The accurate quantification of the proportion of fat in human muscles could help monitor disease status and test effectiveness of interventions in people with neurological conditions whose skeletal ...muscles are frequently infiltrated with fat.
We compared two commonly used magnetic resonance imaging methods to quantify fat in muscles. Measurements were obtained before and after 6 or 8 wk of strength training in a total of 116 muscles spanning the range of intramuscular fat proportions observed in able-bodied young adults and people with spinal cord injury.
We successfully measured fat proportions in all muscles using the mDixon method but were unable to obtain plausible measurements with the T1-weighted method from muscles of able-bodied individuals or from the leaner 23% of muscles of people with spinal cord injury (muscles with less than approximately 8% fat). In muscles with more fat, measurements obtained with the two methods agreed well (intraclass correlation coefficient, 0.88; mean absolute difference, 5%). We also found that, compared with the T1-weighted method, the mDixon method provides a more detailed characterization of fat infiltration in muscle and a less variable measurement of the effect of training on the proportion of fat. The mDixon method showed that 6 or 8 wk of strength training did not appreciably change the proportion of intramuscular fat in either people with spinal cord injury or able-bodied people.
On the basis of these findings, we recommend the use of mDixon methods in preference to T1-weighted methods to determine the effectiveness of interventions aimed at reducing intramuscular fat.
For every day a person is dependent on mechanical ventilation, respiratory and cardiac complications increase, quality of life decreases and costs increase by > $USD 1500. Interventions that improve ...respiratory muscle function during mechanical ventilation can reduce ventilation duration. The aim of this pilot study was to assess the feasibility of employing an abdominal functional electrical stimulation (abdominal FES) training program with critically ill mechanically ventilated patients. We also investigated the effect of abdominal FES on respiratory muscle atrophy, mechanical ventilation duration and intensive care unit (ICU) length of stay.
Twenty critically ill mechanically ventilated participants were recruited over a 6-month period from one metropolitan teaching hospital. They were randomly assigned to receive active or sham (control) abdominal FES for 30 min, twice per day, 5 days per week, until ICU discharge. Feasibility was assessed through participant compliance to stimulation sessions. Abdominal and diaphragm muscle thickness were measured using ultrasound 3 times in the first week, and weekly thereafter by a blinded assessor. Respiratory function was recorded when the participant could first breathe independently and at ICU discharge, with ventilation duration and ICU length of stay also recorded at ICU discharge by a blinded assessor.
Fourteen of 20 participants survived to ICU discharge (8, intervention; 6, control). One control was transferred before extubation, while one withdrew consent and one was withdrawn for staff safety after extubation. Median compliance to stimulation sessions was 92.1% (IQR 5.77%) in the intervention group, and 97.2% (IQR 7.40%) in the control group (p = 0.384). While this pilot study is not adequately powered to make an accurate statistical conclusion, there appeared to be no between-group thickness changes of the rectus abdominis (p = 0.099 at day 3), diaphragm (p = 0.652 at day 3) or combined lateral abdominal muscles (p = 0.074 at day 3). However, ICU length of stay (p = 0.011) and ventilation duration (p = 0.039) appeared to be shorter in the intervention compared to the control group.
Our compliance rates demonstrate the feasibility of using abdominal FES with critically ill mechanically ventilated patients. While abdominal FES did not lead to differences in abdominal muscle or diaphragm thickness, it may be an effective method to reduce ventilation duration and ICU length of stay in this patient group. A fully powered study into this effect is warranted.
The Australian New Zealand Clinical Trials Registry, ACTRN12617001180303. Registered 9 August 2017.
Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, is characterized by impaired lung development with sustained functional abnormalities due to alterations of airways and the ...distal lung. Although clinical studies have shown striking associations between antenatal stress and BPD, little is known about the underlying pathogenetic mechanisms. Whether dysanapsis, the concept of discordant growth of the airways and parenchyma, contributes to late respiratory disease as a result of antenatal stress is unknown. We hypothesized that antenatal endotoxin (ETX) impairs juvenile lung function as a result of altered central airway and distal lung structure, suggesting the presence of dysanapsis in this preclinical BPD model. Fetal rats were exposed to intraamniotic ETX (10 μg) or saline solution (control) 2 days before term. We performed extensive structural and functional evaluation of the proximal airways and distal lung in 2-week-old rats. Distal lung structure was quantified by stereology. Conducting airway diameters were measured using micro-computed tomography. Lung function was assessed during invasive ventilation to quantify baseline mechanics, response to methacholine challenge, and spirometry. ETX-exposed pups exhibited distal lung simplification, decreased alveolar surface area, and decreased parenchyma-airway attachments. ETX-exposed pups exhibited decreased tracheal and second- and third-generation airway diameters. ETX increased respiratory system resistance and decreased lung compliance at baseline. Only Newtonian resistance, specific to large airways, exhibited increased methacholine reactivity in ETX-exposed pups compared with controls. ETX-exposed pups had a decreased ratio of FEV in 0.1 second to FVC and a normal FEV in 0.1 second, paralleling the clinical definition of dysanapsis. Antenatal ETX causes abnormalities of the central airways and distal lung growth, suggesting that dysanapsis contributes to abnormal lung function in juvenile rats.
An international multi-centred, double-blinded, randomised sham-controlled trial (eWALK).
To determine the effect of 12 weeks of transcutaneous spinal stimulation (TSS) combined with locomotor ...training on walking ability in people with spinal cord injury (SCI).
Dedicated SCI research centres in Australia, Spain, USA and Scotland.
Fifty community-dwelling individuals with chronic SCI will be recruited. Participants will be eligible if they have bilateral motor levels between T1 and T11, a reproducible lower limb muscle contraction in at least one muscle group, and a Walking Index for SCI II (WISCI II) between 1 and 6. Eligible participants will be randomised to one of two groups, either the active stimulation group or the sham stimulation group. Participants allocated to the stimulation group will receive TSS combined with locomotor training for three 30-min sessions a week for 12 weeks. The locomotor sessions will include walking on a treadmill and overground. Participants allocated to the sham stimulation group will receive the same locomotor training combined with sham stimulation. The primary outcome will be walking ability with stimulation using the WISCI II. Secondary outcomes will record sensation, strength, spasticity, bowel function and quality of life.
ANZCTR.org.au identifier ACTRN12620001241921.
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
This review aims to determine the effects (benefits and harms) of physical exercise training for increasing ...cardiorespiratory fitness compared with control (i.e. no intervention or placebo intervention) in people with spinal cord injury.
Pretest-posttest design.
To investigate mechanisms by which short-term resistance training (6 weeks) increases strength of partially paralysed muscles in people with spinal cord injury (SCI).
...Community-based setting, Sydney, Australia.
Ten community-dwelling people with partial paralysis of elbow flexor, elbow extensor, knee flexor or knee extensor muscles following SCI (range 5 months to 14 years since injury).
Muscle architecture and strength were assessed before and after participants underwent a six week strength-training program targeting one partially paralysed muscle group. The outcome of primary interest was physiological cross sectional area (PCSA) of the trained muscle group measured using magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Other outcomes were changes in mean muscle fascicle length, muscle volume, pennation angle, isometric strength and muscle strength graded on a 13-point scale.
The mean increase in maximal isometric muscle strength was 14% (95% CI, -3 to 30%) and 1.5 points (95% CI, 0.5 to 2.5) on the 13-point manual muscle test. There was no evidence of a change in muscle architecture.
This study is the first to examine the mechanisms by which voluntary strength training increases strength of partially paralysed muscles in people with SCI. The data suggest that strength gains produced by six weeks of strength training are not caused by changes in muscle architecture. This suggests short-term strength gains are due to increased neural drive or an increase in specific muscle tension.
PurposeThis study aims to investigate the relationship between people’s socially and environmentally responsible apparel practices (SERAP) and valuing US made clothing, current perceptions of US made ...clothing and factors affecting apparel purchases.Design/methodology/approachAn online survey was completed by 502 US consumer aged 18-65. Five factors were identified representing responsible apparel practices and US made clothing. Inter-factor correlations were tested. People’s perceptions toward US made clothing were examined through perceived quality, purchase experience and intentions to pay premium prices.FindingsThere was a positive correlation between SERAP and valuing US made clothing. Perceived quality of US apparel influenced both actual purchase and intentions to pay higher prices. Availability and affordability were major purchase factors.Practical implicationsUS apparel companies that produce their products domestically may consider developing specific messaging that resonates with customers, taking advantage of the perception of high quality and being transparent with the cost of producing apparel domestically.Originality/valueThis study suggests domestically made apparel purchases as part of a move toward SERAP. Although previous studies have addressed consumer responsibility and sustainable businesses, the connection has been inconclusive. This study provides current data of renewed and growing interest in US made apparel and expands its value.
Five articles respond to the Child Centers study in this issue: (1) discusses reasons why child care providers are rated low; (2) suggests heeding constructive recommendations made by the study team; ...(3) analyzes impact of mediocre care on black children; (4) examines effect of making the study public; and (5) presents study findings that reflect the relationship between quality centers and quality care. (BAC)
This is the first of three articles exploring the aspects of clinical care for children with rare neurological disorders including uncertainties old and new. The disruptive technologies of genomic ...sequencing and advanced therapeutics such as gene‐based therapies offer parents of children with severe but rare neurological conditions for the first‐time unprecedented opportunities for ‘precision medicine’. At the same time, the realities of limited genomic diagnostic yields and not infrequent detection of variants of uncertain significance, lack of natural history study data and management guidelines for individually rare neurogenetic conditions, means that high pre‐genomic test expectations are all too often replaced by an accumulation of new uncertainties. This can add to the chronic traumatic stress experienced by many families but may also have under‐recognised impacts for their clinicians, contributing to ‘burn‐out’ and attendant negative psychosocial impacts. This first article aims to address how clinicians might manage the accumulation of uncertainties to be more helpful to patients and their families. Moreover, it seeks to address how clinicians can move forward providing compassionate care to their patients and a little more consideration for themselves.
This is the third article of a three‐part series and addresses how clinicians provide hopefulness meaningfully to families coping with life‐limiting and quality of life impairing neurological ...conditions. The first two articles addressed the enormous challenges faced by carers and also explored the struggles of clinicians trying to provide relief and comfort. Can these families, and those helping clinically, legitimately hope? It is expectation that consolidates desire into a substantial hope that may motivate finding a way forward. Hope must be realistic and directed to something in particular and in someone in particular. Hope and despair are not monolithic but often travel together for both children, families and clinicians. Hope is not denial but a belief that there are positive possibilities. Finding what can be helpfully hoped for and what must be realistically despaired of, is the discerning struggle. Clinicians aim to change what we can and accept what we cannot. Acceptance and grief are arrived at slowly for carers and families. Similarly, clinicians struggle with the hopes of bringing meaningful solace and are supported by trusted colleagues who have shared the same experience. Clinicians strive to respond appropriately and effectively in a dynamic process based on trust, providing presence and compassion when cure is not possible. Clinicians help find the small doable things that foster hope and lessen isolation and abandonment, mindful of the limits of their medical expertise. Surprisingly these modest hopes and faltering acceptances often provide a different form of strength and comfort to sustain a family.
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