bluuebunny/crossref_metadata_2025 huggingface dataset:
Obesity, independent of diet, drives lasting effects on intestinal epithelial stem cell proliferation in mice
Authors: Zhou Weinan , Davis Elizabeth A , Dailey Megan J
Published: June 2018

The intestinal epithelium plays an essential role in nutrient absorption, hormone release, and barrier function. Maintenance of the epithelium is driven by continuous cell renewal by intestinal epithelial stem cells located in the intestinal crypts. Obesity affects this process and results in changes in the size and function of the tissue. Because both the amount of food intake and the composition of the diet are contributing factors to developing and maintaining obesity, it is necessary to tease apart the separate contributions of obesity versus the type/amount of diet in driving the epithelial changes. C57BL/6J mice were fed a 60% high-fat diet versus a 10% low-fat diet for three months. A pair fed group was included (mice were fed with high-fat diet, but in equal kcal as that eaten by the low-fat diet- fed mice to keep them lean). We investigated the differences in (1) crypt-villus morphology in vivo, (2) the number and function of differentiated epithelial cell types in vivo, and (3) lasting effects on intestinal epithelial stem cell proliferation and growth in vitro. We found that high-fat diet-induced obesity, independent of the high-fat diet, increased crypt depth, villus height, the number of intestinal epithelial stem cells and goblet cells in vivo, and enhanced the size of the enterospheres developed from isolated IESCs in vitro. In addition, there is an interaction of obesity, type of diet, and availability of the diet (pair fed versus ad libitum) on protein and mRNA expression of alkaline phosphatase (an enzyme of enterocytes). These results suggest that high-fat diet-induced obesity, independent of the high-fat diet, induces lasting effects on intestinal epithelial stem cell proliferation, and drives the differentiation into goblet cells, but an interaction of obesity and diet drives alterations in the function of the enterocytes.

Impact statement

This study investigates whether obesity or the type/amount of diet differentially alters the proliferation, differentiation, growth, and function of the intestinal epithelial tissue. Although diet-induced obesity is known to alter the growth and function of the epithelium in vivo and cause lasting effects in intestinal epithelial stem cells (IESCs) in vitro, we are the first to tease apart the separate contributions of obesity versus the type/amount of diet in these processes. We found that high-fat diet (HFD)-induced obesity, independent of the HFD, drives lasting effects on IESC proliferation and differentiation into goblet cells, which may contribute to the growth of the epithelium. In addition, there is an interaction of obesity, type of diet, and availability of the diet (PF versus ad libitum) on the function of enterocytes. Identification of the factors driving the epithelial changes may provide new therapeutic strategies to control altered tissue growth and function associated with obesity.
Examining the Inclusion of Students with Severe Disabilities in School-Wide Positive Behavioral Interventions and Supports
Authors: Walker Virginia L. , Loman Sheldon L. , Hara Motoaki , Park Kristy Lee , Strickland-Cohen M. Kathleen
Published: June 2018

To explore the accessibility of school-wide positive behavioral interventions and supports (SWPBIS) for students with severe disabilities, we conducted a survey of 179 schools implementing SWPBIS during the 2015-2016 school year. Personnel from each school reported the frequency and level of importance of SWPBIS implementation across Likert-type scale items related to the domains of systems procedures, practices, and data collection procedures applicable to students with severe disabilities. Personnel from each school also responded to open-ended items to report barriers to and strategies for including students with severe disabilities in SWPBIS. Overall, school personnel reported high levels of implementation and importance across these SWPBIS domains and a range of barriers and strategies related to SWPBIS accessibility. School characteristics related to grade level, tiers of SWPBIS implementation, and the percentage of students included in general education settings for a majority of the school day contributed to statistically significant differences in ratings of frequency and importance for some aspects of the SWPBIS domains.
Emotional intelligence can make a difference: The impact of principals’ emotional intelligence on teaching strategy mediated by instructional leadership
Authors: Chen Junjun , Guo Wei
Published: June 2018

This paper reports on a study that examined the effect of school principals’ emotional intelligence, and their instructional leadership, on improving teachers’ instructional strategies. A sample of 534 primary teachers from 54 primary schools in China was approached and invited to respond to a questionnaire. Structural equation modelling identified the relationships between three constructs – Wong’s Emotional Intelligence Scale, the Principal Instructional Management Rating Scale, and the Instructional Strategy Scale – and between the dimensional levels. The study confirmed the theoretical proposition that principals’ EI and their instructional leadership behavior are influential factors with regard to teachers’ instructional strategies. The findings are of particular interest because they include the element of emotional intelligence for improvement of teaching practice and evaluating the effectiveness of the principal.
Primary post-partum haemorrhage – Causation and management
Authors: Benson Gareth
Published: June 2018

This paper looks to investigate the causes and management of haemorrhage in the post-partum patient, considering the causes of obstetric bleeding and interventions that may be employed to arrest it.
Consenting patients for orthopaedic surgery: Is there need for change?
Authors: Valsamis Epaminondas M , Thornhill Christopher , Watson Jay , Khosla Shivun , Rogers Benedict , Ricketts David
Published: June 2018

An adequate consent form must be completed prior to a planned surgical procedure. Consent forms are mandatory, but the form itself does not reflect or quantify the adequacy of the discussion between surgeon and patient or the patient’s level of understanding. This study audited the adequate completion of consent forms for orthopaedic operations at a Major Trauma Centre in the United Kingdom. We also suggested recommendations regarding the completion of consent forms and proposed that tuition concerning the consent process be included as part of mandatory training for surgeons.
Rucaparib in ovarian cancer: an update on safety, efficacy and place in therapy
Authors: Dal Molin Graziela Z. , Omatsu Kohei , Sood Anil K. , Coleman Robert L.
Published: June 2018

Rucaparib is a poly (ADP-ribose) polymerase (PARP) inhibitor and potent inhibitor of PARP1, PARP2 and PARP3 enzymes. Phase II and III trials have documented that rucaparib has single-agent antitumor activity in patients with high-grade ovarian carcinoma, with both BRCA-mutated (germline and somatic) and with homologous recombination deficiency (HRD). Rucaparib as a maintenance treatment showed increased progression-free survival in patients with ovarian carcinoma who achieved a response to platinum-based chemotherapy, with an acceptable safety profile. The approval of this drug, along with the companion diagnostic FoundationFocus CDxBRCA test represents an important new therapeutic option in the treatment of ovarian cancer. This article reviews the mechanisms of action, safety, pharmacokinetics and pharmacodynamics and indications for use of rucaparib as well as future trials.
Therapy of breast cancer brain metastases: challenges, emerging treatments and perspectives
Authors: Kotecki Nuria , Lefranc Florence , Devriendt Daniel , Awada Ahmad
Published: June 2018

Brain metastases are the most common central nervous system tumors in adults, and incidence of brain metastases is increasing due to both improved diagnostic techniques (e.g. magnetic resonance imaging) and increased cancer patient survival through advanced systemic treatments. Outcomes of patients remain disappointing and treatment options are limited, usually involving multimodality approaches. Brain metastases represent an unmet medical need in solid tumor care, especially in breast cancer, where brain metastases are frequent and result in impaired quality of life and death. Challenges in the management of brain metastases have been highlighted in this review. Innovative research and treatment strategies, including prevention approaches and emerging systemic treatment options for brain metastases of breast cancer, are further discussed.
Subchondral Bone and the Osteochondral Unit: Basic Science and Clinical Implications in Sports Medicine
Authors: Saltzman Bryan M. , Riboh Jonathan C.
Published: June 2018

Context:

Articular cartilage injuries and early osteoarthritis are among the most common conditions seen by sports medicine physicians. Nonetheless, treatment options for articular degeneration are limited once the osteoarthritic cascade has started. Intense research is focused on the use of biologics, cartilage regeneration, and transplantation to help maintain and improve cartilage health. An underappreciated component of joint health is the subchondral bone.

Evidence Acquisition:

A comprehensive, nonsystematic review of the published literature was completed via a PubMed/MEDLINE search of the keywords “subchondral” AND “bone” from database inception through December 1, 2016.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Methods:

Articles collected via the database search were assessed for the association of bone marrow lesions and osteoarthritis, cartilage regeneration, and ligamentous and meniscal injury; the clinical disorder known as painful bone marrow edema syndrome; and the subchondral bone as a target for medical and surgical intervention.

Results:

A complex interplay exists between the articular cartilage of the knee and its underlying subchondral bone. The role of subchondral bone in the knee is intimately related to the outcomes from cartilage restoration procedures, ligamentous injury, meniscal pathology, and osteoarthritis. However, subchondral bone is often neglected when it should be viewed as a critical element of the osteochondral unit and a key player in joint health.

Conclusion:

Continued explorations into the intricacies of subchondral bone marrow abnormalities and implications for the advent of procedures such as subchondroplasty will inform further research efforts on how interventions aimed at the subchondral bone may provide durable options for knee joint preservation.
The Use and Abuse of Human Growth Hormone in Sports
Authors: Siebert David M. , Rao Ashwin L.
Published: June 2018

Context:

Recombinant human growth hormone (rHGH) has become a target of abuse in the sporting world. Conversely, sports medicine clinicians may encounter athletes using rHGH to achieve normalcy in the context of growth hormone (GH) deficiency.

Evidence Acquisition:

Medline and PubMed databases were queried using the following keywords: GH, GH physiology, GH deficiency, acromegaly, GH athlete, GH sports, GH athletic performance, and GH deficiency concussion. Articles focusing on GH physiology, deficiency, excess, and its effects in both deficient and healthy patients were included.

Study Design:

Clinical review.

Level of Evidence:

Level 3.

Results:

GH is a naturally occurring hormone with important roles in human physiology. Patients with GH deficiency (GHD) present variably, and GHD has numerous etiologies. rHGH treatment has substantial therapeutic benefits for patients with GHD. The benefits of rHGH treatment in otherwise-healthy adults are uncertain. GH excess may cause health problems such as acromegaly. Professional, collegiate, and international sports leagues and associations have banned rHGH use to maintain athlete health, safety, and fair play. Athletes misusing GH may face prolonged suspensions from competition. Implementing GH abuse testing is challenging, but new methods, such as the biomarker testing procedure, are being finalized.

Conclusion:

rHGH is not only an important therapeutic agent for GH-deficient patients but also a target of abuse in competitive athletics. Its benefits in a healthy, adult population are uncertain. A safe exercise and competition plan, developed with a physician knowledgeable of GH use, physiology, and abuse potential, should be of benefit to a longitudinal clinician-patient relationship.
Racial/ethnic differences in HIV testing: An application of the health services utilization model
Authors: Lo Celia C , Runnels Ratonia C , Cheng Tyrone C
Published: June 2018

This study applying the health services utilization model examined the importance of predisposing, enabling, and need variables to the social mechanisms explaining lifetime HIV testing across racial/ethnic groups. Data for the study were derived from the National Health Interview Survey (collected 2013–2014), our final sample numbering 18,574 adults. Four subsamples reflected race/ethnicity: 13,347 Whites, 2267 Blacks, 2074 Hispanics, and 886 Asians. Logistic regression established respondent odds of ever having received HIV testing. Further statistical testing evaluated race/ethnicity’s potential moderating role in HIV testing. The findings generally support a role for Aday’s predisposing, enabling, and need factors in explaining HIV testing. Across the four subsamples, female gender, older age, and sexual minority status consistently increased lifetime HIV testing. However, we found racial/ethnic differences in HIV testing’s associations with these factors and others. Our study made a beginning in the effort to specify mechanisms leading to HIV testing—and reliable diagnosis—among four racial/ethnic groups. Understanding these mechanisms might multiply opportunities to raise testing rates for all, in turn reducing racial/ethnic disparities in HIV treatment.
Clinical research on the efficacy of self-made sichongsan in combination with gefitinib on NSCLC patients with EGFR mutation
Authors: Zhao Yibo , Dong Yu , Xing Shu , Fu Xueqi
Published: June 2018

This study is to investigate the efficacy of self-made sichongsan in combination with gefitinib on non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation. A total of 47 NSCLC patients in advanced stage with EGFR mutation who had not received any treatment before admission were divided into the control group (n = 23) and the observation group (n = 24). Patients in the control group underwent gefitinib treatment, while those in the observation group additionally took self-made sichongsan for treatment. The objective response rate of the observation group was 75%, significantly higher than 52.18% in the control group ( P < 0.05). Before treatment, comparisons of the carcinoembryonic antigen (CEA) and carbohydrate antigen 153 (CA153) levels in serum showed no statistical significance ( P > 0.05). At the 12th week of treatment, the levels of CEA and CA153 in the observation group were significantly lower than those in the control group ( P < 0.05). In the observation group, the incidence rate of adverse reaction was 16.7%, which was significantly lower than 47.8% in the control group ( P < 0.05). In conclusion, in terms of the first-line treatment for advanced NSCLC patients with EGFR mutation, the efficacy of self-made sichongsan in combination with gefitinib is superior to the single administration of gefitinib, and the former can more effectively decrease the levels of CEA and CA153 in serum of patients and reduce the incidence rate of adverse effects.
A Prospective Look at the Link Between Frailty and Shoulder Function in Asymptomatic Elderly Individuals
Authors: Kinnucan Elspeth , Molcjan Matthew T. , Wright David M. , Switzer Julie A.
Published: June 2018

Introduction:

The relationship between shoulder function and overall function in the elderly patients is not well understood. It is hypothesized that there is an increased tolerance of shoulder dysfunction in this population. The purpose of our study was to investigate and better understand the relationship between shoulder function, general musculoskeletal health, and frailty in the elderly patients.

Materials and Methods:

The dominant shoulders of 75 individuals aged ≥65 years without known dominant shoulder pathology were assessed. Demographic data were collected. Functional evaluation was conducted by administering the Constant, American Shoulder and Elbow Surgeons (ASES), and the Short Musculoskeletal Function Assessment (SMFA) questionnaires. Shoulder range of motion and strength were measured and the Fried frailty phenotype was calculated. Mean age of the patients was 73.6 years. Sixty-seven percent of the patients were female. Mean body mass index was 31.2 kg/m2.

Results:

Twenty-eight percent of the patients reported the use of an assistive device for ambulation. As frailty increased among the 3 Fried frailty phenotypes (robust, prefrail, and frail), patients had statistically significant lower mean Constant scores ( P < .0001), ASES scores ( P < .0001), higher overall SMFA scores ( P < .0001), and an increase in the use of assistive device for ambulation. Individuals who reported the use of an assistive device for ambulation had lower Constant and ASES scores ( P < .0001 and P = .045, respectively) and higher overall SMFA scores ( P < .0001). There was no evidence of correlation between body mass index and any of the other measures.

Conclusions:

Frailty and the use of an assistive device for ambulation correlate with poor shoulder function in patients who do not register shoulder complaints and have no known shoulder pathology.

Level of Evidence:

Level IV, Prognostic.
Knee Joint Kinematics and Kinetics During Walking and Running After Surgical Achilles Tendon Repair
Authors: Jandacka Daniel , Plesek Jan , Skypala Jiri , Uchytil Jaroslav , Silvernail Julia Freedman , Hamill Joseph
Published: June 2018

Background:

Despite the increasing incidence of Achilles tendon (AT) ruptures, there is a lack of information on the possible risks associated with regular running and walking for exercise after an injury. There are some known kinematic gait changes after an AT rupture, especially at the knee. However, it is not clear whether runners with AT ruptures may be at risk for secondary knee injuries during shod or barefoot running/walking.

Purpose/Hypothesis:

The purpose of this study was to compare the kinematics and kinetics of barefoot walking and barefoot and shod running between athletes with a history of AT ruptures and a healthy control group. We hypothesized that there would be increased knee joint loads in the affected limb of the AT rupture group, especially during shod running.

Study Design:

Controlled laboratory study.

Methods:

Ten patients who had undergone surgical treatment of a unilateral acute AT rupture (6.1 ± 3.7 years postoperatively ) and 10 control participants were matched according to age, sex, physical activity, weight, height, and footfall type. The kinematics and kinetics of barefoot walking and barefoot and shod running were recorded using a high-speed motion capture system synchronized with force platforms.

Results:

The main outcome measures were lower extremity joint angles and moments during the stance phase of walking and running. After AT repair, athletes had increased internal knee abduction moments during shod and barefoot running compared with the healthy control group ( P < .05, η2 > 0.14). There were no significant differences in kinematics and kinetics during walking between the AT rupture and healthy control groups ( P ≥ .05).

Conclusion:

After an AT rupture, athletes had increased internal knee abduction moments during running compared with the healthy control group.

Clinical Relevance:

The increased abduction loads on the knee in patients with an AT rupture could lead to further running-related injuries. However, barefoot walking may be used as a proprioceptive exercise without an increased risk of overuse injuries in these patients.
Collective Free Music Improvisation as a Sociocommunicative Endeavor: A Literature Review
Authors: Ng Hoon Hong
Published: June 2018

This article is a review of literature that conceptualizes the practice of collective free music improvisation as a sociocommunicative endeavor, with its appended value and implications to musicians and music learners. Researchers have revealed that this conceptualization breaks down cultural and stylistic music boundaries to establish understanding and empathy among diverse and unique performers—through live music interactions and communication on an egalitarian and evolving platform that is negotiated by all participants. To enable collective free music improvisation pedagogically, researchers have highlighted the importance and ways of approaching it as a form of social interactionism, developing a personal music language to converse fluently and meaningfully, and establishing shared understanding among fellow improvisers as the foundation for music interaction. Together, these pedagogical implications may be synergized to inform ways in which classroom free improvisational practices may nurture expressive and confident improvisers rooted in the reality of the moment, as well as in the music conversations with one’s self and others.
Venous thromboembolism in patients with B-cell non-Hodgkin lymphoma treated with lenalidomide: a systematic review and meta-analysis
Authors: Yamshon Samuel , Christos Paul J. , Demetres Michelle , Hammad Hoda , Leonard John P. , Ruan Jia
Published: June 2018

Key Points

Lenalidomide is associated with increased venous thrombosis in patients with B-cell NHL, similar to multiple myeloma.
Edge-preserving frequency-offset denoising of seismic data
Authors: Gómez Julián L. , Velis Danilo R.
Published: June 2018

We have developed new algorithms for denoising 2D or 3D poststack seismic-amplitude data that use simple edge-preserving smoothing operators in the frequency-offset domain. The algorithms are aimed to attenuate random and coherent noise, to enhance the signal energy and lateral continuity, and to preserve structural discontinuities such as faults. The methods consist of fitting the frequency slices of the data in the spatial dimension by means of low-order polynomials. We use an overlapping window operator to select the fitting parameters for each point of the slice from the neighborhood with minimum fitting error to provide edge preservation. Various synthetic examples and a field data set are used to demonstrate the strengths and limitations of the algorithms. The denoised outputs indicate enhanced edge preservation of seismic features, which reflects clearer details of semblance attributes.
Using a stereo-modeling operator to reduce aliasing during migration
Authors: Li Jingshuang , Yang Dinghui , Fehler Michael , Huang Xueyuan
Published: June 2018

The sampling theorem requires minimum two points per wavelength to ensure the proper reconstruction of a wavefield. Violation of this limit will result in data aliasing. With the increased demand for high-frequency seismic processing, data recorded in a field may not have sufficient spatial sampling. Reverse time migration (RTM) using a conventional scheme will not be able to produce a high-quality image from such an aliased input data set. However, when the wavefield and its gradients are available, the generalized sampling theorem relaxes the requirement to only one point per wavelength. Stereo-modeling methods use a system of wave equations to compute a vector containing the particle displacement and its spatial gradients in wavefield propagation. Therefore, in cases in which a wavefield and its spatial gradients are available, such as a multicomponent data set, RTM using the stereo-modeling methods can be potentially much more accurate and efficient than those commonly used ones, such as Lax-Wendroff correction. We investigated the merits of one such method, called the nearly analytic central difference, in RTM to produce high-quality images. Numerical experiments on different data sets produce consistent results with the generalized sampling theorem, which indicates that the stereo-modeling method can yield high-quality images from insufficiently sampled data compared with conventional finite-difference methods.
Propofol Attenuates the Myocardial Protection Properties of Desflurane by Modulating Mitochondrial Permeability Transition
Authors: Heiberg Johan , Royse Colin F. , Royse Alistair G. , Andrews David T.
Published: June 2018

BACKGROUND:

Desflurane and propofol are cardioprotective, but relative efficacy is unclear. The aim was to compare myocardial protection of single, simultaneous, and serial administration of desflurane and propofol.

METHODS:

Sixty New Zealand White rabbits and 65 isolated Sprague Dawley rat hearts randomly received desflurane, propofol, simultaneous desflurane and propofol, or sequential desflurane then propofol. Rabbits were subdivided to receive either ischemia-reperfusion with temporary occlusion of the left anterior descending artery or a time-matched, nonischemic perfusion protocol, whereas rat hearts were perfused in a Langendorff model with global ischemia-reperfusion. End points were hemodynamic, functional recovery, and mitochondrial uptake of 3H-2-deoxy-d-glucose as an indicator of mitochondrial permeability transition.

RESULTS:

In rabbits, there were minimal increases in preload-recruitable stroke-work with propofol (P < .001), desflurane (P < .001), and desflurane-and-propofol (P < .001) groups, but no evidence of increases with pentobarbitone (P = .576) and desflurane-then-propofol (P = .374). In terms of end-diastolic pressure–volume relationship, there was no evidence of increase compared to nonischemic controls with desflurane-then-propofol (P = .364), a small but significant increase with desflurane (P < .001), and larger increases with pentobarbitone (P < .001), propofol (P < .001), and desflurane-and-propofol (P < .001).

In rat hearts, there was no statistically significant difference in mitochondrial 3H-activity between propofol and desflurane-and-propofol (165 ± 51 × 10−5 vs 154 ± 51 × 10−5 g·mL·min/μmol; P = .998). Desflurane had lower uptake than propofol (65 ± 21 × 10−5 vs 165 ± 51 × 10−5 g·mL·min/μmol; P = .039), but there was no statistically significant difference between desflurane and desflurane-then-propofol (65 ± 21 × 10−5 vs 59 ± 11 × 10−5 g·mL·min/μmol; P = .999).

CONCLUSIONS:

Propofol and desflurane are cardioprotective, but desflurane is more effective than propofol. The added benefit of desflurane is lost when used simultaneously with propofol.
Perioperative Management in Hepatic Resections: Comparative Effectiveness of Neuraxial Anesthesia and Disparity of Care Patterns
Authors: Zerillo Jeron , Agarwal Parul , Poeran Jashvant , Zubizarreta Nicole , Poultsides George , Schwartz Myron , Memtsoudis Stavros , Mazumdar Madhu , DeMaria Samuel
Published: June 2018

BACKGROUND:

Complication rates after hepatic resection can be affected by management decisions of the hospital care team and/or disparities in care. This is true in many other surgical populations, but little study has been done regarding patients undergoing hepatectomy.

METHODS:

Data from the claims-based national Premier Perspective database were used for 2006 to 2014. The analytical sample consisted of adults undergoing partial hepatectomy and total hepatic lobectomy with anesthesia care consisting of general anesthesia (GA) only or neuraxial and GA (n = 9442). The key independent variable was type of anesthesia that was categorized as GA versus GA + neuraxial. The outcomes examined were clinical complications and health care resource utilization. Unadjusted bivariate and adjusted multivariate analyses were conducted to examine the effects of the different types of anesthesia on clinical complications and health care resource utilization after controlling for patient- and hospital-level characteristics.

RESULTS:

Approximately 9% of patients were provided with GA + neuraxial anesthesia during hepatic resection. In multivariate analyses, no association was observed between types of anesthesia and clinical complications and/or health care utilization (eg, admission to intensive care unit). However, patients who received blood transfusions were significantly more likely to have complications and intensive care unit stays. In addition, certain disparities of care, including having surgery in a rural hospital, were associated with poorer outcomes.

CONCLUSIONS:

Neuraxial anesthesia utilization was not associated with improvement in clinical outcome or cost among patients undergoing hepatic resections when compared to patients receiving GA alone. Future research may focus on prospective data sources with more clinical information on such patients and examine the effects of GA + neuraxial anesthesia on various complications and health care resource utilization.
Variable Ventilation Associated With Recruitment Maneuver Minimizes Tissue Damage and Pulmonary Inflammation in Anesthetized Lung-Healthy Rats
Authors: Camilo Luciana Moisés , Motta-Ribeiro Gabriel Casulari , de Ávila Mariana Barcellos , Paula Luis Felipe Santos Cruz , de Abreu Mariana Boechat , Carvalho Alysson Roncally , Zin Walter Araujo
Published: June 2018

BACKGROUND:

Recruitment maneuver and positive end-expiratory pressure (PEEP) can be used to counteract intraoperative anesthesia-induced atelectasis. Variable ventilation can stabilize lung mechanics by avoiding the monotonic tidal volume and protect lung parenchyma as tidal recruitment is encompassed within the tidal volume variability.

METHODS:

Forty-nine (7 per group) male Wistar rats were anesthetized, paralyzed, and mechanically ventilated. A recruitment maneuver followed by stepwise decremental PEEP titration was performed while continuously estimating respiratory system mechanics using recursive least squares. After a new recruitment, animals were ventilated for 2 hours in volume-control with monotonic (VCV) or variable (VV) tidal volumes. PEEP was adjusted at a level corresponding to the minimum elastance or 2 cm H2O above or below this level. Lungs were harvested for histologic analysis (left lung) and cytokines measurement (right lung). Seven animals were euthanized before the first recruitment as controls.

RESULTS:

A time-dependent increase in respiratory system elastance was observed and significantly minimized by PEEP (P < .001). Variable ventilation attenuated the amount of concentrations of proinflammatory mediators in lung homogenate: neutrophil cytokine-induced neutrophil chemoattractant 1 (VV = 40 ± 5 and VCV = 57 ± 8 pg/mg; P < .0001) and interleukin-1β (VV = 59 ± 25 and VCV = 261 ± 113 pg/mg; P < .0001). Variable ventilation was also associated with lower structural lung parenchyma damage. Significant reductions in air fraction at dorsal and caudal lung regions were observed in all ventilated animals (P < .001).

CONCLUSIONS:

Variable ventilation was more protective than conventional ventilation within the applied PEEP levels.
Electroencephalographic Arousal Patterns Under Dexmedetomidine Sedation
Authors: Sleigh Jamie W. , Vacas Susana , Flexman Alana M. , Talke Pekka O.
Published: June 2018

BACKGROUND:

The depth of dexmedetomidine-induced sedation is difficult to assess without arousing the patient. We evaluated frontal electroencephalogram (EEG) as an objective measure of dexmedetomidine-induced sedation. Our aims were to characterize the response patterns of EEG during a wide range of dexmedetomidine-induced sedation and to determine which spectral power best correlated with assessed levels of dexmedetomidine-induced sedation.

METHODS:

Sedline EEG sensor was positioned on the forehead of 16 volunteers. Frontal EEG data were collected at 250 Hz using the Sedline monitor. A computer-controlled infusion pump was used to infuse dexmedetomidine to four 15-minute target plasma concentrations of 0.3, 0.6, 1.2, and 2.4 ng/mL. Arterial blood samples for dexmedetomidine plasma concentration and sedation (self-reported numerical rating scale) and arousal were measured at baseline and at the end of each infusion step. The EEG signal was used to estimate spectral power in sequential 4-second data segments with 75% overlap for 3 power bands: delta = 0.5–1.5 Hz, alpha = 9–14 Hz, beta = 15–24 Hz. We quantified the relationships among the plasma concentrations of dexmedetomidine, level of sedation, and various EEG parameters.

RESULTS:

EEG data at the end of the dexmedetomidine infusion steps show progressive loss of high frequencies (beta) and increase in alpha and delta powers, with increasing dexmedetomidine concentrations. Beta prearousal spectral power was best in predicting dexmedetomidine-induced level of sedation (R = −0.60, 95% CI, −0.43 to −0.75). The respective values for delta and alpha powers were R = 0.28 (95% CI, 0.03–0.45) and R = 0.16 (95% CI, −0.09 to 0.38). When the beta power has dropped below −16 dB or the delta power is above 15 dB, the subjects show moderate to deep levels of sedation. When awakening the subject, there is a reduction in power in the delta and alpha bands at the 0.6, 1.2, and 2.4 ng/mL dexmedetomidine target levels (P < .001 for all). In beta band, there is a rapid awakening-induced increase in power (P < .001) followed by a slow return toward baseline values. After arousing the subjects, the EEG powers returned toward baseline values significantly slower than our clinical observation of the subjects’ wakefulness would have suggested.

CONCLUSIONS:

Using a wide range of dexmedetomidine doses, we found that frontal EEG beta power of less than −16 dB and/or a delta power of over 15 dB was associated with a state of moderate to deep sedation and that poststimulus return of EEG powers toward baseline values took significantly longer than expected from observation of the arousal response. It is unclear whether these observations are robust enough for clinical applicability.
Adaptations to deep and prolonged diving in phocid seals
Authors: Blix Arnoldus Schytte
Published: June 2018

This Review focuses on the original papers that have made a difference to our thinking and were first in describing an adaptation to diving, and less on those that later repeated the findings with better equipment. It describes some important anatomical peculiarities of phocid seals, as well as their many physiological responses to diving. In so doing, it is argued that the persistent discussions on the relevance and differences between responses seen in forced dives in the laboratory and those during free diving in the wild are futile. In fact, both are two sides of the same coin, aimed at protecting the body against asphyxic insult and extending diving performance.
Handgrip Strength, Function, and Mortality in Older Adults: A Time-varying Approach
Authors: MCGRATH RYAN P. , VINCENT BRENDA M. , LEE I-MIN , KRAEMER WILLIAM J. , PETERSON MARK D.
Published: June 2018

Purpose

To determine the time-varying associations between 1) decreased handgrip strength and disabilities in each activity of daily living (ADL) function, and 2) disaggregated ADL limitations and time to mortality in older adults.

Methods

A United States nationally representative sample of 17,747 older adults from the Health and Retirement Study were followed up for 8 yr. Maximal handgrip strength was measured with a hand-held dynamometer. Ability to perform ADL was self-reported. Date of death was identified by the National Death Index and exit interviews. Separate covariate-adjusted hierarchical logit models were used to examine the time-varying associations between decreased handgrip strength and each ADL outcome. Distinct covariate-adjusted Cox models were used to analyze the time-varying associations between disaggregated ADL limitations and time to mortality.

Results

Every 5-kg decrease in handgrip strength was associated with increased odds for the following ADL limitations: 20% for eating, 14% for walking, 14% for bathing, 9% for dressing, 8% for transferring, and 6% for toileting. The presence of a bathing, walking, toileting, eating, and dressing ADL disability was associated with a 47%, 43%, 32%, 30%, and 19% higher hazard for mortality, respectively. A transferring ADL disability was not significantly associated with mortality.

Conclusions

Decreased handgrip strength was associated with increased odds for each ADL limitation, and in turn, most individual ADL impairments were associated with a higher hazard for mortality in older adults. These findings provide insights into the disabling process by identifying which ADL limitations are most impacted by decreased handgrip strength and the subsequent time to mortality for each ADL disability.
Impact of a Graded Exercise Program on V˙O2peak and Survival in Heart Failure Patients
Authors: SNOEK JOHAN A. , EIJSVOGELS THIJS M. H. , VAN ‘T HOF ARNOUD W. J. , PRESCOTT EVA , HOPMAN MARIA T. , KOLKMAN EVELIEN , DE KLUIVER ED P.
Published: June 2018

Introduction

Although exercise therapy has the potential to improve health outcomes of patients with chronic heart failure (CHF), less than 50% of patients adhere to prescribed physical activity guidelines 1 yr after cardiac rehabilitation. We aimed to assess the effects of an extended cardiac rehabilitation program with 12 months of graded exercise therapy (GET) and resistance exercise training (RT) on exercise capacity and long-term survival in patients with CHF.

Methods

This prospective cohort study included 60 CHF patients between 2009 and 2010. The GET-RT program consisted of exercise sessions at 6 d·wk−1. Total training time of aerobic exercises increased incrementally every other week without changing exercise intensity. Resistance exercise training consisted of 8 exercises with a durable resistance band. Guidance consisted of a step-down approach from in-hospital to home-based training. Cardiopulmonary exercise tests were performed at baseline, 3, 6, and 12 months. Subsequently, patients were propensity score matched on a 1:2 ratio with controls (n = 117) from a CHF registry of patients from the same clinic receiving usual out-patient care and the incidence of all-cause mortality was compared between both groups.

Results

Baseline V˙O2 peak was 15.0 mL·min−1·kg−1 and significantly elevated at 3 months (+1.1 mL·min−1·kg−1 (95% CI, 0.4–1.8), 6 months (+2.9 mL·min−1·kg−1 (95% CI, 1.1–2.9) and 12 months (+2.6 mL·min−1·kg−1 (95% CI, 1.4–3.8). During 8 yr of follow-up 23 (38.3%) patients of the GET-RT program died versus 63 (53.8%) patients of the control group (P = 0.063).

Conclusions

The 12-month GET-RT program was associated with an improved fitness during 1-yr follow-up, whereas a tendency toward better survival rates was observed during long-term follow-up.
Gait Biomechanics in Anterior Cruciate Ligament–reconstructed Knees at Different Time Frames Postsurgery
Authors: GOETSCHIUS JOHN , HERTEL JAY , SALIBA SUSAN A. , BROCKMEIER STEPHEN F. , HART JOSEPH M.
Published: June 2018

Purpose

To examine knee and hip biomechanics during walking and jogging in groups of ACLR patients at early, mid, and late time frames postsurgery and healthy controls.

Methods

Participants included individuals with a history of primary, unilateral ACLR, stratified into early (1.4 ± 0.4 yr post, n = 18), mid (3.3 ± 0.6 yr post, n = 20), and late (8.5 ± 2.8 yr post, n = 20) ACLR groups based on time postsurgery, and a healthy control group (n = 20). Walking and jogging motion capture analysis of knee and hip kinetics and kinematics were measured in the sagittal and frontal planes. Interlimb (within groups) and between-group comparisons were performed for all gait variables. Statistical comparisons were made across the gait cycle by plotting graphs of means and 90% confidence intervals and identifying regions of the gait cycle in which the 90% confidence intervals did not overlap.

Results

Early ACLR group demonstrated reduced knee flexion, knee extension, knee adduction, and hip adduction moments on the ACLR limb. Mid ACLR group demonstrated no gait differences between limbs or other groups. Late ACLR group demonstrated reduced knee flexion moments, and greater knee and hip adduction moments in their ACLR limb. Control group demonstrated no interlimb differences.

Conclusions

Walking and jogging gait biomechanics presented differently in patients at different stages in time after ACLR surgery. The early ACLR group demonstrated lower sagittal and frontal plane joint loading on the ACLR limb compared with contralateral and control limbs. The mid ACLR group did not demonstrate any gait differences compared with the contralateral or control limb. The late ACLR group demonstrated lower sagittal plane joint loading compared with control limbs and greater frontal plane joint loading compared to contralateral and control limbs.
High-Intensity Interval Training Augments Muscle Carnosine in the Absence of Dietary Beta-alanine Intake
Authors: DE SALLES PAINELLI VITOR , NEMEZIO KLEINER MÁRCIO , PINTO ANA JÉSSICA , FRANCHI MARIANA , ANDRADE ISABEL , RIANI LUIZ AUGUSTO , SAUNDERS BRYAN , SALE CRAIG , HARRIS ROGER CHARLES , GUALANO BRUNO , ARTIOLI GUILHERME GIANNINI
Published: June 2018

Purpose

Cross-sectional studies suggest that training can increase muscle carnosine (MCarn), although longitudinal studies have failed to confirm this. A lack of control for dietary β-alanine intake or muscle fiber type shifting may have hampered their conclusions. The purpose of the present study was to investigate the effects of high-intensity interval training (HIIT) on MCarn.

Methods

Twenty vegetarian men were randomly assigned to a control (CON) (n = 10) or HIIT (n = 10) group. High-intensity interval training was performed on a cycle ergometer for 12 wk, with progressive volume (6–12 series) and intensity (140%–170% lactate threshold [LT]). Muscle carnosine was quantified in whole-muscle and individual fibers; expression of selected genes (CARNS, CNDP2, ABAT, TauT, and PAT1) and muscle buffering capacity in vitro (βm
in vitro
) were also determined. Exercise tests were performed to evaluate total work done, V˙O2max, ventilatory thresholds (VT) and LT.

Results

Total work done, VT, LT, V˙O2max, and βm
in vitro
were improved in the HIIT group (all P < 0.05), but not in CON (P > 0.05). MCarn (in mmol·kg−1 dry muscle) increased in the HIIT (15.8 ± 5.7 to 20.6 ± 5.3; P = 0.012) but not the CON group (14.3 ± 5.3 to 15.0 ± 4.9; P = 0.99). In type I fibers, MCarn increased in the HIIT (from 14.4 ± 5.9 to 16.8 ± 7.6; P = 0.047) but not the CON group (from 14.0 ± 5.5 to 14.9 ± 5.4; P = 0.99). In type IIa fibers, MCarn increased in the HIIT group (from 18.8 ± 6.1 to 20.5 ± 6.4; P = 0.067) but not the CON group (from 19.7 ± 4.5 to 18.8 ± 4.4; P = 0.37). No changes in gene expression were shown.

Conclusions

In the absence of any dietary intake of β-alanine, HIIT increased MCarn content. The contribution of increased MCarn to the total increase in βm
in vitro
appears to be small.
Oral aniracetam treatment in C57BL/6J mice without pre-existing cognitive dysfunction reveals no changes in learning, memory, anxiety or stereotypy
Authors: Reynolds Conner D. , Jefferson Taylor S. , Volquardsen Meagan , Pandian Ashvini , Smith Gregory D. , Holley Andrew J. , Lugo Joaquin N.
Published: June 2018

Background: The piracetam analog, aniracetam, has recently received attention for its cognition enhancing potential, with minimal reported side effects.  Previous studies report the drug to be effective in both human and non-human models with pre-existing cognitive dysfunction, but few studies have evaluated its efficacy in healthy subjects. A previous study performed in our laboratory found no cognitive enhancing effects of oral aniracetam administration 1-hour prior to behavioral testing in naïve C57BL/6J mice.

Methods: The current study aims to further evaluate this drug by administration of aniracetam 30 minutes prior to testing in order to optimize any cognitive enhancing effects. In this study, all naïve C57BL/6J mice were tested in tasks of delayed fear conditioning, novel object recognition, rotarod, open field, elevated plus maze, and marble burying.

Results: Across all tasks, animals in the treatment group failed to show enhanced learning when compared to controls.

Conclusions: These results provide further evidence suggesting that aniracetam conveys no therapeutic benefit to subjects without pre-existing cognitive dysfunction.
Spectrum of Pituitary disorders: A retrospective study from Basrah, Iraq
Authors: Mansour Abbas Ali , Alhamza Ali Hussain Ali , Almomin Ammar Mohammed Saeed Abdullah , Zaboon Ibrahim Abbood , Alibrahim Nassar Taha Yaseen , Hussein Rudha Naser , Kadhim Muayad Baheer , Alidrisi Haider Ayad Yassin , Nwayyir Hussein Ali , Mohammed Adel Gassab , Al-Waeli Dheyaa Kadhim , Hussein Ibrahim Hani
Published: June 2018

Background:Pituitary disorders spectrum includes a wide variety of diseases.This study aimed at a comprehensive description of such disorders for patients from  Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah (Southern Iraq).

Methods: Retrospective data analysis of FDEMC for the period from January 2012 through June 2017. We included all patients with pituitary disorders who have MRI pituitary.

Results: The pituitary disorders were more common among women. Those with macroadenoma were older than those with microadenoma with nearly equal gender prevalence of macroadenoma. Pituitary adenoma constituted the bulk of pituitary disorders in this registry (67.2%). Growth hormone secreting adenoma were the commonest adenoma seen in 41.0% followed by clinically non-functioning pituitary adenoma(NFPA)in 31.4% and prolactinoma in 26.9%. About 64.8% of pituitary adenoma was macroadenoma. Macroadenoma was seen in 73.4 % of growth hormone secreting adenoma, 61.2% in NFPA and 62.0% of prolactinoma (of them six were giant prolactinoma)

Conclusion: Pituitary adenoma constituted the bulk of pituitary disorders in Basrah, growth hormone secreting adenoma is the commonest adenoma followed by NFPA and prolactinoma due to referral bias. A change  in  practice of pituitary adenoma treatment is needed.
Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C
Authors: Esfandiari Hamed , Loewen Nils A. , Hassanpour Kiana , Fatourechi Ali , Yazdani Shahin , Wang Chao , Yaseri Mehdi , Pakravan Mohammad
Published: June 2018

Background: The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis.

Methods: In this retrospective comparative case series, 26 FHIC-associated glaucoma patients received trabeculectomy (n=12) or an AGV (n=14). Primary outcome measures were surgical success, defined as intraocular pressure (IOP) ≤21 mmHg, decreasing ≥20% from baseline, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP.

Results: The follow-up was 34.0±17.7 months in patients that received trabeculectomy and 33.4±18.6 months in AGV (P= 0.837). The cumulative probability of success rate was 41.7% for trabeculectomy and 85.7% for AGV, with no significant difference in complications (P>0.05). The IOP in patients that received trabeculectomy dropped from 23.4±3.3 mmHg to 21.6±5.2 mmHg at the final visit (P= 0.041). In patients that received AGV, the IOP decreased from 24±7.8 to 17.1±2.6 mmHg (P= 0.003). The number of glaucoma medications at baseline were 3.3±0.5 in those that received trabeculectomy and 3±0.6 in those that received AGV (P=0.233), and decreased to 2.4±1.0 (P=0.008) and 1.7±0.6 (P=0.002), respectively. BCVA was equal in both groups and did not change (P>0.05).

Conclusion: Primary AGV had a higher success rate than trabeculectomy, with patients also needing fewer medications for the management of FHIC-associated glaucoma.