Chronic intestinal psuedo-obstruction and MIDD, a rare cause of acute abdomen: implications in emergency surgery

Chronic intestinal pseudo-obstruction (CIPO) is a condition typified by the failure of the small bowel to propel contents in the absence of physical obstruction. CIPO is diagnosed after eliminating other causes, presenting a diagnostic challenge in emergency surgery. We report a case of a 32-year-old man with a rare mitochondrial disorder, Maternally inherited diabetes and deafness (MIDD), who presented to our hospital acutely unwell with peritonitis. Laparotomy revealed distended small bowel with no transition point, and turbid fluid with no macroscopic source. Postoperatively he had severe electrolyte and vitamin deficiencies. The diagnosis of CIPO leading to paralytic ileus and bacterial translocation was established and managed with aggressive electrolyte and vitamin replacement. He was discharged day 12 post operatively after a prolonged ileus with follow-up from a quaternary metabolic unit. We discuss here the challenges and gold standard in the emergency management of CIPO.

Clinical Profile of Indian Children with Down Syndrome

This retrospective study was performed on 208 patients with Down syndrome (DS) from heterogeneous ethnic population and admitted under Genetics Metabolic Unit. The aim of the study was to look for phenotypic variability and associated complications in children and adolescents with DS. The average age of the evaluated DS patients was 34 months. Cardiac anomalies were found in 128 (62%) of the 208 cases. Among the cardiac disorders, atrial septal defects accounted for 30% of cases. Other complications observed were hypothyroidism and developmental delay in around 31% cases and neonatal cholestasis in 14% cases. Also, we report two cases with Moya-Moya disease and one case with atlanto-axial dislocation.

Molecular and Epigenetic Basis of Extracellular Vesicles Cell Repair Phenotypes in Targeted Organ-specific Regeneration

: Extracellular vesicles (EVs), which released by most of the cells, constitute a new system of cell-cell communication by transporting DNA, RNA and proteins, in various vesiclesnamely exosomes, apoptotic bodies, protein complexes, high-density lipid (HDL) microvesicles, among others.To ensure accurate regulation of somatic stem cell activity, EVs function as an independent metabolic unit mediating the metabolic homeostasis and pathophysiological of several diseases such as cardiovascular diseases, metabolic diseases, neurodegenerative diseases,immune diseases andcancer. Whist examining the EV biomolecules cargos and its microenvironments that lead to epigenetic alteration of the cell in tissue regeneration, studies have gainedfurther insights into the biogenesis of EVs and their potential roles in cell biology and pathogenicity. Due to its small size, non-virulence, flexibility and ability to cross biological barriers, EVs become promising therapeutic potentials in various diseases.In this review, we describe EV’s mechanism of action in intercellular communication and transfer of biological informationas well as some details about EV-induced epigenetic changes in recipient cells that causephenotypic alteration during tissue regeneration. We also highlight some of the therapeuticpotentials of EVs in organ-specific regeneration.

Excess Dietary Fructose Does Not Alter Gut Microbiota or Permeability in Humans: A Randomized Controlled Pilot Study

ABSTRACTBackground and AimsNon-alcoholic fatty liver disease (NAFLD) is an increasing cause of chronic liver disease that accompanies obesity and the metabolic syndrome. Excess fructose consumption can initiate or exacerbate NAFLD due in part to a consequence of impaired hepatic fructose metabolism. Pre-clinical data have emphasized that fructose-induced altered gut microbiome, increased gut permeability, and endotoxemia play an important role in NAFLD, but human studies are sparse. The present study aimed to explore the relevance of these pre-clinical studies to observations in humans.MethodsWe performed a classical double-blind metabolic unit study in 10 obese subjects (BMI 30-40 mg/kg/m2) providing 75gms. of either fructose or glucose in their individual diets substituted isocalorically for complex carbohydrates in a cross-over study. Excess fructose intake was provided in the fructose arm of the study and totaled a mean of 22.7% of calories.ResultsRoutine blood, uric acid, liver function and lipid measurements were unaffected by the fructose intervention. The fecal microbiome (including Akkermansia muciniphilia), fecal metabolites, gut permeability, indices of endotoxemia, gut damage or inflammation and plasma metabolites were essentially unchanged by either intervention.ConclusionsAlthough pre-clinical rodent studies have shown that excess fructose causes pronounced changes in the gut microbiome, metabolome, and permeability as well as endotoxemia, this did not occur in obese individuals fed fructose in amounts known to enhance NAFLD. Therapeutic efforts to improve NAFLD through changes in the gut microbiome and gut homeostasis may not be beneficial.

­­Correlation analysis of oxygen consumptions between stepper and treadmill movements and implication for rehabilitation

Background: Stepper movement is popular as a home-based exercise. However, it has not been fully investigated how much energy is consumed during movement. This study aimed to investigate oxygen consumption for stepper movements at different cadence levels and to look into whether there are correlations between stepper movement and treadmill walking. Methods: Twenty two healthy volunteers (10 males, 12 females, aged between 18 and 40 years) participated in the study. The participants randomly performed stepper movements and treadmill walking at three different cadences, a self-determined comfortable cadence, a 20% higher and a 20% lower ones than the comfortable one. Their oxygen consumption was measured using Oxycon mobile® system. A set of parameters, e.g. VO2, Metabolic unit, Energy expenditure, etc were obtained. Statistical analysis was carried out to investigate correlations between stepper and treadmill movements in terms of oxygen consumptions. Results: Strong correlations were found between two types of movements, most of metabolic parameters had correlation coefficients ranged proximately between 0.5 to 0.8, p<0.001, e.g. 0.789 for VO2, 0.790 for energy consumption, 0.826 for ventilation, all p<0.001. In the conformable cadence level, VO2 for stepper movements was 826.49±56.02 (ml/min) while VO2 for treadmill walking was 787.16±56.02. Usually, stepper movements have oxygen consumption similar to or slightly higher than that in treadmill walking.Conclusions: This study indicates that stepper movement has similar oxygen consumption level to treadmill at a comfortable cadence level and at a 20% higher than the comfortable one, but stepper movement consumes more energy than treadmill walking by approximately 10% at lower cadence (i.e. 20% lower than the comfortable one). The study shows that the stepper movements is highly correlated with treadmill walking in terms of oxygen consumption, and thus stepper movement data provided can be used as a reference for the healthy to estimate their energy consumption in rehabilitation at home.

Correlation analysis of oxygen consumptions between stepper and treadmill movements and implication for rehabilitation

Background: Stepper movement is popular as a home-based exercise. However, it has not been fully investigated how much energy is consumed during movement. This study aimed to investigate oxygen consumption for stepper movements at different cadence levels and to look into whether there are correlations between stepper movement and treadmill walking. Methods: Twenty two healthy volunteers (10 males, 12 females, aged between 18 and 40) participated in the study. The participants randomly performed stepper movements and treadmill walking at three different cadences, a self-determined comfortable cadence, a 20% higher and a 20% lower ones than the comfortable one. Their oxygen consumption was measured using Oxycon mobile® system. A set of parameters, e.g. VO2, Metabolic unit, Energy expenditure, etc were obtained. Statistical analysis was carried out to investigate correlations between stepper and treadmill movements in terms of oxygen consumptions. Results: Strong correlations were found between two types of movements, most of metabolic parameters had correlation coefficients ranged proximately between 0.5 to 0.8, p<0.001, e.g. 0.789 for VO2, 0.790 for energy consumption, 0.826 for ventilation, all p<0.001. In the conformable cadence level, VO2 for stepper movements was 826.49±56.02 (ml/min) while VO2 for treadmill walking was 787.16±56.02. Usually, stepper movements have oxygen consumption similar to or slightly higher than that in treadmill walking.Conclusions: This study indicates that stepper movement has similar oxygen consumption level to treadmill at a comfortable cadence level and at a 20% higher than the comfortable one, but stepper movement consumes more energy than treadmill walking by approximately 10% at lower cadence (i.e. 20% lower than the comfortable one). The study shows that the stepper movements is highly correlated with treadmill walking in terms of oxygen consumption, and thus stepper movement data provided may be used to predict the treadmill data in rehabilitation in the future.

Correlation Analysis of Oxygen Consumptions Between Stepper and Treadmill Movements and Implication for Rehabilitation

Background: Stepper movement is popular as a home-based exercise. However, it has not been fully investigated how much energy is consumed during movement. This study aimed to investigate oxygen consumption for stepper movements at different cadence levels and to look into whether there are correlations between stepper movement and treadmill walking. Methods: Twenty two healthy volunteers (10 males, 12 females, aged between 18 and 40) participated in the study. The participants performed stepper movements and treadmill walking at three different cadences, a self-determined comfortable cadence, a 20% higher and a 20% lower ones than the comfortable one. Their oxygen consumption was measured using Oxycon mobile® system. A set of parameters, e.g. VO2, Metabolic unit, Energy expenditure, etc were obtained. Statistical analysis was carried out to investigate correlations between stepper and treadmill movements in terms of oxygen consumptions. Results: Strong correlations were found between two types of movements, most of metabolic parameters had correlation coefficients ranged proximately between 0.5 to 0.8, p<0.001. In the conformable cadence level, VO2 for stepper movements was 826.49±56.02 (ml/min) while VO2 for treadmill walking was 787.16±56.02. Usually, stepper movements have oxygen consumption similar to or slightly higher than that in treadmill walking.Conclusions: This study indicates that stepper movement has similar oxygen consumption level to treadmill at a comfortable cadence level and at a 20% higher than the comfortable one, but stepper movement consumes more energy than treadmill walking by approximately 10% at lower cadence (i.e. 20% lower than the comfortable one). The study shows that the stepper movements is highly correlated with treadmill walking in terms of oxygen consumption, and thus stepper movement data provided can be used to predict the treadmill data in rehabilitation.

Parallel evolution in the integration of a co-obligate aphid symbiosis

SUMMARYInsects evolve dependencies - often extreme - on microbes for nutrition. These include cases where insects harbour multiple endosymbionts that function collectively as a metabolic unit. How do these metabolic co-dependencies originate, and is there a predictable sequence of events leading to the integration of new symbionts? While dependency on multiple nutrient-provisioning symbionts has evolved numerous times across sap-feeding insects, there is only one known case of metabolic co-dependency in aphids, between Buchnera aphidicola and Serratia symbiotica in the Lachninae subfamily. Here we identify three additional independent transitions to the same co-obligate symbiosis in different aphids. A comparison of recent and ancient associations allows us to investigate intermediate stages of metabolic and physical integration between the typically facultative symbiont, Serratia, and the ancient obligate symbiont Buchnera. We find that these uniquely replicated evolutionary events support the idea that co-obligate associations initiate in a predictable manner, through parallel evolutionary processes. Specifically, we show (i) how the repeated losses of the riboflavin pathway in Buchnera leads to dependency on Serratia, (ii) evidence of a stepwise process of symbiont integration, whereby dependency evolves first, then essential amino acid pathways are lost (at ~30-60MYA), which coincides with increased physical integration of the companion symbiont; and (iii) dependency can evolve prior to specialised structures (e.g. bacteriocytes), and in one case with no direct nutritional basis. More generally, our results suggest the energetic costs of synthesising nutrients may provide a unified explanation for the sequence of gene loses that occur during the evolution of co-obligate symbiosis.

Indoor Thermal Comfort of Pregnant Women in Hospital: A Case Study Evidence

Despite studies on thermal comfort being consolidated in the scientific literature, people’s well-being in some specific conditions and places, such as hospitals, requires to be further explored. The paper describes the methodological approach adopted to evaluate thermal comfort level and perception of pregnant women hosted in the obstetric ward of a test-bed case (Sant’Orsola hospital in Bologna, Italy). The methodology adopts a mixed approach that compares the results of on-site monitoring by probe (as quantitative data) with the ones of a survey (questionnaire form) delivered to the involved subjects (as qualitative data) to understand if metabolic alteration may influence the pregnant women’s perception of comfort conditions. The first follows ISO 7730, the second, ISO 10551. The comparison between the instrumental collected data and the outcomes of the survey revealed a wide gap between TSV (Thermal Sensation Vote) and PMVm (Predicted Mean Vote, measured on-site). The reason can be identified in the use of a standardized metabolic unit from ISO that does not correctly reflect the physiologic condition of pregnant women. Following a trial and error methodology, a met value for pregnant women is accordingly proposed. Moreover, an adaptive thermal comfort approach is adopted. This research is a first step towards the definition of specific thermal comfort in a hospital ward hosting pregnant women and more generally offers a reflection about the need to define specific met in the standards for some particular categories (children, elderly, pregnant women, etc.) when investigating thermal comfort.