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Medical Sciences

Salvage of hemodialysis catheter in Staphylococccal bacteremia, case series and revisiting the literature

Author: Wasim S. El Nekidy, Derrick Soong, Albert Kadri, Amina Ibrahim, Islam M. Ghazi

Manuscript ID: JNSCI#17-0919


Central venous catheters are widely used to administer medications, provide parenteral nutrition, perform hemodynamic monitoring and carry out hemodialysis (HD). Catheter related blood stream infections are a major complication in hemodialysis patients, leading to increased mortality, morbidity and cost of treatment. Prompt treatment is essential which includes administration of appropriate systemic antibiotics and frequently, catheter removal and replacement. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Thus, minimizing vascular trauma in this patient population is of paramount concern. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species.

We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials evaluating risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma.



Brain and Behavioral Assessment of Executive Functions for Coordinating Levels of Language in Reading Brain

Author: Virginia W. Berninger, Todd L. Richards, and Robert D Abbott

Manuscript ID: JNSCI#17-0908


This brief research report extends prior fMRI connectivity research that had identified brain regions showing common and unique connectivity between cascading adjacent subword, word, syntax, and text levels of language for reading. The research aim was to investigate executive functions for coordinating the multiple levels of language in the reading brain.  First,  brain regions were identified that are (a) unique to each level of language in contrasts between adjacent levels of language on fMRI reading tasks, and (b) contain regions involved in executive functions. Then these brain regions were correlated with clinical neuropsychological measures of executive functions—inhibition/focused attention and flexibility/switching attention for each of six contrasts in levels of language (subword versus two kinds of word level, two kinds of word level versus syntax, and two kinds of syntax versus text).  Delis-Kaplan Inhibition was significantly correlated for left inferior frontal seed with left cingulum for syntax with and without word-specific spelling homonym foils versus word-specific spelling judgments. Wolf and Denckla Rapid Automatic Switching (RAS) was significantly correlated for left supramarginal with left and right cerebellum V on grapheme-phoneme correspondences contrasted with word-specific spelling; left precuneus with right cerebellum V on word-specific spelling contrasted with syntax; left precuneus  with right cerebellum V on word-specific spelling contrasted with syntax; left supramarginal with right cerebellum V on syntax  contrasted with multi-sentence text; and left precuneus with right cerebellum V on syntax contrasted with multi-sentence text. Implications of results are discussed for the role of supervisory attention (focused and switching) in self-regulating  coordination of multiple levels of language in the reading system and other research on the mental self-government of the complex reading brain.


Medical Sciences

Differences Between the Time Course of Changes in Neuromuscular Responses and Pretest versus Posttest Measurements for the Examination of Fatigue

Author: Cory M. Smith, Terry J. Housh, Ethan C. Hill, Kristen C. Cochrane, Nathaniel D.M. Jenkins,Richard J. Schmidt, Glen O. Johnson

Manuscript ID: JNSCI#17-0830


Introduction: The purpose of the current study was to examine the differences between the neuromuscular responses during the time course of changes in neuromuscular responses and pretest versus posttest measurements and to differentiate the information provided by these two methods regarding the motor unit activation strategies used to control force production during the process of fatigue.

Methods: Twelve men performed concentric-only dynamic constant external resistance leg extensions to failure at 70% 1 repetition maximum (1-RM) and 1-RM measurements were taken before and after the fatiguing workbout.

Results: The results indicated decreases in pretest versus posttest 1-RM strength and electromyographic (EMG) frequency, but no changes in EMG amplitude, mechanomyographic (MMG) amplitude, or MMG frequency. The time course of changes in neuromuscular responses during the 70% 1-RM protocol indicated 4 unique phases (1 to 20, 20-60, 60-80, and 80-100% of the repetitions to failure) that generally exhibited increases in EMG amplitude and MMG amplitude, but decreases in EMG frequency and MMG frequency.

Discussion: These findings indicated that maximal pretest versus posttest measurements and the time course of changes in neuromuscular responses provide different information regarding the process of fatigue which may explain the reduction in maximal and submaximal force production.



Angiogenesis and Anti-tumor Immunity in the Tumor Microenvironment: Opportunities for Synergism in Intervention

Author: Christopher Lemmon, Ibrahim Sadek, Zhonglin Hao

Manuscript ID: JNSCI#17-0623


Success of angiogenesis inhibition has met with resurgence of immunomodulation in treatment of metastatic carcinomas. While each of these is effective in some cases, the response rates are low, and resistance soon emerges to single agent treatment. Will combination of the two improve response rate and duration of response through synergy? In addition to blocking neovascular formation, angiogenesis inhibitors (AI) help deliver more effective cytotoxic T lymphocytes to the tumor by improving vascular perfusion. Recent studies also showed that AI not only increased the efficacy of effector immune element but also decreased the number and function of suppressor immune cells such as T-regulatory cells, myeloid-derived suppressor cells or tumor-associated macrophages. In this review, we focus on AI and their effects on antitumor immunity in the tumor microenvironment and their potentials in boosting the efficacy of immunotherapy. In the clinical arena, trials are at the early stage to gauge the feasibility and preliminary signs of synergy.

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