Decreased expression of adipogenic genes in obese subjects with type 2 diabetes

Objective: Our objective was to delineate the potential role of adipogenesis in insulin resistance and type 2 diabetes. Obesity is characterized by an increase in adipose tissue mass resulting from enlargement of existing fat cells (hypertrophy) and/or from increased number of adipocytes (hyperplasia). The inability of the adipose tissue to recruit new fat cells may cause ectopic fat deposition and insulin resistance.

Research Methods and Procedures: We examined the expression of candidate genes involved in adipocyte proliferation and/or differentiation [ CCAAT/enhancer-binding protein (C/EBP) alpha, C/EBPdelta, GATA domain-binding protein 3 (GATA3), C/EBPbeta, peroxisome proliferator-activated receptor (PPAR) gamma2, signal transducer and activator of transcription 5A (STAT5A), Wnt-10b, tumor necrosis factor alpha, sterol regulatory element-binding protein 1c (SREBP1c), 11 beta-hydroxysteroid dehydrogenase, PPARG angiopoietin-related protein (PGAR), insulin-like growth factor 1, PPARitalic gamma coactivator 1alpha, PPARitalic gamma coactivator 1beta, and PPARdelta] in subcutaneous adipose tissue from 42 obese individuals with type 2 diabetes and 25 non-diabetic subjects matched for age and obesity.

Results: Insulin sensitivity was measured by a 3-hour 80 mU/m2 per minute hyperinsulinemic glucose clamp (100 mg/dL). As expected, subjects with type 2 diabetes had lower glucose disposal (4.9 plusminus 1.9 vs. 7.5 plusminus 2.8 mg/min per kilogram fat-free mass; p < 0.001) and larger fat cells (0.90 plusminus 0.26 vs. 0.78 plusminus 0.17 mum; p = 0.04) as compared with obese control subjects. Three genes (SREBP1c, p < 0.01; STAT5A, p = 0.02; and PPARitalic gamma2, p = 0.02) had significantly lower expression in obese type 2 diabetics, whereas C/EBPbeta only tended to be lower (p = 0.07).

Discussion: This cross-sectional study supports the hypothesis that impaired expression of adipogenic genes may result in impaired adipogenesis, potentially leading to larger fat cells in subcutaneous adipose tissue and insulin resistance.

The effect of hook/bait size and angling technique on the hooking location and the catch of recreationally caught black bream Acanthopagrus butcheri

The black bream Acanthopagrus butcheri recreational fishery is the largest estuarine fishery in Victoria. This fishery is managed through legal-minimum length and daily bag limits. The success of this management strategy requires a high survival rate for released fish. Deep-hooking is known to reduce the chance of fish survival after recreational capture and release. This study investigated the potential to reduce deep-hooking and the number of under-size A. butcheri caught by varying angling gear and techniques. Three sizes of long shank hook (small [size 8], medium [size 4] and large [size 1/0]) and two angling techniques (slack line and tight line) were tested for their deep-hooking rates and selectivity characteristics. Increasing the hook size from small to large decreased the likelihood of deep-hooking by 6.6 times (95% CI 2.3–16.3 times). Fishing with a tight line instead of a slack line decreased the chance of deep-hooking by almost 100% (95% CI 0.8–3.6). Fishing with a large hook instead of a small hook significantly (F = 6.71, df = 2, P = <0.001) increased the mean A. butcheri length, although this mean size increase was less than 1 cm. This study was able to identify angling gear and angling technique manipulations that reduced the rate of deep-hooking when targeting A. butcheri in Victorian estuaries.

Spirituality and coping in young adults with diabetes : a cross-sectional study

Aim: Spirituality is an important aspect of wellbeing in people with diabetes. The current study aimed to explore how young adults with diabetes define spirituality, and the relationship between spirituality and coping in young adults with diabetes.

Methods: An exploratory study was conducted in 100 young adults with diabetes aged 18–30 years. Participants completed the Coping Questionnaire for Young Adults with Diabetes and the Spirituality Questionnaire.

Results: Young adults with diabetes defined spirituality as a sense of finding inner self and meaning in life, which is enriched by connections with other people and the universal whole. There was no significant difference in spirituality between religious and non-religious young adults with diabetes. People with a shorter duration of diabetes had higher scores on spiritual needs and engaged in more spiritual practices. Coping was correlated with spirituality (p<0.002) and self-awareness (p<0.000). Lower levels of glycosylated haemoglobin were associated with overall spirituality (p<0.04) and self-awareness (p<0.01).

Conclusions: Young adults with diabetes defined spirituality as a sense of being in touch with the inner self, meaning in life, and connecting with people, nature and a higher being. Spirituality is important to young adults with diabetes and helps them cope with stressful situations.

Adsorption, lubrication, and wear of lubricin on model surfaces : polymer brush-like behavior of a glycoprotein

Using a surface force apparatus, we have measured the normal and friction forces between layers of the human glycoprotein lubricin, the major boundary lubricant in articular joints, adsorbed from buffered saline solution on various hydrophilic and hydrophobic surfaces: i), negatively charged mica, ii), positively charged poly-lysine and aminothiol, and iii), hydrophobic alkanethiol monolayers. On all these surfaces lubricin forms dense adsorbed layers of thickness 60–100 nm. The normal force between two surfaces is always repulsive and resembles the steric entropic force measured between layers of end-grafted polymer brushes. This is the microscopic mechanism behind the antiadhesive properties showed by lubricin in clinical tests. For pressures up to ∼6 atm, lubricin lubricates hydrophilic surfaces, in particular negatively charged mica (friction coefficient μ = 0.02–0.04), much better than hydrophobic surfaces (μ > 0.3). At higher pressures, the friction coefficient is higher (μ > 0.2) for all surfaces considered and the lubricin layers rearrange under shear. However, the glycoprotein still protects the underlying substrate from damage up to much higher pressures. These results support recent suggestions that boundary lubrication and wear protection in articular joints are due to the presence of a biological polyelectrolyte on the cartilage surfaces.

Light-intensity physical activity and cardiometabolic biomarkers in US adolescents

Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomised controlled trial

Background

Many inpatients receive little or no rehabilitation on weekends. Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation.

This was a multicenter, single-blind (assessors) randomized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne, Australia. Patients were eligible if they were adults (aged ≥18 years) admitted for rehabilitation for any orthopedic, neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management. Participants were randomly allocated to usual care Monday to Friday rehabilitation (control) or to Monday to Saturday rehabilitation (intervention). The additional Saturday rehabilitation comprised physiotherapy and occupational therapy. The primary outcomes were functional independence (functional independence measure (FIM); measured on an 18 to 126 point scale), health-related quality of life (EQ-5D utility index; measured on a 0 to 1 scale, and EQ-5D visual analog scale; measured on a 0 to 100 scale), and patient length of stay. Outcome measures were assessed on admission, discharge (primary endpoint), and at 6 and 12 months post discharge.

We randomly assigned 996 adults (mean (SD) age 74 (13) years) to Monday to Saturday rehabilitation (n = 496) or usual care Monday to Friday rehabilitation (n = 500). Relative to admission scores, intervention group participants had higher functional independence (mean difference (MD) 2.3, 95% confidence interval (CI) 0.5 to 4.1, P = 0.01) and health-related quality of life (MD 0.04, 95% CI 0.01 to 0.07, P = 0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P = 0.1) when compared to control group participants. Intervention group participants were 17% more likely to have achieved a clinically significant change in functional independence of 22 FIM points or more (risk ratio (RR) 1.17, 95% CI 1.03 to 1.34) and 18% more likely to have achieved a clinically significant change in health-related quality of life (RR 1.18, 95% CI 1.04 to 1.34) on discharge compared to the control group. There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up. There was no difference in the number of adverse events between the groups (incidence rate ratio = 0.81, 95% CI 0.61 to 1.08).

Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation. 

Oral versus parenteral antimicrobials for the treatment of cellulitis : a randomized non-inferiority trial

Objectives To determine whether outcomes for patients with cellulitis treated with oral antimicrobials are as good as for those who are treated with parenteral antimicrobials.Methods A prospective randomized non-inferiority trial was conducted at a tertiary teaching hospital in Melbourne, Australia. Participants were patients referred by the emergency department for treatment of uncomplicated cellulitis with parenteral antimicrobials. Patients were randomized to receive either oral cefalexin or parenteral cefazolin. Parenteral antimicrobials were changed to oral after the area of cellulitis ceased progressing. The primary outcome was days until no advancement of the area of cellulitis. A non-inferiority margin of 15% was set for the oral arm compared with the parenteral arm. Secondary outcomes were failure of treatment, pain, complications and satisfaction with care. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000685910).Results Twenty-four patients were randomized to oral antimicrobials and 23 to parenteral antimicrobials. Mean days to no advancement of cellulitis was 1.29 (SD 0.62) for the oral arm and 1.78 (SD 1.13) for the parenteral arm, with a mean difference of −0.49 (95% CI: −1.02 to +0.04). The upper limit of the 95% CI of the difference in means of +0.04 was below the 15% non-inferiority margin of +0.27 days, indicating non-inferiority. More patients failed treatment in the parenteral arm (5 of 23, 22%) compared with the oral arm (1 of 24, 4%), although this difference was not statistically significant (P = 0.10). Pain, complications and satisfaction with care were similar for both groups.Conclusions Oral antimicrobials are as effective as parenteral antimicrobials for the treatment of uncomplicated cellulitis.

Self-reported racism and experience of toothache among pregnant Aboriginal Australians: the role of perceived stress, sense of control, and social support

Objectives We hypothesized that the psychosocial factors perceived stress and sense of personal control mediated the relationship between self-reported racism and experience of toothache. We hypothesized that social support moderated this relationship. Methods Data from 365 pregnant Aboriginal Australian women were used to evaluate experience of toothache, socio-demographic factors, psychosocial factors, general health, risk behaviors, and self-reported racism exposure. Hierarchical logistic regression models estimated odds ratios (ORs) and 95 percent confidence intervals (CIs) for experience of toothache. Perceived stress and sense of personal control were examined as mediators of the association between self-reported racism and experience of toothache. Social support was examined as a moderator. Results Self-reported racism persisted as a risk indicator for experience of toothache (OR 1.99, 95 percent CI 1.07-3.72) after controlling for age, level of education, and difficulty paying a $100 dental bill. The relationship between self-reported racism and experience of toothache was mediated by sense of control. The direct effect of self-reported racism on experience of toothache became only marginally significant, and the indirect effect was significant (β coefficient-=-0.04, bias-corrected 95 percent CI 0.004-0.105, 21.2 percent of effect mediated). Stress was insignificant as a mediator. Social support was insignificant as a moderator. Conclusions The findings indicate that high levels of self-reported racism were associated with experience of toothache and that sense of control, but not perceived stress, mediated the association between self-reported racism and experience of toothache among this sample of pregnant Aboriginal Australian women. Social support did not moderate the association between self-reported racism and experience of toothache.

A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial.

AIM: To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease (IHD).

METHODS AND RESULTS: In this single-blind, parallel, two-arm, randomized controlled trial adults (n = 171) with IHD were randomized to receive a mobile phone delivered intervention (HEART; n = 85) plus usual care, or usual care alone (n = 86). Adult participants aged 18 years or more, with a diagnosis of IHD, were clinically stable as outpatients, able to perform exercise, able to understand and write English, and had access to the Internet. The HEART (Heart Exercise And Remote Technologies) intervention involved a personalized, automated package of text messages and a secure website with video messages aimed at increasing exercise behaviour, delivered over 24 weeks. All participants were able to access usual community-based cardiac rehabilitation, which involves encouragement of physical activity and an offer to join a local cardiac support club. All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake (PVO2; primary outcome), self-reported physical activity, health-related quality of life, self-efficacy and motivation (secondary outcomes). Results showed no differences in PVO2 between the two groups (difference -0.21 ml kg(-1)min(-1), 95% CI: -1.1, 0.7; p = 0.65) at 24 weeks. However significant treatment effects were observed for selected secondary outcomes, including leisure time physical activity (difference 110.2 min/week, 95% CI: -0.8, 221.3; p = 0.05) and walking (difference 151.4 min/week, 95% CI: 27.6, 275.2; p = 0.02). There were also significant improvements in self-efficacy to be active (difference 6.2%, 95% CI: 0.2, 12.2; p = 0.04) and the general health domain of the SF36 (difference 2.1, 95% CI: 0.1, 4.1; p = 0.03) at 24 weeks. The HEART programme was considered likely to be cost-effective for leisure time activity and walking.

CONCLUSIONS: A mobile phone intervention was not effective at increasing exercise capacity over and above usual care. The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services.

Perceptual and cerebro-spinal responses to graded innocuous and noxious stimuli following aerobic exercise

The aim of this study was to evaluate the effect of aerobic exercise on perceptual and cerebro-spinal responses to graded electrocutaneous stimuli. The design comprised 2 x 30 min of cycling exercise at 30% and 70% of peak oxygen consumption (VO2 peak) on separate occasions in a counter-balanced order in 10 healthy participants. Assessment of nociceptive withdrawal reflex threshold (NWR-T), pain threshold (PT), and somatosensory evoked potentials (SEPs) to graded electrocutaneous stimuli were performed before and after exercise. Perceptual magnitude ratings and SEPs were compared at 30%PT, 60%PT, 100%PT before (Pre), 5 min after (Post1), and 15 min after (Post2) aerobic exercise. There was no difference in the NWR-T and the PT following exercise at 30% and 70% of VO2 peak. ANOVA for the perceptual response within pooled electrocutaneous stimuli show a significant main effect for time (F2,18=5.41, P=0.01) but no difference for exercise intensity (F1,9=0.02, P=0.88). Within-subject contrasts reveal trend differences between 30%PT and 100%PT for Pre-Post1 (P=0.09) and Pre-Post2 (P=0.02). ANOVA for the SEPs peak-to-peak signal amplitude (N1-P1) show significant main effect for time (F2,18=4.04, P=0.04) but no difference for exercise intensity (F1,9=1.83, P=0.21). Pairwise comparisons for time reveal differences between Pre-Post1 (P=0.06) and Pre-Post2 (P=0.01). There was a significant interaction for SEPs N1-P1 between exercise intensity and stimulus intensity (F2,18=3.56, P=0.05). These results indicate that aerobic exercise did not increase the electrocutaneous threshold for pain and the NWR-T. Aerobic exercise attenuated perceptual responses to innocuous stimuli and SEPs N1-P1 response to noxious stimuli.