Skeletal muscle atrophy in sedentary Zucker obese rats is not caused by calpain-mediated muscle damage or lipid peroxidation induced by oxidative stress.

BACKGROUND: Skeletal muscle undergoes significant atrophy in Type 2 diabetic patients and animal models. We aimed to determine if atrophy of Zucker rat skeletal muscle was due to the activation of intracellular damage pathways induced by excess reactive oxygen species production (specifically those associated with the peroxidation of lipid membranes) and calpain activity. 14 week old obese Zucker rats and littermate lean controls were injected with 1% Evan’s Blue Dye. Animals were anaesthetised and extensor digitorum longus and soleus muscles were dissected, snap frozen and analysed for ROS-mediated F(2)-isoprostane production and calpain activation/autolysis. Contralateral muscles were histologically analysed for markers of muscle membrane permeability and atrophy. RESULTS: Muscle mass was lower in extensor digitorum longus and soleus of obese compared with lean animals, concomitant with reduced fibre area. Muscles from obese rats had a higher proportional area of Evan’s Blue Dye fluorescence, albeit this was localised to the interstitium/external sarcolemma. There were no differences in F(2)-isoprostane production when expressed relative to arachidonic acid content, which was lower in the obese EDL and soleus muscles. There were no differences in the activation of either μ-calpain or calpain-3. CONCLUSIONS: This study highlights that atrophy of Zucker rat skeletal muscle is not related to sarcolemmal damage, sustained hyperactivation of the calpain proteases or excessive lipid peroxidation. As such, establishing the correct pathways involved in atrophy is highly important so as to develop more specific treatment options that target the underlying cause. This study has eliminated two of the potential pathways theorised to be responsible

Establishment of an internationally agreed minimum data set for acute telestroke

Introduction: Globally, the use of telestroke programs for acute care are expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programs does not exist. This study aimed to establish a consensus-based, minimum data set for acute telestroke to enable the reliable comparison of programs, clinical management and patient outcomes. Methods: An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programs in different countries. An international expert panel of clinicians, researchers, and managers (n=20) from the Australasia Pacific region, United States of America, United Kingdom and Europe was convened. A modified-Delphi technique was used to achieve consensus via on-line questionnaires, teleconferences and via email. Results: Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: 1) Details about telestroke network/program (n=12), 2) Details about initiating hospital (n=10), 3) Telestroke consultation (n=17), 4) Patient characteristics (n=7), 5) Presentation to hospital (n=5), 6) General clinical care within first 24 hours (n=10), 7) Thrombolysis treatment (n=10), 8) Endovascular treatment (n=13), 9) Neurosurgery treatment (n=8), 10) Processes of care beyond 24 hours (n=7), 11) Discharge information (n=5), 12) Post-discharge and Follow-up data (n=6). Discussion: The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programs in different countries. Adoption is recommended for new and existing services

Cost-effectiveness of the Victorian Stroke Telemedicine program

Objective Stroke telemedicine improves the provision of reperfusion therapies in regional hospitals, yet evidence of its cost-effectiveness using patient-level data is lacking. The aim of this study was to estimate the cost per quality-adjusted life year (QALY) gained from stroke telemedicine. Methods As part of the Victorian Stroke Telemedicine (VST) program, stroke telemedicine provided to 16 hospitals in regional Victoria was evaluated using a historical-control design. Patient-level costs from a societal perspective (2018 Australian dollars (A$)) and QALYs up to 12 months after stroke were estimated using data from medical records, surveys at 3 months and 12 months after stroke and multiple imputation. Multivariable regression models and bootstrapping were used to estimate differences between periods. Results Costs and health outcomes were estimated from 1024 confirmed strokes suffered by patients arriving at hospital within 4.5 h of stroke onset (median age 76 years, 55$82 449 per person for the control period and A$82 259 in the intervention period (P = 0.986). QALYs at 12 months were estimated to be 0.43 per person for the control period and 0.5 per person in the intervention period (P = 0.02). Following 1000 iterations of bootstrapping, in comparison to the control period, the VST intervention was more effective and cost saving in 50.6$0 and A$50 000 per QALY gained) in 10.4% of iterations. Conclusion The VST program was likely to be cost saving or cost-effective. Our findings provide confidence in supporting wider implementation of telemedicine for acute stroke care in Australia.</jats:p