MO Group Research Articles

When Does an Incidental Chiari I Malformation Require Surgery? A 10-Year Prospective Study on the Evolution and Natural History

Abstract INTRODUCTION The optimal management of incidental CM-I remains elusive, in part, due to a lack of understanding of its natural history. Despite recent efforts, most studies are limited by their retrospective design, small sample size, and variable follow-up as well as indication for surgery. We present a large-scale, long-term, prospective study of the natural history of incidental CM-I in pediatric patients. METHODS A single-institution, prospective review of patients with incidental CM-I was performed from 2008 to 2018. CM-I was defined as “incidental” when it was discovered during workup for an unrelated indication in an otherwise asymptomatic individual. Patients were stratified into observation only, early surgery (<6 mo from initial diagnosis) or delayed surgery (>6 mo) groups. To observe the evolution of CM-I, a minimum follow-up of 1-yr was set as the inclusion criteria for patients in the observation only cohort. Demographics, radiographic features, clinical presentation and indications for surgery were analyzed to define parameters for conservative management and determine predictors of surgery. RESULTS From 777 CM-I patients, 433 (55.73%) were diagnosed incidentally. A total of 390 (90.1%)were managed conservatively while 43 (9.93%) eventually required surgery at an average duration of 10.6 m from diagnosis.Among the surgical cohort, there was a trend toward early surgery with 90.7% undergoing surgery within 3 yr of initial diagnosis (see Kaplan-Meier analysis). Most patients (76%) in the early surgery group presented with a syrinx at initial presentation compared to only 2 (15%) in the delayed surgery group. The remaining patients manifested progressive symptoms.Predictive factors significantly associated with surgery included syrinx, cervicomedullary kinking and gait abnormality (P < .05). CONCLUSION Incidental CM-I has a relatively benign natural history and can be managed in a conservative fashion in majority of pediatric patients. However, careful and longterm follow-up, particularly during the first 3 yr after diagnosis is critical since 9.9% of patients are likely to experience a change in clinical or radiographic status necessitating surgical intervention.

Perioperative outcomes of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in super-obese and super-super-obese patients: a national database analysis

BackgroundEvidence remains contradictory for perioperative outcomes of super-obese (SO) and super-super-obese (SSO) patients undergoing bariatric surgery. ObjectiveTo identify national 30-day morbidity and mortality of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in SO and SSO patients. SettingThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. MethodsAll LSG and LRYGB patients from 2015 through 2017 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database were grouped based on body mass index (BMI) as follows: morbidly obese (MO; BMI 35.0–49.9 kg/m2), SO (BMI 50.0–59.9 kg/m2), and SSO (BMI ≥60.0 kg/m2). Complications and mortality within 30 days were compared between BMI groups using Pearson X2 or Fischer’s exact tests. Multivariate logistic regression was used to adjust for demographic characteristics and co-morbidities, and adjusted odds ratio (AOR) was reported for each outcome. ResultsOf 356,621 patients, 71.6% had LSG and 28.4% LRYGB. A total of 272,195 patients were in the MO group, 65,565 in the SO group, and 18,861 in the SSO group. Higher BMI was associated with increased overall morbidity and mortality. The overall complication rate was significantly higher for SO (AOR = 1.20, 95% confidence interval [CI] 1.13–1.28 for LSG; AOR = 1.08, 95% CI 1.01–1.15 for LRYGB) and SSO (AOR = 1.44, 95% CI 1.31–1.58 for LSG; AOR = 1.31, 95% CI 1.19–1.45 for LRYGB) compared with the MO group. Mortality was also significantly higher for SO (AOR = 1.65, 95% CI 1.10–2.48 for LSG; AOR = 1.85, 95% CI 1.23–2.80 for LRYGB) and SSO (AOR = 3.30, 95% CI 1.98–5.48 for LSG; AOR = 3.32, 95% CI 1.93–5.73 for LRYGB) compared with the MO group. ConclusionsSO and SSO patients are at increased risk of 30-day morbidity and mortality compared with MO patients. Despite this elevated perioperative risk, the overall risk of these procedures remains low and acceptable especially as bariatric surgery is the durable treatment option for obesity.

179 Supplementation of mint oil and yeast cell in lactation diets on the antioxidant status of the dam and performance of offspring during the suckling phase

Abstract Environmental or metabolic heat can increase oxidative stress in sows and may impact suckling pig growth; yeast cell- and oil-based products are used to alleviate oxidative stress. A study was conducted to assess yeast cell and mint oil supplementation in sow lactation diets on sow anti-oxidant status and offspring performance to weaning. A total of 45 sows and gilts (240.7 ± 38.5 kg BW) were assigned to one of 4 diets: Control diet (CON), control + yeast cell at 0.2% (YC), control + mint oil at 10 ppm (MO), and control + yeast cell and mint oil (YCMO). Diets were provided from d 110 of gestation through weaning (21 ± 4 d). Variables evaluated were: sow and piglet growth, litter characteristics at birth, colostrum and milk oxidative status, sow feed intake. Data analyzed as randomized complete block with sow as experimental unit and Tukey’s adjustment as means separation test. There was no effect of maternal diet on sow BW (204.52 ± 43.5 kg) at weaning, piglet birth weight (1.44 ± 0.96 kg), litter size (13.09 ± 6 pig/sow) or sow feed intake (6.32 ± 3.05 kg). Piglets from CON females had lesser gain (P < 0.05) compared with the other groups during the suckling phase (0.23, 0.24, 0.24, and 0.24 ± 0.005 kg in CON, YC, MO, and YCMO group, respectively). Superoxide dismutase activity in sow serum (d110 and weaning), colostrum, and milk was not different among diets and was 39, 59, 45, and 10% lower at weaning than d 110 in CON, YC, MO, and YCMO sows, respectively. Milk glutathione content tended to be lower (P < 0.10) in MO than YCMO sows with CON and YC intermediate (15.2, 32.0, 20.6, and 21.1 U/ml), respectively. Overall, inclusion of yeast cell or mint oil enhanced piglet growth, which may be related to lower sow antioxidant status.

Preventing metabolic syndrome in morbid obesity with resistance training: Reporting interindividual variability

Background and aimsResistant training (RT) improves health markers in obesity, but its effects in morbid obesity are unknown. We aimed to determine the effects of a RT-program in preventing/attenuating the metabolic syndrome (MetS) in patients with morbid obesity. A second aim was to report the interindividual variability in terms of improvements in MetS markers and other related co-variables. Methods and resultsTwenty-one adults with obesity or morbid obesity were divided into two groups based on body mass index (BMI): a control obesity (CO, n = 7, BMI ≥35 < 40.0 kg/m2) and a morbid obese group (MO, n = 14, BMI ≥40 kg/m2). Participants completed a 20-week RT-program (3 sessions/week, 4–8 exercise) using free weights. Participants were assessed for MetS markers (waist circumference, systolic and diastolic blood pressure [BP], fasting glucose, high-density lipoproteins, and triglycerides) and other co-variables (total cholesterol, low-density lipoprotein, one-maximum repetition of biceps curl, and handgrip strength, 6 min walking test). Significant reductions in MetS markers were observed in both CO and MO groups (P < 0.05 to P < 0.0001), but significant reductions in diastolic BP and increases in HDL-C were noted only in the MO group (P < 0.0001). Changes in waist circumference, and systolic and diastolic BP were significantly greater only in the MO group (P < 0.001), but the CO group presented a greater fasting glucose decreases (P < 0.0001). The prevalence of non-responders between CO and MO groups was similar in the MetS outcomes. ConclusionsRT promotes greater improvements in overall MetS outcomes waist circumference, BP, and plasma triglycerides in patients with morbid obesity than in obese peers, with no overall differences in the prevalence of non-responders. Clinical trial numberNCT03921853 at www.clinicaltrials.gov.

Wounds as the Portal of Entrance for Parrot Bornavirus 4 (PaBV-4) and Retrograde Axonal Transport in Experimentally Infected Cockatiels (Nymphicus hollandicus).

In this study, we investigated the natural route of infection of psittacine bornavirus (PaBV), which is the causative agent of proventricular dilatation disease (PDD) in psittacines. We inoculated two infection groups through wounds with a PaBV-4 isolate. In nine cockatiels (Nymphicus hollandicus) we applied a virus suspension with a titer of 103 50% tissue culture infection dose (TCID50) via palatal lesions (Group P, P1-9). In a second group of three cockatiels, we applied a virus suspension with a titer of 104 TCID50 to footpad lesions (Group F, F1-3). In two cockatiels, the control (or "mock") group, we applied a virus-free cell suspension (Group M, M1-2) via palatal lesions. The observation period was 6 mo (Groups P and M) or 7 mo (Group F). We monitored PaBV-4 RNA shedding and seroconversion. At the end of the study, we examined the birds for the presence of inflammatory lesions, PaBV-4 RNA, and antigen in tissues, as well as virus reisolation of brain and crop material. We did not observe any clinical signs typical of PDD during this study. We also did not see seroconversion or PaBV RNA shedding in any bird during the entire investigation period, and virus reisolation was not successful. We only found PaBV-4 RNA in sciatic nerves, footpad tissue, skin, and in one sample from the intestine of Group F. In this group, the histopathology revealed mononuclear infiltrations mainly in skin and footpad tissue; immunohistochemistry showed positive reactions in spinal ganglia and in the spinal cord, and slightly in skin, footpad tissues, and sciatic nerves. In Groups P and M we found no viral antigen or specific inflammations. In summary, only the virus application on the footpad lesion led to detectable PaBV RNA, mononuclear infiltrations, and positive immunohistochemical reactions in tissues of the experimental birds. This could suggest that PaBV spreads via nervous tissue, with skin wounds as the primary entry route.

Cognitive Decline in Chronic Migraine with Nonsteroid Anti-inflammation Drug Overuse: A Cross-Sectional Study.

Background Chronic migraine with medication overuse headache (CM-MOH) is the most common type of chronic migraine, and it increases risk of stroke and white matter lesions. These pathologic changes could induce cognitive decline. However, the alteration of cognitive function in CM-MOH patients is not established. Therefore, we took this study to reveal the cognitive performances in CM-MOH. Methods This cross-sectional study was conducted between December 2015 and January 2017. Patients were divided into CM-MOH, CMwoMOH (chronic migraine without medication overuse), and MO (migraine without aura) groups. Cognitive function was assessed in all cases during interictal periods using Addenbrooke's Cognitive Examination Test (ACE-R), Trail Making Test A/B (TMT A/B), and Digit Symbol Test (DST). Detailed headache characteristics and evaluation of anxiety, depression, and living and sleep quality were collected. Results 116 patients were included in this study. There were 21 CM-MOHs, 20 CMwoMOHs, 35 MOs, and 40 controls. Age and education were the independent risk factors of cognitive decline (P < 0.05). After adjusting, the risk of cognitive decline was higher in CM compared with control in ACE-R score and language fluency (P < 0.05). In addition, CM-MOH sufferers were in higher risk of memory and executive dysfunction (P < 0.05). The cognitive function had no difference between CM-MOH and CMwoMOH (P > 0.05). Meanwhile, CM-MOH got significantly higher scores than MO in anxiety and depression, with poorer performances in sleep and life quality (P < 0.05). Conclusion The risk of cognitive decline increased in chronic migraine patients. Nonsteroid anti-inflammatory drugs overuse had no influence on cognitive performances among chronic migraine sufferers.

Effect of transpulmonary pressure-guided positive end-expiratory pressure titration on lung injury in pigs with acute respiratory distress syndrome

To investigate the effect of positive end-expiratory pressure (PEEP) guided by transpulmonary pressure or with maximum oxygenation-directed PEEP on lung injury in a porcine model of acute respiratory distress syndrome (ARDS). The porcine model of ARDS was induced in 12 standard pigs by intratracheal infusion with normal saline. The pigs were then randomly divided into two groups who were ventilated with the lung-protective strategy of low tidal volume (VT) (6 ml/kg), using different methods to titrate PEEP level: transpulmonary pressure (TP group; n = 6) or maximum oxygenation (MO group; n = 6). Gas exchange, pulmonary mechanics, and hemodynamics were determined and pulmonary inflammatory response indices were measured after 4 h of ventilation. The titrated PEEP level in the TP group (6.12 ± 0.89 cmH2O) was significantly lower than that in the MO group (11.33 ± 2.07 cmH2O) (P < 0.05). The PaO2/FiO2 (P/F) after PEEP titration both improved in the TP and MO groups as compared with that at T0 (when the criteria for ARDS were obtained). The P/F in the TP group did not differ significantly from that in the MO group during the 4 h of ventilation (P > 0.05). Respiratory system compliance and lung compliance were significantly improved in the TP group compared to the MO group (P < 0.05). The VD/VT in the TP group was significantly lower than that in the MO group after 4 h of ventilation (P < 0.05). Central venous pressure increased and the cardiac index decreased significantly in the MO group as compared with the TP group (P < 0.05), whereas oxygen delivery did not differ significantly between the groups (P > 0.05). The pulmonary vascular permeability index and the extravascular lung water index in the TP group were significantly lower than those in the MO group (P < 0.05). The TP group had a lower lung wet to dry weight ratio, lung injury score, and MPO, TNF-, and IL-8 concentrations than the MO group (P < 0.05). In summary, in a pig model of ARDS, ventilation with low VT and transpulmonary pressure-guided PEEP adjustment was associated with improved compliance, reduced dead space ventilation, increased cardiac output, and relieved lung injury, as compared to maximum oxygenation-guide PEEP adjustment.

An observational study of fixed-dose Tanacetum parthenium nutraceutical preparation for prophylaxis of pediatric headache

BackgroundMigraine is one of the most prevalent chronic pain manifestations of childhood. Despite the multitude of available treatments, parents are often concerned about chronic therapies and pediatricians have insufficient confidence in prescribing prophylactic drugs. Therefore, there is now growing interest for natural supplements used to control recurrent migraine headaches. Such approach may increase acceptance and adherence to long-term prophylaxis therapy in children.MethodsThis is an observational multicenter study performed in children (n = 91) with migraine, with (MO) or without aura (MA), or tension-type headache (TTH). A fixed-dose Andrographis paniculata, CoQ10, riboflavin, and magnesium, was administered for 16 weeks. Patients were evaluated at baseline (T0), at week 8 (T1) and at the end of treatment at week 16 (T2). A follow-up period occurred at week 20 (T3) and week 32 (T4).ResultsThe herbal supplement significantly reduced the frequency of headaches in TTH patients during treatment period (T0: 11.97 + 1.92 vs T2: 5.13 + 1.93; p < 0.001) and the efficacy was maintained after 16 weeks of treatment withdrawal (T4: 4.46 + 1.75; p < 0.001 vs T0). The frequency of migraine attacks was also reduced in the MO group during treatment (T0: 9.70 + 0.96 vs T2: 4.03 + 0.75; p < 0.01) and after withdrawal (T4: 2.96 + 0.65; p < 0.01 vs T0). Conversely, MA patients showed reduction in migraine’s frequency during treatment (T0: 8.74 + 1.91 vs T2: 3.78 + 2.02; p < 0.01) but not at the end of the study (T4: 5.57 + 3.31; p > 0.05 vs T0).TTH patients did not report significant improvement of pain intensity. A significant effect was observed in the MO group during treatment (T0: 3.06 + 0.11 vs T2: 2.14 + 0.19; p < 0.001) and after treatment withdrawal (T4: 2.20 + 0.21; p < 0.001 vs T0). Likewise, MA group showed a significant treatment effect (T0: 2.57 + 0.20 vs T2: 0.86 + 0.45; p < 0.001) and the efficacy persisted at the end of the study (T4: 1.00 + 0.58; p < 0.001 vs T0).ConclusionThis fixed-dose Tanacetum parthenium preparation improved headache frequency and pain intensity in children affected by TTH. Despite the main limits, this study supports the use of nutraceutical in pediatric headache/migraine.

Effect of simulated microgravity induced PI3K-nos2b signalling on zebrafish cardiovascular plexus network formation

Local abnormal angiogenesis and cardiovascular system reorganization have been observed in embryos exposed to a simulated microgravity (SM) environment. In this study, changes in key molecular signals and pathways in cardiovascular development have been investigated under microgravity conditions. In particular, the caudal vein plexus (CVP) network, formed by sprouting angiogenesis has been chosen. Zebrafish embryos were exposed to SM using a ground-based microgravity bioreactor for 24 and 36 h. The SM was observed to have no effect on the zebrafish length, tail width and incubation time whereas it was observed to significantly reduce the heart rate frequency and to promote abnormal development of the CVP network in the embryos. Nitric oxide (NO) content demonstrated that the total proteins in zebrafish embryos were significantly higher in SM than in the control group grown under normal conditions. It was then preliminarily determined how NO signals were involved in SM regulated zebrafish CVP network formation. nos2b MO was injected and CVP network evolution was observed in 36 h post fertilization (hpf) under SM condition. The results showed that the CVP network formation was considerably decreased in the nos2b MO treated group. However, this inhibition of the CVP network development was not observed in control MO group, indicating that nos2b is involved in the SM-regulated vascular development process in zebrafish. Moreover, specific phosphoinositide 3-kinase (PI3K) inhibitors such as LY294002 were also tested on zebrafish embryos under SM condition. This treatment significantly inhibited the formation of zebrafish CVP network. Furthermore, overexpression of nos2b partly rescued the LY294002-caused CVP network failure. Therefore, it can be concluded that SM affects zebrafish CVP network remodeling by enhancing angiogenesis. Additionally, the PI3K-nos2b signaling pathway is involved in this process.

The effects of a Melissa officinalis L. based product on metabolic parameters in patients with type 2 diabetes mellitus: A randomized double-blinded controlled clinical trial.

Background Diabetic patients are at increased risk for coronary artery disease. Since phytotherapy has been greatly common, finding safe and effective treatments is of importance. This study aimed to evaluate the effects of a Melissa officinalis L. based product (MO) in patients with type 2 diabetes. Methods A randomized double-blinded controlled study was conducted with 37 dyslipidemic diabetic patients, assigned to either MO or placebo (P) groups receiving two 500 mg capsules daily for 3 months. Finally, 32 cases completed the study and were included in the analysis; MO (n=16) and P (n=16). Results Safe and significant effects in terms of decreasing the serum level of triglyceride (TG) in all patients after 2 months (p-value=0.02) and in patients with higher baseline serum levels of TG (TG≥200 mg/dl) after 3 months (p-value=0.04) were shown in the MO group. However, no metabolic significant changes were seen compared to the control group. Significant decrease in both systolic and diastolic blood pressure from baseline values were also found in patients with higher systolic blood pressure (SBP≥130 mmHg) (p-value=0.02) and those with higher diastolic blood pressure (DBP≥85 mmHg) (p-value=0.02) in the MO group. Conclusion This study showed that MO might be safe and beneficial in decreasing the serum TG level in dyslipidemic diabetic patients. Although, larger long-term studies are required.

Melatonin regulation of transcription in the reversal of morphine tolerance: Microarray analysis of differential gene expression.

Tolerance and associated hyperalgesia induced by long-term morphine administration substantially restrict the clinical use of morphine in pain treatment. Melatonin, a neurohormone released by the pineal gland, has been demonstrated to attenuate anti-nociceptive morphine tolerance. The present study investigates differentially expressed genes in the process of morphine tolerance and altered gene expression subsequent to melatonin treatment in chronic morphine-infused ratspinal cords. Morphine tolerance was induced in male Wistar rats by intrathecal morphine infusion (the MO group). Melatonin (the MOMa group) was administered to overcome the effects derived by morphine. The mRNA collected from L5-S3 of the spinal cord was extracted and analysed by rat expression microarray. Principal component analysis and clustering analysis revealed that the overall gene profiles were different in morphine and melatonin treatments. Subsequent to Gene Ontology analysis, the biological processes of differentially expressed genes of MO and MOMa compared with the control group were constructed. Furthermore, a panel of genes exclusively expressed following melatonin treatment and another panel of genes with inverse expression between the MO and MOMa group were also established. Subsequent to PANTHER pathway analysis, a group of genes with inverse expression following melatonin administrated compared with morphine alone were identified. The expression levels of genes of interest were also confirmed using a reverse transcription-quantitative polymerase chain reaction. The gene panel that was constructed suggests a potential signaling pathway in morphine tolerance development and is valuable for investigating the mechanism of morphine tolerance and the regulatory gene profiles of melatonin treatment. These results may contribute to the discovery of potential drug targets in morphine tolerance treatments in the future.

Effect of molybdenum on reproductive function of male mice treated with busulfan

Infertility is a serious public health problem worldwide. Molybdenum (Mo) plays an important role in maintaining normal metabolism. To explore the therapeutic efficacy of molybdenum (Mo) on male infertility, 90 mice were randomly divided into control, busulfan and busulfan + Mo groups. The male mice in the busulfan and busulfan + Mo groups were exposed to busulfan (20 mg/kg body weight) with a single intraperitoneal injection to establish the infertility model. The sterile mice were successfully obtained 30 days after busulfan exposure. Then, the male mice in the busulfan + Mo group were given drinking water containing 20 mg/L Mo continuously for 42 days. At 72 Day after treatment, 30 mice in the three groups were tested for various indices, and 60 mice were mated with females in spontaneous estrus. Mo significantly reversed the thinner seminiferous tubules and disappeared tubule and germ cells. Mo also normalized previously abnormal levels of testosterone, estradiol, luteinizing hormone, superoxide dismutase, lactate dehydrogenase, malondialdehyde. Furthermore, expression levels expression of Bax, Bcl-2, caspase-3 and caspase-9 returned to control levels; and finally, Mo-treated sterile mice obtained offspring with normal number and gender ratio. These results suggested that Mo at 20 mg/L had a significant therapeutic effect on reproductive dysfunction in sterile mice. Its mechanism could via repair of damaged testicular structures, regulation of abnormal reproductive hormone levels, decreased oxidative stress or and resistance to cell apoptosis. Mo may be a new candidate medicine for treatment of male infertility.

Effect of the body mass index and sexual difference on the muscle activity during trunk exercise: a preliminary study.

There was lack of study which evaluated the effects of characteristics of subjects such as the body mass index (BMI) or waist circumference (WC), as well as sexual differences on trunk muscle activities. The purpose of the present study was to compare the abdominal muscle activities among the groups dividing criterion as the BMI, WC, and the gender. As a criterion of BMI and WC, subjects were arranged to three groups. Female subjects who were less than 25 kg/m2 BMI, and less than 90 WC were arranged as female with underweight group (FU), male subjects who were greater than 25 kg/m2 BMI and greater than 85 WC were arranged as male with overweight group (MO), male subjects who were less than 25 kg/m2 BMI and less than 85 WC were arranged in male with underweight group (MU). Surface electromyography responses of the rectus abdominis, internal oblique, external oblique muscles and lumbar level of erector spinae were obtained during the plank and maximal voluntary isometric contraction (MVIC). The MO group showed significantly higher %MVIC value of the internal oblique and lumbar level of erector spinae, compared to the MU group (P<0.05). The %MVIC of the rectus abdominis was significantly greater with the FU group (P<0.05). There were significant differences in the root mean squared (RMS) values from MVIC among the three groups (P<0.05). Regardless of muscles differences, the MO group showed significantly lower RMS activity values than the FU and the MU groups (P<0.05). Present study indicates some considerations of interpreting surface electromyography (sEMG) signal from region overlapping large fat tissue especially for trunk muscles. Individual characteristics such as gender, BMI, and WC could affect the sEMG signals. The female and male with overweight represent relatively high %MVICs during exercise, but it might be due to relatively low RMS values from procedure of MVICs.

Obesity does not significantly impact outcomes following simultaneous liver kidney transplantation: review of the UNOS database - a retrospective study.

Simultaneous liver kidney transplantation (SLK) is the only curative option for patients with combined end stage liver and kidney disease. With the global obesity epidemic, an increasing number of obese patients are in need of SLK. However, the impact of pre-transplant obesity on outcomes after SLK is unknown. An analysis of the United States OPTN registry (Oct 1987 - June 2016) identified 7205 SLK transplants. Of these, 1677 patients were overweight/obese (OW, BMI 30-39) and 183 were morbidly obese (MO, BMI ≥40). 29% of patients had NASH in the MO group versus 16.4% and 4.7% in the OW and normal weight (NW) groups, respectively. The 1, 3 and 5year overall patient survival, kidney and liver graft survivals were comparable between the three groups. Numerically higher rates of acute kidney rejection were reported in the MO group at 1year [12.73%, 8.59%, and 10.05% for MO, OW and NW, respectively (P=0.22)]. Multivariate analysis identified diagnosis of hepatitis C, donor age, diabetes mellitus, and delayed kidney transplant function but not BMI as risk factors for poor patient and both liver and kidney graft survival. Based on these findings, obesity should not be a contraindication for SLK even for patients with BMIs≥40.

Characteristics and clinical correlates of white matter changes in brain magnetic resonance of migraine females

ObjectiveWhite matter hyperintensities (WMHs) were often found in migraine patients. The aim of study was to characterize WMHs, assess their prevalence, determine relationship to clinical symptoms and homocysteine levels in migraine females. Methods69 women 38 with migraine without aura (MO), 31 with migraine with aura (MA) who underwent brain MRI with 1.5T scanner were enrolled. The WMHs number, location and size in FLAIR sequence were evaluated. Migraine severity was measured by pain intensity, number of attacks per month and MIDAS scale. ResultsWMHs were found in 39.1% females. There was no WMHs and migraine type correlation. The total WMHs number was higher in MO (p=0.027). Patients with WMHs were older (p=0.025), have higher BMI (p=0.042), suffered longer (p=0.001), more often had positive pregnancy history (p=0.010) and less frequent prodromal symptoms. The age of onset, migraine's severity and homocysteine did not correlate with WMHs. No effect of antimigraine medication and oral contraceptive pills (OCP) was found. Both in MO and MA groups WMHs were located only supratentorially. In MO females WMHs were mainly located in one cerebral hemisphere (p=0.024) whereas in MA were found bilaterally. WMHs were most commonly located in the frontal lobes. In MO lesions were small ≤3mm and present in almost all MO patients (p=0.027). ConclusionWMHs are present in more than one third of migraine females, regardless of aura. WHMs are located supratentorially, subcortically and in the frontal lobes. Older age, longer disease's duration, obesity and positive history of pregnancy are main risk factors for WMHs. Symptomatology and migraine severity, hyperhomocysteinemia, OCP and anti-migraine medications do not increase WMHs.

Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor

Objectives To compare the oral application form of misoprostol with the misoprostol vaginal insert (MVI) in a Swiss cohort with special regards to the efficacy and safety. Methods We performed a retrospective case series including a historical group induced with oral misoprostol (MO, n=101) and an MVI group (n=101). The primary outcome was time to delivery. Secondary outcomes were mode of delivery, occurrence of tachysystole, use of analgesia and neonatal adverse outcome. Results A total of 202 women were included in the analysis (101 in the MVI as well as in the MO group). Time from start of induction to delivery was significantly shorter in the MVI group compared to the MO group (15.91 h vs. 37.68 h, P<0.001). Within the first 24 h, 78.2% of the women in the MVI group had given birth compared to 28.7% in the MO group (P<0.001). Tachysystole occurred more often in the MVI group (22.8% vs. 5.0%, P<0.001). Women in the MVI group more often needed opioid analgesia during the induction before onset of active labor (31.7% vs. 2.0%, P<0.001). There was no significant difference between neonatal outcomes in the two groups. Conclusion Time to delivery was significantly shorter in the MVI group with a higher rate of vaginal deliveries within the first 24 h. However, patients needed more opioids for pain relief during induction with MVI. There was no difference in neonatal outcomes.

Molybdenum and Cadmium exposure influences the concentration of trace elements in the digestive organs of Shaoxing duck (Anas platyrhyncha)

To investigate the toxic effects of Molybdenum (Mo) and Cadmium (Cd) on trace elements in digestive organs of Shaoxing duck (Anas platyrhyncha), 120 Shaoxing ducks were randomly divided into control group and 5 treatment groups which were treated with a commercial diet containing different dosages of Mo and Cd. On the 60th and 120th days, the beak, esophagus, glandular stomach, muscular stomach, small intestine, large intestine and feces were collected to determine contents of Mo, Cd, copper (Cu), iron (Fe), zinc (Zn) and selenium (Se), then correlation analysis was performed. The results showed that Cd content in digestive organs significantly increased in co-treated groups compared to single treated groups and Mo concentration increased in Mo-treated groups compared to control group, whereas Cu, Fe, Zn and Se concentrations in digestive organs decreased in co-treated groups. Furthermore, Cd and Mo were mainly accumulated in the small intestine and esophagus, respectively. There was a strongly positive correlation between Cd and Mo while they had negative correlation with Cu, Fe, Zn and Se, respectively. In feces, Mo and Fe contents in high dose of Mo group and high Mo combined with Cd group were significantly higher than those in control group, and Cu content in all treated groups significantly increased and Cd, Zn and Se concentrations had no difference. The results indicated that dietary Mo or/and Cd might disturb homeostasis of trace elements in digestive organs of Shaoxing duck. Moreover, the two elements presented a synergistic relationship.

Quantum-Chemical Analysis of the Electron Transfer in the MgTiF6+12MgCl2 Molten System By Frontier Molecular Orbital Method

Investigation of the electrochemical charge transfer mechanism in molten salts containing transition metal complexes is a challenging task. Such studies could be facilitated by analysis of the corresponding model systems by quantum-chemical methods. However, in practice, a direct search for the transition state in such systems requires enormous computational time. In this work, we suggest to use an approach that allows us to qualitatively characterize possible variants of electron transfer and, thus, to sharply narrow the search for the transition state. We mean the use of the frontier molecular orbital method. The method is traditionally employed to evaluate the reactivity of species. However, when applied to electrochemical systems, the method can also provide extremely useful information on whether a certain electron transfer mechanisms is possible or impossible In this work, we were interested in the state of the complex TiF6 2- near the cathode surface. For this reason, on one side of the molten system, a flat boundary layer consisting of 17 chlorine and magnesium ions was formed. In general, the boundary ions of chlorine and magnesium are not in the same plane. The mutual displacement of these ions was determined from the computation in the model system C96H24+7MgCl2, where C96H24 is a flat carbon cluster simulating the surface of the cathode; hydrogen atoms close the broken bonds of carbon atoms to prevent artifacts. After optimization of this system, the chlorine anions shifted by 0.3 Å relative to the magnesium cations (Δd) in the direction opposite to the surface of the carbon cluster. The direction of this displacement corresponds to the effect of the electric field on the chlorine anions. Thus, the equilibrium shift Δd is 0.3 Å. The model system MgTiF6+12MgCl2 with such shift value will be considered referent. A systematic study of the influence of the Δd value and the length of Ti-F bonds (Δr) on the lowest unoccupied molecular orbital (LUMO) character showed the following: 1) the group of lower free MOs, the main contribution to which gives the TiF6 2- complex, is destabilized with increasing of Ti-F bond contraction; 2) when the shift Δd increases, this MO group is also destabilized and simultaneously free MOs belonging to the boundary ions become more stable. In particular, when the Ti-F bonds are compressed on Δr = 0.05 Å, the critical value of the shift Δd is 0.6 Å. That is, at Δd ≥ 0.6 Å and Δr = 0.05 Å, LUMO is delocalized between the complex and the bridge cation. At excessively large values of Δd and Δr, LUMO is completely localized on the boundary ions, but this is undesirable. The combination of the parameters Δd = 0.6, 0.7 Å and Δr = 0.05 Å is optimal. At these values, LUMO is delocalized between the complex and the bridge cation and the activation energy (~18 kJ mol-1) is close to the experimental value (21±4 kJ mol-1). An increase in the parameter Δr leads to a rapid increase in the activation energy, a contraction value of 0.05 Å is optimal. An equally important characteristic is the highest occupied molecular orbital (HOMO) type of the structure after electron transfer (ET). Theoretically, there may exist three main types of HOMO for our structures (after ET): 1) HOMO is completely localized on the boundary ions; 2) HOMO is delocalized between the boundary ions and the complex; 3) HOMO is completely localized on the complex. In the first case, probability of electron capture by the complex is very small. After diffusion of the complex into the depth of the melt, electron remains on the boundary ions and then returns to the cathode. In the second case, there is a significant probability of ET to the complex through the bridge cation. In the latter case, the probability of electron capture by the complex is close to 100%, if the complex is in contact with the surface of the electrode.

The Protective Effect of Melissa officinalis L. in Visceral Hypersensitivity in Rat Using 2 Models of Acid-induced Colitis and Stress-induced Irritable Bowel Syndrome: A Possible Role of Nitric Oxide Pathway.

Background/AimsThe aim of present study is to estimate the effects of Melissa officinalis L. (MO) on visceral hypersensitivity (VH), defecation pattern and biochemical factors in 2 experimental models of irritable bowel syndrome (IBS) and the possible role of nitric oxide.MethodsTwo individual models of IBS were induced in male Wistar-albino rats. In the acetic acid model, the animals were exposed to rectal distension and abdominal withdrawal reflex, and the defecation patterns were determined. In the restraint stress model, the levels of TNF-α, myeloperoxidase, lipid peroxidation, and antioxidant powers were determined in the (removed) colon. Rats had been treated with MO, L-NG-nitroarginine methyl ester (L-NAME), aminoguanidine (AG), MO + AG, or MO + L-NAME in the mentioned experimental models.ResultsHypersensitive response to rectal distension and more stool defecation in control rats have been observed in comparison to shams. MO-300 significantly reduced VH and defecation frequency in comparison to controls. VH and defecation pattern did not show significant change in AG + MO and L-NAME + MO groups compared to controls. Also, significant reduction in TNF-α, myeloperoxidase, thiobarbituric acid reactive substances (TBARS), and an increase in antioxidant power in MO-300 group was recorded compared to controls. AG + MO and L-NAME + MO groups showed a reverse pattern compared to MO-300 group.ConclusionsMO can ameliorate IBS by modulating VH and defecation patterns. Antioxidant and anti-inflammatory properties along with its effect on the nitrergic pathway seem to play important roles in its pharmacological activity.

Alleviation of mycotoxin biodegradation agent on zearalenone and deoxynivalenol toxicosis in immature gilts

BackgroundThe current study was carried out to evaluate the effects of mycotoxin biodegradation agent (MBA, composed of Bacillus subtilis ANSB01G and Devosia sp. ANSB714) on relieving zearalenone (ZEA) and deoxynivalenol (DON) toxicosis in immature gilts.MethodsA total of forty pre-pubertal female gilts (61.42 ± 1.18 kg) were randomly allocated to four diet treatments: CO (positive control); MO (negative control, ZEA 596.86 μg/kg feed and DON 796 μg/kg feed); COA (CO + 2 g MBA/kg feed); MOA (MO + 2 g MBA/kg feed). Each treatment contained 10 replicates with 1 gilt per replicate. Gilts were housed in an environmentally controlled room with the partially slatted floor.ResultsDuring the entire experimental period of 28 d, average daily gain (ADG) and average daily feed intake (ADFI) of gilts in MO group was significantly reduced compared with those in CO group. The vulva size of gilts was significantly higher in MO group than CO group. In addition, significant increases in the plasma levels of IgA, IgG, IL-8, IL-10 and PRL were determined in MO group compared with that in CO group. ZEA and DON in the diet up-regulated apoptotic caspase-3 in ovaries and uteri, along with down-regulated the anti-apoptotic protein Bcl-2 in ovaries. The supplementation of MBA into diets co-contaminated with ZEA and DON significantly increased ADG, decreased the vulva sizes, reduced the levels of IgG, IL-8 and PRL in plasma, and regulated apoptosis in ovaries and uteri of gilts.ConclusionsThe present results indicated that feeding diet contaminated with ZEA and DON simultaneously (596.86 μg/kg + 796 μg/kg) had detrimental effects on growth performance, plasma immune function and reproductive status of gilts. And MBA could reduce the negative impacts of these two toxins, believed as a promising feed additive for mitigating toxicosis of ZEA and DON at low levels in gilts.