WISE 2005: Aerobic and resistive countermeasures prevent paraspinal muscle deconditioning during 60-days bed rest in women

Microgravity-induced lumbar paraspinal muscle deconditioning may contribute to back pain commonly experienced by astronauts, and may increase the risk of postflight injury. We hypothesized that a combined resistance and aerobic exercise countermeasure protocol that included spinal loading would mitigate lumbar paraspinal muscle deconditioning during 60-days of bed rest in women. METHODS: Sixteen women underwent 60-day, 6° head-down-tilt bed rest and were randomized into control and exercise groups. During bed rest, the control group performed no exercise. The exercise group performed supine treadmill exercise within lower body negative pressure (LBNP) for 3-4 d/wk and flywheel resistive exercise for 2-3 d/wk. Paraspinal muscle cross-sectional area (CSA) was measured using a lumbar spine MRI sequence before and after bed rest (BR). In addition, isokinetic spinal flexion and extension strengths were measured before and after BR. Data are presented as mean ± SD. RESULTS: Total lumbar paraspinal muscle CSA decreased significantly more in controls (10.9 ± 3.4%) than in exercisers (4.3 ± 3.4%; p <0.05). The erector spinae was the primary contributor (76%) to total lumbar paraspinal muscle loss. Moreover, exercise attenuated isokinetic spinal extension loss (-4.3 ± 4.5%), as compared to controls (-16.6 ± 11.2%; p <0.05). CONCLUSIONS: LBNP treadmill and flywheel resistive exercises during simulated microgravity mitigates decrements in lumbar paraspinal muscle structure and spine function. Therefore, space flight exercise countermeasures that attempt to reproduce spinal loads experienced on Earth may mitigate spinal deconditioning during long-duration space travel.

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Lung diffusing capacity for nitric oxide as a marker of fibrotic changes in idiopathic interstitial pneumonias

Lung diffusing capacity for carbon monoxide (DL_CO) is decreased in both usual interstitial pneumonia-idiopathic pulmonary fibrosis (UIP-IPF) and nonspecific interstitial pneumonia (NSIP), but is moderately related to computed tomography (CT)-determined fibrotic changes. This may be due to the relative insensitivity of DL_CO to changes in alveolar membrane diffusive conductance (DM_CO). The purpose of this study was to determine whether measurement of lung diffusing capacity for nitric oxide (DL_NO) better reflects fibrotic changes than DL_CO. DL_NO-DL_CO were measured simultaneously in 30 patients with UIP-IPF and 30 with NSIP. Eighty-one matched healthy subjects served as a control group. The amount of pulmonary fibrosis was estimated by CT volumetric analysis of visually bounded areas showing reticular opacities and honeycombing. DM_CO and pulmonary capillary volume (VC) were calculated. DL_NO was below the lower limit of normal in all patients irrespective of extent and nature of disease, whereas DL_CO was within the normal range in a non-negligible number of patients. Both DL_NO and DL_CO were significantly correlated with visual assessment of fibrosis but DL_NO more closely than DL_CO. DM_CO was also below the lower limit of normal in all UIP-IPF and NSIP patients and significantly correlated with fibrosis extent in both diseases, whereas VC was weakly correlated with fibrosis in UIP-IPF and uncorrelated in NSIP, with normal values in half of patients. In conclusion, measurement of DL_NO may provide a more sensitive evaluation of fibrotic changes than DL_CO in either UIP-IPF or NSIP, because it better reflects DM_CO.

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Rapid cooling after acute hyperthermia alters intestinal tissue morphology and increases the systemic inflammatory response in pigs

The study objective was to determine the direct effects of rapid cooling after acute hyperthermia on intestinal morphology and inflammatory response in pigs. In 4 repetitions, male pigs (N=36; 88.7±1.6 kg) were exposed to thermoneutrality (TN; n = 3/rep; 19.5±0.1°C) for 6 h, or heat stress (HS; 36.4±0.1°C) for 3h, followed by a 3h recovery period of rapid cooling (HSRC; n=3/rep; rapid TN exposure and ice water dousing for 1.5h) or gradual cooling (HSGC; n=3/rep; gradual decrease from HS to TN). Rectal (T_R) and gastrointestinal-tract temperatures (T_GI) were obtained every 15 min for 6h. In repetitions 1 and 2, blood was collected at 60 and 180 min during HS, and 30 and 60 min during recovery, and then pigs were euthanized at 180 min of recovery and duodenum, ileum, and colon tissue were collected to evaluate intestinal morphology. HS increased (p<0.01) maximum T_R (40.7°C) and T_GI (41.5°C) compared to TN treatment (38.9 and 39.3°C, respectively). Recovery reduced T_R (p<0.01; 0.4°C) in HSRC versus HSGC pigs, but T_GI was similar (40.7°C). HSRC reduced (p<0.01) villus height to crypt depth ratio in the duodenum (34%) and ileum (46%) versus HSGC pigs. Serum [LPS] was greater in HSRC pigs (p=0.04; 68.5 and 52.4%, respectively) compared to TN and HSGC pigs, and [TNFα] tended to be greater (p=0.06; 41.2%) compared to HSGC pigs during recovery. In summary, rapid cooling reduced T_R but had no effect on T_GI and this may be linked to increased intestinal damage and a systemic inflammatory response.

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Long-Duration Bed Rest as an Analog to Microgravity

Long-duration bed rest is widely employed to simulate the effects of microgravity on various physiological systems, especially for studies of bone, muscle and the cardiovascular system. This microgravity analog is also extensively used to develop and test countermeasures to microgravity-altered adaptations to Earth gravity. Initial investigations of bone loss used horizontal bed rest with the view that this model represented the closest approximation to inactivity and minimization of hydrostatic effects, but all Earth-based analogs must contend with the constant force of gravity by adjustment of the G vector. Later concerns about the lack of similarity between head-ward fluids shifts in space and those with horizontal bed rest encouraged the use of 6 degrees head-down tilt (HDT) bed rest as pioneered by Russian investigators. Head-ward fluids shifts in space may redistribute bone from the legs to the head. At present, HDT bed rest with normal volunteers is the most common analog for microgravity simulation and to test countermeasures for bone loss, muscle and cardiac atrophy, orthostatic intolerance, and reduced muscle strength/exercise capacity. Also, current physiologic countermeasures are focused on long-duration missions such as Mars, so in this review we emphasize HDT bed rest studies with durations of 30 days and longer. However, recent results suggest that the HDT bed rest analog is less representative as an analog for other important physiological problems of long-duration space flight such as fluid shifts, spinal dysfunction and radiation hazards.

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A low-cost system to easily measure spontaneous physical activity in rodents.

The Spontaneous Physical Activity (SPA) can be responsible for variations of a lot of physiological parameters at the molecular, cellular, tissue, and systemic levels. It is increasingly recognized that the good understanding of a large part of laboratory experimentations, implies to weight results by this SPA in order to reduce the variability, and so to decrease the number of animals necessary to conduct a study. However, because of the high cost of these equipment, only few laboratories are equipped with such a device to measure the SPA of their animals. Here, we present an effective, adaptable and low-cost system to measure SPA in rodents, based on a video acquisition of the animal in his own environment.

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Two stages of directed forgetting: Electrophysiological evidence from a short-term memory task

Abstract

In this study, a short-term memory test was used to investigate the temporal course and neural mechanism of directed forgetting under different memory loads. Within each trial, two memory items with high or low load were presented sequentially, followed by a cue indicating whether the presented items should be remembered. After an interval, subjects were asked to respond to the probe stimuli. The ERPs locked to the cues showed that (a) the effect of cue type was initially observed during the P2 (160–240 ms) time window, with more positive ERPs for remembering relative to forgetting cues; (b) load effects were observed during the N2-P3 (250–500 ms) time window, with more positive ERPs for the high-load than low-load condition; (c) the cue effect was also observed during the N2-P3 time window, with more negative ERPs for forgetting versus remembering cues. These results demonstrated that directed forgetting involves two stages: task-relevance identification and information discarding. The cue effects during the N2 epoch supported the view that directed forgetting is an active process.

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Clinical audit of genetic testing and referral patterns for fragile X and associated conditions

An audit was conducted of laboratory/clinical databases of genetic tests performed between January 2003 and December 2009, and for 2014, as well as referrals to the clinical service and a specialist multidisciplinary clinic, to determine genetic testing request patterns for fragile X syndrome and associated conditions and referrals for genetic counseling/multidisciplinary management in Victoria, Australia. An expanded allele (full mutation, premutation or intermediate) was found in 3.7% of tests. Pediatricians requested ∼70% of test samples, although fewer general practitioners and more obstetricians/gynecologists ordered tests in 2014. Median age at testing for individuals with a full mutation seeking a diagnosis without a fragile X family history was 4.3 years (males) and 9.4 years (females); these ages were lower when pediatricians ordered the tests (2.1 years and 6.1 years, respectively). Individuals with a premutation were generally tested at a later age (median age: males, 33.2 years; females, 36.4 years). Logistic regression showed that a family history of ID (OR 3.28 P = 0.005, CI 1.77–5.98) was the only indication to independently increase the likelihood of a test-positive (FM or PM) result. Following testing, ∼25% of full mutation or premutation individuals may not have attended clinical services providing genetic counseling or multidisciplinary management for these families. The apparent delay in fragile X syndrome diagnosis and lack of appropriate referrals for some may result in less than optimal management for these families. These findings suggest continued need for awareness and education of health professionals around diagnosis and familial implications of fragile X syndrome and associated conditions. © 2016 Wiley Periodicals, Inc.

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Lactobacillus acidophilus Restores Functionality in Uremic Macrophages: Plausible or Lacking Evidence?

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Factors Associated with the Success of In Vitro Fertilization in Women with Inflammatory Bowel Disease

Abstract

Background

It is unknown whether certain factors are associated with the success of in vitro fertilization (IVF) in women with inflammatory bowel disease (IBD).

Aim

This study assessed whether certain characteristics are associated with greater success of live birth following IVF.

Methods

In a cohort study of 8684 women with IBD seen at two tertiary care centers, we identified 121 women with IBD who underwent IVF. We assessed the effect of numerous factors on likelihood of achieving live birth after IVF.

Results

Seventy-one patients with ulcerative colitis (UC) and 49 patients with Crohn's disease (CD) were analyzed. Patients with UC who achieved a live birth were younger (p = 0.03), had a shorter duration of disease (p = 0.01), and were more likely to be in remission (p = 0.03) versus those who did not achieve live birth. Patients with CD who achieved live birth were younger (p < 0.001), had lower body mass index (BMI) (p = 0.02), and had lower cycle day 3 follicle-stimulating hormone levels (p = 0.02). There was no difference in likelihood of achieving live birth among patients in remission and those with mild or unknown disease status (p = 0.69), though most CD patients (79.5 %) were in remission. Prior surgery was not associated with live birth in patients with UC (p = 0.31) or CD (p = 0.62).

Conclusions

As in the general infertility population, younger patients and those with lower BMI were more likely to achieve live birth. History of surgery was not associated with live birth among IBD patients. This is important information for practitioners counseling IBD patients.

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Management of Eosinophilic Esophagitis During Pregnancy

Abstract

There are currently limited data on the management of eosinophilic esophagitis (EoE) during pregnancy. At our center, however, we have followed several pregnant women with EoE and others have asked pertinent questions in pre-pregnancy counseling. The relatively young age of patients with EoE implies that many practitioners will also encounter patients with these questions. In this review, we use four cases to prompt a discussion about concerns focused on the safety of steroids and diet therapy during pregnancy and breast-feeding, potential nutritional risks with dietary elimination, how to optimize therapy, and whether endoscopic evaluation for monitoring of disease activity is safe during pregnancy and breast-feeding. An additional concern is whether the disease could progress during pregnancy and breast-feeding if no therapies are used. Although there are no studies specifically examining pregnant EoE patients, we have reviewed the literature relevant to this population as informed by the treatment of inflammatory bowel disease patients during pregnancy, where these issues have been studied in more depth. Providers who care for EoE patients who could become pregnant should familiarize themselves with these issues.

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James William Osborne, PhD 1928–2015

Radiation Research, Volume 185, Issue 2, Page 214-216, February 2016.


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Errata

Radiation Research, Volume 185, Issue 2, Page e52-e52, February 2016.


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Enhancement of Peroxidase Release from Non-Malignant and Malignant Cells through Low-Dose Irradiation with Different Radiation Quality

Radiation Research, Volume 185, Issue 2, Page 199-213, February 2016.


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Inter-Relationship between Low-Dose Hyper-Radiosensitivity and Radiation-Induced Bystander Effects in the Human T98G Glioma and the Epithelial HaCaT Cell Line

Radiation Research, Volume 185, Issue 2, Page 124-133, February 2016.


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Investigating the Radioresistant Properties of Lung Cancer Stem Cells in the Context of the Tumor Microenvironment

Radiation Research, Volume 185, Issue 2, Page 169-181, February 2016.


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Examining Radiation-Induced In Vivo and In Vitro Gene Expression Changes of the Peripheral Blood in Different Laboratories for Biodosimetry Purposes: First RENEB Gene Expression Study

Radiation Research, Volume 185, Issue 2, Page 109-123, February 2016.


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Predicting Radiosensitivity with Gamma-H2AX Foci Assay after Single High-Dose-Rate and Pulsed Dose-Rate Ionizing Irradiation

Radiation Research, Volume 185, Issue 2, Page 190-198, February 2016.


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Intraoral Mitochondrial-Targeted GS-Nitroxide, JP4-039, Radioprotects Normal Tissue in Tumor-Bearing Radiosensitive Fancd2–/– (C57BL/6) Mice

Radiation Research, Volume 185, Issue 2, Page 134-150, February 2016.


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Mast Cells Contribute to Radiation-Induced Vascular Hyperpermeability

Radiation Research, Volume 185, Issue 2, Page 182-189, February 2016.


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A New Model for Biological Dose Assessment in Cases of Heterogeneous Exposures to Ionizing Radiation

Radiation Research, Volume 185, Issue 2, Page 151-162, February 2016.


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Radiation Biology Irradiator Dose Verification Survey

Radiation Research, Volume 185, Issue 2, Page 163-168, February 2016.


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Paediatric procedural sedation using ketamine in a UK emergency department: a 7 year review of practice

Background

Ketamine is growing in popularity for procedural sedation in the paediatric population, yet safety concerns remain. We performed a retrospective review of practice and outcomes of paediatric ketamine sedation using the World SIVA International Sedation Task Force reporting tool.

Methods

A retrospective inspection of the dedicated emergency department electronic sedation database and subsequent note and sedation chart review was performed for all paediatric sedations throughout a 7 yr period from September 2006. All adverse events were stratified.

Results

During the study period, procedural sedation was provided for a total of 243 children, of whom 215 were sedated with ketamine, most commonly for wound management (n=131). The median patient age was 4 yr (14 months to 15 yr), and 63.7% were male. Of the total, 76.7% were discharged home either directly (n=101) or after brief observation (n=64). One patient required subsequent general anaesthesia after a failed sedation with paradoxical agitation. Of the total, 9.8% of patients had an adverse event, the most severe risk stratification being 'minor risk'. All interventions were 'minimal risk'. There were no 'sentinel risk' outcomes.

Conclusions

These data support the ongoing use of ketamine for paediatric procedural sedation in the emergency department by emergency physicians. Relatively high resource requirements mean that ensuring adequate numbers of procedures may prove challenging.

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Fibrinogen supplementation after cardiac surgery: insights from the Zero-Plasma trial (ZEPLAST)

Background

Fibrinogen supplementation has been proposed both to prevent and treat postoperative bleeding in cardiac surgery. The optimal fibrinogen concentration trigger and target values and the fibrinogen concentrate dose required remain uncertain. This subanalysis of data from the Zero-Plasma Trial (ZEPLAST) assessed target fibrinogen values and the corresponding fibrinogen concentrate dose for supplementation.

Methods

We performed a post hoc analysis of 116 subjects included in the randomized, placebo-controlled ZEPLAST trail. Data considered were fibrin-based thromboelastometry (FIBTEM) maximum clot firmness (MCF) determined by whole-blood thromboelastometry (ROTEM) before and after placebo or fibrinogen concentrate, Clauss fibrinogen concentration after placebo or fibrinogen concentrate, postoperative bleeding and severe bleeding (SB). The association between FIBTEM MCF and Clauss fibrinogen concentration was tested with linear regression analyses. The predictive value for SB of FIBTEM MCF and Clauss fibrinogen concentration was tested with receiver operating characteristic analyses.

Results

There was a good association between FIBTEM MCF and Clauss fibrinogen concentration in the baseline study population (r² = 0.66), which worsened in fibrinogen-supplemented subjects. Both FIBTEM MCF and Clauss fibrinogen concentration yielded a good discriminative power for SB (area under the curve 0.721 and 0.767, respectively). The negative predictive value for SB was 100% for a Clauss fibrinogen concentration of 287 mg dl^–1 and 98% for an FIBTEM MCF of 14 mm. Based on these newly defined target values, the dose of fibrinogen concentrate needed would be 3 g lower than the dose used in ZEPLAST.

Conclusions

A dose of fibrinogen concentrate rarely exceeding 2 g might be sufficient to prevent bleeding in cardiac surgery.

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Neuroanesthesiology Update.

We provide a synopsis of innovative research, recurring themes, and novel experimental findings pertinent to the care of neurosurgical patients and critically ill patients with neurological diseases. The following broad topics are covered: general neurosurgery, spine surgery, stroke, traumatic brain injury, anesthetic neurotoxicity, perioperative cognitive dysfunction, and monitoring. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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