Oxygen-induced impairment in arterial function is corrected by slow breathing in patients with type 1 diabetes

Hyperoxia and slow breathing acutely improve autonomic function in type-1 diabetes. However, their effects on arterial function may reveal different mechanisms, perhaps potentially useful. To test the effects of oxygen and slow breathing we measured arterial function (augmentation index, pulse wave velocity), baroreflex sensitivity (BRS) and oxygen saturation (SAT), during spontaneous and slow breathing (6 breaths/min), in normoxia and hyperoxia (5 L/min oxygen) in 91 type-1 diabetic and 40 age-matched control participants. During normoxic spontaneous breathing diabetic subjects had lower BRS and SAT, and worse arterial function. Hyperoxia and slow breathing increased BRS and SAT. Hyperoxia increased blood pressure and worsened arterial function. Slow breathing improved arterial function and diastolic blood pressure. Combined administration prevented the hyperoxia-induced arterial pressure and function worsening. Control subjects showed a similar pattern, but with lesser or no statistical significance. Oxygen-driven autonomic improvement could depend on transient arterial stiffening and hypertension (well-known irritative effect of free-radicals on endothelium), inducing reflex increase in BRS. Slow breathing-induced improvement in BRS may result from improved SAT, reduced sympathetic activity and improved vascular function, and/or parasympathetic-driven antioxidant effect. Lower oxidative stress could explain blunted effects in controls. Slow breathing could be a simple beneficial intervention in diabetes.Peer reviewe

Turpoava kaula tylpän vamman jälkeen

Vertaisarvioitu. English summary.Tylpät kaulasuonivammat ovat harvinaisia, mutta todennäköisesti alidiagnosoituja. Ne ovat yleensä suuren vammaenergian aiheuttamia. Oireet johtuvat iskeemisistä aivotapahtumista ja voivat vakavuudeltaan vaihdella huomattavasti sekavuudesta halvausoireisiin. Kaulasuonivamma ja verenvuoto voivat myös aiheuttaa painetta ympäröiviin kudoksiin ja ahtauttaa hengitysteitä. Diagnoosi tehdään kaulavaltimoiden TT-angiografialla. Hoidossa pyritään ehkäisemään verisuonen hyytyminen umpeen ja embolioiden muodostuminen. Endovaskulaarisiin tai avotoimenpiteisiin päädytään hyvin harvoin.Tylpät kaulasuonivammat ovat harvinaisia, mutta todennäköisesti alidiagnosoituja. Ne ovat yleensä suuren vammaenergian aiheuttamia. Oireet johtuvat iskeemisistä aivotapahtumista ja voivat vakavuudeltaan vaihdella huomattavasti sekavuudesta halvausoireisiin. Kaulasuonivamma ja verenvuoto voivat myös aiheuttaa painetta ympäröiviin kudoksiin ja ahtauttaa hengitysteitä. Diagnoosi tehdään kaulavaltimoiden TT-angiografialla. Hoidossa pyritään ehkäisemään verisuonen hyytyminen umpeen ja embolioiden muodostuminen. Endovaskulaarisiin tai avotoimenpiteisiin päädytään hyvin harvoin

Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

Background: Patient-reported outcomes (PROS) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments. Methods: Altogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester-Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed. Results: Based on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument. Conclusions: The ePRO versions of the FAAM, the FAOS, the MOXFQ and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Functional analysis and identification of cis-regulatory elements of human chromosome 21 gene promoters

Given the inherent limitations of in silico studies relying solely on DNA sequence analysis, the functional characterization of mammalian promoters and associated cis-regulatory elements requires experimental support, which demands cloning and analysis of putative promoter regions. Focusing on human chromosome 21, we cloned 182 gene promoters of 2500 bp in length and conducted reporter gene assays on transfected-cell arrays. We found 56 promoters that were active in HEK293 cells, while another 49 promoters could be activated by treatment of cells with Trichostatin A or depletion of serum. We observed high correlations between promoter activities and endogenous transcript levels, RNA polymerase II occupancy, CpG islands and core promoter elements. Truncation of a subset of 62 promoters to ∼500 bp revealed that truncation rarely resulted in loss of activity, but rather in loss of responses to external stimuli, suggesting the presence of cis-regulatory response elements within distal promoter regions. In these regions, we found a strong enrichment of transcription factor binding sites that could potentially activate gene expression in the presence of stimuli. This study illustrates the modular functional architecture of chromosome 21 promoters and helps to reveal the complex mechanisms governing transcriptional regulation

Neuroadaptations in Human Chronic Alcoholics: Dysregulation of the NF-κB System

Anna Ökvist is with Karolinska Institute, Sofia Johansson is with Karolinska Institute, Alexander Kuzmin is with Karolinska Institute, Igor Bazov is with Karolinska Institute, Roxana Merino-Martinez is with Karolinska Institute, Igor Ponomarev is with UT Austin, R. Dayne Mayfield is with UT Austin, R. Adron Harris is with UT Austin, Donna Sheedy is with University of Sydney, Therese Garrick is with University of Sydney, Clive Harper is with University of Sydney, Yasmin L. Hurd is with Mount Sinai School of Medicine, Lars Terenius is with Karolinska Institute, Tomas J. Ekström is with Karolinska Institute, Georgy Bakalkin is with Karolinska Institute and Uppsala University, Tatjana Yakovleva is with Karolinska Institute and Uppsala University.Background -- Alcohol dependence and associated cognitive impairments apparently result from neuroadaptations to chronic alcohol consumption involving changes in expression of multiple genes. Here we investigated whether transcription factors of Nuclear Factor-kappaB (NF-κB) family, controlling neuronal plasticity and neurodegeneration, are involved in these adaptations in human chronic alcoholics. Methods and Findings -- Analysis of DNA-binding of NF-κB (p65/p50 heterodimer) and the p50 homodimer as well as NF-κB proteins and mRNAs was performed in postmortem human brain samples from 15 chronic alcoholics and 15 control subjects. The prefrontal cortex involved in alcohol dependence and cognition was analyzed and the motor cortex was studied for comparison. The p50 homodimer was identified as dominant κB binding factor in analyzed tissues. NF-κB and p50 homodimer DNA-binding was downregulated, levels of p65 (RELA) mRNA were attenuated, and the stoichiometry of p65/p50 proteins and respective mRNAs was altered in the prefrontal cortex of alcoholics. Comparison of a number of p50 homodimer/NF-κB target DNA sites, κB elements in 479 genes, down- or upregulated in alcoholics demonstrated that genes with κB elements were generally upregulated in alcoholics. No significant differences between alcoholics and controls were observed in the motor cortex. Conclusions -- We suggest that cycles of alcohol intoxication/withdrawal, which may initially activate NF-κB, when repeated over years downregulate RELA expression and NF-κB and p50 homodimer DNA-binding. Downregulation of the dominant p50 homodimer, a potent inhibitor of gene transcription apparently resulted in derepression of κB regulated genes. Alterations in expression of p50 homodimer/NF-κB regulated genes may contribute to neuroplastic adaptation underlying alcoholism.This work was supported by grants from the AFA Forsäkring to AK, YLH, TJE and GB, the Research Foundation of the Swedish Alcohol Retail Monopoly (SRA) and Karolinska Institutet to AK, TJE and GB, and the Swedish Science Research Council and the Swedish National Drug Policy Coordinator to GB. The Australian Brain Donor Programs NSW Tissue Resource Centre was supported by The University of Sydney, National Health and Medical Research Council of Australia, Neuroscience Institute of Schizophrenia and Allied Disorders, National Institute of Alcohol Abuse and Alcoholism and NSW Department of Health.Waggoner Center for Alcohol and Addiction Researc

Not just a boss but also a leader

The purpose of the study was to investigate expectations on managers at Rosemount Tank Radar AB. The study focused on four different perspectives; the board member perspective, the department manager perspective, the group manager perspective and the employee perspective. The aim was to examine these groups expectations on managers with three research questions. Twenty in-depth interviews were carried out with three board members, six department managers, six group managers and five employees. The result showed that expectations on managers generally did not differ between the perspective holders. Managers were mainly expected to be aligned and to focus on strategic issues, but also to delegate operative work, to inform and communicate and to have enough courage to be a manager

Erfarenheter av palliativ vård hos personer med migrationsbakgrund : en litteraturöversikt

Bakgrund: Migrationen ökar i Sverige och globalt, vilket leder till ökad mångkultur inom sjukvården. En fungerande kommunikation är av stor betydelse för att kunna ge patienter god vård på lika villkor, oavsett kulturell bakgrund. Enligt forskning finns det brister i kulturell kompetens hos vårdpersonal, vilket kan leda till sämre vård för patienter med migrationsbakgrund. För att öka sjuksköterskors och övrig vårdpersonals kulturella kompetens och kunna erbjuda personcentrerad vård på lika villkor för patienter med migrationsbakgrund är det av vikt att ta del av personers erfarenheter av palliativ vård. Syfte: Syftet var att beskriva erfarenheter av palliativ vård hos personer med migrationsbakgrund. Metod: Studien genomfördes som en litteraturöversikt. Tolv artiklar inkluderades och en tematisk analys utfördes enligt Braun och Clarke. Resultat: Resultatet presenterades under fyra huvudteman och fem underteman; Kommunikation: Betydelsen av information från vården, Hinder och resurser vid språkbarriärer. Transkulturell vård: Vårdpersonalens bemötande, Närståendes betydelse. Identitet och tillhörighet: Betydelsen av att befinna sig i sina tankar mellan två länder. Religionens betydelse i palliativ vård. Slutsats: Erfarenheter av palliativ vård hos personer med migrationsbakgrund skiljer sig mellan olika kulturer. Som sjuksköterska i palliativ vård är det av vikt att vara medveten och tillgodogöra sig kunskap om kulturella skillnader och ha insikt om personers kulturella och individuella värderingar för att kunna erbjuda en personcentrerad vård på lika villkor. Information som ges till patienter ska anpassas utifrån individens förutsättningar för att skapa god kommunikation. Vid palliativ vård har närstående en central roll hos personer med migrationsbakgrund, likaså kontinuitet bland vårdpersonal