Addressing Language Barriers in the Intensive Care Unit: A Case-Based Reflection and Brief Appraisal of the Literature.

At present, a substantial number of individuals in the US face limited English proficiency (LEP), posing difficulties for healthcare providers. Language barriers between healthcare providers and patients can lead to poor quality of care, especially in patients with hyperacute conditions such as stroke, myocardial infarction, acute trauma, and more. In the intensive care unit (ICU), diagnosis and rapid treatment decision-making rely on taking an accurate patient history and physical exam. While in-person interpreters are the gold standard for patients with LEP, the fast-paced nature of the ICU may require alternate modes of using interpreting services to fit ICU workflows. We present a case-based reflection of a patient with LEP who presented to our ICU after a motor vehicle accident. We present this case from the perspective of a third-year medical student caring for a patient while rotating in an ICU service. We illustrate how language interpretation impacted the patient's care. We conclude by appraising the ICU literature and providing solutions to addressing language barriers for ICU patients with LEP to deliver patient-centered, high-quality care.

Revisiting niche divergence hypothesis in sexually dimorphic birds: Is diet overlap correlated with sexual size dimorphism?

The evolution of sexual size dimorphism (SSD) is a long-standing topic in evolutionary biology, but there is little agreement on the extent to which SSD is driven by the different selective forces. While sexual selection and fecundity selection have traditionally been proposed as the two leading hypotheses, SSD may also result from natural selection through mechanisms such as sexual niche divergence, which might have reduced resource competition between sexes. Here, we revisited the niche divergence hypothesis by testing the relationship between the sexual overlap in diet and SSD of 56 bird species using phylogenetic comparative analyses. We then assessed how SSD variation relates to the three main hypotheses: sexual selection, fecundity selection, and sexual niche divergence using phylogenetic generalized least squares (PGLS). Then, we compared sexual selection, fecundity selection and niche divergence selection as SSD drivers through phylogenetic confirmatory path analyses to disentangle the possible causal evolutionary relationships between SSD and the three hypotheses. Phylogenetic generalized least squares showed that SSD was negatively correlated with diet overlap, that is, the greater the difference in body size between males and females, the less diet overlap. As predicted by sexual selection theory, the difference in body size between sexes was higher in polygynous species. Confirmatory phylogenetic path analyses suggested that the most likely evolutionary path might include the mating system as a main driver in SSD and niche divergence as a result of SSD. We found no evidence of a role of fecundity selection in the evolution of female-biased SSD. Our study provides evidence that sexual selection has likely been the main cause of SSD and that dietary divergence is likely an indirect effect of SSD.

Diabetes care in the pandemic era in the Midwestern USA: a semi-structured interview study of the patient perspective.

OBJECTIVES: To understand patients' experiences with diabetes care during the COVID-19 pandemic, with an emphasis on rural, medically underserved, and/or minoritised racial and ethnic groups in the Midwestern USA. DESIGN: Community-engaged, semi-structured interviews were conducted by medical student researchers trained in qualitative interviewing. Transcripts were prepared and coded in the language in which the interview was conducted (English or Spanish). Thematic analysis was conducted, and data saturation was achieved. SETTING: The study was conducted in communities in Eastern and Western Iowa. PARTICIPANTS: Adults with diabetes (n=20) who were fluent in conversational English or Spanish were interviewed. One-third of participants were residents of areas designated as federal primary healthcare professional shortage areas and/or medically underserved areas, and more than half were recruited from medical clinics that offer care at no cost. RESULTS: Themes across both English and Spanish transcripts included: (1) perspectives of diabetes, care providers and care management; (2) challenges and barriers affecting diabetes care; and (3) participant feedback and recommendations. Participants reported major constraints related to provider availability, costs of care, access to nutrition counselling and mental health concerns associated with diabetes care during the pandemic. Participants also reported a lack of shared decision-making regarding some aspects of care, including amputation. Finally, participants recognised systems-level challenges that affected both patients and providers and expressed a preference for proactive collaboration with healthcare teams. CONCLUSIONS: These findings support enhanced engagement of rural, medically underserved and minoritised groups as stakeholders in diabetes care, diabetes research and diabetes provider education.

Association between plasma leptin/adiponectin ratio and insulin resistance indexes in prepubertal children.

Objective: To assess the association between leptin/adiponectin ratio (LAR) and insulin resistance surrogates in prepubertal children. Materials and methods: Study based on data from the Growth and Obesity Chilean Cohort Study (GOCS) involving 968 Chilean prepubertal children. Plasma insulin, leptin, and adiponectin were determined by immunoassays. Several common insulin resistance surrogates were calculated, including the homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride/HDL cholesterol index, triglyceride-glucose (TyG) index, and the TyG index corrected for body mass index (BMI; TyG-BMI) and waist circumference (WC; TyG-WC). Associations among variables were assessed using multiple linear and logistic regression analysis. Results: There was a significant direct association between plasma leptin and LAR with BMI z-score but no association between plasma adiponectin and adiposity. After adjustments for sex and age, LAR was significantly associated with all insulin resistance surrogates (which were categorized using the 75th percentile as the cutoff point), with the TyG-WC index emerging as the surrogate with the highest magnitude of association (odds ratio [OR] 2.44, 95% confidence interval [CI] 2.05-2.9). After additional adjustment for BMI z-score, only the association between LAR and TyG-WC remained significant (OR 1.64, 95% CI 1.27-2.12). Conclusion: Plasma leptin and LAR were strongly associated with several common insulin resistance surrogates in prepubertal children, most notably with the TyG-WC index. Associations between LAR and insulin resistance indexes were mainly driven by the effect of plasma leptin, which is also directly associated with increased adiposity.

Association between plasma leptin/adiponectin ratio and insulin resistance indexes in prepubertal children

ABSTRACT Objective: To assess the association between leptin/adiponectin ratio (LAR) and insulin resistance surrogates in prepubertal children. Subjects and methods: Study based on data from the Growth and Obesity Chilean Cohort Study (GOCS) involving 968 Chilean prepubertal children. Plasma insulin, leptin, and adiponectin were determined by immunoassays. Several common insulin resistance surrogates were calculated, including the homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride/HDL cholesterol index, triglyceride-glucose (TyG) index, and the TyG index corrected for body mass index (BMI; TyG-BMI) and waist circumference (WC; TyG-WC). Associations among variables were assessed using multiple linear and logistic regression analysis. Results: There was a significant direct association between plasma leptin and LAR with BMI z-score but no association between plasma adiponectin and adiposity. After adjustments for sex and age, LAR was significantly associated with all insulin resistance surrogates (which were categorized using the 75th percentile as the cutoff point), with the TyG-WC index emerging as the surrogate with the highest magnitude of association (odds ratio [OR] 2.44, 95% confidence interval [CI] 2.05-2.9). After additional adjustment for BMI z-score, only the association between LAR and TyG-WC remained significant (OR 1.64, 95% CI 1.27-2.12). Conclusion: Plasma leptin and LAR were strongly associated with several common insulin resistance surrogates in prepubertal children, most notably with the TyG-WC index. Associations between LAR and insulin resistance indexes were mainly driven by the effect of plasma leptin, which is also directly associated with increased adiposity.

Suture Selection to Minimize Postoperative Postinflammatory Hyperpigmentation in Patients With Skin of Color During Mohs Micrographic Surgery.

The effects of suture selection on postinflammatory hyperpigmentation (PIH) in patients with skin of color who have had Mohs micrographic surgery (MMS) are limited. During the COVID-19 pandemic, fast-absorbing gut sutures reduced the need for in-person follow-up visits without increasing the frequency of postoperative complications. Although absorbable gut sutures are popular, they are highly reactive and can induce inflammation in patients with skin of color. Choosing less inflammatory, nonabsorbable sutures can improve the cosmetic outcome for patients with skin of color who undergo MMS.

EVC-EVC2 complex stability and ciliary targeting are regulated by modification with ubiquitin and SUMO.

Ellis van Creveld syndrome and Weyers acrofacial dysostosis are two rare genetic diseases affecting skeletal development. They are both ciliopathies, as they are due to malfunction of primary cilia, microtubule-based plasma membrane protrusions that function as cellular antennae and are required for Hedgehog signaling, a key pathway during skeletal morphogenesis. These ciliopathies are caused by mutations affecting the EVC-EVC2 complex, a transmembrane protein heterodimer that regulates Hedgehog signaling from inside primary cilia. Despite the importance of this complex, the mechanisms underlying its stability, targeting and function are poorly understood. To address this, we characterized the endogenous EVC protein interactome in control and Evc-null cells. This proteomic screen confirmed EVC's main known interactors (EVC2, IQCE, EFCAB7), while revealing new ones, including USP7, a deubiquitinating enzyme involved in Hedgehog signaling. We therefore looked at EVC-EVC2 complex ubiquitination. Such ubiquitination exists but is independent of USP7 (and of USP48, also involved in Hh signaling). We did find, however, that monoubiquitination of EVC-EVC2 cytosolic tails greatly reduces their protein levels. On the other hand, modification of EVC-EVC2 cytosolic tails with the small ubiquitin-related modifier SUMO3 has a different effect, enhancing complex accumulation at the EvC zone, immediately distal to the ciliary transition zone, possibly via increased binding to the EFCAB7-IQCE complex. Lastly, we find that EvC zone targeting of EVC-EVC2 depends on two separate EFCAB7-binding motifs within EVC2's Weyers-deleted peptide. Only one of these motifs had been characterized previously, so we have mapped the second herein. Altogether, our data shed light on EVC-EVC2 complex regulatory mechanisms, with implications for ciliopathies.

Hedgerows interact with forests to shape the abundance of mesopredators and their predation rate on eggs in farmland landscapes.

Nest predation is the main cause of reproductive failure, particularly in ground-nesting birds on farmlands. Understanding the links between nest predation and habitat change can help design effective management schemes to constrain the negative impact of predation pressure on birds. However, the mechanisms underlying the relationships between landscape attributes, predator distribution, and nest predation are still unclear. Here, we use an experimental approach to examine the effects of distance to the hedgerow as well as hedgerow and forest densities on the abundance of major mesopredators of ground nests of our study area (i.e., corvids) and on the predation rate of artificial ground nests (n = 2576). We found evidence that landscape configuration influenced predation patterns differently depending on the predator species. Nest predation by corvids was more likely in homogeneous and open agricultural landscapes with a low density of forest and hedgerows, whereas predation by other predators was more likely close to hedgerows. Nest predation by corvids and the abundance of corvids also tended to be lower in landscapes dominated by grasslands. Other variables such as road density and distance to human settlements had contrasted effects on the likelihood of a nest being depredated by corvids, i.e., no effect with proximity to human settlements and decreasing trend with road density. Altogether, our results suggest that landscape features interact with mesopredator distribution and their predation rates of ground nests. Therefore, from a conservation and management perspective, a heterogeneous agricultural landscape that includes a mixture of crops associated with patches of forests, hedgerows, and grasslands offering alternative food to generalist predators should contribute to reducing ground-nesting bird predation.

Current and Future Landscape of Perioperative Treatment for Muscle-Invasive Bladder Cancer.

Cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy is the current standard of care for muscle-invasive bladder cancer (MIBC). However, less than half of patients are candidates for this treatment, and 50% will develop metastatic disease. Adjuvant chemotherapy could be offered if neoadjuvant treatment has not been administered for suitable patients. It is important to reduce the risk of systemic recurrence and improve the prognosis of localized MIBC. Systemic therapy for metastatic urothelial carcinoma has evolved in recent years. Immune checkpoint inhibitors and targeted agents, such as antibody-drug conjugates or FGFR inhibitors, are new therapeutic alternatives and have shown their benefit in advanced disease. Currently, several clinical trials are investigating the role of these drugs, as monotherapy and in combination with chemotherapy, in the neoadjuvant and adjuvant settings with promising outcomes. In addition, the development of predictive biomarkers could predict responses to neoadjuvant therapies.

Laparoscopic hepp couinaud for the treatment of caroli's disease: a case report / Hepp Couinaud laparoscópica para el tratamiento de la enfermedad de Caroli: reporte de caso

Caroli disease is a rare congenital disorder characterized by dilatation of intrahepatic bile ducts. The treatment could correspond to hepatic resection for localized disease. This paper describes a case of Caroli's disease in a 60 years old female patient, who presented jaundice and diffuse abdominal pain. Further examinations suggested the diagnosis of Caroli disease associated with cholestatic syndrome. We decided to perform a Hepp Couinaud biliodigestive bypass by video laparoscopy with Roux-en-Y reconstruction. There were no immediate complications and no longterm complications after 6 months of follow-up. The VLP biliodigestive bypass in patients with associated cholestatic syndromes should be considered a treatment prior to a more aggressive approach.

La enfermedad de Caroli es un raro trastorno congénito que consiste en una dilatación de las vías biliares intrahepáticas. Su tratamiento definitivo debe consistir en resección hepática por la enfermedad localizada. Este artículo describe un caso de enfermedad de Caroli en una paciente de sexo femenino de 60 años de edad, quien presentó ictericia y dolor abdominal difuso. Exámenes posteriores sugirieron el diagnóstico de enfermedad de Caroli asociada con síndrome colestásico. Los médicos decidieron realizar un bypass biliodigestivo de Hepp Couinaud mediante videolaparoscopia con reconstrucción en Y de Roux. No hubo complicaciones inmediatas ni complicaciones a largo plazo después de 6 meses de seguimiento. El bypass biliodigestivo VLP en pacientes con síndromes colestásicos asociados debe considerarse un tratamiento previo a un abordaje más agresivo.

Detectability and predator strategy affect egg depredation rates: Implications for mitigating nest depredation in farmlands.

Predation is a major evolutionary force in animal ecology. Mechanisms by which prey coloration provides camouflage has been widely studied. However, predator response to prey camouflage and concealment has received less attention. Understanding vegetation structure effect on depredation success could help managers design strategies to mitigate the depredation of managed species (e.g., threatened or hunted). We aimed to investigate the relationship between depredation rate, nest camouflage and concealment in ground-nesting birds of farmlands, and their predators. We set up an experiment of 2576 artificial ground nests to assess the role of egg coloration (white, light green, and dark green), egg size (small, medium, and large), and vegetation structure (vegetation height and land use) in nest survival rates. We also explored the role of predator searching strategies by analysing clumped depredation and multiple depredation events. Of the nests, 34.0% were depredated, with corvids as the predators 78.5% of the time. Corvid depredation decreased by 40-60% in grasslands and spring crops above a vegetation height of 30 cm. In contrast, vegetation height and land use may be of far less importance in avoiding depredation by other predators. The probability of depredation was spatially clumped, suggesting that predators increase search effort in areas where a nest was previously encountered. Neighboring depredation and depredation repetition were more frequent in corvids than in other predators. Our study indicates that nests in vegetation higher than 30 cm had a drastic reduction in depredation rates by corvids. Management of vegetation structure is a key tool to mitigate depredation risk, and improving the availability of alternative food resources may be a complementary tool.

Asociación entre el nivel de autovalencia y el estado nutricional en adultos mayores chilenos

RESUMEN Introducción: La malnutrición está relacionada con una disminución de las capacidades funcionales en personas adultas mayores. Estudios en población adulta mayor han demostrado asociación directa entre el índice de masa corporal (IMC) y las limitaciones funcionales. Objetivo: Determinar la relación existente entre el nivel de autovalencia y el estado nutricional en población de adultos mayores chilenos. Metodología: Este estudio de carácter cuantitativo descriptivo transversal, analizó una muestra de 837 sujetos de la comuna Los Andes en Chile, a través de una base de datos anonimizada con las atenciones realizadas el año 2017. Para análisis estadístico se aplicó la prueba Chi-cuadrado con un nivel de confianza del 95%, y se determinó el OR para observar el tipo de asociación. Resultados: Según los resultados estadísticamente significativos, existe una asociación negativa entre el "estado nutricional normal" y la "autovalencia con riesgo" (OR= 0,62 p= 0,0012), comportándose como factor protector. Por otra parte, existe una asociación negativa entre el "estado nutricional de obesidad" y la "autovalencia sin riesgo" (OR= 0,51 p= 0,0001) y una asociación positiva con la "autovalencia con riesgo" (OR= 1,54 p= 0,0067) y la dependencia (OR= 1,68 p= 0,001). Conclusión: Un estado nutricional normal se asoció a un menor riesgo de dependencia en la población adulta mayor. La malnutrición por exceso podría ser un factor de riesgo de dependencia.

ABSTRACT Introduction: Malnutrition is associated with decreased functional abilities in older adults. Studies in the older adult population have shown a direct association between body mass index (BMI) and functional limitations. Objective: To determine the relationship between the level of autovalence and nutritional status in a sample of elderly Chileans. Methodology: This cross-sectional descriptive quantitative study analyzed a sample of 837 subjects from Los Andes, Chile, through an anonymized database from 2017. For statistical analysis, the Chi-square test was applied with a confidence level of 95%, and the OR was determined to observe the type of association. Results: We found a statistically significant protective association between "normal nutritional status" and "self-valence with risk" (OR= 0.62 p= 0.0012). In addition, we found a protective association between "obesity nutritional status" and "self-valence without risk" (OR= 0.51 p= 0.0001) and a positive association with "self-valence with risk" (OR= 1.54 p= 0.0067) and dependence (OR= 1.68 p= 0.001). Conclusion: A normal nutritional status was associated with a lower risk of dependency in a sample of older adults. Excess malnutrition could be a risk factor for dependence.

Skin wound closure delay in metabolic syndrome correlates with SCF deficiency in keratinocytes.

Poor wound closure due to diabetes, aging, stress, obesity, alcoholism, and chronic disease affects millions of people worldwide. Reasons wounds will not close are still unclear, and current therapies are limited. Although stem cell factor (SCF), a cytokine, is known to be important for wound repair, the cellular and molecular mechanisms of SCF in wound closure remain poorly understood. Here, we found that SCF expression in the epidermis is decreased in mouse models of delayed wound closure intended to mimic old age, obesity, and alcoholism. By using SCF conditionally knocked out mice, we demonstrated that keratinocytes' autocrine production of SCF activates a transient c-kit receptor in keratinocytes. Transient activation of the c-kit receptor induces the expression of growth factors and chemokines to promote wound re-epithelialization by increasing migration of skin cells (keratinocytes and fibroblasts) and immune cells (neutrophils) to the wound bed 24-48 h post-wounding. Our results demonstrate that keratinocyte-produced SCF is essential to wound closure due to the increased recruitment of a unique combination of skin cells and immune cells in the early phase after wounding. This discovery is imperative for developing clinical strategies that might improve the body's natural repair mechanisms for treating patients with wound-closure pathologies.

PPARGC1A Gene Promoter Methylation as a Biomarker of Insulin Secretion and Sensitivity in Response to Glucose Challenges.

Methylation in CpG sites of the PPARGC1A gene (encoding PGC1-α) has been associated with adiposity, insulin secretion/sensitivity indexes and type 2 diabetes. We assessed the association between the methylation profile of the PPARGC1A gene promoter gene in leukocytes with insulin secretion/sensitivity indexes in normoglycemic women. A standard oral glucose tolerance test (OGTT) and an abbreviated version of the intravenous glucose tolerance test (IVGTT) were carried out in n = 57 Chilean nondiabetic women with measurements of plasma glucose, insulin, and C-peptide. Bisulfite-treated DNA from leukocytes was evaluated for methylation levels in six CpG sites of the proximal promoter of the PPARGC1A gene by pyrosequencing (positions -816, -783, -652, -617, -521 and -515). A strong correlation between the DNA methylation percentage of different CpG sites of the PPARGC1A promoter in leukocytes was found, suggesting an integrated epigenetic control of this region. We found a positive association between the methylation levels of the CpG site -783 with the insulin sensitivity Matsuda composite index (rho = 0.31; p = 0.02) derived from the OGTT. The CpG hypomethylation in the promoter position -783 of the PPARGC1A gene in leukocytes may represent a biomarker of reduced insulin sensitivity after the ingestion of glucose.

Revisiting an old question: Which predators eat eggs of ground-nesting birds in farmland landscapes?

Nest predation is a major cause of reproductive failure in birds, but predator identity often remains unknown. Additionally, although corvids are considered major nest predators in farmland landscapes, whether breeders or floaters are involved remains contentious. In this study, we aimed to identify nest predators using artificial nests, and test whether territorial or non-breeders carrion crow (Corvus corone) and Eurasian magpie (Pica pica) were most likely involved. We set up an experiment with artificial ground nests (n = 1429) in farmland landscapes of western France, and assessed how different combinations of egg size and egg material (small plasticine egg, large plasticine egg, quail and natural hen eggs) might influence predation rates and predator species involved. Nest predators were identified using remotely triggered cameras and marks left in plasticine eggs. Corvids were by far the predators most involved (almost 80% of all predation events), independent of egg type. Carrion crows alone were involved in 60% of cases. Probability of predation increased with egg size, and predation rate was higher for natural than for artificial eggs, suggesting that, in addition to egg size, predators might perceive plasticine and natural eggs differently. Predation rates of artificial nests by corvids were related significantly to corvid abundance, and far more to breeder than floater abundances, for both carrion crows and magpies. This study emphasizes the importance of identifying predators at species level, and considering their social status when assessing corvid abundance impact on prey population dynamics. Combining camera traps and plasticine eggs can achieve this objective. Given the high predation rate by carrion crows, a better understanding of landscape-mediated changes in predator diet seems mandatory to design mitigation schemes able to confront ecological challenges raised by generalist predators.

The impact of vocabulary, grammar and decoding on reading comprehension among children with SLI: a longitudinal study.

Predictors of reading comprehension among children with SLI have been rarely studied in Spanish. Even more sparse are longitudinal studies inspecting the evolution of their reading abilities. The aim of the present study is to inspect how decoding, production of grammatical/ungrammatical sentences, production of simple/complex sentences, and vocabulary (measured with two instruments) predict reading comprehension among Spanish-speaking monolingual school-age children with SLI in two grades: 2nd grade and 4th grade. Forty-eight children were recruited for this study, evenly grouped in two conditions: SLI and Typical. Groups were balanced by gender with no differences in months of age. All children were assessed twice: when in 2nd grade and when in 4th grade. Several multiple regression analyses were conducted. Findings revealed differences in terms of which particular predictors significantly impacted reading comprehension in each group. Vocabulary and syntax complexity are the most consistent predictors of reading performance. Decoding predicted reading comprehension performance only in the observed early stage (2nd grade), becoming non-significant over time. Grammaticality was found to have no impact on reading comprehension in both groups. Reported results suggest that vocabulary and complex syntax solidly predict reading comprehension, while decoding and grammaticality play a minor or even negligible role. Thus, interventions designed to improve reading comprehension among children with SLI might benefit from targeting these two particular dimensions of language.

Practice change in the management of metastatic urothelial carcinoma after ASCO 2020.

Metastatic urothelial carcinoma (mUC) is an incurable and aggressive disease. In the past decades there have been few effective treatment options that have impacted the prognosis of mUC patients. However, in the last few years, several drugs have emerged as new treatment choices that are changing the therapeutic landscape of mUC. Immune checkpoint inhibitors (ICIs) and targeted agents are useful treatment strategies that have been incorporated into our clinical practice. Nevertheless, cisplatin-based chemotherapy is still the standard of care in the first-line of metastatic disease. The results of the JAVELIN Bladder 100 phase 3 trial were presented at ASCO 2020, this trial evaluated the role of avelumab, an ICI, as maintenance therapy in patients who had not progressed after first-line platinum-based chemotherapy. The trial met its primary endpoint demonstrating an overall survival benefit with avelumab maintenance. In addition, new drugs and combinations are being evaluated to improve the outcomes of second and subsequent lines. Fibroblast growth factor receptor (FGFR) inhibitors and immunotherapy combinations were some of the strategies presented at ASCO 2020 that have shown promising results. Finally, the development of predictive biomarkers that help us in the decision-making process will be one of the most important challenges in the next years.

Microstructure of starch-based meals with either palm or soybean oils alter in vitro starch digestibility with no major effects on glycaemic responses.

Glycaemic response (GR) to starch-based meals depends on their food composition and microstructure. We studied the effect of palm and soybean oils on the microstructure of a solid starch-oil-gluten matrix, on the starch gelatinisation and in vitro digestibility. Additionally, a pilot cross-over study was carried out to assess GR after eating gelatinised starch/gluten-based foods with the addition of either palm or soybean oil in 8 young non-diabetic female volunteers (ISRCTN39636850). Both types of foods generated similar starch gelatinisation temperature. Starch/gluten-based food with soybean oil had rougher microstructure compared to food with palm oil, showing a higher initial and lower final in vitro digestion. Administration of starch/gluten-based meals with either palm or soybean oils to volunteers show very similar postprandial glucose or insulin responses. In conclusion, differences in fatty acid composition changes food microstructure and in vitro starch digestibility, with no major effects on glycaemic responses in female volunteers.

Perceived physical exertion is a good indicator of neuromuscular fatigue for the core muscles.

Although several studies have assessed core training, specific prescription recommendations remain lacking. The purpose of the present study was to determine the association between the rate of perceived exertion (RPE) and neuromuscular fatigue of the core muscles during the prone bridging endurance test. Fifteen healthy and moderately active subjects participated. Neuromuscular fatigue was assessed with surface electromyography on the rectus abdominis (RA), external oblique, internal oblique, and lumbar erector spinae. Participants rated the RPE (Borg CR 10) every 5 s. The time to failure was 123.7 ±â€¯58.1 s. From the midpoint of the time to failure, the RPE significantly increased (p < 0.05). The RA muscle showed increased neuromuscular fatigue during the second half of the time to failure (p < 0.05). The other core muscles showed increased neuromuscular fatigue during the last 30% of the time to failure (p < 0.05). The RA muscle showed a strong correlation between neuromuscular fatigue and the RPE (R2 0.85). The other core muscles showed a moderate correlation between neuromuscular fatigue and RPE (R2 0.50-0.69). The measured RPE and neuromuscular fatigue were closely linked for the RA muscle and moderately linked for the other core muscles during the prone bridging endurance test.

Identification and functional analysis of missense mutations in the lecithin cholesterol acyltransferase gene in a Chilean patient with hypoalphalipoproteinemia.

BACKGROUND: Lecithin-cholesterol acyltransferase (LCAT) is a plasma enzyme that esterifies cholesterol in high- and low-density lipoproteins (HDL and LDL). Mutations in LCAT gene causes familial LCAT deficiency, which is characterized by very low plasma HDL-cholesterol levels (Hypoalphalipoproteinemia), corneal opacity and anemia, among other lipid-related traits. Our aim is to evaluate clinical/biochemical features of a Chilean family with a proband showing clinical signs of familial LCAT deficiency, as well as to identify and assess the functional effects of LCAT mutations. METHODS: An adult female proband with hypoalphalipoproteinemia, corneal opacity and mild anemia, as well as her first-degree relatives, were recruited for clinical, biochemical, genetic, in-silico and in-vitro LCAT analysis. Sequencing of exons and intron-exon boundaries was performed to identify mutations. Site-directed mutagenesis was carried out to generate plasmids containing cDNA with wild type or mutant sequences. Such expression vectors were transfected to HEK-239 T cells to asses the effect of LCAT variants in expression, synthesis, secretion and enzyme activity. In-silico prediction analysis and molecular modeling was also used to evaluate the effect of LCAT variants. RESULTS: LCAT sequencing identified rare p.V333 M and p.M404 V missense mutations in compound heterozygous state in the proband, as well the common synonymous p.L363 L variant. LCAT protein was detected in proband's plasma, but with undetectable enzyme activity compared to control relatives. HEK-293 T transfected cells with vector expression plasmids containing either p.M404 V or p.V333 M cDNA showed detectable LCAT protein expression both in supernatants and lysates from cultured cells, but with much lower enzyme activity compared to cells transfected with the wild-type sequence. Bioinformatic analyses also supported a causal role of such rare variations in LCAT lack of function. Additionally, the proband carried the minor allele of the synonymous p.L363 L variant. However, this variant is unlikely to affect the clinical phenotype of the proband given its relatively high frequency in the Chilean population (4%) and its small putative effect on plasma HDL-cholesterol levels. CONCLUSION: Genetic, biochemical, in vitro and in silico analyses indicate that the rare mutations p.M404 V and p.V333 M in LCAT gene lead to suppression of LCAT enzyme activity and cause clinical features of familial LCAT deficiency.