Duchenne Muscular Dystrophy

Duchenne muscular dystrophy is the most common muscular dystrophy with onset in childhood, affecting 1 in 3,300 male newborns, with a prevalence of 63 cases per 1 million.

The disease is genetically transmitted, recessive, X-linked, thus the disease is transmitted to male newborns by mothers who do not develop clinical signs of disease. A third of patients do not have positive family history of disease, suggesting that the disease also occurs by spontaneous mutations. Duchenne disease and Becker phenotype affects almost exclusively males, but Becker phenotype may�also rarely occur in women. Also, women with Turner syndrome or with uniparental disomy, or those having chromosome translocations between X chromosomes� and other autosomes may have a similar phenotype to Duchenne phenotype. Elevated levels of creatine phosphokinase meet two thirds of� carrier women, of which most are clinically asymptomatic.

Duchenne muscular dystrophy was first described by Charles Bell in 1830, but Duchenne in 1868 is the one who established diagnostic criteria that are valid today:

• Weakness with onset in the legs;
• Hyperlordosis with wide-based gait;
• Hypertrophy of weak muscles;
• Progressive course over time;
• Reduced muscle contractility on electrical stimulation in advanced stages of the disease;
• Absence of bladder or bowel dysfunction, sensory disturbance, or febrile illness.

Gowers in 1886 concluded the genetic basis of disease, and in 1986 Kunkel identified dystrophin gene mutations that are responsible for disease development. Although remarkable progress has been made in understanding the molecular substrate of the disease, Duchenne muscular dystrophy remains an incurable disease with 100% mortality.

Duchenne Muscular Dystrophy Causes

Duchenne muscular dystrophy is caused by mutations or deletions that destroy large areas or critical segments of the dystrophin gene, causing Duchenne phenotype.

Dystrophin is a protein that is playing� an integral role in the sarcolemma stability (cell membrane of the muscle cell). Dystrophin is associated with transmembrane proteins such as glycoproteins called sracoglycan and dystroglycan forming dystroglycan complex.

Duchenne Muscular Dystrophy – Dystrphin Gene

Muscle fiber integrity is compromised when dystrophin is absent or has apathological structure. Loss of dystrophin function initiates a cascade of events with loss of sarcolemma integrity, and it leads to calcium influx, oxidative cell injury and ultimately myonecrosis (death of muscle fibers). As the disease progresses and destroyed muscle fibers are removed by macrophages, fatty and connective tissue will fill the empty spaces and muscle pseudohypertrophy will appear.

Duchenne Muscular Dystrophy Symptoms

The disease onset is in childhood between the�age of 1 year and 5 years, but the first manifestations of disease occur at age 3-4 years, when is observed that the child is clumsy, hardly rises, waddling gait, manifestation that can be the first sign noticed. Some children start walking much later. Gowers sign is described as characteristic: the child uses hands to rise from the floor, bend its trunk, leans with hands on knees, climbing himself, due to lumbar and proximal extremity muscles weakness. At the aged of 4 or 5 years, the child present difficulties to climb on a chair, to climb stairs or to keep standing, compared with other children of his age.

On physical examination is observed lumbar lordosis, wide-based gait, modification that are occurring due to lobar aand pelvic muscles atrophy, paraspinal and abdominal muscles atrophy is leading to a lordotic posture with prominent abdomen. Muscular atrophy that is affecting proximal muscles is symmetrical and bilateral.

Duchenne Muscular Dystrophy – Gowers Sign

Another characteristic of the disease is represented by pseudohypertrophy in certain muscle groups by replacing contractile tissue with hyperplastic connective or fat tissue. False hypertrophy occurring even in early stages of the disease, muscles having a diminished force. Calf hypertrophy typically occurs due to replacement of muscle tissue with fat and connective tissue.

Atrophies and muscle weakness are progressive and are affecting proximal lumbar-pelvic belt, neck extensors muscles, shoulders and arms muscles. In general, neck flexors, wrist extensors, quadriceps, anterior tibial muscle, biceps and triceps are more affected than the neck extensors, arm flexors, deltoid and gastrocnemius.

Tendon reflexes diminish progressively as the muscles became weake. Idio-muscular reflexes diminish early and then disappear. In time, at the age of 10 years are present muscle contractures, tendon retractions with vicious limb position, the patient is immobilized in a wheelchair.

Asymmetric damage of paraspinal muscle causes cifoscoliosis that affect lung function. Respiratory muscle strength begins to decline around the age of 8 years, cough efforts lead to pulmonary atelectasis and favor respiratory infection. Vital capacity decreases gradually and lead to hypoxemia characterized by morning headache and lethargy. There appears no sensitivity problems and muscle fasciculations.

Duchenne Muscular Dystrophy

Dystrophin, the protein whose gene is affected, is also found in heart and brain. The children is mentally retarded and cardiac fibrosis is leading to heart failure and lung congestion, changes in the electrocardiogram and fatal arrhythmias.

Respiratory and cardiac muscles are often affected, respiratory failure or cardiac decompensation are common causes of death in these patients. Usually, these children can not climb stairs around the age of 8-10 years and are immobilized in a wheelchair by the age of 10-12 years. Death often occurs in adolescence before the age of 20 years or between 25 and 30 years.

Palpitations

According to a study recently published in European Journal of Preventive Cardiology, palpitations�or atrial extrasystoles�are the main risk factor for atrial fibrillation. Results of a large cohort study show that the most important risk factor for atrial fibrillation installation for both women and men are palpitations and they are most often caused by�lifestyle. The study is the first of its kind to investigate the role of palpitations in the setting of atrial fibrillation.

The study had a sample of 22,815 people recruited from Norway during 1994-1995.�The follow up period was about 11 years and the mean age was 46 years. Patient data such as height, weight, heart rate, blood pressure, total cholesterol and LDL cholesterol were collected and statistical analysis found that atrial fibrillation occurred in 3% of women and 4.2% of men during the follow-up�(11 years). Researchers have also�found that age, palpitations and hypertension are leading risk factors for atrial fibrillation installation.

Palpitations

Atrial fibrillation is the most common cardiac arrhythmia and a major risk factor for heart failure. Basically during�atrial fibrillation�the normal�atrial systole�disappears and atria no longer contract properly. Important to note�is that atrial fibrillation is an irregular�arrhythmia�and�different�from�atrial flutter. If atrial fibrillation�is newly installed, chemical or electrical cardioversion�to normal rhythm�is indicated in the absence of contraindications. However, if the patient can not�be converted to sinus rhythm, he�should follow chronic treatment. One of the�most common drugs�used�in atrial fibrillation is digoxin�in order�to control heart rate. In addition, due to the disappearance of atrial systole, the�blood forms clots. It is therefore recommended that patients with atrial fibrillation take oral anticoagulants chronically�under INR measurement.

During their study,�researchers looked for risk factors for heart palpitations and have found that lifestyle is a major�risk factor. Instead the most important risk factors for atrial fibrillation were biological ones, such as age, weight, diabetes, blood pressure, body mass index. However, the first author Dr Audhild�Nyrnes�from the Department of Community Medicine, University of Tromsø, Norway, said that: “Although the occurrence of palpitations was assessed before a diagnosis of AF and the association remained significant even after adjustment for other AF risk factors, we cannot conclude with certainty that the association is causal.” He added that between the two conditions (palpitations and atrial fibrillation) may be a causal relationship since the palpitations are often described as an irregular��heart rate. Researchers also noted that palpitations are harmless�when are associated with lifestyle�( alcohol, smoking)�lifestyle habits�that can be adjusted.

Study Reveals New Tubal Ectopic Pregnancy Diagnosis Method

According to a study�due to be published in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM), dosage of adrenomedullin�(ADM)��hormone can help diagnose ectopic pregnancy.

Ectopic Pregnancy

Ectopic�pregnancy refers to abnormal embryo implantation elsewhere than the uterus. After the egg is fertilized by the sperm and the embryo is formed, a process takes place in the third side of the fallopian tube,�the embryo�moves with cilia along the tube to the uterus where it implants. In some cases, when the fallopian tube is abnormal or when the cilia is not working properly,the embryo�implants into the fallopian tube. The embryo begins to grow but can not develop properly. In severe cases, the fallopian tube can perforate which triggers a major hemorrhage. Moreover, ectopic tubal pregnancy is a leading cause of death in the first trimester of pregnancy.

Ectopic Pregnancy

Tubal ectopic�pregnancy has several possible causes. One of them is pelvic inflammatory disease, which can create retractions or acceding to the fallopian tube due to inflammation. Another cause can be represented by�endometriosis�which can also cause scar tissue around or inside the fallopian tube. Intrauterine devices, smoking, exposure to certain�substances can also cause tubal ectopic pregnancy.

Recently, researchers have found�a way to�predict a tubal ectopic�pregnancy by dosing�a hormone called adrenomedullin�(ADM). It seems that expression of this hormone is directly proportional to the degree of movement of the cilia of the fallopian tube. A slower movement of the cilia is correlated with slow embryo transport and more likely to implantation in the fallopian tube. The lead author of this study, Wai-Sum�O, PhD, of the University of Hong Kong, said: “This is the first report to address the effect of ADM on cilia beat frequency and muscle contraction in the oviduct.”

Researchers�performed an experiment and�harvested�samples of�fallopian tube tissue from women who�underwent hysterectomies�or were having their fallopian tubes removed�due to�different causes. Fallopian tube tissue was incubated in optimal conditions so as to mimic the hormonal status of a pregnant woman. It was found that the fallopian tubes of women who had tubal ectopic�cilia moved more slowly. Also, adrenomedullin� (ADM) hormone was found in low amounts in�tubal ectopic�pregnancy�.�The interesting fact was�that by administering adrenomedullin hormone,�cilia began to regain�their normal mobility. This demonstrates the role that this hormone�play in diagnosing�tubal ectopic pregnancy.

Vitamin D Keeps Viruses Away During Winter, Research Finds

There has been much debate in the medical world lately regarding the role of vitamin D in the body. It seems that vitamin D plays a role not only in bone growth, but also an important role in immunity and antitumoral�protection. According to a study published in the Journal of leukocytic Biology, vitamin D seems to also�protect against viral infections�during winter.

Viral infection

Vitamin D3, or cholecalciferol, is produced in the�skin�from 7 dehydrocholesterol�under ultraviolet rays. So, during�in winter, vitamin D synthesis in the�skin is low. 7 dehydrocholesterol�is then transformed into cholecalciferol� by a non-enzymatic reaction, under the influence of UVB. Colecalciferol�is then converted�in the liver in 25 hydroxy cholecalciferol�(circulating vitamin D), with poor biological activity. From the�liver, it�is then transported to the kidneys where 25 hydroxy cholecalciferol�is converted into 1, 25 dihydroxy�cholecalciferol. The latter has the highest biological activity and is considered a hormone with a role in regulating calcium metabolism.

Vitamin D has several roles in the body. In the intestine increases calcium absorption and phosphate by stimulating the synthesis of transport proteins. In the bone, it maintains calcium-phosphate balance and promotes bone formation by stimulating osteoclast�bone resorption. It is a well-known�fact vitamin D deficit causes osteoporosis or osteomalacia. Moreover, it has recently been discussed the role of vitamin D in immunity and the possible role of this vitamin in cancer treatment. Furthermore, vitamin D deficiency is considered a risk factor for tuberculosis.

Victor Manuel Martinez-Taboada, MD, a researcher involved in the work from the Division of Rheumatology�at the Hospital Universitario�notes that vitamin D is extremely important for human health. He also added that supplements vitamin D can be useful when conventional treatments fail.

According to the study published in the Journal of leukocytic�Biology, supplements of vitamin D protect against viral infections�during winter. The researchers measured blood levels of vitamin D in individuals that have divided into 3 categories according to age.� What they found was�that��the vitamin decreases with aging. They also have observed that low levels of vitamin�D is correlated with low levels of TLR, toll like receptor, especially TLR 7, a molecule found on the surface of lymphocytes and leukocytes. These molecules have a role in antiviral protection. Therefore, vitamin D should be supplemented�during winter. However, further studies�must be performed in order�to check whether vitamin D deficiency is indeed associated with low immunity�during the�winter months.

Stroke Risk High In Patients Off Anticoagulant Therapy

New research shows that patients who discontinue their�anticoagulant medication�are�at increased risk of stroke within a month. Anticoagulant medication is�generally prescribed�to patients who�suffer from�heart disease such as atrial fibrillation or patients after myocardial infarction. There are several classes of anticoagulants: heparin and heparin derivatives, fondaparinux, bivalirudin�and inhibitor receptors of glycoprotein IIb�/ IIIa�(abciximab, epifibatide).

Anticoagulant medication has many side effects, the most important being bleeding. Therefore, treatment should be adjusted depending on the patient. Also, careful monitoring of patients is necessary to adjust dosage. Another drawback is the intravenous administration or subcutaneous route. For example, high molecular weight heparin should be administered intravenously because bioavailability is small and has a short duration of action. For patients with chronic treatment, such as those with atrial fibrillation�oral anticoagulants are used. These are drugs (acenocoumarol, warfarin) that inhibit synthesis of vitamin K dependent clotting factors. Also,�patient monitoring is required monthly by measuring the INR (International Normalised Ratio).

Anticoagulants

Anticoagulants work by blood clot dissolution. How they handle the clotting factors�differs depending on product. Heparin, for example, acts on factor Xa�only when coupled with antithrombin III. Bivalirudin�lyses�the clot directly, without�its action to be conditioned by prior binding of antithrombin III.
Due to the high risk of bleeding, anticoagulant medication should be discontinued before surgery. Manesh Patel, MD, lead author and assistant professor of medicine at the Duke University School of Medicine, said: “Unfortunately, it’s unclear how to provide optimal anti-coagulation coverage during periods of transition”.

Recent studies (clinical trial known as ROCKET AF) showed that rivaroxaban�is as effective as warfarin for prevention of embolism. In a study of 14,000 patients, it was found that rivaroxaban, a direct factor Xa�inhibitor, can prevent stroke and blood clots as effective as warfarin. Therefore, rivaroxaban�was approved by the FDA in 2011 for prophylaxis of deep venous thrombosis in patients undergoing hip and knee replacement surgery and �in patients with atrial fibrillation for stroke prevention. Rivaroxaban has the advantage of allowing predictable anticoagulation, so no need for coagulation monitoring.

However, there were doubts about the increased risk of stroke after stopping anticoagulation with rivaroxaban. It was found however that the risk of stroke and blood clots�after rivaroxaban�use�is the same�as for warfarin.�In case of�temporal interruption of medication, the risks were similar (25.60/100 for rivaroxaban�and 23.38/100 patient for warfarin). The risk was greater�in�the case of�transition from�rivaroxaban to open label therapy, but was observed only for stroke.

Urinary Tract Infection

Urinary tract infections are caused by bacteria and are up to 10 times more common in women than in men. Over 50% of�all women will suffer at least from�one episode of�UTI in their lifetime and often medical advice�and treatment instituted with antibiotics will be needed. Approximately�in 30-40% of patients that�suffered from urinary tract infections,�the infection�comes back, because it seems that the treatments�are useful�in the first phase but their effect�is not a�long-lasting one. Urinary tract infections can also�recur when a woman is infected again with other bacteria.

Signs And Symptoms Of Urinary Tract Infection

The main manifestations of UTIs are:

• Pain or burning during urination
• Need to urinate more often than usual
• Blood or pus present in urine
• Cramps or pain in lower abdomen
• Chills or fever
• Strong smell of urine
• Pain during intercourse
• Nausea, vomiting and malaise.

Urinary Tract Infection�Risk Factors

• A new sexual partner or multiple sex partners
• Frequent or intense intercourse
• Diabetes
• Pregnancy
• Presence of bacteria E. coli
• Saprophytic�staph infection
• Use of irritating products
• Use of irritating contraceptives, diaphragms and spermicides
• Use�of birth control pills
• Use powerful antibiotics
• A blockage in the urinary tract (due to benign or malignant)
• A history of urinary tract infections, which occurred in a period less than six months. Symptoms may include urinary tract infections and frequent painful urination, fever, chills, abdominal pain and itching. Fortunately, there are practical measures that can be taken to avoid these infections.

Urinary Tract Infection Risk Factors

Urinary tract infections – According to experts, a urinary tract infection occurs more frequently in women. It is believed that about 20% of them have suffered or will suffer a urinary tract infection during their lifetime and of these about in��80%, the infection will be repeated in less than a year. Men may suffer from urinary tract infections but these are often related to obstruction caused by�an enlarged prostate.

Why women are prone to urinary tract infections? The reason is the�female anatomy. Women have a�shorter urethra which means that bacteria get into the urethra easier. In addition, pregnant women are hormonal changes that contribute to a higher incidence of urinary tract infections. Women using a diaphragm, have a higher risk than other women to suffer from urinary tract infections. Regardless of gender, anyone who uses a urinary catheter for a long period of time, whose immune system has recorded changes or kidney stones can block urine flow is a major risk factor for cystitis and other urinary tract infections .

Kidney infection – Elderly people and those with weakened immune systems are particularly sensitive to the appearance of pyelonephritis, so are those who suffer from recurrent urinary tract infections or�present a�history of obstructed urinary tract, such as kidney stones.

Common Symptoms Of Digestive Disorders

Below you can find a list of common digestive disorders symptoms that may point out a suffering of the digestive�tract but it is not a general rule. Please do not hesitate and�contact your doctor if you notice any of these digestive�symptoms.

Inappetence

Inappetence is defined as�poor appetite.�Please note that it is not�the same thing�as food avoidance due to abdominal pain! Can be determined by most digestive diseases, but also occurs during�infectious diseases, heart, kidney or nervous system diseases. Other appetite disorders are:

• Anorexia or�complete lack of appetite, can appear�for all foods�or can be selective (traditional aversion to meat in digestive cancers). Anorexia may be true (due to illness) or false (mental illness). Anorexia nervosa is a mental disorder�of the patient (usually occurs in women)� restrict their food intake more in need, their causes vomiting or using laxatives to remove food intake, with a distorted perception of their body. The opposite of anorexia is hiperorexia, meaning overgrowth occurs in appetite and digestive diseases such as parasites, diabetes, hyperthyroidism, peptic ulcer.
• Bulimia�translates into�food intake in large amounts that exceed the body needs in a short time followed by remorse and then vomit or taking laxatives to remove food intake. It is also a nervous disease.

Fever

Fever�occurs�at more than 37 degrees Celsius and�must be�measured when you feel�the patient feel he�has a�fever or chills (shaking) because�the doctor�can�make use of this kind of information.�Fever value of�38 degrees Celsius�is called low-grade fever and�occurs in�acute hepatitis or during an acutization episode of chronic hepatitis,�inflammatory bowel disease but also in digestive cancers. When the temperature exceeds 38 degrees Celsius it is�typically associated�with chills,�and occurs in digestive infectious diseases such as appendicitis, cholecystitis, angiocolitis, acute pancreatitis.

Weight loss

Weight loss in order to have a pathological�meaning, must be at least 10 kg in 6 months or more pounds quickly, in the absence of a weight loss diet�or program. However, weight loss (not so pronounced) occurs�during prolonged fever, diarrhea, vomiting of various causes.

Abdominal Pain

According to the abdomen region�where it is located and radiating areas, corresponds to a sick organ. The doctor can be�helped very�much if you�pay attention to pain duration, if�it resembles a�cramp or�has a�continuous nature, it�occurs during the�day or night,�occurs after meals or before meals and what kind of food triggers it, if�it stops�after you eat or take a gastric dressing.

Abdomina Pain

Pain behind the breastbone�when�swallowing (odynophagia) is caused by esophageal motor disorders, an ulcer or esophageal cancer. If it perceived as�a burn it is most likely�the consequence of gastro-oesophageal reflux disease�but�angina pectoris�can be manifested�in the same way.

Chest pain (epigastric) can occur in case of�hiatal hernia, gastric, colon, pancreas or gallbladder diseases. Generally, if the patient is bloated and pain�is relieved�after stool emission�or flatulence, the colon is responsible.�If the pain�is relieved�after food intake and gastric dressings,�it is generally�caused by�the stomach. Typically, biliary colic pain�appears right below the ribs, but may begin in the epigastrium, but the association with fever, nausea, bilious vomiting�makes the�diagnosis clearer. Pancreatic pain�occurs after�fat and alcohol abuse and radiates into the spinal colum.

Pain right below the ribs�(right hypochondrium) is usually characteristic�for the�gallbladder, especially if the�pain radiates in the right shoulder. In other cases it can be caused by pleurisy, pneumonia�of the right lung, colon cancer, irritable bowel or kidney disease. In addition, sometimes it is�the�case of�pain caused by a�herniated disc or intercostal neuralgia, which�makes very difficult�to detect exactly where�the pain�originates and where it radiates.

Pain around the navel�(the area around the navel) occurs in IBS�and infectious enteritis.

Pain in the�left part of th�abdomen below the ribs�may be due�gas�accumulated in the left colon, irritable bowel syndrome but also tumors of the colon splenic angle, diseases of the spleen, left kidney, left lung and pleura.

Pain�felt below the navel, above the pubis�(hypogastrium) is produced either by the�small intestine or colon chances (or irritable bowel disease) or gynecological, prostate or bladder problems. Sometimes pain can occur as a knife or lightning inside�the rectum�(proctalgia), the manifestation of irritable bowel and rectum cancer.

Soda Consumption Linked To Higher Stroke Risk

Researchers at the Cleveland Clinic’s Wellness Institute and Harvard University, have made new discoveries on the effects�that soda consumption has�on the human�body. It seems that increased consumption of sweetened beverages increases the risk of stroke. Unlike soda, coffee is associated with a decreased risk of stroke because it contains antioxidants (magnesium, chlorogenic acid). The fact that soda has many harmful effects�on the body is already a well-known�fact. In fact, cola has no benefit�to offer�for�the body, because it is energy dense and low nutritional . It is not a new thing that soda and sweetened drinks cause weight gain and can�even�lead to�obesity by high caloric intake.

soda can

Adam Bernstein, MD, Sc.D., study author and Research Director at the Cleveland Clinic’s Wellness Institute, says that soda remains the leading source of added sugar in our diet. Moreover, weight gain is itself a factor for other cardiovascular disorders. In addition, some light drinks are sweetened with fructose corn syrup� which is more obesogenic and� has even more harmful effects for�vessels and heart. Although they have fewer calories, it seems that light drinks can also�lead to weight gain.�Due to the excess sugar�that it contains, soda may contribute to diabetes�as the pancreas is overloaded.

Apart from that, soda can cause hypertension, hypercholesterolemia, gout, etc.. Dr. Bernstein notes that in the last three decades in U.S. soda consumption has increased dramatically and this has important effects on our health. Other harmful effects of soda are related to the�caffeine it contains, which may cause sleeplessness, tremors and palpitations. Also, soda has a demineralization effect on�teeth due to the�acid pH.

The study, published recently in the American Journal of Clinical Nutrition, is the first to analyze the link between soda consumption�and stroke risk. The study involved 43,371 men and 84,085 women who were followed over a period of nearly 20 years. The researchers found that during the study, nearly 3,000 women and 1,500 men died�after a�stroke diagnosis. Interesting to note is that the�stoke risk was higher in women than men. Stroke occurs due to the effects of hyperglycemia that induces atherosclerosis. Due to the excess sugar in the blood , soda initially causes a hypersecretion of insulin,�which eventually leads�to insulin resistance. All these changes indicate the gradual formation of atherosclerosis� that contribute to�the stroke episode. Researchers also�found that people who drank regular soda also�had�a generally�unhealthy lifestyle with a diet based on fatty foods and red meat.

New Treatment Scheme For Crohn’s Disease

New research shows that Crohn’s disease�patients treated early with biological therapy respond better to treatment and�lesser�need surgery . Crohn’s�disease, or terminal ileitis, is an incurable disease, inflammatory, which can occur anywhere along the digestive tract. Unlike other inflammatory diseases, Crohn’s�disease can affect only segments of the digestive tract and�can be a starting point for adenocarcinoma. Specific for Crohn’s disease is�its transmural nature�and�forming of�granulomas. Clinically, this disease is characterized by fever, abdominal pain, weight loss. There may be complications such as fistulae, abscesses, anal and perianal, toxic megacolon. The cause of this disease is not fully known, although it was associated with other diseases, such as erythema nodosum, arthritis, uveitis, pyoderma�gangrenosum.

Crohn’s Disease

Currently�Crohn’s�disease treatment consists of oral aminosalicylates�or 5-ASA acid derivatives, corticosteroids, immunosuppressive or immunomodulatory agents and antimicrobial agents. In mild or moderate disease,�the combination of aminosalicylates�with metronidazole�is recommended.�When the disease is moderate, �the treatment consists of glucocorticoid�therapy�associated with azathioprine�and in severe forms corticosteroid with cyclosporine is recommended. Therefore, treatment is graded according to severity of disease. Even if patients respond to treatment at a rate of 40-50%, most are operated�due�to complications like�intestinal obstruction or fistula.

Dr. David Rubin, MD, associate professor of medicine and co-director of the University of Chicago’s Medicine inflammatory Bowel Disease Center, tried a new strategy to treat Crohn’s�disease and�reversed the order of treatment. He added that drugs used for Crohn’s�early stages, ie aminosalicylates�acid are�not always effective and risk multiple side effects. Furthermore, steroids are ineffective on the�long-term and have adverse effects� such as �infections. According to Dr. Rubin, doctors hesitate to prescribe immunosuppressant medication�because on the one hand,�it is more expensive, and on the�other hand�, they believe that�immunosuppression therapy�(prescribed generally last in Crohn’s disease) is dangerous. Moreover, he adds, the more are introduced later,� the side effects will be worse because the digestive tract is too damaged to respond as it should�to treatment.

Dr. Rubin and his colleagues analyzed during the study three groups of patients: those treated with step-up therapy (started treatment with aminosalicylates, or corticosteroids) those�on immunosuppressive therapy before anti-TNF�and those treated the first with�anti-TNF. It was found that those treated early with anti-TNF�had a better response to treatment and the need for surgery was low. “This is the first time we did the large assessment of the top-down strategy using early-TNF claims databases,” Rubin said.

Brain Activity During NREM Sleep

A study�conducted by scientists�at the�Cyclotron Research Centre at the University of Liège, in Liège, Belgium, and the�Institut�National de la Santé�et de la Recherche�Médicale�at the Université�Pierre et Marie Curie in Paris, and the Functional Neuroimaging�Unit at theMontreal�Geriatrics�Institute investigated NREM sleep (non-rapid eye movement). Scientists wanted to show that the brain’s activity is composed of many biological modules during this period of the sleep.�Using�functional clustering�(assigning a set of objects into groups and determining the hierarchical�organisation between them)�they found that hierarchically organized�large-scale neural networks were disaggregated into smaller independent modules while a person is in the NREM sleep, and this can reduce the brain’s ability to integrate information. This determines a lower level of consciousness than that found in REM sleep.

Sleeping Man

During the research, the team had to face the challenge that untill nowadays there is no�clue�regarding what�consciousness really is.��Pierre�Maquet, lead�researcher at the Cyclotron Research Centre and Habib�Benali�at the�Institut�National de la�Santé�et de la�Recherche�Médicale�explains:�For many years,�Giulio Tononi�put forward the hypothesis that consciousness is related to the ability of the brain to integrate information. Our objective was simply to test this hypothesis.” Using novel tools that allowed the computation of information exchange within the brain, along with EEG and fMRI, they compared data recorded in the same individuals during wakefulness and deep NREM sleep which is associated to the most reduced level of consciousness found in normal �brain activity. Their findings could help science have a better understanding of the concept consciousness.

The results of the study�revealed�that the amount of information exchanged in the brain actually increases during sleep, but what differs from the awake-state are the patterns of exchange between different regions. “Essentially, there was an increased information exchange within small clusters of mainly homologous brain areas whereas communication between clusters significantly decreased during sleep,� explains Maquet.

The team’s approach to studying the brain activity was functional clustering, which by its nature does not focus on the total�integration in neural network analysis. This arises an important question, sais�Maquet:��We don’t know what is the�information�exchanged within clusters, and I don’t see any technique that could currently answer this question in humans. More generally it is thought that NREM sleep is regulated by the homeostasis of synaptic strength, and perhaps by neuronal energy metabolism.�