Bilateral ovarian artery embolization for a symptomatic large cervical fibroid.

Uterine leiomyomas are one of the most common smooth muscle tumors in women. Cervical leiomyomas, in contrast, are a relatively rare entity with limited available information, presenting a challenge for determining optimal treatment. Uterine artery embolization of cervical leiomyomas has been previously explored and met with some success. However, it has been associated with complications such as expulsion or incomplete embolization. This case, however, describes a patient who presented with a large cervical fibroid and was successfully treated with bilateral ovarian artery embolization, resulting in decreased fibroid burden and resolution of the patient's symptoms. Previous reports have demonstrated successful ovarian artery embolization for uterine leiomyomas, but this approach has yet to be shown for a cervical leiomyoma. Given the challenge presented by cervical leiomyomas, this case emphasizes a unique anatomical variant and the embolization method, providing an alternative, less-invasive option for reducing patient disease burden.

Unraveling the regulatory role of endoplasmic-reticulum-associated degradation in tumor immunity.

During malignant transformation and cancer progression, tumor cells face both intrinsic and extrinsic stress, endoplasmic reticulum (ER) stress in particular. To survive and proliferate, tumor cells use multiple stress response pathways to mitigate ER stress, promoting disease aggression and treatment resistance. Among the stress response pathways is ER-associated degradation (ERAD), which consists of multiple components and steps working together to ensure protein quality and quantity. In addition to its established role in stress responses and tumor cell survival, ERAD has recently been shown to regulate tumor immunity. Here we summarize current knowledge on how ERAD promotes protein degradation, regulates immune cell development and function, participates in antigen presentation, exerts paradoxical roles on tumorigenesis and immunity, and thus impacts current cancer therapy. Collectively, ERAD is a critical protein homeostasis pathway intertwined with cancer development and tumor immunity. Of particular importance is the need to further unveil ERAD's enigmatic roles in tumor immunity to develop effective targeted and combination therapy for successful treatment of cancer.

COPD Patients Have a Restricted Breathing Pattern That Persists with Increased Metabolic Demands.

A healthy respiratory system has variability from breath-to-breath and patients with COPD (PwCOPD) have abnormal variability in breath cycles. The aim of this study was to determine if interbreath-interval and tidal-volume variability, and airflow regularity change as metabolic demands increase (seated, standing, and walking) in PwCOPD as compared to controls. Sixteen PwCOPD (64.3 ± 7.9 yr, 61.3 ± 44.1% FEV1%predicted) and 21 controls (60.2 ± 6.8 yr, 97.5 ± 16.8% FEV1%predicted) sat, stood, and walked at their preferred-pace for five-minutes each while breathing patterns were recorded. The mean, standard deviation, and coefficient of variation of interbreath-intervals and tidal-volume, and the regularity (sample entropy) of airflow were quantified. Results were subjected to ANOVA analysis. Interbreath-interval means were shorter in PwCOPD compared to controls (p = 0.04) and as metabolic demand increased (p < 0.0001), standard deviation was decreased in PwCOPD compared to controls during each condition (p's < 0.002). Mean tidal-volume did decrease as metabolic demand increased across groups (p < 0.0001). Coefficient of variation findings (p = 0.002) indicated PwCOPD decline in tidal-volume variability from sitting to standing to walking; whereas, controls do not. There was an interaction for airflow (p = 0.02) indicating that although, PwCOPD had a more regular airflow across all conditions, control's airflow became more irregular as metabolic demand increased. PwCOPD's airflow was always more regular compared to controls (p = 0.006); although, airflow became more irregular as metabolic demand increased (p < 0.0001). Healthy respiratory systems have variability and irregularity from breath-to-breath decreases with adaptation to demand. PwCOPD have more regular and restricted breathing pattern that may affect their ability to adjust in demanding situations.

Walking speed and spatiotemporal step mean measures are reliable during feedback-controlled treadmill walking; however, spatiotemporal step variability is not reliable.

The purpose of the study was to compare the effects of a feedback-controlled treadmill (FeedbackTM) to a traditional fixed-speed treadmill (FixedTM) on spatiotemporal gait means, variability, and dynamics. The study also examined inter-session reliability when using the FeedbackTM. Ten young adults walked on the FeedbackTM for a 5-minute familiarization followed by a 16-minute experimental trial. They returned within one week and completed a 5-minute familiarization followed by a 16-minute experimental trial each for FeedbackTM and FixedTM conditions. Mean walking speed and step time, length, width, and speed means and coefficient of variation were calculated from all experimental conditions. Step time, length, width, and speed gait dynamics were analyzed using detrended fluctuation analysis. Mean differences between experimental trials were determined using ANOVAs and reliability between FeedbackTM sessions was determined by intraclass correlation coefficient. No difference was found in mean walking speed nor spatiotemporal variables, with the exception of step width, between the experimental trials. All mean spatiotemporal variables demonstrated good to excellent reliability between sessions, while coefficient of variation was not reliable. Gait dynamics of step time, length, width, and speed were significantly more persistent during the FeedbackTM condition compared to FixedTM, especially step speed. However, gait dynamics demonstrated fair to poor reliability between FeedbackTM sessions. When walking on the FeedbackTM, users maintain a consistent set point, yet the gait dynamics around the mean are different when compared to walking on a FixedTM. In addition, spatiotemporal gait dynamics and variability may not be consistent across separate days when using the FeedbackTM.

Energy efficient physiologic coupling of gait and respiration is altered in chronic obstructive pulmonary disease.

AIMS: Coupling between walking and breathing in humans is well established. In healthy systems, the ability to couple and uncouple leads to energy economization. It is unknown if physiologic efficiency is susceptible to alteration, particularly in individuals with airflow obstruction. The aim of this research was to determine if coupling was compromised in a disease characterized by abnormal airflow and dyspnoea, and if this was associated with reduced energy efficiency. METHODS: As a model of airflow obstruction, 17 chronic obstructive pulmonary disease (COPD) patients and 23 control subjects were included and walked on a treadmill for 6 minutes at three speeds (preferred speed and ±20% preferred speed) while energy expenditure, breathing, and walking were recorded. Rating of perceived exertion was recorded at the end of each walking trial. The most commonly used frequency ratio (ie, strides:breath) and cross recurrence quantification analysis were used to quantify coupling. Linear regression models were used to determine associations. RESULTS: Less complex frequency ratios, simpler ratios, (ie, 1:1 and 3:2) accompanied with stronger coupling were moderately associated with increased energy expenditure in COPD subjects. This was found for all three speeds. CONCLUSION: The novel finding was that increased energy expenditure was associated with stronger and less complex coupling. Increased effort is needed when utilizing a frequency ratio of 1:1 or 3:2. The more stable the coupling, the more effort it takes to walk. In contrast to the complex energy efficient coupling of controls, those with airflow obstruction manifested simpler and stronger coupling associated with reduced energy efficiency.

Sampling frequency influences sample entropy of kinematics during walking.

Sample entropy (SaEn) has been used to assess the regularity of lower limb joint angles during walking. However, changing sampling frequency and the number of included strides can potentially affect the outcome. The present study investigated the effect of sample frequency and the number of included strides on the calculations of SaEn in joint angle signals recorded during treadmill walking. Eleven subjects walked at their preferred walking speed for 10 min, and SaEn was calculated on sagittal plane hip, knee, and ankle angle signals extracted from 50, 100, 200, 300, and 400 strides at sampling frequencies of 60, 120, 240, and 480 Hz. Increase in sampling frequency decreased the SaEn significantly for the three joints. The number of included strides had no effect on the SaEn calculated on the hip joint angle and only limited effect on the SaEn calculated on the knee and ankle joint signals. The present study suggests that the number of data points within each stride to a greater extent determines the size of the SaEn compared to the number of strides and emphasizes the use of a fixed number of data points within each stride when applying SaEn to lower limb joint angles during walking. Graphical abstract Sampling frequency influences sample entropy of kinematics during walking.

On the choice of multiscale entropy algorithm for quantification of complexity in gait data.

The present study aimed at identifying a suitable multiscale entropy (MSE) algorithm for assessment of complexity in a stride-to-stride time interval time series. Five different algorithms were included (the original MSE, refine composite multiscale entropy (RCMSE), multiscale fuzzy entropy, generalized multiscale entropy and intrinsic mode entropy) and applied to twenty iterations of white noise, pink noise, or a sine wave with added white noise. Based on their ability to differentiate the level of complexity in the three different generated signal types, and their sensitivity and parameter consistency, MSE and RCMSE were deemed most appropriate. These two algorithms were applied to stride-to-stride time interval time series recorded from fourteen healthy subjects during one hour of overground and treadmill walking. In general, acceptable sensitivity and good parameter consistency were observed for both algorithms; however, they were not able to differentiate the complexity of the stride-to-stride time interval time series between the two walking conditions. Thus, the present study recommends the use of either MSE or RCMSE for quantification of complexity in stride-to-stride time interval time series.

On the calculation of sample entropy using continuous and discrete human gait data.

Sample entropy (SE) has relative consistency using biologically-derived, discrete data >500 data points. For certain populations, collecting this quantity is not feasible and continuous data has been used. The effect of using continuous versus discrete data on SE is unknown, nor are the relative effects of sampling rate and input parameters m (comparison vector length) and r (tolerance). Eleven subjects walked for 10-minutes and continuous joint angles (480Hz) were calculated for each lower-extremity joint. Data were downsampled (240, 120, 60Hz) and discrete range-of-motion was calculated. SE was quantified for angles and range-of-motion at all sampling rates and multiple combinations of parameters. A differential relationship between joints was observed between range-of-motion and joint angles. Range-of-motion SE showed no difference; whereas, joint angle SE significantly decreased from ankle to knee to hip. To confirm findings from biological data, continuous signals with manipulations to frequency, amplitude, and both were generated and underwent similar analysis to the biological data. In general, changes to m, r, and sampling rate had a greater effect on continuous compared to discrete data. Discrete data was robust to sampling rate and m. It is recommended that different data types not be compared and discrete data be used for SE.

Effect of parameter selection on entropy calculation for long walking trials.

It is sometimes difficult to obtain uninterrupted data sets that are long enough to perform nonlinear analysis, especially in pathological populations. It is currently unclear as to how many data points are needed for reliable entropy analysis. The aims of this study were to determine the effect of changing parameter values of m, r, and N on entropy calculations for long gait data sets using two different modes of walking (i.e., overground versus treadmill). Fourteen young adults walked overground and on a treadmill at their preferred walking speed for one-hour while step time was collected via heel switches. Approximate (ApEn) and sample entropy (SampEn) were calculated using multiple parameter combinations of m, N, and r. Further, r was tested under two cases r*standard deviation and r constant. ApEn differed depending on the combination of r, m, and N. ApEn demonstrated relative consistency except when m=2 and the smallest r values used (rSD=0.015*SD, 0.20*SD; rConstant=0 and 0.003). For SampEn, as r increased, SampEn decreased. When r was constant, SampEn demonstrated excellent relative consistency for all combinations of r, m, and N. When r constant was used, overground walking was more regular than treadmill. However, treadmill walking was found to be more regular when using rSD for both ApEn and SampEn. For greatest relative consistency of step time data, it was best to use a constant r value and SampEn. When using entropy, several r values must be examined and reported to ensure that results are not an artifact of parameter choice.

Measuring Coupling of Rhythmical Time Series Using Cross Sample Entropy and Cross Recurrence Quantification Analysis.

The aim of this investigation was to compare and contrast the use of cross sample entropy (xSE) and cross recurrence quantification analysis (cRQA) measures for the assessment of coupling of rhythmical patterns. Measures were assessed using simulated signals with regular, chaotic, and random fluctuations in frequency, amplitude, and a combination of both. Biological data were studied as models of normal and abnormal locomotor-respiratory coupling. Nine signal types were generated for seven frequency ratios. Fifteen patients with COPD (abnormal coupling) and twenty-one healthy controls (normal coupling) walked on a treadmill at three speeds while breathing and walking were recorded. xSE and the cRQA measures of percent determinism, maximum line, mean line, and entropy were quantified for both the simulated and experimental data. In the simulated data, xSE, percent determinism, and entropy were influenced by the frequency manipulation. The 1 : 1 frequency ratio was different than other frequency ratios for almost all measures and/or manipulations. The patients with COPD used a 2 : 3 ratio more often and xSE, percent determinism, maximum line, mean line, and cRQA entropy were able to discriminate between the groups. Analysis of the effects of walking speed indicated that all measures were able to discriminate between speeds.

Bilateral, geographic, peripapillary, chorioretinal atrophy in a patient with porphyria cutanea tarda and high iron stores.

PURPOSE: Porphyria cutanea tarda (PCT) is a systemic disease caused by a deficiency of the enzyme uroporphyrinogen decarboxylase, which is the fifth enzyme in the heme biosynthetic pathway. This deficiency prevents porphyrin and its byproducts from producing heme. CASE REPORT: This case report presents a patient with PCT that is further complicated by high iron stores, chronic hepatitis C virus (HCV), and a history of alcoholism. Bilateral, geographic, peripapillary chorioretinal atrophy is evident and shows progression over a significant period despite improving the PCT. CONCLUSION: A bilateral and progressive appearance of a retinal pathology in a middle-age male patient, with no family ocular history, suggests systemic causation. One theory includes a back flow of porphyrin byproducts from PCT. This is exacerbated by a less-than-productive liver caused by high iron stores, chronic HCV, and a history of alcoholism, which prevents the normal filtering process to occur. We believe this is the first report of a case of presumed bilateral, geographic, peripapillary chorioretinal atrophy in a patient with PCT, complicated by high iron stores, HCV, and alcoholism.