Physical activity and cardiac function in the oldest old

The relationship of physical activity (PA) and cardiac function in the oldest old remains unclear. The objective of this study was to evaluate the relationship between PA and cardiac structure and function, in the oldest old. Subjects were recruited from the Jerusalem Longitudinal Cohort Study that was initiated in 1990 and has followed an age homogeneous cohort of Jerusalem residents born in 1920-1921. A total of 496 of the subjects from the most recent set of data collection in 2005-2006 underwent echocardiography at their place of residence in addition to structured interviews and physical examination. Standard echocardiographic assessment of cardiac structure and function including ejection fraction (EF) and diastolic function as assessed by E:E' measurements was performed. PA was defined as a dichotomous (≥4?hr of light exercise weekly) and as a categorical variable (<4?hr weekly/4 hours weekly/at least 1?hr daily/sport at least twice weekly). On bivariate analysis, mean EF was lower among sedentary versus active women (55.5%±8.5% vs. 58.4%±8.3, p=0.021). No other significant differences were observed between sedentary and active subjects, for either systolic or diastolic function. After adjusting for sex, education, diabetes, ischemic heart disease, hypertension, dependence in activities of daily living, and body mass index (BMI), no significant associations were found between systolic or diastolic function, or left ventricular structure and PA. Gender-specific analyses yielded similar findings. Our study of the oldest old did not demonstrate an association between PA and cardiac structure or function.     

Use of collagen-hydroxyethylmethacrylate hydrogels for cell growth.

Collagen-hydroxyethylmethacrylate hydrogels were prepared by polymerizing monomeric hydroxyethylmethacrylate in the presence of various concentrations of soluble native collagen. The resulting transparent hydrogels were evaluated as substrata for growth of IMR-90 human embryonic lung fibroblasts. Without collagen no significant growth occurred, whereas a dose-response curve expressing maximal cell growth against collagen concentration could be constructed quite readily by the use of appropriate hydrogels. The method allows for quantification of the collagen contribution to cell growth and, in a more general sense, provides the foundation for a relatively easy procedure to probe mechanisms of cell adhesion and cell differentiation.     

Risk factors for delirium after on-pump cardiac surgery: a systematic review

IntroductionAs evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments need to be made for confounding variables. This review aims to systematically identify risk factors for delirium after cardiac surgery and to grade the evidence supporting these associations.MethodA prior registered systematic review was performed using EMBASE, CINAHL, MEDLINE and Cochrane from 1990 till January 2015 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007371). All studies evaluating patients for delirium after cardiac surgery with cardiopulmonary bypass (CPB) using either randomization or multivariable data analyses were included. Data was extracted and quality was scored in duplicate. Heterogeneity impaired pooling of the data; instead a semi-quantitative approach was used in which the strength of the evidence was graded based on the number of investigations, the quality of studies, and the consistency of the association reported across studies.ResultsIn total 1462 unique references were screened and 34 were included in this review, of which 16 (47 %) were graded as high quality. A strong level of evidence for an association with the occurrence of postoperative delirium was found for age, previous psychiatric conditions, cerebrovascular disease, pre-existent cognitive impairment, type of surgery, peri-operative blood product transfusion, administration of risperidone, postoperative atrial fibrillation and mechanical ventilation time. Postoperative oxygen saturation and renal insufficiency were supported by a moderate level of evidence, and there is no evidence that gender, education, CPB duration, pre-existent cardiac disease or heart failure are risk factors.ConclusionOf many potential risk factors for delirium after cardiac surgery, for only 11 there is a strong or moderate level of evidence. These risk factors should be taken in consideration when designing future delirium prevention strategies trials or when controlling for confounding in future etiological studies.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-1060-0) contains supplementary material, which is available to authorized users.     

Declining Trends and Widening Disparities in Overweight and Obesity Prevalence Among Massachusetts Public School Districts, 2009–2014

Objectives. We evaluated the overall and sociodemographic disparities in trends in prevalence of childhood overweight and obesity in Massachusetts public school districts between 2009 and 2014.Methods. In 2009, Massachusetts mandated annual screening of body mass index for students in grades 1, 4, 7, and 10. This was part of the statewide Mass in Motion prevention programs. We assessed trends in the prevalence of overweight and obesity between 2009 and 2014 by district, gender, grade, and district income.Results. From 2009 to 2014, prevalence decreased 3.0 percentage points (from 34.3% to 31.3%) statewide. The 2014 district-level rates ranged from 13.9% to 54.5% (median = 31.2%). When stratified by grade, the decreasing trends were significant only for grades 1 and 4. Although rates of districts with a median household income greater than $37 000 improved notably, rates of the poorest remain unchanged and were approximately 40%.Conclusions. Although overall prevalence began to decrease, the geographic and socioeconomic disparities in childhood obesity are widening and remain a public health challenge in Massachusetts. Special efforts should be made to address the needs of socioeconomically disadvantaged districts and to narrow the disparities in childhood obesity.Childhood obesity has been associated with chronic diseases such as hypertension, cardiovascular disease earlier in life,1–4 asthma, and sleep apnea.2,3,5 Many of these health risks continue well into adulthood, contributing to the higher risks for multiple chronic diseases, all-cause mortality, and premature death.4–8 Although a few studies have reported limited success in childhood obesity control,8,9 reducing the prevalence of overweight and obesity among children and adolescents remains a critically important public health endeavor in the United States.In response to growing concerns over childhood obesity, in 2003, the American Academy of Pediatrics released a policy statement advising that body mass index (BMI) be routinely assessed and tracked over time.10 In 2005, the Institute of Medicine recommended that all school systems develop a BMI measurement program and track their students annually. The Institute of Medicine also called on the federal government to create guidance documents for the development of these state programs.11 Since then, 20 states have developed BMI screening or body composition assessment programs.12In April 2009, the Massachusetts Public Health Council unanimously approved the state’s first BMI screening regulations as a key component of the state’s Mass in Motion initiative. Mass in Motion programs use community-based environmental approaches to promote healthy eating and active living at home, at work, and in communities throughout the state. The goal is to prevent overweight and obesity in all segments of the population.The state’s BMI screening regulation requires all public school districts to measure students’ height and weight, by the school nurse or other trained staff, of all students in grades 1, 4, 7, and 10 annually and report aggregate data to the Massachusetts Department of Public Health (MDPH). Before the 2013–2014 school year, the results of the screening were directly and confidentially communicated to the parents or guardians of each student. Starting in 2013–2014, notifications to parents were no longer required, although they could be done at the discretion of the local school district.Using the data collected between the 2008–2009 and 2013–2014 school years, we assessed the overall and district-level variations in trends in the prevalence of childhood overweight and obesity. These data were used to inform the state’s future efforts on prevention of childhood overweight and obesity. Furthermore, we examined the trends in childhood overweight and obesity by district-level income to inform the state’s efforts to reduce disparities in childhood obesity.     

The role of mTOR in the adaptation and failure of beta-cells in type 2 diabetes

Mammalian target of rapamycin (mTOR) is an important nutrient sensor that plays a critical role in cellular metabolism, growth, proliferation and apoptosis and in the cellular response to oxidative stress. In addition, mTOR-raptor complex, also called mammalian target of rapamycin complex 1 (mTORC1), generates an inhibitory feedback loop on insulin receptor substrate proteins. It was suggested that nutrient overload leads to insulin/insulin-like growth factor 1 resistance in peripheral insulin-responsive tissues and in the beta-cells through sustained activation of mTORC1. In this review, we summarize the literature on the regulation and function of mTOR, its role in the organism's response to nutrients and its potential impact on lifespan, insulin resistance and the metabolic adaptation to hyperglycaemia in type 2 diabetes. We also propose a hypothesis based on data in the literature as well as data generated in our laboratory, which assigns a central positive role to mTOR in the maintenance of beta-cell function and mass in the diabetic environment.     

Neuronal nitric oxide synthase protects the pancreatic beta cell from glucolipotoxicity-induced endoplasmic reticulum stress and apoptosis

Aims/hypothesis  

Cytokines stimulate nitric oxide production in pancreatic beta cells, leading to endoplasmic reticulum (ER) stress and apoptosis. Treatment of beta cells with glucose and NEFA induces nitric oxide synthase (NOS) as well as ER stress. However, the role of NO in glucolipotoxicity-induced ER stress in beta cells is not clear.     

Chemoprevention by nonsteroidal anti-inflammatory drugs eliminates oncogenic intestinal stem cells via SMAC-dependent apoptosis

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as sulindac effectively prevent colon cancer in humans and rodent models. However, their cellular targets and underlying mechanisms have remained elusive. We found that dietary sulindac induced apoptosis to remove the intestinal stem cells with nuclear or phosphorylated β-catenin in APC(Min/+) mice. NSAIDs also induced apoptosis in human colonic polyps and effectively removed cells with aberrant Wnt signaling. Furthermore, deficiency in SMAC, a mitochondrial apoptogenic protein, attenuated the tumor-suppressive effect of sulindac in APC(Min/+) mice by blocking apoptosis and removal of stem cells with nuclear or phosphorylated β-catenin. These results suggest that effective chemoprevention of colon cancer by NSAIDs lies in the elimination of stem cells that are inappropriately activated by oncogenic events through induction of apoptosis.