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Σάββατο, 29 Απριλίου 2017

Orofacial electromyographic correlates of induced verbal rumination

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Publication date: Available online 30 April 2017
Source:Biological Psychology
Author(s): Ladislas Nalborczyk, Marcela Perrone-Bertolotti, Céline Baeyens, Romain Grandchamp, Mircea Polosan, Elsa Spinelli, Ernst H.W. Koster, Hélène Lœvenbruck
Rumination is predominantly experienced in the form of repetitive verbal thoughts. Verbal rumination is a particular case of inner speech. According to the Motor Simulation view, inner speech is a kind of motor action, recruiting the speech motor system. In this framework, we predicted an increase in speech muscle activity during rumination as compared to rest. We also predicted increased forehead activity, associated with anxiety during rumination. We measured electromyographic activity over the orbicularis oris superior and inferior, frontalis and flexor carpi radialis muscles. Results showed increased lip and forehead activity after rumination induction compared to an initial relaxed state, together with increased self-reported levels of rumination. Moreover, our data suggest that orofacial relaxation is more effective in reducing rumination than non-orofacial relaxation. Altogether, these results support the hypothesis that verbal rumination involves the speech motor system, and provide a promising psychophysiological index to assess the presence of verbal rumination.



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Can common serum biomarkers predict complicated appendicitis in children?

Abstract

Purpose

As appendicitis in children can be managed differently according to the severity of the disease, we investigated whether commonly used serum biomarkers on admission could distinguish between simple and complicated appendicitis.

Methods

Admission white blood cell (WBC), neutrophil (NEU), and C-reactive protein (CRP) levels were analysed by ROC curve, and Kruskal–Wallis and contingency tests. Patients were divided according to age and histology [normal appendix (NA), simple appendicitis (SA), complicated appendicitis (CA)].

Results

Of 1197 children (NA = 186, SA = 685, CA = 326), 7% were <5 years, 55% 5–12, 38% 13–17. CA patients had higher CRP and WBC levels than NA and SA (p < 0.0001). NEU levels were lower in NA compared to SA or CA (p < 0.0001), but were similar between SA and CA (p = 0.6). CA patients had higher CRP and WBC levels than SA patients in 5–12- (p < 0.0001) and 13–17-year groups (p = 0.0075, p = 0.005), but not in <5-year group (p = 0.72, p = 0.81). We found CRP >40 mg/L in 58% CA and 37% SA (p < 0.0001), and WBC >15 × 109/L in 58% CA and 43% SA (p < 0.0001).

Conclusions

Admission CRP and WBC levels may help the clinician predict complicated appendicitis in children older than 5 years of age. Early distinction of appendicitis severity using these tests may guide caregivers in the preoperative decision-making process.



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Outcome of stoma closure in babies with necrotising enterocolitis: early vs late closure

Abstract

Newborns undergoing surgery for necrotizing enterocolitis (NEC) often require a stoma. Currently, there is no consensus regarding the best time for stoma closure (SC). Our aim was to determine the outcomes of early versus late closure.

Methods

Retrospective analysis of patients who underwent SC following stoma formation for NEC between Jan 2009 and July 2015 was done. Early (EC) versus late closure (LC) was defined as less than 10 weeks versus at or after 10 weeks of stoma formation.

Results

Of 36 patients, M:F was 23:13. Indications for laparotomy were pneumoperitoneum (30) and gangrene (6). Postoperatively, 9/15 (60.0%) of EC group required ventilator support versus none in LC group (p < 0.05). It took longer to establish full feeds following EC (12 days) versus LC (8 days). Median duration of postoperative hospital stay following EC was 31 days (18–35) versus 7 days (4–54) following LC. Three patients were re-operated for intestinal obstruction (two following EC, one following LC). Three patients developed incisional hernia after EC versus none after LC (p < 0.05). One patient died after EC due to staphylococcus septicaemia.

Conclusion

Early closure before 10 weeks of formation for NEC patients is associated with significant morbidity, increased ventilator requirements and chances of developing incisional hernia.



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Association of Plasma SDF-1 with Bone Mineral Density, Body Composition, and Hip Fractures in Older Adults: The Cardiovascular Health Study

Abstract

Aging is associated with an increase in circulating inflammatory factors. One, the cytokine stromal cell-derived factor 1 (SDF-1 or CXCL12), is critical to stem cell mobilization, migration, and homing as well as to bone marrow stem cell (BMSC), osteoblast, and osteoclast function. SDF-1 has pleiotropic roles in bone formation and BMSC differentiation into osteoblasts/osteocytes, and in osteoprogenitor cell survival. The objective of this study was to examine the association of plasma SDF-1 in participants in the cardiovascular health study (CHS) with bone mineral density (BMD), body composition, and incident hip fractures. In 1536 CHS participants, SDF-1 plasma levels were significantly associated with increasing age (p < 0.01) and male gender (p = 0.04), but not with race (p = 0.63). In multivariable-adjusted models, higher SDF-1 levels were associated with lower total hip BMD (p = 0.02). However, there was no significant association of SDF-1 with hip fractures (p = 0.53). In summary, circulating plasma levels of SDF-1 are associated with increasing age and independently associated with lower total hip BMD in both men and women. These findings suggest that SDF-1 levels are linked to bone homeostasis.



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Evolution of the Marrow Adipose Tissue Microenvironment

Abstract

Adipocytes of the marrow adipose tissue (MAT) are distributed throughout the skeleton, are embedded in extracellular matrix, and are surrounded by cells of the hematopoietic and osteogenic lineages. MAT is a persistent component of the skeletal microenvironment and has the potential to impact local processes including bone accrual and hematopoietic function. In this review, we discuss the initial evolution of MAT in vertebrate lineages while emphasizing comparisons to the development of peripheral adipose, hematopoietic, and skeletal tissues. We then apply these evolutionary clues to define putative functions of MAT. Lastly, we explore the regulation of MAT by two major components of its microenvironment, the extracellular matrix and the nerves embedded within. The extracellular matrix and nerves contribute to both rapid and continuous modification of the MAT niche and may help to explain evolutionary conserved mechanisms underlying the coordinated regulation of blood, bone, and MAT within the skeleton.



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Adipose, Bone, and Myeloma: Contributions from the Microenvironment

Abstract

Researchers globally are working towards finding a cure for multiple myeloma (MM), a destructive blood cancer diagnosed yearly in ~750,000 people worldwide (Podar et al. in Expert Opin Emerg Drugs 14:99–127, 2009). Although MM targets multiple organ systems, it is the devastating skeletal destruction experienced by over 90 % of patients that often most severely impacts patient morbidity, pain, and quality of life. Preventing bone disease is therefore a priority in MM treatment, and understanding how and why myeloma cells target the bone marrow (BM) is fundamental to this process. This review focuses on a key area of MM research: the contributions of the bone microenvironment to disease origins, progression, and drug resistance. We describe some of the key cell types in the BM niche: osteoclasts, osteoblasts, osteocytes, adipocytes, and mesenchymal stem cells. We then focus on how these key cellular players are, or could be, regulating a range of disease-related processes spanning MM growth, drug resistance, and bone disease (including osteolysis, fracture, and hypercalcemia). We summarize the literature regarding MM-bone cell and MM-adipocyte relationships and subsequent phenotypic changes or adaptations in MM cells, with the aim of providing a deeper understanding of how myeloma cells grow in the skeleton to cause bone destruction. We identify avenues and therapies that intervene in these networks to stop tumor growth and/or induce bone regeneration. Overall, we aim to illustrate how novel therapeutic target molecules, proteins, and cellular mediators may offer new avenues to attack this disease while reviewing currently utilized therapies.



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N-glycan and Alzheimer's disease

Publication date: Available online 29 April 2017
Source:Biochimica et Biophysica Acta (BBA) - General Subjects
Author(s): Yasuhiko Kizuka, Shinobu Kitazume, Naoyuki Taniguchi
BackgroundAlzheimer's disease (AD) is a major form of dementia. Many evidence-based clinical trials have been performed, but no effective treatment has yet been developed. This suggests that our understanding of AD patho-mechanisms is still insufficient. In particular, the pathological roles of posttranslational modifications including glycosylation have remained poorly understood, but recent advances in glycobiology technology have gradually revealed that sugar modifications of AD-related molecules are profoundly involved in the onset and progression of this disease.Scope of ReviewWe summarize the roles of N-glycans in AD pathogenesis and progression, particularly focusing on key AD-related molecules, including amyloid precursor protein (APP), α-, β-, γ-secretases, and tau.Major ConclusionsBiochemical, genetic and pharmacological studies have gradually revealed how N-glycans regulate AD development and progression through functional modulation of the key glycoproteins. These findings suggest that further glycobiology approaches in AD research will reveal novel glycan-based drug targets and early biomarkers of AD. However, N-glycan structures of these molecules in physiological and disease conditions and their precise functions are still largely unclear. Deeper glycobiology studies will be needed to reveal how AD pathology is regulated by glycosylation.General SignificanceIt is now known that N-glycans play significant roles in AD development. However, specific pathological functions of particular glycan epitopes on each AD-related glycoprotein are still poorly understood. Future glycobiology studies with more sensitive glycoproteomic techniques and a wider variety of chemical glycosylation inhibitors could contribute to the development of novel glycan-based AD therapeutics.



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Inhibition of Late Sodium Current as an Innovative Antiarrhythmic Strategy

Abstract

Purpose of review

Over the last years, evidence is accumulating that enhanced late sodium current (INaL) in cardiac pathologies has fundamental consequences for cellular electrophysiology. This review discusses the underlying mechanisms of INaL-induced arrhythmias and the significance of INaL-inhibition as a possible therapeutic approach.

Recent Findings

Inhibition of enhanced INaL, e.g., by ranolazine, was shown to reverse these effects in different myocardial diseases including heart failure. The antianginal drug ranolazine has already been examined in larger clinical trials with promising antiarrhythmic actions.

Summary

Enhanced INaL was found to be present in several cardiac pathologies like ischemia, long QT syndromes, hypertrophic cardiomyopathy, and heart failure. In settings of enhanced INaL, a sodium-dependent calcium overload leads to severe impairment of excitation-contraction coupling and therefore has a high proarrhythmogenic potential. Experimental data showed that inhibition of INaL has a high antiarrhythmic potential which could be confirmed in further clinical trials.



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Therapeutic Targeting of PDEs and PI3K in Heart Failure with Preserved Ejection Fraction (HFpEF)

Abstract

Purpose of Review

Heart Failure with preserved Ejection Fraction (HFpEF) is a prevalent disease with considerable individual and societal burden. HFpEF patients often suffer from multiple pathological conditions thatcomplicate management and adversely affect outcome, including pulmonary hypertension and chronic obstructive pulmonary disease (COPD). To date, no treatment proved to be fully effective in reducing morbidity and mortality in HFpEF, possibly due to an incomplete understanding of the underlying molecular mechanisms.

Recent Findings

The emerging view proposes chronic systemic inflammation, leading to endothelial dysfunction and interstitial fibrosis, as a prominent cause of HFpEF, rather than a mere co-existent disease. In the last decade, efforts from pharmaceutical companies attempted to target pharmacologically enzymes which play key roles in systemic and lung inflammation, such as the cyclic nucleotide-degrading enzymes phosphodiesterases (PDEs) and phosphoinositide-3 phosphate kinases (PI3Ks), especially to limit COPD.

Summary

In this review, we will summarize major successes and drawbacks of hitting these enzymes to tackle inflammation in HFpEF-associated co-morbidities, with a major focus on the results of completed and ongoing clinical trials. Finally, we will discuss the potential of repurposing and/or developing new PDE and PI3K inhibitors for HFpEF therapy.



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Regulation of Cardiomyocyte T-Tubular Structure: Opportunities for Therapy

Abstract

Purpose of Review

Membrane invaginations called t-tubules play an integral role in triggering cardiomyocyte contraction, and their disruption during diseases such as heart failure critically impairs cardiac performance. In this review, we outline the growing understanding of the malleability of t-tubule structure and function, and highlight emerging t-tubule regulators which may be exploited for novel therapies.

Recent Findings

New technologies are revealing the nanometer scale organization of t-tubules, and their functional junctions with the sarcoplasmic reticulum called dyads, which generate Ca2+ sparks. Recent data have indicated that the dyadic anchoring protein junctophilin-2, and the membrane-bending protein BIN1 are key regulators of dyadic formation and maintenance. While the underlying signals which control expression and localization of these proteins remain unclear, accumulating data support an important role of myocardial workload.

Summary

Although t-tubule alterations are believed to be a key cause of heart failure, the plasticity of these structures also creates an opportunity for therapy. Promising recent data suggest that such therapies may specifically target junctophilin-2, BIN1, and/or mechanotransduction.



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Addressing the Heterogeneity of Heart Failure in Future Randomized Trials

Abstract

Purpose of the Review

The aim of review is to describe the essential role of study designs beyond RCTs in contemporary contest of HF patients giving perspectives on its evolving. The article concludes with concern about the support of observational studies for future randomized clinical trials.

Recent Findings

With the aging population and spectacular advance in cardiovascular therapy, the clinical syndrome comprising heart failure (HF) is increasingly in complexity of heterogeneity. It remains among the most challenging of clinical syndromes with a magnitude of proposed pathophysiological mechanisms involving the heart and the interplay with cardiac and non-cardiac comorbidities. In this epidemiological scenario, randomized clinical trials are suffering from growing failed treatment, so that a deeper understanding of heterogeneity represents a major unmet need. This field also is greatly in a more nuanced comprehension about the applicability in clinical practice of trials' results derived from well-selected HF population. Thus, we need to reflect on trials failures and the translation of previous trials in clinical practice in order to redirect the future trial intervention.



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Modulation of protein synthesis and degradation maintains proteostasis during yeast growth at different temperatures

Publication date: Available online 29 April 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Marta Benet, Ana Miguel, Fany Carrasco, Tianlu Li, Jordi Planells, Paula Alepuz, Vicente Tordera, José E. Pérez-Ortín
To understand how cells regulate each step in the flow of gene expression is one of the most fundamental goals in molecular biology. In this work, we have investigated several protein turnover-related steps in the context of gene expression regulation in response to changes in external temperature in model yeast Saccharomyces cerevisiae. We have found that the regulation of protein homeostasis is stricter than mRNA homeostasis. Although global translation and protein degradation rates are found to increase with temperature, the increase of the catalytic activity of ribosomes is higher than the global translation rate suggesting that yeast cells adapt the amount of translational machinery to the constraints imposed by kinetics in order to minimize energy costs. Even though the transcriptional machinery is subjected to the same constraints, we observed interesting differences between transcription and translation, which may be related to the different energy costs of the two processes as well as the differential functions of mRNAs and proteins.



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Cochlear implants in children: A cross-sectional investigation on the influence of geographic location in Saudi Arabia

Ahmed A Al-Sayed, Abdulrahman AlSanosi

Journal of Family and Community Medicine 2017 24(2):118-121

INTRODUCTION: The role of the family in detecting a child's hearing difficulty and the age at which an implantation is done have been identified as strong predictors of the outcomes of pediatric cochlear implantation. In the absence of screening programs for hearing loss in Saudi neonates, the family's role is of paramount importance. The aim of this study was to investigate the influence of geographic location on the course of identification, examination, and cochlear implantation in children in Saudi Arabia. MATERIALS AND METHODS: Pediatric patients who had received either unilateral or bilateral cochlear implantation at King Abdulaziz University Hospital in Riyadh, Saudi Arabia, between January 1, 2012, and December 31, 2014, were surveyed. RESULTS: A total of 156 pediatric patients have had a cochlear implant between January 1, 2012, and December 31, 2014. The one-way analysis of variance test to compare the means of the independent sample groups in various geographic zones showed that with a hundred percent access to primary health care, the geographic location of the population had an influence on the detection of hearing loss but not on the cochlear implantation. CONCLUSION: This study found that the geographic location of the population has an influence on the time of detection of hearing loss in children but not on the time of cochlear implantation. Raising parental awareness of the importance of early detection of hearing loss is necessary. Further research is also required to define the role of factors such as the income and the educational level of parents on the early detection of neonatal hearing loss.

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Prevalence and spectrum of functional disability of urban elderly subjects: A community-based study from Central India

Priya Keshari, Hari Shankar

Journal of Family and Community Medicine 2017 24(2):86-90

INTRODUCTION: One of the major determinants of the quality of life of elderly subjects is their functional status, which refers to their ability to perform normal daily activities. This study was carried out to determine the prevalence of functional disability in terms of restriction in the activities of daily livings (ADLs) in elderly subjects. MATERIALS AND METHODS: This community-based cross-sectional study was conducted in an urban area of Varanasi, India, with 616 elderly subjects (60 years and above) selected for the study by an appropriate sampling procedure. A predesigned and pretested questionnaire was used to elicit the desired information after taking consent from the study subjects. Statistical Package for Social Sciences (SPSS 21st version) was used for analysis; Chi-square test and z-test were used to test for statistical significance. RESULTS: Prevalence of functional disability in elderly subjects was 53.6% (95% confidence interval: 49.67–57.5%). Restriction of any ADL with maximum severity was observed in 13.5% of the subjects. Independence in ADLs was maximum (100%) for bowel continence and lowest for climbing stairs (47.4%). On the basis of Barthel Index score, 25.2% and 4.4% of the subjects had moderate and severe dependency, respectively. In comparison to mobility restriction, the proportion of subjects whose ADLs were not affected was significantly (P < 0.01) more in the self-care domain. CONCLUSION: Nearly half of the elderly subjects were functionally disabled on the basis of ADL performance. The number of persons of this age group in the domain of restricted mobility is quite high. It is necessary and also possible to design and implement programs that will involve all persons concerned with their care to improve the functional status of the geriatric population.

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Parents' perceptions about child abuse and their impact on physical and emotional child abuse: A study from primary health care centers in Riyadh, Saudi Arabia

Mohammed N Al Dosari, Mazen Ferwana, Imad Abdulmajeed, Khaled K Aldossari, Jamaan M Al-Zahrani

Journal of Family and Community Medicine 2017 24(2):79-85

OBJECTIVE: To determine perceptions of parents about child abuse, and their impact on physical and emotional child abuse. MATERIALS AND METHODS: Two hundred parents attending three primary health care centers (PHCCs) in Riyadh serving National Guard employes and their families, were requested to participate in this survey. Data was collected by self administered questionnaire. Five main risk factors areas/domains were explored; three were parent related (personal factors, history of parents' childhood abuse, and parental attitude toward punishment), and two were family/community effects and factors specific to the child. SPSS was used for data entry and analysis. Descriptive analysis included computation of mean, median, mode, frequencies, and percentages; Chi-square test and t-test were used to test for statistical significance, and regression analysis performed to explore relationships between child abuse and various risk factors. RESULTS: Thirty-four percent of the parents reported a childhood history of physical abuse. Almost 18% of the parents used physical punishment. The risk factors associated significantly with child abuse were parents' history of physical abuse, young parent, witness to domestic violence, and poor self-control. Child-related factors included a child who is difficult to control or has attention deficit hyperactivity disorder (ADHD). Parents who did not own a house were more likely to use physical punishment. Abusive beliefs of parent as risk factors were: physical punishment as an effective educational tool for a noisy child; parents' assent to physical punishment for children; it is difficult to differentiate between physical punishment and child abuse; parents have the right to discipline their child as they deem necessary; and there is no need for a system for the prevention of child abuse. CONCLUSION: The causes of child abuse and neglect are complex. Though detecting child abuse may be difficult in primary care practice, many risk factors can be identified early. Parents' attitudes can be measured, and prevention initiatives, such as screening and counseling for parents of children at risk, can be developed and incorporated into primary care practice.

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To what extent are Arab pilgrims to Makkah aware of the middle east respiratory syndrome coronavirus and the precautions against it?

Meshaal S Alotaibi, Abdulaziz M Alsubaie, Khaled A Almohaimede, Turki A Alotaibi, Omar A Alharbi, Abdulrahman F Aljadoa, Abdulaziz H Alhamad, Mazin Barry

Journal of Family and Community Medicine 2017 24(2):91-96

BACKGROUND: Approximately, 80% of the many cases of the Middle East respiratory syndrome coronavirus (MERS-CoV) confirmed worldwide were diagnosed in the Kingdom of Saudi Arabia (KSA). The risk of the disease spreading internationally is especially worrying given the role of KSA as the home of the most important Islamic pilgrimage sites. This means the need to assess Arab pilgrims' awareness of MERS-CoV is of paramount importance. MATERIALS AND METHODS: A cross-sectional study was carried out during Ramadan 2015 in the Holy Mosque in Makkah, Saudi Arabia. Self-administered questionnaires were distributed to 417 Arab participants at King Fahad Extension, King Abdullah Prayer Extension and, King Abdullah Piazza Extension after Taraweeh and Fajr prayers. RESULTS: The mean MERS-CoV knowledge score was 52.56. Majority of the respondents (91.3%) were familiar with MERS-CoV. Saudis had significantly higher knowledge of MERS-CoV than non-Saudis (56.92 ± 18.55 vs. 44.91 ± 25.46, p = 0.001). Females had significantly more knowledge about consanguineous MERS-CoV than males (55.82 ± 19.35 vs. 49.93 ± 23.66, p = 0.006). The average knowledge was significantly higher in respondents who had received health advice on MERS-CoV (56.08 ± 20.86 vs. 50.65 ± 22.51, p = 0.024). With respect to stepwise linear regression, knowledge of MERS-CoV tended to increase by 14.23 (B = 14.23%, p = 0.001) in participants who were familiar with MERS-CoV, and by 8.50 (B = 8.50, p = 0.001) in those who perceived MERS-CoV as a very serious disease. CONCLUSION: There is a great need for educational programs to increase awareness about MERS-CoV.

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Eagle's syndrome with facial palsy

Mohammed Al-Hashim, Nasser Al-Jazan, Abdulrahman Abdulqader, Mohammed Al-Ghamdi

Journal of Family and Community Medicine 2017 24(2):128-130

Eagle's syndrome (ES) is a rare disease in which the styloid process is elongated and compressing adjacent structures. We describe a rare presentation of ES in which the patient presented with facial palsy. Facial palsy as a presentation of ES is very rare. A review of the English literature revealed only one previously reported case. Our case is a 39-year-old male who presented with left facial palsy. He also reported a 9-year history of the classical symptoms of ES. A computed tomography scan with three-dimensional reconstruction confirmed the diagnoses. He was started on conservative management but without significant improvement. Surgical intervention was offered, but the patient refused. It is important for otolaryngologists, dentists, and other specialists who deal with head and neck problems to be able to recognize ES despite its rarity. Although the patient responded to a treatment similar to that of Bell's palsy because of the clinical features and imaging, ES was most likely the cause of his facial palsy.

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Perspective of Saudi women in the Makkah region on breast cancer awareness

Tahani H Nageeti, Arwa A. N Abdelhameed, Raid A Jastania, Rania M Felemban

Journal of Family and Community Medicine 2017 24(2):97-101

OBJECTIVE: To assess the perspective of Saudi women in the Makkah region on breast cancer awareness and early detection. MATERIALS AND METHODS: A mixed method study was conducted among 25-65 years old healthy Saudi females from Makkah region during the awareness campaign in October 2014. The participants were recruited by personal invitations at the women's places of work and social gatherings. The initial invitations were issued by either the research coordinator or the investigator. All women were asked to complete a short questionnaire on basic knowledge on breast cancer. This was followed by focus group discussions. All interviews were carried out by female breast cancer consultant oncologists. All discussion transcripts were summarized and categorized into main themes; data presented as frequencies and percentages. RESULTS: Forty Saudi females, aged 25-65 years, were included in the study. Nearly 38% of them had never attended any awareness campaign on breast cancer. Only 10% of the participants correctly answered all five basic questions on the risk and early detection of breast cancer; 63% of the women had never been taught breast self-examination. Participants' perception was discussed in five focus groups. Four themes were identified during the discussions: knowledge about breast cancer and screening; resources of breast cancer awareness; social support for access to awareness program; and beliefs on breast cancer and early detection. CONCLUSION: We recommend that strategies on breast cancer awareness in our population should focus on early detection by improving the knowledge and skills of women. These strategies should include programs widely accessible through primary health-care centers and other health-care institutions. In addition, we recommend that physicians and family members should be involved in these programs.

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Health education to diabetic patients before the start of Ramadan: Experience from a teaching hospital in Dammam

Rayyan M Al-Musally, Mais A Al-Sardi, Zainab A Al-Elq, Afnan H Elahi, Rawan K Alduhailan, Muslim A Al-Elq, Fatma A Zainuddin, Noura A Alsafar, Jannat A Altammar, Abdulmohsen H Al-Elq

Journal of Family and Community Medicine 2017 24(2):111-117

BACKGROUND AND OBJECTIVE: Studies have shown that pre-Ramadan structured educational program for patients with diabetes mellitus (DM) is beneficial. In this study, our aim was to evaluate the degree of adherence of treating physicians to such programs and their influence on the patient's knowledge and behavior. MATERIALS AND METHODS: This cross-sectional study was carried out on adult patients with DM attending a university hospital, who were observed while fasting during Ramadan 1436/2015. Data was collected using a questionnaire-based interview. Baseline characteristics were obtained, and patients were asked whether they had had pre-Ramadan education or not and who the provider was. Patients' knowledge of the components of the recommended structured pre-Ramadan educational program was also tested. Comparison between patients who had the education and those who did not was done using Chi-square test and independent samples Student's t-test; p ≤ 0.05 was considered statistically significant. RESULTS: A total of 298 patients with type 1 or type 2 DM were included in the study; 75.5% of the patients were aged 40 years or older. Only 30% had pre-Ramadan education delivered mainly by diabetic educators or the treating physicians (52% and 44%, respectively). Patients who had the education were younger (mean age: 45.6 ± 17.4 vs. 50.3 ± 14.4, respectively, p = 0.0048), had higher educational qualifications, were more likely to be employed, and self-monitored their blood glucose more frequently (p = 0.0001). There was no difference between the two groups with regard to their knowledge of diet and exercise. CONCLUSION: The adherence to the pre-Ramadan educational program by the treating physician was low. It is necessary to increase the awareness about the importance of these programs among health-care professionals. The programs should target the less educated, the unemployed, and older patients.

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Mild respiratory symptoms in asthmatic patients might not be due to bronchoconstriction

Tarig H Merghani

Journal of Family and Community Medicine 2017 24(2):102-105

BACKGROUND: Although respiratory symptoms in asthmatic patients are likely to be caused by bronchoconstriction, this should be confirmed by spirometry. In this study, our aim was to determine the percentage of asthmatic patients who present with mild respiratory symptoms but fail to show any evidence of bronchoconstriction in spirometry. MATERIALS AND METHODS: A total of 428 known asthmatic patients (57.5% females) participated in the study. Inclusion criteria were age ≥16 years, known asthmatics for at least 1 year, presenting with mild respiratory symptoms including cough, wheezes, shortness of breath, and chest tightness. Patients presenting with moderate or severe asthma exacerbations were excluded from the study. Spirometry measurements were performed according to the guidelines of the American Thoracic Society. SPSS was used for data analysis. The percentage of patients who did not show any evidence of airway obstruction was calculated. For spirometry variables, mean and standard deviation were calculated. For the categorical variables, Chi-square test was performed to determine statistical significance at alpha=0.05. RESULTS: Typical obstructive pattern was found in 38 (or 9%) of all participants. Evidence of obstruction within small or middle airways was found in all those who showed an obstructive pattern and more than 90% of those who showed restrictive or mixed patterns. About 11% of the participants showed a normal spirometric pattern with no evidence of small airway obstruction. Statistical analysis showed an insignificant relation between patterns of spirometry and gender or body mass index of the participants. CONCLUSION: About 11% of asthmatic patients with mild respiratory symptoms who attended the respiratory clinic have no evidence of bronchoconstriction. Spirometry is an essential step for evaluation of every asthmatic patient who presents with respiratory symptoms.

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Satisfaction with a 2-day communication skills course culturally tailored for medical specialists in Qatar

Carma L Bylund, Khalid Alyafei, Abdelhamid Afana, Sheyma Al-Romaihi, Mohammed Yassin, Maha Elnashar, Banan Al-Arab, Abdullatif Al-Khal

Journal of Family and Community Medicine 2017 24(2):122-127

OBJECTIVE: Health-care communication skills training may be particularly needed in the Arabian Gulf countries because of the variety of cultures within the physician and patient populations. This study describes the implementation and results of a communication skills training program for physicians in Qatar that assessed previous training, and effect of previous training on participants' course evaluations. MATERIALS AND METHODS: We conducted a 2-day communication skills training course covering seven culturally adapted modules. Educational strategies included large and small group work with the standardized patient, demonstration videos, and lectures. At the end, participants completed a course evaluation survey. Data analysis performed with SPSS; frequencies and percentages were calculated, and Chi-square test applied to evaluate statistical significance. RESULTS: A total of 410 physicians in Qatar have participated in the course over a period of 2 years. Evaluation ratings of the course were high. Participants rated the module on Breaking Bad News as the most useful, and the small group role-play as the most helpful course component. One-third of participants had previously participated in experiential communication skills training. There was no association between previous experience and evaluation of the course. CONCLUSION: Physicians in Qatar positively evaluated a 2-day communication skills course, though the majority of participants did not have any previous exposure to experiential communication skills training.

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Doctors' knowledge of patients' rights at King Fahd Hospital of the University

Sarah A Al-Muammar, Danya M. K Gari

Journal of Family and Community Medicine 2017 24(2):106-110

OBJECTIVES: To assess the level of physicians' knowledge about the contents of patients' bill of rights (PBR) and its implementation. MATERIALS AND METHODS: This cross-sectional study was carried out at a university hospital in the Eastern Province of Saudi Arabia. All physicians working in the hospital received a self-administered questionnaire to measure their level of knowledge of PBR. Scoring was done to determine the knowledge of the details. The study was approved by the Institutional Review Board of the University Hospital and permission sought from the administration. Data analysis performed with SPSS; descriptive analyses included frequency and percentages for categorical variables, and mean and standard deviations for continuous variables. Bivariate analyses were carried out to determine association between sociodemographic variables and the level of knowledge (adequate/inadequate). Logistic regression analysis were performed to calculate adjusted odds ratio at 0.05 significance level. RESULTS: Most (52.7%) of the physicians were females, were aged between 25 and 30 years (58.5%), and Saudi (80.2%). The majority of the physicians belonged to the residency program (44.9%) and had work experience of 1–5 years (45.4%). About 44% physicians had adequate knowledge about PBR and 55.56% had inadequate knowledge. Regarding physician's response to each item of PBR, the majority (98.1%) gave correct answer to Item 2: “Patients should know the identity and professional status of the healthcare providers responsible for their treatment” (98.1%). Item 25: “Doctors are entitled to withhold any procedures related to a patient's condition if the patient refuses their choice of treatment” was the item with the least correct response (15.5%). CONCLUSION: Reinforcement and strict implementation of PBR are necessary. The institution should provide training and motivate physicians, especially younger doctors regarding PBR to ensure good health for all and safeguard the integrity of both the physician and the hospital.

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Use of International physical activity questionnaire-short form for assessment of physical activity of children

Madhavi Bhargava

Journal of Family and Community Medicine 2017 24(2):131-131



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Alkaline phosphatase and lactate dehydrogenase enzyme activity in gingival crevicular fluid during orthodontic tooth movement

N Yannawar Vijay, RM Dharma, MR Dinesh, Kalpesh Sharma, Sunny Gupta, Garima Chitakara, Abhishek Singh Nayyar

Journal of Clinical Sciences 2017 14(2):86-90

Background: Bone remodeling is a biologic process involving an acute inflammatory response in periodontal tissues during orthodontic tooth movement. The early response of periodontal tissues to mechanical stress involves metabolic changes that allow tooth movement. Aim of the Study: The aim of the present study was to evaluate the changes in alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) enzyme activity in gingival crevicular fluid (GCF) when forces are applied during initial alignment (P1) and retraction (P2). Settings and Design: The study was performed in a hospital-based population with an experimental design. Materials and Methods: Seventeen participants (11–21 years) included in the study, all requiring first premolar extractions were undergoing fixed orthodontic treatment. Maxillary canine and mandibular second molar were used as test tooth (TT) and control tooth (CT) in each patient, respectively. On 14th day after the start of each phase, 2 μL of GCF was collected from mesial side of both TT and CT for ALP and LDH activity determination using a spectrophotometer. Statistical Analysis: The results were subjected for Student's t-test. Results: There was a variation in enzyme activity during orthodontic tooth movement. At TT, there was a statistically significant increase in ALP and LDH activity in P2 as compared to P1 with P = 0.005 and P ≤ 0.001, respectively. At CT, there was no statistically significant difference in ALP and LDH activity in P1 and P2 with P = 0.054 and P = 0.061, respectively. Conclusion: This study concluded that ALP and LDH activity could be successfully estimated in the GCF, and ALP and LDH activity in GCF reflects the biologic activity in the periodontium during orthodontic tooth movements.

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Erythema nodosum leprosum limited to sun-exposed sites: An unusual presentation of type 2 lepra reaction

Ajay Kumar, Ashish Dalal, Sanjeev Gupta, Eshita Dadwal

Journal of Clinical Sciences 2017 14(2):101-103

The distribution of erythema nodosum leprosum lesions limited to sun-exposed sites is an unusual presentation of a type 2 reaction. We report the case of a 23-year-old female who presented with erythematous papules, nodules and plaques confined to sun-exposed areas over the face, extensor aspect of both arms and forearms, and “V” of chest with fever and joint pains as well as ulnar clawing of the left hand. A diagnosis of type 2 lepra reaction was made which was confirmed by slit skin smear and skin biopsy.

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Seroprevalence of hepatitis B and C infection among Nigerian subjects with chronic kidney disease

Christiana Oluwatoyin Amira, Oluwafunmilayo Adenike Lesi

Journal of Clinical Sciences 2017 14(2):58-61

Background and Objective: The prevalence of hepatitis virus infection in subjects with chronic kidney disease (CKD) has important implications for the etiology of kidney disease, infection safety in hemodialysis, and increases challenges in management consideration. The aim of this study was to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among our patients with CKD before the commencement of dialysis. Methods: All CKD patients (n = 1388) dialyzed between January 1996 and December 2012 were enrolled into the study. Demographic data and etiology of CKD were extracted from case records. Patients were screened for HBV and HCV at initiation of dialysis. Hepatitis B surface antigen (HBsAg), HCV antibodies were measured using specific enzyme-linked immunoassay kits (Bio Rad Monalisa HBsAg ULTRA kit, Marnes–la-Coquette, France; HCV Dia.Pro Diagnostics Milano Italy, respectively). All subjects with HIV infection were excluded from the study. Results: The studied group comprised 511 (36.8%) females; the mean age of the patients was 46.1 ± 15.3 years. Eighty-three (6.0%) patients were HBsAg positive, whereas 16 (1.2%) were HCV antibody positive. No difference was observed in gender occurrence. Patients with chronic glomerulonephritis (GN) were significantly more likely to be HBsAg positive (9%) compared with those with hypertension (5.5%) or diabetes (5.3%) (P = 0.015). Conclusion: The prevalence of HBV in CKD patients was high, whereas HCV was low. HBV was significantly associated with chronic GN. Routine screening of all patients with CKD and before hemodialysis for HBV should be mandatory, especially in HBV endemic regions of the world.

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Garcin's syndrome secondary to rectal carcinoma in a Nigerian child

Adesoji O Ademuyiwa, Oludayo A Sowande, Adeoye J Adetiloye, Olusanya Adejuyigbe

Journal of Clinical Sciences 2017 14(2):94-97

Colorectal carcinoma in childhood is rare in spite of the rising prevalence of the condition in the African population. Even rarer is the occurrence of multiple cranial nerve paralysis simulating Garcin's syndrome in this age group. This report discusses a case of an 11-year-old boy who presented to our unit with histologically confirmed adenocarcinoma of the rectum with cerebral metastasis and multiple cranial nerve paralysis suggestive of Garcin's syndrome. Challenges in management were highlighted, and we reviewed the literature on colorectal carcinoma in children.

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Improvement in intensive care unit: Effect on mortality

Adeniyi Adesida, Olanrewaju Akanmu, Rita Oladele, Oyebola Olubodun Adekola, Ibironke Desalu

Journal of Clinical Sciences 2017 14(2):62-67

Background: The Lagos University Teaching Hospital's Intensive Care Unit (ICU) was founded in 1975. It was designed as an eight-bedded ICU, a previous review of outcome of surgical admissions in the ICU in 2002 placed mortality at 40.3%, however, presently run as a five-bed unit with new ICU equipment procured in 2012, arterial blood gas machines, patient monitors, and ventilators with sustained multidisciplinary approach to patient management. We compared the number of admissions, mortality, and discharges to the ward 1 year before (Period I) and after the upgrade of the ICU facilities (Period II). Methods: This was a retrospective study of all patients admitted into the ICU between June 2011 and May 2013. We looked at the admission register of the ICU and retrieved biometric data, diagnosis, age, pattern of units admitting patients into ICU, length of stay (LOS), and outcome of ICU care whether the patient died in ICU or was discharged to the ward. Results: There were 122 patients admitted into the ICU in Period I and 156 patients were admitted in Period II with a mean LOS of 6.3 ± 5.4 days and 7.8 ± 7.3 days, respectively. Mortality rate in Period I was 74.6% while mortality fell to 57.7% in Period II (P = 0.005). Conclusion: There was a significant improvement in the ICU outcome with the upgrade of the ICU facilities.

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Change of guard at the College of Medicine, University of Lagos

Elaine Chinyelu Azinge

Journal of Clinical Sciences 2017 14(2):57-57



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Knowledge and consumption of fruits and vegetables among secondary school students of Obele Community Junior High School, Surulere, Lagos State, Nigeria

Oluwakanyinsola Ojuolape Silva, Olayinka O Ayankogbe, Tinuola O Odugbemi

Journal of Clinical Sciences 2017 14(2):68-73

Background: The incidence of noncommunicable diseases (NCDs) is increasing in developing countries, largely due to lifestyle and dietary changes. Adolescents are a nutritionally vulnerable age group; however, poor eating habits are often observed in adolescents. It has been observed that individuals who develop healthy eating habits early on in life are more likely to maintain them into adulthood and have a reduced risk of developing NCDs. This study aimed to assess the knowledge and consumption pattern of fruits and vegetables among junior secondary school students. Materials and Methods: This was a cross-sectional descriptive study of 220 respondents selected using a multistage sampling technique. An interviewer-administered questionnaire was used to collect data, which was analyzed using Epi Info Version 7 statistical software. Results obtained were presented with the use of frequency tables. Results: Results from this study revealed that 84.99% of the respondents displayed good knowledge of the nutritional and health values of fruits and vegetables; however, the consumption of fruits and vegetables was appropriate in only 5.48% of the respondents, having five portions of fruits and vegetables daily. Parental intake, encouragement, and supervision as well as availability and accessibility to fruits and vegetables at home were motivators for appropriate consumption. Conclusion: This study has revealed that the students of Obele Community Junior High School, Surulere, have good knowledge of the nutritional and health values of fruits and vegetables. However, the students have inappropriate daily consumption, as their consumption falls below the World Health Organization recommended five portions daily. Efforts should be made by the students themselves, the family, the School, all and sundry in the community to effect change soonest, so that these adolescents maintain healthy eating habits into adulthood, and hence prevent the occurrence of nutrition-related NCDs later on in life.

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Multilevel noncontiguous cervical spine injury

Adetunji Mapaderun Toluse

Journal of Clinical Sciences 2017 14(2):91-93

This case report highlights the successful combination of operative and nonoperative management of a patient with noncontiguous cervical spine fractures and incomplete spinal cord injury. A case report of a 40-year-old male victim of a motor vehicular accident who presented with noncontiguous cervical spine fractures (Anderson and D'Alonzo Type III odontoid fracture and traumatic spondylolisthesis of C4/C5) and incomplete spinal cord injury. The odontoid fracture was managed nonoperatively, whereas anterior cervical discectomy and fusion were done at the C4/C5 vertebral level. The patient made full neurologic recovery with radiologic evidence of successful fusion and fracture healing at 12 weeks postoperation in both levels of injuries. Operative and nonoperative modalities can be utilized to manage selected patients.

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Development of pelvis phantom for verification of treatment planning system using convolution, fast superposition, and superposition algorithms

Michael Onoriode Akpochafor, Chibuzo Bede Madu, Muhammad Yaqub Habeebu, Akintayo Daniel Omojola, Samuel Olaolu Adeneye, Moses Adebayo Aweda

Journal of Clinical Sciences 2017 14(2):74-80

Background: The cost of commercial pelvis phantom is a burden to the quality assurance in radiotherapy of small and/or low-income radiotherapy centers. That an algorithm is accurate with short treatment time is a prized asset in treatment planning. Objectives: The purpose of this study was to develop a hybrid algorithm that has balance between accuracy and treatment time and design a pelvis phantom for evaluating the accuracy of a linear accelerator monitor unit. Materials and Methods: A pelvis phantom was designed using Plaster of Paris, styrofoam and water with six hollows for inserting materials mimicking different biological tissues, and the ionization chamber. Computed tomography images of the phantom were transferred to the CMS XiO treatment planning system with three different algorithms. Monitor units were obtained with clinical linear accelerator with isocentric setup. The phantom was tested using convolution (C), fast superposition (FSS), and superposition (S) algorithms with respect to an established reference dose of 1 Gy from a large water phantom. Data analysis value was done using GraphPad Prism 5.0. Results: FSS algorithm showed better accuracy than C and S with bone, lung, and solid water inhomogeneous insert. C algorithm was better in terms of treatment time than S. There was no statistically significant difference between the mean doses for all the three algorithms against the reference dose. The maximum percentage deviation was ±4%, which was below ±5% International Commission on Radiation Units and Measurement minimal limit. Conclusion: This algorithm can be employed in the calculation of dose in advance techniques such as intensity-modulated radiation therapy and RapidArc by radiotherapy centers with multiple algorithm system because it is easy to implement. The materials used for the construction of the phantom are very affordable and simple for low-budget radiotherapy centers.

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Combining Virtual Touch Tissue Imaging and BI-RADS May Improve Solid Breast Lesion Evaluation


Breast Care

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Value of Digital Breast Tomosynthesis versus Additional Views for the Assessment of Screen-Detected Abnormalities - a First Analysis


Breast Care

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Combined Treatment of a Gallbladder Volvulus with a Common Bile Duct Obstruction

Gallbladder volvulus is a rare disease and can lead to an acute cholecystitis. We report the case of an elderly woman with a gallbladder volvulus, diagnosed at CT scan and treated by surgery and endoscopic sphincterotomy.

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Novel Wideband Metallic Patch Antennas with Low Profile

Two planar metallic patch (MP) antennas with low profiles are investigated and compared in this paper. The MP of each antenna consists of metallic patch cells and it is centrally fed by a rectangular slot. Two modes with close resonance frequencies are excited, providing a quite wide bandwidth. The antenna principle is explained clearly through a parametric study. Simulated and measured results show that the MP antennas with profile of 0.06 can obtain a 10 dB impedance bandwidth of ~32% and an average gain of ~10 dBi.

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Reconfigurable Antenna for Jamming Mitigation of Legacy GPS Receivers

We propose a simple solution for jamming mitigation of L1 band GPS by electronically switching antenna beam for wide and narrow beamwidths. Assuming the jamming signal is directed from low elevation angles, antenna reception can be made significantly lower at these angles by electronically reconfiguring the antenna beamwidth. Four-element antenna array and one of the elements of the array are designated as antijam (array) mode and normal mode of the antenna. The antenna is placed on a degenerate-ground with symmetric slots in the ground. Front-end configuration for this antenna is also discussed. Simulations and measurements are performed to validate the proposed design. The antenna achieves more than 15 dB rejection in measurements and more than 20 dB cross-polarization improvement compared to standalone (normal mode) antenna. The system can easily be replaced with existing active antenna to improve antijam capability of the receiver.

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Failed TAVI in TAVI Implantation: TAVI Dislocation Followed by Ensuing Surgical Graft Resection

We are presenting a case report of failed valve-in-valve treatment of severe aortic stenosis. A control ultrasonography after TAVI implantation revealed a severe aortic regurgitation of the graft which was subsequently unresolved with postimplantation dilatation. Second TAVI was implanted with cranial dislocation to the aortic root. Patient underwent a CT examination to clarify the TAVI in TAVI position. Patient underwent a surgical resection of TAVI with implantation of biological aortic valve prosthesis. In situations where TAVI treatment fails or is complicated beyond the possibility of endovascular repair, surgical intervention despite its higher risks is the preferred choice.

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Physical Education in a Thermal Spa Resort to Maintain an Active Lifestyle at Home: A One-Year Self-Controlled Follow-Up Pilot Study

The self-controlled follow-up pilot study was set up to examine the maintenance of engagement in physical activity by a group of older adults in a thermal spa resort, as a consequence of the inclusion of additional physical education sessions within their usual care offers. A cohort of 42 participants (70.4 ± 4.5 years) underwent three weeks of thermal treatment with additional physical education (PE) sessions. Measurements were established during the intervention in 2 periods (baseline and final thermal treatment evaluation) and 4 periods of measurements in the follow-up (+15 days, +2 months, +6 months, and +1 year). Physical measures (anthropometrics, flexibility, and 6-minute walk test) and intrapersonal and psychosocial factors as well as health-related quality of life (HQOL) and physical activity (PA) were self-reported by participants. Only HQOL and PA were assessed during the follow-up. One year after a 3-week PE session combined with the usual thermal care, 64% of the participants exhibited a higher volume of PA than at baseline. The components of the HQOL changed during the follow-up. This strategy to maintain PA engagement appears to be feasible in a population of thermal care older adults. This work demonstrates the feasibility of a study conducted to maintain physical activity engagement after a thermal treatment.

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Surface Treatment on Physical Properties and Biocompatibility of Orthodontic Power Chains

The conventional orthodontic power chain, often composed of polymer materials, has drawbacks such as a reduction of elasticity owing to water absorption as well as surface discoloration and staining resulting from food or beverages consumed by the patient. The goal of this study was to develop a surface treatment (nanoimprinting) for orthodontic power chains and to alleviate their shortcomings. A concave template (anodic alumina) was manufactured by anodization process using pure aluminum substrate by employing the nanoimprinting process. Convex nanopillars were fabricated on the surface of orthodontic power chains, resulting in surface treatment. Distinct parameters of the nanoimprinting process (e.g., imprinting temperature, imprinting pressure, imprinting time, and demolding temperature) were used to fabricate nanopillars on the surface of orthodontic power chains. The results of this study showed that the contact angle of the power chains became larger after surface treatment. In addition, the power chains changed from hydrophilic to hydrophobic. The power chain before surface treatment without water absorption had a water absorption rate of approximately 4%, whereas a modified chain had a water absorption rate of approximately 2%–4%. Furthermore, the color adhesion of the orthodontic power chains after surface modification was less than that before surface modification.

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Factor XII as a Risk Marker for Hemorrhagic Stroke: A Prospective Cohort Study

Background: Coagulation factor XII (FXII) is involved in pathological thrombus formation and is a suggested target of anticoagulants. It is unclear whether FXII levels are correlated with cardiovascular risk factors and whether they are associated with myocardial infarction or ischemic or hemorrhagic stroke. The aim of this study was to investigate the correlation between FXII and cardiovascular risk factors in the general population. We also aimed to study the associations between FXII levels and future myocardial infarction and ischemic and hemorrhagic stroke. Methods: This prospective cohort study measured FXII levels in 1,852 randomly selected participants in a health survey performed in northern Sweden in 1994. Participants were followed until myocardial infarction, stroke, death, or until December 31, 2011. Results: During the median follow-up of 17.9 years, 165 individuals were diagnosed with myocardial infarction, 108 with ischemic stroke, and 30 with hemorrhagic stroke. There were weak correlations between FXII and body mass index, cholesterol, and hypertension. There was no association between FXII and myocardial infarction or ischemic stroke, neither in univariable Cox regression analysis nor after adjustment for age, sex, smoking, body mass index, cholesterol, hypertension, and diabetes. In univariable Cox regression analysis, the hazard ratio for the association between FXII levels and hemorrhagic stroke was 1.42 per SD (95% confidence interval: 0.99–2.05). In the multivariable model, higher levels of FXII were associated with increased risk of hemorrhagic stroke (hazard ratio 1.51 per SD; 95% confidence interval: 1.03–2.21). Conclusion: We found an independent association between FXII levels and the risk of hemorrhagic stroke, but not between FXII levels and ischemic stroke or myocardial infarction.
Cerebrovasc Dis Extra 2017;7:84–94

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Bond Strength and Surface Microhardness of Calcium Silicate-Based Biomaterials

none required


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Double Incision Approach and Early Rehabilitation in a Complicated Bicondylar Tibial Plateau Fracture: A Case Report

Objective: The main goal of this case was to report the treatment of bicondylar fractures of the tibial plateau and the restoration of the metaphyseo-diaphyseal dissociation. Clinical Presentation and Intervention: A 54-year old man who was cycling had a road accident that caused a closed fracture of the right tibial plateau and proximal fibula diagnosed by x-rays. Patient had surgical procedure and was immobilized with a long-leg splint for 4 weeks. After immobilization, aggressive rehabilitation was done. Progressive quadriceps strengthening, movements to improve symmetrical weight bearing, and functional activities were performed. The patient improved muscle strength and obtained high scores for gait and balance, in a relatively short time. Conclusion: In this report, a bicondylar tibial fracture treated with a 2-incision approach and a double plate osteosynthesis, provided a strong fracture stabilization and thereby, allowed an early mobilization with aggressive rehabilitation.


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The effect of retraining on treatment success, life quality and metabolic parameters in patients with type 1 diabetes using insulin pump

Objective: To investigate the effect of insulin pump user retraining on treatment success, quality of life, and metabolic parameters of patients with type 1 diabetes using continuous subcutaneous insulin infusion (CSII). Subjects and Methods: A total of 35 subjects participated in this prospective study. All patients were given insulin pump user retraining. Their knowledge level and application skills, metabolic parameters, life qualities and satisfaction from treatment were evaluated at baseline and after 6 months. Results: There was significant improvement in patients’ knowledge and application skills after insulin pump user retraining (self-assessment of user skills: 69.7#177;11.5 vs. 76.3#177;11.3, p

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A Comparison of Three Different Volumes of Levobupivacaine for Caudal Block in Children Undergoing Orchidopexy and Inguinal Hernia Repair

Objective: The aim of this study was to compare the efficacy of three different volumes of 0.25% levobupivacaine caudally administered on the effect of intra- and post-operative analgesia in children undergoing orchidopexy and inguinal hernia repair. Subjects and Methods: Forty children, aged 1 to 7 years, American Society of Anesthesiologists (ASA) physical status I and II, were randomized into 3 different groups according to the applied volumes of 0.25% levobupivacaine: group 1 (n=13): 0.6 ml.kg-1; group 2 (n=10): 0.8 ml.kg-1 and group 3 (n=17): 1.0 ml.kg-1. The age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage and addition of intraoperative fentanyl were compared among the groups. The time to first use of the analgesic as well as a number of patients who required analgesic 24 hours after surgery in the time intervals: within 6 hours, between 6-12 and between 12-24 hours postoperatively, were evaluated among the groups. Statistical analyses were performed with Dunett t-test, ANOVA or Kruskal Wallis test and Χ2 test. Logistic regression analysis was used in order to examine predictive factors on duration of postoperative analgesia. Results: The age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage and addition of intraoperative fentanyl was similar among the groups. The time to first analgesic use was similar among the groups and logistic regression model showed that the using the three different volumes of levobupivacaine had no predictive influence on duration of postoperative analgesia. The number of patients who required analgesic within 6 (3/2/3), between 6-12 (3/1/3) and between 12-24 hours (1/0/2) after surgery was similar among the groups. Conclusion: The three different volumes of 0.25% levobupivacaine provided the same quality of intra- and post-operative pain relief in pediatric patients undergoing orchidopexy and inguinal hernia repair.


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Increased Visfatin Expression is Associated with Nuclear Factor-kappa β in Obese-Ovalbumin Sensitized Male Wistar Rats Trachea

Objective: To investigate the effects of diet-induced obesity on the expression of nuclear factor-kappa β and visfatin messenger RNA in male Wistar rats’ tracheae after sensitization with ovalbumin (OVA). Materials and Methods: Twenty (20) male Wistar rats were divided into four groups (n=5 for each group), that included a control fed normal diet (ND), and fed normal diet OVA-sensitized (S+ND), high-fat diet (HFD) only, (diet induced obesity) and high-fat diet OVA-sensitized (S+HFD). All animals were fed for 8 weeks with standard pelts or high-fat diet, and then were sensitized and challenged with OVA or saline for another 4 weeks as per the above groups. The rats anesthetized, then the necks were exposed, the tracheae isolated and examined for expression levels of NF-κβ and visfatin mRNA with real time polymerase chain reaction method. Data were compared between different groups using one-way analysis of variance. Results: The expression levels of NF-κβ mRNA in S+HFD: 2.67 was statistically higher than in ND: 0.96 (p=0.001), S+ND: 1.86 (p=0.05), and HFD: 1.26 (p=0.001). Also, visfatin mRNA expression level in S+HFD: 4.21 was higher than ND: 0.92 and S+ND: 1.79 and HFD: 2.20 (p=0.001). Conclusion: In this study, the expression levels of NF-κβ and visfatin were markedly higher in high-fat diet sensitized rat compared with other groups. These findings indicate that alternative signaling pathways might be activated in diet-induced obesity associated with OVA-sensitized animal model and could be responsible for possible altered sensitization phenotype.


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The Skeletal Cell-Derived Molecule Sclerostin Drives Bone Marrow Adipogenesis

Abstract

The bone marrow niche is a dynamic and complex microenvironment that can both regulate, and be regulated by the bone matrix. Within the bone marrow (BM), mesenchymal stromal cell (MSC) precursors reside in a multi-potent state and retain the capacity to differentiate down osteoblastic, adipogenic, or chondrogenic lineages in response to numerous biochemical cues. These signals can be altered in various pathological states including, but not limited to, osteoporotic-induced fracture, systemic adiposity, and the presence of bone-homing cancers. Herein we provide evidence that signals from the bone matrix (osteocytes) determine marrow adiposity by regulating adipogenesis in the bone marrow. Specifically, we found that physiologically relevant levels of Sclerostin (SOST), which is a Wnt-inhibitory molecule secreted from bone matrix-embedded osteocytes, can induce adipogenesis in 3T3-L1 cells, mouse ear- and BM-derived MSCs, and human BM-derived MSCs. We demonstrate that the mechanism of SOST induction of adipogenesis is through inhibition of Wnt signaling in pre-adipocytes. We also demonstrate that a decrease of sclerostin in vivo, via both genetic and pharmaceutical methods, significantly decreases bone marrow adipose tissue (BMAT) formation. Overall, this work demonstrates a direct role for SOST in regulating fate determination of BM-adipocyte progenitors. This provides a novel mechanism for which BMAT is governed by the local bone microenvironment, which may prove relevant in the pathogenesis of certain diseases involving marrow adipose. Importantly, with anti-sclerostin therapy at the forefront of osteoporosis treatment and a greater recognition of the role of BMAT in disease, these data are likely to have important clinical implications.This article is protected by copyright. All rights reserved



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Relationship between activity limitation and health-related quality of life in school-aged children with cerebral palsy: a cross-sectional study

Information on health-related quality of life is becoming increasingly important in children with cerebral palsy. This study investigated the relationship between activity limitation and health-related quality...

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A review of patient-reported outcome measures to assess female infertility-related quality of life

Infertility has a negative impact on quality of life (QoL) and well-being of affected individuals and couples. A variety of patient-reported outcome (PRO) measures to assess infertility-related QoL are availab...

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Nutritional status and quality of life of cancer patients needing exclusive chemotherapy: a longitudinal study

The aims of this study were to report nutritional status in a large panel of patients with cancer requiring exclusive chemotherapy and to study the influence of nutritional status on their quality of life (QoL).

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A systematic approach for studying the signs and symptoms of fever in adult patients: the fever assessment tool (FAST)

Although body temperature is one of four key vital signs routinely monitored and treated in clinical practice, relatively little is known about the symptoms associated with febrile states. The purpose of this ...

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Oral impacts on quality of life and problem-oriented attendance among South East London adults

Dental care seeking behaviour is often driven by symptoms. The value of oral health related quality of life (OHRQoL) measures to predict utilisation of dental services is unknown. This study aims to explore th...

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What's in a name?



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Issue Information



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Profiling of Illicit Cocaine Seized in China by ICP-MS Analysis of Inorganic Elements

Throughout the world, characterization and impurity profiling of seized drugs are increasingly being used to complement routine investigative work by law enforcement authorities. Chemical links between samples may be established, material from different seizures may be classified into groups of related samples and the origin of samples may be identified. That information may be used for evidential purposes or it may be used as a source of more general intelligence to identify drug trafficking patterns and distribution networks [1–3].

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5-Fluorouracil Targets Histone Acetyltransferases p300/CBP in the Treatment of Colorectal Cancer

Although 5-fluorouracil (5-FU) is known to interfere with the synthesis of ribonucleic acid and deoxyribonucleic acid, the mechanism underlying its therapeutic efficacy in colorectal cancer (CRC) has not been fully elucidated. We aimed to investigate the influence of 5-FU on histone acetylation, a well-established anti-cancer target, to reveal novel pharmacological effects of 5-FU and their significance for CRC therapy. Results demonstrated that 5-FU induces global histone de-acetylation in multiple CRC cell lines.

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Predicting multiple target tracking performance for applications on video sequences

Abstract

This paper presents a framework to predict the performance of multiple target tracking (MTT) techniques. The framework is based on the mathematical descriptors of point processes, the probability generating functional (p.g.fl). It is shown that conceptually the p.g.fls of MTT techniques can be interpreted as a transform that can be marginalized to an expression that encodes all the information regarding the likelihood model as well as the underlying assumptions present in a given tracking technique. In order to use this approach for tracker performance prediction in video sequences, a framework that combines video quality assessment concepts and the marginalized transform is introduced. The multiple hypothesis tracker and Markov Chain Monte Carlo data association methods are used as test cases. We introduce their transforms and perform a numerical comparison to predict their performance under identical conditions.



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On the role of asymmetric frontal cortical activity in approach and withdrawal motivation: An updated review of the evidence

Abstract

We review conceptual arguments and research on the role of asymmetric frontal cortical activity in emotional and motivational processes. The current article organizes and reviews research on asymmetrical frontal cortical activity by focusing on research that has measured trait (baseline) frontal asymmetry and related it to other individual differences measures related to motivation (e.g., anger, bipolar disorder). The review also covers research that has measured state frontal asymmetry in response to situational manipulations of motivation and emotion and as an intervening variable in motivation-cognition interactions. This review concludes that much research supports the view that greater left than right frontal cortical activity is associated with greater positively or negatively valenced approach motivation. The view that greater right than left frontal cortical activity is associated with withdrawal motivation, although supported, has received less empirical attention. In addition to reviewing research on the emotive functions of asymmetric frontal cortical activity, the reviewed research illustrates the need to consider motivational direction as separate from affective valence in conceptual models of emotional space.



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Preclinical evaluation of the urokinase receptor-derived peptide UPARANT as an anti-inflammatory drug

Abstract

Background

Inflammation plays a key role in the pathogenesis of several chronic diseases. The urokinase plasminogen activator receptor (uPAR) exerts a plethora of functions in both physiological and pathological processes, including inflammation.

Objective and design

In this study, we evaluated the anti-inflammatory effect of a novel peptide ligand of uPAR, UPARANT, in different animal models of inflammation.

Subjects and treatment

Rats and mice were divided in different groups (n = 5) for single or repeated administration of vehicle (9% DMSO in 0.9% NaCl), UPARANT (6, 12 and 24 mg/kg) or dexamethasone (2 mg/kg). Animals were subjected to carrageenan-induced paw oedema or zymosan-induced peritonitis.

Methods

UPARANT effects were tested on: (1) the carrageenan-induced paw oedema volume, (2) the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) and the nitrite/nitrate (NOx) levels in the paw exudates, (3) cells recruitment into the peritoneal cavity after zymosan injection and (4) NOx levels in the peritoneal lavage.

Results

UPARANT (12 and 24 mg/kg) reduced inflammation in both experimental paradigms. Analysis of pro-inflammatory enzymes revealed that administration of UPARANT reduced iNOS, COX2 and NO over-production.

Conclusions

Our study provides a solid evidence that UPARANT reduces the severity of inflammation in diverse animal models, thus representing a novel anti-inflammatory drug with potential advantages with respect to the typical steroidal agents.



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Methods, tools and current perspectives in proteogenomics [Minireview]

With combined technological advancements in high-throughput next-generation sequencing and deep mass spectrometry-based proteomics, proteogenomics, i.e., the integrative analysis of proteomic and genomic data, has emerged as a new research field. Early efforts in the field were focused on improving protein identification using sample-specific genomic and transcriptomic sequencing data. More recently, integrative analysis of quantitative measurements from genomic and proteomic studies have identified novel insights into gene expression regulation, cell signaling, and disease. Many methods and tools have been developed or adapted to enable an array of integrative proteogenomic approaches and in this article, we systematically classify published methods and tools into four major categories, (1) Sequence-centric proteogenomics; (2) Analysis of proteogenomic relationships; (3) Integrative modeling of proteogenomic data; and (4) Data sharing and visualization. We provide a comprehensive review of methods and available tools in each category and highlight their typical applications.



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Hyper-phosphorylation of Sequestosome-1 distinguishes resistance to cisplatin in patient derived high grade serous ovarian cancer cells [Research]

Platinum-resistance is a major limitation to effective chemotherapy regimens in high-grade serous ovarian cancer (HGSOC). To better understand the mechanisms involved we characterized the proteome and phosphoproteome in cisplatin sensitive and resistant HGSOC primary cells using a mass spectrometry-based proteomic strategy. PCA analysis identified a distinctive phosphoproteomic signature between cisplatin sensitive and resistant cell lines. The most phosphorylated protein in cisplatin resistant cells was sequestosome-1 (p62/SQSTM1). Changes in expression of apoptosis and autophagy related proteins Caspase-3 and SQSTM1, respectively, were validated by western blot analysis. A significant increase in apoptosis in the presence of cisplatin was observed in only the sensitive cell line while SQSTM1 revealed increased expression in the resistant cell line relative to sensitive cell line. Furthermore, site-specific phosphorylation on 20 amino acid residues of SQSTM1 was detected indicating a hyper-phosphorylation phenotype. This elevated hyper-phosphorylation of SQSTM1 in resistant HGSOC cell lines was validated with western blot analysis. Immunofluoresence staining of s28-pSQSTM1 showed inducible localization to autophagosomes upon cisplatin treatment in the sensitive cell line while being constitutively expressed to autophagosomes in the resistant cell. Furthermore, SQSTM1 expression was localized in cancer cells of clinical high-grade serous tumors. Here, we propose hyper- phosphorylation of SQSTM1 as a marker and a key proteomic change in cisplatin resistance development in ovarian cancers by activating the autophagy pathway and influencing down- regulation of apoptosis.



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Validation, identification and biological consequences of the site-specific O-GlcNAcylation dynamics of ChREBP [Research]

O-GlcNAcylation of carbohydrate-responsive element-binding protein (ChREBP) is believed as an important modulator of ChREBP activities, however little direct evidence of O-GlcNAcylation on ChREBP and no exact O-GlcNAcylation sites have been reported so far. Here, we validate O-GlcNAcylation on ChREBP in cell-free coupled transcription/translation system and in cells by chemoenzymatic and metabolic labeling, respectively. Moreover, for the first time, we identify O-GlcNAcylation on Ser614 in the C-terminus of ChREBP by mass spectrometry and validate two important sites, Thr517 and Ser839 for O-GlcNAcylation and their function via molecular and chemical biological method. Under high glucose conditions, Ser514 phosphorylation enhances ChREBP O-GlcNAcylation, maintaining the transcriptional activity of ChREBP; Ser839 O-GlcNAcylation is essential for Mlx-heterodimerization and DNA-binding activity enhancement, consequently inducing transcriptional activity. Ser839 O-GlcNAcylation is also crucial for ChREBP nuclear export partially by strengthening interactions with CRM1 and 14-3-3. This work is a detailed study of ChREBP O-GlcNAcylation and highlights the biological consequences of the site-specific O-GlcNAcylation dynamics of ChREBP.



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Phosphoproteome Analysis Reveals Differential Mode of Action of Sorafenib in Wildtype and Mutated FLT3 AML Cells [Research]

Constitutively activating internal tandem duplication (ITD) alterations of the receptor tyrosine kinase FLT3 (Fms-like tyrosine kinase 3) are common in acute myeloid leukemia (AML) and classifies FLT3 as an attractive therapeutic target. So far, applications of FLT3 small molecule inhibitors have been investigated primarily in FLT3-ITD+ patients. Only recently, a prolonged event-free survival has been observed in AML patients who were treated with the multi-kinase inhibitor sorafenib in addition to standard therapy. Here, we studied the sorafenib effect on proliferation in a panel of 13 FLT3-ITD- and FLT3-ITD+ AML cell lines. Sorafenib IC50 values ranged from 0.001 to 5.6 μM, whereas FLT3-ITD+ cells (MOLM-13, MV4-11) were found to be more sensitive to sorafenib than FLT3-ITD- cells. However, we identified two FLT3-ITD- cell lines (MONO-MAC-1 and OCI-AML-2) which were also sorafenib sensitive. Phosphoproteome analyses revealed that the affected pathways differed in sorafenib sensitive FLT3-ITD- and FLT3-ITD+ cells. In MV4-11 cells sorafenib suppressed mTOR signalling by direct inhibition of FLT3. In MONO-MAC-1 cells sorafenib inhibited the MEK/ERK pathway. These data suggest that the FLT3 status in AML patients might not be the only factor predicting response to treatment with sorafenib.



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The Landscape of Histone Modifications in a High-Fat-Diet-Induced Obese (DIO) Mouse Model [Research]

Type 2 diabetes (T2D) is a major chronic healthcare concern worldwide. Emerging evidence suggests that a histone-modification-mediated epigenetic mechanism underlies T2D. Nevertheless, the dynamics of histone marks in T2D have not yet been carefully analyzed. Using a mass spectrometry-based label-free and chemical stable isotope labeling quantitative proteomic approach, we systematically profiled liver histone post-translational modifications (PTMs) in a prediabetic high-fat-diet-induced obese (DIO) mouse model. We identified 170 histone marks, 30 of which were previously unknown. Interestingly, about 30% of the histone marks identified in DIO mouse liver belonged to a set of recently reported lysine acylation modifications, including propionylation, butyrylation, malonylation, and succinylation, suggesting possible roles of these newly identified histone acylations in diabetes and obesity. These histone marks were detected without prior affinity enrichment with an antibody, demonstrating that the histone acylation marks are present at reasonably high stoichiometry. Fifteen histone marks differed in abundance in DIO mouse liver compared to liver from chow-fed mice in label-free quantification, and six histone marks in stable isotope labeling quantification. Analysis of hepatic histone modifications from metformin-treated DIO mice revealed that metformin, a drug widely used for T2D, could reverse DIO-stimulated histone H3K36me2 in prediabetes, suggesting that this mark is likely associated with T2D development. Our study thus offers a comprehensive landscape of histone marks in a prediabetic mouse model, provides a resource for studying epigenetic functions of histone modifications in obesity and T2D, and suggest a new epigenetic mechanism for the physiological function of metformin.



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Exploring the limits of the usefulness of mutagenesis in studies of allosteric mechanisms

Abstract

The outcome of structure-guided mutational analyses are often used in support of postulated mechanisms of protein allostery. However, the limits of how informative mutations can be in understanding allosteric mechanisms are not completely clear. Here, we report an exercise to evaluate if mutational data can support a simplistic mechanistic model, developed with minimal data inputs. Due to the lack of a mechanism to explain how alanine allosterically modifies the affinity of human liver pyruvate kinase (hL-PYK; approved symbol PKLR) for its substrate, phosphoenolpyruvate (PEP), we proposed a speculative allosteric mechanism for this system. Within the allosteric amino acid binding site (something in the effector site must, of necessity, contribute to the allosteric mechanism), we implemented multiple mutational strategies: 1) site-directed random mutagenesis at positions that contact bound alanine and 2) mutations to probe specific questions. Despite acknowledged inadequacies used to formulate the speculative mechanism, many mutations modified the allosteric coupling constant (Qax) consistent with that mechanism. The observed support for this speculative mechanism leaves us to ponder the best use of mutational data in structure-function studies of allosteric mechanisms. The mutational databank derived from this exercise has an independent value for training and testing algorithms specific to allostery.

This article is protected by copyright. All rights reserved



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The new issue is now available.Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

Vol.41 No.2

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The new issue is now available.Journal of Japan Society of Library and Information Science

Vol.60 No.1

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The new issue is now available.Journal of Japan Society of Library and Information Science

Vol.60 No.2

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1998_2

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1998_6

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The new issue is now available.Journal of the Japan Diabetes Society

Vol.60 No.4

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1999_2

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The new issue is now available.Tetsu-to-Hagane

Vol.103 No.5

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1998_4

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The new issue is now available.Journal of the Geodetic Society of Japan

Vol.62 No.3

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1999_3

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The new issue is now available.Journal of the Geodetic Society of Japan

Vol.62 No.2

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1999_1

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The new issue is now available.Journal of the Geodetic Society of Japan

Vol.62 No.1

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1998_5

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The new issue is now available.Eco-Engineering

Vol.29 No.2

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1998_3

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The new issue is now available.Journal of Environmental Engineering (Transactions of AIJ)

Vol.82 No.734

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The new issue is now available.The Japanese Journal of Language in Society

Vol.7 No.2

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The new issue is now available.Journal of Japan Society for Safety Enginennring

JOURNAL OF JAPAN SOCIETY FOR SAFETY ENGINEERING_1998_1

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Akaryotes and Eukaryotes are independent descendants of a universal common ancestor

Publication date: Available online 28 April 2017
Source:Biochimie
Author(s): Ajith Harish, Charles G. Kurland
We reconstructed a global tree of life (ToL) with non-reversible and non-stationary models of genome evolution that root trees intrinsically. We implemented Bayesian model selection tests and compared the statistical support for four conflicting ToL hypotheses. We show that reconstructions obtained with a Bayesian implementation (Klopfstein et al., 2015) is consistent with reconstructions obtained with an empirical Sankoff parsimony (ESP) implementation (Harish et al. 2013). Both are based on the genome contents of coding sequences for protein domains (superfamilies) from hundreds of genomes. Thus, we conclude that the independent descent of Eukaryotes and Akaryotes (archaea and bacteria) from the universal common ancestor (UCA) is the most probable as well as the most parsimonious hypothesis for the evolutionary origins of extant genomes. Reconstructions of ancestral proteomes by both Bayesian and ESP methods suggest that at least 70% of unique domain-superfamilies known in extant species were present in UCA. In addition, identification of a vast majority (96%) of the mitochondrial superfamilies in the UCA proteome precludes a symbiotic hypothesis for the origin of eukaryotes. Accordingly, neither the archaeal origin of eukaryotes nor the bacterial origin of mitochondria is supported by the data. The proteomic complexity of the UCA suggests that the evolution of cellular phenotypes in the two primordial lineages, Akaryotes and Eukaryotes, was driven largely by duplication of common superfamilies as well as by loss of unique superfamilies. Finally, innovation of novel superfamilies has played a surprisingly small role in the evolution of Akaryotes and only a marginal role in the evolution of Eukaryotes.



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Female white-collar workers remain at higher risk of breast cancer after adjustments for individual risk factors related to reproduction and lifestyle

Objectives

The aim was to investigate the variation in risk of breast cancer between occupational groups with a focus on white-collar and blue-collar workers and to investigate to what extent the differences were explained by risk factors related to reproduction and lifestyle.

Methods

Between 1991 and 1996, 14 119 women born between 1923 and 1950 and residents of Malmö, Sweden, were included in this cohort study. Individual data on risk factors (eg, age, parity, age at first child, months of breast feeding per child, hormonal replacement therapy, physical activity, alcohol consumption, smoking, height and body mass index) and occupational history were assessed using a questionnaire. First-time diagnoses of invasive breast cancer were identified through the Swedish Cancer Registry up until 31 December 2013.

Results

A total of 897 women were diagnosed with breast cancer. Analyses adjusted for age showed an increased risk for white-collar workers compared with blue-collar workers and indicated higher risks in the occupational categories: professionals, administrative and bookkeeping than among women in sales, transportation, production and service work. This difference was only marginally attenuated after adjustment for an extensive set of risk factors related to reproduction and lifestyle.

Conclusion

Reproductive and lifestyle factors explain only a minor part of the increased risk of breast cancer in white-collar workers. Further studies are needed to investigate the remaining factors for the difference in risk between occupational groups.



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The effect of population-based mammography screening in Dutch municipalities on breast cancer mortality: 20 years of follow-up

Abstract

Long-term follow-up data on the effects of screening are scarce and debate exists on the relative contribution of screening versus treatment to breast cancer mortality reduction. Our aim was therefore to assess the long-term effect of screening by age and time of implementation. We obtained data on 69,630 breast cancer deaths between 1980 and 2010 by municipality (N=431) and age of death (40-79) in the Netherlands. Breast cancer mortality trends were analysed by defining the municipality-specific calendar year of introduction of screening as year 0. Additionally, log-linear Poisson regression was used to estimate the turning point in the trend after year 0, per municipality, and the annual percentage change (APC) before and after this point. Twenty years after introduction of screening breast cancer mortality was reduced by 30% in women aged 55-74 and by 34% in women aged 75-79, compared to year 0. A similar and significant decrease was present in municipalities that started early (1987-1992) and late (1995-1997) with screening, despite the difference in availability of effective adjuvant treatment. In the age groups 55-74 and 75-79 the turning point in the trend in breast cancer mortality was estimated in year 2 and 6 after the introduction of screening respectively, after which mortality decreased significantly by 1.9% and 2.6% annually.

These findings show that the implementation of mammography screening in Dutch municipalities is associated with a significant decline in breast cancer mortality in women aged 55-79, irrespective of time of implementation. This article is protected by copyright. All rights reserved.



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Letter to the Editor in response to Herweijer E., Sundström K., Ploner A., Uhnoo I., Sparén P. and Arnheim-Dahlström L. (2016), Quadrivalent HPV vaccine effectiveness against high-grade cervical lesions by age at vaccination: A population-based study. Int. J. Cancer, 138: 2867–2874. doi:10.1002/ijc.30035



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Versatile, robust, and efficient tractography with constrained higher-order tensor fODFs

Abstract

Purpose

Develop a multi-fiber tractography method that produces fast and robust results based on input data from a wide range of diffusion MRI protocols, including high angular resolution diffusion imaging, multi-shell imaging, and clinical diffusion spectrum imaging (DSI)

Methods

In a unified deconvolution framework for different types of diffusion MRI protocols, we represent fiber orientation distribution functions as higher-order tensors, which permits use of a novel positive definiteness constraint (H-psd) that makes estimation from noisy input more robust. The resulting directions are used for deterministic fiber tracking with branching.

Results

We quantify accuracy on simulated data, as well as condition numbers and computation times on clinical data. We qualitatively investigate the benefits when processing suboptimal data, and show direct comparisons to several state-of-the-art techniques.

Conclusion

The proposed method works faster than state-of-the-art approaches, achieves higher angular resolution on simulated data with known ground truth, and plausible results on clinical data. In addition to working with the same data as previous methods for multi-tissue deconvolution, it also supports DSI data.



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Contents

Publication date: May 2017
Source:Health Policy, Volume 121, Issue 5





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Editorial Board

Publication date: May 2017
Source:Health Policy, Volume 121, Issue 5





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Approaches to appropriate care delivery from a policy prospective: A case study of Australia, England and Switzerland

Publication date: Available online 29 April 2017
Source:Health Policy
Author(s): Joelle Robertson-Preidler, Matthew Anstey, Nikola Biller-Andorno, Alexandra Norrish
BackgroundAppropriateness is a conceptual way for health systems to balance Triple Aim priorities for improving population health, containing per capita cost, and improving the patient experience of care. Comparing system approaches to appropriate care delivery can help health systems establish priorities and facilitate appropriate care practices.MethodsWe conceptualized system appropriateness by identifying policies that aim to achieve the Triple Aim and their consequent trade-offs for financing, clinical practice, and the individual patient. We used secondary data sources to compare the appropriate care approaches of Australia, England, and Switzerland according to financial, clinical, and individual appropriateness policies.FindingsHealth system approaches to appropriate care delivery varied. England prioritizes public health, equity and efficiency at the expense of individual choice, while Switzerland focuses on individual patient preferences, but has higher per capita and out of pocket costs. Australia provides equity in public care access and private health care options that allows for more patient choice, with health care costs falling between the two.ConclusionsIntegrating the Triple Aim into health system design and policy can facilitate appropriate care delivery at the system, clinical, and individual levels. Approaches will vary and require countries to negotiate and justify priorities and trade-offs within the context of thehealth system.



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