The effect of 8 weeks of combined interval (resistance-interval training) and combined endurance (endurance-resistance training) on plasma levels of adropin and nitric oxide in males with high blood pressure.

INTRODUCTION: Nitric oxide (NO) is a vasodilator that plays an important role in blood pressure control. The purpose of the present study was to compare the effect of 8 weeks of resistance-interval and endurance-resistance trainings on plasma levels of adropin and NO in males with hypertension. METHOD: Forty-five patients with hypertension were recruited and divided into 3 groups of control (age = 51.1 ± 6.4 years, body mass = 80.4 ± 9.2 kg), resistance-interval training (age = 50.7 ± 5.5 years, body mass = 78.1 ± 11 kg), and endurance-resistance training (age = 52.8 ± 6.1 years, body mass = 79.6 ± 9.2 kg). The resistance training program was performed in 2 sets, 10 to 15 repetitions, with 50% intensity of one repetition maximum. Increasing endurance training was performed for 30-40 min at 60-70% of maximum heart rate (HRmax) on the bike. The high-intensity interval training program consisted of 4 intervals of 80 to 90% of HRmax and 3-min recovery periods of 60 to 70% of HRmax. Blood samples were collected 1 week before the start of the training program and 48 h after the last training session. Plasma levels of adropin and nitrite/nitrate were measured by ELISA before and after the exercise interventions. RESULTS: Eight weeks of resistance-interval and endurance-resistance trainings increased plasma levels of adropin and NO and decreased blood pressure (P ≤ 0.05). Furthermore, plasma levels of adropin increased in both exercise groups, whereas NO levels increased only in the endurance-resistance training. Systolic blood pressure decreased in the resistance-interval training (P ≤ 0.05) while it remained unchanged in the endurance-resistance group. CONCLUSION: Resistance-interval and endurance-resistance trainings are effective in decreasing blood pressure by increasing cardiorespiratory capacity and plasma levels of adropin and NO.

Activity Mapping of Children in Play Using Multivariate Analysis of Movement Events.

PURPOSE: (i) To develop an automated measurement technique for the assessment of both the form and intensity of physical activity undertaken by children during play. (ii) To profile the varying activity across a cohort of children using a multivariate analysis of their movement patterns. METHODS: Ankle-worn accelerometers were used to record 40 min of activity during a school recess, for 24 children over five consecutive days. Activity events of 1.1 s duration were identified within the acceleration time trace and compared with a reference motif, consisting of a single walking stride acceleration trace, obtained on a treadmill operating at a speed of 4 km h. Dynamic time warping of motif and activity events provided metrics of comparative movement duration and intensity, which formed the data set for multivariate mapping of the cohort activity using a principal component analysis (PCA). RESULTS: The two-dimensional PCA plot provided clear differentiation of children displaying diverse activity profiles and clustering of those with similar movement patterns. The first component of the PCA correlated to the integrated intensity of movement over the 40-min period, whereas the second component informed on the temporal phasing of activity. CONCLUSIONS: By defining movement events and then quantifying them by reference to a motion-standard, meaningful assessment of highly varied activity within free play can be obtained. This allows detailed profiling of individual children's activity and provides an insight on social aspects of play through identification of matched activity time profiles for children participating in conjoined play.

'Rapid transit' constipation in children: a possible genesis for irritable bowel syndrome.

Children with chronic idiopathic constipation (CIC) often end up at the surgeon when medical treatments have failed. This opinion piece discusses a recently described pattern of CIC called 'Rapid transit constipation (RTC)' first identified in 2011 as part of surgical workup. RTC was identified using a nuclear medicine gastrointestinal transit study (NMGIT or nuclear transit study) to determine the site of slowing within the bowel and to inform surgical treatment. Unexpectedly, we found that RTC occured in 29% of 1000 transit studies in a retrospective audit. Irritable bowel syndrome (IBS) occurs in 7-21% of the population, with a higher prevalence in young children and with constipation type dominating in the young. While 60% improve with time, 40% continue with symptoms. First-line therapy for IBS in adults is a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols which reduces symptoms in > 70% of patients. In children with functional gastrointestinal disorders, fructose intolerance occurs in 35-55%. Reducing fructose produced significant improvement in 77-82% of intolerant patients. In children with RTC and a positive breath test upon fructose challenge, we found that exclusion of fructose significantly improved constipation, abdominal pain, stool consistency and decreased laxative use. We hypothesise that positive breath tests and improvement of pain and bowel frequency with sugar exclusion diets in RTC suggest these children have IBS-C. These observations raise the possibility that many children with CIC could be treated by reducing fructose early in their diet and this might prevent the development of IBS in later life.

Determination of ginsenoside content in Panax ginseng C.A. Meyer and Panax quinquefolius L. root materials and finished products by high-performance liquid chromatography with ultraviolet absorbance detection: interlaboratory study.

An interlaboratory study was conducted on an HPLC method with UV absorbance detection, previously validated using AOAC single-laboratory validation guidelines, for the determination of the six major ginsenosides (Rg1, Re, Rb1, Rc, Rb2, and Rd) in Panax ginseng C.A. Meyer and Panax quinquefolius L. root materials, extracts, and finished products. Fourteen participating laboratories analyzed five test materials (P. ginseng whole root, P. ginseng powdered extract, P. quinquefolius whole root, P. quinquefolius powdered extract, and P. ginseng powdered extract spiked in a matrix blank) as blind duplicates, and two test materials (P. ginseng powdered whole root tablet and P. quinquefolius powdered extract hard-filled capsule) as single samples. Due to the variability of the ginsenosides (low level concentration of Rb2 in P. quinquefolius raw materials and in P. ginseng spiked matrix blanks, and the possibility of incomplete hydrolysis of the finished products during processing), it was deemed more applicable to analyze total ginsenosides rather than individual ones. Outliers were evaluated and omitted using the Cochran's test and single and double Grubbs' tests. The reproducibility RSD (RSD(R)) for the blind duplicate samples ranged from 4.38 to 5.39%, with reproducibility Horwitz Ratio (HorRat(R)) values ranging from 1.5 to 1.9. For the single replicate samples, the data sets were evaluated solely by their repeatability HorRat (HorRat(r)), which were 2.9 and 3.5 for the capsule and tablet samples, respectively. Based on these results, the method is recommended for AOAC Official First Action for the determination of total ginsenosides in P. ginseng and P. quinquefolius root materials and powdered extracts.

Assessment of paediatric CT dose indicators for the purpose of optimisation.

OBJECTIVES: To establish local diagnostic reference levels (LDRLs) at the Royal Children's Hospital (RCH) Melbourne, Parkville, Australia, for typical paediatric CT examinations and compare these with international diagnostic reference levels (DRLs) to benchmark local practice. In addition, the aim was to develop a method of analysing local scan parameters to enable identification of areas for optimisation. METHODS: A retrospective audit of patient records for paediatric CT brain, chest and abdomen/pelvis examinations was undertaken. Demographic information, examination parameters and dose indicators--volumetric CT dose index (CTDI(vol)) and dose-length product (DLP)--were collected for 220 patients. LDRLs were derived from mean survey values and the effective dose was estimated from DLP values. The normalised CTDI(vol) values, mAs values and scan length were analysed to better identify parameters that could be optimised. RESULTS: The LDRLs across all age categories were 18-45 mGy (CTDI(vol)) and 250-700 mGy cm (DLP) for brain examinations; 3-23 mGy (CTDI(vol)) and 100-800 mGy cm (DLP) for chest examinations; and 4-15 mGy (CTDI(vol)) and 150-750 mGy cm (DLP) for abdomen/pelvis examinations. Effective dose estimates were 1.0-1.6 mSv, 1.8-13.0 mSv and 2.5-10.0 mSv for brain, chest and abdomen/pelvis examinations, respectively. CONCLUSION: The RCH mean CTDI(vol) and DLP values are similar to or lower than international DRLs. Use of low-kilovoltage protocols for body imaging in younger patients reduced the dose considerably. There exists potential for optimisation in reducing body scan lengths and justifying the selection of reference mAs values. The assessment method used here proved useful for identifying specific parameters for optimisation. Advances in knowledge Assessment of individual CT parameters in addition to comparison with DRLs enables identification of specific areas for CT optimisation.

Comparison of organ dosimetry methods and effective dose calculation methods for paediatric CT.

Computed tomography (CT) is the single biggest ionising radiation risk from anthropogenic exposure. Reducing unnecessary carcinogenic risks from this source requires the determination of organ and tissue absorbed doses to estimate detrimental stochastic effects. In addition, effective dose can be used to assess comparative risk between exposure situations and facilitate dose reduction through optimisation. Children are at the highest risk from radiation induced carcinogenesis and therefore dosimetry for paediatric CT recipients is essential in addressing the ionising radiation health risks of CT scanning. However, there is no well-defined method in the clinical environment for routinely and reliably performing paediatric CT organ dosimetry and there are numerous methods utilised for estimating paediatric CT effective dose. Therefore, in this study, eleven computational methods for organ dosimetry and/or effective dose calculation were investigated and compared with absorbed doses measured using thermoluminescent dosemeters placed in a physical anthropomorphic phantom representing a 10 year old child. Three common clinical paediatric CT protocols including brain, chest and abdomen/pelvis examinations were evaluated. Overall, computed absorbed doses to organs and tissues fully and directly irradiated demonstrated better agreement (within approximately 50 %) with the measured absorbed doses than absorbed doses to distributed organs or to those located on the periphery of the scan volume, which showed up to a 15-fold dose variation. The disparities predominantly arose from differences in the phantoms used. While the ability to estimate CT dose is essential for risk assessment and radiation protection, identifying a simple, practical dosimetry method remains challenging.

Frontal ostium neo-osteogenesis and restenosis after modified endoscopic Lothrop procedure in an animal model.

All patients who undergo a modified endoscopic Lothrop procedure have postoperative narrowing of the enlarged frontal ostium. The aim of this study is to evaluate neo-osteogenesis and restenosis of the frontal ostium and its effect on mucociliary clearance. Fourteen sheep underwent an endoscopic modified Lothrop procedure. Pre- and postoperative nuclear medicine gamma scintigraphy of the frontal sinuses was performed. The sizes of the frontal ostia were measured and biopsies taken from the bone of the frontal ostium. Histological evidence of new bone formation was found in 56% of biopsies. The average preoperative mucociliary clearance half times (T1/2) at 15 and 30 min were 70 and 74 min, respectively, and postoperatively were 50 and 67 min. There was a non-significant trend towards poorer clearance in sinuses with neo-osteogenesis. The average size of the frontal ostium decreased by 28%. There was no relationship between the size of the ostium and neo-osteogenesis. Neo-osteogenesis was seen in 56% of biopsies with a 28% reduction in size of the frontal ostium after 224 days. Mucociliary clearance did not alter significantly.

The effect of the modified endoscopic Lothrop procedure on the mucociliary clearance of the frontal sinus in an animal model.

BACKGROUND: The surgical management of recalcitrant frontal sinus disease has been a dilemma for otolaryngologists for many years. Although the osteoplastic flap with obliteration has been the gold standard of treatment for years, the modified endoscopic Lothrop (MEL) procedure recently has been advocated as an alternative. However, little is known about the effect of this procedure on the mucociliary drainage of the frontal sinuses postoperatively and this animal study addresses this issue. METHODS: Fourteen sheep underwent the MEL procedure. The sheep were randomized regarding the use of postoperative irrigation via minitrephines. Each sheep had a nuclear medicine gamma-scintigraphy frontal sinus clearance study via minitrephines performed on each frontal sinus preoperatively and then 3 months postoperatively. Then, the results of these studies were compared. RESULTS: The scans revealed a trend toward faster clearance times postoperatively. However, this decrease was not statistically significant. Importantly, there was no trend or significant increase in clearance times postoperatively. Also, the use of postoperative irrigation was associated with a nonsignificant trend toward faster clearance times postoperatively. CONCLUSION: The MEL procedure has no adverse effects on the mucociliary clearance of the frontal sinus at 3 months postoperatively. Irrigation of the frontal sinus in the immediate postoperative period showed a trend toward improved postoperative mucociliary function at 3 months.

Lateral stability during forward-induced stepping for dynamic balance recovery in young and older adults.

BACKGROUND: Balance dysfunction related to lateral instability has been associated with falls and fall-related injuries among older individuals. Protective stepping for dynamic balance recovery requires the effective control of lateral body motion. This study investigated the relationship between aging, falls, and lateral stability during forward-induced stepping for dynamic balance recovery. METHODS: Forward steps were induced by a motor-driven waist-pull system in 12 younger adults, 20 healthy community-dwelling older adult nonfallers, and 18 older adults who had reported falls. Group differences in kinetic and kinematic stepping characteristics for a range of postural disturbance magnitudes were evaluated. RESULTS: Despite group similarities in anticipatory postural adjustments for minimizing lateral instability, the older fallers demonstrated significantly greater sideways body motion toward the stepping side at first-step foot contact and a more laterally directed foot placement. During the first step, forward-stepping characteristics were generally comparable between the groups, but the older fallers had an earlier liftoff time and longer step duration. CONCLUSIONS: During forward-induced protective stepping, otherwise healthy older adults who had experienced falls showed particular differences in their control of lateral body motion that were not attributable to changes in anticipatory postural mechanisms. Aging changes in controlling lateral body motion during protective stepping appear to involve factors that intervene between the first-step liftoff and foot contact and/or adaptations in stepping patterns related to prior planning.

The influence of stimulus cue on the initiation of stepping in young and older adults.

OBJECTIVES: To investigate the influence of different reaction stimulus cues on the characteristics of ground reaction forces during the initiation of rapid forward stepping, and to determine whether age-related differences in step initiation are influenced by the type of stimulus cue used to trigger stepping. DESIGN: Case-control study. SETTING: University-based research laboratory. PARTICIPANTS: Fifteen healthy younger adults and 35 community-dwelling older adult volunteers. MAIN OUTCOME MEASURES: Subjects performed forward step initiation in response to 3 different reaction stimulus cues (light, sound, electrocutaneous) during simple reaction-time conditions. Ground reaction force data were collected and used to characterize the timing and magnitude features of the postural (weight-transfer) and step components. RESULTS: In comparison with the light and sound stimuli, the nonnoxious electrocutaneous trigger cue was associated with an increase in the magnitude of the initial displacement of the center of pressure (COP) in the mediolateral direction. Overall, older subjects were slower to initiate the postural and step components, and displayed a reduction in the initial posterior displacement of the COP. CONCLUSIONS: The postural component for lateral weight transfer was augmented by the electrocutaneous trigger cue, suggesting its potential to enhance step initiation among clinical populations. Age-related changes in stepping were unaffected by the type of stimulus cue, but the older group had a slower response initiation time and less forward propulsion. The abilities of many older persons may be compromised in situations where rapid adjustments in the base of support through stepping are triggered by environmental stimuli.

Electrical stimulation effects on tenderness of five muscles from Hampshire x Rambouillet crossbred lambs with the callipyge phenotype.

The objective of this study was to determine effects of electrical stimulation (ES) on muscle quality and sensory traits of 12 Hampshire x Rambouillet callipyge lambs. One side of each carcass was randomly assigned to an ES treatment of 550 V and 60 Hz of electricity for 2 s on and 2 s off 15 times. The other side was a nonstimulated control (NES). Heated calpastatin, sarcomere length, myofibrillar fragmentation index (MFI), Warner-Bratzler shear (WBS), and trained sensory panel values were measured on the semitendinosus (ST), semimembranosus (SM), longissimus (ML), supraspinatus (SP), and triceps brachii (TB) muscles. Electrically stimulating the carcass sides induced a more rapid (P = .001) pH decline in the longissimus muscle, and ES sides had a brighter (P = .001) red color of loineye than nonstimulated sides. At d 14 of storage (2 degrees C), the TB had the highest (P < .05) MFI value, indicating more protein degradation, and the ST and ML muscles had the lowest MFI (P = .008). Regardless of ES treatment, SM and ML had the highest (P < .05) WBS values. The ST muscle had higher (P < .05) WBS values than the SP but did not differ (P > .05) from the TB muscle. Electrical stimulation had no effect on WBS or any trained sensory panel values (P > .05). The percentage of loin chops rated slightly tender or better was improved 30 to 34% by electrical stimulation (P < .05). The ML muscle was scored lower (P < .05) in sustained juiciness compared with the SM, SP, and TB but did not differ (P > .05) from the ST muscle. The SM and ML muscles were rated lower (P < .05) in initial and sustained tenderness scores than other muscles. Tenderness scores were higher (P < .05) for the TB than for the SP but did not differ (P > .05) from the ST muscle. Electrically stimulating callipyge carcasses improves the tenderness of loin chops by increasing the percentage of chops rated from slightly tough to slightly tender.

Nurses' perceptions of people who are homeless.

There are few data-based reports about the perceptions of nurses toward marginalized groups and even fewer about the transformation of perceptions. The purpose of this study was to explore nurses' perceptions of people who are homeless and to describe transforming experiences. Rich, detailed experiences of the care provided to people who were homeless were elicited through in-depth interviews with 15 nurses and nursing students. Without exception, each participant in this study indicated that listening, connecting, and understanding were important to them in changing previously held negative beliefs. However, when clients did not express appreciation or behave in expected ways, nurses became frustrated and voiced negative feelings about people who are homeless. Study findings emphasize the importance of listening and connecting with people who are different from ourselves so that our shared humanity is acknowledged and appreciated.

A comparison of patients with different types of syndactyly.

We performed a retrospective review of finger syndactyly releases at Shriners Hospital for Children, Houston Unit, between January 1983 and January 1993. This study was performed in an attempt to compare the long-term postoperative function in patients after release of syndactyly resulting from Poland's syndrome with that in patients with idiopathic forms of syndactyly. Only patients with one involved hand were included in this study. The contralateral hand was used as a control. Twenty-seven patients with only one hand involved underwent syndactyly release during this period. Of these, 13 patients who underwent a total of 30 syndactyly releases were available for evaluation. For each patient, the type of syndactyly was determined. Each patient was subjected to a detailed physical examination and participated in occupational-therapy modalities. We noted statistically significant differences in function between operated-on and control hands in the Poland's group, whereas operated-on hands affected with idiopathic forms of syndactyly did not demonstrate significantly different function compared with contralateral controls. These data suggest that functional deficits in hands affected by Poland's syndrome are attributable to more than the syndactyly alone. Hands affected by idiopathic forms of syndactyly are likely to have little postoperative functional deficit.

Static versus dynamic predictions of protective stepping following waist-pull perturbations in young and older adults.

The purposes of this study were: (1) to determine the frequency of protective stepping for balance recovery in subjects of different ages and fall-status, and (2) to compare predicted stepping based on a dynamic model (Pai and Patton, 1997. Journal of Biomechanics 30, 347 354) involving displacement and velocity combinations of the center of mass (COM) versus a static model based on displacement alone against experimentally induced stepping. Responses to three different magnitudes of forward waist pulls were recorded for 13 young, 18 older-non-fallers and 18 older-fallers. The COM phase plane trajectories derived from motion analysis were compared with the model-predicted threshold values for stepping. We found that the older fallers had the highest percentage of stepping trials (52%), followed by older-non-fallers (17.3%), and young (2.7%) at the lowest perturbation level. Younger subjects stepped less often than the elderly at the middle level. Everyone consistently stepped at the highest level of perturbation. Overall, the dynamic model showed better predictive capacity (65%) than the static model (5%) for estimating the initiation of stepping. Furthermore, the threshold for step initiation derived from the dynamic model could consistently predict when a step must occur. However, it was limited, especially among older fallers at the low perturbation level, in that it considered some steps 'unnecessary' that were presumably triggered by fear of falling or other factors.

Substance P-induced IL-12 production by murine macrophages.

Previous investigations in our laboratory have suggested that substance P (NK-1) receptor expression by macrophages contributes to the resistance against the intracellular bacterial pathogen, Salmonella. To investigate possible mechanisms for such resistance, macrophages were cultured with varying concentrations of a substance P agonist to investigate the ability of this neuropeptide to augment IL-12 expression. The substance P agonist was a potent inducer of both IL-12p35 and IL-12p40 mRNA expression in cultured macrophages. The kinetics of this response were maximal within 6 h and could be observed with concentrations of substance P agonist as low as 0.1 nM. The nonpeptide, substance P receptor antagonist, CP96-345, significantly blocked agonist-induced IL-12 mRNA expression, further demonstrating that this effect was mediated through an NK-1 receptor. Substance P agonist alone could stimulate substantial secretion of IL-12p40, but not IL-12p70, by cultured macrophages. Thus, the substance P agonist had the ability to augment IL-12p35 and IL-12p40 mRNA expression, but not to increase IL-12p70 secretion. Like IFN-gamma, we found that substance P could combine with LPS to significantly augment the secretion of bioactive IL-12p70. The costimulatory effects of substance P agonist plus LPS on IL-12 mRNA expression were additive; however, this combination resulted in synergistic secretion of IL-12p70 by macrophages. Together, these results demonstrate the ability of NK-1 receptors to signal IL-12 production by macrophages and suggest mechanisms for substance P-induced modulation of cellular immunity.

Reverse transcriptase-polymerase chain reaction amplification and partial sequence of T helper 1- and T helper 2-type lymphokine genes from the owl monkey (Aotus trivirgatus).

The reverse transcriptase-polymerase chain reaction (RT-PCR) was used to amplify selected lymphokine mRNAs from phytohemagglutinin-activated leukocytes of the owl monkey (Aotus trivirgatus). Interleukin-2 (IL-2), IL-4, IL-13, and interferon-gamma were selected as lymphokine mRNAs of interest, since expression of these cytokines helps define the type of T helper lymphocyte response (i.e., TH1 versus TH2). Because sequences for these lymphokine genes were not available for the owl monkey, multiple PCR primers for each lymphokine gene were designed based on published human sequences. Various PCR primer pairs were then used in the RT-PCR to determine the conditions for optimal amplification of each owl monkey cytokine mRNA. In addition, each PCR primer pair was compared for the ability to amplify lymphokine mRNAs from other primate species, including African green (Cercopithecus aethiops), squirrel (Saimiri sciureus), and rhesus (Macaca mulatta) monkeys. The specificity and sensitivity of optimal primer pair was also demonstrated by amplification of as little as 10 fg of each lymphokine gene in a background of 300 ng of irrelevant cDNA. Finally, partial sequences of owl monkey coding regions for IL-2, IL-13, and interferon-gamma were determined and compared for homology with their human counterparts. Together, these studies define specific and sensitive conditions for detection of lymphokine mRNA expression in the owl monkey and provide partial sequence information of the coding region for these lymphokines. This investigation should provide molecular probes to investigate the immune response against malaria and the effectiveness of malaria vaccines in the owl monkey that models this human disease.

A computer assisted orthopaedic surgical system for distal locking of intramedullary nails.

This paper presents a prototype system for computer assisted surgery, the purpose of which is to assist orthopaedic surgeons when performing distal locking of intramedullary nails. This system comprises three components, namely: an Intelligent Image Intensifier, a Trajectory Tactician and an Intelligent Trajectory Guide. The Intelligent Image Intensifier is an X-ray vision system that provides accurate X-ray images. Such images enable the Trajectory Tactician software to analyse the operation site and calculate the trajectory required for a screw to lock an intramedullary nail. This involves the capture of two X-ray images from which are extracted the projections of the nail's edge boundaries and its distal locking holes. Using an analytical mathematical model of the nail, the position and orientation of the nail is determined. The trajectory is then implemented by the surgeon using the Intelligent Trajectory Guide. Evaluation in the laboratory suggests that the system is capable of reliably inserting a locking screw into an intramedullary nail. The rapidity with which this computer assisted method achieves locking should benefit both patient and surgeon by reducing radiation dosage and the length of time required to lock a nail.

Adductor transfers in cerebral palsy: long-term results studied by gait analysis.

Thirty-three ambulatory patients with spastic cerebral palsy underwent evaluation and gait analysis an average of 9.6 years after bilateral posterior adductor transfers to the ischium. All patients showed functional improvement postoperatively, which was maintained at long-term follow-up in 94%. Gait analysis, however, documented pelvic obliquity in 85% of this group of patients. Associated with pelvic obliquity was a 36% incidence of unilateral hip subluxation. These complications of posterior adductor transfers have been difficult to treat and have resulted in the abandonment of this procedure at our institution.