Exercise assessment and training in pulmonary rehabilitation for patients with COPD

Chronic obstructive pulmonary disease (COPD) is a common condition with a growing impact on global health services. Patients with COPD frequently complain of dyspnoea and leg fatigue on exertion. Pulmonary rehabilitation (PR) is an established intervention for the management of patients with COPD. There is clear evidence for the benefit in this population. The purpose of this article is to describe the assessment process, exercise intervention and its anticipated benefits, in the context of a rehabilitation programme for individuals with COPD. This has been sub-divided into aerobic, skeletal muscle resistance and inspiratory muscle rationale, assessment and training. The evidence supporting the incorporation of aerobic and skeletal muscle resistance training in PR is well established. The benefit of including inspiratory muscle training (IMT) as an adjunct to PR is less clear.

Pioglitazone in the treatment of NASH: the role of adiponectin

BACKGROUND

Plasma adiponectin is decreased in NASH patients and the mechanism(s) for histological improvement during thiazolidinedione treatment remain(s) poorly understood.

AIM

To evaluate the relationship between changes in plasma adiponectin following pioglitazone treatment and metabolic/histological improvement.

METHODS

We measured in 47 NASH patients and 20 controls: (i) fasting glucose, insulin, FFA and adiponectin concentrations; (ii) hepatic fat content by magnetic resonance spectroscopy; and (iii) peripheral/hepatic insulin sensitivity (by double-tracer oral glucose tolerance test). Patients were then treated with pioglitazone (45 mg/day) or placebo and all measurements were repeated after 6 months.

RESULTS

Patients with NASH had decreased plasma adiponectin levels independent of the presence of obesity. Pioglitazone increased 2.3-fold plasma adiponectin and improved insulin resistance, glucose tolerance and glucose clearance, steatosis and necroinflammation (all P < 0.01-0.001 vs. placebo). In the pioglitazone group, plasma adiponectin was significantly associated (r = 0.52, P = 0.0001) with hepatic insulin sensitivity and with the change in both variables (r = 0.44, P = 0.03). Increase in adiponectin concentration was related also to histological improvement, in particular, to hepatic steatosis (r = -0.46, P = 0006) and necroinflammation (r = -0.56, P < 0.0001) but importantly also to fibrosis (r = -0.29, P = 0.03).

CONCLUSIONS

Adiponectin exerts an important metabolic role at the level of the liver, and its increase during pioglitazone treatment is critical to reverse insulin resistance and improve liver histology in NASH patients.

Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma

SUMMARY

In 5,541 community dwelling men, chronic obstructive pulmonary disease, or asthma was associated with lower bone mineral density (BMD) at the spine and total hip and an increased risk of vertebral and nonvertebral fractures independent of age, body mass index, and smoking. Men prescribed with corticosteroids had the lowest BMD.

INTRODUCTION

It is unclear whether chronic obstructive pulmonary disease (COPD) is independently associated with BMD and fractures.

METHODS

In 5,541 men from the Osteoporotic Fractures in Men Study, history of COPD or asthma, current treatment with corticosteroids, BMD, bone loss after 4.5 years and fractures were ascertained.

RESULTS

Seven hundred fourteen (13%) men reported COPD or asthma, of which 103 were prescribed an oral steroid and 177 an inhaled steroid. Independent of confounders, men prescribed corticosteroids for COPD or asthma had the lowest BMD and a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma (OR 2.13, 95% CI (confidence interval) 1.15-3.93 oral steroids; OR 2.05, 95% CI 1.27-3.31 inhaled steroids). During follow-up, BMD increased at the spine, but there was no difference in bone loss at the hip. However, men with COPD or asthma had a 2.6- and 1.4-fold increased risk of vertebral and nonvertebral fractures, respectively.

CONCLUSION

Chronic obstructive pulmonary disease or asthma was associated with lower BMD at the spine and hip and increased risk of vertebral and nonvertebral fractures independent of age, clinic site, BMI, and smoking. A history of COPD or asthma may be a useful clinical risk factor to identify patients with osteoporosis.

Cell recognition in plants: Determinants of the stigma surface and their pollen interactions

The interaction between compatible pollen grains and the female stigma of Gladiolus gandavensis has been used as a model system for investigation of cell recognition in plants. The molecular architecture of the receptive stigma surface has been investigated, and determinants binding to both concanavalin A and beta-glucosyl artificial carbohydrate antigen, as well as esterase activity, have been characterized, and conditions for their isolation have been established. The stigma surface, before and after modification, was found to bind (125)I-labeled proteins nonspecifically. Pollen tube penetration of the papillar cuticle is prevented when the receptor sites for concanavalin A are occupied. The concanavalin-A-binding determinants of the stigma surface have been fractionated to reveal several glycoproteins in the molecular weight range 43,000-93,000 and a group of glycolipids of molecular weight approximately 22,000. These results are interpreted in terms of two major recognition events regulating pollination.

Pollen-stigma interactions: Identification and characterization of surface components with recognition potential

Male-female recognition in flowering plants is initiated by mutual contact of pollen and stigma surface components. Analysis of the surface macromolecules of both stigma and pollen of Gladiolus gandavensis revealed a complex mixture of proteins, glycoproteins, and glycolipids. The carbohydrate-containing components amounted to 6% in pollen and 23% in stigma and contained the monosaccharides galactose, arabinose, glucose, mannose, and rhamnose. All the mannose of both preparations was associated with a fraction that bound to concanavalin A. The stigma surface contained an arabinogalactan or arabinogalactan protein as a major component. This component has been isolated by affinity chromatography on tridacnin-Sepharose and shown to be similar in composition to a style canal component isolated in the same way. The capacity of the stigma surface preparations to bind nonspecifically to macromolecules from pollen and other sources has been demonstrated in vivo and in vitro. Specific binding of concanavalin A to the stigma surface decreases the adhesive capacity for pollen protein. The arabinogalactan of the stigma surface may act as an adhesive base. The pollen and stigma surfaces apparently complement one another to provide all the components of an ideal adhesive.

Identification and validation of quantitative trait loci for partial resistance to crown rust in oat

Management of oat crown rust disease with host resistance is challenging because major gene resistance is generally short lived. Partially resistant oat cultivars could benefit oat growers by providing more durable resistance. The objective of this study was to validate and discover quantitative trait loci (QTL) affecting crown rust resistance in the partially resistant oat line MN841801-1 using conventional and molecular assessments of disease produced in single-race greenhouse inoculations, single-race polycyclic field tests, and under natural infection in disease-conducive environments. Crown rust was assessed on 150 F(6:9) MN841801-1/'Noble-2' recombinant inbred lines. In total, eight QTL associated with MN841801-1 alleles were detected. Of these, seven matched QTL previously identified while a new QTL (Prq8) was detected on linkage group MN13. Four QTL (Prq1a, Prq2, Prq7, and Prq8) were consistently detected and predicative genetic assays for these QTL should be developed for future validation in additional genetic backgrounds.