Ετικέτες

Δευτέρα 8 Μαΐου 2017

Identification of novel MRP3 inhibitors based on computational models and validation using an in vitro membrane vesicle assay

Publication date: 30 May 2017
Source:European Journal of Pharmaceutical Sciences, Volume 103
Author(s): Izna Ali, Matthew A. Welch, Yang Lu, Peter W. Swaan, Kim L.R. Brouwer
IntroductionMultidrug resistance-associated protein 3 (MRP3), an efflux transporter on the hepatic basolateral membrane, may function as a compensatory mechanism to prevent the accumulation of anionic substrates (e.g., bile acids) in hepatocytes. Inhibition of MRP3 may disrupt bile acid homeostasis and is one hypothesized risk factor for the development of drug-induced liver injury (DILI). Therefore, identifying potential MRP3 inhibitors could help mitigate the occurrence of DILI.MethodsBayesian models were developed using MRP3 transporter inhibition data for 86 structurally diverse drugs. The compounds were split into training and test sets of 57 and 29 compounds, respectively, and six models were generated based on distinct inhibition thresholds and molecular fingerprint methods. The six Bayesian models were validated against the test set and the model with the highest accuracy was utilized for a virtual screen of 1470 FDA-approved drugs from DrugBank. Compounds that were predicted to be inhibitors were selected for in vitro validation. The ability of these compounds to inhibit MRP3 transport at a concentration of 100μM was measured in membrane vesicles derived from stably transfected MRP3-over-expressing HEK-293 cells with [3H]-estradiol-17β-d-glucuronide (E217G; 10μM; 5min uptake) as the probe substrate.ResultsA predictive Bayesian model was developed with a sensitivity of 73% and specificity of 71% against the test set used to evaluate the six models. The area under the Receiver Operating Characteristic (ROC) curve was 0.710 against the test set. The final selected model was based on compounds that inhibited substrate transport by at least 50% compared to the negative control, and functional-class fingerprints (FCFP) with a circular diameter of six atoms, in addition to one-dimensional physicochemical properties. The in vitro screening of predicted inhibitors and non-inhibitors resulted in similar model performance with a sensitivity of 64% and specificity of 70%. The strongest inhibitors of MRP3-mediated E217G transport were fidaxomicin, suramin, and dronedarone. Kinetic assessment revealed that fidaxomicin was the most potent of these inhibitors (IC50=1.83±0.46μM). Suramin and dronedarone exhibited IC50 values of 3.33±0.41 and 47.44±4.41μM, respectively.ConclusionBayesian models are a useful screening approach to identify potential inhibitors of transport proteins. Novel MRP3 inhibitors were identified by virtual screening using the selected Bayesian model, and MRP3 inhibition was confirmed by an in vitro transporter inhibition assay. Information generated using this modeling approach may be valuable in predicting the potential for DILI and/or MRP3-mediated drug-drug interactions.

Graphical abstract

image


http://ift.tt/2qUKhF8

Editorial board members

Publication date: 30 May 2017
Source:European Journal of Pharmaceutical Sciences, Volume 103





http://ift.tt/2qjwyuq

Synthetic nanocarriers for the delivery of polynucleotides to the eye

Publication date: 30 May 2017
Source:European Journal of Pharmaceutical Sciences, Volume 103
Author(s): Sofia M. Saraiva, Vanessa Castro-López, Covadonga Pañeda, María José Alonso
This review is a comprehensive analysis of the progress made so far on the delivery of polynucleotide-based therapeutics to the eye, using synthetic nanocarriers. Attention has been addressed to the capacity of different nanocarriers for the specific delivery of polynucleotides to both, the anterior and posterior segments of the eye, with emphasis on their ability to (i) improve the transport of polynucleotides across the different eye barriers; (ii) promote their intracellular penetration into the target cells; (iii) protect them against degradation and, (iv) deliver them in a long-term fashion way. Overall, the conclusion is that despite the advantages that nanotechnology may offer to the area of ocular polynucleotide-based therapies (especially AS-ODN and siRNA delivery), the knowledge disclosed so far is still limited. This fact underlines the necessity of more fundamental and product-oriented research for making the way of the said nanotherapies towards clinical translation.

Graphical abstract

image


http://ift.tt/2qUNynO

Effect of hyaluronic acid-binding to lipoplexes on intravitreal drug delivery for retinal gene therapy

Publication date: 30 May 2017
Source:European Journal of Pharmaceutical Sciences, Volume 103
Author(s): Thomas F Martens, Karen Peynshaert, Thaís Leite Nascimento, Elias Fattal, Marcus Karlstetter, Thomas Langmann, Serge Picaud, Jo Demeester, Stefaan C De Smedt, Katrien Remaut, Kevin Braeckmans
Intravitreal administration of nanomedicines could be valuable for retinal gene therapy, if their mobility in the vitreous and therapeutic efficacy in the target cells can be guaranteed. Hyaluronic acid (HA) as an electrostatic coating of polymeric gene nanomedicines has proven to be beneficial on both accounts. While electrostatic coating provides an easy way of coating cationic nanoparticles, the stability of electrostatic complexes in vivo is uncertain. In this study, therefore, we compare electrostatic with covalent coating of gene nanocarriers with HA for retinal gene therapy via intravitreal administration. Specifically, DOTAP:DOPE/plasmid DNA lipoplexes coated with HA are evaluated in terms of intravitreal mobility using a previously optimized ex vivo model. We find that both electrostatic and covalent HA coating considerably improve the mobility of the lipoplexes in the vitreous humor of excised bovine eyes. In addition we evaluate in vitro uptake and transfection efficiency in ARPE-19 cells. Contrary to PEGylated lipoplexes it is found that HA coated lipoplexes are efficiently internalized into ARPE-19 cells. Covalent HA-coated lipoplexes had an 8-fold increase of transgene expression compared to the uncoated lipoplexes. We conclude that covalent HA-coating of gene nanomedicines is a promising approach for retinal gene therapy by intravitreal administration.

Graphical abstract

image


http://ift.tt/2qUFdAJ

Expression and splicing of ABC and SLC transporters in the human blood-brain barrier measured with RNAseq

Publication date: 30 May 2017
Source:European Journal of Pharmaceutical Sciences, Volume 103
Author(s): Adam M. Suhy, Amy Webb, Audrey C. Papp, Ethan G. Geier, Wolfgang Sadee
The blood-brain barrier (BBB) expresses numerous membrane transporters that supply needed nutrients to the central nervous system (CNS), consisting mostly of solute carriers (SLC transporters), or remove unwanted substrates via extrusion pumps through the action of ATP binding cassette (ABC) transporters. Previous work has identified many BBB transporters using hybridization arrays or qRT-PCR, using targeted probes. Here we have performed next-generation sequencing of the transcriptome (RNAseq) extracted from cerebral cortex tissues and brain microvessel endothelial cells (BMEC) obtained from two donors. The same RNA samples had previously been measured for transporter expression using qRT-PCR (Geier et al., 2013), yielding similar expression levels for overlapping mRNAs (R=0.66, p<0.001). RNAseq confirms a number of transporters highly enriched in BMECs (e.g., ABCB1, ABCG2, SLCO2B1, and SLC47A1), but also detects novel BMEC transporters. Multiple splice isoforms detected by RNAseq are either robustly enriched or depleted in BMECs, indicating differential RNA processing in the BBB. The Complete RNAseq data are publically available (GSE94064).

Graphical abstract

image


http://ift.tt/2qUKQP4

A structure-activity relationship study of ABCC2 inhibitors

Publication date: 30 May 2017
Source:European Journal of Pharmaceutical Sciences, Volume 103
Author(s): Gloria Wissel, Feng Deng, Pavel Kudryavtsev, Leo Ghemtio, Peter Wipf, Henri Xhaard, Heidi Kidron
Multidrug resistance associated protein 2 (MRP2/ABCC2) is a membrane transport protein that can potentially affect the disposition of many substrate drugs and their metabolites. Recently, we studied the interaction of a library of 432 compounds with ABCC2, and the structure-activity relationship (SAR) of a subset of 64 compounds divided into four scaffolds (Wissel, G. et al., 2015. Bioorg Med Chem., 23(13), pp.3513–25). We have now expanded this test set by investigating 114 new compounds, of which 71 are representative of the previous four scaffolds and 43 compounds belong to a new scaffold. Interaction with ABCC2 was assessed by measuring the compounds effect on 5(6)-carboxy-2′,7′-dichlorofluorescein transport in the vesicular transport assay. In line with our previous study, we observed that anionic charge is not essential for inhibition of ABCC2 transport, even though it often increases the inhibitory activity within the analogue series. Additionally, we found that halogen substitutions often increase the inhibitory activity. The results confirm the importance of structural features such as aromaticity and lipophilicity for ABCC2 inhibitory activity.

Graphical abstract

image


http://ift.tt/2qUDdrW

Multiple analyses indicate that NR1I3 regulating C6 and TNN may be involved in hip BMD regulation

alertIcon.gif

Publication date: Available online 8 May 2017
Source:Journal of Genetics and Genomics
Author(s): Ying-Ying Han, Lan-Juan Zhao, Yong Lin, Hao He, Qing Tian, Wei Zhu, Hui Shen, Xiang-Ding Chen, Hong-Wen Deng




http://ift.tt/2pt1gNQ

Attentional blink to alcohol cues in binge drinkers versus non-binge drinkers

S03064603.gif

Publication date: October 2017
Source:Addictive Behaviors, Volume 73
Author(s): Francesco M. DePalma, Natalie Ceballos, Reiko Graham
Previous studies have shown alcohol-related attentional biases in social drinkers; however, the temporal dynamics of these biases are not well understood. The current study examined this issue in 94 participants (27 male) categorized as binge drinkers (BD) or non-binge drinkers (NBD). Two versions of an alcohol-related attentional blink (AB) paradigm were used: one with words and one with images. It was predicted that BDs (versus NBDs) would exhibit reduced AB for alcohol cues, which would be enhanced for the pictorial version of the task (versus words). The relationships between AB and alcohol craving, quantity and frequency of alcohol consumption, symptoms of alcohol use disorder, and family history of alcohol use disorder (AUD) were also examined. While an AB was observed for both alcohol and non-alcohol targets in the NBD group, no AB was found for alcohol targets in the BD group. Furthermore, the magnitude of the AB was related to drinking, such that higher self-reported hazardous drinking was associated with smaller ABs to alcohol-related targets. However, AB was not related to craving or family history of AUD. These results suggest that alcohol-related stimuli are processed more efficiently by BDs, especially those with hazardous alcohol consumption patterns. These results may inform treatment and prevention efforts targeting binge drinkers.



http://ift.tt/2poHqlO

Associations of blood glucose dynamics with antihyperglycemic treatment and glycemic variability in type 1 and type 2 diabetes

Abstract

Aims

The dynamical structure of glucose fluctuation has largely been disregarded in the contemporary management of diabetes.

Methods

In a retrospective study of patients with diabetes, we evaluated the relationship between glucose dynamics, antihyperglycemic therapy, glucose variability, and glucose exposure, while taking into account potential determinants of the complexity index. We used multiscale entropy (MSE) analysis of continuous glucose monitoring data from 131 subjects with type 1 (n = 18), type 2 diabetes (n = 102), and 11 nondiabetic control subjects. We compared the MSE complexity index derived from the glucose time series among the treatment groups, after adjusting for sex, age, diabetes duration, body mass index, and carbohydrate intake.

Results

In type 2 diabetic patients who were on a diet or insulin regimen with/without oral agents, the MSE index was significantly lower than in nondiabetic subjects but was lowest in the type 1 diabetes group (p < 0.001). The decline in the MSE complexity across the treatment groups correlated with increasing glucose variability and glucose exposure. Statistically, significant correlations existed between higher MSE complexity indices and better glycemic control. In multivariate regression analysis, the antidiabetic therapy was the most powerful predictor of the MSE (β = −0.940 ± 0.242, R 2 = 0.306, p < 0.001), whereas the potential confounders failed to contribute.

Conclusions

The loss of dynamical complexity in glucose homeostasis correlates more closely with therapy modalities and glucose variability than with clinical measures of glycemia. Thus, targeting the glucoregulatory system by adequate therapeutic interventions may protect against progressive worsening of diabetes control.



http://ift.tt/2qUkf51

Patient-reported outcome measures and patient-reported experience measures

<span class="paragraphSection">1I052A123J00</span>

http://ift.tt/2pXT3nJ

Antibiotic stewardship in critical care

<span class="paragraphSection">1A022C033C00</span>

http://ift.tt/2q0561Z

Management of acute upper GI bleeding

<span class="paragraphSection">1A012A053C00</span>

http://ift.tt/2pXVaYP

Perioperative management of the patient with diabetes requiring emergency surgery

<span class="paragraphSection">2A032A062A12</span>

http://ift.tt/2q0ujcE

Perioperative management of opioid-tolerant patients

<span class="paragraphSection">1DO11D022E013E00</span>

http://ift.tt/2pXXBuw

Parkinson's disease

<span class="paragraphSection">2A032A072G01</span>

http://ift.tt/2pZMOhh

IL-33 protects murine viral fulminant hepatitis by targeting coagulation hallmark protein FGL2/fibroleukin expression

S01615890.gif

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Haijing Yu, Yang Liu, Jiaquan Huang, Hongwu Wang, Weiming Yan, Dong Xi, Guanxin Shen, Xiaoping Luo, Qin Ning
Fulminant hepatitis (FH) is characterized by rapid liver failure and high mortality. The pathogenesis of viral FH includes virus-induced immune activation, inflammation, and subsequent hepatic apoptosis and necrosis. However, the mechanisms that underlie FH progression are unclear. IL-33 is a member of the IL-1-related cytokines, considered to be an "alarmin" that participates in various diseases, but its precise role in the coagulation of FH is not very clear. In our study, we found that IL-33 is significantly elevated in mice infected with murine hepatitis virus strain 3 (MHV-3). This is accompanied by an increase in pro-coagulant fibrinogen-like protein 2 (FGL2) in the liver. Previous studies have suggested that an increase in FGL2 is diagnostic of FH and liver necrosis, and animals with no FGL2 had better survivorship during FH. Our studies showed that IL-33 administration in a MHV-3 infection promoted survival during FH, with a significant reduction in FGL2 expression and liver inflammation. In vitro IL-33 treatment abrogated MHV-3 and IFN-γ induced FGL2 expression in RAW264.7 and THP-1 cells, respectively. In conclusion, our research suggests that IL-33 protects against viral fulminant hepatitis in mice by antagonizing expression of the pro-coagulant protein FGL2.



http://ift.tt/2psRc7b

Indocyanine Green Fluorescence-Guided Surgery after IV Injection in Metastatic Colorectal Cancer: A Systematic Review

alertIcon.gif

Publication date: Available online 8 May 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Gabriel Liberale, Pierre Bourgeois, Denis Larsimont, Michel Moreau, Vincent Donckier, Takeaki Ishizawa
ObjectiveIndocyanine green fluorescence-guided surgery (ICG-FGS) has emerged as a potential new imaging modality for improving the detection of hepatic, lymph node (LN), and peritoneal metastases in colorectal cancer (CRC) patients. The aim of this paper is to review the available literature in the clinical setting of ICG-FGS for tumoral detection in various fields of metastatic colorectal disease.MethodsPubMed and Medline literature databases were searched for original articles on the use of ICG in the setting of clinical studies on colorectal cancer. The search terms used were "near-infrared fluorescence", "intraoperative imaging", "indocyanine green", "human" and "colorectal cancer".ResultsICG fluorescence imaging (ICG-FI) is clearly supported as an intraoperative technique that allows the detection of additional superficial hepatic metastases of CRC. Data on the role of ICG-FI in the intraoperative detection of peritoneal metastases and LN metastases are scarce but encouraging and ICG-FI could potentially improve the staging and treatment of these patients.ConclusionICG-FI is a promising imaging technique in the detection of small infraclinic LN, hepatic, and peritoneal metastatic deposits that may allow better staging and more complete surgical resection with a potential prognostic benefit for patients.



http://ift.tt/2pefgi4

Unusual cases of necrotizing fasciitis: a clinical experience from Turkey

Abstract

Background

Necrotizing fasciitis is a rare, destructive soft tissue infection which starts on the skin and subcutaneous tissue, and spreads quickly towards the deeper tissues. Its etiology includes trauma, surgical intervention, perineal abscess, soft tissue infection, minor invasive procedures, abrasion, contusion, burn, laceration, bite, and penetrating injuries. The mortality of the disease can increase in the presence of predisposing factors such as diabetes, hypertension, immunodeficiency, self-care insufficiency, alcoholism, and advanced age. The clinical presentation of necrotizing fasciitis may vary. It is often observed in the abdominal region, the lower extremity, the perineal, perianal, scrotal and genital regions.

Methods

Between December 2011 and September 2016, a retrospective study of all patients admitted due to necrotic wounds and/or tissue defects was undertaken. Their clinical records were reviewed with respect to age, sex, associated morbidities, defect localization, treatment, and outcomes.

Results

Thirteen cases were admitted to the emergency department. There were 10 female and 3 male patients. The defects were located in the gluteal (one), trochanteric (one), thoracic (two), upper extremity (three), lower extremity (two) and perineal region (four). Pressure sores, insect bites, trauma, diabetes mellitus and perineal infections were detected in the etiology of the cases. As observed in our study, NF can present with very different etiological, demographical and clinical findings.

Conclusions

The cases presented some rarely observed characteristics in terms of age, sex, etiology, and infection localization. Therefore, it should be kept in mind that necrotizing fasciitis can exhibit extraordinary characteristics causing confusion with other soft tissue infections, and a detailed and meticulous evaluation must be performed for diagnosis.

Level of Evidence: Level IV, therapeutic study.



http://ift.tt/2qj2LC4

Determinants of Sugar-Sweetened Beverage Consumption among Low-Income Children: Are There Differences by Race/Ethnicity, Age, and Sex?

Publication date: Available online 8 May 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Natasha Tasevska, Derek DeLia, Cori Lorts, Michael Yedidia, Punam Ohri-Vachaspati
BackgroundUnderstanding determinants of high consumption of sugar-sweetened beverages (SSBs), a highly prevalent obesogenic behavior, will help build effective customized public health interventions.ObjectiveOur aim was to identify child and parent lifestyle and household demographic factors predictive of high SSB consumption frequency in children from low-income, ethnically diverse communities that may help inform public health interventions.DesignWe used a cross-sectional telephone household survey.Participants/settingParticipants were 717 boys and 686 girls aged 3 to 18 years old from the New Jersey Childhood Obesity Study living in five low-income cities (Camden, New Brunswick, Newark, Trenton, and Vineland). The adult most knowledgeable about household food shopping completed a questionnaire over the telephone inquiring about their and their child's dietary and physical activity habits, and household-, parent-, and child-level demographics.Main outcome measuresChild's SSB consumption frequency was measured.Statistical analysis performedMultivariate ordered logit models were designed to investigate a variety of variables hypothesized to affect the frequency of SSB consumption. Exploratory stratified analyses by race, sex, and age were also conducted.ResultsEight percent of our study participants never consumed SSBs, 45% consumed SSBs at least once per day, and 23% consumed twice or more per day. SSB consumption was higher among children 12 to 18 years vs 3 to 5 years (P<0.0001), of non-Hispanic black vs non-Hispanic white race/ethnicity (P=0.010), who were moderate fast food consumers vs never consumers (P=0.003), and those whose parents were high vs low SSB consumers (P<0.0001). Living in a non–English-speaking household (P=0.030), having a parent with a college or higher education vs less than high school (P=0.003), and having breakfast 6 to 7 days/wk vs never to 2 days/wk or less were associated with lower SSB consumption (P=0.001).ConclusionsWe identified a number of household-, parent-, and child-level predictors of SSB consumption, which varied by race, sex, and age, useful for building customized interventions targeting certain behaviors in ethnically diverse, low-income children.



http://ift.tt/2pZBl1b

Breast implant associated Anaplastic Large Cell Lymphoma in Australia and New Zealand - high surface area textured implants are associated with increased risk.

Background: The association between breast implants and breast implant associated anaplastic large cell lymphoma (BIA-ALCL), has been confirmed. Implant related risk has been difficult to estimate due to incomplete or unknown implant histories and lack of clarity on the number of implants utilized. Methods: All cases in Australia and New Zealand were identified and analyzed. Textured implants reported in this group were subjected to surface area analysis. Sales data from three leading breast implant manufacturers (Mentor/Allergan/Silimed) dating back to 1999 were secured to estimate implant specific risk. Results: 55 cases of BIA-ALCL were diagnosed in Australia and New Zealand between 2007 and 2016. The mean age of patients was 47.1 and the mean time of implant exposure was 7.46 years. There were 4 deaths in the series related to mass and/or metastatic presentation. All patients were exposed to textured implants. Surface area analysis confirmed that higher surface area was associated with 64 of the 75 implants utilized (85.3%). Biocell salt loss textured (Allergan/Inamed/McGhan) accounted for 58.7% of implants utilized in this series. Comparative analysis showed the risk of developing BIA-ALCL was found to be 14.11 times higher with Biocell textured implants and 10.84 higher with polyurethane (Silimed) textured implants as compared with Siltex textured implants. Conclusion: This study has calculated implant specific risk of BIA-ALCL. Higher surface area textured implants have been shown to significantly increase risk of BIA-ALCL in Australia and New Zealand. We present a unifying hypothesis to explain these observations. (C)2017American Society of Plastic Surgeons

http://ift.tt/2pZAzkI

In vitro study on antagonism mechanism of glutathione, sodium selenite and mercuric chloride

Publication date: 15 August 2017
Source:Talanta, Volume 171
Author(s): Yu Qiao, Xi Huang, Beibei Chen, Man He, Bin Hu
It has been broadly recognized that the antagonism between selenium (Se) and mercury (Hg) can reduce the toxicity of mercury in organism. Glutathione (GSH) can participate in the metabolism of Se and Hg in vivo and promote the formation of low-toxic Hg-Se complexes, which is a vital way of detoxification for Hg. In this paper, the reaction mechanism of GSH-Se(IV) binary system, GSH-Hg(II) binary system and GSH-Se(IV)-Hg(II) ternary system were systematically studied from the aspects of stoichiometry, thermodynamics and kinetics, via hyphenated techniques including high performance liquid chromatography (HPLC)-ultraviolet (UV) detection, HPLC-inductively coupled plasma mass spectrometry (ICP-MS) and HPLC-electrospray ionization mass spectrometry (ESI-MS). For GSH-Se(IV) binary system, selenodiglutathione (GSSeSG) was the crucial intermediate; the reaction was exothermic and irreversible at constant pressure; it followed second-order kinetics with a fast kinetics (rate constant (k)=4534.2mol−1Ls−1). For GSH-Se(IV)-Hg(II) ternary system, GSSeSeSG would form by the extremely weak dissociation of two molecules of GSSeSG; Hg(II) would rapidly coordinate with GSSeSeSG to generate (HgxSey)n(GS)m precipitates. The mechanism of GSH-Se(IV)-Hg(II) antagonism system involves two processes, the competitive combination of Hg and Se with GSH and the formation of (HgxSey)n(GS)m complexes.

Graphical abstract

image


http://ift.tt/2pUV8jK

Chest Pain Unit Network in Germany: Its Effect on Patients With Acute Coronary Syndromes



http://ift.tt/2pdBr86

Mortality and Acute Kidney Injury in Asians With Atrial Fibrillation Treated With Dabigatran or Warfarin



http://ift.tt/2pdw6hr

Ambulatory Hemodynamic Monitoring Reduces Heart Failure Hospitalizations in "Real-World" Clinical Practice

AbstractBackground

In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association [NYHA] Functional Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) rates were lower in patients managed with guidance from an implantable pulmonary artery pressure sensor compared with usual care.

Objectives

This study examined the effectiveness of ambulatory hemodynamic monitoring in reducing HFH outside of the clinical trial setting.

Methods

We conducted a retrospective cohort study using U.S. Medicare claims data from patients undergoing pulmonary artery pressure sensor implantation between June 1, 2014, and December 31, 2015. Rates of HFH during pre-defined periods before and after implantation were compared using the Andersen-Gill extension to the Cox proportional hazards model while accounting for the competing risk of death, ventricular assist device implantation, or cardiac transplantation. Comprehensive heart failure (HF)–related costs were compared over the same periods.

Results

Among 1,114 patients receiving implants, there were 1,020 HFHs in the 6 months before, compared with 381 HFHs, 139 deaths, and 17 ventricular assist device implantations and/or transplants in the 6 months after implantation (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.49 to 0.61; p < 0.001). This lower rate of HFH was associated with a 6-month comprehensive HF cost reduction of $7,433 per patient (IQR: $7,000 to $7,884), and was robust in analyses restricted to 6-month survivors. Similar reductions in HFH and costs were noted in the subset of 480 patients with complete data available for 12 months before and after implantation (HR: 0.66; 95% CI: 0.57 to 0.76; p < 0.001).

Conclusions

As in clinical trials, use of ambulatory hemodynamic monitoring in clinical practice is associated with lower HFH and comprehensive HF costs. These benefits are sustained to 1 year and support the "real-world" effectiveness of this approach to HF management.



http://ift.tt/2psd0Qz

Neurocognitive Risk With PCSK9 Inhibitors: Need for More Robust Evidence



http://ift.tt/2pdDUiR

Real-World Data on Heart Failure Readmission Reduction: Real or Real Uncertain?



http://ift.tt/2pdGvcT

Using Predicted Cardiovascular Disease Risk in Conjunction With Blood Pressure to Guide Antihypertensive Medication Treatment

Abstract

Using cardiovascular disease (CVD) risk instead of or in addition to blood pressure (BP) to guide antihypertensive treatment is an active area of research. The purpose of this review is to provide an overview of studies that could inform this treatment paradigm. We review data from randomized trials on relative and absolute CVD risk reduction that can occur when antihypertensive treatment is guided by CVD risk. We also review population-level data on using CVD risk in conjunction with BP to guide antihypertensive treatment, the broad distribution in CVD risk for people with similar BP levels, and the use of CVD risk for guiding antihypertensive treatment among subgroups including older adults, young adults, and those with diabetes mellitus or chronic kidney disease. In addition, we review potential challenges in implementing antihypertensive treatment recommendations that incorporate CVD risk. In closing, we provide recommendations for using CVD risk in combination with BP to guide antihypertensive treatment.



http://ift.tt/2pdWebK

Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up

AbstractBackground

Data regarding cardiac resynchronization therapy (CRT) in patients with multiple comorbidities are limited.

Objectives

This study evaluated the association of multiple comorbidities with the benefits of CRT over implantable cardioverter-defibrillator (ICD) alone.

Methods

We examined 1,214 MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) study patients with left bundle branch block (LBBB) and 0, 1, 2, or ≥3 comorbidities, including renal dysfunction, hypertension (HTN), diabetes, coronary artery disease, history of atrial arrhythmias, history of ventricular arrhythmias, current smoking, and cerebrovascular accident. In an adjusted analysis, we analyzed risk of heart failure (HF) events or death by comorbidity group in all patients and in patients with CRT with defibrillator (CRT-D) versus ICD. Then we examined percent change in left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV ejection fraction, left atrial volume, and LV dyssynchrony at 1-year in CRT-D patients by comorbidity group.

Results

There was an inverse relationship between comorbidity burden and improvements in LV end-systolic volume, LV end-diastolic volume, left ventricular ejection fraction, left atrial volume, and LV dyssynchrony. In an adjusted model, there was an increasing risk of death or nonfatal HF events with increasing comorbidity burden regardless of treatment group (p < 0.001). During a mean follow-up of 4.65 years, there was no interaction with respect to comorbidity burden and the benefit of CRT-D versus ICD only for death or nonfatal HF events (interaction p = 0.943). In the groups with greatest comorbidity burden (2 and ≥3), the absolute risk reduction associated with CRT-D over ICD alone appeared greater than that seen for groups with less comorbidity burden (0 and 1).

Conclusions

During long-term follow-up of MADIT-CRT study patients with LBBB randomized to CRT-D, there were differences in HF or death risk and in the degree of reverse remodeling among comorbidity groups. However, the burden of comorbidity does not appear to compromise the clinical benefits of CRT-D compared with ICD alone.



http://ift.tt/2psp4Bb

Role of Acquired Cardiovascular Disease in Tetralogy of Fallot Patients >50 Years of Age



http://ift.tt/2pdRVNA

Navigating Choices Among a Sea of Comorbidities



http://ift.tt/2pdGtSj

Reply: The Enigma of Left Ventricular Non-Compaction



http://ift.tt/2pdJTUQ

Prognostic Implications of Moderate Aortic Stenosis in Patients With Left Ventricular Systolic Dysfunction

AbstractBackground

Left ventricular (LV) systolic dysfunction and moderate aortic stenosis (AS) are more frequent with advancing age and often coexist. Afterload reduction is the mainstay of pharmacological treatment of heart failure (HF). Aortic valve replacement (AVR) is only formally indicated for symptomatic severe AS.

Objectives

This study sought to determine the clinical outcome of patients with concomitant moderate AS and LV systolic dysfunction.

Methods

Echocardiographic and clinical data of patients with moderate AS and LV systolic dysfunction between 2010 and 2015 from 4 large academic institutions were retrospectively analyzed. Moderate AS was defined as aortic valve area between 1.0 and 1.5 cm2 and LV systolic dysfunction defined as LV ejection fraction <50%. The primary endpoint was a composite of all-cause death, AVR, and HF hospitalization.

Results

A total of 305 patients (mean age 73 ± 11 years; 75% male) were included. The majority were symptomatic at the time of index echocardiogram (New York Heart Association [NYHA] functional class II: 42%; NYHA functional class III: 28%; and NYHA functional class IV: 4%). Ischemic heart disease was present in 72% of patients. At 4-year follow-up, the primary composite endpoint occurred in 61%. The main predictors for the primary endpoint were male sex (p = 0.022), NYHA functional class III or IV (p < 0.001), and peak aortic jet velocity (p < 0.001). The rate of the composite of all-cause death or HF hospitalization was 48%, rate of all-cause death was 36%, and rate of HF hospitalization was 27%. AVR occurred in 24% of patients.

Conclusions

Patients with concomitant moderate AS and LV systolic dysfunction are at high risk for clinical events. Further studies are needed to determine if earlier AVR in these patients might improve clinical outcome.



http://ift.tt/2pskkvw

JACC Instructions for Authors



http://ift.tt/2pdAEUQ

Aortic Stenosis Is Still Very Tricky, Especially When it Is Moderate



http://ift.tt/2pdBpgG

Advocacy for Health Care: All Hands on Deck!



http://ift.tt/2ps8y4q

Relation of Mitral Valve Surgery Volume to Repair Rate, Durability, and Survival

AbstractBackground

Degenerative mitral valve repair rates remain highly variable, despite established benefits of repair over replacement. The contribution of surgeon-specific factors is poorly defined.

Objectives

This study evaluated the influence of surgeon case volume on degenerative mitral valve repair rates and outcomes.

Methods

A mandatory New York State database was queried and 5,475 patients were identified with degenerative mitral disease who underwent mitral valve operations between 2002 and 2013. Mitral repair rates, mitral reoperations within 12 months of repair, and survival were analyzed using multivariable Cox modeling and restricted cubic spline function.

Results

Median annual surgeon volume of any mitral operations was 10 (range 1 to 230), with a mean repair rate of 55% (n = 20,797 of 38,128). In the subgroup of patients with degenerative disease, the mean repair rate was 67% (n = 3,660 of 5,475), with a range of 0% to 100%. Mean repair rates ranged from 48% (n = 179 of 370) for surgeons with total annual volumes of ≤10 mitral operations to 77% (n = 1,710 of 2,216) for surgeons with total annual volumes of >50 mitral operations (p < 0.001). Higher total annual surgeon volume was associated with increased repair rates of degenerative mitral valve disease (adjusted odds ratio [OR]: 1.13 for every additional 10 mitral operations; 95% confidence interval [CI]: 1.10 to 1.17; p < 0.001); a steady decrease in reoperation risk until 25 total mitral operations annually; and improved 1-year survival (adjusted hazard ratio: 0.95 for every additional 10 operations; 95% CI: 0.92 to 0.98; p = 0.001). For surgeons with a total annual volume of ≤25 mitral operations, repair rates were higher (63.8%; n = 180 of 282) if they operated in the same institution as a surgeon with total annual mitral volumes of >50 and degenerative mitral valve repair rates of >70%, compared with surgeons operating in the other institutions (51.3%; n = 580 of 1,130) (adjusted OR: 1.79; 95% CI: 1.24 to 2.60; p < 0.001).

Conclusions

This study suggests that individual surgeon volume is a determinant of not only mitral repair rates, but also freedom from reoperation, and survival. The data from this study support the guideline's concept of reference referral to experienced mitral surgeons to improve outcomes in patients with degenerative mitral valve disease.



http://ift.tt/2ps1lBb

Global Cardiovascular Health: A Role for the Interventionalist



http://ift.tt/2ps1MM1

The Specialty of Mitral Valve Repair



http://ift.tt/2pe1gVQ

Truncating Variants in Titin Independently Predict Early Arrhythmias in Patients With Dilated Cardiomyopathy



http://ift.tt/2psjqzh

Post-Operative Chylothorax in Patients With Congenital Heart Disease

AbstractBackground

Post-operative chylothorax in patients with congenital heart disease is a challenging problem with substantial morbidity and mortality. Currently, the etiology of chylothorax is poorly understood and treatment options are limited.

Objectives

This study aimed to report lymphatic imaging findings, determine the mechanism of chylothorax after cardiac surgery, and analyze the outcomes of lymphatic embolization.

Methods

We conducted a retrospective review of 25 patients with congenital heart disease and post-operative chylothorax who presented for lymphatic imaging and intervention between July 2012 and August 2016.

Results

Based on dynamic contrast-enhanced magnetic resonance lymphangiography and intranodal lymphangiography, we identified 3 distinct etiologies of chylothorax: 2 patients (8%) with traumatic leak from a thoracic duct (TD) branch, 14 patients (56%) with pulmonary lymphatic perfusion syndrome (PLPS), and 9 patients (36%) with central lymphatic flow disorder (CLFD), the latter defined as abnormal central lymphatic flow, effusions in more than 1 compartment, and dermal backflow. Patients with traumatic leak and PLPS were combined into 1 group of 16 patients without CLFD, of whom 14 (88%) had an intact TD. Sixteen patients underwent lymphatic intervention, including complete TD embolization. All 16 patients had resolution of chylothorax, with a median of 7.5 days from intervention to chest tube removal and 15 days from intervention to discharge. The 9 patients with CLFD were considered a separate group, of whom 3 (33%) had an intact TD. Seven patients underwent lymphatic intervention but none survived.

Conclusions

Most patients in this study had nontraumatic chylothorax and dynamic contrast-enhanced magnetic resonance lymphangiography was essential to determine etiology. Lymphatic embolization was successful in patients with traumatic leak and PLPS and, thus, should be considered first-line treatment. Interventions in patients with CLFD were not successful to resolve chylothorax and alternate approaches need to be developed.



http://ift.tt/2ps4SQ6

The Enigma of Left Ventricular Hypertrabeculation: Knowledge About Pregnancies, Sports, and Neuromuscular Disorders Is Needed



http://ift.tt/2ps1KDT

Utility of intraoral stents in external beam radiotherapy for head and neck cancer

Publication date: July–August 2017
Source:Reports of Practical Oncology & Radiotherapy, Volume 22, Issue 4
Author(s): Hiroshi Doi, Masao Tanooka, Toshihisa Ishida, Kuniyasu Moridera, Kenji Ichimiya, Kazuo Tarutani, Kazuhiro Kitajima, Masayuki Fujiwara, Hiromitsu Kishimoto, Norihiko Kamikonya
AimThis study aimed to assess the utility and stability of intraoral stent during intensity-modulated radiation therapy (IMRT).BackgroundThe benefits of intraoral stents in radiotherapy are unclear.Materials and methodsWe analyzed 386 setup errors in 12 patients who received IMRT for head and neck cancers without intraoral stents (intraoral stent [−]) and 183 setup errors in 6 patients who received IMRT with intraoral stents (intraoral stent [+]). All patients were matched according to the immobilization method (masks and boards). Setup errors were measured as the distance from the initial setup based on the marking on the skin and mask to the corrected position based on bone matching on cone beam computed tomography.ResultsThe mean interfractional setup errors in the right–left, craniocaudal, anterior–posterior (AP), and three-dimensional (3D) directions were −0.33, 0.08, −0.25, and 2.75mm in the intraoral stent (−) group and −0.37, 0.24, −0.63, and 2.42mm in the intraoral stent (+) group, respectively (P=0.50, 0.65, 0.01, and 0.02, respectively). The systematic errors for the same directions were 0.89, 1.46, 1.15, and 0.88mm in the intraoral stent (−) group and 0.62, 1.69, 0.68, and 0.56mm in the intraoral stents (+) group, respectively. The random errors were 1.43, 1.43, 1.44, and 1.22mm in the intraoral stent (−) group and 1.06, 1.11, 1.05, and 0.92mm in the intraoral stents (+) group, respectively.ConclusionSetup errors can be significantly reduced in the AP and 3D-directions by using intraoral stents.



http://ift.tt/2psgoef

Using Epigenetic Reprogramming to Treat Pediatric Brain Cancer

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Milan G. Chheda, David H. Gutmann
In this issue of Cancer Cell, Nagaraja et al. dissect the molecular mechanisms underlying therapeutic responses to transcriptional disruptors in the fatal pediatric brain tumor, diffuse intrinsic pontine glioma (DIPG). Moreover, they identify super-enhancers mediating these effects, highlighting how normal brain developmental programs can be hijacked in cancer.

Teaser

In this issue of Cancer Cell, Nagaraja et al. dissect the molecular mechanisms underlying therapeutic responses to transcriptional disruptors in the fatal pediatric brain tumor, diffuse intrinsic pontine glioma (DIPG). Moreover, they identify super-enhancers mediating these effects, highlighting how normal brain developmental programs can be hijacked in cancer.


http://ift.tt/2pX4M60

The Tribble with APL: A New Road to Therapy

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Ruaidhrí Carmody, Karen Keeshan
The t(15;17) translocation generates a PML-RARα fusion protein causative for acute promyelocytic leukemia (APL). Li et al. now identify the pseudokinase stress protein TRIB3 as an important factor in APL disease progression and therapy resistance. Targeting the interaction of TRIB3 and PML-RARα using peptide technology provides a novel therapeutic approach.

Teaser

The t(15;17) translocation generates a PML-RARα fusion protein causative for acute promyelocytic leukemia (APL). Li et al. now identify the pseudokinase stress protein TRIB3 as an important factor in APL disease progression and therapy resistance. Targeting the interaction of TRIB3 and PML-RARα using peptide technology provides a novel therapeutic approach.


http://ift.tt/2qKcQYt

Tumor Microenvironment: No Effector T Cells without Dendritic Cells

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Christina Pfirschke, Marie Siwicki, Hsin-Wei Liao, Mikael J. Pittet
Successful antitumor immunity is thought to require T cell entry into tumors, though mechanisms regulating this process remain unclear. In this issue of Cancer Cell, Spranger et al. indicate that chemokines produced by intratumoral Batf3 dendritic cells are critical for effector T cell recruitment. The findings have implications for immunotherapy.

Teaser

Successful antitumor immunity is thought to require T cell entry into tumors, though mechanisms regulating this process remain unclear. In this issue of Cancer Cell, Spranger et al. indicate that chemokines produced by intratumoral Batf3 dendritic cells are critical for effector T cell recruitment. The findings have implications for immunotherapy.


http://ift.tt/2pnOGyg

Tackling Resistance to PI3K Inhibition by Targeting the Epigenome

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Shany Koren, Mohamed Bentires-Alj
Phosphoinositide-3-kinase (PI3K) pathway inhibitors have emerged as promising therapeutic agents for estrogen receptor (ERα)-positive breast cancers. However, incipient resistance limits the clinical benefit. Toska and colleagues identified that the epigenetic regulator KMT2D enhances ERα activity in BYL719-treated PIK3CA mutant breast cancer, leading to a rationale for targeting the epigenome and PI3K signaling.

Teaser

Phosphoinositide-3-kinase (PI3K) pathway inhibitors have emerged as promising therapeutic agents for estrogen receptor (ERα)-positive breast cancers. However, incipient resistance limits the clinical benefit. Toska and colleagues identified that the epigenetic regulator KMT2D enhances ERα activity in BYL719-treated PIK3CA mutant breast cancer, leading to a rationale for targeting the epigenome and PI3K signaling.


http://ift.tt/2qKzRun

IDH Mutation, Competitive Inhibition of FTO, and RNA Methylation

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Sara M. Elkashef, An-Ping Lin, Jamie Myers, Heinz Sill, Daifeng Jiang, Patricia L.M. Dahia, Ricardo C.T. Aguiar




http://ift.tt/2po78qv

A TIAM Double Hit to Oppose YAP/TAZ

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Luca Azzolin, Stefano Piccolo
In this issue of Cancer Cell, Diamantopoulou et al. uncover dual mechanisms of inhibiting YAP/TAZ by TIAM1 that oppose invasiveness of colorectal cancer cells: TIAM1 interacts with TAZ in the cytoplasm to promote TAZ degradation by the destruction complex, whereas it antagonizes binding of TAZ/YAP to TEAD in the nucleus.

Teaser

In this issue of Cancer Cell, Diamantopoulou et al. uncover dual mechanisms of inhibiting YAP/TAZ by TIAM1 that oppose invasiveness of colorectal cancer cells: TIAM1 interacts with TAZ in the cytoplasm to promote TAZ degradation by the destruction complex, whereas it antagonizes binding of TAZ/YAP to TEAD in the nucleus.


http://ift.tt/2qKzQ9N

CHD4 Has Oncogenic Functions in Initiating and Maintaining Epigenetic Suppression of Multiple Tumor Suppressor Genes

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Limin Xia, Wenjie Huang, Marina Bellani, Michael M. Seidman, Kaichun Wu, Daiming Fan, Yongzhan Nie, Yi Cai, Yang W. Zhang, Li-Rong Yu, Huili Li, Cynthia A. Zahnow, Wenbing Xie, Ray-Whay Chiu Yen, Feyruz V. Rassool, Stephen B. Baylin
An oncogenic role for CHD4, a NuRD component, is defined for initiating and supporting tumor suppressor gene (TSG) silencing in human colorectal cancer. CHD4 recruits repressive chromatin proteins to sites of DNA damage repair, including DNA methyltransferases where it imposes de novo DNA methylation. At TSGs, CHD4 retention helps maintain DNA hypermethylation-associated transcriptional silencing. CHD4 is recruited by the excision repair protein OGG1 for oxidative damage to interact with the damage-induced base 8-hydroxydeoxyguanosine (8-OHdG), while ZMYND8 recruits it to double-strand breaks. CHD4 knockdown activates silenced TSGs, revealing their role for blunting colorectal cancer cell proliferation, invasion, and metastases. High CHD4 and 8-OHdG levels plus low expression of TSGs strongly correlates with early disease recurrence and decreased overall survival.

Graphical abstract

image

Teaser

Xia et al. show that CHD4 is recruited by OGG1 and ZMYND8, respectively, to interact with oxidative DNA damage sites and double-strand breaks. CHD4 recruits repressive chromatin proteins to these sites and helps maintain DNA hypermethylation-associated transcriptional silencing of tumor suppressor genes.


http://ift.tt/2po79e3

Hippo Signaling Suppresses Cell Ploidy and Tumorigenesis through Skp2

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Shihao Zhang, Qinghua Chen, Qingxu Liu, Yuxi Li, Xiufeng Sun, Lixin Hong, Suyuan Ji, Chengyan Liu, Jing Geng, Weiji Zhang, Zhonglei Lu, Zhen-Yu Yin, Yuanyuan Zeng, Kwang-Huei Lin, Qiao Wu, Qiyuan Li, Keiko Nakayama, Keiich I. Nakayama, Xianming Deng, Randy L. Johnson, Liang Zhu, Daming Gao, Lanfen Chen, Dawang Zhou
Polyploidy can lead to aneuploidy and tumorigenesis. Here, we report that the Hippo pathway effector Yap promotes the diploid-polyploid conversion and polyploid cell growth through the Akt-Skp2 axis. Yap strongly induces the acetyltransferase p300-mediated acetylation of the E3 ligase Skp2 via Akt signaling. Acetylated Skp2 is exclusively localized to the cytosol, which causes hyper-accumulation of the cyclin-dependent kinase inhibitor p27, leading to mitotic arrest and subsequently cell polyploidy. In addition, the pro-apoptotic factors FoxO1/3 are overly degraded by acetylated Skp2, resulting in polyploid cell division, genomic instability, and oncogenesis. Importantly, the depletion or inactivation of Akt or Skp2 abrogated Hippo signal deficiency-induced liver tumorigenesis, indicating their epistatic interaction. Thus, we conclude that Hippo-Yap signaling suppresses cell polyploidy and oncogenesis through Skp2.

Graphical abstract

image

Teaser

Zhang et al. show that Yap promotes polyploidy and polyploid cell growth via Akt signaling and p300-mediated acetylation of Skp2, which causes Skp2 cytosolic retention and differential regulation of p27 and FoxO1/3 stabilities. Dysregulated Hippo-Yap-Skp2 axis is associated with human hepatocellular carcinomas.


http://ift.tt/2pnOE9C

RasGRP3 Mediates MAPK Pathway Activation in GNAQ Mutant Uveal Melanoma

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Xu Chen, Qiuxia Wu, Philippe Depeille, Peirong Chen, Sophie Thornton, Helen Kalirai, Sarah E. Coupland, Jeroen P. Roose, Boris C. Bastian
Constitutive activation of Gαq signaling by mutations in GNAQ or GNA11 occurs in over 80% of uveal melanomas (UMs) and activates MAPK. Protein kinase C (PKC) has been implicated as a link, but the mechanistic details remained unclear. We identified PKC δ and ɛ as required and sufficient to activate MAPK in GNAQ mutant melanomas. MAPK activation depends on Ras and is caused by RasGRP3, which is significantly and selectively overexpressed in response to GNAQ/11 mutation in UM. RasGRP3 activation occurs via PKC δ- and ɛ-dependent phosphorylation and PKC-independent, DAG-mediated membrane recruitment, possibly explaining the limited effect of PKC inhibitors to durably suppress MAPK in UM. The findings nominate RasGRP3 as a therapeutic target for cancers driven by oncogenic GNAQ/11.

Graphical abstract

image

Teaser

Chen et al. find that Ras is required for GNAQ-mediated MAPK activation and identify PKC δ,ɛ and RasGRP3 as components of a signaling module necessary and sufficient to activate the Ras/MAPK pathway in GNAQ mutant uveal melanoma (UM). RasGRP3 is selectively overexpressed in response to GNAQ/11 mutations in UM.


http://ift.tt/2psi9rG

TRIB3 Promotes APL Progression through Stabilization of the Oncoprotein PML-RARα and Inhibition of p53-Mediated Senescence

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Ke Li, Feng Wang, Wen-Bin Cao, Xiao-Xi Lv, Fang Hua, Bing Cui, Jiao-Jiao Yu, Xiao-Wei Zhang, Shuang Shang, Shan-Shan Liu, Jin-Mei Yu, Ming-Zhe Han, Bo Huang, Ting-Ting Zhang, Xia Li, Jian-Dong Jiang, Zhuo-Wei Hu
Acute promyelocytic leukemia (APL) is driven by the oncoprotein PML-RARα, which antagonizes myeloid differentiation and promotes APL-initiating cell self-renewal. Combined all-trans retinoic acid (ATRA) with arsenic trioxide (As2O3) or chemotherapy dramatically improves the prognosis of APL patients. Here we report that expression of pseudokinase Tribble 3 (TRIB3) associates positively with APL progression and therapeutic resistance. The elevated TRIB3 expression promotes APL by interacting with PML-RARα and suppressing its sumoylation, ubiquitylation, and degradation. This represses PML nuclear body assembly, p53-mediated senescence, and cell differentiation, and supports cellular self-renewal. Genetically inhibiting TRIB3 expression or combination of a peptide disturbing TRIB3/PML-RARα interaction with ATRA/As2O3 eradicates APL by accelerating PML-RARα degradation. Our study provides insight into APL pathogenesis and a potential therapeutic option against APL.

Graphical abstract

image

Teaser

Li et al. find that TRIB3 promotes acute promyelocytic leukemia (APL) by suppressing PML-RARα degradation and that the TRIB3 level correlates with APL progression and therapeutic resistance. Disrupting the TRIB3/PML-RARα interaction with a peptide in combination with ATRA or As2O3 suppresses APL in vivo.


http://ift.tt/2qKqxXL

Tumor-Residing Batf3 Dendritic Cells Are Required for Effector T Cell Trafficking and Adoptive T Cell Therapy

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Stefani Spranger, Daisy Dai, Brendan Horton, Thomas F. Gajewski
Effector T cells have the capability of recognizing and killing cancer cells. However, whether tumors can become immune resistant through exclusion of effector T cells from the tumor microenvironment is not known. By using a tumor model resembling non-T cell-inflamed human tumors, we assessed whether adoptive T cell transfer might overcome failed spontaneous priming. Flow cytometric assays combined with intra-vital imaging indicated failed trafficking of effector T cells into tumors. Mechanistically, this was due to the absence of CXCL9/10, which we found to be produced by CD103+ dendritic cells (DCs) in T cell-inflamed tumors. Our data indicate that lack of CD103+ DCs within the tumor microenvironment dominantly resists the effector phase of an anti-tumor T cell response, contributing to immune escape.

Graphical abstract

image

Teaser

Spranger et al. show that effector T cells from adoptive T cell transfer fail to traffic to a non-T cell-inflamed melanoma model due to lack of CXCL9/10 produced by Batf3-driven dendritic cells that are present in inflamed tumors but absent in non-inflamed tumors. Human melanomas appear to have similar regulation.


http://ift.tt/2qKp9nV

Ablation of Key Oncogenic Pathways by RITA-Reactivated p53 Is Required for Efficient Apoptosis

Publication date: 8 May 2017
Source:Cancer Cell, Volume 31, Issue 5
Author(s): Vera V. Grinkevich, Fedor Nikulenkov, Yao Shi, Martin Enge, Wenjie Bao, Alena Maljukova, Angela Gluch, Alexander Kel, Olle Sangfelt, Galina Selivanova




http://ift.tt/2qKmbzC

In Response to “Hypothermia for Neuroprotection in Convulsive Status Epilepticus”

alertIcon.gif

Publication date: Available online 8 May 2017
Source:The Journal of Emergency Medicine
Author(s): Stephane Legriel, Matthieu Resche-Rigon, Alain Cariou




http://ift.tt/2ps2OYf

Graphene for the development of the next-generation of biocomposites for dental and medical applications

S01095641.gif

Publication date: Available online 8 May 2017
Source:Dental Materials
Author(s): Han Xie, Tong Cao, Francisco Javier Rodríguez-Lozano, Emma Kim Luong-Van, Vinicius Rosa
ObjectiveGraphene and its derivatives, graphene oxide (GO) and reduced graphene oxide (rGO), are 2D carbon-based materials with remarkable physical, chemical and biological properties. Graphene sheets have high specific surface area and mechanical strength. Moreover, they have been shown to influence the differentiation of stem cells and to improve properties of biomaterials.MethodsHere, we present the recent achievements on the use of graphene and its derivatives to improve properties and enhance bioactivity of biomaterials. We also discuss the biosafety constraints to be solved to translate these carbonaceous materials to the clinic.ResultsGraphene and its derivatives can be functionalized and further modified with several bioactive molecules. They can be combined with several biomaterials used in regenerative and reconstructive dentistry and medicine. The resultant graphene-modified composites often present improved physico-mechanical properties and enhanced bioactivity. Moreover, graphene-modified composites are promising candidates to deliver growth factors, drugs and others bioactive compounds.SignificanceGraphene can improve the physical, chemical and mechanical properties of biomaterials. As it can be functionalized and combined with several biomolecules, graphene holds enormous potential to be used as drug carriers or substrates and scaffolds for cell-based tissue engineering strategies.



http://ift.tt/2qKnBdu

Ventriculo-caval Shunt Migration

Publication date: Available online 8 May 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): M. Elens, P. Astarci




http://ift.tt/2pX1j7y

Seasonal and interannual variations in whole-ecosystem BVOC emissions from a subtropical plantation in China

alertIcon.gif

Publication date: July 2017
Source:Atmospheric Environment, Volume 161
Author(s): Jianhui Bai, Alex Guenther, Andrew Turnipseed, Tiffany Duhl, James Greenberg
Measurements of BVOC emissions, ozone concentration and environmental parameters were carried out from May 2013 to January 2016 in a subtropical Pinus plantation in China. Isoprene and monoterpene emissions were measured using a relaxed eddy accumulation (REA) system and a gradient technique on an above-canopy tower. In 2013, isoprene comprised 21.2% of total terpenoid emissions, while α-pinene, camphene, β-pinene and limonene constituting 51.5%, 2.4%, 9.1%, and 13.0% of total emissions, respectively. Monoterpenes together were the dominant VOCs measured contributing 71.6%. α-pinene, camphene, β-pinene and limonene constituted 67.7%, 3.2%, 11.9%, 17.2% of total monoterpene emissions. Isoprene and monoterpene emissions displayed strong diurnal variations, with lower emissions in the morning and late evening, and the highest emissions around noon. BVOC peak emissions typically occurred a few hours after the noon PAR peak. Isoprene and monoterpene emissions varied with season and were the highest in summer, contributing more than half of the total annual emission, and the lowest emissions were in winter. Evident interannual variations of isoprene, monoterpenes and total BVOCs were observed. Compared to 2013, annual BVOC emissions decreased in 2015, associated with decreases of PAR, Temperature, water vapor, and an increase of all substances in gas, liquid and solid phases in the atmospheric column (e.g., S/Q, the ratio of solar scattered radiation to global radiation). Ozone concentration showed clear diurnal variation with PAR, higher around noon and lower in the early morning and late evening. Generally, there were no evident correlations between ozone concentrations and BVOC emissions, or the vertical gradients of ozone concentrations and BVOC concentrations. Under all sky conditions (including cloudy skies), no strong correlations at a high confidence level or very similar variation patterns were observed between any two following parameters, BVOC emissions, PAR, temperature, water vapor, and S/Q. The major factors controlling BVOC emissions were PAR and temperature but biomass burning smoke and phenology (pine florescence) may also play a role. The mean emission factors at standard conditions determined using the MEGAN model emission algorithms and empirical model of BVOC emissions were 0.71 and 1.19 mg m−2 h−1 for isoprene and 1.39 and 1.65 mg m−2 h−1 for total monoterpenes, respectively.



http://ift.tt/2pnW7We

Endovascular stroke treatment: Is it “everybody's cup of tea?”

Kamble Rajeev, Moudgil Sandeep, Gupta Vivek

Annals of Indian Academy of Neurology 2017 20(2):157-158



http://ift.tt/2pWYuDD

Bupropion and iron for restless leg syndrome: Do they have efficacy similar to ropinirole?

Samir Kumar Praharaj

Annals of Indian Academy of Neurology 2017 20(2):166-167



http://ift.tt/2pYV8Oi

Molecular genetics of epilepsy: A clinician's perspective

Vikas Dhiman

Annals of Indian Academy of Neurology 2017 20(2):96-102

Epilepsy is a common neurological problem, and there is a genetic basis in almost 50% of people with epilepsy. The diagnosis of genetic epilepsies makes the patient assured of the reasons of his/her seizures and avoids unnecessary, expensive, and invasive investigations. Last decade has shown tremendous growth in gene sequencing technologies, which have made genetic tests available at the bedside. Whole exome sequencing is now being routinely used in the clinical setting for making a genetic diagnosis. Genetic testing not only makes the diagnosis but also has an effect on the management of the patients, for example, the role of sodium channels blockers in SCN1A+ Dravet syndrome patients and usefulness of ketogenic diet therapy in SLC2A1+ generalized epilepsy patients. Many clinicians in our country have no or limited knowledge about the molecular genetics of epilepsies, types of genetic tests available, how to access them and how to interpret the results. The purpose of this review is to give an overview in this direction and encourage the clinicians to start considering genetic testing as an important investigation along with electroencephalogram and magnetic resonance imaging for better understanding and management of epilepsy in their patients.

http://ift.tt/2pX84X4

Right- versus left-onset Parkinson's disease: Other psychometric parameters

Yassar Abdullah S Alamri

Annals of Indian Academy of Neurology 2017 20(2):162-163



http://ift.tt/2pZ4oSJ

Frederic Andrews Gibbs and the assassination of John Fitzgerald Kennedy

Kalyan B Bhattacharyya

Annals of Indian Academy of Neurology 2017 20(2):103-105

Frederic Gibbs, the peerless expert on electroencephalogrphy was summoned to provide opinion on the EEG tracing of Jack Ruby, who murdered Lee Harvey Oswald, the assassin of John Fitzgerald Kennedy, the American President, in 1963. Gibbs pleaded that the tracing suggested features indicative of psychomotor epilepsy and Ruby killed Oswald in a state of fugue. His view was not agreed upon but Gibbs stood his ground unflinchingly. Subsequent appeals to the higher court spared Ruby from imminent execution and finally he died a natural death from metastatic complications of carcinoma of the lung in 1967.

http://ift.tt/2pWKDgo

Limb-girdle muscular dystrophies in India: A review

Satish V Khadilkar, Hinaben Dayalal Faldu, Sarika Bapuso Patil, Rakesh Singh

Annals of Indian Academy of Neurology 2017 20(2):87-95

Limb-girdle muscular dystrophies (LGMDs) are common in India. Information on LGMDs has been gradually evolving in the recent years. This information is scattered in case series and case studies. The aim of this study is to collate available Indian information on LGMDs and put it in perspective. PubMed search using keywords such as limb-girdle muscular dystrophies in India, sarcoglycanopathies, dysferlinopathy, calpainopathy, and GNE myopathy was carried out. The published information on LGMDs in Indian context suggests that dysferlinopathy, calpainopathy, sarcoglycanopathies, and other myopathies such as GNE myopathy are frequently seen in India. Besides these, anecdotal reports of many other forms are available, some with genetic support and others showing immunocytochemical defects. The genotypic information on LGMDs is gradually evolving and founder mutations have been detected in selected populations. Further multicenter studies are necessary to document the incidence and prevalence of these common conditions in India.

http://ift.tt/2pYW1WW

Neurological outcomes following suicidal hanging: A prospective study of 101 patients

Mohammed Turab Jawaid, S Deepak Amalnath, D. K. S. Subrahmanyam

Annals of Indian Academy of Neurology 2017 20(2):106-108

Context: Survivors of suicidal hanging can have variable neurological outcomes – from complete recovery to irreversible brain damage. Literature on the neurological outcomes in these patients is confined to retrospective studies and case series. Hence, this prospective study was carried out. Aims: The aim is to study the neurological outcomes in suicidal hanging. Settings and Design: This was a prospective observational study carried out from July 2014 to July 2016. Subjects and Methods: Consecutive patients admitted to the emergency and medicine wards were included in the study. Details of the clinical and radiological findings, course in hospital and at 1 month postdischarge were analyzed. Statistical Analysis Used: Statistical analysis was performed using IBM SPSS advanced statistics 20.0 (SPSS Inc., Chicago, USA). Univariate analysis was performed using Chi-square test for significance and Odd's ratio was calculated. Results: Of the 101 patients, 6 died and 4 had residual neuro deficits. Cervical spine injury was seen in 3 patients. Interestingly, 39 patients could not remember the act of hanging (retrograde amnesia). Hypotension, pulmonary edema, Glasgow coma scale (GCS) score <8 at admission, need for mechanical ventilation, and cerebral edema on plain computed tomography were more in those with amnesia as compared to those with normal memory and these findings were statistically significant. Conclusions: Majority of patients recovered without any sequelae. Routine imaging of cervical spine may not be warranted in all patients, even in those with poor GCS. Retrograde amnesia might be more common than previously believed and further studies are needed to analyze this peculiar feature.

http://ift.tt/2pWUTW0

Direct mechanical thrombectomy with thromboaspiration in cerebral venous sinus thrombosis

Vikram Bohra, Romnesh deSouza, Vivek Karan, Vikram Huded

Annals of Indian Academy of Neurology 2017 20(2):160-161



http://ift.tt/2pZ4mdz

Unknown patients and neurology casualty services in an Indian metropolitan city: A decades experience

Achary Umesh, Guru S Gowda, Channaveerachari Naveen Kumar, Dwarakanath Srinivas, Bharath Rose Dawn, Ragasudha Botta, Ravi Yadav, Suresh Bada Math

Annals of Indian Academy of Neurology 2017 20(2):109-115

Objectives: A large number of unknown patients without any personal, family, or other identification details represent a unique problem in the neurological emergency services of developing countries like India in a context of legal, humanitarian, and treatment issues. These patients pose a diagnostic and management challenge to treating physicians and staff. There are sparse data on these patients. The objective of this study was to know the clinical, socio-demographic, and investigational profile of "unknown" patients. Materials and Methods: We did retrospective chart review of all "Unknown" patients from January 2002 to December 2011, who was admitted under Neurology Emergency Service at a Tertiary Care Neuropsychiatry Center in South Indian Metropolitan City. Clinical and sociodemographic characteristics and clinical outcome of the sample were analyzed. Results: A total of 151 unknown patients were admitted during the 10 years. Out of these, 134 (88.7%) were males with the mean age of 43.8 ± 14.8 years and 95 (63%) were aged >40 years. Among them, 147 (97.4%) were from the urban vicinity, 126 (83.6%) were brought by police and 75 (49.7%) were registered as medico-legal cases. Out of these, only 3 (2%) patients had normal sensorium, whereas 101 (66.9%) presented with loss of consciousness. Forty-one (27.2%) unknown patients had a seizure disorder, 37 (24.5%) had metabolic encephalopathy, 26 (17.2%) had a stroke, 9 (6%) had neuro-infection, and 17 (11.3%) had a head injury. Deranged liver functions were seen in 65 (43%), renal derangement in 37 (24.5%), dyselectrolytemia in 42 (27.8%), and abnormal brain imaging finding in 95 (62.9%) patients. Furthermore, there were 14 (9.3%) deaths. Conclusions: Our findings demonstrate seizures, metabolic causes, and neuro-infections were the primary reasons for admission of unknown patients to neuro-emergency service. This novel Indian study data show the common causes of admission of unknown patients in neurology. This pattern can be useful to guide the approach of healthcare providers in India.

http://ift.tt/2pX84q2

Molecular diagnosis of limb-girdle muscular dystrophy type 2A by next-generation sequencing

Clara Gómez-González, Maria Isabel Esteban-Rodríguez, Yolanda Ruano, Elena Vallespín, Pablo Lapunzina, Paloma Martínez, Samuel I Pascual, Jesús Molano, Carmen Prior

Annals of Indian Academy of Neurology 2017 20(2):164-165



http://ift.tt/2pYMajW

Study of refractory status epilepticus from a tertiary care center

Sahil Kohli, Suresh Babu Pasangulapati, Sangeetha Yoganathan, Gideon Lyngsyun Rynjah, AT Prabhakar, Sanjith Aaron, Mathew Alexander, Vivek Mathew

Annals of Indian Academy of Neurology 2017 20(2):116-121

Objectives: To determine the proportion of refractory status epilepticus (RSE) and super-RSE (SRSE) among patients with status epilepticus (SE) and to analyze RSE and non-RSE (NRSE) in terms of etiology and predictors for RSE. Materials and Methods: Patients were identified from discharge summaries database with keywords of SE and records of the portable electroencephalogram (EEG) machine from January 2011 to March 2016. Results: Two hundred and eighteen events were included in the study with 114 (52.3%) males, bimodal age preponderance age <5 years 30%, and second peak in age 15–65 years 52.8%, preexisting seizures were present in 34.4% (n = 75). Nearly 77.1% had NRSE (n = 168) and 22.9% had RSE (n = 50). This included 17 patients with SRSE (n = 17, 7.8% of all SE). Central nervous system (CNS) infection was a single largest etiological group in SE (69/218, 31.7%). In RSE, autoimmune encephalitis (17/50) and CNS infection (13/50) were the largest groups. De novo seizures (P = 0.007), low sensorium at admission (P = 0.001), low albumin at admission (P = 0.002), and first EEG being abnormal (P = 0.001) were risk factors on bivariate analysis. An unfavorable status epilepticus severity score (STESS) was predictive for RSE (P = 0.001). On multivariate analysis, de novo seizures (P = 0.009) and abnormal EEG at admission (P = 0.03) were predictive for RSE. Conclusions: Fifty patients had RSE (22.9%), of which 17 went on to become SRSE (7.8%). Unfavorable STESS score was predictive for RSE on bivariate analysis. On multivariate analysis, de novo seizures and abnormal initial EEG were predictors of RSE.

http://ift.tt/2pXcVr8

Piloerection: A rare ictal phenomenon – Case report and review of literature

Samhita Panda, Chandrashekhar Agarwal, Ankkita Sharma

Annals of Indian Academy of Neurology 2017 20(2):169-172



http://ift.tt/2pYT48R

Maintenance of normoglycemia may improve outcome in acute ischemic stroke

Sruthi S Nair, PN Sylaja, Sapna Erat Sreedharan, Sankara Sarma

Annals of Indian Academy of Neurology 2017 20(2):122-126

Introduction: Several studies have shown that high admission glucose is associated with poor outcomes after stroke, but the impact of maintenance of normoglycemia on functional outcome during hospitalization for acute ischemic stroke is less well established. Aims: The aim of this study was to examine the independent association of postadmission glycemic status in the 1st week with 3-month functional outcome in patients with acute ischemic stroke. Methods: Patients with acute ischemic stroke admitted within 48 h of symptom onset with National Institutes of Health Stroke Scale (NIHSS) of ≥4 were selected from a prospectively maintained database by chart review. Demographic data, risk factors, NIHSS, and blood glucose values in the 1st week were collected. The primary outcome was Modified Rankin Scale (mRS) score at 3 months (good outcome-mRS ≤2). Results: Over 3 years, 342 patients were enrolled with 220 (64.32%) males. Mean age was 60.5 ± 13.4 years, and median admission score on NIHSS was 10 (interquartile range: 6–16). Blood glucose values persistently <140 mg/dl in the 1st week were associated with a good 3-month functional outcome in univariate analysis (P = 0.036). Hypoglycemic episodes occurred only in 11 (3.22%) patients. Conclusions: Blood glucose values persistently below 140 mg/dl in the 1st week after acute ischemic stroke were associated with a favorable outcome in our study. Future clinical trials are needed to confirm these findings.

http://ift.tt/2pWTEWU

Turf wars in stroke medicine: Why should patients suffer

Shriram Varadharajan

Annals of Indian Academy of Neurology 2017 20(2):156-156



http://ift.tt/2pZfW8s

Dorsal sural sensory nerve action potential: A study for reference values

Sweta Chetan Chaudhari, Khushnuma Anil Mansukhani, Alika Sharma, Lajita Balakrishnan, Aarthika Sreenivasan

Annals of Indian Academy of Neurology 2017 20(2):127-131

Background: Dorsal sural sensory nerve action potential (SNAP) could help diagnose early or subclinical peripheral neuropathy. Objectives: To establish reference data for dorsal sural SNAP amplitude, latency, and velocity in healthy participants. Materials and Methods: A prospective study was conducted in 45 nerves from healthy participants between 18 and 90 years and stratified into three age groups (a = 18–40 years, b = 41–60 years, and c≥60 years). StataCorp 12.2 statistical program was used for all statistical analyses. Mean-2 standard deviation was used to generate reference values for the lower limit of amplitude and velocity in each age group. ANOVA with Bonferroni correction was used for intergroup comparisons of amplitude and velocity. Regression analysis was used to compute an equation for the predicted amplitude with age, height, and weight as the covariates. Results: The lower limit for amplitude (uv) in Groups a, b, and c was 2.57, 1.97, and 1.01, respectively. The lower limit for velocity (m/s) was 33.6, 32, and 22.8, respectively. Statistical significance was noted between the amplitudes of participants in Groups b and c (P = 0.039) and a and c (P = 0.001). Similarly, velocity was significantly different between Groups b and c (P = 0.04) and a and c (P = 0.008). Age was the covariate with maximum effect on the dorsal sural amplitude. Gender and side-to-side comparison did not show statistical significance for amplitude and velocity measurements. Linear regression analysis of the transformed amplitude gave the predictive equation as (y) =3.338 + age (−0.0167) + height in meters (−0.209) + weight (0.001). Conclusion: This study provides reference data for dorsal sural SNAP in Indian population stratified by age.

http://ift.tt/2pWUOBG

Paradigm shift in stroke prevention: Need of the hour

Pushpendra Nath Renjen

Annals of Indian Academy of Neurology 2017 20(2):158-159



http://ift.tt/2pYAv4P

Teratogenic effects of carbamazepine in mice

Manna Jose, Harikrishnan Vijayakumar Sreelatha, Manjula Valiyamattathil James, Sabareeswaran Arumughan, Sanjeev Varghese Thomas

Annals of Indian Academy of Neurology 2017 20(2):132-137

Objectives: The aim of this study was to determine the teratogenic effects of carbamazepine (CBZ) in BALB/c mice. Materials and Methods: Mature female and male BALB/c mice (25–30 g) were used for all experiments. After standardization of administration and dose of CBZ, animals in the CBZ-treated groups (CBZ 450 mg/kg and 600 mg/kg) were fed on medicinal diet. The dams in the control group were mated on the same day as that of the CBZ-treated dams. After cesarean section (CS), fetal viability status and weights were recorded. Gross histopathological examination of fetuses was conducted to identify alterations in morphology and external or internal organs due to in utero exposure of CBZ. Results: Out of the nine female animals (three treated on CBZ 450 mg/kg, three treated on CBZ 600 mg/kg and three controls), seven were pregnant, and two (one each from the two CBZ-treated groups) were nonpregnant. All fetuses of the control group (n = 31) and CBZ 450 mg/kg treated group (n = 24) were live, but eight out of the twenty fetuses (40%) of CBZ 600 mg/kg treated group were dead at CS. The birth weight of the fetuses antenatally exposed to CBZ was drastically reduced (0.71 ± 0.06) when compared to control fetuses (1.67 ± 0.12) (P < 0.0001). All the fetuses of the CBZ-treated groups showed stunted physical development. Conclusion: Although oral administration of CBZ to mice is a convenient model to study the effect of CBZ to pregnancy, higher oral dose was associated with increased fetal loss. Some of the fetuses exposed to CBZ demonstrated structural abnormalities and low body weight.

http://ift.tt/2pWRaro

Successful revascularization of acute middle cerebral artery occlusion by intravenous thrombolysis while on apixaban

Vivek K Nambiar, TS Dhanya, Amrutha V Ajai

Annals of Indian Academy of Neurology 2017 20(2):161-162



http://ift.tt/2pYW0lQ

Clinical and imaging study of isolated and mixed rest and action tremor-essential tremor versus Parkinson's disease

Sandro Zambito Marsala, Michele Pistacchi, Manuela Gioulis, Franco Ferracci, Livio Capus

Annals of Indian Academy of Neurology 2017 20(2):138-141

Background: Some patients present an unusual association of both action tremor (AT) and rest tremor (RT) making the differential diagnosis between essential tremor (ET) and Parkinson's disease (PD) difficult. Aim: To investigate this particular clinical picture trying to focus on possible peculiar clinical inferences. Patients and Methods: Twenty-three patients with atypical tremor syndrome were selected for the study. They underwent neurological examination, neuroimaging study, and brain DaTSCAN single-photon emission computed tomography. Results: Twenty-three patients were evaluated; 17 presented mixed-tremor syndrome, while six patients showed only isolated AT or RT. DaTSCAN was pathological in 19 patients and normal in 3 patients. The emerging statistical data highlighted a positive correlation between disease duration and DaTSCAN abnormalities; Fisher's exact test showed a marked difference in evolution toward a dysfunction of dopaminergic pathways in patients with both AT and RT phenotype. Conclusion: The possible correlation between PD and ET has often been discussed without any clear findings. Are these patients suffering from ET prone to develop PD? Or are they the expression of a specific clinical phenotype? Our clinical survey has not led to absolute considerations; however, it seeks to highlight the clinical markers that might arouse the suspicion of extrapyramidal disease in patients with atypical tremor syndrome.

http://ift.tt/2pWKCsQ

Nuclear Receptor Function through Genomics: Lessons from the Glucocorticoid Receptor

Publication date: Available online 8 May 2017
Source:Trends in Endocrinology & Metabolism
Author(s): Daniel M. Cohen, David J. Steger
Unlocking the therapeutic potential of the glucocorticoid receptor (GR) has motivated a search for small molecules that selectively modulate its ability to activate or repress gene transcription. Recently, breakthrough studies in the field of genomics have reinvigorated debate over longstanding transcriptional models explaining how GR controls tissue-specific gene expression. Here, we highlight these genomic studies with the dual goals of advancing understanding of nuclear receptor-mediated transcription and stimulating thought on the development of anti-inflammatory and immunosuppressive ligands for GR that have reduced harmful effects on metabolism.



http://ift.tt/2pWTIpC

Adulterant-Contaminant in MT-45 or Coingestion? – Reply from Authors

In a commentary to our publication entitled "Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45",[1] Yip and Deng [2] argue that the lack of opioid symptoms would indicate involvement of another drug class, possibly arsenic or 2,4-dinitrophenol (DNP). In this respect, it should be emphasized that the patients did not seek hospital care for acute opioid overdose symptoms but for unexpected, late adverse side effects involving the skin, hair, and eyes.

This article is protected by copyright. All rights reserved.



http://ift.tt/2prwu82

The characteristics of salivary pepsin in patients with severe motor and intellectual disabilities

alertIcon.gif

Publication date: Available online 8 May 2017
Source:Brain and Development
Author(s): Naoki Hashizume, Suguru Fukahori, Kimio Asagiri, Shinji Ishii, Nobuyuki Saikusa, Naruki Higashidate, Motomu Yoshida, Daisuke Masui, Saki Sakamoto, Yoshiaki Tanaka, Minoru Yagi, Yushiro Yamashita
PurposeThe aim of the present study was to determine the utility of measuring the salivary pepsin level (SPL) as an objective assessment of gastroesophageal reflux disease (GERD) in severe motor and intellectual disabilities (SMID) patients.Subjects and methodsThis prospective study included 26 SMID patients who underwent simultaneous 24-h multichannel intraluminal impedance pH measurement (pH/MII) and SPL evaluation. The enrolled patients were divided into GERD (+) or GERD (−) groups according to the pH/MII findings. The age, gender and pH/MII parameters were compared between the two groups. A correlation analysis was also conducted for the SPL following early-morning fasting and post-enteral feeding and the age, gender, presence of gastrostomy and tracheostomy and pH/MII parameters. The SPL was compared between the two sampling groups.ResultsFifteen patients were classified as GERD (+), and 11 patients were classified as GERD (−). The mean SPL following early-morning fasting and post-enteral feeding among all patients were 104.3 (median: 38, 25th and 75th percentile: 12, 361) ng/ml and 222.2 (median: 152:0, 500) ng/ml, respectively. Regarding positivity, 76.9% and 73.1% of SPL values in early-morning fasting and post-enteral feeding SMID patients, respectively, were positive (≧16ng/ml). The SPL following early-morning fasting demonstrated a weak but significant positive correlation with age. In contrast, we noted no correlation between the pH/MII parameters and the SPL for either the early-morning fasting or post-enteral feeding patients, and no significant difference in the SPL was observed between the GERD (+) and (−) patients.ConclusionsThe present study showed that a high proportion of SMID patients had a relatively high SPL, regardless of the presence of GERD. The SPL in SMID patients might be affected by several distinctive factors in addition to gastroesophageal reflux.



http://ift.tt/2pTVsiV

Clipping and irrigation enhance grass biomass and nutrients: Implications for rangeland management

S1146609X.gif

Publication date: May 2017
Source:Acta Oecologica, Volume 81
Author(s): Samuel Tuffa, Dana Hoag, Anna C. Treydte
Increasing frequency of drought and high herbivore pressure significantly affect individual grass functions in semiarid regions. Reseeding of degraded rangelands by native grass species has been recommended as a tool for restoration semiarid rangelands. However, how grass species used for reseeding respond to stressors has not been fully explored. We examined biomass allocation and nutrient contents of Cenchrus ciliaris and Chloris gayana in the semiarid Borana rangelands, Ethiopia. We tested clipped mature tufts of the same species for biomass allocation and nutritive values. Further, shifts in rainfall and herbivory were simulated by three irrigation and four clipping treatments, respectively, for newly established grasses in pot and field plot experiments. Aboveground biomass (AGB) significantly declined by up to 75% under increased clipping in mature tufts. In contrast, clipping significantly stimulated up to 152% higher AGB of newly established grasses. Lower irrigation reduced the AGB by 24 and 42% in C. ciliaris and in C. gayana, respectively. Clipping, further, significantly enhanced grass nutrients in grass tufts by up to 82 and 105% in C. ciliaris and C. gayana, respectively. Hence, management should focus on balancing this trade-off in mature grasses for nutritious rangeland production by clipping and storing for later supplemental feeding when grass nutrients drop. Further, young pastures should be moderately clipped/grazed for better establishment and biomass allocation. Additionally, our experiments established the first interactive effect of clipping and irrigation frequencies on the biomass allocation of native grasses in the semiarid Borana rangelands, Ethiopia. Knowledge of these interacting factors is deemed essential for policy makers to enhance productivity of degraded rangelands such as the Borana rangelands.



http://ift.tt/2qhR7Y3

Comparison of effectiveness of two commonly used two-handed mask ventilation techniques on unconscious apnoeic obese adults

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> Mask ventilation and tracheal intubation are basic techniques for airway management and mutually inclusive rescue measures to restore ventilation. The aim of this study was to compare the effectiveness of mask ventilation between two commonly used techniques of two-handed mask ventilation in obese unconscious apnoeic adults.<strong>Methods.</strong> Eighty-one obese adults received mask ventilation after induction using C-E clamp and modified V-E clamp techniques in a randomized crossover manner. Mechanical ventilation was provided using a pressure-control mode, at a rate of 10 bpm, with an inspiratory-to-expiratory time ratio of 1:2 and a pre-set plateau airway pressure of 20 cm H<sub>2</sub>O. The primary outcome was expired tidal volume.<strong>Results.</strong> The BMI for the subjects was 37 (<span style="text-transform:lowercase;font-variant:small-caps;">sd</span> 4.9) kg m<sup>−2</sup>. The failure rates for mask ventilation (tidal volume≤anatomical dead space) were 44% for the C-E technique and 0% for the V-E technique (<span style="font-style:italic;">P</span><0.001). Tidal volume was significantly lower for the C-E than the V-E technique [371 (<span style="text-transform:lowercase;font-variant:small-caps;">sd</span> 345) <span style="font-style:italic;">vs</span> 720 (244) ml, <span style="font-style:italic;">P</span><0.001]. The peak airway pressures were 21 (<span style="text-transform:lowercase;font-variant:small-caps;">sd</span> 1.5) cm H<sub>2</sub>O for the C-E technique and 21 (1.3) cm H<sub>2</sub>O for the V-E technique.<strong>Conclusions.</strong> Mask ventilation using the modified V-E technique is more effective than with the C-E technique in unconscious obese apnoeic adults. Subjects who fail ventilation with the C-E technique can be ventilated effectively with the V-E technique.<strong>Clinical trial registration.</strong> NCT02580526.</span>

http://ift.tt/2qhq5Ae

Association of intraoperative cerebral and muscular tissue oxygen saturation with postoperative complications and length of hospital stay after major spine surgery: an observational study

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> Compromised tissue oxygenation is one of the root causes of dysfunction of various organs and postoperative complications. Oxygenation of different tissue beds may follow different patterns of change during physiological derangement.<strong>Methods.</strong> Patients undergoing elective major posterior spine surgery participated in this prospective observational study. Cerebral tissue oxygen saturation (SctO<sub>2</sub>) was monitored on the upper forehead and muscular tissue oxygen saturation (SmtO<sub>2</sub>) on the lower leg. The associations of various oxygenation indices with postoperative composite complications and length of hospital stay (LOH) were investigated.<strong>Results.</strong> The number of composite complications per patient was 3  (2) while the LOH was 6 (3) days (n = 102). Multiple SmtO<sub>2</sub> indices (maximum, minimum, mean, median, and area under curve (AUC)) were associated with composite complications (univariate analysis, <span style="font-style:italic;">P</span> < 0.05). No SctO<sub>2</sub> indices were associated with complications. Multiple SmtO<sub>2</sub> indices (maximum, mean, median, and AUC) showed differences (<span style="font-style:italic;">P</span> < 0.05) between patients with composite complications ≤3 and >3, respectively. SmtO<sub>2</sub> standard deviation, AUC, and AUC weighted, and SctO<sub>2</sub> standard deviation, were associated with LOH (univariate analysis, <span style="font-style:italic;">P</span> < 0.05). Two SmtO<sub>2</sub> indices (AUC and AUC weighted), showed differences (<span style="font-style:italic;">P</span> < 0.05) between the patients with an LOH ≤6 and >6 days, respectively. SmtO<sub>2</sub>, but not SctO<sub>2</sub>, indices improved the adjusted R<sup>2</sup> for composite complications (+54.0%, <span style="font-style:italic;">P</span> = 0.0001) and LOH (+19.0%, <span style="font-style:italic;">P</span> = 0.02) based on multiple linear models.<strong>Conclusions.</strong> Muscular tissue oxygenation has a stronger association with postoperative complications and length of hospital stay than cerebral tissue oxygenation after major spine surgery.</span>

http://ift.tt/2qT4paS

National audits in the UK: fancy acronyms or real patient benefit?

<span class="paragraphSection">'…give us the tools and we will finish the job.'<span style="font-style:italic;">Winston Churchill (1874–1965)</span></span>

http://ift.tt/2qhq27w

Rainbow after the storm

<span class="paragraphSection">Editor–A 71-year-old female presented with polymicrobial sepsis and mediastinitis following a dental procedure. After resuscitation with fluids and antibiotics, she required increasing doses of norepinephrine (up to 0.3 µg kg<sup>−</sup><sup>1</sup> min<sup>−</sup><sup>1</sup>) prior to operative exploration. Point-of-care ultrasound revealed elevated cardiac filling pressures (dilated inferior vena cava without respiratory variation) and hyperdynamic cardiac function (ejection fraction >65%). Central venous pressure was 14 mmHg and central venous saturation was 70%. These findings, in addition to the requirement for high-dose intravenous vasopressors, confirmed a diagnosis of vasoplegia.<a href="#aex066-B1" class="reflinks"><sup>1</sup></a> An intraoperative infusion pump failure of norepinephrine resulted in profound hypotension [blood pressure (BP) 30/20 mm Hg] as measured by an indwelling arterial line. Intravenous vasopressor boluses and 100 mg of methylene blue increased systolic arterial BP to >100 mm Hg for 15 min. Because methylene blue was effective, but only for a short duration, we administered intravenous hydroxocobalamin (1 g/h) to treat her vasoplegia.<a href="#aex066-B2" class="reflinks"><sup>2</sup></a> Her acute oliguria (<10 ml h<sup>−</sup><sup>1</sup>) was reversed and urine output increased to >500 ml h<sup>−</sup><sup>1</sup> during the final hours of surgery.</span>

http://ift.tt/2qT1QFI

Theory and context: putting the science into improvement

<span class="paragraphSection">Quality Improvement has been around in healthcare for decades. However, the phrase "improvement science" is somewhat newer. In their Lancet Editorial in 2013, Marshall, Pronovost and Dixon-Woods proposed that Improvement Science was in Kuhn's <a href="#aew469-B1" class="reflinks"><sup>1</sup></a> previously described "pre-paradigm phase of the emergence of a new discipline, one of the characteristics of which is the absence of an agreed definition."<a href="#aew469-B2" class="reflinks"><sup>2</sup></a> Four yr on, the phrase "Improvement Science" is sometimes used interchangeably with quality improvement (QI). Are they the same thing? What is the point of drawing a distinction?</span>

http://ift.tt/2qhymUD

Reduced hemidiaphragmatic paresis with extrafascial compared with conventional intrafascial tip placement for continuous interscalene brachial plexus block: a randomized, controlled, double-blind trial

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> The incidence of hemidiaphragmatic paresis with continuous interscalene brachial plexus block (CISB) can approach 100%. We tested the hypothesis that extrafascial placement of the catheter tip reduces the rate of hemidiaphragmatic paresis compared with intrafascial tip placement for CISB while providing effective analgesia.<strong>Methods.</strong> Seventy patients undergoing elective major shoulder surgery under general anaesthesia were randomized to receive an ultrasound-guided CISB plexus block for analgesia with the catheter tip placed either within (intrafascial group) or immediately outside (extrafascial group) the brachial plexus sheath midway between the levels of C5 and C6. Catheters were bolus dosed with ropivacaine 0.5% 20 ml before surgery, followed by an infusion of ropivacaine 0.2% at 4 ml h<sup>−1</sup> for the first 2 days after surgery. The primary outcome was hemidiaphragmatic paresis measured by M-mode ultrasonography on postoperative day (POD) 1. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, and rest pain scores.<strong>Results.</strong> The incidence of hemidiaphragmatic paresis on POD 1 was significantly reduced in the extrafascial group {intrafascial, 41% [95% confidence interval (CI) 25–59%]; extrafascial, 15% (95% CI 5–32%); <span style="font-style:italic;">P</span>=0.01}. We were unable to detect a difference between groups in any of the functional respiratory outcomes or in rest pain scores [numerical rating scale (1–10): intrafascial, 3 (95% CI 2–3); extrafascial, 3 (95% CI: 2–4); <span style="font-style:italic;">P</span>=0.93] on POD 1.<strong>Conclusions.</strong> Placement of the catheter tip immediately outside of the brachial plexus sheath reduced the incidence of hemidiaphragmatic paresis on POD 1 associated with ultrasound-guided CISB while providing effective analgesia after major shoulder surgery. Our results do not support the routine placement of the catheter tip within the brachial plexus sheath for CISB.<strong>Clinical trial registration.</strong> NCT02433561.</span>

http://ift.tt/2qT4onk

Taking two steps at a time does not necessarily bring you forward! Monitoring peripheral tissue perfusion with near-infrared spectroscopy

<span class="paragraphSection">Evolution of tissue oxygenation monitoring by near-infrared spectroscopy (NIRS) is one of the most interesting recent developments in clinical monitoring.<a href="#aex032-B1" class="reflinks"><sup>1</sup></a> Given the importance of organ tissue perfusion for outcomes from surgery and critical illness, the fact that this technology can be used to interrogate almost any body region of interest (that can be placed within the device's photon beam) has stimulated a tremendous amount of scientific work on the potential diagnostic utility of NIRS.</span>

http://ift.tt/2qhoIBw

Mayo Clinic Critical Care Case Review , R. Kashyap, J. C. O'Horo, J. C. Farmer.

<span class="paragraphSection"><span style="font-style:italic;">Mayo Clinic Critical Care Case Review</span>, KashyapR., O'HoroJ. C., FarmerJ. C.. Published by Oxford University Press. Pp. 288. ISBN-978-0-19-046481-3.</span>

http://ift.tt/2qSIwbs

What do people expect of general anaesthesia?

<span class="paragraphSection">It is universally acknowledged that the public expect general anaesthesia to be an unconscious state.<a href="#aex040-B1" class="reflinks"><sup>1–4</sup></a> While apparently self-evident, knowing whether different conscious states under anaesthesia are acceptable is important for clarification of the research agenda in anaesthesia, that is appropriately focused on patient-centred outcomes. Furthermore understanding patient expectations may be a key way to improve patient satisfaction with anaesthesia. The great success of anaesthesia is validated through low rates of explicit recall of intraoperative events, however it remains unclear whether the public think amnesia of intraoperative events is a sufficient endpoint for anaesthesia. It is unclear whether dreaming ("disconnected consciousness from the environment") or connected consciousness ("consciousness of external stimuli") are acceptable outcomes under general anaesthesia. These questions are made more pertinent by our recent report that 4.6% of patients undergoing intubation under general anaesthesia respond on the isolated forearm technique, implying they have connected consciousness,<a href="#aex040-B5" class="reflinks"><sup>5</sup></a> with 1.9% reporting connected consciousness with pain. To provide some initial insight into public opinion on this, we conducted a survey posted on our website (<a href="http://ift.tt/2qhMQnw">http://ift.tt/2qSHFHI;), social media (Twitter, Reddit, and Facebook) and distributed electronically. We explored the public's views of states such as disconnected consciousness or dreaming during anaesthesia and intraoperative consciousness with and without amnesia.</span>

http://ift.tt/2qhzyHT

Assessing the pathogenicity of RYR1 variants in malignant hyperthermia

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background</strong>. Missense variants in the ryanodine receptor 1 gene (<span style="font-style:italic;">RYR1</span>) are associated with malignant hyperthermia but only a minority of these have met the criteria for use in predictive DNA diagnosis. We examined the utility of a simplified method of segregation analysis and a functional assay for determining the pathogenicity of recurrent <span style="font-style:italic;">RYR1</span> variants associated with malignant hyperthermia.<strong>Methods</strong>. We identified previously uncharacterised <span style="font-style:italic;">RYR1</span> variants found in four or more malignant hyperthermia families and conducted simplified segregation analyses. An efficient cloning and mutagenesis strategy was used to express ryanodine receptor protein containing one of six <span style="font-style:italic;">RYR1</span> variants in HEK293 cells. Caffeine-induced calcium release, measured using a fluorescent calcium indicator, was compared in cells expressing each variant to that in cells expressing wild type ryanodine receptor protein.<strong>Results.</strong> We identified 43 malignant hyperthermia families carrying one of the six <span style="font-style:italic;">RYR1</span> variants. There was segregation of genotype with the malignant hyperthermia susceptibility phenotype in families carrying the p.E3104K and p.D3986E variants, but the number of informative meioses limited the statistical significance of the associations. HEK293 functional assays demonstrated an increased sensitivity of RyR1 channels containing the p.R2336H, p.R2355W, p.E3104K, p.G3990V and p.V4849I compared with wild type, but cells expressing p.D3986E had a similar caffeine sensitivity to cells expressing wild type RyR1.<strong>Conclusions</strong>. Segregation analysis is of limited value in assessing pathogenicity of <span style="font-style:italic;">RYR1</span> variants in malignant hyperthermia. Functional analyses in HEK293 cells provided evidence to support the use of p.R2336H, p.R2355W, p.E3104K, p.G3990V and p.V4849I for diagnostic purposes but not p.D3986E.</span>

http://ift.tt/2qT6FyI

Lights! Oxygen! Action! Hollywood anaesthesia is coming to a theatre near you

<span class="paragraphSection">By the time you are reading this editorial, '<span style="font-style:italic;">La La Land</span>', an Academy Awards contender movie about love, passion, and professional challenges of two Hollywood dreamers, will have nearly swept the Oscars. In the dream world of general anaesthesia, the top la la land award should undoubtedly be bestowed on Gustafsson and colleagues<a href="#aex077-B1" class="reflinks"><sup>1</sup></a> for their publication in the April issue of <span style="font-style:italic;">British Journal of Anaesthesia</span>.</span>

http://ift.tt/2qhN3Hy

Individual patient data analysis of tidal volumes used in three large randomized control trials involving patients with acute respiratory distress syndrome

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> The acute respiratory distress syndrome (ARDS) is a condition with a high mortality and morbidity. Mechanical ventilation prevents immediate mortality but may further damage patients' lungs. Low tidal volume lung-protective strategies have been shown to increase survival by reducing this iatrogenic damage. Current guidelines recommend tidal volumes of 6–8 ml kg<sup>−1</sup> of predicted body weight. We used data from three large randomized controlled trials of treatments for ARDS to determine compliance with these recommendations.<strong>Methods.</strong> We used the tidal volume recorded at randomization for all patients in the OSCAR, HARP-2, and BALTI-2 studies. In addition, we used the ventilation data for control arm patients in OSCAR and all patients in HARP-2 at days 1 and 7 after randomization.<strong>Results.</strong> The three trials enrolled 1660 patients, with tidal volume data available at least at one time point in 1412 patients. Compliance with the 6–8 ml kg<sup>−1</sup> recommendation for tidal volume ranged from 20 to 39% of patients across all time points in all three trials.<strong>Conclusion.</strong> Poor compliance with the guidelines for tidal volume in patients with ARDS has been demonstrated before in case series, but not in clinical trials where the patient population is specifically selected against standard ARDS diagnostic criteria and the investigators were encouraged to use low tidal volumes. This study may indicate a need to improve implementation and compliance with protective lung ventilation.</span>

http://ift.tt/2qSELTD

In this issue



http://ift.tt/2qhzzLX

Αναζήτηση αυτού του ιστολογίου