Panniculitis in a patient presenting with a pancreatic tumour and polyarthritis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Panniculitis is a rare manifestation of pancreatic disease. Rarer still is the association of panniculitis, pancreatitic disease and polyarthritis. A literature search revealed less than five cases of pancreatic panniculitis associated with pancreatic tumour and polyarthritis.</p> <p>Case presentation</p> <p>An 84-year-old Caucasian man presented with epigastric pain, weight loss, polyarthritis and multiple discharging nodules. A computed tomography scan revealed a mass in the head of the pancreas. Histology of the cutaneous lesions confirmed the diagnosis of pancreatic panniculitis.</p> <p>Conclusion</p> <p>Pancreatic panniculitis can clinically present in many ways to clinicians across a broad scope of specialties. Knowledge and understanding of the association between panniculitis and polyarthritis with pancreatic disease may aid rapid diagnosis and management.</p

Process parameter-growth environment-film property relationships for the sputter deposited yttrium-oxygen system

In this study, a Y target was sputtered in radio frequency (rf)‐excited, rare gas discharges (Ne, Ar) containing 0%–40% O_2, operated at cathode voltage from −1.0 to −1.7 kV. In situ optical emission spectrometry was used to monitor two neutral excited Y atom transitions (λ=0.6191, 0.6793 μm) and an excited O atom transition (λ=0.7774 μm) as a function of changing process parameter. Films were grown on fused SiO_2 substrates, and their crystallography, optical behavior, and electrical resistivity was determined. A "phase diagram" for Y–O not grown under conditions of equilibrium thermodynamics was constructed, and included hexagonal Y, cubic Y_2O_3, and Y and Y_2O_3 that had no long range crystallographic order. Two direct optical transitions across the energy band gap of cubic Y_2O_3, at 5.07 and 5.73 eV, were identified. Combining discharge diagnostics, growth rate, and film property results, it was concluded that Y_2O_3 was formed at the substrate concurrent with the complete oxidation of the target surface. Even after target oxidation, the discharge contained atomic Y. On the basis of fundamental optical absorption edge characteristics, cubic Y_2O_3 that more closely resembled the bulk material was obtained when the Y‐oxide molecule/Y atom flux to the substrate was high

The influence of age and nutrients on insulin sensitivity

The studies presented in this thesis aimed to investigate the effects of nutritional modulation and age-associated changes on insulin sensitivity. Four separate studies were performed; three of these had insulin sensitivity as the primary outcome. Existing studies show that ageing is associated with insulin resistance, but data may be confounded by several factors that also occur with increasing age, such as increased adiposity, skeletal muscle lipid accumulation and reduced physical activity. To elucidate this further the first study compared body composition, skeletal muscle lipid content, fat metabolism during light-intensity exercise and whole-body and skeletal muscle insulin sensitivity between 7 healthy young and 14 older males. Ageing and insulin resistance are also associated with impaired skeletal muscle protein synthesis, however the effects of insulin resistance per se on amino acid metabolism and associated insulin signalling pathways are not really known. The second study involved 8 young healthy males and aimed to explore the effect of insulin resistance on the protein synthetic response to amino acid ingestion and muscle protein signalling pathway in humans. Dietary intake has been shown to affect insulin sensitivity; however it is unclear if diet composition affects liver fat content independent of energy balance. Therefore the third study aimed to investigate the effects of hyperenergetic diets high in fat or carbohydrate on liver fat and insulin sensitivity. The study involved 23 healthy but overweight and obese males who initially consumed an isoenergetic diet for one week, and then were randomised to 2 weeks of either hyperenergetic (+25% excess) high fat or high carbohydrate diets. Liver fat content, abdominal visceral fat, skeletal muscle fat content, hepatic lipid metabolism and insulin sensitivity were assessed before and after the 2 week intervention period. Whilst dietary excess can exacerbate insulin resistance, certain micronutrients may improve insulin sensitivity. Carnitine has shown encouraging outcomes in relation to promoting fatty acid oxidation, metabolism and modulating body composition in healthy young volunteers. However the effects on older people have never been explored. This formed the basis of the fourth study that investigated the effects of 6 months of oral carnitine supplementation or placebo in 14 older (≥65 years of age) healthy males in relation to fatty acid metabolism, skeletal muscle lipid and insulin sensitivity. The main findings are summarised. Irrespective of age, adiposity and physical activity are associated with impaired fatty acid oxidation, greater skeletal muscle lipid accumulation and reduced insulin sensitivity. However ageing per se appears to increase the sympathetic response to exercise and enhance systemic fatty acid delivery and adipose tissue lipolysis. Insulin resistance induced by acute elevation of lipid was found to affect the skeletal muscle protein synthetic response to amino acid ingestion, and this impairment appeared to occur downstream from the Akt insulin signalling pathway. Energy excess per se increases liver fat content and affects liver metabolism but there were no differential effects of carbohydrate or fat on hepatic insulin sensitivity and liver fat content. Finally, oral carnitine ingestion for 6 months successfully increased skeletal muscle total carnitine content of older healthy people and resulted in increased fatty acid oxidation and intramyocellular lipid (IMCL) utilisation during light-intensity exercise, but no effect on skeletal muscle insulin sensitivity was seen. These studies have increased mechanistic insight into the associations between ageing, nutrients and insulin sensitivity, paving the way to further research

The influence of age and nutrients on insulin sensitivity

The studies presented in this thesis aimed to investigate the effects of nutritional modulation and age-associated changes on insulin sensitivity. Four separate studies were performed; three of these had insulin sensitivity as the primary outcome. Existing studies show that ageing is associated with insulin resistance, but data may be confounded by several factors that also occur with increasing age, such as increased adiposity, skeletal muscle lipid accumulation and reduced physical activity. To elucidate this further the first study compared body composition, skeletal muscle lipid content, fat metabolism during light-intensity exercise and whole-body and skeletal muscle insulin sensitivity between 7 healthy young and 14 older males. Ageing and insulin resistance are also associated with impaired skeletal muscle protein synthesis, however the effects of insulin resistance per se on amino acid metabolism and associated insulin signalling pathways are not really known. The second study involved 8 young healthy males and aimed to explore the effect of insulin resistance on the protein synthetic response to amino acid ingestion and muscle protein signalling pathway in humans. Dietary intake has been shown to affect insulin sensitivity; however it is unclear if diet composition affects liver fat content independent of energy balance. Therefore the third study aimed to investigate the effects of hyperenergetic diets high in fat or carbohydrate on liver fat and insulin sensitivity. The study involved 23 healthy but overweight and obese males who initially consumed an isoenergetic diet for one week, and then were randomised to 2 weeks of either hyperenergetic (+25% excess) high fat or high carbohydrate diets. Liver fat content, abdominal visceral fat, skeletal muscle fat content, hepatic lipid metabolism and insulin sensitivity were assessed before and after the 2 week intervention period. Whilst dietary excess can exacerbate insulin resistance, certain micronutrients may improve insulin sensitivity. Carnitine has shown encouraging outcomes in relation to promoting fatty acid oxidation, metabolism and modulating body composition in healthy young volunteers. However the effects on older people have never been explored. This formed the basis of the fourth study that investigated the effects of 6 months of oral carnitine supplementation or placebo in 14 older (≥65 years of age) healthy males in relation to fatty acid metabolism, skeletal muscle lipid and insulin sensitivity. The main findings are summarised. Irrespective of age, adiposity and physical activity are associated with impaired fatty acid oxidation, greater skeletal muscle lipid accumulation and reduced insulin sensitivity. However ageing per se appears to increase the sympathetic response to exercise and enhance systemic fatty acid delivery and adipose tissue lipolysis. Insulin resistance induced by acute elevation of lipid was found to affect the skeletal muscle protein synthetic response to amino acid ingestion, and this impairment appeared to occur downstream from the Akt insulin signalling pathway. Energy excess per se increases liver fat content and affects liver metabolism but there were no differential effects of carbohydrate or fat on hepatic insulin sensitivity and liver fat content. Finally, oral carnitine ingestion for 6 months successfully increased skeletal muscle total carnitine content of older healthy people and resulted in increased fatty acid oxidation and intramyocellular lipid (IMCL) utilisation during light-intensity exercise, but no effect on skeletal muscle insulin sensitivity was seen. These studies have increased mechanistic insight into the associations between ageing, nutrients and insulin sensitivity, paving the way to further research

Relative contribution of intramyocellular lipid to whole-body fat oxidation is reduced with age but subsarcolemmal lipid accumulation and insulin resistance are only associated with overweight individuals

Insulin resistance is closely related to intramyocellular lipid (IMCL) accumulation, and both are associated with increasing age. It remains to be determined to what extent perturbations in IMCL metabolism are related to the aging process per se. On two separate occasions, whole-body and muscle insulin sensitivity (euglycemic-hyperinsulinemic clamp with 2-deoxyglucose) and fat utilization during 1 h of exercise at 50% VO2max ([U-13C]palmitate infusion combined with electron microscopy of IMCL) were determined in young lean (YL), old lean (OL), and old overweight (OO) males. OL displayed IMCL content and insulin sensitivity comparable with those in YL, whereas OO were markedly insulin resistant and had more than twofold greater IMCL in the subsarcolemmal (SSL) region. Indeed, whereas the plasma free fatty acid Ra and Rd were twice those of YL in both OL and OO, SSL area only increased during exercise in OO. Thus, skeletal muscle insulin resistance and lipid accumulation often observed in older individuals are likely due to lifestyle factors rather than inherent aging of skeletal muscle as usually reported. However, age per se appears to cause exacerbated adipose tissue lipolysis, suggesting that strategies to reduce muscle lipid delivery and improve adipose tissue function may be warranted in older overweight individuals

L-theanine in the adjunctive treatment of generalized anxiety disorder: a double-blind, randomised, placebo-controlled trial

Partial or non-response to antidepressants in Generalized Anxiety Disorder (GAD) is common in clinical settings, and adjunctive biological interventions may be required. Adjunctive herbal and nutraceutical treatments are a novel and promising treatment option. L-theanine is a non-protein amino acid derived most-commonly from tea (Camellia sinensis) leaves, which may be beneficial in the treatment of anxiety and sleep disturbance as suggested by preliminary evidence. We conducted a 10-week study (consisting of an 8-week double-blind placebo-controlled period, and 1-week pre-study and 2-week post-study single-blinded observational periods) involving 46 participants with a DSM-5 diagnosis of GAD. Participants received adjunctive L-theanine (450–900 mg) or matching placebo with their current stable antidepressant treatment, and were assessed on anxiety, sleep quality, and cognition outcomes. Results revealed that adjunctive L-theanine did not outperform placebo for anxiety reduction on the HAMA (p = 0.73) nor insomnia severity on the Insomnia Severity Index (ISI; p = 0.35). However, LT treated participants reported greater self-reported sleep satisfaction than placebo (ISI item 4; p = 0.015). Further, a separation in favour of L-theanine was noted on the ISI in those with non-clinical levels of insomnia symptoms (ISI ≤ 14; p = 0.007). No significant cognitive effects (trail making time and the modified emotional Stroop) were revealed. While this preliminary study did not support the efficacy of L-theanine in the treatment of anxiety symptoms in GAD, further studies to explore the application of L-theanine in sleep disturbance are warranted

Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases

The presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting due to concerns of fragility fracture. We examined the efficacy and safety of a modular multi-modal exercise program in prostate cancer patients with bone metastases.Between 2012 and 2015, 57 prostate cancer patients (70.0±8.4 years; BMI 28.7±4.0 kg/m) with bone metastases (pelvis 75.4%, femur 40.4%, rib/thoracic spine 66.7%, lumbar spine 43.9%, humerus 24.6%, other sites 70.2%) were randomised to multi-modal supervised aerobic, resistance and flexibility exercises undertaken thrice weekly (EX, n=28) or usual care (CON, n=29) for 3 months. Physical function subscale of the SF-36 was the primary endpoint as an indicator of patient-rated physical functioning. Secondary endpoints included objective measures of physical function, lower body muscle strength, body composition and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention.There was a significant difference between groups for self-reported physical functioning (3.2 points, 95% CI 0.4-6.0 points; p=0.028) and lower body muscle strength (6.6 kg, 95% CI 0.6-12.7; p =0.033) at 3 months favouring EX. However, there was no difference between groups for lean mass (p=0.584), fat mass (p=0.598), or fatigue (p=0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (p=0.507).Multi-modal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal

Effect of acute and short-term dietary fat ingestion on postprandial skeletal muscle protein synthesis rates in middle-aged, overweight and obese men

Muscle anabolic resistance to dietary protein is associated with obesity and insulin resistance. However, the contribution of excess consumption of fat to anabolic resistance is not well studied. The aim of these studies was to test the hypothesis that acute and short-term dietary fat overload will impair the skeletal muscle protein synthetic response to dietary protein ingestion. Eight overweight/obese males [46.4±1.4 years, BMI 32.3±5.4 kg/m2] participated in the acute feeding study, which consisted of 2 randomised crossover trials. On each occasion, subjects ingested an oral meal (with and without fat emulsion) 4h before the coingestion of milk protein, intrinsically labelled with [1-13C]phenylalanine, and dextrose. Nine overweight/obese males [44.0±1.7 years, BMI 30.1±1.1 kg/m2] participated in the chronic study, which consisted of a baseline 1-week isocaloric diet followed by a 2-week high fat diet (+25% energy excess). Acutely, incorporation of dietary amino acids into the skeletal muscle was 2-fold higher (P<0.05) in the lipid trial compared to control. There was no effect of prior lipid ingestion on indices of insulin sensitivity (muscle glucose uptake, PDC activity and Akt phosphorylation) in response to the protein/dextrose drink. Fat overfeeding had no effect on muscle protein synthesis or glucose disposal in response to whey protein ingestion, despite increased muscle DAG C16:0 (P=0.06) and ceramide C16:0 (P<0.01) levels. Neither acute nor short-term dietary fat overload has a detrimental effect on skeletal muscle protein synthetic response to dietary protein ingestion in overweight/obese men, suggesting dietary-induced accumulation of intramuscular lipids per se is not associated with anabolic resistance