Abstract Objective Chiari type 1 malformations (CM-1) are variations of hind-brain development which can sometimes occur in asymptomatic individuals. Conventional treatment is surgical decompression, ...but little is known about the natural history of patients who do not undergo surgical management. Appreciation of this information is critical to determine how these patients should be managed. We conducted a systematic review of the literature to determine the natural history of CM-1 particularly in patients who did not undergo surgery, and in asymptomatic individuals, to help inform patients and doctors when surgery is likely to be beneficial. Methods A systematic literature search was performed following PRISMA guidelines using the electronic databases PubMed, SCOPUS, the Cochrane foundation and Web of Science. Inclusion and exclusion criteria were predefined. Results In symptomatic patients who did not undergo surgery, headaches and nausea often improved, whereas ataxia and sensory disturbance tended not to improve spontaneously. 27-47% had an improvement in their symptoms after 15 months. 37-40% of patients with cough headache and 89% with nausea who were managed non-operatively improved at follow up. Most asymptomatic individuals with CM-1 remained asymptomatic (93.3%), even in the presence of syringomyelia. Conclusions The natural history of mild symptomatic and asymptomatic CM-1 in adults is relatively benign and non-progressive, therefore the decision to perform surgical decompression should be based on the severity and duration of a patient’s symptoms at presentation. It is reasonable to observe a patient with mild or asymptomatic symptoms, even in the presence of significant tonsillar descent or syringomyelia.
Whey protein supplementation may augment resistance exercise-induced increases in muscle strength and mass. Further studies are required to determine whether this effect extends to mobility-limited ...older adults. The objectives of the study were to compare the effects of whey protein concentrate (WPC) supplementation to an isocaloric control on changes in whole-body lean mass, mid-thigh muscle cross-sectional area, muscle strength, and stair-climbing performance in older mobility-limited adults in response to 6 months of resistance training (RT).
Eighty mobility-limited adults aged 70-85 years were randomized to receive WPC (40g/day) or an isocaloric control for 6 months. All participants also completed a progressive high-intensity RT intervention. Sample sizes were calculated based on the primary outcome of change in whole-body lean mass to give 80% power for a 0.05-level, two-sided test.
Lean mass increased 1.3% and 0.6% in the WPC and control groups, respectively. Muscle cross-sectional area was increased 4.6% and 2.9% in the WPC and control groups, respectively, and muscle strength increased 16%-50% in WPC and control groups. Stair-climbing performance also improved in both groups. However, there were no statistically significant differences in the change in any of these variables between groups.
These data suggest that WPC supplementation at this dose does not offer additional benefit to the effects of RT in mobility-limited older adults.
Influential research on the negative effects of living in a disadvantaged neighborhood assumes that its residents are socially isolated from nonpoor or “mainstream” neighborhoods, but the extent and ...nature of such isolation remain in question. We develop a test of neighborhood isolation that improves on static measures derived from commonly used census reports by leveraging fine-grained dynamic data on the everyday movement of residents in America’s 50 largest cities. We analyze 650 million geocoded Twitter messages to estimate the home locations and travel patterns of almost 400,000 residents over 18 mo. We find surprisingly high consistency across neighborhoods of different race and income characteristics in the average travel distance (radius) and number of neighborhoods traveled to (spread) in the metropolitan region; however, we uncover notable differences in the composition of the neighborhoods visited. Residents of primarily black and Hispanic neighborhoods—whether poor or not—are far less exposed to either nonpoor or white middle-class neighborhoods than residents of primarily white neighborhoods. These large racial differences are notable given recent declines in segregation and the increasing diversity of American cities. We also find that white poor neighborhoods are substantially isolated from nonpoor white neighborhoods. The results suggest that even though residents of disadvantaged neighborhoods travel far and wide, their relative isolation and segregation persist.
Purpose
This longitudinal study examined the major physiological mechanisms that determine the age-related loss of lower extremity muscle power in two distinct groups of older humans. We hypothesized ...that after ~3 years of follow-up, mobility-limited older adults (mean age: 77.2 ± 4,
n
= 22, 12 females) would have significantly greater reductions in leg extensor muscle power compared to healthy older adults (74.1 ± 4,
n
= 26, 12 females).
Methods
Mid-thigh muscle size and composition were assessed using computed tomography. Neuromuscular activation was quantified using surface electromyography and vastus lateralis single muscle fibers were studied to evaluate intrinsic muscle contractile properties.
Results
At follow-up, the overall magnitude of muscle power loss was similar between groups: mobility-limited: −8.5 % vs. healthy older: −8.8 %,
P
> 0.8. Mobility-limited elders had significant reductions in muscle size (−3.8 %,
P
< 0.01) and strength (−5.9 %,
P
< 0.02), however, these parameters were preserved in healthy older (
P
≥ 0.7). Neuromuscular activation declined significantly within healthy older, but not in mobility-limited participants. Within both groups, the cross-sectional areas of type I and IIA muscle fibers were preserved while substantial increases in single fiber peak force (>30 %), peak power (>200 %) and unloaded shortening velocity (>50 %) were elicited at follow-up.
Conclusion
Different physiological mechanisms contribute to the loss of lower extremity muscle power in healthy older and mobility-limited older adults. Neuromuscular changes may be the critical early determinant of muscle power deficits with aging. In response to major whole muscle decrements, major compensatory mechanisms occur within the contractile properties of surviving single muscle fibers in an attempt to restore overall muscle power and function with advancing age.
Incisionless near-infrared fluorescent cholangiography (NIFC) is emerging as a promising tool to enhance the visualization of extrahepatic biliary structures during laparoscopic cholecystectomies.
We ...conducted a single-blind, randomized, 2-arm trial comparing the efficacy of NIFC (n = 321) versus white light (WL) alone (n = 318) during laparoscopic cholecystectomy. Using the KARL STORZ Image1 S imaging system with OPAL1 technology for NIR/ICG imaging, we evaluated the detection rate for 7 biliary structures-cystic duct (CD), right hepatic duct (RHD), common hepatic duct, common bile duct, cystic common bile duct junction, cystic gallbladder junction (CGJ), and accessory ducts -before and after surgical dissection. Secondary calculations included multivariable analysis for predictors of structure visualization and comparing intergroup biliary duct injury rates.
Predissection detection rates were significantly superior in the NIFC group for all 7 biliary structures, ranging from 9.1% versus 2.9% to 66.6% versus 36.6% for the RHD and CD, respectively, with odds ratios ranging from 2.3 (95% CI 1.6-3.2) for the CGJ to 3.6 (1.6-9.3) for the RHD. After dissection, similar intergroup differences were observed for all structures except CD and CGJ, for which no differences were observed. Significant odds ratios ranged from 2.4 (1.7-3.5) for the common hepatic duct to 3.3 (1.3-10.4) for accessory ducts. Increased body mass index was associated with reduced detection of most structures in both groups, especially before dissection. Only 2 patients, both in the WL group, sustained a biliary duct injury.
In a randomized controlled trial, NIFC was statistically superior to WL alone visualizing extrahepatic biliary structures during laparoscopic cholecystectomy.
NCT02702843.
Metabolic profiling may provide insight into biologic mechanisms related to age-related increases in regional adiposity and insulin resistance. The objectives of the current study were to ...characterize the association between mid-thigh intermuscular and subcutaneous adipose tissue (IMAT, SCAT, respectively) and, abdominal adiposity with the serum metabolite profile, to identify significant metabolites as further associated with the homeostasis model assessment of insulin resistance (HOMA-IR), and, to develop a HOMA-IR associated metabolite predictor set representative of regional adiposity, in 73 functionally-limited (short physical performance battery ≤10; SPPB) older adults (age range, 70–85 y). Fasting levels of 181 total metabolites, including amino acids, fatty acids and acylcarnitines were measured with use of an untargeted mass spectrometry-based metabolomic approach. Multivariable-adjusted linear regression was used in all analyses. Thirty-two, seven and one metabolite(s) were found to be associated with IMAT, abdominal adiposity and, SCAT, respectively, including the amino acid glycine, which was positively associated with SCAT and, negatively associated with both IMAT and abdominal adiposity. Glycine and four metabolites found to be significantly associated with regional adiposity were additionally associated with HOMA-IR. Separate stepwise regression models identified glycine as a HOMA-IR associated marker of both IMAT (model R 2 = 0.51, p<0.0001) and abdominal adiposity (model R 2 = 0.41, p<0.0001). Our findings for a positive association between glycine with SCAT but, a negative association between glycine with IMAT and abdominal adiposity supports the hypothesis that SCAT metabolic processes are different from that found in other fat depots. In addition, because of the significant associations found between glycine with HOMA-IR, IMAT, SCAT and abdominal adiposity, our results suggest glycine as a serum biomarker of both insulin sensitivity and regional fat mass in functionally-limited older adults.
Lifestyle Medicine Phillips, Edward M; Frates, Elizabeth P; Park, David J
Physical medicine and rehabilitation clinics of North America,
11/2020, Letnik:
31, Številka:
4
Journal Article
Recenzirano
Lifestyle medicine is a growing field of medicine that addresses key health behaviors, which are the root causes of most premature death, chronic disease, and health care costs. Coaching patients ...with evidence-based behavior change strategies can help them to make lasting habits in key areas, such as physical activity, healthy eating, improved sleep, cessation of tobacco, forming and maintaining relationships, and stress management. Similarities in philosophy between lifestyle medicine and physical medicine and rehabilitation make them complementary and synergistic in treating the whole patient in their social context.
Our careers as surgeons are some of the busiest and perhaps most sought after in existence. We have all put in countless years of tenacious effort, at times blood, frequent sweat, and occasional ...tears, to have the privilege to care for others and correct their ailments. Many of us are like freight trains rolling down the tracks indefinitely. But all too often we finish our training and head down those tracks without considering what stops we should make along the way, which forks in the tracks we should consider taking, and perhaps most often, we do not consider how we are going to eventually stop the train. Most of us have been witness to colleagues who keep working beyond their prime, be it for lack of alternative opportunities, lack of hobbies to retire to, or for lack of insight into their own decline. From these observations was born this presidential panel. As you can see, it is a collection of past presidents of So Cal ACS, with the exception for Dr Freischlag (who we all know would have served as president at some point had she never relocated away from Southern California). Each of these speakers has unique experience from their own careers that they will share with us so we can take pause and consider their insights and wisdom for how to navigate a successful and satisfying career.
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