Category Archives: Physiology

Awards and Honors Across Weill Cornell Medicine August 27, 2021 – Weill Cornell Medicine Newsroom

Dr. Dolores Lamb, who was recruited as assistant professor of molecular biology in urology, has been elected Eastern Regional Administrative Secretary at the American Association of Bioanalysts (AAB) as a member of the AAB Membership Review Committee. Dr. Lambs term began in June 2021.

Dr. Christopher Mason, co-director of theWorldQuant Initiative for Quantitative Predictionand a professor of physiology and biophysics, has been selected to serve on the National Academy of Sciences (NAS) Committee to develop the next 10 years of NASA and space medicine priorities.

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Awards and Honors Across Weill Cornell Medicine August 27, 2021 - Weill Cornell Medicine Newsroom

New imaging, machine-learning methods speed effort to reduce crops’ need for water – University of Illinois News

CHAMPAIGN, Ill. Scientists have developed and deployed a series of new imaging and machine-learning tools to discover attributes that contribute to water-use efficiency in crop plants during photosynthesis and to reveal the genetic basis of variation in those traits.

The findings are described in a series of four research papers led by University of Illinois Urbana-Champaign graduate students Jiayang (Kevin) Xie and Parthiban Prakash, and postdoctoral researchers John Ferguson, Samuel Fernandes and Charles Pignon.

The goal is to breed or engineer crops that are better at conserving water without sacrificing yield, said Andrew Leakey, a professor of plant biology and of crop sciences at the University of Illinois Urbana-Champaign, who directed the research.

Drought stress limits agricultural production more than anything else, Leakey said. And scientists are working to find ways to minimize water loss from plant leaves without decreasing the amount of carbon dioxide the leaves take in.

Plants breathe in carbon dioxide through tiny pores in their leaves called stomata. That carbon dioxide drives photosynthesis and contributes to plant growth. But the stomata also allow moisture to escape in the form of water vapor.

A new approach to analyzing the epidermis layer of plant leaves revealed that the size and shape of the stomata (lighter green pores) in corn leaves strongly influence the crops water-use efficiency.

Micrograph by Jiayang (Kevin) Xie

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The amount of water vapor and carbon dioxide exchanged between the leaf and atmosphere depends on the number of stomata, their size and how quickly they open or close in response to environmental signals, Leakey said. If rainfall is low or the air is too hot and dry, there can be insufficient water to meet demand, leading to reduced photosynthesis, productivity and survival.

To better understand this process in plants like corn, sorghum and grasses of the genus Setaria, the team analyzed how the stomata on their leaves influenced plants water-use efficiency.

We investigated the number, size and speed of closing movements of stomata in these closely related species, Leakey said. This is very challenging because the traditional methods for measuring these traits are very slow and laborious.

For example, determining stomatal density previously involved manually counting the pores under a microscope. The slowness of this method means scientists are unable to analyze large datasets, Leakey said.

There are a lot of features of the leaf epidermis that normally dont get measured because it takes too much time, he said. Or, if they get measured, its in really small experiments. And you cant discover the genetic basis for a trait with a really small experiment.

To speed the work, Xie took a machine-learning tool originally developed to help self-driving cars navigate complex environments and converted it into an application that could quickly identify, count and measure thousands of cells and cell features in each leaf sample.

Jiayang (Kevin) Xie converted a machine-learning tool originally designed to help self-driving cars navigate complex environments into an application that can quickly analyze features on the surface of plant leaves.

Photo by L. Brian Stauffer

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To do this manually, it would take you several weeks of labor just to count the stomata on a seasons worth of leaf samples, Leakey said. And it would take you months more to manually measure the sizes of the stomata or the sizes of any of the other cells.

The team used sophisticated statistical approaches to identify regions of the genome and lists of genes that likely control variation in the patterning of stomata on the leaf surface. They also used thermal cameras in field and laboratory experiments to quickly assess the temperature of leaves as a proxy for how much water loss was cooling the leaves.

This revealed key links between changes in microscopic anatomy and the physiological or functional performance of the plants, Leakey said.

By comparing leaf characteristics with the plants water-use efficiency in field experiments, the researchers found that the size and shape of the stomata in corn appeared to be more important than had previously been recognized, Leakey said.

Along with the identification of genes that likely contribute to those features, the discovery will inform future efforts to breed or genetically engineer crop plants that use water more efficiently, the researchers said.

The new approach provides an unprecedented view of the structure and function of the outermost layer of plant leaves, Xie said.

There are so many things we dont know about the characteristics of the epidermis, and this machine-learning algorithm is giving us a much more comprehensive picture, he said. We can extract a lot more potential data on traits from the images weve taken. This is something people could not have done before.

Leakey is an affiliate of the Carl R. Woese Institute for Genomic Biology at the U. of I. He and his colleagues report their findings in a study published in The Journal of Experimental Botany and in three papers in the journal Plant Physiology (see below).

The National Science Foundation Plant Genome Research Program, the Advanced Research Projects Agency-Energy, the Department of Energy Biosystems Design Program, the Foundation for Food and Agriculture Research Graduate Student Fellows Program, The Agriculture and Food Research Initiative from the U.S. Department of Agriculture National Institute of Food and Agriculture, and the U. of I. Center for Digital Agriculture supported this research.

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New imaging, machine-learning methods speed effort to reduce crops' need for water - University of Illinois News

Neurological manifestations of COVID-19 in patients: from path physiology to therapy – DocWire News

This article was originally published here

Neurol Sci. 2021 Aug 21. doi: 10.1007/s10072-021-05505-7. Online ahead of print.

ABSTRACT

Coronavirus is a family of ARN positive single-stranded belonging to the family of Coronaviridae. There are several families of coronavirus that transmit more or less serious diseases. However, the so-called coronavirus-19 (SARS-CoV2) is the one that is currently causing most of the problems; in fact, biological dysfunctions that this virus causes provoke damage in various organs, from the lung to the heart, the kidney, the circulatory system, and even the brain. The neurological manifestations caused by viral infection, as well as the hypercoagulopathy and systemic inflammation, have been reported in several studies. In this review, we update the neurological mechanisms by which coronavirus-19 causes neurological manifestation in patients such as encephalomyelitis, Guillain-Barr syndrome, lacunars infarcts, neuropsychiatry disorders such as anxiety and depression, and vascular alterations. This review explains (a) the possible pathways by which coronavirus-19 can induce the different neurological manifestations, (b) the strategies used by the virus to cross the barrier system, (c) how the immune system responds to the infection, and (d) the treatment than can be administered to the COVID-19 patients.

PMID:34417704 | DOI:10.1007/s10072-021-05505-7

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Neurological manifestations of COVID-19 in patients: from path physiology to therapy - DocWire News

Inside the Pandemic – Crikey

Lets find our bearings in this ongoing COVID-19 pandemic.

Crikeys Janine Perrett and Amber Schultz, will be joined by one of Australias leading authorities on infection and immunity. Professor Peter Doherty shared the 1996 Nobel Prize in Medicine or Physiology for discovering the nature of cellular immune defence, and is the author of a new book entitled An insiders plague year.

Peter and his colleagues at the Doherty Institute have been at the forefront of the research and study of this highly infectious coronavirus. They are currently working with the federal government in assisting with official modelling to fill in those missing numbers from the four-stage plan.

He will be sharing insights into his new book and the role that science now plays in working with government to create effective health guidelines and policies.

What would you like to ask Peter about COVID-19, the pandemic, Australias response, and the way forward? The two most thoughtful questions will win a copy of the book at the end of the webinar.

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Inside the Pandemic - Crikey

VOX POPULI: If it wasn’t for Takuo Aoyagi, life today would be different | The Asahi Shimbun: Breaking News, Japan News and Analysis – Asahi Shimbun

Apulse oximeter resembles an oversized plastic clothes pin at first glance.

Brought into the limelight by the novel coronavirus pandemic, the device is clipped onto the tip of a patient's index finger to instantly display the oxygen saturation of the blood.

I learned only recently that research by Japanese engineer Takuo Aoyagi led to the invention of the modern pulse oximeter.

Born in Niigata in 1936, Aoyagi aspired to be an inventor and studied engineering at university. After a stint at Shimadzu Corp., he joined Nihon Kohden Corp. in 1971, a leading manufacturer of medical electronics equipment, where he was told by his superior to "develop something unique."

A conversation with an anesthesiologist inspired Aoyagi to devote his research to the development of an easy-to-use device for determining the oxygen level in arterial blood.

Since oximeters back then could not read oxygen levels without drawing a blood sample, health care providers had to make a guess based on the complexion of individual patients.

Aoyagi focused on the pulse and succeeded in isolating signals from arterial blood, which made continuous monitoring possible.

That was a veritable coup. But it took a while before his invention was fully appreciated by the medical community.

The usefulness of his device was fully recognized only in the 1980s, when medical crises caused by oxygen deficiency under anesthesia made news headlines in the United States. This resulted in a number of companies rushing to commercialize pulse oximeters, which came to be marketed globally and saved countless lives.

Aoyagi late in his life was still working to improve his device.

When he died in April last year at the age of 84, a U.S. daily ran a lengthy obituary.

Naoki Kobayashi, 62, a special researcher at Nihon Kohden, recalled, "He was a dyed-in-the-wool engineer who wanted to make useful things rather than author academic papers."

A mourning Yale emeritus professor revealed that he had personally recommended Aoyagi for the 2013 Nobel Prize in Physiology or Medicine.

With more than 100,000 COVID-19 patients around the nation today forced to "help themselves" by recuperating at home, the pulse oximeter has become something of a national lifeline.

It is an invention that definitely deserves greater re-evaluation in Japan.

--The Asahi Shimbun, Aug. 28

* * *

Vox Populi, Vox Dei is a popular daily column that takes up a wide range of topics, including culture, arts and social trends and developments. Written by veteran Asahi Shimbun writers, the column provides useful perspectives on and insights into contemporary Japan and its culture.

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VOX POPULI: If it wasn't for Takuo Aoyagi, life today would be different | The Asahi Shimbun: Breaking News, Japan News and Analysis - Asahi Shimbun

Solution to controlling excessive ripening and senescence of fruits – FreshPlaza.com

Once again for this campaign, pome fruit producers can count on Hold Plus technology to reduce the acceleration of the senescence and ripening processes for apples and pears. And as a novelty this year, Stoller Europe guarantees the use of the solution in Organic Agriculture.

Hold Plus, a Stoller Europe technologyToday, farmers are affected by increasingly unpredictable and significant climate risks that create some economic uncertainties, explains Elodie Brans of Stoller Europe. In this difficult context, Stoller brings a new solution through efficient technology to the various problems that can occur at the different growth stages of pome fruits.

In order to put fruit of quality on the market, Stoller has set up solutions to help crops grow under stress. These solutions are perfectly adapted to fruit orchards, which cover nearly 40,000 hectares in France. However, it is undeniable that fruit productions suffer from climate and technological hazards, which leads to a physiological decline in some regions.

Hold Plus is here to reduce the level of ethylene synthesis and the appearance of accelerated signs of ripening. In this way, the ripening and senescence stages of plant tissue occur at a slower pace. By acting on the enzymes responsible for ethylene biosynthesis, Hold Plus reduces their activity and the final production of ethylene. The solution helps to group ripening without any loss in production or quality, by maintaining the optimal organoleptic characteristics of the fruit before and after harvest.

Grouping ripening without any loss in production or qualityYears of research and many trials have shown that applying Hold Plus on the leaves of the apple tree reduces fruit drop after harvest as well as ethylene emission. Additionally, our great experience with fruit crops has demonstrated that the fruit continues to grow, at a slower pace. Therefore, Hold Plus is a particularly efficient solution to control ripening speed and guarantee a certain quality.

The technology was developed to reduce the fruits emission of ethylene and it gives physiological control over the ripening process of the fruits.

Monitoring fruit ripening at harvest time with the starch test. Foliar application of Hold Plus reduces the ripening speed of the fruits, allowing for good preservation and quality growth.

Improving fruit preservationGiven the important place of the apple on the French market, the Stoller technology is based on improving the preservation quality during the storage period. Harvesting the apples at the optimal ripening stage reduces the possibility of losses during the marketing phase.

Ensuring the quality of the fruit after harvest is a problem common to all apple producers. Hold Plus guarantees the optimal ripening of the fruits while allowing them to maintain a high quality during the entire harvest and the storage period. This is made possible by the synergies established with the active ingredient 1-MCP during storage. Additionally, trials conducted at the station show that foliar applications of Hold Plus on the apple tree help improve the firmness by +0.5 kg/cm2.

We offer this unique solution to help producers improve the quality of their fruit and minimize losses. This is part of the storing process strategy as it increases the length of preservation of the fruit. Obtaining the best state of the fruit is one of the Stoller goals. The efficiency of our solutions, validated by the various trials, helps farmers offer the best product to the most demanding customers.

The fruit sector in France can continue to offer well-preserved nutritional products of quality, while taking into account the requirements of a sustainable diet. Growing can then take place more intelligently and more rationally, so that higher productivity can be reached with the intensive use of inputs. It therefore meets the requirements of the Farm to Fork strategy and of organic and competitive farming, while meeting the challenges of climate change.

Stoller EuropeStoller Europe is a branch of the American multinational Stoller Group. It serves the agricultural markets of Europe, North Africa and Russia. Our team is composed of highly qualified professionals who combine deep knowledge of plant physiology with an understanding of local crops and their specific challenges.

For more information:Elodie BransStoller EuropePhone: +34 965 11 05 22https://stollereurope.com/fr

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Solution to controlling excessive ripening and senescence of fruits - FreshPlaza.com

Texas A&M Bird Collection Influences Future Of Ornithology, Conservation – Texas A&M University Today

Solemn beauty lies inside. Curated winged fragments of Mother Nature sit frozen in time. Some are as tiny as a human thumb, while others are long and lean. The colors on display range from white and drab earth to a vibrant spectrum of tones and shades artists spend years learning to imitate.

Voelker, a curator of birds, professor, ornithologist and evolutionary biologist, said the collection represents decades of collection, curation and utilization by birders, researchers and students the world over.

Our job is to preserve the material and make the data and materials available to the interested public and researchers, he said. Were not a museum in that these birds are not on exhibition. We just have lots and lots of preserved material for research and education.

Texas is home to other bird collections, but the Collection of Birds at BRTC represents the most active receiver, processor and seeker of new avian material in the state, Voelker said. More than 27,000 birds spanning 1,702 species from 59 countries have been prepared and assigned unique numbers in the collection.

The collection also contains 400 egg sets, 1,500 skeletons, 3,000 wings and more than 9,000 tissue and blood samples.

Specimen data within the collection can be accessed by anyone interested viaVertNet. Preserved genetic specimen materials kept in cold storage are curated and available to researchers upon request.

Voelker has provided tissue samples and loaned material to researchers around the globe to further avian science.

Most birds in the collection are from the U.S. and Mexico. Many have been gathered through active collection expeditions around the state, nation and other continents, including Africa and Europe.

The collections diversity reflects the desire to expand the range of data that can be made publicly accessible for research, education and conservation purposes.

A tray of Eastern Meadowlarks in the Texas A&M Collection of Birds.

Laura McKenzie/Texas A&M AgriLife Communications

Voelker said the online specimen data can help birdwatchers interested in learning where and when to find specific species of birds throughout the state. He recently provided a tour of the collection to the Houston Audubon Society, whose members in turn delivered salvaged materials for addition to the collection.

The collection is also used as a teaching aid for more than 500 students at Texas A&M University taking classes such as ornithology, herpetology and mammalogy, and pre-requisites like the natural history of vertebrates, Voelker said. Ornithology students benefit from being able to see and touch the breadth ofbird diversity around the globe.

For ornithology classes, most places have a small teaching collection of birds from around their state, but we are able to do a pretty heavy-duty birds of the world lab where we pull 200-250 birds from the research collection and use those in teaching, he said. So, students are seeing what birds are doing and what they look like all over the world.

The collection also supports targeted research by Voelker and others. One of Voelkers projects is focused on the microbiome of five bird species found in Texas cardinals, mockingbirds, bobwhite and scaled quail, and the golden-fronted woodpecker.

By studying matter in a birds digestive system, Voelker hopes to identify how species interact with encroaching agriculture. For instance, he has taken quail samples from areas in and around cotton fields in places like Matador, Stamford and Lamesa, and a ranch between Presidio and Marfa that has never been in agriculture production, to assess whether pesticides used in agriculture production are affecting overall avian health.

Genetic information can also show how species are related to one another and how lineage can play important roles in bird biology, physiology and health, today and in the past, Voelker said. Samples can also represent as an important ornithological survey that can relate to human health and the potential spread of zoonotic diseases.

Youre building a time series when you add to a collection like this, he said. It can reveal genetic differences linked to changes in the ecosystem through time, and that becomes important when you are talking about things like climate change or habitat going from native flora to ag production or vice versa.

The collections samples date back to 1936, but its range continues to expand.

Over the past 13 years, Voelker said the collection has experienced 90% growth due to research expeditions and an extensive, statewide salvage network that includes birding and conservation groups.

Salvagers provide Voelker pertinent information including the date found and location for each specimen. The collection received around 400 birds salvaged by volunteers walking urban grids in Dallas during the fall 2020 migration alone.

Those volunteers belong toLights Out Texas, a consortium of bird conservationists that advocate for reducing light pollution as a way to decrease bird mortality rates during annual migration periods.

In all, Voelker said the collection has received 500 birds that have yet to be curated and prepared for the collection. The collection will continue to accept good specimens.

Were always excited to see samples come in, especially birds we rarely see, Voelker said. Salvaging specimens is important from a conservation standpoint. We are finding more and more ways to use them as technology and science improves. Scientists are always creatively thinking about ways to answer questions about birds, whether it be migration, physiology or genetics.

Voelker holds a Golden Eagle specimen at the Biodiversity Research and Teaching Collections building.

Laura McKenzie/Texas A&M AgriLife Communications

The annual spring and fall migrations unfortunately provide plenty of salvage for Voelker, his students and interns. Window strikes and other accidents associated with man-made structures or vehicles occur as nearly 2 billion birds migrate through the state.

Texas is a major migratory flyway for birds, according to theTexas A&M Natural Resources Institute (NRI). One quarter to one third of all bird species on the continent migrate through the state in the spring and fall.

Up to one billion birds die each year in the U.S. from colliding into buildings, according to the NRI, a partner in the Lights Out Texas program, which is led by a coalition of conservation nonprofits, universities, governmental organizations and Texans dedicated to bird conservation.

Lights Out programs were initiated to curb bird losses stemming from light pollution. Birds become disoriented by lights at night, which makes them vulnerable to collisions.

Lights Out Texas asks that residents and businesses do their part to protect birds during these migrations by turning out non-essential lighting from 11 p.m. to 6 a.m. between now and Nov. 30, with the priority and critical peak period from Sept. 5 to Oct. 29.

Every light turned out at night helps save migrating birds by reducing collisions with brightly lit buildings along their Texas flyways, said Brittany Wegner, NRI project specialist. As an added bonus, turning off nonessential lights also saves energy and money for cities, local businesses and homeowners. Its easy to participate simply turn off all nonessential lights from 11 p.m. to 6 a.m. during the migration seasons.

Voelker said anyone hoping to contribute to the collection should first make sure the bird meets salvage standards. Essentially, the bird should look fresh and not show signs of deterioration or being attacked by ants.

Salvagers should take note of important data, including the date and location found. They should place the bird in a freezer bag, write the information on the bag, then place the specimen in the freezer and contact the collection, Voelker said.

Weve got people around the state accumulating material, he said. If we are not making an effort to preserve bird specimens when the opportunity is there, then we are losing out on a lot of potentially valuable information.

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Texas A&M Bird Collection Influences Future Of Ornithology, Conservation - Texas A&M University Today

Recovery From an ICU Stay Is Tough. Could More Protein Help? – Undark Magazine

Paul Wischmeyer was a teenage athlete when he learned firsthand just how devastating an intense illness can be. After spending the better part of a year severely sick and frequently hospitalized with undiagnosed severe inflammatory bowel disease, his colon perforated, landing him in the intensive care unit. When he finally recovered, he went from being a starter on his high school basketball team to being too weak to walk down the court profoundly disabled from just being in the hospital.

He built back his strength over the next few years, and eventually worked his way through medical school as a personal trainer in a competitive bodybuilding gym, where he helped clients sculpt their physiques by providing them with targeted workouts and having them add protein and other nutritional supplements to their diets. But it wasnt until his training in critical care medicine that Wischmeyer began to thread together his interest in bodybuilding with his interest in ICU recovery.

Critical care experts have long known that a stay in the ICU can lead to long-term weakness lasting months or even years after discharge, regardless of the specific illness. Wischmeyer was especially struck by his patients massive loss of muscle, which reminded him of his own experience. Id watch people lose half their body weight in a short period of time and not be able to walk, he says.

Today, Wischmeyer, a critical care and nutrition physician at Duke University, is a leading voice among clinicians and scientists investigating whether increasing protein intake during and after hospitalization could be an important and long-overlooked component of recovery. Lean muscle melts away startlingly quickly in ICU patients, and muscle-wasting is a predictor of long-term impairment after hospitalization, studies show. Proponents of the approach say that protein, a nutritional cornerstone for body builders, may help critically ill patients retain muscle or rebuild it as well. Protein is what everyone is interested in in right now, says Zudin Puthucheary, a clinical senior lecturer in intensive care at Queen Mary University of London. (Wischmeyer, like many researchers in the nutrition field, has received funding from industry.)

But some question whether simply adding more protein to patients diets will translate into increased muscle mass and better functioning. While several studies suggest that boosting protein levels early on after critical illness or surgery may improve recovery, they have mostly been small, and other studies have not shown a benefit. Protein provision might be important, but there arent large studies to understand that yet, said Renee Stapleton, a pulmonologist and critical care physician at the University of Vermont Medical Center. A handful of such studies are currently underway, but whether they will bring clarity to the protein picture remains to be seen.

The Covid-19 pandemic has highlighted this issue by bringing huge waves of patients to the ICU. People hospitalized with Covid-19 tend to stay in the ICU longer than other patients, and that, along with the drugs and sedation they receive, likely ratchets up the risk of disability afterwards. I think Covid has highlighted for the general public a lot more about what happens in the ICU, including the challenge of reaching a full recovery, says Lee-anne Chapple, a critical care dietician at the University of Adelaide in Australia.

Researchers think that the massive muscle wasting that occurs during a critical illness deserves much of the blame for making recovery difficult. The first thing we do when anything bad happens is we stop making muscle, says Puthucheary. Not only that, the body also breaks down existing muscle through a process called catabolism. During muscle catabolism, proteins stored in muscle tissue are broken down into smaller molecules called amino acids and energy is released. That breakdown happens quickly: A person who undergoes surgery or who spends time in the ICU can lose up to a kilogram, or 2.2 pounds, of muscle mass per day during the acute stages of their illness.

Id watch people lose half their body weight in a short period of time and not be able to walk, Wischmeyer says.

Theoretically, adding more protein to a patients diet can help minimize the muscle loss. Yet nutrition has traditionally gotten short shrift in medicine, some experts say; a 2019 report from researchers at Harvard University called for better education about nutrition during medical training. This is especially relevant to critical care, a specialty in which monitoring vital statistics, stamping out infections, and generally ensuring survival has been paramount, says Daren Heyland, a critical care physician at Queens University in Kingston, Canada. But the mindset is shifting as physicians start considering nutrition as something that is really modulating the underlying disease process, rather than merely playing a supporting role, Heyland says. It is a major paradigm shift.

Ironically, this shift is driven by improvements in critical care. Today, doctors can save people from trauma and illnesses that would have led to death just two decades ago. With all this great technology, are we creating survivors or victims? Wischmeyer says. Theres this epidemic of impaired quality of life that we have to address. And I think that is drawing a lot more attention to nutrition.

Dietary guidelines recommend that a healthy adult should consume around 0.8 grams of protein per kilogram of body weight each day. Current intensive care guidelines, meanwhile, suggest that adults receive 1.2 to 2 grams of protein per kilogram per day, generally delivered through a feeding tube. Wischmeyer and other experts advocate for amounts at the high end of that range, depending on a persons age and other factors. Yet its not just a question of raising protein targets; clinicians need to ensure those targets are actually being met as studies in U.S. hospitals show that patients are often getting less than half the recommended amount. We are not getting anywhere near the lowest level of recommended protein, says Wischmeyer.

Nutrition interventions are challenging to study particularly in critically ill people, who are a heterogenous group. A blood pressure pill has a measurable physiological effect, and a clinician can see within hours of administering it whether it has done its job. But thats not the case for something like protein. Not only would it take much longer to effect a change in body composition, there are no tests to track whether muscle cells are actually able to use the protein, says Chapple. Additionally, the timeframe of ICU interventions is generally limited to the week or two that a person spends there.

Most critical care studies have tested whether an intervention improves mortality in the months or year after an illness. But expecting a week of protein shakes to determine whether a person lives or dies is unrealistic, Wischmeyer says. Only recently have some studies begun using more nuanced endpoints measuring changes in a persons quality of life, such as their ability to stand up from a seated position or walk a certain distance.

Still, the idea that patients will benefit from increased protein does align with what researchers know about building back muscle after its intense loss, which was comprehensively demonstrated in a study called the Minnesota Starvation Experiment. The study, which ran from 1944 to 1945 and would probably not pass an ethics review today tracked the effects on 36 men of slashing caloric intake in half for six months. The researchers found that the loss of lean muscle mass was extraordinarily hard to reverse, and doing so required sharply increasing the mens calories and protein intake for as long as two years.

Past studies of athletes have helped researchers understand the cellular processes that occur when a person gains muscle. But its not clear how these processes work in critically ill people, says Arthur van Zanten, a critical care physician at Gelderse Valley Hospital and a professor at the Wageningen University and Research in the Netherlands. His work has shown that these patients usually have poorly functioning mitochondria organelles that provide energy to cells in the form of adenosine triphosphate, or ATP. Without enough energy, the body cant build muscle, no matter how much protein a patient consumes, van Zanten says.

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Puthucheary and his colleagues are conducting a small study to test whether ketones an alternative fuel source derived from the bodys breakdown of fat or an amino acid metabolite called hydroxy methylbutyrate might work better. But given the altered physiology associated with critical illness, building muscle may simply prove too difficult, he says. For this reason, Puthucheary is also focusing on trying to prevent muscle wasting, which likely involves a different set of metabolic mechanisms. Rather than making someone whos sick unsick, we are trying to work with the sick physiology, he says.

As researchers continue to investigate how exactly protein and related factors can affect the physiological processes that underlie recovery, a handful of large randomized trials of between 800 to 4,000 participants are currently investigating the basic question of whether increasing protein intake in the ICU improves recovery. A smaller trial combines protein delivery with exercise. In the next two or three years we will know exactly what is happening, says van Zanten. Im personally convinced the higher protein groups will do better.

Puthucheary is less certain for one thing, because most of them dont include exercise, which is also a key component of building muscle, he says but time will tell.

Other studies are exploring interventions that begin after a patient has recovered enough to leave the ICU. Wischmeyers team, for example, is using principles from elite athletic training to develop a diet and training regimen that people can start in the hospital, right after they leave the ICU, and then they can continue at home. Van Zanten and his colleagues are also investigating nutritional and other strategies for promoting recovery in the months after an ICU stay.

That long-term window is virtually unexplored, yet that period may offer an untapped opportunity, van Zanten says. In the ICU, clinicians can monitor precisely what nutrients a person receives, but thats much tougher after discharge. Peoples food intake often slumps when they are sent home, but with inflammation and catabolism resolving, its when protein and other nutritional interventions, as well as physical activity, are likely to be especially effective. It may not always be possible to restore function fully, says van Zanten, but I am very convinced that we can do a better job.

Alla Katsnelson is a science journalist based in Northampton, Massachusetts. Her work has appeared in Chemical & Engineering News, Scientific American, The New York Times, and other outlets.

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Recovery From an ICU Stay Is Tough. Could More Protein Help? - Undark Magazine

What We Think We Know About Metabolism May Be Wrong – The New York Times

Everyone knows conventional wisdom about metabolism: People put pounds on year after year from their 20s onward because their metabolisms slow down, especially around middle age. Women have slower metabolisms than men. Thats why they have a harder time controlling their weight. Menopause only makes things worse, slowing womens metabolisms even more.

All wrong, according to a paper published Thursday in Science. Using data from nearly 6,500 people, ranging in age from 8 days to 95 years, researchers discovered that there are four distinct periods of life, as far as metabolism goes. They also found that there are no real differences between the metabolic rates of men and women after controlling for other factors.

The findings from the research are likely to reshape the science of human physiology and could also have implications for some medical practices, like determining appropriate drug doses for children and older people.

It will be in textbooks, predicted Leanne Redman, an energy balance physiologist at Pennington Biomedical Research Institute in Baton Rouge, La., who also called it a pivotal paper.

Rozalyn Anderson, a professor of medicine at the University of Wisconsin-Madison, who studies aging, wrote a perspective accompanying the paper. In an interview, she said she was blown away by its findings. We will have to revise some of our ideas, she added.

But the findings implications for public health, diet and nutrition are limited for the moment because the study gives a 30,000-foot view of energy metabolism, said Dr. Samuel Klein, who was not involved in the study and is director of the Center for Human Nutrition at the Washington University School of Medicine in St. Louis. He added, I dont think you can make any new clinical statements for an individual. When it comes to weight gain, he says, the issue is the same as it has always been: People are eating more calories than they are burning.

Metabolic research is expensive, and so most published studies have had very few participants. But the new studys principal investigator, Herman Pontzer, an evolutionary anthropologist at Duke University, said that the projects participating researchers agreed to share their data. There are more than 80 co-authors on the study. By combining efforts from a half dozen labs collected over 40 years, they had sufficient information to ask general questions about changes in metabolism over a lifetime.

All of the research centers involved in the project were studying metabolic rates with a method considered the gold standard doubly labeled water. It involves measuring calories burned by tracking the amount of carbon dioxide a person exhales during daily activities.

The investigators also had participants heights and weights and percent body fat, which allowed them to look at fundamental metabolic rates. A smaller person will burn fewer calories than a bigger person, of course, but correcting for size and percent fat, the group asked, Were their metabolisms different?

It was really clear that we didnt have a good handle on how body size affects metabolism or how aging affects metabolism, Dr. Pontzer said. These are basic fundamental things youd think would have been answered 100 years ago.

Central to their findings was that metabolism differs for all people across four distinct stages of life.

Theres infancy, up until age 1, when calorie burning is at its peak, accelerating until it is 50 percent above the adult rate.

Then, from age 1 to about age 20, metabolism gradually slows by about 3 percent a year.

From age 20 to 60, it holds steady.

And, after age 60, it declines by about 0.7 percent a year.

Once the researchers controlled for body size and the amount of muscle people have, they also found no differences between men and women.

As might be expected, while the metabolic rate patterns hold for the population, individuals vary. Some have metabolic rates 25 percent below the average for their age and others have rates 25 percent higher than expected. But these outliers do not change the general pattern, reflected in graphs showing trajectory of metabolic rates over the years.

The four periods of metabolic life depicted in the new paper show there isnt a constant rate of energy expenditure per pound, Dr. Redman noted. The rate depends on age. That runs counter to the longstanding assumptions she and others in nutrition science held.

The trajectories of metabolism over the course of a lifetime and the individuals who are outliers will open a number of research questions. For instance, what are the characteristics of people whose metabolisms are higher or lower than expected, and is there a relationship with obesity?

One of the findings that most surprised Dr. Pontzer was the metabolism of infants. He expected, for example, that a newborn infant would have a sky-high metabolic rate. After all, a general rule in biology is that smaller animals burn calories faster than larger ones.

Instead, Dr. Pontzer said, for the first month of life, babies have the same metabolic rate as their mothers. But shortly after a baby is born, he said, something kicks in and the metabolic rate takes off.

The group also expected the metabolism of adults to start slowing when they were in their 40s or, for women, with the onset of menopause.

But, Dr. Pontzer said, we just didnt see that.

The metabolic slowing that starts around age 60 results in a 20 percent decline in the metabolic rate by age 95.

Dr. Klein said that although people gain on average more than a pound and a half a year during adulthood, they can no longer attribute it to slowing metabolisms.

Energy requirements of the heart, liver, kidney and brain account for 65 percent of the resting metabolic rate although they constitute only 5 percent of body weight, Dr. Klein said. A slower metabolism after age 60, he added, may mean that crucial organs are functioning less well as people age. It might be one reason that chronic diseases tend to occur most often in older people.

Even college students might see the effects of the metabolic shift around age 20, Dr. Klein said. When they finish college they are burning fewer calories than when they started.

And around age 60, no matter how young people look, they are changing in a fundamental way.

There is a myth of retaining youth, Dr. Anderson said. Thats not what the biology says. In and around age 60, things start to change.

There is a time point when things are no longer as they used to be.

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What We Think We Know About Metabolism May Be Wrong - The New York Times

Telehealth enabled NASA to care for astronauts in orbit, but agency is eyeing the moon and beyond – Healthcare Finance News

Dr. Shannan Moynihan, left, and Michelle Frieling of NASA speak during the HIMSS21 conference in Las Vegas on Wednesday.

Photo: Jeff Lagasse/Healthcare Finance News

LAS VEGAS - Space: It's the final frontier not just for humans, but telehealth as well.

The benefits of telehealth have become widely known here on Earth, and it's been an increasingly accepted treatment modality for patients during the pandemic. Remote virtual care has been a lifeline for scores of people with their feet planted on the ground.

But it's also become a lifeline for astronauts inside the International Space Station, and in some ways, low-Earth orbit has been ground zero for telehealth. NASA began treating space-goers remotely as early as 2002, a necessity given that astronauts are uniquely isolated from the world. The lessons learned in that time will be a launchpad for the future as NASA contemplates sending humans beyond low-Earth orbit, and further into the depths of the solar system.

Michelle Frieling, program manager for human health and performance contract at NASA, and Dr. Shannan Moynihan, deputy chief medical officer at the NASA Lyndon B. Johnson Space Center, were on hand at HIMSS21 in Las Vegas to talk about that future in their session, "Caring for Astronauts in Space: NASA's Experience With Telemedicine."

Of course, the treatment of people in space looks a bit different than the terrestrial version, since astronauts experience maladies that are unique to space travel. In addition to the usual sicknesses and injuries that can occur on Earth, these astronaut-specific conditions are linked to the adaptations the body makes in response to low-gravity environments.

"We send up very healthy people," said Moynihan. "That's always the goal. (But) normal physiology is being put into an abnormal environment. It works well while you're up there, but when you come back, those adaptive changes are not always a positive thing."

One of the big adaptive changes that can occur is SANS, or Spaceflight Associated Neuro-ocular Syndrome, an optic disc anemia that can cause temporary vision issues among people who have been on prolonged space missions.

"We don't have a corollary here on Earth," said Moynihan. "It teaches us a lot about the physiology that happens here in space, and my hope is that it helps us understand physiological issues here on Earth."

Other issues include neurovestibular ailments, which can affect an astronaut's balance and posture, causing them to sway while walking when they're back on solid ground. It's a condition that can last for up to two weeks after returning from a flight. Then there are fluid shifts, in which the body's fluids, generally pulled toward the feet by gravity, settle instead around the chest and head. Not a problem for those in space, but certainly an issue for the newly earthbound.

How to treat those conditions, or any other, when a human being is 250 nautical miles away?

Ultrasound machines are the primary imaging devices used on the ISS, according to Frieling. With no CT or MRI machines, the ultrasound machines are used in novel ways, able to give clinically relevant exams in space with the ability to send that information to people on the ground.

These people on the ground who NASA refers to as "remote guiders" are the key. In most other respects, telehealth in space looks like telehealth on the ground: video or audio encounters in which a patient consults with a medical expert. What the remote guiders do is direct astronauts through procedures, in layman's terms, to ensure that clinical robust data is being collected and relevant procedures performed aboard the space station.

"We don't always have a physician on board the space station," said Frieling. "So we're asking somebody who's had maybe 45 minutes of training on the ultrasound device and asking them to get clinically relevant results while learning other stuff too, like ISS systems and the science experiments and activities they're going to do. The remote guiders come in. They walk the crew through various procedures. They're on the ground talking to the crew in real time in order to get the images we need on the ground for clinical diagnoses, or research studies as well."

Ophthalmologists and other specialists examine the data as it's coming down and give tips and techniques to the remote guiders. An important thing for the remote guiders to consider is their own disposition. Since many of these interactions take place via video, the crew onboard the ISS can pick up on smiles and frowns, and these indicators of a person's mood can have an effect on those traversing the vacuum of space.

What telehealth does, essentially, is free astronauts from having to undergo hours of medical training. Instead, they can focus their time and attention on the mission.

Equipment considerations are unique, though, since there's a lot of planning and logistics involved in certifying a medical device to be flown up to the space station. Data needs have to be considered carefully, as well as the compatibility with other devices and technology aboard the ISS. Since the space station is a closed environment, crews have to take into account how something like an ultrasound machine will affect the atmosphere.

For now, the telehealth approach works well as intended. But there are future challenges. Low-Earth orbit is one thing, but plans are already underway to land the first woman and the first person of color on the moon. Beyond that, humanity is eyeing Mars, a mission that could take an astronaut into space for as long as three years.

That will result not only in significant physiological changes for the astronauts, but a rethinking of how telehealth communication will take place. The further away from the planet a crew is, the longer it takes to send and receive data, meaning communications will no longer be in real time.

These will be challenges, but NASA understands these issues and has a rough game plan for how to address them.

"We're going to think about how we do these medical conferences very differently," said Frieling. "We need to develop things like software systems that help make diagnosis and treatment decisions for the crew. We need real-time training videos. We really need an integrated architecture that provides us with advanced analytics so we can put the power in the crew's hands."

Twitter:@JELagasseEmail the writer:jeff.lagasse@himssmedia.com

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Telehealth enabled NASA to care for astronauts in orbit, but agency is eyeing the moon and beyond - Healthcare Finance News