The Illustrations of John Daugherty: AMI's 2022 Lifetime Achievement Award Recipient.

This JBC Showcase features the award winning medical illustration of John Daugherty. John was the recipient of the Association of Medical Illustrators' 2022 Lifetime Achievement Award. His award was presented at the Awards Ceremony during the AMI's 2022 annual meeting held in Des Moines, Iowa. The purpose of the Lifetime Achievement Award is to acknowledge and honor a medical illustrator who has been a Professional AMI Member for at least 30 continuous years, and whose life, work and accomplishments have significantly contributed to the profession and fellow illustrators. This award is the highest honor bestowed by the AMI to an individual, reaching beyond the service awards, to recognize a special person who has enriched our lives and influenced our ideals.

The Imaginative Work of Craig Gosling: A Memorial Showcase.

This JBC Memorial Showcase features the award-winning medical and zoological illustrations by AMI member Craig Gosling, who passed away on July 11, 2021. Craig was extremely active in the Association of Medical Illustrators. Craig was an AMI Past President and served on the Board of Governors. He received the AMI Lifetime Achievement Award, the AMI Outstanding Service Award, the Ranice W. Crosby Distinguished Achievement Award, and the Max Brödel Award for Excellence in Education.

Visualization of a Juvenile Australopithecus afarensis Specimen: Implications for Functional Foot Anatomy.

Since it was named in 1978, analyses of Australopithecus afarensis have culminated in several dominant theories on how humans acquired many of their unique adaptations. Because bipedal locomotion is one of the earliest characteristics of human functional anatomy to appear in the fossil record, its associated anatomy in early hominins has significant implications for human evolution (Stern 2000). The skeleton and overall morphological characteristics of the foot in Australopithecus afarensis provide important clues about the origins of upright bipedal locomotion. Popularly known as "Selam," the 3.3 million-year-old DIK-1-1 fossil was discovered in Dikika, Ethiopia by Dr. Zeresenay Alemseged and his team in 2000. Selam was an australopithecine who died at three years old, making her the youngest early hominin specimen known today (Alemseged et al. 2006). This discovery allows researchers to investigate not only locomotor patterns of A. afarensis within the context of human evolution, but also to examine what child development may have looked like during this pivotal time. The purpose of this project is to create a 3D animation that accurately reconstructs the anatomy and taphonomy of the Dikika foot. By segmenting CT data, 3D modelling, and animating, this investigation aims to contribute to the breadth of fossil reconstruction techniques in the field of biomedical visualization. This method provides a robust means of communication within, and beyond, the paleoanthropological community about new discoveries and how to visualize them.

Defining the molecular signatures of human right heart failure.

AIMS: Right ventricular failure (RVF) varies significantly from the more common left ventricular failure (LVF). This study was undertaken to determine potential molecular pathways that are important in human right ventricular (RV) function and may mediate RVF. MATERIALS AND METHODS: We analyzed mRNA of human non-failing LV and RV samples and RVF samples from patients with pulmonary arterial hypertension (PAH), and post-LVAD implantation. We then performed transcript analysis to determine differential expression of genes in the human heart samples. Immunoblot quantification was performed followed by analysis of non-failing and failing phenotypes. KEY FINDINGS: Inflammatory pathways were more commonly dysregulated in RV tissue (both non-failing and failing phenotypes). In non-failing human RV tissue we found important differences in expression of FIGF, TRAPPAC, and CTGF suggesting that regulation of normal RV and LV function are not the same. In failing RV tissue, FBN2, CTGF, SMOC2, and TRAPP6AC were differentially expressed, and are potential targets for further study. SIGNIFICANCE: This work provides some of the first analyses of the molecular heterogeneity between human RV and LV tissue, as well as key differences in human disease (RVF secondary to pulmonary hypertension and LVAD mediated RVF). Our transcriptional data indicated that inflammatory pathways may be more important in RV tissue, and changes in FIGF and CTGF supported this hypothesis. In PAH RV failure samples, upregulation of FBN2 and CTGF further reinforced the potential significance that altered remodeling and inflammation play in normal RV function and failure.

Efficacy of Electrical Stimulation of the Occipital Nerve in Intractable Primary Headache Disorders: A Systematic Review with Meta-Analyses.

AIMS: To determine the efficacy of occipital nerve stimulation (ONS) in reducing the intensity, duration, and frequency of medically intractable primary headaches. METHODS: A systematic review was carried out by searching three electronic databases: the Cochrane Library, MEDLINE via PubMed, and Web of Science. Randomized controlled trials (RCTs) and case series were eligible for inclusion. RCTs were assessed for quality of evidence by using the Cochrane Risk of Bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tools. Descriptive statistics of reported outcomes in eligible studies are presented in tabular form. Meta-analyses of RCTs comparing ONS therapy to sham therapy in chronic migraine patients were conducted for the outcomes responder rate, headache frequency, and headache intensity. RESULTS: Four RCTs, 1 follow-up study, and 19 case series met the inclusion criteria. The quality of the evidence was low, with all four RCTs assessed as having a high risk of bias and small sample size. Meta-analyses of three RCTs showed patients receiving ONS therapy had a significant reduction of 3 headache days per month (difference in means = -3.061; 95% confidence interval [CI] = -5.162 to -0.961; P = .004) and a significant reduction in Migraine Disability Assessment score (standardized difference in means [SDM] = -0.634; 95% CI = -0.933 to -0.335; P < .001) compared to sham (subthreshold) therapy. There were no statistically significant differences in reduction in pain intensity (SDM = -1.220; 95% CI = -2.489 to -0.049; P = .060) or in the number of responders (risk ratio [RR] = 1.581; 95% CI = 0.749 to 3.355; P = .229). CONCLUSION: ONS may be effective when compared to sham therapy, but the small number of RCTs and the heterogeneity of outcomes suggest further research in this field is needed.

The combination of obesity and hypertension: a highly unfavorable phenotype requiring attention.

PURPOSE OF REVIEW: Body habitus is a key lifestyle characteristic whose current status and future projections are disconcerting. The percentage of the global population who are either overweight or obese has substantially increased, with no indication that any country has a solution to this issue. Hypertension is a key unfavorable health metric that, like obesity, has disastrous health implications if left uncontrolled. Poor lifestyle characteristics and health metrics often cluster together to create complex and difficult to treat phenotypes. Excess body mass is such an example, creating an obesity-hypertension phenotype, which is the focus of this review. RECENT FINDINGS: An increased risk for hypertension is clearly linked to obesity, indicating that the two conditions are intimately linked. The cascade of obesity-induced pathophysiologic adaptations creates a clear path to hypertension. Adopting a healthy lifestyle is a primary intervention for the prevention as well as treatment of the obesity-hypertension phenotype. SUMMARY: The obesity-hypertension phenotype is highly prevalent and has disastrous health implications. A primordial prevention strategy, focused on lifelong healthy lifestyle patterns, is the optimal approach for this condition. For those individuals already afflicted by the obesity-hypertension phenotype, interventions must aggressively focus on weight loss and blood pressure control.

Cardiopulmonary exercise testing in patients with pulmonary hypertension: clinical recommendations based on a review of the evidence.

Pulmonary hypertension (PH) remains an ominous diagnosis despite advances in pharmacological and surgical therapy. Early and effective diagnosis is important for clinicians making treatment determinations and patients wishing to understand the prognostic implications of their illness. Cardiopulmonary exercise testing (CPX) has the power to reveal the underlying pathophysiological consequences of the disease process. Research, especially over the last 10-15 years, has demonstrated the utility of this tool. Several CPX variables have been shown to be consistently altered in patients with PH and more so as severity of disease increases. However, to further enhance clinical application, additional research is needed to better define optimal CPX measures and associated cutoff values. This paper gives class-based recommendations with associated levels of evidence for the use of CPX in the PH patient population.

Transforming cardiac rehabilitation into broad-based healthy lifestyle programs to combat noncommunicable disease.

The current incidence and prevalence of noncommunicable diseases (NCDs) is currently a cause for great concern on a global scale; future projections are no less disconcerting. Unhealthy lifestyle patterns are at the core of the NCD crisis; physical inactivity, excess body mass, poor nutrition and tobacco use are the primary lifestyle factors that substantially increase the risk of developing one or more NCDs. We have now come to recognize that healthy lifestyle interventions are a medical necessity that should be prescribed to all individuals. Perhaps the most well-established model for healthy lifestyle interventions in the current healthcare model is cardiac rehabilitation. To have any hope of improving the outlook for NCDs on a global scale, what is currently known as cardiac rehabilitation must transform into broad-based healthy lifestyle programing, with a shifted focus on primordial and primary prevention.

Exercise Training in Group 2 Pulmonary Hypertension: Which Intensity and What Modality.

Pulmonary hypertension (PH) due to left-sided heart disease (LSHD) is a common and disconcerting occurrence. For example, both heart failure (HF) with preserved and reduced ejection fraction (HFpEF and HFrEF) often lead to PH as a consequence of a chronic elevation in left atrial filling pressure. A wealth of literature demonstrates the value of exercise training (ET) in patients with LSHD, which is particularly robust in patients with HFrEF and growing in patients with HFpEF. While the effects of ET have not been specifically explored in the LSHD-PH phenotype (i.e., composite pathophysiologic characteristics of patients in this advanced disease state), the overall body of evidence supports clinical application in this subgroup. Moderate intensity aerobic ET significantly improves peak oxygen consumption, quality of life and prognosis in patients with HF. Resistance ET significantly improves muscle strength and endurance in patients with HF, which further enhance functional capacity. When warranted, inspiratory muscle training and neuromuscular electrical stimulation are becoming recognized as important components of a comprehensive rehabilitation program. This review will provide a detailed account of ET programing considerations in patients with LSHD with a particular focus on those concomitantly diagnosed with PH.