We could predict good responders to vagus nerve stimulation: a surrogate marker by slow cortical potential shift

Publication date: Available online 15 June 2017
Source:Clinical Neurophysiology
Author(s): Borgil Bayasgalan, Masao Matsuhashi, Tomoyuki Fumuro, Haruhiko Nohira, Naoki Nakano, Koji Iida, Masaya Katagiri, Akihiro Shimotake, Riki Matsumoto, Takayuki Kikuchi, Takeharu Kunieda, Amami Kato, Ryosuke Takahashi, Akio Ikeda
ObjectiveWe investigated whether vagus nerve stimulation (VNS) induces a positive shift of slow cortical potentials (SCPs) in patients with >50% seizure reduction (responders) but not in non-responders.MethodsWe analyzed routine clinical electroencephalograms (EEGs) from 24 patients who were undergoing seizure treatment by VNS. The patients were divided into 2 groups by hardware time constant (TC) of EEG: the TC 10-s group (10 patients) and TC 2-s group (14 patients). We compared SCPs at 5 electrodes (Cz and adjacent ones) between the 2 states of VNS: during stimulation and between stimulations. Seizure reduction was independently judged. Correlation between SCP (positivity or not) and seizure reduction (>50% or not) was estimated.ResultsIn the TC 10-s group, the correlation between SCP and seizure reduction was significant (p < 0.05) (i.e., both good results in 4 and both negative results in 5). In TC 2-s group, the correlation between SCP and seizure reduction was not significant (p = 0.209).ConclusionsA positive shift of SCP recorded by using a TC of 10 s could be a surrogate marker for VNS response.SignificanceSCP could be a biomarker of good responders to VNS.



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Subclinical white matter lesions and medial temporal lobe atrophy are associated with EEG slowing in a memory clinic cohort

Publication date: Available online 15 June 2017
Source:Clinical Neurophysiology
Author(s): Milica G. Kramberger, Katarina Giske, Lena Cavallin, Ingemar Kåreholt, Thomas Andersson, Bengt Winblad, Vesna Jelic
ObjectiveThe aim of the study was to describe the relationship between electroencephalographic (EEG) findings obtained by standardised visual analysis, subclinical white matter lesions (WML) and brain atrophy in a large memory clinic population.MethodsPatients with Alzheimer's disease (AD, n = 58), mild cognitive impairment (MCI, n = 141), subjective cognitive impairment (SCI, n = 194) had clinical, MRI based WML severity and regional atrophy assessments, and routine resting EEG recording. Background activity (BA) and episodic and continuous abnormalities were assessed visually in EEG.ResultsWML (p = 0.006) and atrophy in medial temporal regions (MTA) (p = <0.001) were associated with slower BA in all diagnoses. WML were associated in SCI with total episodic EEG abnormalities (p = 0.03).ConclusionsEEG is associated with subclinical WML burden and cortical brain atrophy in a memory clinic population.SignificanceEven the standard visually assessed EEG can complement a memory clinic diagnostic workup.



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Meetings Calendar

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Table of Contents

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Table of Contents

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Reply to letter to the editor titled “a questionable conclusion by Ido Stahl et al.”

First we would like to thank Dr Feng for taking interest in our publication on the reliability of smartphone-based teleradiology for evaluating thoracolumbar spine fractures [1].

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Editorial Board

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Table of Contents

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A questionable conclusion by Ido Stahl et al.

We read with interest the article by Ido Stahl et al. discussing the reliability of smartphone-based teleradiology for evaluating thoracolumbar spine fractures (volume 17, issue 2, pages 161–167), which conclude that evaluating computed tomography (CT) scans viewed on a smartphone was just as good as evaluating them in the standard way (page 164, line 1 from the bottom, and page 165, lines 1–2) [1]. We fear that this conclusion is questionable for the following reasons.

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Incidental detection of asymptomatic migration of Hem-o-lok clip into the bladder after laparoscopic radical prostatectomy

Abstract

Hem-o-lok clips have been widely used in laparoscopic or robot-assisted surgery. We report a case of an incidentally discovered Hem-o-lok migration into the bladder after laparoscopic radical prostatectomy. The patient was a 75-year-old man with localized prostate cancer who underwent laparoscopic radical prostatectomy in July 2009. At 3 postoperative years, follow-up ultrasonography revealed a small round mass in the bladder. No lower urinary tract symptoms were reported, and urinalysis results had never indicated hematuria or pyuria. Cystoscopy revealed a Hem-o-lok clip in the bladder, near the vesicourethral anastomotic site. We could not remove it with forceps in the outpatient clinic, so we performed the procedure again under general anesthesia and successfully removed the Hem-o-lok clip. To our knowledge, this is the first report of an asymptomatic Hem-o-lok migration into the bladder.

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Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: An observational study in 29 countries.

BACKGROUND: Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES: To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN: This was a prospective international 1-week observational study using the 'Assess Respiratory Risk in Surgical Patients in Catalonia risk score' (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING: Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES: The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS: A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg-1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P

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Women awaken faster than men after electroencephalogram-monitored propofol sedation for colonoscopy: A prospective observational study.

BACKGROUND: Sedation for colonoscopy using intravenous propofol has become standard in many Western countries. OBJECTIVE: Sex-specific differences have been shown for general anaesthesia in dentistry, but no such data existed for gastrointestinal endoscopy. DESIGN: A prospective observational study. SETTING: An academic teaching hospital of Hannover Medical School. PATIENTS: A total of 219 patients (108 women and 111 men) scheduled for colonoscopy. INTERVENTION: Propofol sedation using electroencephalogram monitoring during a constant level of sedation depth (D0 to D2) performed by trained nurses or physicians after a body-weight-adjusted loading dose. MAIN OUTCOME MEASURES: The primary end-point was the presence of sex-specific differences in awakening time (time from end of sedation to eye-opening and complete orientation); secondary outcome parameters analysed were total dose of propofol, sedation-associated complications (bradycardia, hypotension, hypoxaemia and apnoea), patient cooperation and patient satisfaction. Multivariate analysis was performed to correct confounding factors such as age and BMI. RESULTS: Women awakened significantly faster than men, with a time to eye-opening of 7.3 +/- 3.7 versus 8.4 +/- 3.4 min (P = 0.005) and time until complete orientation of 9.1 +/- 3.9 versus 10.4 +/- 13.7 min (P = 0.008). The propofol dosage was not significantly different, with some trend towards more propofol per kg body weight in women (3.98 +/- 1.81 mg versus 3.72 +/- 1.75 mg, P = 0.232). CONCLUSION: The effect of sex aspects should be considered when propofol is used as sedation for gastrointestinal endoscopy. That includes adequate dosing for women as well as caution regarding potential overdosing of male patients. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT02687568). (C) 2017 European Society of Anaesthesiology

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Rocuronium is more hepatotoxic than succinylcholine in vitro.

BACKGROUND: The development of liver failure is a major problem in critically ill patients. The hepatotoxicity of many drugs, as one important reason for liver failure, is poorly screened for in human models. Rocuronium and succinylcholine are neuromuscular blocking agents used for tracheal intubation and for rapid-sequence induction. OBJECTIVE: We used an in-vitro test with a permanent cell line and compared rocuronium and succinylcholine for hepatotoxicity. DESIGN: In-vitro study. SETTING: A basic science laboratory, University Hospital Rostock, Germany. MATERIAL/(PATIENTS): The basic test compound is the permanent human liver cell line HepG2/C3A. In a standardised microtitre plate assay the toxicity of different concentrations of rocuronium, succinylcholine and plasma control was tested. INTERVENTIONS: After two incubation periods of 3 days, the viability of cells (XTT test, lactate dehydrogenase release and trypan blue staining), micro-albumin synthesis and the cytochrome 1A2 activity (metabolism of ethoxyresorufin) were measured. MAIN OUTCOME MEASURES: Differences between rocuronium and succinylcholine were assessed using the Kruskal-Wallis one-way test and two-tailed Mann-Whitney U test. RESULTS: Rocuronium, but not succinylcholine, led to a significant dose-dependent decrease of viability, albumin synthesis and cytochrome 1A2 activity of test cells. CONCLUSION: An in-vitro test with a cell line showed hepatotoxicity of rocuronium that was dose-dependent. Further studies are needed to investigate the underlying mechanisms of the effects of rocuronium on hepatic cellular integrity. TRIAL REGISTRATION: Not suitable. (C) 2017 European Society of Anaesthesiology

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Efficacy and safety of abobotulinumtoxinA (Dysport®) for the treatment of hemiparesis in adults with upper limb spasticity previously treated with botulinum toxin: sub-analysis from a Phase 3, randomized controlled trial

To assess the efficacy and safety of abobotulinumtoxinA in adults with upper limb spasticity previously treated with botulinum toxin A (BoNT-A).

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Conservation of alternative splicing in sodium channels reveals evolutionary focus on release from inactivation and structural insights into gating

Abstract

Voltage-gated sodium channels are critical for neuronal activity, and highly intolerant to variation. Even mutations that cause subtle changes in the activity these channels are sufficient to cause devastating inherited neurological diseases, such as epilepsy and pain. However, these channels do vary in healthy tissue. Alternative splicing modifies sodium channels, but the functional relevance and adaptive significance of this splicing remain poorly understood. Here we use a conserved alternate exon encoding part of the first domain of sodium channels to compare how splicing modifies different channels, and to ask whether the functional consequences of this splicing have been preserved in different genes. Although the splicing event is highly conserved, one splice variant has been selectively removed from Nav1.1 in multiple mammalian species, suggesting that the functional variation in Nav1.1 is less well-tolerated. We show for three human channels (Nav1.1, Nav1.2 and Nav1.7) splicing modifies the return from inactivated to deactivated states, and the differences between splice variants are occluded by antiepileptic drugs that bind to and stabilize inactivated states. A model based on structural data can replicate these changes, and indicates that splicing may exploit a distinct role of the first domain to change channel availability, and that the first domain of all three sodium channels plays a role in determining the rate at which the inactivation domain dissociates. Taken together, our data suggest that the stability of inactivated states is under tight evolutionary control, but that in Nav1.1 faster recovery from inactivation is associated with negative selection in mammals.

This article is protected by copyright. All rights reserved

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Endothelial mechanotransduction proteins and vascular function are altered by dietary sucrose supplementation in healthy young male subjects

Abstract

Endothelial mechanotransduction is important for vascular function but alterations and activation of vascular mechanosensory proteins have not been investigated in humans. In endothelial cell culture, simple sugars effectively impair mechanosensor proteins. To study mechanosensor- and vascular function in humans, twelve young healthy male subjects supplemented their diet with 3 × 75 g sucrose day⁻¹ for 14 days in a randomized cross-over design. Before and after the intervention period, the hyperemic response to passive lower leg movement and active knee extensor exercise was determined by ultrasound doppler. A muscle biopsy was obtained from the thigh muscle before and after acute passive leg movement, to asses the protein amount and phosphorylation status of mechanosensory proteins and NADPH oxidase. The sucrose intervention led to a reduced flow response to passive movement (by 17 ± 2 %) and to 12 watts of active exercise (by 9 ± 1 %), indicating impaired vascular function. Reduced flow response to passive and active exercise was paralleled by a significant upregulation of Platelet endothelial cell adhesion molecule (PECAM-1), endothelial nitric oxide synthase, NADPH oxidase and the Rho family GTPase Rac1 protein expression in the muscle tissue as well as an increased basal phosphorylation status of Vascular endothelial growth factor receptor 2 and a reduced phosphorylation status of PECAM-1. The phosphorylation status was not acutely altered with passive leg movement. These findings indicate that regular intake of high levels of sucrose can impair vascular mechanotransduction, increase the oxidative stress potential and suggest that dietary excessive sugar intake may contribute to the development of vascular disease.

This article is protected by copyright. All rights reserved

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The change of adjacent segment after cervical disc arthroplasty compared with anterior cervical discectomy and fusion: a meta-analysis of randomized controlled trials

Many meta-analyses have been performed to study the efficacy of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF); however, there are few data referring to adjacent segment within these meta-analyses, or investigators are unable to arrive at the same conclusion in the few meta-analyses about adjacent segment. With the increased concerns surrounding adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) after anterior cervical surgery, it is necessary to perform a comprehensive meta-analysis to analyze adjacent segment parameters.

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We could predict good responders to vagus nerve stimulation: a surrogate marker by slow cortical potential shift

Vagus nerve stimulation (VNS) is a palliative treatment option for patients with intractable epilepsy who are not good candidates for surgical resection (Connor et al., 2012). VNS uses an electrical stimulator, like those in cardiac pacemakers, which is implanted in the subclavicular area and delivers trains of electrical pulses to the left vagus nerve via bipolar stimulating electrodes (Terry et al., 1990). The stimulation of the vagus nerve is intermittent, and the usual stimulation condition is set to a signal on-time (VNS ON) of 30 s followed by an off-time (VNS OFF) of 3–5 min (Heck et al., 2002) repeatedly.

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Greater Oxidative Capacity in Primary Myotubes from Endurance-trained Women.

Purpose: Exercise training promotes skeletal muscle mitochondrial biogenesis and an increase in maximal oxygen consumption. Primary myotubes retain some metabolic properties observed in vivo but it is unknown whether this includes exercise-induced mitochondrial adaptations. The goal of this study was to test if primary myotubes from exercise-trained women have higher mitochondrial content and maximal oxygen consumption compared to untrained women. Methods: Six trained and nine untrained Caucasian women participated in this study. Muscle biopsies from the vastus lateralis muscle of the right leg were obtained and primary muscle cells were isolated. Maximal respiration rates, mitochondrial mRNA and protein content, and succinate dehydrogenase activity were measured in skeletal muscle and primary myotubes from trained and untrained women. Results: Trained women, compared to untrained women, had higher maximal whole-body oxygen consumption (+18%, P = 0.03), in vivo maximal skeletal muscle oxidative capacity measured with near infrared spectroscopy (+48%, P

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Issue Information - Editorial Board

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In Response.

No abstract available

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Wind of Change or Siren Song?.

No abstract available

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In Response.

No abstract available

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In Response.

No abstract available

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Intraperitoneal Instillation of Local Anesthetics: Is This a Suitable Alternative for Postcesarean Pain Relief Without Toxicity Profiling?.

No abstract available

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Evaluation of the Temple Touch Pro, a Novel Noninvasive Core-Temperature Monitoring System.

BACKGROUND: The Temple Touch Pro (TTP) is a novel system that estimates core temperature from skin over the temporal artery. We tested the hypothesis that this noninvasive system estimates core temperature to an accuracy within 0.5[masculine ordinal indicator]C. METHODS: Core temperature was continuously monitored in 50 adult and pediatric surgical patients by positioning the sensor patch of a TTP over one temporal artery. The sensor consists of a thermistor array near the skin surface, another set of thermistors above an insulator, and a second insulator between the upper unit and the environment. The sensor measures skin temperature and heat flux, from which the monitor unit estimates core temperature from a proprietary algorithm. Reference core temperature was measured from the esophagus or nasopharynx. We conducted agreement analysis between the TTP and the reference core temperature measurements using the 95% Bland-Altman limits of agreement for repeated measurement data. The proportion of all differences that were within 0.5[masculine ordinal indicator]C and repeat measures concordance correlation coefficient (CCC) were estimated as well. RESULTS: TTP and the reference core temperature measurements agreed well in both adults and pediatric patients. Bland-Altman plots showed no evidence of systematic bias or variability over the temperature from 35.2[masculine ordinal indicator]C to 37.8[masculine ordinal indicator]C. The estimated 95% lower and upper limits of agreement were -0.57[masculine ordinal indicator]C (95% confidence interval [CI], -0.76 to -0.41) and 0.57[masculine ordinal indicator]C (95% CI, 0.44 to 0.71), indicating good agreement between the 2 methods. Ninety-four percentage (95% CI, 87% to 99%) of the TTP temperatures were within 0.5[masculine ordinal indicator]C of the reference temperature. Good agreement was also supported by an estimated repeated measures CCC of 0.82 (95% CI, 0.66 to 0.91). The TTP core temperature measurements also agreed well with nasopharyngeal reference temperatures. CONCLUSIONS: The noninvasive TTP system is sufficiently accurate and reliable for routine intraoperative core temperature monitoring. (C) 2017 International Anesthesia Research Society

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The R148.3 Gene Modulates Caenorhabditis elegans Lifespan and Fat Metabolism

Despite many advances, the molecular links between energy metabolism and longevity are not well understood. Here, we have used the nematode model Caenorhabditis elegans to study the role of the yet uncharacterized gene R148.3 in fat accumulation and lifespan. In wild-type worms, a R148.3p::GFP reporter showed enhanced expression throughout life in the pharynx, in neurons, and in muscles. Functionally, a protein fusing a predicted 22 aa N-terminal signal sequence (SS) of R148.3 to mCherry displayed robust accumulation in coelomyocytes, indicating that R148.3 is a secreted protein. Systematic depletion of R148.3 by RNA interference (RNAi) at L1 but not at young adult stage enhanced triglyceride accumulation, which was associated with increased food uptake and lower expression of genes involved in lipid oxidation. However, RNAi of R148.3 at both L1 and young adult stages robustly diminished mean and maximal lifespan of wild-type worms, and also abolished the long-lived phenotypes of eat-2 and daf-2/InsR mutants. Based on these data, we propose that R148.3 is a secreted signal that modulates fat mass and longevity in an independent manner.

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Daily Activity of the Housefly, Musca domestica, Is Influenced by Temperature Independent of 3' UTR period Gene Splicing

Circadian clocks orchestrate daily activity patterns and free running periods of locomotor activity under constant conditions. While the first often depends on temperature, the latter is temperature-compensated over a physiologically relevant range. Here, we explored the locomotor activity of the temperate housefly, Musca domestica. Under low temperatures, activity was centered round a major and broad afternoon peak, while high temperatures resulted in activity throughout the photophase with a mild mid-day depression, which was especially pronounced in males exposed to long photoperiods. While period (per) mRNA peaked earlier under low temperatures, no temperature-dependent splicing of the last per 3' end intron was identified. The expression of timeless, vrille, and Par domain protein 1 was also influenced by temperature, each in a different manner. Our data indicated that comparable behavioral trends in daily activity distribution have evolved in Drosophila melanogaster and Musca domestica, yet the behaviors of these two species are orchestrated by different molecular mechanisms.

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A Genetic Screen Reveals an Unexpected Role for Yorkie Signaling in JAK/STAT-dependent Hematopoietic Malignancies in Drosophila melanogaster

A gain-of-function mutation in the tyrosine kinase JAK2 (JAK2^V617F) causes human myeloproliferative neoplasms (MPNs). These patients present with high numbers of myeloid lineage cells and have numerous complications. Since current MPN therapies are not curative, there is a need to find new regulators and targets of JAK/STAT signaling that may represent additional clinical interventions. Drosophila melanogaster offers a low complexity model to study MPNs as JAK/STAT signaling is simplified with only one JAK (Hopscotch (Hop)) and one STAT (Stat92E). hop^{Tumorous-lethal (Tum-l)} is a gain-of-function mutation that causes dramatic expansion of myeloid cells, which then form lethal melanotic tumors. Through an F1 deficiency (Df) screen, we identified 11 suppressors and 35 enhancers of melanotic tumors in hop^Tum-l animals. Dfs that uncover the Hippo (Hpo) pathway genes expanded (ex) and warts (wts) strongly enhanced the hop^Tum-l tumor burden, as did mutations in ex, wts and other Hpo pathway genes. Target genes of the Hpo pathway effector Yorkie (Yki) were significantly upregulated in hop^Tum-l blood cells, indicating that Yki signaling was increased. Ectopic hematopoietic activation of Yki in otherwise wild-type animals increased hemocyte proliferation but did not induce melanotic tumors. However, hematopoietic depletion of Yki significantly reduced the hop^Tum-l tumor burden, demonstrating that Yki is required for melanotic tumors in this background. These results support a model in which elevated Yki signaling increases the number of hemocytes, which become melanotic tumors as a result of elevated JAK/STAT signaling.

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A SINE Insertion in ATP1B2 in Belgian Shepherd Dogs Affected by Spongy Degeneration with Cerebellar Ataxia (SDCA2)

Spongy degeneration with cerebellar ataxia (SDCA) is a genetically heterogeneous neurodegenerative disorder with autosomal recessive inheritance in Malinois dogs, one of the four varieties of the Belgian Shepherd breed. Using a combined linkage and homozygosity mapping approach we identified a ~10.6 Mb critical interval on chromosome 5 in a Malinois family with four puppies affected by cerebellar dysfunction. Visual inspection of the 10.6 Mb interval in whole genome sequencing data from one affected puppy revealed a 227 bp SINE insertion into the ATP1B2 gene encoding the β₂ subunit of the Na⁺/K⁺-ATPase holoenzyme (ATP1B2:c.130_131insLT796559.1:g.50_276). The SINE insertion caused aberrant RNA splicing. Immunohistochemistry indicated a reduction of ATP1B2 protein expression in the central nervous system of affected puppies. Atp1b2 knock-out mice had previously been reported to show clinical and neurohistopathological findings similar to the affected Malinois puppies. Therefore, we consider ATP1B2:c.130_131ins227 the most likely candidate causative variant for a second subtype of SDCA in Malinois dogs, which we propose to term spongy degeneration with cerebellar ataxia subtype 2 (SDCA2). Our study further elucidates the genetic and phenotypic complexity underlying cerebellar dysfunction in Malinois dogs and provides the basis for a genetic test to eradicate one specific neurodegenerative disease from the breeding population in Malinois and the other varieties of the Belgian Shepherd breed. ATP1B2 thus represents another candidate gene for human inherited cerebellar ataxias, and SDCA2 affected Malinois puppies may serve as naturally occurring animal model for this disorder.

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Multidimensional Genetic Analysis of Repeated Seizures in the Hybrid Mouse Diversity Panel Reveals a Novel Epileptogenesis Susceptibility Locus

Epilepsy has many causes and comorbidities affecting as many as 4% of people in their lifetime. Both idiopathic and symptomatic epilepsies are highly heritable, but genetic factors are difficult to characterize among humans due to complex disease etiologies. Rodent genetic studies have been critical to the discovery of seizure susceptibility loci, including Kcnj10 mutations identified in both mouse and human cohorts. However, genetic analyses of epilepsy phenotypes in mice to date have been carried out as acute studies in seizure-naive animals or in Mendelian models of epilepsy, while humans with epilepsy have a history of recurrent seizures that also modify brain physiology. We have applied a repeated seizure model to a genetic reference population, following seizure susceptibility over a 36-day period. Initial differences in generalized seizure threshold among the Hybrid Mouse Diversity Panel were associated with a well-characterized seizure susceptibility locus found in mice; Seizure susceptibility 1. Remarkably, Szs1 influence diminished as subsequent induced seizures had diminishing latencies in certain HMDP strains. Administration of eight seizures, followed by an incubation period and an induced retest seizure, revealed novel associations within the calmodulin-activated transcription factor 1, Camta1. Using systems genetics, we have identified 4 candidate genes that are differentially expressed between seizure-sensitive and -resistant strains close to Esf1 that may act individually or as a coordinated response to the neuronal stress of seizures.

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Postnatal Airway Growth in Cystic Fibrosis Piglets

Mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) anion channel cause cystic fibrosis (CF). The leading cause of death in the CF population is lung disease. Increasing evidence suggests that in utero airway development is CFTR-dependent and that developmental abnormalities may contribute to CF lung disease. However, relatively little is known of postnatal CF airway growth, largely because such studies are limited in people. Therefore, we examined airway growth and lung volume in a porcine model of CF. We hypothesized that CF pigs would have abnormal postnatal airway growth. To test this hypothesis, we performed CT-based airway and lung volume measurements in three-week-old non-CF and CF pigs. We found that three-week-old CF pigs had tracheas of reduced caliber and irregular shape. Their bronchial lumens were reduced in size proximally but not distally, were irregularly shaped, and had reduced distensibility. Our data suggest that lack of CFTR results in aberrant postnatal airway growth and development, which could contribute to CF lung disease pathogenesis.

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Applied Physiology, research that makes a difference.

none

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The effects of RSR13 on microvascular PO2 kinetics and muscle contractile performance in the rat arterial ligation model of peripheral arterial disease

Exercise intolerance and claudication are symptomatic of peripheral arterial disease. There is a close relationship between muscle O₂ delivery, microvascular oxygen partial pressure (PmvO₂) and contractile performance. We therefore hypothesized that a reduction of hemoglobin-oxygen affinity via RSR13 would maintain a higher PmvO₂ and enhance blood-muscle O₂ transport and contractile function. In male Wistar rats we created hindlimb ischemia via right side iliac artery ligation (AL). The contralateral (left) muscle served as control (CONT). Seven days after AL, phosphorescence quenching techniques were used to measure PmvO₂ at rest and during contractions (electrical stimulation) in tibialis anterior muscle (TA) under saline (n = 10) or RSR13 (n =10) conditions. RSR13 at rest increased TA PmvO₂ in CONT (13.9 to 19.3 torr, P < 0.05) and AL (9.0 to 9.9 torr, P < 0.05). Furthermore RSR13 extended maintenance of the initial TA force (i.e. improved contractile performance) such that force was not decreased significantly until contraction 240 versus 150 in CONT and 80 versus 20 in AL. This improved muscle endurance with RSR 13 was accompanied by a greater PmvO₂ (PmvO₂ decrease from baseline) (CONT: 7.4 to 11.2, AL: 6.9 to 8.6 torr, both P < 0.05). Whereas RSR13 did not alter the kinetics profile of PmvO₂ (i.e. mean response time) substantially during contractions, muscle force was elevated and the ratio of muscle force-to-PmvO₂ increased. In conclusion, reduction of hemoglobin-oxygen affinity via RSR13 in AL increased PmvO₂ and improved muscle contractile performance most likely via enhanced blood-muscle O₂ diffusion.

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An assessment of the autonomic nervous system in the electrohypersensitive population: a heart rate variability and skin conductance study

The aim of the study was twofold: first, to compare the activity of the autonomic nervous system (ANS) between the population self-declared as electrohypersensitive (EHS) and their matched control individuals without intended exposure to electromagnetic fields (EMF). The second objective was to determine whether acute exposure to different radiofrequency signals modifies ANS activity in EHS. For that purpose, two different experiments were undertaken, in which ANS activity was assessed through heart rate variability (HRV) and skin conductance (SC). In the first experiment, a comparison between the EHS group (n=30) and the control group (n=25) showed that the EHS has an increased number of responses to auditory stimuli as measured by skin conductance activity, and that none of the short-term heart rate variability parameters differ between the two matched study groups. The second experiment, performed in a shielded chamber, involved 10 EHS from the first experiment. The volunteers participated in two different sessions (sham and exposure). The participants were consecutively exposed to four EMF signals (GSM 900, 1800, DECT and Wi-Fi) at environmental level (1 V/m). The experiment was double blinded and counterbalanced. The HRV variables studied did not differ between the two sessions. Concerning electrodermal activity, the data issued from skin conductance and tonic activity did not differ between the sessions, but showed a time variability. In conclusion, the HRV and SC profiles did not significantly differ between the EHS and control under no exposure. Exposure did not have an effect on the ANS parameters we have explored.

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EXERCISE TRAINING IMPROVE CARDIAC AUTONOMIC CONTROL, CARDIAC FUNCTION AND ARRHYTHMOGENESIS IN RATS WITH PRESERVED EJECTION FRACTION HEART FAILURE

Chronic heart failure is characterized by autonomic imbalance, cardiac dysfunction and arrhythmogenesis. It has been shown that exercise training (ExT) improves central nervous system oxidative stress, autonomic control and cardiac function in heart failure with reduced ejection fraction (HFrEF), however to date no comprehensive studies have addressed the effects of ExT, if any, on oxidative stress in brainstem cardiovascular areas, cardiac autonomic balance, arrhythmogenesis and cardiac function in heart failure with preserved ejection fraction (HFpEF). We hypothesize that ExT reduces brainstem oxidative stress, improves cardiac autonomic control, cardiac function and reduces arrhythmogenesis in HFpEF rats. Rats underwent sham or volume overload to induce HFpEF. ExT (60min/day, 25m/min, 10%inclination) was performed for 6 weeks starting at the second week post-HFpEF induction. Rats were randomly allocated into Sham sedentary (Sham+Sed, n=8), Sham exercise training (Sham+ExT, n=6), HFpEF Sedentary (HFpEF+Sed, n=8); or HFpEF Exercise trained (HFpEF+ExT, n=8) groups. Compared to HFpEF+Sed condition, HFpEF+ExT rats displayed reduced NAD(P)H oxidase activity and oxidative stress in the rostral ventrolateral medulla (RVLM), improved cardiac autonomic balance, and reduced arrhythmogenesis. Furthermore, a 3-fold improvement in cardiac function was observed in HFpEF+ExT rats. These novel findings suggestthat moderate-intensity ExT is an effective means to attenuate the progression of HFpEF through the improvement in RVLM redox state, cardiac autonomic control, and cardiac function.

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Intermittent hypercapnic hypoxia during sleep does not induce ventilatory long term facilitation in healthy males

Intermittent hypoxia induced ventilatory neuroplasticity is likely important in obstructive sleep apnea pathophysiology. Although concomitant CO₂ levels and arousal state critically influence neuroplastic effects of intermittent hypoxia, no studies have investigated intermittent hypercapnic hypoxia effects during sleep in humans. Thus, the purpose of this study was to investigate if intermittent hypercapnic hypoxia during sleep induces neuroplasticity (ventilatory long-term facilitation and increased chemoreflex responsiveness) in humans. 12 healthy males were exposed to intermittent hypercapnic hypoxia (24 x 30s episodes of 3% CO₂ and 3.0 ± 0.2% O₂) and intermittent medical air during sleep after two weeks wash-out period in a randomised cross-over study design. Minute ventilation, end-tidal CO₂, O₂ saturation, breath timing, upper airway resistance, and genioglossal and diaphragm electromyograms were examined during 10 min of stable stage 2 sleep preceding gas exposure, during gas and intervening room air periods and throughout 1 hour of room air recovery. There were no significant differences between conditions across time to indicate long-term facilitation of ventilation, genioglossal or diaphragm electromyogram activity, and no change in ventilatory response from the first to last gas exposure to suggest any change in chemoreflex responsiveness. These findings contrast with previous intermittent hypoxia studies without intermittent hypercapnia, and suggest that the more relevant gas disturbance stimulus of concomitant intermittent hypercapnia frequently occurring in sleep apnea influences acute neuroplastic effects of intermittent hypoxia. These findings highlight the need for further studies of intermittent hypercapnic hypoxia during sleep to clarify the role of ventilatory neuroplasticity in the pathophysiology of sleep apnea.

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Locomotor circumvention strategies are altered by stroke: II. Postural Coordination

Locomotor strategies for obstacle circumvention require appropriate postural coordination that depends on sensorimotor integration within the central nervous system. It is not known how these strategies are af...

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Clinical tools to assess nutritional risk and malnutrition in hospitalizaed children and adolescents

Malnutrition in children and adolescents may be underestimated during hospital stay. In western countries, children were often hospitalized for acute or chronic diseases that are not necessarily related to malnutrition. However, acute or chronic injuries may hamper nutritional status, prolonging recovery after admission and consequently length of hospital stay.

Several methods and techniques are known to investigate malnutrition in children, even if their use is not widespread in clinical practice. Many of these are simple and easy to perform and could be useful to a better management of every kind of illness.

In this review, we will focus on clinical tools necessary to reveal a nutritional risk at admission and to assess nutritional status in hospitalized children and adolescents.

L'articolo Clinical tools to assess nutritional risk and malnutrition in hospitalizaed children and adolescents sembra essere il primo su European Review.

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Older Adults Without Close Kin in the United States

Abstract

Objectives:

We document the size and characteristics of the population of older adults without close kin in the contemporary United States.

Methods:

Using the Health and Retirement Study, we examine the prevalence of lacking different types and combinations of living kin, examine how kinless-ness is changing across birth cohorts, and provide estimates of kinless-ness for sociodemographic and health groups.

Results:

In 1998–2010, 6.6% of U.S. adults aged 55 and above lacked a living spouse and biological children and 1% lacked a partner/spouse, any children, biological siblings, and biological parents. Kinless-ness, defined both ways, is becoming more common among adults in their 50s and 60s for more recent birth cohorts. Lacking close kin is more prevalent among women than men, native born than immigrants, never-married, those living alone, college-educated women, those with low levels of wealth, and those in poor health.

Discussion:

Kinless-ness should be of interest to policy makers because it is more common among those with social, economic and health risks; those who live alone, with low levels of wealth, and disability. Aging research should address the implications of kinless-ness for public health, social isolation, and the demand for institutional care.

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Physical Function in an Aging Population in Rural South Africa: Findings From HAALSI and Cross-National Comparisons With HRS Sister Studies

Abstract

Objectives:

We use recently-collected data from the Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) cohort from Agincourt, South Africa, to describe physical functioning in this aging population, and place the overall level and age-trajectories of physical health in the context of other Health and Retirement Study (HRS) sister studies in low- and middle-income countries (LMICs).

Method:

We conduct multiple regression to estimate associations of physical functioning assessed from both self-report (activities of daily living [ADL] limitation, self-reported health) and performance (grip strength, gait speed) with socio-demographic and health characteristics in HAALSI, and use fully-interacted regression models to compare age-patterns of physical functioning outcomes cross-nationally.

Results:

Gender differences in self-reported health are minimal, and men had 30% higher odds of being ADL limited controlling for socio-demographic and health characteristics. Measured physical performance is closely tied with socioeconomic conditions, but self-reported measures have a much smaller or weaker socioeconomic gradient. In international age-adjusted comparisons, the HAALSI sample had lower physical performance outcomes than most comparison populations.

Discussion:

As the first HRS sister study undertaken in Africa, HAALSI adds vital information on population aging and health in the region. Continuing waves of HAALSI data will be a key resource for understanding differences in the complex processes of disability across LMIC contexts.

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Corrigendum

Predictors of Self-Rated Health: Does Education Play a Role Above and Beyond Age

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Variations in Social Network Type Membership Among Older African Americans, Caribbean Blacks, and Non-Hispanic Whites

Abstract

Objectives:

This study examined race differences in the probability of belonging to a specific social network typology of family, friends, and church members.

Method:

Samples of African Americans, Caribbean blacks, and non-Hispanic whites aged 55+ were drawn from the National Survey of American Life. Typology indicators related to social integration and negative interactions with family, friendship, and church networks were used. Latent class analysis was used to identify typologies, and latent class multinomial logistic regression was used to assess the influence of race, and interactions between race and age, and race and education on typology membership.

Results:

Four network typologies were identified: optimal (high social integration, low negative interaction), family-centered (high social integration within primarily the extended family network, low negative interaction), strained (low social integration, high negative interaction), and ambivalent (high social integration and high negative interaction). Findings for race and age and race and education interactions indicated that the effects of education and age on typology membership varied by race.

Discussion:

Overall, the findings demonstrate how race interacts with age and education to influence the probability of belonging to particular network types. A better understanding of the influence of race, education, and age on social network typologies will inform future research and theoretical developments in this area.

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Erratum

In Issue 72(1) of The Journal of Gerontology, Series B: Psychological Sciences, the special issue title was incorrect.

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Erratum

Student Debt Spans Generations: Characteristics of Parents Who Borrow to Pay for Their Children's College Education

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Types of Non-kin Networks and Their Association With Survival in Late Adulthood: A Latent Class Approach

Abstract

Objectives:

Integration into social networks is an important determinant of health and survival in late adulthood. We first identify different types of non-kin networks among older adults and second, investigate the association of these types with survival rates.

Method:

Official register information on mortality is combined with data from the Longitudinal Aging Study Amsterdam (LASA). The sample includes 2,440 Dutch respondents aged 54–85 at baseline in 1992 and six follow-ups covering a time span of 20 years. Using latent class analysis, respondents are classified into distinct types of non-kin networks, based on differences in number and variation of non-kin relations, social support received from non-kin, and contact frequency with non-kin. Next, membership in network types is related to mortality in a Cox proportional hazard regression model.

Results:

There are four latent types of non-kin networks that vary in network size and support. These types differ in their associations with mortality, independent of sociodemographic and health confounders. Older adults integrated into networks high in both number and variation of supportive non-kin contacts have higher chances of survival than older adults embedded in networks low in either amount or variation of support or both.

Discussion:

A combination of structural and functional network characteristics should be taken into account when developing intervention programs aiming at increasing social integration outside the family network.

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Landscape of Research on Older Adults’ Health in the Arab Region: Is It Demography-Driven or Development-Dependent?

Abstract

Objectives:

To describe the quantity, methods, themes, and collaboration profiles of research on older adults' health in the Arab world, and map research productivity against demographic, economic, and development indicators.

Methods:

A scoping review of research on older adults' health drawing from 7 databases and covering the period 1994–2013.

Results:

Aging research output has increased 6-fold over the study period, with middle-income countries showing the sharpest rise. The majority of the reviewed publications are descriptive in nature, oriented toward examining the extent of disease or factors associated with various morbidity and mortality outcomes (88.5%). Despite the increasing regional instability, there is a dearth of studies on "seniors in emergencies." Collaboration with international coauthors (16.0%) has been more frequent than with regional coauthors (4.2%). Correlation analysis suggests that research production has been more strongly influenced by literacy rates than by population aging indicators, Gross Domestic Product, or government investment in research and development.

Discussion:

This study lays the basis for a "roadmap" for research on older adults' health in the Arab region. It calls for cooperation among various stakeholders to produce a targeted and well-informed research agenda that is more responsive to emerging and context-specific needs of older adults in the region.

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Marital Dissolutions and the Health of Older Individuals in a Rural African Context

Abstract

Objectives:

Research from high-income countries has often found a negative relationship between marital dissolutions and health. This paper assesses that relationship among older sub-Saharan Africans, on a now-aging continent. Such individuals are likely to be at risk of a dissolution, or have already experienced one, due to high rates of marriage.

Methods:

Data from over 1,200 rural Malawians, age 45+, are employed from the 2008 and 2010 waves of the Malawi Longitudinal Study of Families and Health. Cross-sectional and lagged dependent variable regressions examine the relationship between marital dissolutions and 4 measures of self-reported health: retrospective health, relative health (compared with others in one's village), and age-standardized SF-12 mental and physical health scales.

Results:

Worse relative, mental, and physical health are associated with being currently divorced/widowed compared with being married. However, worse retrospective health is linked to becoming divorced/widowed between 2008 and 2010. Those divorced/widowed prior to 2008, and who remained so through 2010, are in worse relative and physical health.

Discussion:

The findings question the relative hardship of marital dissolutions for those who have managed to survive into old age, and call for the collection of more detailed longitudinal data on older Africans on this topic.

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Cohort Differences in Received Social Support in Later Life: The Role of Network Type

Abstract

Objectives:

The objective is to assess cohort differences in received emotional and instrumental support in relation to network types. The main guiding hypothesis is that due to increased salience of non-kin with recent social change, those in friend-focused and diverse network types receive more support in later birth cohorts than earlier birth cohorts.

Method:

Data from the Longitudinal Aging Study Amsterdam are employed. We investigate cohort differences in total received emotional and instrumental support in a series of linear regression models comparing birth cohorts aged 55–64, 65–74, 75–84, and 85–94 across three time periods (1992, 2002, and 2012).

Results:

Four network types (friend, family, restricted, and diverse) are identified. Friend-focused networks are more common in later birth cohorts, restrictive networks less common. Those in friend-focused networks in later cohorts report receiving more emotional and instrumental support. No differences in received support are evident upon diverse networks.

Discussion:

The increased salience of non-kin is reflected in an increase in received emotional and instrumental support in friend-focused networks in later birth cohorts. The preponderance of non-kin in networks should not be perceived as a deficit model for social relationships as restrictive networks are declining across birth cohorts.

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Living Conditions, Low Socioeconomic Position, and Mortality in the Ibadan Study of Aging

Abstract

Objectives.

Very little is known about socioeconomic differentials in mortality among persons surviving to old age in sub-Saharan Africa. We report on the impact of low socioeconomic position (SEP) on mortality over a 5-year observation period among community-dwelling older adults living in southwestern Nigeria.

Method.

Data are from a household multistage probability sample of 2,149 Yoruba Nigerians aged 65 years or older. We collected information on indices related to health and well-being at baseline (2003/2004). Socioeconomic positions were estimated using asset-based measures relevant to low income settings. Information on mortality was obtained by research supervisors in multiple waves (2007, 2008, and 2009). Associations between baseline covariates and mortality were explored using discrete time survival models and life tables.

Results.

We recorded 357 deaths over 5 years, or an annual mortality rate of 4.7% (95% CI = 4.2–5.2). Being 80 years or older (HR = 1.6, 95% CI = 1.1–2.5) and belonging to the lowest SEP (HR = 1.5, 95% CI = 1.1–2.1) were the main predictors of mortality. The significant effect of lowest SEP on mortality risk over the study period was independent of age, gender, education, rural or urban residence, weight, physical activity level, and social engagement.

Conclusion.

In this sample of older persons living in an economically disadvantaged context, we found persistent socioeconomic differentials in mortality estimated, conservatively, over 5 years.

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Coming Into Its Own? Developments and Challenges for Research on Aging in Africa

For the first time, an issue of the Journals of Gerontology includes two articles from, and on sub-Saharan Africa (SSA; Ojagbemi, Bello, Luo, & Gureje, 2016a, 2016b). This landmark offers an opportunity to reflect on developments in research on aging in Africa and to speculate on perspectives for the years ahead.

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Face Age and Eye Gaze Influence Older Adults’ Emotion Recognition

Abstract

Objectives:

Eye gaze has been shown to influence emotion recognition. In addition, older adults (over 65 years) are not as influenced by gaze direction cues as young adults (18–30 years). Nevertheless, these differences might stem from the use of young to middle-aged faces in emotion recognition research because older adults have an attention bias toward old-age faces. Therefore, using older face stimuli might allow older adults to process gaze direction cues to influence emotion recognition.

Method:

To investigate this idea, young and older adults completed an emotion recognition task with young and older face stimuli displaying direct and averted gaze, assessing labeling accuracy for angry, disgusted, fearful, happy, and sad faces.

Results:

Direct gaze rather than averted gaze improved young adults' recognition of emotions in young and older faces, but for older adults this was true only for older faces.

Discussion:

The current study highlights the impact of stimulus face age and gaze direction on emotion recognition in young and older adults. The use of young face stimuli with direct gaze in most research might contribute to age-related emotion recognition differences.

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The Combined Effects of Daily Stressors and Major Life Events on Daily Subjective Ages

Abstract

Objectives:

Stressors may be a contributing factor in determining how old an individual feels, looks, or would like to be. Currently, little research has been devoted to understanding the relationship between stressors and subjective age in older adults. We focus on the combined impact of major life-event stressors and daily stressors on multiple indicators of subjective age: felt age, ideal age, and look age. Furthermore, we examine the process by which daily stressors relate to subjective ages by testing whether positive affect, control, and negative affect mediate this relationship.

Method:

Using a daily-diary design, the current study measured older adults' (60–96 years old) stressors, subjective ages, personal control, and affect.

Results:

Felt, ideal, and look ages each demonstrated a unique pattern of interactions between daily stressors and major life-event stressors. Furthermore, our findings suggest that on the daily level, the relationship between stressors and felt age is mediated by negative affect but not by control and positive affect.

Discussion:

Findings indicate the need to consider the broader contextual picture of stressors, as well as their differential impact on multiple indicators of subjective age.

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The Mediating Roles of Primary and Secondary Control in the Relationship between Body Satisfaction and Subjective Well-Being Among Middle-Aged and Older Women

Abstract

Objectives:

This study examined primary and secondary control as mediators in the relationship between body satisfaction and subjective well-being (SWB) and explored age differences in the mediation model.

Method:

Data from 362 women, aged 40–91 years, assessed (i) the relationships between body satisfaction, age, primary and secondary control strategies (body-specific social comparison, acceptance, and positive reappraisal), and three indices of SWB (positive affect, negative affect, and life satisfaction), (ii) the mediation effects of primary and secondary control on the relationship between body satisfaction and SWB, and (iii) whether mediational relationships were moderated by age.

Results:

Body satisfaction was unrelated to age but positively related to positive affect and life satisfaction and negatively related to negative affect. Body satisfaction was also related to primary and secondary control strategies. There were significant indirect (mediated) effects of body satisfaction on all outcome variables through acceptance and positive reappraisal. These mediators were significant at all age levels, but exerted their strongest influence among younger women.

Discussion:

This study provides new information about the mechanisms that influence the relationship between body satisfaction and SWB among a broad age range of women who are experiencing physical changes that are inconsistent with Western beauty standards.

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Age Deficits in Facial Affect Recognition: The Influence of Dynamic Cues

Abstract

Objectives:

Older adults have difficulties in identifying most facial expressions of emotion. However, most aging studies have presented static photographs of intense expressions, whereas in everyday experience people see emotions that develop and change. The present study was designed to assess whether age-related difficulties with emotion recognition are reduced when more ecologically valid (i.e., dynamic) stimuli are used.

Method:

We examined the effect of stimuli format (i.e., static vs. dynamic) on facial affect recognition in two separate studies that included independent samples and distinct stimuli sets. In addition to younger and older participants, a middle-aged group was included in Study 1 and eye gaze patterns were assessed in Study 2.

Results:

Across both studies, older adults performed worse than younger adults on measures of facial affect recognition. In Study 1, older and-middle aged adults benefited from dynamic stimuli, but only when the emotional displays were subtle. Younger adults gazed more at the eye region of the face relative to older adults (Study 2), but dynamic presentation increased attention towards the eye region for younger adults only.

Discussion:

Together, these studies provide important and novel insights into the specific circumstances in which older adults may be expected to experience difficulties in perceiving facial emotions.

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Age Stereotypes and Self-Views Revisited: Patterns of Internalization and Projection Processes Across the Life Span

Abstract

Objectives.

We investigated processes of age stereotype internalization into the self and projection of self-views onto age stereotypes from a life-span perspective, taking age-related differences in the relevance of life domains into account.

Method.

Age stereotypes and self-views in eight life domains were assessed in a sample of N = 593 persons aged 30–80 years (T₁) at two time points that were separated by a 4-year time interval. We estimated cross-lagged projection and internalization effects in multigroup structural equation models.

Results.

Internalization and projection effects were contingent on age group and life domain: Internalization effects were strongest in the young and middle-aged groups and emerged in the domains family, personality, work, and leisure. Projection effects in different domains were most pronounced for older participants.

Discussion.

Our findings suggest that the internalization of age stereotypes is triggered by domain-specific expectations of impending age-related changes and transitions during certain phases of the life span. Projection processes, however, seem to occur in response to changes that have already been experienced by the individual. Our study demonstrates the dynamic interrelation of age stereotypes and self-views across the life course and highlights the importance of a differentiated, life-span perspective for the understanding of these mechanisms.

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Grasp Planning in Older Adults

Sometimes a chance observation can have unexpected consequences. Journal of Gerontology: Psychological Sciences presents an article where this statement holds. The work reported here, by Wunsch, Weigelt, and Stoeckel (2015), opens a new line of investigation whose consequences, like the chance observation on which it is based, may be far reaching in unpredictable ways.

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Examination of Associations Among Three Distinct Subjective Aging Constructs and Their Relevance for Predicting Developmental Correlates

Abstract

Objectives.

This study examined (a) the empirical associations among three subjective aging (SA) constructs: felt age, attitudes toward own aging (ATOA), and awareness of age-related change (AARC); (b) the moderating role of chronological age in these associations; and (c) the predictive relevance of the SA constructs with regard to two developmental correlates: functional health and satisfaction with life.

Method.

Participants were 819 adults aged 40–98 years from the United States and Germany. Parallel multiple mediation, moderated mediation, and hierarchical regression analyses were used.

Results.

As hypothesized, AARC mediated the association between the global measures of SA (felt age and ATOA) and the developmental correlates. Specifically, more negative global subjective aging predicted more AARC losses, which predicted poorer health and well-being. Furthermore, this mediation pathway was moderated by chronological age, such that, with increasing age, greater AARC was more strongly related to poorer functional health (but not well-being). The multidimensional measure, AARC, accounted for a significant amount of the variance in the developmental correlates over and above the unidimensional SA constructs. A consistent pattern emerged supporting the role of domain specificity and valence.

Discussion.

These findings support the need for conceptualizing SA across different behavioral domains and for distinguishing between positive and negative SA.

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Perceived Control Moderates the Effects of Functional Limitation on Older Adults’ Social Activity: Findings From the Australian Longitudinal Study of Ageing

Abstract

Objectives.

Research has shown that functional limitation is related to reduced social activity in older adults; however, individuals with high perceived control have greater confidence in their ability to achieve outcomes and are more likely to show persistence and employ strategies to overcome challenges. The aim of this study was to examine whether perceived control protects against the negative effects of functional limitation on older adults' social activity.

Method.

Participants were 835 older adults aged 69 to 103 years at baseline from the Australian Longitudinal Study of Ageing. Multilevel modeling was used to examine baseline and within-person change in functional limitation and perceived control as predictors of 18-year trajectories of social activity.

Results.

An interaction between baseline functional limitation and perceived control indicated that having greater functional limitation was associated with less social activity and greater decline over time for those with lower perceived control, but not for those with higher control. Within-person change in functional limitation was not reliably associated with social activity.

Discussion.

This study highlights the importance of perceived control as a protective psychological resource and may have implications for developing interventions aimed at enabling older adults to maintain their social activity as they experience functional decline.

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Low-Dose Childhood Radiation Effects to the Thyroid Follow a Linear Dose–Response Trend and Persist Even 45+ Years After Exposure

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 235-236.


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Persistent Hyperthyroidism Is Associated with Increased Mortality

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 214-217.


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Patients with Toxic Nodular Goiter and Graves’ Disease Are at Increased Risk for All-Cause and Cardiovascular Mortality

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 218-220.


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Delaying Surgery by More Than 1 Year for Selected Patients with Papillary Thyroid Microcarcinoma Does Not Compromise Outcomes

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 241-243.


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Thyroid Cancer Incidence and Mortality Are Increasing

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 221-223.


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Does Core Needle Biopsy Have A Role in the Evaluation of Thyroid Nodules with Indeterminate Cytology?

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 232-234.


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Levothyroxine Does Not Lower Hypothyroidism Symptoms in Older Adults with Mild Subclinical Hypothyroidism

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 224-228.


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Thyroid Hormone Receptor Alpha Resistance Causes Variability in the Severity but Not the Nature of Clinical Features

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 237-240.


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High-Intensity Focused Ultrasound Is Useful in the Treatment of Symptomatic Benign Thyroid Nodules

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 229-231.


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Thyroid Tumor Board: The Pathologic Criteria of Poorly Differentiated Thyroid Cancer Can Be Difficult to Distinguish From Differentiated Thyroid Carcinoma

Clinical Thyroidology Jun 2017, Vol. 29, No. 6: 244-246.


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Serve strong: Support your crew

Being a first responder is tough both mentally and physically. Know the signs so you can help your crew get the help that they need.

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A delicate balance: Understanding acid-base issues in EMS patients

A basic understanding of how acid-base imbalances can affect the patient's presentation can help make sense of conflicting symptoms

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Serve strong: Support your crew

Being a first responder is tough both mentally and physically. Know the signs so you can help your crew get the help that they need.

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Serve strong: Support your crew

Being a first responder is tough both mentally and physically. Know the signs so you can help your crew get the help that they need.

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Serve strong: Support your crew

Being a first responder is tough both mentally and physically. Know the signs so you can help your crew get the help that they need.

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Remember REHAB for prolonged incidents

This article first appeared on FireRehab.com, sponsored by Masimo. It's a sunny summer day, and the tones sound for a residential fire, smoke and flames showing from an apartment complex. You and your partner respond in the ambulance. En route, the first arriving engine company gives their first-in report: "Engine 1 is on scene of a three-story, multi-unit apartment structure, with smoke ...

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LifeFlow® Rapid Infuser named a JEMS Hot Product at EMS Today 2017

LifeFlow was one of only 30 innovative products to receive recognition by JEMS at the 36th Annual JEMS EMS Today Conference & Exposition DURHAM, N.C., June 05, 2017 — 410 Medical, Inc., a medical device company focused on developing innovative technologies for the resuscitation of critically ill patients, today announced the selection of the LifeFlow® Rapid Infuser by JEMS (Journal of ...

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Remember REHAB for prolonged incidents

Use the acronym to plan for five key elements needed to handle rehab operations for dozens of firefighters over several hours

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Mind the movement: Frontal asymmetry stands for behavioral motivation, bilateral frontal activation for behavior

Abstract

Frontal asymmetry has been investigated over the past 30 years, and several theories have been developed about its meaning. The original theory of Davidson and its diversification by Harmon-Jones & Allen allocated approach motivation to relative left frontal brain activity and withdrawal motivation to relative right frontal brain activity. Hewig and colleagues extended this theory by adding bilateral frontal activation representing a biological correlate of the behavioral activation system if actual behavior is shown. Wacker and colleagues formulated a theory related to the revised reinforcement sensitivity theory by Gray & McNaughton. Here, relative left frontal brain activation represents the revised behavioral activation system and behavior, while relative right frontal brain activation represents the revised behavioral inhibition system, representing the experience of conflict. These theories were investigated with a newly developed paradigm where participants were able to move around freely in a virtual T maze via joystick while having their EEG recorded. Analyzing the influence of frontal brain activation during this virtual reality task on observable behavior for 30 participants, we found more relative left frontal brain activation during approach behavior and more relative right brain activation for withdrawal behavior of any kind. Additionally, there was more bilateral frontal brain activation when participants were engaged in behavior compared to doing nothing. Hence, this study provides evidence for the idea that frontal asymmetry stands for behavioral approach or avoidance motivation, and bilateral frontal activation stands for behavior. Additionally, observable behavior is not only determined by frontal asymmetry, but also by relevant traits.

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NYC to launch 911 texting service in 2018

The text-to-911 service will aid people who are speech or hearing impaired or crime victims

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Locomotor circumvention strategies are altered by stroke: I. Obstacle clearance

Functional locomotion requires the ability to adapt to environmental challenges such as the presence of stationary or moving obstacles. Difficulties in obstacle circumvention often lead to restricted community...

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Paramedic - Southwest Health

Southwest Health is currently seeking both full-time (36 hours/week) and part-time (24 hours/week) paramedics to work on both the day and night shift. Shifts are from 5:30am-6:00pm or 5:30pm-6:00am. These positions are new to the organization as we transition to a paramedic level service.The Paramedic is responsible for providing pre-hospital emergency medical care at the appropriate level for those ...

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Cohort study of preoperative blood pressure and risk of 30-day mortality after elective non-cardiac surgery

Abstract

Background: Preoperative blood pressure (BP) thresholds associated with increased postoperative mortality remain unclear. We investigated the relationship between preoperative BP and 30-day mortality after elective non-cardiac surgery.Methods: We performed a cohort study of primary care data from the UK Clinical Practice Research Datalink (2004–13). Parsimonious and fully adjusted multivariable logistic regression models, including restricted cubic splines for numerical systolic and diastolic BP, for 30-day mortality were constructed. The full model included 29 perioperative risk factors, including age, sex, comorbidities, medications, and surgical risk scale. Sensitivity analyses were conducted for age (>65 vs <65 years old) and the timing of BP measurement.Results: A total of 251 567 adults were included, with 589 (0.23%) deaths within 30 days of surgery. After adjustment for all risk factors, preoperative low BP was consistently associated with statistically significant increases in the odds ratio (OR) of postoperative mortality. Statistically significant risk thresholds started at a preoperative systolic pressure of 119 mm Hg (adjusted OR 1.02 [95% confidence interval (CI) 1.01–1.02]) compared with the reference (120 mm Hg) and diastolic pressure of 63 mm Hg [OR 1.24 (95% CI 1.03–1.49)] compared with the reference (80 mm Hg). As BP decreased, the OR of mortality risk increased. Subgroup analysis demonstrated that the risk associated with low BP was confined to the elderly. Adjusted analyses identified that diastolic hypertension was associated with increased postoperative mortality in the whole cohort.Conclusions: In this large observational study we identified a significant dose-dependent association between low preoperative BP values and increased postoperative mortality in the elderly. In the whole population, elevated diastolic, not systolic, BP was associated with increased mortality.

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Cardiomyopathy and anaesthesia

1A012A033J02

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Effect of high-intensity aerobic exercise on aerobic fitness and HbA1c in patients with type 2 diabetes

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Effects of 4 weeks of low-load unilateral resistance training, with and without blood flow restriction, on strength, thickness, V wave, and H reflex of the soleus muscle in men

Abstract

Purpose

To test the effects of 4 weeks of unilateral low-load resistance training (LLRT), with and without blood flow restriction (BFR), on maximal voluntary contraction (MVC), muscle thickness, volitional wave (V wave), and Hoffmann reflex (H reflex) of the soleus muscle.

Methods

Twenty-two males were randomly distributed into three groups: a control group (CTR; n = 8); a low-load blood flow restriction resistance training group (BFR-LLRT; n = 7), who were an inflatable cuff to occlude blood flow; and a low-load resistance training group without blood flow restriction (LLRT; n = 7). The training consisted of four sets of unilateral isometric LLRT (25% of MVC) three times a week over 4 weeks.

Results

MVC increased 33% (P < 0.001) and 22% (P < 0.01) in the trained leg of both BFR-LLRT and LLRT groups, respectively. The soleus thickness increased 9.5% (P < 0.001) and 6.5% (P < 0.01) in the trained leg of both BFR-LLRT and LLRT groups, respectively. However, neither MVC nor thickness changed in either of the legs tested in the CTR group (MVC −1 and −5%, and muscle thickness 1.9 and 1.2%, for the control and trained leg, respectively). Moreover, V wave and H reflex did not change significantly in all the groups studied (V_wave/M _wave ratio −7.9 and −2.6%, and H _max/M _max ratio −3.8 and −4%, for the control and trained leg, respectively).

Conclusions

Collectively, the present data suggest that in spite of the changes occurring in soleus strength and thickness, 4 weeks of low-load resistance training, with or without BFR, does not cause any change in neural drive or motoneuronal excitability.

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Evidence in the human of a hypotensive and a bradycardic effect after mouth opening maintained for 10 min

Abstract

Purpose

We have recently shown that in humans submaximal mouth opening associated with partial masticatory movements for 10 min is followed by a small but significant and prolonged reduction of blood pressure and heart rate. We here report the effects of a fixed mouth opener.

Methods

In 22 seated normotensive volunteers the effect on blood pressure and heart rate was studied in randomized order after fixed mandibular extension and after a control procedure consisting in keeping a stick between the incisor teeth (both for 10 min). Automated recordings every 10 min were done for 40 min before and 120 min following the procedure.

Results

Two-way ANOVA for repeated measures on absolute values (actual recordings) and on changes from baseline revealed that, compared to controls, systolic, diastolic and mean blood pressure and heart rate were significantly lower after mandibular extension. Compared to controls, mandibular extension induced an average blood pressure drop of 2.88 mmHg (systolic), 2.55 mmHg (diastolic) and 2.42 mmHg (mean) over the entire observation period. The average decline over the central part of the observation period (30th to 80th min) was, respectively, of 3.62, 3.70 and 3.61 mmHg. The decrements of heart rate were of 2.11 and 2.66 beats per min. All these differences were statistically significant. The hypotensive and bradycardic responses persisted for 70–120 min.

Conclusions

This study shows that, in normotensives, a single fixed submaximal mouth opening for 10 min is followed by prolonged albeit small reductions of blood pressure and heart rate.

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Comparison of the recovery response from high-intensity and high-volume resistance exercise in trained men

Abstract

Purpose

The purpose of this study was to compare the physiological responses of a high-volume (HV; 8 sets of 10 repetitions) versus high-intensity (HI; 8 sets of 3 repetitions) exercise protocol in resistance-trained men.

Methods

Twelve men (24.5 ± 4.2 years; 82.3 ± 8.4 kg; 175.2 ± 5.5 cm) with 6.3 ± 3.4 years of resistance training experience performed each protocol in a counterbalanced, randomized order. Performance [counter movement jump peak power (CMJP), isokinetic (ISOK) and isometric leg extension (MVIC), isometric mid-thigh pull (IMTP), and isometric squat (ISQ)] and muscle morphological [cross-sectional area (CSA) of vastus lateralis] assessments were performed at baseline (BL), 30-min (P-30 min), 24-h (P-24 h), 48-h (P-48 h), and 72-h (P-72 h) post-exercise for each testing session. In addition, endocrine (testosterone and cortisol), inflammatory [interleukin-6 (IL-6) and C-reactive protein (CRP)], and markers of muscle damage [creatine kinase (CK), lactate dehydrogenase (LDH), and myoglobin (Mb)] were assessed at the same time points.

Results

Significantly greater reductions in CMJP (p < 0.001), and peak torque during both ISOK (p = 0.003) and MVIC (p = 0.008) at P-30 min were detected in HV compared to HI protocol. MVIC was still impaired at P-72 h following the HV protocol, while no differences were noted following HI. Markers of muscle damage (LDH, CK, and Mb) were significantly elevated following both HV and HI (p < 0.05), while cortisol and IL-6 concentrations were significantly elevated at P-30 min following HV only (p < 0.001 and p < 0.05, respectively).

Conclusions

Results indicate that high-volume resistance exercise results in greater performance deficits, and a greater extent of muscle damage, than a bout of high-intensity resistance exercise.

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Acute effects of static stretching on muscle–tendon mechanics of quadriceps and plantar flexor muscles

Abstract

Purpose

This study aimed to determine the acute effects of static stretching on stiffness indexes of two muscle groups with a contrasting difference in muscle–tendon proportion.

Methods

Eleven active males were tested on an isokinetic dynamometer during four sessions randomly presented. Two sessions were dedicated to quadriceps and the two others to triceps surae muscles. Before and immediately after the stretching procedure (5 × 30 s), gastrocnemius medialis and rectus femoris fascicle length and myotendinous junction elongation were determined using ultrasonography. Passive and maximal voluntary torques were measured. Fascicle and myotendinous junction stiffness indexes were calculated.

Results

After stretching, maximal voluntary torque similarly decreased for both muscle groups. Passive torque significantly decreased on triceps surae and remained unchanged on quadriceps muscles. Fascicle length increased similarly for both muscles. However, myotendinous junction elongation remained unchanged for gastrocnemius medialis and increased significantly for rectus femoris muscle. Fascicle stiffness index significantly decreased on medial gastrocnemius and remained unchanged on rectus femoris muscle. In contrast, myotendinous junction stiffness index similarly decreased on both muscles.

Conclusion

Depending on the muscle considered, the present results revealed different acute stretching effects. This muscle dependency appeared to affect primarily fascicle stiffness index rather than the myotendinous junction.

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Response to comments on “High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes”

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Mind-muscle connection training principle: influence of muscle strength and training experience during a pushing movement

Abstract

Purpose

To investigate the effect of different attentional focus conditions on muscle activity during the push-up exercise and to assess the possible influence of muscle strength and training experience.

Methods

Eighteen resistance-trained men performed 1RM bench press testing and were familiarized with the procedure during the first session. In the second session, three different conditions were randomly performed: regular push-up and push-up focusing on using the pectoralis major and triceps brachii muscles, respectively. Surface electromyography (EMG) was recorded and analyzed (EMG normalized to max; nEMG) for the triceps brachii and pectoralis major muscles.

Results

Participants had on average 8 (SD 6) years of training experience and 1RM of 1.25 (SD 0.28) kg per kg bodyweight. Focusing on using pectoralis major increased activity in this muscle by 9% nEMG (95% CI 5–13; Cohen's d 0.60) compared with the regular condition. Triceps activity was not significantly influenced by triceps focus although borderline significant, with a mean difference of 5% nEMG (95% CI 0–10; Cohen's d 0.30). However, years of training experience was positively associated with the ability to selectively activate the triceps (β = 0.41, P = 0.04), but not the pectoralis. Bench press 1RM was not significantly associated with the ability to selectively activate the muscles.

Conclusion

Pectoralis activity can be increased when focusing on using this muscle during push-ups, whereas the ability to do this for the triceps is dependent on years of training experience. Maximal muscle strength does not appear to be a decisive factor for the ability to selectively activate these muscles.

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Oral contraceptive pill use and the susceptibility to markers of exercise-induced muscle damage

Abstract

Purpose

Firstly, to establish whether oral contraceptive pill (OCP) users are more susceptible to muscle damage compared to non-users, and secondly, to establish whether differences can be attributed to differences in patella tendon properties.

Methods

Nine female OCP users and 9 female non-users participated in the investigation. Combining dynamometry, electromyography and ultrasonography, patella tendon properties and vastus lateralis architectural properties were measured pre and during the first of 6 sets of 12 maximal voluntary eccentric knee extensions. Serum oestrogen levels were measured on the 7th day of the pill cycle and the 14th day of menstrual cycle in OCP users and non-users, respectively. Maximal voluntary isometric knee extension torque loss, creatine kinase and muscle soreness were measured 48 h pre-damage, post-damage, and 48, 96 and 168 h post-damage.

Results

Oestrogen levels were significantly lower in OCP users compared to non-users (209 ± 115 and 433 ± 147 pg/ml, respectively, p = 0.004). Proposed determinants of muscle damage, patella tendon stiffness and maximal eccentric torque did not differ between OCP users and non-users. The change in creatine kinase from pre to peak was significantly higher in OCP users compared to non-users (962 ± 968 and 386 ± 474 Ul, respectively, p = 0.016). There were no other differences in markers of muscle damage.

Conclusion

Although our findings suggest that, when compared to non-users, the OCP may augment the creatine kinase response following eccentric exercise, it does not increase the susceptibility to any other markers of muscle damage.

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A tale of three cuffs: the hemodynamics of blood flow restriction

Abstract

Introduction

The blood flow response to relative levels of blood flow restriction (BFR) across varying cuff widths is not well documented. With the variety of cuff widths and pressures reported in the literature, the effects of different cuffs and pressures on blood flow require investigation.

Purpose

To measure blood pressure using three commonly used BFR cuffs, examine possible venous/arterial restriction pressures, and measure hemodynamic responses to relative levels of BFR using these same cuffs.

Methods

43 participants (Experiment 1, brachial artery blood pressure assessed) and 38 participants (Experiment 2, brachial artery blood flow assessed using ultrasound, cuff placed at proximal portion of arm) volunteered for this study.

Results

Blood pressure measurement was higher in the 5 cm cuff than in the 10 and 12 cm cuffs. Sub-diastolic relative pressures appear to occur predominantly at <60% of arterial occlusion pressure (AOP). Blood flow under relative levels of restriction decreases in a non-linear fashion, with minimal differences between cuffs [resting: 50.3 (44.2) ml min⁻¹; 10% AOP: 42.0 (36.8); 20%: 33.6 (28.6); 30%: 23.6 (20.4); 40%: 17.1 (15.9); 50%: 12.5 (9.4); 60%: 11.5 (8.1); 70%: 11.4 (7.0); 80%: 10.3 (6.3); 90%: 7.9 (4.8); 100%: 1.5 (2.9)]. Peak blood velocity remains relatively constant until higher levels (>70% of AOP) are surpassed. Calculated mean shear rate decreases in a similar fashion as blood flow.

Conclusions

Under relative levels of restriction, pressures from 40 to 90% of AOP appear to decrease blood flow to a similar degree in these three cuffs. Relative pressures appear to elicit a similar blood flow stimulus when accounting for cuff width and participant characteristics.

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Associations of human skeletal muscle fiber type and insulin sensitivity, blood lipids, and vascular hemodynamics in a cohort of premenopausal women

Abstract

Purpose

Cardiometabolic disease remains a leading cause of morbidity and mortality in developed nations. Consequently, identifying and understanding factors associated with underlying pathophysiological processes leading to chronic cardio metabolic conditions is critical. Metabolic health, arterial elasticity, and insulin sensitivity (SI) may impact disease risk, and may be determined in part by myofiber type. Therefore, the purpose of this study was to test the hypothesis that type I myofiber composition would be associated with high SI, greater arterial elasticity, lower blood pressure, and blood lipids; whereas, type IIx myofibers would be associated with lower SI, lower arterial elasticity, higher blood pressure, blood lipids.

Methods

Muscle biopsies were performed on the vastus lateralis in 16 subjects (BMI = 27.62 ± 4.71 kg/m², age = 32.24 ± 6.37 years, 43% African American). The distribution of type I, IIa, and IIx myofibers was determined via immunohistochemistry performed on frozen cross-sections. Pearson correlation analyses were performed to assess associations between myofiber composition, SI, arterial elasticity, blood pressure, and blood lipid concentrations.

Results

The percentage of type I myofibers positively correlated with SI and negatively correlated with systolic blood pressure SBP, diastolic blood pressure, and mean arterial pressure (MAP); whereas, the percentage of type IIx myofibers were negatively correlated with SI and large artery elasticity, and positively correlated with LDL cholesterol, SBP, and MAP.

Conclusions

These data demonstrate a potential link between myofiber composition and cardiometabolic health outcomes in a cohort of premenopausal women. Future research is needed to determine the precise mechanisms in which myofiber composition impacts the pathophysiology of impaired glucose and lipid metabolism, as well as vascular dysfunction.

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Effects of breaking up prolonged sitting following low and high glycaemic index breakfast consumption on glucose and insulin concentrations

Abstract

Purpose

Breaking up prolonged sitting can attenuate the postprandial rise in glucose and insulin. Whether such effects are dependent of the glycaemic index (GI) of the consumed carbohydrate is unknown. This study examined the acute effects of breaking up prolonged sitting following a low GI and a high GI breakfast on postprandial glucose and insulin concentrations.

Procedures

Fourteen adult males aged 22.1 ± 1.2 years completed four, 4 h experimental conditions: high GI breakfast followed by uninterrupted sitting (HGI-SIT), low GI breakfast followed by uninterrupted sitting (LGI-SIT), high GI breakfast followed by 2 min activity breaks every 20 min (HGI-ACT), and low GI breakfast followed by 2 min activity breaks every 20 min (LGI-ACT). Positive incremental area under the curve (iAUC) for glucose and insulin (mean [95% CI]) for each 4 h experimental condition was calculated. Statistical analyses were completed using linear mixed models.

Results

The sitting × breakfast GI interaction was not significant for glucose positive iAUC (P = 0.119). Glucose positive iAUC (mmol/L 4 h⁻¹) was significantly lower in the activity breaks conditions than the uninterrupted sitting conditions (2.07 [2.24, 2.89] vs. 2.56 [1.74, 2.40], respectively, P = 0.004) and significantly lower in the low GI conditions than the high GI conditions (2.13 [1.80, 2.45] vs. 2.51 [2.18, 2.84], respectively, P = 0.022). Insulin concentrations did not differ between conditions (P ≥ 0.203).

Conclusions

Breaking up prolonged sitting and lowering breakfast GI independently reduced postprandial glucose responses. This indicates that interrupting prolonged sitting and reducing dietary GI are beneficial approaches for reducing cardiometabolic disease risk.

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Adaptations in corticospinal excitability and inhibition are not spatially confined to the agonist muscle following strength training

Abstract

Purpose

We used transcranial magnetic stimulation (TMS) to determine the corticospinal responses from an agonist and synergist muscle following strength training of the right elbow flexors.

Methods

Motor-evoked potentials were recorded from the biceps brachii and flexor carpi radialis during a submaximal contraction from 20 individuals (10 women, 10 men, aged 18–35 years; training group; n = 10 and control group; n = 10) before and after 3 weeks of strength training at 80% of 1-repetition maximum (1-RM). To characterise the input–output properties of the corticospinal tract, stimulus–response curves for corticospinal excitability and inhibition of the right biceps brachii and flexor carpi radialis were constructed and assessed by examining the area under the recruitment curve (AURC).

Results

Strength training resulted in a 29% (P < 0.001) increase in 1-RM biceps brachii strength and this was accompanied by a 19% increase in isometric strength of the wrist flexors (P = 0.001). TMS revealed an increase in corticospinal excitability AURC and a decrease in silent period duration AURC for the biceps brachii and flexor carpi radialis following strength training (all P < 0.05). However, the changes in corticospinal function were not associated with increased muscle strength.

Conclusion

These findings show that the corticospinal responses to strength training of a proximal upper limb muscle are not spatially restricted, but rather, results in a change in connectivity, among an agonist and a synergistic muscle relevant to force production.

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Publication schedule for 2017

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Table of Contents, Volume 173A, Number 7, July 2017

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Cover Image, Volume 173A, Number 7, July 2017

The cover image, by Jennifer M. Kalish et al., is based on the Original Article Nomenclature and definition in asymmetric regional body overgrowth, DOI: 10.1002/ajmg.a.38266.

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Proposed federal legislation could compromise genetic privacy

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Agreement reached on initially discordant genetic variant interpretations

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In this issue

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Phylogenetic analysis of an epidemic outbreak of acute hepatitis C in HIV-infected patients by ultra-deep pyrosequencing

Journal of Clinical Virology

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Vanuatu tests drones to deliver vaccines to remote islands

Reuters Health News

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Implementation and evaluation of a clinical pathway for pancreaticoduodenectomy procedures: A prospective cohort study

Journal of Gastrointestinal Surgery

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Pfizer denies over-charging for cancer drugs in South Africa

Reuters Health News

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Screening for non-alcoholic fatty liver disease in children: Do guidelines provide enough guidance

Obesity Reviews

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Faecal microbiota transplantation for the induction of remission for active ulcerative colitis

Alimentary Pharmacology and Therapeutics

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Infant nutrition and maternal obesity influence the risk of non-alcoholic fatty liver disease in adolescents

Journal of Hepatology

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Efficacy and safety of mycophenolate mofetil and tacrolimus as second-line therapy for patients with autoimmune hepatitis

Clinical Gastroenterology and Hepatology

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Comparable long-term outcomes of 1-minute vs 5-minute endoscopic papillary balloon dilation for bile duct stones

Clinical Gastroenterology and Hepatology

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Impact of detection bias on the risk of gastrointestinal cancer and its subsites in type 2 diabetes mellitus

European Journal of Cancer

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Fas signaling induces stemness properties in colorectal cancer by regulation of Bmi1

Molecular Carcinogenesis

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Hepatitis C virus core antigen: A simplified treatment monitoring tool, including for post-treatment relapse

Journal of Clinical Virology

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