Background Altered γ‐aminobutyric acid signaling is believed to disrupt the excitation/inhibition balance in the striatum, which may account for the motor symptoms of Huntington's disease. Na‐K‐2Cl cotransporter‐1 is a key molecule that controls γ‐aminobutyric acid‐ergic signaling. However, the role of Na‐K‐2Cl cotransporter‐1 and efficacy of γ‐aminobutyric acid‐ergic transmission remain unknown in Huntington's disease. Methods We determined the levels of Na‐K‐2Cl cotransporter‐1 in brain tissue from Huntington's disease mice and patients by real‐time quantitative polymerase chain reaction, western blot, and immunocytochemistry. Gramicidin‐perforated patch‐clamp recordings were used to measure the Eγ‐aminobutyric acid in striatal brain slices. To inhibit Na‐K‐2Cl cotransporter‐1 activity, R6/2 mice were treated with an intraperitoneal injection of bumetanide or adeno‐associated virus‐mediated delivery of Na‐K‐2Cl cotransporter‐1 short‐hairpin RNA into the striatum. Motor behavior assays were employed. Results Expression of Na‐K‐2Cl cotransporter‐1 was elevated in the striatum of R6/2 and Hdh150Q/7Q mouse models. An increase in Na‐K‐2Cl cotransporter‐1 transcripts was also found in the caudate nucleus of Huntington's disease patients. Accordingly, a depolarizing shift of Eγ‐aminobutyric acid was detected in the striatum of R6/2 mice. Expression of the mutant huntingtin in astrocytes and neuroinflammation were necessary for enhanced expression of Na‐K‐2Cl cotransporter‐1 in HD mice. Notably, pharmacological or genetic inhibition of Na‐K‐2Cl cotransporter‐1 rescued the motor deficits of R6/2 mice. Conclusions Our findings demonstrate that aberrant γ‐aminobutyric acid‐ergic signaling and enhanced Na‐K‐2Cl cotransporter‐1 contribute to the pathogenesis of Huntington's disease and identify a new therapeutic target for the potential rescue of motor dysfunction in patients with Huntington's disease. © 2019 International Parkinson and Movement Disorder Society

About one‐third of admissions to the surgical unit annually are diabetes foot infections in need of amputation In St. Kitts and Nevis. However, the risk factors related to diabetes foot and amputation remain unknown. This study investigated factors associated with diabetic foot and amputation (DFA). Retrospective case control study design, and purposive and quota sampling method was used to recruit the participants. Patients with and without DFA were interviewed at two main hospitals, several primary health centres, and a private doctor's office during July and August 2018. Self‐development questionnaires were applied to assess patients' demographic, physical and behaviour, foot care knowledge, attitudes, and practices related to DFA. Chi‐square, t‐test, and multiple logistic regressions were used to analyse the data. A total of 210 patients were evaluated, 89 had DFA, while 121 did not, with a mean age of 61.10 (SD = 11.85). Participants' responses indicated good knowledge, favourable attitudes, and adequate practices related to foot care. The two items of the questionnaire, ways to maintain blood flow in the lower extremities and wash their feet daily, had significant lower score in DFA group. In multiple logistic regression, knowledge, attitudes, and practices related to foot care were not a significant predictor of DFA. Being male was a predictor of DFA than female (OR = 3.53; 95% CI = 1.65‐7.57; P < .01). Participants who were currently unemployed were less likely to have DFA than those who were employed (OR = 0.38; 95% Cl = 0.17‐0.86; P < .05). Comparing patients with the longest experience of diabetes mellitus (31 years or more) with those who had diabetes for the shortest period of time (between 1 and 10 years) was less likely to have DFA (OR = 0.38; 95% CI = 0.15‐0.97; P = <.05). The combination of these independent variables could explain 29% of the variance in DFA. Based on these findings, strategies to prevent diabetic foot and amputation should focus on male and outdoor heavy worker, and longer duration of diabetes patients which are identified in this study.

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The purpose of this study is to investigate the relationships among disease knowledge, self-efficacy, and quality of life in patients with hypertensive nephropathy. A cross-sectional and correlational design is employed in this study, and a total of 213 participants are collected by convenience sampling from the outpatient Department of Nephrology of a regional teaching hospital in Taiwan. The research instruments include the Hypertensive Nephropathy Knowledge Instrument, the Chronic Kidney Disease Self-Efficacy Instrument, and the Medical Outcome Study Short Form-12, and stepwise multiple regression analysis is used to test the explanatory power of each significantly-correlated independent variable regarding the quality of life. The results show that the higher the disease knowledge, the better the self-efficacy, and the better the quality of life, and self-efficacy is the most important predictor of the quality of life.