Πέμπτη 7 Απριλίου 2022

Could Phosphate Provide a Second Chance for Statin Therapy in Kidney Failure?

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Gait Phase Subdivision and Leg Stiffness Estimation During Stair Climbing

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Leg stiffness is considered a prevalent parameter used in data analysis of leg locomotion during different gaits, such as walking, running, and hopping. Quantification of the change in support leg stiffness during stair ascent and descent will enhance our understanding of complex stair climbing gait dynamics. The purpose of this study is to investigate a methodology to estimate leg stiffness during stair climbing and subdivide the stair climbing gait cycle. Leg stiffness was determined as the ratio of changes in ground reac tion force in the direction of the support leg ${F}_{l}$ (leg force) to the respective changes in length ${L}_{l}$ during the entire stance phase. Eight subjects ascended and descended an instrumented staircase at different cadences. In this study, the changes of leg force and length (force–length curve) are described as the leg stiffness curve, the slope of which represents the normalized stiffness during stair climbing. The stair ascent and descent gait cycles were subdivided based on the negative and positive work fluctuations of the center-of-mass (CoM) work rate curve and the characteristics of leg stiffness. We found that the leg stiffness curve consists of several segments in which the force–length relationship was similarly linear and the stiffness value was relatively constant; the phase divided by the leg stiffness curve corresponds to the phase divided by the CoM work rate curve. The results of this study may guide biomimetic control strategies for a wearable lowe r-extremity robot for the entire stance phase during stair climbing.
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Study on the Effects of Different Seat and Leg Support Conditions of a Trunk Rehabilitation Robot

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Performance of trunk rehabilitation exercises while sitting on movable surfaces with feet on the ground can increase trunk and leg muscle activations, and constraining the feet to move with the seat isolates control of the trunk. However, there are no detailed studies on the effects of these different leg supports on the trunk and leg muscle activations under unstable and forcefully perturbed seating conditions. We have recently devised a trunk rehabilitation robot that can generate unstable and forcefully perturbed sitting surfaces, and can be used with ground-mounted or seat-connected footrests. In this study, we have evaluated the differences in balance performance, trunk movement and muscle activation (trunk and legs) of fourteen healthy adults caused by the use of these different footrest configurations under the different seating scenarios. The center of pressure and trunk movement results show that the seat-connected footrest may be a more suitable choice for use in a balance recovery focused rehabilitation protocol, while the ground-mounted footrest may be a more suitable choice for a trunk movement focused rehabilitation protocol. Although it is difficult to make a clear selection between footrests due to the mixed trends observed in the muscle activation results, it appears that the seat-connected footrest may be preferable for use with the unstable seat as it causes greater muscle activations. Furthermore, the results provide limited evidence that targeting of a particular muscle group may be possible through careful selection of the seat and footrest conditions. Therefore, it may be possible to utilize the trunk rehabilitation robot to maximize the training outcomes for a wide range of patients through careful selection of training protocols.
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Optimizing Prehospital Stroke Systems of Care-Reacting to Changing Paradigms (OPUS-REACH): a pragmatic registry of large vessel occlusion stroke patients to create evidence-based stroke systems of care and eliminate disparities in access to stroke care

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Abstract

Background

Large vessel occlusion (LVO) strokes are best treated with rapid endovascular therapy (EVT). There are two routes that LVO stroke patients can take to EVT therapy when transported by EMS: primary transport (ambulance transports directly to an endovascular stroke center (ESC) or secondary transport (EMS transports to a non-ESC then transfers for EVT). There is no clear evidence which path to care results in better functional outcomes for LVO stroke patients. To find this answer, an analysis of a large, real-world population of LVO stroke patients must be performed.

Methods

A pragmatic registry of LVO stroke patients from nine health systems across the United States. The nine health systems span urban and rural populations as well as the spectrum of socioeconomic statuses. We will use univariate and multivariate analysis to explore the relationships between type of EMS transport, socioeconomic factors, and LVO stroke outcomes. We will use geographic information systems and spatial analysis to examine the complex movements of patients in time and space. To detect an 8% difference between groups, with a 3:1 patient ratio of primary to secondary transports, 95% confidence and 80% power, we will need approximately 1600 patients.

The primary outcome is the patients with modified Rankin Scale (mRS) ≤ 2 at 90 days. Subgroup analyses include patients who receive intravenous thrombolysis and duration of stroke systems. Secondary analyses include socioeconomic factors associated with poor outcomes after LVO stroke.

Discussion

Using the data obtained from the OPUS-REACH registry, we will develop evidence based algorithms for prehospital transport of LVO stroke patients. Unlike prior research, the OPUS-REACH registry contains patient-level data spanning from EMS dispatch to ninety day functional outcomes. We expect that we will find modifiable factors and socioeconomic disparities associated with poor outcomes in LVO stroke. OPUS-REACH with its breadth of locations, detailed patient records, and multidisciplinary researchers will design the optimal prehospital stroke system of care for LVO stroke patients.

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Outcomes of Cervical Disc Replacement in Patients With Neck Pain Greater Than Arm Pain

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Although anterior cervical discectomy and fusion (ACDF) is believed to positively impact a patient's radicular symptoms as well as axial neck pain, the outcomes of cervical disc replacement (CDR) with regards to neck pain specifically have not been established.
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Effects of Low Protein-High Carbohydrate Diet during Early and Late Pregnancy on Respiratory Quotient and Visceral Adiposity

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Background. Low Protein-High Carbohydrate (LPHC) diet during pregnancy is considered a nutritional and health problem related to the development of maternal metabolic alterations, such as fatty liver and obesity in the perinatal and postnatal period. It is known that increase in visceral adiposity tissue (VAT) modulates maternal metabolic rate, with the respiratory quotient (RQ) being a parameter related to that variable; however, it is unknown whether LPHC intake during pregnancy affects the VAT and the RQ. In this study, we examine if consumption of LPHC during pregnancy modifies the VAT and RQ in early and late periods of pregnancy. Methods. This is a longitudinal and cross-sectional study with Wistar rats during gestation (G) (3, 8, 15, and 20) and nonpregnant rats. Rats were fed with a co ntrol diet with 63/18% carbohydrate/protein and an experimental diet with 79/6% carbohydrate/protein. We studied water and food consumption and metabolic parameters such as RQ and energy expenditure (EE), calculated by indirect calorimetry. In the cross-sectional study, we determined visceral fat, as well as the concentration of free fatty acids, insulin, glucose, and lipid profile in serum. Results. Nonpregnant rats with LPHC intake decreased significantly in VAT (86%) and the RQ (18%); in pregnant rats in early (8G) and late pregnancy (15G) in LPHC diet, both parameters (VAT and RQ) (25%-92%) increased during light time. When comparing time points during pregnancy in the control and LPHC groups, the RQ increased in 15G during daytime compared to 8G during the night period (17 and 5%, respectively). In late pregnancy, LPHC intake and triacylglyceride levels increased and cholesterol and glucose decreased (45 and 26%, respectively), in comparison to nonpregnant rats. Conclusions. LP HC intake in nonpregnant rats decreases the RQ and VAT. Interestingly, the opposite occurs in early pregnancy: the RQ and VAT increased, and this correlates with free fatty acid (FFA) levels. The increase in RQ and VAT during light time in early pregnancy increased mobilization of carbohydrate and protein metabolism. These results suggest that LPHC intake during pregnancy increases the glucose metabolism as a compensatory mechanism for energy needs in the fetus and the mother in early pregnancy.
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Glycyrrhizin Attenuates Hypoxic-Ischemic Brain Damage by Inhibiting Ferroptosis and Neuroinflammation in Neonatal Rats via the HMGB1/GPX4 Pathway

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With unknown etiology and limited treatment options, neonatal hypoxic-ischemic brain damage (HIBD) remains a major cause of mortality in newborns. Ferroptosis, a recently discovered type of cell death triggered by lipid peroxidation, is closely associated with HIBD. High-mobility group box 1 (HMGB1), a molecule associated with inflammation damage, can induce neuronal death in HIBD. However, it remains unknown whether HMGB1 contributes to neuronal ferroptosis in patients with HIBD. Herein, glycyrrhizin (GL), an HMGB1 inhibitor, was used to investigate the relationship between ferroptosis and HMGB1. RAS-selective lethal 3(RSL3), a ferroptosis agonist, was administered to further confirm the changes in the signaling pathway between HMGB1 and ferroptosis. Western blot analysis revealed that GL mar kedly suppressed the expression of HMGB1 and increased the level of GPX4 in the context of HIBD. We observed changes in neuronal ultrastructure via transmission electron microscopy to further confirm the occurrence of ferroptosis. Real-time PCR indicated that GL inhibited the expression of ferroptosis-related genes and inflammatory factors. Immunofluorescence and immunohistochemistry staining confirmed GL inhibition of neuronal damage and ferroptosis in HIBD associated with GPX4 and ROS. GL not only inhibited ferroptosis induced by RSL3 and oxygen-glucose deprivation in vitro but also inhibited ferroptosis induced by HIBD in vivo. More importantly, GL may improve oxidative stress imbalance and mitochondrial damage, alleviate the downstream production of inflammatory factors, and ultimately reduce ferroptosis and damage to cortical neurons following HIBD via the HMGB1/GPX4 pathway. In conclusion, we showed for the first time that GL could suppress the occurrence of neuronal ferroptos is and reduce neuronal loss in HIBD via the HMGB1/GPX4 pathway. These findings highlight the potential of HMGB1 signaling antagonists to treat neuronal damage by suppressing ferroptosis, provide new and unique insights into GL as a neuroprotective agent, and suggest new prevention and treatment strategies for HIBD.
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