Are school uniforms associated with gender inequalities in physical activity? A pooled analysis of population-level data from 135 countries/regions

Purpose:It is aimed to assess whether school uniforms are associated with population-level gender inequalities in physical activity,and whether associations differ by school level,country/region income,and assessment method.Methods:An ecological study design was employed.We collected data about global uniform practices using an online survey.We searched for country/region-level estimates of school-aged youth meeting physical activity guidelines from international surveillance studies.Study selection was conducted in duplicate using a systematic process,and a random sample of all data was checked to ensure extraction and pooling processes were accurate.We calculated absolute and relative gender inequalities in physical activity for each country.Linear regression examined associations between country/region-level uniform practices(binary yes/no exposure variable)and country/region-level gender inequalities in physical activity guideline compliance(absolute and relative inequalities).We investigated moderation by school level,stratified analyses by income group,and repeated primary analyses using device-measured data.Results:Pooling data from 135 countries/regions(n=1,089,852),we found no association between population-level uniform practices and gender inequalities in physical activity across all ages(absolute:b=-0.2;95%confidence interval(95%CI):-1.7 to 1.3,p=0.74;relative:b=0.1;95%CI:-0.1 to 0.2,p=0.51).Subgroup analysis suggested a positive association in primary school settings(absolute:b=4.3;95%CI:-0.0 to 8.6,p=0.05).Among high-income countries,absolute inequalities were significantly greater in countries/regions with uniform practices(N=37)compared to those without(N=48)(9.1(SD=3.6)vs.7.8 percentage points(SD=4.3)).Repeating analyses using device-measured data(n=32,130;N=24)did not alter our primary finding.From initial descriptive statistics,we found that in countries/regions where a majority of schools(>50%)reportedly use uniforms,there was lower compliance with physical activity guidelines among all genders(median:16.0%,interquartile range:13.2%-19.9%,N=103)compared to generally non-uniform countries/regions(median:19.5%,interquartile range:16.4%-23.5%,N=32)(z=3.04,p=0.002).(N=countries,regions and studies represented;n=sample size or participants included).Conclusion:School uniforms are associated with greater gender inequalities in physical activity in primary school settings and in high-income countries.Our population-level findings warrant testing using individual-level data across contexts.

Prospective associations between joint categories of physical activity and insomnia symptoms with onset of poor mental health in a population-based cohort

Background:Physical inactivity and insomnia symptoms are independently associated with increased risk of depression and anxiety;however,few studies jointly examine these risk factors.This study aimed to prospectively examine the joint association of physical activity(PA)and insomnia symptoms with onset of poor mental health in adults.Methods:Participants from the 2013 to 2018 annnual waves of the Household Income and Labour Dynamics in Australia panel study who had good mental health(Mental Health Inventory-5>54)in 2013,and who completed at least 1 follow-up survey(2014-2018),were included(n=10,977).Poor mental health(Mental Health Inventory-5≤54)was assessed annually.Baseline(2013)PA was classified as high/moderate/low,and insomnia symptoms(i.e.,trouble sleeping)were classified as no insomnia symptoms/insomnia symptoms,with 6 mutually exclusive PAinsomnia symptom groups derived.Associations of PA-insomnia symptom groups with onset of poor mental health were examined using discrete-time proportional-hazards logit-hazard models.Results:There were 2322 new cases of poor mental health(21.2%).Relative to the high PA/no insomnia symptoms group,there were higher odds(odds ratio and 95%confidence interval(95%CI))of poor mental health among the high PA/insomnia symptoms(OR=1.87,95%CI:1.57-2.23),moderate PA/insomnia symptoms(OR=1.93,95%CI:1.61-2.31),low PA/insomnia symptoms(OR=2.33,95%CI:1.96-2.78),and low PA/no insomnia symptoms(OR=1.14,95%CI:1.01-1.29)groups.Any level of PA combined with insomnia symptoms was associated with increased odds of poor mental health,with the odds increasing as PA decreased.Conclusion:The se findings highlight the potential benefit of interventions targeting both PA and insomnia symptoms for promoting mental health.

Socio-Demographic Factors, Clinical Characteristics and Maternal Prognosis of Hypertensive Disorders in Pregnancy at Panzi General Referral Hospital

Background: Hypertensive disease in pregnancy is an important cause of morbidity, long-term disability, and maternal and neonatal mortality. The aim is to determine the socio-demographic characteristics and maternal prognosis of these women with Hypertension during pregnancy. Material and Method: We conducted a cross-sectional study, we interview patients and after discussion we transcripts in a database in Excel software before analysis with SPSS version 20.0 and Stata 14.0 The qualitative variables have been summarised by the Percentage and the quantitative variables will be summarised by Means and Standard Deviation. The associations of the variables were calculated by Pearson’s chi-square test with a significance level set at a p-value Result: The average age of the patients was 30.33 ± 7.020 years, 92.1% were married, 79.8% lived in urban areas, most of the patients were overweight (43%), 92.1% of them had monofetal pregnancies, 36% were multiparous, 34.2% had a previous history of preeclampsia in pregnancy and 14% were known to have hypertension. Pre-eclampsia was the most frequent form of hypertension in pregnancy with 73.68% of cases and represents 84.8% of severe forms of hypertension in pregnancy, 53.4% of the patients delivered vaginally. Eclampsia was the most frequent complication in our patients with 31.7% frequency and among the socio-demographic parameters, age and body mass index were significantly associated with maternal complications. Conclusion: Maternal age and body mass index are important socio-demographic factors associated with the occurrence of maternal complications in women with hypertensive disorders in pregnancy.

Are EPB41 and alpha-synuclein diagnostic biomarkers of sport-related concussion?Findings from the NCAA and Department of Defense CARE Consortium

Background:Current protein biomarkers are only moderately predictive at identifying individuals with mild traumatic brain injury or concussion.Therefore,more accurate diagnostic markers are needed for sport-related concussion.Methods:This was a multicenter,prospective,case-control study of athletes who provided blood samples and were diagnosed with a concussion or were a matched non-concussed control within the National Collegiate Athletic Association-Department of Defense Concussion Assessment,Research,and Education Consortium conducted between 2015 and 2019.The blood was collected within 48 h of injury to identify protein abnormalities at the acute and subacute timepoints.Athletes with concussion were divided into 6 h post-injury(0-6 h post-injury)and after 6 h postinjury(7-48 h post-injury)groups.We applied a highly multiplexed proteomic technique that used a DNA aptamers assay to target 1305proteins in plasma samples from athletes with and without sport-related concussion.Results:A total of 140 athletes with concussion(79.3%males;aged 18.71±1.10 years,mean±SD)and 21 non-concussed athletes(76.2%males;19.14±1.10 years)were included in this study.We identified 338 plasma proteins that significantly differed in abundance(319 upregulated and 19 downregulated)in concussed athletes compared to non-concussed athletes.The top 20 most differentially abundant proteins discriminated concussed athletes from non-concussed athletes with an area under the curve(AUC)of 0.954(95%confidence interval:0.922-0.986).Specifically,after 6 h of injury,the individual AUC of plasma erythrocyte membrane protein band 4.1(EPB41)and alpha-synuclein(SNCA)were 0.956 and 0.875,respectively.The combination of EPB41 and SNCA provided the best AUC(1.000),which suggests this combination of candidate plasma biomarkers is the best for diagnosing concussion in athletes after 6 h of injury.Conclusion:Our data suggest that proteomic profiling may provide novel diagnostic protein markers and that a combination of EPB41 and SNCA is the most predictive biomarker of concussion after 6 h of injury.

Relationship changes in lifestyle, cardiovascular risk factors, and mental health in Japanese workers: A four-year follow up with high-risk and population strategies of the occupational health promotion (HIPOP-OHP) study

Background: Cardiovascular diseases (CVD) are major causes of death in Japan, and controlling the risk factors for CVD is an important public health task. Lifestyle factors, for example, diet and stress, have impacts on risk factors such as hypertension and hyperlipidemia. Deterioration of mental health is related to CVD pathogenesis. Aim: We investigated the relationships between levels of mental health, 4-year changes in lifestyle, and CVD risk factors among Japanese workers, using the SF-36 (Japanese version), which is a comprehensive scale measuring health-related quality of life. We hypothesized that workers’ mental health levels would influence 4-year changes in their lifestyles and CVD risk factors. Methods: Data from the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study, which were collected by examination and administration of the SF-36, were used. The relationships between mental health levels at baseline, lifestyle chan- ges, and cardiovascular risk factors were longitudinally analyzed. Subjects with total SF-36 scores ≥65 were classified as the “Good Mental Health Group,” and those with total scores <65 were classified as the “Poor Mental Health Group.” Results: Multiple logistic regression analyses showed that, as compared to people who had poor mental health, those who had good mental health at baseline had a significantly higher probability of good maintenance of improvements in body mass index, (OR = 1.20, 95% CI: 1.03 - 1.39), blood pressure (OR = 1.20, 95% CI: 1.01 - 1.43), total cholesterol (OR = 1.07, 95% CI: 0.86 - 1.33) and HDL cholesterol (OR = 1.26, 95% CI: 1.07 - 1.47). Conclusion: Japanese workers with good mental health tend to improve or maintain good lifestyle conditions and minimize CVD risk factors, while those with poor mental health generally have difficulty improving their lifestyles and lowering their CVD risk.

Use of complementary and alternative medicines in people with depression and central obesity: Findings from a Tai Chi and Qigong study

Objective:Depression is a global and growing health issue.Complementary and alternative medicines (CAM) use is common among people with depression.We examined the baseline use of CAM (products,not services) in centrally obese adults with depression,a specific and increasingly important population who were part of a trial of Tai Chi and Qigong for depression.Methods:Self-reported use of CAM products (four major groups:vitamins,herbal medicines,mineral supplements and purified chemicals as nutritional supplements) together with demographic,lifestyle and health status characteristics were collected using validated questions within a written survey.We used descriptive statistics to understand patterns of use.Results:Two hundred and sixty patients participated in the assessment.Half of the patients stated they were using CAM,on average reporting 2.3 CAM per patient.Women were more likely than men,and older people (>60 years) more likely than younger people (<40 years) to use any CAM products.Patients reported using CAM mostly for general health and alleviating aches and pains.CAM use was not associated with health state,use of a prescription antidepressant medicine,nor (self-reported) comorbidities such as arthritis,diabetes,hypertension or alcohol or tobacco use.Conclusions:CAM products are commonly used in Australians with moderate depression,particularly in female or older patients.The range and number of CAM in this group with common comorbidity may present additional unknown risks due to potential interactions with other prescribed medications with a myriad of biological and pharmacological effects.The importance of establishing whether depressed patients are taking CAM,the particular CAM and whether the CAM interacts with each other,other drugs used for depression or the biological process of the depression itself are factors to be considered at each assessment.

Epidemic of non-alcoholic fatty liver disease and hepatocellular carcinoma

Non-alcoholic fatty liver disease(NAFLD) associated hepatocellular carcinoma(HCC) incidence is increasing worldwide, paralleling the obesity epidemic. Although most cases are associated with cirrhosis, HCC can occur without cirrhosis in NAFLD. Diabetes and obesity are associated risk factors for HCC in patients. Given the sheer magnitude of the underlying risk factors(diabetes, obesity, non-cirrhotic NAFLD) screening for HCC in the non-cirrhotic population is not recommended. Optimal screening strategies in NAFLD cirrhosis are not completely elucidated with Ultrasound having significant limitations in detection of liver lesions in the presence of obesity and steatosis. Consequently NAFLD-HCC is more often diagnosed at a later stage with larger tumors and reduced opportunities for curative treatments as opposed to HCC in other causes of cirrhosis. When HCC is found at a curative stage treatments including liver transplantation, resection and loco-regional therapies are associated with good results similar to that seen in HCV-HCC. Future strategies under study include the use of chemopreventive and antioxidant agents to reduce development of cirrhosis and non-alcoholic steatohepatitis(NASH). Strategies to reverse NASH via weight loss, control of associated conditions like diabetes are key strategies in reducing the increasing incidence of NASH-HCC. Novel therapeutic agents for NASH are in trials and if successful in achieving reversal of NASH will be an important strategy in reducing NAFLD-HCC.

Carvedilol vs endoscopic variceal ligation for primary and secondary prevention of variceal bleeding: Systematic review and metaanalysis

BACKGROUND Variceal hemorrhage is associated with high mortality and is the cause of death for 20–30%of patients with cirrhosis.Nonselectiveβblockers(NSBBs)or endoscopic variceal ligation(EVL)are recommended for primary prevention of variceal bleeding in patients with medium to large esophageal varices.Meanwhile,combination of EVL and NSBBs is the recommended approach for the secondary prevention.Carvedilol has greater efficacy than other NSBBs as it decreases intrahepatic resistance.We hypothesized that there was no difference between carvedilol and EVL intervention for primary and secondary prevention of variceal bleeding in cirrhosis patients.AIM To evaluate the efficacy of carvedilol compared to EVL for primary and secondary prevention of variceal bleeding in cirrhotic patients METHODS We searched relevant literatures in major journal databases(CENTRAL,MEDLINE,and EMBASE)from March to August 2018.Patients with cirrhosis and portal hypertension,regardless of aetiology and severity,with or without a history of variceal bleeding,and aged≥18 years old were included in this review.Only randomized controlled trials(RCTs)that compared the efficacy of carvedilol and that of EVL for primary and secondary prevention of variceal bleeding and mortality in patients with cirrhosis and portal hypertension were considered,irrespective of publication status,year of publication,and language.RESULTS Seven RCTs were included.In four trials assessing the primary prevention,no significant difference was found on the events of variceal bleeding(RR:0.74,95%CI:0.37-1.49),all-cause mortality(RR:1.10,95%CI:0.76-1.58),and bleedingrelated mortality(RR:1.02,95%CI:0.34-3.10)in patients who were treated with carvedilol compared to EVL.In three trials assessing secondary prevention,there was no difference between two interventions for the incidence of rebleeding(RR:1.10,95%CI:0.75-1.61).The fixed-effect model showed that,compared to EVL,carvedilol decreased all-cause mortality by 49%(RR:0.51,95%CI:0.33-0.79),with little or no evidence of heterogeneity.CONCLUSION Carvedilol had similar efficacy to EVL in preventing the first variceal bleeding in cirrhosis patients with esophageal varices.It was superior to EVL alone for secondary prevention of variceal bleeding in regard to all-cause mortality reduction.

Impacts and challenges of United States medical students during the COVID-19 pandemic

The delivery of medical student education has changed rapidly during the coronavirus disease 2019(COVID-19)pandemic.Students in their pre-clinical years have transitioned to online courses and examinations.Students in their clinical years are not permitted on clinical rotations,and face uncertainties in career exploration and the residency application process.Medical students in all stages of training are volunteering and helping their communities.The future presence of COVID-19 throughout the United States is unknown,and medical students are eager to return to their training.This paper outlines current challenges in medical student education and the various responses that have been adopted.We also discuss possible future directions for students through involvement in telemedicine,outpatient clinic visits,and non-respiratory inpatient care tasks as adequate personal protective equipment,COVID-19 testing,and resources become more widely available.

Dexamethasone Reduces IL-17 and Tim-3 Expression in BALF of Asthmatic Mice

Summary： This study investigated the expression of interleukin-17 （IL-17） and T cell immunoglobulin mucin and domain-containing molecule-3 （Tim-3） in bronchoalveolar lavage fluid （BALF） of asthmatic mice and the effect of dexamethasone （DEX） on these factors. Thirty-six mice were randomly divided into three groups： normal group, asthmatic group and DEX group. The mouse model of asthma was es- tablished by sensitization with ovalbumin in both the asthmatic and DEX groups. The levels of IL-6, IL-10, IL-17 and TGF-β were measured in BALF by enzyme-linked immunesorbent assay （ELISA）. The mRNA expression level of Tim-3 was detected by reverse transcription polymerase chain reaction （RT-PCR）. The ratio of Tim-3＋CD4＋ cells to total CD4＋ cells in BALF was determined by flow cy- tometry. Differential inflammatory cells in BALF were detected. The correlations among IL-17, IL-6, IL-10, Tim-3 and inflammatory cells were analyzed. The results showed that the levels of IL-17, IL-6 and Tim-3 were substantially increased and the IL-10 level decreased in BALF in the asthmatic mice, which was significantly reversed by DEX treatment. IL-17 expression was positively correlated with IL-6 and Tim-3 expression and the number of inflammatory cells but negatively with IL-10 expression. These results indicate that the increased expression of IL-17 and Tim-3 in BALF may be implicated in the occurrence and development of asthmatic inflammation; the mechanism by which DEX suppresses asthmatic airway inflammation involves down-regulation of IL-17 and Tim-3 levels.

Measurement of the Energy Spectrum of a 6 MV Linear Accelerator Using Compton Scattering Spectroscopy and Monte Carlo-Generated Corrections

Purpose: The energy spectrum of a linear accelerator used for dose calculations is determined during beam commissioning by iteratively adjusting the spectrum and comparing calculated and measured percent depth-dose curves. Direct measurement of the energy spectrum using pulse mode detectors is particularly challenging because of the high-energy, high fluence nature of these beams and limitations of the detector systems. This work implements a Compton scattering (CS) spectroscopy setup and presents detector corrections and spectral unfolding techniques to measure the spectrum of a 6 MV linear accelerator using a pulse mode detector. Methods: Spectral measurements were performed using a Varian Clinac 21EX linear accelerator and a high-purity germanium (HPGe) detector. To reduce fluence to the detector, a custom-built lead shield and a CS spectrometry setup were used. The detector was placed at CS angles of 46°, 89°, and 125°. At each of these locations, a detector response function was generated to account for photon interactions within the experimental geometry. Gold’s deconvolution algorithm was used to unfold the energy spectrum. The measured spectra were compared to simulated spectra, which were obtained using an experimentally benchmarked model of the Clinac 21EX in MCNP6. Results: Measurements were acquired and detector response corrections were calculated for all three CS angles. A comparison of spectra for all CS angles showed good agreement with one another. The spectra for all three angles were averaged and showed good agreement with the MCNP6 simulated spectrum, with all points above 400 keV falling within 4%, which was within the uncertainty of the measurement and statistical uncertainty. Conclusions: The measurement of the energy spectrum of a 6 MV linear accelerator using a pulse-mode detector is presented in this work. For accurate spectrum determination, great care must be taken to optimize the detector setup, determine proper corrections, and to unfold the spectrum.

Co-expression of HBZ,TAX and FOXp3 and HTLV-1-associated myelopathy/tropical spastic paraparesis development in HTLV-1-infected individuals:A systematic review

Human T-cell lymphotropic virus type 1(HTLV-1)is associated with the development of HTLV-1-associated myelopathy/tropical spastic paraparesis(HAM/TSP).It has been reported that the HTLV-1 proteins(specifically TAX and HBZ)can modulate FOXp3,resulting in an immune imbalance that can favor the progression of HAM/TSP.This review aims to summarize the literature in order to clarify the relationship between the expression of HTLV-1 m RNAs and/or viral proteins(TAX and HBZ)with the expression of mRNA and/or protein FOXp3 and their correlation with HAM/TSP development.This systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.The search strategy was performed on the Medical Literature Analysis and Retrieval System Online and Latin American and Caribbean Literature in Health Sciences Platform using subject descriptors.After screening,six articles were included in this review.The studies suggested that TAX and HBZ have a directly proportional correlation with FOXp3 in individuals with HAM/TSP,which also presented an increased expression of FOXp3 compared to asymptomatic controls and/or healthy donors.This systematic review indicates that TAX and HBZ can interact with FOXp3 and that interaction may influence HAM/TSP development.

Acute effect of moderate intensity physical exercise on postprandial hyperlipaemia of individuals with central obesity

Introduction: High postprandial triglyceride levels and obesity are associated with coronaropathy, and influence the pathogenesis and progression of atherosclerosis. Objective: To evaluate the effect of immediate acute physical exercise on postprandial hyperlipaemia in individuals with central obesity. Methods: Study included sedentary, normolipidemic individuals aged 18 - 30 years, with waist circumference >80 in for women and >94 for men. The physical exercise was performed for 45 minutes with 55% - 60% of the heart rate reserve. Triglyceride level tests were performed after fasting, and at time intervals of 1h and 3 h after lipid overload, a week before and immediately after a session of physical exercise. Results: Thirty-six individuals were evaluated (mean age 23.74 ± 4.05 years, 88.2% women, BMI = 28.4 ± 3.4). Fasting and post-prandial triglyceride levels were similar before and after the exercise (p = 0.87). A smaller rise in triglyceride levels was observed in the 1st hour in obese individuals (5%) compared with over-weight individuals (21%) p = 0.001. Conclusion: In individuals with central obesity, moderate intensity physical exercise performed immediately before lipid overload does not reduce the hyperlipidemic peak.

Initiation and Regulation of CNS Autoimmunity: Balancing Immune Surveillance and Inflammation in the CNS

While the central nervous system (CNS) was once thought to be immune privileged, more recent data support that certain areas of the healthy CNS are routinely patrolled by immune cells. Further, antigen drainage is another means by which the adaptive arm of the immune system can gain information about the health of the CNS. Altogether these ensure that the CNS is not beyond the scope of immune protection against viruses and tumors. However, immune surveillance in the CNS has to be tightly regulated, as CNS autoimmune disease and inflammation may arise from increased immune cell infiltration. In this review we discuss the concept and implications of CNS immune surveillance and introduce the CNS antigen-presenting cells (APCs) that potentially regulate neuroinflammation and autoimmunity. We also discuss novel animal models in which CNS disease initiation and the role of APCs in disease regulation can be tested.

Dysfunction of the peripheral and central auditory pathway in patients with type 1 diabetes mellitus

Although auditory alterations are not a typical symptom of diabetes mellitus (DM), they can occur in patients with type 1 DM. The findings of previous studies are controversial, because the frequency and degree of hearing loss varies, and quite often alterations are still subclinical. The typical test used to detect and manage hearing loss is the audiogram, but this test alone is only capable of detecting alterations due to injury of the inner hair cells and/or alterations in the central auditory pathway. However, auditory alterations resulting from a dysfunction that is still subclinical are only able to be detected through electrophysiological auditory tests, such as the otoacoustic emissions (OAE) and the auditory brainstem response (ABR) tests. Thus, the purpose of this paper is to review the studies that utilize the OAE and ABR tests, and to verify if the dysfunction is cochlear and/or neural in patients with type 1 DM. The findings of this review demonstrate that patients with type 1 DM can have auditory alterations stemming from a central cochlear origin. Following this finding, early diagnosis is very important in order to implement preventative treatments and initiate therapy.

Patterns and Trends in Diagnostic Tests Used for Detection of Colorectal Cancer after Screening with the Immunochemical Fecal Occult Blood Test in Japan

According to the guidelines by the Japanese government, optical colonoscopy is the most strongly recommended diagnostic test after screening with the immunochemical fecal occult blood test (iFOBT), followed by double-contrast barium enema (BE) or sigmoidoscopy. Our study was to assess patterns and trends of colorectal cancer (CRC) diagnostic testing within 2 years after iFOBT. We analyzed both iFOBT results and claims data provided by employee health insurance societies in Japan from 2005 to 2010. 25,596 enrollees underwent iFOBT screening. The positive rate was 5.1%. 32.3% of those positive underwent diagnostic tests and 1.0% (12 patients) were confirmed as having cancer. The most common test was optical colonoscopy (77.2% of total tests), followed by BE (16.2%). From 2006 to 2009, the rate of optical colonoscopy for females increased from 55% to 82% and that of BE declined from 36% to 12%, while no significant changes were seen for males. Only one-third of those who tested positive underwent diagnostic test in the 2 years following screening iFOBT. As official guidelines for diagnostic testing of CRC recommend, optical colonoscopy is now the most commonly used diagnostic test after positive iFOBT result for enrollees in employee health insurance societies in Japan.

Impact of Cannabis Use on Brain Structure and Function in Suppressed HIV Infection

Background: Brain atrophy and cognitive deficits persist among individuals with suppressed HIV disease. The impact of cannabis use is unknown. Methods: HIV+ and HIV- participants underwent cross-sectional magnetic resonance imaging and neuropsychological testing. Lifetime frequency, duration (years), and recency of cannabis use were self-reported. Relationships of cannabis use to resting-state functional connectivity (RSFC) and to 9 regional brain volumes were assessed with corrections for multiple comparisons. Peripheral blood cytokines and monocyte subsets were measured in the HIV+ group and examined in relation to cannabis exposure. Results: We evaluated 52 HIV+ [50.8 ± 7.1 years old;100% on antiretroviral therapy ≥ 3 months;83% with plasma viral load < 50 copies/mL] and 55 HIV- [54.0 ± 7.5 years old] individuals. Among HIV+ participants, recent cannabis use (within 12 months) was associated with diminished RSFC, including of occipital cortex, controlling for age. Duration of use correlated negatively with volumes of all regions (most strikingly the nucleus accumbens) independently of recent use and intracranial volume. Recent use was associated with larger caudate and white matter volumes and lower soluble vascular cell adhesion molecule-1 and monocyte chemoattractant protein-1 concentrations. Duration of use correlated positively with psychomotor speed. Use > 10 times/lifetime was linked to more somatic symptoms, better executive function, and lower CD14+CD16++ monocyte count. Conclusion: HIV+ individuals demonstrated opposing associations with cannabis. Recent use may weaken RSFC and prolonged consumption may exacerbate atrophy of the accumbens and other brain regions. More frequent or recent cannabis use may reduce the inflammation and CD14+CD16++ monocytes that facilitate HIV neuroinvasion. HIV-specific cannabis studies are necessary.

Gait analysis in swine,sheep,and goats after neurologic injury:a literature review

Medical research on neurologic ailments requires representative animal models to validate treatments before they are translated to human clinical trials.Rodents are the predominant animal model used in neurological research despite limited anatomic and physiologic similarities to humans.As a result,functional testing designed to assess locomotor recovery after neurologic impairment is well established in rodent models.Comparatively,large r,more clinically relevant models have not been as well studied.To achieve similar locomotor testing standardization in larger animals,the models must be accessible to a wide array of researchers.Non-human primates are the most relevant animal model fo r translational research,however ethical and financial barriers limit their accessibility.This review focuses on swine,sheep,and goats as large animal alternatives for transitional studies between rodents and non-human primates.The objective of this review is to compare motor testing and data collection methods used in swine,sheep,and goats to encourage testing standardization in these larger animal models.The PubMed database was analyzed by searching combinations of swine,sheep,and goats,neurologic injuries,and functional assessments.Findings were categorized by animal model,data collection method,and assessment design.Swine and sheep were used in the majority of the studies,while only two studies were found using goats.The functional assessments included open pen analysis,treadmill walking,and guided free walking.Data collection methods included subjective behavioral rating scales and objective tools such as pressure-sensitive mats and image-based analysis software.Overall,swine and sheep were well-suited for a variety of assessment designs,with treadmill walking and guided free walking offering the most consistency across multiple trials.Data collection methods varied,but image-based gait analysis software provided the most robust analysis.Future studies should be conducted to standardize functional testing methods after neurologic impairment in large animals.

Blessing and a curse of outpatient management of delayed graft function

Delayed graft function (DGF) is a common complication occurring most often after deceased donor kidney transplant with several donor characteristics as well as immunologic factors that lead to its development post-transplant.These patients require dialysis and close kidney function monitoring until sufficient allograft function is achieved.This has resulted in limited options for DGF management,either prolonged hospitalization until graft function improves to the point where dialysis is no longer needed or discharge back to their home dialysis unit with periodic follow up in the transplant clinic.DGF is associated with a higher risk for acute rejection,premature graft failure,and 30-d readmission;therefore,these patients need close monitoring,immunosuppression management,and prompt allograft biopsy if prolonged DGF is observed.This may not occur if these patients are discharged back to their home dialysis unit.To address this issue,the University of Wisconsin-Madison created a clinic in 2011 specialized in outpatient DGF management.This clinic was able to successfully reduce hospital length of stay without an increase in 30-d readmission,graft loss,and patient death.

Radiation-Induced Spinal Glioblastoma Multiforme: A Rare Complication in the Management of Head and Neck Cancer

Background: Radiation-induced gliomas of the spinal cord are rare late complications of spinal cord irradiation that typically occur in patients treated at younger ages. Aim: Raise awareness of radiation induced high grade gliomas with a case presentation and a review of the literature. Case Presentation: A 50-year-old male with Stage IVA squamous cell carcinoma of the oropharynx was treated with external beam radiotherapy with a complete response. Seven years later, he presented with a cervical spinal cord mass on MRI. An open biopsy was performed. Pathology revealed an intramedullary WHO grade IV astrocytoma, (i.e., glioblastoma multiforme) of the cervical spine that fulfilled the criteria for a radiation-induced malignancy. Conclusions : Review of the literature suggests that radiation-induced gliomas tend to be high grade and may occur at the periphery of an irradiated field. Radiation-induced gliomas of the spinal cord are a serious complication of radiotherapy that may occur in older patients with head and neck cancers, but are so rare that it should not affect treatment decisions.