Muscle Quality Improves with Extended High-Intensity Resistance Training after Hip Fracture.

BACKGROUND: Muscle mass deficits endure after hip fracture. Strategies to improve muscle quality may improve mobility and physical function. It is unknown whether training after usual care yields muscle quality gains after hip fracture. OBJECTIVES: To determine whether muscle quality improves after hip fracture with high-intensity resistance training and protein supplementation. DESIGN: Case series. SETTING: University of Utah Skeletal Muscle Exercise Research Facility. PARTICIPANTS: 17 community-dwelling older adults, 3.6+/-1.1 months post-hip fracture, recently discharged from usual-care physical therapy (mean age 77.0+/-12.0 years, 12 female), enrolled. INTERVENTION: Participants underwent 12 weeks (3x/week) of unilaterally-biased resistance training. METHODS/MATERIALS: Participants were measured via a 3.0 Tesla whole-body MR imager for muscle lean and intramuscular adipose tissue (IMAT) of the quadriceps before and after resistance training. Peak isometric knee extension force output was measured with an isokinetic dynamometer. Muscle quality was calculated by dividing peak isometric knee extension force (N) by quadriceps lean muscle mass (cm2). In addition, common physical function variables were measured before and after training. RESULTS: Surgical and nonsurgical lean quadriceps muscle mass improved among participants (mean change: 2.9 cm2+/-1.4 cm2, and 2.7 cm2+/-1.3 cm2, respectively), while IMAT remained unchanged. Peak force improved in the surgical limb by 43.1+/-23N, with no significant change in the nonsurgical limb. Significant gains in physical function were evident after training. CONCLUSION: Participants recovering from hip fracture demonstrated improvements in muscle mass, muscle strength, and muscle quality in the surgical limb after hip fracture. These were in addition to gains made in the first months after fracture with traditional care. Future studies should determine the impact that muscle quality has on long-term functional recovery in this population.

High-Intensity Multimodal Resistance Training Improves Muscle Function, Symmetry during a Sit-to-Stand Task, and Physical Function Following Hip Fracture.

OBJECTIVES: Post rehabilitation, older adults with hip fracture display low vertical ground reaction force (vGRF) on the involved lower extremity during a sit-to-stand task and low physical function. The purpose of this study was to test whether muscle performance, involved side vGRF during a sit-to-stand task, and physical function improved following multimodal high-intensity resistance training, when initiated after usual care (2 to 6 months after hip fracture). DESIGN: Case series study, 12 weeks extended high-intensity strength training intervention following hip fracture. SETTING: University hospital outpatient facility. PARTICIPANTS: Twenty-four community-dwelling older adults (mean age 78.4 years (SD 10.4), 16 female/8 male), 3.6 (SD 1.2) months post-hip fracture and discharged from physical therapy participated. Intervention/Measurement: All participants performed sit-to-stand tasks, muscle performance tests, and modified physical performance test (mPPT) before and after 12 weeks (3x/wk) of training. Variables were compared using paired t-tests. RESULTS: The vGRF rate of force development (RFD) and magnitude of discrepancy between limb loading during rising phase of sit-to-stand task (AREA) variables improved post-training (RFD ratio = Pre: 0.78 - Post: 0.82, AREA ratio = Pre: 0.79 - Post: 0.86). Surgical leg extension power gains were large (~65%) while strength gains were moderate (~34%); yielding improved symmetry in both strength (Pre: 0.74 - Post: 0.88) and power (Pre: 0.75 - Post: 0.82). Physical function improved pre-training 25 (SD 5.2) to post training 30 (SD 4.3), (p < 0.001). CONCLUSION: Unique to this study, participants recovering from hip fracture demonstrated improved symmetry in sit-to-stand vGRFs, muscle function, and physical function after training. However, a high percentage of patients continued to experience persistently low vGRF of the involved side compared to previous studies of healthy elderly controls. Developing alternative strategies to improve involved side vGRF may be warranted.

Exposure of the fetus and infant to hens' egg ovalbumin via the placenta and breast milk in relation to maternal intake of dietary egg.

BACKGROUND: Maternally derived allergens may be transferred to the developing infant during pregnancy and lactation. However, it is not known how manipulation of environmental allergen levels might impact on this early-life exposure. OBJECTIVE: To measure dietary egg allergen (ovalbumin (OVA)) in gestation-associated environments, in relation to maternal dietary egg intake. METHOD: OVA was measured by allergen-specific ELISA in maternal blood collected throughout pregnancy, infant blood at birth (umbilical cord) and in breast milk at 3 months post-partum. Samples derived from pregnant women undergoing diagnostic amniocentesis at 16-18 weeks gestation who were not subject to any dietary intervention, and from pregnant women, with personal or partner atopy, randomized to complete dietary egg exclusion or an unmodified healthy diet before 20 weeks gestation as a primary allergy prevention strategy. Maternal dietary egg intake was monitored closely throughout the study period by diary record and serial measurement of OVA-specific immunoglobulin G concentration. RESULTS: Circulating OVA was detected throughout pregnancy in 20% of women and correlated with both presence (P<0.001) and concentration (r=0.754, P<0.001) of infant OVA at birth (umbilical cord). At 3 months post-partum OVA was detected in breast milk samples of 35% women, in higher concentrations than measured in blood. Blood and breast milk OVA were not related to maternal dietary intake or atopic pre-disposition. CONCLUSIONS: Rigorous dietary egg exclusion does not eliminate trans-placental and breast milk egg allergen passage. This early-life exposure could modulate developing immune responses.

Does severity of low-dose, double-blind, placebo-controlled food challenges reflect severity of allergic reactions to peanut in the community?

BACKGROUND: The severity of allergic reactions to food appears to be affected by many interacting factors. It is uncertain whether challenge-based reactions reflect the severity of past reactions or can predict future risk. OBJECTIVE: To explore the relationship of a subject's clinical history of past reactions to the severity of reaction elicited by a low-dose, double-blind, placebo-controlled food challenge (DBPCFC) with peanut. METHOD: Cross-sectional questionnaire assessment of community-based allergic reactions and low-dose DBPCFC in self-selected peanut-allergic subjects. Reaction severity was assessed using a novel scoring system, taking account of the dose of allergen ingested. RESULTS: Forty subjects (15 males, 23 children, 23 asthmatics by history) were studied. Only the most recent community reaction predicted the severity of reaction in the DBPCFC, but even this association was weak (r=0.37, P=0.03). Peanut-specific IgE (PsIgE) and skin prick test (SPT) weal size were not associated with community score but PsIgE level correlated well with the challenge score (r=0.6, P=0.001). Asthma did not affect the eliciting dose or challenge score directly but the association of PsIgE and challenge score was stronger in those without asthma (r=0.72, P=0.001) than in those with asthma (r=0.48, P=0.02). CONCLUSIONS: The scoring system developed appears to improve the sensitivity of assessment of reactions induced by DBPCFC. This is the first prospective study showing an association between PsIgE levels and clinical reactivity in DBPCFC, an effect that is more pronounced in non-asthmatics. This finding has important implications for the clinical care of subjects with food allergy. There is a poor correlation between the severity of reported reactions in the community and the severity of reaction elicited during low-dose DBPCFC with peanut.

New integrated gas turbine CHP (combined heat and power) and incinerator plant.

Despite the complex nature of the project, the clients brief of a 14 month design and installation period was achieved within the approved budget of 2.5 million pounds. Early performance figures indicate that the scheme is on target to achieve the original payback of under four years. Queen Elizabeth Hospital: installation of integrated combined heat and power plant. Client: Central Birmingham Health Authority. Consulting Engineers/Project Managers: Yates, Edge and Partners. Architects: Temple Cox and Nichols. Structural Engineers: Peel and Fowler. Quantity Surveyor: West Midlands Regional Health Authority.

Retrograde flow in the internal mammary artery.

Thirty-two patients undergoing coronary artery bypass grafting were studied to evaluate retrograde flow in the internal mammary artery (IMA). The left IMA pedicle was prepared in routine fashion from the level of the first rib superiorly to just distal to the IMA bifurcation. Following cannulation for cardiopulmonary bypass but before institution of extracorporeal circulation, the IMA was divided 5 mm proximal to its bifurcation and allowed to bleed freely. The flow from each end was then measured by allowing the segment to bleed for 30 seconds. The mean antegrade flow was 73 +/- 34 ml/min, and the retrograde flow was 25 +/- 17.2 ml/min. The difference between the flows was significant (p less than 0.05). Based on these data we do not recommend the retrograde IMA technique as a primary form of revascularization of the myocardium. In selected circumstances it may be used if adequate retrograde flow is demonstrated before constructing the anastomosis.