Bidirectional Relationships Between Weight Change and Sleep Apnea in a Behavioral Weight Loss Intervention

Objective

To examine the bidirectional relationship between weight change and obstructive sleep apnea (OSA) in the context of a behavioral weight loss intervention.

High rate of isolated right ventricular dysfunction in patients with non-significant CT pulmonary angiography

Background

Right ventricular (RV) dysfunction and pulmonary hypertension (PH) are commonly unrecognized in the emergency department (ED), but are associated with poor outcomes. Prior research has found a 30% prevalence of isolated RV dysfunction in ED patients after non-significant computed tomographic pulmonary angiography (CTPA). We aimed to prospectively define the prevalence of RV dysfunction and/or PH in short of breath ED patients, and assess outcomes.

Identification of blast cells in the peripheral blood of patients with acute leukaemia using the Technicon H-1

The Technicon H-1 counter represents a refinement of the cytochemistry-based technology of its predecessors, the H6000 and the Hemalog-D. It also has a new channel, the basophil-lobularity channel, which is said to enhance the sensitivity of leukaemic blast detection in comparison with previous instruments. To evaluate this facility, 35 adult patients with acute leukaemia at different phases of their disease were monitored for the presence of circulating leukaemic blasts during a 4-week period. The ability of the H-1 to detect blasts was compared to a careful manual review of a blood and bone marrow smear. Using the latter review as the standard, the sensitivity was 83.8% with a specificity of 78%. Exclusion of patients with severe leucopenia (less than 1.0 x 10(9)/l) increased the specificity to 89%, with little alteration in the sensitivity. We were unable to confirm the high degree of sensitivity claimed in previous reports. The H-1 blast flag, however, would appear useful for screening patients who are off therapy or on maintenance regimens.     

Diagnosis of pulmonary amyloidosis by transbronchial biopsy

Previously reported cases of pulmonary parenchymal amyloidosis were diagnosed by open lung biopsy or postmortem examination. We describe 3 patients who were found to have amyloid deposits within the lung parenchyma by flexible fiberoptic bronchoscopy. In each case, the diagnosis was suspected when a waxy eosinophilic substance was observed within the alveolar walls of transbronchial biopsy specimens stained with hematoxylin-eosin. When stained with Congo red and examined under polarized light, this amorphous material exhibited the apple-green birefringence characteristic of amyloid fibrils. We suggest that a diagnosis of pulmonary amyloidosis can be made by transbronchial biopsy provided the appropriate histologic stains are employed. Special stains for amyloid should be obtained whenever histologic sections from transbronchial biopsy specimens reveal amorphous eosinophilic material within the alveolar septa or within the walls of small vessels.     

Reactivation of Toxoplasma gondii by cytomegalovirus disease in mice: antimicrobial activities of macrophages

Reactivation of Toxoplasma gondii infection often occurs concurrently with active cytomegalovirus (CMV) disease in immunocompromised patients, and CMV disease results in immunosuppression. To determine if murine CMV (MCMV) infection decreases resistance to T. gondii, mice with latent T. gondii infection were infected with MCMV. T. gondii infection reactivated, manifested primarily as pneumonia. Lung macrophages supported the growth of T. gondii before, during, and after T. gondii reactivation. Peritoneal macrophages inhibited the growth of T. gondii as pneumonia developed and became permissive as pneumonia resolved. Mice with latent T. gondii infection could survive larger doses of MCMV than could controls. Thus, MCMV infection led to reactivation of latent T. gondii infection in mice. Activation of lung macrophages, assessed by their ability to inhibit replication of T. gondii in vitro, was not associated with control of T. gondii infection.     

Genetic and Environmental Factors in Parkinson's Disease Converge on Immune Function and Inflammation

Idiopathic Parkinson's disease (iPD) is a movement disorder characterized by the degeneration of dopaminergic neurons and aggregation of the protein α-synuclein. Patients with iPD vary in age of symptom onset, rate of progression, severity of motor and non-motor symptoms, and extent of central and peripheral inflammation. Genetic and environmental factors are believed to act synergistically in iPD pathogenesis. We propose that environmental factors (pesticides and infections) increase the risk for iPD via the immune system and that the role of PD risk genes in immune cells is worthy of investigation. This review highlights the major PD-relevant genes expressed in immune cells and key environmental factors that activate immune cells and, alone or in combination with other factors, may contribute to iPD pathogenesis. By reviewing these interactions, we seek to enable the future development of immunomodulatory approaches to prevent or delay onset of iPD. © 2020 International Parkinson and Movement Disorder Society     

EFFECTS OF NORMAL AGING ON LOWER EXTREMITY LOADING AND COORDINATION DURING RUNNING IN MALES AND FEMALES

Background

Runners sustain high injury rates. As greater numbers of individuals continue to run past the age of 60, normal physiological changes that occur with aging may further contribute to injuries. Male and female runners demonstrate different mechanics and injury rates. However, whether these mechanics further diverge as runners age and whether or not this potential divergence in mechanics may or may not be associated with a potential for increased injury risk is unknown.

Hypothesis/Purpose

The purpose of this study was to compare measures of loading and lower extremity coupling during running with respect to age and sex. It was hypothesized that males and females would demonstrate increasingly diverging mechanics with increased age.

Methods

Forty‐one subjects were placed in four groups: younger males (n=13), younger females (n=6), older males (n=16), and older females (n=6). Ten running trials were collected and analyzed for each subject. Kinematic data were collected and reconstructed using a nine‐camera motion analysis system and commercial software. Vertical loading rate (VLR), initial (GRF₁) and peak vertical ground reaction force (GRF₂) and lower leg joint coupling were calculated for each subject. Analysis was performed using a 2‐factor ANOVA (sex X age) to determine differences between groups during the stance phase of running.

Results

Compared to younger subjects, older subjects demonstrated higher GRF₁ per body weight (Y: 1.70 (0.19), O: 1.96 (0.23), p < 0.01), higher VLR in body weight/second (Y: 44.17 (6.73), O: 52.76 (8.39), p < 0.01) and lower GRF₂ per body weight (Y: 2.47 (0.18), O: 2.35 (0.18), p=0.04). However, no differences existed between males and females or further diverged in the older subjects. There were no differences between or within groups in joint coupling. Finally, no significant differences were seen between sexes and no interactions were found between any variables in the current study.

Conclusions

Older runners experience greater GRF₁ and VLR and lower GRF₂. These are factors previously associated with tibial loading and stress fractures. Males and females do not differ on these factors suggesting older female runners may be at no greater risk than younger runners or male runners for lower extremity bony injury based on normal mechanics.

Level of Evidence

3     

Historical perspective and contemporary management of acute coronary syndromes: from MONA to THROMBINS2

Acute coronary syndrome (ACS) remains a major burden on morbidity and mortality in the United States. Medical professionals and students often use the mnemonic ‘MONA’ (morphine, oxygen, nitroglycerin and aspirin) to recall treatments for ACS; however, this list of therapies is outdated. We provide a historical perspective on ‘MONA,’ attempt to uncover its origin in the medical literature, and demonstrate the myriad changes that have occurred over the last 50 years of ACS management. We have developed a novel mnemonic, ‘THROMBINS₂’ (thienopyridines, heparin/enoxaparin, renin–angiotensin system blockers, oxygen, morphine, beta blocker, intervention, nitroglycerin, statin/salicylate) to help bedside clinicians recall all the elements of contemporary ACS management. We demonstrate the mortality benefit for each component of contemporary ACS management, correlating the continued improvement with historical data on mortality after myocardial infarction. We encourage providers to utilize this mnemonic to explore options and guide treatments in ACS patients.