Παρασκευή, 24 Νοεμβρίου 2017

Daily inspiratory muscle training lowers blood pressure and vascular resistance in healthy men and women

Abstract

Previous work has shown inspiratory muscle training (IMT) lowers blood pressure after just six weeks, identifying IMT as a potential therapeutic to prevent/treat hypertension. Here, we explore the effects of IMT on respiratory muscle strength and select cardiovascular parameters in recreationally active men and women. Subjects were randomly assigned to IMT (n = 12, 75% maximal inspiratory pressure) or sham training (n = 13, 15% maximum inspiratory pressure) groups and underwent a 6-week intervention comprising 30 breaths day−1, 5 days week−1. Pre- and post- training measures included maximal inspiratory pressure, and resting measures of blood pressure, cardiac output, heart rate, spontaneous cardiac baroreflex sensitivity, and systemic vascular resistance. We evaluated psychological and sleep status via administration of the Cohen-Hoberman inventory of physical symptoms and the Epworth Sleepiness Scale. Male and female subjects in the IMT group showed declines in systolic/diastolic blood pressures (−4.3/−3.9 mmHg SBP/DBP, P < 0.025) and systemic vascular resistance (-3.5 mmHg*min L−1, P = 0.008) at Week 6. There was no effect of IMT on cardiac output (P = 0.722), heart rate (P = 0.795), or spontaneous baroreflex sensitivity (P = 0.776). IMT subjects also reported fewer stress-related symptoms pre versus post training (12.5 ± 8.5 vs. 7.2 ± 9.7, P = 0.025). Based on these results, we suggest a short course of inspiratory muscle training confers significant respiratory and cardiovascular improvements and parallel (modest) psychological benefits in healthy men and women.

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Somatosensory Evoked Potentials and Central Motor Conduction Times in Children with Dystonia and their correlation with outcomes from Deep Brain Stimulation of the Globus pallidus internus

The benefits of Deep Brain Stimulation (DBS) of the Globus Pallidus internus (GPi) for isolated idiopathic or genetic (formerly termed primary) dystonia are now well recognised in both adults and children, with improvements of 52-88% being seen in the Burke-Fahn-Marsden Dystonia Rating Scale motor score (BFMDRS-m)(Coubes et al., 2004; Vidailhet et al., 2005; Zorzi et al., 2005, Alterman et al., 2007). However, isolated dystonia, in which the dystonic movements are the only feature of the neurological disease and structural neuroimaging is normal, is rare, especially in childhood (Roubertie et al., 2002).

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Risk of inferior alveolar nerve injury with coronectomy versus surgical extraction of mandibular third molars - A comparison of two techniques and review of the literature

Abstract

Background

The removal of mandibular third molar teeth is one of the most common oral surgical procedures. In a significant number of patients it carries a degree of associated morbidity, including damage to the inferior alveolar nerve (IAN). For this reason, practitioners desire the most up-to-date guidance on the most appropriate technique, informed by the best available evidence that will produce the lowest incidence of iatrogenic complications.

Objective

Perform a systematic review comparing the effect of coronectomy versus complete surgical extraction of mandibular third molar teeth on the risk of IAN injury and other complications in adults.

Data Sources

Studies were identified through Embase (1980-2015) and Ovid MEDLINE (1946-2015) database searches. Search terms included coronectomy, partial root removal, deliberate vital root retention, odontectomy, surgical removal, surgical extraction, complete tooth extraction, and extract*. Limits included humans, English language, and randomized controlled trials (RCTs).

Inclusion criteria

Only RCTs comparing IAN damage associated with surgical extraction of mandibular third molars versus coronectomy were included.

Results

From our database searches, we identified two unique RCTs matching the inclusion criteria. Both evaluated patients who had specific radiographic signs of intimate relationships with the IAN. Upon detailed analysis, the studies were noted to exhibit a high risk of bias in many categories, thereby rendering their results inconclusive.

Conclusion

Although evidence from two RCTs suggests that coronectomy can reduce the risk of IAN injury compared to surgical removal of high-risk mandibular third molars, the quality of evidence is insufficient to provide definitive conclusions regarding the preferred technique.

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Building Healthy Start Grantees’ Capacity to Achieve Collective Impact: Lessons from the Field

Abstract

Purpose While Healthy Start has emphasized the need for multi-sectorial community engagement and collaboration since its inception, in 2014 Healthy Start adopted Collective Impact (CI) as a framework for reducing infant mortality. This paper describes the development of a peer-focused capacity-building strategy that introduced key elements of CI and preliminary findings of Healthy Start grantees' progress with using CI as an approach to collaboration. Description The Collective Impact Peer Learning Networks (CI-PLNs) consisted of eight 90-min virtual monthly meetings and one face-to-face session that reviewed CI pre-conditions and conditions. Evaluation sources included: a facilitated group discussion at the final CI-PLN exploring grantee CI and CAN accomplishments (n = 57); routine evaluations (n = 144 pre, 46 interim, and 40 post PLN) examining changes in knowledge and practices regarding CI; and post CI-PLN implementation, three in-depth interviews with grantees who volunteered to discuss their experience with CI and participation in the CI-PLN. Assessment CI-PLN participants reported increased knowledge and confidence in the application of CI. Several participants reported that the CI-PLN created a space for engaging in peer sharing challenges, successes, and best practices. Participants also reported a desire to continue implementing CI and furthering their learning. Conclusion The CI-PLNs met the initial goal of increasing Healthy Start grantees' understanding of CI and determining the initial focus of their efforts. By year five, the EPIC Center anticipates Healthy Start CANs will have a sustainable infrastructure in place that supports the established common agenda, shared measures, and ongoing and meaningful inclusion of community members.



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Higher adaptive functioning and lower rate of psychotic comorbidity in married versus unmarried individuals with 22q11.2 deletion syndrome

22q11.2 deletion syndrome (22q11.2DS) is a relatively common genetic disorder. Due to improvement in pediatric care, affected individuals live into adulthood, some of whom marry or have committed relationships, and reproduce. The current study aimed to identify the factors that discriminate between married and unmarried adults with 22q11.2DS. In the presents study, 90 adults with 22q11.2DS (48 men/42 women), aged 29.8 ± 10.3 years, were included in the analysis. Psychiatric comorbidities, IQ score, and adaptive functioning were assessed using gold-standard diagnostic tools. Demographic factors, marital status, and reproductive status were evaluated by self-reports. Of the sample 25 adults (27.7%) were married and 14 (56%) of those had children. Married, as compared to unmarried individuals, were older, had less psychotic comorbidities, showed higher adaptive functioning in all domains of the Vineland Adaptive Behavior Scale, and had higher rates of independent living and sustained employment. Unexpectedly, married individuals showed higher rates of mood disorders and full scale IQ scores did not discriminate between the groups. We propose that multiple factors are associated with marital status among individuals with 22q11.2DS. Identification of key personal, functional, and social characteristics of those who married and reproduced may help counseling health professionals and clinicians in advising affected individuals and their families.



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“Bypassing the barrier: new routes for delivery of macromolecules to the central nervous system”

Abstract

The blood-brain barriers of the central nervous system (CNS) provide a great deal of protection to the brain and spinal cord by blocking penetration of harmful molecules from the peripheral bloodstream.

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The mechanosensitive Piezo1 channel: structural features and molecular bases underlying its ion permeation and mechanotransduction

Abstract

The evolutionarily conserved Piezo family of proteins, including Piezo1 and Piezo2, encodes the long-sought-after mammalian mechanosensitive cation channels that play critical roles in various mechanotransduction processes such as touch, pain, proprioception, vascular development and blood pressure regulation. Mammalian Piezo proteins contain over 2500 amino acids with numerous predicted transmembrane segments, and do not bear sequence homology with any known class of ion channels. Thus, it is imperative, but challenging, to understand how they serve as effective mechanotransducers for converting mechanical force into electrochemical signals. Here, we review the recent major breakthroughs in determining the three-bladed, propeller-shaped structure of mouse Piezo1 using the state-of-the-art cryo-electron microscopy (cryo-EM) and functionally dissecting out the molecular bases that define its ion permeation and mechanotransduction properties, which provide key insights into clarifying its oligomeric status and pore-forming region. We also discuss the hypothesis that the complex Piezo proteins can be deduced into discrete mechanotransduction and ion-conducting pore modules, which coordinate to fulfill their specialized function in mechanical sensing and transduction, ion permeation and selection.

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