RA Group Research Articles

Risk Factors and Early Detection of Diabetes Mellitus in Early Rheumatoid Arthritis WomenBackground: Patients with rheumatoid arthritis show predominance of metabolic disorder characterized by overweight, central obesity, dyslipidemia and impaired glucose

Background: Patients with rheumatoid arthritis show predominance of metabolic disorder characterized by overweight, central obesity, dyslipidemia, and impaired glucose tolerance, specifically, few studies have explained insulin resistance in this disease.Objective: The aim of the present study is to examine insulin resistance and the risk of developing diabetes mellitus in middle age Iraqi women with early rheumatoid arthritis.Patients and methods: This work involved seventy female with early rheumatoid arthritis. Who was attending to the National Diabetic Center (NDC) of Al-Mustansiriya University and 35 healthy subjects as a control group. From all subjects blood sample was drawn in fasting state to measure the biochemical parameters which including plasma glucose level and fasting insulin concentrations. Other measurements (RF and anti-CCP) were made by routine methods. Homeostasis model of assessment insulin resistance (HOMA-IR) by using the formula HOMA model Insulin sensitivity was calculated in RA patients and healthy control.Results: Results revealed a highly significant in the level of the rheumatoid factor (RF), anti-CCP and fasting insulin, and HOMA-IR when compared the patient group with the control group. While a significant increase in the level of FBG in the RA group than the control group. Also, there was a positive correlation with high significance among, Anti-CCP, and RF with HOMA-IR in the rheumatoid arthritis group. Conclusions: This study shows that patient with rheumatoid arthritis have abnormal insulin secretion with a high value of IR than a group of healthy control and these patients may be at risk of diabetic mellitus.
 عوامل الخطر والتشخيص المبكر لداء السكري للنساء حديثات الاصابة بألتهاب المفاصل الروماتويدي
 محمد حسن علي 
 د.عـبير جبـار حسن 
 أيناس جبار حسن 
 الخلاصة:
 خلفية البحث:يكون المرضى الذين يعانون من التهاب المفاصل الروماتويدي عرضة للاصابة بمتلازمة التمثيل بالغذائي والعوامل المرتبطة بها مثل زيادة الوزن، وقلة دهون الدم أو ضعف تحمل الجلوكوز، وهناك بعض الدراسات بينت ان هولاء المرضى يكونون معرضون لمقاومة الانسولين .
 الهدف: صممت هذه الدراسة لفحص مقاومة الانسولين وخطر الإصابة بداء السكري عند النساء العراقيات المصابات حديثا بالتهاب المفاصل الروماتويدي.
 طرق العمل: شملت الدراسة سبعين أنثى مصابات حديثا بالتهاب المفاصل الروماتويدي و 35 من النساء المتطوعات كمجموعة ضابطة. تم سحب عينة الدم من الجميع في حالة الصيام لقياس المعلمات البيوكيميائية بما في ذلك مستوى الجلوكوز ، تركيزالأنسولين وقياسات أخرى مثل (RF and anti-CCP). وايضا تم حساب المقاومة للانسولين (HOMA-IR).
 النتائج أظهرت النتائج وجود زيادة معنوية في مستوى العامل الروماتويدي (RF) وتركيز الانسولين مقاومة الانسولين (HOMA-IR) عند مقارنة مجموعة المرضى مع مجموعة السيطرة. في حين أن زيادة كبيرة في مستوى السكر الصائم في مجموعة المرضى مقارنة بالمجموعة الضابطة. أيضا كان هناك علاقة إيجابية مؤثرة بين، Anti-CCP, and RF و HOMA-IR في مجموعة مرضى التهاب المفاصل الروماتويدي.
 الاستنتاجات: اظهرت نتائج هذه الدراسة أن المرضى بالتهاب المفاصل الروماتويدي يكون لديهم إفراز الأنسولين غير طبيعي وبالتالي تظهر لديهم مقاومة للانسولين ويكونون عرضة لخطر الاصابة بمرض السكري.
 الكلمات المفتاحية: مقاومة الانسولين, داء السكري, التهاب المفاصل الروماتويدي.

Regulation of pravastatin on long-chain fatty acid oxidative enzyme in pre-eclampsia-like mouse model

Objective: To investigate the modulation of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) expression by pravastatin in pre-eclampsia-like mouse model. Methods: C57BL/6J mice were randomly injected with N-nitro-L-arginine methyl ester (L-NAME) as pre-eclampsia-like model group (PE) or saline as normal pregnancy control group (Con) respectively, from gestational the 7th to 18th day. For each group, pravastatin (PE+Pra, Con+Pra group) or saline (PE+N, Con+N Group) was given from the 8th to 18th day of gestation, respectively. Liver and placenta of pregnant mice were collected on gestational day 18. The LCHAD protein expression and mRNA levels of liver and placenta were detected through western blot, immunohistochemistry and real-time quantitative PCR. Results: (1) The average arterial pressure of pregnant mice increased gradually from the 8th to 18th day in PE+N group, but decreased in PE+Pra group from gestational 10th day, 24 hour urinary protein levels in PE+N group [(1 494 ± 201) μg] were significantly higher than that in Con+N group [(935±128) μg, P<0.01], and also higher than that in PE+Pra group [(981±116) μg, P<0.01].(2) The results of western blot: the expression of LCHAD was significantly lower in PE+N group (liver: 0.64±0.11, placenta: 0.48±0.06) than that in Con+N group (liver: 1.06±0.10, placenta: 0.60±0.10), and lower than that in PE+Pra group (liver: 0.99±0.04, placenta: 0.60±0.08; all P<0.01).(3)The results of real-time quantitative PCR: the levels of LCHAD mRNA in liver and placenta in PE+N group (liver: 0.621±0.128, placenta: 0.646±0.129) were significantly decreased compared with Con+N group (liver: 1.007±0.130, placenta: 1.004±0.103; all P<0.01), but there was no significant difference between PE+Pra group (liver: 0.693±0.678, placenta: 0.662±0.183; P>0.05). (4) LCHAD protein was expressed widely and evenly in liver. The expression in placental cytotrophoblast and syncytial trophoblast cells located in outer layer of villous in labyrinth layer was the most. The expression of LCHAD was significantly lower in PE+N group (liver: 0.062±0.016, placenta: 0.147±0.018) than that in Con+N group (liver: 0.126±0.013, placenta: 0.183±0.024), and lower than that in PE+Pra group (liver: 0.111±0.017, placenta: 0.174±0.027; all P<0.05). Conclusion: Pravastatin could upregulate the LCHAD protein expression of liver and placenta in the pre-eclampsia-like mouse, which may be a mechanism to improve the clinical manifestations of pre-eclampsia.

Rheumatoid Arthritis of the Temporomandibular Joint, A Clinical and Radiographical Study

To determine the extent of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis compared with a matched control group. And to evaluate the correlation between clinical findings and radiographical findings.The studied sample comprised 50 patients with rheumatoid arthritis, age ranged from 18 to 72 years with the mean age of 40.98 (± 13.67.The control group consisted of 63 subjects age–matched non rheumatic patients: Each patient was informed about the purpose of the investigation and that it would include questionnaire, clinical and radiographical examinations. The radiographic examination was done by using double TMJ lateral panoramic technique.It was found that 64% of RA patients complained of two or more clinical signs and symptoms compared with 44% of the control group ,the difference was statistically significant (P&lt; 0.05), the most important clinical findings were pain on palpation and on opening and closing, crepitation, limitation of jaw opening and morning stiffness, difference were statistically significant (P&lt; 0.05). Among the clinically involved subjects in study RA group 28 subjects (56%) had bilateral involvement, 3 subjects (6%) had right side involved and 1 subject (2%) had only left side involvement. The radiographic involvement of TMJ was found in 16 subjects (32.0 %) of the study group compared with 1subject (1.6 %) of the control group. There is a highly statistically significant difference between the study group and the control group (P&lt; 0.05); the most common radiographical finding was erosion. Complete condylar destruction was found in 1 patient which resulted in anterior open bite. Among involved cases 11 subjects (22%) had bilateral involvement, 5 subjects (10%) had unilateral involvement (3subjects (6%) had left side involved and, 2 (4 %) subjects had only right side involved. There was no correlation between clinical and radiographic find ings. There was correlation between the extent of radiographical findings and duration of Rheumatoid Arthritis p value (P&lt; 0.05).The clinical and radiographic findings were more common in RA group than in control individual. The clinical and radiographic findings are not always bilateral in TMJs of patients with rheumatoid arthritis.Key words: TMJ disorders, TMJ

Altered levels of exhaled nitric oxide in rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is an autoimmune disorder characterized by bone and joint destruction, but other organ systems can also be involved. Recent studies have suggested that the disease may start in the lungs. Exhaled nitric oxide (FENO) is a marker of inflammation. The aims of the study were to compare the NO parameters between subjects with RA and healthy control subjects, and to examine whether the NO parameters correlated with lung function and disease activity in the subjects with RA. MethodsSubjects with RA (n = 35) were recruited during their regular outpatient visits to the rheumatology department. The nitric oxide (NO) parameters: alveolar NO concentration (CANO), airway compartment diffusing capacity of NO (DawNO), and tissue concentration of NO in the airway wall (CawNO), were algorithmically estimated. Healthy subjects (n = 35) matched by age, gender and height were used as controls. Data are given in median, (quartile 25, 75). Wilcoxon Matched Pairs test was used for group comparisons. Mann-Whitney U test was used to make comparisons between any two groups and for pairwise comparisons. Correlations were tested with Spearman rank order correlation. ResultsCANO was significantly lower in the RA subjects compared with healthy subjects; 1.1 (0.5, 1.8) ppb versus 2.4 (2.0, 3.0) ppb, (p < 0.001). CawNO was significantly lower in the RA subjects with 51 (22, 87) ppb versus 120 (76, 162) ppb in the control group. DawNO was significantly higher at 25 (15, 36) mL/s in the RA group versus the control group's 7.7 (5.3, 10.7) mL/s. ConclusionsThere are significant differences between subjects with RA and matched healthy control subjects regarding the exhaled NO parameters. It is unclear if this can be explained by the pathogenesis of RA, consequences of long-term disease, and/or due to drug treatment.

Effectiveness of regional anaesthesia for treatment of facial and hand wounds by emergency physicians: A 9-month prospective study

ObjectiveWe compared the effectiveness of nerve blocks (regional anaesthesia, [RA]) versus local anaesthesia (LA) to treat face and hand wounds. Emergency physicians who had not previously used nerve blocks administered the anaesthesia based on anatomic landmarks. MethodsThis prospective observational open study was conducted at a military teaching hospital emergency department (ED) between May 1, 2013 and January 31, 2014. All patients requiring treatment of facial or hand wounds were included. The primary outcome was anaesthesia effectiveness 15minutes post-administration. We also recorded the number of injections sites, injected volume, pain of administration, operator comfort, and complications. Lidocaine anaesthesia without epinephrine was used. ResultsOf the 1090 treated patients, 617 patients were included in the analysis: 316 with hand wounds and 301 with facial wounds. Overall, 130 wrist blocks and 63 facial blocks were performed. RA effectiveness was comparable to that of LA: for facial wounds, RA=88.9% versus LA=89% (P=0.86); for hand wounds, RA=82.2% versus LA=90.1% (P=0.15). RA groups had significantly fewer injections than the LA groups, and less anesthetic was injected in the facial RA group. The pain of anaesthesia administration and operator comfort was similar. There was no complication during the 9-month data collection period. ConclusionFacial and wrist nerve blocks are easy to administer and as efficient as local infiltrations, plus they require fewer injection sites, and, for facial RA, less anesthetic. Their teaching and use should be more widespread in EDs.

Robotic versus laparoscopic gastrectomy for gastric adenocarcinoma: Propensity matched analysis of the National Cancer Database.

104 Background: The use of robotic technology in gastrointestinal surgical oncology is on the rise. We compared the outcomes of laparoscopic (LG) and robotic gastrectomies (RG) performed for gastric adenocarcinoma (GA) in the National Cancer Database (NCDB). Methods: The NCDB database was queried for patients ≥ 18 years old with stage I-III GA who underwent LG or RG. Propensity matching was performed between the two groups with regards to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results: A cohort of 1893 (1262-LG, 631-RG) patients was identified in a 2:1 propensity matching. Demographics and co-morbidities were similar between the groups. The clinical staging and the extent of the surgery were well matched. The rate of negative margin as well 30 and 90-day mortality was similar between the two cohorts. Outcomes with respect to readmission and length of stay were also similar (Table 1). Long-term survival was not significantly different between the two cohorts, with a median survival of 49 months for LG cohort and 56.1 months in the RG cohort (p=0.405). Also, lymph node (LN) positivity was similar between the two groups (40.1 % 42.8%, p= 0.278) However, the average number of LN sampled was significantly higher in the RA group compared to the LA group (19.6 vs 17.4, p&lt;0.001). Similarly, the percentage of surgeries in which ≥ 15 LNs were sampled was also greater in the RG group compared to the LG group (63.9% vs 57.6%, p=0.010). Conclusions: Greater number of patients in the RG group achieved NCCN guideline of harvesting ≥ 15 lymph nodes for more accurate staging. RG may allow a greater harvest of lymph nodes without increasing short term adverse outcomes compared to LG. Long term outcomes in this well matched cohort appears comparable for both approaches.

Combined Effect of Retinoic Acid and Basic Fibroblast Growth Factor on Maturation of Mouse Oocyte and Subsequent Fertilization and Development.

BackgroundMany autocrine and paracrine elements that are produced within follicular niche have been the focus of much in vitro maturation (IVM) research. The present study was carried out to compare retinoic acid (RA) and basic fibroblast growth factor (bFGF) efficacy on IVM of mouse oocytes, and their further dual consumption to reach an optimal protocol.Materials and MethodsIn this experimental study, germinal vesicle (GV) oocytes obtained from two-months-old NMRI mice were randomly divided into control, sham and three experimental groups. The basic culture medium was α-MEM supplemented with 10% fetal bovine serum (FBS), 50 mg/l streptomycin, 60 mg/l penicillin and 10 ng/ ml epidermal growth factors. Each of the experimental groups received one of the following treatments: RA (2 µM), bFGF (20 ng/ml) or combination of RA and bFGF with the indicated concentrations. After 24 hours, capacitated spermatozoa were added to in vitro matured oocytes. Five hours later, the oocytes were cultured in fresh droplets of M2 medium for 24 hours and assessed for cleavage to the two-cells stage.ResultsAs compared with the control group, the rate of maturation was significantly increased in the RA (P<0.001) and bFGF+RA (P<0.02) groups with 58 ± 10 and 57 ± 3.46, respectively. The rate of maturation was significant in the RA (P<0.02) and bFGF+RA (P<0.03) groups, in comparison with the bFGF group. The bFGF+RA group had higher rate (83 ± 1.52) of two-cells development, than control (33 ± 1, P<0.001).ConclusionOur findings showed beneficial effects of 2 µM RA and 20 ng/ml bFGF combination on mouse oocyte IVM.

B-Cell Activating Factor (BAFF) and Its Receptors in Systemic Lupus Erythematosus, Rheumatoid Arthritis

Objective: The aim of this study was to determine and compare the serum level of the BAFF and the level of its three receptors in patients with RA and SLE and also to correlate its serum level with disease activity indices and severity. Patients and methods: This study included 60 {RA (n=30), SLE (n=30)} Egyptian patients with collagen diseases from outpatient clinics of the Internal Medicine and Rheumatology Departments of Banha University Hospitals between December 2014 and December 2015 as well as 25 apparently healthy individuals who were either on the medical staff or were patient’s relatives that served as the healthy controls. All participants underwent history taking, clinical examination, laboratory and radiological investigations, and disease activity score estimation. The serum BAFF concentration, the serum TACI concentration, serum BAFFR concentration, serum BCMA concentration were determined with a quantitative sandwich enzyme immunoassay (ELISA) kits. Results: BAFF, BAFF-R, & TACI levels showed statistically significant increase in SLE & RA Groups as compared to control group (P<0.05) and BCMA level was statistically significant decrease in SLE & RA Groups as compared to control group (P<0.05). Further, BAFF, BAFF-R levels were statistically significantly increased in RA Group when compared to SLE Group. A significant positive correlation was found between the BAFF level and BAFF-R levels in both groups and SLE (r=0.854, p<0.001), RA (r=0.614, p<0.001), also between BAFF, BAFF-R and SLEDAI in SLE group (r=0.413, 0.419, p<0.023, 0.021) respectively, and between BAFF, BAFF-R and DAS28 in RA group (r=0.642, 0.430, p<0.001,0.018) respectively. The current study raveled that the best biomarker for diagnosis of RA &SLE were BAFF-R & BAFF as they had the Roc curve with more sensitivity and specificity. Conclusion: The BAFF serum levels and its three receptors levels are increased in patients with SLE and RA versus the controls. They also have a positive correlation with disease severity in SLE and RA, which suggests that BAFF may play a role in the pathogenesis and activity of these diseases. These results may pose the possibility that a human monoclonal antibody drug which selectively inhibits BAFF biological activity may be useful in the treatment of active resistant cases.

Understanding the Early Presentation of Mucopolysaccharidoses Disorders

As therapies are developed for rare disorders, challenges of early diagnosis become particularly relevant. This article focuses on clinical recognition of mucopolysaccharidoses (MPS), a group of ra...

Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery?

Aims: To compare (1) complication and (2) conversion rates to open surgery (OS) from laparoscopic surgery (LS) and robotic-assisted surgery (RA) for rectal cancer patients who underwent rectal resection. (3) To identify patient, physician, and hospital predictors of conversion.Materials and methods: A US-based database study was conducted utilizing the 2012–2014 Premier Healthcare Data, including rectal cancer patients ≥18 with rectal resection. ICD-9-CM diagnosis and procedural codes were utilized to identify surgical approaches, conversions to OS, and surgical complications. Propensity score matching on patient, surgeon, and hospital level characteristics was used to create comparable groups of RA\\LS patients (n = 533 per group). Predictors of conversion from LS and RA to OS were identified with stepwise logistic regression in the unmatched sample.Results: Post-match results suggested comparable perioperative complication rates (RA 29% vs LS 29%; p = .7784); whereas conversion rates to OS were 12% for RA vs 29% for LS (p < .0001). Colorectal surgeons (RA 9% vs LS 23%), general surgeons (RA 13% vs LS 35%), and smaller bed-size hospitals (RA 14% vs LS 33%) have reduced conversion rates for RA vs LS (p < .0001). Statistically significant predictors of conversion included LS, non-colorectal surgeon, and smaller bed-size hospitals.Limitations: Retrospective observational study limitations apply. Analysis of the hospital administrative database was subject to the data captured in the database and the accuracy of coding. Propensity score matching limitations apply. RA and LS groups were balanced with respect to measured patient, surgeon, and hospital characteristics.Conclusions: Compared to LS, RA offers a higher probability of completing a successful minimally invasive surgery for rectal cancer patients undergoing rectal resection without exacerbating complications. Male, obese, or moderately-to-severely ill patients had higher conversion rates. While colorectal surgeons had lower conversion rates from RA than LS, the reduction was magnified for general surgeons and smaller bed-size hospitals.

Effect of short term diet restriction on gene expression in the bovine hypothalamus using next generation RNA sequencing technology

BackgroundNegative energy balance (NEB) is an imbalance between energy intake and energy requirements for lactation and body maintenance affecting high-yielding dairy cows and is of considerable economic importance due to its negative impact on fertility and health in dairy herds. It is anticipated that the cow hypothalamus experiences extensive biochemical changes during the early post partum period in an effort to re-establish metabolic homeostasis. However, there is variation in the tolerance to NEB between individual cows. In order to understand the genomic regulation of ovulation in hypothalamic tissue during NEB, mRNA transcriptional patterns between tolerant and sensitive animals were examined. A short term dietary restriction heifer model was developed which induced abrupt onset of anoestrus in some animals (Restricted Anovulatory; RA) while others maintained oestrous cyclicity (Restricted Ovulatory; RO). A third control group (C) received a higher level of normal feeding.ResultsA total of 15,295 genes were expressed in hypothalamic tissue. Between RA and C groups 137 genes were differentially expressed, whereas between RO and C, 32 genes were differentially expressed. Differentially expressed genes were involved in the immune response and cellular motility in RA and RO groups, respectively, compared to C group. The largest difference between groups was observed in the comparison between RA and RO heifers, with 1094 genes shown to be significantly differentially expressed (SDE). Pathway analysis showed that these SDE genes were associated with 6 canonical pathways (P < 0.01), of which neuroactive ligand-receptor interaction was the most significant. Within the comparisons the main over-represented pathway functions were immune response including neuroprotection (CXCL10, Q1KLR3, IFIH1, IL1 and IL8; RA v C and RA v RO); energy homeostasis (AgRP and NPY; RA v RO); cell motility (CADH1, DSP and TSP4; RO v C) and prevention of GnRH release (NTSR1 IL1α, IL1β, NPY and PACA; RA v RO).ConclusionsThis information will assist in understanding the genomic factors regulating the influence of diet restriction on fertility and may assist in optimising nutritional and management systems for the improvement in reproductive performance.

Intermittent Hypoxia Improves Atherosclerosis Associated with Upregulation of Hif-1α and Nf-κB in Aortic Arch and Serum of Rabbits

Objectives To investigate the role of HIF-1α and NF-κB in intermittent hypoxia (IH) induced atherosclerosis in rabbits. Methods New-Zealand White rabbits were exposed to IH for 12 weeks (intermittent hypoxia of 21% O2 for 30 s and 8% O2 for 30 s, cyclically repeated for 8 h/day). We randomly assigned 48 male rabbits to groups of normoxia (RA) or IH. The rabbits in the RA group were continuously exposed to room air. After intervention of 4, 8, and 12 weeks, serum and aortic arch tissues were subjected to Elisa and immunohistochemical staining analyses respectively. The formation of atherosclerosis in the aortic arch was observed by HE. Results The formation of atherosclerosis in aortic tissue was observed by HE staining after IH. Compared with the RA rats, the level of HIF-1α and NF-κB in the serum of IH rats started to increase 4, 8, and 12 weeks after the beginning of the experiment (p 0.05). NF-κB protein expression was significantly increased after IH (p Conclusions IH may, through increased HIF-1α and NF-κB in rabbits, lead to lipid deposition, which leads to the formation of atherosclerosis and the occurrence of cardiovascular and cerebrovascular diseases.

Association Between Rheumatoid Arthritis and Chronic Periodontitis in Adults: A Hospital Based Study

Background: The chronic inflammation of periodontal disease (PD) with the constant release of inflammatory mediators may be a risk factor for the development of systemic inflammatory disease. Hence, development of both diseases brings considerable consequences for public health and for the quality of life of affected individuals. To test whether a relationship exist between Periodontitis and RA, this study is being conducted. Methods: This is hospital based case control study, a total of 100 subjects between the ages 20-70 years were included in the study. Group A: includes selection of 50 patients diagnosed RA by the Rheumatologist, Group B: 50 general patients without rheumatoid arthritis. All participants underwent a full-mouth periodontal examination on six sites per tooth assessing probing depth (PD) and clinical attachment loss (AL). Results: The prevalence of periodontitis was 78% and 42% for RA and control group. Thus, the present study reported that more severe form of periodontitis existed in rheumatoid arthritis patients. These results indicated that the prevalence of mild to moderate periodontitis was seen in control group. Conclusions: persons who are suffering from RA are also very likely to suffer from moderate to severe periodontitis. Our finding suggests large population-based studies will be needed to define the role of periodontitis in RA disease susceptibility. However, our findings suggest greater attention to periodontal care among the RA patients.

Locoregional Anesthesia Offers Improved Outcomes Following Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

General (GA) and locoregional anesthesia (LA) are two anesthetic options for endovascular repair of ruptured abdominal aortic aneurysms (REVAR). Studies on EVAR of elective, intact aneurysms have indicated that in select patients, LA may provide improved outcomes compared to GA. We evaluated the 30-day outcomes in patients undergoing REVAR under GA and LA in a contemporary nationwide cohort of patients presenting with ruptured abdominal aortic aneurysmss. Patients who underwent REVAR under GA and LA from 2011 to 2015 were studied in the American College of Surgeons National Surgical Quality Improvement Program targeted EVAR database. Preoperative demographics, operation-specific variables, and postoperative outcomes were compared between the two groups. We identified 690 patients (80% male) who underwent REVAR, of which 12.5% (86) were performed under LA. Mean age was 74.3 years. Mean aneurysm size was 7.6 cm and did not differ between the two anesthetic groups. Major comorbidities and proximal or distal aneurysm extent also did not differ between the two groups except a slightly higher rate of congestive heart failure in the LA group (Table). There was a significantly higher rate of bilateral percutaneous access in the LA group (59.3%) than in the RA group (25.2%; P < .01). REVAR under LA had a shorter mean operative time (132 vs 166 minutes; P < .01) and a lower rate of concomitant lower extremity revascularization (2.3% vs 10.6%; P < .01). There otherwise was no difference in the need for other adjunctive procedures or perioperative transfusion. Ultimately, 30-day mortality was significantly lower in the LA group (16.3% vs 25.2%; P < .01). This was even more dramatic in the subgroup of patients with hemodynamic instability (15.4% vs 39.4%; P < .01). After adjustment, there was a twofold higher mortality in patients undergoing REVAR under GA vs LA, with a fourfold increase in the hemodynamically unstable cohort. The American College of Surgeons National Surgical Quality Improvement Program targeted EVAR database shows that LA is used in only 12.5% of patients undergoing REVAR in this nationwide cohort. This rate does not change when examining the subset of patients who are hemodynamically unstable. These data suggest that LA should be considered in patients undergoing REVAR regardless of hemodynamic instability.TableDemographics, operative details and outcomes of general anesthesia (GA) vs locoregional anesthesia (LA) for endovascular repair of ruptured abdominal aortic aneurysm (REVAR)VariableaREVAR-GA (n = 604)REVAR-LA (n = 86)P valueAge, years74.3 (10.4)74.6 (10.3).79Male79.5 (480)81.3 (70).68Body mass index, kg/m228.3 (6.8)28.2 (5.5).90Smoking33.6 (203)29.1 (25).40COPD19.9 (120)14.0 (12).19Congestive heart failure2.5 (15)7.0 (6).02Hypertension67.7 (409)72.1 (62).41End-stage renal disease3.0 (18)2.3 (2).74Proximal extent: infrarenal81.3 (491)86.0 (74).31Distal extent: aortic or common iliac57.0 (344)56.9 (49).99Access-bilateral percutaneous25.2 (152)59.3 (51)<.01Diameter.71 <5 cm7.9 (48)10.5 (9) 5-5.9 cm12.4 (75)10.5 (9) 6-6.9 cm11.8 (71)8.1 (7) 7-7.9 cm17.5 (106)16.3 (14) 8-8.9 cm11.6 (70)10.5 (9) 9-9.9 cm10.3 (62)14.0 (12) >10 cm11.3 (68)14.0 (12)Need for transfusion67.2 (406)61.6 (53).3030-day mortality25.2 (152)16.3 (86)<.01Length of stay Hospital, days9.1 (13.4)6.8 (6.1).12 Intensive care unit, days5.0 (6.7)3.0 (4.2).01Myocardial infarction6.3 (38)8.1 (7).52Pneumonia10.9 (66)3.5 (3).03Ischemic colitis7.8 (47)4.7 (4).30Unplanned readmission8.8 (53)10.5 (9).01Wound complication2.3 (14)1.2 (1).49COPD, Chronic obstructive pulmonary disease.aContinuous data are shown as mean (standard deviation) with the unit of measure and categoric data as percentage (number). Open table in a new tab

A Multifactorial, Criteria-based Progressive Algorithm for Hamstring Injury Treatment.

Given the prevalence of hamstring injuries in football, a rehabilitation program that effectively promotes muscle tissue repair and functional recovery is paramount to minimize reinjury risk and optimize player performance and availability. This study aimed to assess the concurrent effectiveness of administering an individualized and multifactorial criteria-based algorithm (rehabilitation algorithm [RA]) on hamstring injury rehabilitation in comparison with using a general rehabilitation protocol (RP). Implementing a double-blind randomized controlled trial approach, two equal groups of 24 football players (48 total) completed either an RA group or a validated RP group 5 d after an acute hamstring injury. Within 6 months after return to sport, six hamstring reinjuries occurred in RP versus one injury in RA (relative risk = 6, 90% confidence interval = 1-35; clinical inference: very likely beneficial effect). The average duration of return to sport was possibly quicker (effect size = 0.34 ± 0.42) in RP (23.2 ± 11.7 d) compared with RA (25.5 ± 7.8 d) (-13.8%, 90% confidence interval = -34.0% to 3.4%; clinical inference: possibly small effect). At the time to return to sport, RA players showed substantially better 10-m time, maximal sprinting speed, and greater mechanical variables related to speed (i.e., maximum theoretical speed and maximal horizontal power) than the RP. Although return to sport was slower, male football players who underwent an individualized, multifactorial, criteria-based algorithm with a performance- and primary risk factor-oriented training program from the early stages of the process markedly decreased the risk of reinjury compared with a general protocol where long-length strength training exercises were prioritized.

Impaired Pain Modulation in Fibromyalgia Patients in Response to Social Distress Manipulation.

Fibromyalgia (FM), a chronic pain condition, is associated with abnormalities in pain modulation. A growing body of evidence has shown that social distress modulates pain sensitivity. The current study aimed to assess the effects of social distress manipulation on pain in FM patients compared with positive (rheumatoid arthritis, RA) and negative (pain-free) controls. FM, RA patients and pain-free controls (PFC) were recruited. Demographic, medical, and psychological data were collected. Each participant was exposed to 3 study conditions in a random order: the inclusion (positive social effects) and exclusion (negative social effects) conditions of Cyberball, a game that manipulates social distress, and a control condition. Pain sensitivity in response to nociceptive electrical and thermal (cold) stimuli was assessed before and during each study condition. In response to electrical stimuli, pain decreased in both the inclusion and exclusion conditions in PFC and RA groups, whereas inclusion conditions significantly increased pain in the FM group. Social manipulation (inclusion or exclusion) did not affect pain sensitivity as measured in response to thermal stimulation. These results are in line with previous studies demonstrating altered pain inhibition in FM patients, and suggest that unlike PFC or other non-"stress-related" chronic pain conditions, being socially included may increase pain perception in FM patients. Possible underlying mechanisms and clinical relevance are discussed.

TTN genotype is associated with fascicle length and marathon running performance.

Titin provides a molecular blueprint for muscle sarcomere assembly, and sarcomere length can vary according to titin isoform expression. If variations in sarcomere length influence muscle fascicle length, this may provide an advantage for running performance. Thus, the aim of this study was to investigate whether the titin (TTN) rs10497520 polymorphism was associated with muscle fascicle length in recreationally active men (RA; n=137) and marathon personal best time in male marathon runners (MR; n=141). Fascicle length of the vastus lateralis was assessed in vivo using B-mode ultrasonography at 50% of muscle length in RA. All participants provided either a whole blood, saliva or buccal cell sample, from which DNA was isolated and genotyped using real-time polymerase chain reaction. Vastus lateralis fascicle length was 10.4% longer in CC homozygotes, those carrying two copies of the C-allele, than CT heterozygotes (P=.003) in RA. In the absence of any TT homozygotes, reflective of the low T-allele frequency within Caucasian populations, it is unclear whether fascicle length for this group would have been smaller still. No differences in genotype frequency between the RA and MR groups were observed (P=.500), although within the MR group, the T-allele carriers demonstrated marathon personal best times 2minutes 25seconds faster than CC homozygotes (P=.020). These results suggest that the T-allele at rs10497520 in the TTN gene is associated with shorter skeletal muscle fascicle length and conveys an advantage for marathon running performance in habitually trained men.

Low-load high-velocity resistance exercises improve strength and functional capacity in diabetic patients

This study investigated the effects of low-load high-velocity resistance exercises on neuromuscular and functional outcomes in patients with Type 2 diabetes (T2D) during the early-phase of resistance training. Thirty participants with T2D performed 18 training sessions (6 weeks – 3x week) in one of two groups: low-load high-velocity exercises (LLHV, n=15, 62.1±10.5 years) or recreational activities (RA, n=15 56.7 ± 19.4 years). LLHV performed resistance exercises with 3x 8reps as fast as possible with 50-60% 1RM. RA performed light activities. Strength, power, and functional tests were assessed. There was significant increasing in the knee extension peak-torque at 60°/s (7.6%) and 180°/s (12.2%), rate of force development in the LLHV group (P<0.05), whereas there were no changes in the RA group. Significant increases in functional test were observed in the LLHV group (P<0.01) with no changes in the RA group. In conclusion, the LLHV induced marked improvements in neuromuscular parameters, as well as in the functional capacity of participants with T2D.

Effects of Rapamycin on Clinical Manifestations and Blood Lipid Parameters in Different Preeclampsia-like Mouse Models.

Background:The pathogenesis of some types of preeclampsia is related to fatty acid oxidation disorders. Rapamycin can regulate fatty acid metabolism. This study aimed to investigate the effects of rapamycin on the clinical manifestations and blood lipid parameters in different preeclampsia-like mouse models.Methods:Two preeclampsia-like mouse models and a control group were established: L-NA (injected with Nω-nitro-L-arginine methyl ester), LPS (injected with lipopolysaccharide), and the control group with normal saline (NS). The mouse models were established at preimplantation (PI), early- and late-pregnancy (EP, LP) according to the time of pregnancy. The administration of rapamycin (RA; L-NA+RA, LPS+RA, and NS+RA) or vehicle as controls (C; L-NA+C, LPS+C, NS+C) were followed on the 2nd day after the mouse models’ establishment. Each subgroup consisted of eight pregnant mice. The mean arterial pressure (MAP), 24-h urinary protein, blood lipid, fetus, and placental weight were measured. The histopathological changes and lipid deposition of the liver and placenta were observed. Student's t-test was used for comparing two groups. Repeated measures analysis of variance was used for blood pressure analysis. Qualitative data were compared by Chi-square test.Results:The MAP and 24-h urinary protein in the PI, EP, and LP subgroups of the L-NA+C and LPS+C groups were significantly higher compared with the respective variables in the NS+C group (P < 0.05). The preeclampsia-like mouse models were established successfully. There was no significant difference in the MAP between the PI, EP, and LP subgroups of the L-NA+RA and L-NA+C groups and the LPS+RA and LPS+C groups. The 24-h urine protein levels in the PI and EP subgroups of the L-NA+RA group were significantly lower compared with the respective levels in the L-NA+C groups (1037 ± 63 vs. 2127 ± 593 μg; 976 ± 42 vs. 1238 ± 72 μg; both P < 0.05), also this effect appeared similar in the PI and EP subgroups of the LPS+RA and LPS+C groups (1022 ± 246 vs. 2141 ± 432 μg; 951 ± 41 vs. 1308 ± 30 μg; both P < 0.05). The levels of serum-free fatty acid (FFA) in the PI and EP subgroups of the L-NA+RA groups were significantly lower compared with the respective levels in the L-NA+C group (2.49 ± 0.44 vs. 3.30 ± 0.18 mEq/L; 2.23 ± 0.29 vs. 2.84 ± 0.14 mEq/L; both P < 0.05). The levels of triglycerides (TG) and total cholesterol in the PI subgroup of the L-NA+RA group were significantly lower compared with the respective levels in the L-NA+C (1.51 ± 0.16 vs. 2.41 ± 0.37 mmol/L; 2.11 ± 0.17 vs. 2.47 ± 0.26 mmol/L; both P < 0.05), whereas high-density lipoprotein serum concentration was significantly higher (1.22 ± 0.19 vs. 0.87 ± 0.15 mmol/L; P < 0.05) and low-density lipoprotein serum concentration did not exhibit a significant difference. There were no significant differences in the FFA of the PI, EP, and LP subgroups between the LPS+RA and the LPS+C groups. The levels of TG in the PI subgroup of the LPS+RA group were significantly lower compared with the respective levels in the LPS+C group (0.97 ± 0.05 vs. 1.22 ± 0.08 mmol/L; P < 0.05).Conclusion:Rapamycin can improve clinical manifestations and blood lipid profile in part of the preeclampsia-like mouse models.

Prevalence and risk factors associated with glucocorticoid-induced osteoporosis in Chinese patients with rheumatoid arthritis.

This study aims to investigate the prevalence and risk factors of GIOP, and also identify influences of GC daily dosage and GC treatment course for GIOP in Chinese patients with RA. Seven hundred and ninety patients with RA and 158 normal subjects were enrolled in the study. Clinical and laboratory features and medications of GC were recorded in detail. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry in all subjects. BMD at all measured sites in RA was significantly lower than that in control group. Prevalence of OP was obviously higher in RA with GC group (41.6%), compared with RA without GC group (29.4%). Prevalence of OPF in group of RA with GC (21.0%) was higher than that in group of RA without GC (13.3%). Usage of GC, female, and age were risk factors for the occurrence of OP and OPF in RA, while body mass index (BMI) was the protective factor of OP. Prevalence of GIOP and OPF had statistical significance among groups of different treatment courses with GC, whereas no statistical difference was found among groups with different daily dosages of GC. GIOP exists generally in Chinese patients with RA, which relates to treatment course not daily dosage of GC. Usage of GC is also the risk factor for the happening of OPF in Chinese patients with RA.