Lung de-recruitment in the allergic asthma of obesity: evidence from an anatomically based inverse model.

The increase in asthma associated with the obesity epidemic cannot simply be due to airway hyperresponsiveness from chronic lung compression because chronic lung compression is a feature of obesity in general. We therefore sought to investigate what other factors might be at play in the impaired lung function seen in obese individuals with asthma. We measured respiratory system impedance in four groups-Lean Control, Lean Allergic Asthma, Obese Control, and Obese Allergic Asthma-before and after administration of albuterol. Impedance measurements were fit with an anatomically based computational model of lung mechanics that represents the airway tree as a branching structure with a uniform degree of asymmetry and a fixed radius scaling ratio, γ, between branches of sequential order. The two model parameters that define the airway tree, γ and tracheal radius, varied only modestly between the four study groups, indicating relatively minor differences in airway caliber. In contrast, respiratory system elastance was 57, 34, 143, and 271 cmH2O/L, respectively, for the four groups, suggesting that obesity induced significant lung de-recruitment that was exacerbated by allergic asthma. In addition, when the radii of the individual branches of the airway tree were varied randomly, we found that roughly half the terminal airways had to be closed to have the model fit the data well. We conclude that de-recruitment of small airways is a particular feature of Obese Allergic Asthma, and this can be inferred from respiratory system impedance fit with an anatomically based computational model.NEW & NOTEWORTHY Using a novel anatomically based computational model to interpret oscillometry measurements of impedance, we show that respiratory system elastance is increased in obesity and is increased dramatically in individuals with obese allergic asthma. A significant component of this increased elastance in obese allergic asthma appears to be due to closure of small airways rather than alveolar atelectasis, and this closure is partially mitigated by albuterol. These findings potentially point to nonpharmacological therapies in obese allergic asthma aimed at recruiting closed airways.

Exploring Vision-Related Quality of Life: A Qualitative Study Comparing Patients' Experience of Cataract Surgery with a Standard Monofocal IOL and an Enhanced Monofocal IOL.

Purpose: To explore quality of life related with intermediate vision of patients before and after cataract surgery, and to make patients' experience available for the design of future scales that assess visual function related with intermediate distance. Patients and Methods: A qualitative research methodology based on thematic content analysis was used to explore vision-related quality of life based on the experiences of patients with cataract. Patients were recruited at the Service of Ophthalmology of the Hospital de Sant Pau (Barcelona, Spain). Data were collected through nineteen semi-structured interviews conducted with patients diagnosed with cataract and implanted with a standard aspheric monofocal intraocular lens (IOL) (Tecnis® ZA9003) (n = 6), an enhanced monofocal IOL (Tecnis® Eyhance ICB000) (n = 6), and patients from the waiting list (n = 7). The data analysis consisted in coding, aggregation, and theme development of the transcribed audios. Results: Patients on waiting lists reported difficulty and insecurity in performing daily and meaningful tasks related to near visual ranges (eg: threading a needle, reading price tags), intermediate (eg: using a computer or dialling numbers on a smartphone), and distant (eg: recognizing faces, walking on uneven surfaces). Patients after surgery with the standard IOL reported improvement in performing activities mainly in the distant visual range, but also the need for a better communication with clinical staff to adjust their own expectations on the results of the surgery. Finally, patients implanted with the enhanced IOL reported satisfaction and improved visual function in performing daily activities, especially those related to the intermediate visual range. Conclusion: Our exploratory study found that patients after cataract surgery with the enhanced IOL reported a better performance in activities that require the intermediate vision. These results will inform the development of scales to assess vision-related quality of life in the intermediate visual range prioritizing outcomes according to patients' daily and meaningful activities.

Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon?

The prospect of ovarian rejuvenation offers the tantalising prospect of treating age-related declines in fertility or in pathological conditions such as premature ovarian failure. The concept of ovarian rejuvenation was invigorated by the indication of the existence of oogonial stem cells (OSCs), which have been shown experimentally to have the ability to differentiate into functional follicles and generate oocytes; however, their clinical potential remains unknown. Furthermore, there is now growing interest in performing ovarian rejuvenation in situ. One proposed approach involves injecting the ovary with platelet rich plasma (PRP). PRP is a component of blood that remains after the in vitro removal of red and white blood cells. It contains blood platelets, tiny anucleate cells of the blood, which are responsible for forming athrombus to prevent bleeding. In addition, PRP contains an array of cytokines and growth factors, as well as a number of small molecules.The utility ofPRP has been investigatedin a range of regenerative medicine approaches and has been shown to induce differentiation of a range of cell types, presumably through the action of cytokines. A handful ofcasereports have described the use of PRP injections into the ovaryin the human, and while these clinical data report promising results, knowledge on the mechanisms and safety of PRP injections into the ovary remain limited.In this article, we summarise some of the physiological detail of platelets and PRP, before reviewing the existing emerging literature in this area. We then propose potential mechanisms by which PRP may be eliciting any effects before reflecting on some considerations for future studies in the area. Importantly, on the basis of our existing knowledge, we suggest that immediate use of PRP in clinical applications is perhaps premature and further fundamental and clinical research on the nature of ovarian insufficiency, as well as the mechanism by which PRP may act on the ovary, is needed to fully understand this promising development.

Cognition, Health, and Social Support of Formerly Homeless Older Adults in Permanent Supportive Housing.

BACKGROUND AND OBJECTIVES: Formerly homeless older adults residing in Permanent Supportive Housing (PSH) represent an invisible subsector of two distinct, yet related populations: the homeless population and the elderly population. Little research is focused on the complex health concerns facing this aging population within the homelessness response system. Of particular concern is the identification and support of individuals with cognitive impairment and co-occurring chronic conditions. We collaborated with a leading housing services provider to develop a systematic screening system for case managers to capture the cognitive, physical, and psychosocial health of older adults served within homeless housing programs. RESEARCH DESIGN AND METHODS: PSH residents aged ≥50 years in four sites screened as being without cognitive impairment on the Mini-Cog were enrolled. A brief demographic survey and selected PROMIS measures were used to characterize participants' demographics, cognition, global physical and mental health, physical functioning, self-efficacy for social interactions, and instrumental support. PSH case managers were trained to recruit participants and collect data. PROMIS scales were scored using the Health Measures Scoring Service. Descriptive statistics, correlations, and one sample t-tests were performed. RESULTS: Fifty-three residents (mean age = 60.8 years, range 50-76 years) participated. The majority self-identified as male and were military veterans; 60% reported having a history of two or more episodes of homelessness. All PROMIS scores were significantly (p < .05) lower than reference U.S. population means, with global mental health and cognition having the lowest scores. DISCUSSION AND IMPLICATIONS: Self-reported cognitive functioning and global mental health were residents' greatest concerns. Strengthening housing case manager capacity to assess residents' cognitive and health status could increase support for older adults in PSH. It is feasible to train PSH staff to conduct structured interviews to identify resident cognitive and health needs to help support this "invisible" population to successfully age in place.

Interchangeability of Procalcitonin Measurements Using the Point of Care Testing i-CHROMATM Reader and the Automated Liaison XL.

BACKGROUND: Our aim was to verify if procalcitonin (PCT) measurements using the new point-of-care testing i-CHROMATM are interchangeable with those of Liaison XL. METHODS: One hundred seventeen serum samples were processed sequentially on a Liaison XL and i-CHROMATM. Statistical analysis was done using the Passing-Bablok regression, Bland-Altman test, and Cohen's Kappa statistic. RESULTS: Proportional and constant differences were observed between i-CHROMATM and Liaison XL. The 95% CI of the mean bias% was very large, exceeding the maximum allowable TE% and the clinical reference change value. However, the concordance between methods at the clinical relevant cutoffs was strong, with the exception of the 0.25 ng/mL cutoff which was moderate. CONCLUSIONS: Our data suggest that i-CHROMATM is not interchangeable with Liaison XL. However, while the strong concordance at the clinical relevant cutoffs allows us to consider i-CHROMATM a suitable option to Liaison XL to support clinicians' decision-making; nevertheless, the moderate agreement at the 0.25 ng/mL cutoff recommends caution in interpreting the data around this cutoff.