Association of activities of daily living with the load during step ascent motion in nursing home-residing elderly individuals

Objective This study aimed to examine the association of independence in ADL with the loads during step ascent motion and other motor functions in 32 nursing home-residing elderly individuals. Design Independence in ADL was assessed by using the functional independence measure (FIM). The loads at the upper (i.e., pulling up) and lower (i.e., pushing up) levels during step ascent task was measured on a step ascent platform. Hip extensor, knee extensor, plantar flexor muscle, and quadriceps setting strengths; lower extremity agility using the stepping test; and hip and knee joint pain severities were measured. One-legged stance and functional reach distance for balance, and maximal walking speed, timed up-and-go (TUG) time, five-chair-stand time, and step ascent time were also measured to assess mobility. Results Stepwise regression analysis revealed that the load at pushing up during step ascent motion and TUG time were significant and independent determinants of FIM score. FIM score decreased with decreased the load at pushing up and increased TUG time. Conclusions The study results suggest that depending on task specificity, both one step up task's push up peak load during step ascent motion and TUG, can partially explain ADL's FIM score in the nursing home-residing elderly individuals. Lower extremity muscle strength, agility, pain or balance measures did not add to the prediction. Corressponding author Mitsuhiro Masaki, R.P.T., PhD., Department of Physical Therapy, Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan. E-mail: masaki@nuhw.ac.jp. Office phone: +81-25-257-4312. Office fax: +81-25-257-4312 Author Disclosures No potential conflicts of interest were disclosed for the present study. Kyoritsu Denshi Kogyo Co. Ltd. financed this study. The financial providers did not contribute to the implementation of the study, analysis, interpretation of the data, or preparation of this article. The present study is an expansive analysis of our cross-sectional study that has been published previously as an article titled "Association between physical function and the load pattern during stepping-up motion in community-dwelling elderly women" (2016). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Femoral artery blood flow and microcirculatory perfusion during acute, low-level functional electrical stimulation in spinal cord injury

Objective Functional electrical stimulation (FES) may help to reduce the risk of developing macro- and microvascular complications in people with SCI. Low-intensity FES has significant clinical potential since this can be applied continuously throughout the day. This study examines the acute effects of low intensity FES using wearable clothing garment on vascular blood flow and oxygen consumption in people with SCI. Design Cross-sectional observation study Methods Eight participants with a motor complete SCI received 4x3 minutes of unilateral FES to the gluteal and hamstring muscles. Skin and deep femoral artery blood flow and oxygen consumption were measured at baseline and during each bout of stimulation. Results Femoral artery blood flow increased by 18.1% with the application of FES (P=0.02). Moreover, femoral artery blood flow increased further during each subsequent block of FES (P=0.004). Skin perfusion did not change during an individual block of stimulation (P=0.66). Skin perfusion progressively increased with each subsequent bout (P0.05). Conclusion Low-intensity FES acutely increased blood flow during stimulation, with a progressive increase across subsequent FES bouts. These observations suggest continuous, low-intensity FES may represent a practical and effective strategy to improve perfusion and reduce the risk of vascular complications. Correspondence: Dick Thijssen, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, L3 3AF, Liverpool, United Kingdom. Email: d.thijssen@ljmu.ac.uk. Tel: +44 (0)151 904 6264 Fax: +44 (0)151 904 6284 Disclosures The authors declare that there is no conflict of interest. This study was supported by funds received from the Stoke Mandeville-Masson research awards. The funding source had no such involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. This research has previously been presented at IFESS conference 2017. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Optical trocar access for initial trocar placement in laparoscopic gastrointestinal surgery: A propensity score‐matching analysis

Asian Journal of Endoscopic Surgery, EarlyView.


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Mapping of Leaf Rust Resistance Genes and Molecular Characterization of the 2NS/2AS Translocation in the Wheat Cultivar Jagger

Winter wheat cultivar 'Jagger' was recently found to have an alien chromosomal segment 2NS that has Lr37, a gene conferring resistance against leaf rust caused by Puccinia triticina. The objective of this study was to map and characterize the gene(s) for seedling leaf rust resistance in Jagger. The recombinant inbred line (RIL) population of Jagger x '2174' was inoculated with leaf rust pathogen THBJG and BBBDB, and evaluated for infection type (IT) response. A major quantitative trait locus (QTL) for THBJG and BBBDB was coincidently mapped to chromosome arm 2AS, and the QTL accounted for 56.6% - 66.2% of total phenotypic variation in infection type (IT) response to THBJG, and 72.1% - 86.9% to BBBDB. The causal gene for resistance to these rust races was mapped to the 2NS segment in Jagger. The 2NS segment was located in a region of approximately 27.8 Mb starting from the telomere of chromosome arm 2AS, based on the sequences of the A genome in tetraploid wheat. The Lr17a gene on chromosome arm 2AS was delimited to 3.1 Mb in the genomic region, which was orthologous to the 2NS segment. Therefore, the Lr37 gene in the 2NS segment can be pyramided with other effective resistance genes, rather than Lr17a in wheat, to improve resistance to rust diseases.

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Phylogenetic and Phylogenomic Definition of Rhizopus Species

Phylogenomic approaches have the potential to improve confidence about the inter-relationships of species in the order Mucorales within the fungal tree of life. Rhizopus species are especially important as plant and animal pathogens and bioindustrial fermenters for food and metabolite production. A dataset of 192 orthologous genes was used to construct a phylogenetic tree of 21 Rhizopus strains, classified into four species isolated from habitats of industrial, medical and environmental importance. The phylogeny indicates that the genus Rhizopus consists of three major clades, with R. microsporus as the basal species and the sister lineage to R. stolonifer and two closely related species R. arrhizus and R. delemar. A comparative analysis of the mating type locus across Rhizopus reveals that its structure is flexible even between different species in the same genus, but shows similarities between Rhizopus and other mucoralean fungi. The topology of single-gene phylogenies built for two genes involved in mating is similar to the phylogenomic tree. Comparison of the total length of the genome assemblies showed that genome size varies by as much as three-fold within a species and is driven by changes in transposable element copy numbers and genome duplications.

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Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial

Background and Objectives General anesthesia for breast surgery may be supplemented by using a regional anesthetic technique. We evaluated the efficacy of the first pectoral nerve block (Pecs I) in treating postoperative pain after breast cancer surgery. Methods A randomized, double-blind, dual-centered, placebo-controlled trial was performed. One hundred twenty-eight patients scheduled for unilateral breast cancer surgery were recruited. A multimodal analgesic regimen and surgeon-administered local anesthetic infiltration were used for all patients. Ultrasound-guided Pecs I was performed using bupivacaine or saline. The primary outcome was the patient pain score (numerical rating scale [NRS]) in the recovery unit 30 minutes after admission or just before the morphine administration (NRS ≥4/10). The secondary outcomes were postoperative opioid consumption (ie, in the recovery unit and after 24 hours). Results During recovery, no significant difference in NRS was observed between the bupivacaine (n = 62, 3.0 [1.0–4.0]) and placebo (n = 65, 3.0 [1.0–5.0]) groups (P = 0.55). However, the NRS was statistically significantly different, although not clinically significant, for patients undergoing major surgeries (mastectomies or tumorectomies with axillary clearance) (n = 29, 3.0 [0.0–4.0] vs 4.0 [2.0–5.0], P = 0.04). Morphine consumption during recovery did not differ (1.5 mg [0.0–6.0 mg] vs 3.0 mg [0.0–6.0 mg], P = 0.20), except in the major surgery subgroup (1.5 mg [0.0–6.0 mg] vs 6.0 mg [0.0–12.0 mg], P = 0.016). Intraoperative sufentanil and cumulative morphine consumption up to 24 hours did not differ between the 2 groups. Three patients experienced complications related to the Pecs I. Conclusions Pecs I is not better than a saline placebo in the presence of multimodal analgesia for breast cancer surgery. However, its role in extended (major) breast surgery may warrant further investigation. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT01670448. Accepted for publication December 13, 2017. Address correspondence to: Jérôme Cros, MD, MSc, Département d'Anesthésie-Réanimation, Hôpital de la mère et de l'enfant, 8, avenue Dominique Larrey, 87000 Limoges, France (e-mail: jerome.cros@chu-limoges.fr). Funding was provided by Réseau Québécois de Recherche sur la Douleur, Québec, Canada; Fondation d'Anesthésiologie et Réanimation du Québec, Canada; Fonds de Développement du Département d'anesthésiologie de l'Université de Montréal, Québec, Canada; and Fondation de France, Paris, France. This work has been presented in part at Euroanesthesia 2016, London, United Kingdom, May 29, 2016 (presented by J.C., abstract no. 03AP04-3); at the French Society of Anesthesia & Intensive Care Medicine (SFAR) 2016 Annual Meeting, Paris, France, September 24, 2016 (presented by J.C., abstract no. R480 [in French]); and at the World Congress of Pain 2016, Yokohama, Japan, September 27, 2016 (presented by P.B., abstract no. 943). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Coming to the rescue of first responders

Addressing behavioral health needs must be a priority

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Complement receptor 1 gene ( CR1 ) intragenic duplication and risk of Alzheimer’s disease

Abstract

Single nucleotide variants (SNVs) within and surrounding the complement receptor 1 (CR1) gene show some of the strongest genome-wide association signals with late-onset Alzheimer's disease. Some studies have suggested that this association signal is due to a duplication allele (CR1-B) of a low copy repeat (LCR) within the CR1 gene, which increases the number of complement C3b/C4b-binding sites in the mature receptor. In this study, we develop a triplex paralogue ratio test assay for CR1 LCR copy number allowing large numbers of samples to be typed with a limited amount of DNA. We also develop a CR1-B allele-specific PCR based on the junction generated by an historical non-allelic homologous recombination event between CR1 LCRs. We use these methods to genotype CR1 and measure CR1-B allele frequency in both late-onset and early-onset cases and unaffected controls from the United Kingdom. Our data support an association of late-onset Alzheimer's disease with the CR1-B allele, and confirm that this allele occurs most frequently on the risk haplotype defined by SNV alleles. Furthermore, regression models incorporating CR1-B genotype provide a better fit to our data compared to incorporating the SNV-defined risk haplotype, supporting the CR1-B allele as the variant underlying the increased risk of late-onset Alzheimer's disease.

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Modeling of intracerebral interictal epileptic discharges: Evidence for network interactions

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Stephan Meesters, Pauly Ossenblok, Albert Colon, Louis Wagner, Olaf Schijns, Paul Boon, Luc Florack, Andrea Fuster
ObjectiveThe interictal epileptic discharges (IEDs) occurring in stereotactic EEG (SEEG) recordings are in general abundant compared to ictal discharges, but difficult to interpret due to complex underlying network interactions. A framework is developed to model these network interactions.MethodsTo identify the synchronized neuronal activity underlying the IEDs, the variation in correlation over time of the SEEG signals is related to the occurrence of IEDs using the general linear model. The interdependency is assessed of the brain areas that reflect highly synchronized neural activity by applying independent component analysis, followed by cluster analysis of the spatial distributions of the independent components. The spatiotemporal interactions of the spike clusters reveal the leading or lagging of brain areas.ResultsThe analysis framework was evaluated for five successfully operated patients, showing that the spike cluster that was related to the MRI-visible brain lesions coincided with the seizure onset zone. The additional value of the framework was demonstrated for two more patients, who were MRI-negative and for whom surgery was not successful.ConclusionsA network approach is promising in case of complex epilepsies.SignificanceAnalysis of IEDs is considered a valuable addition to routine review of SEEG recordings, with the potential to increase the success rate of epilepsy surgery.



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Principles of Exercise Prescription, and How They Influence Exercise-Induced Changes of Transcription Factors and Other Regulators of Mitochondrial Biogenesis

Abstract

Physical inactivity represents the fourth leading risk factor for mortality, and it has been linked with a series of chronic disorders, the treatment of which absorbs ~ 85% of healthcare costs in developed countries. Conversely, physical activity promotes many health benefits; endurance exercise in particular represents a powerful stimulus to induce mitochondrial biogenesis, and it is routinely used to prevent and treat chronic metabolic disorders linked with sub-optimal mitochondrial characteristics. Given the importance of maintaining a healthy mitochondrial pool, it is vital to better characterize how manipulating the endurance exercise dose affects cellular mechanisms of exercise-induced mitochondrial biogenesis. Herein, we propose a definition of mitochondrial biogenesis and the techniques available to assess it, and we emphasize the importance of standardizing biopsy timing and the determination of relative exercise intensity when comparing different studies. We report an intensity-dependent regulation of exercise-induced increases in nuclear peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) protein content, nuclear phosphorylation of p53 (serine 15), and PGC-1α messenger RNA (mRNA), as well as training-induced increases in PGC-1α and p53 protein content. Despite evidence that PGC-1α protein content plateaus within a few exercise sessions, we demonstrate that greater training volumes induce further increases in PGC-1α (and p53) protein content, and that short-term reductions in training volume decrease the content of both proteins, suggesting training volume is still a factor affecting training-induced mitochondrial biogenesis. Finally, training-induced changes in mitochondrial transcription factor A (TFAM) protein content are regulated in a training volume-dependent manner and have been linked with training-induced changes in mitochondrial content.

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Can We Draw General Conclusions from Interval Training Studies?

Abstract

Interval training (IT) has been used for many decades with the purpose of increasing performance and promoting health benefits while demanding a relatively small amount of time. IT can be defined as intermittent periods of intense exercise separated by periods of recovery and has been divided into high-intensity interval training (HIIT), sprint interval training (SIT), and repeated sprint training (RST). IT use has resulted in the publication of many studies and many of them with conflicting results and positions. The aim of this article was to move forward and understand the studies' protocols in order to draw accurate conclusions, as well as to avoid previous mistakes and effectively reproduce previous protocols. When analyzing the literature, we found many inconsistencies, such as the controversial concept of 'supramaximal' effort, a misunderstanding with regard to the term 'high intensity,' and the use of different strategies to control intensity. The adequate definition and interpretation of training intensity seems to be vital, since the results of IT are largely dependent on it. These observations are only a few examples of the complexity involved in IT prescription, and are discussed to illustrate some problems with the current literature regarding IT. Therefore, it is our opinion that it is not possible to draw general conclusions about IT without considering all variables used in IT prescription, such as exercise modality, intensity, effort and rest times, and participants' characteristics. In order to help guide researchers and health professionals in their practices it is important that experimental studies report their methods in as much detail as possible and future reviews and meta-analyses should critically discuss the articles included in the light of their methods to avoid inappropriate generalizations.

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The Stomach as an Endocrine Organ: Expression of Key Modulatory Genes and Their Contribution to Obesity and Non-alcoholic Fatty Liver Disease (NAFLD)

Abstract

Purpose of Review

Obesity is currently seen in epidemic proportions globally and is one of the largest contributors to the development of NAFLD. The spectrum of NAFLD, particularly the progressive forms of NASH, is likely to become the leading cause of liver disease in the next decade.

Recent Findings

Soluble molecules, encoded by the stomach tissue, have been shown to have pleiotropic effects in both central and peripheral systems involved in energy homeostasis and obesity regulation. As such, the stomach is one of the important players in the complex, multi-system deregulation leading to obesity and NAFLD.

Summary

The understanding of the stomach tissue as an active endocrine organ that contributes to the signaling milieu leading to the development of obesity and NAFLD is crucial.

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Long-term natural history of liver disease in patients with chronic hepatitis B virus infection: an analysis using the Markov chain model

Abstract

Background

The relationship between the hepatitis B e antigen (HBeAg) seroconversion and the long-term natural history of liver disease has not been sufficiently investigated.

Methods

A total of 408 [4352 person-year (PY) units] patients with chronic hepatitis B virus (HBV) without antiviral therapy were enrolled. The study patients were divided into three groups, as follows: Group A (2666 PY units), seroconverted of HBeAg at age < 40; Group B (413 PY units), seroconverted of HBeAg at age ≥ 40; Group C (1273 PY units), persistently HBeAg positive. Yearly transition probabilities from each liver state [chronic HBV infection, chronic hepatitis B, cirrhosis, hepatocellular carcinoma (HCC), and hepatitis B surface antigen (HBsAg) negativity] were calculated using the Markov chain model.

Results

In the analysis of 1 year liver disease state transition probabilities, the liver states remained almost the same in Group A. In Groups B and C, each liver state tended to progress to a worse state. Assuming a chronic hepatitis B state at age 40 as the starting condition for simulation over the next 40 years, the chronic hepatitis B state accounted for approximately 60% of males aged ≥ 50 and approximately 40% of females aged ≥ 60 in Group A, and the HBsAg-negative state accounted for approximately 30–40% of males and females aged ≥ 60. In Groups B and C, the probabilities of patients with cirrhosis and HCC gradually increased with age.

Conclusions

Not only patients with persistent HBeAg positive, but also patients with delayed HBeAg seroconversion showed poor prognosis of liver-related natural history.

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