Testing the effectiveness of the exercise plus program in older women post-hip fracture

Background: Exercise is an important strategy with potential to improve recovery in older adults following a hip fracture.Purpose: The purpose of this study was to test the impact of a self-efficacy based intervention, the Exercise Plus Program, and the different components of the intervention, on self-efficacy, outcome expectations, and exercise behavior among older women post-hip fracture.Methods: Participants were randomized to one of four groups: exercise plus, exercise only, plus only (i.e., motivation), or routine care. Data collection was done at baseline (within 22 days of fracture), 2, 6, and 12 months post-hip fracture.Results: A total of 209 women were recruited with an average age of 81.0 years (SD=6.9). The majority was White (97.1%), was widowed (57.2%), and had a high school education (66.7%). Generalized Estimating Equations were used to perform repeated measures analyses. No differences in trajectories of recovery were observed for self-efficacy or outcome expectations. A statistically significant difference in the overall trajectory of time in exercise was seen (p<.001), with more time spent exercising in all three treatment groups.Conclusions: The study demonstrated that it was possible to engage these women in a home-based exercise program and that the plus only, exercise only, and the exercise plus groups all increased exercise. Support for this project was provided by National Institute on Aging grants R37 AG09901, R01-AG18668, R01 AG17082, and the Claude D. Pepper Older Americans Independence Center P60-AG12583.     

Identification of an Enterocytozoon bieneusi-like microsporidian parasite in simian-immunodeficiency-virus-inoculated macaques with hepatobiliary disease.

Enterocytozoon bieneusi is a common opportunistic pathogen of human patients with acquired immune deficiency syndrome (AIDS) causing significant morbidity and mortality. In a retrospective analysis utilizing conventional histochemical techniques, in situ hybridization, polymerase chain reaction, and ultrastructural examination, we identified 18 simian-immunodeficiency-virus-infected macaques (16 Macaca mulatta, 1 M. nemestrina, and 1 M. cyclopis) with Enterocytozoon infection of the hepatobiliary system and small intestine. The organisms were readily identified in the bile ducts and gall bladder by special stains and by in situ hybridization using a probe directed against the small subunit ribosomal RNA of human origin E. bieneusi. Infection of the biliary system was associated with a nonsuppurative and proliferative cholecystitis and choledochitis. Hepatic involvement was characterized by bridging portal fibrosis and nodular hepatocellular regeneration accompanied by marked bile ductular and septal duct hyperplasia. Ultrastructurally, all developmental stages of the organism were found in direct contact with the host cell cytoplasm; spores and sporoblasts contained a double layer of polar tubes. Sequencing of a 607-bp segment of the small subunit ribosomal RNA revealed 97 and 100% identity to two clones of small subunit ribosomal RNA derived from E. bieneusi of human origin. Extensive morphological and genetic similarities between the simian and human enterocytozoons suggest that experimentally infected macaques may serve as a useful model of microsporidial infection in AIDS.     

Matrix regulation of skeletal cell apoptosis II: role of Arg-Gly-Asp-containing peptides.

This investigation was based on the assumption that arg-gly-asp (RGD)-containing peptides are released from the extracellular matrix of bone and cartilage during the remodeling cycle. We asked the question: Can RGD peptides influence skeletal cell viability? Primary human osteoblasts, mouse MC-3T3-E1 cells, and chick chondrocytes were incubated with purified RGD-containing peptides and cell viability was determined. The RGD peptide did not kill osteoblasts, chondrocytes, or MC-3T3-E1 cells. In contrast, RGDS and GRGDSP peptides killed all three cell types. Osteoblast death was quite rapid, occurring within 6 h of treatment. transferase uridyl mediated nick end labeling (TUNEL) and transmission electron microscopy (TEM) analysis indicated that death was mediated by apoptosis. To learn if mitochondria transduced the death signal, cells were treated with RGDS and organelle function was evaluated using a voltage-sensitive fluorescent probe. It was observed that there was no net loss of fluorescence and, hence, it was concluded that mitochondria were not the primary effectors of the apoptotic response. Experiments were performed with enzyme inhibitors to determine the import of the caspase pathway on RGDS-mediated osteoblast apoptosis. Results of these studies, as well as a study conducted using a fluorescent substrate, pointed to caspase 3 mediating the effector stage of the apoptotic process. Finally, using a purified labeled-RGDS peptide, we showed that the molecule was not restricted by the plasma membrane because it was accumulated in the cytosolic compartment. Results of the investigation support the view that resorption of the extracellular matrix generates peptide products that can induce apoptosis of vicinal cells.     

Anterior ischemic optic neuropathy: Classification of field defects by Octopus™ automated static perimetry

Visual fields of patients with anterior ischemic optic neuropathy (AION) were classified according to quantitative criteria, using the Octopus perimeter. Although a significant altitudinal pattern of field loss was found in 55% of perimetric examinations, the "spared" hemifields routinely showed some loss of sensitivity. This finding, along with the diffuse loss of sensitivity in a high percentage of visual fields, indicates more extensive involvement of the circulation of the anterior optic nerve head than has previously been suggested. Furthermore, patients with diabetes mellitus alone were found to have a statistically separable pattern of visual field loss. The pathophysiologic implications of the visual fields in AION and their relationship to the clinical findings were investigated.     

“Reducing body”-like inclusions in skeletal muscle in childhood-onset acid maltase deficiency

Summary Unusual inclusions with some of the features of reducing bodies were encountered in the skeletal muscle biopsy of a 2.5-year-old boy with childhoodonset acid maltase deficiency. The biopsy revealed a vacuolar myopathy with lysosomal storage of glycogen and eosinophilic refractile inclusions in myofibers, which appeared dark blue with the menadione-nitroblue tetrazolium reaction. The significance of the association of inclusions with reducing properties in the setting of acid maltase deficiency is discussed.     

Current concepts in inguinal hernia in infants and children

Trends are changing in the management of infants and children with indirect inguinal hernias. Advances in neonatal intensive care have resulted in the survival of many small premature infants who have a high incidence of inguinal hernia. The rate of incarceration, strangulation, and gonadal infarction in these babies is twice that of the general pediatric age group. Respiratory immaturity, apnea, bradycardia, and associated neonatal conditions require special management at the time of hernia repair, usually performed just before discharge from the neonatal intensive care unit. New information concerning volume loss and depletion of germ cells beginning at 6 months of age in boys with undescended testes has stimulated the performance of orchiopexy when the patient is 1 year of age. More than 90% of boys with cryptorchid testes at the age of 1 year have an associated hernia that requires concomitant repair at the time of orchiopexy. The use of the peritoneal cavity for fluid absorptive purposes in hydrocephalus treated by venticuloperitoneal shunts or of peritoneal dialysis for renal failure and metabolic diseases such as hyperammonemia and lactic acidosis causes increased intraabdominal pressure and results in the appearance of a previously unrecognized hernia. Recognition of these and other conditions associated with a high incidence of hernial occurrence should allow early diagnosis and treatment before the development of complications. Most elective repairs of hernias are safely performed in the outpatient setting; however, some infants and children with concurrent illnesses are best managed in a morning admissions program, in which hospital admission occurs postoperatively.

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Resumen Este artículo se refiere a las tendencias en el manejo de lactantes y niños con hernias inguinales indirectas. Los avances logrados en el cuidado intensivo neonatal han resultado en la supervivencia de muchos pequeños prematuros, quienes exhiben una elevada incidencia de hernia inguinal. La tasa de incarceración, estrangulación, e infarto gonadal en estos pacientes es dos veces la de la población pediátrica general. La inmadurez respiratoria, apnea, bradicardia, y otras condiciones neonatales asociadas requieren un manejo especial con ocasión de la reparación herniaria, la cual generalmente se realiza inmediatamente antes de la salida de la unidad de cuidado intensivo neonatal. Nuevos conocimientos sobre pérdida de volumen y depleción de las células germinales, lo cual comienza a los 6 meses de edad en niños con testículos no descendidos, ha estimulado la realización de orquidopexia cuando el paciente llegue a la edad de un ano. Más del 90% de los niños con testículos criptorquídicos a la edad de un año tienen una hernia asociada que requiere reparación concomitante con la orquidopexia. El uso de la cavidad peritoneal para efectos de absorción de fluidos en el caso de hidrocéfalos tratados con la implantación de sistemas valvulares ventriculoperitoneales, o de diálisis peritoneal para falla renal y enfermedades metabólicas tales como hiperamonemia o acidosis láctica, causa un aumento en la presión intraabdominal y resulta en la aparición de una hernia previamente inaparente. La identificación de estas y otras condiciones asociadas con una elevada incidencia de hernia debe hacer posible el diagnóstico y tratamiento tempranos, antes de que se presenten complicaciones. La mayoría de las reparaciones herniarias pueden ser realizadas en forma adecuada como procedimientos ambulatorios. Sin embargo, algunos infantes y niños con enfermedades concurrentes pueden ser mejor manejados en un programa de admisión matinal, en el cual la hospitalización se produce en el postoperatorio.

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Résumé Le traitement des hernies inguinales obliques externes chez le bébé et l'enfant évolue. Les progrès accomplis dans les soins intensifs des nouveau-nés ont permis la survie d'un plus grand nombre d'enfants prématurés qui présentent une fréquence plus importante de hernies inguinales. Le taux d'engouement, d'étranglement, et d'ischémie gonadale chez cette population est deux fois celui de la population pédiatrique générale. Le développement respiratoire inachevé, l'apnée, la bradycardie, et d'autres conditions néonatales associées sont autant de facteurs qui nécessitent le travail d'une équipe spécialisée au moment du traitement de la hernie qui se situe juste avant la sortie de l'unité de soins intensifs. Certaines études ayant montré une perte de volume et une déplétion de cellules germinales à partir de l'âge de 6 mois chez le garçon avec une ectopie testiculaire, on préconise une orchidopexie tôt, à l'âge d'un an. Plus de 90% de ces enfants présentent une hernie associée qui doit être réparée en même temps. L'utilisation de la cavité péritonéale pour dériver l'hydrocéphalie par shunt ventriculopéritonéal ou pour dialyse péritonéale en cas d'insuffisance rénale ou autres maladies métaboliques comme l'hyperammonémie et l'acidose lactique sont des causes d'hyperpression intra-abdominale avec augmentation du nombre de cas de hernies jusqu'alors méconnues. Une meilleure connaissance de ces conditions propices à augmenter le nombre de hernies symptomatiques devrait permettre d'en faire le diagnostic plus tôt et de les traiter avant l'apparition des complications. La plupart des hernies non compliquées sont traitées sans hospitalisation. Cependant, quelques bébés et enfants ayant d'autres maladies concomitantes sont mieux traités avec un programme d'hospitalisation de jour, c'est-à-dire que l'enfant est hospitalisé pendant 24 heures après son opération.

     

Lung surfactant gelation induced by epithelial cells exposed to air pollution or oxidative stress

Lung surfactant lowers surface tension and adjusts interfacial rheology to facilitate breathing. A novel instrument, the interfacial stress rheometer (ISR), uses an oscillating magnetic needle to measure the shear viscosity and elasticity of a surfactant monolayer at the air-water interface. The ISR reveals that calf lung surfactant, Infasurf, exhibits remarkable fluidity, even when exposed to air pollution residual oil fly ash (ROFA), hydrogen peroxide (H2O2), or conditioned media from resting A549 alveolar epithelial cells (AEC). However, when Infasurf is exposed to a subphase of the soluble fraction of ROFA- or H2O2-treated AEC conditioned media, there is a prominent increase in surfactant elasticity and viscosity, representing two-dimensional gelation. Surfactant gelation is decreased when ROFA-AEC are pretreated with inhibitors of cellular reactive oxygen species (ROS), or with a mitochondrial anion channel inhibitor, as well as when A549-rho0 cells that lack mitochondrial DNA and functional electron transport are investigated. These results implicate both mitochondrial and nonmitochondrial ROS generation in ROFA-AEC-induced surfactant gelation. A549 cells treated with H2O2 demonstrate a dose-dependent increase in lung surfactant gelation. The ISR is a unique and sensitive instrument to characterize surfactant gelation induced by oxidatively stressed AEC.