Greater Percent Change Research Articles

Acute Effects of Resistance Exercise With Continuous and Intermittent Blood Flow Restriction on Hemodynamic Measurements and Perceived Exertion.

This study compared the acute effects of low-intensity resistance exercise (RE) sessions for the upper limb with continuous and intermittent blood flow restriction (BFR) and high-intensity RE with no BFR on lactate, heart rate, double product (DP; heart rate times systolic blood pressure), and perceived exertion (RPE). Ten recreationally trained men (1-5 years strength training; age mean = 19 ± 0.82 years) performed three experimental protocols in random order: (a) low-intensity RE at 20% one-repetition maximum (1RM) with intermittent BFR (LI + IBFR), (b) low-intensity RE at 20% 1RM with continuous BFR (LI + CBFR), and (c) high-intensity RE at 80% 1RM. The three RE protocols increased lactate and DP at the end of the session ( p < .05) and increased heart rate at the end of each exercise ( p < .05). However, greater local and general RPE was observed in the high-intensity protocol compared with LI + IBFR and LI + CBFR in the lat pull-down, triceps curl, and biceps curl exercises ( p < .05). A greater percentage change in DP and lactate was observed for continuous BFR compared with intermittent BFR; however, RPE was lower for intermittent BFR. In conclusion, intermittent BFR appears to be an excellent option for physical training because it did not differ significantly from continuous BFR in any variable and promoted a lower percentage change in DP and RPE.

The efficacy advantage of evolocumab (AMG 145) dosed at 140 mg every 2 weeks versus 420 mg every 4 weeks in patients with hypercholesterolemia: Evidence from a meta-analysis

BackgroundEvolocumab (AMG 145), a PCSK9 inhibitor, has been shown to decrease low-density lipoprotein cholesterol (LDL-C) levels. Doses of 140mg administered every 2weeks (Q2W) and 420mg administered every 4weeks (Q4W) are widely used, and both dosing schedules were effective in clinical trials. However, some researchers have speculated that 140mg Q2W administration has equal or even greater efficacy. This meta-analysis was performed to assess the differences in efficacy and safety between the two doses. MethodsWe searched the PubMed, EMBASE, and Web of Science databases to identify relevant clinical trials published before January 2016. A total of 2403 patients from 8 randomized controlled trials were identified and included in the analysis. ResultsEvolocumab administered at 140mg Q2W resulted in a greater percent change from baseline in LDL-C concentration (−7.27; 95% confidence interval (CI), −10.36 to −4.18) and had greater efficacy in achieving the treatment goal of LDL-C ≤1.8mmol/L with an relative risk (RR) of 1.09 (95% CI, 1.00 to 1.18) compared with 420mg Q4W in patients who were concomitantly treated with statins. These findings were not significantly different between the 140mg Q2W and 420mg Q4W groups when evolocumab was administered as monotherapy. There was no difference in the rate of occurrence of the main treatment-related adverse events between the two doses. ConclusionsEvolocumab administered at 140mg Q2W was more effective than the 420mg Q4W dosage at lowering lipid concentrations, especially in patients who concomitantly received stable statin therapy.

Effect of phentermine on weight reduction in a pediatric weight management clinic.

Phentermine is the most widely prescribed obesity medication in adults, yet studies of its use in the pediatric population are limited. We conducted a retrospective chart review of adolescents with obesity treated in a pediatric weight management clinic to examine the weight loss effectiveness of phentermine added to standard of care (SOC) lifestyle modification therapy versus SOC alone. All patients receiving phentermine plus SOC (n=25) were matched with a comparison group receiving only SOC (n=274). Differences at 1, 3 and 6 months were evaluated using generalized estimated equations adjusting for age, sex and baseline body mass index (BMI) and robust variance standard error estimates for confidence intervals and P-values. Phentermine use was associated with a greater percent change in BMI at 1 month (-1.6%; 95% confidence interval (CI): -2.6, -0.6%; P=0.001), 3 months (-2.9%; 95% CI: -4.5, -1.4%; P<0.001) and 6 months (-4.1%; 95% CI: -7.1, -1.0%; P=0.009) compared with SOC alone, with no differences in systolic or diastolic blood pressure between groups. Heart rate was higher at all time-points in the phentermine plus SOC compared with SOC-only group. These data suggest that short-term use of phentermine added to SOC may enhance weight loss in adolescents with obesity in the clinical setting.

Evaluation of the effects of anatomic location, histologic processing, and sample size on shrinkage of skin samples obtained from canine cadavers.

OBJECTIVE To evaluate effects of anatomic location, histologic processing, and sample size on shrinkage of excised canine skin samples. SAMPLE Skin samples from 15 canine cadavers. PROCEDURES Elliptical samples of the skin, underlying subcutaneous fat, and muscle fascia were collected from the head, hind limb, and lumbar region of each cadaver. Two samples (10 mm and 30 mm) were collected at each anatomic location of each cadaver (one from the left side and the other from the right side). Measurements of length, width, depth, and surface area were collected prior to excision (P1) and after fixation in neutral-buffered 10% formalin for 24 to 48 hours (P2). Length and width were also measured after histologic processing (P3). RESULTS Length and width decreased significantly at all anatomic locations and for both sample sizes at each processing stage. Hind limb samples had the greatest decrease in length, compared with results for samples obtained from other locations, across all processing stages for both sample sizes. The 30-mm samples had a greater percentage change in length and width between P1 and P2 than did the 10-mm samples. Histologic processing (P2 to P3) had a greater effect on the percentage shrinkage of 10-mm samples. For all locations and both sample sizes, percentage change between P1 and P3 ranged from 24.0% to 37.7% for length and 18.0% to 22.8% for width. CONCLUSIONS AND CLINICAL RELEVANCE Histologic processing, anatomic location, and sample size affected the degree of shrinkage of a canine skin sample from excision to histologic assessment.

Alcohol use risk in adolescents 2 years after bariatric surgery

BackgroundProblematic alcohol use and increased sensitivity postoperatively in adult weight loss surgery patients heightens concerns. No data have characterized these behaviors in adolescents—a gap, given adolescent alcohol use and heavy drinking are public health concerns. ObjectiveTo examine alcohol use behavior in adolescents who underwent weight loss surgery across the first two post-operative years in comparison to nonsurgical adolescents. SettingFive academic medical centers. MethodsUtilizing a prospective controlled design, adolescents undergoing weight loss surgery (n = 242) and nonsurgical adolescents with severe obesity (n = 83) completed the Alcohol Use Disorders Test. Analyses included 216 surgical (Mage = 17.1 ± 1.5, MBMI = 52.9 ± 9.3, 91.8% female, 67.6% white) and 79 nonsurgical participants (Mage = 16.2 ± 1.4, MBMI = 46.9 ± 6.1, 82.3% female, 53.2% white), with baseline data and at 12 or 24 months postoperatively. ResultsThe majority reported never consuming alcohol within the year before surgery (surgical, 92%; nonsurgical, 91%) or by 24 months (surgical, 71%; nonsurgical, 74%), when alcohol use disorder approached 9%. Among alcohol users at 24 months (n = 52 surgical, 17 nonsurgical), 35% surgical and 29% nonsurgical consumed 3+drinks on a typical drinking day; 42% surgical and 35% nonsurgical consumed 6+drinks on at least 1 occasion. For the surgical group, alcohol use changed as a function of older age (odds ratio [OR] = 2.47, P = .01) and lower body mass index (OR = .94, P<.001). Greater percent change in weight (0–24 mo) was associated with increased odds of alcohol use at 24 months (OR = 1.01, 95% confidence interval: 1.002–1.02). ConclusionAlcohol use was lower than national base rates. Alcohol use disorder rates and harmful consumption raise concerns given extant adult literature. Alcohol education focused on harm reduction (i.e., lower consumption, managing situations conducive to alcohol-related harm) and monitoring by healthcare providers as patients mature is indicated.

Repeatability of vascular responsiveness measures derived from near-infrared spectroscopy.

Near‐infrared spectroscopy (NIRS)‐derived measures of tissue oxygen saturation (StO2) have been recently shown to significantly correlate with the widely used method for noninvasively assessing vascular endothelial function, flow‐mediated dilation (FMD). The purpose of this study was to examine the intraday and interday reliability of the reperfusion slope of StO2 (slope 2 StO2) and compare it to FMD. Ultrasound‐derived FMD was quantified following 5 min of distal cuff occlusion of the popliteal artery in nine healthy young men (26 ± 3 years). An FMD test was performed each of 4 days, with a fifth involving three tests. FMD was calculated as the greatest percent change in diameter from baseline (%FMD). StO2 was measured using NIRS throughout each test, with slope 2 StO2 being calculated as the upslope of 10‐sec following cuff release. Reliability was determined using repeatability, intraclass correlation coefficients (ICC), and coefficient of variation (CV). Repeatability of slope 2 StO2 was better than %FMD for both intraday (0.43 and 5.65, respectively) and interday (0.48 and 4.82, respectively) comparisons; approximately 30% of mean values for slope 2 StO2 could be attributed to measurement error, whereas 100% of mean FMD could be for both intraday and interday comparisons. Similarly, ICC and CV values indicated stronger reliability of slope 2 StO2 compared to %FMD for both intraday (ICC 0.92 and 0.36, respectively; CV 9 ± 4% and 44 ± 24%, respectively) and interday (ICC 0.94 and 0.25, respectively; CV 14 ± 5% and 40 ± 22%, respectively) comparisons. In conclusion, NIRS‐derived slope 2 StO2 can be used as a reliable measure of vascular reactivity.

The Impact of Errors on PACER Test Healthy Fitness Zone Classification in Students

PURPOSE: In light of the current disease trends (obesity, diabetes, etc.) in children and adolescents a greater effort has been made for physical education classes to move away from sports skill-based programming to health, wellness, and fitness-based approaches. Accompanying this transition has been the implementation of physical fitness assessments that utilize evidence-based standards that measure physical fitness levels as related to good overall health. The PACER Test (FITNESSGRAM®) is a common fitness assessment that assesses cardiorespiratory fitness/aerobic capacity in children and adolescents. While the protocol and test administration is relatively straight forward, in large groups/classroom settings there can be potential sources of measurement error leading to miss counts and recording of PACER laps. The extent to which these errors affect the health risk classification of students is unknown, therefore the purpose of this study was to examine the impact PACER test recording error has on the health risk classification of students. METHODS: A sample of 528 students (272 males and 256 females), with an average age of 13.2 ± 2.5 yrs, and average BMI of 21.47 ± 4.7, from a large Midwestern school district participated in this project. Data from the PACER Test (FITNESSGRAM®) was adjusted by ±1 and ±2 laps to simulate counting and recording errors that may accompany PACER test administration. RESULTS: Results indicated 64.96% of students were classified in a healthy fitness zone (HFZ), 18.18% were classified as needing improvement (NI), and 16.86% were classified as needing improvement and having health risks (NI-HR). When accounting for lap count error the NI-HR classification saw the greatest percent change (+1: -11.24%, +2: -21.35%, -1: 10.11%, -2: 20.22%). CONCLUSIONS: The study showed that error in data collection of students affects those who need the most intervention to improve their physical fitness. This emphasizes the importance of accurate data collection of fitness tests in physical education classes.

The impact of short-term depot-medroxyprogesterone acetate treatment on resting metabolic rate

ObjectiveThis study examines the effect of a progestogen (depot-medroxyprogesterone acetate, DMPA) on resting metabolic rate (RMR) in a cohort of young, normal-weight healthy women. We hypothesize an increase in RMR and nonshivering thermogenesis (NST) resulting in increased body temperature by DMPA. Study designWe performed a prospective cohort study in 13 subjects tested at baseline, 3weeks and 9weeks after 150mg intramuscular DMPA administration. RMR was determined with indirect calorimetry. Secondary endpoints included changes in body mass index (BMI), body composition, temperature and serum levels of estradiol (E2), luteinizing hormone (LH), progesterone and MPA. ResultsThe percent change in RMR from baseline to week 3 (9%) was significantly higher than the percent change from baseline to week 9 (1.6%) (p=.045). The greatest percent change from baseline to week 3 compared to baseline to week 9 was seen in women initiating DMPA in the luteal phase of the cycle. Hypothalamic-pituitary-ovarian axis was evident by decreases in E2, LH and progesterone. DMPA resulted in increased body temperature with a significant correlation between the change in body temperature and the change in RMR. No change in body composition was seen. ConclusionsRMR and NST increased in young healthy women with normal BMI 3weeks after receiving the initial dose of 150mg DMPA for contraception. The effect was augmented when the drug was administered during the luteal phase of the menstrual cycle. ImplicationDMPA increases RMR and thermogenesis independent of changes in body mass. An increase in weight with chronic DMPA may result from a combination of hyperphagia and abnormal NST in predisposed individuals.

Vascular responsiveness determined by near-infrared spectroscopy measures of oxygen saturation.

Vascular impairments at the macro- and microcirculatory levels are associated with increased risk for cardiovascular disease. Flow-mediated dilation (FMD) is currently the most widely used method for non-invasive assessment of vascular endothelial function. Recently, near-infrared spectroscopy (NIRS)-derived measures of tissue oxygen saturation (StO2) have been used to characterize the dynamic response of local tissue perfusion to a brief period of ischaemia. The purpose of the present study was to establish correlations between the reperfusion rate of StO2 and FMD. Ultrasound-derived FMD was quantified after 5 min of distal cuff occlusion of the popliteal artery in 20 healthy young men (26 ± 3 years old). Triplicate measurements of end-diastolic arterial diameter were made every 15 s after cuff release, and FMD response was calculated as the greatest percentage change in diameter from baseline (%FMD). The StO2 was measured using NIRS throughout the duration of each test. Two consecutive FMD tests were performed, separated by 30 min of rest, and were averaged for %FMD and StO2. The %FMD was significantly correlated with the reperfusion slope of StO2 after cuff release (slope 2 StO2; r = 0.63, P = 0.003). In conclusion, the present study established a correlation between slope 2 StO2 and %FMD in healthy young men. These data suggest that NIRS-derived slope 2 StO2 can be used as a measure of vascular endothelial function.

Timing of hemodynamic changes during transnasal endoscopic surgery.

Although considered less invasive and therefore less morbid than laryngoscopy under general anesthesia, prior research shows that transnasal flexible endoscopic (TNFE) procedures are associated with a significant increase in heart rate and blood pressure. The purpose of this review was to identify the most stimulating portion of the procedure to potentially provide a target for directed pharmacotherapy to ensure hemodynamic stability. Retrospective chart review. Retrospective chart review of adult patients who underwent upper airway intervention in the larynx and trachea by TNFE. Vital signs recorded at 5-minute intervals throughout the procedure were examined and analyzed by Wilcoxon signed rank test and Wilcoxon rank sum test. For heart rate and systolic and diastolic blood pressure, the median change in value was 13 beats per minute (P < 0.0001), 27 mm of mercury (P < 0.0001), and 26.5 mm of mercury (P < 0.0001), respectively. The most significant change in heart rate and saturation was during the application of nasal and laryngeal anesthetic, as well as during the positioning of the scope. Blood pressures were elevated during the procedure itself. With respect to comorbidities, underlying asthma and coronary artery disease were associated with a greater percent change in the heart rate (P = 0.05 for both). There are significant vital sign changes during transnasal endoscopic procedures. Changes in heart rate and oxygen saturation tended to occur during preparation, whereas blood pressure was elevated during the laryngeal intervention. For patients with asthma, the percent change was greater, and perhaps a more controlled environment is warranted. 4. Laryngoscope, 126:2047-2050, 2016.

Does Exercise Influence Pediatric Bone? A Systematic Review.

Periods of growth are thought to be the best time to increase bone mineral content, bone area, and areal bone mineral density (aBMD) through increased loading owing to high rates of bone modeling and remodeling. However, questions remain regarding whether a benefit of exercise is seen at all bone sites, is dependent on pubertal status or sex of the child, or whether other factors such as diet modify the response to exercise. We asked: (1) Does bone-loading exercise in childhood consistently increase bone mineral content, bone area, or aBMD? (2) Do effects of exercise differ depending on pubertal status or sex? (3) Does calcium intake modify the bone response to exercise? A literature search identified 22 unique trials for inclusion in this meta-analysis of the effect of exercise on bone changes by bone site, pubertal status, and sex. Sample sizes ranged from 16 to 410 subjects 3 to 18 years old with length of intervention ranging from 3 to 36 months. Fifteen of 22 trials were randomized (child randomized in nine, classroom/school randomized in six) and seven were observational trials. Ten trials were Level 2 and 11 were Level 3 based on the Oxford Centre for Evidence-Based Medicine criteria. Random effects models tested the difference (intervention mean effect-control mean effect) in percent change in bone mineral content, bone area, and aBMD. Meta-regression was used to identify sources of heterogeneity and funnel plots were used to assess publication bias. Children assigned to exercise had greater mean percent changes in bone mineral content and aBMD than children assigned to the control groups. Mean differences (95% CI) in bone mineral content percent change between intervention and control groups at total body (0.8; 95% CI, 0.3-1.3; p = 0.003), femoral neck (1.5; 95% CI, 0.5-2.5; p = 0.003), and spine (1.7; 95% CI, 0.4-3.1; p = 0.01) were significant with no differences in bone area (all p > 0.05). There were greater percent changes in aBMD in intervention than control groups at the femoral neck (0.6; 95% CI, 0.2-1.1; p = 0.006) and spine (1.2; 95% CI, 0.6-1.8; p < 0.001). Benefit of exercise was limited to children who were prepubertal (bone mineral content: total body [0.9; 95% CI, 0.2-1.7; p = 0.01], femoral neck [1.8; 95% CI, 0.0-3.5; p = 0.047], spine [3.7; 95% CI, 0.8-6.6; p = 0.01], and aBMD: femoral neck [0.6; 95% CI, -0.1-1.2; p = 0.07], spine [1.5; 95% CI, 0.7-2.3; p < 0.001]), with no differences among children who were pubertal (all p > 0.05). Changes in aBMD did not differ by sex (all p > 0.05), although the number of studies providing male-specific results was small (six of 22 eligible studies included boys). There was significant heterogeneity in bone mineral content and bone area for which a source could not be identified. Heterogeneity in spine aBMD was reduced by including calcium intake and intervention length as covariates. Three trials designed to determine whether calcium intake modified the bone response to exercise all reported a greater effect of exercise on leg bone mineral content in children randomized to receive supplemental calcium than those receiving placebo. Exercise interventions during childhood led to 0.6% to 1.7% greater annual increase in bone accrual, with effects predominantly among children who were prepubertal. If this effect were to persist into adulthood, it would have substantial implications for osteoporosis prevention. It is important to identify sources of heterogeneity among studies to determine factors that might influence the bone response to increased exercise during growth. Level II, therapeutic study.

Changes in insulin-like growth factor-I and its binding proteins are associated with diabetes mellitus in older adults.

To determine whether changes in insulin-like growth factor (IGF) protein levels are greater in participants with type 2 diabetes mellitus or worsening glycemia than in normoglycemic individuals over a 9-year follow-up period. Retrospective analysis of a cohort study. Participants were recruited from North Carolina, California, Maryland, and Pennsylvania. Cardiovascular Health Study All Stars participants, a cohort study of community-dwelling adults aged 65 and older (N=897). Plasma IGF-I, IGF binding protein (IGFBP)-1, and IGFBP-3 levels were assessed and American Diabetes Association cut-points for impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus were used to classify participants at baseline (1996-97) and follow-up (2005-06). At baseline, mean age was 76.3±3.6, and 18.5% had diabetes mellitus. Participants with IFG alone and IGT plus IFG had higher IGF-I levels and lower IGFBP-1 levels than those with normoglycemia or diabetes mellitus. The greatest percentage change in IGF levels occurred in those who had diabetes mellitus at baseline (9-year changes: -9.3% for IGF-I, 59.7% for IGFBP-1, -13.4% for IGFBP-3), the smallest in individuals who remained normoglycemic at follow-up (9-year changes: -3.7% for IGF-I, 25.6% for IGFBP-1, -6.4% for IGFBP-3), and intermediate in those who were normoglycemic but developed IFG at follow-up. Degrees of glycemic impairment are associated with varying degrees of change in IGF protein levels. The changes observed in the diabetes mellitus group have been previously shown to be associated with heart failure, cancer, and noncancer mortality.

Effects of Pedicle Screw and Spinous Process Distraction on Adjacent Foramina

Introduction Surgical advances attempt to alleviate lumbar spinal stenosis, which burdens many people in our aging population. One goal of pedicle screw and spinous process distraction is to decompress the neural foramina of the affected segment. The objective of this study is to evaluate the change in the foraminal size adjacent to the distracted level. Materials and Methods The lumbar spine of a prone cadaveric specimen was exposed. Titanium pedicle screws were placed from L1-L5. A titanium rod spanning only two levels on either side of the spine was fastened down at the caudal end and secured at the cephalad end. The screws were distracted until maximal resistance on the left side was reached and then the cephalad set screw was secured. The same amount of distraction was applied to the right side and secured in the same fashion. A second prone cadaveric specimen was exposed. Titanium screws were instead inserted into the spinous processes at levels L1-L4. The distraction technique described above was used with two predetermined distances (3 mm and 6 mm). A CT scan was obtained before and after distraction at each level. Foraminal openings at the level of distraction as well as the adjacent above and below foramina were measured and analyzed. Results In the pedicle-distraction specimen, there was an overall positive percent change at the level of distraction and an overall negative percent change in the levels above and below. The level of L3-L4 on the right revealed the largest percent change (11.09%) in foramen distraction. The foramen superior to the L2-L3 distraction demonstrated the least amount of change (−9.71%). The spinous process-distraction specimen demonstrated an overall positive percent change at the level of the distraction but not an overall negative change at the adjacent levels. The L1-L2 superior adjacent foramina had negative percent changes at the 3 mm and 6 mm of −2.80% R, −12.52% L and −4.20% R,−15.46% L, respectively. Only the right, 3 mm distraction of the inferior adjacent of L1-L2 showed a negative percent change, the rest were positive changes. The L3-L4 distractions including above and below foramina were positive percent changes. The greatest percent change at L3-L4 for the 6 mm distraction was 43.1% at the level of distraction and 6.35% at the above adjacent level. Conclusion Distraction of the lumbar spine at any level does increase foramen size at that level, but adjacent levels are affected differently depending on the type of distraction. Distraction at the spinous process may be more beneficial particularly in the lower lumbar area. Further studies are necessary to reproduce these results to provide a basis for determining an optimal method for foraminal distraction which minimizes adjacent level stenosis. Disclosure of Interest None declared

Abstract MP84: Use of Lifestyle Strategies Following Intervention and Impact on Longer-term Weight Loss Success

Background: Behavioral weight loss interventions are successful in producing weight loss; however, weight regain following cessation of intervention is common. Little is known about use of lifestyle strategies following interventions, differences in use by sex, and how use of strategies relates to longer-term weight trajectories. Methods: This analysis includes participants in the Slow the Adverse Vascular Effects of excess weight (SAVE) study with 24 month follow-up data. SAVE included 349 men and women aged 20-45 years with body mass index 25-39.9kg/m 2 . The SAVE weight loss intervention lasted for 18 months, with sessions decreasing in frequency over time. At 24 months, participants completed a survey about lifestyle strategies used in the past six months, including self-monitoring, group support, behavioral skills, and professional support. Chi-square and Fischer exact tests were used to compare frequency of strategies by sex. T tests were used to compare percent change in weight between baseline and 24-month by use of strategies vs. no use. Results: 214 participants completed 24 month visit (61% of baseline cohort). 74% were female and 86% were white, which did not differ from the baseline cohort. Overall, 65% used self-monitoring, 67% used group support, 94% used behavioral skills, and 27% used professional support within past 6 months. Recording physical activity (52%) and calories (43%) were the most common self-monitoring strategies. Self-weighing (83%), cue management (71%), and portion management (74%) were commonly used behavioral skills. Women were more likely than men to use group support (72% vs. 54%; p = .01). Women were also more likely to use the behavioral skills of rewarding success (32% vs. 9%; p = .001), portion management (78% vs. 64%; p = .046), and cue management (77% vs. 52%; p = .000). Women more frequently reported receiving professional support of diet counseling (48% vs. 15%; p = 0.04) or physical activity counseling (59% vs. 23%; p =0.02) from their PCP than men. Participants who used behavioral strategies had a significantly greater percent change in body weight at 24 months than those who did not (-3.9% vs. -0.7%; p =0.02). No significant differences were found in percent change in body weight at 24 months between participants who used self-monitoring, group support and professional support and those who did not. Conclusions: Participants who completed a weight loss intervention report using a variety of lifestyle strategies after cessation of intervention. Women reported more frequent use of lifestyle strategies than men. Behavioral strategies may be particularly important in longer-term weight loss. Attention should be paid to developing strategies to ensure longer-term weight loss after interventions.

A novel coronary active perfusion system using a conventional intra-aortic balloon pump for off-pump coronary artery bypass grafting

It is important for coronary active perfusion systems to avoid myocardial ischemia during off-pump coronary artery bypass grafting. We have developed a new concept for a perfusion system to pump blood based on changes in helium gas volume. This system uses a conventional intra-aortic balloon pump to activate the perfusion pump. Our study used basic and animal experiments to investigate the most suitable system for coronary perfusion using this new concept. A conventional intra-aortic balloon pump was used to supply power. A device for perfusion was developed with a balloon placed inside a stiff syringe barrel. The device was connected to the helium gas line of the intra-aortic balloon pump. Changes in flow with changes in augmentation level were noted when volumes outside and within the balloon were changed. Six pigs with occlusion of the left anterior descending artery were used for system validation, with monitoring to identify changes in hemodynamics and cardiac enzyme levels. In the basic experiment, an 80-mL outside volume and 3.0-mL inner volume resulted in the greatest percentage change in flow rate with respect to changes in augmentation. In the animal experiment, the new coronary active perfusion system prevented myocardial ischemia during coronary occlusion. We clarified the most suitable method for our new coronary active perfusion system. Using this system, safe anastomosis was consistently performed in animal experiments. Clinically, off-pump coronary artery bypass may potentially be performed more safely and easily using this new system.

Pilocarpine-induced flare is physiological rather than pathological

An elevated aqueous humor protein level (aka flare) has always been considered to represent a pathological breakdown of the blood-aqueous barrier (BAB), regardless of the etiology. Recent studies in humans, using magnetic resonance imaging (MRI) to directly observe BAB kinetics in the posterior chamber of the human eye in-vivo, showed that pilocarpine-induced flare resulting from administration of a single drop of pilocarpine is not the result of breakdown of the BAB in the ciliary body. These MRI studies could not confirm whether pilocarpine caused an increase in iris vascular permeability. In the current studies we completed combined cell-flare meter and intravascular tracer studies, using intravenous horseradish peroxidase (HRP) in rabbits. One hour after receiving 3% pilocarpine in one eye, pupil size significantly decreased and aqueous flare significantly increased in pilocarpine-treated eyes. Light and electron microscopy demonstrated no leakage across either the iris vascular endothelium or the non-pigmented ciliary epithelium in either pilocarpine-treated or control eyes. One animal received HRP directly after pilocarpine to control for a transient increase in permeability before the peak flare response occurred. No leakage was found in the ciliary body or iris of this animal. Additional animals received topical pilocarpine in one eye but after 1 h they were sacrificed without tracer studies. Uveal tissues from these animals were used to assess the distribution of non-HRP protein in the ocular anterior segment and to assess the amount of elutable protein in the iris stromas of both treated and untreated eyes. Immunohistochemistry confirmed the presence of a reservoir of protein in the iris stroma. Analysis of elutable total protein from the iris stroma of pilocarpine-treated and control eyes showed significantly less total elutable protein in pilocarpine-treated eyes. Eyes with the greatest percent change in pupil size (i.e. the strongest miosis) correlated with lowest amounts of residual protein in the iris stroma. The tracer studies confirmed recent MRI studies in humans showing that the source of pilocarpine-induced flare is not disruption of the ciliary epithelial barrier. Extending this work, the current studies also showed no pilocarpine-induced leakage from the iris vasculature. The elutable protein experiments suggested that a primary source of pilocarpine-induced flare was extrusion of a portion of the reservoir of protein in the iris stroma. Taken together, these studies strongly suggest that not all clinically observable flare results from breakdown of the BAB.

Hyperglycemia-induced oxidative stress is independent of excess abdominal adiposity in normal-weight women with polycystic ovary syndrome

What is the effect of glucose ingestion on leukocytic reactive oxygen species (ROS) generation in normal-weight women with polycystic ovary syndrome (PCOS) with and without excess abdominal adiposity (AA)? Normal-weight women with PCOS exhibit an increase in leukocytic ROS generation in response to glucose ingestion, and this increase is independent of excess AA. Excess adipose tissue is a source of oxidative stress. Normal-weight women with PCOS exhibit oxidative stress and can have excess AA. This is a cross-sectional study involving 30 reproductive-age women. Fourteen normal-weight women with PCOS (6 normal AA, 8 excess AA) and 16 body composition-matched controls (8 normal AA, 8 excess AA) underwent body composition assessment by dual-energy absorptiometry and an oral glucose tolerance test (OGTT) at a university medical center. Insulin sensitivity was derived from the OGTT (IS(OGTT)). Blood was drawn while fasting and 2 h after glucose ingestion to measure leukocytic ROS generation and p47(phox) protein content and plasma thiobarbituric acid-reactive substances (TBARS) and C-reactive protein (CRP). Compared with controls, both PCOS groups exhibited lower IS(OGTT) (43-54%) and greater percentage change (% change) in ROS generation (96-140%), p47(phox) protein (18-28%) and TBARS (17-48%). Compared with women with PCOS with excess AA, those with normal AA exhibited higher testosterone levels (29%) and lower CRP levels (70%). For the combined groups, IS(OGTT) was negatively correlated with the % change in ROS generation and p47(phox) protein. CRP was positively correlated with abdominal fat. The % change in p47(phox) protein was positively correlated with CRP and androgens. Although this study is adequately powered to assess differences in ROS generation between the women with PCOS and control participants, the modest sample size merits caution when interpreting the corroborative results of the additional measures of oxidative stress and inflammation. This study highlights the unique pro-oxidant contribution of circulating leukocytes in the development of insulin resistance and hyperandrogenism in PCOS. Supported by NIH grant HD-048535 to F.G. The authors have nothing to disclose.

Measuring the success of combined intravesical dimethyl sulfoxide and triamcinolone for treatment of bladder pain syndrome/interstitial cystitis

The purpose of this study was to investigate change in bladder capacity as a measure of response to combined intravesical dimethyl sulfoxide (DMSO) and triamcinolone instillations for the treatment of newly diagnosed bladder pain syndrome/interstitial cystitis (BPS/IC). 141 newly diagnosed women were identified retrospectively. 79 were treated with weekly DMSO/triamcinolone instillations. Change in bladder capacity with bladder retrofill, daytime urinary frequency, nocturia episodes per night, and Likert scale symptom scores were reviewed. Wilcoxon signed-rank tests, Wilcoxon rank-sum tests, Spearman's rank correlations, COX regression analysis, and a Kaplan-Meier survival curve were performed. Significant changes (median (25(th)-percentile to 75(th)-percentile) were noted for bladder capacity (75 mL (25 to 130 mL), p < 0.0001), inter-void interval (0 hrs (0 to 1 hour), p < 0.0001), nocturia episodes per night (-1 (-2 to 0), p < 0.0001), and aggregate Likert symptom scores (-2 points (-5 to 0), p < 0.0001). Percent change in bladder capacity correlated positively with percent change in inter-void interval (p = 0.03) and negatively with percent changes in nocturia (p = 0.17) and symptom scores (p = 0.01). Women without detrusor overactivity (DO) had greater percent changes in capacity than women with DO (62.5 % vs. 16.5 %, p = 0.02). 61.3 % of patients were retreated with a 36 weeks median time to retreatment and no difference in time to retreatment based upon DO. Greater capacity was protective against retreatment (hazard ratio = 0.997 [95 % CI 0.994,0.999], p = 0.02). Percent change in bladder capacity is a useful objective measure of response to intravesical DMSO/triamcinolone for newly diagnosed BPS/IC. Clinical outcomes do not differ based upon presence of DO.

PWE-085 Age-related changes in diverticular disease admissions in Scottish hospitals 2000–2010

IntroductionRecent studies suggest that acute admissions for diverticular disease (DD) are increasing in younger age groups. Verification of this trend in Scotland and examination of treatment patterns by age will...

Subcortical but Not Cortical Gray Matter Atrophy Predicts Disability Progression over 5 Years in Patients with Early Relapsing-Remitting Multiple Sclerosis (P03.063)

Objective: Investigate the association between long-term subcortical deep gray matter (SDGM) and cortical volume changes and disability progression in early relapsing-remitting multiple sclerosis (RRMS). Background Pathological changes in gray matter are thought to have an important role in MS disease progression. However, no long-term clinical studies of SDGM and cortical changes have been reported in early RRMS. Design/Methods: One hundred eighty RRMS patients who participated in the Avonex-Steroid-Azathioprine study were assessed yearly for clinical and magnetic resonance imaging outcomes over 5 years. Healthy controls (n=48) were also assessed yearly over 2 years. MS patients were divided into those with and without sustained disability progression (SDP), defined as a ≥1.0-point increase in Expanded Disability Status Scale score lasting for ≥12 weeks at any time over the 5-year study period. Results: Of the 180 patients, 90 patients experienced SDP and 90 had stable disease after 5 years. At baseline, SDP patients were older and had longer disease duration, greater T2 lesion volume, and smaller SDGM and cortical volumes ( P ≤0.014). At 2 years, significant differences were seen in T2 and lateral ventricle volumes as well as whole brain, total SDGM, putamen, thalamus, nucleus accumbens, and amygdala volumes across the 2 RRMS groups and healthy controls; SDP patients had larger percentage changes in these same measures except for nucleus accumbens and amygdala when compared with stable MS patients at 2 years. At 5 years, SDP patients had greater percentage change decreases in volumes of whole brain, total SDGM, putamen, and thalamus and a greater increase in lateral ventricle volume than patients with stable disease ( P ≤0.02). No differences in cortical, white matter, or T2 lesion volumes were observed between patients with and without SDP at 5 years. Conclusions: SDP in early RRMS is associated with SDGM atrophy progression, especially in the putamen and thalamus, but not with cortical atrophy. Supported by: Biogen Idec Inc. and Czech Ministry of Education, Research Program MSM 0021620849. Disclosure: Dr. Zivadinov has received personal compensation for activities with Teva Neuroscience, Biogen Idec, EMD Serono, and Questcor Pharmaceuticals as a speaker and/or consultant. Dr. Zivadinov has received research support from Biogen Idec, Teva Neuroscience, Genzyme Corporation, Bracco, Questcor Pharmaceuticals and EMD Serono. Dr. Bergsland has nothing to disclose. Dr. Dolezal has received personal compensation for activities with Merck Serono, Biogen Idec, and Novartis as a consultant. Dr. Hussein has nothing to disclose. Dr. Seidl has received research support from Biogen Idec. Dr. Dwyer has nothing to disclose. Dr. Vaneckova has nothing to disclose. Dr. Krasensky has received research support from Biogen Idec. Dr. Potts has received personal compensation for activities with Biogen Idec. Dr. Havrodova has received personal compensation for activities with Bayer Pharmaceuticals Corporation, Biogen Idec, Genzyme Corporation, GlaxoSmithKline, Inc., Novartis, Merck, Sanofi-Aventis Pharmaceuticals, Serono, Inc., and Teva as consultant, speaker and/or advisory board participant. Dr. Horakova has received personal compensation for activities with Biogen Idec as a speaker.Dr. Horakova has received research support from Biogen Idec.