Comparative study of observed actions,motor imagery and control therapeutic exercise on the conditioned pain modulation in the cervical spine: a randomized controlled trial

Abstract

Aim: The aim of this study was to compare the effects of cervical exercise, motor imagery (MI) and action observation (AO) of cervical exercise actions on conditioned pain modulation and pressure pain thresholds. The second objective was to assess the effects of these interventions on cervical motor activity (ranges of motion and muscle endurance), attention, and the ability to generate motor images.

Study design: Single-blinded randomized controlled trial.

Materials and methods: Fifty-four healthy subjects were randomly assigned to each group. Response conditioned pain modulation, pressure pain threshold, were the main variables. The secondary outcome measures included, cervical range of motion, Neck flexor endurance test, mental movement representation associated and psychosocial variables.

Results: All groups showed significant differences in time factor for all evaluated variables (p?<?.01) except pressure pain threshold over the tibial region. The post hoc analysis revealed significant within-group differences in the AE and AO groups in conditioned pain modulation (p?<?.05), with medium effect size in time [AE (d –0.61); AO (d –0.74)].

Conclusion: The results showed that within-group changes in conditioned pain modulation, cervical muscle endurance, and attention where founded only in the AE and AO groups. Variations in pain thresholds at pressure in the trapezium area were also obtained in the three groups. Changes in the ranges of flexion-extension and rotation movement were presented exclusively in the exercise group, and in the capacity to generate motor images only in the AO group. However, there was no difference in the pressure pain threshold over the tibial region.     

Effectiveness of using an unskilled model in action observation combined with motor imagery training for early motor learning in elderly people: a preliminary study

Abstract

Aim of the study: To investigate a more available model for the early phase of motor learning after action observation combined with motor imagery training in elderly people. To address the purpose, we focused on a slow, unskilled model demonstrating an occasional error.

Materials and methods: A total of 36 elderly people participated in the current study and were assigned to either the unskilled or skilled model observation groups (n?=?12, respectively), or the control group (n?=?12). The participants in the observation groups observed the assigned a video clip of an unskilled or skilled model demonstrating a ball rotation task. During the observation, the participants were instructed to imagine themselves as the person in the video clip. The participants in the control group read a scientific paper during the equivalent period of action observation and motor imagery. We measured ball rotation performance (the time required for five rotations, the number of ball drops) in pre- and post-intervention (observation combined with motor imagery training for intervention groups or reading for control group).

Results: Ball rotation performance (ball rotation speed) significantly improved in the unskilled model observation group compared to the other two groups.

Conclusions: Intervention for action observation using unskilled model combined with motor imagery was effective for improving motor performance during the early phase of motor learning.     

The severity of chewing disorders is related to gross motor function and trunk control in children with cerebral palsy

Abstract

Purpose: The frequency of chewing disorders increases with decreasing level of gross motor function in children with cerebral palsy (CP). Besides its frequency, the severity of chewing disorders is also important. The aim of this study was to determine the relationship between chewing performance level and gross motor function, and trunk postural control in children with CP.

Materials and methods: The study included 119 children with CP (age 2–10 years). Chewing performance level was determined by the Karaduman Chewing Performance Scale (KCPS). The Gross Motor Function Classification System (GMFCS) was used to determine the level of gross motor function. Segmental Assessment of Trunk Control (SATCo) was used to measure trunk control.

Results: Children with spastic CP with a median age of 4?years were evaluated, of which 50.4% were male. The percentages of patients classified to GMFCS levels I to V were 43.7%, 6.7%, 9.2%, 5.0%, and 35.3%, respectively. The median KCPS score was 3 (min?=?0, max?=?4). A good correlation was found between KCPS and GMFCS (p?<?.001, r?=?0.70). Negative, excellent correlations between KCPS and SATCo static, SATCo active, and SATCo reactive postural controls were found (p?<?.001, r?=?–0.75, r?=?–0.77, r?=?–0.79; respectively).

Conclusions: The severity of chewing disorders is related to the level of gross motor function and trunk postural control in children with CP.

Clinical trial number: NCT03241160     

What are the determinants of explicit and implicit motor imagery ability in stroke patients?: a controlled study

Abstract

Purpose: The purposes of the study were to (a) investigate both explicit and implicit motor imagery ability (MIA) impairment after stroke, (b) examine predictive effects of clinical characteristics for MIA after stroke.

Materials and Methods: Forty one patients with stroke (PwS) (mean age 59.41?±?10.19?years; %41 female) and 36 healthy participants (mean age 62.47?±?9.29?years; %47 female) completed Chaotic Motor Imagery Assessment-Hand Rotation for implicit MIA and Movement Imagery Questionnaire-3 (MIQ-3) and Box and Block Test (BBT) for explicit MIA. The severity of motor and sensory impairments were determined by the Fugl-Meyer Assessment-Upper Extremity (FMAUE) scores. The Turkish version of Motor Activity Log-28 was used to assess amount of use (AUS) and quality of movement in daily life.

Results: Our results indicated that both implicit and explicit MIA (except kinaesthetic imagery of MIQ-3) in PwS were statistically impaired compared to controls (p?<?0.05). The sensorimotor impairment level, amount of use and movement quality of the affected upper limb were found to be correlated with MIA in various degrees. Total motor scores in FMAUE and AUS were significant predictors of explicit MIA (p?<?0.01). Additionally, explicit MIA scores of stroke subgroups were statistically different between severely and mildly impaired patients, in favour of mildly impaired group (p?<?0.05).

Conclusion: In conclusion, both motor impairment level and amount of daily use of upper extremity were found to be predictive factors for explicit MIA. Further investigation with brain imaging techniques is needed to explore the validity of these findings in establishing MIA.     

Changes in resting motor threshold of the tongue with normal aging and stroke

Aim of study: To examine the resting motor threshold of the tongue in healthy adults and stroke survivors.

Methods: Thirty-five healthy adults were classified into three groups: Group 1 (19–38?years; n?=?11), Group 2 (50–64?years; n?=?12) and Group 3 (66–78?years; n?=?12). Six chronic stroke survivors (mean age =59?years, SD?=?9.1?years) were recruited (Group 4). The resting motor thresholds (RMTs) of the tongue were measured and compared (i) among the four groups and (ii) between stroke survivors and age-matched healthy adults.

Results: Group 3 showed significantly higher RMTs than Group 1 (p?=?.001) and 2 (p =?0.007). Group 4 showed significantly higher RMTs than Group 1 (p =?.003) and 2 (p?=?.001). The RMTs of Group 3 and 4 were not significantly different (p =?.385). The RMT was positively correlated with age (r?=?0.534; p =?.001). Group 4 showed significantly higher RMTs than the age-matched controls (U?= 2.5, p?=?.009, r?=?0.77).

Conclusions: The resting motor threshold of the tongue is significantly increased in adults aged above 65 and in stroke survivors when compared with healthy adults. The findings suggested that the cortical excitability of the tongue deteriorates in the elderly and the stroke population.     

Forward head posture is associated with pressure pain threshold and neck pain duration in university students with subclinical neck pain

Abstract

Objective: The aims of this study are to investigate the association between: (i) forward head posture (FHP) and pressure pain thresholds (PPTs); (ii) FHP and maladaptive cognitive processes; and (iii) FHP and neck pain characteristics in university students with subclinical neck pain.

Materials/methods: A total of 140 university students, 90 asymptomatic and 50 with subclinical neck pain, entered the study. Demographic data, anthropometric data, FHP, and PPTs were collected for both groups. In addition, pain characteristics, pain catastrophizing, and fear of movement were assessed for participants with neck pain. FHP was characterized by the angle between C7, the tragus of the ear, and the horizontal line. Correlation analysis and multivariate regression analysis were conducted.

Results: Participants with subclinical neck pain showed significantly lower PPTs than participants without neck pain (p?<?.05), but similar FHP (p?>?.05). No significant association was found between FHP and PPTs in the asymptomatic group. In the group of participants with subclinical neck pain, PPTs at the right trapezius and neck pain duration explained 19% of the variance of FHP (R²?=?0.23; adjusted R²?=?0.19; p?<?.05).

Conclusion: This study suggests that FHP is not associated with PPTs in asymptomatic university students. In university students with subclinical neck pain, increased FHP was associated with right trapezius hypoalgesia and with neck pain of shorter duration. These findings are in contrast with current assumptions on the association between neck pain and FHP.     

Observing neck movements evokes an excitatory response in the sympathetic nervous system associated with fear of movement in patients with chronic neck pain

Abstract

The objective of this study was to evaluate the response of the sympathetic-excitatory nervous system in patients with chronic neck pain compared with a control group of asymptomatic subjects who underwent an intervention of watching activities involving movements in the neck region. Thirty participants were divided into two groups: patients with chronic neck pain (n?=?15) and the control group (n?=?15). The patients’ neck disability, fear of movement and catastrophism were assessed with a self-report. The recorded variables related to the autonomic nervous system were skin conductance and skin temperature. The ANOVA test revealed significant differences in the increase in skin conductance in the chronic neck pain group after observing the activities (both in the photographs and video) at the end of the observation and 5?minutes after the intervention (p?<?.01; d?>?0.80). There were no significant differences in skin temperature. Ultimately, the correlation analysis revealed a moderate positive correlation between kinesiophobia and skin conductance at 30?seconds (r?=?0.53) and at 60?seconds (r?=?0.52) of observing the activities in the video for the chronic neck pain group. Based on the results of the present study, we suggest that observing activities involving neck movements causes an activation of the sympathetic-excitatory nervous system in patients with chronic neck pain. These changes could be related to a fear of movement when faced with visual exposure to neck movements that could be interpreted as ‘harmful’ or ‘dangerous’.     

Influence of vision and motor imagery styles on equilibrium control during whole-body rotations

To investigate the influence of vision and motor imagery styles on equilibrium control, displacements of the supporting foot during spontaneous whole-body rotations (“pirouette”) by expert female ballet dancers were analyzed using three-dimensional kinematics. Four turn types were defined according to direction (clockwise, CW vs. counterclockwise, CCW) and supporting foot (SF, left vs. right). Visual influences were examined by including two visual conditions (blindfolded vs. full-vision). Motor imagery styles were determined using the Vividness of Movement Imagery Questionnaire (VMIQ) (Kinesthetic, n = 4 vs. Visual/Kinesthetic, n = 6). Turning direction preference was assessed by a closed-response questionnaire in which all dancers indicated that they preferred CW turn direction. Kinesthetic dancers showed more SF displacement during CCW (non-preferred direction) than CW (preferred direction) pirouettes. However, Visual/Kinesthetic dancers showed no significant effect of turn direction. Furthermore, Kinesthetic dancers showed no significant effect of vision on SF displacement whereas Visual/Kinesthetic dancers showed significantly higher SF displacement when vision was occluded. Thus there appears to be a selective effect of vision on Visual/Kinesthetic dancers, and a selective effect of turn direction on Kinesthetic dancers. These results suggest that perceptual styles should be taken into consideration when training tasks that require fine equilibrium control because the factors that perturb balance differ depending on perceptual style.     

Impact of unilateral spatial neglect on chronic patient's post-stroke quality of life

Abstract

Background: Unilateral spatial neglect (USN) is the prevalent feature in patients with right-sided stroke. It is diagnosed through the behavior inattention test (BIT) and has a negative impact on patients affecting both their functional capacity and quality of life.

Objective: Here, we aimed to evaluate the impact of USN on the quality of life of patients in the chronic phase of stroke.

Methods: This is a cross-sectional study with stroke patients with USN. After confirming the presence of stroke through neuroimaging examinations and of USN through the BIT, patients’ quality of life was evaluated by using the EUROQOL scale. Spearman’s correlation was used to validate the correlation between patients’ USN and quality of life, with a p?<?.05 representing significant results.

Results: Eighteen individuals were included. When correlating the value of each domain of the EUROQOL scale with the results of the BIT, we observed a negative correlation between mobility (r?=?–0.97; p?=?.000), self-care (r?=?–0.82; p?=?.013), usual activities (r?=?–0.87; p?=?.005); pain or discomfort (r?=?–0.88; p?=?.004), anxiety or depression (r?=?–0.97; p?=?.000), and EUROQOL total score (r?=?–0.97, p?=?.000).

Conclusion: After a correlation between the overall EUROQOL and BIT scores, we suggest that the higher the USN degree is in stroke patients, the worse their perceived quality of life tends to be.     

Cerebral haemodynamics during motor imagery of self-feeding with chopsticks: differences between dominant and non-dominant hand

Abstract

Purpose: Motor imagery is defined as a dynamic state during which a subject mentally simulates a given action without overt movements. Our aim was to use near-infrared spectroscopy to investigate differences in cerebral haemodynamics during motor imagery of self-feeding with chopsticks using the dominant or non-dominant hand.

Materials and methods: Twenty healthy right-handed people participated in this study. The motor imagery task involved eating sliced cucumber pickles using chopsticks with the dominant (right) or non-dominant (left) hand. Activation of regions of interest (pre-supplementary motor area, supplementary motor area, pre-motor area, pre-frontal cortex, and sensorimotor cortex was assessed.

Results: Motor imagery vividness of the dominant hand tended to be significantly higher than that of the non-dominant hand. The time of peak oxygenated haemoglobin was significantly earlier in the right pre-frontal cortex than in the supplementary motor area and left pre-motor area. Haemodynamic correlations were detected in more regions of interest during dominant-hand motor imagery than during non-dominant-hand motor imagery.

Conclusions: Haemodynamics might be affected by differences in motor imagery vividness caused by variations in motor manipulation.     

Prognostic and diagnostic significance of mid-regional pro-atrial natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 Study

Abstract

Purpose: To compare the diagnostic and prognostic value of mid-regional pro-ANP (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea.

Methods: MR-proANP and NT-proBNP were measured with commercial immunoassays at hospital admission (n?=?313), on day 2 (n?=?234), and before discharge (n?=?91) and compared for diagnosing acute heart failure (HF; n?=?143) and to predict mortality among patients with acute HF and acute exacerbation of chronic obstructive pulmonary disease (AECOPD; n?=?84) separately.

Results: The correlation coefficient between MR-proANP and NT-proBNP was 0.89 (p?<?0.001) and the receiver-operating area under the curve (AUC) was 0.85 (95% CI 0.81–0.89) for MR-proANP and 0.86 (0.82–0.90) for NT-proBNP to diagnose acute HF. During a median follow-up of 816?days, mortality rates were 46% in acute HF patients and 42% in AECOPD patients. After adjustment for other risk variables by multivariate Cox regression analysis, MR-proANP and NT-proBNP concentrations were associated with mortality in patients with acute HF, but only MR-proANP were associated with mortality among patients with AECOPD: hazard ratio (_lnMR-proANP) 1.98 (95% CI 1.17–3.34).

Conclusion: MR-proANP and NT-proBNP concentrations provide similar diagnostic and prognostic information in patients with acute HF. In contrast to NT-proBNP, MR-proANP measurements also provided independent prognostic information in AECOPD patients.     

Organization of meissner corpuscles in the glabrous skin of monkey and cat

Abstract

Purpose: Motor imagery, the process of imagining a physical action, has been shown to facilitate the excitability of spinal anterior horn cells. In the acute phase after a stroke, the excitability of spinal anterior horn cells is significantly reduced, which leads to motor deficits. This loss of movement can be prevented by increasing the excitability of spinal anterior horn cells immediately following an injury. Motor imagery is an effective method for facilitating the excitability of spinal anterior horn cells in patients with impaired movement; however, the optimal duration for motor imagery is unclear.

Materials and Methods: To investigate time-dependent changes in spinal anterior horn cell excitability during motor imagery, healthy adult participants were recruited to measure the F-wave, an indicator of anterior horn cell excitability. F-waves were measured from participants at baseline, during motor imagery, and post-motor imagery. During motor imagery, participants imagined isometric thenar muscle activity at 50% maximum voluntary contraction for 5?min. F-waves were measured at 1, 3, and 5?min after beginning motor imagery and analysed for persistence and F/M amplitude ratio.

Results: Persistence and F/M amplitude ratios at 1- and 3-min after motor imagery initiation were significantly greater than at baseline. The persistence and F/M amplitude ratio at 5-min after motor imagery initiation, however, was comparable to baseline levels.

Conclusion: Therefore, 1 to 3?min of motor imagery is likely sufficient to facilitate the excitability of spinal anterior horn cells.     

Red-spotted Bluethroats Luscinia s. svecica migrate along the Indo-European flyway: a geolocator study

Capsule Red-spotted Bluethroats Luscinia s. svecica from two European breeding populations spent the boreal winter on the Indian sub-continent.

Aim Tracking the migration of Red-spotted Bluethroats from Europe to the hitherto unknown non-breeding areas and back.

Methods Light-level geolocators were deployed on male Bluethroats at breeding sites in the Czech Republic (n?=?10) and in Norway (n?=?30). Recorded light intensity data were used to estimate the locations of non-breeding sites and migration phenology during the annual cycle.

Results Bluethroats spent the boreal winter in India (n?=?3) and Pakistan (n?=?1), on average more than 6000?km from their breeding areas. Autumn migration started in August (n?=?1) or early September (n?=?2), and lasted for 26–74 days. Spring migration commenced on 8 and 9 April (n?=?2) and lasted for about a month. During both autumn and spring migration, birds stopped over two or three times for more than 3 days.

Conclusion This study for the first time showed where Red-spotted Bluethroats from European breeding populations stay during the boreal winter. This seems to be the first time that a passerine bird has been tracked along the Indo-European flyway.     

Maternal association and influence of DHFR 19 bp deletion variant predisposes foetus to anencephaly susceptibility: a family-based triad study

Abstract

Objective: Previous studies have not used family-based methods to evaluate maternal-paternal genetic effects of the folate metabolizing enzyme, dihydro folate reductase (DHFR) essential during embryogenesis. Present study focuses on evaluating the association and influence of parental genetic effects of DHFR 19?bp deletion in the development of foetal neural tube defects (NTDs) using family-based triad approach.

Materials and methods: The study population (n?=?924) including 124 NTD case-parent trios (n?=?124?×?3?=?372) and 184 healthy control-parent trios (n?=?184?×?3?=?552) from Telangana, India, was genotyped for DHFR 19?bp deletion. Statistical analysis was used by SPSS and parent-of-origin effects (POE).

Results: Foetuses with deletion genotype (DD) were at risk of developing anencephaly (OR =?3.26, p?=?0.020). Among parents, increased maternal risk of having an anencephaly foetus (OR =?2.66, p?=?0.028) was observed in mothers with DD genotype. In addition, POE analysis also demonstrated higher risk of maternal transmission of the deletion allele to anencephaly foetus compared with paternal transmission (OR =?6.00, p?=?0.016). Interestingly, maternal-paternal-offspring genotype incompatibility revealed maternal deletion genotype (DD) in association with paternal heterozygous deletion genotype (WD) significantly increased risk for NTDs (OR =?5.29, p?=?0.013).

Conclusions: This study, using family-based case-parent and control-parent triad approach, is the first to report influence of maternal transmission of DHFR 19?bp deletion in the development of anencephaly in the foetus.     

Comparing the prognostic performance of ASSIST to interleukin-6 and procalcitonin in patients with severe sepsis or septic shock

Abstract

Context: We recently derived and validated a multi-biomarker-based model (ASSIST) to stratify patients with sepsis based on initial mortality risk.

Objective: The objective of this study was to compare the performance of ASSIST to interleukin-6 (IL6) and procalcitonin (PCT).

Methods: The area-under-the-receiver operating characteristic curve for predicting 28-d mortality using ASSIST was compared with that of IL6 (n?=?452) and PCT (n?=?235).

Results: The area under the curve for ASSIST was greater than that of IL6 and PCT.

Conclusions: ASSIST estimated the probability of mortality more reliably than IL6 and PCT in this cohort of patients with sepsis.     

Plasma angiogenesis and oxidative stress markers in patients with diabetic retinopathy

Abstract

Background: Neovascularization in the retina and hyperglycaemia-induced oxidative stress are implicated in the pathogenesis of diabetic retinopathy (DR). In this study, we hypothesized that the plasma angiogenic and oxidative stress markers associated with these derangements could aid in the screening of diabetic patients who are at an increased risk of developing retinopathy.

Methods: This study included normal (n?=?148), type2 diabetes without retinopathy (DNR; n?=?148), proliferative DR (PDR; n?=?74) and non-PDR (NPDR; n?=?148) subjects. Plasma concentrations of vascular endothelial growth factor-A (VEGF-A), hypoxia-inducible factor-1α (HIF-1α), matrix metalloproteinase-9 (MMP-9), pigment epithelium-derived factor (PEDF), nitric oxide (NO), soluble receptors for advanced glycation end products (sRAGE), malondialdehyde (MDA) and protein thiols were estimated.

Results: A statistically significant increase was observed in the plasma concentrations of pro-angiogenic factors and markers of oxidative stress in both retinopathy groups. By contrast, the concentrations of anti-angiogenic factors and antioxidants were decreased significantly in these groups. Receiver operating characteristic analysis indicated that the plasma thresholds of HIF-1α and PEDF can be suitable markers in case of NPDR. However, in PDR, HIF-1α, NO, MMP-9 and PEDF showed high sensitivity and specificity.

Conclusions: The factors associated with hypoxia, matrix degradation and angiogenic inhibition play a crucial role in predicting DR.     

SPARCL1 as a biomarker of maladaptive right ventricular remodelling in pulmonary hypertension

Abstract

Aim: This study assessed the utility of SPARC-like protein 1 (SPARCL1) as a biomarker of maladaptive right ventricular (RV) function in patients with pulmonary hypertension (PH).

Methods: In this prospective study, we examined SPARCL1 levels in 105 patients with adaptive (n?=?34) and maladaptive RV (n?=?32) pressure overload caused by PH, dilated cardiomyopathy (DCM, n?=?18) with LVEF < 35% and preserved RV function and controls without LV or RV abnormalities (n?=?21).

Results: The median SPARCL1 concentration in patients with maladaptive RV function was higher than in those with adaptive RV function (p?<?0.01), DCM (p?<?0.001) or controls (p?<?0.001). Patients with adaptive RV function had higher SPARCL1 concentrations than controls (p?<?0.05), whereas there was no difference between adaptive RV and DCM. SPARCL1 showed good predictive power for maladaptive RV (AUC 0.77, p?<?0.001) with an optimal cut-off value of 9.66?ng/ml. The TAPSE/PASP ratio was the only independent predictor of SPARCL1?≥?9.66?ng/ml in multivariable logistic regression analysis.

Conclusion: SPARCL1 shows potential as novel biomarker of RV pathological remodelling and is associated with RV maladaptation and ventriculoarterial uncoupling in PH.     

Relationship of troponin to incident atrial fibrillation occurrence,recurrence after radiofrequency ablation and prognosis: a systematic review,meta-analysis and meta-regression

Objective: To explore the association between the levels of troponin (Tn) and incident atrial fibrillation (AF) occurrence, AF recurrence after radiofrequency ablation (RFA), and the risk trend of AF related prognosis (stroke, major bleeding and mortality).

Methods: Twenty-seven studies were included after a systematic search in PubMed from 2005 to 2017, including 13 associated with incident AF occurrence, 8 associated with AF recurrence after RFA and 6 studies evaluating the risk trend of AF-related prognosis with increased Tn levels.

Results: Compared with ‘no incident AF occurrence’ patients, the incident AF occurrence group had similar baseline troponin I (TnI) levels (standardized mean differences [SMD]?=?0.42, 95% CI: ?0.02–0.86, p?=?0.06; I²?=?87.0%, N?=?6), but higher troponin T (TnT) levels (SMD?=?3.77, 2.13–5.42, p?<0.001; I²=99.7%, N?=?8). AF recurrence patients had similar peri-ablation TnI levels, but higher peri-ablation TnT levels compared to the ‘no AF recurrence’ group with pooled SMD. (TnI: SMD: ?0.61, ?1.22to 0, p?=?0.049; I²?=?87.1%; TnT: 0.38, 0.14–0.62, p?=?0.002; I²?=?64.7%). On meta-regression, there was an increased risk trend for stroke/systemic embolism (SE) (r²?=?0.93, p?=?0.04) or major bleeding (r²?=?0.99, p?r²?=?0.09, p?=?0.25) or TnT (r²?=?0.20, p?=?0.31), and stroke/SE (r²?=?0.02, p?=?0.74) or major bleeding (r²?=?0.002, p?=?0.92) was non-significantly related to increasing TnI levels.

Conclusions: In our systematic review, meta-analysis and meta-regression, TnT was associated with both incident AF occurrence and AF recurrence after RFA, as well as stroke/SE and major bleeding. In contrast, TnI was not associated with incident AF occurrence, AF recurrence after RFA or prognosis (stroke/SE, major bleeding).     

Neutrophil gelatinase-associated lipocalin after off pump versus on pump coronary artery surgery

Abstract

Context: Cardiac surgery.

Objective: To compare plasma and urinary neutrophil gelatinase-associated lipocalin (P-/U-NGAL) in on-pump (n?=?43) versus off-pump (n?=?40) surgery.

Materials and methods: We obtained perioperative P-/U-NGAL and outcome data.

Results: P-/U-NGAL increased after surgery. P-NGAL was higher post-surgery in on pump patients (139 versus 67?µg L^?1; p?<?0.001), but not at 24?h. There were no differences in U-NGAL. Correlation between P-/U-NGAL and plasma creatinine was weak.

Discussion: P-NGAL acts like a neutrophil activation biomarker and U-NGAL like a tubular injury marker.

Conclusion: On-pump patients had greater neutrophil activation. On- versus off-pump surgery had similar impact on tubular cells.     

Low proportions of folic acid deficiency after introduction of mandatory folic acid fortification in remote areas of northern Queensland,Australia: a secondary health data analysis

Abstract

Background: Australia implemented mandatory folic acid fortification of bread-making flour in 2009.

Objective: To assess the impact of folic acid fortification in remote vs. regional urban areas and Indigenous vs. non-Indigenous populations in northern Queensland.

Methods: Routinely collected data on folic acid measurements in remote areas and two regional urban centres in northern Queensland between 2004 and 2015 were analysed (n?=?13,929) dichotomously (folic deficient vs. non-deficient).

Results: Overall prevalence of folic acid deficiency was 3.2% (235/7282) in urban centres compared with 7.2% (480/6647) in remote areas (p?<?0.001), and 9.3% (393/4240) in the Indigenous population compared with 3.2% (273/8451) in the non-Indigenous population (p?<?0.001). Prevalence of folic acid deficiency dropped from 12.2% (n?=?481) in 2004–2008 to 1.5% (n?=?126) in 2010–2015 (p?<?0.001). This translates into a relative risk reduction (RRR) of 88%. RRR was 79% (7.2% vs. 1.5%) in urban centres, 91% (17.3% vs. 1.5%) in remote areas, 92% (20.5% vs. 1.6%) in the Indigenous population and 80% (7.4% vs. 1.5%) in the non-Indigenous population (p?<?0.001 for all).

Conclusions: Substantial declines of folic acid deficiency to low and comparable proportions in former high-risk populations indicate that mandatory folic acid fortification of flour has had a population-wide benefit in northern Queensland.