Polyphenolic Fractions from Three Millet Types (Fonio,Finger millet,and Pearl millet): their Characterization and Biological Importance

BackgroundAs antioxidant-rich plant foods, cereals can impede lipid and starch breakdown in the human body, are germane to diabetes management.ObjectiveWe aim to identify newer sources of phytochemicals and health-promoting constituents desirable antidiabetic and antioxidant properties.MethodsThree millet types i.e. fonio (Digitaria exilis), finger millet (Eleusine coracana), and pearl millet (Pennisetum glaucum) available locally were investigated for antioxidant ability employing these assays i.e. DPPH, ABTS, H₂O₂, antidiabetic ability employing these assays i.e. α-amylase, α-glucosidase and inhibitory property on glycosylation formation. Preliminary characterization tools were employed i.e. UV-Visible spectroscopy (UV–visible) and Fourier-Transform Infrared Spectroscopy (FTIR) for the polyphenolic confirmation.ResultsThe absorbance intensity range 325–425 nm confirmed that polyphenolics are present in the three millet types; most of the biological results showed the activities are dose-dependent. Fonio millet extract revealed the highest activity against hemoglobin glycosylation (29.469 ± 0.399%) which compared favorably with the standard (acarbose) (29.354 ± 1.607%). Fonio millet extract also showed the best antioxidant activity (significantly higher% inhibition value = 47.909 ± 3.472) and the pearl millet revealed the least antioxidant activity (significantly lower% inhibition value = 44.910 ± 3.597) both at a concentration of 500 mg·ml^?1, though all the millet extracts showed activity towards this assay better than the standard (19.883 ± 2.485%). Fonio millet extract displayed a significantly higher percentage inhibition of α-amylase and glucosidase (43.729 ± 0.410% and 55.835 ± 2.198%) than finger millet (39.002 ± 1.604%; 43.971 ± 5.849%) and pearl millet (33.223 ± 2.708%; 30.845 ± 2.841%), respectively.ConclusionThe polyphenolic extracts from these millet types have therapeutic potentials, which may play significant roles in type 2 diabetes prevention and management, and hence these millets, especially fonio and finger millet, have the potential to be utilized as functional foods.     

Detraining period of the PILATES method on functional capacity of elderly women with type 2 diabetes: A randomized clinical trial

IntroductionThe aim of this study was to verify the effects of a 4-week detraining period on the functional capacity of elderly women with type-2 diabetes (T2D) after 12 weeks of a PILATES training program.MethodsTwenty-two individuals with T2D were randomly allocated into two groups: CONTROL (n = 11; 67.5 ± 6.3 years; 154.7 ± 6.1 cm; 73.5 ± 6.1 kg; calorie intake: 1487.5 ± 360.6 kcal/day) and PILATES (n = 11; 65.5 ± 5.5 years; 155.0 ± 4.5 cm; 66.2 ± 5.4 kg; calorie intake: 1289.3 ± 385.0 kcal/day). The PILATES group participated at a 12-week PILATES program at moderate intensity, 3x/week with each session lasting 60-min. The functional capacity was evaluated in the baseline (PRE), after 12-weeks (POST) and 4-week detraining period (4W_DT). The general index of functional capacity (GI_FC) was calculated for all participants.ResultsIn the PILATES group there was a reduction in performance (increased test time) for the GI_FC after 4W_DT in relation to POST (p < 0.05), however, GI_FC showing maintenance of performance gain in relation to the PRE (p > 0.05) (PRE: 36.0 ± 5.5 s vs. POST: 27.2 ± 4.0 s vs. 4W_DT: 29.0 ± 4.2 s). The CONTROL group had worse performance than the GI_FC POST (35.3 ± 4.6 s) and 4W_DT (35.4 ± 4.6 s) when compared to the PILATES group (F = 106.967; np2 = 0.842; p < 0.001).ConclusionA period of 4W_DT was not able to reduce the functional gains of elderly women with T2D after 12 weeks of PILATES training. These results have a practical application for training professionals, enabling better control and planning of training interruptions on the PILATES method for elderly women with T2D.     

Comparing two types of loading during inspiratory muscle training in patients with weaning difficulties: An exploratory study

BackgroundInspiratory muscle training improves respiratory muscle function and may improve weaning outcomes in patients with weaning difficulties. Compared to the commonly used pressure threshold loading, tapered flow resistive loading better accommodates pressure–volume relationships of the respiratory muscles, which might help to facilitate application of external loads and optimise training responses.ObjectiveThe objective of this study was to compare acute breathing pattern responses and perceived symptoms during an inspiratory muscle training session performed against identical external loading provided as pressure threshold loading or as tapered flow resistive loading. We hypothesised that for a given loading, tapered flow resistive loading would allow larger volume expansion and higher inspiratory flow responses and consequently higher external work of breathing and power than pressure threshold loading and that subsequently patients perceived fewer symptoms during tapered flow resistive loading than during pressure threshold loading.MethodsIn this exploratory study, 21 patients (maximal inspiratory pressure: 35 ± 14 cmH₂O and vital capacity:0.85 L±0.37 L) performed two training sessions against external loads equalling 42 ± 15% of maximal inspiratory pressure provided either as pressure threshold loading or as tapered flow resistive loading. During these training sessions, breath-by-breath data of breathing parameters were collected, and patients rated their perceived breathing effort, dyspnoea, and unpleasantness.ResultsCompared to pressure threshold loading, tapered flow resistive loading allowed significantly larger volume expansion (0.53 ± 0.28 L versus 0.41 ± 0.20 L, p < 0.01) and inspiratory flow responses (0.43 ± 0.20 L/s versus 0.33 ± 0.16 L/s, p = 0.01). Tapered flow resistive loading was perceived as less unpleasant (3.1 ± 1.9 versus 3.8 ± 2.4, p = 0.048). No significant differences in breathing effort, dyspnoea, work of breathing, and power were observed.ConclusionsFor a given loading, inspiratory muscle training with tapered flow resistive loading allowed larger volume expansion and higher inspiratory flow responses than pressure threshold loading, which led patients to perceive tapered flow resistive loading as less unpleasant. This might help us to facilitate early implementation of inspiratory muscle training in patients with weaning difficulties.Clinical trial registration numberClinicaltrials.gov identifier: NCT03240263     

Reduction of correlation dimension in human respiration by inhaling a mixture gas of 5% carbon dioxide and 95% oxygen

In order to investigate the effect of the respiratory control system on deterministic behavior in respiration, we used nonlinear analysis in subjects breathing a mixture gas of 5% carbon dioxide (CO₂) and 95% oxygen (O₂) (CO₂–mixed gas). The respiratory movements during breathing air or CO₂–mixed gas in eight healthy volunteers were measured. We estimated the values of the correlation dimension (D2) in respiratory movement using Grassberger–Procaccia algorithm. The respiratory movements during inhaling either air or CO₂–mixed gas showed a nonlinear behavior using surrogate data method. The values of D2 in respiratory movement during inhaling CO₂–mixed gas (1.77 ± 0.17) were significantly smaller than those during inhaling air (2.52 ± 0.60) (P < 0.05). This might be related to a prompt change in the nonlinear signal from the central respiratory chemical system.     

Echo-Tracking Technology Assessment of Carotid Artery Stiffness in Patients with Coronary Slow Flow

Coronary slow flow (CSF) in coronary angiography (CAG) is a well-recognized clinical entity. Previous studies have suggested that microvascular abnormalities and endothelial dysfunction are responsible for CSF. Accordingly, we hypothesized that the CSF phenomenon is a form of atherosclerosis including both small vessels and epicardial coronary arteries. The echo-tracking (ET) technique is a non-invasive detection method for early prediction of arterial atherosclerosis. Therefore, we investigated carotid elasticity with the ET technique in patients with CSF. Fifty patients with CSF and 50 patients with normal coronary artery blood flow, as determined by CAG, with a similar distribution of risk factors were recruited. The stiffness parameter (β), pressure–strain elastic modulus (E_p), arterial compliance (AC), augmentation index (AIx) and local pulse-wave velocity (PWV) were determined at the level of the bilateral common carotid artery (CCA) with using the ET technique. Levels of serum high-sensitivity C-reactive protein (hs-HSCRP) were determined for the two groups. β, E_p and PWV were significantly higher in the CSF group than in the control group (β: 11.4 ± 3.76 vs. 9.22 ± 3.28, p < 0.01; E_p: 153.44 ± 47.85 vs. 126.40 ± 43.32, p < 0.01; PWV: 7.26 ± 1.10 vs. 6.55 ± 1.02, p < 0.01), but AC was lower in the CSF group than in the control group (0.62 ± 0.20 vs. 0.74 ± 0.24, p < 0.01). The elasticity parameters of the bilateral common carotid artery did not significantly differ. The level of hs-HSCRP was correlated positively with β (r = 0.306, p = 0.015), E_p (r = 0.358, p = 0.005) and PWV (r = 0.306, p = 0.015), but negatively with AC (r = −0.236, p = 0.049). In conclusion, the ET technique is a simple practical method for evaluating carotid artery elasticity, and there is a significant correlation between carotid artery stiffness and level of hs-HSCRP in patients with CSF.     

Slow breathing for reducing stress: The effect of extending exhale

IntroductionSlow breathing techniques are commonly used to reduce stress. While it is believed by mind-body practitioners that extending the exhale time relative to inhale increases relaxation, this has not been demonstrated.MethodsWe conducted a 12-week randomized, single-blinded trial among 100 participants to compare if yoga-based slow breathing with an exhale greater inhale versus an exhale equals inhale produces measurable differences in physiological and psychological stress among healthy adults.ResultsParticipants mean individual instruction attendance was 10.7 ± 1.5 sessions out of 12 offered sessions. The mean weekly home practice was 4.8 ± 1.2 practices per week. There was no statistical difference between treatment groups for frequency of class attendance, home practice, or achieved slow breathing respiratory rate. Participants demonstrated fidelity to assigned breath ratios with home practice as measured by remote biometric assessments through smart garments (HEXOSKIN). Regular slow breathing practice for 12 weeks significantly reduced psychological stress as measured by PROMIS Anxiety (−4.85 S.D. ± 5.53, confidence interval [−5.60, −3.00], but not physiological stress as measured by heart rate variability. Group comparisons showed small effect size differences (d = 0.2) with further reductions in psychological stress and physiological stress from baseline to 12 weeks for exhale greater than inhale versus exhale equals inhale, however these differences were not statistically significant.ConclusionWhile slow breathing significantly reduces psychological stress, breath ratios do not have a significant differential effect on stress reduction among healthy adults.     

Motion characteristics of the lower lumbar spine in individuals with different pelvic incidence: An in vivo biomechanical study

BackgroundPelvic incidence is the quantification of the pelvis anatomical shape which has significant effect on the occurrence of various lumbar degenerative diseases. The aim of this study was to measure the in vivo dynamic motion characteristics of the lower lumbar spine in people with different pelvic incidence.MethodsA total of 55 volunteers were included in the study. The participants were devided into 3 groups (A: pelvic incidence≤40°, B: 40° < pelvic incidence <60° and C: pelvic incidence ≥60°). The L3–S1 vertebrae of each subject was MRI scanned to construct 3D models. The lumbar spine was then imaged using a dual fluoroscopic imaging system as the subject performed physiological position. The 3D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral positions along the motion path. The relative translations and rotations of each motion segment were analyzed.FindingsAt the L5-S1 segment, the primary ranges of motion for left-right axial rotation and flexion-extension of the patients with large pelvic incidence (3.28° ± 0.79°, 7.56° ± 1.81°) were significantly larger than normal pelvic incidence (2.61° ± 1.01°, 6.57° ± 2.18°) and small pelvic incidence (2.00° ± 0.60°, 5.83° ± 1.67°).InterpretationThe anatomic variable pelvic incidence is associated with the ranges of motion in lower lumbar vertebrae, especially in the L4–5 and L5-S1 segments.     

Effect of theophylline on ventilator-induced diaphragmatic dysfunction

PurposeTo evaluate the effect of theophylline in patients with ventilator-induced diaphragmatic dysfunction (VIDD).Materials and MethodsPatients who required mechanical ventilation at least 72 hours, met the criteria for a spontaneous breathing trial, and had evidence of VIDD by ultrasonography were included in the study.ResultsOf the 40 patients, 21 received theophylline and 19 did not. Clinical characteristics were similar in the 2 groups. Assessment of VIDD showed no between-group differences in baseline diaphragmatic excursion (DE) of both hemidiaphragms. Changes in DE from baseline to 72 hours (ΔDE) were significantly higher in the theophylline group than in the nontheophylline group in the right (3.5 ± 4.5 mm vs 0.4 ± 2.1 mm; P = .004) and left (3.2 ± 5.1 mm vs 0.1 ± 4.0 mm; P = .03) hemidiaphragms and in the total DE of both diaphragms (6.9 ± 9.1 mm vs 0.5 ± 5.7 mm; P = .02). In the theophylline group, theophylline was effective for the diaphragms with VIDD, whereas it was not effective for the diaphragms without VIDD. ΔDE in the right (r_s = − 0.49, P = .006) hemidiaphragm and total Δ DE in both diaphragms (r_s = − 0.46, P = .01) correlated negatively with weaning time.ConclusionsTheophylline significantly improved diaphragmatic movements in patients with VIDD. Our results warrant a larger study to determine whether theophylline use has benefits during weaning from mechanical ventilation.     

Wearing a N95 mask increases rescuer's fatigue and decreases chest compression quality in simulated cardiopulmonary resuscitation

ObjectivesN95 mask is essential for healthcare workers dealing with the coronavirus disease 2019 (COVID-19). However, N95 mask causes discomfort breathing with marked reduction in air exchange. This study was designed to investigate whether the use of N95 mask affects rescuer's fatigue and chest compression quality during cardiopulmonary resuscitation (CPR).MethodsAfter a brief review of CPR, each participant performed a 2-minute continuous chest compression on a manikin wearing N95 (N95 group, n = 40) or surgical mask (SM group, n = 40). Compression rate and depth, the proportions of correct compression rate, depth, complete chest recoil and hand position were documented. Participants' fatigue was assessed using Borg score.ResultsSignificantly lower mean chest compression rate and depth were both achieved in the N95 group than in the SM group (p < 0.05, respectively). In addition, the proportion of correct compression rate (61 ± 19 vs. 75 ± 195, p = 0.0067), depth (67 ± 16 vs. 90 ± 14, p < 0.0001) and complete recoil (91 ± 16 vs. 98 ± 5%, p = 0.0248) were significantly decreased in the N95 group as compared to the SM group. At the end of compression, the Borg score in the N95 group was significantly higher than that in the SM group (p = 0.027).ConclusionWearing a N95 mask increases rescuer's fatigue and decreases chest compression quality during CPR. Therefore, the exchange of rescuers during CPR should be more frequent than that recommended in current guidelines when N95 masks are applied.     

In vivo study assessed meropenem and amikacin combination therapy against carbapenem-resistant and carbapenemase-producing Enterobacteriaceae strains

BackgroundCarbapenem-resistant Enterobacteriaceae (CRE), especially for carbapenemase-producing Enterobacteriaceae (CPE), is an emerging cause that pose a significant threat to public health. However, efficient therapy has not been established. We assessed the antimicrobial efficacy of meropenem (MEPM) and amikacin (AMK) combination therapy.Material and methodsTotal eight isolates of Escherichia coli or Klebsiella pneumoniae, including CRE and/or CPE have carbapenemase genes were used. The relationship between phenotype and in vivo efficacy was assessed in neutropenic murine thigh infection model. Efficacy was determined using the change in bacterial density and survival rate.ResultsThe combination therapy showed enhanced antimicrobial activities against CRE+/CPE+ and CRE+/CPE-K. pneumoniae isolates than MEPM monotherapy (0.63 ± 0.04 vs. 2.56 ± 0.24 ⊿log₁₀ cfu/mL, p < 0.05; −1.05 ± 0.15 vs. −0.48 ± 0.30 ⊿log₁₀ cfu/mL, p < 0.05). Likewise, the combination therapy showed enhanced antimicrobial activities against CRE+/CPE+ and CRE+/CPE-E. coli isolates than MEPM monotherapy (0.90 ± 0.68 vs. 1.86 ± 0.23 ⊿log₁₀ cfu/mL, p < 0.05; −1.81 ± 0.06 vs. −0.88 ± 0.23 ⊿log₁₀ cfu/mL, p < 0.05). Also, combination therapy group showed similar to higher survival rates in CRE + E. coli infection mice, compared to MEPM monotherapy group.ConclusionOur results are the first supportive data to threat CRE infections with combination therapy of MEPM and AMK with in vivo model. The current results verify the promising utility of the combination therapy with MEPM and AMK against CRE isolates with a wide range of MEPM MICs.     

Pilates training reduces blood pressure in older women with type 2 diabetes: A randomized controlled trial

IntroductionThe study investigated the effect of 12 weeks of pilates training on the hemodynamic responses of older women with type-2 diabetes (T2D). Methods: 22 individuals with T2D were randomly allocated into two groups: CONTROL (n = 11; 67.5 ± 6.3 years; 154.7 ± 6.1 cm; 73.5 ± 6.1 kg; calorie intake: 1487.5 ± 360.6 kcal/day) and PILATES (n = 11; 65.5 ± 5.5 years; 155.0 ± 4.5 cm; 66.2 ± 5.4 kg; calorie intake: 1289.3 ± 385.0 kcal/day). The PILATES group executed a 12-week PILATES training program at moderate intensity, 3x/week with each session lasting 60-min. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and postprandial blood glucose were assessed at four timepoints: i) baseline; ii) 4th week; iii) 8th week; and iv) 12th week (s) of intervention. Two-way ANOVA for repeated measures and the Pearson's correlation coefficient were adopted. The alpha level was set at 0.05.ResultsA time1group interaction effect was found for SBP (F = 4.206; η² = 0.17; p = 0.02) and DBP (F = 2.624; η² = 0.12; p = 0.05) with significant reductions (mmHg) in the 4^ths and 8^ths in the PILATES (PILATES SBP baseline: 134.9 ± 27.6; 4^ths: 112.4 ± 15.7; 8^ths: 115.8 ± 18.3; 12^ths: 124.3 ± 19.1 vs. CONTROL SBP baseline: 126.5 ± 15.7; 4^ths: 126.3 ± 16.2; 8^ths: 124.5 ± 13.1; 12^ths: 126.3 ± 21.4 | PILATES DBP baseline: 72.9 ± 11.3; 4^ths: 65.1 ± 12.2; 8^ths: 65.8 ± 12.2; 12^ths: 67.6 ± 7.5 vs. CONTROL DBP baseline: 74.6 ± 12.0; 4^ths: 73.9 ± 11.5; 8^ths: 75.3 ± 11.9; 12^ths: 74.5 ± 9.2).ConclusionFour and eight weeks of PILATES training promotes reduction in the SBP and DBP of older women with T2D. The exercises performed in this study were mainly body weight exercises and required a few auxiliary materials, which turns this method of training accessible.     

Radiographic evaluation of acute distal radius fracture stability: A comparative cadaveric study between a thermo-formable bracing system and traditional fiberglass casting

BackgroundDistal radius fractures are common musculoskeletal injuries and many can be treated non-operatively with cast immobilization. A thermo-formable brace has been developed for management of such fractures, but no data exist regarding its comparative stabilizing efficacy to fiberglass casting.MethodsA worst-case distal radius fracture was created in 6 cadaveric forearms. A radiolucent loading fixture was created to apply cantilever bending/compression loads ranging from 4.5N to 66.7N across the simulated fracture in the: (1) non-stabilized, (2) braced; and (3) casted forearms, each forearm serving as its own control. Fracture fragment translations and rotations were measured radiographically using orthogonal radiographs and a 2D-3D, CT-based transformation methodology.FindingsUnder 4.5N of load in the non-stabilized condition, average sagittal plane rotation and 3D center of mass translation of the fracture fragment were 12.3° and 5.3 mm, respectively. At the 4.5N load step, fragment rotation with the brace (avg. 0.0°) and cast (0.1°) reduced sagittal plane rotation compared to the non-stabilized forearm (P < 0.001). There were no significant differences in measured sagittal plane fracture fragment rotations or 3D fragment translations between the brace or cast at any of the four load steps (4.5N, 22.2N, 44.5N, and 66.7N, P ≥ 0.138).InterpretationIn this in vitro radiographic study utilizing 6 cadaveric forearms with simulated severe-case, unstable and comminuted distal radius fractures, the thermo-formable brace stabilized the fracture in a manner that was not radiographically or biomechanically different from traditional fiberglass casting. Study results support the use of the thermo-formable brace clinically.     

Retrospective 4D MR image construction from free-breathing slice Acquisitions: A novel graph-based approach

PurposeDynamic or 4D imaging of the thorax has many applications. Both prospective and retrospective respiratory gating and tracking techniques have been developed for 4D imaging via CT and MRI. For pediatric imaging, due to radiation concerns, MRI becomes the de facto modality of choice. In thoracic insufficiency syndrome (TIS), patients often suffer from extreme malformations of the chest wall, diaphragm, and/or spine with inability of the thorax to support normal respiration or lung growth (Campbell et al., 2003, Campbell and Smith, 2007), as such patient cooperation needed by some of the gating and tracking techniques are difficult to realize without causing patient discomfort and interference with the breathing mechanism itself. Therefore (ventilator-supported) free-breathing MRI acquisition is currently the best choice for imaging these patients. This, however, raises a question of how to create a consistent 4D image from such acquisitions. This paper presents a novel graph-based technique for compiling the best 4D image volume representing the thorax over one respiratory cycle from slice images acquired during unencumbered natural tidal-breathing of pediatric TIS patients.MethodsIn our approach, for each coronal (or sagittal) slice position, images are acquired at a rate of about 200–300 ms/slice over several natural breathing cycles which yields over 2000 slices. A weighted graph is formed where each acquired slice constitutes a node and the weight of the arc between two nodes defines the degree of contiguity in space and time of the two slices. For each respiratory phase, an optimal 3D spatial image is constructed by finding the best path in the graph in the spatial direction. The set of all such 3D images for a given respiratory cycle constitutes a 4D image. Subsequently, the best 4D image among all such constructed images is found over all imaged respiratory cycles. Two types of evaluation studies are carried out to understand the behavior of this algorithm and in comparison to a method called Random Stacking – a 4D phantom study and 10 4D MRI acquisitions from TIS patients and normal subjects. The 4D phantom was constructed by 3D printing the pleural spaces of an adult thorax, which were segmented in a breath-held MRI acquisition.ResultsQualitative visual inspection via cine display of the slices in space and time and in 3D rendered form showed smooth variation for all data sets constructed by the proposed method. Quantitative evaluation was carried out to measure spatial and temporal contiguity of the slices via segmented pleural spaces. The optimal method showed smooth variation of the pleural space as compared to Random Stacking whose behavior was erratic. The volumes of the pleural spaces at the respiratory phase corresponding to end inspiration and end expiration were compared to volumes obtained from breath-hold acquisitions at roughly the same phase. The mean difference was found to be roughly 3%.ConclusionsThe proposed method is purely image-based and post-hoc and does not need breath holding or external surrogates or instruments to record respiratory motion or tidal volume. This is important and practically warranted for pediatric patients. The constructed 4D images portray spatial and temporal smoothness that should be expected in a consistent 4D volume. We believe that the method can be routinely used for thoracic 4D imaging.     

Changes in sub-calcaneal fat pad composition and their association with dynamic plantar foot pressure in people with diabetic neuropathy

BackgroundDiabetic foot disease is associated with physiological and biomechanical abnormalities in the foot that increase risk for ulceration. The objective was to assess MRI changes in the composition of sub-calcaneal fat pad tissue and its association with plantar pressure during walking.MethodsFourteen people with diabetes and peripheral neuropathy and five age-matched healthy controls underwent T1-weighted sagittal plane spin-echo Dixon MRI of the rearfoot. Dixon Chemical Shift Imaging was used to create fat-only and water-only images from which the fat signal fraction in a defined ROI of the sub-calcaneal fat pad was calculated. Barefoot plantar pressure distribution during walking was assessed and associated with fat pad outcomes.FindingsMean ± SD fat signal fraction was significantly lower in the neuropathic subjects than in the healthy controls (0.55 ± 0.11 vs. 0.72 ± 0.03, p < 0.005), and was explained by a lowering in fat signal (R² 0.87), more than an increase in water signal (R² 0.32). Mean ± SD peak pressure at the heel was 391 ± 119 kPa for the neuropathic subjects and 325 ± 53 kPa for the healthy controls (non-significantly different). Fat signal fraction and peak pressure were significantly inversely correlated (r = −0.59, p < 0.01).InterpretationDixon chemical shift MRI showed a reduced fat signal fraction in sub-calcaneal fat pad tissue in people with diabetic neuropathy. Both neuropathic and non-neuropathic factors may be attributed to this outcome. Fat pad function also seems to be compromised, as indicated by an associated increase in peak plantar pressures. This may increase risk for foot ulceration.     

Quantitative-analysis of computed tomography in COVID-19 and non COVID-19 ARDS patients: A case-control study

PurposeThe aim of this study was to assess whether the computed tomography (CT) features of COVID-19 (COVID+) ARDS differ from those of non-COVID-19 (COVID−) ARDS patients.Materials and methodsThe study is a single-center prospective observational study performed on adults with ARDS onset ≤72 h and a PaO₂/FiO₂ ≤ 200 mmHg. CT scans were acquired at PEEP set using a PEEP-FiO₂ table with VT adjusted to 6 ml/kg predicted body weight.Results22 patients were included, of whom 13 presented with COVID-19 ARDS. Lung weight was significantly higher in COVID− patients, but all COVID+ patients presented supranormal lung weight values. Noninflated lung tissue was significantly higher in COVID− patients (36 ± 14% vs. 26 ± 15% of total lung weight at end-expiration, p < 0.01). Tidal recruitment was significantly higher in COVID− patients (20 ± 12 vs. 9 ± 11% of VT, p < 0.05). Lung density histograms of 5 COVID+ patients with high elastance (type H) were similar to those of COVID− patients, while those of the 8 COVID+ patients with normal elastance (type L) displayed higher aerated lung fraction.     

Two reconstruction plates provide superior stability of displaced midshaft clavicle fractures in comparison to single plating – A biomechanical study

BackgroundDisplaced midshaft fractures are the most common surgically treated clavicle fractures. However, they are associated with high complication rates following plating due to fixation failure in terms of plate breakage, screw breakage and/or screw loosening. The aim of this study was to compare the biomechanical competence of three different plating techniques for fixation of displaced midshaft clavicle fractures.MethodsDisplaced midshaft fractures type 2B according to the Robinson classification were simulated by standardized osteotomy gap in 18 synthetic clavicles, assigned to three groups (n = 6) for plating with either superiorly placed Dynamic Compression Plate (width/thickness 11.0/4.0 mm), locked Superior Anterior Clavicle Locking Compression Plate (width/thickness 10.2/2.0 mm), or two non-locked Reconstruction Plates placed superiorly and anteriorly (width/thickness 10.0/2.8 mm). Each specimen was cyclically tested at 3 Hz under craniocaudal cantilever bending, superimposed with torsion around the shaft axis over 720′000 cycles or until failure occurred. The latter was defined by plate breakage, screw breakage or screw loosening.FindingsInitial construct stiffness (N/mm) and cycles to failure in group Reconstruction Plates (22.30 ± 4.07; 712′778 ± 17′691) were significantly higher compared with both groups Compression Plate (12.53 ± 2.09; 348′541 ± 212′941) and Locking Plate (4.19 ± 0.46; 19′536 ± 3′586), p ≤ 0.019. In addition, these two outcomes were significantly higher in group Compression Plate versus Locking Plate, p ≤ 0.029.InterpretationDouble plating of unstable midshaft clavicle fractures with reconstruction plates seems to provide superior fixation stability under dynamic loading, when compared to single compression or locked plating, whereas the latter is associated with inferior performance.     

A ventilation technique for oxygenation and carbon dioxide elimination in CPR: Continuous insufflation of oxygen at three levels of pressure in a pig model

AimPulmonary ventilation remains an important part of cardiopulmonary resuscitation, affecting gas exchange and haemodynamics. We designed and studied an improved method of ventilation for CPR, constructed specifically to support both gas exchange and haemodynamics. This method uses continuous insufflation of oxygen at three levels of pressure, resulting in tri-level pressure ventilation (TLPV). We hypothesized that TLPV improves gas exchange and haemodynamics compared to manual gold standard ventilation (GSV).MethodsIn 14 pigs, ventricular fibrillation was induced and automated CPR performed for 10 min with either TLPV or GSV. After defibrillation, CPR was repeated with the other ventilation method. Gas exchange and haemodynamics were monitored. Data are presented as mean ± standard error of the mean.ResultsTLPV was superior to GSV for PaO₂ (163 ± 36 mmHg difference; P = 0.001), and peak AWP (−20 ± 2 cmH₂O difference; P = 0.000) and higher for mean AWP (8 ± 0.2 cmH₂O difference; P = 0.000). TLPV was comparable to GSV for CPP (5 ± 3 mmHg difference; P = 0.012), VCO₂ (0.07 ± 0.3 mL/min/kg difference; P = 0.001), SvO₂ (4 ± 3%-point; P = 0.001), mean carotid flow (−0.5 ± 4 mL/min difference; P = 0.016), and pH_a (0.00 ± 0.03 difference; P = 0.002). The PaCO₂ data do not provide a conclusive result (4 ± 4 mmHg difference).ConclusionWe conclude that the ventilation strategy with a tri-level pressure cycle performs comparable to an expert, manual ventilator in an automated-CPR swine model.     

Mechanical determinants of early acute ventilatory failure in COPD patients: a physiologic study

Objective  The purpose of this study is to investigate the respiratory mechanics, breathing pattern, and pressure-generating capacity of respiratory muscles during the early phases of an acute exacerbation of COPD. Design  Prospective study. Setting  Division of Emergency Critical Care and Chronic Ventilator Unit. Patients  A total of 24 COPD patients: nine patients requiring ventilatory support because of acute respiratory acidosis due to COPD exacerbation (NPPV group, pH 7.28 ± 0.02); seven patients successfully managed with medical therapy only (SB group, pH 7.39 ± 0.04); eight clinically stable, long term mechanically ventilated, COPD patients (IPPV group). Measurements  Respiratory mechanics during a period of unsupported breathing. Results  A rapid shallow breathing, in the presence of a high drive to breath and a high diaphragmatic tension-time index (TT_di), was found in NPPV and IPPV groups compared to the SB group (f/V _T ratio: 118 ± 43 and 137 ± 65, respectively, versus 37 ± 12 breaths/min/L; P _0.1: 5.0 ± 1.0 and 5.4 ± 1.4, respectively, versus 2.2 ± 0.2 cmH₂O, TT_di: 0.168 ± 0.035 and 0.161 ± 0.039, respectively, versus 0.057 ± 0.033); at variance, PEEPi_dyn was greater in IPPV compared to the other two groups. A significant relationship was observed between TT_di ratio and f/V _T (Rho 0.756). Conclusion  During the early phases of an acute exacerbation, patients with COPD and acute respiratory failure had an imbalance between the decreased capacity of the respiratory muscles to generate pressure and the increased respiratory load. This imbalance was similar to that recorded in patients with COPD and chronic ventilatory failure. In both groups, the imbalance was associated with rapid shallow breathing. Among the mechanical constraints to ventilation, only PEEPi,dyn was different between acute and chronic patients with ventilatory failure. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Ligament deformation patterns of the craniocervical junction during head axial rotation tracked by biplane fluoroscopes

BackgroundFrequently, treatment decisions for craniocervical injuries and instability are based on imaging findings, but in vivo ligament kinematics were poorly understood. This study was to determine in vivo deformation patterns of primary ligaments in the craniocervical junction (i.e., C0–2), including the cruciform ligament, alar ligaments, and accessory ligaments, during dynamic head axial rotation.MethodsThe skulls and cervical spines of eight asymptomatic female subjects were dynamically imaged using a biplane fluoroscopic imaging system, when they performed left and right head axial rotations. Using a 3D-to-2D registration technique, the in vivo positions and orientations of cervical segments were determined. An optimization algorithm was implemented to determine ligament wrapping paths, and the resulting ligament deformations were represented by percent elongations. Using paired t-tests, ligament deformations in the end-range position were compared to those in the neutral position.FindingsNo significant differences were observed in segmental motions during left and right head rotations (p > 0.05). In general, slight deformations occurred in each component of the cruciform ligament. For the alar ligaments, the ipsilateral ligament was lengthened from −0.7 ± 13.8% to 16.6 ± 15.7% (p < 0.001*). For the accessory ligaments, the contralateral ligament was lengthened from −2.9 ± 7.5% to 10.1 ± 6.2% (p < 0.001*).InterpretationThis study reveals that there are distinct deformation patterns in craniocervical junction ligaments during dynamic axial head rotation. These ligament deformation data can enhance our understanding of the synergic function of craniocervical junction ligaments, and guide the treatment of craniocervical instability.     

MR动态增强扫描评估髋部骨髓血流灌注的初步研究

目的 观察FLASH序列T1WI动态增强扫描(DCE-MER)髋部不同部位骨髓时间--信号强度曲线(TIC),分析其血流动力学特点及生理学意义.方法 20例志愿者行髋部FLASH序列DCE-T1WI扫描,以双侧髋臼、干骺端及股骨头为研究对象,分别选择感兴趣IK(ROI),绘制百分比TIC.读取TIC首次峰值(fEmax)、最高信号强度(Emax),比较不同部位ROI各参数值的差异,分析其微循环血流灌注的特点.结果 人体髋臼、干骺端及股骨头fEmax分别是(19.09±3.23、9.50±1.48、4.66±0.68)、Emax值分别是(25.30±3.64,19.27±1.38、10.31±1.20),三部位fEmax、Emax值差异均具有统计学意义(F值分别是283.96、235.96,P值均小于0.05).结论 FLASH序列DCE-TIWI可同时评估富血供红骨髓及乏血供黄骨髓微循环的血流灌注.股骨头低血流灌注可能是发生骨坏死的生理学易患因素之一.