Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026: 05/24/16

Τρίτη 24 Μαΐου 2016

Masthead

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6

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Individual Differences in Working Memory Capacity Predicts Responsiveness to Memory Rehabilitation After Traumatic Brain Injury

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6
Author(s): Joshua Sandry, Kathy S. Chiou, John DeLuca, Nancy D. Chiaravalloti
ObjectiveTo explore how individual differences affect rehabilitation outcomes by specifically investigating whether working memory capacity (WMC) can be used as a cognitive marker to identify who will and will not improve from memory rehabilitation.DesignPost hoc analysis of a randomized controlled clinical trial designed to treat learning and memory impairment after traumatic brain injury (TBI): 2 × 2 between-subjects quasiexperimental design (2 [group: treatment vs control] × 2 [WMC: high vs low]).SettingNonprofit medical rehabilitation research center.ParticipantsParticipants (N=65) with moderate to severe TBI with pre- and posttreatment data.InterventionsThe treatment group completed 10 cognitive rehabilitation sessions in which subjects were taught a memory strategy focusing on learning to use context and imagery to remember information. The placebo control group engaged in active therapy sessions that did not involve learning the memory strategy.Main Outcome MeasureLong-term memory percent retention change scores for an unorganized list of words from the California Verbal Learning Test-II.ResultsGroup and WMC interacted (P=.008, ηp²=.12). High WMC participants showed a benefit from treatment compared with low WMC participants. Individual differences in WMC accounted for 45% of the variance in whether participants with TBI in the treatment group benefited from applying the compensatory treatment strategy to learn unorganized information.ConclusionsIndividuals with higher WMC showed a significantly greater rehabilitation benefit when applying the compensatory strategy to learn unorganized information. WMC is a useful cognitive marker for identifying participants with TBI who respond to memory rehabilitation with the modified Story Memory Technique.

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Editorial Board

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6, Supplement

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Editorial Board

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6

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The Authors Respond

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6
Author(s): Julia Totosy de Zepetnek, Chelsea Pelletier, Audrey Hicks, Maureen MacDonald

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Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6

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Masthead

Rehabilitation After Surgical Reconstruction to Restore Function to the Upper Limb in Tetraplegia: A Changing Landscape

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6, Supplement
Author(s): M. Elise Johanson
Upper limb reconstructive surgical procedures for individuals with tetraplegia are performed in many centers internationally. Most recipients of surgery return to local communities and nonsurgical centers for postoperative rehabilitation and long-term follow-up. This supplement focuses on the clinical significance of upper extremity reconstruction, addressing issues related to the availability and choice for surgery, preoperative assessments, postoperative training paradigms, and appropriate outcome measures. Comprehensive intervention protocols are described in terms of dose, timing, specific activities, modalities, and related outcomes. Shared knowledge of current rehabilitation practice, as it relates to reconstructive surgery, can expand treatment options communicated to patients, increase the availability of postoperative muscle reeducation programs, and motivate long-term follow-up assessments.

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Editors' Selections From This Issue: Volume 97 / Number 6 / June 2016

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6

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Tendon Transfer Surgery for People With Tetraplegia: An Overview

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6, Supplement
Author(s): Jennifer A. Dunn, K. Anne Sinnott, Alastair G. Rothwell, Khalid D. Mohammed, Jeremy W. Simcock
After cervical spinal cord injury, the loss of upper limb function is common. This affects an individual's ability to perform activities of daily living and participate in previous life roles. There are surgical procedures that can restore some of the upper limb function lost after cervical spinal cord injury. Tendon transfer surgery has been performed in the tetraplegic population since the early 1970s. The goals of surgery are to provide a person with tetraplegia with active elbow extension, wrist extension (if absent), and sufficient pinch and/or grip strength to perform activities of daily living without the need for adaptive equipment or orthoses. These procedures are suitable for a specific group, usually with spinal cord impairment of C4-8, with explicit components of motor and sensory loss. Comprehensive team assessments of current functioning, environment, and personal circumstances are important to ensure success of any procedure. Rehabilitation after tendon transfer surgery involves immobilization for tendon healing followed by specific, targeted therapy based on motor learning and goal-orientated training. Outcomes of tendon transfer surgery are not limited to the improvements in an individual's strength, function, and performance of activities but have much greater life affects, especially with regard to well-being, employment, and participation. This article will provide an overview of the aims of surgery, preoperative assessment, common procedures, postoperative rehabilitation strategies, and outcomes based on clinical experience and international published literature.

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Impact of Adapted Sports Activities on the Progression of Carotid Atherosclerosis in Subjects With Spinal Cord Injury

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6
Author(s): José R. Matos-Souza, Guilherme de Rossi, Anselmo A. Costa e Silva, Eliza R. Azevedo, Karla R. Pithon, Roberto Schreiber, Andrei C. Sposito, José I. Gorla, Alberto Cliquet, Wilson Nadruz
ObjectiveTo determine whether regular performance of adapted sports is associated with long-term changes in carotid atherosclerosis in subjects with spinal cord injury (SCI).DesignProspective observational study.SettingAcademic medical center.ParticipantsMen with chronic (>1y) SCI and no preserved motor function below the injury level were evaluated in 2007 and 2012 (N=17). Nine subjects did not perform physical activity between the studied time points (control group), whereas 8 subjects entered competitive upper-body sports programs (rugby: n=5, basketball: n=1, jiu-jitsu: n=1, and tennis: n=1) after baseline and were regularly training at the time of the second evaluation (sports group).InterventionsNot applicable.Main Outcome MeasuresClinical, laboratory, hemodynamic, and carotid ultrasonography analysis.ResultsThe studied groups showed no differences in all studied variables at baseline. After 5 years of follow-up, the control group showed increases in heart rate (87.0±3.1 vs 74.7±3.8 beats per minute; P=.004), but the participants had no significant changes in carotid intima-media thickness (IMT) (.65±.05 vs .67±.03mm; P=.73) or IMT/diameter (.118±.007 vs .136±.013; P=.24). In contrast, the sports group showed long-term decreases in carotid IMT (.56±.05 vs .74±.05mm; P=.001) and IMT/diameter (.097±.006 vs .141±.009; P<.001), but the participants did not show any variation in the other studied variables at follow-up.ConclusionsRegular upper-body sports activities are associated with long-term reductions in carotid atherosclerosis in subjects with SCI and might be a potential prevention strategy aiming to reduce cardiovascular risk in this population.

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Understanding and Overcoming Barriers to Upper Limb Surgical Reconstruction After Tetraplegia: The Need for Interdisciplinary Collaboration

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6, Supplement
Author(s): Vandana Punj, Catherine Curtin
There are approximately 300,000 persons with spinal cord injury living in the United States, and nearly 60% of these persons have suffered tetraplegia with resultant alterations in body function, activity, and therefore participation. Restoring hand function can improve independence, and various studies have shown that persons with tetraplegia rate restoration of arm and hand function higher than bowel and bladder control, walking, or sexuality. There are conservative options to improve upper limb function in this population (eg, orthoses, neuroprostheses). Surgical interventions are also available, and 70% of surgical patients report satisfaction and improvement in various activities of daily living after surgery to restore arm and hand function. Despite these positive surgical outcomes, <10% of the eligible population of 60% to 70% undergo tendon transfer surgery to restore function. Underutilization of surgical interventions can be explained by population-, provider-, and health care systems–specific barriers. With further education of providers and patients and team building across disciplines these barriers can be overcome, ultimately leading to reduced disability and improved quality of life for persons with tetraplegia.

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Correction

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6

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Decision-Making About Upper Limb Tendon Transfer Surgery by People With Tetraplegia for More Than 10 Years

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6, Supplement
Author(s): Jennifer A. Dunn, E. Jean Hay-Smith, Sally Keeling, K. Anne Sinnott
ObjectivesTo quantify time from spinal cord injury to upper limb reconstructive surgery for individuals with tetraplegia; to explore influences on decision-making about surgery for persons with long-standing (>10y) tetraplegia; and to determine the applicability of our previously developed conceptual framework that described the decision-making processes for people with tetraplegia of <5 years.DesignQuantitative-qualitative mixed-methods study.SettingCommunity based in New Zealand.ParticipantsPeople (N=9) living with tetraplegia for >10 years.InterventionsNot applicable.Main Outcome MeasuresAn audit of time frames between injury, assessment, and surgery for people with tetraplegia was undertaken. Interviews of people with tetraplegia were analyzed using constructivist grounded theory.ResultsSixty-two percent of people with tetraplegia assessed for surgery had upper limb reconstructive surgery. Most were assessed within the first 3 years of spinal cord injury. Over half had surgery within 4 years after injury; however, 20% waited >10 years. Changes in prioritized activities, and the identification of tasks possible with surgery, were influential in the decision-making process. Participants were aware of surgery, but required a reoffer from health professionals before proceeding. The influence of peers was prominent in reinforcing the improvement in prioritized activities possible after surgery.ConclusionsFindings confirmed that the previously developed conceptual framework for decision-making about upper limb reconstructive surgery was applicable for people with tetraplegia of >10 years. Similarities were seen in the influence of goals and priorities (although the nature of these might change) and information from peers (although this influence was greater for those injured longer). Repeat offers for surgery were required to allow for changes in circumstances over time.

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Role of Functional Electrical Stimulation in Tetraplegia Hand Surgery

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6, Supplement
Author(s): Ines Bersch, Jan Fridén
The use of functional electrical stimulation (FES) to improve upper limb function is an established method in the rehabilitation of persons with tetraplegia after spinal cord injury. Surgical reconstruction is another well-established yet underused technique to improve the performance of the upper extremities. Hand surgery plays an essential role in restoring hand function, mobility, and quality of life in the tetraplegic population. The knowledge about the effects of FES on a structural and functional level is fundamental for understanding how and when FES can be used best to support the effect of hand surgery, both pre- and postoperatively. In this article we discuss principles of FES and how FES improves functional outcome after surgical reconstruction. The reported results are based on preliminary clinical observations.

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Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6, Supplement
Author(s): Anne M. Bryden, Harry A. Hoyen, Michael W. Keith, Melvin Mejia, Kevin L. Kilgore, Gregory A. Nemunaitis
Scientific advances are increasing the options for improved upper limb function in people with cervical level spinal cord injury (SCI). Some of these interventions rely on identifying an aspect of paralysis that is not uniformly assessed in SCI: the integrity of the lower motor neuron (LMN). SCI can damage both the upper motor neuron and LMN causing muscle paralysis. Differentiation between these causes of paralysis is not typically believed to be important during SCI rehabilitation because, regardless of the cause, the muscles are no longer under voluntary control by the patient. Emerging treatments designed to restore upper extremity function (eg, rescue microsurgical nerve transfers, motor learning-based interventions, functional electrical stimulation) all require knowledge of LMN status. The LMN is easily evaluated using surface electrical stimulation and does not add significant time to the standard clinical assessment of SCI. This noninvasive evaluation yields information that contributes to the development of a lifetime upper extremity care plan for maximizing function and quality of life. Given the relative simplicity of this assessment and the far-reaching implications for treatment and function, we propose that this assessment should be adopted as standard practice for acute cervical SCI.

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Rehabilitation of Supinator Nerve to Posterior Interosseous Nerve Transfer in Individuals With Tetraplegia

Publication date: June 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 6, Supplement
Author(s): Jodie Hahn, Catherine Cooper, Stephen Flood, Michael Weymouth, Natasha van Zyl
Despite being a routine part of the early surgical management of brachial plexus injury, nerve transfers have only recently been used as a reconstructive option for those with tetraplegia. Subsequently, there is limited published literature on the rehabilitation theories and techniques for optimizing outcomes in this population. This article seeks to address this void by presenting our centers' working model for rehabilitation after nerve transfers for individuals with tetraplegia. The model is illustrated with the example of the rehabilitation process after a supinator nerve to posterior interosseous nerve transfer. This nerve transfer reconstructs wrist, finger, and thumb extension. The topics covered in the model include the following: patient selection and presurgical planning/intervention, managing the postoperative healing phase of an individual who is wheelchair dependent, maximizing motor reeducation, increasing muscle strength, and ensuring use in functional tasks. This article provides a platform for further development and collaboration to improve the outcomes of patients who undergo nerve transfers after tetraplegia.

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The STBUR questionnaire for identifying children at risk for sleep-disordered breathing and postoperative opioid-related adverse events

Summary

Background

Children with symptoms of sleep-disordered breathing (SDB) appear to be at risk for perioperative respiratory events (PRAE). Furthermore, these children may be more sensitive to the respiratory-depressant effects of opioids compared with children without SDB.

Aims

The aim of this prospective observational study was to confirm that otherwise healthy children with symptoms of SDB are at greater risk for PRAE compared with children with no symptoms and to determine if these children are also at increased risk for postoperative opioid-related adverse events (ORAE).

Methods

Six hundred and seventy-eight parents of children scheduled for surgery completed the Snoring, Trouble Breathing, and Un-Refreshed (STBUR) questionnaire preoperatively. Data regarding the incidence of PRAE were collected prospectively. Postoperative pulse oximetry desaturation alarm events were downloaded from the institutional secondary alarm notification system.

Results

Children with symptoms of SDB per STBUR (≥3 symptoms) had a two-fold increased likelihood of PRAE compared with children without SDB (52.8% vs 27.9% respectively, LR⁺ = 2.00, 95% CI = 1.60–2.49, P = 0.0001). A subset analysis of children undergoing airway procedures requiring hospital admittance (n = 179) showed that those with SDB were given the same postoperative opioid doses as children without SDB. However, children with SDB symptoms generated a greater number of postoperative oxygen desaturation alarms (14.14 ± 29.3 vs 7.12 ± 13.2, mean difference = 7.02, 95% CI = 0.39–13.64, P = 0.038) and more frequently required escalation of care (15.3% vs 7.1%, LR⁺ = 1.67, 95% CI = 1.22–2.16, P = 0.001) compared with children with no SDB symptoms.

Conclusions

Children presenting for surgery with SDB symptoms are at increased risk for PRAE. Children undergoing airway-related procedures also appear to be at increased risk for ORAE. Furthermore, regardless of the preoperative assessment of risk using the STBUR questionnaire, children received the same doses of opioids postoperatively. Given the increased incidence of postoperative oxygen desaturations among children with SDB symptoms, it would seem prudent to consider titration of opioid doses according to identified risk.

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Arterial blood pressure in anesthetized neonates and infants: a retrospective analysis of 1091 cases

Summary

Background

Hypotension during general anesthesia in neonates and infants is considered to contribute to poor neurological outcome.

Aim

The aim of this retrospective analysis was to determine the incidence of hypotension after induction of anesthesia and sustained hypotension (>10 min) during the anesthesia, and to determine factors contributing to the development of (sustained) hypotension.

Method

We performed a retrospective analysis of 1091 electronic anesthesia records from children <1 year. Patients were stratified for age (group 1: <1 month, group 2: 1–3 months, group 3: 4–6 months, group 4: >6 months). Hypotension was defined as a mean arterial pressure (MAP) <35 mmHg in patients ≤6 months and <43 mmHg in patients >6 months.

Results

The incidence of hypotension after induction was highest in group 1 (25.5%) [P = 0.009 vs group 2 (13.3%), P < 0.0001 vs groups 3 (3.4%) and 4 (1.0%)], in group 2, it was higher than in groups 3 and 4 (P < 0.0001), and in group 3, it was higher than in group 4 (P = 0.033). The incidence of sustained hypotension was highest in group 1 (43.6%) (P < 0.0001 vs groups 2–4), followed by group 2 (15.7%) [P < 0.0001 vs group 3 (3.4%) and P = 0.006 vs group 4 (8.8%)] and group 4 (P = 0.004 vs group 3). Hypotension after induction occurred more often in emergency procedures than in elective procedures in groups 1 (P = 0.002), 2 (P = 0.029), and 3 (P = 0.037).

Conclusion

Hypotension, both postinduction and sustained during surgery, is a common phenomenon in anesthetized children under 1 year, peaking in neonates. Generally accepted lower limits of MAP in anesthetized infants urgently need to be defined, enabling us to develop anesthesia strategies avoiding cerebral hypoperfusion.

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Incidence of hepatotoxicity in directly observed treatment short course

2016-05-24T04-29-47Z
Source: International Journal of Advances in Medicine
Abhishek Chandra, Shivani swami, Girijanair.
Background: Antitubercular treatment induced hepatotoxicity usually has benign course, but may result in serious morbidity and even mortality. This study was undertaken to determine the incidence of hepatotoxicity in intermitted regimens directly observed treatment, short course (DOTS) and to evaluate the risk factors such as age, sex, nutritional status, disease extent, in the development of antitubercular drug induced hepatotoxicity in intermitted regimens (DOTS). Methods: This was an observational study. All adults and adolescents above 15 years of age and weight more than 30 kilogramss, of either sex, on antitubercular treatment under intermitted regimens (DOTS), coming to chest and tuberculosis. Out-patient department of Dr. D.Y. Patil, hospital and research centre, Navi Mumbai, India, were included . Statistical analysis based on t- test done, predictability calculated to know the significance of study. Results: 50 patients at random on intermitted regimens (DOTS) of antitubercular treatment. Majority (52%) were aged between 15-30 years. There were 24 (48%) males and 26 (52%) females. Serum bilirubin show a rise mean values between 2nd week (SD±053) p-value

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Distinct changes of myocyte autophagy during myocardial hypertrophy and heart failure: association with oxidative stress

Myocyte autophagy occurs at basal levels in the heart under normal conditions and increases in heart failure. However, the changes of myocyte autophagy during the stages of myocardial hypertrophy and failure are not fully understood. Little is known about the relationship among myocyte autophagy, hypertrophy, apoptosis and oxidative stress. In the present study, we first examined the changes of myocyte autophagy in mice with chronic pressure overload and the relationships between myocyte autophagy and hypertrophy, apoptosis and oxidative stress. Second, we determined the direct role of hydrogen peroxide on autophagy in cultured cardiomyocytes. Eight-week–old male C57BL/6 J mice underwent transverse aortic constriction (TAC) or sham operation. In TAC mice, left ventricular (LV) wall thickness was increased at 1 week and increased further at 9 weeks. LV end diastolic dimension had no change at 1 week, but increased at 9 weeks in association with systolic dysfunction. Myocyte autophagy was decreased at 1 week after TAC and the decrease was correlated with increased myocyte size. Myocyte autophagy was increased at 9 weeks after TAC and the increase was correlated with increased myocyte apoptosis. The alterations in autophagy after TAC were associated with myocardial oxidative stress. Hydrogen peroxide caused distinct, concentration-dependent changes in autophagy in cultured cardiomyocytes. In conclusion, myocyte autophagy was decreased during myocardial hypertrophy and increased during heart failure. The distinct changes were associated with myocyte hypertrophy, apoptosis and oxidative stress. These findings suggest that oxidative stress may mediate the distinct alterations of myocyte autophagy during myocardial hypertrophy and heart failure.

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Training improves the oxidative phenotype muscle during the transition from cardiac hypertrophy to heart failure without altering MyoD and myogenin

The purpose of this study was to investigate the effects of Physical Training (PT) on phenotypic features (fiber-type content) and myogenic regulatory factors (Myod and myogenin) in rat skeletal muscle during the transition from cardiac hypertrophy to heart failure (HF). We employed the model of ascending aortic stenosis (AS) to induce HF in male Wistar rats. Sham-operated animals were used as age-matched controls. At 18 wk after surgery, rats with ventricular dysfunction were randomized into 4 groups: Sham-operated untrained (Sham-U; n = 8), Sham-operated trained (Sham-T; n = 6), aortic stenosis untrained (AS-U; n = 6) and aortic stenosis trained (AS-T; n = 8). The AS-T and Sham-T groups were submitted to a 10-wk aerobic PT program, while the AS-U and Sham-U groups remained untrained for the same period of time. After the PT program, the groups were euthanized and the soleus muscle collected for phenotypic and molecular analyses. PT promoted type IIa-to-I fiber conversion in the trained groups (Sham-T and AS-T), compared to the untrained groups (Sham-U and AS-U). No significant (P > 0.05) differences were found in Type I or IIa fiber content in the AS-U group compared to the Sham-U group. Additionally, there were no significant (P > 0.05) differences in MRF factors MyoD and myogenin (gene and protein) expression between the groups. Therefore, our results indicate that PT may be a suitable strategy to improve the oxidative phenotype in skeletal muscle during the transition from cardiac hypertrophy to HF, without altering MyoD and myogenin.

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Contribution of peripheral and central chemoreceptors to sympatho-excitation in heart failure

Abstract

Chronic Heart failure (CHF) is a major public health problem. Tonic hyper-activation of sympathetic neural outflow is commonly observed in patients with CHF. Importantly, sympatho-excitation in CHF exacerbates its progression and is strongly related to poor prognosis and high mortality risk. Increases in peripheral and central chemoreflex drive are both considered markers of the severity of CHF. The principal peripheral chemoreceptors are the carotid bodies (CBs) and alteration in their function has been described in CHF. Mainly, during CHF the CB chemosensitivity is enhanced leading to increases in ventilation and sympathetic outflow. In addition to peripheral control of breathing, central chemoreceptors (CC) are considered a dominant mechanism in ventilatory regulation. Potentiation of the ventilatory and sympathetic drive in response to CC activation has been shown in patients with CHF as well as in animal models. Therefore, improving understanding of the contribution of the peripheral and central chemoreflexes to augmented sympathetic discharge in CHF could help in developing new therapeutic approaches intended to attenuate the progression of CHF._Accordingly, the main focus of this review is to discuss recent evidence that peripheral and central chemoreflex_function are altered in CHF and that they contribute to autonomic imbalance and progression of CHF.

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Error signals driving locomotor adaptation: Cutaneous feedback from the foot is used to adapt movement during perturbed walking

Locomotor patterns must be adapted to external forces encountered during daily activities. The contribution of different sensory inputs to detecting perturbations and adapting movements during walking is unclear. Here we examined the role of cutaneous feedback in adapting walking patterns to force perturbations. Forces were applied to the ankle joint during the early swing phase using an electrohydraulic ankle-foot orthosis. Repetitive 80 Hz electrical stimulation was applied to disrupt cutaneous feedback from the superficial peroneal nerve (foot dorsum) and medial plantar nerve (foot sole) during walking (Choi et al. 2013). Sensory tests were performed to measure cutaneous touch threshold and perceptual threshold of force perturbations. Ankle movement were measured while subjects walked on the treadmill over three periods: baseline (1 min), adaptation (1 min) and post-adaptation (3 min). Subjects (n = 10) showed increased touch thresholds measured with Von Frey monofilaments and increased force perception thresholds with stimulation. Stimulation reduced the magnitude of walking adaptation to force perturbation. In addition, we compared the effects of interrupting cutaneous feedback using anaesthesia (n = 5) instead of repetitive nerve stimulation. Foot anaesthesia reduced ankle adaptation to external force perturbations during walking. Our results suggest that cutaneous input plays a role in force perception, and may contribute to the 'error' signal involved in driving walking adaptation when there is a mismatch between expected and actual force.

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Resistance training-induced changes in integrated myofibrillar protein synthesis are related to hypertrophy only after attenuation of muscle damage

Abstract

Skeletal muscle hypertrophy is one of the main outcomes of resistance training (RT) but how hypertrophy is modulated and the mechanisms regulating it are still unknown. To investigate how muscle hypertrophy is modulated through RT, we measured day-to-day integrated myofibrillar protein synthesis (MyoPS) using deuterium-oxide ingestion and assessed muscle damage at the beginning (T1), at 3wk (T2), and 10wk of RT (T3). Ten young men (27(1) y) had muscle biopsies (vastus lateralis) taken to measure integrated MyoPS and muscle damage (Z-band streaming and indirect parameters) before and 24 h and 48 h post-resistance exercise (RE) at T1, T2 and T3. Fibre cross-sectional area (fCSA) was evaluated using biopsies at T1, T2 and T3. Increases in fCSA were observed only at T3 (P = 0.017). Changes in MyoPS post-RE at T1, T2 and T3 were greater at T1 (P < 0.03) than at T2 and T3 (similar values between T2 and T3). Muscle damage was the highest during post-RE recovery at T1, attenuated at T2 and further attenuated at T3. The change in MyoPS post-RE at both T2 and T3, but not at T1, was strongly correlated (r∼0.9, P < 0.04) with muscle hypertrophy (T3−T1). Initial MyoPS response post-RE in a RT program is not directed to support muscle hypertrophy, coinciding with the highest magnitude of muscle damage. However, integrated MyoPS is quickly 'refined', by 3wk of RT, and is related to muscle hypertrophy. We conclude that muscle hypertrophy is the result of accumulated intermittent changes in MyoPS post-RE in RT, which coincides with progressive muscle damage attenuation.

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Time-course of EPSCs in on-type starburst amacrine cells is independent of dendritic location

Abstract

Direction selectivity in the retina relies critically on directionally asymmetric GABA release from the dendritic tips of starburst amacrine cells (SBACs). GABA release from each radially directed dendrite is larger for motion outward from the soma toward the dendritic tips than for motion inwards toward the soma. The biophysical mechanisms generating these directional signals remain controversial. A model based on electron-microscopic reconstructions of the mouse retina proposed that an ordered arrangement of kinetically distinct bipolar cell inputs to ON and OFF type SBACs could produce directional GABA release. We tested this prediction by measuring the time-course of EPSCs in ON type SBACs in the mouse retina, activated by proximal and distal light stimulation. Contrary to the prediction, the kinetics of the excitatory inputs were independent of dendritic location. Computer simulations based on 3D reconstructions of SBAC dendrites demonstrated that the response kinetics of distal inputs were not significantly altered by dendritic filtering. These direct physiological measurements, do not support the hypothesis that directional signals in SBACs arise from the ordered arrangement of kinetically distinct bipolar cell inputs.

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Why are rods more sensitive than cones?

Abstract

One hundred and fifty years ago Max Schultze first proposed the duplex theory of vision, that vertebrate eyes have two types of photoreceptor cells with differing sensitivity: rods for dim light and cones for bright light and color detection. We now know that this division is fundamental not only to the photoreceptors themselves but to the whole of retinal and visual processing. But why are rods more sensitive, and how did the duplex retina first evolve? Cells resembling cones are very old, first appearing among cnidarians; the emergence of rods was a key step in the evolution of the vertebrate eye. Many transduction proteins have different isoforms in rods and cones, and others are expressed at different levels. Moreover rods and cones have a different anatomy, with only rods containing membranous disks enclosed by the plasma membrane. These differences must be responsible for difference in absolute sensitivity, but which are essential? Recent research particularly expressing cone proteins in rods or changing the level of expression seem to show that each of the molecular differences in the activation and decay of the response may have made a small contribution as evolution proceeded stepwise with incremental increases in sensitivity. Rod outer-segment disks were not essential and developed after single-photon detection. These experiments collectively provide a new understanding of the two kinds of photoreceptors and help to explain how gene duplication and the formation of rod-specific proteins produced the duplex retina, which has remained remarkably constant in physiology from amphibians to man.

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Lymphatic pumping: Mechanics, mechanisms and malfunction

Abstract

A combination of extrinsic (passive) and intrinsic (active) forces move lymph against a hydrostatic pressure gradient in most regions of the body. The effectiveness of the lymph pump system impacts not only interstitial fluid balance but other aspects of overall homeostasis. This review focuses on the mechanisms that regulate the intrinsic, active contractions of collecting lymphatic vessels in relation to their ability to actively transport lymph. Lymph propulsion requires not only robust contractions of lymphatic muscle cells, but contraction waves that are synchronized over the length of a lymphangion as well as properly functioning intraluminal valves. Normal lymphatic pump function as determined by the intrinsic properties of lymphatic muscle and the regulation of pumping by lymphatic preload, afterload, spontaneous contraction rate, contractility and neural influences. Lymphatic contractile dysfunction, barrier dysfunction and valve defects are common themes among pathologies that directly involve the lymphatic system, such as inherited and acquired forms of lymphedema, and pathologies that indirectly involve the lymphatic system, such as inflammation, obesity and metabolic syndrome, and inflammatory bowel disease.

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Opioids and tumour metastasis: does the choice of the anesthetic-analgesic technique influence outcome after cancer surgery?.

Purpose of review: Cancer is now one of the leading causes of death worldwide, and excisional surgery is an essential treatment for the four most common adult cancers. Opioids remain the most commonly prescribed analgesics in the perioperative period of cancer surgery, yet the question of whether opioids could influence recurrence or metastasis remains unanswered. Recent findings: In-vitro cell culture, live animal models, and retrospective clinical reviews investigating the effects of opioids on outcomes after cancer surgery have yielded conflicting results, with findings ranging from deleterious, null to potentially protective effects. Summary: Prospective randomized trials are required to investigate this important topic further. Several are currently ongoing. Until the results of these are available for scrutiny, there is currently insufficient evidence to recommend any changes to current clinical practice. Opioids continue to play an important role in the perioperative period. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Role of epithelial to mesenchymal transition in hepatocellular carcinoma

Journal of Hepatology

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Effectiveness of sulodexide might be associated with inhibition of complement system in hepatitis B virus-associated membranous nephropathy: An inspiration from a pilot trial

European Journal of Internal Medicine

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Long-term follow-up of patients undergoing resection of TNM stage I colorectal cancer: an analysis of tumour and host determinants of outcome

World Journal of Surgery

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Coeliac disease and the gluten-free diet: a review of the burdens; factors associated with adherence and impact on health-related quality of life, with specific focus on adolescence

Journal of Human Nutrition and Dietetics

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Primary hepatic epithelioid angiomyolipoma: A malignant potential tumor which should be recognized

World Journal of Gastroenterology

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A multicenter comparison between Child Pugh and ALBI scores in patients treated with sorafenib for Hepatocellular Carcinoma

Liver International

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The safety of intracytoplasmic sperm injection in men with hepatitis B

Archives of Medical Science

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Hybrid, sequential and concomitant therapies for Helicobacter pylori eradication: A systematic review and meta-analysis

World Journal of Gastroenterology

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The effect of small intestinal bacterial overgrowth on minimal hepatic encephalopathy in patients with cirrhosis

Archives of Medical Science

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Prospective assessment of serum periostin as a biomarker for diagnosis and monitoring of eosinophilic oesophagitis

Alimentary Pharmacology and Therapeutics

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Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors

European Journal of Surgical Oncology

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Increased incidence but improved median overall survival for biliary tract cancers diagnosed in Ontario from 1994 through 2012: A population-based study

Cancer

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Extra-gastrointestinal manifestations of inflammatory bowel disease may be less common than previously reported

Digestive Diseases and Sciences

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Undocumented migrant women in Denmark have inadequate access to pregnancy screening and have a higher prevalence Hepatitis B virus infection compared to documented migrants in Denmark: a prevalence study

BMC Public Health

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Difference in serum CRP levels between patients with FPIES and FPIP in Japan

Pediatrics International

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Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration

World Journal of Gastroenterology

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Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis

Surgical Endoscopy

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Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature

World Journal of Gastroenterology

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PD-L1 expression in colorectal cancer is associated with microsatellite instability, BRAF mutation, medullary morphology and cytotoxic tumor-infiltrating lymphocytes

Modern Pathology

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Colorectal tumor molecular phenotype and miRNA: Expression profiles and prognosis

Modern Pathology

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Πληροφορίες

Τρίτη 24 Μαΐου 2016

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