Skeletal muscle capillaries are critical determinants of nutrient delivery and utilization and capillary network density is thought to correlate with insulin sensitivity. Conflicting data exist regarding the consequence of obesity‐associated metabolic disturbances on skeletal muscle capillarization, with positive, negative and no effect having been reported. The purpose of this investigation is to assess the influence of obesity induced by high fat feeding or by leptin receptor mutation, on the angiogenic profile within the skeletal muscle microenvironment, and ultimately, on muscle capillarization. In FVB/n mice fed a high‐fat (HF) or normal chow (NC) diet for 16‐weeks, mRNA levels of VEGF‐A did not change (NC: 1.06 vs. HF: 1.13; P >0.05) but VEGF protein levels were elevated (NC: 81 vs HF: 104 pg/mg; P =0.02). Relative FoxO1 protein levels increased in capillaries isolated from muscle of HF vs. NC mice (NC: 0.67 vs HF: 1.55; P =0.03). Capillary‐to‐fibre ratio (C:F) was not altered in HF‐ compared to NC‐ fed mice (2.22 and 2.04, P =0.34). In contrast, 13 week old mice with leptin receptor activity deficiency (Lepr db ) had a significant reduction in VEGF‐A mRNA (1.85 vs. 1.09, P =0.03) and protein (WT: 98 vs Lepr db : 86 pg/mg; P <0.05) relative to age‐matched C57BL/6 (WT) mice. Both FoxO1 (0.58 vs. 0.86) and THBS1 (0.37 vs. 0.81) mRNA levels tended to increase in Lepr db vs. WT mice. Skeletal muscle C:F was substantially reduced in Lepr db vs. WT mice (1.92 vs. 1.39, P <0.001). Comprehensive profiling of angiogenic regulators will be conducted by microarray analysis. The skeletal muscle microenvironment differs substantially between HF and Lepr db models. Our data suggest that muscle capillarization is maintained during HF feeding due to a balance between pro and anti‐angiogenic factors, which may include VEGF‐A and FoxO1. This balance is disrupted in leptin receptor mutant mice, which results in a loss of capillaries and raises the intriguing possibility that leptin signaling itself modulates muscle capillarization. Thus, the Lepr db model may not be a suitable model to study obesity‐induced vascular alterations in skeletal muscle. Funded by CIHR.
Thoracic empyema and concomitant bronchopleural fistula are serious complications of pneumonia. The treatment of empyema caused by extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has become increasingly challenging.A 57-year-old woman with controlled schizophrenia developed hospital-associated bacterial pneumonia secondary to P. aeruginosa on day 13 of hospitalization for brain meningioma surgery.Chest radiography and computed tomography revealed right-sided necrotizing pneumonia with pneumothorax, a focal soft tissue defect over the right lower chest wall, and a mild right-sided encapsulated pleural effusion with consolidation. XDR-PA was isolated on empyema cultures.The patient was treated with intrapleural amikacin as a bridge to video-assisted thoracoscopic surgery, followed by novel ceftazidime-avibactam therapy.On the 104th day of admission, the patient underwent chest wall debridement and closure. The patient was discharged on day 111. Twenty-eight days after discharge, there were no observable sequelae of empyema.Although the minimum inhibitory concentration of ceftazidime-avibactam for XDR-PA is relatively high (8 mg/L), this report emphasizes the efficacy of ceftazidime-avibactam treatment for XDR-PA empyema, as well as the importance of source control.
Sport and recreation are cornerstones of how we define ourselves as human beings and the competitive spirit is just as prominent in individuals with disabilities as it is in their able-bodied counterparts. Wheelchair sports were initially developed following WWII as a rehabilitation tool to care for the young men and women injured during the war. Today athletes with disabilities are narrowing the gap in competition between the impaired and the unimpaired through training, advancement of technology, and the competitive spirit and ingenuity of the seated athlete. This article examines a number of factors related to maximizing performance and the prevention of injury in wheelchair sport. Physical and technological considerations for various wheelchair sports will be discussed including; metabolic demands, equipment selection, configuration, advances in technology and performance measurement as well as directions for future research.
Graptopetalum paraguayense E. Walther is a popular traditional Chinese herb and possesses several health benefits. In earlier studies, we demonstrated that G. paraguayense showed no genotoxicity and showed several biological activities. However, the constituents of G. paraguayense have not been studied yet. In this present study, we isolated and identified the constituents of the leaves of G. paraguayense E. Walther.A total of seven flavonoid compounds were isolated from the methanolic extract of G. paraguayense. The four major compounds isolated were flavonoid glucoside derivatives of quercetin (1, 3) and kampferol (2, 4), each presenting a 3-hydroxyl-3-methylglutaroyl (HMG) substituent; compounds 3 and 4-the 2´´-acetyl derivatives of 1 and 2, respectively-are novel compounds isolated from nature for the first time. High-performance liquid chromatography for the quantitative analyses of the four major HMG-substituted flavonoid glycosides in G. paraguayense E. Walther were accomplished to acquire the high yields of 1-4 in the methanolic extract (4.8, 5.7, 4.3, and 2.5 mg/g, respectively). Furthermore, the antioxidant activities, including radical-scavenging, reducing power and lipid peroxidation inhibitory effects of these isolated flavonoids were also evaluated. All seven of the isolated flavonoid compounds possessed antioxdative activity.In this study of the constituents of the leaves of G. paraguayense E. Walther, we isolated four major components from its methanolic extract and determined their structures to be (acetylated) HMG-substituted flavonol glycosides, which are rare in nature. All seven of the isolated compounds possessed antioxdative activity, and those flavonoid compounds may be responsible for the functional ingredients in G. paraguayense. Further investigation of their bioactivities or pharmacological activities will be continued.
Migraine headaches can be provoked by surgical stress and vasoactive effects of anesthetics of general anesthesia in the perioperative period. However, it is unclear whether general anesthesia increases the migraine risk after major surgery. Incidence and risk factors of postoperative migraine are also largely unknown. We utilized reimbursement claims data of Taiwan's National Health Insurance and performed propensity score matching analyses to compare the risk of postoperative migraine in patients without migraine initially who underwent general or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI) for migraine risk. A total of 68,131 matched pairs were analyzed. The overall incidence of migraine was 9.82 per 1000 person-years. General anesthesia was not associated with a greater risk of migraine compared with neuraxial anesthesia (aORs: 0.93, 95% CI: 0.80-1.09). This finding was consistent across subgroups of different migraine subtypes, uses of migraine medications, and varying postoperative periods. Influential factors for postoperative migraine were age (aOR: 0.99), sex (male vs. female, aOR: 0.50), pre-existing anxiety disorder (aOR: 2.43) or depressive disorder (aOR: 2.29), concurrent uses of systemic corticosteroids (aOR: 1.45), ephedrine (aOR: 1.45), and theophylline (aOR: 1.40), and number of emergency room visits before surgery. There was no difference in the risk of postoperative migraine between surgical patients undergoing general and neuraxial anesthesia. This study identified the risk factors for postoperative migraine headaches, which may provide an implication in facilitating early diagnoses and treatment.
Commercially available teaching aids related to the human digestive tract were primarily provided in the form of human organ graphics or models for teaching. Such teaching aids often lacked practical operation and game-experiential learning methods, which were less likely to arouse children’s interest in learning. Thus, we designed a set of teaching aids for teaching young children to understand the human digestive tract and low-carbonate (low-carbon) diet. The teaching aids had the interchangeable appearance of a robot detective and an ambulance. They contained the four digestive tract games: the mouth, esophagus, stomach, small intestine, and large intestine. The dynamic game design that simulated the function of the digestive tract, combined with low-carbon diet board games, provided young children with learning in a playful context. The results showed that the teaching aids had advantages, including adaptive learning effects and fun games, enhancing learning motivation and interactive operation, and lightweight and environmentally friendly materials. More extensive teaching applications and follow-up research were recommended in the future.
Sedative−hypnotic misuse is associated with psychiatric diseases and overdose deaths. It remains uncertain whether types of anesthesia affect the occurrence of new postoperative uses of sedative−hypnotics (NPUSH). We used reimbursement claims data of Taiwan’s National Health Insurance and conducted propensity score matching to compare the risk of NPUSH between general and neuraxial anesthesia among surgical patients who had no prescription of oral sedative−hypnotics or diagnosis of sleep disorders within the 12 months before surgery. The primary outcome was NPUSH within 180 days after surgery. Multivariable logistic regression models were used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). A total of 92,222 patients were evaluated after matching. Among them, 15,016 (16.3%) had NPUSH, and 2183 (4.7%) were made a concomitant diagnosis of sleep disorders. General anesthesia was significantly associated both with NPUSH (aOR: 1.17, 95% CI: 1.13−1.22, p < 0.0001) and NPUSH with sleep disorders (aOR: 1.11, 95% CI: 1.02−1.21, p = 0.0212) compared with neuraxial anesthesia. General anesthesia was also linked to NPUSH that occurred 90−180 days after surgery (aOR: 1.12, 95% CI: 1.06−1.19, p = 0.0002). Other risk factors for NPUSH were older age, female, lower insurance premium, orthopedic surgery, specific coexisting diseases (e.g., anxiety disorder), concurrent medications (e.g., systemic steroids), postoperative complications, perioperative blood transfusions, and admission to an intensive care unit. Patients undergoing general anesthesia had an increased risk of NPUSH compared with neuraxial anesthesia. This finding may provide an implication in risk stratification and prevention for sedative−hypnotic dependence after surgery.
'/%3e%3cuse xlink:href='%23a' transform='rotate(60)'/%3e%3ccircle r='17' fill='%23000095'/%3e%3ccircle r='15' fill='%23fff'/%3e%3c/svg%3e)
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)