Friends University

Introduction: The plantar flexors (PFs) are crucial for ankle push-off during gait, providing forward propulsion and controlling foot movement during the stance phase. In stroke survivors, reduced activation of the PFs leads to difficulty with propulsion and toe clearance, contributing to abnormal gait patterns known as hemiplegic gait. This issue is often exacerbated by decreased weight bearing (WB) on the paretic limb and adaptive shortening on the paretic PFs, as PF activation is highly dependent on loading input for balance and gait. Purpose and Hypothesis: This study investigates whether simultaneously increasing paretic WB and PF muscle length can enhance paretic PF muscle activation during a dynamic skateboarding task. We hypothesize that this combination will significantly increase paretic PF activation. Methods: This study was a single-session, randomized controlled trial. We recruited 15 individuals with chronic stroke and measured the activations of their paretic plantar flexors using surface electromyography (EMG). Measurements were taken under six randomized conditions: three paretic limb loadings (50%, 75%, and 90% of BW) paired with two surface configurations (level and incline). During each condition, participants were instructed to roll a skateboard forward and backward for three cycles using their unaffected limbs, all while maintaining the targeted WB level on their paretic limbs. A high-speed camera system recorded foot trajectories to define the onsets of the forward and backward cycles during the skateboarding motions.PF muscle activation was calculated by integrating the EMG signal within a cycle and then normalized to 50% BW on the level condition. Results: The results showed increasing paretic BW loading resulted in significant increases in paretic PF activation. The normalized paretic PF activation was significantly higher during 75% BW and 90% BW loading compared to 50% (p =0.04 and 0.01 respectively). There was a trend of increasing PF activation on the incline surface compared to the level surface, however, this difference was not statistically different. Discussion and Conclusion: These findings suggest greater paretic PF activation is associated with increasing paretic WB. Locomotor exercises should aim to increase WB on the paretic limb to enhance paretic PF activation, which may improve gait and standing balance. Further studies with subacute stroke populations and a larger sample size are needed to generalize these results.

Background: Numerous researches have been undertaken to delineate the significant risk factors linked to miscarriage. The etiology of miscarriage has presented challenges in its elucidation, necessitating a comprehensive understanding of the elements that are linked to this phenomenon. The examination of these aspects has been conducted utilizing diverse methodological techniques and analytical procedures. The Cox's proportional hazards model and the accelerated failure time models are commonly utilized in the field of survival analysis. While these models provide a certain level of flexibility, they do not allow for the differentiation of predictor indicators between high-risk and low-risk subpopulations. In contrast, quantile regression allows for the assessment of separate effects of covariates at different quantiles of the conditional distribution of miscarriage. Objective: This study assessed the risk factors for miscarriage using the censored quantile regression model and compared the results to that of Cox proportional hazard model. Methodology: A secondary data from 6077 records of pregnant women with recognized pregnancy and enrolled in the pre-natal care in Kakamega County General Teaching and Referral Hospital (KCGTRH) in Kakamega county, western Kenya during the period from 1 January, 2019 up to 31 October, 2020 were recruited into the study. The study used chi-squared tests for descriptive analysis. Cox proportional hazards and censored quantile regression were used for modeling. Analysis was done using the R package and 5% was the level of significance. Results: Censored quantile regressions were conducted to estimate the parameters for the quantiles, \(\tau\) = 0.05, 0.1, 0.15, 0.2. The results showed that ethnicity had a positive effect and was statistically significant at \(\tau\) = 0.1 (p = 0.0023) and number of previous stillbirths had a negative effect and was significant at \(\tau\) = 0.15 (p = 0.032) and at \(\tau\) = 0.2 (p = 0.036). Graphical comparison of censored quantile model effects to that of cox PH model revealed that the variables; prior miscarriages, prior stillbirths, place of residence, and number of ANC visits have a statistically significant adverse effect on the survival time of miscarriages in the initial phases of pregnancy, contrary to cox PH model. Conclusion: No variable had a statistically significant influence across all quantiles. The results depicts that at a certain moment in the monitoring procedure, they will have a significant impact on the length of survival for miscarriages. A quantile regression model have the capacity to incorporate cross-over effects, whereby the influence of a covariate can manifest as either positive or negative. In contrast, Cox estimates do not allow for the potential scenario when a covariate initially increases the hazard for a specific time period and subsequently decreases it.

Introduction: Use of in vitro fertilization (IVF), assisted reproductive technology to treat infertility, has risen recently. However, research to date is inconclusive if IVF is associated with increase in cardiovascular disease. We therefore performed a large retrospective study, identifying major adverse cardiovascular and cerebrovascular (MACCE) events in those undergoing IVF. We hypothesize IVF to be associated with an increase in MACCE. Aims: To determine the association between IVF and MACCE. Method: We utilized the TriNetX database (64 healthcare organizations in the United States (US)) to identify women ≥18 years of age who had an IVF-assisted pregnancy. Primary outcomes included overall mortality, acute myocardial infarction (AMI), stroke, peripartum cardiomyopathy, cardiogenic shock, and arrhythmias from index of IVF therapy up to 5 years. We also performed a 1:1 propensity matched analysis of our cohort on 12 characteristics: hypertension, hyperlipidemia, heart failure, atrial fibrillation/flutter, diabetes mellitus, chronic kidney disease, cerebrovascular disease, peripheral vascular disease, body mass index, alcohol abuse, nicotine dependence, and social determinants of health. Results: A total of 35,468 patients met criteria for analysis. Mean age at index was 33.9±5.6 years in the IVF cohort vs 29.4±7.9 years in the non-IVF cohort. The predominant race undergoing IVF were White (71.3%) followed by Asian (5.7%), and Black (5.7%). IVF use was predominant in the Midwest US (44%), followed by the South (25%), West (16 %), and Northeast (14%). There were no statistically significant differences across the 12 baseline characteristics in the matched cohorts. IVF-assisted pregnancy was associated with a decrease in AMI (0.43% vs 0.63%, Risk Ratio (RR) 0.69 (0.56, 0.84)), stroke (0.95% vs 1.83%, RR 0.51 (0.45, 0.59), peripartum cardiomyopathy (0.05% vs 0.18%, RR 0.25 (0.15, 0.44)), and arrythmias (0.93% vs 1.44%, RR 0.65 (0.56, 0.74)). There were no statistically significant differences between cohorts in overall mortality (0.80% vs 0.87%, RR 0.93 (0.79, 1.09)) and cardiogenic shock (0.03% vs 0.03%. RR 1 (0.42, 2.40)). Conclusion: In this large retrospective study of IVF-assisted pregnancy, we found that IVF was not associated with an increase in MACCE. Geographical and racial differences exist in the utilization of IVF in the US which further need investigation, especially socioeconomic status, which may account for the findings in our study.

Reeder addresses a select, interpretive history of John 4 and its influence on views toward the Samaritan woman, specifically and more broadly toward women in the American church. The volume is divided into an introduction, two main parts consisting of three chapters each, and a conclusion. The end matter includes discussion questions, an appropriate bibliography for the topic covered, and indices. The primary lens for this manuscript is described in the title of the Introduction, “Women, Sex, and Sin in the Church.” The association of the Samaritan woman—as well as the female gender on many occasions—with sexual sin by interpreters provides the stage for Reeder's re-storying of the discussion between Jesus and the woman from Samaria. In Part One, Reeder explores and contrasts the writings of Tertullian, Origen, and Chrysostom in Chapter Two; Calvin, Marie Dentière, Clara Lucas Balfour, and Dwight L. Moody in Chapter Three; and Liz Curtis Higgs, Barbara J. Essex, John Piper, and Mary DeMuth in Chapter Four. As a counter setting to these interpretations, Part Two describes “The Samaritan Woman in Her Day.” The language of Chapters Five through Six reads significantly different, even blunt to a degree, as Reeder employs historical references to explore the cultural context for retelling the woman's story in Chapter Seven. Reeder then utilizes these contextual details, as well as materials found across the Gospel of John, to inform her written re-imagining of this not-so-chance encounter with Jesus. Her “new yet old” story helps modern readers better understand the significance of Jesus's dialogue partner during his pause at the well of Sychar. While her retelling and interpretive discussions provide no earth-shattering findings for scholars on the Gospel of John, they may prove enlightening, perhaps even blinding, for pastors and lay leaders who have only heard about this woman through interpretive lenses similar to those Reeder provides in Part One. The volume is highly recommended for those studying John 4 or seeking greater awareness of the increasing resources available for understanding women throughout various strata of the ancient world.

Introduction: Renal denervation (RDN) is a novel intervention targeting sympathetic nerves along the renal artery. Ablation of this neurohormonal pathway alters the pathophysiology of heart failure (HF) and can lead to improvements in clinical outcomes. We conducted a systematic review and meta-analysis to review the outcome of heart failure patients undergoing RDN. Methods: We performed a comprehensive search on PubMed, Cochrane, and Embase from inceptions through June 2023 using the string “(“renal denervation” OR “renal sympathetic denervation “) AND (“heart failure” OR “congestive heart failure”)”. Exclusion criteria include non-human trials, studies without a baseline and control, and studies without outcomes of interest. We collected the number of patients with HF and the resulting outcomes. Outcomes of interest include left ventricular ejection fraction (LVEF), six minute walk distance (SMWD), NT- proBNP, and systolic and diastolic pressures. The random-effects model was used to calculate the odds ratios (OR), mean differences (MD), and confidence intervals (CI). A p value <0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index. Results: Nine randomized control trials involving a total of 513 patients were included in our analysis. We found a significant difference when comparing the RDN group to the control groups for LVEF (MD 1.39, 95% CI [0.03,2.75]), SMWD (MD 200.13 m, 95% CI [187.32,212.95]), NT-proBNP (MD -397.16 pg/ml, 95% CI [-438.90, -355.42]), SBP (MD -3.69 mmHg, 95% CI [-7.24, -0.14]) within 12 months. Interestingly, difference in DBP was insignificant (MD -1.13 mmHg, 95% CI [-3.33,1.07]). Our RDN group had a significant decrease in hospital admissions (OR 0.83, 95% CI [0.25,2.77]) for HF exacerbation within 12 month following denervation. When comparing RND to baseline, we found a significant difference in LVEF (MD 1.90, 95% CI [0.64,3.16]) and SMWD (MD 106.56 m, 95% CI [88.72,124.40]). Conclusions: Our analysis demonstrates RDN results in a significant difference in LVEF, SMWD, NT-proBNP, and SBP in patients with HF when compared to control and baseline. However, further research is needed with larger samples to establish the safety and effectiveness of RDN as a viable therapy in HF.

1. Aim/Background: Reactive oxygen species (ROS) have been identified as compounds responsible for producing cellular damage. The purpose of this research is to examine if there is production of reactive oxygen species through free radical intermediates within human hepatocytes treated with morphine, bilirubin, or furosemide. The investigation examines the early stages of biotransformation by measuring the levels of reactive oxygen species produced inside of the treated hepatocytes within the first and second hours of treatment. The experiment was designed upon a case of a jaundiced (elevated bilirubin) infant who received morphine and furosemide and later died through unknown mechanisms. The experiment looks to examine if these drug compounds could contribute to cellular damage. This can help to further understand the potential interactions and complications of free radical intermediates produced during the phases of biotransformation. 2. Method: Previously cultured human hepatocytes were washed by centrifugation and re-suspended in 1x supplemental buffer to a concentration of 1x106 cells/mL and seeded in a dark clear bottom 96-well microplate at 100,000 stained cells/well. The cells were treated with either furosemide, morphine, bilirubin, a Tert-Butyl hydro peroxide (TBHP) positive control, or left as a background. Reactive oxygen generated in the presence of these agents were quantified by fluorescence excitation/emission measurement at 495nm/529nm. Fluorescence was measured at one and two hours. ROS generated convert 2',7'-dichlorodihydrofluorescein diacetate to 2',7'-dichlorodihydrofluorescein within the cells, which fluoresces. The fluorescence intensity detected is equivalent to the level of ROS generated. Wells that were untreated were used as blanks and subtracted from background and TBPH. 3. Results: Furosemide and Morphine did not produce statistically significant levels of ROS (p >0.05) above the background in both hours 1 and 2 of biotransformation and ROS measurement (Figure 1). Although Bilirubin did not produce statistically significant (p >0.05) levels of ROS above the background (Figure 2) during the first hour, it did produce statistically significant levels in the second hour of biotransformation. Each compound’s level of ROS was reduced during the second hour, signaling the removal of intermediate ROS metabolites (Figure 2). The production of ROS in each compound signifies that there is biotransformation to an intermediate that produces ROS. 4. Conclusion: The production of ROS above the background by each of the compounds shows there is an intermediate free radical compound that is produced during the biotransformation of each compound [21]. In this study, although furosemide and morphine did not produce statistically significant levels of ROS in both hours of biotransformation, bilirubin did produce significant levels of ROS in the second hour of biotransformation. This finding is in line with previous studies that shows morphine to offer protective effects against ROS production [16, 17]; and bilirubin demonstrating deleterious production of ROS at high doses [18]. Further work must be done to examine the correlation between the levels of ROS and extent of hepatocellular damage.