Human IVIG treatment in a neurological disease model for Enterovirus A71 infection in 28-day-old AG129 mice

Enterovirus A71 can cause serious neurological disease in young children. Animal models for EV-A71 are needed to evaluate potential antiviral therapies. Existing models have limitations, including lack of lethality or crucial disease signs. Here we report the development of an EV-A71 model in 28-day-old mice. Virus was serially passaged until it produced consistent lethality and rear-limb paralysis. Onset of disease occurred between days 6-9 post-infection, with mortality following weight loss and neurological signs on days 9-14. In addition, a single administration of human intravenous immunoglobulin at doses of 200, 400 and 800 mg/kg at 4h post-infection was evaluated in the model. Protection from weight loss, neurological signs, and mortality (between 50 and 89%) were observed at doses of 400 mg/kg or greater. Based on these results, IVIG was selected for use as a positive control in this acute model, and suggest that IVIG is a potential therapeutic for EV-A71 infections.

Simultaneous imaging and diffraction in the dynamic diamond anvil cell

The ability to visualize a sample undergoing a pressure-induced phase transition allows for the determination of kinetic parameters, such as the nucleation and growth rates of the high-pressure phase. For samples that are opaque to visible light (such as metallic systems), it is necessary to rely on x-ray imaging methods for sample visualization. Here, we present an experimental platform developed at beamline P02.2 at the PETRA III synchrotron radiation source, which is capable of performing simultaneous x-ray imaging and diffraction of samples that are dynamically compressed in piezo-driven diamond anvil cells. This setup utilizes a partially coherent monochromatic x-ray beam to perform lensless phase contrast imaging, which can be carried out using either a parallel- or focused-beam configuration. The capabilities of this platform are illustrated by experiments on dynamically compressed Ga and Ar. Melting and solidification were identified based on the observation of solid/liquid phase boundaries in the x-ray images and corresponding changes in the x-ray diffraction patterns collected during the transition, with significant edge enhancement observed in the x-ray images collected using the focused-beam. These results highlight the suitability of this technique for a variety of purposes, including melt curve determination.

New dynamic diamond anvil cells for tera-pascal per second fast compression x-ray diffraction experiments

Fast compression experiments performed using dynamic diamond anvil cells (dDACs) employing piezoactuators offer the opportunity to study compression-rate dependent phenomena. In this paper, we describe an experimental setup which allows us to perform time-resolved x-ray diffraction during the fast compression of materials using improved dDACs. The combination of the high flux available using a 25.6 keV x-ray beam focused with a linear array of compound refractive lenses and the two fast GaAs LAMBDA detectors available at the Extreme Conditions Beamline (P02.2) at PETRA III enables the collection of x-ray diffraction patterns at an effective repetition rate of up to 4 kHz. Compression rates of up to 160 TPa/s have been achieved during the compression of gold in a 2.5 ms fast compression using improved dDAC configurations with more powerful piezoactuators. The application of this setup to low-Z compounds at lower compression rates is described, and the high temporal resolution of the setup is demonstrated. The possibility of applying finely tuned pressure profiles opens opportunities for future research, such as using oscillations of the piezoactuator to mimic propagation of seismic waves in the Earth.

A simple and portable multi-channel pyrometer allowing temperature measurements down to 800 K on the microsecond scale

The measurement of transient temperatures less than 1000 K for samples in laser-heated diamond anvil cells remains a challenge. Here we present the design and performance characteristics of a multi-channel pyrometer that works in the near-infrared from 1200 to 2000 nm. It has a relatively small footprint, is portable, requires only low voltage power supplies, and can report temperatures down to 800 K on the millisecond scale or faster. A single data point without averaging can be acquired in 14 µs (sampling rate of 7 kilosamples per second). In conjunction with a diamond anvil cell, the system delivers accurate and rapid measurements down to ∼830 K. The pyrometer has been successfully interfaced several times with the combined x-ray diffraction and laser heating system at the High Pressure Collaborative Access Team at the Advanced Photon Source at Argonne National Laboratories.

Evaluation of antiviral therapies in respiratory and neurological disease models of Enterovirus D68 infection in mice

Enterovirus D68 (EV-D68) is unique among enteroviruses because of the ability to cause severe respiratory disease as well as neurological disease. We developed separate models of respiratory and neurological disease following EV-D68 infection in AG129 mice that respond to antiviral treatment with guanidine. In four-week-old mice infected intranasally, EV-D68 replicates to high titers in lung tissue increasing the proinflammatory cytokines MCP-1 and IL-6. The respiratory infection also produces an acute viremia. In 10-day-old mice infected intraperitoneally, EV-D68 causes a neurological disease with weight-loss, paralysis, and mortality. In our respiratory model, treatment with guanidine provides a two-log reduction in lung virus titers, reduces MCP-1 and IL-6, and prevents histological lesions in the lungs. Importantly, viremia is prevented by early treatment with guanidine. In our neurological model, guanidine treatment protects mice from weight-loss, paralysis, and mortality. These results demonstrate the utility of these models for evaluation of antiviral therapies for EV-D68 infection.

Single crystal toroidal diamond anvils for high pressure experiments beyond 5 megabar

Static compression experiments over 4 Mbar are rare, yet critical for developing accurate fundamental physics and chemistry models, relevant to a range of topics including modeling planetary interiors. Here we show that focused ion beam crafted toroidal single-crystal diamond anvils with ~9.0 μm culets are capable of producing pressures over 5 Mbar. The toroidal surface prevents gasket outflow and provides a means to stabilize the central culet. We have reached a maximum pressure of ~6.15 Mbar using Re as in situ pressure marker, a pressure regime typically accessed only by double-stage diamond anvils and dynamic compression platforms. Optimizing single-crystal diamond anvil design is key for extending the pressure range over which studies can be performed in the diamond anvil cell.

Static pressures exceeding 4 million atmospheres are extremely challenging to achieve, but are necessary for the study of matter that exists under these conditions in natural environments. Here, diamonds anvils with a toroidal design are demonstrated to sustain over 6 million atmospheres in a diamond anvil cell.

Evaluation of cell viability dyes in antiviral assays with RNA viruses that exhibit different cytopathogenic properties

Studies were conducted to determine the performance of four dyes in assessing antiviral activities of compounds against three RNA viruses with differing cytopathogenic properties. Dyes included alamarBlue® measured by absorbance (ALB-A) and fluorescence (ALB-F), neutral red (NR), Viral ToxGlo™ (VTG), and WST-1. Viruses were chikungunya, dengue type 2, and Junin, which generally cause 100, 80-90, and 50% maximal cytopathic effect (CPE), respectively, in Vero or Vero 76 cells Compounds evaluated were 6-azauridine, BCX-4430, 3-deazaguanine, EICAR, favipiravir, infergen, mycophenolic acid (MPA), ribavirin, and tiazofurin. The 50% virus-inhibitory (EC50) values for each inhibitor and virus combination did not vary significantly based on the dye used. However, dyes varied in distinguishing the vitality of virus-infected cultures when not all cells were killed by virus infection. For example, VTG uptake into dengue-infected cells was nearly 50% when visual examination showed only 10-20% cell survival. ALB-A measured infected cell viability differently than ALB-F as follows: 16% versus 32% (dengue-infected), respectively, and 51% versus 72% (Junin-infected), respectively. Cytotoxicity (CC50) assays with dyes in uninfected proliferating cells produced similar CC50 values for EICAR (1.5-8.9μM) and MPA (0.8-2.5μM). 6-Azauridine toxicity was 6.1-17.5μM with NR, VTG, and WST-1, compared to 48-92μM with ALB-A and ALB-F (P<0.001). Curiously, the CC50 values for 3-deazaguanine were 83-93μM with ALB-F versus 2.4-7.0μM with all other dyes including ALB-A (P<0.001). Overall, ALB minimized the toxicities detected with these two inhibitors. Because the choice of dyes affected CC50 values, this impacted on the resulting in vitro selectivity indexes (calculated as CC50/EC50 ratio).

Susceptibilities of enterovirus D68, enterovirus 71, and rhinovirus 87 strains to various antiviral compounds

Compounds were evaluated for antiviral activity in rhabdomyosarcoma (RD) cells against a recent 2014 clinical isolate of enterovirus D68 (EV-D68), a 1962 strain of EV-68D, rhinovirus 87 (RV-87, serologically the same as EV-D68), and enterovirus 71 (EV-71). Test substances included known-active antipicornavirus agents (enviroxime, guanidine HCl, pirodavir, pleconaril, and rupintrivir), nucleobase/nucleoside analogs (3-deazaguanine and ribavirin), and three novel epidithiodiketopiperazines (KCN-2,2'-epi-19, KCN-19, and KCN-21). Of these, rupintrivir was the most potent, with 50% inhibition of viral cytopathic effect (EC50) and 90% inhibition (EC90) of virus yield at 0.0022-0.0053 μM against EV-D68. Enviroxime, pleconaril and the KCN compounds showed efficacy at 0.01-0.3 μM; 3-deazaguanine and pirodavir inhibited EV-D68 at 7-13 μM, and guanidine HCl and ribavirin were inhibitory at 80-135 μM. Pirodavir was active against EV-71 (EC50 of 0.78 μM) but not against RV-87 or EV-D68, and all other compounds were less effective against EV-71 than against RV-87 and EV-D68. The most promising compound inhibiting both virus infections at low concentrations was rupintrivir. Antiviral activity was confirmed for the ten compounds in virus yield reduction (VYR) assays in RD cells, and for enviroxime, guanidine HCl, and pirodavir by cytopathic effect (CPE) assays in A549, HeLa-Ohio-1, and RD cells. These studies may serve as a basis for further pre-clinical discovery of anti-enterovirus inhibitors. Furthermore, the antiviral profiles and growth characteristics observed herein support the assertion that EV-D68 should be classified together with RV-87.

Strength and Debye temperature measurements of cerium across the γ → α volume collapse: the lattice contribution

The longitudinal and transverse sound speeds, cL and cT, of polycrystalline cerium were measured under pressure across the iso-structural γ-α phase transition at 0.75 GPa to beyond 3 GPa. In contrast to previous methods all quantities were directly obtained and no assumptions were made about the size of the volume collapse. Up to the transition our values for cL are in excellent agreement with previous ones, while our values for cT are significantly lower. We deduce values for the adiabatic bulk modulus BS, the shear modulus [Formula: see text], and the pressure dependent Debye temperature, ΘD(p). ΘD(p) is in good agreement with recent results derived from phonon dispersion measurements on single crystals. The ratio of the Debye temperature values bracketing the transition indicates a lattice contribution to the entropy change across the volume collapse, ΔSvib(γ → α) ≈ (0.68 ± 0.06)kB, consistent with previous results obtained by neutron scattering, but significantly larger than other previously determined values.

A versatile medium-resolution x-ray emission spectrometer for diamond anvil cell applications

We present design and performance details for a polycapillary-coupled x-ray spectrometer that provides very high collection efficiency at a moderate energy resolution suitable for many studies of nonresonant x-ray emission spectroscopy, especially for samples of heavy elements under high pressures. Using a single Bragg analyzer operating close to backscattering geometry so as to minimize the effect of the weak divergence of the quasicollimated exit beam from the polycapillary optic, this instrument can maintain a typical energy resolution of 5 eV over photon energies from 5 keV to 10 keV. We find dramatically improved count rates as compared to a traditional higher-resolution instrument based on a single spherically bent crystal analyzer.

X-ray emission spectroscopy of cerium across the γ-α volume collapse transition

High-pressure x-ray emission measurements are used to provide crucial evidence in the longstanding debate over the nature of the isostructural (α, γ) volume collapse in elemental cerium. Extended local atomic model calculations show that the satellite of the Lγ emission line offers direct access to the total angular momentum observable (J(2)). This satellite experiences a 30% steplike decrease across the volume collapse, validating the Kondo model in conjunction with previous measurements. Direct comparisons are made with previous predictions by dynamical mean field theory. A general experimental methodology is demonstrated for analogous work on a wide range of strongly correlated f-electron systems.

Discovering pathways of sarcopenia in older adults: a role for insulin resistance on mitochondria dysfunction

The precise cause of sarcopenia, skeletal muscle loss and strength, in older persons is unknown. However, there is a strong evidence for muscle loss due to insulin resistance as well as mitochondrial dysfunction over aging. Considering that epidemiological studies have underlined that insulin resistance may have a specific role on skeletal muscle fibre atrophy and mitochondrial dysfunction has also been extensively shown to have a pivotal role on muscle loss in older persons, a combined pathway may not be ruled out. Considering that there is growing evidence for an insulin-related pathway on mitochondrial signaling, we hypothesize that a high degree of insulin resistance will be associated with the development of sarcopenia through specific alterations on mitochondrial functioning. This paper will highlight recent reviews regarding the link between skeletal muscle mitochondrial dysfunction and insulin resistance. We will specifically emphasize possible steps involved in sarcopenia over aging, including potential biomolecular mechanisms of insulin resistance on mitochondrial functioning.

Frailty and muscle metabolism dysregulation in the elderly

The frailty syndrome is increasingly recognized by geriatricians to identify elders at an extreme risk of adverse health outcomes. The physiological changes that result in frailty are complex and up to now have been extremely difficult to characterize due to the frequent coexistence of acute and chronic illness. Frailty is characterized by an decline in the functional reserve with several alterations in diverse physiological systems, including lower energy metabolism, decreased skeletal muscle mass and quality, altered hormonal and inflammatory functions. This altered network leads to an extreme vulnerability for disease, functional dependency, hospitalization and death. One of the most important core components of the frailty syndrome is a decreased reserve in skeletal muscle functioning which is clinically characterized by a loss in muscle mass and strength (sarcopenia), in walking performance and in endurance associated with a perception of exhaustion and fatigue. There are a number of physiological changes that occur in senescent muscle tissues that have a critical effect on body metabolism. The causes of sarcopenia are multi-factorial and can include disuse, changing hormonal function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. In this review, we will explore the dysregulation of some biological mechanisms that may contribute to the pathophysiology of the frailty syndrome through age-related changes in skeletal muscle mass and function.

Cachexia and aging: an update based on the Fourth International Cachexia Meeting

This manuscript highlights the new developments in the pathophysiology of anorexia, cachexia and sarcopenia, based on presentations given at the Fourth International Cachexia Meeting. It stresses the importance of these conditions in older persons.

Thermal signatures of the Kondo volume collapse in cerium

X-ray diffraction measurements of cerium in the vicinity of the isostructural gamma-alpha transition have been performed with high precision and accuracy from room temperature to almost 800 K. The disputed location of the critical point has been found to occur at 1.5+/-0.1 GPa and 480+/-10 K. The data are well fit by the Kondo volume collapse model plus a quasiharmonic representation of the phonons. The resultant free energy is validated against data for the thermodynamic Grüneisen parameter and, beyond the dominant spin-fluctuation contribution, indicates a dramatic change in the lattice Grüneisen parameter across the transition.

New cubic phase of Li3N: stability of the N3- ion to 200 GPa

Diamond-anvil cell experiments augmented by first-principles calculations have found a remarkable stability of the N(3-) ion in Li3N to a sixfold volume reduction. A new (gamma) phase is discovered above 40(+/-5) GPa, with an 8% volume collapse and a band gap quadrupling at the transition determined by synchrotron x-ray diffraction and inelastic x-ray scattering. gamma-Li(3)N (Fm3m, Li(3)Bi-like structure) remains stable up to 200 GPa, and calculations do not predict metallization until approximately 8 TPa. The high structural stability, wide band gap, and simple electronic structure make this N(3-) based system analogous to lower valency compounds (MgO, NaCl, Ne), meriting its use as an internal pressure standard.

Protein nutrition and resistance exercise

Strength conditioning will result in an increase in muscle size and this increase in size is largely the result of increased contractile proteins. The mechanisms by which the mechanical events stimulate an increase in RNA synthesis and subsequent protein synthesis are not well understood. Lifting weight requires that a muscle shorten as it produces force (concentric contraction). Lowering the weight forces the muscle to lengthen as it produces force (eccentric contraction). Eccentric contractions produce ultrastructural damage that may stimulate increased muscle protein turnover and a cascade of metabolic events which is similar to an acute phase response and includes complement activation, mobilization of neutrophils, increased circulating and skeletal muscle interleukin-1 and macrophage accumulation. While endurance exercise increases the oxidation of essential amino acids and increases the requirement for dietary protein, resistance exercise results in a decrease in nitrogen excretion, lowering dietary protein needs. Research has indicated that increased dietary protein intake (up to 1.6 g protein x kg(-1) x d(-1)) may enhance the hypertrophic response to resistance exercise. It has also been demonstrated that in very old men and women the use of a protein-calorie supplement was associated with greater strength and muscle mass gains than did the use of placebo.

Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis

We examined the effect of two commonly consumed over-the-counter analgesics, ibuprofen and acetaminophen, on muscle protein synthesis and soreness after high-intensity eccentric resistance exercise. Twenty-four males (25 +/- 3 yr, 180 +/- 6 cm, 81 +/- 6 kg, and 17 +/- 8% body fat) were assigned to one of three groups that received either the maximal over-the-counter dose of ibuprofen (IBU; 1,200 mg/day), acetaminophen (ACET; 4,000 mg/day), or a placebo (PLA) after 10-14 sets of 10 eccentric repetitions at 120% of concentric one-repetition maximum with the knee extensors. Postexercise (24 h) skeletal muscle fractional synthesis rate (FSR) was increased 76 +/- 19% (P < 0.05) in PLA (0.058 +/- 0.012%/h) and was unchanged (P > 0.05) in IBU (35 +/- 21%; 0.021 +/- 0.014%/h) and ACET (22 +/- 23%; 0.010 +/- 0.019%/h). Neither drug had any influence on whole body protein breakdown, as measured by rate of phenylalanine appearance, on serum creatine kinase, or on rating of perceived muscle soreness compared with PLA. These results suggest that over-the-counter doses of both ibuprofen and acetaminophen suppress the protein synthesis response in skeletal muscle after eccentric resistance exercise. Thus these two analgesics may work through a common mechanism to influence protein metabolism in skeletal muscle.

Synthesis of arene-soluble mixed-metal uranium/zirconium complexes using the dizirconium nonaisopropoxide ligand

The utility of polydentate monoanionic [Zr(2)(O(i)Pr)(9)](-) (dzni) in generating arene-soluble, mixed-metal Zr/U complexes is described. K[Zr(2)(O(i)Pr)(9)] reacts readily with UI(3)(THF)(4) to form [Zr(2)(O(i)Pr)(9)]UI(2)(THF), 1, in >90% yield. The integrity of the [[Zr(2)(O(i)Pr)(9)]U](2+) unit in 1 was examined by the reaction of 1 with K(2)C(8)H(8), which formed the organometallic complex [Zr(2)(O(i)Pr)(9)]U(C(8)H(8)), 2. In contrast, the reaction of K[Zr(2)(O(i)Pr)(9)] with UCl(4) did not form U(IV)-dzni complexes, and only the ligand exchange product, [UCl(2)(O(i)Pr)(2)(DME)](2), 3, was isolated. The effect of the dzni ligand on the electrochemistry and near-infrared spectroscopy of U(III) is also described.

Synthesis and structure of tris(alkyl- and silyl-tetramethylcyclopentadienyl) complexes of lanthanum

In efforts to make sterically crowded tris(peralkylcyclopentadienyl) complexes of lanthanum for the exploration of sterically induced reduction chemistry with a diamagnetic system, the synthesis of (C(5)Me(4)R)(3)La complexes has been pursued with R = Me, Et, (i)Pr, and SiMe(3). The complexes were synthesized in four steps: reaction of LaCl(3) with KC(5)Me(4)R to form (C(5)Me(4)R)(2)LaCl(2)K(THF)(2), addition of allylmagnesium chloride to make (C(5)Me(4)R)(2)La(C(3)H(5)), protonolysis with Et(3)NHBPh(4) to make [(C(5)Me(4)R)(2)La][BPh(4)], and finally the replacement of BPh(4)(-) with C(5)Me(4)R(-) using KC(5)Me(4)R to make (C(5)Me(4)R)(3)La. X-ray crystallographic data were obtainable on the (C(5)Me(4)R)(3)La complexes for R = Me, Et, (i)Pr, and SiMe(3). In each complex, the three C(5)Me(4)R ring centroids define a trigonal planar geometry around La. The average La-(ring centroid) distances are 2.64, 2.65, 2.66, and 2.69 A for the Me, Et, (i)Pr, and SiMe(3) structures, respectively, with La-C distances ranging from 2.857 (3) to 3.029 (2) A. Despite the steric crowding, ligand exchange can be observed by NMR spectroscopy.

Human aging is associated with altered TNF-alpha production during hyperglycemia and hyperinsulinemia

Changes in tumor necrosis factor-alpha (TNF-alpha) may provide a mechanism to explain impaired glucose metabolism with advancing age. Hyperglycemic clamps (180 min, 10 mM) were performed on seven older [67 +/- 2 yr; body mass index (BMI) 24.7 +/- 1.0 kg/m(2)] and seven younger (22 +/- 1 yr; BMI 21.8 +/- 1.3 kg/m(2)) healthy sedentary males with normal glucose tolerance. TNF-alpha production at basal and at the end of 180 min of hyperglycemia and hyperinsulinemia was measured ex vivo from lipopolysaccharide-stimulated (1 ng/ml) peripheral blood mononuclear cells. Plasma glucose, insulin, and C-peptide levels were similar in both groups at basal and during the last 30 min of the hyperglycemic clamp. Glucose infusion rates were lower (P < 0.004) in the older group compared with the young, indicating decreased insulin action among the older subjects. Basal TNF-alpha secretion was similar in older and younger subjects. TNF-alpha was suppressed (P < 0.02) in the younger group (230 +/- 46 vs. 126 +/- 49 pg/ml; basal vs. clamp) but not in the older group (153 +/- 37 vs. 182 +/- 42 pg/ml), with significant group differences in response (P < 0.05). A significant correlation was observed between the level of suppression in TNF-alpha production and insulin action (Kendall's rank, tau = 0.40, P < 0.05). Furthermore, the TNF-alpha response during the clamp was related to fat mass (r = 0.88, P < 0.001) and abdominal fat (r = 0.81, P < 0.003). In conclusion, these findings suggest a possible mechanism by which TNF-alpha may modulate glucose metabolism in younger people. Aging and modest increases in adiposity prevent the "normal" suppression of TNF-alpha production after a sustained postprandial-like hyperglycemic-hyperinsulinemic stimulus, which may contribute in part to the decline in insulin sensitivity in older men.

Molecular characteristics of aged muscle reflect an altered ability to respond to exercise

Studies have been performed in humans to identify changes in gene expression that may account for the relatively weak and variable response of aged muscle to resistance exercise. The gene expression profile of skeletal muscle from elderly (62-75 years old) compared to younger (20-30 years old) men demonstrated elevated expression of genes typical of a stress or damage response. The expression of the majority of these genes was unaffected by a single bout of high-intensity resistance exercise in elderly subjects but was altered acutely by exercise in younger subjects so as to approach the pre-exercise levels observed in older subjects. The inability of muscle from elderly subjects to respond to resistance exercise was also apparent in the expression of inflammatory response genes, which increased within 24 hours of the exercise bout only in younger subjects. Othergenes with potentially important roles in the adaptation of muscle to exercise, showed a similar or even more robust response in older compared to younger subjects. Taken together, these results may help to explain the variable hypertrophic response of muscle from older individuals to resistance training.

The tetramethylpiperidinyl-1-oxide anion (TMPO-) as a ligand in lanthanide chemistry: synthesis of the per(TMPO-) complex [(ONC5H6Me4)2Sm(mu-ONC5H6Me4)]2

(C5Me5)3Sm reacts with the free radical 2,2,6,6-tetramethylpiperidinyl-1-oxy (TMPO) to form (C5Me5)2 and the per nitroxide [(eta 1-ONC5H6Me4)2Sm(mu-eta 1:eta 2-ONC5H6Me4)]2.

Short-term moderate weight loss and resistance training do not affect insulin-stimulated glucose disposal in postmenopausal women

OBJECTIVES

Moderate weight loss and exercise have been proposed as important tools in the treatment and prevention of type 2 diabetes. Therefore, we tested the hypothesis that short-term (4 weeks) moderate energy restriction (-750 kcal/day) would result in a significant increase in insulin-stimulated glucose disposal (40 mU x m(-2) x min(-1) hyperinsulinemic-euglycemic clamp) in moderately overweight postmenopausal women and that when combined with resistance training (RT) an even greater effect would be seen.

RESEARCH DESIGN AND METHODS

Older women were randomly assigned to energy restriction (WLoss group; n = 9) or energy restriction plus RT (RT + WLoss group; n = 10).

RESULTS

For the WLoss versus the RT + WLoss groups, changes in body weight (-3.0 +/- 0.2 kg vs. -3.2 +/- 0.3 kg), fat mass (FM) (-3.0 +/- 0.3 kg vs. -3.2 +/- 0.3 kg), and percent body fat (BF) (-2.1 +/- 0.4 vs. -2.4 +/- 0.3%) were not different between groups. Muscle mass (group-by-time interaction, P = 0.04) was preserved in RT + WLoss (0.40 +/- 0.40 kg) and reduced in WLoss (-0.64 +/- 0.18 kg). There were no changes in fat-free mass (FFM) and waist-to-hip ratio in either group. Whole body glucose disposal (WLoss 6.14 +/- 0.57 vs. 6.03 +/- 0.53, RT + WLoss 5.85 +/- 0.60 vs. 6.09 +/- 0.56 mg/kg of FFM/min) did not change in either group.

CONCLUSIONS

The results of this study demonstrate that short-term energy restriction resulting in moderate decreases in body weight (4.0 +/- 0.3%) and FM (8.2 +/- 0.7%) did not improve insulin-stimulated glucose disposal. The addition of RT to the hypoenergetic diet preserved muscle mass but provided no synergistic effect on insulin action. These results suggest that a greater change in body weight or FM may be necessary to observe a significant improvement in insulin action.

Muscle strength and fatigue during isokinetic exercise in individuals with multiple sclerosis

PURPOSE

To compare muscle strength and muscle fatigue of the knee extensors and flexors in individuals with multiple sclerosis (MS) and non-MS control subjects and to evaluate the reliability of muscle strength and muscle fatigue testing in these individuals.

METHODS

Thirty individuals (13 women and 2 men for both MS and control groups), age (mean +/- SD) 38.8 +/- 10 for MS and 33.1 +/- 7.6 yr for controls, participated in this investigation. Peak torque was measured on two occasions separated by approximately 7 d at 30, 60, 90, 120, 180 degrees.s(-1) with 2 min of recovery between each bout. The nondominant leg was tested followed by the dominant leg after 10 min of recovery. Subjects then performed three bouts of 30 flexions and extensions of the dominant leg at 180 degrees.s(-1) with 1 min of recovery between bouts.

RESULTS

The reliability of muscle torque was very high for individuals with MS (only 1 of 20 measurements with an ICC below 0.900). Total work was also highly reliable for MS, but the Fatigue Index (work during the last 15 contractions/work during the first 15 contractions) x 100 was not. Peak torque adjusted for age, body mass, and fat free mass (measured by whole body plethysmography; the Bod Pod; Life Measurement Instruments; Concord, CA) was significantly greater for controls than for MS for three of four lower body muscle groups tested. For the muscle fatigue test (3 bouts of 30 knee extensions and flexions at 180 degrees.s(-1)), the Fatigue Index was greater (less fatigue) for the knee extensors for controls than MS for the third bout. For flexion, the Fatigue Index was greater for controls than MS over the three bouts (group effect). Total work was significantly greater for controls than MS for the flexors (group effect) and approached significance for the extensors.

CONCLUSIONS

Individuals with MS were weaker than controls when data were adjusted for age, body mass, and fat free mass. This latter finding (force relative to age and fat free mass) suggests that there is a reduced ability to activate muscle mass in MS and/or the muscle mass of individuals with MS is of lower quality (i.e., reduced force/unit muscle mass) than controls.

Skeletal muscle PGF(2)(alpha) and PGE(2) in response to eccentric resistance exercise: influence of ibuprofen acetaminophen

PGs have been shown to modulate skeletal muscle protein metabolism as well as inflammation and pain. In nonskeletal muscle tissues, the over the counter analgesic drugs ibuprofen and acetaminophen function through suppression of PG synthesis. We previously reported that ibuprofen and acetaminophen inhibit the normal increase in skeletal muscle protein synthesis after high intensity eccentric resistance exercise. The current study examined skeletal muscle PG levels in the same subjects to further investigate the mechanisms of action of these drugs in exercised skeletal muscle. Twenty-four males (25 +/- 3 yr) were assigned to 3 groups that received the maximal over the counter dose of ibuprofen (1200 mg/d), acetaminophen (4000 mg/d), or a placebo after 10-14 sets of 10 eccentric repetitions at 120% of concentric 1 repetition maximum using the knee extensors. Preexercise and 24 h postexercise biopsies of the vastus lateralis revealed that the exercise-induced change in PGF(2alpha) in the placebo group (77%) was significantly different (P < 0.05) from those in the ibuprofen (-1%) and acetaminophen (-14%) groups. However, the exercise-induced change in PGE(2) in the placebo group (64%) was only significantly different (P < 0.05) from that in the acetaminophen group (-16%). The exercise-induced changes in PGF(2alpha) and PGE(2) were not different between the ibuprofen and acetaminophen groups. These results suggest that ibuprofen and acetaminophen have a comparable effect on suppressing the normal increase in PGF(2alpha) in human skeletal muscle after eccentric resistance exercise, which may profoundly influence the anabolic response of muscle to this form of exercise.

Nutrition, physical activity, and quality of life in older adults: summary

If health-related quality of life--and not longevity--is the key goal for health promotion, then it is captured only partly by the existing mortality and morbidity indexes. Researchers now urge that government agencies and health care providers begin collecting quality-of-life data on the populations they serve. Adding life to years, not years to life, is the current agenda for productive and successful aging. Policies and programs on aging are increasingly focused on identifying ways to improve quality of life and health status rather than just extending life span. In the Healthy People 2000 report, the chief goal of health promotion was to increase the span of healthy life. The focus was on mortality and morbidity data and symptom checklists as the principal measures of ill health. In contrast, the new emphasis in the Healthy People 2010 report is on quality of life and overall well-being. Helping people to increase life expectancy and improve their quality of life is the primary goal of the Healthy People 2010 report. The authors of this special issue of the Journals of Gerontology: Biological Sciences and Medical Sciences are united in the belief that optimal nutrition and physical activity make a significant contribution to the overall quality of life at any age and especially for older adults. The key research challenge lies in deciding which aspects of improved fitness, nutrition, and diet contribute the most to quality-of-life measures. We have attempted to provide a comprehensive review of research on exercise, nutrition, diet, and health in elderly adults. Past studies on diet, nutrition, and fitness have largely addressed biomedical outcomes, pointing to substantial benefits in physical functioning, remission of disease symptoms, and improved health. This special issue goes a step further in assessing the effect of improved nutrition and physical activity on the global quality of life and its four principal domains. Although links between diet and exercise and chronic disease risks have been well documented, more needs to be known about motivations for behavioral change and perceived benefits as assessed using quality-of-life measures. No single segment of our society can benefit more from regularly performed exercise and improved diet than elderly adults. These important articles provide a link between diet and exercise and quality-of-life issues, as outlined in the Healthy People 2010 report.

Effects of a moderate glycemic meal on exercise duration and substrate utilization

PURPOSE

To determine whether eating a breakfast cereal with a moderate glycemic index could alter substrate utilization and improve exercise duration.

METHODS

Six active women (age, 24 +/- 2 yr; weight, 62.2 +/- 2.6 kg; VO(2peak), 46.6 +/- 3.8 mL x kg(-1) x min(-1)) ate 75 g of available carbohydrate in the form of regular whole grain rolled oats (RO) mixed with 300 mL of water or water alone (CON). The trials were performed in random order and the meal or water was ingested 45 min before performing cycling exercise to exhaustion (60% of VO(2peak)). Blood samples were drawn for glucose, glucose kinetics, free fatty acids (FFA), glycerol, insulin, epinephrine (EPI), and norepinephrine (NE) determination. A muscle biopsy was obtained from the vastus lateralis muscle before the trial and immediately after exercise for glycogen determination. Glucose kinetics (Ra) were determined using a [6,6-(2)H] glucose tracer.

RESULTS

Compared with CON, plasma FFA and glycerol levels were suppressed (P < 0.05) during the first 120 min of exercise for the RO trial. Respiratory exchange ratios (RER) were also higher (P < 0.05) for the first 120 min of exercise for the RO trial. At exhaustion, glucose, insulin, FFA, glycerol, EPI, NE, RER, and muscle glycogen were not different between trials. Glucose Ra was greater (P < 0.05) during the RO trial compared with CON (2.36 +/- 0.22 and 1.92 +/- 0.27 mg x kg(-1) x min(-1), respectively). Exercise duration was 5% longer during RO, but the mean times were not significantly different (253.6 +/- 6 and 242.0 +/- 15 min, respectively).

CONCLUSIONS

Increased hepatic glucose output before fatigue provides some evidence of glucose sparing after the breakfast cereal trial. However, exercise duration was not significantly altered, possibly because of the sustained suppression of lipid metabolism and increased carbohydrate utilization throughout much of the exercise period.

Resistance training affects iron status in older men and women

OBJECTIVE

To examine the effects of resistance training on hematological and selected indices of iron status in 17 women aged 54-71 years and 18 men aged 56-69 years.

DESIGN

Tests and evaluations were done before and after all subjects participated in a resistance-training program twice weekly for 12 weeks.

RESULTS

The resistance training was effective as evidenced by increases in skeletal muscle strength of 20 +/- 9% and 23 +/- 13% for the men and women, respectively. Hematological parameters and serum iron concentrations were within normal clinical ranges and were unchanged by resistance training for both the men and the women. Total iron binding capacity (TIBC) and transferrin saturation were also unaffected by resistance training in the women but were significantly affected in the men. The men showed a decreased TIBC (p < .0001) and an increased transferrin saturation (p = .050). Serum ferritin concentrations decreased significantly in the women (p = .041) but were unchanged in the men. Transferrin receptor concentrations were unaffected by resistance training in the women but increased significantly in the men (p = .030).

CONCLUSIONS

With resistance training, iron status of older men and women changes in a sex specific way.

Effects of moderate and high glycemic index meals on metabolism and exercise performance

The purpose of this study was to determine whether pre-exercise ingestion of meals with moderate and high glycemic indexes (GI) affects glucose availability during exercise and exercise performance time. Six male volunteers (22 +/- 1 years; 80.4 +/- 3.7 kg; VO(2peak), 54.3 +/- 1.2 ml. kg(-1). min(-1)) ingested 75 g of carbohydrate in the form of 2 different breakfast cereals, rolled oats (moderate GI, approximately 61; MOD-GI) or puffed rice (high GI, approximately 82; HI-GI), combined with 300 mL of water; or water alone (control). The trials were randomized, and the meals were ingested 45 minutes before the subjects performed cycling exercise (60% VO(2peak)) to exhaustion. Venous blood samples were drawn to measure glucose, free fatty acids (FFAs), glycerol, insulin (INS), epinephrine (EPI) and norepinephrine (NE) concentrations. A muscle biopsy specimen was obtained from the vastus lateralis before the meal and immediately after exercise for glycogen determination. Before exercise, both test meals elicited significant (P <.05) hyperglycemia and hyperinsulinemia compared with control. The glycemic response was higher (P <.05) at the start of exercise after the HI-GI meal than after the control. During exercise, plasma glucose levels were higher (P <.05) at 60 (5.2 +/- 0.1, 4.2 +/- 0.2, and 4.6 +/- 0.1 mmol. L(-1)) and 90 (4.8 +/- 0.1, 4.1 +/- 0.1, and 4.3 +/- 0.1 mmol. L(-1)) minutes after the MOD-GI meal than after either the HI-GI or control. Total carbohydrate oxidation was greater (P <.05) during the MOD-GI trial than in control and was directly correlated with exercise performance time (r =.95, P <.0001). Pre-exercise plasma FFA levels were suppressed (P <.05) 30 and 45 minutes after ingestion of the HI-GI meal and 45 minutes after the MOD-GI meal compared with control. At 30, 60, and 120 minutes of exercise, FFAs remained suppressed (P <.05) for both test meals compared with control. At exhaustion, plasma glucose, INS, FFA, glycerol, EPI, and NE levels and muscle glycogen use were not different for all trials. Exercise time was prolonged (P <.05) after the MOD-GI meal compared with control, but the HI-GI trial was not different from control (MOD-GI, 165 +/- 11; HI-GI, 141 +/- 8; control, 134 +/- 13 minutes). Thus, in contrast to the HI-GI meal or control, the MOD-GI breakfast cereal ingested 45 minutes before exercise enhanced performance time, maintained euglycemia for a longer period during exercise, and resulted in greater total carbohydrate oxidation during the exercise bout. We conclude that a MOD-GI meal provides a significant performance and metabolic advantage when consumed 45 minutes before exercise.

The recommended dietary allowance for protein may not be adequate for older people to maintain skeletal muscle

BACKGROUND

Inadequate dietary protein intake results in loss of skeletal muscle mass. Some shorter-term nitrogen balance studies suggest that the Recommended Dietary Allowance (RDA) of protein may not be adequate for older people. The aim of this study was to assess the adequacy of the RDA of protein for older people by examining longer-term responses in urinary nitrogen excretion, whole-body protein metabolism, whole-body composition, and mid-thigh muscle area.

METHODS

This was a 14-week precisely controlled diet study. Ten healthy, ambulatory men and women, aged 55 to 77 years, were provided eucaloric diets that contained 0.8 g protein.kg(-1).day(-1). The study was conducted at a General Clinical Research Center using an outpatient setting for 11 weeks and an inpatient setting for 3 weeks. The main outcome measures included urinary nitrogen excretion, postabsorptive and postprandial whole-body leucine kinetics via infusion of L-[1-(13)C]-leucine, whole-body density via hydrostatic weighing, total body water via deuterium oxide dilution, and mid-thigh muscle area via computed tomography scans.

RESULTS

Mean urinary nitrogen excretion decreased over time from Weeks 2 to 8 to 14 (p =.025). At Week 14, compared with Week 2, there were no changes in postabsorptive or postprandial leucine kinetics (turnover, oxidation, incorporation into protein via synthesis, release via breakdown, or balance). Whole-body composition (% body fat, fat-free mass, and protein + mineral mass) did not change over time in these weight-stable subjects. Mid-thigh muscle area was decreased by -1.7 +/- 0.6 cm(2) (p =.019) at Week 14 compared with Week 2. The loss of mid-thigh muscle area was associated with the decrease in urinary nitrogen excretion (Spearman r =.83, p =.010).

CONCLUSIONS

The maintenance of whole-body leucine metabolism and whole-body composition is generally consistent with a successful adaptation to the RDA for protein. However, the decrease in mid-thigh muscle area and the association with decreased urinary nitrogen excretion are consistent with a metabolic accommodation. These results suggest that the RDA for protein may not be adequate to completely meet the metabolic and physiological needs of virtually all older people.

Longitudinal muscle strength changes in older adults: influence of muscle mass, physical activity, and health

The longitudinal changes in isokinetic strength of knee and elbow extensors and flexors, muscle mass, physical activity, and health were examined in 120 subjects initially 46 to 78 years old. Sixty-eight women and 52 men were reexamined after 9.7 +/- 1.1 years. The rates of decline in isokinetic strength averaged 14% per decade for knee extensors and 16% per decade for knee flexors in men and women. Women demonstrated slower rates of decline in elbow extensors and flexors (2% per decade) than men (12% per decade). Older subjects demonstrated a greater rate of decline in strength. In men, longitudinal rates of decline of leg muscle strength were approximately 60% greater than estimates from a cross-sectional analysis in the same population. The change in leg strength was directly related to the change in muscle mass in both men and women, and it was inversely related to the change in medication use in men. Physical activity declined yet was not directly associated with strength changes. Although muscle mass changes influenced the magnitude of the strength changes over time, strength declines in spite of muscle mass maintenance or even gain emphasize the need to explore the contribution of other cellular, neural, or metabolic mediators of strength changes.

Marginal protein intake results in reduced plasma IGF-I levels and skeletal muscle fiber atrophy in elderly women

We investigated the effects of dietary protein on plasma IGF-I levels and muscle fiber cross-sectional area (CSA). Twelve healthy elderly women were randomly assigned to a weight-maintaining diet containing either 1.47 (marginal) or 2.94 (adequate) g protein/kg body cell mass (BCM)/d, (0.45 and 0.92 g/kg body weight/d, respectively) for 10wks. Plasma IGF-I levels and muscle fiber areas and distributions were evaluated at baseline and 10wks. After 10wks, both IGF-I and type I fiber CSA had declined significantly in subjects fed the marginal diet (30.1+/-2.1% and 32.7+/-7.9%, respectively) while they increased in those fed the adequate diet (19.5+/-7.0% and 22.3+/-7.5%, for IGF-I and type I CSA, respectively). The change in IGF-I was the only significantly associated with the change in type I fiber CSA (r2=0.70; p<0.03). These findings show that marginal dietary protein intakes will result in losses of muscle mass in the elderly and suggest a role for plasma IGF-I as a biochemical marker for the histological changes in skeletal muscle.

Neurophysiologic mechanisms of attention: a selective review of early information processing in schizophrenics

Attention is an integral component of information processing. A pronounced attention deficit exists among people with schizophrenia and their first-degree relatives as compared to persons without this pathology. Schizophrenics demonstrate marked deficiencies on psychophysical tasks that require temporal and / or spatial integration, properties that are associated with the two primary visual pathways composed of magnocellular (M) and parvocellular (P) cells, respectively. The deficit expresses itself as a dysfunctional information processing system that affects higher order processes, for example, perceptual ability and memory. The focus of this review is to integrate results from several divergent areas of research to include those studies that identify the contributions of the M and P pathways associated with information processing and the attention deficit. The diverse approaches reviewed in this chapter converge to provide a neurophysiologic explanation of the attention deficit in schizophrenia.

Stability and correlates of the California Verbal Learning Test for a sample of normal elderly persons

The test-retest stability of the California Verbal Learning Test was examined for a normal elderly sample of 28 men and 74 women along with the correlation for total recall with scores on selected variables. Mean age was 72 yr. The test was re-administered after one year. Mean total recall did not change; the stability coefficient was .64. Coefficients for the other scores ranged considerably (.27 for recognition hits to .62 for perseverations) and were compared with prior research findings. Recall was moderately correlated with scores on the North American Reading Test, Trails B, visual reproductions, and subjective memory ability.

Relationships of plasma C-peptide and gender to the urinary excretion of inositols in older people

PURPOSE

The urinary excretions of myo-inositol and D-chiro-inositol are elevated in diabetes, and have been suggested as possible markers or effectors of insulin action. The aim of the present study was to measure the urinary excretion of these compounds, and to assess possible relationships with the metabolic control of glucose, in older, non-diabetic men and women.

SUBJECTS

32 older (age range 54-71 yrs), moderately overweight (body mass index 29.1 +/- 0.4 kg/m2, mean +/- SEM), non-diabetic men (n = 17) and women (n = 15).

METHODS

75 g oral glucose tolerance testing was done the day after all subjects had consumed nutrient-defined menus for five days. Plasma samples were analyzed for the concentrations of glucose, insulin, and C-peptide, and the 180-minute area under the curve (AUC) for each of these compounds was calculated. Samples from 24-hour urine collections were analyzed for the concentrations of myo-inositol, D-chiro-inositol, L-chiro-inositol, and pinitol.

RESULTS

The fasting glucose, insulin, and C-peptide, and the AUC for glucose and insulin, were not different between men and women. C-peptide AUC was greater in the men versus the women (p < 0.001). The median urinary excretions (micromol/g creatinine) of myo-inositol (p < 0.001), D-chiro-inositol (p < 0.001), L-chiro-inositol (p < 0.05), and pinitol (p < 0.001) were higher, and the myo-inositol:D-chiro-inositol ratio was lower (p < 0.001), in the men versus women. For all subjects combined, C-peptide AUC was positively correlated with the urinary excretion of each of the measured inositols, as well as the myo-inositol:D-chiro-inositol ratio. The correlations between C-peptide AUC and these inositols were strongly influenced by the co-linear relationship between C-peptide AUC and gender.

CONCLUSIONS

Collectively, these data show that older, moderately overweight, non-diabetic men and women with gender-related differences in glucose-stimulated C-peptide AUC, an indirect indicator of insulin secretion, also display differences in the urinary excretion of myo-inositol, D-chiro-inositol, L-chiro-inositol, and pinitol. The gender-related difference in the myo-inositol:D-chiro-inositol ratio suggests that, while the urinary excretion of all of the inositols measured were higher in the men than the women, the difference was more pronounced for D-chiro-inositol.

Nutritional management in long-term care: development of a clinical guideline. Council for Nutritional Strategies in Long-Term Care

BACKGROUND

Involuntary weight loss resulting from malnutrition is a major problem among residents in long-term care facilities. Although body weight is easily measured, the evaluation of unintended weight loss in long-term care facilities is difficult.

METHODS

The Council for Nutritional Clinical Strategies in Long-Term Care, an expert panel of interdisciplinary thought leaders representing academia and the medical community, derived a structured approach aimed at improving management of malnutrition in long-term care settings, using literature review and consensus development. The Clinical Guide to Prevent and Manage Malnutrition in Long-Term Care is based on a best-evidence approach to the management of nutritional problems in long-term care.

RESULTS

The Clinical Guide is divided into two parts, one designed for nursing staff, dietary staff, and dietitians, and a second directed to physicians, pharmacists, and dietitians.

CONCLUSIONS

A structured approach to the management of unintended weight loss or malnutrition in long-term care is intended to ensure a comprehensive resident evaluation. While the Clinical Guide is presented in a linear fashion, many of the considerations can be done simultaneously and the order varied dependent on the individual resident's needs. Further research to validate the effectiveness of using the algorithm in long-term care settings will be required.

Aged human muscle demonstrates an altered gene expression profile consistent with an impaired response to exercise

The gene expression profile of skeletal muscle from healthy older (62-75 years old) compared with younger (20-34 years old) men demonstrated elevated expression of genes typical of a stress or damage response, and decreased expression of a gene encoding a DNA repair/cell cycle checkpoint protein. Although the expression of these genes was relatively unaffected by a single bout of resistance exercise in older men, acute exercise altered gene expression in younger men such that post-exercise gene expression in younger men was similar to baseline gene expression in older men. The lack of response of muscle from older subjects to resistance exercise was also apparent in the expression of the inflammatory response gene IL-1beta, which did not differ between the age groups at baseline, but increased within 24 h of the exercise bout only in younger subjects. Other genes with potentially important roles in the adaptation of muscle to exercise, specifically in the processes of angiogenesis and cell proliferation, showed a similar response to exercise in older compared with younger subjects. Only one gene encoding the multifunctional, early growth response transcription factor EGR-1, showed an opposite pattern of expression in response to exercise, acutely decreasing in younger and increasing in older subjects. These results may provide a molecular basis for the inherent variability in the response of muscle from older as compared with younger individuals to resistance training.

Parental decision-making differences between patients in two healthcare systems for choroid plexus cysts

OBJECTIVE

We evaluated the medical-sociological implications of parental perception of risk and decision-making choices for prenatally ascertained choroid plexus cysts (CPCs) between two obstetric populations with similar clinical situations.

METHODS

The Wayne State University (WSU) Reproductive Genetics database and the Madigan Army Medical Center (MAMC) experience were reviewed to compare the rates of aneuploidy and invasive testing for cases with CPC. Aneuploidy rates were compared between those with isolated CPC, CPC with advanced maternal age (AMA), and CPC associated with multiple anomalies.

RESULTS

186 cases were identified in the WSU cohort, of whom 27 (15%) declined invasive fetal testing. In the remaining 159 cases, aneuploidy was present in 2/132 (1.5%) isolated CPCs, 3/11 (27%) CPCs with AMA, and 15/16 (93%) CPCs with multiple anomalies. 107 cases were identified in the MAMC cohort, of whom 99 (92%) declined invasive fetal testing. No cases of aneuploidy were found in the 3/12 AMA cases or 5/95 non-AMA cases who underwent amniocentesis.

CONCLUSIONS

The 2 cases of aneuploidy with isolated CPC cannot be ignored, and provide an estimated attributable risk of at least 0.8%, a higher risk than 38 years of age. However, the parental sociologic context may be as important as the genetic-prognostic risk for decision-making.

Parental decision-making differences between patients in two healthcare systems for choroid plexus cysts

We evaluated the medical-sociological implications of parental perception of risk and decision-making choices for prenatally ascertained choroid plexus cysts (CPC) between two obstetric populations. The Wayne State University (WSU) Reproductive Genetics database and the Madigan Army Medical Center (MAMC) experience were reviewed to compare the rates of aneuploidy and invasive testing for cases with CPC. Aneuploidy rates were compared between those with isolated CPC, CPC with advanced maternal age (AMA), and CPC associated with multiple anomalies. In the WSU cohort 186 cases were identified, of whom 27 (15%) declined invasive fetal testing. In the remaining 159 cases, aneuploidy was present in 2/132 (1.5%) isolated CPC, 3/11 (27%) CPC with AMA, and 15/16 (93%) CPC with multiple anomalies. In the MAMC cohort 107 cases were identified, of whom 99 (92%) declined invasive fetal testing. No aneuploidy cases were found in the 3/12 AMA cases or 5/95 non-AMA cases that underwent amniocentesis. The two cases of aneuploidy with isolated CPC cannot be ignored, and provide an estimated attributable risk of at least 0.8%, a higher risk than 38 years of age. However, the parental sociologic context may be as important for decision-making as the genetic-prognostic risk.

Vitamin E, vitamin C, and exercise

Exercise increases the generation of oxygen free radicals and lipid peroxidation. Strenuous exercise in a person who is unconditioned or unaccustomed to exercise will induce oxidative damage and result in muscle injury. However, aerobic exercise training strengthens the antioxidant defense system by increasing superoxide dismutase. Vitamin C and, especially, vitamin E are shown to decrease the exercise-induced increase in the rate of lipid peroxidation. No ergogenic effects of either vitamin C or E have been shown. Vitamin E was shown to significantly increase circulating neutrophils in older, but not younger, subjects performing eccentric exercise that causes an increase in skeletal muscle damage. In addition to its effect in augmenting the neutrophil response to eccentric exercise, vitamin E causes a greater increase in circulating creatine kinase activity, perhaps indicating increased skeletal muscle repair. Increased vitamin E intake has been associated with enhanced glucose tolerance and insulin action as well as improved lipoprotein status. Future research should examine the combined effects of exercise training and vitamins E and C on these health-related outcomes.

Reactivity of "Eu(OiPr)2" with phenols: formation of linear Eu3, square pyramidal Eu5, cubic Eu8, and capped cubic Eu9 polymetallic europium complexes

The direct reaction of europium with 2-propanol and phenols has been investigated under a variety of conditions. The reaction of europium metal with 2,6-dimethylphenol and 2,6-diisopropylphenol in 2-propanol at reflux revealed that polymetallic europium complexes could be generated by this method. Hx[Eu8O6(OC6H3Me2-2,6)12(OiPr)8], 1, and H5[Eu5O5(OC6H3iPr2-2,6)6(NCCH3)8], 2, were isolated by recrystallization in the presence of hexanes and acetonitrile, respectively, and characterized by X-ray crystallography. Complex 1 has a cubic arrangement of europium ions with face-bridging mu 4-O donor atoms, edge-bridging mu-O(phenoxide/phenol) ligands, and terminal O(isopropoxide/2-propanol) ligands. Complex 2 is mixed valent and has a square pyramidal europium core with four Eu(II) ions at the basal positions and one Eu(III) ion at the apex. Since these reactions gave complicated mixtures of products from which 1 and 2 could only be obtained in low yields, direct reactions under less forcing reaction conditions were investigated. Europium reacts slowly at room temperature to form arene-soluble divalent [Eu(OiPr)2(THF)x]n, 3. Complex 3 reacts with 2,6-dimethylphenol to form the arene-insoluble complex (H[Eu(OC6H3Me2)2(OiPr)])n, 4. Recrystallization of 4 in the presence of THF results in the crystallographically characterizable divalent trimetallic complex [Eu(OC6H3Me2-2,6)2(THF)2]3, 5, which has an unusual linear metal geometry. In the presence of HOiPr at ambient conditions in the glovebox, crystals of 5 slowly convert to the mixed valent H10[Eu8O8(OC6H3Me2-2,6)10(OiPr)2(THF)6], 6, which was found to have a cubic arrangement of europium atoms similar to 1 by X-ray crystallography. Complex 4, upon heating under vacuum, followed by reaction with THF, forms the arene-soluble divalent complex H18([Eu9O8(OC6H3Me2-2,6)10(THF)7][Eu9O9(OC6H3Me2-2,6)10(THF)6]), 7, which contains two types of capped cubic arrangements of europium ions in the solid state.

The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders

BACKGROUND

Frail institutionalized elders have a high prevalence of nutritional risk factors, undernutrition, weight loss, and nutrition-related morbidity and excess mortality. Little information is available on effective means to intervene in this setting.

HYPOTHESES

We tested the hypothesis that addition of multinutrient oral supplements to the diet of frail elders would improve their overall nutritional status and functional level.

METHODS

Fifty nursing home residents aged 88+/-1 yr. were followed for 10 weeks in the course of a randomized controlled trial of supplementation with a multinutrient liquid supplement vs. a non-nutritive placebo drink. Three-day food weighing was used to analyze their habitual dietary intake before and during the final week of the intervention. Nutritional status was further assessed with nutritional biochemistries, anthropometric measurements, and body composition analysis as well as physical and functional performance tests.

RESULTS

The nutritional supplement was consumed with high compliance, but did not significantly augment total caloric intake. Supplementation was associated with significant reductions in total energy, protein, fat, water, fiber, and many vitamins and minerals in the habitual diet of these nursing home residents. Nutritional status improved in terms of folate levels in serum, but no other measured vitamin or mineral indices. Body composition analysis revealed a small gain in weight, increases in fat stores, but no improvement in lean tissue mass associated with supplemention. No physical performance or functional gains were associated with supplementation.

CONCLUSION

Short-term nutritional supplementation in elders at nutritional risk is offset by simultaneous reduction in voluntary food intake. It seems likely that changing other components of energy expenditure such as physical activity levels or basal metabolism may be required to produce overall improvements in nutritional intake in this setting.

Construct validity of the Attitudes About Reality Scale

To explore the construct validity of the Attitudes About Reality Scale, a measure of personal epistemology grounded on a social constructionist to logical positivist continuum, 118 employees of a mental health center completed the Attitudes About Reality Scale, three subscales of the Interpersonal Reactivity Inventory as a measure of empathy, the Social Interest Inventory as a measure of the Adlerian social interest concept, the Multistimulus Types Ambiguity Tolerance-I as a measure of tolerance for ambiguity, the Right Wing Authoritarianism Scale, and the Marlowe-Crowne Social Desirability Scale. Significant correlations were found between scores on the Attitudes About Reality Scale and both The Right Wing Authoritarianism Scale and Multiple Stimulus Types Ambiguity Tolerance-I as hypothesized. Those individuals holding master's and doctoral degrees scored significantly lower on the Attitudes About Reality Scale in the social constructionist direction than those with technical or trade school education, but no other differences on demographic measures were noted.