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Medicine & Pharmacology, Other; health policy, VHA, VA, CMS TRICARE, Scandal
Online: 22 June 2018 (15:49:28 CEST)
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In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem. In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing, and more than 10 thousand open or pending prosthetic / sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment. In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system, and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans while phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes. A central payer solution under the CMS would also be viable consideration. A Friedman’s test with Wilcoxon rank sum post-hoc tests suggests that TRICARE patient perceptions of quality are superior to VHA and non-VHA / non-DoD (p<.001), that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance, and that the cost per beneficiary of a TRICARE solution ($6.5K / beneficiary) is far better than a VHA-only solution ($14.0 K / beneficiary), the CMS central payer solution ($12.2K / beneficiary), or the status quo (between $12.2K and $14.0K / beneficiary). The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within our outside of the VHA. In this policy analysis, separate interventions that address the gaps between cost, quality, and access are explored. These policy interventions include maintaining the status quo, returning to a VHA-only option, transitioning to a CMS central payer system, and consolidating care under TRICARE.
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Medicine & Pharmacology, Cardiology; heart rate variability, smoking, hypoxia, autonomic dysfunction
Online: 20 June 2018 (15:38:52 CEST)
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Background and objectives: Smoking leads to autonomic dysfunction. However, the clinical methods for diagnosing this dysfunction are not sufficient. Since exogenous hypoxia leads to changes in the autonomic cardiac control, the aim of our study was to compare the activity of the autonomic nervous system via heart rate variability (HRV) in young “healthy” smokers and non-smokers before, during and after a short-term exogenous hypoxic exposure. Methods: Twenty-one healthy non-smoking males aged 28.0±7.4 (mean±SD) and fourteen healthy smoking males aged 28.1±4.3 with 9.2±5.6 pack-years were subjected to one-hour hypoxic exposure (FiО2=12.3±1.5%) via hypoxicator (AltiPro 8850 Summit+, Altitude Tech, Canada) with simultaneous recording of electrocardiography and pulse oximetry. HRV data was derived via specific software (Kubios HRV, Finland) by analyzing the pre-hypoxic, hypoxic and post-hypoxic periods. Results: Standard deviation of the intervals between normal beats (SDNN) was higher in non-smokers in the pre-hypoxic period (62.0±32.1 vs 40.3±16.2, p=0.013) but not in hypoxia (75.7±34.8 vs 57.9±18.3, p=0.167). When comparing intragroup HRV changes of shifting from hypoxic to post-hypoxic (normoxic) conditions we found that there is a significant increase in the root mean square of successive RR interval differences (RMSSD) (65.9±40.2 vs 75.1±45.9, p=0.011) and in the high frequency (lnHF) (6.8±1.4 vs 7.2±1.3, p=0.014) and a decrease in LF/HF (3.0±2.3 vs 1.9±1.5, p<0.001), but these changes were observed only in the group of non-smokers. Conclusions: Smoking likely impairs autonomic regulation in young healthy males and may lead to a decreased HRV even before subjective clinical signs and symptoms. Hypoxic exposure test could be applied in clinical practice for early detection of autonomic dysfunction in smokers, because their parasympathetic reactivation is blunted when shifting from hypoxic to normoxic ambient conditions measured by HRV.
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Medicine & Pharmacology, Nutrition; metabolic syndrome; vegetarian; vegetarianism practices; overweight; lifestyle behaviors
Online: 20 June 2018 (08:49:24 CEST)
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The prevalence and factors associated with metabolic syndrome (MetS) remain unknown in Malaysian vegetarians. This cross-sectional study aimed to determine the prevalence of MetS among vegetarians in Kuala Lumpur and Selangor and its associated factors. The data on socio-demographic characteristics, vegetarianism practices, lifestyle behaviours, body weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), and blood lipid profiles were collected from 273 vegetarians. A majority of the respondents were lacto-ovo vegetarians (44.0%), females (64.8%) and Chinese (54.9%). The prevalence of MetS was 24.2%. High BP (48.7%) and high WC (43.6%) were the most common MetS components. Females had lower WC, SBP, DBP, FBG, TG and higher HDL-c (p < 0.05) as compared to males. Multiple logistic regression analysis showed that advancing in age (OR = 1.03, 95% CI: 1.00-1.06), and overweight and obesity (OR = 7.90, 95% CI: 4.13-15.11) were the risk factors of MetS after adjusted for sex. This study found that one in four vegetarians had MetS. The present findings emphasize the need to focus among vegetarians with older age. An intervention program to reduce BMI should be established among vegetarians, especially among those vegetarians who were overweight and obese.
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Medicine & Pharmacology, Nutrition; food preferences; early childhood; variety; longitudinal; fruit; vegetables
Online: 20 June 2018 (08:42:52 CEST)
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While it is generally accepted that food habits established during infancy will track into later childhood, longitudinal analysis of children’s food preferences is rare. This paper examines whether maternal-reported child food preferences at five years of age are the same as that reported at two years; and identifies any patterns of change from two- to five- years. Mothers in the Australian NOURISH trial reported child food preferences at two and five years of age. A four point scale was utilised - ‘like’, ‘neither like or dislike’, ‘dislike’, ‘never tried’. The proportion of children having the same preference at the two time points was calculated (95%CI) for 48 foods (cereals, 4; vegetables, 20; fruit, 14; meat/alternatives, 6; dairy, 4). For foods where ≤50% children had consistent preferences, the pattern of food preference change was determined. For 40/48 foods, more than half of the children were reported to have the same preference at two years of age, and three years later, at age five. Foods for which ≤50% children had the same preference at both ages were high-sugar breakfast cereals, zucchini, mushrooms, eggplant, spinach, lettuce, cabbage and celery. Findings reinforce the importance of promoting a consistent message regarding early and frequent exposure to a variety of healthy foods, particularly during the first 2 years of life, as the preferences established in these early years are likely to be maintained over time.
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Medicine & Pharmacology, Nutrition; non-alcoholic fatty liver disease; steatosis; NASH; gene set enrichment analysis; green tea; methionine-choline deficient diet; γ-linolenate biosynthesis_Homo sapiens_PWY-6000
Online: 20 June 2018 (04:07:14 CEST)
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The most common liver disorder nowadays is non-alcoholic fatty liver disease(NAFLD) and it is a progressive disease that rises in severity from steatosis to nonalcoholic steatohepatitis(NASH), fibrosis and cirrhosis to increase risk of developing hepatocellular carcinoma. It is a cause of great concern as there is an estimated seventy million Americans who are currently affected by NAFLD, and this is expected to only increase because of its association with obesity and diabetes and also a lack of therapies to keep its development and progression in check. In this particular study we performed a gene set enrichment analysis(GSEA) of differentially expressed genes in a green tea against methionine-choline deficient diet in high-fat patients in the development of non-alcoholic fatty liver disease(NAFLD). The downregulated genes were used to perform an enrichment analysis and in the ARCHS4 TFs Coexpression database the most significant gene was found to be KLF5_human_tf_ARCHS4_coexpression. In the ARCHS4 Kinases Coexpression pathway database STYK1_human_kinase_ARCHS4 Coexpression was found to be the most significant gene. And finally for the upregulated genes a similar enrichment analysis was performed and in the humancy database γ-linolenate biosynthesis_Homo sapiens_PWY-6000 gene was discovered to be the most significant one. This study has used bioinformatics tools and the Enrichr software to perform a comparative analysis of differentially expressed gene sets for high-fat patients having a diet consisting of green tea against a methionine-choline deficient diet. Green tea is known to contain several antioxidants and polyphenols which provide protection against many liver diseases such as non-alcoholic fatty liver disease(NAFLD). The present study simply tries to build awareness of this to the general public and allow them to learn more about certain diets which have protective effects against liver diseases. Hopefully by implementing these in their daily lifestyles the public can gain some form of protection against these types of liver disorders.
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Medicine & Pharmacology, Oncology & Oncogenics; photothermal microscopy; label-free imaging; melanoma; texture analysis
Online: 19 June 2018 (15:28:53 CEST)
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Label-free confocal photothermal (CPT) microscopy was utilized for the first time to investigate malignancy in mouse skin cells. A laser diode (LD) with 405nm or 488nm was used as a pump and 638nm LD as a probe for the CPT microscope. The Grey Level Cooccurrence Matrix (GLCM) for texture analysis was applied to the CPT images. Nine parameters of GLCM were calculated for the intracellular super-resolved CPT images, and the parameters Entropy and Prominence were found to be most suited among the nine parameters to discriminate between healthy cells and MM cells in case pump wavelength of 488nm is used.
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Medicine & Pharmacology, Ophthalmology; Glaucoma; Intraocular Pressure(IOP) ; fundus images; early detection; Cup-to-Disk Ratio(CDR)
Online: 19 June 2018 (13:54:42 CEST)
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Glaucoma is a disease associated with retina of eye. Presently, millions of human being is suffering from this disease. Early detection of these diseases can save the people from blindness. Therefore, various methods have been developed for its detection. In this paper, we have studied the reported methods and summarized their performance in terms of accuracy of detection.
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Medicine & Pharmacology, Obstetrics & Gynaecology; cell-free DNA analysis; genetic counseling; noninvasive prenatal screening; prenatal screening; results delivery; telehealth
Online: 19 June 2018 (03:45:49 CEST)
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Background: As noninvasive prenatal screening usage grows in the general obstetrics setting, proper patient education on the screen’s benefits and limitations is needed.
Objective: Describe the use of a technology platform designed for large-scale dissemination of noninvasive prenatal screening information and results.
Study Design: The technology platform functioned as follows: Patients were emailed a link to an noninvasive prenatal screening general-education video upon laboratory receipt of a test requisition. Providers were then notified upon availability of patients’ results. If noninvasive prenatal screening results were negative, the patient was sent an automated email with instructions to access results through a secure portal where she could watch tailored informational videos, request “on-demand” or scheduled genetic counseling, or decline any further services. If genetic counseling was elected, a summary of the session was sent to the ordering provider and patient upon completion. If noninvasive prenatal screening results were positive, either the ordering provider or a board-certified genetic counselor contacted the patient directly to communicate test results and provide counseling. The number and type of results issued through the platform, the number and type of genetic counseling consultations completed, and factors associated with requesting laboratory-delivered genetic counseling were tracked and analyzed for a 39-month period.
Results: Over the study period, 67,122 noninvasive prenatal screening results were issued through the platform, and 4,673 patients elected genetic counseling consultations; 95.2% (n=4,450) of consultations were for patients receiving negative results. Over 70% (n= 3,370) of consultations were on-demand rather than scheduled. Median consultation time was 14 minutes for positive results and six minutes for negative results. A positive screen, advanced maternal age, family history, previous history of a pregnancy with a chromosomal abnormality, and other high-risk pregnancy were associated with the greatest odds of electing laboratory-delivered genetic counseling.
Conclusions: By combining web education, automated notifications, and genetic counseling, we implemented a service that effectively facilitates results disclosure for ordering providers. These data demonstrate the capability to deliver noninvasive prenatal screening results, education, and counseling—congruent with management guidelines—to a large population, which is imperative to quality care as uptake increases.
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Medicine & Pharmacology, Other; renalase; KIM-1; calbindin; MCP-1
Online: 15 June 2018 (14:53:54 CEST)
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Diagnosis of kidney diseases has recently become more comprehensive and accurate by using new renal markers. Despite the fact that creatinine and cystatin c have been sufficient in determining kidney function, they did not indicate the exact site of the damage and they were often insufficient in predicting the course of the disease. Aim of the study was to evaluate the potential correlations and differences in levels of six factors related to kidney function and injury: kidney injury molecule-1 (KIM-1), ncalbindin (CALB), glutathione S-transferase Pi (GST-Pi), calbindin and monocyte chemoattractant protein-1 (MCP-1), between renal patients with diabetic nephropathy (DM), congenital defects (CD) of the kidney and glomerulonephritis (GN). Study involved 75 patients: 49 with diabetic nephropathy, 12 with congenital defects and 14 with glomerulonephritis. Levels of renalase was measured using immunoenzymatic tests. Levels of other markers: calbindin, glutathione-S-transferase (GST-pi), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1) and monocyte chemoattractant protein-1 (MCP-1), were analyzed using Kidney Toxicity-1 Panel and BioPlex system, designed for analyses in urine and optimized by us for serum.From all analyzed markers, only levels of KIM-1 differed significantly between any subgroups, and that was for CD and DM. Renalase correlated significantly negatively with creatinine and positively with all other markers, apart from MCP-1. Obtained results indicate, that serum renalase, KIM-1, calbindin and GST-pi are related to kidney function, with KIM-1 being the most exact, while MCP-1 levels are unrelated to creatinine and glucose levels, does not differ between patients with diabetic nephropathy and other subgroups, and therefore seem to be independent of diabetes. Also, serum-optimized Kidney Toxicity Panel 1 kit for determination of selected markers gave results similar to previous ones and therefore the method can be valuable in determination of analyzed factors.
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Medicine & Pharmacology, Ophthalmology; short tunnel small flap; glaucoma drainage device implantation; tube exposure; STSF; Ahmed glaucoma valve; AGV
Online: 15 June 2018 (09:40:16 CEST)
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Purpose: To compare the efficacy and safety of graft-free short tunnel small flap (STSF) technique with that of scleral patch graft (SPG) in Ahmed glaucoma valve (AGV) implantation. Design: Randomized clinical trial. Participants: Eighty-eyes of eighty patients with medically uncontrolled glaucoma including 41 in STSF and 39 eyes in SPG. Methods: Patients were enrolled and assigned randomly to STSF or SPG. Main Outcome Measures: tube exposure, Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), surgical complications, and success rate ( defined as intraocular pressure (IOP) >5 mmHg, ≤21 mmHg, and IOP reduction ≥20% from baseline at two consecutive visits after three months, no reoperation for glaucoma). Results: only one case in SPG developed tube exposure at 1-year follow-up. The cumulative probability of success during the first year of follow-up was 70% in the STSF and 65% in SPG (P = 0.36). IOP decreased significantly from 29.6 ± 8.6 mmHg at baseline to 16.4 ± 3.6 mmHg at the final follow-up in STSF (p = 0.001). The corresponding numbers for SPG were 30.9 ± 11.2 and 15.8 ± 4.7, respectively (p = 0.001). The final IOP was comparable between both groups (p = 0.65). Mean ± standard deviation of the number of glaucoma medications was 1.8 ± 0.9 in STSF and 1.6 ± 0.9 in SPG at final follow-up (P = 0.32). Postoperative complications developed in 8 patients (19%) in STSF and 9 patients (23%) in SPG (P = 0.81). Conclusions: STSF and SPG techniques had comparable complication rate at one-year follow-up. Both techniques were comparable in terms of success rate, postoperative IOP, and glaucoma medications.
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Medicine & Pharmacology, General Medical Research; ApoB-100 lipoproteins-Proteoglycans-Interactions-Arterial intima Atherosclerosis-LDL modifications
Online: 14 June 2018 (16:17:40 CEST)
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Experimental and clinical data indicates that the initiation and progress of atherosclerosis, and its clinical manifestations, are caused first by circulating apoB-100 lipoproteins that enter and are retained in the arterial intima. Extracellular sulfated proteoglycans (PGs) of the intima are the retention agents. The PGs also initiate physical and biochemical lipoprotein degradation with the production of bioactive, lipid products that trigger an inflammatory response that leads to atherosclerosis. There are many simple methods for measuring abnormalities of circulating lipoproteins and their relation to atherosclerotic cardiovascular disease (ACVD). However, limited research has been aimed to evaluate procedures that could report quantitatively about the contribution of the apo-100 lipoprotein-arterial intima PGs interaction to clinical manifestation of ACVD. In the present review we will discuss observations indicating that simple ex vivo evaluation of the affinity of apoB-100 lipoproteins for arterial PGs and glycosaminoglycans (GAGs) can give indication of its association with clinical manifestations of atherosclerosis. In addition, we will discuss molecular and cellular aspect of the apoB-100 lipoproteins association with arterial PGs that are related to atherogenesis and that support the experimental framework behind the current “Response-to-Retention” hypothesis of atherosclerosis
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Medicine & Pharmacology, Nursing & Health Studies; Engagement; Emotional Intelligence; Nurses; sexo.
Online: 14 June 2018 (14:34:29 CEST)
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1) Background: Aware that engagement in the healthcare field needs high levels of emotional intelligence, we began this study in to the relationship between engagement and emotional intelligence in nurses. The objective of this study was to determine the explanatory value of the components of emotional intelligence for engagement in a sample of nurses, and to identify which of the emotional intelligence components have the greatest explanatory value for dimensions of engagement, by sex.; 2) Methods: The final study sample was made up of 2126 working nursing professionals with a mean age of 31.66 (SD=6.66). To compile the data, an ad hoc questionnaire was used to collect sociodemographic information, and to collect professional and employment information, the Utrecht Work Engagement Scale, and the Reduced Emotional Intelligence Inventory for Adults.; 3) Results: The results show that nurses with higher levels of emotional intelligence also scored more highly in engagement, with the Interpersonal factor being the greatest predictor of engagement.; and 4) Conclusions: This study have significant practical implications for the creation of intervention programs and activities to improve the performance of nurses in the workplace.
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Medicine & Pharmacology, General Medical Research; green bitter weed; Hymenoxys odorato; liver and kidney toxicity
Online: 14 June 2018 (11:07:44 CEST)
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Background: Medicinal plants are of great importance to health of individual and communities. About 80% of the population in Uganda relies on traditional medicine because western-trained medical personnel are limited especially in villages. Most Ugandans use Hymenoxys odorato for medicinal purposes e.g. to treat colds, fever, coughs, anti-helminthes, locally used as tea, anti-allergy and also as an anti-venom to relieve snake bites. Method: A group of 25 male wistar rats of 150 g–210 g were kept for 14 days while being fed and treated with the extract. At 14th day, anesthesia was given and blood samples collected by cardiac puncture for hematological and biochemical investigations. Serum was analyzed for Alkaline Phosphatase, Aspartate Transaminase and Alanine Transaminase while whole blood was used for complete blood count. The liver and kidney were removed and placed in 10% formalin to prepare for histology staining using haematoxylin and eosin technique. Results: The extract elevated hepatic biomarker enzymes i.e. ALP, ALT and AST. The increase was found to be significantly different (P > 0.05) at 400 and 500 mg/kg doses as compared to the control group. Histological sections of the liver showed distortion of liver cytoarchitecture, steatosis, necrosis of hepatocytes and congestion of the sinusoids at high doses 300, 400 and 500 mg/kg body weight. In the sections of the kidney, there was mild distortion of the integrity of the kidney with glomerular hypercellularity at high doses (400 and 500 mg/kg per body weight). Conclusion: Hymenoxys odorato aqueous extract has toxic effects on the liver and kidney of wistar rats. The effects were observed to be in a dose dependent manner.
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Medicine & Pharmacology, General Medical Research; Diagnosis delay; rare diseases; undiagnosed programs; standardized phenotype; phenotype ontologies; whole exome analysis; international data sharing
Online: 13 June 2018 (15:41:21 CEST)
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One of the IRDiRC goals for 2017-2027 is to achieve definitive diagnosis for rare undiagnosed diseases within one year, as diagnosis delay remains one of the pending issues in the rare diseases field. The Spanish Undiagnosed Rare Diseases Program (SpainUDP) was created in response to this challenging scenario to cover patients’ needs and after seeing the success of the UDP in USA. SpainUDP offers a multidisciplinary approach to those patients who have long sought a diagnosis without any success. During a first phase of the protocol, undiagnosed cases are sent to SpainUDP by individual patients, patient organizations or hospitals. After a carefully analysis of phenotype, data from sequencing experiments (WES) is processed with a standard pipeline and a detailed standardized phenotypic information (mapped to HPO) is connected to genetic data. In addition, the participation of SpainUDP in international initiatives such as the European projects RD-Connect and Solve RD, the Undiagnosed Diseases Network International (UDNI), and the MatchMaker Exchange platform, allows the establishment of a global data sharing strategy across multiple projects submitting data to these international initiatives. From the official beginning of the program (at the end of 2015) until early 2018, 147 cases were accepted in SpainUDP. During this time, 37 cases (25 %) dropped out the program due to several reasons. The remaining 110 cases are distributed as follows: phenotypic and genotypic (WES) characterization was finished in 30 cases, of which 20 (67 %) were diagnosed; 21 cases are pending on variants validation by Sanger; in 25 cases, WES is ongoing and 34 cases are in a deep phenotypic characterization. As a conclusion, SpainUDP aims to achieve a diagnosis following two recommendations of the IRDiRC: the patients’ diagnosis in a period of time as short as possible and the promotion of data sharing (especially genomic) at the international level.
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Medicine & Pharmacology, Other; ceftaroline; cephalosporin; methicillin resistant Staphylococcus aureus MRSA; pediatrics; safety; community-acquired infection; bacteria infection; pneumonia; skin infection
Online: 13 June 2018 (12:04:22 CEST)
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Objective: The objective of this review is to describe the outcomes of patients treated with ceftaroline in non-Food and Drug Administration (FDA) approved indications in pediatric or adult populations with infections caused by MRSA. Data sources: A systematic overview was conducted by searching PubMed, Medline, and The Cochrane Library up to October 2017. Study selection and data extraction: All English-language clinical trials and case reports related to the efficacy of ceftaroline in new, not yet approved FDA indications in methicillin-resistant Staphylococcus aureus infections in pediatric or adult populations. Data synthesis: In the case of methicillin-resistant Staphylococcus aureus (MRSA) infections, three different randomized studies in pediatric patients showed effectiveness of ceftaroline. When used in the case of adult populations with MRSA bacteremia, a small trial of 16 patients showed 50% clinical success in patients with acute bacterial skin and skin structure infections versus 63% clinical success in patients with community-acquired bacterial pneumonia, respectively. Another case series of 6 refractory case reports showed 50% clinical success of ceftaroline in patients with MRSA bacteremia. Conclusions: Although there are few case reports and limited data to date, ceftaroline fosamil should continue to be studied as an alternative therapy in different type of infections.
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Medicine & Pharmacology, Pharmacology & Toxicology; Retinoid X receptor; RXR; antagonists; structural classification; heterodimers; permissive; tRXR
Online: 13 June 2018 (10:45:58 CEST)
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Retinoid X receptor (RXR) antagonists are not only useful as chemical tools for biological research, but also are candidate drugs for treatment of various diseases, including diabetes and allergy, although no RXR antagonist has yet been approved for clinical use. In this review, we describe currently available RXR antagonists, their structural classification, and their evaluation, focusing on the latest research.
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Syed Mustafa Ali,
Farah Naureen,
Arif Noor,
Maged Kamel N. Boulos,
Javariya Aamir,
Muhammad Ishaq,
Naveed Anjum,
John Ainsworth,
Aamna Rashid,
Arman Majidulla,
Irum Fatima
Medicine & Pharmacology, Nursing & Health Studies; mHealth; mobile data collection; data quality; data quality assessment framework; Tuberculosis control; developing countries
Online: 12 June 2018 (10:34:33 CEST)
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Background
Increasingly, healthcare organizations are using technology for the efficient management of data. The aim of this study was to compare the data quality of digital records with the quality of the corresponding paper-based records by using data quality assessment framework.
Methodology
We conducted a desk review of paper-based and digital records over the study duration from April 2016 to July 2016 at six enrolled TB clinics. We input all data fields of the patient treatment (TB01) card into a spreadsheet-based template to undertake a field-to-field comparison of the shared fields between TB01 and digital data.
Findings
A total of 117 TB01 cards were prepared at six enrolled sites, whereas just 50% of the records (n=59; 59 out of 117 TB01 cards) were digitized. There were 1,239 comparable data fields, out of which 65% (n=803) were correctly matched between paper based and digital records. However, 35% of the data fields (n=436) had anomalies, either in paper-based records or in digital records. 1.9 data quality issues were calculated per digital patient record, whereas it was 2.1 issues per record for paper-based record. Based on the analysis of valid data quality issues, it was found that there were more data quality issues in paper-based records (n=123) than in digital records (n=110).
Conclusion
There were fewer data quality issues in digital records as compared to the corresponding paper-based records. Greater use of mobile data capture and continued use of the data quality assessment framework can deliver more meaningful information for decision making.
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Medicine & Pharmacology, Oncology & Oncogenics; cancer; lung cancer; selectivity; Tetraclinis articulata (Vahl) Mast., Cupressaceae
Online: 12 June 2018 (09:02:50 CEST)
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In our continuous search for selective anticancer treatments, we have screened 65 extracts from 45 plants collected in several areas of Western Andalusia (Spain) for cytotoxic activity against lung cancer cells and lung normal cells. Active extracts were also tested against 11 cell lines from other tissues. An extract from the leaves of Tetraclinis articulata (Vahl) Mast. (Cupressaceae) showed a marked cytotoxicity (IC50 = 0.37 ± 0.03 µg/mL) and selectivity (selectivity index = 378.3) against the lung cancer cells; cisplatin, 5-fluorouracil and an extract from the leaves of Taxus baccata L. (Taxaceae) were less cytotoxic and selective.
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Medicine & Pharmacology, Dermatology; fish oil; polyunsaturated fatty acids; psoriasis; systematic review; meta-analysis
Online: 12 June 2018 (08:03:52 CEST)
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Fish oils, which contain omega-3 polyunsaturated fatty acids as the active ingredients, possess anti-inflammatory activities and may have therapeutic potential in diseases with an inflammatory etiology. Fish oil supplement has been advocated for treating psoriasis which is a chronic inflammatory dermatosis. In order to investigate the effects of fish oil supplement on psoriasis, we searched CENTRAL, Embase and MEDLINE on 24 January 2018 for randomized control trials (RCTs) on the effects of fish oil supplement in treating psoriasis. The Cochrane Collaboration’s tool was used to assess the risk of bias of included RCTs. We performed a random-effects model meta-analysis to obtain the pooled treatment effect estimates. We included 13 RCTs with 625 participants. Three RCTs involving 337 participants provided usable data for meta-analysis. Fish oil supplement did not significantly reduce the severity of psoriasis when assessed by Psoriasis Area and Severity Index score (mean difference -0.28; 95% confidence interval -1.74 to 1.19). The current evidence does not support the use of fish oil supplement in treating psoriasis.
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Medicine & Pharmacology, Ophthalmology; neovascular AMD; new therapies; anti-VEGFs; AMD signalling
Online: 12 June 2018 (06:26:56 CEST)
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Neovascular age-related macular degeneration (nAMD) accounts for one of the leading causes of blindness among the aging population. The current treatment options for nAMD include intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). However, standardised frequent administration of anti-VEGF injections only improves the vision in approximately 30%-40% of nAMD patients. Current therapies targeting nAMD pose a significant risk of retinal fibrosis and geographic atrophy (GA) development in nAMD patients. A need exists to develop new therapies to treat nAMD with effective and long-term anti-angiogenic effects. Recent research on nAMD has discovered novel therapeutic targets and angiogenic signalling mechanisms involved in its pathogenesis. For example, tissue factor, human intravenous immune globulin, interferon-β signalling, cyclooxygenase-2 (COX-2) and cytochrome P450 monooxygenase lipid metabolites have been identified as key players in the development of angiogenesis in AMD disease models. Furthermore, novel therapies such as NLRP3 inflammasome inhibition, targeted intraceptor nanoparticle therapy, inhibitors of integrins and tissue factor are currently being tested at the level of clinical trials to treat nAMD. The aim of this review is to discuss the scope for alternative therapies proposed to anti-VEGFs for the treatment of nAMD.
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Medicine & Pharmacology, Nutrition; protein; skeletal muscle; sarcopenia; gut microbiome; metabolome; diet; supplementation
Online: 11 June 2018 (11:05:04 CEST)
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Muscle mass, strength and physical function are known to decline with age. This is associated with the development of geriatric syndromes including sarcopenia and frailty. These conditions are associated with disability, falls, longer hospital stay, higher readmission rates, institutionalisation, osteoporosis, and death. Moreover, they are associated with reduced quality of life, as well as substantial costs to health services around the world. Dietary protein is essential for skeletal muscle function. Older adults have shown evidence of anabolic resistance, where greater amounts of protein are required to stimulate muscle protein synthesis and therefore require higher daily amounts of dietary protein. Research shows that resistance exercise has the most beneficial effect on preserving skeletal muscle. A synergistic effect has been noted when this is combined with dietary protein, yet studies in this area lack consistency. This is due, in part, to the variation that exists within dietary protein, in terms of dose, quality, source, amino acid composition and timing. Research has targeted participants that are replete in dietary protein with negative results. Inconsistent measures of muscle mass, muscle function, physical activity and diet are used. This review attempts to summarise these issues, as well as introduce the possible role of the gut microbiome and its metabolome in this area.
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Medicine & Pharmacology, Oncology & Oncogenics; matrix metalloproteases; breast cancer; proteomics
Online: 11 June 2018 (04:38:22 CEST)
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Matrix metalloproteases (MMPS) are a family of well-known enzymes which operate prevalently in the extracellular domain, where they fulfil the function of remodeling the extracellular matrix. Within the about 26 family members, encoded by 24 genes in humans, MMP-2 and MMP-9, have been regarded as the primary responsibility for the basement membrane and pericellular ECM rearrangement. In cases of infiltrating carcinomas, which arise from the epithelial tissues of a gland or of an internal organ, a marked alteration of the expression and the activity levels of both MMPs is known to occur. Present investigation represents the continuation and upgrading of our previous studies, now focusing on the occurrence and intensity levels of MMP-2 and -9, and their proteomic correlations, in a cohort of 80 breast cancer surgical tissues
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Medicine & Pharmacology, Pharmacology & Toxicology; Gambogenic acid; apoptosis; CNE-2Z cells; volume-sensitive outwardly rectifying chloride
Online: 8 June 2018 (16:00:24 CEST)
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Nasopharyngeal carcinoma (NPC) has not been thoroughly studied, and the pathogenesis of NPC is unclear. Scientists have neither discovered effective therapies nor achieved a desirable prognosis. Some studies have found that the regulation of intra- and extracellular ion channels hinges directly on cell apoptosis, and treatment with Gambogenic acid (GNA) brings changes to the volume-sensitive outwardly rectifying chloride (VSOR Cl-) current of CNE-2Z cells recorded by the patch clamp method. Nevertheless, rarely have any researchers probed into the relevance between this variation and the anti-tumor mechanism of GNA. This paper is suggested that GNA activates the VSOR Cl- current on the CNE-2Z cell membrane, and the activation of VSOR Cl- currents by GNA in CNE-2Z cells is blocked by the chloride channel blockers DIDS and DCPIB. GNA induces the down-regulation of GRP78 and up-regulation of ATF4 as well as chop proteins, which is evidence for the induction of CNE-2Z cell apoptosis, and this correlates with ER stress. GNA can activate the VSOR Cl- channel and lead to the occurrence of ER stress, thus inducing the apoptosis of CNE-2Z cells and inhibiting the proliferation of CNE-2Z cells.
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Yung-Hsing Huang,
Ommoleila Molavi,
Abdulraheem Alshareef,
Moinul Haque,
Qian Wang,
Michael P. Chu,
Christopher P. Venner,
Irwindeep Sandhu,
Anthea C. Peters,
Afsaneh Lavasanifar,
Raymond Lai
Medicine & Pharmacology, Oncology & Oncogenics; 3D culture; multiple myeloma; STAT; bortezomib; CETSA; stattic
Online: 8 June 2018 (13:32:11 CEST)
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Malignant cells cultured in three-dimensional (3D) models have been found to be phenotypically and biochemically different from their counterparts cultured conventionally. Since most of these studies employed solid tumor types, how 3D culture affects multiple myeloma (MM) cells is not well understood. Here, we compared MM cells (U266 and RPMI8226) in a 3D culture model with those in conventional culture. While the conventionally cultured cells were present in single cells or small clusters, MM-3D cells grew in large spheroids. We discovered that STAT3 was the pathway that was more activated in 3D in both cell lines. The active form of STAT3 (phospho-STAT3 or pSTAT3), which was absent in MM cells cultured conventionally, became detectable after 1-2 days in 3D culture. This elevated pSTAT3 level was dependent on the 3D environment, since it disappeared after transferring to conventional culture. STAT3 inhibition using a pharmacological agent, Stattic, significantly decreased the cell viability of MM cells and sensitized them to bortezomib in 3D culture. Using an oligonucleotide array, we found that 3D culture significantly increased the expression of several known STAT3 downstream genes implicated in oncogenesis. Since most primary MM tumors are naturally STAT3-active, studies of MM in 3D culture can generate results that are more representative of the disease.
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Medicine & Pharmacology, Other; opportunity; challenge; perspective; health data; disease prediction; clinical outcome prediction; healthcare process; data quality; quantity and quality analysis; artificial intelligence
Online: 8 June 2018 (13:22:08 CEST)
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Health information technology has been widely used in healthcare, which has contributed a huge amount of data. Health data has four characteristics: high volume; high velocity; high variety and high value. Thus, they can be leveraged to i) discover associations between genes, diseases and drugs to implement precision medicine; ii) predict diseases and identify their corresponding causal factors to prevent or control the diseases at an earlier time; iii) learn risk factors related to clinical outcomes (e.g., patients’ unplanned readmission), to improve care quality and reduce healthcare expenditure; and iv) discover care coordination patterns representing good practice in the implementation of collaborative patient-centered care. At the same time, there are major challenges existing in data-driven healthcare research, which include: i) inefficient health data exchanges across different sources; ii) learned knowledge is biased to specific institution; iii) inefficient strategies to evaluate plausibility of the learned patterns and v) incorrect interpretation and translation of the learned patterns. In this paper, we review various types of health data, discuss opportunities and challenges existing in the data-driven healthcare research, provide solutions to solve the challenges, and state the important role of the data-driven healthcare research in the establishment of smart healthcare system.
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Medicine & Pharmacology, Cardiology; cardiovascular risk assessment; postmenopausal women; cardiovascular risk factors; emerging risk factors; hormone replacement therapy
Online: 8 June 2018 (12:46:31 CEST)
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Cardiovascular diseases (CVD) are rising rapidly among the postmenopausal woman but they are less likely to identify their risk by an appropriate risk assessment tool. This review evaluates available literature on cardiovascular risk assessment among postmenopausal women to provide a concise view of risk factors and disease burden among them, present risk assessment systems including their drawbacks, emergence of new risk factors and their role in risk prediction, and finally use of hormone replacement therapy during menopause. Results demonstrate that menopause is a transition point for developing CVD not due to physiological changes only but psychosocial factors like depression and marital stress are also responsible. Both conventional and emerging risk factors burden are high among postmenopausal women. Though data regarding CVD risk assessment among postmenopausal population is lacking but existing evidences claimed underestimation or overestimation of risk among women. Moreover application of different tools on same population has revealed significant variation in result. In this regard, recalibration of conventional tools with local data and new risk factors has showed improvement of risk prediction. Hormone replacement therapy during early menopause has reported beneficial to prevent CVD but in secondary prevention it has no role. All of these findings demand further studies on cardiovascular risk assessment, especially in developing countries where women after menopause are not in consideration of health strategy makers.
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Medicine & Pharmacology, Anesthesiology; chronic pediatric pain; low income country; middle income country; low and middle income country; pediatric palliative care.
Online: 8 June 2018 (12:45:24 CEST)
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Chronic pain is a serious health concern and potentially debilitating condition, leading to anxiety, depression, reduced productivity and functionality, and poor quality of life. This condition can be even more detrimental and incapacitating in the pediatric patient population. In low and middle income countries (LMICs), pain services are inadequate or unavailable, leaving most of the world's pediatric population with chronic pain untreated. Many of these children in LMICs are suffering without treatment, and often die in pain. Awareness and advocacy for this population must be prioritized. We reviewed the available literature on the chronic pediatric pain burden in LMICs, barriers to treatments, and current efforts to treat these patients.
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Medicine & Pharmacology, Pediatrics; negatively factors; pertussis; preschool children; vaccine immunity
Online: 8 June 2018 (11:28:56 CEST)
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Introduction: The top priority of active immunoprophylaxis of pertussis is immunisation of infants as they can develop severe multiple-organ complications or even die from this disease. Objectives: The aim of the work is the identification of factors negatively affecting vaccine immunity to pertussis in preschool children prior to the administration of the first booster. Patients and Methods: The research was conducted on 352 children from 4.5 to 5.9 years of age who were hospitalised in the University Children’s Hospital in Lublin (Poland) from 1 January 2012 to 31 December 2015. The children taking part in the study had been administered all the mandatory vaccines from their birth to the age of 2 or 2.5 years old according to the Polish Immunisation Program 2008-2009. The immunoenzymatic method ELISA was applied to assess vaccine immunity to tetanus, diphtheria, pertussis, Haemophilus influenzae type b (Hib), poliomyelitis (IPV), mumps, rubella and measles. The level of vaccine antibodies to hepatitis type B was determined chemilumiscently. Results: The protective antibody titer was not found in 41 (11.65%) children before the administration of the booster. To verify the collective impact of parameters analised on antibody titer to pertussis, the Generalized Linear Model (GLZ) was used. Gender, type of vaccine, asthma, Hib and mumps antibody titers have been shown to be predicators of vaccine immunity to pertussis. Conclusions: Immunomodulation considered on the example of titer of IgG antibody to pertussis can serve as a useful model of the assessment of development of acquired immunity after mandatory vaccinations.
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Medicine & Pharmacology, Nutrition; Camellia oleifera cake; phenolic component; organic acid; antioxidant capacity; antimicrobial activity
Online: 7 June 2018 (12:34:19 CEST)
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There is a great interest in finding antioxidants and products with antimicrobial activities from natural sources. The aim of this study was to obtain and identify the phenolic components and organic acids from Camellia oleifera cake. In addition, their antioxidant and antimicrobial activities were also investigated. The purity of phenolic components and organic acids obtained were 94.1 ± 0.5% w/w and 96.0 ± 0.3% w/w, respectively. There are 15 phenolic components have been detected and identified by HPLC-ESI-MS. Oxalic, citric, acetic, malic, and succinic acids are found to be major organic acids. The phenolic components and organic acids both had good antioxidant capacity, evaluated by 4 antioxidant activity assays (hydroxyl radical scavenging, superoxide radical scavenging, 1,1-diphenyl-2-picryl-hydrazyl radical scavenging and lipid peroxidation inhibition). In addition, the phenolic components and organic acids exhibited significant inhibitory activity against bacteria Staphylococcus aureus, Escherichia coli, Bacillus subtilis, and fungi Mucor racemosus, Aspergillus oryzae, Rhizopus stolonifer. The phenolic components and organic acids from C. oleifera cake both showed good antioxidant capacity and exhibited antimicrobial activities. These results may be useful for the future use of phenolic components and organic acids from C. oleifera cake.
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Medicine & Pharmacology, Nutrition; preterm infant; enteral nutrition; lipids; omega-3 fatty acids; omega-6 fatty acids; Docosahexaenoic acid; Arachidonic acid; long-chain polyunsaturated fatty acids.
Online: 7 June 2018 (11:34:53 CEST)
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Human milk fat is a concentrated source of energy and provides essential and long chain polyunsaturated fatty acids. According to previous experiments, human milk fat is partially lost during continuous enteral nutrition. However, these experiments were done over relatively short infusion times, and a complete profile of the lost fatty acids was never measured. Whether this lost happens considering longer infusion times or if some fatty acids are lost more than others remain unknown. Pooled breast milk was infused through a feeding tube by a peristaltic pump over a period of 30 minutes and 4, 12 and 24 hours at 2 ml/hour. Adsorbed fat was extracted from the tubes, and the fatty acid composition was analyzed by Gas chromatography-mass spectrometry. Total fat loss (average fatty acid loss) after 24 hours was 0.6 ± 0.1%. Short-medium chain (0.7%, p=0.15), long chain (0.6%, p=0.56) saturated (0.7%, p=0.4), monounsaturated (0.5%, p=0.15), polyunsaturated fatty (0.7%, p=0.15), linoleic (0.7%, p=0.25), and docosahexaenoic acids (0.6%, p=0.56) were not selectively adsorbed to the tube. However, very long chain fatty (0.9%, p=0.04), alpha-linolenic (1.6%, p=0.02) and arachidonic acids (1%, p=0.02) were selectively adsorbed and therefore lost in a greater proportion than other fatty acids. In all cases, the magnitude of the loss was clinically low.
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Medicine & Pharmacology, Pharmacology & Toxicology; Male reproduction; High-fat diet; Mytilus edulis; Obesity
Online: 7 June 2018 (10:55:51 CEST)
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Obesity is a complex metabolic disease, which induces a variety of diseases, such as cardiovascular disease, type 2 diabetes, hypertension, and cancer. Various chemical agents can be used for treat obesity, but adverse some side effects, such cardiovascular disease and stroke. Natural products reported possessing anti-obesity activity. Mytilus edulis (ME) has been associated with some functional properties such as antioxidant and anti-inflammation. This study aims to determine the preventive effects of Mytilus edulis water extract (MWE) on male reproduction dysfunction in high-fat diet (HFD)-induced obesity rats. The Sprague-Dawley (SD) rats used for obesity model and fed by HFD for 13 weeks. The rats were treated with three different doses of MWE (MWE1, 150 mg/kg body weight; MWE2, 300 mg/kg; MWE5, 750 mg/kg). The results showed that the MWE can reduce body weight, total cholesterol (TC), and triglyceride (TG). In reproduction function, MWE showed that the percentage of sperm motility and progressive motility significantly increase compared to no treated-HFD group. MWE was also reduced oxidative stress and increase the enzymatic antioxidant activity such as superoxide dismutase (SOD) and glutathione peroxidase (GPx). In the conclusion suggested that MWE had beneficial effects on the male reproduction dysfunction in HFD-induced obese rats
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Peter Memiah,
Tristi Ah Mu,
Shreya Madhavaram,
Caroline Kingori,
Courtney Cook,
Sarah Dawson,
Hannah Funk,
Jackson Sebeza,
Michelle Mwangi,
Mtebe Majigo,
Samuel Muhula,
Wairimu Mwangi,
Vernon Mochache,
Kevin Owour,
John Paul Oyore,
Eric Remera,
Sabin Nsanzimana,
Claude Kumalija,
Carol Ngunu
Medicine & Pharmacology, General Medical Research; Data Management; Utilization and Analysis; Capacity Building; Health professionals; Workforce Development; Evidence Based
Online: 7 June 2018 (08:54:20 CEST)
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The objective of the study was to investigate the gap between data and evidence-based decisions among healthcare professionals considering the enormous amount of individual and aggregate data collected. Our study assessed the capacity, skills, and knowledge of the Ministry of Health leadership staff to understand data management, analysis, utilization, and dissemination. Three key components were assessed: 1) Knowledge through true/false questions, 2) Level of Skill (and Competency) using a Likert scale, and 3) Understanding of Key Concepts and Tools based on a Likert scale. The 183 study respondents were diverse healthcare professionals from Kenya, Tanzania, and Rwanda. Majority of respondents had not received any training on data management, analysis, interpretation, and utilization techniques, further there was a significant difference between those who had received training versus those who had not(p=0.005). The respondents were competent in work-related experiences but lacked skills and knowledge on: data concepts and tools, study designs, and types of data analysis. These findings explain the gap between data management, analysis, utilization, and dissemination among health professional’s cadre. To enhance service delivery and optimal provision of health care, it is imperative to have all health care professionals receive a well-designed training on data management, analysis, interpretation, and utilization.
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Medicine & Pharmacology, Oncology & Oncogenics; fibroblast growth factor; fibroblast growth factor receptor; targeted treatments; breast cancer
Online: 7 June 2018 (07:50:30 CEST)
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Breast cancer (BC) is the most common malignancy and second only to lung cancer in terms of mortality in women. Despite the incredible progress made in this field, the metastatic breast cancer leaves a poor prognosis. In an era of personalized medicine, there is an urgent need for a better knowledge of the biology leading to the disease, which can lead to the design of always more accurate drugs against patients’ specific molecular aberrations. Among one of the actionable targets is the Fibroblast Growth Factor Receptor (FGFR) pathway, triggered by specific ligands. The FGFRs/FGFs axis offers interesting molecular targets to be pursued in clinical development. This mini-review will focus on the current knowledge of the FGFRs mutations leading to tumour formation and summarizes the state-of-the-art of therapeutic strategies for targeted treatments against the FGFRs/FGFs axis in the context of BC.
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Medicine & Pharmacology, Obstetrics & Gynaecology; metformin; pregnancy; gestational diabetes; polycystic ovarian syndrome; type 2 diabetes; obesity
Online: 6 June 2018 (12:09:00 CEST)
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Metformin use in pregnancy is increasing worldwide as randomised controlled trial (RCT) evidence is emerging demonstrating its safety and efficacy. The Metformin in Gestational Diabetes (MiG) RCT changed practice in many countries demonstrating that metformin had similar pregnancy outcomes to insulin therapy with less maternal weight gain and a high degree of patient acceptability. A multicentre RCT is currently assessing the addition of metformin to insulin in pregnant women with type 2 diabetes. RCT evidence is also available for the use of metformin for women with Polycystic Ovarian Syndrome and for non-diabetic women with obesity. No evidence of an increase in congenital malformations or miscarriages has been observed even when metformin is started before pregnancy and continued to term. Body composition and metabolic outcomes at two, seven and nine years have now been reported for the offspring of mothers treated in the MiG study. In this review, we will briefly discuss the action of metformin and then consider the evidence from the key clinical trials.
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Medicine & Pharmacology, Oncology & Oncogenics; ovarian cancer; heated intraperitoneal chemotherapy (HIPEC); intraperitoneal chemotherapy (IP); cytoreductive surgery; secondary cytoreduction; interval cytoreduction
Online: 6 June 2018 (11:56:33 CEST)
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Heated intraperitoneal chemotherapy (HIPEC) has several potential benefits. Higher doses of chemotherapy can be used with HIPEC because the plasma-peritoneal barrier results in little absorption into the blood stream. HIPEC offers higher peritoneal penetration in comparison to an intravenous (IV) regimen and does not have the traditional normothermic intraperitoneal (IP) regimen limitation of post-operative adhesions. Hyperthermia itself has cytotoxic effects and can potentiate antineoplastic effects of chemotherapy in part by increasing the depth of tumor penetration by up to 3 mm. For the treatment of ovarian cancer, HIPEC has been evaluated in the recurrent setting with secondary cytoreduction. Recent studies, including a prospective trial, have evaluated its role in primary management of ovarian cancer. This review summarizes previous and ongoing studies regarding the use of HIPEC in the management of ovarian cancer.
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Medicine & Pharmacology, Dentistry; er:yag laser; debonding; laminate veneer; scanning electron microscopy
Online: 6 June 2018 (11:53:01 CEST)
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The purpose of this study consists to verify if Er:YAG laser, at low fluences, is able to debond porcelain veneers, successfully used to improve anterior tooth esthetics, without damaging the tooth structures. A total of twelve freshly extracted teeth were used and samples were decontaminated, stored, prepared to obtain Veneers adhesion. One week after, Er:YAG laser with a non-contact sapphire tip with air-water spray was used for veneer debonding at 100 mJ of power and 30Hz of frequency (Fluence 5.91 J/cm2). Results demonstrated that veneer debonding is possible with an Er:YAG laser and that the total number of pulses does not seem related to its efficiency. SEM observation confirms that residual tooth structure is not altered when using these low fluences. Low fluences with Er:YAG laser are able to debond veneers while preserving the tooth structures. SEM observation confirmed that residual tooth structure is not altered with low fluences.
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Medicine & Pharmacology, Anesthesiology; anesthesia; neurotoxicity; synapse; mTOR; neurodevelopment
Online: 6 June 2018 (10:36:51 CEST)
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Human epidemiologic studies and laboratory investigations in animal models suggest that exposure to general anesthetic agents (GAs) have harmful effects on brain development. The mechanism underlying this putative iatrogenic condition is not clear and there are currently no accepted strategies for prophylaxis or treatment. Recent evidence suggests that anesthetics might cause persistent deficits in synaptogenesis by disrupting key events in neurodevelopment. Using an in vitro model consisting of dissociated primary cultured mouse neurons we demonstrate abnormal pre- and post-synaptic marker expression after a clinically relevant isoflurane anesthesia exposure conducted during neuron development. We find that pharmacologic inhibition of the mechanistic target of rapamycin (mTOR) pathway can reverse the observed changes. Isoflurane exposure increases expression of phospho-S6, a marker of mTOR pathway activity, in a concentration-dependent fashion and this effect occurs throughout neuronal development. The mTOR 1 complex (mTORC1) and the mTOR 2 complex (mTORC2) branches of the pathway are both activated by isoflurane exposure and this is reversible with branch-specific inhibitors. Upregulation of mTOR is also seen with sevoflurane and propofol exposure, suggesting that this mechanism of developmental anesthetic neurotoxicity may occur with all the commonly used GAs in pediatric practice. We conclude that GAs disrupt the development of neurons during development by activating a well-defined neurodevelopmental disease pathway and that this phenotype can be reversed by pharmacologic inhibition.
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Medicine & Pharmacology, General Medical Research; health data science; clinical trials; research participant reporting; personal health data diary; personal private webserver; research data integrity
Online: 6 June 2018 (09:40:35 CEST)
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We describe how clinical researchers can exploit the Android cell phone as an economic platform for the gathering of data from clinical trial participants. The aim was to provide a solution with the shortest possible learning curve for researchers who are comfortable with setting up web pages. The additional requirement is that they extend their skills to the installation of a local webserver on the cell phone and then use four simple PHP templates to construct the clinical research data collection and processing forms. Data so collected is automatically written to local csv files on the cell phone. These csv phones can be retrieved from the device by the researcher simply by plugging the cell phone into their desktop PC and accessing the cell phone memory in just the same way as they would a USB memory stick. The results are presented as a list of recommended Android Apps along with settings that have proved to provide a stable combination likely to be easily used by clinical research participants. We have made a limited ‘user trial’ of this approach with satisfactory feedback received. We have concluded that this approach will reward researchers with a solution that is user friendly, will provide transcription free data and that is more than cost competitive with the conventional error prone/poor compliance ‘paper based participant form – researcher transcription’ cycle.
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Medicine & Pharmacology, Behavioral Neuroscience; Growth Hormone; cognition; recent memory; PET-SCAN; hippocampus; amygdala; parahippocampus; ApoE genotype.
Online: 5 June 2018 (15:18:11 CEST)
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1) Background: We analyzed, by PET-SCAN, how growth hormone (GH) could act on the brain of an older woman, not GH-deficient, which was beginning to show some cognitive deficiencies and presented an ApoE genotype 4/3; 2) Methods: After performing a first psychometric study (TAVEC verbal learning test), the metabolic activity of brain structures related to knowledge, memory, and behavior was analyzed using 18-F Fluorodeoxyglucose PET-SCAN. The patient was then treated with GH (0.4 mg/day) for three weeks and on the last day under this treatment, a new PET-SCAN was performed. One month after beginning treatment with GH, a new TAVEC test was performed; 3) Results: GH administration normalized the cognitive deficits observed in the first psychometric test and increased significantly (P < 0.025) the metabolic activity in practically all brain cortical areas, specifically in the left hippocampus and left amygdala, although not in the left parahippocampus; and 4) Conclusions: This is the first study in which the positive effects of GH on cerebral metabolism have been visualized in a human patient. Our data confirm the positive effects of this hormone on cognition, memory and behavior in patients affected by mild cognitive impairments.
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Medicine & Pharmacology, Sport Sciences & Therapy; treadmill; curved; running gait; imbalance; step angle; stride length; step length
Online: 5 June 2018 (13:04:21 CEST)
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Running on a non-motorized, curved-deck treadmill is thought to improve gait mechanics. It is not known, though, if the change in gait carries over to running on a motorized treadmill or level ground. To determine the effect of running on a curved non-motorized treadmill (CNT) on gait characteristics measured during a subsequent bout of running on a traditional motorized treadmill (TMT). Sixteen healthy college-aged participants, age (mean±SD) 20.4±1.6 years volunteered to have their gait analyzed while running on a TMT and CNT. After familiarization and warm-up on both treadmills, each subject completed five, 4-minute bouts of running alternating between traditional motorized and curved non-motorized treadmills: TMT-1, CNT-1, TMT-2, CNT-2, and TMT-3. Variables of interest included step length (m), stride length (m), imbalance score (%), and step angle (°) and were measured using Optogait gait analysis equipment. Differences in gait char acteristics among TMT-1, TMT-2, and TMT-3 can be attributed to running on the CNT. The results show that running on a CNT resulted in significant changes in gait characteristics. These findings suggest that running on a CNT can significantly alter gait characteristics may result in improvements in running gait that persist to subsequent running on a TMT.
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Medicine & Pharmacology, Nutrition; engagement; adolescents; obesity; diet; prevention; management
Online: 5 June 2018 (11:21:25 CEST)
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Obesity is one of the greatest health challenges facing today’s adolescents. Dietary interventions are the foundation of obesity prevention and management. As adolescents are digital frontrunners and early adopters of technology, digital health interventions appear the most practical modality for dietary behaviour change interventions. Despite the rapid growth in digital health interventions, effective engagement with adolescents remains a pertinent issue. Key strategies for effective engagement include co-designing interventions with adolescents, personalisation of interventions, and just-in-time adaptation using data from wearable devices. The aim of this paper is to appraise these strategies, which may be used to improve effective engagement and thereby improve the dietary behaviours of adolescents now and in the future.
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Medicine & Pharmacology, Other; mTOR; mTORC1; mTORC2; rapamycin; rapalogues; rapalogs; mTOR inhibitors; senescence; ageing; aging; cancer; neurodegeneration; immunosenescence; senolytics; biomarkers
Online: 5 June 2018 (09:49:19 CEST)
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Chronological age represents the greatest risk factor for many life-threatening diseases including neurodegeneration, cancer and cardiovascular disease; ageing also increases susceptibility to infectious disease. Current therapies that effectively tackle individual diseases may have little impact on the overall healthspan of older individuals, who would still be vulnerable to other age-related pathologies. However, recent progress in ageing research has highlighted the accumulation of senescent cells with chronological age as a probable underlying cause of pathological ageing. Cellular senescence is an essentially irreversible proliferation arrest mechanism that has important roles in development, wound healing and preventing cancer, but it may limit tissue function and cause widespread inflammation with age. The serine/threonine kinase mTOR is a regulatory nexus heavily implicated in both ageing and senescence. Excitingly, a growing body of research has highlighted rapamycin and other mTOR inhibitors as promising treatments for a broad spectrum of age-related pathologies, including neurodegeneration, cancer, immunosenescence, osteoporosis, rheumatoid arthritis, age-related blindness, diabetic nephropathy, muscular dystrophy, and cardiovascular disease. In this review, we assess the use of mTOR inhibitors to treat age-related pathologies, discuss possible molecular mechanisms of action where evidence is available, and consider strategies to minimize undesirable side effects. We also emphasize the urgent need for reliable, non-invasive biomarkers of senescence and biological ageing to better monitor the efficacy of any healthy ageing therapy.
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Medicine & Pharmacology, Behavioral Neuroscience; Lyme disease; Borrelia burgdorferi; tickborne diseases; persistent infection; treatment; assessment; depression; anxiety; sleep disorders; opioid addiction
Online: 5 June 2018 (08:33:20 CEST)
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There is increasing evidence and recognition that Lyme borreliosis, and other associated tick-borne diseases (LB/TBD) cause mental symptoms. Data was drawn from databases, search engines and clinical experience to review current information on LB/TBD. LB/TBD infections cause immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity and may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments. Screening assessment followed by a comprehensive psychiatric clinical exam relevant to patient’s complaints and findings with a thorough history, mental status exam, review of systems, neurological exam, physical exam, a knowledgeable interpretation of laboratory findings, pattern recognition and clinical judgment facilitate diagnosis. Psychotropics and antibiotics may help improve functioning and prevent further disease progression. Awareness of the association between LB/TBD and neuropsychiatric impairments and studies of their prevalence in neuropsychiatric conditions can improve understanding of the causes of mental illness and violence and result in more effective prevention, diagnosis and treatment.
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Medicine & Pharmacology, Nutrition; polyphenols; folic acid-chitosan; encapsulation; loading efficacy; TEM
Online: 4 June 2018 (10:41:51 CEST)
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Encapsulation of antioxidant polyphenols leads to increase solubility and bioavailability of these micronutrients in solution. The encapsulation of antioxidant resveratrol, genistein and curcumin by folic acid-chitosan nanocapsules was studied in aqueous solution, using multiple spectroscopic methods, TEM images. Structural analysis showed that polyphenol bindings are via hydrophilic, hydrophobic and H-bonding contacts with resveratrol forming more stable conjugates. As chitosan size increased, the binding efficacy and stability of polyphenol-polymer adducts were increased. Polyphenol binding induced major alterations of chitosan morphology. Chitosan nanoparticles are capable of delivery of polyphenols in vitro.
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Jean Christopher Chamcheu,
Islam Rady,
Roxane-Cherille N. Chamcheu,
Abu Bakar Siddique,
Melissa B. Bloch,
Sergette Banang Mbeumi,
Abiola S. Babatunde,
Mohammad B. Uddin,
Felicite K. Noubissi,
Peter W. Jurutka,
Yong-Yu Liu,
Vladimir S. Spiegelman,
G. Kerr Whitfield,
Khalid A. El Sayed
Medicine & Pharmacology, Dermatology; Annona muricata; apoptosis; basal cell carcinoma; cutaneous squamous cell carcinoma; graviola; Hedgehog signaling pathway; natural products chemistry; non-melanoma skin cancer
Online: 1 June 2018 (13:00:02 CEST)
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Non-melanoma skin cancers (NMSCs) are the leading cause of skin cancer-related morbidity and mortality. Effective strategies are needed to control NMSC occurrence and progression. Non-toxic, plant-derived extracts have been shown to exert multiple anti-cancer effects. Graviola (Annona muricata), a tropical fruit-bearing plant, has been used in traditional medicine against multiple human diseases including cancer. The current study investigated the effects of graviola leaf and stem extract (GLSE) and its solvent-extracted fractions on two human NMSC cell lines, UW-BCC1 and A431. GLSE was found to: i) dose-dependently suppress UW-BCC1 and A431 cell growth, motility, wound closure, and clonogenicity; ii) induce G0/G1 cell cycle arrest by downregulating cyclin/cdk factors while upregulating cdk inhibitors, and (iv) induce apoptosis as evidenced by cleavage of caspases-3, -8 and PARP. Further, GLSE suppressed levels of activated hedgehog (Hh) pathway components Smo, Gli 1/2, and Shh while inducing SuFu. GLSE also decreased the expression of pro-apoptotic protein Bax while decreasing the expression of the anti-apoptotic protein Bcl-2. We determined that these activities were concentrated in an acetogenin/alkaloid-rich dichloromethane subfraction of GLSE. Our data identify graviola extracts and their constituents as promising sources for new chemopreventive and therapeutic agent(s) to be further developed for the control of NMSCs
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Medicine & Pharmacology, Pediatrics; childhood malnutrition; community-based management of acute malnutrition–CMAM; moderate acute malnutrition–MAM; supplementary feeding programs–SFP; Zambia
Online: 1 June 2018 (12:04:50 CEST)
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Background: Evaluation of nutrition programs is essential to guarantee the effectiveness of community-based management of acute malnutrition (CMAM). Methods: The Rainbow Project Supplementary Feeding Programs (SFPs) in Zambia were evaluated between years 2015-17, following implementation of new recommendations based on previous evaluations (years 2012-14). Outcomes of the program were compared with International Standards and with those of 2012-14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: Data for 900 under age 5 years malnourished children (48.8% male; mean age 19.7months ±9.9) were analyzed. Rainbow 2015-17 program outcomes met International Standards, for general malnutrition or stratified moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). When comparing with 2012-14 outcomes, better performance was noted: mortality rates were reduced by half (5.6% vs 3.1%, p = 0.01; for SAM: 12.4% vs 6.7%, p = 0.006), with significant improvement in average weight gain and mean length of stay (p<0.001), and increased awareness of HIV status (+30%; p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ < −3 at baseline (4.6; 1.3–16.1) and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Conclusion: The effectiveness of the Rainbow SFPs for child malnutrition treatment and prevention in Zambia has significantly improved after evaluation and implementation activities, with impressive outcomes which resulted in a 50% reduction in mortality.
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Medicine & Pharmacology, Pediatrics; development; milestones; screening; poverty; stunting; lead exposure; developmental risk; child health; global health; pediatrics
Online: 1 June 2018 (11:11:19 CEST)
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There is a need for developmental screening that is easily administered in resource-poor settings. 1) We hypothesized that known risk factors would predict failed developmental screening on an adapted screening tool in East African children living in poverty. 2) The sample included 100 healthy Ugandan children aged 6-59 months. We adapted a parent-reported developmental screener based on the Child Development Review chart. The primary outcome was failure to meet age-appropriate milestones for any developmental domain. Venous blood was analyzed for lead, and caregivers completed a demographics questionnaire. We used multivariate logistic regression models to determine if elevated blood lead and stunting predicted failure on the screener, controlling for maternal education level, age in months past the lower bound of the child’s developmental age group, and absence of home electricity. 3) In the sample, 14% (n=14) of children failed one or more milestones on the screener. Lead levels or stunting did not predict failing the screener after controlling for covariates. 4) Though this tool was feasibly administered, it did not demonstrate preliminary construct validity and is not yet recommended for screening in high-risk populations. Future research should include a larger sample size and cognitive interviews to ensure it is contextually relevant.
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Medicine & Pharmacology, Obstetrics & Gynaecology; endocannabinoid system; gynaecological cancers; endometrial cancer; cervical cancer; ovarian cancer, CB1R; CB2R; FAAH;
Online: 1 June 2018 (05:45:19 CEST)
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Background: The endocannabinoid system (ECS) is a very heterogeneous array consisting of many proteins like ligands, enzymes and receptors synthetized in various tissues and immunity cells. The main endogenous ligands are unsaturated fatty acid derivatives like anandamide(AEA), 2-arachidonoylglycerol(2-AG), but many others are under study. Endocannabinoids are involved in both physiological and pathological conditions. ECS plays an important role in the regulation of main processes which lead to cancer and also in sex steroid hormone-related cancers.
Methods: With focus on gynaecological cancers, main papers and review articles, up to April 2018, on the role of the ECS, were acquired by PubMed searches using the search terms: ‘cancer’, ‘cannabinoid’, ‘endocannabinoid’, ‘gynaecology’ and ‘malignancy’.
Results: The review of recent literature data showed the involvement of the endocannabinoid system in numerous physiological and pathological conditions of the female genital tract up to the development of gynaecological malignancy as cervical, endometrial and ovarian cancer.
Conclusions: The endocannabinoid system has an important role in antitumor actions involving different signalling receptor and receptor-independent pathways. It represents an exciting challenge to researchers for its potential use in diagnosis and treatment of all gynaecological malignancies
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Medicine & Pharmacology, Other; screen time; sleep duration; body mass index (BMI); time use
Online: 31 May 2018 (16:34:38 CEST)
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Today, due to recent developments in technology, children devote plenty of time for screen viewing. However, its harmful effects are not yet clear. The purpose of present study was to examine the associations among screen viewing and sleep duration, and body mass index (BMI) in under-five years old children. This cross-sectional study was conducted with 322 under-five healthy children that were selected using multistage stratified cluster sampling method in 2017. The data that were gathered by time-use diary method were analyzed using Kolmogorov-Smirnov test, Spearman correlation tests, multiple linear regression analysis, one-way ANCOVA, two-way ANCOVA. There was a negative correlation between screen time and sleep duration (rs = -0.42, p = 0.00), positive correlation between screen time and BMI (rs = 0.38, p = 0.00) and sleep duration negatively correlated with BMI (rs = -0.22, p = 0.00). screen viewing was a predictive factor for both sleep duration (β = -0.26, p = 0.00) and BMI (β = -0.26, p = 0.00). screen viewing had a significant impact on sleep duration (4, 314) = 5.02, P = 0.001) and BMI (F (4, 314) = 1.16, P=0.298). Results of this study indicated that screen viewing is related to sleep duration and BMI in under-five children. furthermore, screen time has an impact on sleep duration and BMI scores of children. findings of our study suggest that sleep duration negatively is associated with BMI in under-five-year-old children.
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Janet L. Williams,
Wendy K. Chung,
Alex Fedotov,
Krzysztof Kiryluk,
Chunhua Weng,
John J. Connolly,
Margaret Harr,
Hakon Hakonarson,
Kathleen A. Leppig,
Eric B. Larson,
Gail P. Jarvik,
David L. Veenstra,
Christin Hoell,
Maureen E. Smith,
Ingrid A. Holm,
Josh F. Peterson,
Marc S. Williams
Medicine & Pharmacology, General Medical Research; genomics; genomic medicine; health outcomes; evidence; standards; eMERGE; ClinGen; precision public health
Online: 31 May 2018 (11:27:23 CEST)
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Genomic medicine is moving from research to the clinic. There is a lack of evidence about the impact of genomic medicine interventions on health outcomes. This is due in part to a lack of standardized outcome measures that can be used across different programs to evaluate the impact of interventions targeted to specific genetic conditions. The eMERGE Outcomes working group (OWG) developed measures to collect information on outcomes following the return of genomic results to participants for several genetic disorders. These outcomes were compared to outcome intervention pairs for genetic disorders developed independently by the ClinGen Actionability working group (AWG). In general, there was concordance between the defined outcomes between the two groups. The ClinGen outcomes tended to be higher level and the AWG scored outcomes represented a subset of outcomes referenced in the accompanying AWG evidence review. eMERGE OWG outcomes were more detailed and discrete, facilitating collection of relevant information from health records. This paper demonstrates that common outcomes for genomic medicine interventions can be identified. Further work is needed to standardize outcomes across genomic medicine implementation projects and make these publicly available to enhance dissemination and assist in making precision public health a reality.
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Medicine & Pharmacology, Oncology & Oncogenics; Tspo; prostate cancer; stomach cancer; colon cancer; liver cancer; lung cancer; kidney cancer; breast cancer; brain cancer
Online: 31 May 2018 (10:59:31 CEST)
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Tspo is a receptor involved in the regulation of cellular proliferation, apoptosis and mitochondrial functions. Previous studies showed the expression of TSPO protein correlated positively with tumour malignancy and negatively with patient survival. The aim of this study was to determine the transcription of Tspo mRNA in various types of normal and cancer tissues. In situ hybridization was performed to localise the Tspo mRNA in various human normal and cancer tissues. The relative level of Tspo mRNA was quantified using fluorescent intensity and visual estimation of colorimetric staining. RT-PCR was used to confirm these mRNA levels in normal lung, lung cancer, liver cancer and cervical cancer cell lines. There was a significant increase in the level of transcription in liver, prostate, kidney and brain cancers while a significant decrease was observed in cancers of the colon and lung. Quantitative RT-PCR confirmed that the mRNA levels of Tspo are higher in a normal lung cell line than in a lung cancer cell line. An increase in the expression levels of TSPO makes it a good diagnostic biomarker and TSPO could serve as a target for anticancer drug development.
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Medicine & Pharmacology, Psychiatry & Mental Health studies; pain; depression; treatment; meditation; synaptic plasticity and homeostasis; nerve stimulation
Online: 31 May 2018 (09:56:35 CEST)
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Major depressive disorder (MDD) is a common mental disorder, which results in seriously impaired condition in the patients and great global disability burden. In light of its quite diverse etiologies, comorbidity with many other diseases, and complex underlying pathology, it has been a great challenge to understand the physiological basis of MDD, which may be a complex of related diseases, rather than a single one. In addition to the partial understanding of MDD, the individual heterogeneities among patients may render the development of a universal treatment an elusive goal. But studying how each of currently available treatments affects the disease can generate useful information to stratify patients into different subtypes for individualized treatments. In this case report, we present the first report of repeated success of using meditation as the only treatment of MDD, compared to initial success but no remission with other conventional antidepressants on the same patient. We hypothesized that the short but continuous natural pain during one-hour meditation sittings has the therapeutic effect to treat depression in the case of this patient and potentially others with MDD. This special opportunity of eliminating tremendous heterogeneity among different individuals has enabled us to probe deeply into the potential mechanism of depression treatments and the complex physiology of depression itself, both of which have likely profound implications in the treatment of other MDD patients as well. More importantly, this case report helps us dissect one specific component of meditation for its long-known and well-established benefit against depression.
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Medicine & Pharmacology, Psychiatry & Mental Health studies; pain; depression; treatment; meditation; synaptic plasticity and homeostasis; DNA damage response
Online: 31 May 2018 (09:51:27 CEST)
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The correlation and comorbidity between depression and chronic pain have been observed for a long time. Generally, it is considered that the two conditions reinforce each other, whereas the causal relationship between them is not clear. However, some evidence suggested that chronic pain may reverse the progression of depression in some cases. This article presents a selective review of clinical and pharmacological relationship between depression and pain, and their interactions at neurochemical and neurobiological levels. In addition, we open a discussion on a recent case report of repeated success of using short but continuous pain (SCP) during meditation as the only treatment for depression, compared to initial success but no remission with other conventional antidepressants on the same patient. Together this review proposes an updated model for depression and its various treatments that is based on synaptic and system homeostasis. More importantly, it suggests that SCP may benefit depression recovery through its properties that are different from either acute or chronic pain and represents a novel research area that has been largely neglected to date.
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Medicine & Pharmacology, Other; undiagnosed rare diseases; diagnostic odyssey; NGS; deep phenotyping; genomic matchmaking; secondary findings; patient involvement
Online: 31 May 2018 (09:35:32 CEST)
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The time required to reach a correct diagnosis is one of the most important problems for rare disease (RD) patients. Diagnostic delay can be intolerably long, to the point that it is usually described as a “diagnostic odyssey” and, sometimes, a diagnosis might never occur. The International Rare Disease Research Consortium proposed, as ultimate goal for 2017-2027, to enable all people with a suspected RD to be diagnosed within one year if the disorder is known, and to enter a globally coordinated diagnostic and research pipeline for the unsolved cases. In-depth analysis of the genotype through next generation sequencing, together with a standardized in-depth phenotype description and sophisticated high-throughput approaches, have been applied as diagnostic tools to increase the chance of a timely and accurate diagnosis. This approach is very fruitful as, according to the Orphanet database, from 2010 to March 2017 more than 600 new RDs have been described and about 3600 genes linked to RDs have been identified. However, combination of -omics and phenotype data and international sharing of this information raise ethical concerns. Values to be assessed include not only patient autonomy but also family implications, beneficence, non-maleficence, justice, solidarity and reciprocity, which must be respected and promoted and, at the same time, balanced among each other. In this work we suggest that, to maximise patients involvement in the search for a diagnosis and identification of new causative genes, undiagnosed patients should have the possibility to: 1) actively participate in the description of their phenotype; 2) choose the level of visibility of their profile in matchmaking databases; 3) express their preferences regarding return of new findings, in particular which level of Variant of Unknown Significance (VUS) significance should be considered relevant to them. The quality of the relation between individual patients and physicians, and between the patient community and the scientific community is critically important for making the best use of available data and combining efforts in the search for matches with similar cases worldwide that will help to solve unsolved cases. The contribution of patients to collecting and coding data comprehensively is critical for efficient use of data downstream of data collection.
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Medicine & Pharmacology, Nutrition; sphingolipids; ceramide; flavonoids; resveratrol; genistein; curcumin, nutrients; nutraceuticals; chemotherapeutics
Online: 31 May 2018 (08:26:07 CEST)
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The latest scientific literature outlines a resilient interconnection between cancer modulation and dietary polyphenols by sphingolipid-mediated mechanisms, usually correlated with a modification of their metabolism. We aim to extensively survey this relation to show how it could be advantageous in cancer treatment or prevention by nutrients. Polyphenols, chemically characterized by polyhydroxylated phenolic structure, are well known for their pervasive pharmacological properties: anti-inflammatory, antibiotic, antiseptic, antitumor, antiallergic, cardioprotective and others. Pervasive is also their distribution in food products especially in plant foods as vegetables, cereals, legumes, fruits, nuts and beverages as wine, cider, beer, tea, cocoa. Recently, sphingolipids have been correlated with cancer by a dysregulation of their rheostat emerging as mediator of cell proliferation in cancer and modulator of chemotherapeutics.
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Medicine & Pharmacology, Oncology & Oncogenics; bladder cancer; dynamic model; uncertainty quantification; model calibration; cancer prognosis
Online: 31 May 2018 (08:18:00 CEST)
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Bladder cancer is one of the most common malignant diseases in the urinary system and a highly aggressive neoplasm. The prognosis is not favourable usually and its evolution for particular patients is very difficult to find out. In this paper we propose a dynamic mathematical model that describes the bladder tumor growth and the immune response evolution. This model is customized for a single patient, determining appropriate model parameter values via model calibration. Due to the uncertainty of the tumor evolution, using the calibrated model parameters, we predict the tumor size and the immune response evolution over the next few months assuming three different scenarios: favourable, neutral and unfavourable. In the former, the cancer disappears; in the second a 5mm tumor is expected around the middle of August 2018; in the worst scenario, a 5mm tumor is expected around the end of May 2018. The patient has been cited around June 15th, 2018, to check the tumor size, if it exists.
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Medicine & Pharmacology, Nutrition; CKD; renal function; nutrients; nutraceuticals; xenobiotics; inflammation; functional nutrition.
Online: 30 May 2018 (17:15:58 CEST)
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Chronic kidney disease (CKD) affects worldwide 8-16% of the population. In developed countries, the most important risk factors for CKD are diabetes, hypertension and obesity, calling into question the importance of educating and acting on lifestyles and nutrition. A balanced nutrition and supplementation can indeed support the maintenance of a general health status, including preservation of renal function, and help to manage and curb the main risk factors for renal damage. While the concepts of protein and salt restriction in nephrology are historically acknowledged, the role of some nutrients on renal health and the importance of nutrition as a preventative measure for renal care are less known. In this review, we provide an overview of the demonstrated and potential actions of some selected nutrients, nutraceuticals and xenobiotics on renal health and function. The effects on kidney of fibres, proteins, fatty acids, curcumin, steviol glycosides, green tea, coffee, nitrates, nitrites, and alcohol, both direct and indirect, in CKD and non-CKD condition, are reviewed here. In a view of a functional and personalized nutrition, understanding the renal and systemic effects of dietary components is essential since many chronic conditions and CKD are related to systemic dysfunctions such as chronic low-grade inflammation.
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Medicine & Pharmacology, General Medical Research; Photodynamic inactivation, reactive oxygen species, chitosan, cell wall
Online: 30 May 2018 (16:19:51 CEST)
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Photodynamic inactivation (PDI) combines the nontoxic photosensitizer (PS) and visible light to generate reactive oxygen species (ROS), which can cause oxidative damages in (on) microbial organisms. Previously, we have shown that chitosan can augment the bactericidal efficacy mediated by PDI against bacteria and Candida. In this study, we showed that the antimicrobial action of chitosan to augment PDI relates to the enlargement of cell surface destruction. The microbial cell surfaces exhibit severe irregular shapes after PDI in the presence of chitosan. Furthermore, increase in the concentrations or incubation time of chitosan significantly reduce the amounts of photosensitizers TBO required, indicating that chitosan could be a synergistic agent with PDI against human pathogens. A prolonged lag phase was found in PDI surviving microbial cells, in which chitosan can act to synergistically eradicate the cells. Once the impaired cells rebuild their cellular functions from PDI-induced damage, the increased cytotoxic effect of chitosan disappeared. Together, our results suggest that chitosan with an augmented bactericidal activity after PDI is to inhibit the rehabilitation of PDI surviving cells, leading to microbial death.
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Medicine & Pharmacology, Pharmacology & Toxicology; neem leaves; sequential pressurized liquid extraction; antiproliferative activity
Online: 30 May 2018 (07:45:25 CEST)
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Azadirachta indica A. Juss (neem) extracts have been used in pharmaceutical applications as antitumor agents, due to their terpenes and phenolic compounds. To obtain extracts from neem leaves with potential antiproliferative effect, a sequential process of pressurized liquid extraction was carried out in a fixed bed extractor at 25 ºC and 100 bar, using hexane (SH), ethyl acetate (SEA) and then ethanol (SE) as solvents. An extraction using only ethanol (EE) was also conducted to compare the characteristics of the fractionated extracts. The results obtained by liquid chromatography-electrospray ionization mass spectrometry suggested the highest concentration of terpenes for SEA extract in comparison to SH, SE and EE extracts. Therefore, antiproliferative activity showed SEA extracts were the most efficient inhibitors to human tumor cells MCF-7, NCI-H460, HeLa, and HepG2 between all other extracts studied. However, hepatocellular normal cells were more resistant to SH, SEA, SE, and EE compared to malignant cells of breast, lung, hepatocellular, and cervical. Neem fractioned extracts obtained in the present study seem to be more selective for malignant cells compared to the normal cells.
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Medicine & Pharmacology, Oncology & Oncogenics; breast cancer; comorbidities; older women; radiotherapy; survival
Online: 29 May 2018 (13:01:28 CEST)
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Background: Radiotherapy plays an important role in the management and survival of patients with breast cancer. The aim of this study was to examine the association between age, comorbidities and use of radiotherapy in this population. Methods: Patients diagnosed with breast cancer from 2004–2013 were identified from the American College of Surgeons National Cancer Database (NCDB). Follow-up time was measured from the date of diagnosis (baseline) to the date of death or censoring. Adjusted hazard ratios (aHR) and 95% confidence intervals (95%CI) were used as the measure of association. Results: Independently of comorbidities and other important outcome-related factors, patients >65 years of age who received radiotherapy survived significantly longer than those who did not receive radiotherapy (aHR = 0.53, 95%CI = 0.52–0.54). However, as women aged, those with comorbidities were less likely to receive RT (adjusted P-trend by age <0.0001). Conclusions: The development of decision-making tools to assist clinicians, and older women with breast cancer and comorbidities, are needed to facilitate personalized treatment plans regarding RT. This is particularly relevant as the population ages and the number of women with breast cancer is expected to increase in the near future.
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Medicine & Pharmacology, Other; biological activity; crosslinking; drug delivery; cosmetic; food-supplement; functionalization; hyaluronan applications; hyaluronan derivatives; hyaluronan synthases; hyaluronic acid; hyaluronidases; physico-chemical properties
Online: 29 May 2018 (12:13:48 CEST)
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Since its first isolation in 1934, hyaluronic acid (HA) has been studied across a variety of research areas. This unbranched glycosaminoglycan consisting of repeating disaccharide units of N-acetyl-D-glucosamine and D-glucuronic acid is almost ubiquitary in humans and in other vertebrates. HA is involved in many key processes -including cell signaling, wound reparation, tissue regeneration, morphogenesis, matrix organization and pathobiology-, and has unique physico-chemical properties -such as biocompatibility, biodegradability, mucoadhesivity, hygroscopicity and viscoelasticity. For these reasons, exogenous HA has been investigated as drug delivery system and treatment in cancer, ophthalmology, arthrology, pneumology, rhinology, urology, aesthetic medicine and cosmetic. To improve and customize its properties and applications, HA can be subjected to chemical modifications: conjugation and crosslinking. The present review gives an overview regarding HA, describing its history, physico-chemical, structural and hydrodynamic properties, and biology –occurrence, biosynthesis (by hyaluronan synthases), degradation (by hyaluronidases and oxidative stress), roles, mechanisms of action and receptors. Furthermore, both conventional and recently emerging methods developed for the industrial production of HA and its chemical derivatization are presented. Finally, the medical, pharmaceutical and cosmetic applications of HA and its derivatives are reviewed, reporting examples of HA-based products which currently are on the market or are undergoing further investigations.
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Medicine & Pharmacology, General Medical Research; advanced glycation end products; glyoxal; hypoxanthine/xanthine oxidase; methyl glyoxal; RCS-trapping
Online: 28 May 2018 (13:28:19 CEST)
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Advanced Glycation End Products (AGEs) represent a set of substances that contribute directly to the triggering and/or aggravation of pathologies associated with ageing. AGEs are produced by the reaction between reducing sugars (or α-dicarbonyl compounds) proteins and amino acid residues. Current methodologies require an incubation period of 1-3 weeks to generate AGEs. In this study the reaction time for the formation of AGEs (48 and 3 hours) is significantly reduced by coupling and adapting procedures already existing in the literature to the free radical generation system called the hypoxanthine/xanthine oxidase assay. The capacity of different classes and chemical compounds (aminoguanidine, chlorogenic acid, rutin, extracts of Hancornia speciosa Gomes) were evaluated to inhibit the protein glycation process, acting as capturing agents of α-dicarbonyl species. Aminoguanidine, rutin and the leaf extracts of Hancornia speciosa Gomes show a high capacity to act as α-dicarbonyl compound scavengers (RCS-trapping) and resulting in the inhibition of AGEs formation.
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Medicine & Pharmacology, Nutrition; retinal degeneration; DNA methylation; epigenetics; oxidative stress; inflammation
Online: 28 May 2018 (10:33:13 CEST)
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The role of epigenetic alterations in the pathogenesis of age-related macular degeneration (AMD) has been pending so far. Our study investigated the effect of oxidative stress and inflammation on DNA methyltransferases (DNMTs) and Sirtuin 1 (SIRT1) functions, as well as on long interspersed nuclear element-1 (LINE-1) methylation, in human retinal pigment epithelial (ARPE-19) cells. Therefore, we evaluated whether treatment with resveratrol may restore changes in LINE-1 methylation by modulating DNMTs and SIRT1 functions. Cells were treated with 25 mU/ml glucose oxidase (GOx) or 10 µg/ml lipopolysaccharide (LPS) to mimic oxidative or inflammatory conditions, respectively. Oxidative stress decreased DNMT1, DNMT3a, DNMT3b and SIRT1 expression (p-values <0.05), as well as total DNMTs (-28.5%; p<0.0001) and SIRT1 (-29.0%;p<0.0001) activities. Similarly, inflammatory condition decreased DNMT1 and SIRT1 expression (p-values<0.05), as well as total DNMTs (-14.9%;p=0.007) and SIRT1 (-20.1%;p<0.002) activities. Interestingly, GOx- and LPS-treated cells exhibited lower LINE-1 methylation compared to controls (p-values<0.0001). We also demonstrated that treatment with 10 μM resveratrol for 24 hours counteracted the detrimental effect on LINE-1 methylation via increasing DNMTs and SIRT1 functions in cells upon oxidative and inflammatory conditions. However, further studies should explore the perspectives of resveratrol as a suitable strategy for the prevention and/or treatment of AMD.
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Medicine & Pharmacology, Psychiatry & Mental Health studies; dependence; nicotine; tobacco; coffee
Online: 28 May 2018 (05:16:08 CEST)
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Introduction. Few studies have compared the dependence to different tobacco and nicotine products. Besides how dependence may vary between tobacco products there is even less known how it relates to other common drugs, e.g. caffeine. In this study degree of dependence was compared between snus, cigarettes, nicotine replacement (NR), electronic cigarettes and coffee. Methods. An internet panel was used to obtain a representative sample of 3001 Swedes. The responders were asked among other related things about their use of snus, NR, traditional cigarette or e-cigarette use and coffee consumption. The indicators of dependence used were: A. the Heavy Smoking Index, B. The proportions that used within 30 min after raising in the morning, C. rating the first use in the morning as the most important and D. Stating that it would be very hard to give up entirely. Results. Significantly fewer among coffee drinkers started use within 30 minutes of awakening compared with all other products. The first use of the day was found to be more important for snus users compared with other products. On HSI there was no difference between snus and cigarettes. Snus and cigarettes were rated as being more difficult to give up than NR and coffee. Conclusion. Dependence to traditional cigarettes and snus seem to be relatively similar while NR was rated lower and coffee lowest. Since the prevalence of caffeine use in all forms is so much more prevalent than nicotine use there might be more persons in the society heavily dependent on caffeine. Implication. Tobacco products are likely more dependence forming that NR products and coffee. The addiction to coffee or caffeine is seldom discussed in the society. But if there are more individuals heavily dependent on coffee than nicotine and some nicotine containing products like snus and even more so NR are not that much more harmful than coffee how problematic is the addiction?
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Medicine & Pharmacology, Anesthesiology; ultrasonography; preoperative; postoperative; collabsibility index; inferior vena cava diameter
Online: 25 May 2018 (11:42:21 CEST)
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Background: Ultrasound measurement of dynamic changes in inferior vena cava (IVC) diameter and collapsibility index (CI) evaluates to estimate the fluid responsiveness and intravascular volume status. We conducted a analysis to quantify the sonographic measurement of IVC diameter changes in adult patients at preoperative and postoperative period.
Methods: Ultrasonography was performed on 72 patients scheduled for surgery with American Society of Anesthesiologists physical status I to III. Quantitative assessments of the end-expiration (Dmin), end-inspiration (Dmax) and CI at preoperative and postoperative period were compared in a prospective, observational study. The patients received intravenous fluid according to standard protocol regimes peroperatively. The cutt-off value of dIVC 40% was accepted as hypovolemia.
Results: Ultrasonography of IVC measurement was unsuccessful in 12.5% of patients and 63 patients remained for analyses. The mean age was 43.29 ± 17.22 (range 18 - 86) years. The average diameter of the Dmin, Dmax and dIVC at preoperative and postoperative were 1.99 ± 0.31 vs. 2.05 ± 0.29 cm, 1.72 ± 0.33 vs. 1.74 ± 0.32 cm, 14.0 ± 9.60 % vs. 15.14 ± 11.18 %, respectively (p<0.05). Using a threshold dIVC of 40%, one patient preoperatively and 5 postoperatively were hypovolemic (p<0.05). CI was also positively associated preoperatively and postoperatively (regression coefficient = 0.438, p<0.01).
Conclusion: The diameter of IVC did not change preoperatively and postoperatively in adult patients with standard fluid regimens. The parameters of the IVC diameter increased postoperatively according to preoperative period.
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Medicine & Pharmacology, Pharmacology & Toxicology; autophagic cell death; curcumin; human GD3 synthase (hST8Sia I); A549 cells; transcriptional regulation
Online: 25 May 2018 (11:12:02 CEST)
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Curcumin, a natural polyphenolic compound isolated from the plant Curcuma longa, is known to induce autophagy in various cancer cells, including lung cancer. In the present study, we also confirmed by LC3 immunofluorescence and immunoblotting analyses that curcumin triggers autophagy in human lung adenocarcinoma A549 cell line. In parallel with autophagy induction, gene expression of human GD3 synthase (hST8Sia I) responsible for ganglioside GD3 synthesis was markedly elevated in response to curcumin in A549 cells. To investigate transcriptional activation of hST8Sia I associated with autophagy formation in curcumin-treated A549 cells, functional characterization of the 5’-flanking region of the hST8Sia I gene was carried out using luciferase reporter assay system. Deletion analysis demonstrated that the -1146 to -646 region, which includes putative c-Ets-1, CREB, AP-1 and NF-κB binding sites, functions as the curcumin-responsive promoter of hST8Sia I in A549 cells. Site-directed mutagenesis and chromatin immunoprecipitation assay demonstrated that the NF-κB binding site at -731 to -722 was indispensable for the curcumin-induced hST8Sia I gene expression in A549 cells. Moreover, the transcriptional activation of hST8Sia I by curcumin A549 cells was strongly inhibited by compound C, an inhibitor of AMP-activated protein kinase (AMPK). These results suggest that curcumin controls hST8Sia I gene expression via AMPK signal pathway in A549 cells.
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Medicine & Pharmacology, Pathology & Pathobiology; autism spectrum disorder; endocrine; estrogen; immune activation; melanin concentrating hormone
Online: 25 May 2018 (10:37:23 CEST)
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The voluminous daily output of autism research has become increasingly disconnected, existing largely within highly specific subspecialty areas, and lacking cross-disciplinary linkages of context, theory, and findings to inform a unified body of knowledge. Robust syntheses of published research across the fields of psychiatry, cellular and molecular biology, neurology, endocrinology, immunology, behavioral and social sciences, and pedagogy may help clarify and extend current knowledge by guiding more efficient future research efforts investigating underlying causes, developmental divergences, novel treatments, and specific, sensitive biological markers in autism. This synthesis of interdisciplinary research indicates the hypothalamic-pituitary-adrenal (HPA) stress axis may be at the center of an interaction among sex steroids, immune function, signaling protein transcriptions, neurogenesis, and dysregulation of brain structures sending or receiving projections from the HPA stress axis. These interaction manifest observably as a range of sexually dimorphic behaviors and functional limitations often falling within the current diagnostic features of Autism Spectrum Disorder (ASD). The pathogenicity of endocrine dysregulation may serve as a valuable model for developing a cohesive theory of ASD by explaining how the HPA and connected brain areas respond to extreme conditions of dysregulated endocrine signaling to cause symptoms associated with autism.
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Medicine & Pharmacology, Oncology & Oncogenics; lung cancer; molecular analysis; NGS; oncogene drivers
Online: 25 May 2018 (09:44:51 CEST)
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Recent changes in lung cancer care, including new approvals in first line and the introduction of high throughput molecular technologies in routine testing led us to question ourselves on how deeper molecular testing may be helpful for the optimal use of targeted drugs. In this article we review recent results in the scope of personalized medicine in lung cancer. We discuss biomarkers that have a therapeutic predictive value in lung cancer with a focus on recent changes and on the clinical value of large scale sequencing strategies. We review the use of second and third generation EGFR and ALK inhibitors with a focus on secondary resistance alterations. We discuss anti-BRAF and anti-MEK combo, emerging biomarkers as NRG1 and NTRKs fusions and immunotherapy. Finally we discuss the different technical issues of comprehensive molecular profiling and show how large screenings might refine the prediction value of individual markers. Based on a review of recent publications (2012–2018), we address promising approaches for the treatment of patients with lung cancers and the technical challenges associated to the identification of new predictive markers.
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Medicine & Pharmacology, Pharmacology & Toxicology; Periostracum cicadae; IgA nephropathy; inflammation; fibrosis; apoptosis
Online: 24 May 2018 (06:32:22 CEST)
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Periostracum cicadae, the cast-off shell of the cicada Cryptotympana pustulata Fabricius, is used in traditional Chinese medicine for its diaphoretic, anticonvulsive, sedative, antipyretic, and antiallergic effects. However, the exact pathogenesis of immunoglobulin A nephropathy (IgAN) remains unclear, thereby hindering investigations to identify novel therapeutic agents. A rat IgAN model was established by administration of bovine serum albumin, lipopolysaccharide, and carbon tetrachloride, which simultaneously established blood stasis and a heat syndrome model. The animals were sacrificed to detect changes in protein levels in urine and blood. Immunofluorescence was performed to assess IgA deposition in the glomeruli. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin 6 (IL-6) levels were measured in bronchoalveolar lavage fluid (BALF) by enzyme-linked immunosorbent assay. Hematology and eosin, periodic acid-Schiff, TUNEL, and immunohistochemical staining were performed to evaluate histopathological changes in kidney tissues. Additionally, target-related proteins were measured by western blotting. Periostracum cicadae resulted in a reduction in blood and urine protein levels. Serum TNF-α, IL-1β, and IL-6 levels significantly decreased in the periostracum cicadae-treated groups compared to the IgAN group. Furthermore, a reduction in MCP-1, TLR4, and IgA expression levels and a dose- dependent increase in caspace-3 expression were observed in response to periostracum cicadae treatment. TGF-β1 levels decreased, whereas that of Fas increased in the kidney tissues of the periostracum cicadae-treated groups. The findings of the present study indicate that periostracum cicadae induces apoptosis and improves kidney inflammation and fibrosis in IgA nephropathy rat models.
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Medicine & Pharmacology, Other; Reproducibility, Mathematical Modeling, Multiscale Modeling, Translational Research, Biomedical Research, Experimental Biology, Clinical Research Article Type: Essay
Online: 23 May 2018 (16:18:52 CEST)
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The “Crisis of Reproducibility” has received considerable attention both within the scientific community and without. While factors associated with scientific culture and practical practice are most often invoked, I propose that the Crisis of Reproducibility is ultimately a failure of generalization with a fundamental scientific basis in the methods used for biomedical research. The Denominator Problem describes how limitations intrinsic to the two primary approaches of biomedical research, clinical studies and pre-clinical experimental biology, lead to an inability to effectively characterize the full extent of biological heterogeneity, which compromises the task of generalizing acquired knowledge. Drawing on the example of the unifying role of theory in the physical sciences, I propose that multi-scale mathematical and dynamic computational models, when mapped to the modular structure of biological systems, can serve a unifying role as formal representations of what is conserved and similar from one biological context to another. This ability to explicitly describe the generation of heterogeneity from similarity addresses the Denominator Problem and provides a scientific response to the Crisis of Reproducibility.
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Medicine & Pharmacology, Oncology & Oncogenics; smoking; pathologic stage; pathologic grade; low risk
Online: 23 May 2018 (08:48:03 CEST)
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AbstractWe investigated the effect of cigarette smoking on pathological staging in clinically low-risk patients. Data of 59 patients who were diagnosed with bladder tumor for the first time and had a single lesion radiologically and endoscopically smaller than 3 cm were investigated retrospectively. 33 patients who smoked were classified as Group I, and 26 patients who did not smoke were classified as Group II. Pathological diagnoses of the patients in both groups were compared. The mean age of the patients were 64.8 (20–86) years. In Group II, 5 (19.2%) were female and 21 (80.8%) were male (p < 0.05). Nine patients (27.3%) in Group I and 18 patients (69.2%) in Group II had Ta disease (p < 0.05). Nineteen patients (57.6%) in Group I and 5 patients (19.2%) in Group II had T1 disease (p < 0.05). The number of patients with low grade (LG) tumor were 8 (24.2%) and 19 (73.1%) in Group I and in Group II, respectively (p < 0.05). The number of patients with high grade(HG) tumor were 25 (75.8%) and 7 (26.9%) in Group I and in Group II, respectively (p < 0.05). TaHG was detected in 9 (27.3%) patients in Group I. In contrast, no patients in Group II had TaHG disease (p < 0.05). The number of patients with T1HG was 17(51.5%) patients in Group I and 2 (7.69%) patients in Group II (p < 0.05). Smoking is associated with pathologically HG and stage in patients with first time bladder tumor which is single and smaller than 3 cm.
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Medicine & Pharmacology, Nutrition; microencapsulation; polyphenols; freeze-drying; antioxidant activity; in vitro dialyzability; in vitro anti-diabetic potential
Online: 23 May 2018 (08:11:46 CEST)
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Microencapsulation of polyherbal formulation (PHF) extract was carried out by freeze drying method, by employing gum arabic (GA), gelatin (GE), and maltodextrin (MD) with their designated different combinations as encapsulating wall materials. Antioxidant components (i.e total phenolic contents (TPC),Total flavonoids contents (TFC), and total condensed contents (TCT)), antioxidant activity (i.e. DPPH, β-carotene & ABTS+ assays), moisture contents, water activity (aw), solubility, hygroscopicity, glass transition temperature (Tg), particle size, morphology, in vitro alpha-amylase and alpha-glucosidase inhibition and bioavailability ratios of the powders were investigated. Amongst all encapsulated products, TB (5% GA and 5% MD) and TC (10% GA) has proven to be the best treatments with respect to the highest preservation of antioxidant components and their antioxidant potential by DPPH and β-carotene assays and noteworthy for an ABTS+ assays, in addition, the aforesaid treatments also demonstrated lower moisture content, aw, particle size and higher solubility, hygroscopicity and glass transition temperature (Tg). All freeze dried samples showed irregular (asymmetrical) microcrystalline structures. Furthermore, TB and TC also illustrated the highest in vitro anti-diabetic potential due to great potency for inhibiting alpha-amylase and alpha-glucosidase activities. In the perspective of bioavailability, TA, TB and TC demonstrated the excellent bioavailability ratios (%).Futhermore, the phytochemo-profiling of ethanolic extract of PHF was also revealed to find out the bioactive compounds.
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Medicine & Pharmacology, Other; Neisseria gonorrhoeae; antibiotic resistance; gonorrhea; treatment
Online: 23 May 2018 (07:46:34 CEST)
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Gonorrhea is a sexually transmitted disease with a high morbidity burden. Incidence of this disease is rising due to the increasing number of antibiotic-resistant strains. Neisseria gonorrhoeae has shown an extraordinary ability to develop resistance to all antimicrobials introduced for its treatment. In fact, it was recently classified as a “Priority 2” microorganism in the WHO Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery and Development of New Antibiotics. Seeing as there is no gonococcal vaccine, control of the disease relies entirely on prevention, diagnosis and, especially, antibiotic treatment. Different health organizations worldwide have established treatment guidelines against gonorrhea, mostly consisting in dual therapy with a single oral or intramuscular dose. However, gonococci continue to develop resistances to all antibiotics introduced for treatment. In fact, the first strain of super-resistant N. gonorrhoeae was recently detected in the United Kingdom, which was resistant to ceftriaxone and azithromycin. This increasing detection of resistant gonococcal strains may lead to a situation where gonorrhea becomes untreatable. Seeing as drug resistance appears to be unstoppable, new treatment options are necessary in order to control the disease. Three approaches are currently being followed for the development of new therapies against drug-resistant gonococci: (1) novel combinations of already existing antibiotics, (2) development of new antibiotics and (3) development of alternative therapies which might slow down the appearance of resistances. N. gonorrhoeae is a public health threat due to the increasing number of antibiotic-resistant strains. Current treatment guidelines are already being challenged by this Superbug. This has lead the scientific community to develop new antibiotics and alternative therapies in order to control this disease.
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Medicine & Pharmacology, Pediatrics; parents; children; asthma; qualitative research; psychological distress; psychological adjustment
Online: 22 May 2018 (12:21:47 CEST)
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Many parents have difficulty managing childhood asthma. In Hong Kong (HK), while medication is the primary form of treatment, traditional Chinese medicine is another favored option. In addition, HK follows a dual-track healthcare system, which may pose unique experiences for Chinese parents in childhood asthma management. This qualitative descriptive study aimed to explore the experiences of HK Chinese parents in caring for their children with asthma. Methods: Fourteen HK Chinese mothers of children (aged 3-10) suffering from asthma were purposively sampled to participate in individual, semi-structured interviews. A realist approach following conventional content analysis was used to interpret the interviews. Results: The mothers expressed feelings of uncertainty, fear of asthma crises, and searching for ways to cope. These feelings triggered various strategies to control their child’s asthma. As long as the child’s asthma symptoms recurred, the mothers’ distress continued. Their distress was sometimes exacerbated by self-doubt and worries about whether they would receive adequate support from their family and healthcare professionals. Conclusion: Helping parents to understand their limits may help them be more open to varied aspects of their caregiving experiences, and thus to cope better. Psychological interventions together traditional educational training may help to alleviate parents’ psychological difficulties.
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Medicine & Pharmacology, Nutrition; diet; cholesterol; NHANES-WWEIA; food groups
Online: 22 May 2018 (11:37:00 CEST)
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The 2015 Dietary Guidelines for Americans recommends that individuals should eat as little dietary cholesterol as possible. However, current dietary cholesterol intake and its food sources have not been well-characterized. We examined dietary cholesterol intake by age, sex, race, and food sources using 24-hour dietary recall data from a nationally representative sample of 5047 adults aged 20 years or older who participated in NHANES (2013–2014 survey cycle). We also reported trends in cholesterol intake across the past 7 NHANES surveys. Mean dietary cholesterol intake was 293 mg/day (348 mg/day for males and 242 mg/day for females) in the 2013–2014 survey cycle; 39% of adults had dietary cholesterol intake above 300 mg/day (46% for males and 28% for females). Meat, eggs, grain products, and milk were the highest four food sources of cholesterol, contributing to 96% of the total consumption. Both average cholesterol intake and food source varied by age, sex, and race (each p < 0.05). Mean cholesterol intake of the overall population had been relatively constant at ~290 mg/day from 2001–2002 to 2013–2014 (p-trend = 0.98). These results should inform public health efforts in implementing dietary guidelines and tailoring dietary recommendations.
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Medicine & Pharmacology, Behavioral Neuroscience; IGF-1; MT; Blackcurrant extracts; Oxidative stress; Mecp2; Speech therapy; Neurostimulation; cyclic glycine-proline; GPE.
Online: 22 May 2018 (11:25:58 CEST)
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1) This study describes the good evolution of a 6-year-old girl genetically diagnosed with Rett syndrome (RTT), after having been treated with IGF-1, MT (MT), blackcurrant extracts (BC), and rehabilitation during 6 months. 2) The patient stopped her normal development from the first year of age. The patient showed low weight and height and met the main criteria for typical RTT. Curiously, there was pubic hair (Tanner II), very high plasma testosterone, despite low gonadotropins. No adrenal enzymatic deficits existed, and ultrasound abdominal studies were normal. Treatment consisted in IGF-1 (0.04 mg/kg/day, 5/week, sc) during 3-months and then 15-days resting, MT (50 mg/day, orally, uninterruptedly) and neurorehabilitation. The new blood tests were absolutely normal and the pubic hair disappeared. Then, a new treatment with IGF-1, MT, and BC started for another 3 months. After it, pubic Tanner stage increased to III, without a known cause. 3) The treatment followed led to clear improvements in most of the initial impairments, perhaps because of the effect of IGF-I, the antioxidant effects of MT and BC, and the increase in cyclic-glycine-proline (cGP) after BC administration. 4) A continuous treatment with IGF-1, MT and BC may recover most of the neurologic disabilities that occur in RTT.
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Medicine & Pharmacology, Pharmacology & Toxicology; anterior cruciate ligament; fucoidan; meniscectomy; obesity; osteoarthritis
Online: 22 May 2018 (07:54:22 CEST)
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Osteoarthritis (OA) has become one of the most common disabilities among elders, especially in female. Obesity and mechanical injury causing OA are attributed to joint loading, cartilage disintegration, bone loss and inflammation as well. Several strategies used for treatment OA including non-pharmacological and pharmacological. Fucoidan possesses several bioactivities such as antitumor, antiviral, anticoagulation, anti-obesity, and immunomodulation. This study aims to investigate the effect of fucoidan in surgery-induced OA on diet-induced obesity rats. OA was induced by anterior cruciate ligament transection and partial medial meniscectomy (ACLT+MMx). Male SD rats were fed high-fat diet (HFD) for 4 weeks to induce obesity before ACLT+MMx to induce OA. OA rats were administered with intragastric water or fucoidan in three different concentrations (32 mg/kg, 64 mg/kg, and 320 mg/kg) after the surgeries for 40 days with HFD. We observed that the swelling in knee joint was alleviated and hind paw weight distribution was rectified after feeding fucoidan, with no significant effect on weight gain and feed intake. Fucoidan administration indicated no significant variation on HDL-Cholesterol level, but reduced plasma triglycerides and LDL-Cholesterol level. In addition, weight-bearing tests showed improvement in the fucoidan-treated group. Our results suggested that fucoidan may improve meniscal/ligamentous injury and obesity-induced OA.
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Medicine & Pharmacology, Dentistry; trapezoidal flap; modified triangular flap; sinus augmentation; VAS; VRS; thermal infrared imaging
Online: 18 May 2018 (09:26:15 CEST)
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Background: Post-operative pain and swelling are frequently observed after sinus lift procedures. The aim of the present study was a clinical evaluation of swelling and pain of two sinus lift different flaps technique measured through visual analogue scale (VAS), verbal rating scale (VRS) and infrared thermal imaging (i.e., thermography). Methods: A randomized controlled trial was conducted in fifteen patients treated for a total of 30 sinus randomly allotted into two groups. In patients of Group I, a triangular flap was performed, while in Group II modified triangular flap without anterior release was performed. Postoperative pain was scored by VAS and inflammation was recorded by VRS at 2, 4, 6 and 14 days. The facial temperature was recorded before and after sinus augmentation, at 2, 4, 6 day intervals for the first week and at 14 day, to check the course of healing. Results: In group I the pain intensity was recorded at 2 days after the surgery with a score of 38.67 ± 6.4 mm. Swelling was higher at 2 and 4 day, and it was absent at day 6. Facial temperature difference before and after the procedure was 3 (4.737 °C ± 0.37). In Group II the pain was lower than in Group I (p < 0,05). Swelling scored 2 on the first and second day, and it was reduced at day 4. After the second day the difference of temperature reduced significantly compared to day of surgery (0.77 °C), at 2 and 4 days no difference was registered. Conclusion: In conclusion based on the outcome of the present study, modified triangular flap can be used with success in sinus augmentation procedures and is to be preferred to trapezoidal flap.
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Medicine & Pharmacology, Dermatology; melatonin; UVB; HaCaT keratinocytes; collagen; ROS; Hedgehog; Cox-2; MMP-1
Online: 18 May 2018 (08:51:37 CEST)
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Though melatonin is known to improve ultraviolet B (UVB)-induced oxidative damage and inflammatory conditions via blockade of nuclear factor (NF)-κB, interleukin (IL)-6, there is no report on anti-wrinkle effect of melatonin to date. Hence in the present study, anti-wrinkle mechanism of melatonin was elucidated in UVB treated HaCaT keratinocytes and hairless mice. Herein melatonin protected against a radical initiator tert-Butyl hydroperoxide (t-BOOH) induced reactive oxygen species (ROS) production, matrix metalloprotease 1 (MMP-1) and cytotoxicity in HaCaT keratinocytes. Also, melatonin suppressed the expression of sonic hedgehog (SHH) and GLI for hedgehog signaling, p-NF-kB, cyclooxygenase (COX-2), p-ERK for inflammatory responses in UVB treated HaCaT keratinocytes. Furthermore, melatonin protected skin from wrinkle formation, transdermal water loss in hairless mice irradiated by UVB for 8 weeks. Notably, melatonin prevented against epidermal thickness and dermal collagen degradation in UVB irradiated hairless mice by Hematoxylin & Eosin and Masson’s trichrome staining. Taken together, these findings suggest that melatonin reduces wrinkle formation via inhibition of ROS/SHH and inflammatory proteins such as NF-kB/COX-2/ERK/MMP1.
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Medicine & Pharmacology, General Medical Research; spinal cord injury; glial cell line-derived neurotrophic factor (GDNF), GFRα-1; cRET; Schwann cells; Astrogliosis; neuroprotection; axonal regeneration; combinational therapies; neurotrauma
Online: 17 May 2018 (12:54:50 CEST)
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Following an initial mechanical insult, traumatic spinal cord injury (SCI) induces a secondary wave of injury, resulting in a toxic lesion environment inhibitory to axonal regeneration. This review focuses on the glial cell line-derived neurotrophic factor (GDNF) and its application, also in combination with other factors and cell transplantations, for repairing the injured spinal cord. As recent decades of studies strongly suggest combinational treatment approaches hold the greatest therapeutic potential for the central nervous system (CNS) trauma, future directions of combinational therapies will also be discussed.
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Estefanía Burgos-Morón,
Nuria Pastor,
Manuel Luis Orta,
Julio José Jiménez-Alonso,
Carlos Palo-Nieto,
Margarita Vega-Holm,
José Manuel Vega-Pérez,
Fernando Iglesias-Guerra,
Santiago Mateos,
Miguel López-Lázaro,
José Manuel Calderón-Montaño
Medicine & Pharmacology, Oncology & Oncogenics; aziridine; cancer; cytotoxic; cytotoxicity; selectivity; nucleotide excision repair
Online: 15 May 2018 (09:00:29 CEST)
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We recently screened a series of new aziridines β-D-galactopyranoside derivatives for selective anticancer activity and identified 2-methyl-2,3-[N-(4-methylbenzenesulfonyl)imino]propyl 2,3-di-O-benzyl-4,6-O-(S)-benzylidene-β-D-galactopyranoside (AzGalp) as the most promising compound. In this article, we explore possible mechanisms involved in the cytotoxicity of this aziridine and evaluate its selective anticancer activity using cancer cells and normal cells from a variety of tissues. Our data show that AzGalp induces DNA damage (detected with the comet assay). Cells deficient in the DNA repair pathway nucleotide excision repair (NER) were hypersensitive to the cytotoxicity of this compound. These results suggest that AzGalp induces bulky DNA adducts, and that cancer cells lacking a functional NER pathway may be particularly vulnerable to the anticancer effects of this aziridine. Several experiments revealed that neither the generation of oxidative stress nor the inhibition of glycolysis played a significant role in the cytotoxicity of AzGalp. The combinations of AzGalp with either oxaliplatin or 5-fluorouracil slightly improved the ability of both anticancer drugs to selectively kill cancer cells. AzGalp also displayed selective cytotoxicity against a panel of malignant cells versus normal cells; the highest selectivity was observed for two acute promyelocytic leukemia cell lines. Additional preclinical studies are necessary to evaluate the anticancer potential of AzGalp.
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Medicine & Pharmacology, Psychiatry & Mental Health studies; hippocampus volume; mood Disorders; MRI; depression; subiculum; CA1
Online: 11 May 2018 (06:32:32 CEST)
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Background and objectives: due to the neurotoxic effect caused by high levels of cortisol, studies suggest that stress and certain psychiatric disorders, such as mood disorders, have influences under the hippocampus, causing a decrease in volume and consequent memory changes. This study aims to evaluate the relationship between hippocampal volume in patients with mood disorders under therapy. Materials and Methods: the PRISMA protocol for systematic reviews was followed. Pubmed, Cochraine and Scielo databases were searched by terms “Hippocampus”, “Mood Disorders” and “MRI”, and variants in other languages, in human, from January 2011 to September 2016. The individual quality of the articles was analyzed using the Cochraine modified scale for clinical trials and the Agency for Healthcare Research and Quality scale for observational studies. Results: all studies showed reduction of hippocampal volume in depressive patients. Change in hippocampal volume is not related to the use of antidepressant. Particularly the sub-region of the subculum is more reduced, without lateralizations. Significant relationship between stress and right hippocampal reduction. The findings seem to point out: a common pathway of hippocampus reduction, mediated by stress, explaining memory deficits due to depression, where the cortisol pathway seems to act; alteration in the prefrontal cortex; reduction in the subiculum related to inhibition of the hypothalamic-pituitary-adrenal axis, corroborating the hypothesis of cortisol. Conclusions: the papers suggest: association between global hippocampal atrophy with mood disorders; reduction of hippocampal subiculum; refractoriness to clinical treatment among patients with lower hippocampal volume.
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Medicine & Pharmacology, Pharmacology & Toxicology; Tamarix nilotica; Tamaricaceae; polyphenols; HPLC/HRESI/MS/MS; antifibrotic activity
Online: 11 May 2018 (05:18:58 CEST)
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Tamarix nilotica (Ehrenb.) Bunge (Tamaricaceae), an indigenous plant to the Middle East region, is well-known as a medicinal plant for treating many human ailments. The current study aimed at exploring the polyphenols profile of T.nilotica alcohol soluble fraction of aqueous extract, assessing its in-vivo antifibrotic activity and the possible underlying mechanism, to unravel the impact of quantitative difference of sulphated polyphenols content on the antifibrotic activity of T.nilotca grown in two different habitats. Polyphenols profiling of T. nilotica extracts was performed using HPLC-HRESI-QTOF-MS-MS. The major polyphenol components included sulphated flavonoids, phenolic acids and free aglycones. The antifibrotic activity was evaluated through carbon tetrachloride-induced liver fibrosis in rats. Biochemical evaluations revealed that both fractions ameliorated the increased levels of hepatic aminotransferases, lipid peroxidation, hydroxyproline, α-smooth muscle actin (α-SMA), tumor necrosis factor-α (TNF-α), cyclooxygenase-2 (COX-2) and nuclear factor kappa B (NF-κB). Moreover, both fractions reduced catalase activity (CAT) and enhanced hepatic glutathione (GSH) content. Histopathological imaging undoubtedly confirmed such results. In conclusion, T. nilotica polyphenols rich fraction exhibited potential antifibrotic activity in rats. Significant alterations in GSH levels were recorded based on sulphated polyphenol metabolites content.
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Medicine & Pharmacology, Other; e-portfolio; clinical skills; competences; medicine
Online: 11 May 2018 (04:45:11 CEST)
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Clinical training in medical schools in Spain is performed by rotations in university hospitals. During these internships, students are expected to acquire and master basic procedural skills. However, the assessment tools available rarely check whether these skills are completely acquired by the students. We have used an e-portfolio to determine the optimal number of times the students need to repeat a procedure to be able to perform it independently. The results were compared with the actual performance during the internships. An e-portfolio collected qualitative information about the internships. Quantitative information was also requested about the number of times each clinical skill was performed. Later, a survey asked these students and their teachers the optimal number of times each skill should be repeated before it could be considered fully acquired. The questionnaire was answered by 98.6% of the students and 70.3% of their teachers. Out of the 21 clinical skills and procedures selected, both students and their tutors agreed in a similar optimal value in 16 of them; only in five of them, teachers thought that students needed a greater number of times than that selected by the students. When these optimal values were compared with the actual values recorded in the portfolio during the internships, it was found that about half of the clinical skills were carried out less frequently than expected, thus providing an important feedback about the internships. Quantitative information collected in portfolios reveals a moderate mismatch between students and tutors perceptions of their training needs.
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Medicine & Pharmacology, Other; Leptospira; ornamental water; water; waterborne pathogen; microbial contamination; environmental exposure; Colombia
Online: 10 May 2018 (09:24:18 CEST)
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Leptospirosis is a disease endemic to both rural and urban areas of tropical countries and resource-poor communities, favored by socioeconomic and climatic determinants. The survival and persistence of pathogenic leptospires in water are key to the epidemiology of the disease. Little information is available on the actual presence of Leptospira spp. in water sources of urban habitats. A study was conducted to detect the presence of pathogenic Leptospira in open-air ornamental water fountains in Cali, Colombia. Twenty-seven water fountains were tested for pathogenic Leptospira using EMJH culture and a multiplex PCR assay targeting the secY and the flaB genes. The presence of pathogenic Leptospira was confirmed in 12 (44%) ornamental water fountains. The isolation frequency of pathogenic Leptospira was highest (67%) for those water fountains located in parks, plazas, building exteriors, and sidewalks. We conclude that ornamental water fountains might be urban reservoirs of pathogenic Leptospira, thereby posing a health hazard to humans. These fountains are frequently outdoors and are exposed to rodents, stray animals, and rainfall. Regular cleaning and disinfection of water in fountains prevent people from exposure, not only to pathogenic Leptospira, but also to other waterborne pathogens.
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Medicine & Pharmacology, Dermatology; celiac disease; dermatitis herpetiformis; alopecia areata; cutaneous vasculitis; urticaria; atopic dermatitis; psoriasis; recurrent aphtous ulceration; chronic ulcerative stomatitis; gluten-free diet
Online: 10 May 2018 (08:04:40 CEST)
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Celiac disease (CD) is an immune-mediated gluten-induced enteropathy that affects predisposed individuals of all ages. Many patients with CD do not report gastrointestinal symptoms making it difficult to reach an early diagnosis. On the other hand, CD is related to a wide spectrum of extra-intestinal manifestations, being dermatitis herpetiformis (DH) the best characterized. These associated conditions may be the clue for reaching the diagnosis of CD. Over the last years, there have been multiple reports of the association between CD and several cutaneous manifestations that may improve with a gluten-free diet (GFD). The presence of some of these skin diseases, even in absence of gastrointestinal symptoms, should give rise to an appropriate screening for CD. The aim of this paper is to describe the different cutaneous manifestations that have been associated to CD and the possible mechanisms involved.
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Medicine & Pharmacology, Cardiology; miRNA; cardiomyocytes; cardiovascular diseases
Online: 10 May 2018 (05:44:24 CEST)
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Study of micro-RNA regulatory networks (known as miRNA’s or miR’s), during development and in known pathologies have been the basis of study over the past decades. Herein, we recapitulate these findings in order to highlight the best underlying mechanisms found to date. We also seek to elucidate how miRNA dysregulation can be associated with many cardiovascular diseases. Furthermore, we discuss miR regulation mechanism during in early development in vivo and invitro. Since many of the miR’s are precursors to transcriptional regulation, we relate back to their molecular control as we can then look together at the fundamental disease they might be exacerbating by this dysregulation.
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Medicine & Pharmacology, Ophthalmology; Marfan syndrome; ophthalmology; ectopis lentis; ocular complication; management
Online: 9 May 2018 (06:37:24 CEST)
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Marfan syndrome is an autosomal dominant genetic connective tissue disorder that results from mutations in the fibrillin-1 gene located on chromosome band 15q 15–21. Fibrillin, a glycoprotein, is widely expressed throughout the body and contribute to elasticity and force-bearing capacity of connective tissue. In the eye, fibrillin is a key constituent of the ciliary zonules, which suspend the crystalline lens in place. The zonular defect leads to ectopia lentis that is hallmark of Marfan ocular abnormalities and occurs in 60 to 80% of cases. Other less common ocular features of Marfan syndrome are increased axial length, astigmatism, and flat cornea. Visual function in Marfan syndrome could be affected in several ways: ectopia lentis, refractive error, amblyopia, retinal detachment, cataract, and glaucoma. Management of subluxated lens starts with correction of refractive error with eyeglasses in mild cases. In more severe cases, especially when lens bisects the pupil, complete correction of refractive error is impossible without removing subluxated lens. The best method for visual rehabilitation after lens extraction is still debated. Aphakic Artisan implantation at the time of subluxated lens removal results in good visual outcomes with acceptable safety profile. Studies with longer term follow up and larger sample populations are needed to evaluate the safety of this procedure in patients with Marfan syndrome.
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Medicine & Pharmacology, Gastroenterology; BET inhibitors; HDAC inhibitors; pancreatic cancer; aberrant transcription; enhancers; transcription factors; distal regulatory elements; MYC; FOXA1; BRD4
Online: 8 May 2018 (10:47:27 CEST)
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While the mortality rates of cancer are generally declining, pancreatic cancer persists to be an exception with a 5-year-survival rate of less than 7%. Late diagnosis and resistance to conventional therapies contribute to high mortality rates in spite of the remarkable recent advances in cancer management and research. Consequently, there is an urgent need to find new and unconventional therapeutic targets to improve prognosis and survival of pancreatic cancer patients. In this review, we discuss the transcriptional effects of the most widely used epigenetic inhibitors in pancreatic cancer focusing on Bromodomain and Extraterminal domain (BET) and Histone Deacetylase (HDAC) inhibitors, which are currently highly promising therapeutic options. We suggest that these inhibitors can be better utilized at lower doses which exploit their transcriptional modulatory effects on pancreatic cancer transcriptional programs directed by specific factors such as MYC and FOXA1, rather than simply based on their anti-proliferative effects. This approach can potentially help avoid the intolerable adverse events frequently elicited by the use of these treatments at higher doses. In particular, we underscore the crucial role of distal regulatory elements in mediating the specific effects of these epigenetic inhibitors and propose using them in a more selective and prudent manner.
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Ludmila Sevcikova,
Jana Babjakova,
Jana Jurkovicova,
Martin Samohyl,
Zuzana Stefanikova,
Erika Machacova,
Diana Vondrova,
Etela Janekova,
Katarina Hirosova,
Alexandra Filova,
Michael Weitzman,
Lubica Argalasova
Medicine & Pharmacology, Other; Environmental Tobacco Smoke (ETS); Slovak school children; mental health; physical health; Columbia Impairment Scale; Behavioral Problem Index
Online: 7 May 2018 (09:23:27 CEST)
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ETS exposure has been shown as an important environmental risk factor in vulnerable population groups. The aim of the project is to analyze the relationships among the ETS and behavior and health in 6−15-year-old children in Slovakia. The status of physical and mental health of children in relation to exposure to tobacco smoke was examined in the representative group of 1478 school children. The methods used, included anonymous questionnaires filled in by parents, Columbia Impairment Scale (CIS), Behavior Problem Index (BPI) and anthropometry. The prevalence of passive smoking is the highest in the capital (27%) and southern cities. Significant relationships have been confirmed between ETS and the age, socio-economic status, the incompleteness of the family, the level of mother's education and the significantly higher prevalence of respiratory diseases (26.7%).The relationships of ETS with emotional (CIS scores ≥16) and behavioral functions (BPI score ≥14) were significant in children exposed to mother‘s and father‘s smoking at home. In the multivariate analysis this association was not significant; the factors such as income and completeness of the family were dominant. The results confirmed the impact of ETS and social factors on health state and health behavior and could be the argumentation for legislative changes.
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Yuichiro Hayashi,
Shuhei Minamiyama,
Takashi Ohya,
Masaki Iida,
Toshinori Iwai,
Toshiyuki Koizumi,
Senri Oguri,
Makoto Hirota,
Mitomu Kioi,
Masaharu Hata,
Masataka Taguri,
Kenji Mitsudo
Medicine & Pharmacology, Oncology & Oncogenics; oral cancer; radiotherapy; intra-arterial chemotherapy; head and neck cancer
Online: 7 May 2018 (08:48:20 CEST)
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Purpose: The aim of present study was to compare the treatment results of daily cisplatin (CDDP), weekly docetaxel (DOC) intra-arterial infusion chemotherapy combined with radiotherapy (DIACRT) regimen and weekly CDDP intra-arterial infusion chemotherapy combined with radiotherapy (WIACRT) for patients with tongue cancer. Materials and Methods: Between January 2007 and December 2016, a total of 11 patients treated with WIACRT and 45 patients treated with DIACRT were enrolled in present study. In DIACRT group, 25 patients had T2, 20 patients had T3. A total of 9 patients had T2 and 2 had T3 in WIACRT (p = NS). In DIACRT, the treatment schedule consisted of intra-arterial chemotherapy (DOC, total 60 mg/m2; CDDP, total 150 mg/m2) and daily concurrent radiotherapy (RT) (total, 60 Gy). In WIACRT, the treatment schedule consisted of intra-arterial chemotherapy (CDDP, total 360 mg/m2) and daily concurrent RT (total, 60 Gy). Results: The median follow-up periods for DIACRT and WIACRT were 61 and 66 months respectively. The 5-year local control (LC) and overall survival (OS) rate were 94.5% and 89.6% for DIACRT group, 60.6% and 63.6% for WIACRT group respectively. The LC rate and OS of DIACRT group were significantly higher than that of WIACRT group. As regards toxicities, no treatment-related deaths were observed during the follow-up periods both in two groups. Conclusions: DIACRT was found to be feasible and effective for patients with tongue cancer and could become a new treatment modality.
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Medicine & Pharmacology, Other; contrast-induced nephropathy; hypoxia-inducible factor 2α; N-acetyl-cysteine; sildenafil
Online: 7 May 2018 (08:15:36 CEST)
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Background and objectives: Contrast-induced nephropathy (CIN), is an acute renal damage due to contrast agents. This study is conducted to determine the potential diagnostic value of hypoxia-inducible factor 2-alpha (HIF2-α) and to evaluate the renal protective effects of N-acetyl cysteine (NAC) and sildenafil in a rat CIN model. Material/Methods: This randomized, controlled, interventional animal study was conducted on Wistar rats. Totally, rats (n = 36) were randomly assigned to four groups: control (n = 9), CIN group (n = 9), CIN+NAC group (n = 9), and sildenafil (n = 9). The rat model was used to form iohexol-originated CIN. During the modelling, prophylactic treatment was performed at 24th and 48th hours. After 48 hours of the modelling; blood, urine, tissue samples were obtained for biochemical analyses. HIF-2-α levels were measured in renal tissue, serum and urine samples. Renal sections were performed in order for histopathologic and immunohistochemical evaluations. Results: In the CIN model, HIF-2α levels and other biochemical parameters were significantly increased (p < 0.01). Both sildenafil and NAC, efficiently decreased the renal damage due to contrast agents (p < 0.05). Similarly, after treatment with sildenafil and NAC, HIF-2α levels were significantly decreased (p < 0.05). Conclusions: The current study constructs an experimental base for the use of HIF-2α for clinical prevention and treatment of CIN. Several mechanisms may be postulated for the changes in HIF-2α levels. Besides, the increased HIF-2α levels with CIN and decreased HIF-2α levels after treatment may be used for the treatment and follow-up of patients with CIN.
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Medicine & Pharmacology, General Medical Research; rabies; zoonotic; lyssavirus; RABV
Online: 7 May 2018 (07:39:03 CEST)
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Rabies is one of the neglected tropical diseases, almost 100% fatal, but preventable. Rabies virus causes the disease and causes about 59000 human deaths annually. The author searched the Pubmed Database at NCBI for articles on rabies disease published between 2007 and 2018. All articles are open access, free for redistribution and in English. To examine rabies virus, Seller’s test was used. In this article, references written by the author were included and relevant publications were also included. The author reviewed a rabies dog case kept at Nelwan Institution for Human Resource Development. The dog showed clinical signs such as aggressive behavior, in-appetence, and soaking in water. Currently, there are no drugs to treat rabies. Vaccination is the best way to prevent the disease. To eradicate rabies, mass vaccination in dogs, post-exposure prophylaxis, and gene therapy can be used. To prevent rabies disease, minimum 70% of the dog population should receive vaccination. Humans with category II exposure should receive rabies vaccine and rabies immunoglobulin. For treatment, in vivo experiment showed that gene therapy can eliminate rabies from the infected neurons by using rAAV-N796. To fight rabies virus, induced pluripotent cells in combination with CRISPR/Cas9 system can also be beneficial. Furthermore, it needs US$ 8.6 billion to fight rabies annually.
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Xiangbing Meng,
Shujie Yang,
Yujun Li,
Yiyang Li,
Jianling Bi,
Xinhao Wang,
Shaikamjad Umesalma,
Eric J. Devor,
Kristina W. Thiel,
Dawn E. Quelle,
Kimberly K. Leslie
Medicine & Pharmacology, Oncology & Oncogenics; p53; proteasome inhibitor; endometrial cancer; ovarian cancer; gain-of-function mutation
Online: 4 May 2018 (09:03:27 CEST)
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Mutations in the “guardian of the genome” TP53 predominate in solid tumors. In addition to loss of tumor suppressor activity, a specific subset of missense mutations confers additional oncogenic properties. These “gain-of-function” (GOF) mutations portend poor prognosis across cancer types regardless of treatment. Our objective in this study was to identify novel therapeutic opportunities to overcome the deleterious effects of GOF TP53 mutants. Using gynecologic cancer cell lines with known TP53 mutational status, we established that treatment with a proteasome inhibitor induced cell death in cells with two recurrent GOF TP53 mutations (R175H and R248Q), and addition of a histone deacetylase inhibitor (HDACi) enhanced this effect. By contrast, p53-null cancer cells were relatively resistant to the combination. Towards understanding the mechanism, we found that proteasome inhibition promotes apoptosis of cells with TP53 GOF mutations, potentially through induction of the unfolded protein response. In line with the reported hyperstabilization of GOF p53 protein, cells treated with HDACi exhibited reduced levels of p53 protein. Together, these data form the basis for future clinical studies examining therapeutic efficacy in a preselected patient population with GOF TP53 mutations.
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Medicine & Pharmacology, Other; Alum Bheg; anthropometry; identification; 1857 Sepoy mutiny; skull
Online: 4 May 2018 (05:15:18 CEST)
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Introduction: We undertook the present study to analyze morphological features of a skull supposed to be that of Alum Bheg, a martyr from 1857 Indian Freedom Struggle (also called Sepoy Mutiny), using established methods to validate identity with regards to age and height as available in the note found with the skull (about 32 year and 5 feet 7½ inch). Methods: Identification of sex of the skull was done based on established criteria. Analysis for closure of skull sutures (cranial and facial) and measurement of orbitomedial (OM) & maxillomedial (MM) facial anthropometric lines were undertaken to provide an estimated age against each examined suture as well as group of sutures through established scoring systems. Further, approximate height of individual was estimated from skull length using regression equations from a reference adult Indian male population. Results: Established criteria confirmed that the skull was of a male individual and skull sutures and age related morphological changes in bones indicate that it belonged to an individual in age range 20 -50 years with an average of 30 years and approximate height between 5 feet 8.2 inch to 6 feet 1 inch. Discussion: Based on our observations we suggest that the skull belonged to a male individual around 30 years of age and height 5 feet 8.2 inch to 6 feet 1 inch. The observed values are in approximation with that mentioned in the historical note and slight differences may be attributed either to gross reporting of original values or limitations of anthropometric analysis.
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Medicine & Pharmacology, Pediatrics; newborn screening; SCID; TREC
Online: 3 May 2018 (13:24:15 CEST)
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The incidence of Severe Combined Immunodeficiency (SCID) in Manitoba, (1/15,000), is at least three to four times higher than the national average and that reported from other jurisdictions. It is overrepresented in two population groups: Mennonites (ZAP70 founder mutation) and First Nations of Northern Cree ancestry (IKBKB founder mutation). We have previously demonstrated that in these two populations the most widely utilized T-cell receptor excision circle (TREC) assay is an ineffective newborn screening test to detect SCID as these patients have normal numbers of mature T-cells. We have developed a semi-automated, closed tube, high resolution DNA melting procedure to simultaneously genotype both of these mutations from the same newborn blood spot DNA extract used for the TREC assay. Parallel analysis of all newborn screening specimens utilizing both TREC analysis and the high resolution DNA procedure should provide as complete ascertainment as possible of SCID in the Manitoba population.
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Medicine & Pharmacology, Sport Sciences & Therapy; surfing; rotator cuff; shoulder; strength ratio; profiling; assessment
Online: 3 May 2018 (13:04:08 CEST)
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The shoulder region has the highest incidence of acute injuries in the sport of surfing. Little is known about the strength profile at the shoulder in a surfing cohort. The primary aim of this study was to establish the reliability of a rotator cuff strength testing procedure for surfers with a secondary aim of providing a profile of internal (IR) and external rotation (ER) strength in a competitive surfing cohort. Shoulder IR and ER isometric strength was measured using a hand-held dynamometer in 13 competitive surfers. Intra-class coefficient values ranged from 0.97 to 0.98 for intra rater reliability and were lower for inter rater reliability ranging from 0.80 to 0.91. Normalised force (N/Kg) for IR strength was significantly greater than ER strength bilaterally (dominant, p= 0.007, non-dominant, p<0.001). No significant differences (p< 0.79) were found in IR strength (N/Kg) between the dominant and non-dominant arms. ER strength (N/Kg) was significantly weaker on the non-dominant arm compared with the dominant arm (p<0.02). The non-dominant arm ER to IR ratio (0.82 ± 0.15) was significantly (p=0.025) lower than the dominant (0.88 ± 0.14) The current procedure is reliable with the same clinician, results indicate musculature asymmetry specific to the external rotators.
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Javadi Monisha,
Nand Kishor Roy,
Ganesan Padmavathi,
Kishore Banik,
Devivasha Bordoloi,
Amrita Devi Khwairakpam,
Frank Arfuso,
Arunachalam Chinnathambi,
Tahani Awad Alahmadi,
Sulaiman Ali Alharbi,
Gautam Sethi,
Alan Prem Kumar,
Ajaikumar B. Kunnumakkara
Medicine & Pharmacology, Oncology & Oncogenics; Oral cancer; mTOR pathway; secreted glycoprotein; drug resistance
Online: 3 May 2018 (12:47:14 CEST)
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Oral cancer is a major public health burden worldwide. The lack of biomarkers for early diagnosis has increased the difficulty in managing this disease. Recent studies have reported that neutrophil gelatinase-associated lipocalin (NGAL), a secreted glycoprotein, is upregulated in various tumors. In our study we found that NGAL was significantly downregulated in primary malignant and metastatic tissues of oral cancer compared to normal tissues. The downregulation of NGAL was strongly correlated with the degree of differentiation and stage (I-IV), and can serve as a prognostic biomarker for oral cancer. Tobacco carcinogens were also found to be involved in the downregulation of NGAL. Mechanistic studies revealed that knockdown of NGAL increased oral cancer cell proliferation, survival, and migration, and also induced resistance against cisplatin. Silencing of NGAL activated mTOR signaling and reduced autophagy by the LKB1-AMPK-p53-Redd1 signaling axis. Moreover, cyclin-D1, Bcl-2, and MMP-9 were upregulated, and caspase-9 was downregulated, suggesting that silencing of NGAL increases oral cancer cell proliferation, survival, and migration. Thus, from our study it is evident that downregulation of NGAL activates the mTOR pathway and helps in the progression of oral cancer.
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Medicine & Pharmacology, Clinical Neurology; Hyperpolarized gas MRI; xenon; gas retention; Alzheimer’s disease; wash out; vascular
Online: 3 May 2018 (12:02:44 CEST)
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Biomarkers have the potential to aid in the study of Alzheimer’s disease (AD); unfortunately, AD biomarker values often have a high degree of overlap between healthy and AD individuals. This study investigates the potential utility of a series of novel AD biomarkers, the sixty second 129Xe retention time, and the xenon washout parameter, based on the washout of hyperpolarized 129Xe from the brain of AD participants following inhalation. The xenon washout parameter is influenced by cerebral perfusion, T1 relaxation of xenon, and the xenon partition coefficient, all factors influenced by AD. Participants with Alzheimer’s disease (n=4) and healthy volunteers (n=4) were imaged using hyperpolarized 129Xe magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) to determine the amount of retain xenon in the brain. At 60 sec post breath hold, AD patients retained significantly higher amounts of 129Xe compared to healthy controls. Data was fit to a pharmacokinetic model and the xenon washout parameter was extracted. Xenon washout in white and grey matter occurs at a slower rate in Alzheimer’s participants (129Xe half-life time of 42s and 43s, respectively) relative to controls (20s and 16s, respectively). Following larger scale clinical trials for validation, the xenon washout parameter has the potential to become a useful biomarker for the support of an AD diagnosis.
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Medicine & Pharmacology, Pharmacology & Toxicology; hair; solar light; photodegradation; amphetamines; MDMA; ketamine; photoproduct; photostability; solar simulator
Online: 3 May 2018 (09:11:57 CEST)
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Background: Drug incorporated in hair are exposed to the environment and to cosmetic and chemical treatments, with possible decrease of their content. Knowledge concerning the effect of sun light on drug content in hair can be helpful to the forensic toxicologist, in particular when investigating on drug concentrations above or below pre-determined cut-offs. Materials and Methods: Twenty authentic positive hair samples were selected that had previously tested positive for amphetamines and/or ketamine. Washed hairs were divided into two identical strands: the former was exposed at 765 W/m2 (310–800 nm spectrum of irradiance) for 48 hours in a solar simulator, the latter was kept in the dark. Hair samples were extracted and analyzed by LC-HRMS detection. The percent photodegradation was calculated for each analyte (amphetamine, methamphetamine, methylendioxyamphetamine methylendioxymethamphetamine, ketamine, norketamine). In parallel, photodegradation processes of standard molecules dissolved in aqueous and organic solutions were studied. Results: In 20 hair samples positive for the targeted analytes, exposure to artificial sun light induced an appreciable decrease of drug concentrations. The concentration ranges in the non-irradiated hair samples were 0.01–24 ng/mg; 65% of samples exhibited a decrease in post-irradiation samples, with reduction from 3% to 100%. When more drugs were present in the same hair sample (e.g, MDMA and ketamine) the degradation yields were compound dependent. A degradation product induced by irradiation of ketamine in aqueous and methanol solutions was identified; it was also found to be present in a true positive hair sample after irradiation. Conclusions: Ketamine, amphetamines and their metabolites incorporated in hair of drug users undergo degradation when irradiated by artificial sunlight. Only for ketamine a photoproduct was identified in irradiated standard solutions and in true positive irradiated hair. When decisional cut-offs are applied to hair analysis, photodegradation must be taken into account since sunlight may produce false negative results. Moreover, new markers could be investigated as evidence of illicit drug use.