The Influence of Exercise Dose, Exercise Intensity, and Weight Loss and Change in C-Reactive Protein in Sedentary Overweight Women

Objective: To examine the effect physical activity included in a weight loss program has on high sensitivity C-reactive protein (hs-CRP) levels in sedentary overweight women. Design, Setting, and Participants: This study examined the change in hs-CRP in overweight and obese women in response to a 6 month behavioral weight loss program. The parent study was a randomized trial involving 201 sedentary overweight women who participated in a weight control program, with data from 182 subjects available for this secondary analysis. Methods: Participants were randomly assigned to 1 of 4 exercise groups based on energy expenditure (1000kcal/week or 2000 kcal/week) and intensity (vigorous vs. moderate). Groups included: vigorous intensity/high dose; vigorous intensity/moderate dose; moderate intensity/moderate dose; and moderate intensity/high dose. Participants were prescribed an energy restricted diet consisting of 1200 kcal/day or 1500 kcal/day and daily dietary fat intake between 20%-30% of total energy intake. Results: There were no statistically significant differences between dose of exercise, moderate vs. high, (F=0.330, p=0.58) or level of intensity, moderate vs. vigorous (F=0.118, p=0.731) for change in hs-CRP. However, there was a significant decrease in hs-CRP from baseline to 6 months (F=25.553, p<0.0004); there was a significant 3 way interaction between energy expenditure, intensity, and Pre/Post differences (F=4.035, p=0.035), post hoc analysis revealed a significant decrease in hs-CRP in the moderate/high (p<0.0004) and vigorous/moderate groups (p=004). The results were unchanged after controlling for the change in body weight, body fatness, or body distribution. The change in hs-CRP was not significantly correlated with the change in body weight, percent body fat, waist circumference, or self-reported physical activity. hs-CRP at 6 months was correlated with 6 month measures of weight, BMI, percent body fat, and fat distribution (p<0.0004). Conclusions: hs-CRP was reduced in overweight and obese women in response to a 6 month weight loss intervention that included a prescribed reduction in energy intake and a prescribed increase in exercise with a significant reduction in the moderate intensity/high dose and vigorous intensity/moderate dose groups. Further research is needed to determine what effect exercise and or weight loss may have on markers of inflammation

A glutamatergic biomarker panel enables differentiating Grade 4 gliomas/astrocytomas from brain metastases

BackgroundThe differentiation of high-grade glioma and brain tumors of an extracranial origin is eminent for the decision on subsequent treatment regimens. While in high-grade glioma, a surgical resection of the tumor mass is a fundamental part of current standard regimens, in brain metastasis, the burden of the primary tumor must be considered. However, without a cancer history, the differentiation remains challenging in the imaging. Hence, biopsies are common that may help to identify the tumor origin. An additional tool to support the differentiation may be of great help. For this purpose, we aimed to identify a biomarker panel based on the expression analysis of a small sample of tissue to support the pathological analysis of surgery resection specimens. Given that an aberrant glutamate signaling was identified to drive glioblastoma progression, we focused on glutamate receptors and key players of glutamate homeostasis.MethodsBased on surgically resected samples from 55 brain tumors, the expression of ionotropic and metabotropic glutamate receptors and key players of glutamate homeostasis were analyzed by RT-PCR. Subsequently, a receiver operating characteristic (ROC) analysis was performed to identify genes whose expression levels may be associated with either glioblastoma or brain metastasis.ResultsOut of a total of 29 glutamatergic genes analyzed, nine genes presented a significantly different expression level between high-grade gliomas and brain metastases. Of those, seven were identified as potential biomarker candidates including genes encoding for AMPA receptors GRIA1, GRIA2, kainate receptors GRIK1 and GRIK4, metabotropic receptor GRM3, transaminase BCAT1 and the glutamine synthetase (encoded by GLUL). Overall, the biomarker panel achieved an accuracy of 88% (95% CI: 87.1, 90.8) in predicting the tumor entity. Gene expression data, however, could not discriminate between patients with seizures from those without.ConclusionWe have identified a panel of seven genes whose expression may serve as a biomarker panel to discriminate glioblastomas and brain metastases at the molecular level. After further validation, our biomarker signatures could be of great use in the decision making on subsequent treatment regimens after diagnosis

PNEUMATIC ARTIFICIAL HEART DRIVER PARAMETER EFFECTS ON THE RATE OF PRESSURE CHANGE ((+) DP/DT MAX)

The aim of the research was to investigate the effects of three parameters of the artificial heart on the (+) dP/dt max. The study was conducted using a mock circulation which was connected to an artificial heart. The data were collected using the COMDU software developed for the computer which monitors the artificial heart. Stepwise regression analysis was utilized to test the three hypotheses. Two of the null hypotheses for the study could not be rejected, as the independent variable did not significantly affect (+) dP/dt max. Although the third hypothesis was accepted, the results were not clinically significant. Limitations in the study were multicollinearity among the independent variables, small sample size, and the inability of the mock circulation to represent human responses

Bayesian modeling to predict malignant hyperthermia susceptibility and pathogenicity of RYR1, CACNA1S and STAC3 variants

Aim: Identify variants in RYR1, CACNA1S and STAC3, and predict malignant hyperthermia (MH) pathogenicity using Bayesian statistics in individuals clinically treated as MH susceptible (MHS). Materials & methods: Whole exome sequencing including RYR1, CACNA1S and STAC3 performed on 64 subjects with: MHS; suspected MH event or first-degree relative; and MH negative. Variant pathogenicity was estimated using in silico analysis, allele frequency and prior data to calculate Bayesian posterior probabilities. Results: Bayesian statistics predicted CACNA1S variant p.Thr1009Lys and RYR1 variants p.Ser1728Phe and p.Leu4824Pro are likely pathogenic, and novel STAC3 variant p.Met187Thr has uncertain significance. Nearly a third of MHS subjects had only benign variants. Conclusion: Bayesian method provides new approach to predict MH pathogenicity of genetic variants

Efficacy of modified team‐based learning in a flipped classroom for an acute‐care nursing course: A mixed‐methods study

Abstract Aim To test a modified team‐based learning approach on undergraduate learning outcomes in an acute‐care nursing course in Japan. Design Mixed‐methods. Methods Students worked on three simulated cases, engaged in pre‐class preparation, completed a quiz and engaged in group work. We collected data on team approach, critical‐thinking disposition and time spent in self‐learning at four time‐points: before the intervention and after each simulated case. Data were analysed using a linear mixed model, a Kruskal–Wallis test and a content analysis. Data sources We recruited nursing students attending a mandatory course in acute‐care nursing at University A. Data were collected at four time‐points between April and July 2018. Data from 73 of 93 respondents were analysed. Results Team approach, critical thinking and self‐learning all increased significantly across the time‐points. Four categories emerged from students' comments: ‘achievement of teamwork’, ‘sense of learning efficacy’, ‘satisfaction with course approach’ and ‘issues related to course approach’. The modified team‐based learning approach led to improvements in team approach and critical‐thinking disposition across the course. Conclusion Incorporating team‐based learning into the curriculum not only contributes to team building but is also effective as a teaching method to improve student learning. Implications for the profession and/or patient care The intervention led to improvements in team approach and critical‐thinking disposition across the course. The educational intervention also led to more time for self‐learning. Future studies should include participants from various universities and evaluate the outcomes over a longer period