Intrarenal Resistance Index as a Prognostic Parameter in Patients with Liver Cirrhosis Compared with Other Hepatic Scoring Systems

Background and Aims: Patients with advanced liver cirrhosis who develop renal dysfunction have a poor prognosis. Elevated intrarenal resistance indices (RIs) due to renal vascular constriction have been described before in cirrhotic patients. In the current study, we prospectively investigated the course of intrarenal RIs and compared their prognostic impact with those of the Model for End-Stage Liver Disease (MELD) and the Child-Pugh scores. Methods: Sixty-three patients with liver cirrhosis underwent a baseline visit which included a sonographic examination and laboratory tests. Forty-four patients were prospectively monitored. The end points were death or survival at the day of the follow-up visit. Results: In 28 patients, a follow-up visit was performed after 22 8 months (group 1). Sixteen patients died during follow-up after 12 8 months (group 2). Group 2 patients showed a significantly higher baseline RI (0.76 +/- 0.05) than group 1 patients (RI = 0.72 +/- 0.06; p < 0.05). As shown by receiver operating characteristic analysis, the RI and the MELD score achieved similar sensitivity and specificity {[}area under the curve (AUC): 0.722; 95% confidence interval (95% CI): 0.575-0.873 vs. AUC: 0.724; 95% CI: 0.575-0.873, z = 0.029, n.s.] in predicting survival and were superior to the Child-Pugh score (AUC: 0.677; 96% Cl: 0.518-0.837). Conclusion: The RI is not inferior in sensitivity and specificity to the MELD score. Cirrhotic patients with elevated RIs have impaired short- and long-term survival. The RI may help identify high-risk patients that require special therapeutic care. Copyright (C) 2012 S. Karger AG, Base

Human notochordal cell transcriptome unveils potential regulators of cell function in the developing intervertebral disc

The adult nucleus pulposus originates from the embryonic notochord, but loss of notochordal cells with skeletal maturity in humans is thought to contribute to the onset of intervertebral disc degeneration. Thus, defining the phenotype of human embryonic/fetal notochordal cells is essential for understanding their roles and for development of novel therapies. However, a detailed transcriptomic profiling of human notochordal cells has never been achieved. In this study, the notochord-specific marker CD24 was used to specifically label and isolate (using FACS) notochordal cells from human embryonic and fetal spines (7.5-14 weeks post-conception). Microarray analysis and qPCR validation identified CD24, STMN2, RTN1, PRPH, CXCL12, IGF1, MAP1B, ISL1, CLDN1 and THBS2 as notochord-specific markers. Expression of these markers was confirmed in nucleus pulposus cells from aged and degenerate discs. Ingenuity pathway analysis revealed molecules involved in inhibition of vascularisation (WISP2, Noggin and EDN2) and inflammation (IL1-RN) to be master regulators of notochordal genes. Importantly, this study has, for the first time, defined the human notochordal cell transcriptome and suggests inhibition of inflammation and vascularisation may be key roles for notochordal cells during intervertebral disc development. The molecules and pathways identified in this study have potential for use in developing strategies to retard/prevent disc degeneration, or regenerate tissue.This research was funded by Arthritis Research UK (reference 21165 to SMR/JAH/LW) and the Henry Smith Charity (to JAH/SMR/MH). RRP was supported by a grant from the Programme for Advanced Medical Education, sponsored by Fundacão Calouste Gulbenkian, fundação Champalimaud, Ministério da Saúde, Fundação para a Ciência e Tecnologia and Apifarma, Portugal. Support was also received from the UK Medical Research Council (MR/J003352/1 to KPH), the Wellcome Trust (NAH was a senior fellow in clinical science, 088566; additional support from grant, 097820), and the British Council (14BX15NHBG to NAH). Consumable and technical support for this project (Sonal Patel) was funded by the National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. We are very grateful to all women who consented to take part in our research programme and for the assistance of research nurses and clinical colleagues at Manchester University NHS Foundation Trust. The authors would like to thank Prof Kathy Cheah and group for advice regarding the identification of sex-specific markers within microarray datasets.info:eu-repo/semantics/publishedVersio

The Impact of Exercise Consultation on Activity Levels and Metabolic Markers in Obese Adolescents: A Pilot Study

Objective. To assess the impact of exercise consultation on physical activity (PA) levels, anthropometric measures, and metabolic markers in obese adolescents. Methods. Obese adolescents (14–18 years) were randomized to either an exercise consultation (intervention group) or to review “Canada's Physical Activity Guide for Youth” (control group). Outcomes, including accelerometry, anthropometrics, blood pressure, stage of exercise behavior change, fasting glucose, insulin, and lipids, were measured at baseline and 3 months later. Results. Thirty adolescents (mean BMI = 36.1 kg/m2; SD = 6.9) completed the study. At follow-up, the intervention group had significantly greater PA compared with controls (P < .05). Similarly, the intervention group weighed an average 2.6 kg less than the control group (P < .05), with a mean BMI z-score of 2.15 compared to 2.21 for controls (P = .054). No other differences were noted. Conclusion. Exercise consultation may be a simple approach to increase PA levels, reduce weight, and lower BMI in obese adolescents

Come to Daddy? Claiming Chris Cunningham for British Art Cinema

Twenty years after he came to prominence via a series of provocative, ground-breaking music videos, Chris Cunningham remains a troubling, elusive figure within British visual culture. His output – which includes short films, advertisements, art gallery commissions, installations, music production and a touring multi-screen live performance – is relatively slim, and his seemingly slow work rate (and tendency to leave projects uncompleted or unreleased) has been a frustration for fans and commentators, particularly those who hoped he would channel his interests and talents into a full-length ‘feature’ film project. There has been a diverse critical response to his musical sensitivity, his associations with UK electronica culture – and the Warp label in particular – his working relationship with Aphex Twin, his importance within the history of the pop video and his deployment of transgressive, suggestive imagery involving mutated, traumatised or robotic bodies. However, this article makes a claim for placing Cunningham within discourses of British art cinema. It proposes that the many contradictions that define and animate Cunningham's work – narrative versus abstraction, political engagement versus surrealism, sincerity versus provocation, commerce versus experimentation, art versus craft, a ‘British’ sensibility versus a transnational one – are also those that typify a particular terrain of British film culture that falls awkwardly between populism and experimentalism

Kinematic characteristics of elite men's 50 km race walking.

Race walking is an endurance event which also requires great technical ability, particularly with respect to its two distinguishing rules. The 50 km race walk is the longest event in the athletics programme at the Olympic Games. The aims of this observational study were to identify the important kinematic variables in elite men's 50 km race walking, and to measure variation in those variables at different distances. Thirty men were analysed from video data recorded during a World Race Walking Cup competition. Video data were also recorded at four distances during the European Cup Race Walking and 12 men analysed from these data. Two camcorders (50 Hz) recorded at each race for 3D analysis. The results of this study showed that walking speed was associated with both step length (r=0.54,P=0.002) and cadence (r=0.58,P=0.001). While placing the foot further ahead of the body at heel strike was associated with greater step lengths (r=0.45,P=0.013), it was also negatively associated with cadence (r= -0.62,P<0.001). In the World Cup, knee angles ranged between 175 and 186° at initial contact and between 180 and 195° at midstance. During the European Cup, walking speed decreased significantly (F=9.35,P=0.002), mostly due to a decrease in step length between 38.5 and 48.5 km (t=8.59,P=0.014). From this study, it would appear that the key areas a 50 km race walker must develop and coordinate are step length and cadence, although it is also important to ensure legal walking technique is maintained with the onset of fatigue

Analysis of lower limb internal kinetics and electromyography in elite race walking.

The aim of this study was to analyse lower limb joint moments, powers and electromyography patterns in elite race walking. Twenty international male and female race walkers performed at their competitive pace in a laboratory setting. The collection of ground reaction forces (1000 Hz) was synchronised with two-dimensional high-speed videography (100 Hz) and electromyography of seven lower limb muscles (1000 Hz). As well as measuring key performance variables such as speed and stride length, normalised joint moments and powers were calculated. The rule in race walking which requires the knee to be extended from initial contact to midstance effectively made the knee redundant during stance with regard to energy generation. Instead, the leg functioned as a rigid lever which affected the role of the hip and ankle joints. The main contributors to energy generation were the hip extensors during late swing and early stance, and the ankle plantarflexors during late stance. The restricted functioning of the knee during stance meant that the importance of the swing leg in contributing to forward momentum was increased. The knee flexors underwent a phase of great energy absorption during the swing phase and this could increase the risk of injury to the hamstring muscles

Preferences of Hungarian consumers for quality, access and price attributes of health care services — result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments