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Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

In the present study, we performed a meta-analysis to assess the ability of leucine supplementation to increase the muscle protein fraction synthetic rate and to augment lean body mass or leg lean mass in elderly patients. A literature search was conducted on Medline, Cochrane, EMBASE and Google Scholar databases up to 31 December 2013 for clinical trials that investigated the administration of leucine as a nutrient that affects muscle protein metabolism and muscle mass in elderly subjects. The included studies were randomised controlled trials. The primary outcome for the meta-analysis was the protein fractional synthetic rate. Secondary outcomes included lean body mass and leg lean mass. A total of nine studies were included in the meta-analysis. The results showed that the muscle protein fractional synthetic rate after intervention significantly increased in the leucine group compared with the control group (pooled standardised difference in mean changes 1·08, 95 % CI 0·50, 1·67; P, 0·001). No difference was found between the groups in relation to lean body mass (pooled standardised difference in mean changes 0·18, 95 % CI 20·18, 0·54; P¼ 0·318) or leg lean mass (pooled standardised difference in mean changes 0·006, 95 % CI 2 0·32, 0·44; P¼ 0·756). These findings suggest that leucine supplementation is useful to address the age-related decline in muscle mass in elderly individuals, as it increases the muscle protein fractional synthetic rate. Key words: Essential amino acids: Elderly: Dietary supplements: SarcopeniaAgeing is accompanied by a progressive decline in muscle mass and strength (sarcopenia) and is associated with a lower quality of life due to the reduced ability of an individual to perform daily living activities (1) . It also predisposes people to the development of chronic metabolic disorders such as diabetes and obesity (2) . The prevalence of sarcopenia differs by sex and living settings (3) . For example, age-related muscle loss has been reported to be prevalent in about 68 % of elderly men and 21 % of elderly women living in nursing homes (4,5) , but in about 10 % of men and 33 % of women living in the community (4,6)

Two recent genome-wide association studies reported significant associations of genetic variants at 1q22, 10q23 and 20p13 with gastric cancer (GC) risk in Chinese populations. However, these findings have not been confirmed in other independent studies. Here, we performed an independent case-control study in a Chinese population by genotyping three loci (rs4072037A>G at 1q22, rs2274223A>G at 10q23 and rs13042395C>T at 20p13) in 1681 GC cases and 1858 controls. We found that rs4072037 at 1q22 and rs2274223 at 10q23 were significantly associated with risk of GC with per allele odds ratio (OR) of 0.72 [95% confidence interval (CI): 0.63-0.81; P = 2.98 × 10(-7)] and 1.42 (95% CI: 1.27-1.58; P = 9.68 × 10(-10)), respectively. The association was more prominent for rs2274223 in female (OR = 1.86, 95% CI: 1.49-2.32) and gastric cardia adenocarcinoma (GCA) (OR = 1.71, 95% CI: 1.49-1.95). Furthermore, we combined the two single-nucleotide polymorphisms to evaluate the joint effect and found that the GC risk significantly increased with the number of risk allele increasing with a trend P value of 6.66 × 10(-16), and individuals with four risk alleles had a 3.28-fold (95% CI: 1.75-6.13) risk of GC compared with those having no risk alleles. However, no significant association was detected between rs13042395 at 20p13 and GC risk (OR = 1.04, 95% CI: 0.94-1.15; P = 0.452). In conclusion, our results indicate that genetic variants at 1q22 and 10q23 but not 20p13 may serve as candidate markers for GC susceptibility in the Chinese population.

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This study investigates a torque estimation method for muscle fatigue tracking, using stimulus evoked electromyography (eEMG) in the context of a functional electrical stimulation (FES) rehabilitation system. Although FES is able to effectively restore motor function in spinal cord injured (SCI) individuals, its application is inevitably restricted by muscle fatigue. In addition, the sensory feedback indicating fatigue is missing in such patients. Therefore, torque estimation is essential to provide feedback or feedforward signal for adaptive FES control. In this work, a fatigue-inducing protocol is conducted on five SCI subjects via transcutaneous electrodes under isometric condition, and eEMG signals are collected by surface electrodes. A myoelectrical mechanical muscle model based on the Hammerstein structure with eEMG as model input is employed to capture muscle contraction dynamics. It is demonstrated that the correlation between eEMG and torque is time-varying during muscle fatigue. Compared to conventional fixed-parameter models, the adaptedparameter model shows better torque prediction performance in fatiguing muscles. It motivates us to use a Kalman filter with forgetting factor for estimating the time-varying parameters and for tracking muscle fatigue. The assessment with experimental data reveals that the identified eEMG-to-torque model properly predicts fatiguing muscle behavior. Furthermore, the performance of the time-varying parameter estimation is efficient, suggesting that real-time tracking is feasible with a Kalman filter and driven by eEMG sensing in the application of FES.

No abstract

PurposeThe sit-to-stand test (STST) has been used to evaluate the exercise tolerance of patients with COPD. However, mutual comparisons to predict poor exercise tolerance have been hindered by the variety of STST modes used in previous studies, which also did not consider patients’ subjective perceptions of different STST modes. Our aim was to compare the five-repetition sit-to-stand test (5STS) with the 30-second sit-to-stand test (30STS) for predicting poor performance in the six-minute walking test and to evaluate patients’ subjective perceptions to determine the optimal mode for clinical practice.Patients and methodsPatients with stable COPD performed 5STS, 30STS and the 6MWT and then evaluated their feelings about the two STST modes by Borg dyspnea score and a questionnaire. Moreover, we collected data through the pulmonary function test, mMRC dyspnea score, COPD assessment test and quadriceps muscle strength (QMS). A receiver operating characteristic curve analysis of the 5STS and 30STS results was used to predict 6-minute walk distance (6MWD) <350 m.ResultsThe final analysis included 128 patients. Similar moderate correlations were observed between 6MWT and 5STS (r=−0.508, P<0.001) and between 6MWT and 30STS (r=0.528, P<0.001), and there were similar correlations between QMS and 5STS (r=−0.401, P<0.001) and between QMS and 30STS (r=0.398, P<0.001). The 5STS and 30STS score cutoffs produced sensitivity, specificity and positive and negative predictive values of 76.0%, 62.8%, 56.7% and 80.3% (5STS) and 62.0%, 75.0%, 62.0% and 75.0% (30STS), respectively, for predicting poor 6MWT performance. The 5STS exhibited obvious superiority in terms of the completion rate and the subjective feelings of the participants.ConclusionAs a primary screening test for predicting poor 6MWD, the 5STS is similar to the 30STS in terms of sensitivity and specificity, but the 5STS has a better patient experience.