We have taken advantage of an acclimation phenomenon in a chilling-sensitive maize inbred to investigate the molecular, biochemical, and physiological responses to chilling in preemergent maize seedlings. Three-day-old seedlings were exposed to 4[deg]C for 7 days and did not survive chilling stress unless they were preexposed to 14[deg]C for 3 days. cDNAs representing three chilling acclimation-responsive (CAR) genes were isolated by subtraction hybridization and differential screening and found to be differentially expressed during acclimation. Identification of one of these CAR genes as cat3, which encodes the mitochondrial catalase3 isozyme, led us to hypothesize that chilling imposes oxidative stress in the seedlings. Hydrogen peroxide levels were elevated during both acclimation and chilling of nonacclimated seedlings. Further molecular and biochemical analyses indicated that whereas superoxide dismutase activity was not affected, the levels of cat3 transcripts and the activities of catalase3 and guaiacol peroxidase were elevated in mesocotyls during acclimation. Accumulation of H2O2 following a short treatment with aminotriazole, a catalase inhibitor, indicated that catalase3 seems to be an important H2O2-scavenging enzyme in the seedlings. Control 3-day-old seedlings pretreated with H2O2 or menadione, a superoxide-generating compound, at 27[deg]C induced chilling tolerance. Both of these chemical treatments also increased cat3 transcripts and catalase3 and guaiacol peroxidase activities. We suggest that peroxide has dual effects at low temperatures. During acclimation, its early accumulation signals the production of antioxidant enzymes such as catalase3 and guaiacol peroxidase. At 4[deg]C, in nonacclimated seedlings, it accumulates to damaging levels in the tissues due to low levels of these, and perhaps other, antioxidant enzymes.

Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. The United States Preventive Service Task Force (USPSTF) has developed criteria for prioritizing conditions of public health importance with the potential for providing screening recommendations to improve clinical care. The quality of existing evidence needed to inform clinical guidelines has not been previously reviewed. Using the National Library of Medicine (NLM) database PubMed, we first identified 18 peer reviewed articles that addressed co-occurring medical conditions in adults with DS. Those conditions discussed in over half of the articles were prioritized for further review. Second, we performed detailed literature searches on these specific conditions. To inform the search strategy and review process a series of key questions were formulated a priori. The quality of available evidence was then graded and knowledge gaps were identified. The number of participating adults and the design of clinical studies varied by condition and were often inadequate for answering all of our key questions. We provide data on thyroid disease, cervical spine disease, hearing impairment, overweight-obesity, sleep apnea, congenital heart disease, and osteopenia-osteoporosis. Minimal evidence demonstrates massive gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The development of evidence-based clinical guidance will require an expanded clinical knowledge-base in order to move forward.

; for the Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup IMPORTANCE Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients. OBJECTIVE To develop an evidence-based clinical practice guideline for adults with Down syndrome. EVIDENCE REVIEW The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE,

Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. Many of these conditions are of public health importance with the potential to develop screening recommendations to improve clinical care for this population. Our workgroup previously identified and prioritized co-occurring medical conditions in adults with DS. In this study, we again performed detailed literature searches on an additional six medical conditions of clinical importance. A series of key questions (KQ) were formulated a priori to guide the literature search strategy. Our KQs focused on disease prevalence, severity, risk-factors, methodologies for screening/evaluation, impact on morbidity, and potential costs/benefits. The available evidence was extracted, evaluated and graded on quality. The number of participants and the design of clinical studies varied by condition and were often inadequate for answering most of the KQ. Based upon our review, we provide a summary of the findings on hip dysplasia, menopause, acquired cardiac valve disease, type 2 diabetes mellitus, hematologic disorders, and dysphagia. Minimal evidence demonstrates significant gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The creation of evidence-based clinical guidance for this population will not be possible until these gaps are addressed.

Electroconvulsive therapy is geographically accessible for most Canadians. Even when geography is not a factor, however, there are significant barriers to access resulting from inadequate availability of qualified professional staff, treatment areas, and funding.