Change of telomerase activity in peripheral whole blood of head and neck squamous cell carcinoma patients before and after surgery: a pilot study

BACKGROUND The purpose of this study was to evaluate telomerase activity in peripheral whole blood from head and neck squamous cell carcinoma (HNSCC) patients as a biomarker for diagnosis of HNSCC or detection of recurrence during follow-up. MATERIALS AND METHODS Telomerase activity was measured from peripheral whole blood extracts by telomerase repeat amplification protocol (TRAP) in HNSCC patients before and after surgery and in a control group. Sixty-two HNSCC patients and 42 control subjects were included. RESULTS Telomerase activity was found in 41 out of 62 (66.1%) HNSCC patients before surgery and in 8 out of 42 (19.0%) controls (p<0.001). Among 41 HNSCC patients who showed positive telomerase activity before surgery, 32 (78.1%) showed a conversion of telomerase activity to negative after surgery. In follow-up, 6 out of 8 (75%) showed conversion of telomerase activity from negative to positive after recurrence. Telomerase activity was changed to negative in 4 out of 6 (66%) recurred patients with positive telomerase activity after second surgery. CONCLUSION The telomerase activity in peripheral whole blood extracts of HNSCC patients might be a useful biomarker for detecting recurrence after treatment. Further study with larger sample size using a more sensitive detection method of telomerase activity is necessary to verify these results.

Compensatory Growth of Grower Olive Flounder (Paralichthys olivaceus) with Different Feeding Regime at Suboptimal Temperature

Compensatory growth of grower olive flounder (Paralichthys olivaceus) was determined at suboptimal temperature (13.0±1.9°C). Fifteen fish averaging 201.1 g per tank were distributed into 18 of 300 L flow-through tanks. Six treatments were prepared in triplicate: fish were hand-fed with an extruded pellet to apparent satiation once a day for 16 weeks (16 WF); and the other five groups of fish were hand-fed for 15, 14, 13, 12 and 10 weeks after 1-, 2-, 3-, 4- and 6-week feed deprivation, referred to as 15 WF, 14 WF, 13 WF, 12 WF and 10 WF, respectively. A linear relationship between body weight of fish and feed deprivation was observed: Y (Body weight of fish) = −1.81X (Weeks of feed deprivation)+201.07, R² = 0.83. Weight gain of grower olive flounder in 15 WF, 14 WF, 13 WF and 12 WF treatments was comparable to that of fish in 16 WF treatment, but lower than that of fish in 10 WF treatment. Specific growth rate of fish in 15 WF treatment was higher than that of fish in 16 WF, 14 WF and 10 WF treatments. Feed consumption of fish was not affected by feeding regime. Feed and protein efficiency ratios of fish in 15 WF treatment were higher than those of fish in 13 WF, 12 WF and 10 WF treatments. Grower olive flounder could achieve full compensatory growth when fish were daily fed for 12 weeks after 4-week feed deprivation at suboptimal temperature.

Prognostic factors for idiopathic pulmonary fibrosis: clinical, physiologic, pathologic, and molecular aspects

BACKGROUND

Previous studies identified clinical and physiologic factors of idiopathic pulmonary fibrosis (IPF) that are related to an increased risk of mortality. But there are few studies about histologic and molecular approach.

OBJECTIVE

We investigated whether the C-reactive protein (CRP), fibroblastic foci, phosphorylated Smad2/3 (p-Smad2/3), tumor growth factor-beta (TGF-beta), TGF-beta receptor II (TbetaRII), and the polymorphism of the TGF-beta1 codon 10 are associated with the progression of IPF patients.

DESIGN

Eighty-six IPF patients who underwent surgical lung biopsies were examined. For each patient, clinical and physiologic parameters were investigated, and we performed immunohistochemical staining for p-Smad2/3 and TbetaRII, and genotyping of the TGF-beta1 codon 10 polymorphism.

RESULTS

Age at diagnosis, gender, symptom duration, and smoking status did not show a significant association. However, the amount of smoking (p = 0.002), severe reduction in the percentages of predicted forced vital capacity (p = 0.013) and diffusion lung capacity of carbon monoxide (p = 0.023), CRP (p = 0.009) at diagnosis, and fibroblastic foci (p = 0.026) were associated with a poor prognosis. Cellularity, fibrosis, expression level of p-Smad2/3 and TbetaRII, and genotype of the TGF-beta1 codon 10 polymorphism did not have a statistically significant association with the prognosis.

CONCLUSION

This study confirmed the amount of smoking, abrupt decrease in follow-up pulmonary function parameters, fibroblastic foci, and increased levels of CRP concentration at diagnosis were significantly associated with poor survival. Larger studies are required to confirm all prognostic factors including CRP.

The study of new vacuum pressure measurement technique using ultrasonic acoustic impedance transducers

Ultrasonic sensors of 500 kHz frequency have been used to study the measuring of gas pressure in the range 1.33 × 10(3)-2.026 × 10(5) Pa. From the experimental data it was observed that amplitude of the transmitted ultrasound was dependent on gas pressure. The results confirm that by using appropriate instruments including sensors and electronic devices, pressure of the gas can be successfully measured by measuring the magnitude of the received signal. The proposed method is expected to be applied to develop as new vacuum pressure measurement instrument.

PARP-14 mediates B cell memory response through the regulation of energy metabolism and gene transcription (61.5)

Immunological memory, including both persistent and recall antibody (Ab) responses, enables more efficient and effective protection against recurrent or chronic infection. Although many basic features of memory responses are understood, key molecular mechanisms regulating emergence and persistence of memory B cells and plasma cells remain unknown. Recent evidence suggests that the regulation of energy metabolism might mediate memory T cell differentiation and function. PARP-14, a Stat6-interacting protein is highly expressed in lymphoid organs, influences B cell subset ratios as well as the initial IgA response to antigen, and has intrinsic ADP-ribosyltransferase activity. We now show that PARP-14 is essential for the regulation of energy metabolism in B cells and has been significant role in the increased Ag-specific Ab levels that follow booster immunization. Investigation of the mechanism(s) revealed that PARP-14 mediates at least in part to the formation of long-lived plasma cell formation and regulates IL-4 induction of PRDM1 (Blimp-1), a master regulator of plasma cell differentiation. These results reveal a novel function of a mammalian ADP-ribosyltransferase in memory of B lineage cells and may shed a light on a new target for vaccine development.

Peripheral venous pressure as an alternative to central venous pressure in patients undergoing laparoscopic colorectal surgery

BACKGROUND

Peripheral venous pressure (PVP) is strongly correlated with central venous pressure (CVP) during various surgeries. Laparoscopic surgery in the Trendelenburg position with pneumoperitoneum typically increases CVP. To determine whether PVP convincingly reflects changes in CVP, we evaluated the correlation between PVP and CVP in patients undergoing laparoscopic colorectal surgery.

METHODS

Both CVP and PVP were measured simultaneously at predetermined time intervals during elective laparoscopic colorectal surgery in 42 patients without cardiac disease. The pairs of venous pressure measurements were analysed for correlation, and the Bland-Altman plots of repeated measures were used to evaluate the agreement between CVP and PVP.

RESULTS

A total of 420 data pairs were obtained. The overall mean CVP was 11.3 (sd 4.5) mm Hg, which was significantly lower than the measured PVP of mean 12.1 (4.5) mm Hg (P=0.005). There was a strong positive correlation between overall CVP and PVP (correlation coefficient=0.96, P<0.0001). The mean bias (PVP-CVP) corrected for repeated measurements using random-effects modelling was 0.9 mm Hg [95% confidence interval (CI) 0.54-1.19 mm Hg] with 95% limits of agreement of -1.2 mm Hg (95% CI -1.75 to -0.62 mm Hg) to 2.9 mm Hg (95% CI 2.35-3.48 mm Hg).

CONCLUSIONS

PVP displays a strong correlation and agreement with CVP under the increased intrathoracic pressure of pneumoperitoneum in the Trendelenburg position and may be used as an alternative to CVP in patients without cardiac disease undergoing laparoscopic colorectal surgery.

Variations in the STK10 gene and possible associations with aspirin-intolerant asthma in a Korean population

BACKGROUND AND OBJECTIVE

Lymphocyte-oriented kinase deficiency encoded by the serine/threonine kinase 10 (STK10) gene correlates with the intracellular adhesion molecule 1 (ICAM-1)/lymphocyte function associated antigen 1 (LFA-1) complex in aspirin hypersensitivity. This study investigated the association between single nucleotide polymorphisms (SNPs) of STK10 and aspirin-intolerant asthma (AIA).

METHODS

A total of 54 SNPs were genotyped in 163 AIA patients and 429 aspirin-tolerant asthma (ATA) controls.

RESULTS

Logistic regression revealed that a synonymous variant (rs2306961G>A) had the most significant association with AIA (P = .008 under the codominant model; P = .004 under the dominant model), suggesting that tissue-specific codon usage between Lys_TTT and Lys_CTT could play a role in regulating expression of STK10 in airway epithelium. Haplotype analysis revealed that 4 haplotypes, including STK10_BL4-ht1, which is unique to rs2306961G>A, were significantly associated with aspirin hypersensitivity in asthmatics (P < .05).

CONCLUSIONS

Although replications in independent cohorts and further functional evaluations are needed, our preliminary findings suggest that STK10 polymorphisms might be susceptible genetic markers of AIA and that gene expression could be mediated by tissue-specific codon usage.

Cbl-b regulates airway mucosal tolerance to aeroallergen

BACKGROUND

As an E3 ubiquitin ligase and a molecular adaptor, Cbl-b controls the activation threshold of the antigen receptor and negatively regulates CD28 costimulation, functioning as an intrinsic mediator of T cell anergy that maintains tolerance. However, the role of Cbl-b in the airway immune response to aeroallergens is unclear.

OBJECTIVE

To determine the contribution of Cbl-b in tolerance to aeroallergens, we examined ovalbumin (OVA)-induced lung inflammation in Cbl-b-deficient mice.

METHODS

Cbl-b(-/-) mice and wild-type (WT) C57BL/6 mice were sensitized and challenged with OVA intranasally, a procedure normally tolerated by WT mice. We analysed lung histology, bronchoalveolar lavage fluid total cell counts and differential, cytokines and chemokines in the airway, and cytokine response by lymphocytes after re-stimulation by OVA antigen.

RESULTS

Compared with WT mice, OVA-challenged Cbl-b(-/-) mice showed significantly increased neutrophilic and eosinophilic infiltration in the lung and mucus hyperplasia. The serum levels of IgG2a and IgG1, but not IgE, were increased. The levels of inflammatory mediators IFN-γ, IL-10, IL-12, IL-13, IP-10, MCP-1, MIP-1α, eotaxin, and RANTES, but not IL-17A or IL-6, were elevated in the airway of Cbl-b(-/-) mice. Lymphocytes from Cbl-b(-/-) mice released increased amount of IFN-γ, IL-10, IL-13, and IP-10 in response to OVA re-stimulation. However, no significant changes were noted in the CD4(+) CD25(+) T regulatory cell populations in the lung tissues after OVA stimulation and there was no difference between WT and Cbl-b(-/-) mice.

CONCLUSION

These results demonstrate that Cbl-b deficiency leads to a breakdown of tolerance to OVA allergen in the murine airways, probably through increased activation of T effector cells, indicating that Cbl-b is a critical factor in maintaining lung homeostasis upon environmental exposure to aeroallergens.

Short-term influence of phosphate and nitrate on heavy metal accumulation by red alga Acrosorium uncinatum

Heavy metal accumulation (Cu, Zn, Ni, and Pb) in common marine macroalga, Acrosorium uncinatum under nutrient (phosphate and nitrate) enriched (experiment 1) and starved (experiment 2) conditions over a short exposure period (12 h) were examined in this study. Control was maintained in seawater contained nutrient solution without addition of metals and in seawater alone for experiment 1 and 2, respectively. Among the four metals studied, the accumulation of Zn, Ni, and Pb was considerably lower than Cu. The accumulation factor for all metals varies greatly in different nutrient concentrations, but it increases as the exposure of metal concentration decreases in both the experiments. The results of the present findings established that this macroalga is an accumulator of metals Cu, Zn, Ni, and Pb and have the potential to accumulate these metals even in a short time exposure period (12 h). Even though metal accumulation by A. uncinatum largely depends on the available concentration in the medium, nutrients like phosphate and nitrate can affect the accumulation significantly.

Assessment of meat quality properties and development of a palatability prediction model for Korean Hanwoo steer beef

Effects of the Korean carcass-grading system on carcass traits and meat quality parameters for the longissimus dorsi (LD) and semimembranosus (SM) muscles were investigated for Hanwoo steer beef. High quality grade beef cuts had significantly higher intramuscular fat content than those of low quality grade beef cuts. To establish a guaranteed system of eating quality for Hanwoo steer beef, a palatability prediction model was developed. The model development approach used canonical discriminant analysis and multivariate regression to assess effects of muscle type, cooking method, and aging treatment on Hanwoo beef quality grade. The palatability prediction model can provide Korean consumers with detailed information about expected eating quality for an individual cut, as well as provide critical information to the industry for maintaining high-quality beef production. The model is a significant advance in grading compared with the traditional carcass grading system, which applies a single quality grade to an entire carcass.

Role of ABA and ABI3 in desiccation tolerance

We show in bryophytes that abscisic acid (ABA) pretreatment of moss (Physcomitrella patens) cells confers desiccation tolerance. In angiosperms, both ABA and the transcriptional regulator ABSCISIC ACID INSENSITIVE 3 (ABI3) are required to protect the seed during desiccation. ABA was not able to protect moss cells in stable deletion lines of ABI3 (DeltaPpabi3). Hence, moss has the same functional link between ABA, ABI3, and the desiccation tolerance phenotype that is found in angiosperms. Furthermore, we identified 22 genes that were induced during ABA pretreatment in wild-type lines. When their expression was compared with that of DeltaPpabi3 during ABA pretreatment and immediately after desiccation, a new target of ABI3 action appears to be in the recovery period.

Asarone inhibits adipogenesis and stimulates lipolysis in 3T3-L1 adipocytes

Asarone is a molecule found in certain plants such as Acorus calamus, the root of which is used in traditional medicine to treat diabetes. We determined the molecular mechanism underlying the anti-diabetic activity of asarone. Treatment of asarone significantly inhibited the differentiation of 3T3-L1 preadipocytes through suppression of expression of the transcription factors, CCAAT/enhancer binding protein-alpha and peroxisome proliferator activated receptor-gamma, which activate adipogenesis. Intracellular triglyceride levels were reduced by asarone in a dose-dependent manner and asarone treatment stimulated the phosphorylation of hormone-sensitive lipase. Together, the present findings indicate that asarone inhibits adipogenesis by down-regulation of PPARgamma and C/EBPalpha and reduces lipid accumulation by stimulation of lipolysis through an increase in hormone-sensitive lipase activity.

Metabolic syndrome and quality of life (QOL) using generalised and obesity-specific QOL scales

OBJECTIVES

We investigated the association between metabolic syndrome (MS) and health-related quality of life (HRQOL) assessed using generalised and obesity-specific QOL instruments.

METHODS

We recruited 456 outpatients [age: 19-81 years, body mass index (BMI): 16.3-36.7 kg/m2] in the primary care division from 12 general hospitals in Korea. HRQOL was measured using EuroQol comprising the health states descriptive system (EQ-5D) and visual analogue scale (EQ-VAS) as a general instrument. The Korean Obesity-related QOL scale (KOQOL) composed of six domains was used as a disease-specific QOL instrument. MS was defined on the basis of International Diabetes Federation (IDF) criteria with Korean-specific waist circumference cutoffs (men: 90 cm, women: 85 cm).

RESULTS

Subjects with MS displayed significantly higher impairment of EQ-5D and KOQOL. Binary logistic regression analysis of MS patients with controls for age, gender, smoking, alcohol, exercise, education, income, marital status and medication history disclosed odds ratio (OR) values of 2.13 (1.33-3.41) for impaired total KOQOL, 2.07 (1.31-3.27) for impaired physical health, 1.63 (1.03-2.60) for impaired work-related health, 2.42 (1.45-4.04) for impaired routine life, 2.08 (1.27-3.40) for impaired sexual life and 2.56 (1.59-4.11) for diet distress. Among the EQ-5D dimensions, only pain/discomfort displayed a significantly increased OR of 1.60 (1.01-2.56) in MS group.

CONCLUSIONS

Subjects with MS displayed a significantly impaired HRQOL compared with those without MS. MS and HRQOL were more strongly associated in obesity-specific QOL than in generalised QOL.

KITENIN recruits Dishevelled/PKC delta to form a functional complex and controls the migration and invasiveness of colorectal cancer cells

BACKGROUND AND AIMS

KITENIN was previously reported to promote metastasis in mouse colon tumour models; however, the signalling mechanism of KITENIN at the cellular level was unknown. Here the functional role of KITENIN with respect to colorectal cancer (CRC) cell invasion and its expression in CRC tissues were investigated.

METHODS

The effect of KITENIN on cell motility was analysed in a migration and invasion assay upon its overexpression and knockdown. Immunoprecipitation was used to elucidate binding partners, and immunohistochemistry was used to study expression levels.

RESULTS

KITENIN overexpression enhanced the migration of rat intestinal epithelial cells, whereas a loss of invasiveness was observed in CRC cells after KITENIN knockdown. Mechanically, KITENIN served as a scaffolding molecule that simultaneously recruited both Dishevelled (Dvl) and protein kinase C delta (PKC delta) through the membrane-spanning C-terminal region to form a complex that stimulated extracellular signal-regulated kinase (ERK)/activating protein-1 (AP-1) via a PKC delta component but also organised the actin filament via a Dvl component. The KITENIN complex controlled the invasiveness of CRC cells aetiologically harbouring various mutations in APC, beta-catenin or K-ras, in which AP-1 activation is redundant but the organisation of the actin filament is indispensable for cell motility. Clinically, KITENIN expression was significantly higher in colon cancer tissues from advanced stage (III, IV) than that of stage I CRC and also in corresponding metastatic tissues.

CONCLUSIONS

The functional KITENIN complex acts as an executor with regard to cell motility and thereby controls CRC cell invasion, which may contribute to promoting metastasis.

PARP-14 mediates IL-4-enhanced metabolic function and survival of B cells (97.4)

IL-4 is survival factor for lymphocytes and other hematopoietic cells. Whether there are mechanisms of pro-survival signaling induced by IL-4 apart from PI3K-Akt activation is not fully clear. Our laboratory identified PARP-14, a poly-ADP-ribose polymerase subfamily member, as a Stat6-interacting protein. PARP-14 is highly expressed in lymphoid organs, influences B cell subset ratios as well as the IgA response to antigen, and has intrinsic ADP-ribosyltransferase activity. ADP-ribosyltransferases and PARPs catalyze mono- and poly-ADP-ribosylation, transferring ADP from NAD+ to target proteins. ADP-ribosylation is a post-translational modification used by bacterial exotoxins to impact signal transduction, or, in the case of the mammalian PARP-1, to influence gene transcription and DNA repair or trigger apoptosis. Almost nothing is known about biological roles or mechanisms of action of other mammalian PARPs. We now show that PARP-14 is essential for full survival signaling despite normal Akt activation in B cells. Investigation of the mechanism(s) revealed that PARP-14 mediates IL-4 induction of gene products known to promote cell survival, and also metabolic functions of B cells. Moreover, intervention that restored glycolytic activity in IL-4-treated B cells also rescued pro-survival signaling. These results reveal a novel link to metabolic regulation via a mammalian ADP-ribosyltransferase.

Predictors of bronchial hyperresponsiveness in chronic rhinosinusitis with nasal polyp

BACKGROUND

Chronic rhinosinusitis with nasal polyposis (CRSNP) and asthma are inflammatory lesions of the respiratory epithelium. This study was conducted to evaluate predictive factors of bronchial hyperresponsiveness (BHR) in patients with CRSNP.

METHODS

BHR was evaluated using a methacholine bronchoprovocation test (MBPT) in 122 consecutive patients newly diagnosed with CRSNP at Seoul National University Hospital from January 2004 to June 2006. The following parameters were analyzed and compared between the BHR and non-BHR groups: symptoms, atopic status, current smoking, disease severity of CRSNP based on the Lund-Mackay scoring system of sinus CT, and counts of eosinophils in the serum and nasal tissues.

RESULTS

Thirty-five percent of the patients were found to have BHR, and BHR was found to occur more frequently in patients that were currently suffering from sneezing (P = 0.007). In addition, the mean eosinophil counts of the serum and nasal tissues were higher in the BHR group than in the non-BHR group (P = 0.001 for the serum, P = 0.045 for the nasal tissues), and the eosinophil counts of the serum correlated to those of the nasal tissues (r = 0.334, P = 0.013). The disease severity, as determined by the Lund-Mackay scoring system, was not different between the two groups (P > 0.05). The best cutoff serum eosinophil count for predicting BHR in CRSNP patients was determined to be 300 cells/microl (sensitivity 70%, specificity 70%).

CONCLUSION

Taken together, these results indicate that moderate to severe sneezing and a serum eosinophil count > or = 300 cells/microl may be predictive factors for BHR in patients with CRSNP.

Hydrophilized poly(lactide-co-glycolide) nanospheres with poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) triblock copolymer

A novel method for preparing the PLGA nanospheres with hydrophilic surface has been designed and characterized. Because of good solubility of tetraglycol in water, PLGA (poly(lactide-co-glycolide)) nanospheres were formed by spraying the PLGA/tetraglycol solution into water. The size of PLGA nanospheres was manipulated by changing the concentration of PLGA/tetraglycol solution. Based on the hydrophobic interaction between PLGA and poly(propylene oxide) domain of F-127 (one of Pluronics, poly(ethylene oxide)-poly(propylene oxide)poly(ethylene oxide) triblock copolymer, F-127-coated PLGA nanospheres was prepared to enhance the stability of PLGA nanospheres in the aqueous media. For the application as a drug delivery vehicle, it was characterized by measuring the loading amount, the encapsulation efficiency and the release pattern of drug. Paclitaxel used as a potent anti-cancer drug was selected as a model drug.

Association of angiotensin I-converting enzyme gene polymorphisms with aspirin intolerance in asthmatics

BACKGROUND

Aspirin-intolerant asthma (AIA) refers to the development of bronchoconstriction in asthmatic individuals following the ingestion of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs). Angiotensin I-converting enzyme (ACE), a membrane-bound peptidase present in the lung, plays a pivotal role in the metabolism of the endogenous peptides involved in the pathogenesis of asthma.

METHODS

We screened a Korean asthma cohort (581 asthmatics including 81 aspirin-intolerant asthmatics and 231 aspirin-tolerant asthmatics, and 181 normal controls) for four single nucleotide polymorphisms (SNPs; -262 A>T and -115 T>C in the 5'-flanking region and +5467 T>C [Pro450Pro] and+11860 A>G [Thr776Thr] in the coding region) and one ins/del (+21288 CT) in the ACE gene.

RESULTS

None of the SNPs or haplotypes showed any association with the development of asthma, but they were significantly associated with the risk of AIA. Logistic regression indicated that the frequency of the rare alleles of -262 A>T and -115 T>C was higher in subjects with AIA than in subjects with aspirin-tolerant asthma (ATA) (P=0.003-0.01, P( corr)=0.015-0.05). Subjects homozygous for the rare alleles of -262 A>T and -115 T>C showed a greater decline in forced expiratory volume in 1 s (FEV(1)) after aspirin provocation than those homozygous for the common alleles (P<0.05). A luciferase reporter assay indicated that ACE promoters containing the rare -262 A>T allele possessed lower activity than did those containing the common allele (P=0.009). In addition, ACE promoters bearing the rare -115 T>C allele had no luciferase activity. DNA-protein binding assays revealed a band containing the ACE promoter region (including -262 A) and a protein complex.

CONCLUSION

The -262 A>T polymorphism in the promoter of the ACE gene is associated with AIA, and the rare allele of -262 A>T may confer aspirin hypersensitivity via the down-regulation of ACE expression.

Changes in neck muscle electromyography and forward head posture of children when carrying schoolbags

This study tested the effects of three alternative types of backpack on head posture and neck muscle electromyography (EMG) in children. Four loading conditions were tested: no pack; a backpack; a double pack; a modified double pack (designed with a backpack and a front pack weighing 10% and 5% of body weight, respectively). Dependent variables were neck muscle activity, forward head angle and forward head distance (the perpendicular distance from C7 to a vertical line through the tragus of the ear). Fifteen children were asked to walk at a speed of 0.8 m/s on a treadmill. The EMG activity of upper trapezius, sternocleidomastoid and midcervical paraspinals muscles and the forward head angle and forward head distance were all significantly higher when carrying a backpack than for the other conditions. When carrying a double pack, there was a backward head posture characterised by an increased negative forward head angle, decreased forward head distance, increased sternocleidomastoid EMG signal and decreased midcervical paraspinals EMG signal, compared to carrying no pack. When carrying a modified double pack, the forward head angle and forward head distance decreased when compared to carrying a backpack. These findings indicate that the modified double pack minimises postural deviation.