Disease-related Challenges Research Articles

Newcastle disease in local hens – A case report

Traditional local chicken farming, as opposed to commercial poultry breeds, faces numerous disease-related challenges, with one of the prominent threats being the Newcastle disease virus. This case report describes 8-week-old local hens infected with the Newcastle disease virus detected through epidemiological aspect, pathological, and virology investigations. The morbidity of this farm was 65%, with 20% mortality and 30.7% case fatality rate. The anatomopathology and histopathology examination revealed pathological changes in various organs. Laboratory tests using the Haemmaglutination-Inhibition and Haemmaglutination assays confirmed the presence of the Newcastle disease virus. Based on clinical symptoms, anatomopathological findings, histopathological analysis, virus isolation, and identification, it is concluded that the affected hens were infected with viscerotropic velogenic Newcastle disease.

Practical tips by peer support in chronic vestibular hypofunction: an exploratory survey.

Patients with chronic vestibular hypofunction typically suffer from dizziness, imbalance and oscillopsia (blurred vision); symptoms that pose challenges to everyday life. Currently, advice on how to deal with such challenges is mainly provided by health care professionals (i.e., ENT-surgeons, neurologists, physiotherapists and psychologists). However, fellow patients with a similar condition and a true appreciation of the lived experiences, are likely to provide valuable support and advice as well. The purpose of this study, therefore, was to collect tips and advice from patients with chronic vestibular hypofunction. An exploratory survey was designed to collect tips from fellow chronic vestibular hypofunction patients on how to cope with disease-related challenges in everyday life. The survey was distributed both online and in person. The list of tips was coded and analyzed thematically and deductively, by using the international classification of functioning, disability, and health (ICF) model. In total, 425 tips were obtained from the 179 participants. Most tips were coded under "environmental factors" (46%) and "activities and participation" (39%). The remaining tips were categorized as "body functions" (15%). No tips were about "body structures." The participants coped with their daily struggles by investing in assistive products and technology, like adapted bikes, special footwear, walking frames. They described the importance of ensuring minimal light intensity for visibility (i.e., installing light sources in dark places). During activities, participants gave the advice to avoid bumpy roads and obstacles, and highlighted the necessity of adequate visual fixation to maintain balance. To ensure optimal activity, participants emphasized the importance of managing energy and taking sufficient rest. This study gives insight into how patients with chronic vestibular hypofunction cope with everyday struggles due to their symptoms. These tips can expand advice given by healthcare professionals. Knowing that fellow patients experience similar struggles and learned to deal with their struggles in adequate ways, might offer support and help patients focus on possibilities rather than on disabilities. Further research should investigate the effect of sharing tips to see whether improvement in (mental) health can be achieved in patients with chronic vestibular hypofunction.

Recent Advances in the Use of Cubosomes as Drug Carriers with Special Emphasis on Topical Applications.

Topical drug delivery employing drug nanocarriers has shown prominent results in treating topical ailments, especially those confined to the skin and eyes. Conventional topical formulations persist with drug and disease-related challenges during treatment. Various nanotechnology-driven approaches have been adopted to mitigate the issues associated with conventional formulations. Among these, cubosomes have shown potential applications owing to their liquid crystalline structure, which aids in bioadhesion, retention, sustained release, and loading hydrophilic and hydrophobic moieties. The phase transition behavior of glyceryl monooleate, the concentration of stabilizers, and critical packing parameters are crucial parameters that affect the formation of cubosomes. Microfluidics-based approaches constitute a recent advance in technologies for generating stable cubosomes. This review covers the recent topical applications of cubosomes for treating skin (psoriasis, skin cancer, cutaneous candidiasis, acne, and alopecia) and eye (fungal keratitis, glaucoma, conjunctivitis, and uveitis) diseases. The article summarizes the manufacturing and biological challenges (skin and ocular barriers) that must be considered and encountered for successful clinical outcomes. The patented products are successful examples of technological advancements within cosmeceuticals that support various topical applications with cubosomes in the pharmaceutical field.

Quality of life in patients with Fabry's disease: a cross-sectional study of 86 adults.

BackgroundFabry disease (FD) is a multi-organ disorder associated with severe physical and psychological impairments, particularly in adulthood. To date, comprehensive data on the psychological burden of FD are lacking. The present study assessed quality of life (QOL) in a representative cohort of adults with FD.MethodsPatient-reported outcome measures were retrospectively analyzed in 86 adults with FD (49.6±16.6 years; 62.8% female) and compared to adults with congenital heart defects (ACHD) which is another lifelong disease and affliction. QOL was assessed using the European Quality of Life 5 Dimensions 5 Levels questionnaire (EQ-5D-5L).ResultsSubjects affected by FD reported an overall reduced QOL (EQ-VAS: 71.8±20.0). Most frequently reported complaints occurred within the dimensions pain/discomfort (69.7%), daily activities (48.9%) and anxiety/depression (45.4%). Compared to ACHD, individuals with FD scored significantly lower in the areas of pain/discomfort, usual activities and mobility (all P<0.05). Older age and female sex were particularly associated with diminished QOL (P=0.05).ConclusionsPatients with FD are at high risk for impaired QOL. They require additional support to cope with disease-related challenges. Increased attention should be directed towards improving their subjective well-being to potentially increase their QOL and long-term health outcomes.

‘It’s the empathy’—defining a role for peer support among people living with chronic kidney disease: a qualitative study

ObjectivesPersons with advanced chronic kidney disease (CKD) have unique support needs associated with managing a chronic yet often silent condition, complex treatment-related decisions and care transitions. The aim of this...

Mapping the complex everyday challenges and needs of people with rheumatic disease and their surroundings using a multi-actor approach.

This study aimed to gain insight into the real-world complexity of the challenges experienced by patients, their significant others, care professionals and the work and education environment concerning rheumatic diseases as well as the interrelation between these challenges; it also aimed to prioritise the identified challenges. Using the Dialog Model, 21 people with various rheumatic diseases, 24 care professionals, 9 significant others, and 3 education and work representatives were asked about rheumatic disease-related challenges and needs in a series of focus groups and interviews. Data were inductively coded and analysed, resulting in a mind map thematically displaying the challenges. The mind map was translated into a survey, and respondents (N=1802) prioritised themes and challenges. Of the six identified themes, 'physical complaints' was prioritised the most, followed by 'collaboration in healthcare', 'social and mental wellbeing', 'self-management', 'information and options in healthcare' and 'work and education'. Challenges of people with rheumatic diseases appeared to be complexly interrelated. For instance, fatigue and pain affect everyday functioning, but can also heavily impact social and mental wellbeing. To facilitate support for these challenges, which many patients desire, patients and care professionals said that better collaboration between primary and secondary care professionals is needed. Additionally, patients felt that their experiential expertise deserves more acknowledgement from care professionals. Results were similar across different rheumatic diseases. Many patients desire more support to manage life with their disease. To facilitate this, collaboration and communication between healthcare professionals, and between healthcare professionals and individual patients, should be improved.

Evolution of Therapy for Older Patients With Acute Myeloid Leukemia: How Should We Use Currently Available Agents?

Most patients with newly diagnosed acute myeloid leukemia (AML) are 65 years or older. The treatment of AML in older patients has been characterized by distinct patient- and disease-related challenges that have impeded the meaningful progress that has been observed in younger patients with AML. Higher rates of comorbidities and frailty contribute to higher rates of treatment-related complications, whereas adverse disease features such as poor-risk genomics and secondary AML are associated with therapeutic resistance and shortened survival. Intensive chemotherapy and allogeneic stem cell transplant, although still considered standard for many newly diagnosed patients with AML, may not be appropriate for a larger subset of older patients with AML. Lower-intensity approaches such as hypomethylating agents have been widely applied for newly diagnosed older and unfit patients with AML, improving tolerability among this subset, but providing more modest response rates. Numerous analyses have attempted to tackle the utility of higher- versus lower-intensity therapy in older AML and identify the factors that can help choose the approach that best optimizes tolerability and efficacy. Recently, a greater understanding of the genomic and biologic heterogeneity of AML has led to better risk stratification and has contributed to the development of specific targeted therapies that are starting to narrow the gap between safety and efficacy. Newly approved agents, such FLT3 (FMS-like tyrosine kinase 3) inhibitors, IDH1 and IDH2 inhibitors, and the BCL2 inhibitor venetoclax, as well postremission maintenance therapy with CC-486 (oral 5-azacitidine), are being systematically incorporated into the evolving treatment of older patients with newly diagnosed AML.

‘Well-being paradox’ revisited: a cross-sectional study of quality of life in over 4000 adults with congenital heart disease

ObjectiveThe present cross-sectional study investigated quality of life (QOL) in a large cohort of German adults with congenital heart disease (ACHDs) in association with patient-related and clinical variables.DesignCross-sectional survey.ParticipantsBetween 2016...

Quality of life in patients with Marfan syndrome: a cross-sectional study of 102 adult patients.

Marfan syndrome (MFS) is a genetically determined multiorgan disease that leads to severe physiological and psychological impairments in adult life. Little consensus exists regarding quality of life (QOL) in individuals with MFS. The present study sought to investigate QOL in a representative cohort of adults with MFS. Patient-reported outcome measures from a representative sample of 102 adults with MFS (39.3±13.1 years of age; 40.2% female) were retrospectively analyzed and compared with those from adults with different congenital heart defects (CHD), at the German Heart Center Munich. QOL was assessed using the updated five-level version of the EQ-5D. Differences between both populations were analyzed. Subjects affected by MFS reported an overall reduced QOL. Compared to CHD patients, individuals with MFS scored significantly lower in the dimensions of pain/discomfort, anxiety/depression, mobility and usual activities (P<0.05). Patients with MFS are at high risk for impaired QOL, especially in mental and physical domains. Psychosocial consequences of MFS cost resources for both, patients and professionals. Current findings highlight the great importance of additional psychological support to cope with disease-related challenges. Increased attention should be directed towards enhancing their subjective wellbeing to potentially improve their QOL and long-term health outcomes.

Web-based MINDfulness and Skills-based distress reduction in cancer (MINDS): study protocol for a multicentre observational healthcare study

IntroductionAlthough a high percentage of patients with cancer experience severe psychological distress, few of them receive psycho-oncological care, largely due to barriers on the side of patients and healthcare providers...

“What more can we ask for?”: an ethnographic study of challenges and possibilities for people living with haemophilia

Abstract Background Haemophilia treatment has improved life expectancy as well as lowered annual bleed rates and treatment burden for recent generations of people with haemophilia (PwH). However, PwH still face significant disease-related challenges on a day-to-day basis. Aims The aim of the present study was to explore the everyday life of PwH, including their beliefs and experiences related to their condition, their treatment, the challenges they face, and their ways of managing their condition. Materials and methods PwH were recruited through patient organisations in five European countries (Italy, Germany, Spain, UK and Ireland). Between 8–12 hours were spent with each person with haemophilia and/or their family, to follow them in their daily lives. Patient consultations with health care professionals (HCPs) were also observed when it was agreed in advance by both parties. In addition, HCPs were interviewed and haemophilia treatment centres (HTCs) were visited. Data were collected through semi-structured interviews, written exercises, facilitated group dialogues, and on-site observations of the interactions of PwH with friends, family, and HCPs. Results Research was conducted with 42 people with haemophilia A and 9 people with haemophilia B, between 1.5 and 82 years of age. Interviews often included the wider social ecology of each PwH, including friends, family, and caregivers. In addition, 18 HCPs from seven HTCs were interviewed (on-site observation was carried out at six HTCs). The study found that despite treatment adherence and advances in treatment approaches, many PwH may be suboptimally protected and still experienced regular bleeds, pain and restrictions in their daily life. Moreover, many had built a narrative of normalcy around this way of living with haemophilia, and as such these issues are an expected and neglected reality of living with haemophilia today. Conclusions The results of this research indicate the need for more personalised and optimised treatment approaches which are better adapted to personal and life-stage specific challenges of PwH. Such an approach could help reduce challenges for PwH, their families, and the health care system, and further research into such approaches would be valuable.

Health-related quality of life in pre-adolescent liver transplant recipients with biliary atresia: A cross-sectional study

Pediatric recipients of liver transplantation (LT) often report lower Health-Related Quality of Life (HRQOL) than healthy controls when assessed on generic HRQOL measurement tools. The recent addition of the Pediatric Liver Transplant Quality of Life (PeLTQL), a novel disease-specific HRQOL instrument for pediatric LT recipients, into the clinical armamentarium of tools now routinely available to clinical care teams, provides the unique opportunity to identify disease-related challenges in children who have undergone this life-saving intervention. This study assesses HRQOL in pre-adolescent aged patients with a primary diagnosis of biliary atresia (BA) who underwent LT as an infant, using both generic and disease-specific HRQOL instruments validated for children. We also examined modifiable factors associated with HRQOL after pediatric LT. HRQOL was the primary outcome of this study assessed using the disease-specific PeLTQL and the generic Pediatric Quality of Life Inventory 4.0 (PedsQL). Exposure variables of interest included medication status (e.g., monotherapy, dual therapy) and participation in sports. A total of 70 (56% female, mean age 9.89 ± 1.25 years) pediatric LT recipients (mean interval since LT was 9.0 ± 1.26 years) comprised the study cohort. LT recipients reported significantly lower PedsQL Scores relative to the general population. Immunosuppression monotherapy was associated with higher patient-reported PeLTQL Scores, and sports participation was associated with higher parent-reported PedsQL Scores. Pre-adolescents who underwent LT as an infant with BA, self-report low HRQOL on both disease-specific and generic HRQOL tools. Further research targeting sports participation and simplifying immunosuppression may further optimize quality of life years restored by life-saving LT.

Group Medical Visits for patients with chronic disease – innovative tool to improve patient’s outcomes through inter-patient interaction and inter-patient empowerment

Introduction : (comprising context and problem statement) The increase of patients affected by multiple chronic conditions requires a shift in health care delivery from acute episodic interactions towards continuous, proactive care. In order to be effective, chronic care needs to put the patients’ personal needs, experiences and values are in the center of care delivery. Yet, interventions translating these policies into everyday care delivery are scarce and highly sought after by healthcare policy makers and health practitioners. One answer to these imperatives are “Group Medical Visits” (GMV). GMVs are an innovative primary care intervention empowering and engaging chronically ill patients not only in their own care delivery. GMV have been recognized to be an effective and efficient tool improving outcomes for chronically ill patients, and to decreasing costs. Short description of practice change implemented : Out of various GMV models, Cooperative Health Care Clinics (CHCCs), developed at Kaiser Permanente, is the most commonly one used. In CHCC the same 10-12 patients, affected by the same chronic disease, meet bi-monthly in a group session with their GP, instead of seeing him individually in one-on-one visits. Each CHCC session is composed of five phases conducted in the group setting, concluded by optional one-on-one patient-physician-time. Table 1. Template CHCC model Phase Duration Introduction / Warm up ~ 5-10 Minutes Patient centered group discussion ~ 20-30 Minutes Treatment ~ 30-50 Minutes Questions and Answers ~ 10-15 Minutes Closing and Planning ~ 5-10 Minutes Brief one-on-one visits as necessary Aim and theory of change : CHCC reside on the facts, that patients have accumulated comprehensive disease specific knowledge and gained a wealth of problem solving skills and personal experience in how to overcome disease related challenges. By providing a supportive, physician guided peer group format for patients to exchange their individual knowledge, their “real-world-tested” coping strategies and their personal experience, CHCC aim to utilize and foster the patients’ self-care capabilities and strengthen their health literacy. Targeted population and stakeholders : Chronically ill patients were targeted to improve their ability to better self-manage and engage in their healthcare. Stakeholders are GPs as well as patients themselves, fostering… …exchange of problem solving strategies and coping mechanisms for disease specific challenges …motivation to alter hazard lifestyles …dealing with psychosocial aspects of chronic care Timeline :3 years Highlights : (innovation, impact and outcomes) Proven CHCCs outcomes: patient satisfaction physician satisfaction quality of care effectiveness and efficiency in care provision Comments on sustainability : CHCC constitute an efficient alternative to one-on-one visits, as they require less physician time per patient. Comments on transferability : Developed by Kaiser Permanente, CHCCs have now been successfully trialed in various integrated and non-integrated healthcare systems. Conclusions : (comprising key findings) Aiming at supporting chronically ill to manage their conditions, to access and adapt coping strategies via peers affected from the same challenges, has been proven an effective tool. CHCCs… improve user experience as chronic care is translated from episodic to continuous interactions with the primary care provider in a group setting with peers improve health of chronically ill, by inter-patient exchange of knowledge and coping strategies increase the efficiency of primary care provision by replacing one-on-one visit Discussions : GMVs are not the panacea for chronic care delivery; however they are an instrument every GP should have in his “chronic care toolbox”. CHCC support GPs to help patients self-manage effectively, improve health outcomes and avoid inappropriate usage of healthcare resources. They are an instrument to enable patients to make choices of treatment options, to alter hazard lifestyles, and to access coping strategies. Lessons learned : Implementing GMVs to multiply self-care skills and enhance health literacy for the entire chronically ill patient panel at physician clinics requires change management and project management capabilities, which are not necessarily present in small independent GP practices.

Patients’Perceptions of Having a Good Life One Year after Arthritis Patient Education: A Qualitative Study Nested within a Randomized Controlled Trial

Background: Patients with inflammatory polyarthritis have various degrees of disease-related challenges such as joint pain, stiffness, fatigue, and physical limitations. Despite these challenges, patients strive for a good life using their personal resources, often taught in patient education. The effect of patient education in polyarthritis is well studied; however, long-term studies on what patients perceive as a good life after participating in arthritis patient education are scarce.Purpose: The aim of this study was to explore patients’ perceptions of having a good life one year after attending a nurse-led patient education intervention.Methods: This was a qualitative study nested within a randomized controlled trial (RCT) studying the effect of nurse-led patient education. Fifteen individual semi-structured interviews were conducted among those who attended the nurse-led patient education intervention. The intervention focused on the consequences of living with chronic inflammatory arthritis. The interviews explored how and whether the intervention had made any changes in the informants perceived health, well-being, arthritis, flares, and treatment regimes. The data were analyzed thematically using systematic text condensation.Results: The findings showed that the informants’ perceptions of having a good life were related to a stable disease with few symptoms, effective treatment regimes, discovering new opportunities and perspectives in life, as well as making choices that felt right. Creating a good life was something the informants had acquired knowledge about in the nurse-led patient education intervention, particularly in the part where they had discussed and shared experiences with each other on how they managed their arthritis in different ways and settings.Conclusion: Participating in a nurse-led patient education intervention in arthritis helped the informants to discover new opportunities and perspectives on creating a good life, especially through exchanging experiences with fellow patients.

Flying the nest: a challenge for young adults with cystic fibrosis and their parents.

ObjectivesAs young patients with cystic fibrosis (CF) grow up, they are expected to take increasing responsibility for the treatment and care of their disease. The aim of this study was to explore the disease-related challenges faced by young adults with CF and their parents, when they leave home.Materials and methodsA questionnaire survey of Danish patients with CF aged 18–25 years and their parents was conducted. The questionnaires were based on focus-group interviews with young adults with CF and their parents, and addressed challenges faced in the transition phase between childhood and adulthood, including different areas of disease management in everyday life.ResultsAmong all of the patients invited, 62% (n=58/94) of young adults and 53% (n=99/188) of their parents participated in the study. In total, 40% of the 18- to 25-year-olds were living with their parents, and the parents continued to play an active role in the daily care of their offspring’s disease. Among the young adults who had left home, both the patients and their parents reported many difficulties regarding disease management; the young adults reported difficulties in contacting social services and in affording and preparing sufficient CF-focused meals, and their parents reported difficulties in answering questions concerning social rights and CF in general, and in knowing how to give their offspring the best help, how much to interfere, and how to relinquish control of managing their offspring’s disease.ConclusionYoung adults with CF who have left home have difficulties in handling the disease and their parents have difficulties in knowing how to give them the best help. There is an urgent need for holistic CF transitional care, including ensuring that young adults master the essential skills for self-management as they leave their parents.

Dermatology discharge continuity clinic enhances resident autonomy and insight into transitions-of-care competencies: a cross-sectional survey study

Dermatology residents perform consults on hospitalized patients, but are often limited in their ability to follow-up with these patients after discharge, leading to inadequate follow-up and understanding of post-discharge transitions of care. In 2013, a discharge continuity clinic (DCC) staffed by the inpatient consult dermatology resident and attending dermatologist was established at one of the four adult hospital sites residents rotate through in the Harvard Combined Dermatology Residency Program. Resident perceptions about the DCC and their educational experience on inpatient consult rotations with a DCC and without a DCC were obtained using a cross-sectional survey instrument in June 2016. Self-reported data from a multi-year cohort of dermatology residents (n = 14 of 20, 70% response rate) reveals that the DCC enabled resident autonomy and resident satisfaction in care of their patients,insight into the disease-related challenges and the broader social context during transitions of care from inpatient to outpatient settings, and more enriching learning experiences than inpatient consult rotations without a DCC. Dermatology residents self-report participation in an inpatient consult rotation with aDCC supports their autonomy and achievement of post-discharge transitions-of-care competencies.

Patients' Perspectives on Information and Communication About Sexual and Relational Issues in Rheumatology Health Care.

Men and women with rheumatic diseases report a significantly negative impact on multiple areas of life, including sexuality. Research indicates that patients want to discuss sexual issues with health professionals (HPs) in rheumatology care but these issues are rarely addressed in consultations. The objective of the present study was to explore patients' experiences of communication with HPs about disease-related sexual issues, their perceptions of the relevance of these issues in rheumatology care and their preferences for how these topics should be handled. A qualitative design was used and 18 semi-structured interviews were performed, including eight women and ten men with inflammatory rheumatic joint diseases, aged 29-62 years. The interviews were recorded and transcribed verbatim. Data were analysed thematically. Four main themes were derived from the interviews: (i) relevance of sexual issues; (ii) vital conditions for communication; (iii) individual preferences in mode and timing of information and communication; and (iv) benefits of information and communication. The participants expressed that, although sexual issues are relevant, necessary conditions for good communication are largely lacking. HPs' knowledge, experience and personal skills, as well as having sufficient time were essential. HPs lack of initiating sexual topics contributed to uncertainty about whether their sexual challenges were disease related and whether it was a legitimate topic to discuss in rheumatology care. Patients wanted HPs to possess knowledge about possible disease-related challenges in sexual life and intimate relationships, and to facilitate communication about these aspects. There is a need to develop practice guidelines to enable HPs to integrate sexual issues as an aspect of healthcare delivery in a patient-friendly manner. Copyright © 2016 John Wiley & Sons, Ltd.

Patients' confidence in coping with arthritis after nurse-led education; a qualitative study.

BackgroundThe aim of this study was to explore how patients with chronic inflammatory polyarthritis described coping with their disease after a nurse-led patient education program and compare these experiences to patients in a control group who did not receive any education.MethodsThis was a qualitative study nested within a randomized controlled trial (RCT) investigating the effect of nurse-led patient education for patients with chronic inflammatory polyarthritis. Twenty-six individual face-to-face interviews, 15 in the intervention group and 11 in the control group were conducted approximately two months after the educational program. The same opening question; «Can you please tell me how you have been these last four months, since last time we spoke», followed by questions about the informants’ experiences of coping with disease-related challenges, disease activity changes, coping with disease activity changes, the informants’ perceptions of good and challenging situations to be in were asked to all informants.ResultsInformants who attended the educational program expressed a strengthened confidence in coping with the consequences of having arthritis, which made them feel good. The strengthened confidence was attributed to sharing experiences with other participants in the group and learning something new. Informants in the intervention group further linked their confidence to 1) coping with disease fluctuations, 2) changed health behaviours and 3) knowledge about medications.ConclusionsPatients taking part in nurse-led patient education described a strengthened confidence in coping with their arthritis stemming from sharing experiences with other patients and learning something new.Trial registrationThe RCT was registered in ClinicalTrials.gov (NCT00623922) in February 2008.

Exercise training improves vascular mitochondrial function.

Exercise training is recognized to improve cardiac and skeletal muscle mitochondrial respiratory capacity; however, the impact of chronic exercise on vascular mitochondrial respiratory function is unknown. We hypothesized that exercise training concomitantly increases both vascular mitochondrial respiratory capacity and vascular function. Arteries from both sedentary (SED) and swim-trained (EX, 5 wk) mice were compared in terms of mitochondrial respiratory function, mitochondrial content, markers of mitochondrial biogenesis, redox balance, nitric oxide (NO) signaling, and vessel function. Mitochondrial complex I and complex I + II state 3 respiration and the respiratory control ratio (complex I + II state 3 respiration/complex I state 2 respiration) were greater in vessels from EX relative to SED mice, despite similar levels of arterial citrate synthase activity and mitochondrial DNA content. Furthermore, compared with the SED mice, arteries from EX mice displayed elevated transcript levels of peroxisome proliferative activated receptor-γ coactivator-1α and the downstream targets cytochrome c oxidase subunit IV isoform 1,isocitrate dehydrogenase(Idh)2, and Idh3a, increased manganese superoxide dismutase protein expression, increased endothelial NO synthase phosphorylation (Ser(1177)), and suppressed reactive oxygen species generation (all P< 0.05). Although there were no differences in EX and SED mice concerning endothelium-dependent and endothelium-independent vasorelaxation, phenylephrine-induced vasocontraction was blunted in vessels from EX compared with SED mice, and this effect was normalized by NOS inhibition. These training-induced increases in vascular mitochondrial respiratory capacity and evidence of improved redox balance, which may, at least in part, be attributable to elevated NO bioavailability, have the potential to protect against age- and disease-related challenges to arterial function.

What Engineering Technology Could Do for Quality of Life in Parkinson's Disease: A Review of Current Needs and Opportunities.

Parkinson's disease (PD) involves well-known motor symptoms such as tremor, rigidity, bradykinesia, and altered gait, but there are also nonlocomotory motor symptoms (e.g., changes in handwriting and speech) and even nonmotor symptoms (e.g., disrupted sleep, depression) that can be measured, monitored, and possibly better managed through activity-based monitoring technologies. This will enhance quality of life (QoL) in PD through improved self-monitoring and also provide information that could be shared with a healthcare provider to help better manage treatment. Until recently, nonmotor symptoms ("soft signs") had been generally overlooked in clinical management, yet these are of primary importance to patients and their QoL. Day-to-day variability of the condition, the high variability in symptoms between patients, and the isolated snapshots of a patient in periodic clinic visits make better monitoring essential to the proper management of PD. Continuously monitored patterns of activity, social interactions, and daily activities could provide a rich source of information on status changes, guiding self-correction and clinical management. The same tools can be useful in earlier detection of PD and will improve clinical studies. Remote medical communications in the form of telemedicine, sophisticated tracking of medication use, and assistive technologies that directly compensate for disease-related challenges are examples of other near-term technology solutions to PD problems. Ultimately, a sensor technology is not good if it is not used. The Parkinson's community is a sophisticated early adopter of useful technologies and a group for which engineers can provide near-term gratifying benefits.