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Exercise-induced dynamic hyperinflation in chronic obstructive pulmonary disease
No full textChronic obstructive pulmonary disease (COPD) is an inflammatory lung disease caused by inhalation of noxious particles, most commonly cigarette smoking. The consequent changes in airways, lung parenchyma and pulmonary vasculature lead to increased resistive, elastic and threshold loads and impaired capacity of the respiratory muscle pump. COPD is characterized by progressive expiratory flow limitation. During exercise, increases in respiratory rate lead to shortening of expiratory time with consequent gas trapping. The resultant increase in end-expiratory lung volume is referred to as dynamic hyperinflation. Dynamic hyperinflation leads to further load–capacity imbalance with consequent increased neural respiratory drive to maintain ventilatory homeostasis, which is closely related to exertional breathlessness intensity. Neuromechanical dissociation, resulting in uncoupling of increased neural respiratory drive from ventilatory output, develops due to mechanical limitations on tidal volume expansion and reduced force-generating capacity of the diaphragm as dynamic hyperinflation progresses during exercise. This review provides an overview of methods of measuring dynamic hyperinflation in COPD and clinical interventions that aim to alleviate lung hyperinflation and improve exercise tolerance
Omega-3 long-chain polyunsaturated fatty acid supplementation did not reduce inflammation to improve iron absorption in South African women living with overweight or obesity
Get PDFBackground: Young South African women face a double-burden of overweight or obesity and iron deficiency, with the former predicting the latter. Omega-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation can reduce inflammation. It is uncertain if this effect extends to adiposity-related inflammation, thereby reducing hepcidin secretion and improving iron absorption. Objectives: Using stable iron isotopes, we determined the effect of omega-3 LCPUFA supplementation on fractional iron absorption (FIA) from a meal containing iron as ferrous sulfate without and with ascorbic acid (AA). Methods: In this single-blind, uncontrolled, before–after intervention stable isotope study, 30 South African women aged 18–35 y with body mass index ≥28 kg/m 2, systemic inflammation, and a low omega-3 LCPUFA status, consumed a noninhibitory meal containing 6 mg iron, without and with AA, before and after 3 mo of daily supplementation with 2.1 g omega-3 LCPUFA. At baseline and endpoint, we measured FIA 14 d after consumption of the second meal, iron and inflammation markers, hepcidin, and omega-3 index. Results: At baseline and endpoint, addition of AA significantly improved FIA from the meal. Median (IQR) FIA before compared with after supplementation was not different for the meal without AA [9.7 (4.3–24.6)% compared with 11.8 (2.8–22.3)%; P = 0.962] nor the meal with AA [27.5 (10.6–43.8)% compared with 30.8 (9.6–60.9)%; P = 0.249]. Supplementation increased the omega-3 index from 4.61 (4.10–5.11)% to 5.97 (5.48–8.16)% (P < 0.001), but did not reduce hepcidin or improve the inflammation and iron status markers. In multiple linear regression analyses, hepcidin was a stronger predictor of FIA than AA. Conclusions: Addition of AA to the test meal, rather than omega-3 LCPUFA supplementation, improved iron absorption in South African women with overweight or obesity. Despite an increase in omega-3 index after omega-3 LCPUFA supplementation, it remained suboptimal, possibly explaining the lack of reduction in inflammation and hepcidin concentrations. This study was registered at clinicaltrials.gov as NCT05220735 (https://clinicaltrials.gov/study/NCT05220735?cond=obesity&term=iron%20absorption&rank=4).</p
Patients’ Experiences of Sexual Violence in Psychiatric Inpatient Care: A Systematic Review and Synthesis of Qualitative Studies
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Receptor-targeted technetium-99m radiopharmaceuticals:increasing access to molecular imaging in healthcare
Get PDFThe γ-emitting radionuclide, technetium-99m (99mTc), is widely accessible from 99mTc generators, and is routinely incorporated into diagnostic imaging radiopharmaceuticals that measure perfusion or anatomical process in disease. There is potential to expand the use of 99mTc to molecular radiopharmaceuticals, and leverage well-established and existing nuclear medicine infrastructure and resources (including nuclear reactor and 99mTc generator supply chains, radiopharmacies, γ-scintigraphy and SPECT cameras, and trained nuclear medicine staff) to increase patient access to the benefits of receptor-targeted molecular imaging, particularly in oncology. To achieve this, suitable chemistry is required to develop new 99mTc-labelled radiopharmaceuticals that incorporate 99mTc into biomolecules. This review describes how existing 99mTc chemistry has recently been applied to such innovations: chelator and ligand motifs (including mercapto-peptide, amine oxine, phosphine, isonitriles) that are already used for kit-based synthesis of 99mTc perfusion agents have been derivatised with biomolecular pharmacophores for receptor-targeted molecular imaging. Recent clinical trials have established an evidence basis illustrating the utility of these new receptor-targeted 99mTc radiopharmaceuticals. This work also describes the potential for an economical companion “theranostic” approach with the β--emitter, rhenium-188 (188Re), which can also be produced using generator technology. Initial preclinical and clinical studies have demonstrated that chemically analogous 99mTc and 188Re radiotracers show highly similar biodistribution patterns.</p
Exocrine Pancreatic Insufficiency Manifesting Before Insulin Dependence in Adult-Onset Type 1 Diabetes
Get PDFExocrine pancreatic insufficiency may precede insulin dependence in adult-onset type 1 diabetes. Unexplained steatorrhea or weight loss in people with diabetes warrants further investigations including imaging of abdomen/pancreas, exocrine pancreatic function and diabetes antibody testing. Early recognition and multidisciplinary care lead to improvements in symptoms and glycemic control.</p
Multimodal imaging suggests potential immune-vascular contributions to altered regional brain perfusion and oxygen metabolism in Post-COVID-19 Syndrome
Get PDFPost-COVID-19 Syndrome (PCS) frequently presents with persistent fatigue, cognitive impairment, and emotional symptoms. Although structural brain changes remain subtle, growing evidence implicates functional and metabolic disruptions in ongoing symptomatology. We used multimodal MRI to investigate cerebral perfusion and oxygen metabolism in PCS and examined their associations with cognitive function and peripheral biomarkers. We enrolled 40 individuals with prior mild SARS-CoV-2 infection, including 20 with persistent fatigue and 20 recovered controls matched for age, sex, BMI, and acute COVID-19 severity. Participants underwent structural MRI, arterial spin labelling (ASL) to quantify regional cerebral blood flow (CBF), and asymmetric spin echo imaging to estimate oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen consumption (CMRO 2). We assessed cognition using an online battery and measured serum levels of TNF-α, IL-6, IL-8, IL-13, IFN-γ, GFAP, and S100β, alongside blood routine tests. We performed ANCOVAs on predefined regions of interest (hippocampus, anterior cingulate cortex [ACC], insula, amygdala, striatum), followed by Bayesian inference and exploratory whole-brain analyses. PCS participants showed increased CMRO 2 in the hippocampus and decreased CMRO 2 in the ACC. Subfield analysis revealed elevated OEF and CMRO 2 across most hippocampal regions, excluding the entorhinal cortex. Whole-brain analyses identified increased perfusion in salience-related regions (insula, ACC, thalamus) and decreased perfusion in posterior cortical and cerebellar areas, in the absence of grey matter volume differences. Higher hippocampal metabolism positively correlated with cognitive performance, suggesting compensatory adaptation to sustain function. In contrast, lower ACC CMRO 2 correlated with depressive symptoms, reduced motivation, and elevated TNF-α and GFAP, consistent with neurovascular uncoupling possibly driven by immune-glial activation. These findings reveal distinct physiological disruptions in PCS, with potential implications for stratified, metabolism-focused interventions. </p
Building Community-Based Networks for Empowering Older Adults:The Role of Social Support Systems in Aging in Place.
No full textAgeing in place is a key objective in global health and social care policy. This chapter examines the role of community-based networks and social support systems in empowering older adults to live independently. Drawing on research, social support is explored as emotional, instrumental, informational, and social companionship. Through a synthesis of qualitative and quantitative data from community health initiatives, it presents an analytical framework that links structural and functional support with outcomes such as mental well-being, autonomy, and health service utilisation. Furthermore, it identifies enabling mechanisms such as intergenerational connectivity, local governance partnerships, and informal caregiving networks. Emphasis is placed on intergenerational ties, local partnerships, and informal caregiving. Recommendations include creating community hubs, enhancing digital inclusion, and promoting co-designed support structures. Empowered ageing is proposed as a shift from dependency to participation. Advocates for a paradigm shift from passive ageing to empowered ageing