F2 females derived from the LG/J × SM/J intercross also show an a

F2 females derived from the LG/J × SM/J intercross also show an association between Peg3 genotype and maternal performance, thus increasing the likelihood of the participation of this gene in maternal behavior. Peg3 has a high level of sequence similarity

between mice and humans (Kim et al. 1997, 2000), is also imprinted in humans (Murphy et al. 2001), and has a similar protein expression pattern in the brains of both species (Kim et al. 1997), suggesting Inhibitors,research,lifescience,medical conserved functions. Thus, our results further implicate this paternally expressed, maternally imprinted gene in inappropriate maternal behavior. These data also support future studies to investigate human variants and to study associations between Peg3 and nurturing dysfunctions. Acknowledgments We thank R. de Brito and I. Sobrinho Jr for comments and I. M. Watanabe for help in analyzing the results

of the FS test. This study was supported by grants from the Sao Paolo State Inhibitors,research,lifescience,medical Foundation for Research Support (FAPESP: 09/01333–8 to S. C. and 04/14583–9 and 05/56353–2 to A. C. P.). B. S. and G. A. were recipients of FAPESP and CAPES master’s fellowship, respectively. S. C. is a research scholar of CNPq-Brazil.
Stressful events early in life have been widely linked to behavioral phenotypes and have been implicated in the development of psychiatric disorders (Heim and Nemeroff 2001; Inhibitors,research,lifescience,medical Gilman et al. 2003). For instance, early life adversity appears to play a major role in the etiology of depression (Gillespie et al. 2005), and hormones involved in the stress response, including corticotrophin-releasing hormone (CRH) and cortisol, have been shown to be elevated in depressed individuals (Gibbons and Mchugh 1962; Merali et al. 2004). Clearly, Inhibitors,research,lifescience,medical not everyone experiencing stress early in life becomes depressed and it has been suggested Inhibitors,research,lifescience,medical that genetic factors influence susceptibility or resilience to the adverse effects of early life stress (Caspi et al. 2003; Heim et al. 2008). Mounting evidence suggests that these gene–environment interactions

(G × E) may be mediated by epigenetic mechanisms Org 27569 operating at the interface between the genome and the environment (GSK J4 Dolinoy et al. 2007). Changes in DNA methylation following early life stress have been associated with long-term changes in gene expression and behavior (Champagne and Curley 2009) and may contribute to psychiatric disorders (Rutten and Mill 2009) and physiological disturbances (Gluckman et al. 2007) later in life. Recent research using rodent models provides direct evidence for the role of early life stress on the epigenome. Weaver et al. (2004) observed that poor maternal care in rats alters DNA methylation at a specific sequence motif upstream of the glucocorticoid receptor gene (Nr3c1) in the hippocampus of the offspring, directly affecting transcription and subsequent stress responses in adulthood.

Additional physiotherapy reduced the rate of falls and supplement

Additional physiotherapy reduced the rate of falls and supplementation with high dose vitamin D3 therapy reduced the rate of hospital readmission. These two interventions may be useful together as they address two distinct but important complications after hip facture. Hip fractures are predicted to increase

in incidence by 36% by 2051 in Australia (Sanders et al 1999). Studies aiming to improve outcomes in this group with effective and relatively low cost interventions have potentially substantial impact for the individual, their family, and costs to the health system. This study is a valuable addition to the limited evidence regarding effective interventions in reducing falls or improving associated outcomes in this high selleck risk group. Importantly, this study adds to the substantial evidence available that inhibitors exercise programs can reduce falls in at-risk older people, although few of these studies have investigated high risk clinical groups such as patients with hip fracture or stroke. The 25% reduction in falls, and a non-significant although substantial reduction in hospitalisations, and Z VAD FMK hip fracture-related hospitalisations are impressive outcomes. One critical element for physiotherapists is the content of the exercise program (Hill and Williams 2009), particularly given the findings of a recent meta-analysis that a critical element

of successful fall prevention exercise programs is that they incorporate challenges to the balance system (Sherrington et al 2008). In the brief description of the exercise program in this paper, there appears to be limited focus on balance (‘standing on both legs then standing on one leg while holding Dipeptidyl peptidase a handrail’). Other successful falls prevention exercise programs such as the Otago program (Robertson et al 2002) have incorporated a stronger focus on specific balance activities. Given that falls in most cases caused the hip fracture in these patients, and balance impairment is strongly implicated in falls, it will be worth investigating if stronger focus on

balance performance can achieve even better outcomes. “
“Summary of: Bleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley D, Bradbury I, et al (2010) Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ 340: c1964 doi:10.1136/bmj.c1964 [Prepared by Margreth Grotle and Kåre Birger Hagen, CAP Editors.] Question: What is the effect of an accelerated intervention incorporating early therapeutic exercise as compared to a standard intervention of protection, rest, ice, compression, and elevation after acute ankle sprain? Design: Randomised, controlled trial with blinded outcome assessment and intention-to-treat analysis. Setting: An emergency department and sports injury clinic in Northern Ireland. Participants: Men and women 16–65 years, with acute (< 7 days) grade 1 or 2 ankle sprain.

15 The average working hours per week for male workers of the car

15 The average working hours per week for male workers of the car ABT-737 concentration battery industry was more than 50 which possibly leads to the fatigue-related impact of long working hours and occupational dissatisfaction. However, a recent study on 96915 workers in the United States indicates that although males show greater risks of injury compared to females, working hours is significantly associated with toxic risk only for women. This is probably due to the decreased recovery time and inadequate sleep, and elevated fatigue-related impact of long working hours for female workers.17 Nevertheless, additional objective measures are warranted in order to come to a more reliable conclusion.

Chronic lead exposure Inhibitors,research,lifescience,medical is implicated in the development of hypertension.18 Although 23.2% of workers had higher than normal systolic or diastolic blood pressures, the diagnosis of hypertension could not be made in the first-time visit. Our findings showed no association between systolic/diastolic blood pressure and BLC, which was consistent with Inhibitors,research,lifescience,medical other reports.19,20 It seems that lead Inhibitors,research,lifescience,medical exposure was not sufficiently durable to cause hypertension in this young

population. In this study, the level of education was inversely correlated with BLC which was consistent with the reports from other developing countries.21-23 Thus, improvement of education and socioeconomic status plays key role in the prevention of lead poisoning in these countries. According to guidelines,14 workers with severe lead poisoning should be hospitalized and treated with parenteral infusion. Since no severe case of lead poisoning was found among the studied population, Inhibitors,research,lifescience,medical workers were asked to avoid lead exposure and/or treated as outpatients. Toxicokinetics With normal renal function, lead is

excreted in the urine. Random urine sample shows short-term exposure to heavy metals.24,25 Urine and blood lead correlations are not reliable enough to substitute urine lead concentration for BLC, especially when the exposure is mild and BLC is less than 100 µg/L.24,26 Gulson et al, believed that the inaccuracy in predicting BLC by measuring ULC mostly applies Inhibitors,research,lifescience,medical to children and female adults because of the potential these contamination during sampling.24 On the other hand, Moreira et al. claimed that spot urine test could be used to replace blood sampling for the evaluation of occupational lead exposure in both children and adults.27 Hematologic Manifestations Lead poisoning is a known cause of microcytic anemia.1 Although we failed to detect depressed Hb/Hct concentrations in workers, Mean Corpuscular Hemoglobin (MCH) and Mean Corposcular Hemoglobin Concentration (MCHC) values were negatively correlated with blood lead concentration. Other RBC indices were not significantly affected. Katavolos et al. demonstrated that MCHC and hemoglobin concentration in two avian species decreased significantly with rising blood lead concentration.

40 Of note, NAA reductions were correlated with Cortisol levels 4

40 Of note, NAA reductions were correlated with Cortisol levels.48 Interestingly,

reduced hippocampal volume has been observed in depressed women with a history of early life trauma49 but not in children with PTSD.50 Hippocampal volume reduction in PTSD may reflect the accumulated toxic effects of repeated exposure to increased glucocorticoid levels or increased Inhibitors,research,lifescience,medical glucocorticoid sensitivity, though recent evidence also suggests that decreased hippocampal volumes might be a pre-existing vulnerability factor for developing PTSD.24 Indeed, hippocampal deficits may promote activation of and failure to terminate stress responses, and may also contribute to impaired extinction of conditioned fear as well as deficits in discriminating between safe and unsafe environmental contexts. Studies using functional neuroimaging have further shown that PTSD patients have deficits in hippocampal activation Inhibitors,research,lifescience,medical during a verbal declarative memory task.51 Both hippocampal atrophy and functional deficits reverse to a considerable extent after treatment with SSRIs,52 which have been demonstrated to increase neurotrophic factors and neurogenesis in some preclinical studies,5 but not PI3K Inhibitor Library in vivo others.53 Amygdala

The amygdala is a limbic structure involved in emotional processing Inhibitors,research,lifescience,medical and is critical for the acquisition of fear responses. The functional role of the amygdala in mediating both stress responses and emotional learning implicate its role in the pathophysiology of PTSD. Although there is no clear evidence for structural alterations of the amygdala in PTSD, functional imaging studies have revealed hyper-responsiveness in PTSD during the presentation of stressful scripts, cues,

Inhibitors,research,lifescience,medical and/or trauma reminders.41 PTSD patients further show increased amygdala responses to general emotional stimuli that Inhibitors,research,lifescience,medical are not trauma-associated, such as emotional faces.41 The amygdala also seems to be sensitized to the presentation of subliminally threatening cues in patients with PTSD,54-56 and increased activation of the amygdala has been reported in PTSD patients during fear acquisition in a Thymidine kinase conditioning experiment.57 Given that increased amygdala reactivity has been linked to genetic traits which moderate risk for PTSD,58,59 increased amygdala reactivity may represent a biological risk factor for developing PTSD. Cortex The medial prefrontal cortex (PFC) comprises the anterior cingulate cortex (ACC), subcallosal cortex, and the medial frontal gyrus. The medial PFC exerts inhibitory control over stress responses and emotional reactivity in part by its connections with the amygdala. It further mediates extinction of conditioned fear through active inhibition of acquired fear responses.41 Patients with PTSD exhibit decreased volumes of the frontal cortex,60 including reduced ACC volumes.61,62 This reduction in ACC volume has been correlated with PTSD symptom severity in some studies.

Other in vivo studies in this field include the investigations ca

Other in vivo studies in this field include the investigations carried out by Shen et al. [109], which focused on the codelivery of paclitaxel and survivin short hairpin RNA (shRNA) for circumventing chemoresistance in lung cancer. The investigators utilized the pluronic block co-polymer P85 combined

with D-α-Tocopheryl polyethylene glycol 1000 succinate (P85-PEI/TPGS) for developing the nanoparticles to be implemented in this study [109]. Inhibitors,research,lifescience,medical These nanoparticles were based upon triblock structural formation of hydrophilic poly(ethylene oxide) (PEO) blocks and hydrophobic poly(propylene oxide) (PPO) blocks, which also gives enhanced capacity to revert chemoresistance due to drug efflux pump inhibition properties, downregulation Inhibitors,research,lifescience,medical of ATPase activity and P85-induced inhibition of the gluthathione S-transferase compound detoxification enzyme at the subcellular level [109]. Paclitaxel and surviving shRNA were selected as the ideal drugs for nanoparticle delivery due to the former having poor efficacy due to chemoresistance

within the tumour, and survivin was identified as highly expressed within chemoresistant tumours [109]. The in vivo activity of such nanoparticle systems (with/without paclitaxel and survivin Inhibitors,research,lifescience,medical shRNA) was evaluated on BALB/c nude mice injected with viable, paclitaxel-resistant, A549/T lung adenocarcinoma epithelial cells [109]. The results of this study demonstrated that deployment of the nanoparticle-based chemoEpigenetics Compound Library nmr therapeutic drug proved to have distinct enhancement Inhibitors,research,lifescience,medical of antitumour efficacy, when compared to deployment of the drug/s alone [109]. Chemoresistance to the aromatase inhibitor letrozole in postmenopausal breast cancer is another major therapeutic hurdle which was investigated in vivo [110]. Biodegradable PLGA-polyethylene glycol copolymer nanoparticles were developed by nanoprecipitation and designed to

incorporate hyaluronic acid-bound letrozole (HA-Letr-NPs) [110]. The addition of hyaluronic Inhibitors,research,lifescience,medical acid served to enhance letrozole binding specificity to CD44 on the target tumour cell surface, with the expected consequences of enhanced drug accumulation within the target tumour cell cytoplasm and resultant re-sensitization of the target tumour cells to letrozole CYTH4 activity [110]. Such HA-Letr-NPs, once produced at a size of less than 100nm diameter, were deployed within a letrozole-resistant murine xenograft tumour model [110]. The results of this study demonstrated a highly efficient nanoparticle-based drug delivery system, with the IC(50) for HA-Letr-NPs within the murine xenograft model being only 5μM when compared to the control groups, thus enhancing the in vivo aromatase enzyme activity within the xenograft and ultimately inducing a prolonged resensitising of the breast cancer tumour to letrozole activity [110].

Antibody responses to serotype 14 of the vaccine however were hig

Antibody responses to serotype 14 of the vaccine however were higher amongst infants who were smaller at 12 months 5-FU order of age and showed slower growth between 3 and 12 months of age. In addition, infants born during July to December (the ‘hungry’ season) had higher antibody titres to serotype 14. The data from this study offer only limited support an early-life programming effect of early nutrition on antibody response to vaccination in adulthood within this environment. The observed associations between early life exposures and response to serotype 14 of the pneumococcal vaccine only

are rather difficult to explain. Globally, serotype 14 is the most important serotype causing disease worldwide, inhibitors although carriage rates vary between populations [12], [22] and [23]. Of the 4 serotypes assessed in the current study (1, 5, 14 and 23f), exposure to 23F

and 14 are most likely similar and so early exposures during infancy are unlikely to explain check details the difference. Technically, type 14 is the ‘purest’ serotype to assay, with little cross-reaction with other serotypes when measured in ELISA (D Goldblatt, personnel communication), but it is unlikely that this alone explains the observed differences. Selection of serotypes was primarily based on carriage rates amongst infants in The Gambia. However, and since it is known that pneumococcal carriage is not equally distributed between adults and children in this population, and is also variable by age (for infants) and season [24], knowledge of precise carriage rates (through nasopharyngeal swabs) at the time of vaccination may have been informative. Inclusion of additional serotypes, such as those known to elicit a ‘weak’ response may help explain this observation. Indeed, previous research has identified serotype 6B as being sensitive to modulation by infant feeding status[25], following vaccination with a conjugated vaccine. Such serotypes TCL may, therefore, be more sensitive to nutritional exposures

early in life. In interpreting the results presented here, consideration should be given to the limitations of the current study. Much of the programming literature in based on the follow up of cohorts of adults for whom records from early-life are available. In The Gambia, the UK Medical Research Council (MRC) has been maintaining demographic and health-related records for three rural villages since 1949 [26]. From 1976, these records have included detailed information on maternal and infant health, allowing the study of early-life predictors of current health within this population. However, as with many studies within this field [27], the current study suffered with considerable loss to follow up. A total of 78 (9%) of the 858 subjects born during the study period were known to have died prior to the start of fieldwork. In addition, we were only able to recruit 41% of the remaining 781 subjects available for follow up.

Secondly, understanding the cellular basis of aberrant synchroni

Secondly, understanding the cellular basis of aberrant synchronized discharges of neurons during epileptic seizures also yields insights into the selleck kinase inhibitor mechanisms of normal synchronization in the

brain. Finally, the necessity to perform invasive electrode (depth and subdural) recordings in patients with epilepsy results in unique opportunities to study human cognitive processes at extremely high time resolution by recording Inhibitors,research,lifescience,medical field or even single unit potentials during cognitive tasks. This technique can be combined with different functional imaging techniques, which ideally complement invasive recordings from the human brain by providing excellent spatial resolution. Research into the basic mechanisms of epilepsy The study of idiopathic genetic epilepsies : how do single gene mutations cause epilepsy? Genetic factors are the major determinants in at least

40% of all epilepsies; these are designated Inhibitors,research,lifescience,medical as “idiopathic epilepsies.” Only about 2% of these idiopathic epilepsies are inherited as monogenic disorders, in which one gene conveys the major heritable impact, while environment and lifestyle Inhibitors,research,lifescience,medical play a limited role. Genetic studies have allowed identification of the first disease genes that define monogenic idiopathic epilepsies.1,2 In these cases, genetic studies have identified causal gene variants, many of them neuronal ion channels, receptors, or associated proteins. Subsequently, the function of these variants was examined carefully in expression Inhibitors,research,lifescience,medical systems, and specific functional changes were found. These analyses, while compelling in implicating specific genes in idiopathic epilepsies, are not the last word in understanding how a gene mutation leads to a behavioral and clinical phenotype. We are beginning to obtain such an understanding in some instances from transgenic mouse models that carry disease-associated gene Inhibitors,research,lifescience,medical variants.3 The advantage of such models is that they harbor human disease-associated

gene variants, and can be examined at various points during the development Thiamine-diphosphate kinase of epilepsy with in vitro and molecular techniques. The limitation of such models is that the mechanisms of epileptogenesis may not be the same in mice and humans, and that disease-associated human gene variants are expressed on a background of mouse genes that may interact in unexpected ways with the human ortholog. Nevertheless, such studies are increasingly part of an integrated strategy to understand the mechanisms of monogenic epilepsies involving both human genetics and physiological, and molecular studies in transgenic mouse models. The study of focal epilepsy What are the mechanisms of seizures? By far most types of epilepsies, however, are not monogenic.

, 2005) In humans,

developing social support and friends

, 2005). In humans,

developing social support and friendships (Kral et al., 2014 and Yi et al., 2005) as well as having secure relationships which reduces suicidality in veterans of Operation Enduring Freedom and Operation Iraqi Freedom (Youssef et al., 2013), has been found essential to establishing resilience. Furthermore, characteristics of active coping that reduce stress and symptoms of mental illness include the following: creating a sense of coherence in their lives (Matsushita et al., 2014) or in the community (Hall et al., 2014), exercising self-control (Moses, 2014), developing a strong sense of identity including professional identity for workplace resilience (Hunter and Warren, 2014), maintaining a realistic perception of threat (Karstoft et al., A-1210477 supplier 2013), possessing optimism (McGarry et al., 2013 and Boyson et al., 2014), having a sense of inhibitors purpose (Pietrzak and Cook, 2013), and the use of problem-focused coping (Yi et al., 2005). Anticancer Compound Library manufacturer However not all coping strategies are adaptive; passive coping is characterized by feelings of helplessness, relying on others for stress resolution and is associated with vulnerability

to psychopathology (Zeidner and Norman, 1995, Folkman and Lazarus, 1980 and Billings and Moos, 1984). Consistent with this view, vulnerable individuals use passive coping strategies such as avoidance and blaming others (Yi et al., 2005). Therefore, the impact of a stressor on an individual’s however psychological well-being depends to a considerable extent on the strategy used to cope with the stressful life event. Resilience can be defined as positive adaptation, or the ability to maintain or regain mental health, despite experiencing adversity and challenges (Herrman et al., 2011 and Karatsoreos and McEwen, 2013). In order to understand the biological basis

of how some individuals are resilient to social stress and how others are vulnerable, we will focus on studies in which variations in the impact of stress are observed. That is, the focus is on studies in which subgroups of individuals defined as vulnerable or resilient emerge following exposure to the same stressor and not on studies that examine mechanisms that modify the impact of social stress homogenously in all subjects. This is because not all mechanisms that uniformly reduce the impact of stress necessarily underlie resilience. They may underlie resilience or they may not, but focusing on studies in which subpopulations emerge will allow the determination of those specific mechanisms demonstrated to underlie resilience and/or vulnerability. Further, because of the robust impact that stress has on mental health, we have a particular focus on those studies in which measures related to psychopathology are assessed. Furthermore, in clinical literature, varying coping strategies have been associated with differences in susceptibility to stress-related pathology.

In the German study population with 2 960 patients, SWN was used

In the German study population with 2 960 patients, SWN was used to assess the patients’ perspective. At baseline, patients and physicians categorized compliance as “almost always compliant,” “partly compliant,” or “almost never compliant.” The relationship between changes in compliance (improvement n=225, no change n=1366, worsening n=78) and clinical variables were assessed by factor analysis. This revealed the strongest correlations for SWN (r2=0.866), followed by symptoms (r2=0.772) and side effects Inhibitors,research,lifescience,medical (r2=0.480) (Karow et al, unpublished data). SW seems to be of potent influence on adherence during

maintenance treatment, but not in the acute phase, as Mutsatsa et al43 did not find a significant relationship Inhibitors,research,lifescience,medical between SWN and early medication adherence in 101 first-episode patients. Numerous studies show the advantages of atypical versus typical antipsychotics, and these advantages are most prominent from the patients’ perspectives: Atypical antipsychotics improve subjective quality of life more

than typical antipsychotics,44,45 Inhibitors,research,lifescience,medical subjective response is significantly better under atypical compared with typical drugs,46 and, not surprisingly, switching from a typical to atypical antipsychotic is associated with a marked subjective improvement.47,48 Subjective well-being as a find more Remission criterion in the SOHO study In the SOHO study, SWN was used as an important single component of Inhibitors,research,lifescience,medical the complete remission criterion, according to the new consensus statement on criteria and the time frame of remission in schizophrenia published by the Remission in Schizophrenia Working Group.30 In contrast to previous definitions, the consensus included the incorporation of subjective rating next to sustained symptomatic (ie, positive, negative, and cognitive

symptoms) as well as functional remission (ie, activities of daily living, employment).49-57 Remission criteria and predictor variables were assessed at baseline, at 3, 6, 12, 18, Inhibitors,research,lifescience,medical and 24 months with standardized scales. Complete remission was defined as patients Non-specific serine/threonine protein kinase fulfilling all criteria for (i) symptomatic, (ii) functional, and (iii) subjective well-being over a period of at least 6 months (ie, at the 18-month and 24-month visits). Symptomatic remission was defined as receiving a Clinical Global Impressions Scale (CGI)-Schizophrenia score58 of no worse than “mild” (≤3) in assessments of overall severity, positive, and cognitive subscores and a score of no worse than “moderate” (≤4) in the negative subscore. Functional remission was defined as a positive occupational/vocational status, ie, paid or unpaid, full- or part-time employment, being an active student or head of a household with an employed partner, and independent living, ie, living alone, living with a partner, living with peers. Subjective well-being was met if a SWN total score of ≥ 80 points was achieved.

They ranged from 29 to 3097 I U with a mean value of 899 in the

They ranged from 29 to 3097 I.U. with a mean value of 899 in the first decade, from 57 to 6574 (mean: 2763 I.U.) in the second decade, from 87 to 3422 in the third decade (mean: 1047 I.U.). Older patients showed a decrease of CK values probably due to progressive muscle loss. Signs and symptoms of heart function were also evaluated: 45% of patients Inhibitors,research,lifescience,medical had normal echographic findings, 54% had mild Paclitaxel in vivo hypertrophy and 1% had moderate hypertrophy. None of the patient in our group had severe cardiac hypertrophy. Molecular data AGL gene was analyzed by direct sequence of the

coding region and splicing sites. 35 patients could be completely characterized (69%), whereas only one allele was identified in 7 patients Inhibitors,research,lifescience,medical (14%), while 9 patients (17%) resulted negative. The majority of changes are represented by mutations giving rise to null alleles. The IVS21 + 1G/A intronic change is the most frequent mutation in our series (23.4%). Missense mutations amount to 25% of total. Identified mutations are widespread along the whole gene and no particular hot spot could be found. Grouping mutation type by severity (null vs. missense) and gathering clinical and Inhibitors,research,lifescience,medical genetic data, it came out that null patients have higher probability to develop more severe myopathic and hepatic involvements. Anyway, exceptions in both directions exist. Furthermore,

as with other genetic diseases, Inhibitors,research,lifescience,medical the difficulty in establishing genotype-phenotype correlations is something well known with GSDIII. IVS21 + 1G/A is a good example in this sense (9). Among our patients, we observed the case of three genotypically identical adult patients, which were homozygous for the exon 21 skipping. All of them developed a severe myopathy, and hepatopathy, though at quite different ages and degree, but only the older of them suffers Inhibitors,research,lifescience,medical from cardiopathy. A further complication comes from the presence of intrafamilial clinical variability. As far as different types of GSDIII are concerned, all our informative patients (those older than 30: n = 19) are affected by GSD type IIIa. Genetic screening on ethnically different populations

has shown that only very few mutations are common in a considered geographic area, the great majority being private mutations. The only mutation shared Terminal deoxynucleotidyl transferase by Caucasians coming from different countries is R864X, identified in Mediterranean and North American population. The mutation IVS6 + 3 A/G accounts for 11.7% of mutated alleles in Mediterranean families (10). Therapy and perspectives Therapy is not available for debranching enzyme deficit. To avoid fasting hypoglycaemia in infancy, dietary measures have been prospected. Frequent daytime high-protein feedings (45% carbohydrate, 25% protein, 30% fat) and supplementation of uncooked corn starch before sleep showed to be effective in young patients with regard to metabolic control and growth retardation.