Nutrition, body composition and physical activity in malignant pleural disease: associations with patient outcomes and response to an exercise intervention

Background: Patients with malignant pleural disease (MPD) have advanced cancer and high symptom burden. Goals of patient care are to optimise health-related quality-of-life (HR-QoL) and participation in daily physical activities. Supportive care interventions such as nutrition and exercise could offer benefit to patients. However, there is a lack of information on the prevalence of low muscle mass (i.e., pre-sarcopenia), malnutrition, inactivity and poor physical functioning in patients with MPD. Additionally, little is known about the factors associated with development of pre-sarcopenia and malnutrition or their associations with patient outcomes. Purpose: The objectives were to: 1) characterise physical activity levels and their relationship with patient outcomes; 2) compare methodology used to classify presarcopenia; 3) determine the prevalence of pre-sarcopenia and malnutrition and investigate their relationship with activity behaviours and HR-QoL; 3) determine the prevalence of poor physical functioning and nutritional outcomes throughout the two years postdiagnosis; 5) describe body composition changes and investigate their relationship with physical activity and dietary intake; and 6) examine the effects of nutritional status and dietary intake on outcomes of an exercise intervention. Methods: Three studies in patients with MPD were conducted: a cross-sectional study, a prospective observational study, and an exercise intervention study. Participants in the cross-sectional study (n=46) underwent assessment of physical activity levels (accelerometer). Participants in the observational (n=36) and exercise intervention (n=33) studies underwent assessment of nutritional status (Patient-Generated Subjective Global Assessment), body composition (computed tomography [CT], dual-energy x-ray absorptiometry [DXA]), physical activity levels (accelerometer), physical functioning (Timed Up-and-Go), HR-QoL (Short-Form 36; Functional Assessment of Cancer Therapy [FACT]-General), appetite (FACT-Anorexia Cachexia Scale) and fatigue (FACTFatigue). Participants in the intervention study underwent additional tests of physical functioning (Six-Minute Walk Test, chair rise) and muscular strength (1-repetition maximum leg press). Results: In the cross-sectional study, 89% of participants did not meet physical activity guidelines. There was moderate agreement between CT and DXA for the classification of pre-sarcopenia (ĸ=0.424; p=0.006). Fifty-four percent of participants were pre-sarcopenic, and 38% were malnourished. Compared to participants with normal muscle mass, presarcopenic participants were more sedentary (p=0.001) and participated in less light activity (p=0.008). Compared to participants who were well-nourished, malnourished participants had poorer HR-QoL (p0.05). In the exercise intervention, participants with adequate dietary intake (40%) had a significant increase in muscle mass (p=0.004), while participants with inadequate dietary intake (60%) maintained muscle mass (p=0.737). There were no differences between well-nourished and malnourished participants with respect to completion, adherence or tolerance of the intervention (p\u3e0.05). Conclusion: Overall, there were high rates of pre-sarcopenia, malnutrition, inactivity, and poor physical functioning among participants with MPD. Pre-sarcopenia and malnutrition were associated with negative patient outcomes. Muscle loss was associated with decline in physical activity. The results indicate dietary intake could influence the effects of exercise. Interventions that target both physical activity and dietary intake could be most impactful

Functional evolution of the feeding system in rodents

The masticatory musculature of rodents has evolved to enable both gnawing at the incisors and chewing at the molars. In particular, the masseter muscle is highly specialised, having extended anteriorly to originate from the rostrum. All living rodents have achieved this masseteric expansion in one of three ways, known as the sciuromorph, hystricomorph and myomorph conditions. Here, we used finite element analysis (FEA) to investigate the biomechanical implications of these three morphologies, in a squirrel, guinea pig and rat. In particular, we wished to determine whether each of the three morphologies is better adapted for either gnawing or chewing. Results show that squirrels are more efficient at muscle-bite force transmission during incisor gnawing than guinea pigs, and that guinea pigs are more efficient at molar chewing than squirrels. This matches the known diet of nuts and seeds that squirrels gnaw, and of grasses that guinea pigs grind down with their molars. Surprisingly, results also indicate that rats are more efficient as well as more versatile feeders than both the squirrel and guinea pig. There seems to be no compromise in biting efficiency to accommodate the wider range of foodstuffs and the more general feeding behaviour adopted by rats. Our results show that the morphology of the skull and masticatory muscles have allowed squirrels to specialise as gnawers and guinea pigs as chewers, but that rats are high-performance generalists, which helps explain their overwhelming success as a group

A clinical audit of the nutritional status and need for nutrition support amongst head and neck cancer patients treated with radiotherapy

Radiotherapy is an effective treatment for head and neck cancers but patients often experience side effects which lead to weight loss. Nutrition intervention in the form of counselling or oral nutrition support (ONS) is frequently needed for these patients. For some patients, tube feeding is required to minimise weight loss during treatment.MethodData was collected on 48 patients who received radiotherapy to the head and neck region over a nine-month period (June 2009–March 2010). Retrospective data collection was commenced in July 2010. Each patient’s Diet Therapy Department record was reviewed. Main outcome measures were: 1) type of nutrition support; 2) percentage weight change during treatment; and 3) Patient-Generated Subjective Global Assessment Global (PG-SGA) rating.ResultsOn initial assessment 28 (77.8%) patients were classified as well nourished using the PG-SGA. Mean weight loss during radiotherapy was 5.74%. Risk factors for the need for ONS and enteral nutrition support (ENS) were older age, presence of nutrition impact symptoms, high-risk tumour sites, advanced disease and chemotherapy. No significant difference was shown in weight loss between ONS and ENS groups.ConclusionThis study identified the need for early dietetic intervention for high nutritional risk groups of head and neck cancer patients to prevent significant weight loss. Pre-treatment nutritional status did not influence weight loss during treatment. ONS alone cannot prevent significant weight loss in patients with multiple nutrition impact symptoms. Early enteral feeding should be considered in this group of patients

Dalfampridine sustained-release for symptomatic improvement of walking speed in patients with multiple sclerosis

Dalfampridine sustained-release (SR) is a time-release formulation of 4-aminopyridine, recently approved by the Food and Drug Administration to improve walking in patients with multiple sclerosis (MS). In Phase II trials, walking speed and lower extremity muscle strength was increased in patients with MS, but the increase in walking speed did not reach statistical significance. A responder analysis revealed that approximately 35% of treated patients had a statistically significant and clinically meaningful increase in walking speed. When treated responders were compared with treated nonresponders, walking speed significantly increased in the responder group, but not in the nonresponder or placebo groups. This result was duplicated in two larger Phase III trials. The optimal dose to maximize the risk–benefit ratio was 10 mg twice daily. Higher doses were associated with a greater risk of seizure, but no further improvement in walking speed or in the proportion of responders. Dalfampridine SR is eliminated by renal clearance and undergoes only limited metabolism (<10%). It is contraindicated in patients with moderate or severe renal insufficiency and in those with a history of seizures or epileptiform activity on electroencephalography. The development of time-released 4-aminopyridine represents a major advance in symptomatic therapy for MS

The fast and forceful kicking strike of the secretary bird

The study of animal locomotion has uncovered principles that can be applied to bio-inspired robotics, prosthetics and rehabilitation medicine, while also providing insight into musculoskeletal form and function [1, 2, 3, 4]. In particular, study of extreme behaviors can reveal mechanical constraints and trade-offs that have influenced evolution of limb form and function [1, 2]. Secretary birds (Sagittarius serpentarius; Figure 1A) are large terrestrial birds of prey endemic to sub-Saharan Africa, which feed on snakes, lizards and small mammals [5]. They frequently kick and stamp on the prey’s head until it is killed or incapacitated, particularly when dispatching larger lizards and venomous snakes [5]. The consequences of a missed strike when hunting venomous snakes can be deadly [5], so the kicking strikes of secretary birds require fast yet accurate neural control. Delivery of fast, forceful and accurate foot strikes that are sufficient to stun and kill prey requires precision targeting, demanding a high level of coordination between the visual and neuromuscular systems

Absolute Reticulocyte Count Acts as a Surrogate for Fetal Hemoglobin in Infants and Children with Sickle Cell Anemia.

Hemoglobin switching is largely complete in humans by six months of age. Among infants with sickle cell anemia (HbSS, SCA), reticulocytosis begins early in life as fetal hemoglobin (HbF) is replaced by sickle hemoglobin (HbS). The objective of this study was to determine if absolute reticulocyte count (ARC) is related to HbF levels in a cohort of pediatric SCA patients. A convenience sample of 106 children with SCA between the ages of 1 month and 20 years who were not receiving hydroxyurea or monthly blood transfusions were enrolled in this observational study. Hematologic data, including ARC and HbF levels, were measured at steady state. F-cells were enumerated by flow cytometry. Initial studies compared infants with ARC greater than or equal to 200 K/μL (ARC ≥ 200) based upon the previously reported utility of this threshold as a predictive marker for SCA severity. Mean HbF and F-cell levels were significantly lower in the ARC ≥ 200 group when compared to the ARC \u3c 200 group. Both HbF and F-cell percentages were negatively correlated to ARC in infants and in children between the ages of 1 and 9 years. However, the inverse relationship was lost after the age of 10 years. Overall, decreased expression and distribution of HbF during childhood SCA is well-correlated with increased reticulocyte production and release into the peripheral blood. As such, these data further support the clinical use of reticulocyte enumeration as a disease severity biomarker for childhood sickle cell anemia

Fitting statistical distributions to sea duck count data: Implications for survey design and abundance estimation

Determining appropriate statistical distributions for modeling animal count data is important for accurate estimation of abundance, distribution, and trends. In the case of sea ducks along the U.S. Atlantic coast, managers want to estimate local and regional abundance to detect and track population declines, to define areas of high and low use, and to predict the impact of future habitat change on populations. In this paper, we used a modified marked point process to model survey data that recorded flock sizes of Common eiders, Long-tailed ducks, and Black, Surf, and White-winged scoters. The data come from an experimental aerial survey, conducted by the United States Fish & Wildlife Service (USFWS) Division of Migratory Bird Management, during which east-west transects were flown along the Atlantic Coast from Maine to Florida during the winters of 2009–2011. To model the number of flocks per transect (the points), we compared the fit of four statistical distributions (zero-inflated Poisson, zero-inflated geometric, zero-inflated negative binomial and negative binomial) to data on the number of species-specific sea duck flocks that were recorded for each transect flown. To model the flock sizes (the marks), we compared the fit of flock size data for each species to seven statistical distributions: positive Poisson, positive negative binomial, positive geometric, logarithmic, discretized lognormal, zeta and Yule–Simon. Akaike’s Information Criterion and Vuong’s closeness tests indicated that the negative binomial and discretized lognormal were the best distributions for all species for the points and marks, respectively. These findings have important implications for estimating sea duck abundances as the discretized lognormal is a more skewed distribution than the Poisson and negative binomial, which are frequently used to model avian counts; the lognormal is also less heavy-tailed than the power law distributions (e.g., zeta and Yule–Simon), which are becoming increasingly popular for group size modeling. Choosing appropriate statistical distributions for modeling flock size data is fundamental to accurately estimating population summaries, determining required survey effort, and assessing and propagating uncertainty through decision-making processes

Preliminary Analysis of Male and Female Size Differences of the Achilles Tendon in Active Aging Adults

Achilles tendinopathy impacts athletes of all ages. The Achilles tendon plays a key role in most athletic movements and is vital in the gait cycle. The prevalence of Achilles tendinopathy is associated with increasing age, which causes problems with gait and decreases quality of life. PURPOSE: We investigated factors associated with differences in Achilles size — cross sectional area (CSA) and thickness — in active maturing adults. METHODS: Participants were chosen from volunteers competing in the Huntsman World Senior Games in St. George, UT, October 2021. Participants rested prone on a treatment table with the ankle in a neutral position. A strap connected to the end of the table was placed around each foot to create a 90-degree angle at the ankle. Ultrasound (US) transmission gel was applied to the head of the probe to collect transverse and longitudinal images using a ML 6-15 Probe. The midportion of the Achilles tendon CSA was measured at the intersection of a line between the medial and lateral malleoli. The probe was then rotated 90 at this point to capture thickness measurements. Random selection of 20 males (age=68.050, weight=181.780 lbs., height=67.925 in., body fat=13.875%) and 20 females (age=63.391, weight=147.409 lbs., height=65.543 in., body fat=33.500%) were chosen from a larger data set and analyzed by a single researcher in this preliminary study. RESULTS: There was a significant difference between the CSA of males and females (p=0.046), with an average of 0.747 cm2 and 0.565 cm2 respectively. Achilles thickness also had a significant difference when comparing males and females (p=0.029), with an average of 0.601 cm and 0.491 cm respectively. Weight, body fat, and age were significant independent variables for both CSA and thickness. There was not a significant relationship between left and right Achilles tendons (p0.23). Large effect sizes (1.07 and 0.97) were found for CSA and thickness between groups indicative of a meaningful clinical difference. CONCLUSION: Males and females have a quantifiable size difference of the midportion of the Achilles tendon in an active older adult population. These values are important for interpreting images within this population and may also be important in determining pathologic tendons

Fiber optic sensors for gas turbine control

An apparatus for detecting flashback occurrences in a premixed combustor system having at least one fuel nozzle includes at least one photodetector and at least one fiber optic element coupled between the at least one photodetector and a test region of the combustor system wherein a respective flame of the fuel nozzle is not present under normal operating conditions. A signal processor monitors a signal of the photodetector. The fiber optic element can include at least one optical fiber positioned within a protective tube. The fiber optic element can include two fiber optic elements coupled to the test region. The optical fiber and the protective tube can have lengths sufficient to situate the photodetector outside of an engine compartment. A plurality of fuel nozzles and a plurality of fiber optic elements can be used with the fiber optic elements being coupled to respective fuel nozzles and either to the photodetector or, wherein a plurality of photodetectors are used, to respective ones of the plurality of photodetectors. The signal processor can include a digital signal processor

Fiber optic sensors for gas turbine control

An apparatus for detecting flashback occurrences in a premixed combustor system having at least one fuel nozzle includes at least one photodetector and at least one fiber optic element coupled between the at least one photodetector and a test region of the combustor system wherein a respective flame of the fuel nozzle is not present under normal operating conditions. A signal processor monitors a signal of the photodetector. The fiber optic element can include at least one optical fiber positioned within a protective tube. The fiber optic element can include two fiber optic elements coupled to the test region. The optical fiber and the protective tube can have lengths sufficient to situate the photodetector outside of an engine compartment. A plurality of fuel nozzles and a plurality of fiber optic elements can be used with the fiber optic elements being coupled to respective fuel nozzles and either to the photodetector or, wherein a plurality of photodetectors are used, to respective ones of the plurality of photodetectors. The signal processor can include a digital signal processor