Modulation of ATP/ADP Concentration at the Endothelial Cell Surface by Flow: Effect of Cell Topography

Determining how flow affects the concentration of the adenine nucleotides ATP and ADP at the vascular endothelial cell (EC) surface is essential for understanding flow-induced mobilization of intracellular calcium. Previously, mathematical models were formulated to describe the ATP/ADP concentration at the EC surface; however, all previous models assumed the endothelium to be flat. In the present study we investigate the effect of surface undulations on ATP/ADP concentration at the EC surface. The results demonstrate that under certain geometric and flow conditions, the ATP + ADP concentration at the EC surface is considerably lower for a wavy cell surface than for a flat surface. Because ECs in regions of disturbed arterial flow are expected to have larger undulations than cells in non-disturbed flow zones, our findings suggest that ECs in regions of flow disturbance would exhibit lower ATP + ADP concentrations at their surfaces, which may lead to impaired calcium signaling. If validated experimentally, the present results may contribute to our understanding of endothelial cell dysfunction observed in regions of disturbed flow

Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial

<p>Abstract</p> <p>Background</p> <p>Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group.</p> <p>Methods/Design</p> <p>A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m²) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months.</p> <p>Discussion</p> <p>Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness.</p> <p>Trial Registration</p> <p>Clinical Trials.gov NCT00902694</p