Chronic intermittent hypoxia attenuates noradrenergic innervation of hypoglossal motor nucleus.

The state-dependent noradrenergic activation of hypoglossal motoneurons plays an important role in the maintenance of upper airway patency and pathophysiology of obstructive sleep apnea (OSA). Chronic intermittent hypoxia (CIH), a major pathogenic factor of OSA, contributes to the risk for developing neurodegenerative disorders in OSA patients. Using anterograde tracer, channelrhodopsin-2, we mapped axonal projections from noradrenergic A7 and SubCoeruleus neurons to hypoglossal nucleus in DBH-cre mice and assessed the effect of CIH on these projections.

Secondary B-cell acute lymphoblastic leukaemia in a patient with multiple myeloma.

Although patients with multiple myeloma (MM) have improved survival with current therapies, there remains a long-term risk of treatment-associated second primary malignancies. We present a case of a patient with IgG kappa MM undergoing treatment for relapsed disease who was noted to have progressive pancytopenia. For his MM, he had previously undergone autologous stem cell transplant with high-dose melphalan and had received immunomodulatory (IMiD) agents in induction, maintenance and relapse regimens.

Mimic of malignancy: delineating IgG4-related disease and lymphoma.

Here, we describe the case of a 74-year-old man who was incidentally found to have a hepatic lesion during routine screening. Additional diagnostic studies demonstrated elevated IgG4 levels, IgG4 plasma cell-predominant lymphadenopathy and an inflammatory retroperitoneal mass encasing the bilateral ureters and the aorta. Given the concurrence of a lymphomatous process and IgG4-related disease (IgG4-RD), a multidisciplinary approach was required to determine whether targeting the lymphoma or IgG4-RD would be most efficacious.

An Integrative Review of Behavioral Disturbances in Veterans With Dementia and PTSD.

Objective: Both posttraumatic stress disorder (PTSD) and dementia have been associated with a variety of behavioral changes; however, little is known about the behavioral consequences of comorbid PTSD and dementia. An integrative review was conducted to identify and examine studies reporting on behavioral disturbances in Veterans with PTSD and dementia.

Methods: PubMed and PsychINFO databases were searched for articles on behavioral disturbances in Veterans with comorbid PTSD and dementia.

2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.

Objective: To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).

Methods: We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others.

2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.

Objective: To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).

Methods: We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others.

How are medical groups identified as high-performing? The effect of different approaches to classification of performance.

Background: Payers and policy makers across the international healthcare market are increasingly using publicly available summary measures to designate providers as "high-performing", but no consistently-applied approach exists to identifying high performers. This paper uses publicly available data to examine how different classification approaches influence which providers are designated as "high-performers".

Methods: We conducted a quantitative analysis of cross-sectional publicly-available performance data in the U.

Cytotoxic effect caspase activation dependent of a genetically engineered fusion protein with a CD154 peptide mimetic (OmpC-CD154) on B-NHL cell lines is mediated by the inhibition of bcl-6 and YY1 through MAPK p38 activation.

The interaction between CD40, and its ligand, CD154, is essential for the development of humoral and cellular immune responses. The selective inhibition or activation of this pathway forms the basis for the development of new therapeutics against immunologically based diseases and malignancies. We are developing a gene fusion of Salmonella typhi OmpC protein expressing the CD154 Tyr140-Ser-149 amino acid strand.

Neuroanatomical Basis of State-Dependent Activity of Upper Airway Muscles.

Obstructive Sleep Apnea (OSA) is a common sleep-related respiratory disorder that is associated with cognitive, cardiovascular, and metabolic morbidities. The major cause of OSA is the sleep-related reduction of upper airway muscle tone that leads to airway obstructions in individuals with anatomically narrow upper airway. This reduction is mainly due to the suppressant effect of sleep on hypoglossal motoneurons that innervate upper airway muscles.

The Cutting Edge: Doppler Probe in Guiding Endoscopic Hemostasis.

This article examines use of the Doppler endoscopic probe (DEP) for risk stratification and as a guide to definitive hemostasis of nonvariceal upper gastrointestinal (NVUGI) bleeding and colonic diverticular hemorrhage. Studies report that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared with those without such SRH. Lesions with a persistently positive DEP signal after endoscopic hemostasis have a higher 30-day rebleeding rate.

Dual role of hypoxia-inducible factor 1 α in experimental pulmonary tuberculosis: its implication as a new therapeutic target.

Aim: Investigate the role of hypoxia-inducible factor-1α (HIF-1α) in pulmonary tuberculosis (TB).

Methods & Results: A model of progressive pulmonary TB in BALB/c mice, immunohistochemistry and digital pathology were used. High HIF-1α expression was observed during early TB in activated macrophages.

Role of Yin Yang-1 (YY1) in the transcription regulation of the multi-drug resistance () gene.

Resistance to chemotherapy hinders the successful treatment of acute lymphoblastic leukemia (ALL). The multi-drug resistance-1 (/ABCB1) gene encodes P-glycoprotein (P-gp), which plays an important role in chemoresistance; however, its transcriptional regulation remains unclear. We investigated the role of YY1 in the regulation of and its relation to ALL outcomes.

Alleviating Thoracotomy Pain With Intercostal Liposomal Bupivacaine: A Case Report.

Unlabelled: Thoracotomy pain is common after chest surgery and may result from injury to the lung pleura, intercostal muscles, costovertebral joint, or intercostal nerves. Inappropriately controlled postoperative pain can hinder recovery and increase the risk of complications such as infection, atelectasis, blood clots, and development of post-thoracotomy pain syndrome. A number of treatment options for acute pain are available, most of which require systemic medications or indwelling catheters that may be contraindicated in patients on anticoagulants.

Associative learning versus fear habituation as predictors of long-term extinction retention.

Violation of unconditioned stimulus (US) expectancy during extinction training may enhance associative learning and result in improved long-term extinction retention compared to within-session habituation. This experiment examines variation in US expectancy (i.e.

Xylooligosaccharide supplementation alters gut bacteria in both healthy and prediabetic adults: a pilot study.

Background: It has been suggested that gut microbiota is altered in Type 2 Diabetes Mellitus (T2DM) patients.

Objective: This study was to evaluate the effect of the prebiotic xylooligosaccharide (XOS) on the gut microbiota in both healthy and prediabetic (Pre-DM) subjects, as well as impaired glucose tolerance (IGT) in Pre-DM.

Subjects/methods: Pre-DM (n = 13) or healthy (n = 16) subjects were randomized to receive 2 g/day XOS or placebo for 8-weeks.

Tracheal epithelial-myoepithelial carcinoma associated with sarcoid-like reaction: A case report.

Epithelial-myoepithelial carcinomas are rare tumors that primarily originate in the salivary glands but have also been found in the tracheobronchial tree. We report the first case of epithelial-myoepithelial carcinoma associated with sarcoidosis. A 61 year old Hispanic man presented with altered mental status and hypercalcemia.

Emergency Physicians' Perceptions and Decision-making Processes Regarding Patients Presenting with Palpitations.

Background: Palpitations are a common emergency department (ED) complaint, yet relatively little research exists on this topic from an emergency care perspective.

Objectives: We sought to describe the perceptions and clinical decision-making processes of emergency physicians (EP) surrounding patients with palpitations.

Methods: We conducted 21 semistructured interviews with a convenience sample of EPs.

Coccidioidal meningitis: clinical presentation and management in the fluconazole era.

Despite the advent of new antifungal agents, coccidioidal meningitis (CM) remains a difficult-to-treat condition with significant morbidity and mortality. In this study we directly compare the clinical presentation and management of patients with Coccidioides immitis meningitis in the azole era (after 1980) to that of a cohort of patients from the pre-azole era. We reviewed 30 CM cases seen at 3 Los Angeles hospitals between the years 1993 to 2008 ("2008 cohort") and compared them to 31 patients ("1980 cohort") described by Bouza et al in a previous study.

MR imaging of soft-tissue masses of the foot.

As with other parts of the musculoskeletal system, the soft tissues of the foot can be affected by a wide variety of pathologic entities including trauma, congenital abnormalities, infections, and neoplastic disorders. While plain radiographs are usually the initial examination for evaluation of pathology, magnetic resonance imaging (MRI) is critical to evaluate for abnormalities within the ligaments, tendons, and other nonosseous structures within the foot. The constellation of clinical and MRI findings often allows a relatively specific diagnosis to be rendered.