The Effects of Sex Hormones on Liver Regeneration after Liver Trauma in Animal Model

Background: The surgical management of liver injuries remains a great challenge for the traumatologists and general surgeons. We hypothesized that administration of 17 â-estradiol, a female sex hormone, improves hepatocellular healing after liver trauma.Methods: In an experimental model, 60 rats were divided into six subgroups: A (male control), B (male and estradiol), C (castrated male and estradiol), D (female control), F (female and estradiol), and G (oopherectomized female). After inducing liver trauma, estradiol subgroups received 3 doses of intravenous 17 â-estradiol (1 mg/kg) every 8 hours. 2 weeks post trauma, animals were sacrificed and hepatocellular regeneration was measured with the help of stereologic parameters of regeneration. Hepatocellular healing was compared between previous left lobe samples and the new post-traumatic right lobe samples.Results: Stereological parameters of rats receiving 17 b-estradiol after trauma was much better regarding mean angiogenesis point counting and volume density, compared with non-receiver groups after 2 weeks of trauma (P < 0.005). There was no significant difference for hepatocyte nucleus, hepatocyte point counting and volume density between estradiol receiver and non-receiver groups. In a comparison between subgroups, female sex had the same effect as giving estradiol. Oopherectomized female rats had more fibrogenesis but less angiogenesis (P < 0.005). Fibrogenesis was more in groups that were estradiol non-receiver (P < 0.005). In an explicit comparison of control females and males, estradiol infused males and females, and castrated male or oopherectomized female groups showed that stereological parameters of hepatocyte and hepatocyte nucleus were lower in female subgroups, but angiogenesis was better for female groups except for oopherectomized females.Conclusions: This study did support the administration of exogenic female hormone as an approach to augment the angiogenesis as a good index of regeneration for traumatic liver in rats

Utilization of base deficit and reliability of base deficit as a surrogate for serum lactate in the peri-operative setting

<p>Abstract</p> <p>Background</p> <p>Base deficit (BD) is commonly used in the operating room (OR) as an endpoint of resuscitation. BD is used as a surrogate marker for the accumulation of lactic acid(Lac). However, the BD can be affected by large amounts of saline.</p> <p>Methods</p> <p>We conducted a survey of anesthesiologists regarding the use of BD. We also studied the reliability of BD to determine the presence of hyperlactatemia (HL). Patients undergoing general anesthesia were eligible for enrollment if they were receiving an arterial line as part of their routine care. If an arterial blood gas was drawn by the operative team as part of the routine care, the remainder of the unused blood was also used to measure Lac.</p> <p>Results</p> <p><it>Survey</it>: 73 staff anesthesiologists were surveyed. Over 70% of respondents used BD as an endpoint of resuscitation.</p> <p><it>Base Deficit Study</it>: 35 patients were enrolled resulting in 88 arterial blood gases with corresponding Lac. Mean age was 61.4 ± 14.3 years, 43% were male. Mean pH was 7.39 ± 0.05, the mean bicarbonate was 23.0 ± 2.3 meq/L, the mean BD 1.34 ± 2.3, and the mean Lac was 1.58 ± 0.71 mmol/L. Mean ASA risk score was 3.16 ± 0.71. ROC area under the curve for base deficit to detect HL was 0.58.</p> <p>Conclusion</p> <p>BD can often mislead the clinician as to the actual Lac. Lac can now be measured in the OR in real time. Therefore, if clinicians in the operative setting want to know the Lac, it should be measured directly.</p

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Timing and Activation Intensity of Shoulder Muscles during Handball Penalty Throwing in Subjects with and without Shoulder Impingement

Introduction: Shoulder injuries are common among athletes in sports that involve overhead throwing of the ball such as handball. The objectives of this study were to evaluate the timing and activation intensity of shoulder muscles during handball penalty throwing in individuals with shoulder pain and in control subjects. Materials and Methods: Using BTS FREE EMG 300 system with bipolar surface electrodes, the timing (onset) and intensity of the activation of the shoulder muscles were measured including upper trapezius, anterior, middle and posterior deltoid, latissimus dorsi, pectoralis major, supraspinatus and triceps during penalty throwing. Multivariate analysis of variance (ANOVA) was used for between group comparisons with the significance level P< 0.05. Results: The activation intensity of upper trapezius and latissimus dorsi muscles in the healthy individuals were about 50.74% and 43.42% higher than in patients. Middle deltoid in healthy individuals was about 38.05% smaller than that in patients. In control group, supraspinatus muscle started earlier (23.5 ms) than the shoulder motion initiation. Triceps muscle was activated about 18.5 ms later than shoulder motion initiation. In patients, supraspinatus muscle started sooner (11 ms) and triceps brachialis muscle started later than the other muscles (22.16 ms). Conclusion: The coordination of shoulder muscles i.e. the onset and intensity of muscle activity is disturbed in the patient group during throwing. Hence, strength and stretching programs are recommended for athletes to reduce the risk of shoulder pain syndrome. The rehabilitation program can be focused on modifying the pattern of activity in upper trapezius, supraspinatus, latissimus dorsi and deltoid muscles in addition to pain control in the rehabilitation centers

Shoulder Muscles\' Function during Arm Flexion with and without Load in Patient\'s with Chronic Low Back Pain and Healthy Individuals

Objective: Shoulder muscle injuries are very prevalence. So determining of injuries mechanism could be a suitable way for identifying rehabilitation methods. The purpose of this study was to compare the electromygraphical activity of shoulder girdle muscles in lowback pain patients and healthy subjects during arm flexion with and without load. Methods: Tensubjects with chronic low back pain and ten age-matched control healthy subjects participated in this study. All participants were asked to perform arm flexion activities with and without load (with both dominant and nondominant sides) in a standing position. The outcome measures included electromygraphical activity of anterior and medial deltoid, infra and supra spinatus muscles for both groups. MANOVA and repeated measure statistical tests were used for between and within group comparisons. Alpha level was set at p˂0.05. Results:The intensity of muscle activity in anterior and medial deltoid, infra spinatus and supra spinatus muscles of dominant upper limb in healthy group were 26.3&plusmn;2.67, 17.01&plusmn;2.02, 11.1&plusmn;1.67, 12.40&plusmn;2.34 percent of maximum voluntary isometric cotraction, respectively. These values for patients group were 27.90&plusmn;3.78, 14.73&plusmn;3.14, 16.48&plusmn;2.37, and 18.19&plusmn;3.31, respectively. There were not any significant diffrences between groups (p˃0.05). Load effect in dominant upper limb for the groups accounted for 132% and 136% increase in the total muscular activity. Conclusion: Shoulder girdle muscle activity is similar in low back pain patients compred with the healthy subjects during arm flexion. It seems that low back pain didn't have any affect on shoulder muscular activiry; however, further studies are warranted

Experimental evaluation of mechanically stabilized earth walls with recycled crumb rubbers

Traditional techniques for treatment of waste rubber, such as burning, generate some highly non-degradable synthetic materials that cause unrepairable environmental damages by releasing heavy metals, such as arsenic, chromium, lead, manganese and nickel. For this, scrap tires are used as lightweight alternative materials in many engineering applications, such as retaining wall backfilling. In the present study, 90 laboratory models were prepared to evaluate the stability of mechanically stabilized earth (MSE) walls with plate anchors. Then, the bearing capacity and horizontal displacements of the retaining walls were monitored by exerting a static loading to investigate the effects of adding different contents (5 wt%, 10 wt%, 15 wt% and 20 wt%) of recycled crumb rubber (RCR) to the fill of a mechanically stabilized retaining wall with plate anchors. To visualize the critical slip surface of the wall, the particle image velocimetry (PIV) technique was employed. Results showed that the circular anchor plates almost continually provided a higher bearing capacity and wall stability than the square plates. Moreover, the backfill with 15 wt% RCR provided the maximum bearing capacity of the wall. Increasing the weight percentage of RCR to 20 wt% resulted in a significant reduction in horizontal displacement of the wall, which occurred due to the decrease in lateral earth pressure against the whole walls. An increase in RCR content resulted in the decrease in the formation of failure wedge and the expansion of the wall slip surface, and the failure wedge did not form in the sand mixtures with 15 wt% and 20 wt% RCRs. Keywords: Mechanically stabilized earth (MSE) wall, Plate anchor, Recycled crumb rubber (RCR), Particle image velocimetry (PIV