Τρίτη, 1 Μαρτίου 2016

Multiple Self-Reported Concussions Are More Prevalent in Athletes With ADHD and Learning Disability

imageObjective: We evaluated how attention deficit-hyperactivity disorder (ADHD) and learning disability (LD) are associated with concussion history and performance on standard concussion assessment measures. Based on previous reports that developmental disorders are associated with increased injury proneness and poorer cognitive performance, we anticipated that ADHD and LD would be associated with increased history of concussion and poorer baseline performance on assessment measures. Design: Cross-sectional study. Setting: Clinical research center. Participants: The study sample aggregated data from two separate projects: the National Collegiate Athletic Association Concussion Study and Project Sideline. Interventions: We analyzed preseason baseline data from 8056 high school and collegiate athletes (predominantly male football players) enrolled in prior studies of sport-related concussion. Main Outcome Measures: Measures included demographic/health history, symptoms, and cognitive performance. Results: Attention deficit-hyperactivity disorder and LD were associated with 2.93 and 2.08 times the prevalence, respectively, of 3+ historical concussions (for comorbid ADHD/LD the prevalence ratio was 3.38). In players without histories of concussion, individuals with ADHD reported more baseline symptoms, and ADHD and LD were associated with poorer performance on baseline cognitive tests. Interactive effects were present between ADHD/LD status and concussion history for self-reported symptoms. Conclusions: Neurodevelopmental disorders and concussion history should be jointly considered in evaluating concussed players. Clinical Relevance: Clinical judgments of self-reported symptoms and cognitive performance should be adjusted based on athletes' individual preinjury baselines or comparison with appropriate normative samples.

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Comparisons of Bone Mineral Density Between Recreational and Trained Male Road Cyclists

imageObjective: To compare measures of training, performance, body composition, and areal bone mineral density (aBMD) between age-matched recreational and competitively trained male road cyclists. Design: Cross-sectional. Setting: Laboratory. Participants: Male cyclists (N = 28) aged 21–54 years riding more than 3 hours per week. Assessment of Risk Factors: Men who train at high (≥8 h/wk) and moderate volumes (3–8 h/wk). Main Outcome Measures: Areal bone mineral density assessments by dual energy x-ray absorptiometry of the whole body, lumbar spine (L1-L4), right and left hips, maximal oxygen uptake (V[Combining Dot Above]O2max), and training history. Results: Trained cyclists had higher power to weight (5.3 ± 0.4 vs 4.7 ± 0.3 W/kg, P = 0.001), V[Combining Dot Above]O2max (57.2 ± 4.5 vs 53.0 ± 6.1 mL·kg−1·min−1, P = 0.049) and training volume (10.6 ± 2.1 vs 6.3 ± 0.9 h/wk, P

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Mouthguard Use and Awareness of Junior Rugby League Players in the Gold Coast, Australia: A Need for More Education

imageObjective: To investigate knowledge, attitude, and awareness of appropriate mouthguard use, as well as the management of traumatic dental injuries (TDIs). Design: Cross-sectional survey. Setting: Community survey. Participants: Four hundred ninety-four junior rugby league players and their coaches in the Gold Coast, Australia. Interventions: Data were collected anonymously during training sessions by means of a survey questionnaire, followed by a presentation on mouthguards and the management of TDIs. Main Outcome Measures: Descriptive statistics on the frequency distribution of the demographic characteristics, knowledge, and use of mouthguards as well as the relationships between the type of mouthguard worn and questions related to mouthguard use. Results: The majority of players surveyed reported wearing a mouthguard (68.2%). Cost (40.1%) and not believing that they work (35.7%) were listed as the main reasons for not doing so. The boil-and-bite type was the most used by players (64.7%). Almost 44% of coaches and 50% of players responded that only a dentist can manage an avulsed tooth, that a tooth had to be reinserted within 15 minutes (40.6% and 21.9%, respectively), and that either water or milk can be used to transport an avulsed tooth to the dentist (100% and 82.2%, respectively). Conclusions: Education related to the correct use of mouthguards and the management of TDIs should be ongoing for players, their caregivers, and their coaches and should be required as part of the training of coaches to prevent injury in rugby league. Clinical Relevance: This study found that although the overwhelming majority of junior rugby league coaches encourage the wearing of mouthguards, only two-thirds of the players do so. Players' compliance to wear mouthguards is largely influenced by their perception of efficacy and its comfort. Educational campaigns with involvement of dental practitioners, related to the correct use of mouthguards and the management of TDIs, should be ongoing for players, their caregivers, and their coaches and should also be required as part of the training of coaches.

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Differential Sensitivity Between a Virtual Reality Balance Module and Clinically Used Concussion Balance Modalities

imageObjective: Balance assessments are part of the recommended clinical concussion evaluation, along with computerized neuropsychological testing and self-reported symptoms checklists. New technology has allowed for the creation of virtual reality (VR) balance assessments to be used in concussion care, but there is little information on the sensitivity and specificity of these evaluations. The purpose of this study is to establish the sensitivity and specificity of a VR balance module for detecting lingering balance deficits clinical concussion care. Design: Retrospective case–control study. Setting: Institutional research laboratory. Participants: Normal controls (n = 94) and concussed participants (n = 27). Interventions: All participants completed a VR balance assessment paradigm. Concussed participants were diagnosed by a Certified Athletic Trainer or physician (with 48 hours postinjury) and tested in the laboratory between 7 and 10 days postinjury. Receiver operating characteristic curves were performed to establish the VR module's sensitivity and specificity for detecting lingering balance deficits. Main Outcome Measures: Final balance score. Results: For the VR balance module, a cutoff score of 8.25 was established to maximize sensitivity at 85.7% and specificity at 87.8%. Conclusions: The VR balance module has high sensitivity and specificity for detecting subacute balance deficits after concussive injury. Clinical Relevance: The VR balance has a high subacute sensitivity and specificity as a stand-alone balance assessment tool and may detect ongoing balance deficits not readily detectable by the Balance Error Scoring System or Sensory Organization Test. Virtual reality balance modules may be a beneficial addition to the current clinical concussion diagnostic battery.

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Visual Defects in Special Olympics Participants From Europe

imageObjective: To describe visual problems among athletes with intellectual disabilities (IDs) and the role of vision in special sports. Design: A cross-sectional observational study. Setting: Athletes participating in Special Olympics European Summer Games 2010 in Warsaw attended vision screening by Special Olympics Lions Clubs International Opening Eyes. Participants: Coaches were encouraged to bring all athletes to screening without selection; 900 athletes from 52 European countries participated. Interventions: Standard noninvasive eye examination procedures. Independent variables were age, gender, sport, and country of origin. Main Outcome Measures: Eyeglasses wear, presenting visual acuity, refractive error, and ocular health. Results: Testability rates were very high. Findings confirmed high prevalence of ocular/visual defects in people with ID. There was an association between acuity and sport discipline. Few athletes used sports glasses. Screening revealed a lack of eye care even in the most developed nations. Conclusions: The impact of vision on sports activity in athletes with ID is significant. More needs to be done to ensure good vision and safety correction for active people with ID. Better provision and greater awareness of eye care in people with ID is needed in all European societies. Clinical Relevance: Data presented highlight the need for increased awareness of the role of vision in sporting achievements, personal development, and quality of life in active people with ID. Athletes with ID should have easily accessible comprehensive eye care, and when appropriate, corrective and protective glasses. This will require the efficient cooperation of vision specialists, coaches, carers, and athletes themselves.

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Effects of 100-km Ultramarathon on Acute Kidney Injury: Erratum

No abstract available

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Dietary Supplements: Knowledge and Adverse Event Reporting Among American Medical Society for Sports Medicine Physicians

imageObjective: Certain dietary supplements (DSs) used by military populations pose a threat to overall readiness. This study assessed members of the American Medical Society for Sports Medicine (AMSSM) regarding their knowledge of DS use among their patients and reporting of suspected adverse events. Design: A thirteen-question retrospective, cross-sectional, Web-based survey sought data on practices regarding DSs and adverse event reporting. Setting: Anonymous Web-based survey. Participants: Military and civilian sports medicine physicians. Main Outcome Measures: The primary finding of the study was how frequently practitioners report adverse events associated with DS use. Results: A total of 311 physicians responded to the survey. Only 51% of respondents had a reliable source for information on DS safety and 58% routinely discussed DS use with their patients. Although a majority (71%) of respondents had encountered adverse events associated with DS use, few of those (10%) confirmed reporting such events. Reasons that physicians did not report adverse events were lack of knowledge regarding where to report (68%), how to report (61%), and availability of time (9%). Conclusions: Our results indicate that some AMSSM physicians are familiar with DSs and have encountered adverse events associated with their use. However, reporting of these adverse events to the appropriate agency is minimal at best. The significant gaps in physician knowledge regarding how and where to report such events indicate a need to educate physicians on this subject. Clinical Relevance: The findings of this survey indicate the need for provider education on reporting adverse events associated with DS use. Although reporting of adverse events is essential for removing harmful DSs from the market, a majority of physicians have limited knowledge on this issue. Moreover, the survey provides insight into the barriers to physician reporting of adverse events.

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Final 2016 AMSSM Case Abstracts

No abstract available

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Pharmacogenetic Effects of Inhaled Salbutamol on 10-km Time Trial Performance in Competitive Male and Female Cyclists

imageObjective: To determine the effects of single nucleotide polymorphisms (SNPs) in the adrenergic β2-receptor gene (ADRB2, rs1042713, and rs1042714) and epithelial Na+ channel gene (SCNN1A, rs2228576) on cycling performance after the inhalation of salbutamol. Design: Randomized double-blind, mixed-model repeated measures. Setting: University Research Setting. Participants: Sixty-nine trained (maximal oxygen consumption: 62.3 ± 7.6 mL·kg−1·min−1) male and female cyclists, aged 19 to 40 years. Interventions: Participants performed two 10-km time trials 60 minutes after the inhalation of 400 μg of salbutamol or placebo. Subjects were genotyped for the three SNPs (rs1042713: AA 8, AG 30 GG 31; rs1042714: CC 19, CG 35, GG 15; rs2228576: GG: 31 GA: 34 AA: 4). Main Outcome Measures: Forced expiratory volume in 1 second (FEV1) was assessed immediately before and 30 minutes after inhalation. Performance was measured by mean power output maintained over the duration of the time trial. Results: There was a significant increase in FEV1 after the inhalation of salbutamol [mean (SD) = 5.68% (4.7)] compared with placebo [0.84% (2.8); P

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Research Podium Presentations

No abstract available

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“Effect of Mobilization/Manipulation Directed At Cervical Spine and Thoracic Spine in Patients With Mechanical Neck Pain”

2016-03-01T17-48-30Z
Source: International Journal of Therapies and Rehabilitation Research
SHWETA RAJENDRA NAIDU, G.J. RAMTEKE.
Abstract: Mechanical neck pain is a major health problem in modern society. Intervertebral joint dysfunctions are defined as a reduction of mobility of cervical segment and if identified on clinical examination, is often the focus of treatment of mobilization/ manipulation. The purpose of this study is to compare the effects of conventional treatment alone with added effect of cervical mobilization/ manipulation with conventional treatment and cervical and thoracic spine mobilization /manipulation in patients with mechanical neck pain. Methods: 60 participants of mechanical neck pain were selected by purposive sampling method and randomly allocated to three groups, 6 treatment sessions over a period of 2 weeks were given. The Numerical Pain Rating Scale and the Neck Disability Index score was considered in pre and post assessment. Statistical comparison amongst the groups was made using the one way ANOVA & POST Hoc analysis. Result: The present experiments indicate that both mobilization/ manipulation were equally effective as compared to conventional treatment.


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Sexy CPR video goes viral



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Skeletal Muscle Hypertrophy with Concurrent Exercise Training: Contrary Evidence for an Interference Effect

Abstract

Over the last 30+ years, it has become axiomatic that performing aerobic exercise within the same training program as resistance exercise (termed concurrent exercise training) interferes with the hypertrophic adaptations associated with resistance exercise training. However, a close examination of the literature reveals that the interference effect of concurrent exercise training on muscle growth in humans is not as compelling as previously thought. Moreover, recent studies show that, under certain conditions, concurrent exercise may augment resistance exercise-induced hypertrophy in healthy human skeletal muscle. The purpose of this article is to outline the contrary evidence for an acute and chronic interference effect of concurrent exercise on skeletal muscle growth in humans and provide practical literature-based recommendations for maximizing hypertrophy when training concurrently.



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Sexy CPR video goes viral



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Sexy CPR video goes viral



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Sexy CPR video goes viral



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The effect of balance training on postural control in people with multiple sclerosis using the CAREN virtual reality system: a pilot randomized controlled trial

Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Imbalance appears in most people with multiple sclerosis (PwMS). ...

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Heterogeneity in xeroderma pigmentosum [Genetics]

Xeroderma pigmentosum (XP) is a rare DNA repair disorder characterized by increased susceptibility to UV radiation (UVR)-induced skin pigmentation, skin cancers, ocular surface disease, and, in some patients, sunburn and neurological degeneration. Genetically, it is assigned to eight complementation groups (XP-A to -G and variant). For the last 5 y,...

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Nonautonomous cell death in the Drosophila ovary [Genetics]

Programmed cell death (PCD) is usually considered a cell-autonomous suicide program, synonymous with apoptosis. Recent research has revealed that PCD is complex, with at least a dozen cell death modalities. Here, we demonstrate that the large-scale nonapoptotic developmental PCD in the Drosophila ovary occurs by an alternative cell death program...

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Sex-specific regulation of Lgr3 [Genetics]

The development of sexually dimorphic morphology and the potential for sexually dimorphic behavior in Drosophila are regulated by the Fruitless (Fru) and Doublesex (Dsx) transcription factors. Several direct targets of Dsx have been identified, but direct Fru targets have not been definitively identified. We show that Drosophila leucine-rich repeat G...

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Visualizing de novo mutations in human testes [Genetics]

De novo point mutations arise predominantly in the male germline and increase in frequency with age, but it has not previously been possible to locate specific, identifiable mutations directly within the seminiferous tubules of human testes. Using microdissection of tubules exhibiting altered expression of the spermatogonial markers MAGEA4, FGFR3, and...

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Prostaglandin E2/cyclooxygenase pathway in human skeletal muscle: influence of muscle fiber type and age

Prostaglandin E2 (PGE2) produced by the cyclooxygenase (COX) pathway regulates skeletal muscle protein turnover and exercise training adaptations. The purpose of this study was twofold: 1) define the PGE2/COX pathway enzymes and receptors in human skeletal muscle, with a focus on type I and II muscle fibers; and 2) examine the influence of aging on this pathway. Muscle biopsies were obtained from the soleus (primarily type I fibers) and vastus lateralis (proportionally more type II fibers than soleus) of young men and women (n = 8; 26 ± 2 yr), and from the vastus lateralis of young (n = 8; 25 ± 1 yr) and old (n = 12; 79 ± 2 yr) men and women. PGE2/COX pathway proteins [COX enzymes (COX-1 and COX-2), PGE2 synthases (cPGES, mPGES-1, and mPGES-2), and PGE2 receptors (EP1, EP2, EP3, and EP4)] were quantified via Western blot. COX-1, cPGES, mPGES-2, and all four PGE2 receptors were detected in all skeletal muscle samples examined. COX-1 (P < 0.1) and mPGES-2 were ~20% higher, while EP3 was 99% higher and EP4 57% lower in soleus compared with vastus lateralis (P < 0.05). Aging did not change the level of skeletal muscle COX-1, while cPGES increased 45% and EP1 (P < 0.1), EP3, and EP4 decreased ~33% (P < 0.05). In summary, PGE2 production capacity and receptor levels are different in human skeletal muscles with markedly different type I and II muscle fiber composition. In aging skeletal muscle, PGE2 production capacity is elevated and receptor levels are downregulated. These findings have implications for understanding the regulation of skeletal muscle adaptations to exercise and aging by the PGE2/COX pathway and related inhibitors.



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Energy expenditure during level human walking: seeking a simple and accurate predictive solution

Accurate prediction of the metabolic energy that walking requires can inform numerous health, bodily status, and fitness outcomes. We adopted a two-step approach to identifying a concise, generalized equation for predicting level human walking metabolism. Using literature-aggregated values we compared 1) the predictive accuracy of three literature equations: American College of Sports Medicine (ACSM), Pandolf et al., and Height-Weight-Speed (HWS); and 2) the goodness-of-fit possible from one- vs. two-component descriptions of walking metabolism. Literature metabolic rate values (n = 127; speed range = 0.4 to 1.9 m/s) were aggregated from 25 subject populations (n = 5-42) whose means spanned a 1.8-fold range of heights and a 4.2-fold range of weights. Population-specific resting metabolic rates (Vo2rest) were determined using standardized equations. Our first finding was that the ACSM and Pandolf et al. equations underpredicted nearly all 127 literature-aggregated values. Consequently, their standard errors of estimate (SEE) were nearly four times greater than those of the HWS equation (4.51 and 4.39 vs. 1.13 ml O2·kg–1·min–1, respectively). For our second comparison, empirical best-fit relationships for walking metabolism were derived from the data set in one- and two-component forms for three Vo2-speed model types: linear (V1.0), exponential (V2.0), and exponential/height (V2.0/Ht). We found that the proportion of variance (R2) accounted for, when averaged across the three model types, was substantially lower for one- vs. two-component versions (0.63 ± 0.1 vs. 0.90 ± 0.03) and the predictive errors were nearly twice as great (SEE = 2.22 vs. 1.21 ml O2·kg–1·min–1). Our final analysis identified the following concise, generalized equation for predicting level human walking metabolism: Vo2total = Vo2rest + 3.85 + 5.97·V2/Ht (where V is measured in m/s, Ht in meters, and Vo2 in ml O2·kg–1·min–1).



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Maintaining the integrity of peer review



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Central nervous system integration of sensorimotor signals in oral and pharyngeal structures: oropharyngeal kinematics response to recurrent laryngeal nerve lesion

Safe, efficient liquid feeding in infant mammals requires the central coordination of oropharyngeal structures innervated by multiple cranial and spinal nerves. The importance of laryngeal sensation and central sensorimotor integration in this system is poorly understood. Recurrent laryngeal nerve lesion (RLN) results in increased aspiration, though the mechanism for this is unclear. This study aimed to determine the effect of unilateral RLN lesion on the motor coordination of infant liquid feeding. We hypothesized that 1) RLN lesion results in modified swallow kinematics, 2) postlesion oropharyngeal kinematics of unsafe swallows differ from those of safe swallows, and 3) nonswallowing phases of the feeding cycle show changed kinematics postlesion. We implanted radio opaque markers in infant pigs and filmed them pre- and postlesion with high-speed videofluoroscopy. Markers locations were digitized, and swallows were assessed for airway protection. RLN lesion resulted in modified kinematics of the tongue relative to the epiglottis in safe swallows. In lesioned animals, safe swallow kinematics differed from unsafe swallows. Unsafe swallow postlesion kinematics resembled prelesion safe swallows. The movement of the tongue was reduced in oral transport postlesion. Between different regions of the tongue, response to lesion was similar, and relative timing within the tongue was unchanged. RLN lesion has a pervasive effect on infant feeding kinematics, related to the efficiency of airway protection. The timing of tongue and hyolaryngeal kinematics in swallows is a crucial locus for swallow disruption. Laryngeal sensation is essential for the central coordination in feeding of oropharyngeal structures receiving motor inputs from different cranial nerves.



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Letter to the Editor



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Influence of muscle metabolic heterogeneity in determining the VO2p kinetic response to ramp-incremental exercise

The pulmonary O2 uptake (Vo2p) response to ramp-incremental (RI) exercise increases linearly with work rate (WR) after an early exponential phase, implying that a single time constant () and gain (G) describe the response. However, variability in and G of Vo2p kinetics to different step increments in WR is documented. We hypothesized that the "linear" Vo2p-WR relationship during RI exercise results from the conflation between WR-dependent changes in and G. Nine men performed three or four repeats of RI exercise (30 W/min) and two step-incremental protocols consisting of four 60-W increments beginning from 20 W or 50 W. During testing, breath-by-breath Vo2p was measured by mass spectrometry and volume turbine. For each individual, the Vo2p RI response was characterized with exponential functions containing either constant or variable and G values. A relationship between and G vs. WR was determined from the step-incremental protocols to derive the variable model parameters. and G increased from 21 ± 5 to 98 ± 20 s and from 8.7 ± 0.6 to 12.0 ± 1.9 ml·min–1·W–1 for WRs of 20-230 W, respectively, and were best described by a second-order () and a first-order (G) polynomial function of WR (lowest Akaike information criterion score). The sum of squared residuals was not different (P > 0.05) when the Vo2p RI response was characterized with either the constant or variable models, indicating that they described the response equally well. Results suggest that and G increase progressively with WR during RI exercise. Importantly, these relationships may conflate to produce a linear Vo2p-WR response, emphasizing the influence of metabolic heterogeneity in determining the apparent Vo2p-WR relationship during RI exercise.



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Regional specific modulation of the glycocalyx and smooth muscle cell contractile apparatus in conduit arteries of tail-suspended rats

The glycocalyx is a key mechanosensor on the surfaces of vascular cells (endothelial cells and smooth muscle cells), and recently, we reported that the redistribution of the hemodynamic factors in tail-suspended (TS) hindlimb-unloaded rats induces the dimensional adaptation of the endothelial glycocalyx in a regional-dependent manner. In the present study, we investigated the coverage and gene expression of the glycocalyx and its possible relationship with smooth muscle contractility in the conduit arteries from the TS rats. The coverage of the glycocalyx, determined by the area analysis of the fluorescein isothiocyanate-labeled wheat germ agglutinin (WGA-FITC) staining to the cryosections of rat vessels, showed a 27.2% increase in the common carotid artery, a 13.3 and 8.0% decrease in the corresponding abdominal aorta and the femoral artery after 3 wk of tail suspension. The relative mRNA levels of syndecan-2, 3, 4, glypican-1, smooth muscle protein 22 (SM22), smoothelin (SMTN), and calponin were enhanced to 1.40, 1.53, 1.70, 1.90, 2.93, 2.30, and 5.23-fold, respectively, in the common carotid artery of the TS rat. However, both glycocalyx-related genes and smooth muscle contractile apparatus were totally or partially downregulated in the abdominal aorta and femoral artery of the TS rat. A linear positive correlation between the normalized coverage of glycocalyx and normalized mRNA levels of SM22, SMTN, and calponin exists. These results suggest the regional-dependent adaptation of the glycocalyx in simulated microgravity condition, which may affect its mechanotransduction of shear stress to regulate the contractility of the smooth muscle, finally contributing to postspaceflight orthostatic intolerance.



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Eliminating medullary 5-HT neurons delays arousal and decreases the respiratory response to repeated episodes of hypoxia in neonatal rat pups

Arousal from sleep is a critical defense mechanism when infants are exposed to hypoxia, and an arousal deficit has been postulated as contributing to the etiology of the sudden infant death syndrome (SIDS). The brainstems of SIDS infants are deficient in serotonin (5-HT) and tryptophan hydroxylase (TPH) and have decreased binding to 5-HT receptors. This study explores a possible connection between medullary 5-HT neuronal activity and arousal from sleep in response to hypoxia. Medullary raphe 5-HT neurons were eliminated from neonatal rat pups with intracisterna magna (CM) injections of 5,7-dihydroxytryptamine (DHT) at P2-P3. Each pup was then exposed to four episodes of hypoxia during sleep at three developmental ages (P5, P15, and P25) to produce an arousal response. Arousal, heart rate, and respiratory rate responses of DHT-injected pups were compared with pups that received CM artificial cerebrospinal fluid (aCSF) and those that received DHT but did not have a significant reduction in medullary 5-HT neurons. During each hypoxia exposure, the time to arousal from the onset of hypoxia (latency) was measured together with continuous measurements of heart and respiratory rates, oxyhemoglobin saturation, and chamber oxygen concentration. DHT-injected pups with significant losses of medullary 5-HT neurons exhibited significantly longer arousal latencies and decreased respiratory rate responses to hypoxia compared with controls. These results support the hypothesis that in newborn and young rat pups, 5-HT neurons located in the medullary raphe contribute to the arousal response to hypoxia. Thus alterations medullary 5-HT mechanisms might contribute to an arousal deficit and contribute to death in SIDS infants.



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Relationship between blood pressure and cerebral blood flow during supine cycling: influence of aging

The cerebral pressure-flow relationship can be quantified as a high-pass filter, where slow oscillations are buffered (<0.20 Hz) and faster oscillations are passed through relatively unimpeded. During moderate intensity exercise, previous studies have reported paradoxical transfer function analysis (TFA) findings (altered phase or intact gain). This study aimed to determine whether these previous findings accurately represent this relationship. Both younger (20–30 yr; n = 10) and older (62–72 yr; n = 9) adults were examined. To enhance the signal-to-noise ratio, large oscillations in blood pressure (via oscillatory lower body negative pressure; OLBNP) were induced during steady-state moderate intensity supine exercise (~45–50% of heart rate reserve). Beat-to-beat blood pressure, cerebral blood velocity, and end-tidal Pco2 were monitored. Very low frequency (0.02–0.07 Hz) and low frequency (0.07–0.20 Hz) range spontaneous data were quantified. Driven OLBNP point estimates were sampled at 0.05 and 0.10 Hz. The OLBNP maneuvers augmented coherence to >0.97 at 0.05 Hz and >0.98 at 0.10 Hz in both age groups. The OLBNP protocol conclusively revealed the cerebrovascular system functions as a high-pass filter during exercise throughout aging. It was also discovered that the older adults had elevations (+71%) in normalized gain (+0.46 ± 0.36%/%: 0.05 Hz) and reductions (–34%) in phase (–0.24 ± 0.22 radian: 0.10 Hz). There were also age-related phase differences between resting and exercise conditions. It is speculated that these age-related changes in the TFA metrics are mediated by alterations in vasoactive factors, sympathetic tone, or the mechanical buffering of the compliance vessels.



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Redistribution of inhaled hyperpolarized 3He gas during breath-hold differs by asthma severity

The purpose of this work was to quantify the redistribution of ventilation-weighted signal in the lungs of asthmatic subjects during a breath-hold using high temporal-spatial resolution hyperpolarized (HP) He-3 MRI. HP He-3 MRI was used to obtain time-resolved, volumetric images of lung ventilation during breath-hold in 39 human subjects classified as either healthy/nondiseased (n = 14), mild-to-moderate asthmatic (n = 17), or severely asthmatic (n = 8). Signals were normalized to a standard lung volume, so that voxels within the lung from all 39 subjects could be analyzed as a group to increase statistical power and enable semiautomated classification of voxels into 1 of 5 ventilation level categories (ranging from defect to hyperintense). End-inspiratory ventilation distribution and temporal rates of mean signal change for each of the five ventilation categories were compared using ANOVA. Time rates of signal change were hypothesized to represent underlying gas redistribution processes, potentially influenced by disease. We found that mild-to-moderate asthmatic subjects showed the greatest rate of signal change, even though those with severe asthma had the greatest end-inspiration ventilation heterogeneity. The observed results support the existence of local differences in airway resistances associated with the different obstructive patterns in the lungs for severe vs. mild-to-moderate asthmatic subjects.



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Reply to Drs. Teppema and Berendsen



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Ohio fire, EMS departments to buy body armor



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Evaluation of mental health using hospital anxiety and depression scale in primary caregivers of patients undergoing dialysis

2016-03-01T09-10-25Z
Source: International Journal of Medical Science and Public Health
Akshay Prashanth Giri, Subhashini Mohanasundaram, P C Kesavankutty Nayar, R N Sharma, George Kurian.
Background: There is inadequate research on anxiety and depression in the primary caregivers of the patients undergoing dialysis. Objective: To analyze the anxiety and depression of primary caregivers of patients undergoing dialysis using Hospital Anxiety and Depression Scale (HADS). Materials and Methods: This study enrolled 52 patients from Amrita Institute of Medical Sciences Hospital, Kochi, Kerala, India. Their mental health was assessed by using HADS. The patients caregivers were categorized into three groups based on their age namely 60 years. The caregivers characteristics such as relationship, educational status, type of family, income status, frequency of dialysis, number of hospitalization per year, and monthly expenditure for dialysis were taken into consideration. Result: The total number of caregivers enrolled in this study was 52 (men: 18, women: 34). The overall HADS indicated that both anxiety and depression were mildly higher than the normal. However, the gender-based analyses showed that women caregivers were moderately depressed and mildly anxious that too middle-aged female caregivers were affected with both, whereas in men the young male caregivers were in mild depression. In the remaining male groups, no significant depression and anxiety were noted. Conclusion: The middle-aged women caregivers (4159 years) were mildly depressed and anxious when compared with other groups.


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Knowledge, attitude and practice of cupping therapy among Saudi patients attending primary healthcare in Makkah, Kingdom of Saudi Arabia

2016-03-01T09-10-25Z
Source: International Journal of Medical Science and Public Health
Sultan Sameer Ghazi.
Background: The practice of Al-Hijamah has been part of Middle-Eastern cultural practice for thousands of years with citations dating back to the time of Hippocrates (400 BC). Up to date there are no scientifically approved research trials anywhere in the world which investigated the impact of cupping at a physiological level, although numerous small scale studies have been done promoting the benefits of cupping for various diseases. Objectives: To explore the knowledge, attitude, and practicing of Saudi population regarding to Al-Hijamah, as one of the old traditional modality of treatments. Materials and Methods: A cross-sectional study was conducted through the period from October 1, 2011 to March 30, 2012. It included a representative sample of male adult patients (>18 years old), who attended primary health-care centers (PHCs) in Makkah, Kingdom of Saudi Arabia (KSA) throughout the study period. Makkah was divided into four regions; one PHC was selected from each region using simple random sampling technique. One-hundred patients were selected from each center using a systematic random sampling technique. Every second patient who attended the selected PHCs was invited to voluntarily participate in the study. A pre-designed questionnaire was utilized. This questionnaire included information regarding: personal data, knowledge, attitude, and practice of cupping therapy among participants. Result: The study included 400 adult male patients attended PHC, Makkah throughout the study period. Their ages ranged between 18 and 73 years. Approximately two-thirds of the participants (61.5%) have their information about cupping therapy from the community whereas only 11.8% and 11.3% have their information from TV and doctors, respectively. Most of them believed that Hijamah is a kind of prevention and treatment of diseases (82.3% and 88.5%, respectively). Two-thirds of the participants (269; 67.3%) have personal experience with Hijamah or experience of Hijamah among their friends or relatives. Among them, 240 (89.2%) reported that they got benefits from Hijamah. The majority of participants treated with Hijamah for back pain (97.9%), headache (96.6%), joint pain (91.7), hypersomnia (88.9%), and fatigue (84.3%) showed improvement compared to 68.2% among those performed Hijamah to treat other conditions (fever, bronchial asthma, dizziness, hyperlipidaemia, irritable bowel syndrome). This difference is statistically significant (p

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Delayed-type of hypersensitivity reaction due to piperacillin/tazobactam causing severe thrombocytopenia

2016-03-01T08-55-39Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Mihir Parekh, Sanket Sheth, Bhalendu Vaishnav, Anusha Mangalampalli.
Piperacillin/tazobactam is a frequently prescribed and well-tolerated β-lactam antibiotic used in various clinical conditions with favorable side effect profile. Very few cases of piperacillin/tazobactam-induced thrombocytopenia have been reported so far. We report a case of piperacillin/tazobactam-induced delayed thrombocytopenia. A 63-year-old female was being treated with piperacillin/tazobactam for aspiration pneumonia after an episode of seizures. While the patients condition rapidly improved after hospitalization, she developed isolated severe thrombocytopenia on the 12th day. Other possible causes of thrombocytopenia were ruled out by appropriate investigations and the possibility of piperacillin/tazobactam-induced thrombocytopenia was kept. Upon discontinuation of piperacillin/tazobactam, her platelet counts improved rapidly. While treating patients with this drug, clinicians should keep the possibility of thrombocytopenia in mind as a rare but potentially serious side effect. Immediate withdrawal of the drug may be life saving in such situations. Moreover, delayed type of reaction with piperacillin/tazobactam warrants caution for clinicians to continue patients on this drug at home after discharge from the hospital, which is not an uncommon scenario in resource limited countries such as India.


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Ohio fire, EMS departments to buy body armor



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Gamber-Johnson Announces the Availability of Extended Service Plan

STEVENS POINT, Wisconsin – Gamber-Johnson announced the availability of a no fault, 5-year Extended Service Plan for Gamber-Johnson Docking Stations and Electronic products. Gamber-Johnson Extended Service Plan builds on our standard warranty by adding free loaner docks, accidental damage, expedited service and free shipping. The Extended Service Plan is available on all docking stations and other ...

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Ohio fire, EMS departments to buy body armor



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Ohio fire, EMS departments to buy body armor



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4 students injured in Ohio school shooting

A suspect is in custody after allegedly walking into the lunchroom at a Middletown, Ohio, school and opening fire.

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4 students injured in Ohio school shooting

A suspect is in custody after allegedly walking into the lunchroom at a Middletown, Ohio, school and opening fire.

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4 students injured in Ohio school shooting

A suspect is in custody after allegedly walking into the lunchroom at a Middletown, Ohio, school and opening fire.

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My EMS Story (2016) : Official Trailer 1

'My EMS Story' is an official mini web-series produced by Parastar MultiMedia documenting the lives of real men and women in the EMS field today. Learn what inspired these brave men and women to pursue their profession as EMT's and Paramedics and how EMS has shaped their lives today. Follow each week with a new episode and prepare to tell your EMS Story.

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4 students injured in Ohio school shooting

A suspect is in custody after allegedly walking into the lunchroom at a Middletown, Ohio, school and opening fire.

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My EMS Story (2016) : Official Trailer 1

'My EMS Story' is an official mini web-series produced by Parastar MultiMedia documenting the lives of real men and women in the EMS field today. Learn what inspired these brave men and women to pursue their profession as EMT's and Paramedics and how EMS has shaped their lives today. Follow each week with a new episode and prepare to tell your EMS Story.

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Ohio School Shooting: 4 Students Injured

A suspect is in custody after allegedly walking into the lunchroom at a Middletown, Ohio, school and opening fire.

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My EMS Story (2016) : Official Trailer 1

'My EMS Story' is an official mini web-series produced by Parastar MultiMedia documenting the lives of real men and women in the EMS field today. Learn what inspired these brave men and women to pursue their profession as EMT's and Paramedics and how EMS has shaped their lives today. Follow each week with a new episode and prepare to tell your EMS Story.

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My EMS Story (2016) : Official Trailer 1

'My EMS Story' is an official mini web-series produced by Parastar MultiMedia documenting the lives of real men and women in the EMS field today. Learn what inspired these brave men and women to pursue their profession as EMT's and Paramedics and how EMS has shaped their lives today. Follow each week with a new episode and prepare to tell your EMS Story.

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A Huge Retroperitoneal Neurofibroma mimicking broad ligament fibroid in postmenopausal women: An extremely rare report with review of literature

2016-03-01T05-10-19Z
Source: The Southeast Asian Journal of Case Report and Review
Katke Rajshree Dayanand.
The neurofibroma is a tumour of neural origin. This kind of neoplasm, though, is generally skin located. Rare cases in deep organs or in the peritoneal cavity are also reported in the literature. There are two types of neurofibromas, localized and diffuse; the latter is associated with von Recklinghausen disease and always occurs together with skin neurofibromas. Here we report the case of a 62-year-old woman affected by neurofibroma, but not associated with von Recklinghausen disease. A computed tomography (CT) scan described a retroperitoneal pararenal lesion with no clear involvement of adjacent viscera. We describe the diagnostic modality, treatment planning and the timing of treatment of this neoplasm, reviewing also the literature.


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Editorial Board



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Application of Y-shaped, coated self-expandable metallic stents for anastomotic stenosis after gastrojejunostomy (Billroth II)

Acta Radiologica

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Age, sex and arterial pressure: the kidney is essential



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Predicting a response to antibiotics in patients with the irritable bowel syndrome

Digestive Diseases and Sciences

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Reply



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Polyphosphate derived from lactobacillus brevis inhibits colon cancer progression through induction of cell apoptosis

Anticancer Research

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How and why transient testing may better reveal peripheral chemoreceptor function in humans



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Safety and efficacy of sofosbuvir-containing regimens in hepatitis C infected patients with impaired renal function

Liver International

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Impact of calcium regulation on eccrine sweating and sweating disorders: the view from cells to glands to intact human skin



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Association between long-term lipid profiles and disease severity in a large cohort of patients with inflammatory bowel disease

Digestive Diseases and Sciences

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Sex hormone effects on autonomic and endothelial function

Thumbnail image of graphical abstract

A video slideshow Introduction to the Symposium by symposium organiser Nina S. Stachenfeld can be found here.



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Osteoprotegerin: A novel biomarker for inflammatory bowel disease and gastrointestinal carcinoma

Journal of Gastroenterology and Hepatology

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Addressing the role of food in irritable bowel syndrome symptom management

The Journal for Nurse Practitioners

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Role of diet in fecal incontinence: A systematic review of the literature

International Urogynecology Journal

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Identification of hepatitis C virus genotype 3 by a commercial assay challenged by natural polymorphisms detected in Spain from patients with diverse origins

Journal of Clinical Virology

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Gastrointestinal tolerance and plasma status of carotenoids, EPA and DHA with a fiber- enriched tube feed in hospitalized patients initiated on tube nutrition: randomized controlled trial

Clinical Nutrition

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Pancreatoduodenectomy, fifteen years of experience

BMC Cancer

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Dietary risk factors for colorectal cancer in Brazil: A case control study

Nutrition Journal

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Three-year monitoring of serum p53 antibody during chemotherapy and surgery for stage IV rectal cancer

Abstract

The overexpression of mutant p53 stimulates serum p53 antibody production in patients with colorectal carcinoma even in superficial tumors. Although the short-term perioperative monitoring of serum p53 antibody titers is reported to be useful in predicting tumor recurrence and patient survival in colorectal carcinoma, the clinical utility of the long-term monitoring of serum p53 antibody titers in patients with colorectal cancer remains unknown. Here, we report the 3-year monitoring of serum p53 antibody titers in a 60-year-old man with rectal cancer, clinical stage IV (T2N2M1b, lung and liver metastases), who was treated with chemotherapy and surgery. Screening tests for CEA (29.4 ng/ml), CA19-9 (41.1 U/ml), and serum p53 antibody (2170 U/ml) were positive before treatment. After chemotherapy with mFOLFOX6 + bevacizumab (B-mab), CEA and CA19-9 decreased to the normal range. However, serum p53 antibody titer remained positive (283 U/ml). After low anterior resection, the serum p53 antibody titer still remained positive (63.4 U/ml). Serum p53 antibody titer significantly changed and was associated with treatment response and tumor recurrence. In the last 6 months of the patient's life, serum p53 antibody titer gradually decreased, which possibly reflects the modification of the patient's immune response to p53 antigens.



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Reactivation of resolved hepatitis B virus infection with immune escape mutations after long-term corticosteroid therapy

Abstract

Hepatitis B virus (HBV) reactivation from resolved infection is a serious problem which can frequently lead to severe hepatitis. Generally, it occurs several months after the start of immunosuppressive therapy; however, it sometimes occurs a few years later, even after cessation of therapy. Here we report a patient with de novo HBV infection who had received corticosteroid therapy for pemphigus vulgaris for 6 years. Full-genome HBV sequence analysis using serial serum samples revealed that the patient was infected with HBV subgenotype C2, which had the G1896R mixed mutation in the precore region. Interestingly, it had the immune escape mutations P120A and G145R in the S gene. Because both hepatitis B surface antigen and antibodies to hepatitis B surface antigen (HBsAb) were positive at the onset of the de novo infection, it was considered that HBV with these mutations escaped from neutralization by the pre-existing HBsAbs. This case indicates that HBV reactivation with an immune escape mutant can occur long after immunosuppressive therapy.



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Expanding the phenotype of CRB2 mutations – A new ciliopathy syndrome?

Abstract

Recessive CRB2 mutations were recently reported to cause both steroid resistant nephrotic syndrome and prenatal onset ventriculomegaly with kidney disease. We report two Ashkenazi Jewish siblings clinically diagnosed with ciliopathy. Both presented with severe congenital hydrocephalus and mild urinary tract anomalies. One affected sibling also has lung hypoplasia and heart defects. Exome sequencing and further CRB2 analysis revealed that both siblings are compound heterozygotes for CRB2 mutations p.N800K and p.Gly1036Alafs*43, and heterozygous for a deleterious splice variant in the ciliopathy gene TTCB21. CRB2 is a polarity protein which plays a role in ciliogenesis and ciliary function. Biallelic CRB2 mutations in animal models result in phenotypes consistent with ciliopathy. This report expands the phenotype of CRB2 mutations to include lung hypoplasia and uretero-pelvic renal anomalies, and confirms cardiac malformation as a feature. We suggest that CRB2–associated disease is a new ciliopathy syndrome with possible digenic/triallelic inheritance, as observed in other ciliopathies. Clinically, CRB2 should be assessed when ciliopathy is suspected, especially in Ashkenazi Jews, where we found that p.N800K carrier frequency is 1/64. Patients harboring CRB2 mutations should be tested for the full range of ciliopathy manifestations.



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