Sustainable mobility leveraging on 5G mobile communication infrastructures in the context of smart city operations

Abstract

Economic growth has been strongly associated with urbanization, overwhelming cities with vehicles. This renders mobility inside cities problematic, since it is often associated with large waste of time in traffic congestions, environmental pollution and accidents. Cities struggle to invent and deploy continuously evolving, "smart" solutions in the domain of urban mobility, so as to improve the overall quality of life therein. In this context, the paper discusses on the fundamental challenges that cities face when trying to become smarter, focusing on the particular area of mobility-as-a-service. Moreover, the paper describes a specific framework that leverages on 5G mobile communication infrastructures, in order to increase the effectiveness of vehicular communications and the relevant mobility services and applications offered in urban environments.

http://ift.tt/2cUb0id

Some Stones Are Precious—Extraluminal Appendicoliths

Abstract

Appendicoliths are commonly implicated in the etiopathogenesis of acute appendicitis. Extraluminal appendicoliths are not uncommon and are frequently encountered with ruptured appendicitis. The present image scenario focuses on the importance of identifying and subsequently retrieval of these extraluminal appendicoliths to prevent long-term complications, including intra-abdominal abscess.

http://ift.tt/2d9W2Ur

Mammographic extent of microcalcifications and oestrogen receptor expression affect preoperative breast carcinoma in situ size estimation

Abstract

Background

The aim of our study was to establish which clinical, radiologic and pathologic factors could predict the risk of under- and overestimation of the breast ductal carcinoma in situ (DCIS) size when preoperatively measuring the maximum mammographic extent of microcalcifications (MEM).

Methods

We made a retrospective review of patients with a DCIS treated in our Breast Unit between May 2005 and May 2012. Clinical, pathologic and radiologic data were evaluated as possible predictive factors for over- or underestimation of DCIS size when measuring MEM.

Results

We obtained precise measurements of MEM in 82 patients (84 DCIS lesions). Maximum MEM measurement correctly estimated maximum pathology size in 57 lesions (68.7 %). Patients with a correctly estimated DCIS, with an underestimated DCIS and with an overestimated DCIS significantly differed in DCIS ER expression (p = 0.022) and in maximum MEM measurement (p = 0.000). Constructing two ROC curves, we found that a maximum MEM measurement ≥25 mm and ER expression ≥90 % were both discrimination points for overestimation and ER ≤ 45 % was a discrimination point for underestimation. Using these cutoff points, we defined four groups of patients with different risks of over- and underestimation.

Conclusions

Risk of over- or underestimation of DCIS size through MEM measurement depends on DCIS ER expression and MEM itself. Identifying which patients are at a significant risk of over- or underestimation could help the breast surgeon when discussing the surgical options with the patient.

http://ift.tt/2cSVmks

Blood group antigen expression is involved in C. albicans interaction with buccal epithelial cells

Abstract

Human blood group polymorphisms are known to be determined by the expression of A, B or H antigens and the Lewis antigens. Protection against microbial infections has been associated with inheritance of polymorphisms in genes encoding and regulating the expression of ABH and Lewis antigens in bodily secretions and epithelial tissue surfaces, subsequently resulting in the presentation of different glycosylated terminal antigens on the cell surface. We investigated the role of blood group antigens in diversifying the glycosylation of buccal epithelial cells (BEC) that line the oral cavity. Specifically, we characterized and statistically evaluated the expression of histo-blood group (A, B, O) antigens on N-and O-linked glycans from BEC membrane proteins of various individuals that represented different blood group type and secretor status using a porous graphitic carbon liquid chromatography electrospray ionization mass spectrometry (PGC-LC-ESI-MS) based glycomics approach. From these BEC membrane proteins a total of 77 N-glycan and 96 O-glycan structures were structurally characterized from 19 individuals and relatively quantitated. The N-glycans from the secretor individuals did not express any A/B blood group determinants, but contained several terminal H-antigens. Apart from the non-secretors, the N-glycan profiles of BEC from all blood groups displayed similar glycan types, while varying in their relative intensities between individuals. However, multivariate analysis of the O-glycans from individuals displayed segregation patterns clearly associated with their blood group type and secretor status. In adhesion assays the oral pathogen Candida albicans showed a significantly higher interaction to blood group O type BECs relative to other blood groups.

http://ift.tt/2cSL2sz

The casuistic method of practical ethics

Abstract

This essay concerns itself with the methodology of practical ethics. There are a variety of methods employed in ethics. Although none have been firmly established as dominant, it is generally agreed that casuistry, or the case-based method, is one important strategy commonly used for resolving ethical issues. Casuists compare the case under consideration to a relevantly similar (analogous) precedent case in which judgements have already been made, and they use these earlier judgements to determine the proper resolution of the present case. In this article, I try to provide a better understanding of the nature of contemporary casuistry. To accomplish this, I explain (in the first section) the basic features of casuistic reasoning. The second section focuses on the logic of casuistry. By assessing casuistic reasoning from the logical viewpoint, casuistry can be reconstructed as a logically correct method of reasoning. The third section looks at casuistry from the epistemic point of view and investigates the justificatory force of casuistic reasoning. Finally, in the fourth section, I show the usefulness of formal casuistry.

http://ift.tt/2d7h0k1

FAST

Abstract

We propose Frontier Allocation Synchronized by Token passing (FAST), a distributed algorithm for online terrain coverage using multiple mobile robots, ensuring mutually exclusive selection of frontier cells. Many existing approaches cover the terrain in an irregular fashion, without considering the usability of the already covered region. For instance, in the task of floor cleaning in an office building, these approaches do not guarantee the cleanliness of large unbroken areas until a majority of the task is complete. FAST on the other hand, incrementally traverses the terrain generating structured trajectories for each robot. Following a structured trajectory for coverage path planning is proven to be a very powerful approach in literature. This renders large portions of the terrain usable even before the completion of the coverage task. The novel map representation techniques used in FAST render it scalable to large terrains, without affecting the volume of communication among robots. Moreover, the distributed nature of FAST allows incorporation of fault-tolerance mechanisms. Empirical investigations on maps of varied complexities and sizes both in simulation and on an experimental test-bed demonstrate that the proposed algorithm performs better than some of the benchmark approaches in terms of coverage completion time and less redundant coverage.

http://ift.tt/2cIUcpv

Laquinimod efficacy in relapsing-remitting multiple sclerosis: how to understand why and if studies disagree

Abstract

Background

The results of two randomized phase 3 trials that investigated the use of laquinimod in patients with relapsing-remitting multiple sclerosis were analyzed using a propensity score model.

Methods

The propensity score in each study was defined as the probability of an individual patient being assigned to either the laquinimod or placebo study arm. The analysis included two main stages: (1) calculation of a propensity score for each patient, given a broad set of baseline covariates that included second-degree interactions, and (2) incorporation of the propensity score as another covariate into the predefined primary analysis model to test the treatment effect of laquinimod (0.6 mg/d) vs placebo on the annualized relapse rate (ARR).

Results

The BRAVO study showed baseline imbalances for T2 volume and the proportion of patients with gadolinium (Gd)-enhancing lesions, both parameters known to correlate with risk of relapse. Adjustment using the propensity score as a categorical variable showed that the estimated difference in ARR between laquinimod and placebo was 0.078, in favor of laquinimod.

In ALLEGRO, the baseline Gd-enhancing lesion mean score was higher for placebo vs laquinimod. When the primary analysis model was adjusted for the propensity score as a categorical variable, the covariate adjusted difference in mean ARR between laquinimod and placebo was 0.084, in favor of laquinimod.

Conclusions

Propensity scores addressing differences in baseline characteristics may be helpful to better understand whether observed treatment effect differences in randomized controlled trials are accurate results or result from inherent differences between patients with multiple sclerosis.

http://ift.tt/2cY71Nu

Primary aldosteronism in patients with acute stroke: prevalence and diagnosis during initial hospitalization

Abstract

Background

Hypertension is the prime risk factor for stroke, and primary aldosteronism (PA) is the most common cause of secondary hypertension. The prevalence of PA in stroke patients has never been reported. The aim of this study was to elucidate the prevalence of PA.

Methods

A total of 427 consecutive patients with acute stroke were prospectively enrolled for this study. The screening tests were performed at the initial visit and a week after admission by measuring plasma aldosterone concentration and plasma renin activity. The rapid adrenocorticotropic hormone (ACTH) test was performed as the confirmatory test when both screening tests were positive. The primary endpoint was a final diagnosis of PA.

Results

The sensitivity of the dual screening system for the diagnosis of PA was 88.2 %, and PA was finally diagnosed in 4.0 % of acute stroke patients and in 4.9 % of stroke patients with a history of hypertension. Patients with PA were less likely to be male and have diabetes, and they had higher blood pressure at the initial visit, lower potassium concentration, and more intracerebral hemorrhage. The rapid ACTH test was performed safely even in acute stroke patients.

Conclusions

The prevalence of PA is not low among acute stroke patients. Efficient screening of PA should be performed particularly for patients with risk factors.

Trial registration

UMIN-CTR; UMIN000011021. Trial registration date: June 23, 2013 (retrospectively registered).

http://ift.tt/2cPhOwf

Prevalence of stroke in children admitted with sickle cell anaemia to Mulago Hospital

Abstract

Background

Stroke is a major complication of sickle cell anaemia (SCA). It occurs commonly in childhood with about 10 % of children with sickle cell anaemia getting affected by this complication. In Uganda, there is paucity of data on the prevalence of stroke in children admitted in a tertiary institution. We determined the prevalence of stroke amongst children with SCA admitted to Mulago National Referral Hospital in Uganda and described the ir co-morbidities.

Methods

We conducted a retrospective record review of children with SCA admitted from August 2012 to August 2014 to the Paediatric Haematology Ward of Mulago Hospital in Kampala, Uganda. The target population was SCA children age 6 months-17 years of age. A descriptive analysis was used to summarize the demographic characteristics and clinical diagnosis.

Results

There were 2,176 children with SCA admitted who were included in this study. There were 147 children with stroke. Their mean age 6.1, (SD 3), with a male to female ratio was 1:1 (71 males and 76 females). The M: F ratio of non-stroke children was 1.1:1 (1084 males and 945 females) with a mean age of 5.2, (SD 3). The prevalence of stroke was 6.8 % (147 of 2176). Amongst the children with stroke, 72.1 % (106 of 147) had co-morbidities which included severe anaemia 21.7 % (23 of 106), bacteraemia and vaso-occlusive crisis 17 % (18 of 106), pneumonia 8.4 % (9 of 106) and malaria 6.6 % (7 of 106).

Conclusion

The prevalence of stroke in hospitalized Ugandan children with SCA was 6.8 %. Children with stroke were often admitted with other medical conditions such as severe anaemia, bacteraemia and vaso-occlusion.

http://ift.tt/2cPh3Dk

In situ FTIR spectroscopy study on the rapid dissolution process of modified poly(vinyl alcohol)

Abstract

In this article, modified poly(vinyl alcohol) (m-PVA) has been synthesized via copolymerization of vinyl acetate in methanol by adding comonomers acrylic acid and butyl acrylate followed by saponification. This modified poly(vinyl alcohol) can be completely dissolved into water before 60 °C without agitation. The rapid dissolution process of m-PVA was investigated by temperature-dependent Fourier transform infrared (FTIR) spectroscopy from 20 °C to 85 °C. The results showed that the wavenumber ranges of m-PVA in the O-H stretching and bending bands beyond the measuring range of the spectrometer were much larger than those of common PVA. This demonstrated that m-PVA chains could interact with water molecules more strongly and form hydrogen bonds with the hydroxyl groups of water more easily. The introduction of carboxyl groups destroyed the chemical regularity of polymer chains, which led to the decreasing crystallinity degree and imperfect crystal structures. Both the lower crystallinity degree and imperfect crystal structures were crucial factors to the rapid dissolution of m-PVA. Moreover, traditional Fourier transform infrared (FTIR) spectra, ¹H nuclear magnetic resonance (¹H NMR), and differential scanning calorimetry (DSC) were also applied to study the m-PVA in this paper.

http://ift.tt/2d75bug

Increasing incidence of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in Belgian hospitals

Abstract

Carbapenemase-producing Enterobacteriaceae are increasingly reported worldwide. The aim of the study was to determine the incidence and molecular epidemiology of carbapenemase-producing (CP) Escherichia coli and Klebsiella pneumoniae (CP-E/K) in Belgium. Eleven hospital-based laboratories collected carbapenem non-susceptible (CNS) isolates of E. coli and K. pneumoniae detected in clinical specimens from January 2013 to December 2014. All CNS strains were tested for carbapenemase production and typed by multilocus sequence typing (MLST) for a 6-month period as part of the European Survey on Carbapenemase-Producing Enterobacteriaceae in Europe (EuSCAPE) structured survey. In addition, an equal number of carbapenem-susceptible isolates collected were preserved as a control group for risk factor analysis. The overall incidence rate of CP-E/K isolates in hospitals increased from 0.124 in 2013 to 0.223 per 1000 admissions in 2014. From November 2013 to April 2014, 30 CP K. pneumoniae [OXA-48 (n = 16), KPC (n = 13), OXA-427 (n = 1)] and five CP E. coli [OXA-48 (n = 3), NDM (n = 1), OXA-427 (n = 1)] isolates were detected in ten hospitals. The 16 OXA-48-producing K. pneumoniae strains were distributed into eight sequence types (STs), while the 13 KPC-producing K. pneumoniae clustered into three STs dominated by ST512 (n = 7) and ST101 (n = 5). Compared to controls, we observed among CP-E/K carriers significantly higher proportion of males, respiratory origins, previous hospitalization, nosocomial setting, and a significantly lower proportion of bloodstream infections. Our study confirms the rapid spread of CP-E/K in Belgian hospitals and the urgent need for a well-structured and coordinated national surveillance plan in order to limit their dissemination.

http://ift.tt/2cIFhvA

Uropathogen distribution and antimicrobial susceptibility in uncomplicated cystitis in Belgium, a high antibiotics prescribing country: 20-year surveillance

Abstract

Treatment of cystitis in primary care is usually empirical, guided by the prior probability of causal pathogens and their susceptibility. To re-evaluate empirical treatment guidelines, the actual distribution and susceptibility of uropathogens was examined and compared with two previous surveys in Belgium over the past 20 years. Because of the alarming increase in carriage of extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Escherichia coli, this specific resistance was explored. From May 2014 to December 2015, 120 general practitioners collected midstream urine specimens from adult pre- and postmenopausal female patients with suspected cystitis. A dipslide was inoculated and sent for microbiological analysis. Anal swabs were collected for ESBL and carbapenemase detection. Of 265 enrolled patients, 203 (79.3 %) had a positive culture. Escherichia coli (81.6 %) was the most frequently isolated uropathogen, followed by Staphylococcus saprophyticus (8 %), confirming the results of the 1995 and 2005 surveys. The susceptibility of E. coli remained nearly 100 % for nitrofurantoin and fosfomycin, decreased from nearly 100 % in 1995 to 94.2 % for quinolones, from 73.2 to 55.5 % for ampicillin, and from 83.3 to 76.3 % for trimethoprim–sulfamethoxazole (TMP-SMX). In E. coli present in positive urine cultures, ESBLs were found in 2.5 % and carbapenemases were absent. In fecal specimens, ESBL-producing E. coli were found in 7.9 % and carbapenemases were not detected. Over a 20-year period, the distribution of uropathogens in women with cystitis remained unchanged. Susceptibility remained excellent for nitrofurantoin and fosfomycin. For TMP-SMX, ampicillin, and quinolones, there was a decrease.

http://ift.tt/2cm4jmV

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery

Abstract

Background

Enhanced recovery may be viewed as a comprehensive approach to improving meaningful outcomes in patients undergoing major surgery. Evidence to support enhanced recovery pathways (ERPs) is strong in patients undergoing colorectal surgery. There is some controversy about the adoption of specific elements in enhanced recovery "bundles" because the relative importance of different components of ERPs is hard to discern (a consequence of multiple simultaneous changes in clinical practice when ERPs are initiated). There is evidence that specific approaches to fluid management are better than alternatives in patients undergoing colorectal surgery; however, several specific questions remain.

Methods

In the "Perioperative Quality Initiative (POQI) Fluids" workgroup, we developed a framework broadly applicable to the perioperative management of intravenous fluid therapy in patients undergoing elective colorectal surgery within an ERP.

Discussion

We discussed aspects of ERPs that impact fluid management and made recommendations or suggestions on topics such as bowel preparation; preoperative oral hydration; intraoperative fluid therapy with and without devices for goal-directed fluid therapy; and type of fluid.

http://ift.tt/2cz7S8N

Adipokines and bone metabolism: an interplay to untangle

http://ift.tt/2cTyG6v

Effects of high-intensity interval training on physical capacities and substrate oxidation rate in obese adolescents

Abstract

Purpose

To investigate the effects of a 3-week weight-management program entailing moderate energy restriction, nutritional education, psychological counseling and three different exercise training (a: low intensity, LI: 40 % V′O₂max; b: high intensity, HI: 70 % V′O₂max; c: high-intensity interval training, HIIT), on body composition, energy expenditure and fat oxidation rate in obese adolescents.

Methods

Thirty obese adolescents (age: 15–17 years, BMI: 37.5 kg m⁻²) participated in this study. Before starting (week 0, W0) and at the end of the weight-management program (week 3, W3), body composition was assessed by an impedancemeter; basal metabolic rate (BMR), energy expenditure and substrate oxidation rate were measured during exercise and post-exercise recovery by indirect calorimetry.

Results

At W3, body mass (BM) and fat mass (FM) decreased significantly in all groups, the decreases being significantly greater in the LI than in the HI and HIIT subgroups (BM: −8.4 ± 1.5 vs −6.3 ± 1.9 vs −4.9 ± 1.3 kg and FM: −4.2 ± 1.9 vs −2.8 ± 1.2 vs −2.3 ± 1.4 kg, p < 0.05, respectively). V′O₂peak, expressed in relative values, changed significantly only in the HI and HIIT groups by 0.009 ± 0.005 and 0.007 ± 0.004 L kg FFM⁻¹ min⁻¹ (p < 0.05). Furthermore, the HI and HIIT subgroups exhibited a greater absolute rate of fat oxidation between 50 and 70 % V′O₂peak at W3. No significant changes were observed at W3 in BMR, energy expenditure during exercise and post-exercise recovery.

Conclusion

A 3-week weight-management program induced a greater decrease in BM and FM in the LI than in the HI and HIIT subgroups, and greater increase in V′O₂peak and fat oxidation rate in the HI and HIIT than in the LI subgroup.

http://ift.tt/2cG3wfs

The Cancer Research Network: a platform for epidemiologic and health services research on cancer prevention, care, and outcomes in large, stable populations

Abstract

Purpose

The ability to collect data on patients for long periods prior to, during, and after a cancer diagnosis is critical for studies of cancer etiology, prevention, treatment, outcomes, and costs. We describe such data capacities within the Cancer Research Network (CRN), a cooperative agreement between the National Cancer Institute (NCI) and organized health care systems across the United States.

Methods

Data were extracted from each CRN site's virtual data warehouse using a centrally written and locally executed program. We computed the percent of patients continuously enrolled ≥1, ≥5, and ≥10 years before cancer diagnosis in 2012–2015 (year varied by CRN site). To describe retention after diagnosis, we computed the cumulative percentages enrolled, deceased, and disenrolled each year after the diagnosis for patients diagnosed in 2000.

Results

Approximately 8 million people were enrolled in ten CRN health plans on December 31, 2014 or 2015 (year varied by CRN site). Among more than 30,000 recent cancer diagnoses, 70 % were enrolled for ≥5 years and 56 % for ≥10 years before diagnosis. Among 25,274 cancers diagnosed in 2000, 28 % were still enrolled in 2010, 45 % had died, and 27 % had disenrolled from CRN health systems.

Conclusions

Health plan enrollment before cancer diagnosis was generally long in the CRN, and the proportion of patients lost to follow-up after diagnosis was low. With long enrollment histories among cancer patients pre-diagnosis and low post-diagnosis disenrollment, the CRN provides an excellent platform for epidemiologic and health services research on cancer incidence, outcomes, and costs.

http://ift.tt/2cycJKz

Microbial nitrification in throughfall of a Japanese cedar associated with archaea from the tree canopy

To investigate the nitrification potential of phyllospheric microbes, we incubated throughfall samples collected under the canopies of Japanese cedar (Cryptomeria japonica) and analyzed the transformation of inor...

http://ift.tt/2cSqyAc

Atmospheric phase screen correction in ground-based SAR with PS technique

Ground-based synthetic aperture radar (GBSAR) is a powerful tool used in monitoring structures, such as bridges and dams. However, despite the extremely short range of GBSAR interferometry, the atmosphere effe...

http://ift.tt/2d9o7LI

Hybrid Pareto artificial bee colony algorithm for multi-objective single machine group scheduling problem with sequence-dependent setup times and learning effects

Group scheduling is significant for efficient and cost effective production system. However, there exist setup times between the groups, which require to decrease it by sequencing groups in an efficient way. C...

http://ift.tt/2cSr5SJ

Integrating climate-smart rice agriculture into secondary-level curriculum: lessons from three high schools in the Philippines

Climate change (CC) is an urgent and highly relevant topic that must be integrated into the school curriculum. Literature on CC integration, however, is scarce, let alone literature on integrating climate-sma...

http://ift.tt/2d9nIZT

Current Concepts in the Medical Management of the Pediatric Burn Patient

Abstract

Purpose of Review

Management of the pediatric burn patient involves a careful, multi-faceted approach in order to meet treatment goals. Due to advances in surgical and medical care, mortality and morbidities can be minimized. This chapter seeks to address current advances which allow practitioners to provide excellent systemic care.

Recent Findings

Judicious fluid management of children with severe burn injury can improve the respiratory outcome measures of these children. A multi-modal approach to pain and sedation can improve the neurologic status of severely burned children.

Summary

Children with significant burn injury can have the most favorable outcomes when the principles of skillful critical care are applied. Systemic critical care based on the best evidence available not only improves survival rates but also improves quality of life for these delicate patients.

http://ift.tt/2cP4vvG

Lipid microdomain modification sustains neuronal viability in models of Alzheimer’s disease

Abstract

Decreased neuronal insulin receptor (IR) signaling in Alzheimer's disease is suggested to contribute to synaptic loss and neurodegeneration. This work shows that alteration of membrane microdomains increases IR levels and signaling, as well as neuronal viability in AD models in vitro and in vivo. Neuronal membrane microdomains are highly enriched in gangliosides. We found that inhibition of glucosylceramide synthase (GCS), the key enzyme of ganglioside biosynthesis, increases viability of cortical neurons in 5xFAD mice, as well as in cultured neurons exposed to oligomeric amyloid-β-derived diffusible ligands (ADDLs). We furthermore demonstrate a molecular mechanism explaining how gangliosides mediate ADDL-related toxic effects on IR of murine neurons. GCS inhibition increases the levels of functional dendritic IR on the neuronal surface by decreasing caveolin-1-mediated IR internalization. Consequently, IR signaling is increased in neurons exposed to ADDL stress. Thus, we propose that GCS inhibition constitutes a potential target for protecting neurons from ADDL-mediated neurotoxicity and insulin resistance in Alzheimer's disease.

http://ift.tt/2ch9HsW

Microglial CX 3 CR1 promotes adult neurogenesis by inhibiting Sirt 1/p65 signaling independent of CX 3 CL1

Abstract

Homo and heterozygote cx3cr1 mutant mice, which harbor a green fluorescent protein (EGFP) in their cx3cr1 loci, represent a widely used animal model to study microglia and peripheral myeloid cells. Here we report that microglia in the dentate gyrus (DG) of cx3cr1 ^−/− mice displayed elevated microglial sirtuin 1 (SIRT1) expression levels and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) p65 activation, despite unaltered morphology when compared to cx3cr1 ^+/− or cx3cr1 ^+/+ controls. This phenotype was restricted to the DG and accompanied by reduced adult neurogenesis in cx3cr1 ^−/− mice. Remarkably, adult neurogenesis was not affected by the lack of the CX₃CR1-ligand, fractalkine (CX₃CL1). Mechanistically, pharmacological activation of SIRT1 improved adult neurogenesis in the DG together with an enhanced performance of cx3cr1 ^−/− mice in a hippocampus-dependent learning and memory task. The reverse condition was induced when SIRT1 was inhibited in cx3cr1 ^−/− mice, causing reduced adult neurogenesis and lowered hippocampal cognitive abilities. In conclusion, our data indicate that deletion of CX₃CR1 from microglia under resting conditions modifies brain areas with elevated cellular turnover independent of CX₃CL1.

http://ift.tt/2cfb8mH

Noninvasive pulmonary artery pressure monitoring by EIT: a model-based feasibility study

Abstract

Current monitoring modalities for patients with pulmonary hypertension (PH) are limited to invasive solutions. A novel approach for the noninvasive and unsupervised monitoring of pulmonary artery pressure (PAP) in patients with PH was proposed and investigated. The approach was based on the use of electrical impedance tomography (EIT), a noninvasive and safe monitoring technique, and was tested through simulations on a realistic 4D bio-impedance model of the human thorax. Changes in PAP were induced in the model by simulating multiple types of hypertensive conditions. A timing parameter physiologically linked to the PAP via the so-called pulse wave velocity principle was automatically estimated from the EIT data. It was found that changes in PAP could indeed be reliably monitored by EIT, irrespective of the pathophysiological condition that caused them. If confirmed clinically, these findings could open the way for a new generation of noninvasive PAP monitoring solutions for the follow-up of patients with PH.

http://ift.tt/2d2T45l

Estimation of Upper Limit of Normal for Serum Alanine Transaminase in Healthy South Indian Population

Abstract

Alanine aminotransferase (ALT) is the most common and cost effective screening test for asymptomatic liver disease. There is paucity of data on normal ALT among healthy individuals in India. An observational cross sectional study was conducted from January to July 2013 to estimate the upper limit of normal for ALT in healthy south Indian population. Adults undergoing voluntary or pre-employment health screening were included. Those with current and past alcoholism or smoking, acute illness or hospitalization during preceding 12 months, non-steroidal anti-inflammatory or over the counter medication use within a month, current or past intake of herbal medications, any chronic medical illness, abnormal body mass index (BMI), fatty liver in ultrasound, abnormality in haemoglobin, platelet count, blood sugar, creatinine, lipid profile and thyroid function test and positive serology (Hepatitis B, C or HIV) were excluded. A total of 2600 subjects were screened. 344 were included for analysis. Mean age was 35 years in men and 34.83 years in women, with a mean BMI of 22.2 kg/m² in men and 21.8 kg/m² in women. The mean ALT in men and women were 21.87 ± 2.9 (97.5th percentile 28 U/L) and 19.35 ± 3.3 (97.5th percentile 24 U/L) respectively. In conclusion, mean and upper limit of ALT (97.5th percentile) in south Indian men was 21.87 and 28 IU/L and women were 19.35 and 24 IU/L respectively. There is a need to re-consider ALT levels in our population for better detection of individuals at risk for liver disease.

http://ift.tt/2cSfoeL

Wire cerclage can restore the stability of the thoracic spine after median sternotomy: an in vitro study with entire rib cage specimens

Abstract

Purpose

The influence of the anterior rib cage on the stability of the human thoracic spine is not completely known. One of the most common surgical interventions on the anterior rib cage is the longitudinal median sternotomy and its fixation by wire cerclage. Therefore, the purpose of this in vitro study was to examine, if wire cerclage can restore the stability of the human thoracic spine after longitudinal median sternotomy.

Methods

Six fresh frozen human thoracic spine specimens (C7–L1, 56 years in average, range 50–65), including the intact rib cage without intercostal muscles, were tested in a spinal loading simulator and monitored with an optical motion tracking system. While applying 2 Nm pure moment in flexion/extension (FE), lateral bending (LB), and axial rotation (AR), the range of motion (ROM) and neutral zone (NZ) of the functional spinal units of the thoracic spine (T1–T12) were studied (1) in intact condition, (2) after longitudinal median sternotomy, and (3) after sternal closure using wire cerclage.

Results

The longitudinal median sternotomy caused a significant increase of the thoracic spine ROM relative to the intact condition (FE: 12° ± 5°, LB: 18° ± 5°, AR: 25° ± 10°) in FE (+12 %) and AR (+22 %). As a result, the sagittal cut faces of the sternum slipped apart visibly. Wire cerclage fixation resulted in a significant decrease of the ROM in AR (−12 %) relative to condition after sternotomy. ROM increased relative to the intact condition, in AR even significantly (+8 %). The NZ showed a proportional behavior compared to the ROM in all loading planes, but it was distinctly higher in FE (72 %) and in LB (82 %) compared to the ROM than in AR (12 %).

Conclusions

In this in vitro study, the longitudinal median sternotomy resulted in a destabilization of the thoracic spine and relative motion of the sternal cut faces, which could be rectified by fixation with wire cerclage. However, the stability of the intact condition could not be reached. Nevertheless, a fixation of the sternum should be considered clinically to avoid instability of the spine and sternal pseudarthrosis.

http://ift.tt/2clPMY8

Complexes of Peptide Blockers with Kv1.6 Pore Domain: Molecular Modeling and Studies with KcsA-Kv1.6 Channel

Abstract

Potassium voltage-gated Kv1.6 channel, which is distributed primarily in neurons of central and peripheral nervous systems, is of significant physiological importance. To date, several high-affinity Kv1.6-channel blockers are known, but the lack of selective ones among them hampers the studies of tissue localization and functioning of Kv1.6 channels. Here we present an approach to advanced understanding of interactions of peptide toxin blockers with a Kv1.6 pore. It combines molecular modeling studies and an application of a new bioengineering system based on a KcsA-Kv1.6 hybrid channel for the quantitative fluorescent analysis of blocker-channel interactions. Using this system we demonstrate that peptide toxins agitoxin 2, kaliotoxin1 and OSK1 have similar high affinity to the extracellular vestibule of the K⁺-conducting pore of Kv1.6, hetlaxin is a low-affinity ligand, whereas margatoxin and scyllatoxin do not bind to Kv1.6 pore. Binding of toxins to Kv1.6 pore has considerable inverse dependence on the ionic strength. Model structures of KcsA-Kv1.6 and Kv1.6 complexes with agitoxin 2, kaliotoxin 1 and OSK1 were obtained using homology modeling and molecular dynamics simulation. Interaction interfaces, which are formed by 15–19 toxin residues and 10 channel residues, are described and compared. Specific sites of Kv1.6 pore recognition are identified for targeting of peptide blockers. Analysis of interactions between agitoxin 2 derivatives with point mutations (S7K, S11G, L19S, R31G) and KcsA-Kv1.6 confirms reliability of the calculated complex structure.

http://ift.tt/2d9eWLf

Modulation of Binge-like Ethanol Consumption by IL-10 Signaling in the Basolateral Amygdala

Abstract

Excessive ethanol consumption alters the neuroimmune system and particularly impacts the cytokine milieu of the CNS. Cytokine dysregulation has been shown to underlie addictive-like behaviors including alcohol abuse; however, many studies focus primarily on the proinflammatory cytokine profile during alcohol dependence. The current study furthers this research by determining the impact of excessive ethanol consumption on interleukin-10 (IL-10) and interleukin-4 (IL-4) activity in a model of non-dependent binge consumption called the "drinking in the dark" (DID) paradigm. Furthermore, the ability of IL-10 to modulate ethanol consumption was tested using site-directed pharmacology. Immunohistochemistry analyses determined that ethanol decreased IL-10 by 50 % in the basolateral amygdala (BLA) but had no effect on IL-4. Neither IL-10 nor IL-4, however, were altered in the central amygdala (CEA). Enzyme linked immunosorbent assays confirmed that IL-10 was decreased in the amygdala but not in the serum, suggesting changes of this cytokine with the DID paradigm are restricted to the central nervous system. Finally, bilateral infusions of IL-10 into the BLA, but not CeA, reduced binge-like drinking and corresponding blood ethanol concentrations without impacting either locomotor activity or anxiety-like behavioral correlates. Together, these data support the idea that alcohol abuse dysregulates specific anti-inflammatory cytokines; however, ameliorating alcohol-induced effects on cytokines, like IL-10, may prove to be an effective therapy in curbing excessive consumption.

http://ift.tt/2cSgCGO

Feeding Consequences of Hand and Foot Disability in Wild Adult Chimpanzees ( Pan troglodytes schweinfurthii )

Abstract

Many wild primates experience long-term limb disability, and their ability to cope with disability has implications for survival and fitness. We quantified the arboreal feeding and postural behaviors of adult chimpanzees to study the consequences of physical limb disabilities. We collected behavioral data for a total of 8 mo on chimpanzees at Sebitoli, Kibale National Park, Uganda, focusing on the time spent feeding, common feeding tree species, body postures, and substrate use. Of the 51 chimpanzees we observed, 16 (31%) exhibited limb anomalies, which varied in form and severity. Disabled chimpanzees climbed as high as chimpanzees without disabilities and did not differ from nondisabled chimpanzees in the amount they used feeding tree species. Adult chimpanzees with severe hand disability spent significantly more time feeding than nondisabled individuals. In addition, manually disabled adults did not suspend themselves from branches during feeding as frequently as nondisabled adults and used larger substrates for gripping and sitting than nondisabled adults. These results indicate that disabled individuals compensate to carry out feeding activities in trees.

http://ift.tt/2d8oUwg

Which Characteristics are Associated with the Timing of the First Healthcare Consultation, and Does the Time to Care Influence the Duration of Compensation for Occupational Back Pain?

Abstract

Purpose To identify the characteristics associated with the timing of the first healthcare consultation and to measure the impact of that timing on the duration of the first episode of compensation for occupational back pain following the injury. Methods We analyzed data from a cohort of workers with compensated back pain in 2005 in Ontario obtained from the Workplace Safety and Insurance Board. Cox multivariable survival models were performed to identify factors associated with the time to care and to measure its association with the length of the first episode of 100 % compensation. Results Among the 5520 claims analyzed, 93.7 % of workers accessed care within the first week (average = 2.1 days; median = 1 day). Time to care was shorter for males, for workers who had received previous compensation and for those with access to an early return to work program. Age, number of employees in the company and personal earnings were positively associated with the time to care. More severe nature of injury, employers doubt about the work-relatedness of the injury and consulting a physiotherapist as the first healthcare provider were also associated with longer time to care. Considering potential confounders, longer time to care was significantly associated with a delay in the end of the first episode of compensation (hazard ratio = 0.98; P < 0.001). Conclusion Temporal access to a source of care is not problematic for the vast majority of Ontarian workers who receive compensation for occupational back pain; however, for the minority of workers who do not rapidly access care, the timing of the first healthcare consultation is a significant predictor of the duration of the first episode of compensation.

http://ift.tt/2cxSzAv

Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain

Abstract

Objective To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers. Methods We analyzed data from a cohort of 5511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period. Results Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10–1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71–0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02–2.19], P value = 0.040) rather than a physician (reference). Conclusion The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker's compensation system. Further investigation is required to understand the between-provider differences.

http://ift.tt/2cyQCAs

Identifying attachment ruptures underlying severe music performance anxiety in a professional musician undertaking an assessment and trial therapy of Intensive Short-Term Dynamic Psychotherapy (ISTDP)

Kenny has proposed that severe music performance anxiety that is unresponsive to usual treatments such as cognitive-behaviour therapy may be one manifestation of unresolved attachment ruptures in early life. I...

http://ift.tt/2d6z6CX

Tropomyosin movement is described by a quantitative high-resolution model of X-ray diffraction of contracting muscle

Abstract

Contraction of skeletal and cardiac muscle is controlled by Ca²⁺ ions via regulatory proteins, troponin (Tn) and tropomyosin (Tpm) associated with the thin actin filaments in sarcomeres. In the absence of Ca²⁺, Tn-C binds actin and shifts the Tpm strand to a position where it blocks myosin binding to actin, keeping muscle relaxed. According to the three-state model (McKillop and Geeves Biophys J 65:693–701, 1993), upon Ca²⁺ binding to Tn, Tpm rotates about the filament axis to a 'closed state' where some myosin heads can bind actin. Upon strong binding of myosin heads to actin, Tpm rotates further to an 'open' position where neighboring actin monomers also become available for myosin binding. Azimuthal Tpm movement in contracting muscle is detected by low-angle X-ray diffraction. Here we used high-resolution models of actin-Tpm filaments based on recent cryo-EM data for calculating changes in the intensities of X-ray diffraction reflections of muscle upon transitions between different states of the regulatory system. Calculated intensities of actin layer lines provide a much-improved fit to the experimental data obtained from rabbit muscle fibers in relaxed and rigor states than previous lower-resolution models. We show that the intensity of the second actin layer line at reciprocal radii from 0.15 to 0.3 nm⁻¹ quantitatively reports the transition between different states of the regulatory system independently of the number of myosin heads bound to actin.

http://ift.tt/2cxKxYy

Ibutilide protects against cardiomyocytes injury via inhibiting endoplasmic reticulum and mitochondrial stress pathways

Abstract

Atrial fibrillation (AF) is a complex disease with multiple inter-relating causes culminating in rapid atrial activation and atrial structural remodeling. The contribution of endoplasmic reticulum and mitochondria stress to AF has been highlighted. As the class III antiarrhythmic agent, ibutilide are widely used to AF. This study was designed to explore whether ibutilide could treat AF by inhibiting endoplasmic reticulum stress pathways and mitochondria stress. The neonatal rat cardiomyocytes were isolated and exposed to H₂O₂, ibutilide was add to the culture medium 12 h. Then the cell viability, oxidative stress levels and apoptotic rate were analyzed. In addition, endoplasmic reticulum stress related protein (GRP78, GRP94, CHOP), mitochondria-dependent protein (Bax, Bcl-2) and caspase-3/9/12 were identified by real-time PCR and western blot analysis. In our results, remarkable decreased cell viability and oxidative stress levels were detected in cardiomyocytes after treating with H₂O₂. The apoptotic rate and the expression of proteins involved in mitochondrial stress and endoplasmic reticulum stress pathways increased. While ibutilide significantly inhibited these changes. These data suggested that ibutilide serves a protective role against H₂O₂-induced apoptosis of neonatal rat cardiomyocytes, and the mechanism is related to suppression of mitochondrial stress and endoplasmic reticulum stress.

http://ift.tt/2d6oFPE

Sleep-Disordered Breathing—Do We Have to Change Gears in Heart Failure?

Abstract

The majority of patients with heart failure have sleep-disordered breathing (SDB)—with central (rather than obstructive) sleep apnoea becoming the predominant form in those with more severe disease. Cyclical apnoeas and hypopnoeas are associated with sleep disturbance, hypoxaemia, haemodynamic changes, and sympathetic activation. Such patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and partially normalise the sleep and respiratory physiology, but recent randomised trials of cardiovascular outcomes in central sleep apnoea have been neutral or suggested the possibility of harm, likely from increased sudden death. Further randomised outcome studies (with cardiovascular mortality and hospitalisation endpoints) are required to determine whether mask-based treatment for SDB is appropriate for patients with chronic systolic heart failure and obstructive sleep apnoea, for those with heart failure with preserved ejection fraction, and for those with decompensated heart failure. New therapies for sleep apnoea—such as implantable phrenic nerve stimulators—also require robust assessment. No longer can the surrogate endpoints of improvement in respiratory and sleep metrics be taken as adequate therapeutic outcome measures in patients with heart failure and sleep apnoea.

http://ift.tt/2cRSzYt

Recombinant Sj16 from Schistosoma japonicum contains a functional N-terminal nuclear localization signal necessary for nuclear translocation in dendritic cells and interleukin-10 production

Abstract

Sj16 is a Schistosoma japonicum-derived protein (16 kDa in molecular weight) that has been identified as an immune modulation molecule, but the mechanisms of modulation of immune responses are not known. In this report, we aimed to investigate the host immune regulation mechanism by recombinant Sj16 (rSj16) and thus illuminate the molecular mechanism of immune evasion by S. japonicum. The effect of rSj16 and rSj16 mutants on the biology of dendritic cells (DCs) was assessed by examining DC maturation, cytokine production, and expression of surface markers by flow cytometry and enzyme-linked immunosorbent assay. We found that rSj16 significantly stimulated interleukin (IL)-10 production and inhibited LPS-induced bone marrow-derived dendrite cell (BMDC) maturation in a dose-dependent manner. By using antibody neutralization experiments and IL-10-deficient (knockout) mice, we confirmed that the inhibitory effect of rSj16 on LPS-induced BMDCs is due to its induction of IL-10 production. To understand how rSj16 induces the production of IL-10, we analyzed the protein sequence and revealed two potential nuclear localization signals (NLS) in Sj16. The N-terminal NLS (NLS1) is both necessary and sufficient for translocation of rSj16 to the nucleus of BMDCs and is important for subsequent induction of IL-10 production and the inhibition of BMDC maturation by rSj16. The results of our study concluded that the ability of rSj16 to inhibit DC functions is IL-10 dependent which is operated by IL-10R signal pathway. This study also confirmed that NLS is an important domain associated with increased production of IL-10. Our findings will extend the current understanding on host-schistosome relationship and provide insight about bottleneck of parasitic control.

http://ift.tt/2cxWpGG

A double-blind placebo controlled study of acotiamide hydrochloride for efficacy on gastrointestinal motility of patients with functional dyspepsia

Abstract

Background

Acotiamide is widely used to improve symptoms in patients with functional dyspepsia (FD) in multiple large-scale clinical studies, but there are few reports about the drug's mechanism of action. The aim of this study was to assess the effects of acotiamide on gastric accommodation and gastric emptying, gastrointestinal symptoms, and health-related quality of life (HR-QOL) in a placebo-controlled study.

Methods

We conducted a randomized, double-blind placebo-controlled study. Fifty Japanese FD patients were randomly assigned to either placebo (n = 25) or acotiamide 100 mg × 3/day for 2 weeks (n = 25). At baseline and at 2 weeks of treatment, we evaluated the patients' gastric motility using scintigraphy to determine the accommodation and emptying values, gastrointestinal symptom rating scale (GSRS), HR-QOL (SF-8), and anxiety and depression scale (HADS).

Results

Four patients failed to complete the medication regimen and were omitted from analysis; data from 24 placebo patients and 22 acotiamide patients were analyzed. Acotiamide significantly increased gastric accommodation compared to the placebo (p = 0.04 vs. p = 0.08; respectively). Acotiamide significantly accelerated gastric emptying (50 % half-emptying time) (p = 0.02 vs. p = 0.59). Acotiamide significantly improved the total GSRS scores compared to placebo (p = 0.0007 vs. p = 0.14). HR-QOL did not differ significantly between the two groups, but acotiamide significantly improved the HADS anxiety score compared to placebo (p = 0.04 vs. p = 0.20).

Conclusions

Our placebo-controlled study demonstrated that acotiamide significantly increased both gastric accommodation and gastric emptying in Japanese FD patients. Acotiamide also improved the patients' dyspeptic symptoms and anxiety score.

Clinical Trials Registry no: UMIN000013544.

http://ift.tt/2d2hagt

Association between Achilles tightness and lower extremity injury in children

Abstract

Background

It is unclear whether isolated gastroc/soleus tightness can increase the risk of lower extremity injury in an otherwise healthy child.

Questions/Purposes

(1) Is there a difference in gastroc/soleus tightness, as represented by ankle dorsiflexion with the knee extended, in children presenting with upper versus lower extremity complaints? (2) Is there a difference in gastroc/soleus tightness in children presenting with atraumatic versus traumatic lower extremity complaints?

Methods

We performed a cross-sectional study of 206 consecutive walking age children presenting to a county orthopedic clinic with new upper or lower extremity complaints. Passive ankle dorsiflexion was measured based on the lateral border of the foot versus the anterior lower leg with the knee fully extended and the foot in inversion.

Results

Average age was 10.0 ± 4.5 years. In the 117 patients presenting with upper extremity complaints, ankle dorsiflexion was 15.0° ± 11.6°. Of the lower extremity patients, 40 presented without trauma, with dorsiflexion of 11.8° ± 14.5°, while 49 presented with trauma, with dorsiflexion of 6.5° ± 12.0°. Multiple regression analysis found significantly decreased ankle dorsiflexion with increasing age and in the lower extremity trauma group. Twelve percent of upper extremity patients had 0° or less of dorsiflexion, as compared to 25% of lower extremity nontrauma patients and 41% of lower extremity trauma patients.

Conclusions

Patients presenting with lower extremity trauma had significantly more gastroc/soleus tightness in their well leg than patients presenting with upper extremity complaints. Gastroc/soleus tightness may present a simple target for reducing lower extremity injury rates in children.

http://ift.tt/25LfEDS

Erratum to: Clinical Results and Failure Mechanisms of a Nonmodular Constrained Knee Without Stem Extensions

http://ift.tt/1UyKt35

Further Research Is Needed to Define the Benefits of Non-operative Rotator Cuff Treatment

Abstract

Kukkonen et al.'s "Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up" compared the efficacy of physical therapy, acromioplasty, and rotator cuff repair for the treatment of degenerative supraspinatus tendon tears in patients aged over 55. This review examines the authors' findings and their implications on clinical practice. Kukkonen et al. reported no significant difference in clinical outcome among patients treated operatively versus non-operatively for degenerative rotator cuff tears. The authors concluded that non-operative treatment is an appropriate option for patients aged 55 or older. Rotator cuff treatment outcomes are closely linked to patient age, and while this level I study found no evidence of a benefit of surgical treatment, the age range in the studied demographic was perhaps too wide to draw generalizable conclusions. Furthermore, 2-year follow-up may be inadequate to fully demonstrate the differences in outcomes between these treatment options.

http://ift.tt/25LggcH

Erratum to: Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis

http://ift.tt/1UyK2FQ

All-Arthroscopic Modified Rotator Interval Slide for Massive Anterosuperior Cuff Tears Using the Subdeltoid Space: Surgical Technique and Early Results

Abstract

Background

Traditional intra-articular arthroscopic repair techniques for massive anterosuperior rotator cuff tears are technically demanding and necessitate sacrifice of the rotator interval to enable visualization. An interval slide allows mobilization through release of the medial aspect of the rotator interval, while leaving the lateral, bridging fibers intact.

Questions/Purposes

The purpose of this study was to report a novel, arthroscopic, open-equivalent technique using the subdeltoid space to address these tears along with early clinical results.

Methods

A retrospective review of prospectively collected data identified 11 consecutive arthroscopic massive anterosuperior rotator cuff repairs with a concomitant biceps tenodesis performed by the senior surgeon using a uniform technique. Outcome measures included range of motion, visual analog scale for pain, rotator cuff strength, American Shoulder and Elbow Surgeons (ASES) outcome scale, and Short Form-12 (SF-12).

Results

Average length of follow-up was 22.2 months (range 12.5–30.0 months). Visual analog scale (VAS) pain scores, ASES, and SF-12 all demonstrated significant improvement from pre-op to final follow-up from 6.2 to 0.9 (p < 0.05), 27.4 to 82.8 (p < 0.05), and 26.6 to 45.5 (p < 0.05) respectively. Average forward flexion improved from 145° to 160° (p < 0.05). Seven of the nine patients with a positive preoperative belly press had a negative test at final follow-up. Nine of the 10 patients with a positive lift off test demonstrated a negative test on final follow-up. Ninety-one percent reported they were satisfied with their outcome.

Conclusions

The described modified all-arthroscopic subdeltoid approach for anterosuperior cuff repairs enabled an open-equivalent interval slide technique that preserved the bridging lateral fibers of the rotator interval and demonstrated promising early-term clinical results.

http://ift.tt/1UyJLmv

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study

Abstract

Background

Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery.

Questions/Purposes

The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV).

Methods

After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon. A blinded observer measured alignment on digital radiographs. Operating room records were reviewed for procedure times. Two-tailed paired sample t tests and McNemar's test were used as appropriate. Alpha level was 0.05 for all tests.

Results

Preoperative cohort characteristics were not different. Mean postoperative long-leg mechanical alignment was within ±1° of neutral for both groups, although statistically different (p = 0.026). There were no other significant differences in coronal alignment. PSI exhibited significantly greater posterior tibial slope (4.4°) compared to NAV (2.7°) (p = 0.004); PSI resulted in significantly more outliers (>6°; p = 0.004). Procedure time for unilateral TKAs was lower for PSI (74.4 min) compared to that for NAV (80.6 min; p = 0.023).

Conclusion

NAV and PSI technologies provided excellent coronal plane alignment. NAV was better for sagittal tibial slope, while PSI procedure times were shorter for unilateral TKA. The impact of these technologies on patient-reported outcomes and TKA survivorship is controversial and should be the focus of future research.

http://ift.tt/1UyK3tk

Displaced Proximal Humerus Fractures: is a Sling as Good as a Plate?

Abstract

The treatment of displaced proximal humerus fractures is challenging and complex, as its success is predicated on multiple factors. While it is clear that a majority of proximal humerus fractures may be treated nonoperatively, it is less clear which patients benefit from surgical management. The PROFHER trial, a randomized controlled study, used patient-reported outcomes to compare surgical to nonsurgical management of displaced proximal humerus fractures. The purpose of this review is to highlight the strengths and weaknesses of the PROFHER trial and to assess the validity of its conclusion in the context of existing literature. The authors found no difference in the Oxford Shoulder Score (OSS) between the surgical and nonsurgical groups. Additionally, no difference was found between groups in any of the secondary outcomes, which included the Short-Form 12 (SF-12) health survey, surgical and fracture-related complications, additional surgery or therapy, inpatient medical complications, and mortality. They concluded that the recent increase in surgical management of proximal humerus fractures is perhaps unwarranted. While the randomization was successful and the pragmatic design may enable greater generalizability, this study possesses numerous flaws inherent in such an ambitious endeavor, including an inability to identify specific factors which explain the lack of superiority of surgical management. Despite its weaknesses, this study is a valuable datapoint which encourages surgeons to reexamine their surgical indications for this injury.

http://ift.tt/2cRvjtN

Treatment of Pre-Collapse Stages of Osteonecrosis of the Femoral Head: a Systematic Review of Randomized Control Trials

Abstract

Background

Treatment for osteonecrosis of the femoral head (ONFH) remains controversial. Current reviews include low-level evidence studies evaluating the treatment of both pre-collapse and collapse stages of the disease.

Questions/Purposes

The purpose of the current study is to systematically review the literature evaluating core decompression (CD) with bone marrow mesenchymal cells (BMMCs), CD alone, and bisphosphonate treatment in pre-collapse ONFH by focusing just on randomized clinical trials (RCTs) reporting functional and radiologic outcomes. We aim to determine if the literature provides evidence supporting any single approach.

Methods

Using PubMed and EMBASE databases, we reviewed the clinical evidence of treatments for pre-collapse ONFH following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve RCTs met the inclusion criteria.

Results

Results showed that CD with BMMCs has lower risk of femoral head collapse when compared to the CD alone excluding hips lost to follow-up (relative risk (RR) [95% CI]:0.25 [0.11, 0.60]; p = 0.002) and when assumed that hips lost to follow-up experienced collapse (RR [95% CI]: 0.11 [0.03, 0.47]; p = 0.003). Neither CD nor bisphosphonate treatments showed lower risk to femoral head collapse when compared to control treatments (p = 0.46 and 0.31, respectively)

Conclusion

Current literature shows that there is a lower risk of femoral head collapse in patients with ONFH treated with CD combined with BMMCs when compared to CD alone; however, there is no robust evidence to determine the effect on functional outcomes. More RCTs assessing new combination therapies and using standardized outcome measures are required.

http://ift.tt/1PK8QyW

ACL Damage and Deficiency is Associated with More Severe Preoperative Deformity, Lower Range of Motion at the Time of TKA

Abstract

Background

ACL status varies in the arthritic knee during TKA.

Questions/Purposes

The purpose of this study was to examine clinical features and intraoperative findings associated with stages of ACL degeneration.

Methods

Coronal deformity, ROM, intra-articular degenerative patterns, and ligament releases were assessed for 1656 knees during TKA. Common patterns of deformity and severity of degenerative change were assessed as a function of the severity of ACL deficiency.

Results

Of the 1656 knees assessed, 27% had a normal ACL, 55% exhibited damage, and 18% exhibited complete absence of the ACL. Increased coronal deformity and lower preoperative ROM was associated with ACL deficiency. Increased chondral and meniscal damage and more extensive osteophyte formation were also found. More extensive ligament releases were required in ACL-deficient knees.

Conclusions

The status of the ACL is predictive of the need for increased surgical deformity correction. A better understanding of ACL status is an important consideration during in choosing TKA as opposed to unicompartmental arthroplasty. The status of the ACL should be considered in planning for implant choice in TKA.

http://ift.tt/1RXILqf

Cervical Spondylodiscitis After Oxygen–Ozone Therapy for Treatment of a Cervical Disc Herniation: a Case Report and Review of the Literature

http://ift.tt/1UyJEY0

Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis

Abstract

Background

Rotational alignment of prosthetic components in total knee arthroplasty (TKA) is important to successful outcomes. Component malrotation is a known cause of revision and understanding normal rotational alignment may help recreate normal joint kinematics. To date, no large MRI study assessing femorotibial rotational alignment in nonarthritic knees has been undertaken.

Questions/Purposes

Is Insall's tibial axis a reliable rotational landmark against common femoral rotational axes in the nonarthritic patient population?

Methods

We reviewed 544 knee MRI scans performed for suspected soft tissue pathology and identified Insall's tibial rotational axis as well as the femoral clinical trans-epicondylar axis (TEAc), femoral surgical trans-epicondylar axis (TEAs), posterior condylar articular axis (PCA), and a modified Eckhoff's cylindrical axis. The perpendiculars of these axes were superimposed on Insall's tibial axis, and the angular differences were measured.

Results

Insall's axis was internally rotated to the TEAc by 1.4°, externally rotated to Eckhoff's cylindrical axis by 1.8°, externally rotated to the TEAs by 2.7°, and externally rotated to the PCA by 3.5°. The mean deviation from 0° (optimal alignment for each femoral axis) was significantly greater for the PCA relative to all other femoral axis.

Conclusion

Insall's axis is a reliable landmark for rotational positioning of the tibial component and may optimize femorotibial kinematics in fixed-bearing TKA.

http://ift.tt/25Lgtwh

Higher Acetabular Anteversion in Direct Anterior Total Hip Arthroplasty: A Retrospective Case-Control Study

Abstract

Background

Surgical approach is known as a risk factor that influences cup malposition while performing total hip arthroplasty (THA). However, no study has been conducted comparing cup positioning between the supine direct anterior (DA) and supine direct lateral (DL) THA approaches.

Questions/Purposes

(1) Is there a difference in acetabular cup positioning between supine DA and supine DL THA approaches?

(2) Are there differences in complications based on acetabular cup positioning between the two approaches?

Methods

From 2012 to 2014, 186 patients who underwent primary THAs using DA approach were matched with 186 patients using DL approach by body mass index, age, and gender. Cup anteversion and abduction angles were measured from standing anteroposterior pelvis radiographs by two blinded observers. The Lewinnek safe zone was used as the standard for cup positioning. Cup anteversion, abduction angles, and complications were recorded and compared.

Results

Cup anteversion was on average 3° higher in the DA approach compared to the DL approach. The abduction angle for the DA approach was equivalent to the DL approach both averaging 46° to 47°. There were more DA hips outside of the safe zone (10%) for anteversion than DL (3%) hips. There were no differences in complications between DA and DL approaches.

Conclusion

There is a tendency to antevert the acetabular cup when performing THAs using the DA approach, and one must be mindful of this when implanting the acetabular component.

http://ift.tt/2d8qyOO

Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database

Abstract

Purpose

Anterior abdominal wall hernias are among the most commonly encountered surgical disease. We sought to identify risk factors that are associated with 30-day postoperative mortality following emergent abdominal wall hernia repair using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Methods

A retrospective analysis of data from the ACS NSQIP from 2005 to 2010 was performed. Patients were selected using Current Procedural Terminology (CPT) and International Classification of Disease 9 Clinical Modification (ICD9) codes for the repair of inguinal, femoral, umbilical, epigastric, ventral, or incisional hernias that were incarcerated, obstructed, strangulated, or gangrenous. Only emergent cases occurring within two days of admission and admitted as inpatients were included. Univariate and multivariable analysis was performed. A risk score was also created.

Results

There were 4298 cases of emergent anterior abdominal wall hernia surgery. The most common was inguinal (25.3 %), followed by incisional (23.8 %), umbilical (23.5 %), ventral (12.1 %), femoral (8.8 %), and epigastric (6.5 %) hernias. Multivariable analysis demonstrated six statistically significant predictors of short-term mortality, including history of congestive heart failure (CHF) [odds ratio (OR) 8.24, 95 % confidence interval (CI) 4.05–16.75), age (OR 5.52, 95 % CI 3.48–8.77), history of peripheral vascular disease (PVD) (OR 4.98, 95 % CI 2.08–11.92), presence of ascites (OR 3.16, 95 % CI 1.64–6.08), preoperative blood urea nitrogen (OR 1.35, 95 % CI 1.22–1.49), and preoperative white blood cell count (OR 1.22, 95 % CI 1.02–1.45). The C-statistic for the risk model was 0.858.

Conclusion

We present a large study on short-term mortality following emergent anterior abdominal wall hernia repairs based on the ACS NSQIP with a derived risk model that demonstrates excellent discriminative ability.

http://ift.tt/2cx9dAg

Middle-term effects after timber harvesting with heavy machinery on a fine-textured forest soil

Abstract

Global competition in timber market leads to intensive mechanization of harvesting processes. Consequently heavy equipment is needed, which induces tremendous soil stresses, resulting in severe compaction and degradation of top- and subsoils, especially under moist conditions. Under these circumstances, it is still doubtful that natural processes are able to regenerate the impairments of a harmed forest soil. To test this hypothesis, a long-term field plot has been established in 2003 in Rhineland-Palatinate (Western Germany) on a silty clay loam Cambisol, combined with a measurement of the initial effects of mechanized timber logging on soil properties. Therefore, harvesting operations with a conventional heavy wood-loaded forwarder (Ponsse Caribou; total mass: 22 tons; maximum wheel load: 3.9 tons) were simulated to carry out two treatments with different driving intensities (1 pass, 5 passes). In 2013, analyses were reiterated (focusing on soil physical properties) to estimate the recovery status after a 10 year time span. The results reveal that the structural deformations associated with harmful effects on topsoil and subsoil, caused by wheeling, are still present. A slight regeneration can be considered for the low passing frequency, whereas the higher trafficked forest soil seems to be irreversibly damaged. It is to be expected that these adverse effects will never be fully recovered by natural regeneration.

http://ift.tt/2cwIoMI

Retention of the cellophane wall of a patency capsule by intestinal stenosis: a report of three cases

Abstract

Here we report three cases in which the cellophane wall of the PillCam^® patency capsule (tag-less PC), lacking a radio frequency identification tag, was retained. Case 1 A 33-year-old man with Crohn's disease (CD) who was administered the tag-less PC, subsequently underwent resection for perforated colon. We recovered the cellophane wall that could perforate the intestine and cause peritonitis. Case 2 A 34-year-old man with a recurring intestinal obstruction of unknown cause was administered the tag-less PC test. Computed tomography (CT) detected the cellophane wall at the oral side of an ileal stenosis. He was subsequently diagnosed with CD. Case 3 A 60-year-old woman with recurrent diarrhea was examined using CT, which revealed a thickened ileal wall. She was administered the tag-less PC test. CT detected the cellophane wall at the oral side of an ileal stenosis. Double-balloon enteroscopy revealed that the stenosis was caused by a malignant lymphoma, and the cellophane wall was simultaneously removed. Although there are numerous studies that report the usefulness and safety of tag-less PCs, few studies mention entrapment of the cellophane wall. Our present report indicated that tag-less PCs may cause such adverse effects and illustrated the usefulness of CT for detecting the trapped cellophane wall.

http://ift.tt/2cWhtoL

Genetic markers as therapeutic target in rheumatoid arthritis: A game changer in clinical therapy?

Abstract

Rheumatoid arthritis (RA) is a chronic, inflammatory, multi-systemic autoimmune disease unremitted by genetic and environmental factors. The factors are crucial but inadequate in the development of disease; however, these factors can be representative of potential therapeutic targets and response to clinical therapy. Insights into the contribution of genetic risk factors are currently in progress with studies querying the genetic variation, their role in gene expression of coding and non-coding genes and other mechanisms of disease. In this review, we describe the significance of genetic markers architecture of RA through genome-wide association studies and meta-analysis studies. Further, it also reveals the mechanism of disease pathogenesis investigated through the mutual findings of functional and genetic studies of individual RA-associated genes, which includes HLA-DRB1, HLA-DQB1, HLA-DPB1, PADI4, PTPN22, TRAF1-C5, STAT4 and C5orf30. However, the genetic background of RA remains to be clearly depicted. Prospective efforts of the post-genomic and functional genomic period can travel toward real possible assessment of the genetic effect on RA. The discovery of novel genes associated with the disease can be appropriate in identifying potential biomarkers, which could assist in early diagnosis and aggressive treatment.

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Current Safety Concerns with Human Papillomavirus Vaccine: A Cluster Analysis of Reports in VigiBase ®

Abstract

Introduction

A number of safety signals—complex regional pain syndrome (CRPS), postural orthostatic tachycardia syndrome (POTS), and chronic fatigue syndrome (CFS)—have emerged with human papillomavirus (HPV) vaccines, which share a similar pattern of symptomatology. Previous signal evaluations and epidemiological studies have largely relied on traditional methodologies and signals have been considered individually.

Objective

The aim of this study was to explore global reporting patterns for HPV vaccine for subgroups of reports with similar adverse event (AE) profiles.

Methods

All individual case safety reports (reports) for HPV vaccines in VigiBase^® until 1 January 2015 were identified. A statistical cluster analysis algorithm was used to identify natural groupings based on AE profiles in a data-driven exploratory analysis. Clinical assessment of the clusters was performed to identify clusters relevant to current safety concerns.

Results

Overall, 54 clusters containing at least five reports were identified. The four largest clusters included 71 % of the analysed HPV reports and described AEs included in the product label. Four smaller clusters were identified to include case reports relevant to ongoing safety concerns (total of 694 cases). In all four of these clusters, the most commonly reported AE terms were headache and dizziness and fatigue or syncope; three of these four AE terms were reported in >50 % of the reports included in the clusters. These clusters had a higher proportion of serious cases compared with HPV reports overall (44–89 % in the clusters compared with 24 %). Furthermore, only a minority of reports included in these clusters included AE terms of diagnoses to explain these symptoms. Using proportional reporting ratios, the combination of headache and dizziness with either fatigue or syncope was found to be more commonly reported in HPV vaccine reports compared with non-HPV vaccine reports for females aged 9–25 years. This disproportionality remained when results were stratified by age and when those countries reporting the signals of CRPS (Japan) and POTS (Denmark) were excluded.

Conclusions

Cluster analysis reveals additional reports of AEs following HPV vaccination that are serious in nature and describe symptoms that overlap those reported in cases from the recent safety signals (POTS, CRPS, and CFS), but which do not report explicit diagnoses. While the causal association between HPV vaccination and these AEs remains uncertain, more extensive analyses of spontaneous reports can better identify the relevant case series for thorough signal evaluation.

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Prevention of Medication Errors in Hospitalized Patients: The Japan Adverse Drug Events Study

Abstract

Introduction

The nature of medication errors (MEs) and the frequency of identified or intercepted MEs are not being scrutinized in daily practice in Japan.

Objectives

The aim of this study was to clarify the epidemiology of MEs and the risk factors for non-intercepted and unidentified MEs.

Methods

The Japan Adverse Drug Events (JADE) study was a prospective cohort study carried out at three tertiary-care teaching hospitals in Japan. Participants were consecutive patients (N = 3459) aged ≥15 years who were admitted to the study wards. MEs were identified by on-site reviews of all medical charts, self-reports, and prescription queries by pharmacists. Two independent physicians reviewed and classified all MEs and adverse drug events and determined the stages at which the MEs occurred and whether there was interception or identification of the MEs.

Results

A total of 514 MEs were observed among 433 patients. Sixty-four percent of MEs occurred at the ordering stage. Among these, 60 % were due to duplicate drug orders. Overall, 63 % and 45 % of MEs were not intercepted or identified during hospitalization, respectively. The independent risk factors for non-intercepted MEs were hospitalization in the surgical ward (odds ratio [OR] 2.94) and the intensive care unit (OR 3.57). MEs by resident physicians were more likely to be intercepted (OR 0.52 for non-intercepted MEs).

Conclusions

MEs frequently occurred and most at the ordering stage. Almost half of MEs were not intercepted or identified. Many MEs at the later stages were less likely to be intercepted and resulted in actual patient harm. Systems to improve the identification and interception of MEs should be implemented.

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Chronic Inguinal Pain After Kidney Transplantation, a Common and Underexposed Problem

Abstract

Background

The incidence and impact of chronic inguinal pain after kidney transplantation is not clearly established. A high incidence of pain after inguinal hernia repair, a comparable surgical procedure, suggests an underexposed problem.

Methods

Between 2011 and 2013, 403 consecutive patients who underwent kidney transplantation were invited to complete the Caroline Comfort Scale (CCS) and Visual Analog Scale (VAS) in order to assess the incidence of chronic inguinal pain and movement disabilities, complemented by questions regarding comorbidity during follow-up.

Results

The response rate was 58 % (n = 199) with a median follow-up of 22 months (IQR 12–30). In total, 90 patients (45 %) reported a CCS > 0 and 64 patients (32 %) experienced at least mild but bothersome complaints. Most inguinal complaints were reported during bending over and walking with a mean CCS score of 1.1 (SD ± 2.2) and 1.2 (SD ± 2.4), respectively. A high body mass index (BMI), delayed graft function, and the need for a second operation were associated with a higher CCS score on univariate analysis. Using multivariate analysis, only BMI (p = 0.02) was considered an independent risk factor for chronic inguinal pain.

Conclusions

The incidence of chronic inguinal pain is a common though underexposed complication after kidney transplantation. More awareness to prevent neuropathic pain seems indicated.

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Comment on: “Prevention of Esophageal Stricture After Endoscopic Submucosal Dissection: A Systematic Review”

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Surgical Informed Consent Revisited: Time to Revise the Routine?

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Factors predicting CPAP adherence in obstructive sleep apnea syndrome

Abstract

Purpose

Obstructive sleep apnea (OSA) is associated with a range of neurocognitive and cardiovascular complications, leading to a compromised quality of life. Continuous positive airway pressure (CPAP) is the gold standard therapeutic intervention for this disorder, yet patient compliance remains essential to its success. This study aimed at identifying the determinants of short-term and long-term CPAP adherence in a group of Lebanese patients.

Methods

This cross-sectional study, conducted at the Sleep Center of Hôtel-Dieu de France hospital in Lebanon, included patients diagnosed with OSA and treated with CPAP for at least one night between June 2008 and January 2015. Adherence was assessed based on patients' self-report.

Results

The study enrolled 138 patients. Adherence rate was 70.3 % at 6 months and around 50 % after 5 years. Cox models showed that use of nasal masks (HR 0.48, p = 0.048) and higher oxygen desaturation index at baseline (HR 0.98 p = 0.048) were associated with a better short-term CPAP adherence. Patients who bought their devices (HR 0.18, p < 0.001), those who were frequently contacted by the CPAP provider (HR 0.85, p 0.024), and those who reported improvement on treatment (HR 0.36, p < 0.001) were significantly more likely to remain adherent on the long term. Conversely, individuals on a diet plan tended to interrupt the treatment earlier (HR 4.85, p 0.039).

Conclusion

The present findings should be further explored in order to tailor interventions to the specific needs of different patient profiles and secure an improved CPAP adherence.

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Low-level laser therapy reduces the fatigue index in the ankle plantar flexors of healthy subjects

Abstract

Low-level laser therapy (LLLT) has been suggested as a resource capable of increasing resistance to fatigue and enhancing muscle performance through its metabolic and photochemical effects. This study evaluated the immediate effects of the application of LLLT on neuromuscular performance of the plantar ankle flexors in healthy subjects through a fatigue-induced protocol. This is a randomized controlled clinical trial, attended by 60 young and physically active volunteers of both genders. The subjects were randomly assigned into three groups, control, placebo, and laser, and underwent a preliminary evaluation of the isokinetic performance of plantar flexors and electromyographic activity of the soleus muscle to ensure homogeneity between groups. After the application of the respective intervention protocols, participants were induced to fatigue by performing 100 isokinetic concentric contractions of ankle plantar flexors at a speed of 90°/s. The dynamometric fatigue index (DFI) and median frequency were recorded during the fatigue protocol for comparison between groups. The group receiving the laser application showed significantly lower dynamometric fatigue index (p = 0.036) when compared to control and placebo groups. In relation to the median frequency during the fatigue test, there was a decrease in all groups, however with no differences between them. We suggest that LLLT being applied prior to exercise can reduce the fatigue index in the ankle plantar flexors of healthy subjects.

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Photobiomodulation therapy reduces apoptotic factors and increases glutathione levels in a neuropathic pain model

Abstract

Neuropathic pain (NP) is caused by damage to the nervous system due to reactive oxygen spices (ROS) increase, antioxidants reduction, ATP production imbalance, and induction of apoptosis. In this investigation, we applied low-level laser 660 nm (photobiomodulation therapy) as a new strategy to modulate pain. In order to study the effects of photobiomodulation therapy (660 nm) on NP, chronic constriction injury (CCI) model was selected. Low-level laser of 660 nm was used for 2 weeks. Thermal and mechanical hyperalgesia were measured before and after surgery on days 7 and 14, respectively. Paw withdrawal thresholds were also evaluated. Expression of p2x3, Bax, and bcl2 protein was measured by western blotting. The amount of glutathione (GSH) was measured in the spinal cord by continuous spectrophotometric rate determination method. The results are presented as mean ± SD. Statistical analysis of data was carried out using SPSS 21. CCI decreased the pain threshold, 2-week photobiomodulation therapy significantly increased mechanical and thermal threshold, decreased P2X3 expression (p < 0.001), and increased bcl2 expression (p < 0.01), but it was not effective on the Bax expression. We speculated that although photobiomodulation therapy increased ROS generation, it increased antioxidants such as GSH. Increase in bcl2 is another mitochondrial protection mechanism for cell survival and that pain relief and decrease in P2X3 expression confirm it.

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Increase in the nitric oxide release without changes in cell viability of macrophages after laser therapy with 660 and 808 nm lasers

Abstract

The aim of this study was to evaluate the influence of low-level laser therapy (LLLT) with different parameters and wavelengths on nitric oxide (NO) release and cell viability. Irradiation was performed with Ga-Al-As laser, continuous mode and wavelengths of 660 and 808 nm at different energy and power densities. For each wavelength, powers of 30, 50, and 100 mW and times of 10, 30, and 60 s were used. NO release was measured using Griess reaction, and cell viability was evaluated by mitochondrial reduction of bromide 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) to formazan. LLLT promoted statistically significant changes in NO release and MTT value only at the wavelength of 660 nm (p < 0.05). LLLT also promoted an increase in the NO release and cell viability when the energy densities 64 (p = 0.04) and 214 J/cm² (p = 0.012), respectively, were used. LLLT has a significant impact on NO release without affecting cell viability, but the significance of these findings in the inflammatory response needs to be further studied.

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Gelatin Binding Proteins in Reproductive Physiology

Abstract

In order to advance the assisted reproductive technologies used in animals and human beings, it is important to accumulate basic informations about underlying molecular mechanisms that shape the biological processes of reproduction. From within seminal plasma, proteins perform a wide variety of distinct functions that regulate major reproductive events such as fertilization. The ability of such proteins to bind and interact with different antagonistic ions and biomolecules such as polysaccharides, lipids, and other proteins present in the male and female reproductive tract define these capabilities. Over the last two decades, extensive work has been undertaken in an attempt to define the role of seminal plasma proteins, of which, Gelatin binding proteins (GBPs) represent a large family. GBPs comprise of known group of Bovine seminal plasma (BSP) protein family, matrix metallo proteinases (MMP 2 and MMP 9) and fibronectin, which have been widely studied. The presence of a type II repeat is a characteristic feature of GBPs, which is similar in structure to the fibronectin type II domain (fn2), which has ability to bind multiple ligands including gelatin, glycosaminoglycans, choline phospholipids, and lipoproteins. Two fn2 domains are present within the BSP protein family, while, three fn2 domains are found in gelatinases (MMP-2 and MMP9), and ELSPBP1 (Epididymosomes Transfer Epididymal Sperm Binding Protein 1) contains four long fn2 domains. For the most part BSP proteins are exclusively expressed in seminal vesicles although mBSPH1, mBSPH2 and hBSPH1 are all expressed in the epididymis. The expression of gelatinases has been demonstrated in several organs and tissues such as the prostate, testis, epididymis, ovary, human placenta, cervix and endometrial wall. This review intends to bring current updates on the role of GBPs in reproductive physiology to light, which may act as basis for future studies on GBPs.

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