Irisin/FNDC5: A Novel Player in Musculoskeletal Health

Osteoporosis is a major health problem that affects mainly aging and postmenopausal women and is characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility. Emerging shreds of evidence suggested that physical exercise has a beneficial effect on bone loss/osteoporosis. Irisin is a novel hormone-like myokine that was reported in 2012 and proposed to be produced in abundance by skeletal muscle as well as bone tissue in response to exercise. The studies have provided shreds of evidence that irisin can promote osteoblast differentiation, mineralization and increases bone mass and mechanical strength, and geometry in mice. We also review the autocrine effects of irisin in skeletal muscle, in which it upregulates expression of several pro-myogenic and exercise response genes in skeletal muscle including the expression of its precursor (FNDC5). In this review, we emphasize the structure and function of irisin and its functional role in skeletal homeostasis as well as skeletal muscle mass and regeneration. Further, the review narrates the future efficacy of irisin restoring the bone and reversing muscle wasting and could be developed as an irisin-based therapy for physically weaken and osteoporosis patients.

From Cardiopulmonary Resuscitation, Cardiopulmonary Exercise Test and Cardiopulmonary Coupling to NewTheory of Holistic Integrative Physiology and Medicine

The Holistic Integrative Physiology and Medicine (HIPM), which was firstly purposed by Xing-Guo Sun since 2011 at APS conference, is a brand-new concept of physiology and medicine for human being. It originated from the philosophy of traditional Chinese and Western medicine and culture. It steps upon the coupling ideas of systems, such as cardiopulmonary resuscitation (CPR) by Yuan-Chang Wang and Kouwenhoven, cardiopulmonary exercise testing (CPET) by Karlman Wasserman and cardiopulmonary coupling (CPC) and integrated physiology. HIPM’s concept is always combining not only “Holistic” but “Integrative” (rather than integrated), not only time but space, not only normal (i.e. physiology) but abnormal (i.e. pathophysiology and medicine) for human physiology and medicine: only one inseparable set in whole contenting the all functional systems and their control and regulation in human being are internally integrative altogether, rather than the integrated one-by-one system of two or more systems as integrative physiology in systemic physiology. HIPM approaches the mechanism of neurohumoral control and regulation with the integration of all systems in the human body. We described the rough constructural frame of HIPM theory and clearly explained many unique questions in physiological and medical and pathophysiological mechanism of patients with chronic diseases (CDs). With HIPM, we can widely apply the methods of CPET, CPC and continuous functional monitoring for accurate diagnosis and differential diagnosis, evaluation, training, treatment, rehabilitation, prognosis and prevention in clinical medicine. We also can accurately and quantitatively manage CDs and do initial successful practice of integration of optimized traditional therapy, rehabilitation, health care and management, eating, drinking, exercise, sleep and lifestyle modification in China. The implementation and popularization of HIPM has the excellent opportunity and prospect. HIPM is the future of human physiology and medicine.

Changes in Microvascular Reactivity and Systemic Vascular Resistance in Patients With Psoriasis

The aim: of this pilot study was to explore local blood flow in psoriatic plaques and normal skin before and after provocations known to alter cutaneous vascular resistance in order to test whether the increased flow was caused by a failure of normal vascular control processes in plaque skin and what association it has with cardiovascular parameters. Material and methods: 11 patients who had a diagnosis of psoriasis vulgaris were enrolled in the study. Cutaneous blood flow was recorded over plaque and clinically normal skin. 10 healthy sex and age matched subjects were selected as controls. Blood flow in psoriatic and normal skin was measured by a single- channel Laser Doppler blood flowmeter (Blood Flow meter, AD Instruments Ltd., Oxford, UK). Post-occlusive reactive hyperaemia was assessed on the plaque and non-plaque site. Cardiovascular parameters: heart rate, systolic and diastolic pressure, cardiac output, and vascular resistance were continuously monitored by a Finapres (FINAPRES Medical Systems, The Netherlands). Results: In patients, basal-LD flow was significantly higher in psoriatic skin compared to nonpsoriatic skin and significantly higher than in the controls. However, the post-occlusive hyperaemia test did not reveal significant differences between the patients and control subjects. Systemic vascular resistance was significantly lower in patients with psoriasis compared to healthy individuals. Conclusions: The results suggest that reduced microvascular resistance is associated with a significant increase in blood flow of psoriatic plaques and with lower systemic vascular resistance.

Are Plasma ST2 and Galectin-3 Predictors for Clinical Outcomes After Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy?

ST2 is a member of the interleukin-1 receptor family, which is expressed in a trans membrane form (ST2L) as well as in a soluble secreted form [1]. Recently, soluble ST2(sST2) was found to be elevated in patients with chronic heart failure with reduced ejection fraction (HFrEF) and regarded as a promising novel biomarkers that can improve risk stratification [2, 3]. In 2012, Broch K et al. showed that baseline sST2 was associated with death due to worsening heart failure (HF), hospitalization due to worsening HF, and all cardiovascular hospitalization in older patients with ischemic HF[4]. In a multicenter study enrolled 447 patients with acutely decompensated heart failure, sST2 was an independent predictor of mortality for 1 year follow-up, regardless of the left ventricular ejection fraction[5]. As a β-galactoside-binding lectin secreted by activated macrophages, galectin-3 (Gal-3) exists in the cytoplasm and in a secreted form, and is involved in several physiological and pathological processes that contribute to HF, including myocardial fibrosis, inflammation and cardiac remodeling [6-8]. Sub study of RELAX trial suggested that Gal-3 levels were associated with severity of renal dysfunction. De Boer et al. found that Gal-3 is an independent marker for composite end of all-cause mortality and HF hospitalization in HF and appears to be more powerful in patients with heart failure with preserved ejection fraction (HFpEF)[9]. According to results from the Aldo-DHF trial, plasma Gal-3 in HFpEF was associated with adverse outcome, independent of treatment or NT-proBNP [10].

Neonatal Size and Birth Canal Dimensions

The limitation of the fetal growth process during pregnancy is supposed to be an adaptative response to a physical or a physiological constraint: the pelvic size or the maternal resources and metabolism. In this study 131 mother-infant dyads were recruited. We investigate correlation between maternal traits (height, BMI) pelvic variables (conjugate diameter, inter-spinous diameter, sub-pubic angle) and neonatal traits (gestational age, birthweight, head, suboccipito-brematic and abdominal girth). We found that the three neonatal variables are significantly inter-correlated. Among maternal traits, height is highly correlated with conjugate and inter-spinous diameters. Subpubic angle is correlated with inter-spinous diameter. Among neonatal and pelvimetry correlations, conjugate diameter is highly correlated with suboccipito-bregmatic girth. The pelvic size seems to be the primary constraint to the fetal growth process. This adjustement of fetus size to the birth canal dimensions limits the risk of dystocia. But the way this adjustement occurs at the end of pregnancy is unclear. We assume that the uterus expansion limitation may be an intermediate mechanism explaining the high correlation between pelvic and neonatal traits.

Blood Pressure and Geometry of the Left Ventricle in Power Sports Athletes of Heavy Weight Categories

To research blood pressure and heart geometry in power sports athletes of heavy weight categories. Material and methods 645 representatives of the power sports (weightlifting, powerlifting, bodybuilding) having sports qualification of CMS, MS, IMS with the average body weight of 102.7 ± 6.4kg were examined. Everything to the examined athletes along with survey carried out the standard electrocardiogram of rest, double measurement of the ABP, a transthoracic echocardiography. Results A survey of 645 athletes of power sports of heavy weight categories showed that 238 (37%) athletes have high blood pressure (systolic blood pressure-157.4 ± 5.6, diastolic blood pressure-91.2 ± 5.3) and violation of left ventricular geometry. Reliably in hypertensive athletes, compared with normotensive athletes, the following heart parameters were increased: TIS by 0.1mm (p<0.01), TPWLV by 0.2mm <0.01), DRV by 4.2mm (p<0.01), LVMM by 32.2g (p<0.01), LVMI by 17.8g/m2 (p<0.01), RWTLV by 0.08mm (p<0.01). And also in the group of hypertensive athletes there was a significantly lower EDD by 0.2mm (p<0.05). Conclusion Thus, the patterns obtained in relation to associations of blood pressure and disorders of heart geometry of athletes of power sports, heavy weight categories, it may be implemented in prevention programs in future with priority focus on the "risk-bearing" groups of men.

Sunken Brain Syndrome

A 34-year old Chinese lady presented to the hospital in 2013 with acute left sided weakness and was found to have a right middle cerebral artery territory infarct requiring thrombolysis using intravenous alteplase. Her condition deterioriated post thrombolysis as it was complicated by right subdural hematoma, left parieto-occipital hematoma with mass effect and midline shift, for which she required urgent decompressive craniectomy and insertion of ventriculo-peritoneal (VP) shunt for hydrocephalus. Post-operatively she had severe physical and cognitive impairments. She was discharged home with a caregiver after an extensive period of inpatient rehabilitation. Repeated computed tomography (CT) brain between 2014 to 2016 revealed interval resolution of hematoma and stable hydrocephalus. (Figure 1). In late 2017 she was noted to have right gaze preference. Her Glasgow Coma Scale was 15 with no changes to her cognition or behavior. Blood pressure was 110/60 mmHg and pulse rate was 72/minute. Physical examination revealed concavity on the left temporalparietal region of the head. A repeat CT brain showed a concavity of the left craniectomy site suggestive of sunken brain syndrome (SBS) and progressive hydrocephalus from partial shunt blockage without trans-tentorial herniation (Figure 2). Prompt neurosurgical consult was sought and this was quickly followed with an acrylic cranioplasty and revision of VP shunt. She was reviewed post-operatively with resolution of right gaze preference.