy of Fallot, GATA4, molecular screening, risk factors.

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NAEMSP® 2019 Annual Meeting Will Reunite Governor with Lifesaving First Responders

OVERLAND PARK, Kan. — The National Association of EMS Physicians (NAEMSP) has several inspiring and informative presentations lined up for its 2019 Annual Meeting, which will take place January 7-12 in Austin, Texas. The conference will reunite its keynote speaker, former Pennsylvania Governor Tom Ridge, with the first responders who resuscitated him after his cardiac arrest in November...

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Harnessing genomic information for livestock improvement

Harnessing genomic information for livestock improvement

Harnessing genomic information for livestock improvement, Published online: 04 December 2018; doi:10.1038/s41576-018-0082-2

Improvements to livestock genetics will be critical to tackling the looming food crisis. Achieving this goal will require implementation of improved genomic technologies and better use of a wider range of genomic information.

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Supervisor, EMS Operations - TRF Area Ambulance - Sanford Health EMS

Daily duties for the Supervisor of EMS Operations may consist of but not limited to coordinating the scheduling of emergency medical systems and operations, overseeing the orientation of new staff, yearly licensure/credentialing, dealing with employee issues/behaviors, assisting with hiring/termination, maintaining transport equipment/checklists , and peer reviews. Individuals must demonstrate the ability ...

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Delaying laparoscopic surgery in pregnant patients with an equivocal acute appendicitis: a step-wise approach does not affect maternal or fetal safety

Abstract

Background

Accurate and timely diagnoses of acute appendicitis (AA) during pregnancy avoids maternal and fetal morbidity and mortality. We present our experience of using an initial transabdominal ultrasound (US) performed at presentation to diagnose AA in pregnant patients as well as the value of a delayed repeat study in those who remain equivocal. We explore the sensitivity and specificity of this algorithm as well as the maternal and fetal safety of this approach.

Methods

Of the 225 patients identified within the study period who underwent laparoscopic appendectomy, 216 met the inclusion criteria and were retrospectively analyzed. If the US performed on presentation revealed AA, surgery was performed. Patients with a non-diagnostic US were admitted with surgery performed if there was clinical and/or biochemical deterioration. Patients who remained equivocal underwent a repeat delayed study. The results of the initial versus delayed studies were compared. Maternal and fetal complications were recorded and contrasted.

Results

Of the 216 patients included, 164 (75.9%) had AA, 14 (6.5%) had complicated AA and 38 (17.6%) had a normal appendix. Initial US was diagnostic for 125/216 (57.9%) of patients and 19/34 (55.8%) of patients who underwent a delayed repeat study. The remaining patients underwent empirical surgery. The pooled sensitivity and specificity of US for the cohort was 79.2% and 92.1%, respectively. There was no difference in proxies of maternal or fetal safety between the groups.

Conclusion

US is a useful tool for diagnosing AA in pregnancy. In this cohort, performing a delayed repeat US during a period of observation in those patients who remained otherwise equivocal increased the diagnostic yield of the US. Delaying surgery in this specific group of patients does not affect maternal or fetal safety.

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The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018

Abstract

Background

The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community.

Methods

Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018.

Results

9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29–1.72], I² 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60–0.94], I² 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35–0.90], I² 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D.

Conclusion

We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).

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Report: The estimated costs of NG911

After two years of research, a team of experts has determined that it will cost between $9.5 and $12.7 billion over the next ten years to expand NG911

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Paramedic praises George H.W. Bush for making his ‘dream come true’

Paramedic Josh Grzyb, who worked for President Bush and his wife at their Maine home, said Bush helped him get into medical school before he died

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Features of multiple self‐healing squamous epithelioma and Loeys‐Dietz syndrome in a patient with a novel TGFBR1 variant

Multiple self‐healing squamous epithelioma (MSSE, Ferguson‐Smith disease) and Loeys‐Dietz syndrome (LDS) are allelic conditions associated with pathogenic variants in the transforming growth factor beta receptor 1 gene (TGFBR1). We describe a patient with a novel missense variant in this gene: c.664G > A, p.[Gly222Arg], who clinically presents with both syndromes. The patient also has a history of gastric antral vascular ectasia, which has not been reported previously in LDS.

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Lipin1 is required for skeletal muscle development by regulating MEF2c and MyoD expression

Key points

Lipin1 is critical for skeletal muscle development. Lipin1 regulates MyoD and MEF2c expression through PKC/HDAC5 mediated pathway. Inhibition of PKCμ activity suppresses myoblast differentiation through inhibiting MyoD and MEF2c expression.

Abstract

Our previous characterization of global lipin1‐deficient (fld) mice demonstrated that lipin1 played a novel role in skeletal muscle (SM) regeneration. This study using cell type‐specific Myf5‐cre;Lipin1^fl/fl conditional knockout mice (Lipin1^Myf5cKO) shows that lipin1 is a major determinant of SM development. Lipin1 deficiency induced reduced muscle mass and myopathy. Our results from lipin1‐deficient myoblasts suggested that lipin1 regulates myoblast differentiation through the protein kinase Cμ (PKCμ)/histone deacetylase 5 (HDAC5)/myocyte‐specific enhancer factor 2C (MEF2c):MyoD‐mediated pathway. Lipin1 deficiency leads to the suppression of PKC isoform activities, as well as the inhibition of the downstream target of PKCμ, class II deacetylase HDAC5 nuclear export, and consequently, the inhibition of MEF2c and MyoD expression in the SM of Lipin1^Myf5cKO mice. Restoration of diacylglycerol‐mediated signaling in lipin1 deficient myoblasts by phorbol 12‐myristate 13‐acetate (PMA) transiently activated PKC and HDAC5, and upregulated MEF2c expression. Our findings provide insights into the signaling circuitry that regulates SM development, and have important implications for developing intervention aimed at treating muscular dystrophy.

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A genome‐wide association study identifies new genes associated with developmental dysplasia of the hip

Developmental dysplasia of the hip (DDH) is one of the most common congenital malformations and covers a spectrum of hip disorders from mild dysplasia to irreducible dislocation. The pathological mechanisms of DDH are poorly understood, which hampers the development of diagnostic tools and treatments. To gain insight into its disease mechanism, we explored the potential biological processes that underlie DDH by integrating pathway analysis tools and performing a genome‐wide association study (GWAS). A total of 406 DDH‐associated genes (P< 0.001) were identified by our GWAS using a Chinese Han cohort consisting of 386 DDH cases and 500 healthy controls (Set A). We verified the significant loci (P<10^‐5) in another Chinese Han cohort consisting of 574 DDH patients and 569 healthy controls (Set B). An intronic SNP (rs61930502) showed significant association in Set A and Set B (P=2.65 x 10^‐7 and 2.0 x 10^‐4, respectively). The minor allele, rs61930502‐A, which tended to prevent DDH showed a dominant effect. Heat shock 70 kDa protein 8 (HSPA8) showed the most direct interactions with other proteins which were coded by DDH‐associated genes in the protein‐protein interaction analysis. Interestingly, KEGG enrichment analysis suggested a relation between DDH and the genes involved in type II diabetes mellitus pathway (P=0.0067). Our genetic and protein interaction evidence could open avenues for future studies of DDH.

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Effectiveness of Health and Social Service Networks for Severely Mentally Ill Patients’ Outcomes: A Case–Control Study

Abstract

Mental health and social care services networks aim to provide patients with continuity of care and support their recovery. There is, however, no conclusive evidence of their effectiveness. Since 2011, Belgium has been implementing a nation-wide reform of mental health care by commissioning service networks. Using a case–control design, we assessed the reform's effectiveness for continuity of care, social integration, quality of life, and re-hospitalization for 1407 patients from 23 networks. Greater reform exposure was associated with a slight improvement in continuity of care, but not with other outcomes. We concluded that service networks alone do not affect patient-level outcomes.

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Harnessing genomic information for livestock improvement

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Pancreatic cancer arising from the remnant pancreas after pancreatectomy: a multicenter retrospective study by the Kyushu Study Group of Clinical Cancer

Abstract

Background

After initial pancreatic resection, local recurrence of pancreatic cancer (PC) or new primary PC can develop in the remnant. There are limited data available regarding this so-called remnant PC. The aim of this retrospective study was to clarify the clinical features and establish a treatment strategy for remnant PC.

Methods

A multicenter retrospective study with the Kyushu Study Group of Clinical Cancer was carried out. Clinical data from 50 patients who developed remnant PC were analyzed. RAS mutation analysis of the initial tumor and of remnant PC was performed in 17 cases.

Results

The initial pancreatic resections were performed for 37 invasive ductal carcinomas, and for 13 other tumors. Thirty-seven patients underwent a second pancreatectomy for remnant PC (resected group), while thirteen patients were not operated (unresected group). The median overall survival times were 42.2 months in the resected group and 12.3 months in the unresected group (HR 0.374; 95% CI 0.17–0.83). In RAS mutation analysis, 14 cases had at least 1 missense variant of KRAS, HRAS, or NRAS in the initial pancreatic tumor and/or remnant PC. The same missense variants between the initial tumor and remnant PC were discovered only in KRAS of one patient, and in HRAS of one patient. No case had completely consistent missense variants between the initial tumor and remnant PC.

Conclusions

This study found that repeated pancreatectomy for remnant PC can prolong patient survival, and RAS mutation analysis indicated that many remnant PCs are developed from metachronous multifocal origins.

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Is transperitoneal laparoscopic radical nephrectomy suitable for patients with a history of abdominal surgery?

Abstract

Introduction

Laparoscopic radical nephrectomy is the gold standard for treatment of renal cell carcinoma. However, previous abdominal surgery is generally regarded as a contraindication to the laparoscopic approach because it causes intraperitoneal adhesions, which are thought to interfere with subsequent laparoscopic procedures inside the abdominal cavity. Few studies have examined the influence of prior surgery on laparoscopic nephrectomy. Therefore, the aim of this study was to evaluate the impact of previous laparotomy on laparoscopic nephrectomy.

Methods

The records of 251 consecutive patients who had undergone laparoscopic nephrectomy for renal cell carcinoma at our hospital between 2005 and 2015 were reviewed retrospectively.

Results

Of the 251 laparoscopic nephrectomy patients, 76 patients (30%) had undergone prior abdominal surgery (surgery group), whereas the remaining 175 patients (70%) had not previously had abdominal surgery (control group). There were no significant differences between the control group and the surgery group with regard to pneumoperitoneum time (143 vs 135 min, P = 0.241) or blood loss (39 vs 36 mL, P = 0.763). Next, we divided the patients into two cohorts based on surgeon experience: 98 patients had been treated by an expert (i.e. someone who performs more than 50 laparoscopic procedures per year) and 153 patients had been treated by a non‐expert. There was no significant difference in pneumoperitoneum time between the control and surgery groups in each cohort (treated by experts, 108 vs 103 min; treated by non‐experts: 162 vs 166 min).

Conclusion

We conclude that laparoscopic nephrectomy may be feasible after previous abdominal surgery and could be one of the surgical options.

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Laparoscopic repair of secondary perineal hernia with coverage by the mobilized cecum

Abstract

The incidence of secondary perineal hernia (SPH) has increased since the introduction of extralevator abdominoperineal resection and laparoscopic abdominoperineal resection. Currently, laparoscopic mesh repair is the usual procedure. Here, we demonstrate a repair of SPH without mesh that uses the mobilized cecum to cover the pelvic hernial orifice. An 83‐year‐old man complained of discomfort when sitting for long periods. He was status post laparoscopic abdominoperineal resection and was diagnosed with SPH. Hernia repair was performed. After transperitoneal adhesiolysis in the inferior pelvis, the right colon was laparoscopically mobilized, and the pelvic orifice was covered by suturing the cecum to the pelvic brim. The perineal skin was managed with negative pressure wound therapy. The postoperative course was uneventful. There has been no sign of recurrent herniation for 12 months. This method of SPH repair is simple to perform and avoids mesh‐related complications.

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Objective assessment of robotic suturing skills with a new computerized system: A step forward in the training of robotic surgeons

Abstract

Introduction

The purpose of this study was to assess robot‐assisted suturing skills on a laparoscopic intestinal anastomosis model by using a novel computerized objective assessment system.

Methods

This study compared the suturing skills of 13 surgically naïve participants on an artificial intestinal anastomosis model that mimics real tissue. Each examinee sutured using da Vinci robot assistance under 2‐D and 3‐D visualization and with conventional laparoscopy (CL). Pressure‐measuring and image‐processing devices were employed to quantitatively evaluate suturing skills. Five unique criteria were used to evaluate the skills of participants.

Results

Suturing under 3‐D visualization (P < 0.01) and with CL (P < 0.05) were significantly faster than under 2‐D visualization. Sutures placed under 3‐D (P < 0.05) and 2‐D (P < 0.01) visualization had significantly better suture tension than those placed with CL, which did not meet acceptable values for suture tension. Sutures placed with CL had significantly better air pressure leakage than those placed under 2‐D visualization (P < 0.05), which did not meet acceptable values for air pressure leakage and wound opening area. One participants failed to achieve full‐thickness sutures with 2‐D, two participants with CL, and one participant with 3‐D.

Conclusion

Using 3‐D vision is necessary for complex maneuvering during robot‐assisted minimally invasive surgery. Our quantitative assessment system is useful for evaluating the skill acquisition of surgeon‐trainees undergoing robotic surgery training.

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Rare Pelvic Malignant Tumors in Adults: Treatment Features and Clinical Outcome in Nonmetastatic Disease (Single Institution Experience)

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.

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Epidermal Growth Factor Receptor Mutation Detection in Cerebrospinal Fluid of Lung Adenocarcinoma Patients with Leptomeningeal Metastasis

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.

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A comparison of the Macintosh laryngoscope, McGrath video laryngoscope, and Pentax Airway Scope in paediatric nasotracheal intubation.

A comparison of the Macintosh laryngoscope, McGrath video laryngoscope, and Pentax Airway Scope in paediatric nasotracheal intubation.

Sci Rep. 2018 Nov 26;8(1):17365

Authors: Yoo JY, Chae YJ, Lee YB, Kim S, Lee J, Kim DH

Abstract
We evaluated the performance of the McGrath video laryngoscope and Pentax Airway Scope in comparison with the Macintosh laryngoscope for nasotracheal intubation in paediatric patients. For this, 108 patients were enrolled in an open-label, randomized controlled trial. Patients were randomly allocated to one of three groups based on use of the Macintosh laryngoscope, McGrath video laryngoscope, or Pentax Airway Scope. Time to intubation, the intubation difficulty, and the quality of navigation were compared among groups. The median nasotracheal intubation time [interquartile range] in the Macintosh group (33.5 [28.3-39.8] s) was significantly shorter than those of the McGrath (39.0 [32.0-43.0] s) and Pentax groups (43.0 [35.0-52.0] s). The difficulty of nasotracheal intubation was similar among all groups. When navigating and aligning the tube from the oropharynx into the glottic inlet, the cuff inflation method was required in significantly fewer patients for the Macintosh group (11.1%) than for the McGrath (48.6%) and Pentax (51.4%) groups. Thus, compared to the McGrath video laryngoscope and Pentax Airway Scope, the Macintosh laryngoscope allowed shorter nasotracheal intubation times and better facilitated tracheal navigation, requiring less use of the cuff inflation method to navigate the tracheal tube into the glottic inlet.

PMID: 30478457 [PubMed - in process]

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