Seeking to close the loopholes in transplant tourism and organ trafficking.

No abstract available

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Sequential and urgent coronary artery bypass surgery followed by kidney transplantation in a highly sensitized patient with unstable angina.

No abstract available

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Early effects of renal replacement therapy on cardiovascular comorbidity in children with end-stage kidney disease: findings from the 4C-T Study.

Background: The early impact of renal transplantation on subclinical cardiovascular measures in pediatric patients has not been widely investigated. This analysis is performed for pediatric patients participating in the prospective 4C study and focuses on the early effects of RRT modality on cardiovascular comorbidity in patients receiving a preemptive transplant or started on dialysis. Methods: We compared measures indicating subclinical cardiovascular organ damage (aortal pulse wave velocity, carotid intima media thickness, left ventricular mass index) and evaluated cardiovascular risk factors in 166 pediatric patients before and 6 to 18 months after start of RRT (n=76 transplantation, n=90 dialysis). Results: RRT modality had a significant impact on the change in arterial structure and function: compared to dialysis treatment, transplantation was independently associated with decreases in pulse wave velocity ([latin sharp s]=-0.67; p

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Differential sensitivity of presynaptic and postsynaptic GABAB receptors in rat ventrolateral periaqueductal gray.

The ventrolateral periaqueductal gray (PAG) in the midbrain plays a key role in the descending pain modulatory system. [gamma]-Aminobutyric acid type B (GABAB) receptors belong to a metabotropic receptor subfamily and mediate both presynaptic and postsynaptic effects in PAG. It has been well documented that activation of GABAB receptors yields analgesia in some PAG subdivisions. In the present study, employing whole-cell patch-clamp recordings on acute rat PAG slices, we simultaneously monitored the responses of presynaptic and postsynaptic GABAB receptors. We found that the GABAB agonist, baclofen, exhibits less efficacy and potency at GABAB postsynaptic versus presynaptic receptors. This sensitivity bias may contribute to synapse homeostasis and implicate a novel pharmacotherapy treatment. (C) 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Hydrogen gas attenuates sevoflurane neurotoxicity through inhibiting nuclear factor [kappa]-light-chain-enhancer of activated B cells signaling and proinflammatory cytokine release in neonatal rats.

Anesthesia neurotoxicity in developing brain has gained increasing attention. However, knowledge regarding its mitigating strategies remains scant. Sevoflurane, a commonly used anesthetic, is responsible for learning and memory deficits in neonates. Molecular hydrogen is reported to be a potential neuroprotective agent because of its antioxidative and anti-inflammatory activities. This study aimed to investigate the effect of hydrogen gas on sevoflurane neurotoxicity. The newborn rats were treated with sevoflurane and/or hydrogen gas for 2 h. Spatial recognition memory and fear memory were determined by Y-maze and fear conditioning tests at 10 weeks of age. Nuclear factor [kappa]-light-chain-enhancer of activated B cells (NF-[kappa]B) and proinflammatory cytokine levels were detected using western blot analysis. The data showed that the spatial recognition memory and fear memory of the rats treated with sevoflurane decreased compared with the control, and the cognitive function of the rats treated with sevoflurane and hydrogen gas significantly increased in comparison with treatment with sevoflurane alone. Moreover, hydrogen gas suppressed NF-[kappa]B phosphorylation and nuclear translocation and reduced the production of interleukin-1[beta], interleukin-6, and tumor necrosis factor-[alpha] following sevoflurane administration. Thus, the results proposed that hydrogen gas might protect against sevoflurane neurotoxicity by inhibiting NF-[kappa]B activation and proinflammatory cytokine release, providing a novel therapeutic strategy for anesthesia neurotoxicity. (C) 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Parasympathetic activation enhanced by slow respiration modulates early auditory sensory gating.

Sensory gating is a preattentional mechanism to filter irrelevant information from the environment. It is typically reflected as a suppression of the event-related P50 component for successive sounds in the auditory modality. Although stress-induced sympathetic activation has been reported to disrupt P50 suppression, little is known about the modulatory effect of parasympathetic activation on early auditory sensory gating. We determined the parasympathetic effect on the magnetic P50 (P50m) suppression by controlling the respiratory rhythm and recording data simultaneously with magnetoencephalography and electrocardiography, using three successive click sounds as stimulus and ten normal individuals as study participants. The respiratory rhythm was guided by visual cues and set at 0.3, 0.25, or 0.2 Hz for distinct auditory stimulus sequence blocks. Heart rate variability analysis showed that slow respiration leads to significantly large high-frequency power, which is known as the parasympathetic index, whereas low-frequency/high-frequency ratio, known as the sympathetic index, did not differ with the respiratory rhythm. Although P50m suppression was observed in the left and right primary auditory areas for every respiratory condition, the left P50m intensity for the first sound was significantly decreased in the case of slow respiration, thereby indicating disruption of the left P50m suppression. Since background alpha oscillatory power, reflecting the arousal level, was similar for every respiratory rhythm, it is concluded that parasympathetic activation enhanced by slow respiration modulates P50m gating by reducing the initial neural sensitivity for an auditory input. Not only sympathetic but also parasympathetic effects should be considered in the evaluation of P50/P50m biomarkers. (C) 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Altered resting-state functional connectivity of default-mode network and sensorimotor network in heavy metal music lovers.

The aim of this study was to investigate the spontaneous neural activity and functional connectivity (FC) in heavy metal music lovers (HMML) compared with classical music lovers (CML) during resting state. Forty HMML and 31 CML underwent resting-state functional MRI scans. Fractional amplitude of low-frequency fluctuations (fALFF) and seed-based resting-state FC were computed to explore regional activity and functional integration. A voxel-based two-sample t-test was used to test the differences between the two groups. Compared with CML, HMML showed functional alterations: higher fALFF in the right precentral gyrus, the bilateral paracentral lobule, and the left middle occipital gyrus, lower fALFF in the left medial superior frontal gyrus, an altered FC in the default-mode network, lower connectivity between the right precentral gyrus and the left cerebellum-6 and the right cerebellum-3, and an altered FC between the left paracentral lobule and the sensorimotor network, lower in the right paracentral lobule and the right inferior temporal gyrus FC. The results may partly explain the disorders of behavioral and emotional cognition in HMML compared with CML and are consistent with our predictions. These findings may help provide a basic understanding of the potential neural mechanism of HMML. (C) 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

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The effects of brief swaying on postural control.

Postural control can be improved with balance training. However, the nature and duration of the training required to enhance posture remains unclear. We studied the effects of 5 min of a self-initiated balance exercise along a single axis on postural control in healthy individuals. Postural control was measured before and after a 5-min period where members of the experimental group were asked to lean their entire body forward and backward and members of the control group were asked to remain seated. A significant improvement for sway velocity, a postural control variable significantly associated with an increased risk of falls, was found in the experimental group following the body sway exercise. These data suggest that a basic exercise can rapidly improve postural control and reduce the risk of falls. (C) 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Monoamine and neuropeptide connections significantly alter the degree distributions of the Caenorhabditis elegans connectome.

To understand the behaviors of an individual, it is crucial to understand the neural connections of the nervous system, that is, the connectome. The hermaphrodite Caenorhabditis elegans connectome has served as a prototype for analytical studies since the chemical synapses and gap junctions among the 302 neurons were completely mapped. Recently, monoamine (MA) and neuropeptide (NP) connections were established, which form a multilayer connectome in conjunction with chemical synapses and gap junctions. In this study, we investigated the difference in the in-degree and out-degree distributions, respectively, among the connectomes with and without MA and NP connections. We found that the in-degree and out-degree distributions show different properties of dissimilarity. We discovered that only a few of the degree distributions can be fitted perfectly to power-law or exponential models. Finally, clustering analysis suggests that MA and NP connections significantly alter the degree distributions of the C. elegans connectome. Overall, our study provides an insight into the structural properties of the multilayer connectome with MA and NP connections and confirms the necessity to investigate the multilayer connectome to understand the behaviors of a worm. (C) 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Characterization of spontaneous hydrocephalus development in the young atherosclerosis-prone mice.

Little has been reported on whether abnormal lipid metabolism affects hydrocephalus, although congenital malformations and infectious diseases are major causal factors for hydrocephalus development. In a study on the pathogenesis of atherogenesis in mice, we unexpectedly discovered that hydrocephalus occurred in partial apolipoptotein E (apoE) and low-density lipoprotein receptor (LDLR) double-knockout (apoE-/-/LDLR-/-) mice fed either chow or a high-fat and high-cholesterol diet between the ages of 4 and 12 weeks. In the 12-week-old high-fat and high-cholesterol group, the incidence rate was as high as 15%. Transcription levels of transforming growth factor-[beta]1 (TGF-[beta]1), Smad3, Smad4, and Smad7 in the cortex of the hydrocephalic cerebrum were significant downregulated in 4-week-old mice, but were increased in the 8 and 12-week-old groups compared with that of age-matched nonhydrocephalic mice. The mRNA level of tissue inhibitor of metalloproteinases 1 was significantly increased, whereas matrix metalloproteinase-9 was lower in hydrocephalic mice of all ages. The translation level of TGF-[beta]1 increased in the hydrocephalic brains of 8 and 12-week-old mice. This study provides primary evidence for the connection between lipid metabolic disorder and hydrocephalus development. This may suggest that both hyperglyceridemia and hypercholesterolemia are harmful factors in hydrocephalus development because of adverse effects on TGF-[beta]1/Smad signaling in the brain. (C) 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Reply to the Letter to the Editor Concerning: ‘Changes in Swallowing-Related Quality of Life After Endoscopic Treatment for Zenker’s Diverticulum Using SWAL-QOL Questionnaire’

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A Survey of Australian Dysphagia Practice Patterns

Abstract

Dysphagia assessment and rehabilitation practice is complex, and significant variability in speech-language pathology approaches has been documented internationally. The aim of this study was to evaluate swallowing-related assessment and rehabilitation practices of SLPs currently working in Australia. One hundred and fifty-four SLPs completed an online questionnaire administered via QuickSurveys from May to July 2015. Results were analysed descriptively. The majority of clinicians had accessed post-graduate training in dysphagia management and assessment (66.23%). Referral and screening were typically on an ad hoc basis (74.03%). Clinical swallow examination (CSE) and Videofluoroscopic Swallowing Study were used by 93.51 and 88.31% of respondents, respectively. CSE was the assessment that predominantly informed clinical decision-making (52.63%). Clinicians typically treated clients with dysphagia for 30 min per session (46.10%), with recommendations of repetition of exercises inconsistent across settings. Outcome measures were utilised by many (67.53%), which however were typically informal. Results indicate variable practice patterns for dysphagia assessment and management across Australia. This variability may reflect the heterogeneous nature of dysphagia and the varying needs of patients accessing different services.

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Table of contents

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Masthead

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Temporal remodeling of pial collaterals and functional deficits in a murine model of ischemic stroke

Publication date: Available online 18 September 2017
Source:Journal of Neuroscience Methods
Author(s): Benjamin Okyere, Miranda Creasey, Yeonwoo Lebovitz, Michelle H. Theus
BackgroundLeptomeningeal anastomoses play a critical role in regulating reperfusion following cerebrovascular obstruction; however, methods to evaluate their temporospatial remodeling remains under investigation.New methodWe combined arteriole-specific vessel painting with histological evaluation to assess the density and diameter of inter-collateral vessels between the middle cerebral artery and anterior cerebral artery (MCA-ACA) or posterior cerebral artery (MCA-PCA) in a murine model of permanent middle cerebral artery occlusion (pMCAO).ResultsWhile the overall density was not influenced by pMCAO, the size of MCA-ACA and MCA-PCA vessels had significantly increased 2days post-pMCAO and peaked by 4days compared to the un-injured hemisphere. Using a combination of vessel painting and immunofluorescence, we uniquely observed an induction of cellular division and a remodeling of the smooth muscle cells within the collateral niche following post-pMCAO on whole mount tissue sections. Vessel painting was also applied to pMCAO-injured Cx3cr1^GFP mice, in order to identify the spatial relationship between Cx3cr1-positive peripheral-derived monocyte/macrophages and the vessel painted collaterals. Our histological findings were supplemented with analysis of cerebral blood flow using laser Doppler imaging and behavioral changes following pMCAO.Comparison with existing methodsCompared to polyurethane and latex methods for collateral labeling, this new method provides detailed cell-type specific analysis within the collateral niche at the microscopic level, which has previously been unavailable.ConclusionsThis simple and reproducible combination of techniques is the first to dissect the temporospatial remodeling of pial collateral arterioles. The method will advance investigations into the underlying mechanisms governing the intricate processes of arteriogenesis.



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A comparison between the neural correlates of laser and electric pain stimulation and their modulation by expectation

Publication date: Available online 19 September 2017
Source:Journal of Neuroscience Methods
Author(s): E.J. Hird, A.K.P. Jones, D. Talmi, W. El-Deredy
BackgroundPain is modulated by expectation. Event-related potential (ERP) studies of the influence of expectation on pain typically utilise laser heat stimulation to provide a controllable nociceptive-specific stimulus. Painful electric stimulation has a number of practical advantages, but is less nociceptive-specific. We compared the modulation of electric versus laser-evoked pain by expectation, and their corresponding pain-evoked and anticipatory ERPs.New MethodWe developed understanding of recognised methods of laser and electric stimulation. We tested whether pain perception and neural activity induced by electric stimulation was modulated by expectation, whether this expectation elicited anticipatory neural correlates, and how these measures compared to those associated with laser stimulation by eliciting cue-evoked expectations of high and low pain in a within-participant design.ResultsDespite sensory and affective differences between laser and electric pain, intensity ratings and pain-evoked potentials were modulated equivalently by expectation, though ERPs only correlated with pain ratings in the laser pain condition. Anticipatory correlates differentiated pain intensity expectation to laser but not electric pain.Comparison with Existing MethodPrevious studies show that laser-evoked potentials are modulated by expectation. We extend this by showing electric pain-evoked potentials are equally modulated by expectation, within the same participants. We also show a difference between the pain types in anticipation.ConclusionsThough laser-evoked potentials express a stronger relationship with pain perception, both laser and electric stimulation may be used to study the modulation of pain-evoked potentials by expectation. Anticipatory-evoked potentials are elicited by both pain types, but they may reflect different processes.



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Spike-contrast: A novel time scale independent and multivariate measure of spike train synchrony

Publication date: Available online 19 September 2017
Source:Journal of Neuroscience Methods
Author(s): Manuel Ciba, Takuya Isomura, Yasuhiko Jimbo, Andreas Bahmer, Christiane Thielemann
BackgroundSynchrony within neuronal networks is thought to be a fundamental feature of neuronal networks. In order to quantify synchrony between spike trains, various synchrony measures were developed. Most of them are time scale dependent and thus require the setting of an appropriate time scale. Recently, alternative methods have been developed, such as the time scale independent SPIKE-distance by Kreuz et al..New MethodIn this study, a novel time-scale independent spike train synchrony measure called Spike-contrast is proposed. The algorithm is based on the temporal "contrast" (activity vs. non-activity in certain temporal bins) and not only provides a single synchrony value, but also a synchrony curve as a function of the bin size.ResultsFor most test data sets synchrony values obtained with Spike-contrast are highly correlated with those of the SPIKE-distance (Spearman correlation value of 0.99). Correlation was lower for data containing multiple time scales (Spearman correlation value of 0.89). When analyzing large sets of data, Spike-contrast performed faster.Comparison of existing MethodSpike-contrast is compared to the SPIKE-distance algorithm. The test data consisted of artificial spike trains with various levels of synchrony, including Poisson spike trains and bursts, spike trains from simulated neuronal Izhikevich networks, and bursts made of smaller bursts (sub-bursts).ConclusionsThe high correlation of Spike-contrast with the established SPIKE-distance for most test data, suggests the suitability of the proposed measure. Both measures are complementary as SPIKE-distance provides a synchrony profile over time, whereas Spike-contrast provides a synchrony curve over bin size.



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StimTrack: An open-source software for manual transcranial magnetic stimulation coil positioning

Publication date: Available online 19 September 2017
Source:Journal of Neuroscience Methods
Author(s): Emilia Ambrosini, Simona Ferrante, Mark van de Ruit, Stefano Biguzzi, Vera Colombo, Marco Monticone, Giorgio Ferriero, Alessandra Pedrocchi, Giancarlo Ferrigno, Michael J. Grey
BackgroundDuring Transcranial Magnetic Stimulation (TMS) experiments researchers often use a neuronavigation system to precisely and accurately maintain coil position and orientation.New methodThis study aimed to develop and validate an open-source software for TMS coil navigation. StimTrack uses an optical tracker and an intuitive user interface to facilitate the maintenance of position and orientation of any type of coil within and between sessions. Additionally, online access to navigation data is provided, hereby adding e.g. the ability to start or stop the magnetic stimulator depending on the distance to target or the variation of the orientation angles.ResultsStimTrack allows repeatable repositioning of the coil within 0.7mm for translation and <1° for rotation. Stimulus-response (SR) curves obtained from 19 healthy volunteers were used to demonstrate that StimTrack can be effectively used in a typical experiment. An excellent intra and inter-session reliability (ICC >0.9) was obtained on all parameters computed on SR curves acquired using StimTrack.Comparison with existing methodStimTrack showed a target accuracy similar to that of a commercial neuronavigation system (BrainSight, Rogue Research Inc.). Indeed, small differences both in position (∼0.2mm) and orientation (<1°) were found between the systems. These differences are negligible given the human error involved in landmarks registration.ConclusionsStimTrack, available as supplementary material, is found to be a good alternative for commercial neuronavigation systems facilitating assessment changes in corticospinal excitability using TMS. StimTrack allows researchers to tailor its functionality to their specific needs, providing added value that benefits experimental procedures and improves data quality.

Graphical abstract

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Cry1Ab Adsorption and Transport in Humic Acid-Coated Geological Formation of Alumino-Silica Clays

Abstract

Genetically modified agricultural products have been introduced to increase food supply by enhancing their resistance to pests and diseases, along with easily adapting to environmental conditions. Due to the modification of DNA, public objections are prevalent, including concerns on the impact on the ecosystem. In this research, adsorption and transport of Cry1Ab, a toxin exuded by the transgenic Bt maize in alumino-silica clays, were evaluated in laboratory columns under steady-state flow conditions. Since Cry1Ab fate and transport were very responsive to animal waste field applications, during which humic acids were released, Cry1Ab adsorption and transport in humic acid-coated alumino-silica clays were also investigated. Cry1Ab breakthrough curves were simulated using the convection-dispersion transport models. It was discovered that the humic acid coating increased Cry1Ab deposition during the transport. Based on analysis of the breakthrough curves, adsorption isotherms of Cry1Ab in alumino-silica clays were obtained and compared with those of batch experiments. The humic acid coating changed the bonding energy between Cry1Ab and the adsorption receptor sites on alumino-silica clay surfaces, thereby changing Cry1Ab partition between the aqueous phase and the solid phase.

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The acid-sensing ion channel, ASIC2, promotes invasion and metastasis of colorectal cancer under acidosis by activating the calcineurin/NFAT1 axis

The tumor acidic microenvironment, a common biochemical event in solid tumors, offers evolutional advantage for tumors cells and even enhances their aggressive phenotype. However, little is known about the mol...

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Reply to the Letter to the Editor Concerning: ‘Changes in Swallowing-Related Quality of Life After Endoscopic Treatment for Zenker’s Diverticulum Using SWAL-QOL Questionnaire’

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A technique for intraoperative maxillomandibular fixation

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Correction of whistle deformity using autologous free fat grafting: first results of a pilot study and review of the literature

Abstract

Purpose

Whistle deformities are frequent sequelae after surgical correction of cleft lip, trauma, or tumor excision. The aim of this study was to examine the role of autologous free fat grafting in the reconstruction of whistle deformity.

Patients

Fifteen patients with whistle deformity were enrolled in this pilot study. The mean follow-up period was 19 months. Liposuction was done followed by the replantation of an average of 2.2 ml autologous fat per patient (range 0.7–4 ml). An overcorrection was performed in all patients.

Results

All the patients showed improvements in whistle deformity. The mean resorption rate was 53% (range 30–80%). Three patients (20%) were not satisfied with the postoperative result. Six complications were assessed (4× feeling of pressure [27%], one hematoma [7%], one recurrent pain [7%]), but a major complication did not occur.

Review

We also present a review of the literature with different techniques that were described in the last 20 years.

Conclusion

Autologous free fat graftings for reconstruction of whistle deformity represent a reliable method with a low complication rate. However, the resorption rate is unpredictable. If necessary, several autologous fat transplantations should be conducted at an interval of at least 6 months.

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Detection of Malignancy Among Suspicious Thyroid Nodules

Thyroid , Vol. 0, No. 0.


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Obstructive sleep apnea in pregnancy is associated with adverse maternal outcomes: a national cohort

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): Ghada Bourjeily, Valery A. Danilack, Margaret H. Bublitz, Heather Lipkind, Janet Muri, Donna Caldwell, Iris Tong, Karen Rosene-Montella
ObjectivePregnancy and the obesity epidemic impacting women of reproductive age appear to predispose women to obstructive sleep apnea (OSA) in pregnancy. The aim of this study is to examine the association between OSA and adverse maternal outcomes in a national cohort.MethodsThe National Perinatal Information Center in the US was used to identify women with a delivery discharge diagnosis of OSA from 2010 to 2014. We used the International Classification of Diseases, ninth Revision to classify OSA diagnosis and maternal outcomes.MeasurementsThe sample consisted of 1,577,632 gravidas with a rate of OSA of 0.12% (N = 1963). There was a significant association between OSA and preeclampsia (adjusted odds ratio (aOR) 2.22, 95% confidence interval (CI) 1.94–2.54), eclampsia (aOR 2.95, 1.08–8.02), and gestational diabetes (aOR 1.51, 1.34–1.72) after adjusting for a comprehensive list of covariates which includes maternal obesity. OSA status was also associated with a 2.5–3.5-fold increase in risk of severe complications such as cardiomyopathy, congestive heart failure, and hysterectomy. Length of hospital stay was significantly longer (5.1 + 5.6 vs 3.0 + 3.0 days, p < 0.001) and odds of an admission to an intensive care unit higher (aOR 2.74, 2.36–3.18) in women with OSA.ConclusionsCompared to pregnant women without OSA, pregnant women with OSA have a significantly higher risk of pregnancy-specific complications such as gestational hypertensive conditions and gestational diabetes, and rare medical and surgical complications such as cardiomyopathy, pulmonary edema, congestive heart failure, and hysterectomy. OSA diagnosis was also associated with a longer hospital stay and significantly increased odds for admission to the intensive care unit.



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What predicts inattention in adolescents? An experience-sampling study comparing chronotype, subjective, and objective sleep parameters

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): Timo Hennig, Katarina Krkovic, Tania M. Lincoln
ObjectiveMany adolescents sleep insufficiently, which may negatively affect their functioning during the day. To improve sleep interventions, we need a better understanding of the specific sleep-related parameters that predict poor functioning. We investigated to which extent subjective and objective parameters of sleep in the preceding night (state parameters) and the trait variable chronotype predict daytime inattention as an indicator of poor functioning.MethodsWe conducted an experience-sampling study over one week with 61 adolescents (30 girls, 31 boys; mean age = 15.5 years, standard deviation = 1.1 years). Participants rated their inattention two times each day (morning, afternoon) on a smartphone. Subjective sleep parameters (feeling rested, positive affect upon awakening) were assessed each morning on the smartphone. Objective sleep parameters (total sleep time, sleep efficiency, wake after sleep onset) were assessed with a permanently worn actigraph. Chronotype was assessed with a self-rated questionnaire at baseline. We tested the effect of subjective and objective state parameters of sleep on daytime inattention, using multilevel multiple regressions. Then, we tested whether the putative effect of the trait parameter chronotype on inattention is mediated through state sleep parameters, again using multilevel regressions.ResultsWe found that short sleep time, but no other state sleep parameter, predicted inattention to a small effect. As expected, the trait parameter chronotype also predicted inattention: morningness was associated with less inattention. However, this association was not mediated by state sleep parameters.ConclusionsOur results indicate that short sleep time causes inattention in adolescents. Extended sleep time might thus alleviate inattention to some extent. However, it cannot alleviate the effect of being an 'owl'.



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The association of mothers' and fathers' insomnia symptoms with school-aged children's sleep assessed by parent report and in-home sleep-electroencephalography

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): Natalie Urfer-Maurer, Rebekka Weidmann, Serge Brand, Edith Holsboer-Trachsler, Alexander Grob, Peter Weber, Sakari Lemola
ObjectiveSleep plays an essential role for children's well-being. Because children's sleep is associated with parental sleep patterns, it must be considered in the family context. As a first aim of the present study, we test whether parental insomnia symptoms are related to children's in-home sleep-electroencephalography (EEG). Second, we examine the association between parental insomnia symptoms and maternal and paternal perception of children's sleep using actor–partner interdependence models.MethodsA total of 191 healthy children enrolled in public school and aged 7–12 years took part in the study. Ninety-six were formerly very preterm born children. Children underwent in-home sleep-EEG, and parents reported children's sleep-related behavior by using the German version of the Children's Sleep Habits Questionnaire. Further, parents completed the Insomnia Severity Index to report their own insomnia symptoms.ResultsMaternal but not paternal insomnia symptoms were related to less children's EEG-derived total sleep time, more stage 2 sleep, less slow wave sleep, later sleep onset time, and later awakening time. Mothers' and fathers' own insomnia symptoms were related to their reports of children's bedtime resistance, sleep duration, sleep anxiety, night wakings, and/or daytime sleepiness. Moreover, maternal insomnia symptoms were associated with paternal reports of children's bedtime resistance, sleep anxiety, and sleep-disordered breathing. The associations between parental insomnia symptoms and parents' perception of children's sleep could not be explained by children's objectively measured sleep.ConclusionsMothers' insomnia symptoms and children's objective sleep patterns are associated. Moreover, the parents' own insomnia symptoms might bias their perception of children's sleep-related behavior problems.



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Combined resting state functional magnetic resonance imaging and diffusion tensor imaging study in patients with idiopathic restless legs syndrome

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): Yaoyao Zhuo, Yuncheng Wu, Yanhong Xu, Lunbo Lu, Ting Li, Xifu Wang, Kangan Li
ObjectiveRestless legs syndrome (RLS) is a common neurological disorder characterized by an urge to move the legs along with paraesthesia deep within them. In this study, we aimed to use diffusion tensor imaging (DTI) and regional homogeneity (ReHo) to investigate the changes in regional spontaneous brain activity change for RLS patients against age- and gender-matched normal control (NC) subjects.MethodsA total of 35 RLS patients and 27 age- and gender-matched NC subjects were recruited for group comparison research that used DTI and ReHo techniques. DTI was analysed by FSL and tract-based spatial statistics (TBSS) software to measure the values of fractional anisotropy (FA) or mean diffusivity (MD) in brain regions. Statistical Parametric Mapping 8 (SPM8) was used for data preprocessing and Data Processing Assistant for Resting-State fMRI (DPARSF) toolbox was used for ReHo calculation. For multiple comparison correction, the AlphaSim program implemented in AFNI was used to control the false-positive rate (corrected p < 0.05).ResultsThere was no significant difference between the iRLS and NC groups in age or gender. In the one-sample t-test, both the NC and RSL groups showed increased ReHo in the bilateral posterior cingulate/precuneus cortex compared to the groups' global means, indicating that the default mode network was at rest. The RLS group showed a smaller cluster size than the NC group. In the two-sample t-test, the RLS group showed increased ReHo in the bilateral middle frontal gyrus, anterior cingulate cortex, caudate nucleus, insula, thalamus, putamen and left posterior cingulate cortex compared to the NC group. The statistical analysis of DTI images did not show any difference between the two groups. TBSS group comparison did not reveal any difference in FA or mean diffusivity (MD) of any brain region.ConclusionRLS patients showed that greater ReHo within the striatum, thalamus and the limbic system, which implies that the emotional processing, motion control and cognition in the cortico-striatal-thalamic-cortical (CSTC) loop may be the site of dysfunction in RLS patients. This finding may provide imaging evidence to explore the pathophysiology of RLS. On the other hand, we did not see any change in the microstructure in the DTI analysis for RLS patients when compared to the NC group, which suggests a metabolic impairment.



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Identifying clinically important difference on the Epworth Sleepiness Scale: results from a narcolepsy clinical trial of JZP-110

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): Lawrence Scrima, Helene A. Emsellem, Philip M. Becker, Chad Ruoff, Alan Lankford, Gary Bream, Moise Khayrallah, Yuan Lu, Jed Black
BackgroundWhile scores ≤10 on the Epworth Sleepiness Scale (ESS) are within the normal range, the reduction in elevated ESS score that is clinically meaningful in patients with narcolepsy has not been established.MethodsThis post hoc analysis of a clinical trial of patients with narcolepsy evaluated correlations between Patient Global Impression of Change (PGI-C) and ESS. Data of adult patients with narcolepsy from a double-blind, 12-week placebo-controlled study of JZP-110, a wake-promoting agent, were used in this analysis. Descriptive statistics and receiver operating characteristic (ROC) analysis compared PGI-C (anchor measure) to percent change from baseline in ESS to establish the responder criterion from patients taking either placebo or JZP-110 (treatments).ResultsAt week 12, patients (n = 10) who reported being "very much improved" on the PGI-C had a mean 76.7% reduction in ESS score, and patients (n = 33) who reported being "much improved" on the PGI-C had a mean 49.1% reduction in ESS score. ROC analysis showed that patients who improved were almost exclusively from JZP-110 treatment group, with an area-under-the-curve of 0.9, and revealed that a 25% reduction in ESS (sensitivity, 81.4%; specificity, 80.9%) may be an appropriate threshold for defining a meaningful patient response to JZP-110 and placebo.ConclusionsA ≥25% reduction in patients' subjective ESS score may be useful as a threshold to identify patients with narcolepsy who respond to JZP-110 treatment.



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Sleep architecture in patients with Juvenile Myoclonic Epilepsy

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): Jaidaa F. Mekky, Sonia M. Elbhrawy, Mohamed F. Boraey, Horeya M. Omar
AimThe aim is to analyze the sleep architecture using polysomnography (PSG) in patients with Juvenile Myoclonic Epilepsy (JME): (newly diagnosed and those on valproate drug) attending epilepsy clinic at Alexandria University Hospitals.MethodsThis study involved 20 patients with JME on valproate (age: 22.40 ± 5.80 years; M:F = 6:14), 20 newly diagnosed patients (age: 18.55 ± 6.0 years; M:F = 6:14), and 20 matched healthy controls (age: 22.10 ± 5.0 years; M:F = 6:14). Clinical assessment, electroencephalogram (EEG), evaluation with comprehensive sleep questionnaire, and PSG were done for all patients.ResultsPSG showed significant alterations in sleep architecture in the total JME group in the form of reduced mean sleep efficiency (p = 0.001^∗), increased mean Rapid eye movement (REM) onset latency (p = 0.046^∗), decrease mean REM percentage (p = 0.011^∗), increased mean wakefulness after sleep onset (p = 0.018^∗), increase the index of total arousal (p = 0.005^∗), increased mean periodic limb movement index (P = 0.001^∗), and reduced apnea hypopnea index (P = <0.001) in comparison to control group. Valproate treated group showed increased sleep efficiency (p = 0.040^∗), decreased REM arousal index (P = 0.012), longer stage 3 (P = 0.038), and prolonged stage 2 (P = 0.049^∗) than the newly diagnosed group.ConclusionsSleep architecture was significantly disturbed in JME, with improvement in sleep efficiency in valproate treated patients.



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Sleep phenotypes in infants and toddlers with neurogenetic syndromes

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): Emily A. Abel, Bridgette L. Tonnsen
BackgroundAlthough sleep problems are well characterized in preschool- and school-age children with neurogenetic syndromes, little is known regarding the early emergence of these problems in infancy and toddlerhood. To inform syndrome-specific profiles and targets for intervention, we compared parent-reported sleep problems in infants and toddlers with Angelman syndrome (AS), Williams syndrome (WS), and Prader–Willi syndrome (PWS) with patterns observed among same-aged typically developing (TD) controls.MethodsMothers of 80 children (18 AS, 19 WS, 19 PWS, and 24 TD) completed the Brief Infant Sleep Questionnaire. Primary dependent variables included (1) sleep onset latency, (2) total sleep duration, (3) daytime and nighttime sleep duration, and (4) sleep problem severity, as measured by both maternal impression and National Sleep Foundation guidelines.ResultsSleep problems are relatively common in children with neurogenetic syndromes, with 41% of mothers reporting problematic sleep and 29% of children exhibiting abnormal sleep durations as per national guidelines. Across genetic subgroups, problems are most severe in children with AS and WS, particularly in relation to nighttime sleep duration. Although atypical sleep is characteristically reported in each syndrome later in development, infants and toddlers with PWS exhibited largely typical patterns, potentially indicating delayed onset of sleep problems in concordance with other medical features of PWS.ConclusionsOur findings suggest that sleep problems in neurogenetic syndromes emerge as early as infancy and toddlerhood, with variable profiles across genetic subgroups. This work underscores the importance of early sleep screenings as part of routine medical care of neurosyndromic populations and the need for targeted, syndrome-sensitive treatment.



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College student with actigraphy performed during final examinations

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): Shelley Hershner




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Periodic neck myoclonus during sleep

Publication date: October 2017
Source:Sleep Medicine, Volume 38
Author(s): L. Pérez-Carbonell, C. Silva, C. Gaig, M. Carreño, J. Santamaria, A. Iranzo




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Needle migration and dosimetric impact in high-dose-rate brachytherapy for prostate cancer evaluated by repeated MRI

Publication date: Available online 19 September 2017
Source:Brachytherapy
Author(s): Simon Buus, Maria Lizondo, Steffen Hokland, Susanne Rylander, Erik M. Pedersen, Kari Tanderup, Lise Bentzen
PurposeTo quantify needle migration and dosimetric impact in high-dose-rate brachytherapy for prostate cancer and propose a threshold for needle migration.Methods and MaterialsTwenty-four high-risk prostate cancer patients treated with an HDR boost of 2 × 8.5 Gy were included. Patients received an MRI for planning (MRI1), before (MRI2), and after treatment (MRI3). Time from needle insertion to MRI3 was ∼3 hours. Needle migration was evaluated from coregistered images: MRI1-MRI2 and MRI1-MRI3. Dose volume histogram parameters from the treatment plan based on MRI1 were related to parameters based on needle positions in MRI2 or MRI3. Regression was used to model the average needle migration per implant and change in D90 clinical target volume, CTVprostate+3mm. The model fit was used for estimating the dosimetric impact in equivalent dose in 2 Gy fractions for dose levels of 6, 8.5, 10, 15, and 19 Gy.ResultsNeedle migration was on average 2.2 ± 1.8 mm SD from MRI1-MRI2 and 5.0 ± 3.0 mm SD from MRI1-MRI3. D90 CTVprostate+3mm was robust toward average needle migration ≤3 mm, whereas for migration >3 mm D90 decreased by 4.5% per mm. A 3 mm of needle migration resulted in a decrease of 0.9, 1.7, 2.3, 4.8, and 7.6 equivalent dose in 2 Gy fractions for dose levels of 6, 8.5, 10, 15, and 19 Gy, respectively.ConclusionsSubstantial needle migration in high-dose-rate brachytherapy occurs frequently in 1–3 hours following needle insertion. A 3-mm threshold of needle migration is proposed, but 2 mm may be considered for dose levels ≥15 Gy.



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The reliability of different methods of manual volumetric segmentation of pharyngeal and sinonasal sub regions

Publication date: Available online 18 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Bala Chakravarthy Neelapu, Om Prakash Kharbanda, Harish Kumar Sardana, Abhishek Gupta, Srikanth Vasamsetti, Rajiv Balachandran, Shailendra Singh Rana, Viren Sardana
Objectives: The purpose of the study was to test the intra- and interobserver reliability of manual volumetric segmentation of pharyngeal and sinonasal airway sub-regions. Study Design: CBCT data of 15 patients were collected from an orthodontic clinical database. Two experienced orthodontists independently performed manual segmentation of the airway sub-regions. Four performance measures were considered to test intra- and interobserver reliability of manual segmentation: (i) volume correlation, (ii) mean slice correlation, (iii) percentage of volume difference, and (iv) percentage of non-overlapping voxels. Results: Intra- and interobserver reliability was observed to be greater than 0.96 for the entire pharyngeal and sinonasal airway sinus sub-regions for both observers using the volume correlation method. Mean slice correlation was found to be greater than 0.84, showing the existence of non-overlapping voxels. Therefore, the percentage of non-overlapping voxels was used as a reliability measure and was found to be less than 20% for both intra- and interobserver markings. Conclusion: The mean slice correlation and percentage of non-overlapping voxels were the most reliable performance measures of segmentation correctness. Volume correlation and the percentage of volume difference were observed to be the most reliable performance measures for volume correctness.



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Evaluation of KGF, EGF, VEGF, bcl-2, IL-6 and ki67 expression in oral epithelium adjacent to bisphosphonate-related osteonecrosis and florid osseous dysplasia: a comparative immunohistochemical study

Publication date: Available online 18 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Natália Santos Carneiro, Luciana Armada, Débora Lima Pereira, Pablo Agustin Vargas, Márcio Ajudarte Lopes, Fábio Ramôa Pires
Bisphosphonates are associated with impairment of epithelial proliferation and it is suggested that this feature can play a role in the pathogenesis of bisphosphonate-related osteonecrosis of the jaws (ON). Objective: to compare the expression of proliferative markers and apoptosis-associated proteins in the oral mucosa adjacent to bone sequestrum associated with ON and florid osseous dysplasia (OD). Study design: oral mucosal samples derived from surgical procedures performed for treatment of ON and OD (10 cases each) were retrieved. Histological analysis was done on hematoxylin and eosin stained slides; immunohistochemical reactions against epidermal growth factor (EGF), keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF), Bcl-2 protein, interleukin 6 (IL-6) and Ki-67 antigen were performed with the immunoperoxidase technique. Results: epithelium was hyperplastic in 60% and 22% of ON and OD samples, respectively. Cytoplasmic EGF and KGF expression and Bcl-2, VEGF and IL-6 expressions, and the mean epithelial proliferative index were not statistically different comparing both groups. Membranous EGF expression was more evident in samples showing hyperplastic epithelium. Conclusion: exposure to bisphosphonates did not alter the expression of KGF, EGF, VEGF, Bcl-2, IL-6 and the epithelial proliferating index in comparison with inflamed oral mucosa not exposed to bisphosphonates.



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Temporal distribution of alcohol related facial fractures

Publication date: Available online 19 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Kai Lee, Michael Qiu, Jiandong Sun
ObjectivesAlcohol intoxication as a common concomitant factor in facial fractures is well reported. However, less has been described on its temporal pattern of presentations. Studies have found such pattern to be dependent on factors such as seasonal climate variations, timing of social, leisure and sporting activities, and road traffic conditions.Study DesignThis study retrospectively examined the Victorian admitted episodes data-set (VAED) between year 2010 to 2013. VAED is a standardised set of data collected during all hospital presentations in Victoria.ResultsThe study found higher incidence of alcohol-related facial fracture presentations during weekends and during summer and spring months when compared with non-alcohol related fractures (statistically significant). Alcohol-related facial fractures are more likely to involve male patients in 20-29 year age group, occur as a result of interpersonal violence and require shorter hospital stay during weekend admissions (statistically significant). There are no statistically significant relationship observed in seasonal variation across all variables.ConclusionsThis study found distinct characteristics in temporal distribution of alcohol-related facial fractures. These characteristics are in particular significant in weekend trauma admissions. Such information is important in workforce planning, resource distribution and implementation of injury prevention programs.



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Prochlorperazine Increases KCC2 Function and Reduces Spasticity after Spinal Cord Injury

Journal of Neurotrauma , Vol. 0, No. 0.


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ABCG2 c.421C>A Is Associated with Outcomes after Severe Traumatic Brain Injury

Journal of Neurotrauma , Vol. 0, No. 0.


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Effective Bioremediation of Endocrine-Disrupting Phthalate Esters, Mediated by Bacillus Strains

Abstract

Phthalic acid esters (PAEs) is a class of refractory organic compounds, widely used as additives or plasticizers in plastic industry. PAEs are ubiquitous endocrine-disrupting pollutants and can be degraded by microorganisms. The present study described the assimilation of four PAE mixture (dimethyl, diethyl, dipropyl, and dibutyl phthalate) by two bacillus species: Bacillus thuringiensis and Bacillus cereus, isolated from different agricultural soil and their consortium. Among which, the optimal degradation of 82–96% was achieved by B. thuringiensis. This is the first report on the metabolic breakdown of four basic PAE mixture. The optimum conditions for biodegradation were found to be pH 7, temperature 30 °C, inoculum size 10 mL, and concentration 400 mg/L. Moreover, the respective biodegradation followed the first-order kinetic model. Our results proffered supplementary confirmation of the wide spectrum of PAE utilization by B. thuringiensis and suggest the possibility of applying it for the remediation of PAE contamination waste.

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Evaluation of Water Quality for Sustainable Agriculture in Bangladesh

Abstract

Sustainable groundwater quality has become a major concern for the agro-based country like Bangladesh. Integrated approaches of various irrigation water quality indices and geostatistical modeling were applied to evaluate the suitability and for spatial mapping of groundwater quality of Faridpur District in central Bangladesh. The irrigation water quality index (IWQI) revealed that majority of the samples were suitable for irrigation. Similar outcomes were recorded from other indices including Na%, sodium adsorption ratio (SAR), residual sodium bicarbonate (RSBC), total hardness (TH), Kelley's ratio (KR), and magnesium adsorption ratio (MAR). Classifications based on Wilcox diagram and permeability index (PI) plot indicated a similar conclusion wherein almost all the samples were safe for agricultural uses without posing considerable effect on the soil fertility and overall crop yield. Principal component analysis (PCA) grouped the major cations and anions into three principal components including dissolution of calcite minerals, leaching of silicate sediments, and ion exchange process. Spatial mapping of IWQI identified that groundwater in the northern side of Faridpur region were more suitable for irrigational uses relative to central and southern side, possibly due to gradients of domestic discharges and agricultural activates from north to south side. These findings would provide useful information to water distributors, managers, and decision makers for taking adaptive measures in irrigation water quality management systems.

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The Influence of Sleep Disorders on Voice Quality

To verify the influence of sleep quality on the voice.

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Roles for Innate Immunity in Combination Immunotherapies

Immunity to infectious agents involves a coordinated response of innate and adaptive immune cells working in concert, with many feed-forward and regulatory interactions between both arms of the immune system. In contrast, many therapeutic strategies to augment immunity against tumors have focused predominantly on stimulation of adaptive immunity. However, a growing appreciation of the potential contributions of innate immune effectors to antitumor immunity, especially in the context of combination immunotherapy, is leading to novel strategies to elicit a more integrated immune response against cancer. Here we review antitumor activities of innate immune cells, mechanisms of their synergy with adaptive immune responses against tumors, and discuss recent studies highlighting the potential of combination therapies recruiting both innate and adaptive immune effectors to eradicate established tumors. Cancer Res; 77(19); 1–7. ©2017 AACR.

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New Advances and Challenges of Targeting Cancer Stem Cells

The second International Cancer Stem Cell Conference in Cleveland, Ohio, on September 20–23, 2016, convened 330 attendees from academic, industrial, and clinical organizations. It featured a debate on the concepts and challenges of the cancer stem cells (CSC) as well as CSC-centered scientific sessions on clinical trials, genetics and epigenetics, tumor microenvironment, immune suppression, metastasis, therapeutic resistance, and emerging novel concepts. The conference hosted 35 renowned speakers, 100 posters, 20 short talks, and a preconference workshop. The reported advances of CSC research and therapies fostered new collaborations across national and international borders, and inspired the next generation's young scientists. Cancer Res; 77(19); 1–6. ©2017 AACR.

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HIGH BCR-ABL/GUSIS LEVELS AT DIAGNOSIS OF CHRONIC PHASE CML ARE ASSOCIATED WITH UNFAVORABLE RESPONSES TO STANDARD-DOSE IMATINIB

Purpose: The approval of second-generation tyrosine kinase inhibitors (TKIs) for the first line treatment of chronic myeloid leukemia (CML) has generated an unmet need for baseline molecular parameters associated with inadequate Imatinib responses. Experimental Design: We correlated BCR-ABL/GUSIS and BCR-ABL/ABLIS transcripts at diagnosis with the outcome - defined by the 2013 European LeukemiaNet recommendations - of 272 newly diagnosed CML patients receiving Imatinib 400 mg/daily. Applying Receiver Operating Characteristic curves we defined BCR-ABL/GUSIS and BCR-ABL/ABLIS levels associated with lower probabilities of optimal response, failure-free (FFS), event-free (EFS), transformation-free (TFS) and overall survival (OS). Results: With a median follow-up of 60 months, 65.4% of patients achieved an optimal response (OR), 5.6% were classified as "warnings", 22.4% failed Imatinib and 6.6% switched to a different TKI because of drug intolerance. We recorded 19 deaths (6.9%), 7 (2.5%) attributable to disease progression. We found that higher BCR-ABL/GUSIS levels at diagnosis were associated with inferior rates of OR (p<0.001), FFS (p<0.001) and EFS (p<0.001). Elevated BCR-ABL/GUSIS levels were also associated with lower rates of TFS (p=0.029) but not with OS (p=0.132). Similarly, high BCR-ABL/ABL levels at diagnosis were associated with inferior rates of OR (p=0.03), FFS (p=0.001) and EFS (p=0.005), but not with TFS (p=0.167) or OS (p=0.052). However, in internal validation experiments, GUS outperformed ABL in samples collected at diagnosis as the latter produced 80% misclassification rates. Conclusions: Our data suggest that high BCR-ABL transcripts at diagnosis measured employing GUS as a reference gene identify CML patients unlikely to benefit from standard dose Imatinib.

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ImmunoPET of malignant and normal B cells with 89Zr- and 124I-labeled obinutuzumab antibody fragments reveals differential CD20 internalization in vivo

Purpose: The B-cell antigen CD20 provides a target for antibody-based positron emission tomography (immunoPET). We engineered antibody fragments targeting human CD20 and studied their potential as immunoPET tracers in transgenic mice (huCD20TM) and in a murine lymphoma model expressing human CD20. Experimental Design: Anti-CD20 cys-diabody (cDb) and cys-minibody (cMb) based on rituximab (Rx) and obinutuzumab (GA101) were radioiodinated and used for immunoPET imaging of a murine lymphoma model. Pairwise comparison of obinutuzumab-based antibody fragments labeled with residualizing (89Zr) versus non-residualizing (124I) radionuclides by region of interest (ROI) analysis of serial PET images was conducted both in the murine lymphoma model and in huCD20TM to asses antigen modulation in vivo. Results: 124I-GAcDb and 124I-GAcMb produced high-contrast immunoPET images of B-cell lymphoma and outperformed the respective rituximab-based tracers. ImmunoPET imaging of huCD20TM showed specific uptake in lymphoid tissues. The use of the radiometal 89Zr as alternative label for GAcDb and GAcMb yielded greater target-specific uptake and retention compared with 124I-labeled tracers. Pairwise comparison of 89Zr- and 124I-labeled GAcDb and GAcMb allowed assessment of in vivo internalization of CD20/antibody complexes and revealed that CD20 internalization differs between malignant and endogenous B cells. Conclusions: These obinutuzumab-based PET tracers have the ability to noninvasively and quantitatively monitor CD20-expression and have revealed insights into CD20 internalization upon antibody binding in vivo. Because they are based on a humanized mAb they have the potential for direct clinical translation and could improve patient selection for targeted therapy, dosimetry prior to radioimmunotherapy (RIT), and prediction of response to therapy.

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The Immune-microenvironment Confers Chemoresistance of Colorectal Cancer through Macrophage-derived IL-6

Purpose: Tumor-associated macrophages (TAMs) are frequently associated with poor prognosis in human cancers. However, the effects of TAM in colorectal cancer (CRC) are contradictory. We therefore investigated the functions, mechanisms and clinical significance of TAMs in CRC. Experimental Design: We measured the macrophage infiltration (CD68), P-gp and Bcl2 expression in CRC tissues using Immunohistochemistry staining. Co-culture of TAMs and CRC cells both in vitro and in vivo models was used to evaluate the effects of TAMs on CRC chemoresistance. Cytokine Antibody Arrays, enzyme linked immunosorbent assay, neutralizing antibody and luciferase reporter assay were performed to uncover the underlying mechanism. Results: TAM infiltration was associated with chemoresistance in CRC patients. CRC-conditioned macrophages increased CRC chemoresistance and reduced drug-induced apoptosis by secreting IL-6, which could be blocked by a neutralizing anti-IL-6 antibody. Macrophage-derived IL-6 activated the IL-6R/STAT3 pathway in CRC cells, and activated STAT3 transcriptionally inhibited the tumor suppressor miR-204-5p. Rescue experiment confirmed that miR-204-5p is a functional target mediating the TAM-induced CRC chemoresistance. miR-155-5p, a key microRNA regulating C/EBPβ, was frequently downregulated in TAM, resulting in increased C/EBPβ expression. C/EBPβ transcriptionally activated IL-6 in TAM, and TAM-secreted IL-6 then induced chemoresistance by activating the IL-6R/STAT3/miR-204-5p pathway in CRC cells. Conclusions: Our data indicate that the maladjusted miR-155-5p/C/EBPβ/IL-6 signaling in TAM could induce chemoresistance in CRC cells by regulating the IL-6R/STAT3/miR-204-5p axis, revealing a new crosstalk between immune cells and tumor cells in CRC microenvironment.

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BMP4 induces M2 macrophage polarization and favors tumor progression in bladder cancer.

Purpose: Bladder cancer (BC) is a current clinical and social problem. At diagnosis, most patients present non-muscle invasive tumors, characterized by a high recurrence rate, which could progress to muscle invasive disease and metastasis. Bone morphogenetic protein (BMP)-dependent signaling arising from stromal bladder tissue mediates urothelial homeostasis by promoting urothelial cell differentiation. However, the possible role of BMP ligands in BC is still unclear. Experimental Design: Tumor and normal tissue from 68 patients with urothelial cancer were prospectively collected and analyzed for expression of BMP and macrophage markers. The mechanism of action was assessed in vitro by experiments with BC cell lines and peripheral blood monocyte-derived macrophages. Results: We observed BMP4 expression is associated and favored type-2 macrophage differentiation. In vitro experiments showed that both recombinant BMP4 and BMP4-containing conditioned media from BC cell lines favored monocyte/macrophage polarization toward M2 phenotype macrophages, as shown by the expression and secretion of IL-10. Using a series of human BC patient samples we also observed increased expression of BMP4 in advanced and undifferentiated tumors in close correlation with epithelial-mesenchymal transition (EMT). However, the p-Smad 1,5,8 staining in tumors showing EMT signs was reduced, due to the increased miR-21 expression leading to reduced BMPR2 expression. Conclusions: These findings suggest that BMP4 secretion by BC cells provides the M2 signal necessary for a pro-tumoral immune environment. In addition, the repression of BMPR2 by miR-21 makes the tumor cells refractory to the pro-differentiating actions mediated by BMP ligands, favoring tumor growth.

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Quantitative and Mechanistic Understanding of AZD1775 Penetration across Human Blood-Brain Barrier in Glioblastoma Patients using an IVIVE-PBPK Modeling Approach

Purpose: AZD1775, a first-in-class, small molecule inhibitor of the Wee1 tyrosine kinase, is under evaluation as a potential chemo- and radio-sensitizer for treating glioblastoma. This study was to prospectively, quantitatively, and mechanistically investigate the penetration of AZD1775 across human blood-brain barrier (BBB). Experimental Design: AZD1775 plasma and tumor pharmacokinetics were evaluated in 20 glioblastoma patients. The drug metabolism, transcellular passive permeability, and interactions with efflux and uptake transporters were determined using human derived in vitro systems. A whole-body physiologically based pharmacokinetic (PBPK) model integrated with a 4-compartment permeability-limited brain model was developed for predicting the kinetics of AZD1775 BBB penetration and assessing the factors modulating this process. Results: AZD1775 exhibited good tumor penetration in glioblastoma patients, with the unbound tumor-to-plasma concentration ratio ranging from 1.3 to 24.4 (median, 3.2). It was a substrate for ABCB1, ABCG2, and OATP1A2, but not for OATP2B1 or OAT3. AZD1775 transcellular passive permeability and active efflux clearance across MDCKII-ABCB1 or MDCKII-ABCG2 cell monolayers were dependent on the basolateral pH. The PBPK model well predicted observed drug plasma and tumor concentrations in patients. The extent and rate of drug BBB penetration were influenced by BBB integrity, efflux and uptake active transporter activity, and drug binding to brain tissue. Conclusions: In the relatively acidic tumor microenvironment where ABCB1/ABCG2 transporter-mediated efflux clearance is reduced, OATP1A2-mediated active uptake becomes dominant driving AZD1775 penetration into brain tumor. Variations in the brain tumor regional pH, transporter expression/activity, and BBB integrity collectively contribute to the heterogeneity of AZD1775 penetration into brain tumors.

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Characterization of the Immune Microenvironment in Hepatocellular Carcinoma (HCC)

Purpose: Hepatocellular carcinoma (HCC) often arises in the setting of chronic liver inflammation and may be responsive to novel immunotherapies. Experimental Design: To characterize the immune microenvironment in HCC, immunohistochemical (IHC) staining was performed for CD8 positive T lymphocytes, PD-1 positive and LAG-3 positive lymphocytes, CD163 positive macrophages, and PD-L1 expression in tumor and liver background from 29 cases of resected HCC. Results: Expression of CD8 was reduced in tumor and expression of CD163 was reduced at the tumor interface. Positive clusters of PD-L1 expression were identified in 24/29 cases (83%) and positive expression of LAG-3 on tumor infiltrating lymphocytes was identified in 19/29 cases (65%). The expression of both PD-L1 and LAG-3 was increased in tumor relative to liver background. No association between viral status or other clinicopathologic features and expression of any of the IHC markers investigated was noted. Conclusions: LAG-3 and PD-L1, two inhibitory molecules implicated in CD8 T-cell tolerance, are increased in most HCC tumors, providing a basis for investigating combinatorial checkpoint blockade with a LAG-3 and PD-L1 inhibitor in HCC.

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Le lifting du visage sous anesthésie locale en ambulatoire : une autre approche

Publication date: Available online 19 September 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): D. Boccara, K. Serror




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Extradigital glomic tumor of the forearm. About a case and review of literature

Publication date: Available online 18 September 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): U. Lancien, F. Duteille, P. Perrot
We report the clinical case of a 72-year-old man followed for 10years by a specialized pain center, for neuropathic pain poorly systematized, triggered by the contact of the anteromedial face of the right forearm. After surgical excision, histological analysis indicated a well-circumscribed nodule in the subcutaneous region, confirming that the mass was a glomus tumor. In this clinical case, surgical excision allowed an immediate disappearance of the pains without recurrence to this day.



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Toxine botulique : un complément important à la chirurgie du rajeunissement facial

Publication date: Available online 19 September 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): C. Le Louarn
L'amélioration de la compréhension de l'anatomie fonctionnelle et de l'action de la toxine botulique nous a permis de proposer une nouvelle procédure d'injection qui décroît nettement le risque de descente du sourcil ou de la paupière et qui en augmente les possibilités et l'efficacité. Ainsi avec moins d'unités plus précisément utilisées il est possible d'agir sur plus de muscles. Les concentrations variables permettent de s'adapter à chaque muscle. Grâce à cette procédure, les résultats peuvent être proches de la chirurgie endoscopique pour le haut du visage. Des résultats intéressants sont obtenus pour rajeunir le canthus externe par injection du tarse supérieur externe, pour remonter la pointe du nez par injection du pied des ailes et pour rajeunir l'ovale et le cou. Enfin, un effet de lissage est obtenu sur la peau (méso botox) par l'action anticholinergique sur les récepteurs cutanés.The improved understanding of the functional anatomy of the face and of the action of the botulinum toxin A leads us to determine a new injection procedure which consequently decreases the risk of eyebrow and eyelid ptosis and increases the toxin's injection possibilities and efficiencies. With less units of toxin, the technique herein described proposes to be more efficient on more muscles: variable toxin injections concentration adapted to each injected muscle are used. Thanks to a new procedure in the upper face, toxin A injection can be quite close to an endoscopic surgical action. In addition, interesting results are achievable to rejuvenate the lateral canthus with injection on the upper lateral tarsus, to rejuvenate the nose with injection at the alar base, the jawline and the neck region. Lastly, a smoothing effect on the skin (meso botox) is obtained by the anticholinergic action of the toxin A on the dermal receptors.



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Laboratory markers of cardiac and metabolic complications after generalized tonic-clonic seizures

Generalized tonic-clonic seizures (GTCS) frequently lead to emergency inpatient referrals. Laboratory blood values are routinely performed on admission to detect underlying causes and metabolic or cardiac comp...

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A targeted next-generation sequencing panel reveals novel mutations in Japanese patients with primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) is a rare genetic disorder caused by functional impairment of cilia throughout the body. The early diagnosis of PCD is important for the prevention of long-term sequelae; however, this is often challenging because of the phenotypic heterogeneity of PCD and difficulty in genetic analysis. The majority of PCD patients in Japan are not diagnosed properly. To diagnose PCD more accurately, we developed a targeted next-generation sequencing (NGS) panel.

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An unusual case of temporal bone encephalomeningocele occurring together with normal pressure hydrocephalus

Temporal bone encephalomeningoceles are uncommon clinical entities that can be challenging to diagnose and treat. Common presenting complaints include symptoms of aural fullness, hearing loss, clear otorrhea and meningitis. Common etiologies are chronic middle ear disease and trauma. A significant proportion of cases are spontaneous, which occurs in relation to benign intracranial hypertension. Normal pressure hydrocephalus associated with temporal bone encepahomeningoceles has not been previously described.

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The Use of TIGR Matrix in Breast Aesthetic and Reconstructive Surgery

Publication date: Available online 18 September 2017
Source:Clinics in Plastic Surgery
Author(s): Stefano Pompei, Dora Evangelidou, Floriana Arelli, Gianluigi Ferrante

Teaser

The authors document their experience in the use of synthetic 100% bioresorbable surgical mesh (TIGR Matrix, Novus Scientific, Uppsala, Sweden) in breast reconstruction as well as in breast aesthetic surgery. They performed a retrospective review on patients who underwent implant-based breast reconstruction as well as patients who underwent breast reduction mammoplasty procedures with the use of TIGR Matrix Surgical Mesh. When compared with other synthetic but nonresorbable meshes, it appears to show a potentially lower seroma and infection rates, but most importantly, a lower rate of revisional and mesh explantation surgeries.


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Indications and Controversies in Partial Mastectomy Defect Reconstruction

Publication date: Available online 18 September 2017
Source:Clinics in Plastic Surgery
Author(s): Jean-François Honart, Anne-Sophie Reguesse, Samuel Struk, Benjamin Sarfati, Françoise Rimareix, Heba Alkhashnam, Frédéric Kolb, Kessara Rem, Nicolas Leymarie

Teaser

Breast cancer surgical treatment nowadays includes oncoplastic surgery. It is a reliable oncologic surgical treatment, which also prevents functional and aesthetic sequelae, thus improving the patient's quality of life and satisfaction. Numerous techniques have been described, with different levels of complexity and technicality. Their indications differ depending on the global breast volume and the degree of ptosis, on the tumor volume compared with the breast volume, and on the tumor location. This article describes the authors' many years of experience of breast cancer treatment using oncoplastic surgery. They also established a decision-making guide, whose implementation enables treatment of every patient.


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Indications and Controversies in Total Breast Reconstruction With Lipomodeling

Publication date: Available online 18 September 2017
Source:Clinics in Plastic Surgery
Author(s): Emmanuel Delay, Andreea Carmen Meruta, Samia Guerid

Teaser

Complete breast reconstruction with fat grafting is an appealing technique because it does not add scars or use flaps, is autologous, and has the secondary benefit of liposuction. It is a multiple stage surgery and usually requires balancing of the contralateral breast. After using this technique since 2001, the authors narrowed the indications, the ideal candidate being a patient with small breasts and enough donor sites for up to 4 or 5 lipomodeling sessions. Breast reconstruction with fat grafting alone in total breast reconstruction has very limited indications, because lipomodeling in combination with other autologous reconstruction gives very nice results.


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Indications and Controversies for Implant-Only Based Breast Reconstruction

Publication date: Available online 18 September 2017
Source:Clinics in Plastic Surgery
Author(s): Mitchell Brown, James D. Namnoum

Teaser

Today's demographic of the breast reconstruction patient is younger, often prophylactic or at an early stage of diagnosis, and is more likely to be bilateral. These factors combined with an increase in breast implant options, internal support matrices, fat transfer, technologies for intraoperative real time assessment of tissue perfusion, and an increasing appreciation for morbidity associated with autogenous procedures have resulted in an increase in the percentage of women seeking alloplastic breast reconstruction. This article discusses the indications for implant-only reconstruction and reviews the authors' approach to the use of adjunctive techniques that are used in most of their patients.


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Indications and Controversies in Lipofilling for Partial Breast Reconstruction

Publication date: Available online 18 September 2017
Source:Clinics in Plastic Surgery
Author(s): Emmanuel Delay, Samia Guerid, Andreea Carmen Meruta

Teaser

The treatment of sequelae after conservative breast cancer treatment can be a challenge. Lipomodeling, although controversial in the beginning, is a safe technique that can help in the treatment of these deformities, without an important impact on the imaging surveillance. Depending on the severity of the deformity, one or several sessions of fat transfer can be required. The technique is easy and reproducible, but before obtaining satisfying results with a low complication rate, a learning curve should be completed. The final result is natural, with normal breast consistency, with no additional scars.


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Monitoring of Incremental Changes in Maximum Interincisal Opening After Gap Arthroplasty Omits the Risk of Re-ankylosis

The aim of this clinical study was to prospectively measure the incremental changes in the MIO after 1 cm gap arthroplasty, compare these changes between unilateral and bilateral cases, and emphasize the importance of the monitoring of the MIO for at least 24 months.

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Impact of patient audio-visual re-education through a smartphone on quality of bowel preparation before colonoscopy; a single-blinded randomized study

Preparation education is essential for successful colonoscopy. This study aimed to evaluate the impact of audio-visual (AV) re-education through a smartphone before colonoscopy on bowel preparation quality.

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Endovascular Salvage of Ruptured TAAA Following Stent Graft Distraction after TEVAR for Type B Aortic Dissection

Publication date: Available online 18 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Baolei Guo, Weiguo Fu




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Catheter Foam Sclerotherapy of the Great Saphenous Vein, with Perisaphenous Tumescence Infiltration and Saphenous Irrigation

Publication date: Available online 18 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Attilio Cavezzi, Giovanni Mosti, Fausto Campana, Lorenzo Tessari, Luca Bastiani, Simone U. Urso
ObjectivesThis was a prospective observational study to assess the short- to mid-term efficacy and safety of catheter foam sclerotherapy (CFS) of the great saphenous vein (GSV), including peri-saphenous tumescence infiltration (PST) and intra-saphenous saline irrigation (ISI), in combination with phlebectomy of the varicose tributaries.MethodsEighty-eight limbs in 82 patients (19 male, 63 female, mean age 55.7 years) affected by varices related to GSV incompetence were submitted to CFS of the refluxing GSV segment after PST and ISI, combined with phlebectomy of the varicose tributaries. Sodium tetradecylsulfate (STS) 3% + CO2/O2 sclerosant foam (SF) (median 7 mL) was injected in the GSV trunk (median caliber 7.1 mm) by means of a 4F catheter. Clinical and colour duplex ultrasound (CDU) investigation was performed pre-operatively, and 40 days, 6, 12, and 36 months post-operatively. A visual analogue scale (VAS) was used to assess procedure related symptoms and venous symptoms before and 40 days after the treatment.ResultsClinical recurrence (visible varices) at 40 days, 6 and 12 months was 0%, whereas at 36 months it was 4.7%; VAS pre-operative score of heaviness, pain, and cramps/paraesthesiae decreased from 6 (IQR 6–8) to 1 (IQR 0–3), from 3 (IQR 0–7) to 0 (IQR 0–1), and from 3 (IQR 0–7) to 0 (IQR 0–1) respectively at 40 days. The CDU based occlusion rate at 40 days, 6, 12, and 36 months was 100% (88/88), 100% (88/88), 94.3% (83/88), and 89.4% (76/85) respectively. Six of the nine patent saphenous veins (average diameter 1.4 mm) had anterograde flow (overall 96.5% reflux free GSVs). One superficial venous thrombosis was recorded without any further relevant complication.ConclusionsGSV treatment by means of CFS and adjuvant PST + ISI, combined with phlebectomy of varicose tributaries, proved to be safe and effective in terms of clinical and duplex based outcomes at short/mid-term follow-up.



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PET CT to Confirm an Infected Popliteal Stent Graft Used to Treat Popliteal Artery Aneurysm

Publication date: Available online 18 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Stuart R. Walker




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False Aneurysm of the Dorsal Pedal Artery

Publication date: Available online 19 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Wolfgang G. Mouton, André Wyss




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Meeting abstracts from the 65th British Thyroid Association Annual Meeting

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A retrospective review of the multidisciplinary management of medullary thyroid cancer: eligibility for systemic therapy

Abstract

Background

Medullary thyroid carcinoma (MTC) accounts for 1-2% of all thyroid cancers. The clinical course of metastatic disease can be indolent. Our aim was to characterize the natural history of disease to evaluate the true proportion of patients who would be eligible for the currently available systemic therapies.

Methods

The British Columbia Cancer Agency (BCCA) provides cancer care to a population of 4.6 million. A retrospective chart review was conducted of all patients with MTC referred to the BCCA from 1991 to 2013. Clinical characteristics, pathology, treatment and outcome data were collected. Relapse free survival and overall survival was determined for patients based on staging at the time of diagnosis.

Results

Of the 98 patients referred to the BCCA during the study period, inherited mutations were found in 6% though 60% did not undergo genetic testing. Based on clinical SEER staging at diagnosis 50% had localized disease, 38% regional, and 12% had distant metastasis. 77% had complete surgical resection of which 25% received adjuvant radiation therapy. Five year relapse free survival (RFS) for localized and regional disease was 75% and 66%, respectively (p = 0.006). Initial treatment of 23 patients with locally unresectable and metastatic disease predominantly involved multiple modalities. Of the 37 patients with relapsed or metastatic MTC only 7 (19%) patients received one or more course of chemotherapy for metastatic disease: 1 temsirolimus, 2 adriamycin, 3 sunitinib, 3 sorafenib, and 3 vandetanib. Five year OS based on clinical SEER stage: localized 93%, regional 72% and distant 33% (p < 0.001).

Conclusion

Localized and regional MTC treatment patterns reflect multidisciplinary management based on disease characteristics. Patients with distant disease had poor outcomes with 28% of patients dying from disease. In our cohort the minority of patients ultimately received systemic therapy due to timing and lack of TKI availability.

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Interface Between Cosmetic and Migraine Surgery

Abstract

This article describes connections between migraine surgery and cosmetic surgery including technical overlap, benefits for patients, and why every plastic surgeon may consider screening cosmetic surgery patients for migraine headache (MH). Contemporary migraine surgery began by an observation made following forehead rejuvenation, and the connection has continued. The prevalence of MH among females in the USA is 26%, and females account for 91% of cosmetic surgery procedures and 81–91% of migraine surgery procedures, which suggests substantial overlap between both patient populations. At the same time, recent reports show an overall increase in cosmetic facial procedures. Surgical techniques between some of the most commonly performed facial surgeries and migraine surgery overlap, creating opportunity for consolidation. In particular, forehead lift, blepharoplasty, septo-rhinoplasty, and rhytidectomy can easily be part of the migraine surgery, depending on the migraine trigger sites. Patients could benefit from simultaneous improvement in MH symptoms and rejuvenation of the face. Simple tools such as the Migraine Headache Index could be used to screen cosmetic surgery patients for MH. Similarity between patient populations, demand for both facial and MH procedures, and technical overlap suggest great incentive for plastic surgeons to combine both.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Do Dynamic Fat and Fat-Free Mass Changes follow Theoretical Driven Rules in Athletes?

Introduction: Maximizing fat mass (FM) loss while preserving or increasing fat-free mass (FFM) is a central goal for athletic performance but the composition of body weight (BW) changes over time with training are largely unknown. Purpose: We aimed to analyze FM and FFM contributions to BW changes and to test if these contributions follow established rules and predictions over one athletic season. Methods: Seventy athletes (42 men; handball, volleyball, basketball, triathlon, and swimming) were evaluated from the beginning to the competitive stage of the season and were empirically divided into those who lost (n = 20) or gained >1.5% BW (n = 50). FM and FFM were evaluated with a four-compartment model. Energy densities (ED) of 1.0 kcal·g−1 for FFM and 9.5 kcal·g−1 for FM were used to calculate ED/per kilogram BW change. Results: Athletes that lost >1.5% BW decreased FM by 1.7 ± 1.6 kg (P 1.5% BW increased FFM by 2.3 ± 2.1 kg (P

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Activity Recognition in Youth Using Single Accelerometer Placed at Wrist or Ankle—Erratum

No abstract available

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Calculated versus Measured MVV—Surrogate Marker of Ventilatory CPET

Introduction: Maximum voluntary ventilation (MVV), a surrogate marker of maximum ventilatory capacity, allows for measuring ventilatory reserve during cardiopulmonary exercise testing (CPET), which is necessary to assess ventilatory limitation. MVV can be measured directly during a patient maneuver or indirectly by calculating from forced expiratory volume in 1 s (FEV1 × 40). We investigated for a potential difference between calculated MVV and measured MVV in pediatric subjects, and which better represents maximum ventilatory capacity during CPET. Methods: Data were collected retrospectively from CPET conducted in pediatric subjects for exercise-induced dyspnea from January 2014 to June 2015 at Akron Children's Hospital. Subjects with neuromuscular weakness, morbid obesity, and suboptimal effort during the testing were excluded from the study. Results: Thirty-five subjects (mean ± SD, age = 13.8 ± 2.7 yr, range = 7–18 yr) fulfilled the criteria. Measured MVV was significantly lower than calculated MVV (89.9 ± 26.4 vs 122.4 ± 34.5 L·min−1; P

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Breaks in Sitting Time: Effects on Continuously Monitored Glucose and Blood Pressure

Purpose: We examined the effects of interrupting prolonged sitting with multiple 2-min walking breaks or one 30-min continuous walking session on glucose control and ambulatory blood pressure (ABP). Methods: Ten overweight/obese, physically inactive participants (five men; 32 ± 5 yr; BMI, 30.3 ± 4.6 kg·m−2) participated in this randomized four-trial crossover study, with each trial performed on a separate, simulated workday lasting 9 h: 1) 30 min of continuous moderate-intensity (30-min MOD) walking at 71% ± 4% HRmax; 2) 21 × 2 min bouts of moderate-intensity (2-min MOD) walking at 53% ± 5% HRmax, each performed every 20 min (42 min total); 3) 8 × 2 min bouts of vigorous-intensity (2-min VIG) walking at 79% ± 4% HRmax, each performed every hour (16 min total); 4) 9 h of prolonged sitting (SIT). Participants underwent continuous interstitial glucose monitoring and ABP monitoring during and after the simulated workday spent in the laboratory, with primary data analysis from 12:30 h to 07:00 h the next morning. Results: Compared with SIT (5.6 ± 1.1 mmol·L−1), mean 18.7-h glucose was lower during the 2-min MOD (5.2 ± 1.1 mmol·L−1) and 2-min VIG (5.4 ± 0.9 mmol·L−1) trials and mean 18.7-h glucose during the 30-min MOD trial (5.1 ± 0.8 mmol·L−1) was lower than all other trials (P

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Physical Activity, Not Sedentary Time, Predicts Dual-Energy X-ray Absorptiometry–measured Adiposity Age 5 to 19 Years

Purpose: To examine the associations among physical activity (PA), sedentary time (SED), and TV viewing (TV) with fat mass (FAT) and visceral adipose tissue mass (VAT) from childhood through adolescence (5–19 yr). Methods: Participants in the Iowa Bone Development Study (n = 230 males and 233 females) were examined at ages 5, 8, 11, 13, 15, 17, and 19 yr. Accelerometers measured moderate- or vigorous-intensity PA (MVPA; min·d−1), light-intensity PA (LPA; min·d−1), and SED (h·d−1). Parent-proxy report (5 and 8 yr) and child-report (11, 13, 15, 17, and 19 yr) measured TV (h·d−1). X-ray absorptiometry scans measured FAT (kg) and VAT (g). Sex-specific growth models were used to create FAT and VAT growth curves for individual participants (level 1), and to test the effect of MVPA, LPA, SED, and TV (level 2) after adjusting for weight, height, linear age, nonlinear age, and maturity. Results: Growth models indicated that low levels of MVPA were associated with high levels of FAT and VAT for males and high levels of FAT for females. TV viewing was positively associated with FAT and VAT for males and females. LPA was positively associated with FAT in males. Sedentary time was not associated with FAT or VAT for males or females (P > 0.05). Conclusions: This study supports current PA guidelines focusing on MVPA rather than SED. The contribution of high TV, but not high SED, to high levels of adiposity suggests that TV's contribution to obesity is not just a function of low energy expenditure.

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Effect of Prior Injury on Changes to Biceps Femoris Architecture across an Australian Football League Season

Purpose: To assess in-season alterations of biceps femoris long head (BFlh) fascicle length in elite Australian footballers with and without a history of unilateral hamstring strain injury (HSI) in the past 12 months. Methods: Thirty elite Australian football players were recruited. Twelve had a history of unilateral HSI. Eighteen had no HSI history. All had their BFlh architecture assessed at approximately monthly intervals, six times across a competitive season. Results: The previously injured limb's BFlh fascicles increased from the start of the season and peaked at week 5. Fascicle length gradually decreased until the end of the season, where they were shortest. The contralateral uninjured limb's fascicles were the longest when assessed at week 5 and showed a reduction in-season where weeks 17 and 23 were shorter than week 1. Control group fascicles were longest at week 5 and reduced in-season. The previously injured limb's BFlh fascicles were shorter than the control group at all weeks and the contralateral uninjured limb at week 5. Compared with the control group, the contralateral uninjured limb had shorter fascicles from weeks 9 to 23. Conclusions: Athletes with a history of HSI end the season with shorter fascicles than they start. Limbs without a history of HSI display similar BFlh fascicle lengths at the end of the season as they begin with. All athletes increase fascicle length at the beginning of the season; however, the extent of the increase differed based on history of HSI. These findings show that a HSI history may influence structural adaptation of the BFlh in-season.

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Writing Case Reports: A Practical Guide from Conception through Publication

No abstract available

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Beetroot Juice Increases Human Muscle Force without Changing Ca2+-Handling Proteins

Dietary inorganic nitrate (NO3−) supplementation improves skeletal muscle (SkM) contractile efficiency, and although rodent literature has suggested improvements in calcium handling or redox modifications as likely explanations, the direct mechanism of action in humans remains unknown. Purpose: This study aimed to examine the effects of 7 d of beetroot juice (BRJ) supplementation on SkM contractile characteristics and function. Methods: Recreationally active males (n = 8) underwent transcutaneous electrical muscle stimulation of the vastus lateralis for the evaluation of contractile characteristics before and after 7 d of BRJ supplementation (280 mL·d−1, ~26 mmol NO3−). An additional group of individuals (n = 8) followed the same supplementation protocol but underwent SkM biopsies pre- and post-supplementation for the determination of proteins associated with calcium handling via Western blotting, and the ratio of reduced/oxidized glutathione (GSH:GSSG), an indicator of cellular redox state, via high-performance liquid chromatography (HPLC). Results: After supplementation, there was no change in maximal voluntary force production (602 ± 50 vs 596 ± 56 N) or electrically induced tetanic contractions. By contrast, force production was increased at 10 Hz electrical stimulation (41.1% ± 2.3% vs 37.6% ± 2.4% of peak force, P

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Solid Organ Laceration in an Adolescent Soccer Player: A Case Report

Pediatric solid organ lacerations are a relatively uncommon but potentially dangerous injury that must be addressed urgently once recognized. Seen most often during recreational or team sports, they usually occur after a blunt or deceleration mechanism to the abdomen or flank. Depending on the severity of injury, solid organ laceration may not be immediately apparent clinically. This emphasizes the importance of sideline witnessing and evaluation, acting quickly once symptoms develop, and placing importance on safe sporting technique. In addition, management has changed over time to favor medical management for minor injuries, with laparotomy reserved for high-grade or hemodynamically unstable lacerations. Awareness of solid organ laceration in pediatric populations is more important than ever as they are beginning to appear in younger adolescents. Here we present a case of a 14-yr-old girl sustaining a grade IV liver laceration while playing contact team sports.

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Systolic and Diastolic Left Ventricular Mechanics during and after Resistance Exercise

Purpose: To improve the current understanding of the impact of resistance exercise on the heart, by examining the acute responses of left ventricular (LV) strain, twist, and untwisting rate ("LV mechanics"). Methods: LV echocardiographic images were recorded in systole and diastole before, during and immediately after (7–12 s) double-leg press exercise at two intensities (30% and 60% of maximum strength, one-repetition maximum). Speckle tracking analysis generated LV strain, twist, and untwisting rate data. Additionally, beat-by-beat blood pressure was recorded and systemic vascular resistance (SVR) and LV wall stress were calculated. Results: Responses in both exercise trials were statistically similar (P > 0.05). During effort, stroke volume decreased, whereas SVR and LV wall stress increased (P 0.05). Immediately after exercise, systolic LV mechanics returned to baseline levels (P

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Longitudinal Physical Activity, Body Composition, and Physical Fitness in Preschoolers

Purpose: This study aimed to investigate longitudinal associations of objectively measured physical activity (PA) and sedentary behavior (SB) with body composition and physical fitness at a 12-month follow-up in healthy Swedish 4-yr-old children. Methods: The data from the population-based MINISTOP trial were collected between 2014 and 2016, and this study included the 138 children who were in the control group. PA and SB were assessed using the wrist-worn ActiGraph (wGT3x-BT) accelerometer during seven 24-h periods and, subsequently, defined as SB, light-intensity PA, moderate-intensity PA, vigorous-intensity PA (VPA), and moderate-to-vigorous PA (MVPA). Body composition was measured using air-displacement plethysmography and physical fitness (cardiorespiratory fitness, lower and upper muscular strength as well as motor fitness) by the PREFIT fitness battery. Linear regression and isotemporal substitution models were applied. Results: Greater VPA and MVPA at the age of 4.5 yr were associated with higher fat-free mass index (FFMI) at 5.5 yr (P

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A Cluster RCT to Reduce Workers’ Sitting Time: Impact on Cardiometabolic Biomarkers

Purpose: To evaluate the initial and long-term impacts on cardiometabolic health indicators of the Stand Up Victoria intervention—a 12-month, multicomponent workplace-delivered intervention that successfully reduced overall sitting time, primarily by increasing standing time. Methods: Office worksites (≥1 km apart) from a single organization were cluster randomized to intervention (n = 7) or control (n = 7). Participants were 136 intervention and 95 control desk-based workers (5–39 per worksite; 68% women; mean ± SD age = 45.6 ± 9.4 yr). Outcomes, assessed at baseline (0 months), 3, and 12 months, were 14 individual biomarkers of body composition, blood pressure, glucose metabolism, lipid metabolism, and a composite overall cardiometabolic risk score. Intervention effects were assessed by linear mixed models, accounting for repeated measures and clustering, baseline values, and potential confounders. Missing data were multiply imputed. Significance was set at P

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Environmental and Physiological Factors Affect Football Head Impact Biomechanics

Purpose: Recent anecdotal trends suggest a disproportionate number of head injuries in collegiate football players occur during preseason football camp. In warmer climates, this season also represents the highest risk for heat-related illness among collegiate football players. Because concussion and heat illnesses share many common symptoms, we need 1) to understand if environmental conditions, body temperature, and hydration status affect head impact biomechanics; and 2) to determine if an in-helmet thermistor could provide a valid measure of gastrointestinal temperature. Methods: A prospective cohort of 18 Division I college football players (age, 21.1 ± 1.4 yr; height, 187.7 ± 6.6 cm; mass, 114.5 ± 23.4 kg). Data were collected during one control and three experimental sessions. During each session, the Head Impact Telemetry System recorded head impact biomechanics (linear acceleration, rotational acceleration, and severity profile) and in-helmet temperature. A wet bulb globe device recorded environmental conditions, and CorTemp™ Ingestible Core Body Temperature Sensors recorded gastrointestinal temperature. Results: Our findings suggest that linear acceleration (P = 0.57), rotational acceleration (P = 0.16), and Head Impact Technology severity profile (P = 0.33) are not influenced by environmental or physiological conditions. Conclusions: We did not find any single or combination of predictors for impact severity. Rotational acceleration was approaching significance between our early experimental sessions when compared with our control session. More research should be conducted to better understand if rotational accelerations are a component of impact magnitudes that are affected due to changes in environmental conditions, body temperature, and hydration status.

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Television Viewing Time and Inflammatory-Related Mortality

Purpose: Television (TV) viewing time is associated with increased risk of all-cause, cardiovascular and cancer mortality. Although TV time is detrimentally associated with key inflammatory markers, the associations of TV time with other inflammatory-related mortality (with a predominant inflammatory, oxidative or infectious component, but not attributable to cancer or cardiovascular causes), are unknown. Methods: Among 8933 Australian adults (4593 never-smokers) from the baseline (1999–2000) Australian Diabetes, Obesity and Lifestyle Study (median follow-up, 13.6 yr), we examined TV time in relation to noninflammatory and inflammatory-related mortality (not attributable to cancer or cardiovascular causes, hereafter "inflammatory-related" mortality). Because smoking has a significant inflammatory component, we also examined this relationship in never-smokers. Results: Of 896 deaths, 248 were attributable to cardiovascular disease, 346 to cancer, 130 to other inflammatory-related causes (71 for never-smokers), and 172 to noninflammatory-related causes (87 for never-smokers). After multivariate adjustment for age, sex, education, household income, smoking status, alcohol intake, energy intake, diet, and cardiometabolic risk biomarkers (model 3), every additional hours per day of TV time was associated with increased risk of inflammatory-related mortality in the overall population (hazard ratio, 1.12; 95% confidence interval, 1.00–1.25) and in never-smokers (1.18; 1.00, 1.40). These results were attenuated after additional adjustment for leisure-time physical activity. After multivariate adjustment (model 3), no association was observed for noninflammatory mortality in the overall population (0.95; 0.85, 1.07), but risk tended to decrease for never-smokers (0.85; 0.75, 1.02). Conclusions: In summary, before adjustment for leisure-time physical activity, TV time was associated with increased risk of inflammatory-related mortality. This is consistent with the hypothesis that high TV viewing may be associated with a chronic inflammatory state.

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