Adiponectin and Nitric Oxide Deficiency-Induced Cognitive Impairment in Fatigued Home-Resident in Mature and Older Adults: A Case-Control Study.

Objective: The present study explores the underlying factors of cognitive abilities in relation to the expression of adiponectin and nitric oxide, fatigue, and other cofounder variables such as physical activity, diabetes, and adiposity status in healthy home-resident mature and older adults. Background: Fatigue has been shown to be correlated with many metabolic and psychiatric conditions, such as cognitive, neurological, musculoskeletal, and hormonal disorders, as well as physical and unhealthy lifestyles. Methods: A total of 85 home residents aged 50-85 years participated in this case-control study. Mental, fatigue, and pain status were assessed by the cognitive assessment (LOTCA), fatigue questionnaire (CIS20r), and pain score (0-10). VO2 max and the prevalidated global physical activity questionnaire were used to estimate physical status. The levels of adiponectin, nitric oxide (NO), and variables related to diabetes, such as blood sugar and glycated hemoglobin (HbA1c %), were assessed using ELISA and spectrophotometric immunoassays. Results: The participants were classified according to the CIS-fatigue score into two groups: the healthy group (n = 40) and the fatigue group (n = 45). In fatigued subjects, LOTCA scores as a measure of cognitive performance significantly decreased (65.97 ± 7.17; P = 0.01) as compared with healthy subjects (LOTCA scores, 94.2 ± 7.5). The results of cognitive performance domains (LOTCA seven-subset scores) showed a significant decrease in the scores of orientation, visual perception, spatial perception, motor praxis, vasomotor organization, thinking operations, attention, and concentration in older subjects with fatigue compared with healthy subjects. In addition, pain scores significantly increased, and the expression of both nitric oxide (NO) and adiponectin significantly reduced in older adults with fatigue as compared with healthy controls. The decline in cognitive abilities among older adults with fatigue is significantly associated with the CIS-fatigue score, sedentary lifestyle, obesity, pain status, diabetes, and reduction in the levels of nitric oxide (NO), and adiponectin. Moreover, in fatigued cases, the expression of both NO and adiponectin was significantly correlated with CIS-fatigue score, physical activity, obesity, and diabetes, which indicates its availability as diagnostic markers for cognition in mature and older adults with fatigue. Conclusion: In the present study, the data concluded that cognitive abilities were significantly associated with the lower expression of adiponectin and NO as endothelial vascular markers in association with fatigue among home-resident older adults. In addition, the reduction in cognition was significantly affected by other parameters, such as diabetes, obesity, and unhealthy sedentary life activities. Moreover, the results might recommend the use of cellular adiponectin and NO as diagnostic indicators of cognitive abilities in fatigued mature and older adults. However, more studies on larger sample sizes are required.

The Prevalence and Association of Stress Urinary Incontinence, Core Muscle Endurance, and Low Back Pain among Married Women in Saudi Arabia: A Case-Control Study.

PURPOSE: There may be a strong association among stress urinary incontinence (SUI), low back pain (LBP), and core muscle endurance (CME) in married women. This study is aimed at evaluating the prevalence and clinical association between SUI, CME, and LBP among married women in Saudi Arabia. METHODS: The study was based on a case-control research design, conducted among 143 women with LBP (mean age, 32 ± 7.4 years) and 160 healthy women (mean age, 31.7 ± 6.7 years). SUI, CME, and functional disability were assessed using the international consultation on the Incontinence Questionnaire-Short Form (ICIQ-SF), prone plank test (PP), and Oswestry Disability Index for LBP-United Arab Emirates edition (ODI-UAE). RESULTS: The prevalence of SUI was found to be 60% in the LBP group while 20% in the control group. CME revealed a stronger negative correlation with SUI in the LBP group (r s = -0.75) than in the control group (r s = -0.63). CONCLUSIONS: The prevalence of SUI was observed higher in women with LBP than healthy women. CME exhibited a stronger association with SUI than LBP among women with LBP compared to healthy women in Saudi Arabia. Therefore, the role of CME in SUI development or vice versa among married women with LBP may be subjected to further research.

Do orthopaedic and neurosciences inpatients who are at risk of falls have best practice fall prevention strategies implemented during their acute inpatient hospitalization?

OBJECTIVE: To determine whether inpatients identified as being at high risk for falls received fall prevention interventions as recommended in the Best Practice Guidelines for Australian Hospitals. METHODS: This cross-sectional study examined medical record data from a convenience sample of inpatients admitted to orthopaedic and neurosciences wards (N = 100). Data were compared to the fall prevention recommendations. Percentages were used to describe compliance and independent samples t-tests to assess difference in adherence. RESULTS: Data revealed that 45% and 62% of recommendations were implemented amongst inpatients on orthopaedic and neurosciences ward, respectively (P < 0.001). There was a significant positive correlation between orthopaedic inpatients at higher risk of falls and those with a greater length of stay [r(39) = .46, P = 0.003]. When analysed together, patients who were admitted following a fall had a lower percentage of fall prevention strategies implemented (P < 0.001). CONCLUSION: Implementation of fall prevention strategies is essential to target in the inpatient setting.

Effect of quadriceps and calf muscles fatigue on standing balance in healthy young adult males.

OBJECTIVE: The present study aimed to compare the effects of quadriceps or calf muscles fatigue on static and dynamic standing balance in young healthy adult males. METHODS: Forty-five healthy, physically active male adults aged 18-30 years were randomly divided into three groups; Quadriceps muscle fatigue group (n=15), Calf muscles fatigue group (n=15), and a control group (n=15). The Modified Clinical Test of Sensory Interaction on Balance, Unilateral Stance, and Limits of Stability (reaction time and movement velocity) were selected as outcome measures for this study. RESULTS: The results showed a non-significant difference between pretest and posttest balance scores (p>0.05) for quadriceps and calf muscles fatigue on balance. Similarly, there were non-significant differences in posttest balance scores when comparing fatigue effects between the groups (p>0.05). CONCLUSIONS: These results suggested that the fatigue of the quadriceps or calf muscles did not influence standing balance in healthy young adult males. Future longitudinal studies are recommended to further understanding the mechanisms behind localized muscle fatigue effects on standing balance in subjects of different age groups of both genders.

A systematic review of the effectiveness of task-specific rehabilitation interventions for improving independent sitting and standing function in spinal cord injury.

CONTEXT: Impaired balance function after a spinal cord injury (SCI) hinders performance of daily activities. OBJECTIVE: To assess the evidence on the effectiveness of task-specific training on sitting and standing function in individuals with SCI across the continuum of care. METHODS: A systematic search was conducted on literature published to June 2016 using people (acute or chronic SCI), task-specific interventions compared to conventional physical therapy, and outcome (sitting or standing balance function). The PEDro scale was used to investigate the susceptibility to bias and trial quality of the randomized controlled trials (RCTs). A standardized mean difference (SMD) was conducted to investigate the effect size for interventions with sitting or standing balance outcomes. RESULTS: Nineteen articles were identified; three RCTs, two prospective controlled trials, one cross-over study, nine pre-post studies and four prospective cohort studies. RCT and cross-over studies were rated from 6 to 8 indicating good quality on the PEDro scale. The SMD of task-specific interventions in sitting compared to active and inactive (no training) control groups was -0.09 (95% CI: -0.663 to 0.488) and 0.39 (95% CI: -0.165 to 0.937) respectively, indicating that the addition of task-specific exercises did not affect sit and reach test performance significantly. Similarly, the addition of BWS training did not significantly affect BBS compared to conventional physical therapy -0.36 (95% CI: -0.840 to 0.113). Task-specific interventions reported in uncontrolled trials revealed positive effects on sitting and standing balance function. CONCLUSION: Few RCT studies provided balance outcomes, and those that were evaluated indicate negligible effect sizes. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further research to evaluate specific features of training interventions to improve both sitting and standing balance function in SCI.

Predictors of global job satisfaction among Saudi physiotherapists: a descriptive study.

BACKGROUND AND OBJECTIVE: Job satisfaction is an important consideration in the recruitment and retention of physiotherapists (PTs). To date, the job satisfaction of PTs working in Saudi Arabia has not been investigated. The aim of this study was to measure the level of job satisfaction of PTs working in Saudi Arabia and evaluate predictors of job satisfaction. DESIGN AND SETTINGS: This was a cross-sectional observational study among licensed physical therapists working across 11 health care centers and university hospitals in Riyadh between 2013 and 2014. SUBJECTS AND METHODS: A total of 183 physical therapists participated in the survey. Level of job satisfaction and factors influencing satisfaction were explored using a purpose-designed job satisfaction questionnaire. It consisted of 8 survey domains, and the scores were normalized to allow between-domain comparison. RESULTS: Global job satisfaction was 37%. The highest levels of job satisfaction were seen in the domains of professional development and teamwork and the lowest levels of job satisfaction in the domains of supervisory/ management relationship (75%) and working environment (60%). Predictors of job satisfaction were gender (OR [odds ratio] 1.4, 95% CI 1.1-2.3), age (OR 0.7, 95% CI 0.5-0.9), relationships with supervisors and managers (OR 1.3, 95% CI 1.2-1.9), working environment (OR 1.2, 95% CI 1.0-2.3), and opportunities for professional development (OR 1.4, 95% CI 1.2-3.7). CONCLUSION: Saudi PTs were moderately satisfied with their job; strategies should be designed in such a way that they experience a high level of job satisfaction and retention thus resulting in improved rehabilitation services in Saudi Arabia.

Activation of activating transcription factor 2 by p38 MAP kinase during apoptosis induced by human amylin in cultured pancreatic beta-cells.

Amylin-mediated islet beta-cell death is implicated in diabetogenesis. We previously reported that fibrillogenic human amylin (hA) evokes beta-cell apoptosis through linked activation of Jun N-terminal kinase 1 (JNK 1) and a caspase cascade. Here we show that p38 kinase [p38 mitogen-activated protein (MAP) kinase] became activated by hA treatment of cultured beta-cells whereas extracellular signal-regulated kinase (ERK) did not; by contrast, nonfibrillogenic rat amylin (rA) altered neither. Pretreatment with the p38 kinase-inhibitor SB203580 decreased hA-induced apoptosis and caspase-3 activation by approximately 30%; as did combined SB203580 and JNK inhibitor I, by about 70%; and the combination of SB203580, the JNK inhibitor I and a caspase-8 inhibitor, by 100%. These findings demonstrate the requirement for concurrent activation of the p38 kinase, JNK and caspase-8 pathways. We further showed that hA elicits time-dependent activation of activating transcription factor 2 (ATF-2), which was largely suppressed by SB203580, indicating that this activation is catalyzed mainly by p38 kinase. Furthermore, hA-induced apoptosis was suppressed by specific antisense ATF-2, and increased phospho-ATF-2 (p-ATF-2) was associated with increased CRE (cAMP-response element) DNA binding and CRE-mediated transcriptional activity, as well as enhancement of c-jun promoter activation. We also detected changes in the phosphorylation status and composition of the CRE complex that may play important roles in regulation of distinct downstream target genes. These studies establish p38 MAP kinase-mediated activation of ATF-2 as a significant mechanism in hA-evoked beta-cell death, which may serve as a target for pharmaceutical intervention and effective suppression of beta-cell failure in type-2 diabetes.

Testosterone selectively reduces the high molecular weight form of adiponectin by inhibiting its secretion from adipocytes.

The antidiabetic hormone adiponectin circulates in blood as several oligomeric complexes, and the ratios between them are critical in determining insulin sensitivity. In this study we investigated the role of testosterone in regulating the oligomeric complex distribution of adiponectin. Gel filtration analysis revealed that circulating adiponectin existed as the forms of high molecular weight (HMW), middle molecular weight, and low molecular weight complexes in both human and mice. The concentration of HMW adiponectin in female was significantly higher than that in male, whereas there were no gender differences for the other two forms. Castration induced a dramatic elevation of the HMW form but had no effect on either the middle molecular weight or the low molecular weight form in mice. Testosterone treatment, on the other hand, caused a specific reduction of HMW adiponectin in the circulation. Pulse-chase labeling experiments in rat adipocytes revealed that the three oligomeric forms of adiponectin were secreted into the culture medium at different rates and that testosterone selectively impeded the secretion of HMW adiponectin but not the other two forms. The inhibitory effect of testosterone on secretion of HMW adiponectin was largely restored by the transcription inhibitor actinomycin D, suggesting the involvement of a transcriptional event in this process. The selective inhibition of HMW adiponectin by testosterone might contribute to the sex dimorphism of adiponectin in terms of its oligomeric complex distribution and could partly explain why men have higher risk to insulin resistance and atherosclerosis than women.

Proteomic analysis of adipocyte differentiation: Evidence that alpha2 macroglobulin is involved in the adipose conversion of 3T3 L1 preadipocytes.

Adipogenesis is an important aspect of energy homeostasis. Here we have used a differential proteome mapping strategy to identify intracellular proteins that are differentially expressed during adipose conversion of 3T3 L1 preadipocytes. Two-dimensional gel electrophoresis analysis identified 8 proteins that are induced following hormone-evoked differentiation. In addition, we found that a alpha2 macroglobulin fragment was abundantly present in 3T3 L1 preadipocytes, but was virtually undetectable in fully differentiated adipocytes. Metabolic radiolabeling with (35S)methionine and Northern blot analysis indicated that the intracellular alpha2 macroglobulin fragment in preadipocytes was derived from the extracellular culture medium, not de novo synthesis. Incubation of preadipocytes with an antialpha2 macroglobulin polyclonal antibody caused depletion of the intracellular alpha2 macroglobulin fragments, and also enhanced spontaneous adipose conversion. These results suggest that intracellular alpha2 macroglobulin fragment inhibits adipocyte differentiation, and that hormone treatment induces differentiation at least in part by suppression of intracellular alpha2 macroglobulin activity in 3T3 L1 preadipocytes.