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irispublisherspsychology · 4 years ago

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Iris publishers-Open Access Journal of Addiction and Psychology (OAJAP)

When the Brain Coordinates Life-Risk Behavior: A Rewarding Anorexia

Authored by Valérie Compan*

Abstract

Understanding how brain supports adapted (and adaptive) decisions when individuals deal with challenge of the environment (stressor) is critical as adapted decision-making (goal-directed behavior) is supposed to protect from disturbances including unexpected death. How does the brain can then trigger chronic consumption of drugs or persistent food restriction (anorexia) until the point of death? In the neurosciences field, most of studies report correlations between behavioral disturbances in the face of environmental challenges and deregulations of neural circuits. Even if causal relationship is less described, exploring these correlations in simpler animal models makes possible the study of molecular and behavioral phenotypes in isolation and has revealed the conservation of specific molecular mechanisms in humans. For instance, involvement of serotonergic system in eating behavior remains crucial as current investigations, consistent with several decades (79 years from 1940 to 2019) of studies, reveals the conservation of specific molecular underpinnings of eating behaviors in animals and humans with eating disorders, suggesting the robustness of identified effects. In this context, studies describe commonalities between restrictive food intake and addiction, as in the nucleus accumbens - a critical structure of the brain’s reward system - activation of addictive signaling under the control of serotonin (5-HT, 5-hydroxytryptamine) 4 receptors (5-Ht4Rs) mediates reduction in motivation for food in food-deprived mice, and ties anorexia and motor hyperactivity; Two hallmarks of anorexia nervosa. Accordingly, the brain prevents the transition from transient to persistent hypophagia (anorexia) with a network governing goal-directed behavior against depressive-like behavior, under the control of 5-Ht4Rs localized in the medial prefrontal cortex. Food restriction at the onset following stress appears as an adapted behavior for managing stressors (as mediated by specific molecular changes related to depression resistance), but in the face of chronic stress, loss-of-control of the mPFC could imbalance the activity of the NAc and triggers persistent anorexia.

Keywords:Addiction; Anorexia; Stress; Food intake; Locomotion; Animal models; Brain; Nucleus accumbens; Medial prefrontal cortex; Serotonin 4 receptors

Abbreviations: cAMP: Cyclic Adenosine Monophosphate; CART: Cocaine- and Amphetamine-Regulated Transcript; KO: Knockout; mPFC: Medial Prefrontal Cortex; Nac: Nucleus Accumbens; Pka: Protein Kinase A; 5-Ht: 5-Hydroxytryptamine Or Serotonin; 5-Htrs: Serotonin Receptors; 5-Ht4rs: Serotonin 4 Receptors; Sirna: Small Interference RNA

Introduction

All behavior appears to be the result of context-dependent brain functions; neuronal networks implement gradually over development during their interrelationships with environmental factors. This cerebral network likely becomes mature contextdependently and may gradually favor adapted (and adaptive) behavior as adapted decision-making (i.e., goal-directed behavior). Goal-directed behavior expresses motivation. For instance, when individuals feel hungry, they are motivated to obtain food under physiological circumstances. Feeling hungry then translates into the demand for energy. Hunger impels the organism to display goal-directed behavior to seek and consume foods and thus survive. However, individuals do not make the decision to feel hungry, but can decide to satisfy or not satisfy hunger. For some individuals, eating behavior can be chronically disordered and can include persistent food restriction and/or excessive intake despite negative consequences, suggesting disturbances of motivation, and of goal-directed behavior. Food is a basic primary reward, requiring motivation to obtain it (“wanting”) [1]. Some investigators assimilate excessive consumption of foods, regardless of whether it is associated with obesity (Corwin RL, et al.) [2], to addiction [3]. However, whether binge eating represents a kind of addiction remains unclear [2]. Here, we describe common molecular mechanisms between anorexia and addiction.

Towards Critical Implication of 5-HT Volume Transmission

The rewarding effect of anorexia has been described in humans at the onset of anorexia nervosa symptoms [4]. Is it the result of excess synapses (fixed brain) that maintain food restriction until the point of death? As the prospect of receipt of a positive reward is capable of inducing risky, and potentially lethal behavior, impairments in the neural underpinnings of persistent food restriction until lethal point could be included in those of dependence.

Some investigators examine the activity of neural centers involved in the recognition of rewards and the development of habits [5]. A report described goal-directed decision-making as a complicated process and argued that reward-based decisions depend on the habit and goal-oriented systems [6]. The habit system “stores” stimulus-response associations based on past rewards and the goal-oriented system selects one action by anticipating the positive and negative outcomes [6]. Indeed, “Addiction is a form of learning and relapse is a persistent memory of the drug experience” [7]. As neural bases of learning and memory appears the result of synapse function, as mainly demonstrated by studies of Eric Kandel; Does neural communication, as the serotonin (5-hydroxytryptamine, 5-HT) volume transmission, serve to avoid habits for conferring the most instant flexibility to better adapt to environmental changes [8]?

The existence of the synapse was critically challenged until 1954; and, in 1975, Descarries L, et al. [9], described that 5-HT binds receptors (5-HTRs), more often located at 100 μm than at 20 nm (synaptic transmission), introducing the volume transmission (Descarries L, et al.) [9], from the site of 5-HT release. The preponderant 5-HT volume transmission extends the ubiquitous distribution of the serotonergic system, supporting its multiple functions; all physiologically interrelated, from habituation, memory, moving etc., to protecting survival, likely in order to critically contribute to adaptive and adapted eating responses to stress. The phylogenetically old serotonergic system then appears as a continued red line underlying crucial functions, which appear sophisticated to the point of a 5-HT-independent action of some 5-HTRs to evoke constitutive activity, such as the 5-Ht4 receptors (5-Ht4Rs), in eating behavior [10].

Serotonergic System in Brain Serves to Reduce Food Intake and Motivation to eat

In mammals, the serotonergic neuronal cell bodies assemble in the raphe nuclei (reviewed in [11]). Among nine nuclei, the dorsal and median raphe nuclei (DR, MR) send axons to the whole forebrain [11]. In particular, the serotonergic axons in the cerebral cortex mainly arise from the DR (Figure 1a). 5-HT binds 18 G-protein coupled receptors (5-HTRs) and commonly mediates reduction in food intake [8].

Hoebel and Leibowitz’s groups in 1976 and 1986 reported, in series of studies, that 5-HT volume transmission commonly serves to reduce food intake, i.e. hypophagia, and to enhance satiety, in the hypothalamus. Following up these findings, decades of reports have described hypophagia following stimulation of 5-HT1B and 5-HT1C receptors (5-HT1BR, 5-HT1CR), whereas 5-HT1AR and 5-HT2BR can exceptionally serve to enhance feeding [12]. In 2004, 5-HT volume transmission has also been reported to favor less motivation for food in food-deprived mice, mediating anorexialike behavior through the activation of addictive signaling (cAMP: cyclic adenosine monophosphate / PKA: protein kinase A / CART: cocaine- and amphetamine-regulated transcript), in the NAc [13,14]. In 2017, causal relationships between the activity of the serotonergic system and hypophagia in response to external stress were identified in a network governing goal-directed behavior [15]. This network consists of the ascending serotonergic inputs from the DR to the mPFC and is controlled by 5-Ht4Rs [15].

In sum (reviewed in Compan V. [8]), under basal conditions, specific 5-HTRs located in an automatic executive system (the hypothalamus) serve to stabilize usual food intake, whereas in response to external stressors, other 5-HTRs; 5-Ht4Rs located in a more adaptive-decisive system, including the mPFC and the NAc, favor rewarding effects of food restriction [14-19]. Such dual organization of 5-HTRs could promote decisional processing and dampen autonomic input, resulting in dysfunctional eating irrespective to requirements for energy. When food intake varies temporarily to the baseline, survival is not compromised, and restrictive food intake may well be adapted (and adaptive with beneficial effects on longevity), but when eating response to stress persists, as seen in anorexia nervosa, survival is compromised [20]. The predominance of cortical control could reflect adaptive processes to prevent “negative emotions” as neural commonalities exist between anorexia and antidepressant effect (Jean A, et al.) [15], (Figure 1); while, hypothalamic events could represent an executive system, which became autonomous as learned during long conserved evolutionary processes. It results the hypothesis formulated above: The low number of 5-HT cortical synapses (30%) could serve to prevent habits (do not have to be memorized) for conferring the most instant flexibility to better adapt to environmental changes [8].

Common Signaling Pathway Between Anorexia and Addiction under the Control of Serotonin 4 receptors

The cerebral distribution of 5-Ht4Rs is conserved from rodents to humans, with one of the highest levels in the NAc [21,22]. Four 5-Ht4Rs splice variants were described in mice (10 in humans) called 5-Ht4(a)R, 5-Ht4(b)R, 5-Ht4(e)R, 5-Ht4(f)R [23]. Stimulation of 5-Ht4Rs reduces deficits of associative learning in olfactory discrimination task (Bockaert J, et al. [24]), and, 5-Ht4Rs favor longterm (but not short-term) memory [25]. In humans, stimulation of 5-Ht4Rs also favors memory [26]. The 5-Ht4Rs may therefore have conserved functions such as feeding from mice to humans. Indeed, stimulation of 5-Ht4Rs reduces food intake in rodents [14-16,19]. And, the concentration of 5-Ht4Rs is low when patients with Alzheimer’s disease overeat, but not in individuals with Alzheimer who did not display hyperphagia [27]. Importantly, 5-Ht4Rs (and apparently not the other 5-HTRs) in the NAc serve to a rewarding effect of restrictive food intake, as stimulation of 5-Ht4Rs mediates anorexia-like behavior through activation of an addictive signaling pathway [cAMP/PKA/CART] [14,19], (Figure 1). Indeed, in neurons of the NAc, activation of a cAMP signaling is a means of transforming an immediate reduction of drugs’ rewarding effect into a durable dependence [28]. Cocaine triggers counteracted adaptive responses as an increased activity of cAMP/PKA signaling in the NAc [28]. The resultant phosphorylation of the cAMP-responsive element binding (pCREB) dampens rewarding effects [29]. The sensitivity to subsequent drug exposures then decreases (tolerance) with increased activity of reward pathways (dependence) to the point that drugs removal triggers declines in motivation, mimicking depression, leading to maladaptive decision [28]. Considering the involvement of CART in motivational properties of cocaine (Rogge G, et al.) [30], these findings evidence commonalities between addiction and anorexia, consistent with the rewarding effect of anorexia seen at the onset of symptoms. Food restriction is initially highly rewarding because the individual feels to cope with difficultto- manage stressors during adolescence and adulthood [31]. Indeed, the brain can implement food restriction until death, as the result of maladaptive decision-making. As deep brain stimulation in the NAc or the anterior cingulate cortex (that is homologous to the rodent mPFC) in patients with anorexia nervosa led to an overall improvement, our studies conducted in animal models may have critical clinical significance [32]. Accordingly, mPFC-5-Ht4Rs serve to prevent persistent food restriction by controlling the ascending 5-HT inputs from the DR to the mPFC under stressful conditions [15], (Figure 1). We predict that deregulation of 5-Ht4Rs could play a vital role in pathological appetitive decision as NAc-5-Ht4R levels are abnormal in overweight humans, which could be related to the capacity of 5-Ht4Rs to reshapes excitatory synaptic connections (Evgeni Ponimaskin, submitted), consistent with less dendritic spines in the NAc in 5-Ht4R knockout (KO) mice [8].

Conclusion

The neuronal network underlying eating behaviors is part of a larger network implicating reward and decision-making systems that react to environmental cues. Accordingly, environmental changes (i.e., stressors) associated with biological predisposition could alter motivation and adaptive decision-making, including persistent food restriction. Adaptive responses to stress depend on the serotonergic system – and, here, adaptive feeding response to stress depends on 5-Ht4Rs - eating disorders could emerge when serotonergic neurons reach the limit of their adaptive capacities. We suggest that a predominance of a cortical control reflects an adaptive process to prevent depressive-like behavior when facing an acute stress at the onset of anorexia nervosa (Figure 1). Numerous studies have to be conducted to test whether in the face of chronic stress, limits of this adaptive process could “submerge” cortical control and “release the influence of the subcortical areas” such as the NAc (autonomous control without adaptive decisional control), in which uncontrolled oscillating changes in common molecule levels (cAMP, CREB: all controlled by G-protein coupled receptors, here by 5-Ht4Rs) could lead to an anarchic consumption of foods (from anorexia to bulimia and/or binge eating).

To read more about this article: https://irispublishers.com/oajap/fulltext/when-the-brain-coordinates-life-risk-behavior-a-rewarding-anorexia.ID.000521.php

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#Iris Publishers LLC #Irispublishersreviews #open access journals of psychology #addiction

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mollykittykat · 7 years ago

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The Cupboard Game pt. 10

AU in which Splinter evaded the contents of the mutagen canister and ended up raising the turtles as a human.

No real warnings apply. Mostly family fluff/action-adventure with a teeny hint of angst.

(Also available on A03: http://archiveofourown.org/works/10471893/chapters/30131685)

None of the stolen keys looked like they would fit the lock. Splinter felt he should’ve expected that much, but luckily the cage was held shut with a simple padlock, which he knew he could easily undo with the pick he had the forethought to carry with him. He kneeled down and went to work, the trapped turtles rambling on about an ugly man and his weird friends. They asked questions of why and how, to all of which Splinter answered with requests for silence “I told you, I’ll explain later” he whispered, working to undo the cogs as quickly and efficiently as he could.

“They said they were going to sell us to a lab!” Donatello said “They’re pretty mad at you!” Leonardo interjected “They offered like… a billion dollars to who could beat you! Did you fight them? Are y’going to fight them?” “Fight bad guys?” Mikey asked, eyes turning starry with awe “this mean you’re a superhero Papa?” “No no. Just a normal hero” Raphael answered his younger sibling, nudging him with his elbow “Superheroes have to have super powers dummy!”

“Look, will you please be quiet for a moment?” Splinter whispered back, tone far harsher than it had been before “If you’ll just stop asking questions and let me focus-”

Suddenly there was a click, but it didn’t emanate from a lock finally loosing it’s hold on the cage door, it was the click of a revolver from the outskirts of the ring behind Splinter. He froze, another flurry of clicks slowly surrounding him as barrels of guns peaked out of the shadows all around the fighting ring. Lights came on one by one, revealing the once empty space was now filled with men who’s weapons were fixed upon their one target in the center of the arena. Yoshi stood up and turned around, quick to realize his situation. In the back of his mind he’d had a bad sense about what he was walking into from the beginning, but his desperation had silenced his natural instincts.

There was a familiar crumb-clogged laugh. The obese form of Don Visioso sat just behind his line of hired gunmen, shoving another handful of popcorn into his mouth as his lackey’s infiltrated the ring from all sides and apprehended their target.

Despite the brief disappearance of the doorboy, the warehouse was opened up from the inside by the time 8:15 rolled around, and the swarm of thugs entered with loud anticipation and heavy indecisive footsteps like a pack of feral dogs. The world within was dim as the air filled with a shallow layer of smoke that further obstructed the view of the audience. There were a few lamps illuminating the back where a makeshift bar sold watered down alcohol and overpriced cigarettes, but most of the group eventually found their way to the edges of the spotlighted ring, like they had been turned from excited wolves to wandering moths. Of course the light wasn’t the main attraction, but rather the man standing calmly and quietly within the ring, feigning confidence even while his wrists were fastened to one of the four corners by a set of handcuffs.

He didn’t bestow the group with any sort of response, though he was forced to move his head slightly to the side in order to dodge glass bottle that was thrown his way by a drunken attendee. To his luck there was enough sportsmanship in the unruly crowd to put a stop to that, and the convicted assailant was immediately ushered out in a flurry of shoves and blows, knocking him about until with a final toss from the bouncer he was sent stumbling to the ground outside of the warehouse. The doors were shut behind him, and he groggily rolled over onto his bruised stomach and tried to get to his feet. Somewhere in the midst of his dizzy efforts, a large and cold foot pressed him back into the dirt as someone- or something- walked over him. They were from a pair of newcomers, utterly unfamiliar in appearance, well dressed but off in their arrival time. The drunken outcast squinted through his haze, and noted that one of them held something shaped vaguely like a gun.

“Hey!”

The two suited men halted and turned around at the drunkard’s shout. Their faces were identical and the gun they held was strange and unearthly, looking more like the prop to an 80’s scifi film than a legitimate weapon. Seeing this, and taking in the unsettling oddities through his alcoholic fog, the outcast simply squinted and muttered something unintelligible about ‘no violence’ as he stumbled away. The suited men glanced at each other for a moment, and looked at their instrument.

“The Mutant Scanner brings us to the place that is known as this place” one said to the other

“Kraang, mutants are not to be pursued in the places known as the places that are filled with that which are known as ‘witnesses’” his partner replied

“Protocols do not forbid that which is known as a ‘brief examination’ of the mutant location”

“Kraang is correct in that assertion”

“Then let us proceed with caution.”

Thus, the gun was folded up, and the two monotone men went in. They hadn’t really any solid indication of what they were getting into, though they had done enough research on the subject of human behavior to recognize an underground fight when they saw one. The shackled captive standing in the spotlight raised no questions with them, as the object of their interest was not at all the fight itself.

They scanned the room slowly and methodically, trying to indicate their vague unidentified target, which was a good deal more difficult now that their machinery wasn’t allowed to be put into use. However they suspected they’d know their target when they saw it, and one of them was certain they spotted the mutant when they noticed a lighted balcony just off from the ring, wherein a hideous thing sat between two armed men, shoving two ice-cream cones into his mouth at once. “Some mutated species of blob fish” was the Kraang’s guess, but his partner was quick to disagree.

“Negative. That which is falsely labeled a ‘mutant’ is just what some humans look like”

The Kraang further examined the fat man, staring through it’s expressionless gaze until he could confirm his partner’s correction. "That is... that which is known as... unfortunate”

No sooner had they made their criticisms did the fat man called for the unruly room’s attention. The identical newcomers paid momentary attention to the announcement, hoping it would aide them in their search, but they quickly lost interest. They cared for neither the reputation of the captured human nor the offer of money to whoever could succeed in beating him, all they wanted was the mutant their tracker had picked up on. Then something new caught their attentions: a the small glint of something hanging from the rafters high above. They both stared, their mechanical eyes zooming in on the darkened ceiling until through the shadows they saw the outline of a cage, and a tiny pair of green eyes looking down at them.

“Raph they’ll see you!” Leonardo scolded, pulling his brother back from the edge of the bars. Raph returned this tug with a sharp shove that caused their cage to sway. “I wanna see Dad fight!”

“Don’t worry Leo” Don muttered from his end of the cage, where he prodded his tiny finger into the padlock, working his brain to try and figure out his father’s progress in undoing it “it’s dark up here. If we get out of the cage now, we can prob’ly sneak down without being seen!”

“An’ fight the guys fightin’ Dad!” Raph added, going right back to watching what was going on below. By now things were finally getting exciting. The cuffs holding Yoshi in place had been undone, leaving him free to combat the first opponents climbing up over the ropes and into the ring. Leonardo wisely gave up on dragging his brother away, afraid of shaking the cage again, their perilous position up in the rafters only adding to his instinctive caution. “How do we get down once the cage is open?” “I dunno…” Donatello replied, jostling the door testily “but maybe we can be sneaky and get it unlocked first?”

“M‘kay. How do we get the door unlocked though?”

“I dunno!” Don suddenly snapped, his broken focus causing him to loose patience “Dad used a lock pick, but the bad guys took it!”

Leonardo narrowed his brow, frustration and fear tempting him to cry. Just old enough to have a sense of pride, he instead decided examine each of his brothers to see if any of them needed comforting. Raph was still trying to catch a glance at his fighting father, Donatello struggling to figure out how to undo the padlock, while Mikey… who had been oddly silent this whole time… continued gnawing on the thoroughly cleaned chicken bone as he tried to catch a peak of the pandemonium from over Raphael’s shoulder. With a frustrated humph Leo yanked the bone from his youngest brother’s mouth, and was about to throw it through the bars when he paused in realization. He looked the slobbery bone over, finding that without the sinews and the meat clinging to it it looked thin and pointy, like a caveman tool.

A spark of hope alighted in his tiny chest, and he hurried to Donatello and held it out “Will this work?” Donnie turned and looked at the bone his brother held. He appeared skeptical, but he took the object with a sigh and a nod before he wriggled the end of the bone into the padlock, trying to see what gears he could configure with his measly tool.

Hamato Yoshi had walked right into a trap, and he was still trying to determine how much of that was bad luck or just his own stupidity. However, as was the pattern, the terrible twist of fate was peppered through with small instances of good luck, just enough to keep his hopes alive.

The throwing blades Yoshi had hid on his person were overlooked when he was frisked, the knives small enough to evade the searching fingers of those more accustomed to unveiling hidden revolvers. He had also convinced Don Visioso to allow him the keep the chest armor after informing him of his unfortunate collision with the car. He argued that if he went down too quickly it would make for a terrible show, as well as create bad press given the value placed on his defeat. Visioso, thankfully overconfident, fulfilled his simple request, but only after testing Splinter’s claim with a commanded strike to the ribs, causing him to buckle in pain before the gunmen took hold of him once more and dragged him into his restrains. There was undoubtably a feeling of indignity when Splinter was locked into the handcuffs, but it paled in comparison to the sinking helplessness he felt when the turtles were taken away once again, lifted high into the rooftops where their cage shackled to the rafters.

So here he was, his children dangling thirty feet above him, weaponized goons positioned all around to ensure he didn’t pull another stunt, the fat man himself sitting at a safe distance away, stuffing his face as he watched his captive fight for his kids like this was some sort of cheap gameshow.

But Yoshi still drew breath, and the turtles were still in his sights, thus… though the situation was bleak… there was still a chance of the situation somehow turning out okay in the end.

So he fought with all his might, forbidding his lack of sleep and the pressing injuries to impair him. He wasn’t sure if he was fighting just as well as he ever had, or better than ever due to the situation, but the audience sure seemed to grow more and more excited with every blow he delivered and ever fighter he cut down. He was determined to not allow himself to get distracted, but he could only follow through only to a certain extent. There was one moment in the middle of the fifth round when he saw something that nearly placed him on the receiving end to a solid blow to the temple There was a man climbing the walls. No... two men... one on each side of the room. They were mostly hidden in darkness but he could see them, spider-like as the scaled the vertical wall, well dressed, identical, and utterly unnerving, especially given the fact that they seemed to be heading straight for the rafters. Or, more specifically, the cage dangling from the rafters far overhead.

#The Cupboard game #tmnt 2012 #tmnt 2k12 #fanfic #fanfiction #turtle tots

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lupine-publishers-sjo · 4 years ago

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Lupine Publishers | Impact of Insomnia on Optimism-A Predictor Factor Among Young Adults in Indian Context

Lupine Publishers | Journal of Otolaryngology

Abstract

Recent research studies have revealed that inadequate quantity of sleep cycle and deprived sleep quality, are one of the most common emerging issues which are affecting the personality and attitude traits of an individual. There are significant research studies conducted which indicates optimism and self-esteem are the core salient features for maintaining a good health.

Aim of the study: There is a dearth of knowledge regarding the possible determinants of positive optimism characteristics among young adults. Therefore, the present study was conducted to examine the relationship of optimism with insomnia symptoms among young adults.

Method: Sleep parameters and optimism were assessed by administering standardized questionnaire(s) among a sample of 92 young adults aged between 17 and 26 years studying in University.

Results: Statistical analysis shows significant correlation between optimism scale and sleep cycle, the participants exhibiting higher score of insomnia tend to show lower score on optimism scale.

Conclusion: The result provides preliminary input on risk factors for insomnia and effect on optimism, as adequate amount of sleep has a strong relationship with optimism leading to a more confident and improved quality of life.

Keywords: Insomnia Symptoms; Sleep Duration; Optimism

Introduction

Emerging research supports the findings that nocturnal sleep is one of the most important aspect of our life for maintaining a sound physical and mental health. This area is one of the emerging areas in the field of psychology which has been immensely studied. Various research studies indicate that sleeping less than 7 hours as well as sleeping more than 8 hours is closely linked to an increased susceptibility to a broad range of physical and psychological health problems, such as ranging from poor vigilance and memory to reduced mental and physical reaction times, reduced motivation, depression, insomnia, metabolic abnormalities, obesity, immune impairment, and even a greater risk of coronary heart disease and even cancer [1,2]. Longitudinal evidence suggests that, insomnia is most common co-morbid condition seen with mood, anxiety and predates the onset of low optimistic attitude within an individual [3]. Numerous research studies also reveal significant results which indicates that sleep deprivation among young adults tends to interfere with the mechanism, which is responsible for regulating personality characteristics including optimism, with increased risk for anxiety, negative mood, impulsivity, and inability to cope up with social stresses [4-8].

Neurobiology of Sleep

The circadian rhythm i.e. the sleep-wake cycle is controlled by the suprachiasmatic nucleus of hypothalamus [9]. The inhibitory projections of ventrolateral preoptic nucleus (VLPO) of the hypothalamus to the tuberomammillary nucleus (TMN), the dorsal and median raphe nucleus and the locus coeruleus, the cholinergic basal forebrain, the pedunculopontine thalamic nucleus (PPT) and lateral dorsal thalamic nucleus (LDT) functions as a switch promoting sleep [10]. The orexinergic neurons of lateral hypothalamic area (LHA) promote wakefulness and the inhibitory effect of VLPO promotes sleep [10].

Models of Insomnia

There are various models which define the foundation of insomnia explaining the various factors that are responsible for related sleep disturbances. One such model is The Diathesis Stress Model or the 3-P model (predisposing, precipitating and perpetuating) factors given by Spielman and colleagues (2011) mentioned the role of the three P’s in development and maintenance of insomnia. The insomnia symptoms worsen in an attempt to relieve it hence the model focuses on behavioral pattern [11]. For example, an attempt to compensate for reduced sleep by spending increased time in bed, may worsen insomnia unintentionally. The classical conditioning principles proposed by Bootzin (1972) is the basis of the stimulus control model which states that the person with insomnia becomes conditioned to sleep and bed environment as a stimulus for wakefulness instead of sleep. The therapy attempts to decondition to this stimulus by limiting activities like lying awake, watching TV in bed and ensuring bed is used for sleep only [12]. According to Cognitive Model of insomnia thoughts, (worry about poor sleep and its daytime effects) and associated feeling interferes with the sleep [13]. Study has suggested that scanning of the internal and environment threat signals, and the safety behaviours to increase sleep and minimize the outcome of insomnia ,worsens insomnia [13] whereas, the role of selective attention to sleep-related indicators in the development and maintenance of insomnia is as per the basis of the Psychobiological Inhibition Model [14]. As per Diagnostic Guidelines of Insomnia (ICD-10, 2004) the following are essential clinical features for a definite diagnosis [15].

a) The complaint is either of difficulty falling asleep or maintaining sleep or of poor quality of sleep.<

b) The sleep disturbance has occurred at least three times per week for at least 1 month.

c) There is preoccupation with the sleeplessness and excessive concern over its consequences at night and during the day.

d) The unsatisfactory quantity and/or quality of sleep either causes marked distress or interferes with ordinary activities in daily living.

e) The unsatisfactory quantity and /or quality of sleep is the patients only complain.

Compared to the research studies conducted on consequences of poor sleep, there is inadequate evidence regarding the association between sleep duration with positive individual characteristics. According to the data published by National Sleep Foundation (2002) revealed that individuals who had an average sleeping duration of 7 – 8 hours reported to have better mental satisfaction with life compared to the other group of individuals who had a sleeping duration of less than 6 hours a night [16]. Fredriksen (1994) conducted another similar kind of study in which the results obtained were evident indicating that longer the sleep duration higher is the self-esteem in adolescents [17]. Various other studies revealed a strong association between ample sleep duration and short sleep onset latency resulting in higher optimism in children [3]. Another experimental study was administered to examine the effect of insomnia and the results indicated that sleep deprivation leads to gradual degradation of self-reported optimism and poor social interaction in young adults, which suggested that sleep duration is a determinant factor for the initiation of positive personality characteristics in an individual [18]. Most of the research studies say that lack of sleep may lead to co-morbid condition which could be anxiety and depressive symptoms and also lack of optimism. In the present study, we therefore tested associations of sleep parameters with optimism among university students aged 17 to 26 years. In particular, the study was conducted to examine the relation between symptoms of insomnia and optimism. Simultaneously, also aimed to evaluate whether individuals with an average sleep duration (between 7 and 8 hours/day) are more optimistic compared to individuals who sleep less than 7 hours or, conversely, more than 8 hours per day [19].

Method

Participants

A total of 92 subjects were selected using purposive sampling based on their encouragement to participate in the present study from the university. The participants were divided into

a) Group 0: 63 (aged 17-21 years)

b) Group 1: 29 (aged 22-26 years)

Individuals who fulfilled the criteria of insomnia with the minimum age of 18 years were included in the study. On the other hand, individuals who were suffering from other psychiatric illness or co morbid conditions were excluded from the study. All the subjects were explained in detail regarding the purpose of the study. Primarily, the mother tongue of all the participants was Hindi simultaneously had a good knowledge of English. Informed consent and personal information were taken from the participant.

Materials Used

Two questionnaires were administered:

a) Pittsburgh Sleep quality Index (PSQI) which consisted of 19 individual items, creating 7 components. Higher the score on Pittsburgh quality index, the lower is the sleep quality and vice versa [19].

b) Optimism sleeping Index (OSI) to measure the five facets of Optimism. There are 60 items in the test which are in 5-point Likert system. All the questions were closed set task with 3-point rating scale i.e., yes or no and not sure [20].

The data collected was analyzed using SPSS (version 17, IBM Corporation, Bengaluru, India), along with percentages of the study subjects, with respect to a particular response. The percentages and proportions of different categories of questionnaires were used to analyze the data.

Results and Discussion

The aim of the study was to find out the relationship between insomnia and five facets of Optimism among University students. On statistical analysis, the correlation (Table 1) between Pittsburgh Sleep Quality Index and Optimism Index was found to be: (r = -.342, P < .01). Therefore, the findings reveal that there is a negative correlation between Sleeping Difficulties and Optimism which means higher level of optimism is related to better Sleep Quality and more sleeping difficulties relate to lower level of optimism. Further, the data analysed on optimism five facets Positive Emotions (P_E), Engagement (E_M), Meaningfulness(M_F), Relationships(R_S) and Accomplishment(A_C) also provides negative correlation is found again between Sleep Difficulties using PSIQ and each Optimism Facet using OSI (Table 1). Extensive research study on optimism; which is an major aspect of positive personality is important as it is considered one of core platform for the development subjective well-being and health [21].A prospective review study was conducted over a 9 year follow-up period which showed a protective effect of dispositional optimism against various cardiovascular mortality in old age controlling the initial health status [22].Considering the literature current study also revealed similar result findings among the university students. The detailed description are as follows:

Table 1: MRI of the parotid gland showing homogeneous mass on the superficial lobe of the left parotid gland on hyper signal T1 and T2 and a weak signal on fat suppressed sequences. The lesion is hypointense to parotid and uniformly non-enhancing.

a) Positive Emotions and PSIQ: On statistical analysis, the correlation between Positive Emotions and Pittsburgh Sleep Quality Index was found to be: (r = -.304, P < .01) as shown in (Figure 1). This indicates that there is a negative correlation between Sleeping Difficulties & Positive Emotions. This implies the inference that good quality sleep is related to higher value of positive emotions and vice versa.

Figure 1: Graph representing relationship between Sleep Quality Index and Positive Emotions.

Figure 2: Graph representing relationship between Sleep Quality Index and Engagement.

b) Engagement and PSIQ: The relationship between Engagement and Pittsburgh sleep quality index is (r = -.241, P < .05) which implies a negative correlation between Sleeping Difficulties and Engagement also (Figure 2). A higher value of engagement is seen in students with lower Pittsburgh sleep quality index score as compared to those with higher Pittsburgh score. This implies the same inference as with above facet i.e. good quality sleep relates to good engagement score and Sleeping Difficulties relate to low engagement score/bad engagement skills.

c) Relationship and PSIQ: The correlation value between Relationship and sleep quality Index: (r = -.289, P < .01). A negative correlation value also indicates that this facet of optimism also relates to a higher value corresponding to lower values on Pittsburgh Sleep Quality Index (Figure 3). This again confirms our inference that more Sleeping Difficulties are related to lower inter-personal Relationship skills. A good quality sleep is related to a higher level of Relationship values in students. There are similar supporting studies which shows that people with lower social network and relationships tend to exhibit poor sleep. Researchers pointed out the importance of relationship support on health which indicated that higher level of non-reciprocity in social interaction, the higher level of sleep problems, depression and lower level of physical and mental health [23].

Figure 3: Graph representing relationship between Sleep Quality Index and Relationship.

d) Meaningfulness and PSIQ: The fourth facet of optimism is meaningfulness which correlates as: (r = -.258, P < .05) with the Pittsburgh score. This value also suggests that a good meaningfulness score is seen in students with good quality sleep as compared to those with sleep difficulties (Figure 4). Haack And Mullington [24] demonstrated that sleep deprivation resulted in a gradual reduction of self-reported optimism and sociability in young adults, which suggests a causal relation between sleep and positive personality characteristics. There are rich literature studies conducted which shows the relationship between insomnia and physical health [25] wherein optimism on one side has a sleep-enhancing effect; whereas poor sleep constitutes pessimism on the other side [24,25]. Similarly, it’s interesting to study that depressive mood fully moderates the first pathway, from optimism to sleep quality, the effects of sleep on optimism are only partially explained by depressive mood [26].

Figure 4: Graph representing relationship between Sleep Quality Index and Meaningfulness.

e) Accomplishment and PSIQ: The last facet which is accomplishment has a correlation value: (r = -.289, P < .01) with the Pittsburgh score. This facet is also related to Pittsburgh Sleep Quality Index similarly. Sleeping Difficulties relate to a lower value of accomplishment and good quality sleep relates to a higher value of accomplishment (Figure 5). Robert et al. [27] stated that chronic insomnia is one of the leading causes that can result in poor performances in various aspects, including the interpersonal, somatic and psychological functioning of an individual [27].

Figure 5: Graph representing relationship between Sleep Quality Index and Accomplishment.

Further, analysis was done to compare the variation in Optimism Index and Pittsburgh Score of participants with variation across the age Group (Table 2). The mean Optimism Index for Age Group 0 & Age Group 1 (Table 2) were found to be M(SD) = 222.06(18.562) & M(SD) = 226.59(27.514). These mean optimism index scores of the students of the two age groups was compared and the variation was found to be just 2.04%, the mean Optimism Index increased by just 2.04% when moving from lower age group(Group 0) to higher age group(Group 1), which was considered as a marginal difference. This implies in turn reveals that Optimism level was comparatively better in Group 1: “22-26” age group. Thus, this present study also suggests age doesn’t have a significant impact on the optimism level of university students. Comparison was also done between the mean Pittsburgh scores of the two age groups. The Mean Pittsburgh Sleep Quality Index Scores for Age Group 0 and Age Group 1 found to be M(SD) = 6.05(3.333) & M(SD) = 5.86(3.710) which was suggestive marginal/negligible difference. However, there are longitudinal studies conducted on adolescence which revealed that sleep duration decreased with age. Longer sleep duration was concurrently associated with better subjective psychological wellbeing [28] whereas, there was contraindicatory findings which showed that both the age groups had a variation of just 3.14% in Mean Pittsburgh Index Scores. The Mean Pittsburgh Sleep Quality Index shows a decrease by 3.14% from lower age group (Group 0) to higher age group (Group1). This finding suggest that Sleep Quality was found marginally better in Group 1 i.e. “22-26” age group which indicates that age group variation among university students doesn’t significantly affect their sleep quality which can be related to limited sample size. A similar study was conducted on effect of Optimism and Self-Esteem related to sleep in a large community-Based Sample and results indicated that individuals with insomnia symptoms scored lower on optimism and selfesteem which was largely independent of age and sex, controlling for symptoms of depression and short duration. Thus, the current findings confirm the previous knowledge gained by studies that people with better sleep quality have higher optimism and people with poor sleep quality have lower optimism. Also, that high level of optimism also directly or indirectly results in better sleep quality

Table 2: Sociodemographic details and Clinical Characteristics of participants(N=92).

Despite the success to find out the impact of insomnia on the five facets of optimism among young adults, there were certain limitations in the current study, which are as follows:

a) As the data collected was disproportionate in terms of sample size, gender therefore, standard generalization of the result is limited.

b) The optimism index scale questionnaire used in the study is under construction hence, superficial information regarding the facets of optimism was obtained which can be a factor that may affect the result analysis.

To overcome these shortcomings, further studies should be conducted so that a causal linkage between the variables can be drawn. Also, in order to give some more accurate result, different other aspects of the variable (e.g., stress and five facets of optimism; depression and optimism) should also be measured. Moreover, standardized objective instruments should be used to measure the variables, so that the reliability can be measured, and generalized results can be increased.

Conclusion and Implication

In summary, current study extends the knowledge towards the facets of optimism, elaborating that a better sleep quality is also related to higher level of positive facets viz. Positive Emotions, Engagement, Relationship, Meaningfulness & Accomplishment. It also the expands the knowledge towards expansion of the facets of optimism, elaborating that a better sleep quality is related to five positive facets of optimism index scale viz. Positive Emotions, Engagement, Relationship, Meaningfulness & Accomplishment. Future studies can make a greater effort in verifying the relationship among optimism, stress, depression, social support and how they interact with each other in order to predict insomnia or any sleep deprivation.

In a university setting, finding can be implemented to nurture optimism and guide sleep hygiene promotion and intervention among college students.

Acknowledgement

The authors would like to acknowledge all the participants of this study and also acknowledge all the participants who willingly participated in the study. Authors would also like to extend the gratitude toward Chancellor and Pro-vice chancellor of Amity University Haryana for their valuable support, motivation, and help during data collection and preparation of the manuscript.

For more Otolaryngology Journals please click on below link https://lupinepublishers.com/otolaryngology-journal/

#Lupine Publishers #Lupine Publishers Group #Journal of Otolaryngology #ENT Research Journal #SJO

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nunchukaninja-archive · 7 years ago

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A quick analysis regarding Journey To The Center of Mikey’s Mind

1. Mikey’s Memories

April warns Michelangelo’s brothers before they begin exploring that the memories may not be ‘altogether accurate’ based off the mere fact that it’s Mikey they’re dealing with

However, there’s not much to say beyond that, because aside from a few slight exaggerations (such as the comedic manner in which Bigfoot cradled Donnie in her arms) Mikey’s memories actually seem to be pretty true to life

This brings me to question a number of Mikey’s weirder claims when his perception of reality seems fairly normal. Were they exaggerations of casual events for the sake of a story? Or did those things really happen and his brothers simply never got around to believing him?

2. The Subconscious

As pointed out by @tenderborn, the sizes of different characteristics of Mikey’s subconscious are telling. While his gluttonous and weird personality traits are fairly normal sized (give or take a bit of obesity), his ‘funny’ self is teeny tiny while his angry self is absolutely enormous.

“Ah, the little-seen angry Mikey” Despite the offhandedness of this quote from Raph, there is a note of truth to it. Despite anger being amongst what seem to be Mikey’s major personality traits... the goofball, the weirdo, the comedian and the food lover... Mikey has never been depicted as a particularly angry person. It can be assumed that he holds back on a lot of his negative emotions, which may be the cause of the inflated size of that particular personality trait.

3. Imagination Land

Michelangelo’s personalities describe Mikey’s extensive imagination as “The Center of my Psyche.” Psyche is defined as “the human soul, mind, or spirit” so it’s interesting that Michelangelo appears to regard his imagination to be the very center of his being. Whatever his imagination is, it clearly holds a lot of weight and personal value to Michelangelo.

“Makes sense. Whenever things get bad he jumps into his wacky lala land” Another quote from Raph that’s unexpectedly telling. Clearly Michelangelo’s imagination is not only the crux his internal self, but it is also a coping mechanism and a means of escape.

The door to Mikey’s imagination is tiny and jagged, covered in bright-colored crayon scribbles, the glowing sign above it written in a sloppy childish script, his favorite food the secret password. The door to Mikey’s Imagination is a lot like the entrance to a child’s secret club house, and the world inside... though a good deal more complicated and magnificent than the door leading up to it... seems to follow a similar pattern of being cheerful, simple, brightly colored and lighthearted.

The more we see of Mikey’s imagination, the more it paints itself as a “world of escape” where fiction and reality meld and everybody gets along with everybody. Michelangelo was shown to have few issues interpreting reality as it was, but whatever may happen there is always this little space at the very center of his soul where everything’s bright and sunny and doesn’t follow any rules of logic or reason.

4. The Central Self

A six year old child: “The One True Mikey” according to his personified personality traits. “The Inner Self” according to Fugitoid.

This is not exactly an account of emotional immaturity, but more descriptive of the nature of his outlook. “The inner self is an individual’s personal, internal identity - one that is distinct from identities defined by external, social forces and relationships. It is closely linked to a person’s values, beliefs, goals and motivations.”

Michelangelo’s values reflect a willingness to give second chances to those who may not deserve it and offer everyone the benefit of the doubt. He’ll hurt those trying to hurt him and his brothers, but at the very center of it all he just wants to make friends and get along in life. As for his goals and motivations... he takes things one day at a time, and wants little more than to have fun and eat pizza in a world where everyone’s safe. This outlook isn’t so much immature, but it is somewhat childlike in nature.

The moment Michelangelo sees his brothers he rushes over and clings to them, shouting a gleeful “I knew you guys would find me!”... even though it’s a little odd that he would be looking for a rescue from his siblings when the issues are happening inside his own head.

“What’s the plan big bros?” “Don’t let them near me!” “Why are you guys looking at me?”- emotional reliance seems to be a major theme for The Inner Self. Sure, he has the strength to fight his own battles, but he can only recognize it once his older siblings show him the positive reinforcement he needs to confront his problems. When they do, however, his brain shows itself to be completely capable of handling the intruders. All he needed was that extra push and a word of encouragement.

#tmnt 2012 #long post #meta #journey to the center of mikey's mind

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totally-sewer-apples-blog · 8 years ago

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Could you do a Raph x Chubby reader (maybe her with some insecurities but sweet disposition and a "others before self" personality)? Sfw or nsfw is fine. If you could that'd be so awesome! It's hard to find turtles x a chubby reader and I'm a raph girl (it's sad cuz he's the one who has the least amount of x chubby readers and it makes me cry) so... Thanks! 😊

Okay so, this was something I noticed in the queue… And I want to address it because; wat. Please, is someone could explain to me, what is this chubby reader thing? I’ve seen it time and time again but… Why are you letting your size define you?

Fuck it I’d probably say I’m chubby (got some lovely double Ds know so, y'know, you win some you lose some) but I don’t let that define me? And yeah everyone gets insecure about their weight sometimes but to me, this makes it sound like its some big part of your identity that maybe you’re not stick thin, why?

I wouldn’t mind if this was something brought up in maybe, one or two one shots as minor details or even the occasional plot but why is there a demand for this? And there’s no drama either cause in reader inserts, it’s usually happy and the canon doesn’t care and they move on, that’s how it should be in real life too tbh.

Idk, I don’t mean to be rude but this is not something I’ll write because I don’t believe in letting your dress size define you. Other things like idk amnesia!reader, deaf!reader, heck even neko!reader(hi trash part of the fandom is me again). All of that has some big effect on your life, on how a partner might support you in a relationship. Something as silly as that doesn’t.

Don’t get me wrong being healthy is important but to me, chubby isn’t obese. It’s not an issue, it’s not going to hurt your quality of life, it’s just not being stick thin. I horse ride, swim and I’m veggie, still chubby. What you gonna do lol. But, thank you, I’m still gorgeous and I’m sure all you other chubby girls out there are as well.

Now you might be asking would I write obese!reader X anyone? No, basically cause the plot would be ‘yeah no legit do something about it’, medical conditions notwithstanding.

Haha, wow I just put this up on tumblr, now I just gotta wait for the backlash.

Seriously, this wasn’t meant to offend anyone. It’s only my view that to box yourself into this chubby archetype that needs to be 'accepted’ seems horrid to me, making it suggest like your partner has done you a favour by accepting you. No, if you ever feel like that, either your lover is a dickhole or you’ve been conditioned to think that. You’re beautiful, m kay?

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venitisblr-blog · 7 years ago

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OBESITY ALL IN OUR HEADS!

Is the solution to the obesity epidemic all in our heads? A study by researchers at The Rockefeller University suggests that it might be. “We have identified two new populations of cells in the brain that potently regulate appetite,” says Alexander Nectow. The two types of cells, located in a part of the brainstem called the dorsal raphe nucleus, are potential targets for new drugs to treat…

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juniperpublishers-dentistry · 5 years ago

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Acupuncture Therapy in Orthodontics - A Review- Juniper Publishers

Acupuncture Therapy in Orthodontics - A Review

Authored by Rohit Kulshrestha

Abstract

Acupuncture is a technique which has originated in China, in which different health issues are treated by inserting specially designed needles at various points on the body - acupuncture points. Acupuncture stimulates the nervous system and alters the perception and processing of pain signals and also releases natural painkillers. These painkillers (endorphins and serotonin) are present in the nervous system. These points serve as a tunnel to deeper circulating channels and stimulation of these points activates the body’s natural healing ability. The most common use of acupuncture is in the management of pain, for which a number of studies have shown it to be effective, particularly in the treatment of temporomandibular pain. It is intended that acupuncture may play a promising role in certain dental conditions like TMJ dysfunction, facial pain, decreasing the level of anxiety and reducing gag reflex. Aim of this article was to review acupuncture techniques and related articles in the literature that have focused on its applications in preventing gag reflex and TMJ pain.

Keywords: Acupuncture; Temporomandibular joint pain; Gag reflex

Introduction

Acupuncture first originated in china 3000 years ago [1]. It involves the insertion of needles into various parts of the body aiming to cure diseases. Still it is being relied as an alternative or adjunct during various medical therapies and also in dentistry [2]. Early studies state that acupuncture play role in treatment of several disorders with pain as the primary symptom such as in psychiatric disorders, sensor-neural deafness, hypertension, asthma, tinnitus, smoking addictions and obesity [3]. The use of acupuncture in dentistry has been mentioned by many authors and they have concluded that acupuncture is effective in various conditions like TMD, pain management and clinical conditions like Sjogren’s syndrome [4-6]. As research works on Acupuncture have started only few decades back, there lies a hint of skepticism among the dental professionals for its use in various treatment procedures. Acupuncture literally means to puncture with a needle (Figure 1).

Various Techniques used in Acupuncture

Traditional body acupuncture (Body needling)

Microsystems acupuncture

Electro-acupuncture (electric acupuncture)

Laser treatment (photo treatment)

Trigger point acupuncture

Moxibustion

Acupressure

Okibari - Japanese style.

Mechanism of Action

Acupuncture stimulates myelinated nerve fibres present in muscle, which send impulses to the spinal cord and then activate the midbrain along with pituitary-hypothalamus. It has been proved that enkephalin; beta endorphin, serotonin, dynorphin and noradrenalin are involved in the process [10]. It is known that a painful stimulation activates two types of nerve fibres in the peripheral nervous system: A-Delta and C-fibres which will terminate at the second layer of the black horn. From the second layer of the black horn, the pain sensation is via inter-neurons transmitted to the cortex and we will experience a pain [11]. It is accepted that the insertion of a needle in an acupuncture point will create a small inflammatory process which releases neurotransmitters such as histamine bradykinin, etc. and subsequent stimulate A-Delta fibres located in the skin and muscle. These fibres terminate into the second layer of the black horn and inhibit the incoming painful sensations by release of enkephaline [12]. This segmental model is the simplest mode of action and accounts probably for the pain relieving effect of acupuncture in most cases [13-15]. From the second layer of the black horn, the A-Delta fibres continues to its fifth layer, cross over to the opposite side and ascend via the spinothalamic tract to the mid brain where the raphe magnus nucleus is stimulated [16]. Raphe magnus nucleus produces serotonin in the brain and is believed to play a key role in acupuncture’s mode of action. Thus, it showed that serotonin is a pro-drug for endorphin which probably accounts for the central (extra-segmental) effect of acupuncture [17]. Moreover, it has been shown that serotonin is a pro-drug for ACTH, which acts via pituitary gland and is responsible for the increase of cortisol which has been shown after acupuncture and thus improves the immune system [18]. Finally, Serotonin has a direct effect on the cortex and it is likely that the beneficial effect of acupuncture on anxiety and stress is because of this direct effect [19]. It has been suggested that the pituitary gland plays role in the production of endorphin.

Uses in Dentistry

Acupuncture has been widely used in dentistry in different parts of the world. There have been reports of randomized controlled trials on the analgesic effect of acupuncture for postoperative pain from various dental procedures which include extractions, pulp devitalization, and acute apical periodontitis [20-23]. Systematic review of papers on the use of acupuncture in dentistry which had been published between 1966 and 1996 were assessed. It was found that 11 out of 15 randomized controlled studies with blind controls had appropriate statistics and sufficient follow-ups. This showed that standard acupuncture was more effective than a placebo or sham acupuncture [24- 25]. It was concluded that acupuncture should be considered a reasonable alternative to current dental practice as an analgesic [26]. Its use in the treatment of temporomandibular joint dysfunction was also supported in these studies.

Uses in Orthodontics

Gag reflex

Gagging has been defined as an ejector contraction of the muscles of the pharyngeal sphincter. It is a normal protective reflex which is designed to protect the airway and remove irritant material from the posterior oropharynx and the upper gastrointestinal tract [27]. Its causes can be somatic, brought about by stimulating certain trigger areas in the oral cavity or psychogenic, which is induced by thought stimulus modulated by higher brain centres. Hyperactive gag reflex can be a hindrance to dental procedures, such as taking of alginate impression for diagnostic and record keeping procedures. The use of acupuncture points like PC6 Neiguan and CV24 Chengjiang (Figure 2) have been reported to significantly reduce gag reflex [28]. Auricular acupuncture is used for treating severe gag reflex and the role of acupuncture as a method of controlling the gag reflex is safe and quick [29]. The anti gagging point located on the ear corresponds with the skin of the external acoustic meatus which is innervated by the auricular branch of the vagus nerve and that adjacent to the auricle (innervated by the auriculotemporal which is a branch of the mandibular division of the trigeminal nerve). The branches of both vagus and trigeminal nerves are responsible for the sensory and motor function of the larynx, pharynx, and palatal region. It can be suggested that stimulation of the anti gagging auricular acupuncture point may inhibit the muscular activity, thus reducing the gag reflex [30,31]. Reports suggest that auricular acupuncture is helpful in treating severe gag reflex [32]. The acupuncture point PC6 Neiguan, located on the palmer side of the forearm — two inches above the transverse crease of the wrist, belongs to the pericardium meridian, which has the effect of “calming the heart which houses the spirit”. It was proposed that acupuncture may trigger an increase in circulating β-Endorphine, which binds to the opioid receptor, creating an anti-emetic effect [33]. More studies to verify the effectiveness of acupuncture in controlling gag reflex should be carried out. Various controlled trials have postulated that ear acupuncture is as effective as intranasal midazolam for reducing dental anxiety and reducing the gag reflex [34-35]. Rosted et al. [36] examined the effect of acupuncture administered prior to dental treatment on patients’ level of anxiety. 21 case reports were submitted eight dentists submitted regarding their treatments for dental anxiety. Beck Anxiety Inventory (BAI) assessed the anxiety levels before and after acupuncture treatment. All patients received an acupuncture treatment for 5 minutes before the planned dental treatment. There was a significant reduction in median value of BAI scores just after treatment (26.5 reduced to 11.5; P < 0.01), and it was possible to perform the treatment in all 20 cases after acupuncture treatment.

A clinical study by Sari and Sari [37] assessed the role of acupuncture for treating orthodontic patients with gag reflex. The study also investigated two acupuncture approaches for orthodontic patients with the gag reflex. Each patient had an maxillary alginate impression taken and that patient’s gag reflex was evaluated using the Gagging Severity Index (GSI). After applying acupuncture, a second impression was taken, and the Gagging Prevention Index (GPI) was then used to evaluate the patient’s gag reflex. There was a significant decrease in GPI values, compared to GSI values, was observed in the treatment groups, compared with a placebo group. The researchers concluded that acupuncture points used were successful in controlling the gag reflex in orthodontic patients.

Management of temporomandibular disorders and pain

Temporomandibular Disorders (TMDs) involves a group of conditions that affect the temporomandibular joint (TMJ), and the associated head and neck musculoskeletal structures and muscles of mastication [38]. Acupuncture therapy is not helpful in treating TMD caused by structural anomalies like disc displacement and degenerative changes, it may aid in relieving pain and discomfort associated with the conditions, especially of muscular origin [39]. As documented, acupuncture helps in muscle relaxation and reduces muscle spasms. Relaxing the lateral Pterygoid muscles minimizes the anterior displacing force on the meniscus of TMJ and helps in alleviate TMJ clicking [40]. The efficacy of acupuncture in symptomatic curing of TMDs was conducted from a systematic review of randomised controlled trials for assessing [41]. Nineteen reports were included and the review suggests moderate evidence for acupuncture to be effective intervention to reduce TMDs symptoms, though more studies of larger sample sizes are needed to investigate the longterm efficacy of acupuncture [42].

Raustia et al. [43] compared the efficacy of acupuncture with conventional treatment modalities in the management of TMD. It was found that both the methods had similar effect on a number or subjective and objective variables [43]. List et al. [44] compared occlusal splint and acupuncture with a control group. It was found that both occlusal splint and acupuncture reduced symptoms compared with the control group. Acupuncture gave a better subjective result than the occlusal splint. List et al. [44] treated patients with facial pain with acupuncture. It was found that acupuncture may be a realistic alternative to conventional treatment.

Discussion

From various clinical trials it was tested and concluded that acupuncture could play a promising role in complementing conventional treatment modalities as acupuncture is generally safe and nontoxic it produces very negligible adverse reactions. After performing various research of acupuncture’s therapeutic effects has been recognized, even though the mechanisms are still not understood properly. A better understanding of the underlying mechanisms for how acupuncture works would help future researchers to perform large-scale experimental studies with better experimental prototype to confirm acupuncture’s applications in dentistry and other areas. As believed that conventional medicine is with side effect and that ‘alternative’ techniques are totally safe; numerous reports of adverse effects after acupuncture are present. These are (to mention a few) Endocarditis and hepatitis Pneumothorax some resulting in fatalities [45]. However, it must be appreciated that most of these result are from ignorance of basic human anatomy or because of non applying aseptic procedures carried out by non-medical/ dental qualified practitioners. When these are figured out of analysis, acupuncture proves to be a very safe technique in the hands of a properly trained practitioner.

Conclusion

The application of acupuncture has a long history and proves to be an effective treatment modality. Be it in control of postoperative pain or in the management of TMD and facial pain it may be a useful alternative to the conventional armamentarium of the general dental practitioner. Although the mechanism of action and positive clinical trials lag much behind the widespread use, physicians should know its potential applications for better treatment of their patients. Some physicians must take training to administer acupuncture. Acupuncture is not a miracle cure which is going to replace the drill. However, the technique can be an adjunct to conventional treatments in facial pain, TMDs, pain management Sjoegrens syndrome, and in anxiety and phobias. Acupuncture has a scientific background and the efficiency has been tested in a number of clinical trials including pain management, TMD, facial pain, and increasing of the pain threshold. Proper training is essential because Acupuncture has adverse effect. The technique can be mastered by any dentist after a short training programme.

For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com

For more articles in Open Access Journal of Dentistry & Oral Health please click on: https://juniperpublishers.com/adoh/classification.php

To know more about Peer Review Journal of Dentistry & Oral Health

#Acupuncture Therapy #Orthodontics #oral health #Juniper Publishers #Open access journal

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inosukh · 5 months ago

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look what you fucking did

original and (i forgot what its called) under cut

#emo raph #mutant mayhem #raphael #tales of the tmnt #wreck it ralph #fattie #obese #/hj #twitter meme

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kathleenseiber · 5 years ago

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“Hunger neurons” control energy output, too

A group of brain cells previously shown to regulate hunger also controls energy expenditure, according to new research.

Since our body weight depends both on the calories we consume and the energy we burn, the findings could lead to a new type of weight-loss medication that acts on both sides of the energy equation.

Effective weight-loss strategies call for eating less food, burning more calories—or ideally, both. But for the more than 90 million Americans who suffer from obesity, a disease that contributes to conditions ranging from cancer to heart disease, behavioral change is hard to accomplish or not effective enough—which is why scientists have long sought drugs that would help people shed pounds. Yet effective, long-lasting treatments have thus far eluded them.

Energy balance

Thus far, most obesity research has focused on the biological mechanisms that govern how much we eat. Yet manipulating the neural circuits that control our calorie intake hasn’t led to broadly successful anti-obesity drugs. So, Marc Schneeberger Pané, a postdoctoral fellow in Jeffrey M. Friedman’s lab at Rockefeller University, launched a project to investigate the processes by which we burn energy instead.

Mammals like mice and humans expend energy in many ways, and producing heat is among the most important. When the ambient temperature drops, we burn more fuel to maintain a steady body temperature; when it rises, we burn less. We even possess a special form of fat tissue, known as brown fat, that the body burns to produce heat directly.

Scientists knew that some populations of temperature-sensitive neurons in the hypothalamus region of the brain play a role in regulating heat production and, therefore, energy expenditure. But they did not know exactly how those neurons exerted their influence, or if other cells outside the hypothalamus might play a similar role.

‘A new horizon in obesity research’

The researchers began by mapping the brain regions activated by a rise in ambient temperature. They used an advanced 3D-imaging technique called iDISCO to scan the brains of mice they exposed to hot temperatures, looking for signs of neuronal activity.

As expected, the team saw activity in the hypothalamus. But they also saw activity among a particular group of neurons in a part of the brainstem known as the dorsal raphe nucleus—and, to the researchers’ surprise, these happened to be the very same neurons that, just two years earlier, the lab had found to be crucial for controlling hunger.

“Our new findings demonstrate that these neurons regulate energy balance by modulating both food intake and energy expenditure through partially overlapping circuit mechanisms,” says Alexander R. Nectow, who led researchers at Princeton University contributing to the work.

The possibility that these cells, which the lab had previously dubbed “hunger neurons,” might regulate both hunger and energy expenditure raised the prospect that they could serve as powerful levers for managing body weight.

“We were very excited,” recalls Schneeberger Pané, who adds that he and his colleagues view these multitalented neurons as “a new horizon in obesity research.”

The researchers used sophisticated biochemical techniques to alternately turn these temperature-sensitive brainstem neurons on and off. They discovered that activating the neurons reduced the temperature of the animals’ brown fat, which the body burns to generate heat, and core body temperature as well. Suppressing the neurons, meanwhile, amped up heat production—and, as the scientists had shown previously, it also made the animals less hungry.

A potential one-two punch

But generating heat by burning brown fat isn’t the only way to expend energy. Physical activity burns calories too, as do all the basic tasks that keep the body alive: breathing, digesting food, and so on. So the researchers put the mice in special cages tricked out with sensors to track their movements and gauge how much carbon dioxide they produce and how much food, water, and oxygen they consume. The goal was to see if the temperature-sensitive hunger neurons dorsal raphe nucleus could control energy expenditure not only by regulating temperature, but by other means as well.

Again, the results were clear: just as activating the neurons caused heat production to plummet, so too did it cause movement, metabolic activity, and overall energy expenditure to nosedive. Suppressing the neurons, on the other hand, caused all of them to rise.

The team has already begun searching for unique receptors in these dual-purpose neurons that govern both hunger and energy expenditure. The idea is to identify targets that researchers can use to create novel anti-obesity drugs capable of delivering a one-two punch.

“When you inhibit these neurons, they suppress food intake and increase energy expenditure at the same time,” says Schneeberger Pané. Figuring out how to quiet them in people could enable a doubly effective assault against a massive public health problem.

The new research appears in Cell.

Source: Rockefeller University

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rayman-25 · 7 years ago

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Podcast 2017 Episode Special Fairy Tale

Hello everyone, this is Rayman20 and today, we meet for the Chapter Special Fairytale Podcast 2017. And so without further ado, we will start the fanfic I'm still waiting for the second part of Gemturtles' night shadows chapter if it's over or not. Good reading

Warning I do not have Gravity Falls, Phineas, and Ferb characters, Welcome to the Loud, Ninja Tortus, and Youtubeur (Moketo, Squeezie, Normal, Koretech, and Kirbendoworld) With the exception of John, Mark, and Alice.

Podcast 2017 Episode Special Fairy Tale

It was such a beautiful evening at Loud's house. In the garden, Leo breathed with his eyes closed. Master Splinter spoke to him in spirit. "Leonardo, you must continue to watch your brothers and your sister during my absence. Make fun of becoming the leader, "said Spinter's ghost. "I ... I do not know how to do without you, Master," Leo said worriedly on his face. "It must be, Leonardo. You are the master now. Your brother needs you, April needs, Lincoln, Dipper, Mabel and Irving need you. Luna Jean and the podcast we need you Karai needs "and he turned to him" Dipper is the leader now. And one day, when I'm gone, you'll be the master of the Hamato clan. "

"And him the leader," said Leo. "If you want to face your enemies, you'll have to train them. And one day, you'll finally see me again, "he says. "Leo! Says a familiar path "Are you all right? " "Albert?” Leo asked. "Who are you talking to? " "Nothing to people" "Go in between you're going to be cold. The sisters of Lincoln are waiting for you » " Why ? What is happening ? Linky did something? " " No ! It's ... well you'll see when we're in Lori's room. " Leo and Albert went up the stairs and they entered Lori's room. Lori and her sisters looked at Leo with a worried face. "It's okay, Leo," Lori asked. "Yes," says Leo At that moment, Lori and Leni approached them and asked everyone to leave their room. John and Lincoln went up the stairs with chips'n cheese.

" And the girls !” John said “tonight we're going to eat pizza. Mikey to order 44 peppery pizzas » " Are you serious ?” Lisa asked " No it is true !” Mikey yelled down, "and you know what? Tonight is Lola's birthday » All the sisters except Lincoln, panicked. They shouted. And they wondered what gifts should have been bought. Jean and Lincoln went back to the Podcast. Leo leaves the room with Lori and Leni. Luna approached Leo, Leni and lori "Girls, Leo, quickly! It's Lola Loud's birthday today!” Luna Loud shouted. Lori and Leni hid in their room the other sisters in theirs without Lola getting to destroy everything. "Girls, come on! It's just a birthday!” Leo relieved the Loud sisters. "Did not you understand, Leo?” Lori explained, "If it's Lola's birthday, do not get her angry." "But it's just a little girl. She can not hurt a fly " "It's way worse, turtle boy," Luna shouted "last year, they destroyed everything. If we make her angry " You know what !” Leo shouted "If Lola is mad at you, that will be your problem! Not mine ! "

And he went to the Podcast.

Later, it was 8:30 pm, John and Lincoln, do not know what to do. "Raphael and Donnie, I do not know where your master is hiding. I searched the whole city, but I did not find anything. Me, Albert, Alice and Linky we did not give up. I am sorry " But they saw Leo entered with anger. "Leo, are you okay? Asked Raph. "It's okay, it's just to tell you tonight is Lola's birthday" "Lola's birthday, you mean it's the birthday of Twin Sisters Loud," said John. "Start the sisters ... I see it's Lana's birthday too. I must find a gift » And what age is it small?” Koretech asked. " Seven years !” Lincoln said. "Ah, that's good," said Marc. "Oh that's cute" Alice blushes "I'm going to get Mabel, Soos and the others" "No, Alice wait!” Leo shouted. Suddenly behind Leo, Soos, Melody Norman and Krib entered the house. "Hello friends, you have the floor hesitate. You are fine ? Soos asked. " No. But, Leo was angry because of the princess peach of the Loud family, "says Jean. "Do you want to talk about Lola? Kirb asked. "Exactly," says Raph "and it's the birthday of two twin sisters Loud. Mousse and Melody looked into their eyes and they looked at the others. "Friends have an idea"

In the Loud House, the sisters meet in Lori and Leni's room for hiding. Lola as for Elle, walked the stairs and she saw that the place was deserted. Suddenly she heard noises coming into the Loud garden. She walked angrily to see what was happening.

After she arrived in the garden, she saw flares of fireworks and there was music heard “Happy Birthday Congratulations Happy Birthday Happy Birthday Happy Birthday Happy Birthday to youuuu! " "Happy birthday, Lola Loud" says Leo "But before eating the cake, or es Lana we are cutting the cake" "Lincoln, April, turtles ... friends! Thanks for the cake, "said Lola with tears. The Loud sisters entered the garden and he looks shocked. "Hi girls," said Lola with a nice smile "So today is my birthday and this Lana" "I know it's not our program, but it's thanks to Lincoln that we made the decor of the garden ..." John Donna an elbow on Norman's belly "I mean it's thanks to Irving that we did the garden decoration. And Soos brought you a present » "Where is my present?” Lola asked Soos took the gift and gave it to Lola. She opened the gift and she was happy "A fairy tale book? Oh, thank you Foam, "she glared on her face. " Cool ! And for Lana, what did you bring him? Asked Grenda "You know, we did not bring any presents for Lana," Norman said. "But if you want," said Mabel, "we made cupcake Pizza" "Thank you girls," said Lana. Later in Lori and Leni's room, Lola organizes a pajama party for her birthday. "Friends, thank you for this holiday I never celebrated for the first time with Irving's work" "Oh you know it's thanks to Phineas and ferb if they're not, here" Irving said. "Soos's gift," continued Lola. " Oh oh oh ! Stop it tickling, "said Soos when Mabel and Wendy touched her belly. Lola was disgusted. "Um, Wendy?” Asked John "Yours, speaking of a fairy tale, is one of Lola's favorite stories?” Alice asked. " Yes ! I want Little Red Riding Hood!” She shouted "Ah, not the Little Red Riding Hood yet," said Lori. "Lori Loud. You know what happens when Lola gets angry " "Okay, you won," said Lori, scared. " Go if you get angry it does not bother me," Tambry said. "Why do you like this Lola tale?” Says Leo "Well you know, like every birthday party, she always wants to be told Little Red Riding Hood," Lori explained. "That story was so ... cute," Lola said. "Cute? You're kidding. In the end, chasing him cut the wolf's belly to make Little Red Riding Hood and grandmother, "explained John. "Are you sure? I thought it was the wolf who had fed the hunter who cut the little red riding hood " Irivng "Yuck," said Lincoln's sisters disgusted. 20 minutes later, Melody do not know what to choose. She looked shocked. "Ah, but it's horrible! All the tales are monstrous » "Wake up, Melody all the tales of her monstrous," said Pacifiqua, "cinderella, slavery. Snow white and the seven dwarf, poisoned apple. Hansel and Gretel… " "Not Hansel and Gretel! It scares me this tale, "Irving shouted. "Calm, Irving is just a tale of fact. It does not hurt a fly, "says Katie. "But how am I going to tell a nice story? Melody asked "I have an idea, why do not you invent a story? Irving asked. "Uh yes and no, Irving. You know that the fairy tales they are are created by the grimms brothers, "explained Moketo. "So who wants to tell a story? John asked. "Not me," Norman said. "I'd like to, but I'm not a kid anymore," Koretech said. "Please someone!” Loud kids said with glowing eyes including Mabel, Dandinous, Grenda and Candy. "Oh, you're so cute. Okay, I'll try, "said Melody. She sits on a chair and tells them a story. "There were times, in a house in the middle of the city, lived a goat mum who had 10 kids. The groin was the cutest. The second, he had glasses. The third most obese. The fourth, was the most play with a dental device. The fifth had a blue cap. The sixth was the smartest. The seventh was a black goat, the eighth was the cutest as his brother. The ninth a Scout and the last was a Korean goat. One day, their mother said to them, "But children, I have to leave you to pick some cherries. But watch out for the big bad guy who ode close to here. He is very clever and he intended to devour you every ten. "Do not worry, Mom," said the second, "we're not going to open it. Even if it's not your voice, or it has a black paw and claws "" the kid mom kissed her children and she went into the forest. A few minutes later, the kids did not hear the door of the house. Knock Knock knock. "Who is there?" Asked the groin. "It's your mom who comes back from the forest and she brings you a little present! " " I know ! Irving shouted "a manga from DBZ" "But finally, Irving. Kids, do not read DBZ Manga, "explained Melody. "Agreements. But the comic Grabouille it counts? " " No more ? " Ben, of course, if. There is one of the kids who read my comics " "Hi Jack, Hi Bart. How do you find it cool? Here, I brought you a new one. Go to more we ended up at the music festival. "What did I tell you," but Melody was sad. "I do not want to tell stories that want to tell the rest? " "I'm going to do it! Norman said and began to tell. But instead of reading he started rapping " L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario » "Norman, stop singing. It's a count, not a lullaby. And then your song is shit! "Cried Jean, looking at Lola," sorry for foul language, Lola " "Well, who wants to tell the rest of my story? Melody asked "Me, me please, please say yes, yes! Irving said hesitantly Okay, but not like Mikey, "says Raph. "You're not going to regret it, you guys are going to be action, suspense and company! Irving hesitated. They are all asleep. "Wake up I did not even start! Irving shouted. Yes, yes, sorry, go ahead, "said Leo. "After eating a chalk and putting his paws on the flour, the wolf went into the house of the 10 little kids," Irving told the book to the others. "Mia mia. So like that, the ten kids are Batman comics. I have to eat them " " story of not wasting time, the wolf teleported directly to the house of kids instead of knocking on the door " And yes you're not running, in my story, the wolf they can be teleported. Explained Irving. "Like Goku" says Norman "Yes, like Goku" "The wolf teleported to the ten kids' house, but he saw that there were people," Irving continued. "He walked into the house when he saw a person with a chest that contained I give you a thousand. The ten kids "There's no Batman yum yum? The wolf asked. "Suddenly, someone came in through the door. It was the mommy goat 'hello sir what do you do. Yours, hello day, Mrs. Wolf, have you eaten my ten children? Asked the goat mum "I do not eat children, me. I only eat mangas, hamburgers, and comics "she looked into his eyes and he looked in the eyes of the man" you have big eyes "is to better see you, madam" you have big teeth " it's better for you ... "" And also you have mustaches and a helmet! She looked at the man and he said shouting "Ah ah you're not a nice gentleman, you are ... Darth Vader! " "Darth Vader in a fairy tale? Mindy asked. "Yes, dark Vader in a fairy tale," said Irving. "He used the force to push the table" Bravo, but you're not, either, the goat's mom. "" She looked at him and said, "You got me unmasked I am super cute the rascal funnily cute "they began to attack. Darth Vader used telekinesis and when he was super cute he used his laser cannon ... " "Wait," said Robbie, "this is an invented tale" "Is it anything from where it comes out of galactic battles with aliens? Dammed Lola. "From my head Lola," Irving explained, "a kid kids free himself, ate the cherries and he threw himself on Darth Vader. Pif, paf, boom, they smashed him. Meanwhile, the wolf, found the children's room "" Yummy comics, yum and he devours all Batman comics "and without paying attention, he crunches a magic comic and shows up a fairy" "I'm the fairy" "Said the fairy. The wolf ate the fairy and turned into a prince. "" I am a prince, "he shouted. Meanwhile, in the living room, Darth Vader sent a shower of meteorites. Fortunately, tenth is breaking dance. Super cute, turns into super ugly and sent Darth Vader to the other end of the universe "" I'll come back! The mom was really happy and she proposed to play a little Monopoly with Prince Charming End! And he saw that the room was on fire. " You know what ? I'm going to sleep in Lincoln's room. Good night guys "but one thing he did not know, everyone was scared and amazed. The next morning, in the room Lola and Irving walked to talk about last night "You know, Irving one day I'll be a great princess and I'll fight a witch or a wizard like Baxster Stockman," Lola said. "Well, I thought to myself that a pretty little princess set a mutant on fire that turned into a charming prince. Not true, Raph? Irving asked Raph "The fairy tale is only for the little ones" says Raph read his comics with Moketo and Tambry " Yes indeed ? Why did not you ask Tambry to kiss her? "Lola asked. Tambry approached Raph "Me a princess? " Raph ran into Loud Tambry's house and Moketo followed him. "There are times that your prince charming silk mutant himself. A bit like Spinter "says John « L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario Eh moi j'suis vénère J'dois m'habiller en vert Avec cette couleur On m'prend pour un éboueur Mario par-là Mario par-ci Le perso qu'on choisit Ce n'est jamais Luigi Pourtant j'fais des efforts Luigi fait du sport J'ai un max de pec’s Lui est gros comme un porc Luigi’s Mansion c'était ma carrière solo Mais en arme de tueur Ils m'ont mis un aspirateur L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario Je n'ai pas la peste Je n'suis pas boiteux Alors pourquoi Luigi Est toujours le joueur deux Putain ça m'saoule Mario fait des couv’s Pendant que Luigi Est derrière en tout petit Sa meuf s'appelle Peach C'est l'nom d'une brioche S'ils font un gosse Putain il s'ra méga-moche Mario a du talent Ce n'est pas si sûr Mais vu qu'toutes ses cascades Sont faites par une doublure Tellement Mario pèse Qu'il a sa figurine Pez Il prend le melon Traîne avec Alain Delon Il gère des Go Prend des cachets illégaux Mais l'meilleur épisode C'est quand j'l'ai vu pécho Toad L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario L.U.I.G.I. Mon nom c'est Luigi Here we here we go C'est la fin de Mario Tu ramasses toutes les pièces Mais t'es pas milliardaire Mario est locataire Luigi est propriétaire J'suis propriétaire Luigi est propriétaire J'suis propriétaire Luigi est propriétaire J'suis propriétaire Luigi est propriétaire J'suis propriétaire Luigi bab’ Here we go Here we here we go Here we go Here we go Here we here we go Here we go C'est la fin de Mario »

THE END Notes from the author: This Fanfic takes place at the beginning of the arc 5 No super villains appear in Paralogue This episode is based on the birthday of Twin Loud I can not wait for Gemturtles 2nd chapter. As for chapters 3, 4 and 5, I wait until perhaps arrived in September 2018 or in 2019. After the second chapter, I'll put the 6 things to know about leonard and the second HS. Of course, the first will come out when Lincoln meets the turtles in people This is the first anniversary of Gemturtles' summary and ideas.

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