Comparing the effectiveness of general dietary advice versus a very low energy diet in an obese outpatient population in Australia.

PURPOSE: Obesity is a major public health burden. Outpatient clinics are an essential resource for individuals with obesity to access advice for weight loss management. The aim of this study was to compare anthropometric and weight loss outcomes between participants receiving general dietary (GD) advice, and those on a very low energy diet (VLED) under non-trial conditions. METHODS: Data from 276 adults with obesity attending a multidisciplinary weight management clinic were analysed. Changes in anthropometry, body composition, and blood pressure (BP) over 12 months were analysed using linear mixed-effects models. RESULTS: Males on the GD demonstrated statistically greater reductions in body weight (BW), BMI, percent fat mass (FM), systolic BP, waist and hip circumference (p < 0.01). Changes in males on a VLED did not reach significance. Females showed statistically significant reductions in BW, BMI, waist and hip circumference regardless of dietary intervention (p < 0.01); those on the GD significantly reduced percent FM (p < 0.001). Females on a VLED had statistically greater reductions in BW, BMI and systolic BP compared to those on the GD. No effect of exercise physiologist was observed in this study. Participants prescribed a GD attended for significantly longer than those on a VLED (p < 0.05), irrespective of gender. At 12 months, 14.3 and 4.5% of males and females on a VLED were still attending, compared to 10.6 and 4.5% on the GD. CONCLUSIONS: In this retrospective study, females in both dietary intervention groups achieved significant changes across multiple measures. Only men receiving GD advice demonstrated significant changes. LEVEL OF EVIDENCE: Level II-2.

Medical Students' Perception of the Usage of Lecture Recording Software.

BACKGROUND: Lecture recording software is a useful reference tool that allows students to revisit lectures and understand complicated concepts in higher education. It is also a useful tool for students with learning difficulties, allowing them to reference and learn the material at their own pace. A significant advantage of this tool is the accessibility of course material to the students off campus. This study attempted to learn the students' perception of the purpose, use, and benefit of lecture recording software at a medical school. METHODS: The study was conducted using a structured questionnaire delivered, via an Internet-based survey application in the Fall semester of 2017, to 105 students attending the basic sciences courses. A web link was generated after the 18-point questionnaire was uploaded to an online survey software. The link was communicated electronically to each student along with the date and time of the survey. The survey was anonymous. The results of the survey were summarized using descriptive statistics and graphical methods. Students were asked to submit voluntary, informed consent to participate in the study before attempting to answer the questionnaire. The institutional review board approved the research. RESULTS: The results showed 77% students used this resource to understand points they missed in the class, 75% of them relearned complex ideas/concepts, and 62% of them used it to rewrite class notes. Reportedly, the software was used by students (78%) who missed a class due to an illness or while attending clinical shadowing. Of the students, 87% agreed that the software is helpful because of its off-campus availability while 84% of the students liked the service, as it allowed them to listen to the lectures at their own pace. Many students (65%) felt that the service helped them score better in the exams, whereas 38% did not think the recordings was helpful to get the desired grade and 50% student felt it was time-consuming. CONCLUSION: Despite the time-consuming listening process, students expressed a positive opinion about the usefulness of this software. Recording and archiving class lectures could be a useful academic resource. Students could learn from these archived lectures before the class and engage in the discussion later, enhancing active learning. The result suggests that students should also use other study resources and methods to achieve the desired grades. The induction of this student service into a professional curriculum would enhance the students' satisfaction, effectiveness, and outcomes.

Adverse birth outcomes associated with Zika virus exposure during pregnancy in São José do Rio Preto, Brazil.

OBJECTIVES: We aimed to report the first 54 cases of pregnant women infected by Zika virus (ZIKV) and their virologic and clinical outcomes, as well as their newborns' outcomes, in 2016, after the emergence of ZIKV in dengue-endemic areas of São Paulo, Brazil. METHODS: This descriptive study was performed from February to October 2016 on 54 quantitative real-time PCR ZIKV-positive pregnant women identified by the public health authority of São José do Rio Preto, São Paulo, Brazil. The women were followed and had clinical and epidemiologic data collected before and after birth. Adverse outcomes in newborns were analysed and reported. Urine or blood samples from newborns were collected to identify ZIKV infection by reverse transcription PCR (RT-PCR). RESULTS: A total of 216 acute Zika-suspected pregnant women were identified, and 54 had the diagnosis confirmed by RT-PCR. None of the 54 women miscarried. Among the 54 newborns, 15 exhibited adverse outcomes at birth. The highest number of ZIKV infections occurred during the second and third trimesters. No cases of microcephaly were reported, though a broad clinical spectrum of outcomes, including lenticulostriate vasculopathy, subependymal cysts, and auditory and ophthalmologic disorders, were identified. ZIKV RNA was detected in 18 of 51 newborns tested and in eight of 15 newborns with adverse outcomes. CONCLUSIONS: Although other studies have associated many newborn outcomes to ZIKV infection during pregnancy, these same adverse outcomes were rare or nonexistent in this study. The clinical presentation the newborns we studied was mild compared to other reports, suggesting that there is significant heterogeneity in congenital Zika infection.

Bile salt stimulated lipase: Inhibition by phospholipids and relief by phospholipase A2.

INTRODUCTION: Bile salt stimulated lipase (BSSL; Enzyme Commission (EC) number 3.1.1.13) has been a candidate triglyceridase for improving enzyme therapy for pancreatic insufficiency; however, its efficacy is near absent. We hypothesise that similarly to pancreatic lipase, BSSL is inhibited by phospholipids and this inhibition is relieved by Phospholipase A2 (PLA2; EC 3.1.1.4), and the present study was undertaken to explore this possibility. MATERIALS AND METHODS: Synthetic emulsions of triglyceride and phosphatidylcholine (PC) or lysophosphatidylcholine (LPC)/bile salt mixed micelles were used as a model of intestinal digestion-media. The effect of PLA2 treatment of systems containing PC on BSSL activity was also explored. Automatic titration at constant pH (pH-stat) and nuclear magnetic resonance (NMR) spectroscopy were used to measure the rate and identify products of lipolysis. RESULTS: PC was inhibitory to BSSL activity, while LPC became inhibitory only above an LPC/bile salt concentration ratio of 0.3. PLA2 treatment relieved the inhibition only below this ratio, despite its complete phospholipid-hydrolysing action. Thus, LPC had an inhibitory effect at higher concentrations. CONCLUSIONS: These results may implicate a change in the design of enzyme therapy in patients with pancreatic exocrine insufficiency. Supplementation of BSSL with PLA2 could improve patient health with adequate manipulation of phospholipid and lysophospholipid concentrations in the intestinal fluid.

Body condition and habitat use by Hermann's tortoises in burnt and intact habitats.

UNLABELLED: In Mediterranean regions, fires threaten terrestrial tortoises. Nevertheless, varying proportions of adults survive fire; these surviving individuals can play a central role for population recovery. The regions devastated by fire often include important habitat of Hermann's tortoises (Testudo hermanni hermanni), so assessing the ability of survivors to persist is essential for conserving the species. Body-condition indices provide an integrative estimate of how well individuals cope with environmental variations and impacts, including fires. Between 2002 and 2009, we monitored Hermann's tortoises in intact and burnt habitats in southeastern France. In summer 2003, a strong fire ravaged half of the surveyed zone, providing an opportunity to compare body condition of tortoises between intact and burnt areas over time. Six years later, the impact of fire on vegetation was still marked; large trees were abundant in the intact area, whereas open shrub vegetation prevailed in the burnt area. In both areas, the mean body condition of tortoises fluctuated over time; however, there were no differences between the two areas. A radio-tracking experiment demonstrated that individuals from each area were residents, and not vagrants commuting between areas. We also assessed changes in body condition and microhabitat use in radio-tracked individuals. We found no significant differences between the tortoises living in the burnt and intact areas, despite subtle differences in habitat use. IN CONCLUSION: (i) surviving tortoises in an area ravaged by fire can maintain their body condition like individuals living in an intact area, and thus, individuals from burnt areas should not be translocated to supposedly better areas; and (ii) depopulated burnt areas are likely to be appropriate for population-augmentation programmes.

A gene variant of PNPLA3, but not of APOC3, is associated with histological parameters of NAFLD in an obese population.

OBJECTIVE: Mechanisms explaining the relationship in non-alcoholic fatty liver disease (NAFLD), obesity, and insulin resistance are poorly understood. A genetic basis has been suggested. We studied the association between the genes patatin-like phospholipase domain-containing protein 3 (PNPLA3) and apolipoprotein C3 (APOC3) and metabolic and histological parameters of NAFLD in obese patients. DESIGN AND METHODS: Overweight and obese patients underwent a metabolic and liver assessment. If NAFLD was suspected, liver biopsy was proposed. APOC3 variant rs2854117 and PNPLA3 variant rs738409 were genotyped. RESULTS: Four hundred seventy patients were included (61.1% had liver biopsy). The percentage of patients with non-alcoholic steatohepatitis (NASH) was significantly different according to the PNPLA3 variant. After adjustment for age and body mass index, the PNPLA3 variant was associated with alanine aminotransferase (P < 0.001) and aspartate aminotransferase (P < 0.001). The PNPLA3 variant was associated with more severe features of steatohepatitis: steatosis (P < 0.001), lobular inflammation (P < 0.001), and ballooning (P = 0.002), but not with liver fibrosis, anthropometry, or insulin resistance. No significant difference in liver histology, anthropometric, or metabolic parameters was found between carriers and non-carriers of the APOC3 variant. CONCLUSIONS: PNPLA3 polymorphism rs738409 was associated with NASH and the severity of necroinflammatory changes independently of metabolic factors. No association between APOC3 gene variant rs2854117 and histological or metabolic parameters of NAFLD was found.

[Susceptibility weighted magnetic resonance sequences "SWAN, SWI and VenoBOLD": technical aspects and clinical applications]. / Séquences IRM « SWAN, SWI et VenoBOLD ¼ exploitant le phénomène de susceptibilité magnétique : principes techniques et applications cliniques.

Susceptibility-weighted MR sequences, T2 star weighted angiography (SWAN, General Electric), Susceptibility weighted imaging (SWI, Siemens) and venous blood oxygen level dependant (VenoBOLD, Philips) are 3D spoiled gradient-echo sequence that provide a high sensitivity for the detection of blood degradation products, calcifications, and iron deposits. For all these sequences, an appropriate echo time allows for the visualization of susceptibility differences between adjacent tissues. However, each of these sequences presents a specific technical background. The purpose of this review was to describe 1/the technical aspects of SWAN, VenoBOLD and SWI sequences, 2/the differences observed in term of contrast within the images, 3/the key imaging findings in neuroimaging using susceptibility-weighted MR sequences.

Hirayama disease: an uncommon cause of distal upper extremity deficit.

Hirayama disease is a myelopathy related to flexion movements of the neck that produce ischemic damage in the anterior horn of the cervical cord. The disease affects young people and is characterized by a distal upper extremity deficit that develops gradually. The diagnosis is confirmed by cervical magnetic resonance imaging (MRI) in flexion demonstrating a forward shift of the posterior dural sac and spinal cord compression. On radiology, there should be suggestive signs in neutral position such as cord atrophy, intramedullary bilateral high signal intensity on T2-weighted images, straightening of the cervical spine, and loss of attachment between the posterior dural sac and subjacent lamina. Exploration should be completed by an MR study in neck flexion. We report here on two typical cases of the disease and also include a review of the literature.

Idiopathic hypertrophic cranial pachymeningitis treated by oral methotrexate: a case report and review of literature.

Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare clinical entity, characterized by a chronic inflammation causing thickening of the dura. Adequate therapeutic management is still a matter of debate. We present a patient with an IHCP, non-responsive to corticotherapy. Oral methotrexate was introduced (12.5 mg weekly) and total remission was observed after 6 weeks, both clinically and after neuro-imaging. We conclude that methotrexate can be effective and a therapeutical option in patients with IHCP who are resistant to corticotherapy or present major side-effects of chronic corticosteroids use.

Quality of anaesthesia-related information accessed via Internet searches.

BACKGROUND: We conducted a study to examine the quality and stability of information available from the Internet on four anaesthesia-related topics. METHODS: In January 2006, we searched using four key words (porphyria, scleroderma, transfusion risk, and epidural analgesia risk) with five search engines (Google, HotBot, AltaVista, Excite, and Yahoo). We used a published scoring system (NetScoring) to evaluate the first 15 sites identified by each of these 20 searches. We also used a simple four-point scale to assess the first 100 sites in the Google search on one of our four topics ('epidural analgesia risk'). In November 2006, we conducted a second evaluation, using three search engines (Google, AltaVista, and Yahoo) with 14 synonyms for 'epidural analgesia risk'. RESULTS: The five search engines performed similarly. NetScoring scores were lower for transfusion risk (P < 0.001). One or more high-quality sites was identified consistently among the first 15 sites in each search. Quality scored using the simple scale correlated closely with medical content and design by NetScoring and with the number of references (P < 0.05). Synonyms of 'epidural analgesia risk' yielded similar results. The quality of accessed information improved somewhat over the 11 month period with Yahoo and AltaVista, but declined with Google. CONCLUSIONS: The Internet is a valuable tool for obtaining medical information, but the quality of websites varies between different topics. A simple rating scale may facilitate the quality scoring on individual websites. Differences in precise search terms used for a given topic did not appear to affect the quality of the information obtained.

The PIP5K2A and RGS4 genes are differentially associated with deficit and non-deficit schizophrenia.

Several putative schizophrenia susceptibility genes have recently been reported, but it is not clear whether these genes are associated with schizophrenia in general or with specific disease subtypes. In a previous study, we found an association of the neuregulin 1 (NRG1) gene with non-deficit schizophrenia only. We now report an association study of four schizophrenia candidate genes in patients with and without deficit schizophrenia, which is characterized by severe and enduring negative symptoms. Single-nucleotide polymorphisms (SNPs) were genotyped in the DTNBP1 (dysbindin), G72/G30 and RGS4 genes, and the relatively unknown PIP5K2A gene, which is located in a region of linkage with both schizophrenia and bipolar disorder. The sample consisted of 273 Dutch schizophrenia patients, 146 of whom were diagnosed with deficit schizophrenia and 580 controls. The strongest evidence for association was found for the A-allele of SNP rs10828317 in the PIP5K2A gene, which was associated with both clinical subtypes (P = 0.0004 in the entire group; non-deficit P = 0.016, deficit P = 0.002). Interestingly, this SNP leads to a change in protein composition. In RGS4, the G-allele of the previously reported SNP RGS4-1 (single and as part of haplotypes with SNP RGS4-18) was associated with non-deficit schizophrenia (P = 0.03) but not with deficit schizophrenia (P = 0.79). SNPs in the DTNBP1 and G72/G30 genes were not significantly associated in any group. In conclusion, our data provide further evidence that specific genes may be involved in different schizophrenia subtypes and suggest that the PIP5K2A gene deserves further study as a general susceptibility gene for schizophrenia.

Functional analysis of the NPDC-1 gene.

Mouse NPDC-1 (Neural Proliferation Differentiation and Control-1) is specifically expressed in neural cells when they stop dividing and start to differentiate. The NPDC-1 protein has been shown to interact with the E2F1 transcription factor, D-type cyclins and Cdk2. Immunocytochemical studies and subcellular fractionation of rat brains disclosed a partial colocalization of NPDC-1 with synaptic vesicle proteins, suggesting additional functional interactions. Here, we report the characterization of the mouse and human genes that were found to display very similar structures. We mapped the human gene to chromosome 9q34.3. No obvious pathological defect has been previously linked to this region. In order to gain further insights into its function(s), we generated null mice for the NPDC-1 gene. We did not detect any macroscopic phenotypical defect. Analysis of the upstream sequence of the mouse NPDC-1 gene delineated two regions involved in its negative and positive transcriptional regulation. Evidence for the regulation of NPDC-1 by Krox family transcription factors is presented.

A murine model of Holt-Oram syndrome defines roles of the T-box transcription factor Tbx5 in cardiogenesis and disease.

Heterozygous Tbx5(del/+) mice were generated to study the mechanisms by which TBX5 haploinsufficiency causes cardiac and forelimb abnormalities seen in Holt-Oram syndrome. Tbx5 deficiency in homozygous mice (Tbx5(del/del)) decreased expression of multiple genes and caused severe hypoplasia of posterior domains in the developing heart. Surprisingly, Tbx5 haploinsufficiency also markedly decreased atrial natriuretic factor (ANF) and connexin 40 (cx40) transcription, implicating these as Tbx5 target genes and providing a mechanism by which 50% reduction of T-box transcription factors cause disease. Direct and cooperative transactivation of the ANF and cx40 promoters by Tbx5 and the homeodomain transcription factor Nkx2-5 was also demonstrated. These studies provide one potential explanation for Holt-Oram syndrome conduction system defects, suggest mechanisms for intrafamilial phenotypic variability, and account for related cardiac malformations caused by other transcription factor mutations.

Photodarkening and partial photobleaching: application to dichromated gelatin.

Photodarkening or partial photobleaching of photochromic solid media is described by means of an approximated analytical equation. The equation shows that the effective rate of the photochemical reaction is proportional to the square root of the final transmittance of the illuminated layer. The model is applied to describe the photodarkening of dichromated gelatin at 488 nm.