Fitzpatrick Kvist (bowlturn0)
Background This study aimed to evaluate the changes in aortic stiffness in young patients undergoing thoracic endovascular aortic repair (TEVAR) after blunt thoracic aortic injury (TBAI) and to examine the associated cardiovascular complications during follow-up. Patients and methods We included survivors of TBAI who underwent stent graft placement between November 2009 and November 2019 and gave their consent to participate. Patients with relevant cardiovascular risk factors, comorbidities with potential impact on arterial stiffness, and prior aortic surgical or endovascular interventions were excluded. Fourteen TEVAR patients prospectively underwent clinical and noninvasive examinations and morphological imaging (mean time of follow-up and duration of implanted stent graft 5.3 ± 1.8 years; mean age 35.1 ± 8.7 years) and were compared to 14 healthy controls (matched for sex, age, height, and body mass index) in order to evaluate aortic stiffness. During the follow-up examinations, we assessed the pulse wave velocity (PWV; m/s) and development of arterial hypertension or heart failure, as indicated by N-terminal pro-brain natriuretic peptide (NT-proBNP; pg/mL) levels and performed echocardiography. Results A significant increase in PWV values was recorded in the TEVAR group (median = 10.1; interquartile range [IQR] = 8.9-11.6) compared to the healthy controls (median = 7.3; IQR = 6.7-8.4), with an increase in the rank mean PWV (+ 3.8; Mann-Whitney U test p less then .001). NT-proBNP levels of patients after TEVAR did not vary significantly compared to those of healthy controls (Mann-Whitney U test, p = .154). After TEVAR, five patients developed arterial hypertension during the follow-up, and three of them exhibited diastolic dysfunction. Conclusions In young patients, TEVAR after TBAI may cause adverse cardiovascular complications due to increased aortic stiffness; therefore, screening for arterial hypertension during follow-up is recommended.This paper conceptualizes shame as an acute stress response to an unacceptable view of oneself mediated through another's perspective. After reviewing the developmental antecedents and ontogenetic role of shame, the author first illustrates how shame may induce a depressive paralysis and self-hurtful intent when the goal of reconciliation is thwarted. She then addresses how shame ignited by narcissistic injury can mobilize aggressive behavior toward others, motivated by a need to restore the self.The goals of this paper are to demonstrate that the configurations of shame are manifestations of interpersonal traumatization, to define them as predictable stress responses that activate specific goal-directed behaviors, and to propose the use of these conceptualizations in the empirical study of interpersonal traumatization.Older adults are at increased risk of being bedridden and experiencing negative health outcomes including the loss of muscle tissue and functional capacity. We hypothesized that supplementing daily meals with a small quantity (3-4 g/meal) of leucine would partially preserve lean leg mass and function of older adults during bed rest. During a 7 day bed rest protocol, followed by 5 days of inpatient rehabilitation, healthy older men and women (67.8 ± 1.1 y, 14 men; 6 women) were randomized to receive isoenergentic meals supplemented with leucine (LEU, 0.06 g/kg/meal; n=10) or an alanine control, (CON, 0.06g/kg/ meal; n=10). Outcomes were assessed at baseline, following bed rest and after rehabilitation. Body composition was measured using dual energy x-ray absorptiometry. Functional capacity was assessed using knee extensor isokinetic and isometric dynamometry, peak aerobic capacity and the short physical performance battery. Muscle fiber type, cross-sectional area, signaling protein expression levels and single fiber characteristics were determined from biopsies of the vastus lateralis. Leucine supplementation reduced the loss of leg lean ma
