Factors affecting minimally invasive surgery utilization during elective colectomies for diverticular disease in the United States.

Background: Compared with open surgery, minimally invasive surgery (MIS) has been shown to have improved outcomes when treating diverticular disease. This study aimed to analyze recent trends in MIS utilization for elective colectomy for diverticular disease and to identify individual variables and hospital characteristics associated with MIS utilization. Methods: This population-based study examined individuals from the National Inpatient Sample who underwent elective colectomy for diverticular disease from 2016 to 2019. Results: Hospitals in the Midwest used MIS less than those in other geographic regions. Rural hospitals used MIS less than urban hospitals. Hospital bed size and teaching status were not associated with differences in MIS utilization. Patients with private insurance were more likely to have an MIS operation. There was also a racial disparity in MIS utilization, even after adjusting for insurance status. Conclusions: While there is no longer any variance in MIS utilization based on hospital bed size or teaching status, disparities concerning patient race remain, even after adjusting for insurance status. Further investigation is needed to determine the roots of these disparities.

Sensorimotor Learning in a Computerized Athletic Training Battery.

Sensorimotor abilities are crucial for performance in athletic, military, and other occupational activities, and there is great interest in understanding learning in these skills. Here, behavioral performance was measured over three days as twenty-seven participants practiced multiple sessions on the Nike SPARQ Sensory Station (Nike, Inc., Beaverton, Oregon), a computerized visual and motor assessment battery. Wrist-worn actigraphy was recorded to monitor sleep-wake cycles. Significant learning was observed in tasks with high visuomotor control demands but not in tasks of visual sensitivity. Learning was primarily linear, with up to 60% improvement, but did not relate to sleep quality in this normal-sleeping population. These results demonstrate differences in the rate and capacity for learning across perceptual and motor domains, indicating potential targets for sensorimotor training interventions.

Exercise training-induced adaptations associated with increases in skeletal muscle glycogen content.

Chronic exercise training results in numerous skeletal muscle adaptations, including increases in insulin sensitivity and glycogen content. To understand the mechanism leading to increased muscle glycogen, we studied the effects of exercise training on glycogen regulatory proteins in rat skeletal muscle. Female Sprague Dawley rats performed voluntary wheel running for 1, 4 or 7 weeks. After 7 weeks of training, insulin-stimulated glucose uptake was increased in epitrochlearis muscle. As compared with sedentary control rats, muscle glycogen did not change after 1 week of training, but increased significantly after 4 and 7 weeks. The increases in muscle glycogen were accompanied by elevated glycogen synthase activity and protein expression. To assess the regulation of glycogen synthase, we examined its major activator, protein phosphatase 1 (PP1), and its major deactivator, glycogen synthase kinase (GSK)-3. Consistent with glycogen synthase activity, PP1 activity was unchanged after 1 week of training but significantly increased after 4 and 7 weeks of training. Protein expression of R(GL)(G(M)), another regulatory PP1 subunit, significantly decreased after 4 and 7 weeks of training. Unlike PP1 activity, GSK-3 phosphorylation did not follow the pattern of glycogen synthase activity. The ~ 40% decrease in GSK-3α phosphorylation after 1 week of exercise training persisted until 7 weeks, and may function as a negative feedback mechanism in response to elevated glycogen. Our findings suggest that exercise training-induced increases in muscle glycogen content could be regulated by multiple mechanisms, including enhanced insulin sensitivity, glycogen synthase expression, allosteric activation of glycogen synthase, and PP1 activity.