Background Chronic heart failure is one of a number of disorders associated with the development of a wasting syndrome. The precise mechanisms of this remain unknown, but previous studies have ...suggested a role for immune and neurohormonal factors. Methods We aimed to investigate in detail the differences in body composition (dual X-ray absorptiometry) and the relationship to candidate biochemical factors of the immune, neurohormonal and metabolic systems in 15 healthy controls, 36 stable non-cachectic and 18 cachectic patients with chronic heart failure. Results Non-cachectic patients showed reduced leg lean tissue (−9·1%,P<0·01) compared to controls. Cachectic patients had significantly reduced lean (−21·0% vs controls, −19·9% vs non-cachectics), fat (−33·0% vs controls, −37·0% vs non-cachectics) and bone tissue (−17·5% vs controls, −15·9% vs non-cachectics) (allP<0·0001). Cachectic patients showed a significantly increased cortisol/dehydroepiandrosterone ratio (+203% vs controls,P<0·0001; +89% vs non-cachectics,P=0·0011) and increased cytokine levels (TNF-α, soluble TNF-receptor 1, interleukin-6). The levels of catabolic hormones and cytokines correlated significantly with reduced muscle and fat tissue content and reduced bone mass. Conclusion Peripheral loss of muscle tissue is a general finding in chronic heart failure. The wasting in cardiac cachexia affects all tissue compartments and is significantly related to neurohormonal and immunological abnormalities.
Abstract Background Deep neck flexor (DNF) muscles stabilize the neck and contribute to head acceleration control. The function of DNF in cervical spine dynamic stabilization has not been examined in ...athletes of any age group, including adolescents. This investigation was necessary prior to studying the DNF muscles’ role in cervical spine injury patterns. Objectives (1) To determine average Deep Neck Flexor Endurance Test (DNFET) time scores in high school and university-aged subjects (ages 14-22); and (2) To establish the relationship between gender and age for adolescent DNFET time scores. Design Cross-Sectional Design. Setting Public High School and Private University. Participants 81 (40 males, 41 females) healthy high school and collegiate athletes. Intervention DNFET time scores (in seconds) were collected and means values were calculated. Inter-rater reliability was established using the first 15 university-aged subjects enrolled in the study. Main Outcomes Mean DNFET time (seconds) scores. Results Deep Neck Flexor (DNF) muscle endurance inter-rater reliability coefficient of reproducibility for 4 allied health clinicians was ICC (2,4) 0.712 (confidence interval, 0.24-0.85). The mean (SD) DNFET time score for females was 31.86 (±8.53) seconds versus 35.57 (±10.43) seconds for males. The DNFET performance demonstrated a significant but fair correlation with age (r = 0.401, p= .0001). No significant performance differences were found between male and female subjects in the 14-17yo ( U = 187.0, p = .285), 18-22yo subjects ( U = 145.0, p = .215), or total male versus female subject groups ( U = 653.0, p = .083). Conclusion Our study establishes a normative data set available for the DNFET in the adolescent population. The fair correlation between DNFET time scores and age is consistent with other studies. These findings serve as a basis for clinician testing, objectifying and monitoring DNF dysfunction in an adolescent athletic population.
Unicompartmental knee arthroplasty (UKA) is a demanding procedure, with tibial component subsidence or pain from high tibial strain being potential causes of revision. The optimal position in terms ...of load transfer has not been documented for lateral UKA. Our aim was to determine the effect of tibial component position on proximal tibial strain.
A total of 16 composite tibias were implanted with an Oxford Domed Lateral Partial Knee implant using cutting guides to define tibial slope and resection depth. Four implant positions were assessed: standard (5° posterior slope); 10° posterior slope; 5° reverse tibial slope; and 4 mm increased tibial resection. Using an electrodynamic axial-torsional materials testing machine (Instron 5565), a compressive load of 1.5 kN was applied at 60 N/s on a meniscal bearing via a matching femoral component. Tibial strain beneath the implant was measured using a calibrated Digital Image Correlation system.
A 5° increase in tibial component posterior slope resulted in a 53% increase in mean major principal strain in the posterior tibial zone adjacent to the implant (p = 0.003). The highest strains for all implant positions were recorded in the anterior cortex 2 cm to 3 cm distal to the implant. Posteriorly, strain tended to decrease with increasing distance from the implant. Lateral cortical strain showed no significant relationship with implant position.
Relatively small changes in implant position and orientation may significantly affect tibial cortical strain. Avoidance of excessive posterior tibial slope may be advisable during lateral UKA.
: A. M. Ali, S. D. S. Newman, P. A. Hooper, C. M. Davies, J. P. Cobb. The effect of implant position on bone strain following lateral unicompartmental knee arthroplasty: A Biomechanical Model Using Digital Image Correlation.
2017;6:522-529. DOI: 10.1302/2046-3758.68.BJR-2017-0067.R1.
Most cancer patients die of metastatic or recurrent disease, hence the importance to identify target genes upregulated in these lesions. Although a variety of gene signatures associated with ...metastasis or poor prognosis have been identified in various cancer types, it remains a critical problem to identify key genes as candidate therapeutic targets in metastatic or recurrent cancer. The aim of our study was to identify genes consistently upregulated in both lymph node micrometastases and recurrent tumours compared to matched primary tumours in human cervical cancer. Taqman Low-Density Arrays were used to analyse matched tumour samples, obtained after laser-capture microdissection of tumour cell islands for the expression of 96 genes known to be involved in tumour progression. Immunohistochemistry was performed for a panel of up- and downregulated genes. In lymph node micrometastases, most genes were downregulated or showed expressions equal to the levels found in primary tumours. In more than 50% of lymph node micrometastases studied, eight genes (AKT, BCL2, CSFR1, EGFR1, FGF1, MMP3, MMP9 and TGF-beta) were upregulated at least two-fold. Some of these genes (AKT and MMP3) are key regulators of epithelial-mesenchymal transition in cancer. In recurrent tumours, almost all genes were upregulated when compared to the expression profiles of the matched primary tumours, possibly reflecting their aggressive biological behaviour. The two genes showing a consistent downregulated expression in almost all lymph node metastases and recurrent tumours were BAX and APC. As treatment strategies are very limited for metastatic and recurrent cervical cancer, the upregulated genes identified in this study are potential targets for new molecular treatment strategies in metastatic or recurrent cervical cancer.
Streptomycin, gentamicin, and tetracycline are currently considered the antimicrobials of choice for the treatment of tularemia. Preliminary data suggest that quinolones may be effective alternative ...agents; however, clinical experience is limited, and their role in treating severe disease is uncertain. We recently treated two acutely ill immunocompromised patients who had presumed "atypical" pneumonia with levofloxacin. Both patients had an excellent clinical response and were diagnosed with tularemia only when blood cultures subsequently yielded Francisella tularensis. Neither patient relapsed during 12 months of follow-up. Including our two cases, a total of 10 cases of tularemia treated with quinolones have been reported. In all 10 cases, a favorable clinical response was documented, and no relapses occurred. We conclude that the quinolones appear promising for the treatment of even severe tularemia, and they should be considered efficacious alternative agents for patients who do not require parenteral therapy or are intolerant of more standard treatment regimens.
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Single depositions of 316L stainless steel in pulsed laser powder bed fusion were performed to understand the influence of energy density input strategy on melt pool morphology, ...microstructure and temperature fields. Depositions performed at equal energy inputs, but variable laser powers, produced keyhole mode depositions for laser powers ≥150 W and conduction mode depositions for laser powers below 150 W. The laser power combined to the laser exposure time was found to control the penetration depth, increasing from 50 μm to 300 μm as the laser exposure increases. An increase in laser exposure time was found to decrease the isotherm liquidus velocity, from 1.2 mm s−1 to 0.2 mm s−1. EBSD maps of deposition cross-sections highlighted the change in temperature gradients as the melt pool increased in depth during keyhole and conduction mode depositions. Strong sub-surface temperature gradients were found for keyhole mode with weak gradients above the surface. In conduction mode variation in the temperature gradient throughout the melt pool was less pronounced. The decrease in cooling rate as the exposure time is increased was highlighted in coarsening of the cell spacing produced by the solute redistribution during solidification, diverging between bottom and dome of the deposition melt pool.
Large-scale glass fibre reinforced polymer (GFRP) and carbon fibre reinforced polymer (CFRP) sandwich structures (1.6 m x 1.3 m) were subject to explosive air blast (100 kg TNT equivalent) at ...stand-off distances of 14 m. Digital image correlation (DIC) was used to obtain full-field data for the rear-face of each deforming target. A steel plate of comparable mass per unit area was also subjected to the same blast conditions for comparison. The experimental data was then verified with finite element models generated in Abaqus/Explicit. Close agreement was obtained between the numerical and experimental results, confirming that the CFRP panels had a superior blast performance to the GFRP panels. Moreover all composite targets sustained localised failures (that were more severe in the GFRP targets) but retained their original shape post blast. The rear-skins remained intact for each composite target with core shear failure present.
Objectives
Hearing, vision, and cognitive impairment commonly co‐occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a ...“sensory intervention” (SI) to support hearing and vision in PwD. Here, we report the findings of an international open‐label field trial, and nested case series, to explore the impact of the SI on dementia‐related outcomes.
Methods
This was a home‐based trial conducted in France, England, and Cyprus. Participants were people with mild‐to‐moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The “basic” SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the “extended” SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia‐related, health utility and resource utilisation outcomes were performed.
Results
Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self‐efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication.
Conclusions
These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention.
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