Pre-, post-, and remote conditioning of the myocardium are well described adaptive responses that markedly enhance the ability of the heart to withstand a prolonged ischemia/reperfusion insult and ...provide therapeutic paradigms for cardioprotection. Nevertheless, more than 25 years after the discovery of ischemic preconditioning, we still do not have established cardioprotective drugs on the market. Most experimental studies on cardioprotection are still undertaken in animal models, in which ischemia/reperfusion is imposed in the absence of cardiovascular risk factors. However, ischemic heart disease in humans is a complex disorder caused by, or associated with, cardiovascular risk factors and comorbidities, including hypertension, hyperlipidemia, diabetes, insulin resistance, heart failure, altered coronary circulation, and aging. These risk factors induce fundamental alterations in cellular signaling cascades that affect the development of ischemia/reperfusion injury per se and responses to cardioprotective interventions. Moreover, some of the medications used to treat these risk factors, including statins, nitrates, and antidiabetic drugs, may impact cardioprotection by modifying cellular signaling. The aim of this article is to review the recent evidence that cardiovascular risk factors and their medication may modify the response to cardioprotective interventions. We emphasize the critical need to take into account the presence of cardiovascular risk factors and concomitant medications when designing preclinical studies for the identification and validation of cardioprotective drug targets and clinical studies. This will hopefully maximize the success rate of developing rational approaches to effective cardioprotective therapies for the majority of patients with multiple risk factors.
PurposeThe Jefferson Center for Injury Research and Prevention (JCIRP) is a full entity of the Department of Surgery’s Trauma Division and the College of Nursing at Thomas Jefferson University. The ...ability to have stakeholders at the table, with the sole mission of saving life and reducing disability, exemplifies the importance of strengthening research partnerships in a health care system. Our injury science experts devote themselves to conducting research, providing education, engaging social entrepreneurship and partnering with communities in the Delaware Valley and beyond. The aim of this Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis is to evaluate the effectiveness of an injury-based research partnership within an academic, medical and trauma center.Methods/ApproachThe constant monitoring and a periodic review and reformation of health systems are of fundamental importance in all countries of the world, in order to increase the efficiency and effectiveness of healthcare services delivery, quality, equity, and sustainable financing (Han, 2012). To identify the SWOT of JCIRP a thorough analysis was completed by the center’s leadership and stakeholders. Through this analysis, facilitators and barriers were identified that helped cultivate the growth of our research center.ResultsAnalyzation of the SWOT analysis identified four prominent themes. The accessibility of multidisciplinary professionals with a common interest of injury research and prevention and continued opportunities to enhance research partnerships in various disciplines at Jefferson was a commonality. The demonstration of return of investment in injury prevention research and advocacy and the controversial nature of violence prevention research in an ICRC were identified barriers to the successful implementation of an ICRC.ConclusionThe benefits of interdisciplinary partnerships and the investment of enterprise support are integral for the success of an ICRC.Significance and ContributionStrengthening research partnerships in an ICRC through various disciplines will afford us the opportunity to continue injury prevention research.
Background/Aim
The shape of the working model is one of the major factors affecting the thickness of thermoformed mouthguards. The aim of this study was to clarify the priority of model trimming to ...prevent thinning during mouthguard thermoforming.
Materials and Methods
Mouthguards were thermoformed using 4.0 mm thick ethylene‐vinyl‐acetate sheets and a vacuum forming machine. Working models were trimmed so that the angles of the labial surface to the model base were 100°, 90°, and 80°. The posterior height was unified to 30 mm, and the anterior heights were 30 mm (A100‐L), 35 mm (A90‐M), and 40 mm (A80‐H), respectively. When the sheet temperature reached 100°C, vacuum forming was performed. Six specimens were formed for each condition. Mouthguard thickness (incisal edge, labial surface, cusp, and buccal surface) was measured using a specialized caliper accurate to 0.1 mm. Differences in thickness reduction rate due to model shapes were analyzed by one‐way ANOVA and Bonferroni's multiple comparison tests.
Results
At the incisal edge, there were no significant differences in the reduction rate of the thickness of the mouthguard according to model shapes. On the labial surface, cusp, and buccal surface, the smaller the model angle, the smaller the reduction rate of thickness, and significant differences were observed between A100‐L and A80‐H, and A90‐M and A80‐H. On the labial and buccal surfaces, A80‐H was more than 7.1% thicker compared with A100‐L and more than 5.6% thicker compared with A90‐M, and the thickness reduction rate was reduced when the model was trimmed to an acute angle. At the cusp, A80‐H was more than 4.3% thicker than A100‐L and A90‐M.
Conclusions
It is useful to trim the model at an acute angle in order to prevent thinning during mouthguard thermoforming, even if the anterior height of the model is increased.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Acute kidney injury (AKI) often triggers physiological processes aimed at restoring renal function and architecture. However, this response can become maladaptive, leading to nephron loss and ...fibrosis. Although the therapeutic effects of resveratrol (RSV) are well established, its impact after AKI and for subsequent chronic kidney disease (CKD) remains unclear. This study assessed whether transient administration of RSV following ischaemia–reperfusion injury (IRI) could prevent the progression to CKD. Forty‐one male Wistar rats were assigned randomly to sham surgery, bilateral renal ischaemia for 30 min (IR) or IR+RSV. The RSV treatment commenced 24 h after IRI and continued for 10 days. The rats were studied for either 10 days or 5 months, after which kidney function and structure were evaluated. Mitochondrial homeostasis, oxidant defence and renal inflammation state were also evaluated. Despite having the same severity of AKI, rats receiving RSV for 10 days after IRI exhibited significant improvement in kidney histological injury and reduced inflammation, although renal haemodynamic recovery was less pronounced. Resveratrol effectively prevented the elevation of tubular injury‐related molecules and profibrotic signalling with reduced myofibroblast proliferation. Furthermore, RSV substantially improved the antioxidant response and mitochondrial homeostasis. After 5 months, RSV prevented the transition to CKD, as evidenced by the prevention of progressive proteinuria, renal dysfunction and tubulointerstitial fibrosis. This study demonstrates that a brief treatment with RSV following IRI is enough to prevent maladaptive repair and the development of CKD. Our findings highlight the importance of the early days of reperfusion, indicating that maladaptive responses can be reduced effectively following severe AKI.
Key points
Physiological processes activated after acute kidney injury (AKI) can lead to maladaptive responses, causing nephron loss and fibrosis. Prophylactic renoprotection with resveratrol (RSV) has been described in experimental AKI, but its impact after AKI and for subsequent chronic kidney disease (CKD) remains unclear.
In this study, we found that histological tubular injury persists 10 days after ischaemia–reperfusion injury and contributes to a failed repair phenotype in proximal tubular cells.
Short‐term RSV intervention influenced the post‐ischaemic repair response and accelerated tubular recovery by reducing oxidative stress and mitochondrial damage. Furthermore, RSV targeted inflammation and profibrotic signalling during the maladaptive response, normalizing both processes.
Resveratrol effectively prevented AKI‐to‐CKD transition even 5 months after the intervention.
The study serves as a proof of concept, proposing RSV as a valuable candidate for further translational clinical studies to mitigate AKI‐to‐CKD transition.
figure legend In rodents experiencing ischaemic (I/R) acute kidney injury, a 10 day regimen of resveratrol (RSV) post‐injury ameliorated multiple aspects of maladaptive repair, including tubular injury, cellular death, mitochondrial dysfunction, disrupted antioxidant response, inflammatory processes and the initiation of fibrotic pathways. These beneficial effects led to a reduction in the progression towards chronic kidney disease (CKD), evident even 5 months post‐injury. Created with Biorender.com.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
PURPOSESport-related head impact biomechanics research has been male-centric and focused primarily on American football and ice hockey, which do not address popular sports in which both sexes ...participate. The purpose of this study was to quantify college female and male lacrosse and soccer head impact biomechanics.
METHODSHead impact biomechanics were collected from college lacrosse and soccer players across two Division 1 college athletic programs (96 female athletes, 141 male athletes; age, 19.8 ± 1.3 yr; height, 174.8 ± 9.2 cm; mass, 72.4 ± 11.7 kg). We deployed helmetless head impact measurement devices (X2 Biosystems xPatch) before each event. Peak linear and rotational accelerations were log-transformed for random intercepts general linear mixed models, and subsequently categorized based on impact magnitude for additional categorical analyses.
RESULTSMost linear (69.4%) and rotational (72.3%) head impact accelerations sustained by our study cohort were categorized as mild. On average, male athletes sustained impacts with higher linear accelerations than females (P = 0.04), and lacrosse athletes sustained higher linear acceleration impacts than soccer athletes (P = 0.023). Soccer athletes sustained significantly higher-magnitude impacts during competitions versus practices (linear, P < 0.001, rotational, P < 0.001), whereas lacrosse athletes sustained higher-magnitude impacts during practices versus competition (linear, P < 0.001; rotational, P < 0.001). Male athletes sustained higher accelerations in competitions versus practice (linear, P = 0.004; rotational, P < 0.001), whereas female athletes sustained higher accelerations in practice versus competitions (linear, P < 0.001; rotational, P = 0.02). There were no interactions between sex and sport on impact magnitude.
CONCLUSIONSMale athletes and lacrosse athletes experience higher-magnitude head impacts. Given the limited literature in this area, future research should continue characterizing head impact biomechanics in women’s and nonhelmeted sports as well as validate nonhelmeted head impact technologies.
Abstract Background Anterior Cruciate Ligament (ACL) injury is frequently encountered in sports. Purpose To analyze the effects of ACL injury prevention programs on injury rates in female athletes ...between different sports. Methods A comprehensive literature search was performed in September 2012 using Pubmed Central, Science Direct, CINAHL, PEDro, Cochrane Library, SCOPUS, SPORTDiscus. The key words used were: ‘anterior cruciate ligament’, ‘ACL’, ‘knee joint’, ‘knee injuries’, ‘female’, ‘athletes’, ‘neuromuscular’, ‘training’, ‘prevention’. The inclusion criteria applied were: (1) ACL injury prevention training programs for female athletes; (2) Athlete–exposure data reporting; (3) Effect of training on ACL incidence rates for female athletes. Results 13 studies met the inclusion criteria. Three training programs in soccer and one in handball led to reduced ACL injury incidence. In basketball no effective training intervention was found. In season training was more effective than preseason in ACL injury prevention. A combination of strength training, plyometrics, balance training, technique monitoring with feedback, produced the most favorable results. Conclusion Comparing the main components of ACL injury prevention programs for female athletes, some sports-dependent training specificity issues may need addressing in future studies, related primarily to the individual biomechanics of each sport but also their most effective method of delivery.
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FSPLJ, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
500.
Ventilator-Induced Lung Injury Slutsky, Arthur S; Ranieri, V. Marco
The New England journal of medicine,
11/2013, Volume:
369, Issue:
22
Journal Article
Peer reviewed
Mechanical ventilation may cause injury to the ventilated lung. This article reviews the probable causes of such injury and ways to prevent it.
The purpose of mechanical ventilation is to rest the ...respiratory muscles while providing adequate gas exchange. Ventilatory support proved to be indispensable during the 1952 polio epidemic in Copenhagen, decreasing mortality among patients with paralytic polio from more than 80% to approximately 40%.
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Despite the clear benefits of this therapy, many patients eventually die after the initiation of mechanical ventilation, even though their arterial blood gases may have normalized.
This mortality has been ascribed to multiple factors, including complications of ventilation such as barotrauma (i.e., gross air leaks), oxygen toxicity, and hemodynamic compromise.
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During the polio epidemic, investigators noted . . .
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