Comparing Diet and Exercise Monitoring Using Smartphone App and Paper Diary: A Two-Phase Intervention Study.

BACKGROUND: There is increasing recognition that personalized approaches may be more effective in helping people establish healthier eating patterns and exercise more, and that this approach may be particularly effective in adolescents. OBJECTIVE: The objective of this study was to investigate the use of a smartphone app (FoodWiz2) in supporting healthy lifestyle choices in adolescence. METHODS: Participants (N=34: 11 male, 23 female) aged 16-19 years in full- or part-time education were recruited from sixth form colleges, schools, and other further education establishments in Norfolk and Suffolk, United Kingdom, between February and May 2015. Participants recorded food intake and exercise using a paper diary for 4-5 weeks and then used the app for the same duration. Initial nutrition education and general support were provided during the paper diary use, but the app included personalized messages sent in response to app activity. At the end of each study phase, participants completed an online questionnaire to describe their experience of using the paper diary and app. RESULTS: Record completion declined throughout the study, possibly affected by examination pressure. Food intake data showed increased fruit consumption and significantly reduced consumption of chocolate snacks (P=.01) and fizzy drinks (P=.002) among participants using the app. Questionnaire responses indicated that the app was generally preferred to the paper diary, in particular, the app was seen as less boring to use (P=.03) and more acceptable in social settings (P<.001). CONCLUSIONS: This app-based approach has shown the potential for a more effective approach to improving adolescent diet and exercise levels.

Chronic joint pain and handgrip strength correlates with osteoporosis in mid-life women: a Singaporean cohort.

This study aimed to identify novel correlates which may relate to low bone mass at lumbar spine in mid-life Asian women. The possibility of developing a prediction model for osteoporosis (OP) was explored which resulted in a risk assessment tool that performed better than currently available tools. INTRODUCTION: In order to identify novel correlates associated with low spinal bone mineral density (BMD) in mid-life women, we examined a large number of lifestyle and medical and performance measurements and developed a prediction model for triage to BMD scanning. METHODS: Women (n = 512) aged 45-69 years (mean 57.0 ± 6.3) attending gynecology clinics for "well woman" visits were recruited for this cross-sectional study from 2014 to 2015. We assessed symptoms, medical history, anthropometry, and physical performance. Stepwise multinomial logistic regressions were performed to examine significant associated covariates for pre-specified outcomes (normal [T-score ≥ -1.0], low bone mass [T-score between -1 and -2.5], and OP [T-score ≤ -2.5] at the lumbar spine). A new screening model was developed, and its performance was compared with the OP Screening Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX®). RESULTS: Spinal OP was found in 6.8%. Multivariate analysis indicated that chronic joint pain, the most common symptom reported by 37.5% of the women, was significantly associated with OP. Only age (Relative Risk Ratio [RRR] 1.63; 95%CI, 1.03-2.60), weight (RRR 0.14; 95% CI, 0.07-0.27), postmenopausal status (RRR 11.59, 95%CI, 1.15-116.73), chronic joint pain (RRR, 4.12; 95% CI, 1.53-11.07), and right handgrip strength (RRR 0.50; 95% CI, 0.31-0.80) were independently associated with spinal OP. Combining these five variables, our final model's area under curve (AUC) was significantly higher at 84% than both the OSTA [AUC; 79% (p value < 0.0231 'c' statistics)] and FRAX® [AUC 58% (p value < 0.0001 'c' statistic)]. CONCLUSION: A novel screening tool that combines age, weight, and menopausal status with chronic joint pain and right handgrip strength more reliably predicts spinal OP in mid-life Singaporean women.

Remote ischemic preconditioning attenuates EGR-1 expression following myocardial ischemia reperfusion injury through activation of the JAK-STAT pathway.

BACKGROUND/OBJECTIVES: Remote ischemic preconditioning (RIPC) protects the myocardium from ischemia/reperfusion (I/R) injury however the molecular pathways involved in cardioprotection are yet to be fully delineated. Transcription factor Early growth response-1 (Egr-1) is a key upstream activator in a variety of cardiovascular diseases. In this study, we elucidated the role of RIPC in modulating the regulation of Egr-1. METHODS: This study subjected rats to transient blockade of the left anterior descending (LAD) coronary artery with or without prior RIPC of the hind-limb muscle and thereafter excised the heart 24h following surgical intervention. In vitro, rat cardiac myoblast H9c2 cells were exposed to ischemic preconditioning by subjecting them to 3cycles of alternating nitrogen-flushed hypoxia and normoxia. These preconditioned media were added to recipient H9c2 cells which were then subjected to 30min of hypoxia followed by 30min of normoxia to simulate myocardial I/R injury. Thereafter, the effects of RIPC on cell viability, apoptosis and inflammatory markers were assessed. RESULTS: We showed reduced infarct size and suppressed Egr-1 in the heart of rats when RIPC was administered to the hind leg. In vitro, we showed that RIPC improved cell viability, reduced apoptosis and attenuated Egr-1 in recipient cells. CONCLUSIONS: Selective inhibition of intracellular signaling pathways confirmed that RIPC increased production of intracellular nitric oxide (NO) and reactive oxygen species (ROS) via activation of the JAK-STAT pathway which then inactivated I/R-induced ERK 1/2 signaling pathways, ultimately leading to the suppression of Egr-1.

Aortic Wall Extracellular Matrix Proteins Correlate with Syntax Score in Patients Undergoing Coronary Artery Bypass Surgery.

AIMS: The SYNTAX score correlate with major cardiovascular events post-revascularization, although the histopathological basis is unclear. We aim to evaluate the association between syntax score and extracellular matrix histological characteristics of aortic punch tissue obtained during coronary artery bypass surgery (CABG). This analysis compares coronary artery bypass surgery patients with High and Low syntax score which were followed up for one year period. METHODS AND RESULTS: Patients with High (score ≥ 33, (n=77)) and Low Syntax Scores (score ≤ 22, (n=71)) undergoing elective CABG were recruited prospectively. Baseline clinical characteristics and surgical risks were well matched. At 1 year, EMACCE (Sum of cardiovascular death, stroke, congestive cardiac failure, and limb, gut and myocardial ischemia) was significantly elevated in the High syntax group (P=0.022). Mass spectrometry (MS)-based quantitative iTRAQ proteomic results validated on independent cohort by immunohistochemistry (IHC) revealed that the High syntax group had significantly upraised Collagen I (P<0.0001) and Elastin (P<0.0001) content in ascending aortic wall. CONCLUSION: This study shows that aortic extracellular matrix (ECM) differ between High and Low syntax groups with up-regulation of Collagen I and Elastin level in High Syntax Score group. This identifies aortic punches collected during CABG as another biomarker source related with atherosclerosis severity and possible clinical outcome.

Design and operation of a fast electromagnetic inductive massive gas injection valve for NSTX-U.

Results from the operation of an electromagnetic valve, that does not incorporate ferromagnetic materials, are presented. Image currents induced on a conducting disc placed near a pancake solenoid cause it to move away from the solenoid and open the vacuum seal. A new and important design feature is the use of Lip Seals for the sliding piston. The pressure rise in the test chamber is measured directly using a fast time response Baratron gauge. The valve injects over 200 Torr l of nitrogen in less than 3 ms, which remains unchanged at moderate magnetic fields.

Sphingosine kinase 1 promotes malignant progression in colon cancer and independently predicts survival of patients with colon cancer by competing risk approach in South asian population.

OBJECTIVES: Sphingosine kinase 1 (SphK1) phosphorylates the membrane sphingolipid, sphingosine, to sphingosine-1-phosphate (S1P), an oncogenic mediator, which drives tumor cell growth and survival. Although SphK1 has gained increasing prominence as an oncogenic determinant in several cancers, its potential as a therapeutic target in colon cancer remains uncertain. We investigated the clinical relevance of SphK1 expression in colon cancer as well as its inhibitory effects in vitro. METHODS: SphK1 expression in human colon tumor tissues was determined by immunohistochemistry and its clinicopathological significance was ascertained in 303 colon cancer cases. The effects of SphK1 inhibition on colon cancer cell viability and the phosphoinositide 3-kinase (PI3K)/Akt cell survival pathway were investigated using a SphK1-selective inhibitor-compound 5c (5c). The cytotoxicity of a novel combination using SphK1 inhibition with the chemotherapeutic drug, 5-fluorouracil (5-FU), was also determined. RESULTS: High SphK1 expression correlated with advanced tumor stages (AJCC classification). Using a competing risk analysis model to take into account disease recurrence, we found that SphK1 is a significant independent predictor for mortality in colon cancer patients. In vitro, the inhibition of SphK1 induced cell death in colon cancer cell lines and attenuated the serum-dependent PI3K/Akt signaling. Inhibition of SphK1 also enhanced the sensitivity of colon cancer cells to 5-FU. CONCLUSION: Our findings highlight the impact of SphK1 in colon cancer progression and patient survival, and provide evidence supportive of further development in combination strategies that incorporate SphK1 inhibition with current chemotherapeutic agents to improve colon cancer outcomes.

Percutaneous coronary intervention in Asians--are there differences in clinical outcome?

BACKGROUND: Ethnic differences in clinical outcome after percutaneous coronary intervention (PCI) have been reported. Data within different Asian subpopulations is scarce. We aim to explore the differences in clinical profile and outcome between Chinese, Malay and Indian Asian patients who undergo PCI for coronary artery disease (CAD). METHODS: A prospective registry of consecutive patients undergoing PCI from January 2002 to December 2007 at a tertiary care center was analyzed. Primary endpoint was major adverse cardiovascular events (MACE) of myocardial infarction (MI), repeat revascularization and all-cause death at six months. RESULTS: 7889 patients underwent PCI; 7544 (96%) patients completed follow-up and were included in the analysis (79% males with mean age of 59 years ± 11). There were 5130 (68%) Chinese, 1056 (14%) Malays and 1001 (13.3%) Indian patients. The remaining 357 (4.7%) patients from other minority ethnic groups were excluded from the analysis. The primary end-point occurred in 684 (9.1%) patients at six months. Indians had the highest rates of six month MACE compared to Chinese and Malays (Indians 12% vs. Chinese 8.2% vs. Malays 10.7%; OR 1.55 95%CI 1.24-1.93, p < 0.001). This was contributed by increased rates of MI (Indians 1.9% vs. Chinese 0.9% vs. Malays 1.3%; OR 4.49 95%CI 1.91-10.56 p = 0.001), repeat revascularization (Indians 6.5% vs. Chinese 4.1% vs. Malays 5.1%; OR 1.64 95%CI 1.22-2.21 p = 0.0012) and death (Indians 11.4% vs. Chinese 7.6% vs. Malays 9.9%; OR 1.65 95%CI 1.23-2.20 p = 0.001) amongst Indian patients. CONCLUSION: These data indicate that ethnic variations in clinical outcome exist following PCI. In particular, Indian patients have higher six month event rates compared to Chinese and Malays. Future studies are warranted to elucidate the underlying mechanisms behind these variations.

Treatment of RO brine-towards sustainable water reclamation practice.

Treatment and disposal of RO brine is an important part in sustaining the water reclamation practice. RO brine generated from water reclamation contains high concentration of organic and inorganic compounds. Cost-effective technologies for treatment of RO brine are still relatively unexplored. Thus, this study aim to determine a feasible treatment process for removal of both organic and inorganic compounds in RO brine generated from NEWater production. The proposed treatment consists of biological activated carbon (BAC) column followed by capacitive deionization (CDI) process for organic and inorganic removals, respectively. Preliminary bench-scale study demonstrated about 20% TOC removal efficiency was achieved using BAC at 40 mins empty bed contact time (EBCT) while the CDI process was able to remove more than 90% conductivity reducing it from 2.19 mS/cm to only about 164 microS/cm. More than 90% cations and anions in the BAC effluent were removed using CDI process. In addition, TOC and TN removals of 78% and 91%, respectively were also attained through this process. About 90% water recovery was achieved. This process shows the potential of increased water recovery in the reclamation process while volume for disposal can be further minimized. Further studies on the sustainable operation and process optimization are ongoing.

[Perspectives in rehabilitation. General position paper on future trends and challenges in rehabilitation by the Health Advisory Board of the German Federal Association for Rehabilitation]. / Perspektiven der Rehabilitation. Ein Positionspapier des Arztlichen Sachverständigenrates der Bundesarbeitsgemeinschaft f ü r Rehabilitation (BAR) zur Weiterentwicklung der Rehabilitation.

The Health Advisory Board of the German Federal Association for Rehabilitation (BAR) describes future trends and challenges in rehabilitation as deriving from the socio-demographic development in Germany and the structural characteristics of its Social and Health Care Insurance System. The focus is on elder employees to sustain and regenerate their capacity for employment, on people which are no longer employed to activate their autonomy and ability for self-support, and on rehabilitation as a holistic and integrative process extending through the social security and health insurances. There is an urgent need and a real chance to benefit from already existing scientific findings more frequently and to integrate them effectively into adequate further education and training programmes for professionals. Finally the conclusion summarises 8 theses to facilitate rehabilitation as an integral and essential part of the German social security and health sector. This paper was fully accredited by the members of the BAR Managing Board.

[Changes of teaching in the interdisciplinary subject "rehabilitation, physical medicine, naturopathic treatment" in the German medical faculties 2004 to 2006/07]. / Entwicklung der Lehre im Querschnittsbereich "Rehabilitation, Physikalische Medizin, Naturheilverfahren" an den medizinischen Fakultäten 2004-2006/07.

BACKGROUND: Rehabilitation, Physical Medicine, Naturopathic Treatment (Querschnittsbereich Q-12) was introduced as a compulsory interdisciplinary subject in the revised Federal Medical Licensing Regulations (Approbationsordnung für Arzte) in October 2003. This offered the opportunity to increase the students' interest in rehabilitation-related issues and to integrate current evidence of rehabilitation research. The implementation of the Q-12 in the German medical faculties was investigated by yearly questionnaires during a three-year-period. METHODS: In 2004, 2005, and 2006/07 anonymous postal questionnaires concerning the teaching in Q-12 were sent to the 36 medical faculties in Germany. Non-responders were reminded at least once by a repeat postal questionnaire. RESULTS: The response rates were 67% in 2004, 72% in 2005, 50% in 2006/07, respectively. Of the 36 faculties 34 responded at least once. Ten faculties responded to all questionnaires. In a considerable number of faculties, Q-12 is being coordinated by university institutions which are not denominated as one of the subjects designated in the Q-12 title. Major differences regarding the implementation of Q-12 were found between the faculties. Further development of Q-12 faces several limitations of resources. Almost all faculties provide curricula for teaching Q 12, some of which are still incomplete. During all three examinations lecturer-centered teaching methods (lectures, seminars, other presentations) were used most frequently. POL-cases and other structured patient oriented teaching were also reported less frequently. E-learning was very rarely offered to the students. Musculoskeletal and neurological disorders were the most frequent specific indications for practice-related integration of Q-12 issues. Compulsory election subjects (Wahlpflichtfächer) related to Q-12 issues before and during the final year of the medical students, are not being offered by all faculties. The vast majority of the faculties advocate an exchange of materials for teaching and examinations. CONCLUSIONS: During the three examinations, major differences concerning the implementation of Q-12 were found between the faculties. Therefore, it is recommended that all faculties verify whether they adequately cover the joint educational objectives recommended for Q-12 by two German scientific societies. Furthermore, the more frequent application of up-to-date practice-oriented teaching and examination methods, an intensified implementation of Q-12-related issues in teaching specific indications, the completion of curricula, enhanced offer of compulsory election subjects related to Q-12 issues, continued scientific investigations and symposia/workshops concerning the promotion of Q-12-related teaching as well as the generation and exchange of teaching and examination materials are recommended.

[Problem oriented learning (POL) in rehabilitation on the example of a patient with ankylosing spondylitis]. / Problemorientiertes Lernen (POL) in der Rehabilitation am Beispiel eines Patienten mit Spondylitis ankylosans.

Through innovative teaching and learning methods relevant topics in rehabilitation can be conveyed effectively. Therefore, in this paper a papercase for problem-oriented learning (POL) is presented concerning rehabilitation in rheumatology, exemplified by a patient with ankylosing spondylitis. This papercase can be applied in the integrated course Rehabilitation, Physical Medicine and Naturopathic Treatment, the curricular part of teaching rehabilitation during the medical training according to the 9 (th) revision of the Federal Medical Licensing Regulations (Approbationsordnung). In addition the teaching material presented can be used in other courses, such as elective courses for non-medical professionals of the interdisciplinary rehabilitation team. First experiences gathered with the papercase in the Health and Nursing Sciences study programme of the Faculty of Medicine of Martin-Luther-University Halle-Wittenberg are reported.

[Current teaching, learning and examination methods in medical education and potential applications in rehabilitative issues]. / Aktuelle Lehr-, Lern- und Prüfungsmethoden in der medizinischen Ausbildung und ihre Anwendungsmöglichkeiten für die Rehabilitation.

With introduction of the new Federal Medical Licensing Regulations (Approbationsordnung) in Germany, integrated teaching in "Rehabilitation, Physical Medicine, Naturopathic Treatment" (Querschnittsbereich Q12) has become obligatory for the first time. Furthermore, the new Regulations require the medical faculties in Germany to realize an innovative didactic orientation in teaching. This paper provides an overview of recent applications of teaching techniques and examination methods in medical education with special consideration of the new integrated course Q12 and further teaching methods related to rehabilitative issues. Problem-oriented learning (POL), problem-based learning (PBL), bedside teaching, eLearning, and the examination methods Objective Structured Clinical Examination (OSCE) and Triple Jump are in the focus. This overview is intended as the basis for subsequent publications of the Commission for Undergraduate and Postgraduate Training of the German Society of Rehabilitation Science (DGRW), which will present examples of innovative teaching material.

Subspecialization and pancreaticoduodenectomy: learning experience from 71 consecutive cases.

BACKGROUND: Pancreaticoduodenectomy (PD) is a major procedure with significant mortality and morbidity. In this study, we reviewed our departmental results with PD as subspecialization for hepatopancreaticobiliary surgery developed, and evaluated the effects on surgical technique and practice. METHODS: Between January 1995 and October 2000, 71 consecutive patients underwent PD for various diseases at our institution. Patients were analysed in two groups according to the 35-month time period in which they underwent surgery: Group A, January 1995 to November 1997 (n = 28), and Group B, December 1997 to October 2000 (n = 43). RESULTS: The two groups were comparable for age, gender distribution, race and associated medical illnesses. Overall 30-day mortality was 5.6% (n = 4); three patients (10.7%) died in Group A and one (2.3%) in Group B. Compared to Group A, there was less surgery-related morbidity (25% vs 16.3%), intraoperative median blood loss (700 mL vs 500 mL), and median intensive-care stay (2 days vs 1 day) in Group B. No significant changes were noted in the overall complication rates (35.7% vs 39.5%), median operating time (4.7 vs 6.1 hours), median blood transfusion requirement (1.46 vs 1.29 units), and median hospital stay (17 vs 18 days). There was a significant shift away from pancreaticojejunostomy (PJ) reconstruction towards pancreaticogastrostomy (PG), especially in Group B. Although preoperative histological confirmation of carcinoma was important in the earlier group, there was less emphasis on this need for a diagnosis before resection in the later period. CONCLUSIONS: Subspecialization in our department has improved the results of PD to an acceptable level, with a mortality of only 2.3%. However, this procedure still causes morbidity, with surgery-related morbidity of 16.3% even with subspecialization. Whether further reductions in morbidity can be achieved with more technical innovations remains to be seen. PG reconstruction was safer than PJ in our practice, with no anastomotic leaks.

A European head injury evaluation chart.

In 1988, 40 experts (physicians, psychologists, social workers, lawyers, family association representatives...) coming from the E.E.C., the United States, Canada and Sweden met in Brussels to derive the guidelines for a minimal assessment of head injured people. This workshop led to a research contract between E.B.I.S. (European Brain Injury Society) and the E.E.C. Directorate for Science regarding a European evaluation document. The aims of the document are both clinical and scientific. Hence the document has to be simple, specific and feasible. The document has two parts: initial state and repeated follow-up. It ends with final comments and action plan. The first statistical data of the validation study concern mainly the link between initial severity of injury and final handicap, cognitive and behavioural troubles, familial and professional aspects of handicap.

Rh blood group mosaicism in a healthy elderly woman.

One example of Rh blood group mosaicism showing a mixed cell population of CcDe and cde red blood cells was found in tests on 552 normal individuals aged 60 years or more. The mosaic person was uninformative for other chromosome 1 markers having the phenotypes Fy (a-b+), 6-PGDA and PGM1(1). Dosage of the activity of intraerythrocytic ENO-1 and 6-PGD of both cell populations fell in the normal range. Chromosome studies on peripheral lymphocytes did not reveal abnormalities. No definite conclusion could be drawn on the mechanism responsible for the phenomenon.

Trypanosoma cruzi: the fate of bloodstream trypomastigote, amastigote, metacyclic trypomastigote and epimastigote forms in the peritoneal macrophages of immune and non-immune mice in vivo.

Experiments were done in vivo in order to compare the ability of Trypanosoma cruzi bloodstream trypomastigotes (BTr), amastigotes (Am), metacyclic trypomastigotes (MTr) and epimastigotes (Ep) to proliferate in the peritoneal macrophages of the following groups of A/Sn mice: actively immunized with increasing doses of living BTr (AIM); mice passively immunized with homologous immune serum (ISTM); mice passively transfused with normal homologous serum (NSTM) and normal mice (NM). Parasite load was evaluated by counting the number of infected peritoneal macrophages harvested on the 4th day after i.p. challenge with one of the forms. All four parasite stages infected NM. AIM seldom showed parasitized macrophages after challenge with any of the forms. ISTM always harboured numerous parasitized macrophages. The only form susceptible to humoral immunity was the Am.