INTRODUCTION: Exercise increases insulin stimulated glucose uptake (insulin action) if expended energy (kcal) is withheld following exercise, but the effect is blunted when expended energy is replaced as carbohydrate. Restricting carbohydrate and replacing expended energy as fat maintains increased insulin action in rodents; however, this effect has not been evaluated in humans. In humans, restricting carbohydrate intake following exercise may be a useful strategy to maximize the effect of individual exercise bouts on insulin action and promote gains in metabolic health over time. Therefore, the purpose of this study was to determine if carbohydrate restriction following exercise (carbohydrate deficit) increased insulin action in sedentary, overweight adults as hypothesized. METHODS: Ten healthy, sedentary, men and women, aged 21±2 years, body fat 37.3±3.1%, and VO2peak 34.6±1.2ml×kg-1×min-1 completed three, two-day experimental conditions in random order: 1) a no-exercise baseline condition (BASE), 2) exercise followed by a high-carbohydrate meal (HIGH-CHO= 76.3±2.5% CHO), and 3) exercise followed by a low-carbohydrate meal (LOW-CHO=17.8±0.1% CHO). On DAY 1, subjects came to the laboratory (early evening) and expended 30% of total daily energy expenditure on a cycle ergometer at 70% of VO2peak. Following exercise, an isocaloric meal (HIGH-CHO or LOW-CHO) was consumed to refeed the expended energy during exercise and venous blood samples were taken to record the insulin and glucose responses to the meals. Twelve hours later (Day 2), whole-body insulin action (steady-state glucose uptake per unit insulin) was measured using a continuous infusion of glucose with stable isotope tracers. A paired t-test was used to detect differences between exercise bouts and the glucose and insulin responses to the post-exercise meals. A one-way repeated measures ANOVA was performed to evaluate the effect of experimental condition on insulin action (p<0.05, for all tests). RESULTS: Intensity (VO2peak), duration (minutes) and energy expenditure (kcal) were similar between exercise bouts. After exercise, plasma glucose and insulin concentrations were significantly higher following the HIGH-CHO meal compared to the LOW-CHO meal (p<0.001, respectively). The next morning, insulin action was similar between experimental conditions (p=0.30). Non-oxidative glucose disposal was increased during the glucose infusion in Low-CHO compared to BASE (27.2±3.2 vs. 16.9±3.5µM×kg-1×min-1, p<0.05). Carbohydrate oxidation was reduced in Low-CHO (8.6±1.3µM×kg-1×min-1) compared to High-CHO (12.2±1.2µM×kg-1×min-1), and to BASE (17.1 ± 2.2 µM×kg-1×min-1), p<0.05 respectively. Resting fat oxidation was increased in Low-CHO compared to BASE (109.8 ± 10.5 mg×min-1 vs. 80.7 ± 9.6 mg×min-1, p<0.05) and remained elevated during the glucose infusion. CONCLUSION: Limiting carbohydrate, but not energy intake after exercise (carbohydrate deficit) resulted in increased non-oxidative glucose disposal, decreased carbohydrate oxidation and increased fat oxidation during the glucose infusion, compared to baseline, indicating a favorable shift in energy metabolism. Creating a carbohydrate deficit, by withholding expended carbohydrate but not energy following exercise may be a sensible strategy to promote favorable gains in insulin action that requires further evaluation.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24787号 / 医博第4979号 / 新制||医||1066(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 秀一, 教授 森本 尚樹, 教授 安達 泰治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Objective: This study aims to evaluate the application of Pictorial Representation of Illness and Self-Measure (PRISM) in educating patients regarding oral health before endoprosthesis (EP). Methods: The study consisted of two parts: (I) a cross-sectional study, where patients received a PRISM interview, oral health briefing and oral examinations (treatment need, oral focus). (II) In an observational part, patients were randomly assigned to either PRISM task (Test) or flyer-based verbal briefing (Control). Before and after the interviews, patients answered a questionnaire regarding importance of oral health for EP. Results: (I) 122 patients were included. The distance between subject (“myself”) and objects (oral health issues or EP) in the PRISM task were mainly not associated with age, gender, and oral conditions. In part (II), 80 patients (PRISM: n = 40, Control: n = 40) were included. After the interview, the values for perceived relationship between EP and teeth (p < 0.01), EP and gums (p < 0.01), and EP and dental consultations (p < 0.01) significantly increased in both groups. Both groups perceived a high benefit of the interview and felt well educated. Conclusions: PRISM has comparable positive effects like a flyer-based verbal briefing. PRISM as a novel visual tool can support the patient education regarding oral health before EP

No description available.

Observations of Bromus tectorum L. (cheatgrass or downy brome) monocultures have shown that populations are susceptible to stand die-off or replacement failures. Die-offs, where the seed bank from the previous year fails to emerge, occurs in cheatgrass stands and it is unclear the trigger or cause. The fungus Fusarium has been identified in plant and seed samples from die-offs and may drive die-off activity through pathogenicity. Die-off recovery may take several years but cheatgrass populations eventually reestablish. The purpose of our study was to determine whether Fusarium is a potential player in a die-off, and understand how die-offs recover after multiple years of stand failure. Our objectives were to determine: 1- litter and water effects on die-off activity; 2- if fungal pathogens, such as Fusarium, decrease the proportion of cheatgrass emergence in a die-off; and 3- whether direct or broadcast seeding, water, and litter treatments increase establishment in recovering die-offs. Litter absent plots had significantly (P < 0.0001 and P < 0.001) more emergence at 49.2% and 41% compared to litter present plots 21.3% and 23.7%. The litter absent plots significantly (P = 0.0003 and P = 0.001) increased survival (82% and 52%) compared to litter present plots (70% and 41%). Direct planted versus broadcast seeding had significantly (P < 0.0001) more emergence, 36% to 11.9%. The addition of Fusarium inoculum to field plots did not effectively replicate anticipated disease levels. The fungicide treatment did not have a significant influence at either site. The results from the study indicate that nothing inhibits cheatgrass from establishing following a persistent die-off disturbance. A unique window may be available for land managers to revegetate natives in invasive populations as large quantities of cheatgrass seeds fail to emerge during die-off events.

Oral iron replacement therapy is often used as a first-line modality for the treatment of iron deficiency anemia (IDA). Oral iron replacement options include tablets, capsules, and liquid formulations. Esophagitis due to iron tablet administration is a well-documented phenomenon, yet peptic ulcer disease secondary to iron tablet administration is less well-known. An 83-year-old female with a past medical history of chronic kidney disease stage V, anemia of inflammatory disease, heart failure with preserved ejection fraction, and gastroesophageal reflux disease presented to the hospital with diffuse abdominal pain and dark red emesis. She was started on ferrous sulfate supplementation two weeks ago and described progressive abdominal pain and nausea since beginning the medication. She was not taking nonsteroidal anti-inflammatories (NSAIDs), antiplatelets, or anticoagulants. Six months ago, she had an unremarkable upper endoscopy performed for new-onset gastroesophageal reflux disease. Laboratory studies revealed a hemoglobin of 7.3 mg/dL and due to a concern for rapid blood loss, she was given one unit of packed red blood cells. A non-contrast computed tomography was performed showing wall thickening of the stomach and the first two portions of the duodenum. A possible ulcer was seen in the distal posterior stomach. The patient was made NPO, and twice daily intravenous pantoprazole was started. An upper endoscopy was performed which revealed a 2.5 cm clean-based ulcer in the duodenal bulb. Biopsies showed acute inflammation and positivity for iron debris but were negative for Helicobacter pylori. Once daily pantoprazole was continued, and her ferrous sulfate tablets were discontinued. Her symptoms did not return. Ferrous sulfate may erode and ulcerate the gastric and duodenal mucosa like that of a chemical burn. Iron deposits may be seen on biopsies performed with Prussian blue staining. Brown crystalline deposits may be seen on hematoxylin and eosin staining. Iron injury may be seen in pill or capsule formulations due to a concentration effect, but this is typically not seen with solution forms. Treatment includes discontinuation of tablet or capsule formulations and substitution with liquid forms.

Introduction: Below knee amputation is the safest treatment for aggressive benign and malignant bone tumours of the distal tibia yielding good oncological and functional results. However, in selected patients where limb salvage is feasible and amputation unacceptable to the patient, limb salvage using a distal tibial replacement (DTR) can be considered. This study aims to present the oncological and functional results of the use of this treatment method in our unit. Patients &amp; Methods: A retrospective folder review was performed for all 10 patients who received a modular distal tibial replacement between 01/01/2005 and 31/01/2019 for a primary bone tumour either benign aggressive or malignant. Six were female and the mean age was 31 (1275) years. There were five patients with giant cell tumour of bone, four with osteosarcoma and one with a low-grade chondrosarcoma. The patients with osteosarcoma had neo-adjuvant chemotherapy before surgery. Function was assessed by the Musculoskeletal Tumor Society (MSTS) score. Results: There were six females and four males, with a mean age of 31 (12-75) years. Two patients had local recurrence treated with a BKA and one other patient died of metastases three years postoperatively. At a mean follow-up of three years, the remaining eight patients had a mean MSTS score of 83% (67–93%). There were no radiological signs of loosening, and no revision surgeries. Conclusion: Endoprosthetic replacement of the distal tibia for primary bone tumours can be a safe treatment option in very selected cases.

No description available.

The market for maintenance of dwellings in the construction industry is only getting more significant due to the time factor. Dwellings are only getting older, and demands for refurbishment are getting more obligatory for tenant-owned cooperatives.  This study examines the project manager’s approach when dealing with tenant-owned cooperatives and the management of pipe replacement. What risks and factors that are important to identify to achieve a possible decrease in disturbances in pipe replacement projects. To answer the purpose and the research questions asked, eight interviews were conducted.  The interviews were project managers with different experience level in the field of pipe replacement. The questions asked were based on the theoretical aspect of this study to examine further strategies that could help to achieve a successful project. The result from the interviewees was then analyzed and compressed to understand main factors and identify strategies to decrease disturbance during a pipe replacement project. The result from this master thesis indicates that a well-functioned communication prevents unpredictable risks together with a comprehensive pre-study. When dealing with a non-professional client, the right approach and educational level have to be established in the first interaction. When asked to rank the critical success factors, the most important ones were; Human-related factors, Project procedures, and Project-related factors. This consequently, implies which areas that are important for a project manager. As for the result of using risk management in pipe replacement projects, it could be regarded as either the most important or one very important tool to generate a successful project. / Marknaden för underhåll av bostadsrättföreningars bostäder i byggbranschen blir bara allt större på grund av tidsfaktorn. Bostäder blir bara äldre och krav på renovering blir mer obligatorisk för bostadsrättsföreningarna.   Denna studie undersöker projektledarens synsätt om hur man hanterar bostadsrättföreningar och projektledningen av stambyte. Vilka risker och faktorer som är viktiga att identifiera för att uppnå så nära som möjligt ett störningsfritt projekt. För att svara på syftet och frågeställningar har åtta intervjuer genomförts. Intervjuerna var med projektledare med olika erfarenhetsnivåer inom stambyte. Frågorna var baserad på den teoretiska aspekten av denna studie för att undersöka strategier som skulle kunna bidra till att uppnå ett framgångsrikt projekt. Resultatet från intervjuerna analyserades och undersöktes för att sedan förstå huvudfaktorerna och därmed identifieringsstrategier för att minska störningarna under ett stambytesprojekt. Resultatet av detta examensarbete visar att en väl fungerande kommunikation hindrar oförutsägbara risker med en djup förstudie. När projekt ledarna arbetar med en icke-professionell beställare måste man redan från början etablera rätt inställning. När de som intervjuades frågades om att rangordna vilka av de kritiska framgångsfaktorerna som var de viktigaste, var följande resultat; Mänskliga faktorer, upphandlingsprocesser och Projektrelaterade faktorer. Följaktligen, innebär vilket område som är viktigt för en projektledare. När det gäller resultatet av att använda riskhantering i rörbytesprojekt, kan det betraktas som antingen det viktigaste eller ett mycket viktigt verktyg för att skapa ett framgångsrikt projekt.

The purpose of this study was to investigate the influence of tibial stem geometry on stress shielding of the tibia for patients with a total knee replacement. Finite element analysis was used to study different tibial stem geometry types, as well as a vast array of different geometric sizes. Both a peg and stem type geometry were analyzed and compared in order to determine what type geometry causes the least amount of stress shielding. A static loading condition with a dynamic loading factor of three was used for the system and the stress responses were analyzed at regions of interest at various depths. Regions of interest include the posterior and medial regions, at depths ranging from the resurfaced tibial surface to 100 mm below the surface. It was found that the smallest stem/peg sizes produced the least amount of stress shielding, indicating that the less amount of foreign material within the tibia, the more natural the bending and stress response of the tibia. It was also concluded that for the loading conditions used in this study, peg type geometry yields a decreased amount of stress shielding when compared to stem type geometry. This is due to the fact that the peg type geometry allowed for more natural bending and a distributed loading transfer between two pegs rather than one long central stem. Further studies should be completed on other geometry types in order to understand how to best replicate the natural bending of the tibia.