Motor behavior-induced prefrontal cortex activation and episodic memory function.

BACKGROUND: The objective of this paper was to evaluate the potential individual and combined effects of acute exercise coupled with bilateral interhemispheric activation on episodic memory function. Six experiments were conducted. METHODS: Experiment 1 was a within-subject, counterbalanced experiment. Participants completed four visits, including 1) exercise and saccadic eye movements, 2) exercise only, 3) saccadic eye movements only, and 4) no exercise and no saccadic eye movements (control). A word-list memory assessment was employed, including a long-term (20-min delay) memory evaluation. In Experiment 2, we evaluated the effects of saccadic eye movements on prefrontal cortex oxygenation, a proxy for neuronal activity. Similarly, in our third experiment, we evaluated the effects of acute exercise on prefrontal cortex oxygenation. Thus, experiments 2 and 3 were employed to provide mechanistic insights from the results shown in experiment 1. Experiment 4 replicated Experiment 1, but instead of increasing prefrontal cortex activation via saccadic eye movements, we used a fist clenching protocol. Experiment 5 evaluated the effects of fist clenching on prefrontal cortex oxygenation. RESULTS: Collectively, these 5 experimental studies showed that acute exercise (Experiment 1), saccadic eye movements (Experiment 1), and fist clenching (Experiment 4) enhanced memory function, and that acute exercise (Experiment 3), saccadic eye movements (Experiment 2) and fist clenching (Experiment 5) all increased prefrontal cortex oxygenation. Experiment 6 demonstrated that prefrontal cortex oxygenation was positively associated with episodic memory function. CONCLUSION: These six experiments suggest that several behaviors, such as acute exercise, saccadic eye movements and fist clenching may improve memory function and may, potentially, do so via increases in prefrontal cortex oxygenation.

Clinical and molecular characterization of patients with hereditary hemorrhagic telangiectasia: Experience from an HHT Center of Excellence.

In this retrospective single-center study, we evaluated whether/how pathogenic/likely pathogenic variants of three hereditary hemorrhagic telangiectasia (HHT)-associated genes (ENG, ACVRL1, and SMAD4) are associated with specific clinical presentations of HHT. We also characterized the morphological features of pulmonary arteriovenous malformations (AVMs) in patients with these variants. Pathogenic or likely pathogenic variants were detected in 64 patients. Using nonparametric statistical tests, we compared the type and prevalence of specific HHT diagnostic features associated with these three variants. Pathogenic variants in these genes resulted in gene-specific HHT clinical presentations. Epistaxis was present in 93%, 94%, and 100% of patients with ENG, ACVRL1, and SMAD4 variants, respectively (p = 0.79). Pulmonary AVMs were more common in patients with the ENG variant (p = 0.034) compared with other subgroups. ACVRL1 variant was associated with the lowest frequency of pulmonary AVMs (p = 0.034) but the highest frequency of hepatic AVMs (p = 0.015). Patients with the ACVRL1 variant did not have significantly more pancreatic AVMs compared with the other groups (p = 0.72). ENG, ACVRL1, and SMAD4 pathogenic or likely pathogenic variants are associated with gene-specific HHT presentations, which is consistent with results from other HHT centers.

Characterization of pulmonary arteriovenous malformations in ACVRL1 versus ENG mutation carriers in hereditary hemorrhagic telangiectasia.

PurposePulmonary arteriovenous malformations (pAVMs) are major contributors to morbidity and mortality in hereditary hemorrhagic telangiectasia (HHT). Mutations in ENG and ACVRL1 underlie the vast majority of clinically diagnosed cases. The aims of this study were to characterize and compare the clinical and morphologic features of pAVMs between these two genotype groups.MethodsSixty-six patients with HHT and affected family members were included. Genotype, phenotypic data, and imaging were obtained from medical records. Morphologic features of pAVMs were analyzed using computed tomography angiography. HHT symptoms, pAVM imaging characteristics, frequency of procedural intervention, and HHT severity scores were compared between ENG and ACVRL1 genotype groups.ResultsENG mutation carriers were more likely than ACVRL1 mutation carriers to have pAVMs (P < 0.001) or multiple lesions (P = 0.03), and to undergo procedural intervention (P = 0.02). Additionally, pAVMs in ENG carriers were more likely to exhibit bilateral lung involvement and growth over time, although this did not reach statistical significance. The HHT severity score was significantly higher in ENG than in ACVRL1 (P = 0.02).ConclusionThe propensity and multiplicity of ENG-associated pAVMs may contribute to the higher disease severity in this genotype, as reflected by the HHT severity score and the frequency of interventional procedures.

Adverse effects of bisphenol A (BPA) on the dopamine system in two distinct cell models and corpus striatum of the Sprague-Dawley rat.

The aim of this study was to examine the effects of bisphenol A (BPA) on the brain dopamine (DA) system utilizing both in vitro models (GH3 cells, a rat pituitary cell line, and SH-SY5Y cells, a human neuroblastoma cell line) and an animal model such as Sprague-Dawley (SD) rats. First, cellular DA uptake was measured 2 or 8 h following BPA exposure (0.1-400 µM) in SH-SY5Y cells, where a significant increase in DA uptake was noted. BPA exerted no marked effect on dopamine active transporter levels in GH3 cells exposed for 8 or 24 h. However, SH-SY5Y cells displayed an increase in dopamine transporter (DAT) levels following 24 h of exposure to BPA. In contrast to DAT levels, BPA exposure produced no marked effect on DA D1 receptor levels in SH-SY5Y cells, yet a significant decrease in GH3 cells following both 8- and 24-h exposure periods was noted, suggesting that BPA exerts differential effects dependent upon cell type. BPA produced no significant effects on prolactin levels at 2 h, but a marked fall occurred at 24 h of exposure in GH3 cells. Finally, to examine the influence of dietary developmental exposure to BPA on brain DA levels in F1 offspring, SD rats were exposed to BPA (0.5-20 mg/kg) through maternal transfer and/or diet and striatal DA levels were measured on postnatal day (PND) 60 using high-performance liquid chromatography (HPLC). Data demonstrated that chronic exposure to BPA did not significantly alter striatal DA levels in the SD rat.

Comparison of sunscreen availability in Chicago Hispanic and non-Hispanic neighborhoods.

BACKGROUND: Poorer survival rates from melanoma among Hispanics have been previously reported. There is little information regarding sunscreen acquisition behaviors or availability/access to products that may help reduce the risk of skin cancer in Hispanic communities. This study sought to understand perceptions regarding sun protection and skin cancer risk and whether the availability of over-the-counter sunscreen products differed in three Chicago neighborhoods with different ethnic compositions. METHODS: We drew on interviews with 65 adult Spanish speaking Hispanics (23-72 years) recruited from faith-based institutions to better understand sunscreen use perceptions. Commercial establishments open to the general public were physically canvassed to determine whether there were any differences in sunscreen products availability. RESULTS: Stores carrying sun protection products are nearly twice as common in non Hispanic White neighborhoods versus Hispanic. In addition, when sunscreens are available for sale, Hispanics have fewer sunscreens to choose from. DISCUSSION: Emergent themes that were elicited during the interviews revealed that barriers to increased sunscreen use include economic and erroneous perceptions regarding skin cancer incidence and risk. Environmental factors that may reinforce these beliefs include lower availability and variety of sun protection products in Hispanic neighborhoods. CONCLUSION: These findings indicate that providing culturally appropriate public health information encouraging the use of sunscreen and improving its availability in Hispanic communities are potential points of intervention in attempts to improve morbidity from skin cancer.

A lack of race and ethnicity data in the treatment of hereditary hemorrhagic telangiectasia: a systematic review of intravenous bevacizumab efficacy.

BACKGROUND: For extreme hereditary hemorrhagic telangiectasia (HHT) disease, treatments such as intravenous bevacizumab are often utilized. However, whether its efficacy is similar across diverse races and ethnicities is unclear. METHODS: In this systematic review, we performed a search for English-language articles identified through PubMed, Embase, and Scopus databases whose research occurred in the United States (US). Search terms related to HHT, epistaxis, and intravenous bevacizumab. We searched specifically for the intervention of intravenous bevacizumab because the term serves as a suitable surrogate to convey a patient who has both a diagnosis of HHT and established care. We focused on number of patients recruited in intravenous bevacizumab trials who were identified by race or ethnicity. RESULTS: Our search identified 79 studies, of which four were conducted in the US. These four were selected for our systematic review. In these studies, 58 total patients were evaluated (ranging from 5 to 34 participants), whereby, information on age and gender were included. However, none of the US-based studies shared race or ethnicity data. CONCLUSION: Inability to find studies regarding intravenous bevacizumab use in patients with HHT in which race and ethnicity are reported limits our ability to understand the therapy's efficacy in specific populations. Without emphasis on race and ethnicity in such trials, showing the potential of HHT-related diversity in individuals with this disease may reaffirm implicit bias around HHT diagnosis and treatment. Future work on HHT should emphasize sociodemographic data collection and reporting in an effort to understand this disease in diverse populations.

Evaluation of a cognitive affective model of physical activity behavior.

Background: To empirically evaluate a cognitive affective model of physical activity. This bidirectional, cyclical model hypotheses that executive control processes directly influence habitual engagement in exercise and also directly subserve the exercise-induced affective response to acute exercise associated with future physical activity. Methods: The present study employed a one-week prospective, multi-site design. Participant recruitment and data collection occurred at two separate University sites (one in the United States and the other in Canada). Participants completed a bout of treadmill exercise, with affect and arousal assessed before, during and after the bout of exercise. Subjective and objective measures of executive function were assessed during this visit. Following this laboratory visit, seven days of accelerometry were employed to measure habitual engagement in physical activity. Results: Within our inactive, young adult sample, we observed some evidence of 1) aspects of executive function were associated with more light-intensity physical activity in the future (1-week later) (r = 0.36, 95% CI = -0.03 to 0.66, P = 0.07), 2) aspects of executive function were associated with post-exercise affect (r = -0.39, 95% CI = -0.67 to -0.03, P = 0.03) and forecasted affect (r =0.47, 95% CI = 0.11 to 0.72, P = 0.01), and 3) aspects of acute exercise arousal and affect were associated with current mild-intensity physical activity behavior (r = 0.41, 95% CI = 0.04 to 0.68, P = 0.03). Conclusion : We demonstrate partial support of a cognitive-affective model of physical activity.

Experimental Investigation Examining the Effects of Acute Exercise on Implicit Memory Function.

Emerging work suggests that acute exercise can enhance explicit memory function. Minimal research, however, has examined whether acute exercise is associated with implicit memory, which was the purpose of this study. Three separate experimental studies were computed (N = 120; Mean age = 21). In Experiment 1, participants were randomly assigned to either a moderate-intensity bout of acute exercise (15-minute) or engaged in a seated control task (15-minute), followed by the completion of a word-fragmentation implicit memory task. Experiment 2 replicated Experiment 1, but instead employed a higher-intensity exercise protocol. For Experiment 3, participants were randomly assigned to either a moderate-intensity bout of acute exercise (15-minute) or engaged in a seated control task (15-minute), followed by the completion of a real world, 3-dimensional implicit memory task. For Experiment 1, the exercise and control groups, respectively, had an implicit memory score of 7.0 (0.5) and 7.5 (0.6) (t(38) = 0.67, p = .51). For Experiment 2, the exercise and control groups, respectively, had an implicit memory score of 6.9 (1.9) and 7.8 (2.4) (t(38) = 1.27, p = .21). These findings suggest that exercise, and the intensity of exercise, does not alter implicit memory from a word fragmentation task. For Experiment 3, the exercise and control groups, respectively, had a discrimination implicit memory index score of 0.48 (0.18) and 0.29 (0.32) (t(38) = 2.16, p = .03). In conclusion, acute exercise does not influence a commonly used laboratory-based assessment of implicit memory but may enhance real world-related implicit memory function.

Supporting the carers of people with dementia.

Dementia is a progressive neurological syndrome. Because of its complexity and longevity, dementia can have a negative effect on the health of informal carers, including spouses, family members and friends. Carers of people with dementia are at increased risk of depression and some long-term conditions; however, there are interventions that nurses can implement to support them. This article reviews the effect that caring has on carers of people with dementia, while exploring how nurses can provide optimal support through care planning, signposting to external services and understanding the importance of the role of carers.

The minimal important difference of the epistaxis severity score in hereditary hemorrhagic telangiectasia.

OBJECTIVES/HYPOTHESIS: Hereditary hemorrhagic telangiectasia (HHT) is a disease of abnormal angiogenesis, causing epistaxis in over 96% of patients. The Epistaxis Severity Score (ESS) was developed as a standardized measurement of nasal symptoms among HHT patients. The minimal important difference (MID) of a disease index estimates the smallest change that a patient and clinician would identify as important. This study aims to establish the MID of the ESS in a diverse population of HHT patients. STUDY DESIGN: Retrospective cross-sectional study in patients with a diagnosis of HHT using Curacao criteria or genetic testing. METHODS: The ESS questionnaire and Medical Outcomes Study 36-Item Short Form (SF-36) were administered to participants recruited through the HHT Foundation Web site. Demographics and relevant medical histories were collected from all participants. An anchor-based method using a change of 5 in the Physical Component Summary (PCS) of the SF-36 and a distributional method were used to estimate the MID. RESULTS: A total of 604 subjects were recruited between April and August 2008. All participants reported epistaxis. An increasing ESS in the study cohort showed a significant negative correlation to the PCS (r = -0.43, P < 0.001). The MID was determined to be 0.41 via the anchor-based approach and 1.01 via the distribution-based approach, giving a mean MID of 0.71. CONCLUSION: Using both the anchor-based and distribution-based approaches, the estimated MID for the ESS in HHT is 0.71. Further implications include key metrics to help guide treatment responses in clinical care and essential information to calculate power and sample size for future clinical trials. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1029-1032, 2016.

Using a clinical decision-making support tool to enhance practice.

As nursing practice expands nurses need easy access to reliable cohesive guidance. PRODIGY is a support tool for clinical decision-making which is approved by the Department of Health. It is a learning resource that provides information on about 170 illnesses and covers condition management, prescribing options and patient information leaflets. This article uses a fictional case study to illustrate how nurses can make use of PRODIGY guidance to provide holistic, patient-centred care.