The elucidation of the molecular architecture of cell membranes is a central goal for cell biology, as structure lies at the heart of function. The erythrocyte plasma membrane has long provided a favored testing ground for this inquiry. Human red blood cells are readily available, relatively homogeneous, and relevant to medicine. Their plasma membranes can be easily isolated intact and essentially free of contamination from other cells, organelles, and cytoplasmic contents. This membrane is complex enough to be interesting and, to some degree, representative, yet it is simple enough to be analyzed as a whole. These circumstances make it likely that the human red cell plasma membrane will be the first whose molecular anatomy is known in any degree of satisfying detail. The literature concerning the proteins of erythrocyte membranes and membranes in general has been the subject of repeated review (1 9). This article will focus on the localization and modes of association of individual major polypeptides within the human red cell membrane.
Daily habits and actions powerfully affect the risk of cardiovascular disease (CVD), in general, and coronary heart disease, in particular. Regular physical activity, sound nutrition, weight management, and not smoking cigarettes have all been demonstrated to significantly reduce the risk of CVD. In 2 large cohort studies a reduction of risk of CVD of >80% and diabetes >90% were demonstrated in individuals who followed a cluster of these lifestyle practices. The study of the impact of lifestyle factors on CVD risk has coalesced under the framework of “lifestyle medicine.” Despite the overwhelming evidence that lifestyle factors affect CVD, a distinct minority of individuals are following these practices. The American Heart Association estimates that only 5% of individuals follow all of these lifestyle factors as components of a strategy to achieve “ideal” cardiovascular health. The challenge to the medical and health care communities is to more aggressively incorporate this information into the daily practices of medicine.
Despite the advancement in medicine, management of heart failure (HF), which usually presents as a disease syndrome, has been a challenge to healthcare providers. This is reflected by the relatively higher rate of readmissions along with increased mortality and morbidity associated with HF. In this review article, we first provide a general overview of types of HF pathogenesis and diagnostic features of HF including the crucial role of exercise in determining the severity of heart failure, the efficacy of therapeutic strategies and the morbidity/mortality of HF. We then discuss the quality control measures to prevent the growing readmission rates for HF. We also attempt to elucidate published and ongoing clinical trials for HF in an effort to evaluate the standard and novel therapeutic approaches, including stem cell and gene therapies, to reduce the morbidity and mortality. Finally, we discuss the appropriate utilization/documentation and medical coding based on the severity of the HF alone and with minor and major co-morbidities. We consider that this review provides an extensive overview of the HF in terms of disease pathophysiology, management and documentation for the general readers, as well as for the clinicians/physicians/hospitalists.
Background: Coronary artery bypass graft (CABG) is the most common treatment for relieving symptoms and reducing early mortality in patients with coronary artery disease. Cardiac rehabilitation (CR) is a standardized physical and functional enhancement program. The referral rate for cardiac rehabilitation post-operatively is very low, and further compliance is a bigger problem. Tele cardiac rehabilitation is beneficial for increasing participation in CR. Therefore, this study will assess the effect of tele CR on patients with CABG.
Methods: A randomized controlled trial was conducted in a multispecialty hospital for four years. A total of 48 consecutive CABG patients were included and divided into a telerehabilitation and home exercise group through convenient sampling. Patients of both groups were unaware of group allocation and were assessed for functional independence, hand grip strength, and 6-minute walk test distance at discharge, at 1 month, and at 3 months postdischarge.
Results: At 3 months post-discharge, patients in the tele cardiac rehabilitation group showed statistically significant improvement in functional status (p=0.041) and functional capacity (p=0.019). Hand grip strength was not different in both groups (p=0.162) after 3 months of discharge.
Conclusion: Tele-cardiac rehabilitation benefits patients with CABG who cannot attend center-based cardiac rehabilitation and want to improve their daily lives.
Irvane E. Nelson, Kobi A. Baker, Ary Faraji
et al.
Abstract Background Sugar alcohols, such as erythritol, are low-impact candidates for attractive toxic sugar baits (ATSB) to kill mosquitoes. To determine whether erythritol has a viable future in ATSB formulations, a suite of assays was conducted to diagnose toxicity mechanisms and starvation effects on mortality in Aedes aegypti (L.) as a model system. Methods We measured general carbohydrate load, glucosidase levels, and free glucose in intoxicated adult mosquitoes to observe whether sugar digestion was impaired. We assayed the effects of sugar combinations with erythritol on larvae and adults. To measure erythritol effects when mosquitoes were not resource-deprived, additional assays manipulated the prior starvation status. Results Up to 50,000 ppm of erythritol in water had no effect on larvae within 72 h, but an ammonia spike indicated diuresis in larvae as early as 4 h (F 8,44 = 22.50, P < 0.0001) after sucrose/erythritol combinations were added. Adult consumption of erythritol was diuretic regardless of the sugar pairing, while sucrose and erythritol together generated above 80% mortality (F 2,273 = 33.30, P < 0.0001) alongside triple the normal excretion (F 5,78 = 26.80, P < 0.0004). Glucose and fructose paired individually with erythritol had less mortality, but still double the fecal excretion. When ingesting erythritol-laced meals, less sugar was detected in mosquitoes as compared to after sucrose meals (χ 2 = 12.54, df = 1, P = 0.0004). Conclusions Data showed that erythritol is a linear competitive inhibitor of α-glucosidase, marking it as a novel class of insecticide in the current research climate. However, the efficacy on larvae was null and not persistent in adult mosquitoes when compared across various starvation levels. Despite significant diuresis, the combined effects from erythritol are not acute enough for vector control programs considering ATSB against mosquitoes. Graphical Abstract
Naruhiro Kimura, Toru Setsu, Yoshihisa Arao
et al.
Abstract Background and Aim Symptoms of primary biliary cholangitis (PBC) frequently impair one's quality of life (QOL). Nonetheless, with improved treatment, the prognosis of PBC also improves. QOL plays an important role in patients with PBC. In this study, we aimed to reevaluate the transition of new symptom development in PBC and its predictive factors. Methods This retrospective multicenter study enrolled 382 patients with PBC for symptom analysis. The impact of a newly developed symptom on PBC prognosis was investigated by Kaplan–Meier analysis with propensity score matching and logistic progression analysis. Results The cumulative risk of developing a new symptom after 10 and 20 years of follow‐up was 7.6 and 28.2%, and specifically that of pruritus, which was the most common symptom, was 6.7 and 23.3%, respectively. In Cox hazard risk analysis, serum Alb level (hazard ratio [HR], 1.097; 95% confidence interval [CI], 1.033–1.165; P = 0.002), the serum D‐Bil level (HR, 6.262; 95% CI, 2.522–15.553, P < 0.001), and Paris II criteria (HR, 0.435; 95% CI, 0.183–1.036; P = 0.037) were significant independent predictors of a new symptom. Kaplan–Meier analysis showed that the overall survival and liver‐related death were not significant between patients with and without a new symptom. Conclusion The cumulative risk of new symptom development is roughly 30% 20 years after diagnosis and could be predicted by factors including serum albumin levels, serum D‐Bil level, and Paris II criteria.
Diseases of the digestive system. Gastroenterology
Abstract While phylogenetic trees and associated data have been getting easier to generate, it has been difficult to reuse, combine, and synthesize the information they provided, because published trees are often only available as image files and associated data are often stored in incompatible formats. To increase the reproducibility and reusability of phylogenetic data, the ggtree object was designed for storing phylogenetic tree and associated data, as well as visualization directives. The ggtree object itself is a graphic object and can be rendered as a static image. More importantly, the input tree and associated data that are used in visualization can be extracted from the graphic object, making it an ideal data structure for publishing tree (image, tree, and data in one single object) and thus enhancing data reuse and analytical reproducibility, as well as facilitating integrative and comparative studies. The ggtree package is freely available at https://www.bioconductor.org/packages/ggtree.
Computer applications to medicine. Medical informatics
Background: The expression levels of the programmed cell death ligand 1 (PD-L1), known as an immune-inhibitory molecule, are closely associated with cancer stem cell (CSCs) immune escape. Recently, PD-L1 has also been reported to be able to regulate the self-renewal of cancer stem cells. However, The expression and intrinsic role of PD-L1 in endometrial cancer stem-like cell (ECSC) maintenance and its underlying mechanism of action remain unclear. Methods: Using flow cytometry and western blot assays, we have demonstrated that PD-L1 expression is higher in ECSCs derived from endometrial cancer than in nonstem-like cancer cells. Using mouse xenograft assays for ECSC tumorigenicity. Using gene reporter assay for uncovering the regulation mechanism of PD-L1 in the hypoxia. Results: We revealed the high expression levels of PD-L1 in ECSCs and its correlation with self-renewal. We further found that PD-L1 knockdown reduced expression of several pluripotency-related genes (aldehyde dehydrogenase 1 (ALDH1), CD133, OCT4, SOX2, NANOG), impaired ECSC proliferation and undifferentiated colonies and decreased the number of CD133 positive ECSCs and the number of stem-like spheres. Furthermore, we found that PD-L1 knockdown inhibited ECSC tumorigenicity and the PD-L1 induced self-renewal capability of ECSCs was dependent upon hypoxia HIF-1α and HIF-2α activation. Conclusions: These data link ECSC maintenance to PD-L1 expression through hypoxia and suggest a promising target for PD1/PD-L1 immunotherapy.
Terezka S. Mollee, Pieter U. Dijkstra, Rienk Dekker
et al.
Abstract Background Obesity is common in persons with a lower limb amputation, an amputation can also lead to further weight gain. Data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. Methods A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects’ body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. Results In total, 413 persons were enrolled. Of them, 39% (95 % confidence interval 35;44) were overweight and 28% (95% confidence interval 24;33) were obese. A total of 77% (95% confidence interval 73;81) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0;8.9)). Conclusions Our findings show that obesity is common in the Dutch ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.
MOHAMMAD SAEED GHARAATI JAHROMI, MITRA AMINI, MAHSA MOOSAVI
et al.
Introduction: Bedside teaching plays a crucial role in acquiring essential clinical skills. Therefore, the main aim of this study is assessing the validity and reliability of the Persian version of German bedside teaching (BST) instrument. This instrument was specially developed for evaluation of bedside teaching.Methods: The present cross-sectional study was conducted on 150 last year medical students, using convenience sampling. The Persian version of the bedside teaching (BST) was used for datagathering. To calculate the reliability of the questions, Cronbach’s alpha was used and to determine the construct validity of the questionnaire, confirmatory factor analysis was used. All analyseswere performed in LISREL 10 and SPSS 21 software.Results: Cronbach’s alpha indicated excellent reliability for each subscale (α=0.77–0.85). All of the value of the questions are more than a significant number of 1.96 and concluded to be significant. There was an acceptable fit between the hypothetical model and the data and all comparative fit indices (CFI, NFI, RFI, IFI) showed good model fitness. BST is a valid and reliable instrument for the assessment of clinical teaching at bedside. It has 18 items with 5 point Likert scales.Conclusion: The findings suggest that the Persian version of the BST questionnaire is a valid and reliable tool for the evaluation of teachers and providing feedback in a clinical setting. However,more studies should be conducted in other cities in Iran.