Nighttime sleep duration and hedonic eating in childhood

Background:

Higher food intake is implicated in the elevated risk of obesity associated with shorter sleep in children, but the mechanisms driving higher intake are uncertain. Research in adults suggests that acute sleep deprivation affects brain reward systems, which increases responsiveness to palatable foods. However, there have been few studies addressing habitual sleep duration, and few in children, among whom the strongest associations with body mass index (BMI) are seen.

Objective:

The objective of this study is to test the hypothesis that shorter-sleeping children are more food responsive and explore the mediation of the relationship between sleep and weight by food responsiveness (FR).

Methods:

Participants were families from Gemini, a UK twin birth cohort, who had provided complete information on their children's sleep and appetite at age 5 years (n=1008). One child from each twin pair was randomly selected for analyses. Nighttime sleep duration was calculated from parent-reported bedtime and wake time, and categorised as shorter, adequate or longer according to age-specific reference values. FR was assessed with the Child Eating Behaviour Questionnaire. BMI s.d. scores (BMI-SDS) were calculated from parent-measured heights and weights using the UK 1990 reference data and were available for 494 children.

Results:

There was a significant linear association between shorter sleep and higher FR at age 5 years (P for linear trend=0.032), which was maintained after adjusting for age, sex, birth weight, maternal education and BMI-SDS. In the subset with BMI data at age 5 years, shorter sleep was associated with higher BMI-SDS (P=0.026) as expected. Testing for mediation by adding FR to the model attenuated the linear relationship to borderline significance (P=0.049), suggesting partial mediation.

Conclusions:

Shorter sleep in childhood is associated with higher FR, which may partly explain the association between shorter sleep and adiposity in childhood.

Recall of physical activity advice was associated with higher levels of physical activity in colorectal cancer patients

OBJECTIVES

The present study tested the hypothesis that recall of receiving physical activity (PA) advice would be associated with higher levels of PA in patients with a diagnosis of colorectal cancer (CRC).

SETTING

Colorectal cancer patients who were diagnosed in 2010 or 2011, and had been treated in the English National Health Service (NHS).

PARTICIPANTS

17,753 respondents completed at least one section of the survey relevant to the current study and after exclusion of 171 with dementia (since results relied on recall), 15,254 had complete data for the current study. 60% were male, 67% were >65 years and 96% were from a white ethnic group.

PRIMARY AND SECONDARY OUTCOME MEASURES

Patients completed the 'Living with and Beyond Colorectal Cancer' Patient-Reported Outcome Measures (PROMS) survey in 2013. The survey included questions on receiving exercise advice/information ('PA advice'), and the frequency of currently doing at least 30 min of brisk PA per day ('PA level': 0, 1-4 or 5-7 days, within the past week; with the top category meeting UK guidelines).

RESULTS

A third of respondents (31%) recalled receiving PA advice. Independent of demographics and treatment, patients who recalled having PA advice were more likely to be currently doing some brisk PA (51% in the advice group vs 42% in the no advice group; OR 1.74, 95% CI 1.60 to 1.90; p<0.001), and more likely to be meeting PA guidelines (25% vs 20%; OR 1.70, CI 1.54 to 1.88; p<0.001).

CONCLUSIONS

Recalling being given PA advice after a diagnosis of CRC was associated with higher levels of PA. However, less than a third of patients recalled receiving advice. Future research should examine the context in which advice is given and randomised trials are required. However, encouraging clinicians working with patients with CRC to give brief PA advice is warranted and may help improve outcomes for CRC survivors.

Tissue engineered periodontal products

Attainment of periodontal regeneration is a significant clinical goal in the management of advanced periodontal defects arising from periodontitis. Over the past 30 years numerous techniques and materials have been introduced and evaluated clinically and have included guided tissue regeneration, bone grafting materials, growth and other biological factors and gene therapy. With the exception of gene therapy, all have undergone evaluation in humans. All of the products have shown efficacy in promoting periodontal regeneration in animal models but the results in humans remain variable and equivocal concerning attaining complete biological regeneration of damaged periodontal structures. In the early 2000s, the concept of tissue engineering was proposed as a new paradigm for periodontal regeneration based on molecular and cell biology. At this time, tissue engineering was a new and emerging field. Now, 14 years later we revisit the concept of tissue engineering for the periodontium and assess how far we have come, where we are currently situated and what needs to be done in the future to make this concept a reality. In this review, we cover some of the precursor products, which led to our current position in periodontal tissue engineering. The basic concepts of tissue engineering with special emphasis on periodontal tissue engineering products is discussed including the use of mesenchymal stem cells in bioscaffolds and the emerging field of cell sheet technology. Finally, we look into the future to consider what CAD/CAM technology and nanotechnology will have to offer.

Does rigidity in structure of muscarinic agonists and antagonists reflect drug specificity?

The present work is an attempt to elucidate: (1) whether highly rigid structural analogs of acetylcholine are still capable of activating the muscarinic receptor; (2) whether such analogs, be they agonists or antagonists, discriminate among the various ACh-mediated functions, thereby providing a tool for the study of a possible receptor heterogeneity; (3) whether structural rigidity is a significant factor in the kinetics of drug-receptor interaction. To this end, we investigated some properties of drugs in the spiro-(1,3-dioxolane-4,3')-quinuclidine system (SDQ) which embodies the muscarinic pharmacophore in a framework of utmost rigidity. Wherever possible, these properties were compared with those of a closely related but more flexible analog. Variation in effect between members of a rigid-flexible pair or among drugs of varying rigidity is considered to reflect varying affinities towards various sites of action. 2-Methyl-spiro-(1,3-dioxolane-4,3')-quinuclidine (AF-30) is a weak but selective muscarinic agonist. It can be viewed as a highly rigid version of 3-acetoxyquinuclidine (3-AcQ) and it can be used as a probe for detection of heterogeneity among muscarinic receptors. AF-30 is equipotent with 3-AcQ in causing tremors (mice), but has 1/17th the activity of 3-AcQ in the guinea-pig ileum, 1/30th in lowering blood pressure (cats) and 1/10th in inducing analgesia (mice). 2-Diphenylmethyl-spiro(1,3-dioxolane-4',3)-quinuclidine (AF-41) and 2.2-diphenyl-spiro-(1,3-dioxolane-4,3')-quinuclidine (AF-32 are potent antagonists and possess KD values in the same range as those of the more flexible congener 3-diphenylacetoxy-quinuclidine (AF-43) and atropine (0.6--2 nM) but with koff = 0.1 msec-1 (AF-41) and koff = 1 msec-1 (AF-43) (carp atrium). Thus, duration of drug action of drug action at the receptor is a function of structural rigidity in the drug molecule, termination of action being fastest with the flexible molecules. Differences in rigidity among various antagonists also find expression in an unequal distribution of potencies in various tests; thus the rigid antagonists differentiate between two central effects in mice, viz., prevention of oxotremorine-induced tremors and fall from the rotating rod by a factor of 1:20 (especially AF-41 versus AF-43), whereas the more flexible antagonists (AF-43, atropine or even 3-quinuclidinyl-benzilate) do not show such as a selectivity. The existence of heterogenous muscarinic receptors can be inferred from data presented. Both theoretical and practical implications are discussed.

Health professionals' provision of lifestyle advice in the oncology context in the United Kingdom

A healthy lifestyle following a cancer diagnosis is linked with better long-term outcomes. Health professionals can play an important role in promoting healthy lifestyles after cancer, but little is known about the factors that influence whether or not they give lifestyle advice. We conducted an online survey to examine levels of, and predictors of, health professionals' provision of lifestyle advice to cancer patients in the United Kingdom. The survey included questions on awareness of lifestyle guidelines for cancer survivors, current practices with regard to giving advice on smoking, diet, exercise, weight and alcohol, and perceived barriers to giving advice. Nurses, surgeons and physicians (N=460) responded to the survey. Many (36%) were not aware of any lifestyle guidelines for cancer survivors, but 87% reported giving some lifestyle advice; although this was lower for individual behaviours and often to <50% of patients. Respondents who were aware of lifestyle guidelines were more likely to give lifestyle advice on all behaviours (all OR's>1.76, all P's<0.05). Not believing lifestyle would affect outcomes was associated with lower odds of giving lifestyle advice (all OR's<0.48, all P's<0.05). Improved survivorship education for health professionals may increase the number of patients receiving lifestyle advice, and improve their long-term outcomes.

Array comparative genomic hybridization and fetal congenital heart defects: a systematic review and meta-analysis

OBJECTIVE

Array comparative genomic hybridization (aCGH) is a molecular cytogenetic technique that is able to detect the presence of copy number variants (CNVs) within the genome. The detection rate of imbalances by aCGH compared to standard karyotyping and 22q11 microdeletion analysis by fluorescence in-situ hybridization (FISH), in the setting of prenatally-diagnosed cardiac malformations, has been reported in several studies. The objective of our study was to perform a systematic literature review and meta-analysis to document the additional diagnostic gain of using aCGH in cases of congenital heart disease (CHD) diagnosed by prenatal ultrasound examination, with the aim of assisting clinicians to determine whether aCGH analysis is warranted when an ultrasonographic diagnosis of CHD is made, and to guide counseling in this setting.

METHODS

Articles in PubMed, EMBASE and Web of Science databases from January 2007 to September 2014 describing CNVs in prenatal cases of CHD were included. Search terms were: 'array comparative genomic hybridization', 'copy number variants' and 'fetal congenital heart defects'. Articles regarding karyotyping or 22q11 deletion only were excluded.

RESULTS

Thirteen publications (including 1131 cases of CHD) met the inclusion criteria for the analysis. Meta-analysis indicated an incremental yield of 7.0% (95% CI, 5.3-8.6%) for the detection of CNVs using aCGH, excluding aneuploidy and 22q11 microdeletion cases. Subgroup results showed a 3.4% (95% CI, 0.3-6.6%) incremental yield in isolated CHD cases, and 9.3% (95% CI,  6.6-12%) when extracardiac malformations were present. Overall, an incremental yield of 12% (95% CI, 7.6-16%) was found when 22q11 deletion cases were included. There was an additional yield of 3.4% (95% CI, 2.1-4.6%) for detecting variants of unknown significance (VOUS).

CONCLUSIONS

In this review we provide an overview of published data and discuss the benefits and limitations of using aCGH. If karyotyping and 22q11 microdeletion analysis by FISH are normal, using aCGH has additional value, detecting pathogenic CNVs in 7.0% of prenatally diagnosed CHD, with a 3.4% additional yield of detecting VOUS.

Evaluation of observed blast loading effects on NIF x-ray diagnostic collimators

We present the "debris wind" models used to estimate the impulsive load to which x-ray diagnostics and other structures are subject during National Ignition Facility experiments. These models are used as part of the engineering design process. Isotropic models, based on simulations or simplified "expanding shell" models, are augmented by debris wind multipliers to account for directional anisotropy. We present improvements to these multipliers based on measurements of the permanent deflections of diagnostic components: 4× for the polar direction and 2× within the equatorial plane-the latter relaxing the previous heuristic debris wind multiplier.

Sleep and energy intake in early childhood

Background And Objectives:

Shorter sleep is associated with higher weight in children, but little is known about the mechanisms. The aim of this study was to test the hypothesis that shorter sleep was associated with higher energy intake in early childhood.

Methods:

Participants were 1303 families from the Gemini twin birth cohort. Sleep duration was measured using the Brief Infant Sleep Questionnaire when the children were 16 months old. Total energy intake (kcal per day) and grams per day of fat, carbohydrate and protein were derived from 3-day diet diaries completed by parents when children were 21 months old.

Results:

Shorter nighttime sleep was associated with higher total energy intake (P for linear trend=0.005). Children sleeping <10 h consumed around 50 kcal per day more than those sleeping 11–<12 h a night (the optimal sleep duration for children of this age). Differences in energy intake were maintained after adjustment for confounders. As a percentage of total energy intake, there were no significant differences in macronutrient intake by sleep duration. The association between sleep and weight was not significant at this age (P=0.13).

Conclusions:

This study provides the first evidence that shorter nighttime sleep duration has a linear association with higher energy intake early in life. That the effect is observed before emergence of associations between sleep and weight indicates that differences in energy intake may be a mechanism through which sleep influences weight gain.

ImaGiNe Seldinger: first simulator for Seldinger technique and angiography training

In vascular interventional radiology, procedures generally start with the Seldinger technique to access the vasculature, using a needle through which a guidewire is inserted, followed by navigation of catheters within the vessels. Visual and tactile skills are learnt in a patient apprenticeship which is expensive and risky for patients. We propose a training alternative through a new virtual simulator supporting the Seldinger technique: ImaGiNe (imaging guided interventional needle) Seldinger. It is composed of two workstations: (1) a simulated pulse is palpated, in an immersive environment, to guide needle puncture and (2) two haptic devices provide a novel interface where a needle can direct a guidewire and catheter within the vessel lumen, using virtual fluoroscopy. Different complexities are provided by 28 real patient datasets. The feel of the simulation is enhanced by replicating, with the haptics, real force and flexibility measurements. A preliminary validation study has demonstrated training effectiveness for skills transfer.

Pressure and energy balance of stagnating plasmas in z-pinch experiments: implications to current flow at stagnation

Detailed spectroscopic diagnostics of the stagnating plasma in two disparate z pinches allow, for the first time, the examination of the plasma properties within a 1D shock wave picture, demonstrating a good agreement with this picture. The conclusion is that for a wide range of imploding-plasma masses and current amplitudes, in experiments optimizing non-Planckian hard radiation yields, contrary to previous descriptions the stagnating plasma pressure is balanced by the implosion pressure, and the radiation energy is provided by the imploding-plasma kinetic energy, rather than by the magnetic-field pressure and magnetic-field-energy dissipation, respectively.