50 Remarkable & Wise Quotes About Patience

Who hasn't heard the saying "Have patience, my friend, have patience; For Rome wasn't built in a day!"?

Nevertheless, this is not the only wise saying about patience. We have actually even omitted this in our quotes collection as there are so many others, even more significant and noteworthy words about patience.

Image: Elena Schaelike (Wisejam)

This collection contains 50 of the best wise sayings and quotes on patience, arranged by birth year of the author. Enjoy!

Wise to resolve,
and patient to perform.
Homer
(7th or 8th century BC,
greatest of ancient Greek epic poets)

Patience is bitter,
but its fruit is sweet.
Aristotle
(384 – 322 BC, Greek philosopher and scientist)

Patience is the best remedy
for every trouble.
Plautus
(c. 254 – 184 BC, Roman playwright of the Old Latin period)

It is easier to find men
who will volunteer to die,
than to find those
who are willing to endure pain with patience.
Gaius Julius Caesar
(100 BC – 44 BC, Roman statesman, general
and notable author of Latin prose)

Bear patiently with a rival.
Publius Ovidius Naso,
known as Ovid
(43 BC – AD 17/18, Roman poet)

Everyone ought to bear patiently
the results of his own conduct.
Phaedrus
(first century Roman fabulist,
Latin author and versifier of Aesop's fables)

Patience is the companion of wisdom.
Augustine of Hippo,
also known as Saint Augustine or Saint Austin
(354 – 430, Algerian Christian theologian and philosopher)

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NSC 2015 Dispatch: APTA President Sharon Dunn

APTA President Sharon Dunn, PT, PhD, OCS, reflects on her experience engaging with PT and PTA students at #APTANSC.

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A "Patient-Like" Orthotopic Syngeneic Mouse Model of Hepatocellular Carcinoma Metastasis

The metastatic spread of cancer is the major cause of cancer-related deaths. We provide an in-depth description of our survival surgery methodology for establishing a "patient-like" orthotopic syngeneic mouse model system for studying the mechanisms of metastasis in solid organ tumors.

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From the outgoing editor in chief

Publication date: Available online 23 October 2015
Source:Journal of Electromyography and Kinesiology
Author(s): Moshe Solomonow




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Hip joint motion and gluteal muscle activation differences between healthy controls and those with varying degrees of hip osteoarthritis during walking

Publication date: Available online 23 October 2015
Source:Journal of Electromyography and Kinesiology
Author(s): Derek Rutherford, Janice Moreside, Ivan Wong
PurposeCompare gluteal muscle activation patterns and three-dimensional hip joint movements among those with severe hip osteoarthritis (OA), moderate OA and a healthy group during walking.Scope: 20 individuals with severe OA, 20 with moderate OA and 20 healthy individuals were recruited. Three-dimensional hip motion and surface electromyograms from gluteus maximus and medius were collected during treadmill walking at a self-selected speed. Angular displacement characteristics were calculated for three-dimensional hip motions. Principal component analysis extracted amplitude and temporal features from electromyographic waveforms. Analysis of Variance models and student t-tests using Bonferroni corrections determined between group differences in these gait features (α=0.05).ConclusionsSagittal plane hip range of motion was significantly reduced with increasing severity of OA (p<0.05) where as frontal and transverse plane range of motion was reduced in the severe OA group only (p<0.05). Activation patterns of gluteus medius and maximus did not differ between the healthy group and those with moderate hip OA (p>0.05). Individuals with severe OA walking with more prolonged gluteus maximus activation and prolonged and less dynamic gluteus medius activation compared to the other two groups (p<0.05). This study highlights the changing function of the hip joint during walking with increasing hip OA severity.



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Back muscle fatigue of younger and older adults with and without chronic low back pain using two protocols: A case-control study

Publication date: Available online 23 October 2015
Source:Journal of Electromyography and Kinesiology
Author(s): Rubens A. da Silva, Edgar R. Vieira, Marcos Cabrera, Leandro R. Altimari, Andreo F. Aguiar, Alexandre H. Nowotny, Adriana F. Carvalho, Marcio R. Oliveira
The purpose of this study was to compare back muscle fatigue of younger and older participants with and without chronic low back pain (CLBP). Twenty participants without and 20 with nonspecific CLBP participated in this study. Each group contained 10 younger (50% males; mean age: 31±6 yrs) and 10 older adults (50% males; age mean: 71±7.5 yrs). Two isometric fatigue protocols were presented randomly: (1) to maintain the unsupported trunk at the horizontal position while on a 45° Roman chair for a minute, and (2) to maintain a 10% of body weight box close to the trunk in the upright position for a minute. Surface electromyography (EMG) signals from the back (multifidus and iliocostalis) and one hip (biceps femoris) muscles were recorded bilaterally, and the median frequency fatigue estimate from linear regression slopes of the EMG time-series was computed. There were no significant (P > 0.05) age effects, and group-by-age interaction in both isometric and functional fatigue tasks. However, the CLBP groups (both younger and old) displayed more back fatigue than people without CLBP in both fatigue protocols (P < 0.01; effect size varying of d = 0.17 to 0.32). This study was sensitive to discriminate that individuals with CLBP did present significantly more pronounced EMG back fatigue than people without CLBP, in both younger and older adults. These results have significant clinical implications for low back pain rehabilitation programs with regard to endurance assessment in both younger and older.



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Neuromuscular and physiological variables evolve independently when running immediately after cycling

Publication date: Available online 23 October 2015
Source:Journal of Electromyography and Kinesiology
Author(s): Joel A. Walsh, Alexander Stamenkovic, Romuald Lepers, Gregory Peoples, Paul J. Stapley
During the early period of running after cycling, EMG patterns of the leg are modified in only some highly trained triathletes. The majority of studies have analysed muscle EMG patterns at arbitrary, predetermined time points. The purpose of this study was to examine changes to EMG patterns of the lower limb at physiologically determined times during the cycle-run transition period to better investigate neuromuscular adaptations. Six highly trained triathletes completed a 10 min isolated run (IR), 30 min of rest, then a 20 min cycling procedure, before a 10 min transition run (C-R). Surface EMG activity of eight lower limb muscles was recorded, normalised and quantified at four time points. Oxygen uptake and heart rate values were also collected. Across all muscles, mean (±SD) EMG patterns, demonstrated significant levels of reproducibility for each participant at all four time points (α < 0.05; r = 0.52 - 0.97). Mean EMG patterns during C-R correlated highly with the IR patterns (α < 0.05). These results show that EMG patterns during subsequent running are not significantly affected by prior cycling. However, variability of muscle recruitment activity does appear to increase during C-R transition when compared to IR.



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Dynamic balance in elite karateka

Publication date: Available online 21 October 2015
Source:Journal of Electromyography and Kinesiology
Author(s): Matteo Zago, Andrea Mapelli, Yuri Francesca Shirai, Daniela Ciprandi, Nicola Lovecchio, Christel Galvani, Chiarella Sforza
In karate, balance control represents a key performance determinant. With the hypothesis that high-level athletes display advanced balance abilities, the purpose of the current study was to quantitatively investigate the motor strategies adopted by elite and non-elite karateka to maintain balance control in competition. The execution of traditional karate techniques (kihon) in two groups of elite Masters (n=6, 31±19years) and non-elite Practitioners (n=4, 25±9years) was compared assessing body center of mass (CoM) kinematics and other relevant parameters like step width and angular joint behavior.In the considered kihon sequence, normalized average CoM height was 8% lower (p<0.05), while CoM displacement in the horizontal direction was significantly higher in Masters than in Practitioners (2.5 vs. 1.9m, p<0.05), as well as CoM average velocity and rms acceleration (p<0.05). Step width was higher in Masters in more than half of the sequence steps (p<0.05).Results suggest that elite karateka showed a refined dynamic balance control, obtained through the increase of the base of support and different maneuvers of lower limbs. The proposed method could be used to objectively detect talented karateka, to measure proficiency level and to assess training effectiveness.



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Electromechanical delay of the hamstrings during eccentric muscle actions in males and females: Implications for non-contact ACL injuries

Publication date: Available online 23 October 2015
Source:Journal of Electromyography and Kinesiology
Author(s): Mark B.A. De Ste Croix, Youssif O. ElNagar, John Iga, David James, Francisco Ayala
Sex differences in neuromuscular functioning has been proposed as one of the factors behind an increased relative risk of non-contact anterior cruciate ligament (ACL) injury in females. The aim of this study was to explore sex differences in electromechanical delay (EMD) of the hamstring muscles during eccentric muscle actions and during a range of movement velocities. This study recruited 110 participants (55 males, 55 females) and electromyography of the semitendionosis, semimembranosus and biceps femoris was determined during eccentric actions at 60, 120 and 240°/s. No significant sex differences were observed irrespective of muscle examined or movement velocity. Irrespective of sex EMD significantly increased with increasing movement velocity (P < 0.01). There was no significant difference in the EMD of the 3 muscles examined. Our findings suggest that during eccentric actions of the hamstrings that there are no sex differences, irrespective of movement velocity. This would suggest that other factors are probably responsible for the increased relative risk of non-contact ACL injury in females compared to males.



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Pain intensity attenuates movement control of the lumbar spine in low back pain

Publication date: Available online 19 October 2015
Source:Journal of Electromyography and Kinesiology
Author(s): C.M. Bauer, F.M. Rast, M.J. Ernst, S. Oetiker, A. Meichtry, J. Kool, S.M. Rissanen, J.H. Suni, M. Kankaanpää
IntroductionPain intensity attenuates muscular activity, proprioception, and tactile acuity, with consequent changes of joint kinematics. People suffering from low back pain (LBP) frequently show movement control impairments of the lumbar spine in sagittal plane. This cross-sectional, observational study investigated if the intensity of LBP attenuates lumbar movement control. The hypothesis was that lumbar movement control becomes more limited with increased pain intensity.MethodsThe effect of LBP intensity, measured with a numeric rating scale (NRS), on lumbar movement control was tested using three movement control tests. The lumbar range of motion (ROM), the ratio of lumbar and hip ROM as indicators of direction specific movement control, and the recurrence and determinism of repetitive lumbar movement patterns were assessed in ninety-four persons suffering from LBP of different intensity and measured with an inertial measurement unit system. Generalized linear models were fitted for each outcome.ResultsLumbar ROM (+0.03°, p=0.24) and ratio of lumbar and hip ROM (0.01, p=0.84) were unaffected by LBP intensity. Each one point increase on the NRS resulted in a decrease of recurrence and determinism of lumbar movement patterns (-3.11 to -0.06, p⩽0.05).DiscussionOur results indicate changes in movement control in people suffering from LBP. Whether decreased recurrence and determinism of lumbar movement patterns are intensifiers of LBP intensity or a consequence thereof should be addressed in a future prospective study.



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Effect of interelectrode distance on surface electromyographic signals of vastus intermedius muscle in women and men

Publication date: Available online 13 October 2015
Source:Journal of Electromyography and Kinesiology
Author(s): Aya Tomita, Ryosuke Ando, Akira Saito, Kohei Watanabe, Hiroshi Akima
We previously developed a novel technique to record surface electromyography (EMG) of the vastus intermedius (VI) in men. The purpose of the present study was to assess whether this technique can be applied to women in the same way. We measured the subcutaneous fat thickness at the site of electrode placement on VI using ultrasonography. Nine men and ten women performed isometric knee extensions at 25%, 50%, 75%, and 100% of the maximal voluntary contraction. During the tasks, surface EMG signals were recorded from the superficial region of VI with interelectrode distances (IEDs) of 10mm (IED-10) and 20mm (IED-20). The subcutaneous fat thickness in women was significantly greater than in men (women: 8.7±2.1mm; men: 5.6±1.6mm, p<0.01). However, the amplitude and frequency of the EMG signal of VI at the different force levels were not affected by IEDs in either sex. These results suggest that surface EMG recording of VI with both IED-10 and IED-20 would be applicable to relatively lean women with a similar sensitivity to that in men.



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Synthesis and activities of new indolopyrrolobenzodiazepine derivatives toward Acute Myeloid Leukemia cells

Publication date: Available online 24 October 2015
Source:Bioorganic & Medicinal Chemistry
Author(s): Francis Giraud, Marion Bourhis, Edris Ebrahimi, Lars Herfindal, Romy Roy Choudhury, Ronja Bjørnstad, Stein Ove Døskeland, Fabrice Anizon, Pascale Moreau
The synthesis of new indolopyrrolobenzodiazepine derivatives is described. Six compounds were selected for evaluation of cytotoxicity towards acute myeloid leukemia (AML) cells and normal fibroblasts. One compound (29) showed selective AML cell death induction. Its action was only partly overcome by knock-down of p53 or Bcl-2 overexpression, suggesting a strong activation of intrinsic apoptotic pathways.

Graphical abstract

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Novel derivatives of nitro-substituted salicylic acids: Synthesis, antimicrobial activity and cytotoxicity

Publication date: Available online 24 October 2015
Source:Bioorganic & Medicinal Chemistry
Author(s): Georgios Paraskevopoulos, Martin Krátký, Jana Mandíková, František Trejtnar, Jiřina Stolaříková, Petr Pávek, Gurdyal Besra, Jarmila Vinšová
Inspired by the high antituberculous activity of novel nitro-substituted derivatives and based on promising predicted ADMET properties we have synthesized a series of 33 salicylanilides containing nitro-group in their salicylic part and evaluated them for their in vitro antimycobacterial, antimicrobial and antifungal activities. The presence of nitro-group in position 4 of the salicylic acid was found to be beneficial and the resulting molecules exhibited minimum inhibitory concentrations (MICs) ranging from 2 to 32 μM against Mycobacterium tuberculosis. The best activity was found for 2-hydroxy-4-nitro-N-[4-(trifluoromethyl)phenyl]benzamide (MIC = 2 μM). 4-Nitrosalicylanilides were also found to be active against all Staphylococcus species tested while for MRSA strain 2-hydroxy-4-nitro-N-[4-(trifluoromethyl)phenyl]benzamide's MIC was 0.98 μM. None of the nitrosalicylanilides was active against Enterococcus sp. J 14365/08 and no considerable activity was found against Gram-negative bacteria or fungi. The hepatotoxicity of all nitrosalicylanilides was found to be in the range of their MICs for HepG2 cells.

Graphical abstract

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Design, synthesis and preliminary bioactivity studies of imidazolidine-2,4-dione derivatives as Bcl-2 inhibitors

Publication date: Available online 23 October 2015
Source:Bioorganic & Medicinal Chemistry
Author(s): Gang Wang, Yutao Wang, Lei Wang, Leiqiang Han, Xuben Hou, Huansheng Fu, Hao Fang
Anti-apoptotic B-cell lymphoma-2 (Bcl-2) proteins are promising targets for cancer therapy. In the present study, a series of imidazolidine-2,4-dione derivatives were designed and synthesized to test their inhibitory activities against anti-apoptotic Bcl-2 proteins. Among them, compound 8k had better growth inhibitory effects on K562 and PC-3 cell lines compared to lead compound WL-276.

Graphical abstract

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Carbonic anhydrase inhibitors: design, synthesis, kinetic, docking and molecular dynamics analysis of novel glycine and phenylalanine sulphonamide derivatives

Publication date: Available online 23 October 2015
Source:Bioorganic & Medicinal Chemistry
Author(s): İsmail Fidan, Ramin Ekhteiari Salmas, Mehmet Arslan, Murat Şentürk, Serdar Durdagi, Deniz Ekinci, Esra Şentürk, Sedat Coşgun, Claudiu T. Supuran
The inhibition of two human cytosolic carbonic anhydrase isozymes I and II, with some novel glycine and phenylalanine sulphonamide derivatives were investigated. Newly synthesized compounds G 1-4 and P 1-4 showed effective inhibition profiles with KI values in the range of 14.66 – 315 μM for hCA I and of 18.31 – 143.8 μM against hCA II, respectively. In order to investigate the binding mechanisms of these inhibitors, in silico docking studies were applied. Atomistic Molecular Dynamic simulations were performed for docking poses which utilize to illustrate the inhibition mechanism of used inhibitors into active site of CAII. These sulfonamide containing compounds generally were competitive inhibitors with 4-nitrophenylacetate as substrate. Some investigated compounds here showed effective hCA II inhibitory effects, in the same range as the clinically used sulfonamide, sulfanilamide or mafenide and might be used as leads for generating enzyme inhibitors possibly targeting other CA isoforms which have not been yet assayed for their interactions with such agents.

Graphical abstract

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Synthesis, quorum sensing inhibition and docking studies of 1,5-dihydropyrrol-2-ones

Publication date: Available online 23 October 2015
Source:Bioorganic & Medicinal Chemistry
Author(s): Wai-Kean Goh, Christopher R. Gardner, Kondapalli V.G. Chandra Sekhar, Nripendra N. Biswas, Shashidhar Nizalapur, Scott A. Rice, Mark Wilcox, David StC. Black, Naresh Kumar
Gram-negative bacteria such as Pseudomonas aeruginosa and Escherichia coli use N-acylated L-homoserine lactones (AHLs) as autoinducers (AIs) for quorum sensing (QS), a chief regulatory and cell-to-cell communication system. QS is responsible for social adaptation, virulence factor production, biofilm production and antibiotic resistance in bacteria. Fimbrolides, a class of halogenated furanones isolated from the red marine alga Delisea pulchra, have been shown to exhibit promising QS inhibitory activity against various Gram-negative and Gram-positive bacterial strains. In this work, various lactam analogues of fimbrolides viz., 1,5-dihydropyrrol-2-ones, were designed and synthesized via an efficient lactamization protocol. All the synthesized analogues were tested for QS inhibition against the E. coli AHL-monitor strain JB357 gfp (ASV). Compound 17a emerged as the most potent compound, followed by 9c, with AIC40 values (the ratio of synthetic inhibitor to natural AHL signaling molecule that is required to lower GFP expression to 40%) of 1.95 and 19.00 respectively. Finally, the potential binding interactions between the synthesized molecules and the LasR QS receptor were studied by molecular docking. Our results indicate that 1,5-dihydropyrrol-2-ones have the ability to serve as potential leads for the further development of novel QS inhibitors as antimicrobial therapeutics.

Graphical abstract

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Inhibition of human topoisomerase I and II and anti-proliferative effects on MCF-7 cells by new titanocene complexes

Publication date: Available online 24 October 2015
Source:Bioorganic & Medicinal Chemistry
Author(s): Chimento Adele, Saturnino Carmela, Iacopetta Domenico, Mazzotta Rosaria, Caruso Anna, Plutino Maria Rosaria, Mariconda Annaluisa, Ramunno Anna, Sinicropi Maria Stefania, Pezzi Vincenzo, Longo Pasquale
The antitumor activity shown by many platinum complexes has produced a strong interest in research of new organometallic compounds having anticancer action. Among the many metal compounds synthesized and tested, those based on titanium have received considerable attention because of their cytotoxic activity against solid tumors. Particularly, new titanocene compounds containing aromatic groups linked to the Cp (cyclopentadienyl ring, C5H5) have been synthetized, such as the titanocene Y (bis-[(p-methoxybenzyl) cyclopentadienyl]titanium dichloride) that displayed promising medium-high cytotoxic activity on breast cancer cell lines. Other titanocene complexes recently synthesized, obtained by replacing the substituent methoxy-aryl of cyclopentadienes of titanocene Y with ethenyl-methoxide or ethenyl-phenoxide, showed increased cytotoxic activity on breast cancer cell lines being more stable compounds. In this paper, we report that new titanocene complexes holding lipophilic groups, for instance a methyl group on benzyl carbon, exhibit improved antiproliferative effect on breast cancer cell line MCF-7. Similar results have been obtained introducing a 5-methoxy naphthyl group to further stabilize the titanocene complexes. These inhibitory effects on breast cancer cells have been ascribed to human topoisomerase I and II inhibition as demonstrated by specific enzymatic assays.

Graphical abstract

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Triazole linked mono carbonyl curcumin-isatin bifunctional hybrids as novel anti tubulin agents: Design, synthesis, biological evaluation and molecular modeling studies

Publication date: Available online 23 October 2015
Source:Bioorganic & Medicinal Chemistry
Author(s): Sahil Sharma, Manish K. Gupta, Ajit K. Saxena, Preet Mohinder S. Bedi
Keeping in view the limitations associated with currently available anticancer drugs, molecular hybrids of mono carbonyl curcumin and isatin tethered by triazole ring have been synthesized and evaluated for in-vitro cytotoxicity against THP-1, COLO-205, HCT-116, A549, HeLa, CAKI-I, PC-3, MiaPaca-2 human cancer cell lines. The results revealed that the compounds SA-1 to SA-9, SB-2, SB-3, SB-4, SB-7 and SC-2 showed a good range of IC50 values against THP-1, COLO-205, HCT-116 and PC-3 cell lines, while the other four cell lines among these were found to be almost resistant. Structure activity relationship revealed that the nature of Ring X and substitution at position R influences the activity. Methoxy substituted phenyl ring as Ring X and H as R were found to be the ideal structural features. The most potent compounds (SA-2, SA-3, SA-4, SA-7) were further tested for tubulin inhibition. Compound SA-2 was found to significantly inhibit the tubulin polymerization (IC50 = 1.2 μM against HCT-116). Compound SA-2, moreover, lead to the disruption of microtubules as confirmed by immunofluoroscence technique. The significant cytotoxicity and tubulin inhibition by SA-2 was streamlined by molecular modeling studies where it was docked at the curcumin binding site of tubulin.

Graphical abstract

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Synthesis and Biological Evaluation of New C-10 Substituted Dithranol Pleiotropic Hybrids

Publication date: Available online 23 October 2015
Source:Bioorganic & Medicinal Chemistry
Author(s): Stavros E. Bariamis, George E. Magoulas, Katerina Grafanaki, Eleni Pontiki, Theodore Tsegenidis, Constantinos M. Athanassopoulos, George Maroulis, Dionissios Papaioannou, Dimitra Hadjipavlou-Litina
Selective alkylation of the antipsoriatic drug dithranol (DTR) at C-10 with tert-butyl bromoacetate, followed by acid-mediated deprotection, produced the corresponding carboxylic acid 4 which was coupled with selectively protected polyamines (PAs), such as putrescine (PUT), spermidine (SPD) and spermine (SPM), dopamine and aliphatic amines and substituted benzylamines producing a series of DTR-PA hybrids, after acid-mediated deprotection, as well as simple amides. The compounds were tested as antioxidants and inhibitors of lipoxygenase (LOX). The amides 4,4'-dimethoxybenzhydrylamide 13 (86% and 95%), 2,4-dimethoxybenzylamide 12 (87% and 81%) and dodecylamide 9 (98% and 74%), and the hybrid DTR-SPM (7) (93% and 87%), showed the highest antioxidant activity in the DPPH and AAPH assays, whereas the most potent inhibitors of LOX were amide 13 (IC50=7 μM), the benzylamide 10 (IC50=7.9 μM) and the butylamide 8 (IC50=10 μM). Molecular binding studies showed that binding of these derivatives into the hydrophobic domain blocks approach of substrate to the active site, inhibiting soybean LOX. Amide 13 presented the highest anti-inflammatory activity (79.7%). The DTR moiety was absolutely necessary for securing high anti-inflammatory potency. Ethyl ester 3 (IC50=0.357 μM) and the amides 9 (IC50=0.022 μM) and 13 (IC50=0.56 μM) exhibited higher antiproliferative activity than DTR (IC50=0.945 μM) on HaCaT keratinocytes whereas amide 13 generally presented better cytocompatibility. Amide 13 is a very promising lead compound for further development as an anti-inflammatory and antiproliferative agent.

Graphical abstract

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Bowel Function After Spinal Cord Injury

Publication date: Available online 23 October 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Gianna M. Rodriguez




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Findings of Abnormal Videoflouroscopic Swallowing Study Identified by High-resolution Mamometry Parameters

Publication date: Available online 24 October 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Donghwi Park, Yoongul Oh, Ju Seok Ryu
ObjectivesTo identify the parameters of high-resolution manometry (HRM) with a significant correlation to abnormal findings of videofluoroscopic swallowing study (VFSS)Participants40 patients with dysphagia symptomsDesignProspective studySettingHospital rehabilitation departmentInterventionParticipants were evaluated once using VFSS in neutral head position, and evaluated twice using HRM with 5cc of thin fluid.Main Outcome MeasuresHRM parameters included maximal pressure, area integral, rise time, duration of the velopharynx and tongue base, maximal pressure of pre-upper esophageal sphincter (UES), low pharynx, cricopharyngeus, minimal UES pressure, UES activity time, and nadir UES duration. HRM parameters were compared with the findings of VFSS. ROC analysis was performed to obtain the cutoff value, sensitivity, and specificity of HRM parameters for the prediction of findings of VFSS.ResultsThe maximum pressure of velopharynx showed a significantly positive prediction for most abnormal parameters of VFSS in the pharyngeal phase. Nadir UES pressure duration was significant for impaired laryngeal elevation, residue at pyriformis sinus, and combination of penetration and aspiration. The maximum pressure of velopharynx below 180.0 showed 100% sensitivity and 75.0% specificity for the presence of penetration and aspiration, and the cutoff point of 178.8 showed 86.7% sensitivity and 75.0% specificity for the presence of subglottic aspiration.ConclusionsThis study identified significant HRM parameters that are highly specific for individual abnormalities of VFSS , suggesting the cutoff value, sensitivity, and specificity. Since HRM could inform the quantitative measurement of pharyngeal weakness, the cutoff value for HRM parameters could be used to predict aspiration in patients with pharyngeal weakness.



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Patterns and predictors of early mortality among emergency department patients in Addis Ababa, Ethiopia

Background: Ethiopian emergency department (ED) patients have a considerable burden of illness and injury for which all-cause mortality rates have not previously been published. This study sought to characterize the burden of and to identify predictors for early all-cause mortality among patients presenting to the Tikur Anbessa Specialized Hospital ED (TASH-ED) in Ethiopia. Methods: Data was prospectively collected from the records of all patients who died within 72 h of ED presentation. Pearson's Chi square and Fisher's exact tests were used to investigate associations between two outcome variables: (a) time to death and (b) immediate cause of death in relation to specific demographic and clinical factors. Time from ED presentation to death was dichotomized as 'very early' mortality within ≤6 h and death >6–72 h and logistic regression was used to assess the adjusted impact of these demographic and clinical variables on the probability of dying within 6 h of ED presentation. Results: Between October 2012 and May 2013, 9956 patients visited the ED and 220 patients died within 72 h of admission. After excluding patients dead on arrival (n = 34), the average age of death was 43.1 years and the overall mortality rate was 1.9 %. Head injury (21.5 %) and sepsis (18.8 %) were the most common causes of death. Relative to medical patients, trauma patients were more likely to be male (p < 0.01), less likely to have had prior recent ED visits (p < 0.01) and more likely to be triaged as higher acuity (p = 0.04). The sole statistically significant predictor of death within 6 h from our multivariable logistic regression model was symptom duration less than 4 h (4–48 h vs. <4 h: OR = 0.20, 95 % CI 0.07, 0.53, p < 0.01; >48 h vs. <4 h: OR = 0.27, 95 % CI 0.09, 0.81, p = 0.02). Conclusions: The mortality burden of trauma and sepsis in the TASH-ED is substantial, and mortality patterns differ between these groups. As emergency medicine develops as a specialty in the Ethiopian health system, the potential impact of context-specific clinical care protocol development, trauma prevention advocacy and ED care re-organization initiatives to reduce mortality among these young, previously well patients warrants exploration.

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Knowledge of stroke a study from a sex perspective

Background: Public health is increasingly concerned with recognising factors that lead to sex differences in stroke. We conducted a study to determine the effect of sex on knowledge of stroke risk factors and warning signs, and how both are perceived, in a representative sample of adults. Methods: A representative sample of the population of Extremadura, Spain was selected using a double randomisation technique. Previously trained medical students carried out face-to-face interviews using a structured questionnaire. Results: 2409 subjects were interviewed [59.9 % women; mean age (SD) 49.0 (18.7) years]. Seventy-three percent of all subjects reported at least one correct warning sign of stroke (OR: 1.01; 95 % CI: 0.84–1.21). The most frequently mentioned warning signs were sudden weakness, dizziness, and headache. There were no sex differences regarding the types of warning symptoms that respondents listed. Women displayed better knowledge of risk factors than men (OR: 1.23; 95 % CI: 1.05–1.46). Women were more likely to name hypertension as a risk factor for stroke whereas men more frequently listed smoking, alcohol consumption and a sedentary lifestyle as risk factors. In response to stroke, women were significantly less likely than men to choose to call an ambulance or to go immediately to hospital (OR: 0.69; 95 % CI: 0.60–0.85). Conclusions: Stroke knowledge is suboptimal in both men and women. We detected better knowledge of stroke risk factors in women, as well as differences in the type of risk factors listed by men and women. There were significant sex differences regarding response to stroke or to its warning signs.

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Acute serum sodium concentration changes in pediatric patients undergoing cardiopulmonary bypass and the association with postoperative outcomes

The objective of this study is to investigate the degree of serum sodium changes and its association with patient outcomes in pediatrics undergoing heart surgery with cardiopulmonary bypass (CPB). We reviewed the medical records of 275 pediatric patients who underwent heart surgery with CPB. Prior to CPB, hyponatremia (≤135 mmol/L) was observed in 21 of 275 patients. After initiation of CPB, serum sodium decreased significantly and severe hyponatermia (≤130 mmol/L) subsequently developed in 32 patients. At the end of CPB, however, hypernatremia (≥145 mmol/L) developed in 86 patients. The degree of acute serum sodium change during CPB was not associated with patient outcomes. However, the patients with preoperative hyponatremia and those with hypernatremia at the conclusion of CPB had longer hospital stays and higher postoperative complication rates. Lower serum sodium prior to CPB and higher serum sodium at the end of CPB, along with age and duration of the operation, were independently associated with worse in-hospital outcomes. Acute and transient hyponatremia occurred frequently after initiation of CPB, and then serum sodium immediately increased above preoperative levels at the end of CPB. Caution is required to avoid serum sodium overcorrection on the conclusion of CPB.

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A study of heat and mass transfer in a fractional MHD flow over an infinite oscillating plate

Exact expressions of velocity, temperature and mass concentration have been calculated for free convective flow of fractional MHD viscous fluid over an oscillating plate. Expressions of velocity have been obtained both for sine and cosine oscillations of plate. Corresponding fractional differential equations have been solved by using Laplace transform and inverse Laplace transform. The expression of temperature and mass concentration have been presented in the form of Fox-H function and in the form of general Wright function, respectively and velocity is presented in the form of integral solutions using Generalized function. Some limiting cases of fluid and fractional parameters have been discussed to retrieve some solutions present in literature. The influence of thermal radiation, mass diffusion and fractional parameters on fluid flow has been analyzed through graphical illustrations.

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Hemoperitoneum in a patient with spontaneous rupture of the posterior wall of an unscarred uterus in the second trimester of pregnancy

Background: Hemoperitoneum resulting from a rupture of an unscarred uterus is a rare condition. Uterine rupture in patients without evident risk factors is associated with non-specific signs and symptoms that can delay the diagnosis. This is a report of spontaneous rupture of posterior wall of the uterus in the second trimester of pregnancy presented as intra-abdominal bleeding.Case presentationHere, we report the case of a 31-year-old Caucasian multiparous female (gravida 3, para 1) who had a sudden onset of abdominal pain at 28 weeks of gestation. The patient had no history of caesarean section. Exploratory laparotomy was performed due to deterioration of the patient's clinical condition, and ultrasound results were suspicious for hemoperitoneum. Uterine rupture in the posterior wall with active bleeding from the defect was confirmed. A caesarean section was performed, and a live female infant weighing 1000 g, with an Apgar score of three, was delivered. A hysterectomy was performed during the caesarean section. Conclusion: Diagnostic difficulties arise from the rarity of the disease, a nonspecific clinical picture and the absence of the main risk factors. Uterine rupture should be considered in the differential diagnosis of hemoperitoneum in patients with an unscarred uterus.

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A joint latent class model for classifying severely hemorrhaging trauma patients

Background: In trauma research, "massive transfusion" (MT), historically defined as receiving ≥10 units of red blood cells (RBCs) within 24 h of admission, has been routinely used as a "gold standard" for quantifying bleeding severity. Due to early in-hospital mortality, however, MT is subject to survivor bias and thus a poorly defined criterion to classify bleeding trauma patients. Methods: Using the data from a retrospective trauma transfusion study, we applied a latent-class (LC) mixture model to identify severely hemorrhaging (SH) patients. Based on the joint distribution of cumulative units of RBCs and binary survival outcome at 24 h of admission, we applied an expectation-maximization (EM) algorithm to obtain model parameters. Estimated posterior probabilities were used for patients' classification and compared with the MT rule. To evaluate predictive performance of the LC-based classification, we examined the role of six clinical variables as predictors using two separate logistic regression models. Results: Out of 471 trauma patients, 211 (45 %) were MT, while our latent SH classifier identified only 127 (27 %) of patients as SH. The agreement between the two classification methods was 73 %. A non-ignorable portion of patients (17 out of 68, 25 %) who died within 24 h were not classified as MT but the SH group included 62 patients (91 %) who died during the same period. Our comparison of the predictive models based on MT and SH revealed significant differences between the coefficients of potential predictors of patients who may be in need of activation of the massive transfusion protocol. Conclusions: The traditional MT classification does not adequately reflect transfusion practices and outcomes during the trauma reception and initial resuscitation phase. Although we have demonstrated that joint latent class modeling could be used to correct for potential bias caused by misclassification of severely bleeding patients, improvement in this approach could be made in the presence of time to event data from prospective studies.

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The role of cyclooxygenase-1 in high salt diet-induced microvascular dysfunction in humans

Abstract

Objectives

To assess the effect of 1-week high salt (HS) diet on the role of cyclooxygenases (COX-1,-2) and vasoconstrictor prostaglandins - thromboxane A₂ (TXA₂) and prostaglandin F2α (PGF_2α) on skin microcirculatory blood flow and to detect its effect on markers of endothelial activation such a soluble cell adhesion molecules (sCAMs).

Methods

Young women (N = 54) were assigned to either HS diet group (N = 30) (_∼14 g of NaCl/day) or low salt (LS) diet group (N = 24) (<2.3 g NaCl/day) for 7 days. Post-occlusive reactive hyperemia (PORH) in the skin microcirculation was assessed by laser Doppler flowmetry (LDF). Plasma Renin Activity (PRA), plasma aldosterone, plasma and 24 h-urine sodium and potassium, plasma concentrations of TXB₂ (stable TXA₂ metabolite) and PGF_2α, sCAMs and blood pressure (BP) were measured before and after diet protocols. One HS diet group subset received 100 mg of indomethacin (non-selective COX-1,2 inhibitor), and another HS group subset received 200 mg of celecoxib (selective COX-2 inhibitor) before repeating LDF measurements.

Results

BP was unchanged after HS diet, but significantly reduced after LS diet. 24 h-urinary sodium was increased, PRA and plasma aldosterone levels decreased after HS diet. HS diet significantly impaired PORH and increased TXA₂, but did not change PGF_2α levels. Indomethacin restored microcirculatory blood flow, reduced TXA₂. In contrast, celecoxib decreased TXA₂ levels, but had no significant effects on blood flow.

Conclusions

Restoration of of PORH by indomethacin during high salt diet suggest an important role of COX-1 derived vasoconstrictor metabolites in regulation of microvascular blood flow during high salt intake.

This article is protected by copyright. All rights reserved

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NSC 2015 Dispatch: Foundation's Marquette Challenge

The Foundation for Physical Therapy 2015 Marquette Challenge student coordinators talk about this year's challenge to students of physical therapy and discuss the importance of the program.

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Durée de sommeil et métabolisme

Publication date: Available online 24 October 2015
Source:Revue des Maladies Respiratoires
Author(s): V. Viot-Blanc
Le temps consacré au sommeil se réduit depuis quelques dizaines d'années, tandis qu'explose une épidémie d'obésité et de diabète. Les études de restriction expérimentales de sommeil ont mis en évidence une augmentation de l'appétit et une dysrégulation endocrinienne avec en particulier une insulino-résistance. De très nombreuses études épidémiologiques ont donc recherché si une durée de sommeil habituellement courte pouvait avoir un lien avec l'obésité et le diabète. Une grande majorité des études transversales ont confirmé l'association entre sommeil court, mais aussi sommeil long et obésité chez l'adulte, plus que chez le sujet âgé. Chez les enfants, l'association du sommeil court à l'obésité est forte et est présente également chez l'adolescent. Les études prospectives sont plus contradictoires, y compris chez l'enfant. Les temps de sommeil courts ou longs sont associés au diabète mais seul le sommeil court est prédictif de son apparition. L'insomnie contribue fortement aux durées de sommeil objectivement courte, on retrouve peu d'association à l'obésité, en revanche, de nombreuses études confirment son association au diabète de type 2 mais aussi un caractère fortement prédictif de son apparition. D'autres travaux ont également montré l'association du temps de sommeil court et de l'insomnie aux différentes composantes du syndrome métabolique, en particulier l'hypertension artérielle et le risque coronarien et dans certains cas leur caractère prédictif pour ces pathologies. L'effet de l'allongement du temps consacré au sommeil quand il est trop court et de la prise en charge de l'insomnie sur le syndrome métabolique mériterait d'être étudié à l'avenir.Sleep duration has gradually diminished during the last decade while obesity and type 2 diabetes have become epidemics. Experimental sleep curtailment leads to increased appetite, hormonal disturbances and, especially, insulin resistance. Numerous epidemiological studies have therefore examined whether habitual short sleep is associated with obesity and type 2 diabetes. A large majority of cross-sectional studies have confirmed an association between short, and also long sleep duration and obesity in adults more than in the elderly. Short sleep is strongly associated to obesity in children and adolescents. Prospective studies, including studies in children, are not conclusive with regard to the effect of short sleep on the incidence of obesity. Both short and long sleep durations are associated with diabetes, but only short sleep duration seems predictive of future diabetes. Insomnia seems to be a strong contributor to short sleep duration but the association of insomnia with obesity is not clear. Insomnia is associated with type 2 diabetes and also predictive of a higher incidence. Other studies have shown that short sleep duration and insomnia are associated with, and sometime predictive of, other components of the metabolic syndrome, especially hypertension and the risk of coronary disease. The treatment of short sleep duration and insomnia with regard to their effects on the metabolic syndrome merits further study.



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Évaluation des connaissances sur le dépistage du cancer par test de concordance de script

Publication date: Available online 23 October 2015
Source:Revue des Maladies Respiratoires
Author(s): S. Couraud, P. Girard, N. Girard, P.-J. Souquet, B. Coiffard, B. Charlin, B. Milleron
IntroductionLe dépistage du cancer bronchique par scanner thoracique faible dose annuel permet une réduction de mortalité. Une enquête menée en Rhône-Alpes pointait le besoin de formation des médecins sur le dépistage. Les tests de concordance de script (TCS) sont une modalité d'évaluation du raisonnement clinique en situation d'incertitude, mais n'ont jamais été utilisés en France pour l'évaluation de connaissance en formation continue.MéthodeUn questionnaire comprenant 5 questions à choix multiples (QCM) et deux scénarios de TCS a été envoyé par courriel à tous les médecins et internes inscrits sur les listes de diffusion de la Société de pneumologie de langue française (SPLF) et de l'association des jeunes pneumologues (AJPO2).RésultatsAu total, 190 réponses ont été analysées. Soixante-dix pour cent considéraient que réduire la mortalité était le meilleur critère d'efficacité et 75 % que le scanner sans injection était le meilleur examen de dépistage. Quarante-cinq pour cent connaissaient les critères d'éligibilité recommandés et 62 % la fréquence de réalisation des scanners. La participation à des réunions de concertation pluridisciplinaires, le fait d'avoir une qualification en oncologie thoracique étaient des variables significativement associées à un meilleur score aux QCM et aux TCS. Les scores obtenus aux QCM et aux TCS étaient corrélés (Rho de Spearman 0,339 ; p<10⁻⁴).ConclusionLes TCS sont réalisables à grande échelle par voie électronique et semblent pertinents. Les connaissances des pneumologues sur le dépistage et sa pratique restent imparfaites.BackgroundAnnual screening for lung cancer using low-dose CT-scans is associated with decreased mortality. A survey conducted in Rhône-Alpes area in France found that clinicians need education and information on this topic. Script concordance tests (SCT) are a tool for assessing clinical reasoning in situations of uncertainty. They have not previously been used in France in the context of continuing medical education.MethodWe created a questionnaire with 5 multiple-choice questions (MCQ) and two SCT scenarios. The questionnaire was sent to all clinicians and residents who are members of French-Speaking Respiratory Society or the French Young Pulmonologist Association.ResultsOne hundred and ninety answers were analyzed. Seventy percent stated that decreasing mortality was the best criterion for assessing the effectiveness of a cancer screening policy, and 75% that low-dose CT scan was the best test to achieve this in lung cancer screening. Forty-five percent knew the eligibility criteria of the population, and 62% that low-dose CT scan should be performed annually. Participation in tumor boards and certification in oncology were significantly associated with a better score at MCQ and SCT. SCT and MCQ scores were significantly correlated (Spearman's Rho 0.339; P<0.0001).ConclusionSCT are feasible by electronic survey and seem relevant. Improving knowledge of clinicians on lung cancer screening is still critical.



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Conséquences fonctionnelles respiratoires et qualité de vie des patients traités pour tuberculose pulmonaire : une problématique sous-évaluée dans les pays à ressources limitées

Publication date: Available online 23 October 2015
Source:Revue des Maladies Respiratoires
Author(s): A.R. Ouedraogo, K.S. Adjoh, A.A. Fiogbe, S.A. Adambounou, A. Mourtala, J. Efalou, M. Boukari, A. Soumana, O. Tidjani




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Un angiosarcome mimant une embolie pulmonaire récidivante

Publication date: Available online 24 October 2015
Source:Revue des Maladies Respiratoires
Author(s): C. Goyard, O. Sanchez, G. Mourin, S. Mussot, A. Boudjemaa, V. de Montpreville, G. Meyer, A. Ferre
IntroductionLe sarcome artériel pulmonaire est une pathologie rare dont les symptômes ne sont pas spécifiques. La présentation clinique et radiologique peut mimer une embolie pulmonaire avec hypertension pulmonaire post-embolique. Sa prise en charge est essentiellement chirurgicale mais le pronostic de cette pathologie reste sombre.ObservationNous rapportons le cas d'un patient dont la présentation initiale était celle d'une embolie pulmonaire. L'évolution clinique était défavorable sous traitement par anti-vitamine K bien conduit avec une extension des images endovasculaires et une majoration de l'hypertension pulmonaire. Les résultats suspects de la tomographie par émission de positons avaient permis d'orienter le diagnostic vers un sarcome artériel pulmonaire, confirmé lors de la prise en charge chirurgicale. Cependant, l'évolution était défavorable, conduisant au décès du patient.ConclusionCe cas conforte l'idée que les présentations cliniques et scanographiques du sarcome artériel pulmonaire et de l'hypertension pulmonaire post-embolique sont similaires. La tomographie par émission de positons est un examen potentiellement intéressant pour distinguer ces deux diagnostics.IntroductionPulmonary artery sarcoma is a rare disease with non-specific symptoms. The clinical and radiological presentation can mimic pulmonary embolism with chronic thromboembolic pulmonary hypertension. Management is essentially surgical but the prognosis remains poor.Case reportA patient presented with symptoms of pulmonary embolism. Despite vitamin K antagonist therapy, he suffered from extension of the endovascular defects and his pulmonary hypertension increased. Suspicious results of positron emission tomography suggested the diagnosis of pulmonary artery sarcoma that was confirmed by surgery. However, the outcome was unfavourable, leading to death of the patient.ConclusionThis case reinforces the idea that the clinical and tomodensitometric presentations of pulmonary arterial sarcoma and chronic thromboembolic pulmonary hypertension are similar. The positron emission tomography seems to be a key to distinguishing these two diagnoses.



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Redox imaging of skeletal muscle using in vivo DNP-MRI and its application to an animal model of local inflammation

Publication date: Available online 23 October 2015
Source:Free Radical Biology and Medicine
Author(s): Hinako Eto, Fuminori Hyodo, Nutavutt Kosem, Ryoma Kobayashi, Keiji Yasukawa, Motonao Nakao, Mamoru Kiniwa, Hideo Utsumi
Disorders of skeletal muscle are often associated with inflammation and alterations in redox status. A non-invasive technique that could localize and evaluate the severity of skeletal muscle inflammation based on its redox environment would be useful for disease identification and monitoring, and for the development of treatments; however, no such technique currently exists. We describe a method for redox imaging of skeletal muscle using dynamic nuclear polarization magnetic resonance imaging (DNP-MRI), and apply this method to an animal model of local inflammation. Female C57/BL6 mice received injections of 0.5% bupivacaine into their gastrocnemius muscles. Plasma biomarkers, myeloperoxidase activity, and histological sections were assessed at 4 and 24h after bupivacaine injection to measure the inflammatory response. In vivo DNP-MRI was performed with the nitroxyl radicals carbamoyl-PROXYL (cell permeable) and carboxy-PROXYL (cell impermeable) as molecular imaging probes at 4 and 24h after bupivacaine administration. The images obtained after carbamoyl-PROXYL administration were confirmed with the results of l-band EPR spectroscopy. The plasma biomarkers, myeloperoxidase activity, and histological findings indicated that bupivacaine injection caused acute muscle damage and inflammation. DNP-MRI images of mice treated with carbamoyl-PROXYL or carboxy-PROXYL at 4 and 24h after bupivacaine injection showed similar increases in image intensity and decay rate was significantly increased at 24h. In addition, reduction rates in individual mice at 4h and 24h showed faster trends with bupivacaine injection than in their contralateral sides by image-based analysis. These findings indicate that in vivo DNP-MRI with nitroxyl radicals can non-invasively detect changes in the focal redox status of muscle resulting from locally-induced inflammation.

Graphical abstract

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Identification of an unstable 4-hydroxynoneal modification on the 20S proteasome subunit α7 by recombinant antibody technology.

Publication date: Available online 22 October 2015
Source:Free Radical Biology and Medicine
Author(s): Jesper Just, Tobias Jung, Niels Anton Friis, Simon Lykkemark, Kim Drasbek, Gunhild Siboska, Tilman Grune, Peter Kristensen
Numerous cellular functions rely on an active proteasome allowing degradation of damaged or misfolded proteins. Therefore changes in the proteasomal activity have important physiological consequences. During oxidative stress the production of free radicals can result in the formation of 4-hydroxynonenal (HNE) following lipid peroxidiation. The HNE moiety is highly reactive and via a nucleophilic attack readily forms covalent links to cysteine, histidine and lysine side chains. However, as the chemical properties of these amino acids differ, so does the kinetics of the reactions. While covalent linkage through Michael addition is well established, reversible and unstable associations have only been indicated in a few cases. In the present study we have identified an unstable HNE adduct on the α7 subunit of the 20S proteasome using phage display of recombinant antibodies. This recombinant antibody fragment recognized HNE modified proteasomes in vitro and showed that this epitope was easily HNE modified, yet unstable, and influenced by experimental procedures. Hence unstable HNE-adducts could be overlooked as a regulatory mechanism of proteasomal activity and a participating factor in the decreased proteasomal activity associated with oxidative stress.

Graphical abstract

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