An intestinal model with a finger-like villus structure fabricated using a bioprinting process and collagen/SIS-based cell-laden bioink

The surface of the small intestine has a finger-like microscale villus structure, which provides a large surface area to realize efficient digestion and absorption. However, the fabrication of a villus structure using a cell-laden bioink containing a decellularized small intestine submucosa, SIS, which can induce significant cellular activities, has not been attempted owing to the limited mechanical stiffness, which sustains the complex projective finger-like 3D structure. In this work, we developed a human intestinal villi model with an innovative bioprinting process using a collagen/SIS cell-laden bioink. Methods: A Caco-2-laden microscale villus structure (geometry of the villus: height = 831.1 ± 36.2 μm and diameter = 190.9 ± 3.9 μm) using a bioink consisting of collagen type-I and SIS was generated using a vertically moving 3D bioprinting process. By manipulating various compositions of dECM and a crosslinking agent in the bioink and the processing factors (printing speed, printing time, and pneumatic pressure), the villus structure was achieved. Results: The epithelial cell-laden collagen/SIS villi showed significant cell proliferation (1.2-fold) and demonstrated meaningful results for the various cellular activities, such as the expression of tight-junction proteins (ZO-1 and E-cadherin), ALP and ANPEP activities, MUC17 expression, and the permeability coefficient and the glucose uptake ability, compared with the pure 3D collagen villus structure. Conclusion: In vitro cellular activities demonstrated that the proposed cell-laden collagen/dECM villus structure generates a more meaningful epithelium layer mimicking the intestinal structure, compared with the pure cell-laden collagen villus structure having a similar villus geometry. Based on the results, we believe that this dECM-based 3D villus model will be helpful in obtaining a more realistic physiological small-intestine model.

A Myoblast-Laden Collagen Bioink with Fully Aligned Au Nanowires for Muscle-Tissue Regeneration

Contact guidance can promote cell alignment and is thus widely employed in tissue regeneration. In particular, skeletal muscle consists of long fibrous bundles of multinucleated myotubes formed by the fusion and differentiation of the satellite cells of myoblasts. Herein, a functional bioink and cell-printing process supplemented with an electric field are proposed for obtaining highly aligned myoblasts in a collagen-based bioink. To achieve the goal, we mixed Au nanowires (GNWs) with the collagen-based bioink to provide aligned topographical cues to the laden cells. Because the aligned GNWs could clearly provide topographical cues to the cells, we adjusted various processing parameters (flow rate, nozzle speed, and processing temperature) and applied an external electric field to optimally align the GNWs. By selecting an appropriate condition, the GNWs in the printed C2C12-laden structure were well aligned in the printing direction, and they eventually induced a high degree of myoblast alignment and efficient myotube formation. Through the several in vitro cellular activities and in vivo works revealing the myogenesis of the cell-laden structure, we conclude that the collagen/GNW-based cell-laden structure fabricated using the proposed method is a new prospective platform for the effective formation of muscle tissues.

Galectin-3 Interacts with C/EBPβ and Upregulates Hyaluronan-Mediated Motility Receptor Expression in Gastric Cancer

The hyaluronan-mediated motility receptor (HMMR) is overexpressed in gastric cancer; however, the apparent role of HMMR has not been well defined owing to lack of detailed studies on gastric tumorigenesis. Therefore, we elucidated the functional and regulatory mechanisms of HMMR in gastric cancer. Using publicly available data, we confirmed HMMR overexpression in patients with gastric cancer. HMMR silencing decreased proliferation, migration, and invasion of gastric cancer cells, whereas HMMR overexpression reversed these effects. A gastric cancer xenograft mouse model showed statistically significant inhibition of tumor growth upon HMMR depletion. Previous data from cDNA microarray showed reduced HMMR expression upon inhibition of galectin-3. However, overexpression of galectin-3 increased HMMR expression, cell proliferation, and motility in gastric cancer cells, whereas HMMR silencing blocked these effects. Interestingly, galectin-3 interacted directly with C/EBPβ and bound to HMMR promoter to drive its transcription, and gastric cancer cell proliferation and motility. Altogether, high expression of HMMR promoted gastric cancer cell proliferation and motility and could be a prognostic factor in gastric cancer. In addition, HMMR expression was regulated by the interaction between C/EBPβ and galectin-3. Therefore, targeting HMMR along with galectin-3 and C/EBPβ complex could be a potential treatment strategy for inhibiting gastric cancer progression and metastasis. IMPLICATIONS: This study provides evidence that galectin-3 interacts with C/EBPβ in gastric cancer, and galectin-3 and C/EBPβ complex promotes gastric cancer cell progression and motility through upregulating HMMR expression.

Geranium thunbergii extract-induced G1 phase cell cycle arrest and apoptosis in gastric cancer cells

Geranium thunbergii is a traditional East Asian medicine for stomach diseases including dysentery and stomach ulcers in East Asia and has been reported to possess biological activity. The benefits of G. thunbergii in gastric cancer are unknown. In this study, we demonstrate that G. thunbergii extract suppresses proliferation and induces death and G1/S cell cycle arrest of gastric cancer cells. Proliferation was significantly inhibited in a time- and dose-dependent manner. Cell cycle arrest was associated with significant decreases in CDK4/cyclinD1 complex and CDK2/cyclinE complex genes expression. In addition, the protein expression of caspase-3 was decreased and that of activated poly (ADP-ribose) polymerase (PARP) was increased, which indicated apoptosis. The expressions of the Bax and Bcl-2, which are apoptosis related proteins, were upregulated and down-regulated, respectively. The results indicate that G. thunbergii extract can inhibit proliferation and induce both G/S cell cycle arrest and apoptosis of gastric cancer cells. Also, the induction of apoptosis involved the intrinsic pathways of the cells. Take the results, we suggest that G. thunbergii extract has anti-gastric cancer activity and may be a potential therapeutic candidate for gastric cancer.

Comparison of Hot Deformation Behavior Characteristics Between As-Cast and Extruded Al-Zn-Mg-Cu (7075) Aluminum Alloys with a Similar Grain Size

The hot compressive behavior and processing maps of as-cast and extruded 7075 aluminum alloys with a similar grain size (320–350 μm) were studied and compared, which allows us to directly observe the effect of segregated phases in the as-cast microstructure on the deformation behavior and hot workability of 7075 alloys. In the as-cast alloy, the compound phases segregated along the interdendritic interfaces within the interiors of original grains provided the additional sites for continuous dynamic recrystallization via the particle stimulation nucleation mechanism. As a result, the as-cast alloy exhibited higher fractions of recrystallized grains and smaller grain sizes than the extruded alloy after compression. The stress exponent values of the as-cast alloy were smaller than those of the extruded alloy. In the processing maps, the domain associated with high power dissipation efficiencies (≥35%) occurred in a wider temperature range in the as-cast alloy compared to the extruded alloy. The segregated phases that remained undissolved in the as-cast alloy after compressive deformation could be effectively eliminated during the solid solution treatment (753 K for 2 h) for T6 aging applied after hot compression. The current results suggest the possibility and advantage of omitting the extrusion step when preparing 7xxx aluminum forging or extrusion feedstocks for hot working. The proposed method can be applied to other precipitation hardenable aluminum alloys.

Effect of Hierarchical Scaffold Consisting of Aligned dECM Nanofibers and Poly(lactide-co-glycolide) Struts on the Orientation and Maturation of Human Muscle Progenitor Cells

Extracellular matrices (ECMs) derived from tissues and decellularized are widely used as biomaterials in tissue engineering applications because they encompass tissue-specific biological and physical cues. In this study, we utilized a solubilized decellularized tissue (dECM) obtained from skeletal muscle to fabricate a nanofibrous structure using the electrospinning technique. The dECM was chemically modified by methacrylate reaction (dECM-MA) to improve the structural stability before electrospinning. The electrospun dECM-MA nanofibers were combined with microscale fibrillated poly(lactide-co-glycolide) (PLGA) constructs fabricated by three-dimensional printing and fibrillation/leaching of poly(vinyl alcohol) to promote skeletal muscle cell orientation and maturation. Using the electrostatic force-assisted fiber-alignment method, a multiscale composite scaffold consisting of fibrillated PLGA and aligned dECM-MA nanofibers was fabricated. The multiscale dECM-MA/PLGA composite scaffold significantly promoted the cellular orientation and myotube formation of human muscle progenitor cells compared to control scaffolds. The results suggested the potential use of the multiscale dECM-MA/PLGA composite scaffold, which contains the biochemical and topographical cues, for bioengineering a skeletal muscle tissue construct.

Identification of chronic obstructive pulmonary disease subgroups in 13 Asian cities

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition that can differ in its clinical manifestation, structural changes and response to treatment.

OBJECTIVE

To identify subgroups of COPD with distinct phenotypes, evaluate the distribution of phenotypes in four related regions and calculate the 1-year change in lung function and quality of life according to subgroup.

METHODS

Using clinical characteristics, we performed factor analysis and hierarchical cluster analysis in a cohort of 1676 COPD patients from 13 Asian cities. We compared the 1-year change in forced expiratory volume in one second (FEV1), modified Medical Research Council dyspnoea scale score, St George's Respiratory Questionnaire (SGRQ) score and exacerbations according to subgroup derived from cluster analysis.

RESULTS

Factor analysis revealed that body mass index, Charlson comorbidity index, SGRQ total score and FEV1 were principal factors. Using these four factors, cluster analysis identified three distinct subgroups with differing disease severity and symptoms. Among the three subgroups, patients in subgroup 2 (severe disease and more symptoms) had the most frequent exacerbations, most rapid FEV1 decline and greatest decline in SGRQ total score.

CONCLUSION

Three subgroups with differing severities and symptoms were identified in Asian COPD subjects.

PIN1 is a new therapeutic target of craniosynostosis

Gain-of-function mutations in fibroblast growth factor receptors (FGFRs) cause congenital skeletal anomalies, including craniosynostosis (CS), which is characterized by the premature closure of craniofacial sutures. Apert syndrome (AS) is one of the severest forms of CS, and the only treatment is surgical expansion of prematurely fused sutures in infants. Previously, we demonstrated that the prolyl isomerase peptidyl-prolyl cis-trans isomerase interacting 1 (PIN1) plays a critical role in mediating FGFR signaling and that Pin1+/- mice exhibit delayed closure of cranial sutures. In this study, using both genetic and pharmacological approaches, we tested whether PIN1 modulation could be used as a therapeutic regimen against AS. In the genetic approach, we crossbred Fgfr2S252W/+, a mouse model of AS, and Pin1+/- mice. Downregulation of Pin1 gene dosage attenuated premature cranial suture closure and other phenotypes of AS in Fgfr2S252W/+ mutant mice. In the pharmacological approach, we intraperitoneally administered juglone, a PIN1 enzyme inhibitor, to pregnant Fgfr2S252W/+ mutant mice and found that this treatment successfully interrupted fetal development of AS phenotypes. Primary cultured osteoblasts from Fgfr2S252W/+ mutant mice expressed high levels of FGFR2 downstream target genes, but this phenotype was attenuated by PIN1 inhibition. Post-translational stabilization and activation of Runt-related transcription factor 2 (RUNX2) in Fgfr2S252W/+ osteoblasts were also attenuated by PIN1 inhibition. Based on these observations, we conclude that PIN1 enzyme activity is important for FGFR2-induced RUNX2 activation and craniofacial suture morphogenesis. Moreover, these findings highlight that juglone or other PIN1 inhibitors represent viable alternatives to surgical intervention for treatment of CS and other hyperostotic diseases.

Intestinal Villi Model with Blood Capillaries Fabricated Using Collagen-Based Bioink and Dual-Cell-Printing Process

The human intestine, a vital organ in our digestive system, shows an anatomically complex architecture. The fabrication of three-dimensional (3D) intestinal models containing villus structures has been an important topic for intestine regeneration or organ-on-a-chip, because a 3D model can provide broad surface area and help absorption and transportation of digested nutrients. In this study, we developed a 3D intestinal villi model containing an epithelium layer and a blood capillary structure, using an innovative cell-printing process. The epithelium and capillary network of the 3D model were fabricated using two collagen-based bioinks laden with Caco-2 cells and human umbilical vein endothelial cells (HUVECs). The fabricating conditions were optimized to obtain a unique 3D villus structure, with capillary in the core and high cell viability. A fabricated single villus was 183 ± 12 μm in diameter and 770 ± 42 μm in height, which means the aspect ratio of the structure was 4.2 ± 0.3. The results indicate that the cell-laden intestinal villi successfully mimicked the 3D geometry of human intestinal villi. In vitro cellular activity of the 3D villi model containing epithelium and capillary demonstrated significantly higher cell growth and expression of enzymes and MUC17, compared to those of 2D models and a 3D villi model without the capillary network. The suggested 3D intestinal villi also exhibited the enhancement of the barrier function as compared to those of the others, and even demonstrated an increase of the permeability coefficient of FITC-dextran and glucose uptake ability (FITC, fluorescein isothiocyanate). These results indicate that a 3D intestinal villi model would be a highly promising for mimicking the human intestine.

Effect of relative humidity on inactivation of foodborne pathogens using chlorine dioxide gas and its residues on tomatoes

The effect of relative humidity (RH) on the antimicrobial efficacy of chlorine dioxide (ClO₂ ) gas against foodborne pathogens on tomatoes was evaluated. Also, levels of ClO₂ residues on tomatoes after exposure to ClO₂ gas under different RH conditions were measured to determine the quantity of solubilized ClO₂ gas on tomato surfaces. Escherichia coli O157:H7, Salmonella Typhimurium and Listeria monocytogenes were inoculated on tomatoes and exposed to ClO₂ gas (5, 10, 20 and 30 ppmv) under different RH conditions (50, 70 and 90%). As ClO₂ gas concentration and treatment time increased, significant differences (P < 0·05) were observed between inactivation levels under different RH conditions. Exposure to 30 ppmv of ClO₂ gas (50% RH) for 20 min resulted in 1·22-1·52 log reductions of the three foodborne pathogens. Levels of the three foodborne pathogens were reduced to below the detection limit (0·48 log CFU per cm² ) within 15 min when exposed to 30 ppmv of ClO₂ gas at 70% RH and within 10 min at 90% RH. At a given ClO₂ gas concentration, ClO₂ residues on tomatoes significantly (P < 0·05) increased with increasing RH, and there were close correlations between log reductions of pathogens and ClO₂ residues on tomatoes.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study reported on the correlation between the amount of ClO₂ residues on produce surfaces and the level of inactivation of pathogens after ClO₂ gas treatment. Variations in RH have great effect on the solubilization of ClO₂ gas on tomato surfaces considering that ClO₂ residues on tomatoes increased with increasing RH. Also, the amount of ClO₂ residues on tomatoes is positively correlated with the level of inactivation of pathogens. The results of this study provide insights for predicting inactivation patterns of foodborne pathogens by ClO₂ gas for practical application by the fresh produce industry.

Topologically Micropatterned Collagen and Poly(ε-caprolactone) Struts Fabricated Using the Poly(vinyl alcohol) Fibrillation/Leaching Process To Develop Efficiently Engineered Skeletal Muscle Tissue

Optimally designed three-dimensional (3D) biomedical scaffolds for skeletal muscle tissue regeneration pose significant research challenges. Currently, most studies on scaffolds focus on the two-dimensional (2D) surface structures that are patterned in the micro-/nanoscales with various repeating sizes and shapes to induce the alignment of myoblasts and myotube formation. The 2D patterned surface clearly provides effective analytical results of pattern size and shape of the myoblast alignment and differentiation. However, it is inconvenient in terms of the direct application for clinical usage due to the limited thickness and 3D shapeability. Hence, the present study suggests an innovative hydrogel or synthetic structure that consists of uniaxially surface-patterned cylindrical struts for skeleton muscle regeneration. The alignment of the pattern on the hydrogel (collagen) and poly(ε-caprolactone) struts was attained with the fibrillation of poly(vinyl alcohol) and the leaching process. Various cell culture results indicate that the C2C12 cells on the micropatterned collagen structure were fully aligned, and that a significantly high level of myotube formation was achieved when compared to the collagen structures that were not treated with the micropatterning process.

Effective Dose of Remifentanil for Control of Haemodynamic Response to Insertion of the Streamlined Liner of the Pharyngeal Airway

Objective

To determine the dose of remifentanil needed to achieve successful insertion of the Streamlined Liner of the Pharyngeal Airway (SLIPA™) without the development of hypertension in 95% of the patients.

Design

Randomised controlled trial.

Setting

operating theatre of a university hospital

Methods

A total of 100 ASA I or II patients requiring SLIPA insertion were randomly assigned to receive normal saline (Group C) or one of the four different doses (0.5 µg/kg [Group R0.5], 1.0 µg/kg [Group R1], 1.5 µg/kg [Group R1.5] or 2.0 µg/kg [Group R2]) of remifentanil. Arterial blood pressure and heart rate were recorded at preanesthetic baseline, preinserton, and every one minute during the initial 3 minutes period after insertion.

Results

A Probit model of remifentanil concentration was predictive of successful insertion of SLIPA without the development of hypertension. The ED95 of remifentanil needed to suppress haemodynamic response from SLIPA insertion was 1.39 µg/kg (95% confidence interval, 1.06-2.61 µg/kg).

Conclusions

A single administration of remifentanil can effectively suppress haemodynamic changes due to the insertion of SLIPA.

Effect of motor imagery training and electromyogram-triggered neuromuscular electrical stimulation on lower extremity function in stroke patients: a pilot trial

[Purpose] To investigate the effect of motor imagery training and electromyogram-triggered neuromuscular electrical stimulation (MIT-EMG NMES) on the lower extremity function of stroke patients. [Subjects and Methods] This study recruited eight patients with hemiplegia due to stroke. All patients received MIT-EMG NMES for 20 min daily, 5 days per week for 4 weeks. Lower extremity function were assessed using the timed up-and-go (TUG) and 10-meter walk (10MW) tests. [Results] The results of TUG test decreased significantly from 20.5 ± 4.5 to 14.0 ± 3.5 s, while those of 10 MW test showed a significant decrease from 21.3 ± 4.5 to 15.5 ± 3.2 m. [Conclusion] This study suggests that MIT-EMG NMES is a new rehabilitation therapy for lower extremity recovery in hemiplegic stroke patients.

Effects of jaw opening exercise on aspiration in stroke patients with dysphagia: a pilot study

[Purpose] The purpose of this study was to investigate the effect of jaw opening exercise (JOE) on aspiration in patients with dysphagia after stroke. [Subjects and Methods] Three subjects were recruited. Isometric and isotonic JOE were performed using a rubber ball, 5 days a week for 4 weeks. Aspiration was evaluated using the penetration-a spiration scale (PAS) based on a videofluoroscopic swallowing study. [Results] All subjects showed a score reduction of at least 1 point and a maximum reduction of 2 points in the PAS in the liquid type. [Conclusion] This study confirmed that JOE can be used to reduce aspiration in patients with dysphagia after stroke.

Effect of neuromuscular electrical stimulation on lip strength and closure function in patients with dysphagia after stroke

[Purpose] This study aimed to investigate the effect of neuromuscular electrical stimulation (NMES) on lip strength and closure function of patients with dysphagia after stroke. [Subjects and Methods] Eight patients with dysphagia were recruited. NMES was applied to the orbicularis oris muscle. All the participants received NMES for 30 min/d, 5 d/wk, for 4 weeks. Lip strength was measured using the Iowa Oral Performance Instrument. To assess lip closure, the lip closure subitem of the videofluoroscopic dysphagia scale was used. [Results] Lip strength showed significant improvement and lip closure function showed a significant decrease. [Conclusion] This study demonstrates that NMES is useful for improving lip strength and closure function.

Differences in maximal strength and endurance of the tongue according to region in healthy adults

[Purpose] The purpose of this study was to identify differences in maximal strength and endurance of the tongue among healthy adults. [Subjects and Methods] A total of 60 healthy volunteers (30 men; 30 women; age range, 20–26 years) were recruited and evaluated for maximal strength and endurance of the anterior and posterior regions of the tongue using the Iowa Oral Performance Instrument. [Results] Tongue strength in the anterior region was greater than that in the posterior region. In contrast, tongue endurance in the posterior region was greater than that in the anterior region. [Conclusion] In conclusion, these results confirm that the anterior region of the tongue exhibits greater strength, whereas the posterior region exhibits greater endurance.

Development of a tannic acid cross-linking process for obtaining 3D porous cell-laden collagen structure

Cell-printing is an emerging technique that enables to build a customized structure using biomaterials and living cells for various biomedical applications. In many biomaterials, alginate has been widely used for rapid gelation, low cost, and relatively high processability. However, biocompatibilities enhancing cell adhesion and proliferation were limited, so that, to overcome this problem, an outstanding alternative, collagen, has been extensively investigated. Many factors remain to be proven for cell-printing applications, such as printability, physical sustainability after printing, and applicability of in vitro cell culture. This study proposes a cell-laden collagen scaffold fabricated via cell-printing and tannic acid (TA) crosslinking process. The effects of the crosslinking agent (0-3wt% TA) in the cell-laden collagen scaffolds on physical properties and cellular activities using preosteoblasts (MC3T3-E1) were presented. Compared to the cell-laden collagen scaffold without TA crosslinking, the scaffold with TA crosslinking was significantly enhanced in mechanical properties, while reasonable cellular activities were observed. Concisely, this study introduces the possibility of a cell-printing process using collagen and TA crosslinking and in vitro cell culture for tissue regeneration.

Comparative study of new autologous material, bone-cartilage composite graft, for ossiculoplasty with Polycel® and Titanium

OBJECTIVE

Ossiculoplasty is a surgical procedure that recreates sound transmission of the middle ear in conductive hearing loss. Various materials have been used for ossicular reconstruction, but the most ideal material for ossiculoplasty remains controversial. The purpose of this study was to introduce a novel method of autologous ossiculoplasty, bone-cartilage composite graft (BCCG) and to compare its surgical results with different types of ossiculoplastic prostheses.

STUDY DESIGN

A retrospective study was performed in a tertiary referral centre.

METHODS

Data of 275 patients who received ossiculoplasty using the three different materials of BCCG, Polycel^® and titanium were analysed according to type of ossiculoplasty: partial or total ossicular replacement prosthesis (PORP or TORP). Hearing results, complication rates and clinical parameters including age, sex, past history, preoperative diagnosis and surgery type were compared among different groups.

RESULTS

Ossiculoplasty with BCCG showed satisfactory hearing outcomes and the lowest complication rate among the three different materials. In particular, its extrusion rate was 0%.

CONCLUSION

We propose that the BCCG technique is a useful alternative method for ossiculoplasty, with proper patient selection.

Preparation and characterization of gelatin/α-TCP/SF biocomposite scaffold for bone tissue regeneration

In this study, we suggest a new biocomposite scaffold composed of gelatin/α-TCP (tricalcium phosphate)/SF (silk-fibroin) (GTS) which has enhanced mechanical strength and high level of cellular activity. To fabricate GTS scaffold, a temperature-controlled 3D printing process was used and appropriate printing conditions were selected based on rheological data. To show the feasibility as a biomedical scaffold for bone tissue regeneration, the various physical and biological results, using MG63 (osteoblast-like cells), of the GTS scaffold were compared with those of a pure gelatin (G) and gelatin/α-TCP (GT) composite scaffold. GTS scaffolds showed enhanced mechanical properties in dry and wet state compared to those of the G and GT scaffolds. Also, significantly high cell-proliferation and differentiation of MG63 cells were observed in the GTS scaffold. Therefore, the GTS composite scaffold will be one of highly potential biomaterials to be used in bone regeneration.

Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation

OBJECTIVE

To analyse the predictors and mortality rate among patients receiving mechanical ventilation (MV) for respiratory failure due to pulmonary tuberculosis (TB).

DESIGN

We retrospectively compared patients who required MV for TB with patients who required MV for community-acquired pneumonia (CAP).

RESULTS

In-hospital mortality was significantly different between the two groups: 95.1% in TB vs. 62.7% in CAP (P < 0.001 using the χ(2) test). TB patients had a higher 30-day mortality (P = 0.040 using log-rank test), although the median sequential organ failure assessment (SOFA) (7.0 vs. 6.0, P = 0.842) and mean Acute Physiology and Chronic Health Evaluation (APACHE) II scores (20.0 ± 6.7 vs. 21.2 ± 6.7, P = 0.379) for TB and CAP patients were not different. TB patients were more likely to have increased lung lesion intrusions (OR 1.307, 95%CI 1.042-1.641, P = 0.021), and reduced albumin (OR 0.073, 95%CI 0.016-0.335, P = 0.001), C-reactive protein (OR 0.324, 95%CI 0.146-0.716, P = 0.005) and CURB-65 score (confusion, uraemia, respiratory rate, blood pressure and age ⩾65 years) (OR 0.916, 95%CI 0.844-0.995, P = 0.037).

CONCLUSIONS

TB patients showed identical SOFA and APACHE II scores, but higher mortality than CAP patients. The higher mortality was not related to severity, but suggested an association with the extent of destructive lung lesions.

The effects of tongue stretching exercise on tongue length in healthy adults: a preliminary study

[Purpose] The purpose of this study was to investigate the effects of tongue stretching exercise on the tongue length of healthy adults. [Subjects and Methods] This study recruited 6 healthy adults. They were treated for 4 weeks with tongue stretching. The change in tongue length during tongue protrusion before and after intervention was measured using a ruler. [Results] All 6 participants showed increased tongue length (minimum 20 mm to maximum 40 mm). [Conclusion] This study confirms that tongue stretching is a useful method to increase tongue length.

Precision of dual-energy X-ray absorptiometry of the knee and heel: methodology and implications for research to reduce bone mineral loss after spinal cord injury

STUDY DESIGN

Methodological validation of dual-energy x-ray absorptiometry (DXA)-based measures of leg bone mineral density (BMD) based on the guidelines of the International Society for Clinical Densitometry.

OBJECTIVES

The primary objective of this study was to determine the precision of BMD estimates at the knee and heel using the manufacturer provided DXA acquisition algorithm. The secondary objective was to determine the smallest change in DXA-based measurement of BMD that should be surpassed (least significant change (LSC)) before suggesting that a biological change has occurred in the distal femur, proximal tibia and calcaneus.

SETTING

Academic Research Centre, Canada.

METHODS

Ten people with motor-complete SCI of at least 2 years duration and 10 people from the general population volunteered to have four DXA-based measurements taken of their femur, tibia and calcaneus. BMDs for seven regions of interest (RIs) were calculated, as were short-term precision (root-mean-square (RMS) standard deviation (g cm^-2), RMS-coefficient of variation (RMS-CV, %)) and LSC.

RESULTS

Overall, RMS-CV values were similar between SCI (3.63-10.20%, mean=5.3%) and able-bodied (1.85-5.73%, mean=4%) cohorts, despite lower absolute BMD values at each RIs in those with SCI (35%, heel to 54%, knee; P<0.0001). Precision was highest at the calcaneus and lowest at the femur. Except at the femur, RMS-CV values were under 6%.

CONCLUSIONS

For DXA-based estimates of BMD at the distal femur, proximal tibia and calcaneus, these precision values suggest that LSC values >10% are needed to detect differences between treated and untreated groups in studies aimed at reducing bone mineral loss after SCI.