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Σάββατο 9 Σεπτεμβρίου 2017

Comparative gene set enrichment analysis (GSEA) of the embryonic stem cell (ES) gene signatures in canine and human osteosarcoma

Abstract

Osteosarcoma (OSA) is one of the most common malignancies in humans (especially children) and dogs. Canine OSA is considered an ideal model of human OSA because OSA in both species shares comparable oncogenic properties—including histopathological features, tumor biology, therapeutic approaches, and molecular mechanisms. In this study, we sought to compare the expression profiles of embryonic stem cell (ES) gene signatures in canine and human OSA tissues and cell lines. The expression patterns of three major ES gene signatures (modules or gene sets)—namely Myc, Core, and PRC modules—were primarily analyzed through the gene set enrichment analysis method in three gene expression datasets. For verification of the primary results, an additional 13 ES gene sets which were categorized into four groups—namely NOS targets, ES expressed, Myc targets, and Polycomb targets—were evaluated in expression datasets. Additionally, the prognostic efficacy of the gene sets with a similar enrichment pattern in humans and dogs was evaluated using the Cox proportional hazard model. Our results revealed that there were similar ES module expression patterns in the human OSA tissue and cell line, where the MYC modules, Myc targets, ES exp1, and NOS target modules were upregulated and the Polycomb target modules were downregulated in both entities. The canine OSA cell line showed ES enrichment patterns more similar to the patterns in its human counterpart, where we were able to detect the upregulation of the MYC modules, Myc targets, ES exp1, and NOS target modules and the downregulation of the Polycomb targets, including H3K27 bound and PRC2 targets. However, the canine OSA tissues presented a similar enrichment pattern at a lower degree than the canine OSA cell line. Furthermore, survival analysis identified the NOS targets as a more robust prognostic gene signature that efficiently predicted survival time in the human and canine OSA samples.



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Know History, Know Self: Art Therapists' Responsibility to Dismantle White Supremacy

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Challenging Neoliberalism and Multicultural Love in Art Therapy

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A New Diagnostic Resource for Ceratitis capitata Strain Identification Based on QTL Mapping

The Mediterranean fruit fly Ceratitis capitata (Wiedemann) is a destructive agricultural pest and the subject of exclusion efforts in many countries. Suppression and eradication of invasive populations to prevent establishment is facilitated by the release of sterile males using the sterile insect technique (SIT). In active SIT release areas, it is critical to accurately discriminate between released sterile males and wild-caught individuals to be able to detect extremely rare invasive individuals in areas inundated with millions of sterile male flies. Current methods for discrimination exist, but are not always definitive, and a more reliable method is necessary. To address this, we took a novel approach and developed a genotyping assay that is linked to traits that facilitate male-only releases and are maintained in the SIT colonies, white pupae (wp) and temperature sensitive lethal (tsl). The development of this assay was achieved through linkage mapping and QTL mapping of wp in a mapping population derived from SIT colony flies and wild-type colony flies. This new method to discriminate released SIT flies from wild individuals was demonstrated across SIT colonies and wild individuals from across the geographic range of this species. In addition, linkage and QTL mapping of wp in C. capitata has larger impacts as it can serve as a foundational tool to identify the genetic basis of traits that facilitate the separation of male from female flies which can be used to develop SIT programs in related species.



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Caenorhabditis elegans HIF-1 Is Broadly Required for Survival in Hydrogen Sulfide

Hydrogen sulfide is common in the environment, and is also endogenously produced by animal cells. Although hydrogen sulfide is often toxic, exposure to low levels of hydrogen sulfide improves outcome in a variety of mammalian models of ischemia-reperfusion injury. In Caenorhabditis elegans, the initial transcriptional response to hydrogen sulfide depends on the hif-1 transcription factor, and hif-1 mutant animals die when exposed to hydrogen sulfide. In this study, we use rescue experiments to identify tissues in which hif-1 is required to survive exposure to hydrogen sulfide. We find that expression of hif-1 from the unc-14 promoter is sufficient to survive hydrogen sulfide. Although unc-14 is generally considered to be a pan-neuronal promoter, we show that it is active in many non-neuronal cells as well. Using other promoters, we show that pan-neuronal expression of hif-1 is not sufficient to survive exposure to hydrogen sulfide. Our data suggest that hif 1 is required in many different tissues to direct the essential response to hydrogen sulfide.



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Machine Learning Analysis Identifies Drosophila Grunge/Atrophin as an Important Learning and Memory Gene Required for Memory Retention and Social Learning

High throughput experiments are becoming increasingly common, and scientists must balance hypothesis driven experiments with genome wide data acquisition. We sought to predict novel genes involved in Drosophila learning and long-term memory from existing public high-throughput data. We performed an analysis using PILGRM, which analyzes public gene expression compendia using machine learning. We evaluated the top prediction alongside genes involved in learning and memory in IMP, an interface for functional relationship networks. We identified Grunge/Atrophin (Gug/Atro), a transcriptional repressor, histone deacetylase, as our top candidate. We find, through multiple, distinct assays, that Gug has an active role as a modulator of memory retention in the fly and its function is required in the adult mushroom body. Depletion of Gug specifically in neurons of the adult mushroom body, after cell division and neuronal development is complete, suggests that Gug function is important for memory retention through regulation of neuronal activity, and not by altering neurodevelopment. Our study provides a previously uncharacterized role for Gug as a possible regulator of neuronal plasticity at the interface of memory retention and memory extinction.



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Why do surgeons receive more complaints than their physician peers?

Background

Compared with other doctors, surgeons are at an increased risk of medicolegal events, including patient complaints and negligence claims. This retrospective study aimed to describe the frequency and nature of complaints involving surgeons compared with physicians.

Methods

We assembled a national data set of complaints about surgeons and physicians lodged with medical regulators in Australia from 2011 to 2016. We classified the complaints into 19 issues across four domains: treatment and procedures, other performance, professional conduct and health. We assessed differences in complaint risk using incidence rate ratios (IRRs). Finally, we used a multivariate model to identify predictors of complaints among surgeons.

Results

The rate of complaints was 2.3 times higher for surgeons than physicians (112 compared with 48 complaints per 1000 practice years, P < 0.001). Two-fifths (41%) of the higher rate of complaints among surgeons was attributable to issues other than treatments and procedures, including fees (IRR = 2.68), substance use (IRR = 2.10), communication (IRR = 1.98) and interpersonal behaviour (IRR = 1.92). Male surgeons were at a higher risk of complaints, as were specialists in orthopaedics, plastic surgery and neurosurgery.

Discussion

Surgeons are more than twice as likely to attract complaints as their physician peers. This elevated risk arises partly from involvement in surgical procedures and treatments, but also reflects wider concerns about interpersonal skills, professional ethics and substance use. Improved understanding of these patterns may assist efforts to reduce harm and support safe practise.



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Premature Growth Plate Closure in a Ballet Dancer en Pointe

imageAbstract: A 13-year-old ballet dancer who had been dancing en pointe (on the tips of the toes) since 10 years presented to the clinic with a shortened right second toe. She had no previous history of pain or trauma. She was diagnosed with premature growth arrest of the second metatarsal head physes resulting in a shortened metatarsal. This is the first reported case of premature growth arrest in a ballet dancer as a result of dancing en pointe.

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Radial Extracorporeal Shock Wave Therapy Is Effective and Safe in Chronic Distal Biceps Tendinopathy

imageObjective: To assess the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for chronic distal biceps tendinopathy (cDBT). Design: Case–control study (level of evidence, 3). Setting: SUN Orthopaedics and Sports Medicine. Patients: Patients with a diagnosis of cDBT were recruited between January 2010 and February 2015. Interventions: Patients received a single session of rESWT (2000 shock waves with energy flux density of 0.18 mJ/mm2) or other forms of nonoperative therapy. Main Outcome Measures: Patients completed the visual analog scale (VAS), the modified QuickDASH (MQD) score, and the Roles and Maudsley (RM) score over a 12-month period. Results: Forty-eight patients completed the final review at 12 months and were included in the study. Subjects ranged in age from 30 to 64 years. Mean pretreatment VAS scores for the rESWT and control groups were 8.3 and 8.5, respectively. Three and 12 months after inclusion in the study, the mean VAS scores for the rESWT and control groups were 3.4 and 5.6 (P

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Incidence of Iron Deficiency and Iron Deficient Anemia in Elite Runners and Triathletes

imageObjective: To assess the incidence of iron deficiency (ID), and iron deficient anemia (IDA) within a cohort of highly trained runners and triathletes, and to examine the association of oral iron supplementation history with serum ferritin (sFe) and hemoglobin (Hb) concentrations. Methods: A retrospective analysis of routine blood test data taken from 2009 to 2015 from (n = 38) elite level runners and triathletes between the ages of 21 to 36 years. Oral iron supplement intake was assessed through a questionnaire. Results: Triathletes (female, FT; male, MT) and runners (female, FR; male, MR) had higher incidence of at least 1 episode of ID (FT 60.0%, MT 37.5%, FR 55.6%, MR 31.3%) compared with values reported in the literature for endurance athletes (20%-50% females, 0%-17% males). Male triathletes and runners had a higher incidence of IDA than their female teammates (25% MT, 20% FT, 6.3% for MR, 0% FR), a finding which has previously not been reported. Hemoglobin concentrations were low, with incidence of Hb

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Effects of Femoral Rotational Taping on Dynamic Postural Stability in Female Patients With Patellofemoral Pain

imageObjective: To investigate the effects of femoral rotational taping on task performance, dynamic postural control, and pain during the Star Excursion Balance Test (SEBT) in patients with patellofemoral pain (PFP) compared to healthy controls. Design: Case–control study, pretest–posttest. Setting: Laboratory. Participants: Twenty-four female participants (16 with PFP, 8 controls). Interventions: Participants in both the PFP and control groups performed SEBT with no taping, sham taping, and femoral rotational taping. Main Outcome Measures: The maximum anterior excursion distance, 3-dimensional hip and knee kinematics of the stance leg, and pain score (VAS) during SEBT were recorded. The coefficients of variance (CV) of kinematic data gathered from electromagnetic sensors on pelvis and femur were calculated to represent segmental stability. Results: When performing the SEBT in the anterior direction, application of femoral rotational taping increased maximum excursion distance (65.57% vs 66.15% leg length, P = 0.027), decreased hip adduction excursion (47.6 vs 32.1 degrees, P = 0.010), and pain (3.34 vs 2.38, P = 0.040) in the PFP group. Femoral rotational taping also improved the medial-lateral (7.1 vs 4.6, P = 0.015) and proximal-distal stability (7.5 vs 4.5, P = 0.020) of the pelvis, and medial-lateral stability (7.2 vs 6.1, P = 0.009) of the femur. Conclusions: The results support the use of femoral rotational taping for improving dynamic postural control and reducing pain during SEBT. Clinical Relevance: Femoral rotational taping could be used in the management of young female patients with PFP.

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Early Screening for Cardiovascular Abnormalities With Preparticipation Echocardiography: Feasibility Study

imageObjective: The traditional history and physical (H&P) is a poor screening modality to identify athletes at risk for sudden cardiac death. Although better than H&P alone, electrocardiograms (ECG) have also been found to have high false-positive rates. A limited portable echocardiogram by a frontline physician (PEFP) performed during preparticipation physical examination (PPE) allows for direct measurements of the heart to more accurately identify athletes with structural abnormalities. Therefore, it is worthwhile to assess the feasibility of incorporating limited PEFP as part of PPEs. The aim of this study was to investigate the feasibility of incorporating limited screening PEFP into routine PPEs. Methods: Thirty-five Division I male collegiate athletes were prospectively enrolled in the study after informed consent was obtained. Each athlete underwent screening with H&P, ECG, and limited PEFP. The H&P was performed based on the 2007 twelve-element preparticipation cardiovascular screening guidelines from the American Heart Association. The ECGs were interpreted using the 2013 Seattle Criteria. The limited echocardiographic (ECHO) measurements were obtained in the parasternal long axis view. End-diastolic measurements were recorded for the left ventricular diameter (LVD), left ventricular posterior wall diameter (LVPWd), interventricular septal wall diameter (IVSWd), aortic root diameter, and ascending aorta. The length of time of each screening station was recorded and reported in seconds (sec) and compared by one-way repeated-measures of analysis of variance with pairwise Bonferroni correction. A priori alpha level was set as 0.05. Results: The length of time for screening was significantly shorter with limited PEFP (137.7 ± 40.4 seconds) compared with H&P (244.2 ± 80.0 seconds) and ECG (244.9 ± 85.6 seconds, P

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Assessment of the Postural Stability of Female and Male Athletes

imageObjective: Postural stability is often affected by sport-related injuries and subsequently evaluated during postinjury examinations. Intrinsic factors, however, may also affect postural control. We sought to compare the postural control of female and male athletes as measured simultaneously by (1) the modified balance error scoring system (mBESS) and (2) a video-force plate system. Design: Cross-sectional study. Setting: Sports injury prevention center. Participants: Pediatric, adolescent, and young adult athletes who performed mBESS during an injury prevention evaluation. Independent Variables: We compared the postural control of female and male athletes. We also accounted for independent variables associated with postural stability, including age, body mass index, and history of ankle injury, concussion, and migraine headache. Main Outcome Measures: Total errors committed during the mBESS and measurements derived from integrated kinematic and kinetic data obtained by a video-force plate system. Differences between males and females were tested using analysis of covariance. Results: Participants (n = 409) ranged in age from 10 to 29 years (mean = 14.6 ± 2.8); 60% were female. No significant differences on mBESS were detected between females and males; however, female athletes demonstrated significantly better postural stability on the video-force plate analysis during double-leg (P = 0.03, d = 0.28), single-leg (P

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Concussion in Ice Hockey: Current Gaps and Future Directions in an Objective Diagnosis

imageObjective: This review provides an update on sport-related concussion (SRC) in ice hockey and makes a case for changes in clinical concussion evaluation. Standard practice should require that concussions be objectively diagnosed and provide quantitative measures of the concussion injury that will serve as a platform for future evidence-based treatment. Methods: The literature was surveyed to address several concussion-related topics: research in ice hockey-related head trauma, current subjective diagnosis, promising components of an objective diagnosis, and current and potential treatments. Main Results: Sport-related head trauma has marked physiologic, pathologic, and psychological consequences for athletes. Although animal models have been used to simulate head trauma for pharmacologic testing, the current diagnosis and subsequent treatment in athletes still rely on an athlete's motivation to report or deny symptoms. Bias-free, objective diagnostic measures are needed to guide quantification of concussion severity and assessment of treatment effects. Most of the knowledge and management guidelines of concussion in ice hockey are generalizable to other contact sports. Conclusions: There is a need for an objective diagnosis of SRC that will quantify severity, establish a prognosis, and provide effective evidence-based treatment. Potential methods to improve concussion diagnosis by health care providers include a standardized concussion survey, the King–Devick test, a quantified electroencephalogram, and blood analysis for brain cell-specific biomarkers.

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Allergies and Exercise-Induced Bronchoconstriction in a Youth Academy and Reserve Professional Soccer Team

imageObjectives: A high prevalence of respiratory allergies and exercise-induced bronchoconstriction (EIB) has been reported among endurance athletes. This study was designed to analyze the frequency of sensitization to respiratory allergens and EIB in young soccer players. Design: Prospective cohort design. Setting: Youth academy and reserve professional soccer team during the seasons 2012 to 2013 and 2013 to 2014. Participants: Eighty-five soccer players (mean age: 20 ± 4 years) participated. Intervention: Players underwent skin prick tests (SPTs) during the seasons 2012 to 2013 and 2013 to 2014. Spirometry and a eucapnic voluntary hyperpnea test were performed on soccer players during the first season 2012 to 2013 (n = 51) to detect EIB. Two self-administered questionnaires on respiratory history and allergic symptoms (European Community Respiratory Health Survey and Allergy Questionnaire for Athletes) were also distributed during both seasons (n = 59). Main Outcome Measures: The number of positive SPTs, exercise-induced respiratory symptoms, presence of asthma, airway obstruction, and EIB. Results: Forty-nine percent of players were sensitized to at least one respiratory allergen, 33% reported an allergic disease, 1 player presented airway obstruction at rest, and 16% presented EIB. Factors predictive of EIB were self-reported exercise-induced symptoms and sensitization to at least 5 allergens. Conclusions: Questioning players about exercise-induced respiratory symptoms and allergies as well as spirometry at the time of the inclusion medical checkup would improve management of respiratory health of soccer players and would constitute inexpensive preliminary screening to select players requiring indirect bronchial provocation test or SPTs. Clinical relevance: This study showed that despite low frequencies, EIB and allergies are underdiagnosed and undertreated in young soccer players.

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In Response to: Prediction of Maximal Heart Rate in Children and Adolescents: Prediction Study in Cross-Sectional Design, Is It True?

No abstract available

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Analysis of Central and Peripheral Vision Reaction Times in Patients With Postconcussion Visual Dysfunction

imageObjective: To determine whether central and peripheral vision reaction times (PVRTs) are prolonged in patients with visual dysfunction after sustaining a concussion. Design: Comparison of Dynavision D2 central and PVRTs in patients with postconcussion visual dysfunction were compared with control data from a normative patient database. Concussion patients without visual dysfunction were not included in this study. Setting: National Collegiate Athletic Association Division 1 college training room and university based, academic health center. Participants: Patients were selected for inclusion based on diagnosis of new visual dysfunction as indicated either by physical examination of the team physician or by patient self-report of symptoms. Patients included college athletes, college students, and concussion patient's presenting to a university based, academic health center. Intervention: Measurement of central and PVRTs using a Dynavision D2 reaction time program were used as the dependent variables. Evaluations were conducted from 3 days to 11 months postconcussion, depending on the temporal development of visual symptoms after the concussion. No intervention was used. Main Outcome Measures: Average central and PVRTs for patients with postconcussion visual symptoms were compared with an asymptomatic control group with no history of concussion. Results: Both central and PVRTs were significantly prolonged in patients with postconcussion visual symptoms compared with patients with no history of concussion. Conclusions: Central and PVRTs are both prolonged in patients with postconcussion visual dysfunction with PVRT being disproportionately prolonged. The percent change from central to PVRT was also increased in patients with postconcussion visual dysfunction.

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A 12-Month Prospective Cohort Study of Symptoms of Common Mental Disorders Among European Professional Footballers

imageObjective: To determine the 12-month incidence and comorbidity of symptoms of common mental disorders (CMD) among European professional footballers and to explore the association of potential stressors with the health conditions under study among those European professional footballers. Design: Observational prospective cohort study with a follow-up period of 12 months. Participants: Male professional footballers from 5 European countries (n = 384 at baseline). Assessment of Risk Factors: Adverse life events, conflicts with trainer/coach, and career dissatisfaction were explored by using validated questionnaires. Main Outcome Measures: Symptoms of distress, anxiety/depression, sleep disturbance, and adverse alcohol use were assessed using validated questionnaires. Results: A total of 384 players (mean age of 27 years old; mean career duration of 8 years) were enrolled, of which 262 completed the follow-up period. The incidence of symptoms of CMD were 12% for distress, 37% for anxiety/depression, 19% for sleep disturbance, and 14% for adverse alcohol use. Over the follow-up period of 12 months, approximately 13% of the participants reported 2 symptoms, 5% three symptoms, and 3% four symptoms. Professional footballers reporting recent adverse life events, a conflict with trainer/coach, or career dissatisfaction were more likely to report symptoms of CMD, but statistically significant associations were not found. Conclusions: The 12-month incidence of symptoms of CMD among European professional footballers ranged from 12% for symptoms of distress to 37% for symptoms of anxiety/depression. A professional football team typically drawn from a squad of 25 players can expect symptoms of CMD to occur among at least 3 players in one season.

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Normative Values of the Sport Concussion Assessment Tool 3 (SCAT3) in High School Athletes

imageObjective: Establish sex, age, and concussion history–specific normative baseline sport concussion assessment tool 3 (SCAT3) values in adolescent athletes. Design: Prospective cohort. Setting: Seven Wisconsin high schools. Participants: Seven hundred fifty-eight high school athletes participating in 19 sports. Independent Variables: Sex, age, and concussion history. Main Outcome Measures: Sport Concussion Assessment Tool 3 (SCAT3): total number of symptoms; symptom severity; total Standardized Assessment of Concussion (SAC); and each SAC component (orientation, immediate memory, concentration, delayed recall); Balance Error Scoring System (BESS) total errors (BESS, floor and foam pad). Results: Males reported a higher total number of symptoms [median (interquartile range): 0 (0-2) vs 0 (0-1), P = 0.001] and severity of symptoms [0 (0-3) vs 0 (0-2), P = 0.001] and a lower mean (SD) total SAC [26.0 (2.3) vs 26.4 (2.0), P = 0.026], and orientation [5 (4-5) vs 5 (5-5), P = 0.021]. There was no difference in baseline scores between sex for immediate memory, concentration, delayed recall or BESS total errors. No differences were found for any test domain based on age. Previously, concussed athletes reported a higher total number of symptoms [1 (0-4) vs 0 (0-2), P = 0.001] and symptom severity [2 (0-5) vs 0 (0-2), P = 0.001]. BESS total scores did not differ by concussion history. Conclusion: This study represents the first published normative baseline SCAT3 values in high school athletes. Results varied by sex and history of previous concussion but not by age. The normative baseline values generated from this study will help clinicians better evaluate and interpret SCAT3 results of concussed adolescent athletes.

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Epidemiology of Snow Skiing– Versus Snowboarding-Related Concussions Presenting to the Emergency Department in the United States from 2010 to 2014

imageObjectives: To examine the trend of concussions in skiers and snowboarders from 2010 to 2014; and to quantify and compare the incidence of concussions injuries in skiers and snowboarders who presented to emergency departments in the United States in 2014. Design: Cross-sectional study of concussions in skiers and snowboarders who were evaluated in emergency departments in the United States. Main Outcomes Measure: Incidence of concussions. Results: The trend of the annual incidence of concussions for skiers and snowboarders remained stable from 2010 to 2014. An estimated total of 5388 skiing-related concussions and 5558 snowboarding-related concussions presented to emergency departments in the United States between January 1st, 2014, and December 31st, 2014. This represented an incidence of 16.9 concussions per 1 000 000 person-years for skiers and 17.4 concussions per 1 000 000 person-years for snowboarders. The incidence of concussions in the pediatric and young adult population of skiers was significantly higher than the incidence in the adult population. Similarly, the incidence of concussions in the pediatric and young adult population of snowboarders was significantly higher than the incidence in the adult population. The incidence of concussions was significantly higher in males compared with females in both skiing and snowboarding. Conclusions: The incidence of concussions from 2010 to 2014 plateaued in both skiers and snowboarders. Pediatric and young adult skiers and snowboarders had significantly higher incidences of concussion than the adult population. In contrast to the higher incidence of concussions in females in several sports including ice hockey, soccer, and basketball, the incidence of concussions was higher in males compared with females in both skiing and snowboarding.

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Patellar Tendinopathy and Potential Risk Factors: An International Database of Cases and Controls

imageObjectives: Numerous risk factors have been identified for patellar tendinopathy (PT), often in small population studies. The aim was to use an international online questionnaire to generate a large database and identify significant risk factors. Design: Case–control study. Setting: Private practice and sporting teams recruited from England, Spain, and Italy with the questionnaire available in all 3 languages (equivalence between online and self-administration shown previously). All data were anonymized and password protected. Participants: Eight hundred twenty-five data sets collected between January 2012 and May 2014. Assessment of Risk Factors: A total of 23.4% of participants had clinically diagnosed PT. A comparison between these participants and participants without PT was made. Main Outcome Measure: Association between the presence of PT and risk factors. Results: Eight risk factors were included in the analysis based on a purposeful selection procedure: sex, hours of training, hamstring flexibility, previous patellar tendon rupture, previous knee injury, current/previous back pain, family history, and age. Four were found to have statistically significant odds ratios: female sex [0.70, 95% confidence interval (CI), 0.49-1.00, P = 0.05], hours of training (>20 hours 8.94, 95% CI, 4.68-17.08, P

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Abdominal Aortic Dissection and Cold-Intolerance After Whole-Body Cryotherapy: A Case Report

imageAbstract: Whole-body cryotherapy (WBC) involves short exposures to air temperatures below −100°C and is purported to enhance recovery after exercise and accelerate rehabilitation after injury. It is generally considered a procedure with few side effects, but there are no large studies that have established its safety profile. We present the case of a 56-year-old patient who developed an abdominal aortic dissection after receiving 15 sessions of WBC. The patient had no other strong risk factors for aortic dissection. Exposure to cold temperatures, including WBC, has multiple hemodynamic effects, including increases in blood pressure, heart rate, and an adrenergic response. We suggest that these changes could act as a trigger for the onset of aortic dissections. This could be the first reported cardiovascular complication associated with WBC.

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Trunk Muscle Function Deficit in Youth Baseball Pitchers With Excessive Contralateral Trunk Tilt During Pitching

imageObjective: Pitching technique is one of many factors that affect injury risk. Exhibiting excessive contralateral trunk tilt (CLT) during pitching has been linked to higher ball speed but also to increased joint loading. Deficit in trunk muscle strength has been suggested as an underlying cause of this movement pattern. The purpose of the study was to compare trunk muscle strength between youth baseball pitchers with varying degree of CLT during pitching. Design: Cross-sectional study. Setting: Baseball practice fields. Participants: Twenty-eight youth baseball pitchers. Independent Variables: Pitching technique was captured using a video camera. Based on the 2-dimensional trunk contralateral flexion angle, pitchers were categorized into low (30 degrees) CLT groups. Main Outcome Measures: Maximum isometric strength tests for trunk flexion, extension, and bilateral rotation, measured using a dynamometer. Results: The pitchers with high CLT (n = 10) had longer pitching experience (P = 0.014), produced higher ball speed (P = 0.003) compared with the pitchers with moderate (n = 10) and low (n = 8) CLT, but demonstrated greater asymmetry in trunk rotation strength (relative weakness in rotation strength toward dominant side) compared with the pitchers with low CLT (P = 0.015). Conclusions: Excessive CLT may be a strategy that young pitchers learn to achieve higher ball velocity but also may be associated with imbalance between the oblique muscles on dominant and nondominant side, which may be acquired from repetitive pitching. Strengthening and emphasizing the use of dominant side oblique muscles may keep pitchers from leaning excessively during pitching and thus decrease joint loading.

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Bilateral Anterior Knee Pain in a High School Cross-Country Runner: An Atypical Etiology

imageAbstract: Anterior knee pain is a common complaint found in distance runners, and can be the end result of a variety of benign processes. A 17-year-old female cross-country runner presented to a sports medicine clinic with insidious onset of bilateral patellofemoral pain (PFP). In the workup of the significant quadriceps weakness discovered on her initial examination, a principal contributing cause of her PFP, she was found to have a form of spinal muscular atrophy, an uncommon neurodegenerative disease that typically requires multidisciplinary medical care. Her case provides a good example for clinicians to consider, at times, an in-depth assessment of the root causes of benign conditions.

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Return to Sports After Multiple Trauma: Which Factors Are Responsible?—Results From a 17-Year Follow-up

imageObjective: We hypothesize that the majority of polytraumatised patients are unable to maintain their preinjury level of sporting activity, and that musculoskeletal injuries are a major contributing factor. We assessed the impact of such injuries on sporting prowess, with a focus on isolating, particularly debilitating musculoskeletal trauma. Methods: We conducted a cohort study of 637 patients at a level 1 trauma centre, to assess the long-term outcome of severe trauma on return to sporting activities (RTS). Data collated on the multiply injured patient included preinjury physical activity, standardized outcome scores (SF-12, GOS, HASPOC), and clinical follow-up of at least 10 years duration. The return to preinjury sports participation was defined as a primary outcome parameter. Regression analyses were performed to identify specific injuries interfering with the RTS. Study Design: Prognostic study; Level of evidence, II. Results: Mean follow-up was 17 ± 5 years. We included 465 patients, including 207 athletic and 258 nonathletic individuals. Mean age at the time of injury was 26 ± 11.5 years and injury severity was comparable between the 2 cohorts. The deleterious effects on quality of life and the total duration of the rehabilitation process were also similar in athletes and nonathletes. Athletes were more likely to be unable to return to preinjury activities, or to return to a lower level of sporting prowess posttrauma. We identified knee injuries as the type of musculoskeletal trauma most likely to be career ending for the athlete (odds ratio 3.4, 95% confidence interval, 1.4-8.3; P = 0.008). Conclusion: Our results demonstrate an enforced shift from high-impact and team sports to low-impact activities after multiple trauma. Injuries of the lower extremities, especially around the knee joint, seem to have the highest lifechanging potential, preventing individuals from returning to their previous sporting activities.

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Reply

No abstract available

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Enhancement of Surfactin and Fengycin Production by Bacillus mojavensis A21: Application for Diesel Biodegradation

This work concerns the study of the enhancement of surfactin and fengycin production by B. mojavensis A21 and application of the produced product in diesel biodegradation. The influences of the culture medium and cells immobilization were studied. The highest lipopeptides production was achieved after 72 hours of incubation in a culture medium containing 30 g/L glucose as carbon source and a combination of yeast extract (1 g/L) and glutamic acid (5 g/L) as nitrogen sources with initial pH 7.0 at 30°C and 90% volumetric aeration. The study of primary metabolites production showed mainly the production of acetoin, with a maximum production after 24 h of strain growth. The use of immobilized cells seemed to be a promising method for improving lipopeptides productivity. In fact, the synthesis of both lipopeptides, mainly fengycin, was greatly enhanced by the immobilization of A21 cells. An increase of diesel degradation capacity of approximately 20, 27, and 40% in the presence of 0.5, 1, and 2 g/L of produced lipopeptides, respectively, was observed. Considering these properties, B. mojavensis A21 strain producing a lipopeptide mixture, containing both surfactin and fengycin, may be considered as a potential candidate for future use in bioremediation and crop protection.

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Histone 3.3 Mutations in Giant Cell Tumor and Giant Cell-Rich Sarcomas of Bone

Mutually exclusive histone 3.3 gene mutations have been recognized in chondroblastoma and giant cell tumor of bone (GCTB), which may be useful for differential diagnostic purposes in morphologically ambiguous cases. While over 90% of GCTB presents histone 3.3 variants exclusively in the H3F3A gene, chondroblastoma is mutated mainly in H3F3B. In this study we examined a series of giant cell rich primary bone tumors, aiming to evaluate the possible diagnostic role of histone 3.3 mutations in the differential diagnosis between GCTB and giant cell rich sarcomas.

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Angiomyomatous Hamartoma of Lymph Nodes, Revisited: Clinico-pathologic Study of 21 Cases, Emphasizing Its Distinction from Lymphangioleiomyomatosis of Lymph Nodes

Angiomyomatous hamartoma of lymph nodes (AMH-LN) is an uncommon benign proliferation of smooth muscle, blood vessels, collagenous stroma and adipocytes, most commonly affecting inguinal LN. A similar constellation of cell types constitutes various members of the perivascular epithelioid cell tumor (PEComa) family, including lymphangioleiomyomatosis (LAM) which can involve LN in women. Because some LN-LAM patients have tuberous sclerosis complex (TSC) and/or other PEComa family lesions, it is clinically relevant to distinguish LN-LAM from AMH-LN.

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Small bowel stenosis: a manifestation of chronic graft-versus-host disease in children?

Digestive graft versus host disease (GVHD) is a frequent complication after bone marrow transplantation (BMT), but small bowel obstruction is an extremely rare event. We present herein the first pediatric series of 4 cases of small bowel obstruction after BMT with detailed gross, histological data and their genetic status of the NOD2 gene. All patients had a history of severe acute GVHD treated by immunosuppressive agents and/or infliximab (in 3 cases). Acute or progressively worsening abdominal pain accompanied by small bowel occlusion occurred 5–16months after graft and CT-scan revealed multiple small intestinal stenosis.

http://ift.tt/2wRWJIY

Expression of YES-associated protein (YAP) and its clinical significance in breast cancer tissues

The transcriptional co-activator YES-associated protein (YAP) has been reported to act as both an oncogene and tumor suppressor in breast cancers. In this study, we evaluated YAP expression immunohistochemically in 324 breast cancer tissues and correlated the expression with clinicopathological findings and patient survival data. Additionally, we reviewed the literature to clarify the role of YAP in breast cancer. We detected YAP, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth receptor-2 (HER2) expression and a Ki67 labeling index >20% in 53.4%, 49.0%, 45.0%, 28.3%, and 57.4% of invasive ductal carcinoma (IDC) tissues, respectively.

http://ift.tt/2xTI4we

Characterization of genome-wide copy number aberrations in colonic mixed adenoneuroendocrine carcinoma and neuroendocrine carcinoma reveals recurrent amplification of PTGER4 and MYC genes

Colonic Mixed adenoneuroendocrine Carcinoma (MANEC) is an aggressive neoplasm with worse prognosis compared to adenocarcinoma. To gain a better understanding of the molecular features of colonic MANEC, we characterized the genome-wide copy number aberrations (CNA) of 14 MANECs and 5 neuroendocrine carcinomas using the OncoScan FFPE assay. Compared to 269 colonic adenocarcinomas, 19 of 42 chromosomal arms of MANEC exhibited a similar frequency of major aberrant events as adenocarcinomas, and 13 chromosomal arms exhibited a higher frequency of copy number gains.

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Epithelial-mesenchymal transition of tumor budding in colorectal cancer: the mystery of CD44-positive stromal cells

(See Fig..)

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Cognitive Function of Artemisia argyi H. Fermented by Monascus purpureus under TMT-Induced Learning and Memory Deficits in ICR Mice

The cognitive effect of Artemisia argyi H. under liquid-state fermentation by Monascus purpureus (AAFM), which has cellular antioxidant activity and neuronal cell viability, on trimethyltin- (TMT-) induced learning and memory impairment in Institute of Cancer Research (ICR) mice was confirmed. Tests were conducted to determine the neuroprotective effects against H2O2-induced oxidative stress, and the results showed that AAFM has protective effects through the repression of mitochondrial injury and cellular membrane damage against H2O2-induced neurotoxicity. In animal experiments, such as the Y-maze, passive avoidance, and Morris water maze tests, AAFM also showed excellent ameliorating effects on TMT-induced cognitive dysfunction. After behavioral tests, brain tissues were extracted to assess damage to brain tissue. According to the experimental results, AAFM improved the cholinergic system by upregulating acetylcholine (ACh) contents and inhibiting acetylcholinesterase (AChE) activity. AAFM effectively improved the decline of the superoxide dismutase (SOD) level and the increase of the oxidized glutathione (GSH) ratio and lipid peroxidation (malondialdehyde (MDA) production) caused by TMT-induced oxidative stress. The occurrence of mitochondrial dysfunction and apoptosis was also decreased compared with the TMT group. Finally, quinic acid derivatives were identified as the major phenolic compounds in AAFM using ultra-performance liquid chromatography quadrupole-time-of-flight (UPLC-Q-TOF) MS analysis.

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Atezolizumab in platinum-treated locally advanced or metastatic urothelial carcinoma: post-progression outcomes from the phase II IMvigor210 study

Abstract
BackgroundConventional criteria for tumor progression may not fully reflect the clinical benefit of immunotherapy or appropriately guide treatment decisions. The phase II IMvigor210 study demonstrated the efficacy and safety of atezolizumab, a programmed death-ligand 1–directed antibody, in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (mUC). Patients could continue atezolizumab beyond Response Evaluation Criteria In Solid Tumors (RECIST) v1.1 progression at the investigator's discretion: this analysis assessed post-progression outcomes in these patients.Patients and methodsPatients were treated with atezolizumab 1200 mg intravenously every 3 weeks until loss of clinical benefit. Efficacy and safety outcomes in patients who experienced RECIST v1.1 progression and did, or did not, continue atezolizumab were analyzed descriptively.Results220 patients who experienced progression from the overall cohort (n = 310) were analyzed: 137 continued atezolizumab for ≥ 1 dose after progression, 19 received other systemic therapy, and 64 received no further systemic therapy. Compared with those who discontinued, patients continuing atezolizumab beyond progression were more likely to have had a baseline Eastern Cooperative Oncology Group performance status of 0 (43.1% vs 31.3%), less likely to have had baseline liver metastases (27.0% vs 41.0%), and more likely to have had an initial response to atezolizumab (responses in 11.7% vs 1.2%). Five patients (3.6%) continuing atezolizumab after progression had subsequent responses compared with baseline measurements. Median post-progression overall survival was 8.6 months in patients continuing atezolizumab, 6.8 months in those receiving another treatment, and 1.2 months in those receiving no further treatment. Atezolizumab exposure–adjusted adverse event frequencies were generally similar before and following progression.ConclusionIn this single-arm study, patients who continued atezolizumab beyond RECIST v1.1 progression derived prolonged clinical benefit without additional safety signals. Identification of patients most likely to benefit from atezolizumab beyond progression remains an important challenge in the management of mUC.ClinicalTrials.gov IDNCT02108652.

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Detection of Arteriovenous Malformations on the Underside of the Duodenal Papilla



http://ift.tt/2jcTWae

Definition, Pathogenesis and Management of that cursed Dyspepsia

Dyspepsia is an umbrella term used to encompass a number of symptoms thought to originate from the upper gastrointestinal tract. These symptoms are relatively non-specific; not surprisingly, therefore, a myriad of conditions may present with any one or a combination of these symptoms. Therein lies the clinician's first challenge: detecting the minority who may have a potentially life-threatening disorder, such as gastric cancer, from a population whose symptoms are, for the most part, considered functional in origin.

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Obesity, but not physical activity, is associated with higher prevalence of asymptomatic diverticulosis



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Successful Treatment of a Patient With Gastric Mucosa-associated Lymphoma



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Large Meckel’s Diverticulum and Dilated Adjacent Small Intestine Presenting with Intestinal Obstruction



http://ift.tt/2jen4xL

P 16 The implementation of Near-Infrared-Spectroscopy (NIRS) in sports science – a verification of suitability using the compound movement squat

Near - Infrared Spectroscopy (NIRS) serves as a promising tool to examine cortical activity in a sports-scientific context. The associated feasibility of said method remains to be validated as exercise - induced confounders such as increases in extracerebral blood flow have been postulated (Tachtsidis and Scholkmann, 2016). Additionally, the relationship between force and cortical activity is yet to be investigated in compound movements. Both parameters show a linear relationship in isolated movements (Shibuya et al., 2014) yet it remains unclear whether this relationship applies to compound movements.

http://ift.tt/2xWJtTy

P 18 Prefrontal and motor cortex transcranially evoked potentials (TEP) in children and adolescents

Potentials evoked by transcranial magnetic stimulation (TEP) differ depending on the cortical areas where TMS has been applied. Moreover, TEP underly a marked development during childhood and adolescence.

http://ift.tt/2xluTbb

P 15 Voice-identity processing deficits are induced by lesions in the temporal and inferior parietal lobe

Human voice recognition is an essential skill for social interactions. The mechanisms that the human brain uses for voice recognition are to-date unknown. According to studies in patients with brain lesions, voice recognition critically involves the bilateral temporal lobe and the right inferior parietal lobe. In contrast, functional magnetic resonance imaging (fMRI) studies suggest that primarily the right temporal lobe contributes to voice recognition. In order to systematically investigate brain regions required for voice recognition, we conducted a voxel-based lesion symptom mapping (VLSM) study.

http://ift.tt/2xWJtmw

P 17 Neural signatures of post-perceptual attention and selective working memory encoding

Post-perceptual cues can enhance visual short term memory encoding even after the offset of the visual stimulus. However, both the mechanisms by which the sensory stimulus characteristics are buffered as well as the mechanisms by which post-perceptual selective attention enhances short term memory encoding remain unclear.We analyzed late post-perceptual event-related potentials (ERP) in visual change detection tasks (100ms stimulus duration) by high-resolution ERP analysis to elucidate these mechanisms.

http://ift.tt/2xnbDdo

Lack of Apparent Survival Benefit from the Use of Androgen Deprivation Therapy in Patients with High-Risk Prostate Cancer Treated with Combined External Beam Radiotherapy and Brachytherapy

The benefits of androgen deprivation therapy (ADT) with combined external beam radiotherapy and brachytherapy for patients with high-risk prostate cancer are unknown. Using a large, national cohort of high-risk patients, we found that ADT was associated with an improvement in overall survival for patients managed with EBRT alone but not for patients treated with combined modality radiotherapy, suggesting that ADT may not improve overall survival for select high-risk patients treated with combined modality radiotherapy.

http://ift.tt/2wPWrEU

Heat resistance of viable but non-culturable Escherichia coli cells determined by differential scanning calorimetry

Abstract
Several reports have suggested that the viable but non-culturable (VBNC) state is a resistant form of bacterial cells that allows them to remain in a dormant form in the environment. Nevertheless, studies on the resistance of VBNC bacterial cells to ecological factors are limited, mainly because techniques that allow this type of evaluation are lacking. Differential scanning calorimetry (DSC) has been used to study the thermal resistance of culturable bacteria but has never been used to study VBNC cells. In this work, the heat resistance of E. coli cells in the VBNC state was studied using the DSC technique. The VBNC state was induced in E. coli ATCC 25922 by suspending bacterial cells in artificial sea water (ASW), followed by storage at 3 ± 2°C for 110 days. Periodically, the behaviour of E. coli cells was monitored by plate counts, direct viable counts and DSC. The entire bacterial population entered the VBNC state after 110 days of storage. The results obtained with DSC suggest that the VBNC state does not confer thermal resistance to E. coli cells in the temperature range analysed here.

http://ift.tt/2xdgU6E

An Increasingly Complex Relationship Between Salt and Water

One hundred fifty years ago this year, physiologist Moritz Schiff proclaimed from a pulpit at the University of Florence that the sensation of thirst, rather than being secondary to dryness of the throat, is a "general sensation, stemming from lack of water in the blood." Expounding, he declared "the dryness of the throat that normally accompanies [thirst] is merely a secondary phenomenon, analogous to the weight of the eyelids that accompanies sleepiness."1 Fifty years later, Erich Leschke would demonstrate that intravenous infusion of hypertonic saline in humans provoked a "sudden and violent thirst."2 Subsequent studies revealed that increased dietary salt stimulates fluid consumption in experimental animals, and the role of increased oral fluid intake in mitigating dietary salt–induced hypertonicity while expanding extracellular fluid volume became established renal canon.

http://ift.tt/2xlZ7v1

Baclofen Toxicity in Kidney Disease

Baclofen, a commonly prescribed muscle relaxant, is primarily excreted via the kidneys; toxicity is a potentially serious adverse outcome in patients with decreased kidney function. We describe a patient with end-stage kidney disease receiving hemodialysis who developed neurotoxicity and hemodynamic instability after receiving baclofen for muscle spasms. In this case, prompt recognition of baclofen toxicity and urgent hemodialysis were effective in reversing this toxicity. This case is used to examine the pharmacokinetics and pathophysiology of baclofen toxicity and discuss appropriate diagnosis and management of baclofen toxicity.

http://ift.tt/2gSIhZR

Factor Xa inhibition by rivaroxaban in the trough steady state can significantly reduce thrombin generation

Summary

Aims

The aim of the present study was to demonstrate evidence of reduced thrombin generation at the trough plasma rivaroxaban concentration.

Methods

A single-centre, prospective, non-randomised, drug intervention, self-controlled study was conducted in 51 anticoagulation therapy-naïve patients with non-valvular atrial fibrillation. Plasma rivaroxaban concentration was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS) and anti-factor Xa chromogenic assay. Partial thrombin time (PT), protein-C activity and protein-S antigen, prothrombin fragment 1+2 (F1+2), D-dimer, thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasminogen activator inhibitor-1 (PAI-1) and tissue factor pathway inhibitor (TFPI) were also measured at the trough steady state after 4 weeks of rivaroxaban treatment and compared with baseline.

Results

Plasma concentrations obtained by LC-MS/MS and anti-Xa assay were correlated (r = 0.841, P < 0.001). The mean concentration of rivaroxaban at the trough steady state was 23.6 ng/ml, at which F1+2, TAT and D-dimer had decreased from the baseline values (P < 0.0001, P = 0.029 and P < 0.005, respectively). PT was prolonged (+0.59 seconds, P < 0.0001). TFPI increased from baseline to the trough steady state in the first to third quartile groups (+0.79 pg/ml, P = 0.048). In contrast, PAI-1, protein-C activity, protein-S antigen and TM remained within the normal range at the trough steady state.

Conclusions

Residual plasma rivaroxaban at the trough steady state may explain the antithrombin effect of rivaroxaban in patients with non-valvular atrial fibrillation.



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Pharmacokinetics of multiple doses of Co-Crystal of Tramadol-Celecoxib: findings from a 4-way randomized open-label Phase I clinical trial

Summary

Aim

We compared the pharmacokinetic (PK) profiles of Co-Crystal of Tramadol-Celecoxib (CTC) versus each reference product (alone and in open combination) after single (first dose) and multiple dosing.

Methods

Healthy adults aged 18–50 years received, under fasted conditions, 15 twice-daily doses of the following treatments (separated by ≥14-day wash-out): 200 mg immediate-release (IR) CTC (equivalent to 88 mg tramadol and 112 mg celecoxib; Treatment-1); 100 mg IR tramadol (Treatment-2), 100 mg celecoxib (Treatment-3); and 100 mg IR tramadol and 100 mg celecoxib (Treatment-4). Treatment sequence was assigned by computer-generated randomization. PK parameters were calculated using non-compartmental analysis. Parameters for CTC were adjusted according to reference product dose.

Results

Thirty subjects (20 males, mean age 35 years) were included. Multiple-dose tramadol PK parameters for Treatments-1, -2 and -4, respectively, were 551, 632 and 661 ng ml-1 (mean maximum plasma concentration [Cmax]); 4796, 4990 and 5284 ng h ml-1 (area under the plasma concentration–time curve over the dosing interval at steady state); and 3.0, 2.0 and 2.0 h (median time to Cmax at steady state). For Treatments-1, -3 and -4, multiple-dose celecoxib PK parameters were 445, 536 and 396 ng ml-1; 2803, 3366 and 2897 ng h ml-1; and 2.0, 2.0 and 3.0 h. Single-dose findings were consistent with multiple-dose data. Types of adverse events were consistent with known reference product safety profiles.

Conclusion

After single (first dose) and multiple dosing, PK parameters of each active pharmaceutical ingredient in CTC were modified by co-crystallization compared with reference products alone or in open combination.



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Impact of non-adherence on the safety and efficacy of uric acid lowering therapies in the treatment of gout

Summary

Aims

Dual-urate lowering therapy (ULT) with xanthine oxidase inhibitor and uricosuric medications is a treatment option for severe gout. Uricosurics can cause hyperuricosuria, a risk factor for nephrolithiasis and acute uric acid nephropathy. The aims of this study were to simulate the relation between suboptimal drug adherence and efficacy, and to quantify the risk of hyperuricosuria in gout patients receiving mono and dual-ULTs.

Methods

The impact of poor medication adherence was studied using 2-compartment PK models based on published evidence and a semi-mechanistic, 4-compartment pharmacodynamic (PD) model. The PKPD model was used to simulate mono and dual-ULT in gout patients with either under-excretion (lowered clearance) or overproduction of uric acid, with suboptimal adherence modelled as either a single drug holiday of increasing duration or doses taken at random.

Results

Simulation results showed a surge in urinary uric acid occurring when dosing is restarted following missed doses. For under-excreters taking a 20 day drug holiday, the addition of 200 mg (or 400 mg) lesinurad to 80 mg febuxostat increased the percentage of patients experiencing hyperuricosuria form 0% to 1.4% (or 3.1%). In overproducers, restarting ULTs following drug holidays of more than 5 days leads to over 60% of patients experiencing hyperuricosuria.

Conclusions

Sub-optimal medication adherence may compromise safety and efficacy of mono and dual-ULTs, especially in patients with gout resulting from an overproduction of uric acid. Clinicians and pharmacists should consider counselling patients with respect to the risks associated with partial adherence, and offer interventions to improve adherence or tailor treatments, where appropriate.



http://ift.tt/2vWjPRR

Study of Protein-protein Interactions in Autophagy Research

Presented here are two antibody-based protein-protein interaction research techniques: immunofluorescence and immunoprecipitation. These techniques are suitable for studying physical interactions between proteins for the discovery of novel components of cellular signaling pathways and for understanding protein dynamics.

http://ift.tt/2faRwVe

Multidimensional phenotyping of breast cancer cell lines to guide preclinical research

Abstract

Purpose

Cell lines are extremely useful tools in breast cancer research. Their key benefits include a high degree of control over experimental variables and reproducibility. However, the advantages must be balanced against the limitations of modelling such a complex disease in vitro. Informed selection of cell line(s) for a given experiment now requires essential knowledge about molecular and phenotypic context in the culture dish.

Methods

We performed multidimensional profiling of 36 widely used breast cancer cell lines that were cultured under standardised conditions. Flow cytometry and digital immunohistochemistry were used to compare the expression of 14 classical breast cancer biomarkers related to intrinsic molecular profiles and differentiation states: EpCAM, CD24, CD49f, CD44, ER, AR, HER2, EGFR, E-cadherin, p53, vimentin, and cytokeratins 5, 8/18 and 19.

Results

This cell-by-cell analysis revealed striking heterogeneity within cultures of individual lines that would be otherwise obscured by analysing cell homogenates, particularly amongst the triple-negative lines. High levels of p53 protein, but not RNA, were associated with somatic mutations (p = 0.008). We also identified new subgroups using the nanoString PanCancer Pathways panel (730 transcripts representing 13 canonical cancer pathways). Unsupervised clustering identified five groups: luminal/HER2, immortalised ('normal'), claudin-low and two basal clusters, distinguished mostly by baseline expression of TGF-beta and PI3-kinase pathway genes.

Conclusion

These features are compared with other published genotype and phenotype information in a user-friendly reference table to help guide selection of the most appropriate models for in vitro and in vivo studies, and as a framework for classifying new patient-derived cancer cell lines and xenografts.



http://ift.tt/2vWRydW

Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners

Abstract

Immersive learning environments that use virtual simulation technology are increasingly relevant as medical learners train in an environment of restricted clinical training hours and a heightened focus on patient safety. We conducted a consensus process with a breakout group of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes." This group examined the current uses of virtual simulation in training and assessment, including limitations and challenges in implementing virtual simulation into medical education curricula. We discuss the role of virtual environments in formative and summative assessment. Finally, we offer recommended areas of focus for future research examining virtual simulation technology for assessment, including high stakes assessment in medical education. Specifically, we discuss needs for determination of areas of focus for virtual simulation training and assessment, development and exploration of virtual platforms, automated feedback within such platforms, and evaluation of effectiveness and validity of virtual simulation education.

This article is protected by copyright. All rights reserved.



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Glucocorticoid treatment earlier in childhood and adolescence show dose-response associations with diurnal cortisol levels

Abstract

Heightened levels of glucocorticoids in children and adolescents have previously been linked to prolonged changes in the diurnal regulation of the stress-hormone cortisol, a glucocorticoid regulated by the hypothalamic-pituitary-adrenal-axis (HPA-axis). To address this question, we examined the salivary cortisol awakening response (CAR) and daily cortisol output in 36 children and adolescents (25 girls/11 boys) aged 7–16 years previously treated with glucocorticoids for nephrotic syndrome or rheumatic disorder and 36 healthy controls. Patients and controls did not significantly differ in the CAR or diurnal cortisol output; however, sex-dependent group differences were observed. Specifically, female patients had a higher CAR relative to female controls, while male patients had higher daily cortisol levels compared to male controls. Notably, CAR in female patients and daily cortisol levels in male patients showed a positive linear relationship with the mean daily glucocorticoid doses administered during treatment. The observed dose-response associations suggest that glucocorticoid therapy during childhood and adolescence might trigger long-term changes in HPA-axis regulation, which may differ for males and females.



http://ift.tt/2wgLrfu

Maternal salivary testosterone in pregnancy and fetal neuromaturation

Abstract

Testosterone exposure during pregnancy has been hypothesized as a mechanism for sex differences in brain and behavioral development observed in the postnatal period. The current study documents the natural history of maternal salivary testosterone from 18 weeks gestation of pregnancy to 6 months postpartum, and investigates associations with fetal heart rate, motor activity, and their integration. Findings indicate maternal salivary testosterone increases with advancing gestation though no differences by fetal sex were detected. High intra-individual stability in prenatal testosterone levels extend into the postnatal period, particularly for pregnancies with male fetuses. With respect to fetal development, by 36 weeks gestation higher maternal prenatal salivary testosterone was significantly associated with faster fetal heart rate and less optimal somatic-cardiac integration. Measurement of testosterone in saliva is a useful tool for repeated-measures studies of hormonal concomitants of pregnancy. Moreover, higher maternal testosterone levels are associated with modest interference to fetal neurobehavioral development.



http://ift.tt/2wQb7mI

Increased sign-tracking behavior in adolescent rats

Abstract

An autoshaping procedure was used to test the notion that conditioned stimuli (CSs) gain greater incentive salience during adolescence than young adulthood under conditions of social isolation rearing and food restriction. Rats were single-housed and placed on food restriction during 10 daily training sessions in which a lever (CS+) was presented then followed immediately by a food unconditioned stimulus (US). A second lever (CS) was presented on intermixed trials and was not reinforced. Despite the fact that food delivery was not contingent on the rats' behavior, all rats exhibited behaviors directed towards the lever (i.e., sign-tracking). In the adolescent group, the rate of lever pressing and the percentage of trials with a lever press were higher than in young adults. Initially, group differences were observed when rats were retrained when the adolescents had reached young adulthood. These findings support the hypothesis that cues that come to predict reward become imbued with excessive motivational value in adolescents, perhaps contributing to the hyper-responsiveness to reward-related stimuli typically observed during this period of development.



http://ift.tt/2wgDAi9

Toddler hand preference trajectories predict 3-year language outcome

Abstract

A growing body of work suggests that early motor experience affects development in unexpected domains. In the current study, children's hand preference for role-differentiated bimanual manipulation (RDBM) was measured at monthly intervals from 18 to 24 months of age (N = 90). At 3 years of age, children's language ability was assessed using the Preschool Language Scales 5th edition (PLS™-5). Three distinct RDBM hand preference trajectories were identified using latent class growth analysis: (1) children with a left hand preference but a moderate amount of right hand use; (2) children with a right hand preference but a moderate amount of left hand use; and (3) children with a right hand preference and only a mild amount of left hand use. Stability over time within all three trajectories indicated that children did not change hand use patterns from 18 to 24 months. Children with the greatest amount of preferred (i.e., right) hand use demonstrated higher expressive language scores compared to children in both trajectories with moderate levels of non-preferred hand use. Children with the greatest amount of right hand use also had higher scores for receptive language compared to children with a right hand preference but moderate left hand use. Results support that consistency in handedness as measured by the amount of preferred hand use is related to distal language outcomes in development.



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Phenotypic variation of an ALK-positive large cell neuroendocrine lung carcinoma with carcinoid morphology during treatment with ALK-inhibitors

Abstract

Rearrangement of the ALK gene and overexpression of ALK seems to occur very rarely in neuroendocrine lung tumors, with only 3 cases of atypical carcinoid and 1 large cell neuroendocrine carcinoma (LCNEC) reported in detail until now.1,2,3,4 Here, we report a case of an ALK-positive neuroendocrine lung tumor showing a variable phenotype during the course of treatment.

A pulmonary lesion with mediastinal adenopathies was detected in a 69-year-old, non-smoking female of Turkish origin during work-up for back pain. A very small amount of tumoral tissue was obtained through fine needle aspiration of a lymph node and stainings performed on paraffin-embedded tissue showed a very limited amount of tumoral tissue with a well-differentiated cytological aspect with regular nuclei.

This article is protected by copyright. All rights reserved.



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Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology

Abstract

Although sudden cardiac death (SCD) is one of the most important modes of death in Western countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology has developed these guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate investigation of SCD. The present version is an update of our original article, published 10 years ago. This is necessary because of our increased understanding of the genetics of cardiovascular diseases, the availability of new diagnostic methods, and the experience we have gained from the routine use of the original guidelines. The updated guidelines include a detailed protocol for the examination of the heart and recommendations for the selection of histological blocks and appropriate material for toxicology, microbiology, biochemistry, and molecular investigation. Our recommendations apply to university medical centers, regionals hospitals, and all healthcare professionals practicing pathology and forensic medicine. We believe that their adoption throughout Europe will improve the standards of autopsy practice, allow meaningful comparisons between different communities and regions, and permit the identification of emerging patterns of diseases causing SCD. Finally, we recommend the development of regional multidisciplinary networks of cardiologists, geneticists, and pathologists. Their role will be to facilitate the identification of index cases with a genetic basis, to screen appropriate family members, and ensure that appropriate preventive strategies are implemented.



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The cytopathology of Actinomyces, Nocardia, and their mimickers

Nocardia species and Actinomyces species are 2 of the most commonly diagnosed filamentous bacteria in routine cytopathology practice. These genera share many overlapping cytomorphologic features, including their thin, beaded, branching, Gram-positive, GMS-positive filamentous structures that fragment at their peripheries into bacillary- and coccoid-appearing forms. Features that help distinguish between these 2 microorganisms include the width of their filamentous structures, the angles at which they branch, and their ability or lack thereof to retain a modified acid-fast stain. In addition to cytomorphologic overlap, overlap in clinical presentation is frequent with pulmonary and mucocutaneous presentations seen in both. Differentiating between Nocardia and Actinomyces is essential because patients with these infections require different approaches to medical management. Both antibiotic susceptibilities and the need for early surgical intervention as part of the treatment plan vary greatly among these 2 groups. This review focuses on the clinical presentation, cytomorphology and staining characteristics that can be useful in identifying and distinguishing between Nocardia and Actinomyces infections, as well as their mimickers.



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Thymic enteric type adenocarcinoma: A case report with cytological features

Abstract

Primary thymic adenocarcinoma is an extremely rare tumor, and thymic enteric type adenocarcinoma has recently been proposed as a distinct pathological entity. Herein, we report the first cytological description of thymic enteric type adenocarcinoma. A 29-year-old Japanese female without a significant past medical history was found to have an abnormal chest shadow. Chest computed tomography demonstrated a well-circumscribed tumor in the anterior mediastinum, and thymectomy was performed. The Papanicolaou staining of the touch smear of the resected tumor demonstrated tightly cohesive epithelial cell clusters in a necrotic background. These cells were cuboidal to columnar in shape and had large round to oval nuclei with conspicuous nucleoli. Some of these neoplastic cells had intracytoplasmic mucin. Immunocytochemically, the neoplastic cells were positive for cytokeratin 20 and CDX-2. Histopathological study revealed tubular and papillotubular neoplastic growth composed of cuboidal to columnar neoplastic cells that contained large round to oval nuclei. Some of the neoplastic cells had intracytoplasmic mucin. Immunohistochemical study confirmed the expression of cytokeratin 20 and CDX-2. The final diagnosis of thymic enteric type adenocarcinoma was made. The cytological and immunocytochemical features of this case led to a diagnosis of enteric type adenocarcinoma. However, these features alone cannot be differentiated from a metastatic adenocarcinoma arising from the gastrointestinal tract. Cytological examination of a fine-needle aspiration of the mediastinal tumor has been reported to be useful in making a diagnosis. Therefore, an awareness of this new pathological entity is important for differentiating a thymic tumor from a metastatic carcinoma in the thymus.



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Performance of different prostate specific antibodies in the cytological diagnosis of metastatic prostate adenocarcinoma

Abstract

Background

Diagnosis of metastatic prostate adenocarcinoma (metPA) in cytology specimens can be challenging and frequently requires the use of immunohistochemistry (IHC). Prostate specific membrane antigen (PSMA) and NKX3.1 have emerged as promising IHC markers to determine prostatic origin of metPA in surgical specimens. Our goal is to evaluate the performance of PSMA and NKX3.1 and compare them with those of prostate-specific antigen (PSA) and prostate specific alkaline phosphatase (PSAP) in the cytological diagnosis of metPA

Materials

Cytology specimens from patients with a history of prostate adenocarcinoma at our institution between January 01, 2005 and December 31, 2015 were retrieved. IHC stains were performed on the cell blocks. In addition to the staining pattern and intensity, the sensitivity, and specificity of PSMA and NKX3.1 were assessed and compared to those of PSA and PSAP markers.

Results

A total of 56 cytology cases were retrieved with the following diagnoses: 13 metPA, 37 metastatic carcinomas from other origins, 4 rare atypical cells, and 2 benign. Additional 9 cases were re-classified as metPA based on positive PSMA and/or NKX3.1 immunostains. In our cohort of 22 cases of metPA, 18 were positive for PSMA (82%), 15 for NKX3.1 (68%), 9 for PSA (41%), and 9 for PSAP (41%). PSMA and NKX3.1 were negative in all 6 cases of metastatic carcinoma of nonprostate origin (specificity 100%). PSMA demonstrated strong membranous staining pattern, and NKX3.1 exhibited moderate nuclear staining pattern.

Conclusion

Because of their higher sensitivity and specificity, PSMA and NKX3.1 are valuable surrogate markers for metPA in cytology specimens, when compared with PSA and PSAP markers.



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Identifying the subtypes of cancer-related fatigue: results from the population-based PROFILES registry

Abstract

Purpose

Little research has been done to identify possible cancer-related fatigue (CRF) subtypes and to classify cancer survivors accordingly. We aimed to identify CRF subtypes in a large population-based sample of (long term) stage I–III colorectal cancer survivors. We also identified factors associated with the CRF subtypes.

Methods

Respondents completed the Multidimensional Fatigue Inventory and other validated questionnaires on anxiety and reduced positive affect (anhedonia), sleep quality, and lifestyle factors (body mass index and physical activity). Latent class analysis was used to derive the CRF subtypes. Factors associated with the derived CRF subtypes were determined with multinomial logistic regression.

Results

Three CRF classes were identified: class 1 (no fatigue and distress, n = 644, 56%), class 2 (low fatigue, moderate distress, n = 256, 22%), and class 3 (high fatigue, moderate distress, n = 256, 22%). Multinomial logistic regression results show that survivors in class 3 were more likely to be female, were treated with radiotherapy, have comorbid diabetes mellitus, and be overweight/obese than survivors in class 1 (reference). Survivors in classes 2 and 3 were also more likely to have comorbid heart condition, report poorer sleep quality, experience anhedonia, and report more anxiety symptoms when compared with survivors in class 1.

Conclusions

Three distinct classes of CRF were identified which could be differentiated with sleep quality, anxiety, anhedonia, and lifestyle factors.

Implications for cancer survivors

The identification of CRF subtypes with distinct characteristics suggests that interventions should be targeted to the CRF subtype.



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Masthead



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In This Issue



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Editorial Board



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Table of Contents



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Solid pseudopapillary neoplasm presenting as a primary ovarian mass in an eighteen-year-old female: report of a case and review of the literature



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Music and speech distractors disrupt sensorimotor synchronization: effects of musical training

Abstract

Humans display a natural tendency to move to the beat of music, more than to the rhythm of any other auditory stimulus. We typically move with music, but rarely with speech. This proclivity is apparent early during development and can be further developed over the years via joint dancing, singing, or instrument playing. Synchronization of movement to the beat can thus improve with age, but also with musical experience. In a previous study, we found that music perturbed synchronization with a metronome more than speech fragments; music superiority disappeared when distractors shared isochrony and the same meter (Dalla Bella et al., PLoS One 8(8):e71945, 2013). Here, we examined if the interfering effect of music and speech distractors in a synchronization task is influenced by musical training. Musicians and non-musicians synchronized by producing finger force pulses to the sounds of a metronome while music and speech distractors were presented at one of various phase relationships with respect to the target. Distractors were familiar musical excerpts and fragments of children poetry comparable in terms of beat/stress isochrony. Music perturbed synchronization with the metronome more than speech did in both groups. However, the difference in synchronization error between music and speech distractors was smaller for musicians than for non-musicians, especially when the peak force of movement is reached. These findings point to a link between musical training and timing of sensorimotor synchronization when reacting to music and speech distractors.



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Antibody production by in vivo RNA transfection.

Antibody production by in vivo RNA transfection.

Sci Rep. 2017 Sep 07;7(1):10863

Authors: Romani B, Kavyanifard A, Allahbakhshi E

Abstract
Monoclonal antibodies have a variety of applications in research and medicine. Here, we report development of a new method for production of monoclonal antibodies. Our method relies on in vivo RNA transfection rather than peptide vaccination. We took advantage of RNA transcripts complexed with DOTMA and DOPE lipids to transfect mice. Intravenous administration of our RNA vaccine to mice resulted in expression of the antigenic peptides by splenic dendritic cells and detection of the antigens in the serum. The RNA vaccine stimulated production of specific antibodies against the RNA-encoded peptides. We produced monoclonal antibodies against viral, bacterial, and human antigens. In addition, we showed that our RNA vaccine stimulated humoral immunity and rescued mice infected with influenza A virus. Our method could be used as an efficient tool to generate monoclonal antibodies and to stimulate humoral immunity for research and medical purposes.

PMID: 28883620 [PubMed - in process]



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Homogeneous processing in the striatal direct and indirect pathways: Single body part sensitive type IIb neurons may express either dopamine receptor D1 or D2

Abstract

Striatal medium spiny projection neurons (MSNs) output through two diverging circuits, the "direct and indirect pathways" which originate from minimally overlapping populations of MSNs expressing either the dopamine receptor D1 or the dopamine receptor D2. One modern theory of direct and indirect pathway function proposes that activation of direct pathway MSNs facilitates output of desired motor programs, while activation of indirect pathway MSNs inhibits competing motor programs. A separate theory suggests that coordinated timing or synchrony of the direct and indirect pathways is critical for the execution of refined movements. These hypotheses are made testable by a common type of striatal neuron known as type IIb MSNs. Clusters of these MSNs exhibit phasic increases in firing rate related to sensorimotor activity of single body parts. If these MSNs were to reside in only the direct pathway, evidence would be provided that D1 MSNs are "motor program" specific, which would lend credence to the "competing motor programs" hypothesis. However, id type IIb reside in both pathways, evidence would be provided for the "coordinated timing or synchrony" hypothesis. Our results show that type IIb neurons may express either D1 or D2. This evidence supports the theory that the coordinated timing or synchrony of the direct and indirect pathways is critical for refined movements. We also propose a model in which the direct and indirect pathways act as a differentiator circuit, providing a possible mechanism by which coordinated activity of D1 and D2 neurons may output meaningful somatosensorimotor information to downstream structures.

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The anterior insula bidirectionally modulates cost-benefit decision making on a rodent gambling task

Abstract

Deficits in cost-benefit decision making, as assessed in the Iowa Gambling Task (IGT), are commonly observed in neuropsychiatric disorders such as addiction. There is considerable variation in the maximisation of rewards on such tasks, both in the general population and in rodent models, suggesting individual differences in decision making may represent a key endophenotype for vulnerability to neuropsychiatric disorders. Increasing evidence suggests that the insular cortex, which is involved in interoception and emotional processes in humans, may be a key neural locus in the control of decision making processes. However, the extent to which the insula contributes to individual differences in cost-benefit decision making remains unknown. Using male Sprague-Dawley rats we first assessed individual differences in the performance over the course of a single session on a rodent analogue of the IGT (rGT). Rats were matched for their ability to maximise reward and received bilateral excitotoxic or sham lesions of the anterior insula cortex (AIC). Animals were subsequently challenged on a second rGT session with altered contingencies. Finally, animals were also assessed for instrumental conditioning and reversal learning. AIC lesions produced bidirectional alterations on rGT performance; rats that had performed optimally prior to surgery subsequently showed impairments, and animals that had performed poorly showed improvements in comparison to sham operated controls. These bidirectional effects were not attributable to alterations in behavioural flexibility or in motivation. These data suggest that the recruitment of the AIC during decision making may be state-dependent and help guide response selection toward subjectively favourable options.

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Trial-by-trial co-variation of pre-stimulus EEG alpha power and visuospatial bias reflects a mixture of stochastic and deterministic effects

Abstract

Human perception of perithreshold stimuli critically depends on oscillatory EEG-activity prior to stimulus-onset. However, it remains unclear exactly which aspects of perception are shaped by this pre-stimulus activity and what role stochastic (trial-by-trial) variability plays in driving these relationships. We employed a novel Jackknife approach to link single-trial variability in oscillatory activity to psychometric measures from a task that requires judgement of the relative length of two line-segments (the landmark task). The results provide evidence that pre-stimulus alpha fluctuations influence perceptual bias. Importantly, a mediation analysis showed that this relationship is partially driven by long-term (deterministic) alpha-changes over time, highlighting the need to account for sources of trial-by-trial variability when interpreting EEG predictors of perception. These results provide fundamental insight into the nature of the effects of ongoing oscillatory activity on perception. The jackknife approach we implemented may serve to identify and investigate neural signatures of perceptual relevance in more detail.

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Atypical brain responses to auditory spatial cues in adults with autism spectrum disorder

Abstract

The auditory processing atypicalities experienced by many individuals on the autism spectrum disorder might be understood in terms of difficulties parsing the sound energy arriving at the ears into discrete auditory "objects." Here we asked whether autistic adults are able to make use of two important spatial cues to auditory object formation – the relative timing and amplitude of sound energy at the left and right ears. Using electroencephalography, we measured the brain responses of 15 autistic adults and 15 age-and verbal-IQ-matched control participants as they listened to dichotic pitch stimuli – white noise stimuli in which interaural timing or amplitude differences applied to a narrow frequency band of noise typically lead to the perception of a pitch sound that is spatially segregated from the noise. Responses were contrasted with those to stimuli in which timing and amplitude cues were removed. Consistent with our previous studies, autistic adults failed to show a significant Object Related Negativity (ORN) for timing-based pitch, although their ORN was not significantly smaller than that of the control group. Autistic participants did show an ORN to amplitude cues, indicating that they do not experience a general impairment in auditory object formation. However, their P400 response – thought to indicate the later attention-dependent aspects of auditory object formation – was missing. These findings provide further evidence of atypical auditory object processing in autism with potential implications for understanding the perceptual and communication difficulties associated with the condition.

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Unveiling neural coupling within the sensorimotor system: directionality and nonlinearity

Abstract

Neural coupling between the central nervous system and the periphery is essential for the neural control of movement. Corticomuscular coherence is a popular linear technique to assess synchronized oscillatory activity in the sensorimotor system. This oscillatory coupling originates from ascending somatosensory feedback and descending motor commands. However, corticomuscular coherence cannot separate this bi-directionality. Furthermore, the sensorimotor system is nonlinear, resulting in cross-frequency coupling. Cross-frequency oscillations cannot be assessed nor exploited by linear measures. Here, we emphasize the need of novel coupling measures, which provide directionality and acknowledge nonlinearity, to unveil neural coupling in the sensorimotor system. We highlight recent advances in the field and argue that assessing directionality and nonlinearity of neural coupling will break new ground in the study of the control of movement in healthy and neurologically impaired individuals.

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The Involvement of Centralized and Distributed Processes in Sub-second Time Interval Adaptation: An ERP Investigation of Apparent Motion

Abstract

Accumulating evidence suggests that the timing of brief stationary sounds affects visual motion perception. Recent studies have shown that auditory time interval can alter apparent motion perception not only through concurrent stimulation but also through brief adaptation. The adaptation aftereffects for auditory time intervals were found to be similar to those for visual time intervals, suggesting the involvement of a central timing mechanism. To understand the nature of cortical processes underlying such aftereffects, we adapted observers to different time intervals by using either brief sounds or visual flashes and examined the evoked activity to the subsequently presented visual apparent motion. Both auditory and visual time interval adaptation led to significant changes in the ERPs elicited by the apparent motion. However, the changes induced by each modality were in the opposite direction. Also, they mainly occurred in different time windows and clustered over distinct scalp sites. The effects of auditory time interval adaptation were centered over parietal and parieto-central electrodes while the visual adaptation effects were mostly over occipital and parieto-occipitial regions. Moreover, the changes were much more salient when sounds were used during the adaptation phase. Taken together, our findings within the context of visual motion point to auditory dominance in the temporal domain and highlight the distinct nature of the sensory processes involved in auditory and visual time interval adaptation.

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Beta-band oscillations during passive listening to metronome sounds reflect improved timing representation after short-term musical training in healthy older adults

Abstract

Sub-second time intervals in musical rhythms provide predictive cues about future events to performers and listeners through an internalized representation of timing. While the acuity of automatic, sub-second timing as well as cognitively controlled, supra-second timing declines with aging, musical experts are less affected. The present study investigated the influence of piano training on temporal processing abilities in older adults using behavioural and neuronal correlates. We hypothesized that neuroplastic changes in beta networks, caused by training in sensorimotor coordination with timing processing, can be assessed even in the absence of movement. Behavioural performance of internal timing stability was assessed with synchronization-continuation finger-tapping paradigms. Magnetoencephalography (MEG) was recorded from older adults before and after one month of one-on-one training. For neural measures of automatic timing processing, we focused on beta oscillations (13–30 Hz) during passive listening to metronome beats. Periodic beta-band modulations in older adults before training were similar to previous findings in young listeners at a beat interval of 800ms. After training, behavioural performance for continuation tapping was improved and accompanied by an increased range of beat-induced beta modulation, compared to participants who did not receive training. Beta changes were observed in the caudate, auditory, sensorimotor and premotor cortices, parietal lobe, cerebellum, and medial prefrontal cortex, suggesting that increased resources are involved in timing processing and goal-oriented monitoring as well as reward-based sensorimotor learning.

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Lesion evidence for a critical role of left posterior but not frontal areas in alpha-beta power decreases during context-driven word production

Abstract

Different frequency bands in the electroencephalogram are postulated to support distinct language functions. Studies have suggested that alpha-beta power decreases may index word-retrieval processes. In context-driven word retrieval, participants hear lead-in sentences that either constrain the final word ("He locked the door with the") or not ("She walked in here with the"). The last word is shown as a picture to be named. Previous studies have consistently found alpha-beta power decreases prior to picture onset for constrained relative to unconstrained sentences, localised to the left lateral-temporal and lateral-frontal lobes. However, the relative contribution of temporal versus frontal areas to alpha-beta power decreases is unknown. We recorded the electroencephalogram from patients with stroke lesions encompassing the left-lateral temporal and inferior parietal regions or left-lateral frontal lobe and from matched controls. Individual-participant analyses revealed a behavioural sentence context facilitation effect in all participants, except for in the two patients with extensive lesions to temporal and inferior-parietal lobes. We replicated the alpha-beta power decreases prior to picture onset in all participants, except for in the two same patients with extensive posterior lesions. Thus, whereas posterior lesions eliminated the behavioural and oscillatory context effect, frontal lesions did not. Hierarchical clustering analyses of all patients' lesion profiles, and behavioural and electrophysiological effects identified those two patients as having a unique combination of lesion distribution and context effects. These results indicate a critical role for the left lateral-temporal and inferior parietal lobes, but not frontal cortex, in generating the alpha-beta power decreases underlying context-driven word production.

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A review of renal disease in children with HIV infection

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Topoisomerases and Anthracyclines: Recent Advances and Perspectives in Anticancer Therapy and Prevention of Cardiotoxicity.

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Topoisomerases and Anthracyclines: Recent Advances and Perspectives in Anticancer Therapy and Prevention of Cardiotoxicity.

Curr Med Chem. 2017;24(15):1607-1626

Authors: Mordente A, Meucci E, Martorana GE, Tavian D, Silvestrini A

Abstract
Topoisomerases are ubiquitous enzymes involved in maintaining genomic stability of the cell by regulating the over- or underwinding of DNA strands. Besides their customary functions, topoisomerases are important cellular targets of widely used anticancer drugs. In particular, topoisomerase IIα (Top2α) has been postulated as the primary molecular target of anthracycline's anticancer activity, whereas topoisomerase IIβ (Top2β), the only Top2 present in heart tissue, seems to be involved in the development of anthracycline-induced cardiotoxicity. Noteworthy, cardiotoxicity is the most frequent adverse effect of both conventional and modern anticancer targeted therapy, representing the leading noncancer-related cause of morbidity and mortality in long-term survivors. The molecular mechanisms of anthracyclineinduced cardiotoxicity have been investigated for decades and, despite the numerous mechanistic hypotheses put forward, its aetiology and pathogenesis still remain controversial. This review is aimed at focusing on the double edge sword of topoisomerase-anthracycline interaction, and, in particular, on the potential role of topoisomerases in anthracyclines anticancer activity as well as in the pathogenesis of anthracycline-induced cardiotoxicity.

PMID: 27978799 [PubMed - indexed for MEDLINE]



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Short-term effects of passive mobilization on the sublingual microcirculation and on the systemic circulation in patients with septic shock

Active mobilization is not possible in patients under deep sedation and unable to follow commands. In this scenario, passive therapy is an interesting alternative. However, in patients with septic shock, passi...

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Gene Therapy

HEMATOLOGY/ONCOLOGY CLINICS OF NORTH AMERICA

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Hematopoietic Stem Cell Approaches to Cancer

Hematopoietic stem cells (HSCs) are unique in their ability to self-renew and generate all blood lineages for the entire life. HSC modification affects red blood cells, platelets, lymphocytes, and myeloid cells. Chemotherapy can result in myelosuppression, limiting effective chemotherapy administration. For diseases like glioblastoma, high expression of methlylguanine methyltransferase can inactivate alkylating agent chemotherapy. Here we discuss how HSCs can be modified to overcome this resistance, permitting sensitization of tumors to chemotherapy while simultaneously protecting the hematopoietic system. We also discuss how HSCs can be harnessed to produce powerful tumor killing T cells, potentially benefitting and complementing T-cell–based immunotherapies.

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Historical Perspective on the Current Renaissance for Hematopoietic Stem Cell Gene Therapy

Gene therapy using hematopoietic stem cells (HSC) has developed over the past 3 decades, with progressive improvements in the efficacy and safety. Autologous transplantation of HSC modified with murine gammaretroviral vectors first showed clinical benefits for patients with several primary immune deficiencies, but some of these patients suffered complications from vector-related genotoxicity. Lentiviral vectors have been used recently for gene addition to HSC and have yielded clinical benefits for primary immune deficiencies, metabolic diseases, and hemoglobinopathies, without vector-related complications. Gene editing using site-specific endonucleases is emerging as a promising technology for gene therapy and is moving into clinical trials.

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Contents

Daniel E. Bauer and Donald B. Kohn

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In Vivo Hematopoietic Stem Cell Transduction

Current protocols for hematopoietic stem cell (HSC) gene therapy, involving the transplantation of ex vivo lentivirus vector-transduced HSCs into myeloablated recipients, are complex and not without risk for the patient. In vivo HSC gene therapy can be achieved by the direct modification of HSCs in the bone marrow after intraosseous injection of gene delivery vectors. A recently developed approach involves the mobilization of HSCs from the bone marrow into peripheral the blood circulation, intravenous vector injection, and re-engraftment of genetically modified HSCs in the bone marrow. We provide examples for in vivo HSC gene therapy and discuss advantages and disadvantages.

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Forthcoming Issues

Hematology/Oncology Emergencies

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Gene Editing

The clinical application and regulatory strategy of genome editing for ex vivo cell therapy is derived from the intersection of two fields of study: viral vector gene therapy trials; and clinical trials with ex vivo purification and engraftment of CD34+ hematopoietic stem cells, T cells, and tumor cell vaccines. This article covers the regulatory and translational preclinical activities needed for a genome editing clinical trial modifying hematopoietic stem cells and the genesis of this current strategy based on previous clinical trials using genome-edited T cells. The SB-728 zinc finger nuclease platform is discussed because this is the most clinically advanced genome editing technology.

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Contributors

GEORGE P. CANELLOS, MD

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Copyright

ELSEVIER

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Gene Therapy for Hemophilia

The best currently available treatments for hemophilia A and B (factor VIII or factor IX deficiency, respectively) require frequent intravenous infusion of highly expensive proteins that have short half-lives. Factor levels follow a saw-tooth pattern that is seldom in the normal range and falls so low that breakthrough bleeding occurs. Most hemophiliacs worldwide do not have access to even this level of care. In stark contrast, gene therapy holds out the hope of a cure by inducing continuous endogenous expression of factor VIII or factor IX following transfer of a functional gene to replace the hemophilic patient's own defective gene.

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Gene Modified T Cell Therapies for Hematological Malignancies

This article focuses on clinical applications of T cells transduced to express recombinant T cell receptor and chimeric antigen receptor constructs directed toward hematological malignancies, and considers newer strategies incorporating gene-editing technologies to address GvHD and host-mediated rejection. Recent data from clinical trials are reviewed, and an overview is provided of current and emerging manufacturing processes; consideration is also given to new developments in the pipeline.

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Gene Therapy Approaches to Hemoglobinopathies

Gene therapy for hemoglobinopathies is currently based on transplantation of autologous hematopoietic stem cells genetically modified with a lentiviral vector expressing a globin gene under the control of globin transcriptional regulatory elements. Preclinical and early clinical studies showed the safety and potential efficacy of this therapeutic approach as well as the hurdles still limiting its general application. In addition, for both beta-thalassemia and sickle cell disease, an altered bone marrow microenvironment reduces the efficiency of stem cell harvesting as well as engraftment. These hurdles need be addressed for gene therapy for hemoglobinopathies to become a clinical reality.

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Integrating Vectors for Gene Therapy and Clonal Tracking of Engineered Hematopoiesis

Gene therapy using autologous or allogeneic cells offers promising possibilities to treat inherited and acquired diseases, ideally leading to a long-lasting therapeutic correction. This article summarizes efforts that use integrating vectors derived from retroviruses and transposons, and briefly explains integrating vector biology and integration site analysis and recent successful application of this technology in clinical trials. Moreover, outlined is how these vectors can be used for cancer gene discovery and clonal tracking of benign and malignant hematopoiesis to gain insights into the dynamics of hematopoiesis.

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