Short-term Improvement in Physical Activity and Body Composition Following Supervised Exercise Training Program in Idiopathic Pulmonary Fibrosis

Publication date: Available online 8 February 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Baruch Vainshelboim, Benjamin Daniel Fox, Mordechai Reuven Kramer, Shimon Izhakian, Evgeni Gershman, Jose Oliveira
ObjectiveTo examine the effect of participating in a 12-week supervised exercise training (ET) program on physical activity and body composition in Idiopathic Pulmonary Fibrosis (IPF) patients.DesignRandomized controlled trial assessing physical activity and body composition at baseline, after 12-weeks intervention and at 11 months follow up.SettingHospital outpatient Pulmonary Institute.ParticipantsThirty four patients with IPF (68±8 yr) recruited for this study, 32 patients completed the 12-week intervention (ET group, n=15, control group, n=17) and 28 patients (14 in each group) reassessed at 11 months follow-up from baseline.InterventionParticipation in a 12-week supervised ET program or regular medical treatment.Main Outcome MeasureChanges in physical activity levels as measured by International Physical Activity Questionnaire.ResultsAfter 12-weeks intervention physical activity levels were significantly enhanced in the ET group while the control group showed a trend of deterioration [median difference between the groups (interquartile range) 2164 (1576) METS-min/week, p<0.001]. Body composition was also significantly improved in the ET group, while the control group showed an opposite trend. At 11 months follow-up no significant differences were observed between the groups in all variables. ET group lost their achieved benefits in the outcomes and returned to near baseline values, while the control group showed a trend toward worsened outcome.ConclusionsPhysical activity and body composition in patients with IPF were improved following 12-week supervised ET program although the benefits were not-sustained at 11 months follow-up. These results may support the efficacy of participating in supervised ET to improve physical activity and body composition in IPF patients, however maintenance strategies are warranted to preserve the enhanced outcomes. Trial registration: NCT01499745, Clinicaltrials.gov



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Effect of prosthetic restoration on masticatory function in patients with shortened dental arches: a multicentre study

Summary

The aim of this multicentre study was to investigate the effect of prosthetic restoration for missing posterior teeth on mastication in patients with shortened dental arches (SDAs). Partially dentate patients who had an intact teeth in anterior region and missed distal molar(s) (2–12 missing occlusal units) classified as Kennedy Class I or Class II were recruited from seven university-based dental hospitals in Japan. Of the 125 subjects who underwent baseline (pre-treatment) and follow-up/post-treatment evaluation, 53 chose no replacement of missing teeth and 72 chose treatment with removable partial dentures (n = 53) or implant-supported fixed partial dentures (n = 19). Objective masticatory performance (MP) was evaluated using a gummy jelly test. Perception of chewing ability (CA) was rated using a food intake questionnaire. In the no-treatment group, mean MP and CA scores at baseline were similar to those at follow-up evaluation (P > 0·05). In the treatment group, mean MP after treatment was significantly greater than the pre-treatment mean MP (P < 0·05). However, the mean perceived CA in the treatment groups was similar at pre- and post-treatment (P > 0·05). In a subgroup analysis of subjects in the treatment group, subjects with lower pre-treatment CA showed a significant CA increase after treatment (P = 0·004), but those with higher pre-treatment CA showed a significant decrease in CA (P = 0·001). These results suggest that prosthetic restoration for SDAs may benefit objective masticatory performance in patients needing replacement of missing posterior teeth, but the benefit in subjective chewing ability seems to be limited in subjects with perceived impairment in chewing ability before treatment.

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Biomass derived solvents for scalable production of single layer graphene from graphite

Chem. Commun., 2016, Accepted Manuscript
DOI: 10.1039/C6CC00256K, Communication

Mukesh Sharma, Dibyendu Mondal, Nripat Singh, Kamalesh Prasad
Among four different biomass derived green and sustainable solvents namely levulinic acid (LA), ethyl lactate (EL), [gamma]-valerolactone (GVL) and formic acid (FA) only LA was found to exfoliate graphite to...
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Qi-Shen-Yi-Qi Dripping Pills Promote Angiogenesis of Ischemic Cardiac Microvascular Endothelial Cells by Regulating MicroRNA-233-3p Expression

Traditional Chinese medicine (TCM) research shows that Qi-Shen-Yi-Qi Dripping Pills (QSYQ) can promote ischemic cardiac angiogenesis. Studies have shown that microRNAs (miRNAs) are the key component of gene regulation networks, which play a vital role in angiogenesis and cardiovascular disease. Mechanisms involving miRNA by which TCM promotes ischemic cardiac angiogenesis have not been reported. We found that microRNA-223-3p (mir-223-3p) was the core miRNA of angiogenesis of rats ischemic cardiac microvascular endothelial cells (CMECs) and inhibited angiogenesis by affecting RPS6KB1/HIF-1α signal pathway in previous study. Based on the results, we observed biological characteristics and optimal dosage for QSYQ intervening in rats ischemic CMECs angiogenesis and concluded that QSYQ low-dose group had the strongest ability to promote angiogenesis of ischemic myocardium. Using miRNA chip and real-time PCR techniques in this study, we identified mir-233-3p as the pivotal miRNA in QSYQ that regulated angiogenesis of ischemic CMECs. From real-time PCR and western blot analysis, research showed that gene and protein expression of factors located RPS6KB1/HIF-1α signaling pathway, including HIF-1α, VEGF, MAPK, PI3K, and AKT, were significantly upregulated by QSYQ to regulate angiogenesis of ischemic CMECs. This study showed that QSYQ promote ischemic cardiac angiogenesis by downregulating mir-233-3p expression in rats ischemic CMECs.

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Use and effectiveness of quitlines versus Web-based tobacco cessation interventions among 4 state tobacco control programs

BACKGROUND

Comparative effectiveness studies of state tobacco quitlines and Web-based tobacco cessation interventions are limited. In 2009, the US Centers for Disease Control and Prevention undertook a study of the comparative effectiveness of state quitlines and Web-based tobacco cessation interventions.

METHODS

Standardized questionnaires were administered to smokers who enrolled exclusively in either quitlines or Web-based tobacco cessation services in 4 states in 2011-2012. The primary outcome was the 30-day point prevalence abstinence (PPA) rate at 7 months both between and within interventions.

RESULTS

A total of 4086 participants were included in the analysis. Quitline users were significantly older, more heterogeneous in terms of race and ethnicity, less educated, less likely to be employed, and more often single than Web-based users. The 7-month 30-day PPA rate was 32% for quitline users and 27% for Web-based users. Multivariate models comparing 30-day PPA rates between interventions indicated that significantly increased odds of quitting were associated with being partnered, not living with another smoker, low baseline cigarette use, and more interactions with the intervention. After adjustments for demographic and tobacco use characteristics, quitline users had 1.26 the odds of being abstinent in comparison with Web-based users (95% confidence interval, 1.00-1.58; P = .053).

CONCLUSIONS

This is one of the largest comparative effectiveness studies of state tobacco cessation interventions to date. These findings will help public health agencies develop and tailor evidence-based tobacco cessation programs. Further research should focus on users of Web-based cessation interventions sponsored by state health departments and their cost-effectiveness. Cancer 2015. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

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A novel ATM-dependent checkpoint defect distinct from loss of function mutation promotes genomic instability in melanoma

Abstract

Melanomas have high levels of genomic instability that can contribute to poor disease prognosis. Here, we report a novel defect of the ATM-dependent cell cycle checkpoint in melanoma cell lines that promotes genomic instability. In defective cells, ATM signalling to CHK2 is intact, but the cells are unable to maintain the cell cycle arrest due to elevated PLK1 driving recovery from the arrest. Reducing PLK1 activity recovered the ATM-dependent checkpoint arrest, and over-expressing PLK1 was sufficient to overcome the checkpoint arrest and increase genomic instability. Loss of the ATM-dependent checkpoint did not affect sensitivity to ionising radiation demonstrating that this defect is distinct from ATM loss of function mutations. The checkpoint defective melanoma cell lines over-express PLK1, and a significant proportion of melanomas have high levels of PLK1 over-expression suggesting this defect is a common feature of melanomas. The inability of ATM to impose a cell cycle arrest in response to DNA damage increases genomic instability. This work also suggest that the ATM-dependent checkpoint arrest is likely to be defective in a higher proportion of cancers than previously expected.

This article is protected by copyright. All rights reserved.

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Legionellosis in Transplantation

Abstract

Legionella species are emerging opportunistic pathogens in hematopoietic stem cell and solid organ transplant recipients, associated with significant morbidity and mortality. The clinical and radiological features of Legionella infections can mimic other opportunistic pathogens in these profoundly immunocompromised patients. Diagnosis in transplant patients is challenging as non-pneumophila Legionella infections, for which these patients are at risk, cannot be identified using the urinary antigen test. Changes in management of transplant recipients and changes in Legionella epidemiology suggest that the number of transplant patients potentially exposed to Legionella spp. may be on the rise. Yet, evidence-based, transplant-specific guidelines for managing and preventing Legionella infections are not currently available. In this article, we review the epidemiology, clinical features, diagnostic challenges, treatment options, and preventive strategies of Legionella infections in these high-risk patient populations.

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Emerging Techniques for Ultrasensitive Protein Analysis

Analyst, 2016, Accepted Manuscript
DOI: 10.1039/C6AN00059B, Minireview

Xiaolong Yang, Yanan Tang, Ryan Richard Alt, Xiaoyu Xie, Feng Li
Many important protein-based biomarkers for devastating diseases and biochemical processes are present in ultralow levels. Traditional techniques, such as enzyme-linked immunosorbent assays (ELISA), mass spectrometries, protein microarrays, are often not...
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Metal-responsive interdigitated bilayer for selective quantification of mercury(II) traces by surface plasmon resonance

Analyst, 2016, Accepted Manuscript
DOI: 10.1039/C5AN02523K, Communication

Elizaveta Ermakova, Oleg Raitman, Alexander V. Shokurov, Maria A. Kalinina, Sofia L. Selector, Aslan Yu. Tsivadze, Vladimir Arslanov, Michel Meyer, Alla Bessmertnykh Lemeune, R Guilard
An innovative design of reusable SPR chips allowing the quantitative and selective determination of mercury(II) at ppt level is reported.
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Guiding Hypertension Management Using Central Blood Pressure: Effect of Medication Withdrawal on Left Ventricular Function

BACKGROUND

Central blood pressure (BP) is an acknowledged contributor to end-organ damage and independent determinant of prognosis. Primary analysis from the BPGUIDE study demonstrated no detriment on left ventricular (LV) structure from central BP-guided hypertension management, despite significant medication withdrawal. However, the effect of this on LV function has not been investigated. In this study, we sought to investigate the impact of central BP-guided hypertension management on LV systolic and diastolic performance.

METHODS

A total of 286 enrollees with uncomplicated hypertension were randomized to therapeutic decisions guided by best-practice usual care (UC) or, in addition, by central BP intervention (CBP) for 12 months. Each participant underwent baseline and follow-up 2-dimensional echocardiography, with assessment undertaken by an expert blinded to participant allocation.

RESULTS

Antihypertensive medication quantity remained unchanged for UC but significantly decreased with intervention. However, no significant between-group differences were noted for changes during follow-up in both brachial and central BP, as well as other central hemodynamic parameters: augmentation index and augmented pressure. Similarly, there were no differences between groups in parameters of LV diastolic function: tissue e' velocity (UC vs. CBP; P = 0.27) and E/e' ratio (UC vs. CBP; P = 0.60), and systolic parameters: LV longitudinal strain (UC vs. CBP; P = 0.55), circumferential strain (UC vs. CBP; P = 0.79), and ejection fraction (UC vs. CBP; P = 0.15).

CONCLUSIONS

Hypertension management guided by central BP, resulting in significant withdrawal of medication to maintain appropriate BP control, had no adverse effect on LV systolic or diastolic function.

clinical trials registration

Australia New Zealand Clinical Trial Registry Number ACTRN12608 000041358

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Association of Post-Saline Load Plasma Aldosterone Levels With Left Ventricular Hypertrophy in Primary Hypertension

BACKGROUND

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity in hypertension. Current evidence suggests a contribution to LVH of plasma aldosterone levels that are inappropriately elevated for the salt status. The aim of this study was to investigate whether inappropriate modulation of aldosterone production by a saline load is associated with left ventricular (LV) mass in hypertensive patients.

METHODS

In 90 hypertensive patients free of clinically relevant cardiovascular complications in whom secondary forms of hypertension were ruled out, we performed a standard intravenous saline load (0.9% NaCl, 2 l in 4 hours) with measurement of plasma aldosterone and active renin at baseline and end of infusion. Bi-dimensional echocardiography was performed for the assessment of cardiac morphology and function.

RESULTS

LVH was present in 19% of patients who had significantly worse renal function and higher body mass, blood pressure, and plasma aldosterone levels measured both at baseline and after the saline load than patients without LVH. LV mass was directly related to age, body mass, systolic blood pressure, duration of hypertension, baseline, and post-saline load plasma aldosterone levels and inversely to glomerular filtration. Multivariate regression analysis showed independent correlation of LV mass with body mass, systolic blood pressure, and plasma aldosterone levels measured after intravenous saline load, but not at baseline.

CONCLUSIONS

In patients with hypertension, aldosterone levels measured after intravenous saline load are related to LV mass independent of age, body mass, and blood pressure, suggesting that limited ability of salt to modulate aldosterone production could contribute to LVH.

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Blood Pressure Out of the Office: Its Time Has Finally Come

The diagnosis of hypertension includes measurement of blood pressure out of the office by either 24-hour ambulatory monitoring or home blood pressure monitoring. These methods have led to recognition of "white coat hypertension" (WCH) and "masked hypertension" (MH). Research in the 1930s first demonstrated that blood pressures in the office were often far different from those out of the office, at a time when there was no effective treatment. International attention was focused on another imminent world war and a highly controversial election in the United States. Hypertension was not a priority for concern. From the 1950s onward: (i) epidemiology linked hypertension to risk of cardiovascular disease, (ii) effective and safe drugs for treatment of hypertension appeared, (iii) randomized clinical trials demonstrated that drug treatment of hypertension is highly effective for prevention of cardiovascular disease, and (iv) advances in technology led to development of small, portable devices for recording blood pressure noninvasively at home or during usual activities. Accurate measurement of blood pressure in "real life" is now necessary and feasible for appropriate diagnosis and assessment of treatment. Out-of-office blood pressure measurement is emerging as the standard of care for hypertension.

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Comparison of 4 Admission Blood Pressure Indexes for Predicting 30-Day Mortality in Patients With ST-Segment Elevation Myocardial Infarction

BACKGROUND

We compared admission systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) in predicting 30-day all-cause mortality in patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock.

METHODS

A retrospective study was performed in 7,033 consecutive STEMI patients. Multivariate-adjusted hazard ratios (HRs) with a 10mm Hg increment and quartiles of each blood pressure were determined by Cox proportional hazard analyses; Wald ² tests were used to compare the strength of relationships.

RESULTS

Totally 593 (8.4%) patients died during follow-up. Of 4 indexes, only SBP (HR 0.94 per 10mm Hg, 95% confidence interval (CI) 0.91 to 0.98; P = 0.001) and PP (HR 0.89 per 10 mmHg, 95% CI 0.85 to 0.94; P < 0.001) were significantly associated with 30-day all-cause mortality; these in the highest vs. lowest quartiles of SBP (≥140 vs. <110mm Hg) and PP (≥60 vs. <40mm Hg) had HRs of mortality of 0.70 (95% CI 0.55 to 0.87; P = 0.003) and 0.60 (95% CI 0.47 to 0.75; P < 0.001), respectively. Compared with SBP, PP was a better predictor for mortality no matter in men ( ² = 5.9 for per 10mm Hg, ² = 10.8 for quartiles) or women ( ² = 15.1 for per 10mm Hg, ² = 19.5 for quartiles), and the relationship remained significant after adjustment of SBP. There was a pattern of declining risk with increasing blood pressures for mortality, and this trend was mainly observed in age groups of more than 70 years.

CONCLUSIONS

Pulse pressure was an independent predictor of mortality in patients with STEMI, and low admission blood pressure should serve as a warning sign.

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Carotid Artery Tonometry: Pros and Cons

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Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure Variability, and Cognitive Function in Old Age

BACKGROUND

Visit-to-visit blood pressure (BP) variability is associated with cognitive impairment. We assessed to what extent the association between BP variability and cognitive impairment is mediated by the association of BP lowering medication (BPLM) with both BP variability and cognition.

METHODS

We studied 5,606 participants from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). BP was measured every 3 months during 3.2 years; BP variability was defined as the SD of BP measurements during follow-up. Cognitive function was assessed at baseline and during follow-up using the Stroop test, Letter-Digit Coding test, and immediate and delayed Picture-Word Learning tests. Multivariate regression models were used with and without adjustments for BPLM to calculate the percentage to which BPLM mediated the association between BP variability and cognition.

RESULTS

Participants taking calcium antagonists had a higher score in baseline Letter-Digit Coding test (mean difference (95% confidence interval (CI) 0.45 (0.06; 0.88). Participants taking beta-blockers had a steeper decline in Stroop test (additional change per year (95% CI) 0.40 (0.09; 0.70) and Letter-Digit Coding test (0.08 (–0.15; –0.02)). Furthermore, a steeper decline in Stroop test was found in participants taking renin-angiotensin system (RAS) inhibitors (0.50 (0.16; 0.85). Systolic BP variability was higher in participants taking beta-blockers and RAS inhibitors (mean difference in systolic BP variability in mm Hg (95% CI) 0.75 (0.45; 1.04) and 1.37 (1.04; 1.71) respectively). Participants taking diuretics, calcium antagonists, and RAS inhibitors had a higher diastolic BP variability (mean difference in diastolic BP variability in mm Hg (95% CI) 0.27 (0.04; 0.49), 0.37 (0.12; 0.62) and 0.65 (0.37; 0.93) SD, respectively). Beta estimates remained essentially the same when we adjusted for BPLM in the association of BP variability with cognitive function.

CONCLUSIONS

The association between BP variability and cognitive impairment was not mediated by BPLM.

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Carotid Artery Applanation Tonometry Does Not Cause Significant Baroreceptor Activation

BACKGROUND

Carotid artery applanation tonometry is widely used in estimating local carotid artery pressure waveforms and carotid–femoral pulse wave velocity. However, the substantial pressure applied locally to the carotid artery with applanation tonometry might well evoke a baroreceptor response, resulting in bradycardia and hypotension. Therefore, when carotid and femoral tonometry are performed sequentially, baroreceptor activation could lead to different hemodynamic conditions between carotid and femoral acquisitions. Combining those acquisitions into one pulse wave velocity measure would be erroneous. In this study, we assessed whether carotid applanation tonometry has an influence on heart rate and blood pressure.

METHODS

In 26 hypertensive subjects, heart rate and blood pressure were assessed by continuous finger pulse waveform recording during carotid as well as femoral applanation tonometry. Both carotid and femoral acquisitions were measured in alternation and in triplicate. Median averaging over the 3 carotid and femoral measurements, respectively, was used to obtain a subject's median heart rate and blood pressure during carotid as well as femoral tonometry.

RESULTS

Difference in heart rate during carotid and femoral tonometry was –0.7±2.2 bpm. Differences in systolic, pulse, and diastolic blood pressure were –0.7±6.8, –0.1±3.8, and –0.3±3.5mm Hg, respectively. All differences were statistically nonsignificant. Confidence intervals were used to calculate the maximum absolute difference at 95% certainty, which was 1.6 bpm for heart rate and ≤3.5mm Hg for all blood pressures.

CONCLUSIONS

We conclude that in our study, carotid artery applanation tonometry as performed by an experienced researcher did not cause clinically significant baroreceptor activation.

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Persistence of Masked Hypertension in Chinese Patients

BACKGROUND

Masked hypertension (MH) has 10–15% prevalence and carries risk similar to that of sustained hypertension, but its short-term persistence remains uncertain.

METHODS

Forty-five patients with MH (mean age 52.2 years; 37.8% women) were enrolled in the placebo arm of a randomized clinical trial of Chinese medicine (NCT02156024) and followed up for 4 weeks. MH was office normotension (<140/90mm Hg) and daytime (8:00–18:00) hypertension (≥135/85mm Hg).

RESULTS

At enrolment, office and daytime systolic/diastolic blood pressure (BP) averaged 129.0/80.6mm Hg and 132.9/88.9mm Hg, respectively. Daytime BP thresholds for MH were met in 5 patients (11.1%) for systolic BP, in 25 (55.6%) for diastolic BP and in 15 (33.3%) for both. At follow-up, systolic and diastolic BP had not changed compared with baseline (P ≥ 0.12), except for a 2.1mm Hg decrease in office systolic BP (P = 0.049). MH remained present in 28 patients (62.2%; 95% CI, 48.1–76.3%), whereas 13 (28.9%; 15.7–42.1%) and 4 (8.9%; 0.6–17.2%) converted to normotension (daytime BP <135/85mm Hg) or sustained hypertension (office BP ≥140/90mm Hg), respectively. Substituting daytime by 24-hour BP, using 130/80mm Hg as threshold, produced consistent results. Systolic office BP at baseline independently predicted persistence of MH or progression to sustained hypertension at 4 weeks (odds ratio per 1 – SD increase, 3.49; 95% CI, 1.06–11.2; P = 0.04).

CONCLUSIONS

The information that MH persists over 4 weeks in over two-thirds of this sample of patients should inform future clinical trials and guidelines.

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Association of Nocturnal Hypertension With Disease Activity in Rheumatoid Arthritis

OBJECTIVES

Both nocturnal hypertension (HT) and systemic inflammation underlying rheumatoid arthritis (RA) have been shown to be independent predictors of cardiovascular disease (CVD), although little is known on the relationship between nocturnal blood pressure (BP) and disease activity in RA patients.

METHODS

We performed 24-hour ambulatory BP monitoring (ABPM) in 71 RA patients to examine the relationship of nocturnal fall in BP and RA disease activity based on a disease activity score of 28 joint counts with C-reactive protein (CRP, 28-joint disease activity score (DAS28)-CRP). Among them, 25 RA patients whose consent obtained were reexamined by ABPM to assess the improvement of nocturnal fall in BP after RA therapeutic intervention.

RESULTS

The mean DAS28-CRP level was 4.8±1.6 in 71 RA patients. The mean nocturnal fall in BP was 5.6±8.9%. DAS28-CRP was associated significantly and independently in a negative manner with the nocturnal fall in BP (β = –0.388, P = 0.004). In 25 RA patients, DAS28-CRP improved from 5.4±1.1 to 3.5±0.8 (P < 0.0001) and the nocturnal fall in BP increased significantly from 4.5±9.2% to 10.6±5.8% (P = 0.002) with the significant decrease of nighttime systolic BP (SBP) from 121.2±22.5mm Hg to 112.5±18.8mm Hg (P = 0.02) in spite of no change in daytime BP after 4 weeks of RA treatment.

CONCLUSIONS

The present study observed that higher RA activity was associated with lower nocturnal fall in BP, but not daytime BP, in RA patients.

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Reduction of Central Blood Pressure in Response to Oral Glucose Loading Is Blunted in Patients With Diabetes Mellitus

BACKGROUND

Recent studies have shown that arterial stiffness is reduced after meal intake. We evaluated the acute response of central hemodynamics to glucose loading and the variation in their responses among normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM).

METHODS

The study enrolled 85 patients with known or suspected coronary artery disease who underwent a 75-g oral glucose tolerance test. Central hemodynamic measurements were assessed using radial applanation tonometry at fasting, 60, and 120 minutes after glucose loading.

RESULTS

Glucose loading decreased the augmentation index normalized to a heart rate of 75 bpm (AIx@75) (81.6±13.9 to 74.5±14.1%, P < 0.01) and central systolic blood pressure (SBP) (115±22 to 109±21mm Hg, P < 0.01) at 120 minutes without a significant change in brachial SBP (126±25 to 125±25mm Hg, P = 0.93). Glucose loading decreased central SBP in NGT and IGT groups but did not affect the DM group. Change in AIx@75 at 120 minutes after glucose loading was blunted in IGT and DM groups compared with the NGT group (–5.7±4.4 vs. –3.6±4.1 vs. –9.3±6.2%, P < 0.01). Multivariate logistic regression analysis identified DM as an independent factor associated with the presence of blunted response of AIx to glucose loading.

CONCLUSIONS

Oral glucose loading decreased central SBP and AIx@75 without a significant change in brachial SBP, and these central hemodynamic responses were blunted in patients with DM.

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Nocturnal Intermittent Hypoxia Is Associated With Left Ventricular Hypertrophy in Middle-Aged Men With Hypertension and Obstructive Sleep Apnea

BACKGROUND

Obstructive sleep apnea (OSA) and left ventricular (LV) hypertrophy are considered to be closely associated. However, the relationship has not yet been fully demonstrated and is hence still controversial. The purpose of this study was to assess in hypertensive male patients the relationship between OSA and cardiac structure using a new index, namely, integrated area of desaturation (IAD), in addition to the apnea-hypopnea index (AHI) that is currently the most frequently used index of sleep-disordered breathing.

METHODS

In our cross-sectional study, 223 hypertensive men younger than 65 years with sleep apnea and normal cardiac function were enrolled. All subjects were evaluated by fully attended polysomnography. Cardiac structure and function were evaluated by echocardiography.

RESULTS

LV mass index significantly correlated with IAD (r = 0.203, P < 0.05), but not with AHI. Multivariate linear regression analyses showed that IAD, brain natriuretic peptide (BNP), and age are independent variables affecting the LV mass index (β = 0.262, 0.237, and 0.173, respectively, P < 0.05). IAD was the one and only determinant among the indices of sleep-disordered breathing.

CONCLUSIONS

Nocturnal intermittent hypoxia defined by IAD may be associated with LV hypertrophy in men with well-controlled hypertension and obstructive sleep apnea.

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Association of Brachial-Ankle Pulse Wave Velocity With Cardiovascular Events in Atrial Fibrillation

BACKGROUND

Atrial fibrillation (AF) and increased arterial stiffness share several risk factors and the 2 diseases often coexist. However, the prognostic value of increased arterial stiffness remains uncertain in the AF population. We evaluated whether brachial–ankle pulse wave velocity (baPWV), a marker of arterial stiffness, can predict cardiovascular events, and determined that the baPWV is a more favorable prognostic marker compared with conventional clinical and echocardiographic markers in patients with AF.

METHODS

We enrolled 167 patients with persistent AF. Arterial stiffness was assessed using baPWV. Cardiovascular events were defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, and hospitalization for heart failure. The relative risk of cardiovascular events was analyzed using Cox regression models. An improvement in model prediction was determined using the –2 log likelihood ratio statistic.

RESULTS

During a median 26-month follow-up, 42 (24.9%) cardiovascular events were observed. The baPWV emerged as an independent predictor of cardiovascular events (adjusted hazard ratio: 1.152; 95% confidence interval: 1.054–1.259; P = 0.002) in the multivariate analysis. Furthermore, the addition of baPWV to a Cox model comprising standard clinical, biochemical, and echocardiographic parameters improved the prediction of adverse cardiovascular events (P < 0.001).

CONCLUSIONS

In patients with AF, a high baPWV is associated with increased cardiovascular events and improve the prediction of adverse cardiovascular events. Hence, baPWV might be included when examining patients with AF for prediction of adverse cardiovascular outcomes.

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Biomaterial-Stabilized Soft Tissue Healing for Healing of Critical-Sized Bone Defects: the Masquelet Technique

Critical-sized bone defects present a significant burden to the medical community due to their challenging treatment. However, a successful limb-salvaging technique, the Masquelet Technique (MT), has significantly improved the prognosis of many segmental bone defects in helping to restore form and function. Although the Masquelet Technique has proven to be clinically effective, the physiology of the healing it induces is not well understood. Multiple modifiable factors have been implicated by various surgical and research teams, but no single factor has been proven to be critical to the success of the Masquelet Technique. In this review the most recent clinical and experimental evidence that supports and helps to decipher the traditional Masquelet, as well as the modifiable factors and their effect on the success of the technique are discussed. In addition, future developments for the integration of the traditional Masquelet Technique with the use of alternative biomaterials to increase the effectiveness and expand the clinical applicability of the Masquelet Technique are reviewed.

The Masquelet technique is a two-step surgical procedure used to treat critical-sized bone defects. Although clinically effective, the physiology of healing is not well understood and much has yet to be elucidated and optimized. Multiple modifiable factors have been identified and implemented. This review looks at the factors crucial to the success of the Masquelet technique and how we can further optimize them in clinical practice.

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Assessment of renal function using intravoxel incoherent motion diffusion-weighted imaging and dynamic contrast-enhanced MRI

Purpose

To assess the correlation between each of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) metrics in renal parenchyma with renal function, in a cohort of patients with chronic liver disease.

Materials and Methods

Thirty patients with liver disease underwent abdominal MRI at 1.5T, including a coronal respiratory-triggered IVIM-DWI sequence and a coronal 3D FLASH DCE-MRI acquisition. Diffusion signals in the renal cortex and medulla were fitted to the IVIM model to estimate the diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (PF). The apparent diffusion coefficient (ADC) was calculated using all b-values. The glomerular filtration rate (GFR), cortical and medullary renal plasma flow (RPF), mean transit times (MTT) of vascular and tubular compartments and the whole kidney, were calculated from DCE-MRI data by fitting to a three-compartment model. The estimated GFR (eGFR) was calculated from serum creatinine measured 30 ± 27 days of MRI.

Results

ADC, PF, and RPF were significantly higher in renal cortex vs. medulla (P < 10⁻⁵). DCE-MRI GFR significantly correlated with, but underestimated, eGFR (Spearman's r/P = 0.49/0.01). IVIM-DWI parameters were not significantly correlated with eGFR. DCE-MRI GFR correlated weakly with D (cortex, r/P = 0.3/0.03; medulla r/P = 0.27/0.05) and ADC (cortex r/P = 0.28/0.04; medulla r/P = 0.34/0.01). Weak correlations were observed for pooled cortical and medullar RPF with PF (r/P = 0.32/10⁻³) and with ADC (r/P = 0.29/0.0025). Significant negative correlations were observed for vascular MTT with cortical D* (r/P = −0.38/0.004) and D*×PF (r/P = −0.34/0.01).

Conclusion

The weak correlations between renal IVIM and DCE-MRI perfusion parameters imply that these functional measures could be complementary. J. Magn. Reson. Imaging 2016.

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Dynamic contrast-enhanced MRI for oncology drug development

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a promising tool for evaluating tumor vascularity, as it can provide vasculature-derived, functional, and quantitative parameters. To implement DCE-MRI parameters as biomarkers for monitoring the effect of antiangiogenic or vascular-disrupting treatment, two crucial elements of surrogate endpoint, ie, validation and qualification, should be satisfied. Although early studies have shown the accuracy and reliability of DCE-MRI parameters for evaluating treatment-driven vascular alterations, there have been an increasing number of studies demonstrating the limitations of DCE-MRI parameters as surrogate endpoints. Therefore, in order to improve the application of DCE-MRI parameters in drug development, it is necessary to establish a standardized evaluation method and to determine the correct therapeutics-oriented meaning of individual DCE-MRI parameter. In this regard, this article describes the biophysical background and data acquisition/analysis techniques of DCE-MRI while focusing on the validation and qualification issues. Specifically, the causes of disagreement and confusion encountered in the preclinical and clinical trials using DCE-MRI are presented in detail. Finally, considering these limitations, we present potential strategies to optimize implementation of DCE-MRI. J. Magn. Reson. Imaging 2016.

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Does altered aortic flow in marfan syndrome relate to aortic root dilatation?

Purpose

To examine possible hemodynamic alterations in adolescent to adult Marfan syndrome (MFS) patients with aortic root dilatation.

Materials and Methods

Four-dimensional flow MRI was performed in 20 MFS patients and 12 age-matched normal subjects with a 3T system. The cross-sectional areas of 10 planes along the aorta were segmented for calculating the axial and circumferential wall shear stress (WSS_axial, WSS_circ), oscillatory shear index (OSI_axial, OSI_circ), and the nonroundness (NR), presenting the asymmetry of segmental WSS. Pearson's correlation analysis was performed to present the correlations between the quantified indices and the body surface area (BSA), aortic root diameter (ARD), and Z score of the ARD. P < 0.05 indicated statistical significance.

Results

Patients exhibited lower WSS_axial in the aortic root and the WSS_circ in the arch (P < 0.05–0.001). MFS patients exhibited higher OSI_axial and OSI_circ in the sinotubular junction and arch, but lower OSI_circ in the descending aorta (all P < 0.05). The NR values were lower in patients (P < 0.05). The WSS_axial or WSS_circ exhibited moderate to strong correlations with BSA, ARD, or Z score (R² = 0.50–0.72) in MFS patients.

Conclusion

The significant differences in the quantified indices, which were associated with BSA, ARD, or Z score, in MFS were opposite to previous reports for younger MFS patients, indicating that altered flows in MFS patients may depend on the disease progress. The possible time dependency of hemodynamic alterations in MFS patients strongly suggests that longitudinal follow-up of 4D Flow is needed to comprehend disease progress. J. Magn. Reson. Imaging 2016.

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Rapid T2 mapping of mouse heart using the carr–purcell–meiboom–gill sequence and compressed sensing reconstruction

Purpose

To develop and prove preliminary validation of a fast in vivo T₂ mapping technique for mouse heart.

Materials and Methods

Magnetic resonance imaging (MRI) experiments were performed on a 7T animal scanner. The standard Carr–Purcell–Meiboom–Gill (CPMG) sequence was modified to minimize the effect of stimulated echoes for accurate T₂ quantification. The acquisition was further accelerated with the compressed sensing approach. The accuracy of the proposed method was first validated with both phantom experiments and numerical simulations. In vivo T₂ measurement was performed on seven mice in a manganese-enhanced MRI study.

Results

In phantom studies, T₂ values obtained with the modified CPMG sequence are in good agreement with the standard spin-echo method (P > 0.05). Numerical simulations further demonstrated that with the application of the compressed sensing approach, fast T₂ quantification with a spatial resolution of 2.3 mm can be achieved at a high temporal resolution of 1 minute per slice. With the proposed technique, an average T₂ value of 25 msec was observed for mouse heart at 7T and this number decreased significantly after manganese infusion (P < 0.001).

Conclusion

A rapid T₂ mapping technique was developed and assessed, which allows accurate T₂ quantification of mouse heart at a temporal resolution of 1 minute per slice. J. Magn. Reson. Imaging 2016.

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MR neurographic orthopantomogram: Ultrashort echo-time imaging of mandibular bone and teeth complemented with high-resolution morphological and functional MR neurography

Purpose

Panoramical radiographs or cone-beam computed tomography (CT) are the standard-of-care in dental imaging to assess teeth, mandible, and mandibular canal pathologies, but do not allow assessment of the inferior alveolar nerve itself nor of its branches. We propose a new technique for "MR neurographic orthopantomograms" exploiting ultrashort echo-time (UTE) imaging of bone and teeth complemented with high-resolution morphological and functional MR neurography.

Materials and Methods

The Institutional Review Board approved the study in 10 healthy volunteers. Imaging of the subjects mandibles at 3.0T (Magnetom Skyra, Siemens-Healthcare) using a 64-channel head coil with isotropic spatial resolution for subsequent multiplanar reformatting, was performed. Bone images were acquired using a 3D PETRA sequence (TE, 0.07 msec). Morphological nerve imaging was performed using a dedicated 3D PSIF and 3D SPACE STIR sequence. Functional MR neurography was accomplished using a new accelerated diffusion-tensor-imaging (DTI) prototype sequence (2D SMS-accelerated RESOLVE). Qualitative and quantitative image analysis was performed and descriptive statistics are provided.

Results

Image acquisition and subsequent postprocessing into the MR neurographic orthopantomogram by overlay of morphological and functional images were feasible in all 10 volunteers without artifacts. All mandibular bones and mandibular nerves were assessable and considered normal. Fiber tractography with quantitative evaluation of physiological diffusion properties of mandibular nerves yielded the following mean ± SD values: fractional anisotropy, 0.43 ± 0.07; mean diffusivity (mm²/s), 0.0014 ± 0.0002; axial diffusivity, 0.0020 ± 0.0002, and radial diffusivity, 0.0011 ± 0.0001.

Conclusion

The proposed technique of MR neurographic orthopantomogram exploiting UTE imaging complemented with high-resolution morphological and functional MR neurography was feasible and allowed comprehensive assessment of osseous texture and neural microarchitecture in a single examination. J. Magn. Reson. Imaging 2016.

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Nocturnal polyuria: excess of nocturnal urine production, excess of definitions: influence on renal function profile

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Dysfunctional elimination symptoms in childhood and adulthood: comment

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Professor, EMS 10 month Tenure Track - Valencia College

Ten-month, tenure-track professors are, in addition to teaching in discipline, responsible for curriculum development, selection of discipline resources, assists in the development and evaluation of faculty and participates in college governance activities. As a 10-month, tenure track faculty member, you will be on a continuing contract to teach 5 courses, maintain 10 office hours, and 10 college service ...

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Frequent Flyers: Ambulance history with Capt. Salty

See all of Lenwood Brown's comics.

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Overview of Cancer Prevention and Control and African-Americans

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Evaluating the Use of Plain Language in a Cancer Clinical Trial Website/App

Abstract

Medically complex titles and descriptions found on clinical trial websites and online applications present a barrier to comprehension for users from the general public. In this study, we examine the effectiveness of plain language trial descriptions for user comprehension of basic trial details. Two hundred seventeen volunteers recruited from patient waiting areas completed 441 user tests of ten plain language trial descriptions. The majority of volunteers adequately comprehended the cancer type and basic inclusion/exclusion criteria from plain language trial descriptions. Difficulty comprehending the treatment being studied was seen in seven of ten descriptions tested. Revision and retesting of the seven trial descriptions showed continued user challenges in comprehending the treatment being studied. Plain language clinical trial descriptions integrated into a website/app allowed users to understand basic inclusion/exclusion criteria. Despite plain language used, discerning the treatment being studied may be difficult for some users. Integration of plain language descriptions into clinical trial online applications can help users understand trial basics. Further research regarding effective use of plain language to communicate the treatment being studied is needed.

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Who Is a Cancer Survivor? A Systematic Review of Published Definitions

Abstract

The term "cancer survivor" is commonly used by different persons, clinical institutions, academic bodies, and political organizations although it lacks of a unanimous and detailed definition. The objective of the study is to make a systematic review of published and proposed definitions of "cancer survivor." Utilizing a systematic search strategy with different strings of "cancer survivor," we searched the following databases: Medline (June 1975–June 2015), Scopus (all the years), Web of Science (all the years), Google Scholar (all the years), ERIC (all the years). This review suggests that there is not a unique definition of who is a "cancer survivor" and what is "cancer survivorship." However, the most widely used definition sees cancer survivorship as a process that begins at the moment of diagnosis and continues through the balance of life. This definition highlights psychological and legal patient's needs—as well as medical ones—to receive care and assistance from the beginning and, at the same time, it establishes valid criteria for making scientific and statistical sampling research. The extensive use of the term "cancer survivor" indicates that it is a significant term. This review has been written to outline the state of the art and it invites to reflect on a shared definition that could satisfy both clinical and research aspects. Implication for cancer survivors: this compendium of proposed definitions may improve communication among the many patients and patient organizations that use and work with this term.

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Influence of Esophageal Washout on Local Carcinoma Recurrence After Curative Resection

Condition:   Esophageal Neoplasms
Intervention:   Drug: Betaisodona
Sponsor:   Technische Universität Dresden
Not yet recruiting - verified February 2016

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Skin/Soft Tissue Elasticity in Head and Neck Cancer Survivors With Lymphedema and Fibrosis

Conditions:   Cancer Survivor;   Head and Neck Carcinoma;   Lymphedema-Related Fibrosis Adverse Event;   No Evidence of Disease
Interventions:   Procedure: Medical Examination;   Other: Questionnaire Administration;   Procedure: Shear Wave Elastography
Sponsors:   Vanderbilt-Ingram Cancer Center;   National Cancer Institute (NCI)
Not yet recruiting - verified February 2016

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Efficacy of Radium 223 in Radioactive Iodine Refractory Bone Metastases From Differentiated Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:   Radiation: Radium 223
Sponsor:   Gustave Roussy, Cancer Campus, Grand Paris
Recruiting - verified February 2016

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Phase III Trial Comparing Methotrexate and Cetuximab in First-line Treatment of Recurrent and/or Metastatic Squamous Cell Head and Neck Cancer

Condition:   Head Neck Cancer Squamous Cell Recurrent
Interventions:   Drug: Cetuximab;   Drug: Methotrexate
Sponsors:   Gustave Roussy, Cancer Campus, Grand Paris;   National Cancer Institute, France;   Ligue contre le cancer, France;   Merck Serono International SA
Recruiting - verified February 2016

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Differentiated Thyroid Cancer: is There a Need for Radioiodine Ablation in Low Risk Patients?

Condition:   Low Risk Differentiated Thyroid Cancer
Interventions:   Drug: rhTSH stimulation;   Drug: I131;   Other: Follow up
Sponsor:   Gustave Roussy, Cancer Campus, Grand Paris
Recruiting - verified February 2016

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Complementary subicular pathways to the anterior thalamic nuclei and mammillary bodies in the rat and macaque monkey brain

Abstract

The origins of the hippocampal (subicular) projections to the anterior thalamic nuclei and mammillary bodies were compared in rats and macaque monkeys using retrograde tracers. These projections form core components of Papez circuit, which is vital for normal memory. The study revealed a complex pattern of subicular efferents, consistent with the presence of different, parallel information streams, whose segregation appears more marked in the rat brain. In both species, the cells projecting to the mammillary bodies and anterior thalamic nuclei showed laminar separation, but also differed along other hippocampal axes. In the rat, these diencephalic inputs showed complementary topographies in the proximal-distal (columnar) plane, consistent with differential involvement in object-based (proximal subiculum) and context-based (distal subiculum) information. The medial mammillary inputs, which arose along the anterior-posterior extent of the rat subiculum, favoured the central subiculum (septal hippocampus) and the more proximal subiculum (temporal hippocampus). In contrast, anterior thalamic inputs were largely confined to the dorsal (i.e., septal and intermediate) subiculum, where projections to the anteromedial nucleus favoured the proximal subiculum, while those to the anteroventral nucleus predominantly arose in the distal subiculum. In the macaque, the corresponding diencephalic inputs were again distinguished by anterior-posterior topographies, as subicular inputs to the medial mammillary bodies predominantly arose from the posterior hippocampus while subicular inputs to the anteromedial thalamic nucleus predominantly arose from the anterior hippocampus. Unlike the rat, there was no clear evidence of proximal-distal separation as all of these medial diencephalic projections preferentially arose from the more distal subiculum.

This article is protected by copyright. All rights reserved.

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Brain glucose feedback predicts food choice (Commentary on Wakabayashi et al.)

Abstract

Strategies for making choices are of broad multidisciplinary interest (Glimcher, 2010). From a viewpoint of evolutionary survival, speed and accuracy are desirable, but contradictory, attributes of decision-making. Indeed, observations in many fields, including neuroscience, economics, and psychology, suggest that choice involves trade-off between accuracy and speed (e.g. Abraham et al., 2004; Kahneman, 2011). A much-discussed theory is that the brain has evolved one system for using indirect but easily accessible information to make rapid but potentially inaccurate decisions, and another system for using direct but harder-to-get information to make more accurate but slower decisions (Kahneman, 2011).

This article is protected by copyright. All rights reserved.

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Taking Stock: A report from the UK Teacher Education Network for sustainable development (ESD) /global citizenship (GC) - survey on provision for ESD/GC in initial teacher education in the UK

Hunt, F; Li Ting Chung, H; Rogers, M; Inman, S; (2011) Taking Stock: A report from the UK Teacher Education Network for sustainable development (ESD) /global citizenship (GC) - survey on provision for ESD/GC in initial teacher education in the UK. Teacher Education for Equity and Sustainability Network (TEESNet): London, UK.

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School Drop out: Patterns, Causes, Changes and Policies

Sabates, R; Westbrook, J; Akyeampong, K; Hunt, F; (2010) School Drop out: Patterns, Causes, Changes and Policies. United Nations Educational, Scientific and Cultural Organisation (UNESCO): Paris, France.

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Beyond the Hoax: A Response to Emily A. Schultz

Sokal, A; (2011) Beyond the Hoax: A Response to Emily A. Schultz. Reviews in Anthropology , 40 (2) pp. 169-173. 10.1080/00938157.2011.572477 . Green open access

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Role-taking and social connectedness in autism.

Garcia-Perez, R.M.; (2004) Role-taking and social connectedness in autism. Doctoral thesis, University of London. Green open access

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A Typology for Complex Social-Ecological Systems in Mountain Communities

Altaweel, M; Virapongse, A; Griffith, D; Alessa, L; Kliskey, A; (2016) A Typology for Complex Social-Ecological Systems in Mountain Communities. Sustainability: Science, Practice, & Policy , 11 (2) (In press). Green open access

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Maxwell’s demon and the management of ignorance in stochastic thermodynamics

Ford, IJ; (2016) Maxwell's demon and the management of ignorance in stochastic thermodynamics. Contemporary Physics pp. 1-22. 10.1080/00107514.2015.1121604 .

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Convection and Chemistry in the Atmospheric Boundary Layer

Petersen, AC; (1999) Convection and Chemistry in the Atmospheric Boundary Layer. Doctoral thesis, Utrecht University.

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Idiopathic partial thrombosis is associated with cycling and the presence of a fibrous web on MRI

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