Adrenal insufficiency due to bilateral adrenal metastases - A systematic review and meta-analysis

Objective: Bilateral adrenal metastases may cause adrenal insufficiency (AI) but it is unclear if screening for AI in patients with bilateral adrenal metastases is justified, despite the potential for adrenal crises. Method: A search using PubMed/Medline, ScienceDirect and Cochrane Reviews was performed to collect all original research articles and all case reports from the past 50 years that describe AI in bilateral adrenal metastases. Results: Twenty studies were included with 6 original research articles, 13 case reports and one case series. The quality was generally poor. The prevalence of AI was 3–8%. Of all cases of AI (n ¼ 25) the mean pooled baseline cortisol was 318 237 nmol/L and stimulated 423 238 nmol/L. Hypotension was present in 69%, hyponatremia in 9% and hyperkalemia in 100%. Lung cancer was the cause in 35%, colorectal 20%, breast cancer 15% and lymphoma 10%. The size of the adrenal metastases was 5.5 2.8 cm (left) and 5.5 3.1 cm (right), respectively. There was no correlation between basal cortisol, stimulated cortisol concentration or ACTH with the size of adrenal metastases. The median time to death was 5.0 months (IQR 0.6–6.5). However, two cases were alive after 12–24 months. Conclusion: The prevalence of AI in patients with bilateral adrenal metastases was low. Prognosis was very poor. Due to the low prevalence of AI, screening is likely only indicated in patients with symptoms and signs suggestive of hypocortisolism

Estimating the influence of different urban canopy cover types on atmospheric particulate matter (PM10) pollution abatement in London UK

In the urban environment atmospheric pollution by PM10 (particulate matter with a diameter less than 10 x 10-6 m) is a problem that can have adverse effects on human health, particularly increasing rates of respiratory disease. The main contributors to atmospheric PM10 in the urban environment are road traffic, industry and powerproduction. The urban tree canopy is a receptor for removing PM10s from the atmosphere due to the large surface areas generated by leaves and air turbulence created by the structure of the urban forest. In this context urban greening has long been known as a mechanism to contribute towards PM10 removal from the air, furthermore, tree canopy cover has a role in contributing towards a more sustainable urban environment.The work reported here has been carried out within the BRIDGE project (SustainaBle uRban plannIng Decision support accountinG for urban mEtabolism). The aim of this project is to assess the fluxes of energy, water, carbon dioxide and particulates within the urban environment and develope a DSS (Decision Support System) to aid urban planners in sustainable development. A combination of published urban canopy cover data from ground, airborne and satellite based surveys was used. For each of the 33 London boroughs the urban canopy was classified to three groups, urban woodland, street trees and garden trees and each group quantified in terms of ground cover. The total [PM10] for each borough was taken from the LAEI (London Atmospheric Emissions Inventory 2006) and the contribution to reducing [PM10] was assessed for each canopy type. Deposition to the urban canopy was assessed using the UFORE (Urban Forest Effects Model) approach. Deposition to the canopy, boundary layer height and percentage reduction of the [PM10] in the atmosphere was assessed using both hourly meterological data and [PM10] and seasonal data derived from annual models. Results from hourly and annual data were compared with measured values. The model was then applied to future predictions of annual [PM10] and future canopy cover scenarios for London. The contribution of each canopy type subjected to the different atmospheric [PM10] of the 33 London boroughs now and in the future will be discussed. Implementing these findings into a decision support system (DSS) for sustainable urban planning will also be discussed<br/

A call for inclusive conservation

An age-old conflict around a seemingly simple question has resurfaced: why do we conserve nature? Contention around this issue has come and gone many times, but in the past several years we believe that it has reappeared as an increasingly acrimonious debate between, in essence, those who argue that nature should be protected for its own sake (intrinsic value)1, 2 and those who argue that we must also save nature to help ourselves (instrumental value)

Age-related skeletal muscle dysfunction is aggravated by obesity: An investigation of contractile function, implications and treatment

Obesity is a global epidemic and coupled with the unprecedented growth of the world’s older adult population, a growing number of individuals are both old and obese. Whilst both ageing and obesity are associated with an increased prevalence of chronic health conditions and a substantial economic burden, evidence suggests that the coincident effects exacerbate negative health out-comes. A significant contributor to such detrimental effects may be the reduction in the contractile performance of skeletal muscle, given that poor muscle function is related to chronic disease, poor quality of life and all-cause mortality. Whilst the effects of ageing and obesity independently on skeletal muscle function have been investigated, the combined effects are yet to be thoroughly explored. Given the importance of skeletal muscle to whole-body health and physical function, the present study sought to provide a review of the literature to: (1) summarise the effect of obesity on the age-induced reduction in skeletal muscle contractile function; (2) understand whether obesity effects on skeletal muscle are similar in young and old muscle; (3) consider the consequences of these changes to whole-body functional performance; (4) outline important future work along with the potential for targeted intervention strategies to mitigate potential detrimental effects

The impact of a high-fat diet in mice is dependent on duration and age, and differs between muscles.

Prolonged high-fat diets (HFD) can cause intramyocellular lipids (IMCL) accumulation that may negatively affect muscle function. We investigated the duration of a HFD required to instigate these changes, and whether effects are muscle-specific and aggravated in older age. Muscle morphology was determined in the soleus, extensor digitorum longus (EDL) and diaphragm muscles from female CD-1 mice divided into 5 groups: young fed a HFD for 8 weeks (YS-HFD, n=16), young fed a HFD for 16 weeks (YL-HFD, n=28) and young control (Y-CON, n=28). The young animals were 20 weeks old at the end of the experiment. Sixty 70-week-old female CD-1 mice received either a normal diet (O-CON, n=30) or a HFD for 9 weeks (OS-HFD, n=30). Body mass, body mass index and IMCL content increased in old OS-HFD (p≤0.003). In the young mice, this increase was seen in YL-HFD and not YS-HFD (p≤0.006). The soleus and diaphragm fibre cross-sectional area (FCSA) in YL-HFD was larger compared to Y-CON (p≤0.004) while old mice had a larger soleus FCSA compared to CON after only 9 weeks on a HFD (p<0.001). The FCSA of the EDL muscle did not differ significantly between groups. Oxidative capacity of fibres increased in young only, irrespective of HFD duration (p<0.001). High-fat diet-induced morphological changes occur earlier in the old animals when compared to young, and adaptations to HFD are muscle-specific with the EDL being least responsive

Morphological alterations of mouse skeletal muscles during early ageing are muscle specific

One of the hallmarks of ageing is muscle wasting that may be preceded by morphological changes, such as capillary rarefaction. Muscle-specific changes in morphology in early ageing may differ between locomotor and respiratory muscles. To investigate this, we compared capillarization, fiber type composition, fiber cross-sectional area (FCSA) and oxidative capacity of individual fibers of the soleus (n = 6/5 for 20- and 79 weeks, respectively), extensor digitorum longus (EDL: n = 3/3) and diaphragm (n = 7/5) muscles in 20- (mature) and 79-week-old (early ageing) CD-1 female mice. There was no significant loss of soleus and EDL mass. The FCSA was larger and the capillary density lower at 79 than 20 weeks in the diaphragm, while in the EDL the opposite was found (both p ≤ 0.002) with no significant ageing-related differences in the soleus. The heterogeneity in capillary spacing, which may negatively impact on muscle oxygenation, was highest in muscles from 20-week-old mice, irrespective of muscle (p ≤ 0.011). Succinate dehydrogenase activity, indicative of oxidative capacity, and capillary to fiber ratio did not significantly change with age in any muscle. At all ages, the capillary supply to a fiber was positively related to FCSA in each muscle. We conclude that despite previously reported early age-related reductions in specific tension in both locomotor and respiratory muscles, morphological changes show a muscle-specific pattern in early ageing CD-1 mice. Specifically, early ageing was associated with 1) diaphragm hypertrophy 2) and fiber atrophy in the EDL that was not accompanied by angiogenesis, capillary rarefaction or reductions in oxidative capacity

Cross-disciplinary evidence principles for social-environmental sustainability

Evidence-based approaches to sustainability challenges must draw on knowledge from the environment, development and health communities. To be practicable, this requires an approach to evidence that is broader and less hierarchical than the standards often applied within disciplines