It's time to regulate - The importance of accurate surgical-grade tourniquet autoregulation in blood flow restriction exercise applications

OBJECTIVE

Evaluate the efficacy of five common blood flow restriction (BFR) systems to accurately maintain and autoregulate BFR pressure in the tourniquet cuff near target pressure throughout exercise.

DESIGN

Randomised crossover design.

SETTING

Laboratory.

PARTICIPANTS

15 healthy individuals.

OUTCOME MEASURES

1) Percentage of total BFR time that surgical-grade tourniquet autoregulation, defined as automatic and rapid self-regulation of cuff pressure to within ±15 mmHg of initial target pressure within 1 s in the presence of transient pressure changes associated with exercise, was provided; 2) pressure change in the BFR cuff throughout exercise, by comparing the initial target pressure to the measured pressure at completion of BFR exercise.

RESULTS

One BFR system could provide surgical-grade tourniquet autoregulation for the whole duration (100 ± 0%) of the BFR exercise in all subjects. In two of the five BFR systems evaluated, measured cuff pressure at the end of exercise was not different (p < 0.05) to the initial target pressure.

CONCLUSIONS

Surgical-grade tourniquet autoregulation is important to consistently and reliably apply a targeted BFR pressure stimulus. This may allow BFR methodology and protocols to be accurately implemented and controlled so that the results can be more meaningfully compared, leading to the potential optimization of applications.

Testing the framework in real life – application for country HSPA process

The ability to use the existing health system assessment tools, HSPA processes and widely available indicators is an important, although not exhaustive, part of the practical application of the framework. With this in mind, we created an annotated template that can be used along with HSPA framework for UHC to facilitate information collection and harmonisation.

This annotated template was tested for Estonia and Azerbaijan with the aim to help with evaluating the transferability of HSPA information between existing approaches and in different settings. More specifically, we tested the extent to which information on assessment areas of the framework can be extracted from the existing sources; the ease of use and clarity of the annotated template; and how the information collected through the annotated template can be combined into a meaningful health system performance assessment, in line with health system goals.

The test showed that the information for Estonia and Azerbaijan could be obtained to complete much of the template. This can be done through a country-led performance assessment process that ensures that the indicative measures in the annotated template are relevant to the country context. The information collected also needs to be assessed in the context of policy priorities of the national health systems. Thus, more detailed guidance on the use of the framework can help to streamline such national processes and clarify the linkages between performance of specific functions and overall health system performance.

The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature

Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.

[An epidemiologic study of pelvic organ prolapse in urban Chinese women: a population-based sample in China]

Objective: This study aimed to assess the prevalence and factors associated with pelvic organ prolapse (POP) in a representative sample of Chinese urban women. Methods: A total of 29613 Chinese urban women were recruited to this cross-sectional study between February 2014 and March 2016. The prevalence of POP, defined as any stage Ⅱ or higher POP resulting in symptoms, was assessed using questionnaires and physical examinations. Multivariable logistic regression was used to assess factors associated with POP. Results: 2 864 of 29 613 women (9.67%) had POP. The prevalence of POP increased with age ranging from 1.23% (82/6 646) of women aged between 20 and 29 years to 26.11% (727/2 784) for those aged 70 years or older (P<0.000 1). Overweight and obese women were more likely to have POP than normal weight women [AOR=1.56, 95%CI 1.42-1.72 vs AOR=1.74, 95%CI 1.48-2.03]. In the multivariate analysis, the independent risk factors were cough (AOR=1.70, 95%CI 1.44-2.02), constipation (AOR=2.05, 95%CI 1.82-2.32), physical disease (AOR=1.27, 95%CI 1.15-1.41), and gynecological diseases (AOR=2.08, 95%CI 1.89-2.29). Nulliparous (AOR=0.12, 95%CI 0.06-0.22) and caesarean section (CS) (AOR=0.55, 95%CI 0.47-0.64) were protective factors for POP. Conclusions: POP affects nearly 10% of women in Chinese urban region. The prevalence of POP increases significantly with age. The independent risk factors for POP are body mass index, cough, constipation, physical disease and gynecological diseases. Nulliparous and CS are protective factors for POP.

A Handheld, Colorimetric Optoelectronic Dynamics Analyzer for Measuring Total Ammonia of Biological Samples

This paper introduces a wireless, solid-state, portable, and automated device capable of measuring the total ammonia [ammonia (NH₃) and ammonium (NH₄⁺)] levels of fluids, including biological samples. This device reliably measures the total ammonia of biological samples (e.g., urine) faster than the current ammonia quantification techniques. Medical professionals typically estimate NH4⁺ levels using error-prone indirect measurement techniques (i.e., urine anion gap), which are time-consuming and are seldom suitable for periodic measurements. Several instantaneous measurements of total ammonia levels in a patient urine could be utilized as an early warning for both acid-base and/or potassium disturbances. Given the device’s operation mechanism, it is able to quantify the total ammonia concentration within a biological sample in only 5 s and can simultaneously transmit data to other devices via Bluetooth. The analytical operation demonstrated high sensitivity, high specificity, fast reversibility, rapid response time, and has enabled the accurate determination of total ammonia concentration in urine samples produced by subjects who had consumed diets of variable protein compositions.

Automotive shredder residue (ASR) management: An overview

On the basis of statistical data, approximately 6.5 million tons of ELVs were produced in Europe in 2011. ELVs are processed according to a treatment scheme comprising three main phases: depollution, dismantling and shredding. The ferrous fraction represents about 70-75% of the total shredded output, while nonferrous metals represent about 5%. The remaining 20-25% is referred to as automotive shredder residue (ASR). ASR is largely landfilled due to its heterogeneous and complex matrix. With a start date of January 1st 2015, the European Directive 2000/53/EC establishes the reuse and recovery of a minimum of 95% ELV total weight. To reach these targets various post-shredder technologies have been developed with the aim of improving recovery of materials and energy from ASR. In order to evaluate the environmental impacts of different management options of ELVs, the life cycle assessment (LCA) methodology has been applied taking into account the potential implication of sustainable design of vehicles and treatment of residues after shredding of ELVs. Findings obtained reveal that a combination of recycling and energy recovery is required to achieve European targets, with landfilling being viewed as the least preferred option. The aim of this work is to provide a general overview of the recent development of management of ELVs and treatment of ASR with a view to minimizing the amount of residues disposed of in landfill.

Review of Italian experience on automotive shredder residue characterization and management

Automotive Shredder Residue (ASR) is a special waste that can be classified as either hazardous or non hazardous depending on the amount of hazardous substances and on the features of leachate gathered from EN12457/2 test. However both the strict regulation concerning landfills and the EU targets related to End-of-Life Vehicles (ELVs) recovery and recycling rate to achieve by 2015 (Directive 2000/53/EC), will limit current landfilling practice and will impose an increased efficiency of ELVs valorization. The present paper considers ELVs context in Italy, taking into account ASRs physical-chemical features and current processing practice, focusing on the enhancement of secondary materials recovery. The application in waste-to-energy plants, cement kilns or metallurgical processes is also analyzed, with a particular attention to the possible connected environmental impacts. Pyrolysis and gasification are considered as emerging technologies although the only use of ASR is debatable; its mixing with other waste streams is gradually being applied in commercial processes. The environmental impacts of the processes are acceptable, but more supporting data are needed and the advantage over (co-)incineration remains to be proven.

Avoidable mortality in Estonia: exploring the differences in life expectancy between Estonians and non-Estonians in 2005-2007

OBJECTIVES

A considerable increase in social inequalities in mortality was observed in Eastern Europe during the post-communist transition. This study evaluated the contribution of avoidable causes of death to the difference in life expectancy between Estonians and non-Estonians in Estonia.

STUDY DESIGN

Descriptive study.

METHODS

Temporary life expectancy (TLE) was calculated for Estonian and non-Estonian men and women aged 0-74 years in 2005-2007. The ethnic TLE gap was decomposed by age and cause of death (classified as preventable or treatable).

RESULTS

The TLE of non-Estonian men was 3.53 years less than that of Estonian men, and the TLE of non-Estonian women was 1.36 years less than that of Estonian women. Preventable causes of death contributed 2.19 years to the gap for men and 0.78 years to the gap for women, while treatable causes contributed 0.67 and 0.33 years, respectively. Cardiorespiratory conditions were the major treatable causes of death, with ischaemic heart disease alone contributing 0.29 and 0.08 years to the gap for men and women, respectively. Conditions related to alcohol and substance use represented the largest proportion of preventable causes of death.

CONCLUSIONS

Inequalities in health behaviours underlie the ethnic TLE gap in Estonia, rather than inequalities in access to health care or the quality of health care. Public health interventions should prioritize primary prevention aimed at alcohol and substance use, and should be implemented in conjunction with wider social policy measures.

Short Communication: Changes in Micromineral, Magnesium, Cytokine, and Cortisol Concentrations in Blood of Dairy Goats Following Intramammary Inoculation with Staphylococcus aureus

The aim of this study was to investigate mineral metabolism and immune response in dairy goats following intramammary inoculation with varying doses of Staphylococcus aureus. Blood samples were collected at 0, 2, 4, 8, 12, 24, 48, and 72 h after intramammary inoculation. Lowered plasma Fe concentrations were observed from 12 to 24 h postinoculation in groups SAA (Staph. aureus at 10(4) cfu, n = 5) and SAB (Staph. aureus at 10(8) cfu, n = 5). Plasma Cu concentrations increased in group SAB 2 h after inoculation and maintained greater concentrations until the end of the experiment compared with the control group (phosphate-buffered saline, n = 5). Increased plasma Zn concentrations in group SAB were observed 48 h after inoculation, and the concentration was still greater 72 h after inoculation compared with the control group. Greater plasma Mg concentrations were detected in groups SAA and SAB compared with the control group at all timepoints after inoculation. Plasma Mg concentrations were generally greater in group SAA than in group SAB through 72 h (except at 2 h). Plasma tumor necrosis factor-alpha concentrations were unchanged following intramammary inoculation with Staph. aureus throughout the study. Plasma IL-6 concentrations in groups SAA and SAB increased gradually compared with the control group and peaked at 48 h after inoculation. In group SAB, serum cortisol concentrations started to increase from 8 h postinoculation and peaked at 12 h postinoculation. In conclusion, increasing the inoculum dose does not induce more rapid proinflammatory cytokine responses, whereas the data indicate that mineral metabolic alterations occur during the course of Staph. aureus mastitis in the goat.

Characterization of the insulin-like growth factor axis and Wilms' tumour suppressor gene in hyperparathyroidism

Background

Genetic mutations and upregulation of growth factors are implicated in the pathogenesis of hyperparathyroidism. The aim of this study was to evaluate the role of Wilms' tumour suppressor gene (WT-1) and the insulin-like growth factor (IGF) axis in hyperparathyroidism.

Methods

The expression of WT-1 and IGF components was examined by immunohistochemistry, reverse transcriptase–polymerase chain reaction and western immunoblotting in a panel of parathyroid specimens from both primary and secondary hyperparathyroidism. A human parathyroid cell culture model was established to examine the parathyroid response to IGF stimulation.

Results

There was a significantly lower level of WT-1 expression in parathyroid tumours than in normal parathyroid glands. Most tumours expressed IGF-I and IGF-II receptors and responded to IGF stimulation. Only IGF-I was present in normal parathyroid glands, whereas IGF-II was expressed exclusively in parathyroid tumours.

Conclusion

Abnormal expression of WT-1 and the IGF axis may play a role in the pathogenesis of hyperparathyroidism.

The effect of angle on wall shear stresses in a LIMA to LAD anastomosis: numerical modelling of pulsatile flow

The purpose of this study was to examine the effect of anastomotic angle on the flow patterns and wall shear distributions at the distal anastomosis of a left interior mammary artery (LIMA) graft to the left anterior descending artery (LDA). It is now well recognized that abnormal wall shear stress distributions along the anastomotic bed, around the toe, and around the heel can contribute to the focal development of intimal hyperplasia. However, the exact nature of the interaction between the dominant pulsing flow and the anastomotic angle on wall shear stresses has not been fully investigated numerically. In this study a commercial CFD package was used for three-dimensional flow analysis where the pulsatile waveforms and flowrates used as the boundary conditions are representative of an anastomosed left internal mammary artery and a stenosed left anterior descending coronary artery (intermediate, <70 per cent diameter narrowing). The flow patterns and distributions of time-averaged wall shear stress (TAWSS) and the oscillatory shear index (OSI) for three anastomotic angles of 20, 40, and 60 degrees were evaluated and compared with other published data. The findings indicated that transient, highly disturbed flow patterns occurred in localized regions of the proximal and distal native segments and in the anastomotic domain including recirculation zones, moving points of stagnation, and oscillating wall shear stresses mainly on the bed, at the toe, and at the heel. Moreover, higher anastomotic angles resulted in more extreme variations in TAWSS and OSI values, particularly around the toe and along the bed. In addition, the effect of anastomotic angle on OSI values at the heel followed the same pattern whereas the TAWSS values along the graft at the heel showed a significant increase at the lowest anastomotic angle of 20 degrees.

Insulin-like growth factors (IGF) I and II utilize different calcium signaling pathways in a primary human parathyroid cell culture model

BACKGROUND

In most cell types, influx of calcium (Ca2+) induces a growth or secretory response. The opposite occurs in parathyroid (PTH), cells where there is an inverse relationship between intracellular Ca2+ concentration and PTH secretion. We have examined the effects of calcium channel and metabolism modulators on insulin-like growth factors (IGFs) in a parathyroid cell culture model.

METHODS

Cell cultures were prepared from 9 patients undergoing operation for hyperparathyroidism. Following adhesion, the cells were transferred to serum-free medium and dosed with IGF I, II +/- ethyleneglycol-bis(beta-aminoethyl)-N,N,N',N'-tetraacetic acid (EGTA), nifedipine, nickel, 2-aminoethoxy-diphenylborate (2-APB), or dantrolene. Proliferation (96 hours) was assessed by measuring tritiated thymidine incorporation and PTH release (1 and 3 hours) assayed by IRMA.

RESULTS

Both IGF I and II increased DNA synthesis to 162.8% +/- 10.6% (SEM) and 131.1% +/- 7.7%, respectively (P < 0.05). EGTA at 0.2 mmol (ionized Ca2+ 0.2 mmol) did not affect the response to both IGFs. EGTA at 2 mmol (ionized Ca2+ 0 mmol) reduced the DNA synthesis of IGF I and II to 29% and 26%, respectively (P < 0.05). Nifedipine and nickel (nonspecific Ca2+ channel blocker) were equally potent in negating the mitogenic effects of both IGFs. 2-APB (IP3R blocker) reduced the basal DNA synthesis to 51.3% +/- 8.4% but had no effect on either IGF. Dantrolene (ryanodine receptor blocker) negated IGF II induced mitogenisis (74.2% +/- 6.7%) and partially inhibited IGF I mitogenesis (123% +/- 6%) (P < 0.05). The rate of PTH secretion was greater after IGF II stimulation than after IGF I stimulation.

CONCLUSIONS

IGFs I and II induce mitogenesis by different calcium signaling pathways. These data suggest that parathyroid cells may utilize different calcium signaling pathways to distinguish growth factors and serum calcium changes.

Serotonergic polymorphisms and psychotic disorders in populations from North Spain

There is strong biological evidence relating alterations in the serotonergic system with mental disorders. These alterations may be originated at the DNA level by sequence mutations that alter the functioning of serotonin receptors and transporter. To test this hypothesis we investigated three genetic variants of the 5-HT2A receptor (-1438G/A, 102T/C and His452Tyr) and two variants of the serotonin transporter (a VNTR in the second intron and a 44 bp insertion/delition in the promoter region of the gene) in a clinical sample recruited in a human isolate and in surrounding areas in Northern Spain (N = 257) and in ethnically matched controls (N = 334). No clear association was found between 5-HT2A variants and psychosis. However, marginal associations were observed between the 5-HTT LPR and VNTR variants and psychosis (P < or = 0.05) indicating a minor contribution to psychosis of genetic alterations in this gene.

Penetrating keratoplasty in children: visual and graft outcome

AIMS

To review factors affecting graft survival and determinants of visual acuity after penetrating keratoplasty in children.

METHODS

All cases of penetrating keratoplasty performed in an ophthalmic unit, in children aged less than 15 years at the time of operation, for the period 1984 to 2002 were included.

RESULTS

19 penetrating keratoplasties were done in 18 eyes of 16 children, age range 2 weeks to 14 years 8 months (mean 9.24 years), with mean follow up 6.6 years. 73.7% of grafts have remained clear for up to 14 years. Postoperative visual acuity among congenital indications for graft was better than 6/60 in only 14.2% of cases, but was better than or equal to 6/12 in all cases of keratoconus.

CONCLUSION

This series shows that prolonged corneal graft survival can be achieved in children, but successful restoration of visual acuity depends upon a period of normal visual development before the onset of corneal opacification.

Evidence implicating a mid-region sequence of IGFBP-3 in its specific IGF-independent actions

Insulin-like growth factor binding protein-3 (IGFBP-3) is one of six high affinity-binding proteins that share a common function in regulating the bioavailability of the insulin-like growth factors. The six binding proteins have highly conserved C- and N-terminals that are essential to this function. Additionally, they all have specific functions on cellular homeostasis independent to the regulation of the insulin-like growth factors. It has previously been shown that insulin-like growth factor binding protein-3 can accentuate UV-induced apoptosis in a human carcinoma cell line. Using the KYSE 190 oesophageal carcinoma cell line we have demonstrated that a 15 amino acid (aa) peptide that lies within the mid-region of the protein can mimic the effect of the intact protein. This region contains the serine residues Ser(111) and Ser(113). Using two protocols, we modified these serine residues and have shown that both phosphorylation and derivatization of IGFBP-3 can negate the accentuation of UV-induced cell death. These three independent pieces of evidence support the hypothesis that the variable mid-region is responsible for the specific pro-apoptotic functions of IGFBP-3, and suggest that phosphorylation may provide a mechanism for regulation of this action.

Differential interactions between IGFBP-3 and transforming growth factor-beta (TGF-beta) in normal vs cancerous breast epithelial cells

In addition to modulating insulin-like growth factors action, it is now clear that insulin-like growth factor-binding protein-3 also has intrinsic effects on cell growth and survival. We have compared the effects of insulin-like growth factor-binding protein-3 and transforming growth factor-beta on cell proliferation and death of Hs578T cells and the normal breast epithelial cell line, MCF-10A. The growth of MCF-10A cells was inhibited at low concentrations of insulin-like growth factor-binding protein-3 but stimulated at high concentrations. These differential effects were unaffected in the presence of an insulin-like growth factor-I receptor antagonist. A synthetic peptide corresponding to the serine phosphorylation domain of insulin-like growth factor-binding protein-3 (that does not bind to insulin-like growth factors) also mimicked these differential actions. The growth of both cell lines was significantly inhibited by transforming growth factor-beta, this was associated with a 14-fold increase of insulin-like growth factor-binding protein-3 secreted by the Hs578T cells but a five-fold decrease of insulin-like growth factor-binding protein-3 secreted by MCF-10A cells. Replacement doses of exogenous insulin-like growth factor-binding protein-3 overcame the transforming growth factor-beta-induced growth inhibition in the MCF-10A cells. Cell death induced by ceramide was significantly reduced by insulin-like growth factor-binding protein-3 in the MCF-10A cells and depleting insulin-like growth factor-binding protein-3 with transforming growth factor-beta in these cells consequently increased their susceptibility to ceramide. In contrast, insulin-like growth factor-binding protein-3 enhanced apoptosis induced by ceramide in the Hs578T cells but transforming growth factor-beta treated Hs578T cells were resistant to apoptosis. The addition of anti-sense mRNA to insulin-like growth factor-binding protein-3 significantly abrogated this effect of transforming growth factor-beta. These data indicate that insulin-like growth factor-binding protein-3 has intrinsic activity capable of inhibiting or enhancing the growth and survival of breast epithelial cells depending on the cell line and exposure to other cytokines.

LIBS using dual- and ultra-short laser pulses

Pre-ablation dual-pulse LIBS enhancement data for copper, brass and steel using ns laser excitation are reported. Although large enhancements are observed for all samples, the magnitude of the enhancement is matrix dependent. Whereas all of the dual-pulse studies used ns laser excitation we see interesting effects when using ps and fs laser excitation for single-pulse LIBS. LIBS spectra of copper using 1.3 ps and 140 fs laser pulses show much lower background signals compared to ns pulse excitation. Also, the atomic emission decays much more rapidly with time. Because of relatively low backgrounds when using ps and fs pulses, non-gated detection of LIBS is shown to be very effective. The plasma dissipates quickly enough using ps and fs laser pulses, that high pulse rates, up to 1,000 Hz, are effective for increasing the LIBS signal, for a given measurement time. Finally, a simple near-collinear dual-pulse fiber-optic LIBS probe is shown to be useful for enhanced LIBS measurements.

Changes in cytoplasmic calcium determine the secretory response to extracellular cations in human parathyroid cells: a confocal microscopy study using FM1-43 dye

Whether activation of the calcium receptor (CaR) modulates secretory events was investigated by real-time fluorescence and confocal microscopy using fura 2 and FM1-43 fluorescent dye. Two paradigms were used: human parathyroid cells, which are stimulated by a step from a high to a low extracellular calcium concentration ([Ca(2+)](ext)), and rMTC6-23 cells, a rat medullary thyroid carcinoma cell line whose secretion is stimulated by an increase in [Ca(2+)](ext). Parathyroid cells were dispersed from parathyroid adenomas removed from 18 patients with primary hyperparathyroidism. In both cell types, incubation with FM1-43 (2 microM) resulted in staining of the plasma membranes, which was rapidly increased following changes in [Ca(2+)](ext) known to stimulate secretion. A high [Ca(2+)](ext) and lanthanum (La(3+)) decreased the membrane-associated FM1-43 fluorescence. Prolonged incubation (5-30 min) in the presence of FM1-43 resulted in accumulation of the dye in the cytoplasm, its granular distribution suggesting targeting of the secretory compartment. These data suggest that FM1-43 fluorescence is determined by: (i) changes in cell membrane surface area associated with secretion-associated events, (ii) displacement/quenching by extracellular cations and (iii) endocytosis of the dye. In parathyroid cells, a rise in FM1-43 fluorescence occurred during incubation in a high (inhibitory) [Ca(2+)](ext) if the cytoplasmic calcium concentration ([Ca(2+)](i)) was decreased by the calcium chelator BAPTA/AM [bis-(o-aminophenoxy)ethane-N,N,N',N'-tetra-acetic acid tetrakis(acetoxymethyl ester)] (10-50 microM). Alternatively, the expected rise in FM1-43 fluorescence did not occur during incubation in a low (stimulatory) [Ca(2+)](ext) if [Ca(2+)](i) was increased by addition of the calcium ionophore A23187 (10-25 microM). These data suggest that [Ca(2+)](i), rather than the absolute value of [Ca(2+)](ext), is the main modulator of secretion from parathyroid cells.