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1.
Clin Infect Dis ; 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32604415

RESUMO

The surge of coronavirus disease 2019 (COVID-19) hospitalizations at our 877-bed quaternary care hospital in Detroit led to an emergent demand for Infectious Diseases (ID) consultations. The traditional one-on-one consultation model was untenable. Therefore, we rapidly restructured our ID division to provide effective consultative services. We implemented a novel unit-based group rounds model that focused on delivering key updates to teams and providing unit-wide consultations simultaneously to all team members. Effectiveness of the program was studied using Likert-scale survey data. The survey captured data from the first month of the Detroit COVID-19 pandemic. During this period there were approximately 950 patients hospitalized for treatment of COVID-19. The survey of trainees and faculty reported an overall 95% positive response to delivery of information, new knowledge acquisition, and provider confidence in the care of COVID-19 patients. This showed that the unit-based consult model is a sustainable effort to provide care during epidemics.

2.
Physiol Rep ; 8(11): e14453, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32519460

RESUMO

Daily rhythms in several physiological processes are important for cardiometabolic health. The lipid panel is used clinically to assess cardiovascular disease risk, but previous attempts to demonstrate circadian variation in lipids have failed to uncouple the endogenous circadian rhythm from the effects of meals and wake duration. Changes in basal lipid levels and dampening of circadian rhythms have been reported with aging, but it is unknown whether aging is also associated with changes in the rhythmic variation of lipids. We measured fasting lipid panels (triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein) in blood at wake time in 21 healthy adults using a specialized laboratory protocol that uncouples sleep-wake and activity-related effects from the endogenous circadian rhythm. Young and older adults exhibited endogenous circadian variations in fasting triglycerides, with both groups peaking in the early biological morning. Young adults also exhibited significant circadian rhythmicity in total cholesterol and low-density lipoprotein, while older adults did not exhibit circadian rhythmicity in any other lipids. These results reveal that triglyceride metabolism may be regulated by the central circadian pacemaker. Moreover, our findings may have clinical implications in assessing cardiovascular risk in shift workers and younger adults, since routine measurement of morning/fasting lipids may not fully and reliably assess triglyceride- and other lipid-related biomarkers of cardiovascular disease risk in these groups.

3.
Ophthalmic Genet ; : 1-7, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32543920

RESUMO

INTRODUCTION: Diagnostic next generation sequencing (NGS) services for patients with inherited retinal diseases (IRD) traditionally use gene panel based approaches, which have cost and resource implications. Phenotype-based gene panels use a targeted strategy with further testing protocols, if initial results are negative. We present the molecular findings of the Oxford phenotype-based NGS panels for genetic testing in IRD. METHODS: Results of 655 consecutive patients referred for phenotype-based panel testing over 54 months were analysed to assess diagnostic yield. RESULTS: Variants were identified in 450 patients (68.7%). The overall diagnostic yield from phenotype-based panels was 42.8%. The diagnostic yield was highest from panels representing distinct clinical phenotypes: Usher panel 90.9% and congenital stationary night blindness panel 75.0%. Retinitis pigmentosa/rod-cone dystrophy was the commonest presenting phenotype (n = 243) and Usher syndrome was the commonest presenting syndromic disease (n = 39). Patients presenting with late-onset (≥50 years) macular disease had a lower diagnostic yield (18.0%) compared with patients <50 years (24.2%). Additionally, a diagnostic yield of 1.8% was attributable to copy number variants. CONCLUSIONS: Phenotype-based genetic testing panels provide a targeted testing approach and reduce bioinformatics demand. The overall diagnostic yield achieved in this study reflects the wide range of phenotypes that were referred. This pragmatic approach provides a high yield for early-onset and clearly defined genetically determined disorders but clinical utility is not as clear for late-onset macular disorders. This phenotype-based panel approach is clinician-referrer orientated, and can be used as a front-end virtual panel, when whole genome sequencing is introduced into diagnostic services for IRD.

4.
Nucleic Acids Res ; 48(11): 5907-5925, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32383760

RESUMO

Mammalian antibody switch regions (∼1500 bp) are composed of a series of closely neighboring G4-capable sequences. Whereas numerous structural and genome-wide analyses of roles for minimal G4s in transcriptional regulation have been reported, Long G4-capable regions (LG4s)-like those at antibody switch regions-remain virtually unexplored. Using a novel computational approach we have identified 301 LG4s in the human genome and find LG4s prone to mutation and significantly associated with chromosomal rearrangements in malignancy. Strikingly, 217 LG4s overlap annotated enhancers, and we find the promoters regulated by these enhancers markedly enriched in G4-capable sequences suggesting G4s facilitate promoter-enhancer interactions. Finally, and much to our surprise, we also find single-stranded loops of minimal G4s within individual LG4 loci are frequently highly complementary to one another with 178 LG4 loci averaging >35 internal loop:loop complements of >8 bp. As such, we hypothesized (then experimentally confirmed) that G4 loops within individual LG4 loci directly basepair with one another (similar to characterized stem-loop kissing interactions) forming a hitherto undescribed, higher-order, G4-based secondary structure we term a 'G4 Kiss or G4K'. In conclusion, LG4s adopt novel, higher-order, composite G4 structures directly contributing to the inherent instability, regulatory capacity, and maintenance of these conspicuous genomic regions.

5.
Glob Chang Biol ; 2020 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-32445424

RESUMO

Biogenic volatile organic compounds (BVOCs) play important roles at cellular, foliar, ecosystem and atmospheric levels. The Amazonian rainforest represents one of the major global sources of BVOCs, so its study is essential for understanding BVOC dynamics. It also provides insights into the role of such large and biodiverse forest ecosystem in regional and global atmospheric chemistry and climate. We review the current information on Amazonian BVOCs and identify future research priorities exploring biogenic emissions and drivers, ecological interactions, atmospheric impacts, depositional processes and modifications to BVOC dynamics due to changes in climate and land cover. A feedback loop between Amazonian BVOCs and the trends of climate and land-use changes in Amazonia is then constructed. Satellite observations and model simulation time series demonstrate the validity of the proposed loop showing a combined effect of climate change and deforestation on BVOC emission in Amazonia. A decreasing trend of isoprene during the wet season, most likely due to forest biomass loss, and an increasing trend of the sesquiterpene to isoprene ratio during the dry season suggest increasing temperature stress-induced emissions due to climate change.

6.
Indoor Air ; 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32424858

RESUMO

With the gradual reduction of emissions from building products, emissions from human occupants become more dominant indoors. The impact of human emissions on indoor air quality is inadequately understood. The aim of the Indoor Chemical Human Emissions and Reactivity (ICHEAR) project was to examine the impact on indoor air chemistry of whole-body, exhaled, and dermally emitted human bioeffluents under different conditions comprising human factors (t-shirts/shorts vs long-sleeve shirts/pants; age: teenagers, young adults, and seniors) and a variety of environmental factors (moderate vs high air temperature; low vs high relative humidity; presence vs absence of ozone). A series of human subject experiments were performed in a well-controlled stainless steel climate chamber. State-of-the-art measurement technologies were used to quantify the volatile organic compounds emitted by humans and their total OH reactivity; ammonia, nanoparticle, fluorescent biological aerosol particle (FBAP), and microbial emissions; and skin surface chemistry. This paper presents the design of the project, its methodologies, and preliminary results, comparing identical measurements performed with five groups, each composed of 4 volunteers (2 males and 2 females). The volunteers wore identical laundered new clothes and were asked to use the same set of fragrance-free personal care products. They occupied the ozone-free (<2 ppb) chamber for 3 hours (morning) and then left for a 10-min lunch break. Ozone (target concentration in occupied chamber ~35 ppb) was introduced 10 minutes after the volunteers returned to the chamber, and the measurements continued for another 2.5 hours. Under a given ozone condition, relatively small differences were observed in the steady-state concentrations of geranyl acetone, 6MHO, and 4OPA between the five groups. Larger variability was observed for acetone and isoprene. The absence or presence of ozone significantly influenced the steady-state concentrations of acetone, geranyl acetone, 6MHO, and 4OPA. Results of replicate experiments demonstrate the robustness of the experiments. Higher repeatability was achieved for dermally emitted compounds and their reaction products than for constituents of exhaled breath.

7.
Artigo em Inglês | MEDLINE | ID: mdl-32342100

RESUMO

OBJECTIVE: To evaluate the validity and reliability of inertial measurement unit (IMU) sensors in the assessment of spinal mobility in axial spondyloarthritis (axSpA). METHODS: A repeated measures study design involving 40 participants with axSpA was used. Pairs of IMU sensors were used to measure the maximum range of movement at the cervical (Cx) and lumbar (Lu) spine. A composite IMU score was defined by combining the IMU measures. Conventional metrology and physical function assessment were performed. Validation was assessed considering the agreement of IMU measures with conventional metrology and correlation with physical function. Reliability was assessed using intra-class correlation coefficients (ICCs). RESULTS: The composite IMU score correlated closely (r = 0.88) with the BASMI. Conventional Cx rotation and lateral flexion tests correlated closely with IMU equivalents (r = 0.85, 0.84). All IMU movement tests correlated strongly with BASFI, while this was true for only some of the BASMI tests. The reliability of both conventional and IMU tests (except for chest expansion) ranged from good to excellent. Test-retest ICCs for individual conventional tests varied between 0.57 and 0.91, in comparison to a range from 0.74 to 0.98 for each of the IMU tests. Each of the composite regional IMU scores had excellent test-retest reliability (ICCs=0.94-0.97), comparable to the reliability of the BASMI (ICC=0.96). CONCLUSION: Cx and Lu spinal mobility measured using wearable IMU sensors is a valid and reliable assessment in multiple planes (including rotation), in patients with a wide range of axSpA severity.

8.
Proc Natl Acad Sci U S A ; 117(18): 9973-9980, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32303657

RESUMO

When transitioning from the environment, pathogenic microorganisms must adapt rapidly to survive in hostile host conditions. This is especially true for environmental fungi that cause opportunistic infections in immunocompromised patients since these microbes are not well adapted human pathogens. Cryptococcus species are yeastlike fungi that cause lethal infections, especially in HIV-infected patients. Using Cryptococcus deneoformans in a murine model of infection, we examined contributors to drug resistance and demonstrated that transposon mutagenesis drives the development of 5-fluoroorotic acid (5FOA) resistance. Inactivation of target genes URA3 or URA5 primarily reflected the insertion of two transposable elements (TEs): the T1 DNA transposon and the TCN12 retrotransposon. Consistent with in vivo results, increased rates of mutagenesis and resistance to 5FOA and the antifungal drugs rapamycin/FK506 (rap/FK506) and 5-fluorocytosine (5FC) were found when Cryptococcus was incubated at 37° compared to 30° in vitro, a condition that mimics the temperature shift that occurs during the environment-to-host transition. Inactivation of the RNA interference (RNAi) pathway, which suppresses TE movement in many organisms, was not sufficient to elevate TE movement at 30° to the level observed at 37°. We propose that temperature-dependent TE mobilization in Cryptococcus is an important mechanism that enhances microbial adaptation and promotes pathogenesis and drug resistance in the human host.

9.
Philos Trans R Soc Lond B Biol Sci ; 375(1800): 20190274, 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32306881

RESUMO

In this study, the odour thresholds (OT) and atmospheric lifetimes (AL) were compared for a suite of volatile organic compounds. It was found that odour threshold, as determined by the triangle bag method, correlated surprisingly well with atmospheric lifetime for a given chemical family. Molecules with short atmospheric lifetimes with respect to the primary atmospheric oxidant OH tend to be more sensitively detected by the human nose. Overall the correlation of odour threshold with atmospheric lifetime was better than with mass and vapour pressure. Several outliers from the correlations for particular chemical families were examined in detail. For example, diacetyl was an outlier in the ketone dataset that fitted the trend when its more important photolysis lifetime was included; and similarly, the relatively low odour threshold of carbonyl sulfide (OCS) was interpreted in terms of uptake by vegetation. The OT/AL relationship suggests that OH rate constants can be used as a first-order estimate for odour thresholds (and vice versa). We speculate that the nose's high sensitivity to chemicals that are reactive in the air is likely an evolved rather than a learned condition. This is based on the lack of dependence on ozone in the aliphatics, that the anthropogenically emitted aromatic compounds had the worst correlation, and that OCS had a much lower than predicted OT. Finally, we use the OT/AL relationships derived to predict odour thresholds and rate constants that have not yet been determined in order to provide a test to this hypothesis. This article is part of the Theo Murphy meeting issue 'Olfactory communication in humans'.

10.
Environ Sci Technol ; 54(9): 5419-5428, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32233434

RESUMO

Ammonia (NH3) is typically present at higher concentrations in indoor air (∼10-70 ppb) than in outdoor air (∼50 ppt to 5 ppb). It is the dominant neutralizer of acidic species in indoor environments, strongly influencing the partitioning of gaseous acidic and basic species to aerosols, surface films, and bulk water. We have measured NH3 emissions from humans in an environmentally controlled chamber. A series of experiments, each with four volunteers, quantified NH3 emissions as a function of temperature (25.1-32.6 °C), clothing (long-sleeved shirts/pants or T-shirts/shorts), age (teenagers, adults, and seniors), relative humidity (low or high), and ozone (<2 ppb or ∼35 ppb). Higher temperature and more skin exposure (T-shirts/shorts) significantly increased emission rates. For adults and seniors (long clothing), NH3 emissions are estimated to be 0.4 mg h-1 person-1 at 25 °C, 0.8 mg h-1 person-1 at 27 °C, and 1.4 mg h-1 person-1 at 29 °C, based on the temperature relationship observed in this study. Human NH3 emissions are sufficient to neutralize the acidifying impacts of human CO2 emissions. Results from this study can be used to more accurately model indoor and inner-city outdoor NH3 concentrations and associated chemistry.

11.
Hypertension ; 75(4): 1045-1053, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32160100

RESUMO

LSD1 (lysine-specific demethylase-1) is an epigenetic regulator of gene transcription. LSD1 risk allele in humans and LSD1 deficiency (LSD1+/-) in mice confer increasing salt-sensitivity of blood pressure with age, which evolves into salt-sensitive hypertension in older individuals. However, the mechanism underlying the relationship between LSD1 and salt-sensitivity of blood pressure remains elusive. Here, we show that LSD1 genotype (in humans) and LSD1 deficiency (in mice) lead to similar associations with increased blood pressure and urine potassium levels but with decreased aldosterone levels during a liberal salt diet. Thus, we hypothesized that LSD1 deficiency leads to an MR (mineralocorticoid receptor)-dependent hypertensive state. Yet, further studies in LSD1+/- mice treated with the MR antagonist eplerenone demonstrate that hypertension, kaliuria, and albuminuria are substantially improved, suggesting that the ligand-independent activation of the MR is the underlying cause of this LSD1 deficiency-mediated phenotype. Indeed, while MR and epithelial sodium channel expression levels were increased in LSD1+/- mouse kidney tissues, aldosterone secretion from LSD1+/- glomerulosa cells was significantly lower. Collectively, these data establish that LSD1 deficiency leads to an inappropriate activation and increased levels of the MR during a liberal salt regimen and suggest that inhibiting the MR pathway is a useful strategy for treatment of hypertension in human LSD1 risk allele carriers.

12.
Sci Adv ; 6(10): eaay4109, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32181345

RESUMO

The contamination of indoor nonsmoking environments with thirdhand smoke (THS) is an important, poorly understood public health concern. Real-time THS off-gassing from smokers into a nonsmoking movie theater was observed with online and offline high-resolution mass spectrometry. Prominent emission events of THS tracers (e.g., 2,5-dimethylfuran, 2-methylfuran, and acetonitrile) and other tobacco-related volatile organic compounds (VOCs) coincided with the arrival of certain moviegoers and left residual contamination. These VOC emission events exposed occupants to the equivalent of 1 to 10 cigarettes of secondhand smoke, including multiple hazardous air pollutants (e.g., benzene and formaldehyde) at parts-per-billion concentrations. Nicotine and related intermediate-volatility nitrogen-containing compounds, which vaporized from clothes/bodies and recondensed onto aerosol, comprised 34% of observed functionalized organic aerosol abundance. Exposure to THS VOC emission events will be considerably enhanced in poorly ventilated or smaller spaces in contrast with a large, well-ventilated theater-amplifying concentrations and potential impacts on health and indoor chemistry.

13.
J Geriatr Phys Ther ; 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32175993

RESUMO

BACKGROUND AND PURPOSE: The instrumented Timed Up and Go test (iTUG) affords quantification of the subelements of the Timed Up and Go test to assess fall risk and physical performance. A miniature sensor applied to the back is able to capture accelerations and velocities from which the subelements of the iTUG can be quantified. This study is the first to compare iTUG performance between people with dementia (PWD) and their age-matched caregivers. The aims of this study were to explore how age moderates the differences in performance on the iTUG between PWD and their informal caregivers. METHODS: Eight-three community-dwelling older PWD and their informal caregivers were recruited for this cross-sectional, observational study. Participants were grouped by age: younger than 70 years, 70 to 79 years, and 80 years and older. Participants wore an inertial sensor while performing the iTUG in their home. The performance of the subelements sit-to-stand, walking, and turning were captured through an algorithm converting accelerations and velocities into performance metrics such as duration and peak velocity. Performance for PWD was compared with caregivers for each age-matched group, and multiple regression models incorporating age, gender, and presence or absence of dementia were computed. RESULTS: People with dementia took longer to turn in the younger than 70-year group, suggesting this may be an early indicator of functional decline in this age group. People with dementia took longer to complete the whole iTUG compared with caregivers in the 70- to 79-year-old group. In the 80+-year-old group, PWD took longer to complete both walking phases, sit-to-stand, and the full iTUG along with displaying slower turning velocity. Multiple regression models illustrated that gender failed to contribute significantly to the model, but age and presence of dementia explained around 30% of the variance of time to complete walking phases, total iTUG, and turning velocity. CONCLUSIONS: Differences were evident in performance of the iTUG between PWD and caregivers even after controlling for age. Age moderates the differences observed in performance.

14.
Sci Rep ; 10(1): 4767, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32179809

RESUMO

Reduced pancreas volume, as measured by non-contrast magnetic resonance imaging (MRI), is observed in individuals with newly-diagnosed type 1 diabetes (T1D) and declines over the first year after diagnosis. In this study, we determined the repeatability and inter-reader reproducibility of pancreas volume measurements by MRI. Test-retest scans in individuals with or without T1D (n = 16) had an intraclass correlation coefficient (ICC) of 0.985 (95% CI 0.961 to 0.995) for pancreas volume. Independent pancreas outlines by two board-certified radiologists (n = 30) yielded an ICC of 0.945 (95% CI 0.889 to 0.973). The mean Dice coefficient, a measurement of the degree of overlap between pancreas regions of interest between the two readers, was 0.77. Prandial state did not influence pancreatic measurements, as stomach volume did not correlate with pancreas volume. These data demonstrate that MRI measurements of pancreas volume between two readers are repeatable and reproducible with ICCs that correspond to excellent clinical significance (ICC > 0.9), are not related to changes in stomach volume, and could be a useful tool for clinical investigation of diabetes and other pancreas pathologies.

15.
Hypertension ; 75(4): 1002-1011, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32148128

RESUMO

We have previously reported that in salt-resistant rat phenotypes brain, Gαi2 (guanine nucleotide-binding protein alpha inhibiting activity polypeptide 2) proteins are required to maintain blood pressure and sodium balance. However, the impact of hypothalamic paraventricular nucleus (PVN) Gαi2 proteins on the salt sensitivity of blood pressure is unknown. Here, by the bilateral PVN administration of a targeted Gαi2 oligodeoxynucleotide, we show that PVN-specific Gαi2 proteins are required to facilitate the full natriuretic response to an acute volume expansion (peak natriuresis [µeq/min] scrambled (SCR) oligodeoxynucleotide 41±3 versus Gαi2 oligodeoxynucleotide 18±4; P<0.05) via a renal nerve-dependent mechanism. Furthermore, in response to chronically elevated dietary sodium intake, PVN-specific Gαi2 proteins are essential to counter renal nerve-dependent salt-sensitive hypertension (mean arterial pressure [mm Hg] 8% NaCl; SCR oligodeoxynucleotide 128±2 versus Gαi2 oligodeoxynucleotide 147±3; P<0.05). This protective pathway involves activation of PVN Gαi2 signaling pathways, which mediate sympathoinhibition to the blood vessels and kidneys (renal norepinephrine [pg/mg] 8% NaCl; SCR oligodeoxynucleotide 375±39 versus Gαi2 oligodeoxynucleotide 850±27; P<0.05) and suppression of the activity of the sodium chloride cotransporter assessed as peak natriuresis to hydrochlorothiazide. Additionally, central oligodeoxynucleotide-mediated Gαi2 protein downregulation prevented PVN parvocellular neuron activation, assessed by FosB immunohistochemistry, in response to increased dietary salt intake. In our analysis of the UK BioBank data set, it was observed that 2 GNAI2 single nucleotide polymorphism (SNP) (rs2298952, P=0.041; rs4547694, P=0.017) significantly correlate with essential hypertension. Collectively, our data suggest that selective targeting and activation of PVN Gαi2 proteins is a novel therapeutic approach for the treatment of salt-sensitive hypertension.

16.
J Clin Endocrinol Metab ; 105(6)2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32163150

RESUMO

CONTEXT: Complex relationships between aldosterone and calcium homeostasis have been proposed. OBJECTIVE: To disentangle the influence of aldosterone and intravascular volume on calcium physiology. DESIGN: Patient-oriented and epidemiology studies. SETTING: Clinical research center and nationwide cohorts. PARTICIPANTS/INTERVENTIONS: Patient-oriented study (n = 18): Participants were evaluated after completing a sodium-restricted (RES) diet to contract intravascular volume and after a liberalized-sodium (LIB) diet to expand intravascular volume. Cross-sectional studies (n = 3755): the association between 24h urinary sodium and calcium excretion and risk for kidney stones was assessed. RESULTS: Patient-oriented study: compared to a RES-diet, a LIB-diet suppressed renin activity (LIB: 0.3 [0.1, 0.4] vs. RES: 3.1 [1.7, 5.3] ng/mL/h; P < 0.001) and plasma aldosterone (LIB: 2.0 [2.0, 2.7] vs. RES: 20.0 [16.1, 31.0] vs. ng/dL; P < 0.001), but increased calciuria (LIB: 238.4 ±â€…112.3 vs. RES: 112.9 ±â€…60.8 mg/24hr; P < 0.0001) and decreased serum calcium (LIB: 8.9 ±â€…0.3 vs. RES: 9.8 ±â€…0.4 mg/dL; P < 0.0001). Epidemiology study: mean urinary calcium excretion was higher with greater urinary sodium excretion. Compared to a urinary sodium excretion of < 120 mEq/day, a urinary sodium excretion of ≥220 mEq/day was associated with a higher risk for having kidney stones in women (risk ratio = 1.79 [95% confidence interval 1.05, 3.04]) and men (risk ratio = 2.06 [95% confidence interval 1.27, 3.32]). CONCLUSIONS: High dietary sodium intake suppresses aldosterone, decreases serum calcium, and increases calciuria and the risk for developing kidney stones. Our findings help disentangle the influences of volume from aldosterone on calcium homeostasis and provide support for the recommendation to restrict dietary sodium for kidney stone prevention.

17.
J Ren Nutr ; 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-32001127

RESUMO

OBJECTIVE: Constipation is common in patients with end-stage kidney disease. Nondrug strategies to manage constipation are challenging because of dietary potassium, phosphate, and fluid restrictions. Nuts are a high-fiber food but are excluded from the diet because of the high potassium and phosphate content. The aim of this study was to examine the safety and efficacy of using nuts to improve constipation in adults undertaking hemodialysis (HD). DESIGN AND METHODS: Adult patients undertaking HD were recruited to this nonrandomized, 10-week repeated measures, within-subject, pragmatic clinical trial, conducted in two HD units. The intervention consisted of consumption of 40g of raw almonds daily for four weeks, followed by a two-week washout and four-week control period. The primary safety outcome measures were change in predialysis serum potassium and phosphate levels. The primary efficacy outcome was reduction in constipation, measured using the Bristol Stool Form Scale and Palliative Care Outcome Scale (POS-S) renal symptom score. Secondary outcomes included quality of life, selected uremic toxins, cognition, gut microbiota profile, and symptom burden. RESULTS: Twenty patients completed the trial (median age: 67 [interquartile range: 57.5-77.8] years, 51% male). After controlling for dialysis adequacy, anuria, dietary intake, bicarbonate, and parathyroid hormone, there were no statistically significant changes in serum potassium (P = 0.21) or phosphate (P = 0.16) associated with daily consumption of almonds. However, statistically significant improvements in constipation were seen at weeks 2, 3, 4, and 10. There were statistically significant improvements in quality of life (P = 0.030), overall symptom burden (P = 0.002), vomiting (P = 0.020), itching (P = 0.006), and skin changes (P = 0.002). CONCLUSION: Daily consumption of almonds for four weeks was safe, effective, and well tolerated. Improvements in quality of life and symptom burden warrant further research to elucidate potential mechanisms. The findings support the potential reinclusion of foods such as nuts into the diet of patients who underwent HD.

18.
Anal Chem ; 92(5): 3674-3681, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-31999103

RESUMO

Electron-based fragmentation methods have revolutionized biomolecular mass spectrometry, in particular native and top-down protein analysis. Here, we report the use of a new electromagnetostatic cell to perform electron capture dissociation (ECD) within a quadrupole/ion mobility/time-of-flight mass spectrometer. This cell was installed between the ion mobility and time-of-flight regions of the instrument, and fragmentation was fast enough to be compatible with mobility separation. The instrument was already fitted with electron transfer dissociation (ETD) between the quadrupole and mobility regions prior to modification. We show excellent fragmentation efficiency for denatured peptides and proteins without the need to trap ions in the gas phase. Additionally, we demonstrate native top-down backbone fragmentation of noncovalent protein complexes, leading to comparable sequence coverage to what was achieved using the instrument's existing ETD capabilities. Limited collisional ion activation of the hemoglobin tetramer before ECD was reflected in the observed fragmentation pattern, and complementary ion mobility measurements prior to ECD provided orthogonal evidence of monomer unfolding within this complex. The approach demonstrated here provides a powerful platform for both top-down proteomics and mass spectrometry-based structural biology studies.

19.
Cerebellum ; 19(1): 161-163, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31721007

RESUMO

Spinocerebellar ataxia type 5 (SCA-5) is a predominantly slowly progressive adult onset ataxia. We describe a child with a presentation of ataxic cerebral palsy (CP) and developmental delay at 6 months of age. Genetic testing confirmed a c.812C>T p.(Thr271Ile) mutation within the SPTBN2 gene. Seven previous cases of infantile onset SCA-5 are reported in the literature, four of which had a CP presentation. Early onset of SCA-5 presents with ataxic CP and is a rare cause of cerebral palsy.

20.
Phys Ther Sport ; 41: 16-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31683159

RESUMO

OBJECTIVES: To assess the reliability, precision and differences between scores produced using the standard 36″ start position and 3 modified start positions of the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), towards normalisation to the individual. DESIGN: RCT of 4 conditions. SETTING: Clinical. PARTICIPANTS: Thirty-four asymptomatic individuals. MAIN OUTCOME MEASURES: Using an RCT method, variations in CKCUEST starting hand position were tested using hand spacing at standard 36″, 50% height, bi-acromial distance, and bi-acromial distance with reach to 36″. The average number of touches over 3 × 15 s maximal efforts were used to assess the intra-variation reliability, minimum detectable change (MDC) and differences to the standard 36″ start position. RESULTS: The most reliable variation was the 50% height (ICC: 0.93) and with the smallest MDC (14%). 36″ results were second-most reliable (ICC: 0.90), with a low MDC (19%). Significant differences were found between bi-acromial and 50% height to the 36″ standard setup. CONCLUSIONS: A setup position where the hand separation is 50% of the individual's height offers excellent repeated measures reliability and the smallest MDC, suggesting it is the most sensitive to change and is a recommendation to clinicians. Conversion calculations between start variations are presented.

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