Δευτέρα, 26 Σεπτεμβρίου 2016

Spinal Cord Injury Level Influences Acute Plasma Caffeine Responses.

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Purpose: To investigate the absorption curve and acute effects of caffeine at rest in individuals with no spinal cord injury (SCI), paraplegia (PARA) and tetraplegia (TETRA). Methods: Twenty-four healthy males (8 able-bodied (AB), 8 PARA and 8 TETRA) consumed 3 mg[BULLET OPERATOR]kg-1 caffeine anhydrous (CAF) in a fasted state. Plasma caffeine [CAF], glucose, lactate, free-fatty acid [FFA] and catecholamine concentrations were measured during a 150 min rest period. Results: Peak [CAF] was greater in TETRA (21.5 [mu]M) compared to AB (12.2 [mu]M) and PARA (15.1 [mu]M), and mean peak [CAF] occurred at 70, 80 and 80 min, respectively. Moderate and large ES were revealed for TETRA compared to PARA and AB (-0.55 and -1.14, respectively) for the total area under the [CAF] versus time curve. Large inter-individual responses were apparent in SCI groups. The change in plasma catecholamine concentrations following CAF did not reach significance (p>0.05) however both adrenaline and noradrenaline concentrations were lowest in TETRA. Significant increases in [FFA] were seen over time (p0.05). Conclusion: Level of SCI influenced the caffeine absorption curve and there was large inter-individual variation within and between groups. Individual curves should be considered when using caffeine as an ergogenic aid in athletes with an SCI. The results indicate TETRA should trial low doses in training and PARA may consider consuming caffeine greater than 60 min prior to exercise performance. The study also supports caffeine's direct effect on adipose tissue, which is not secondary to catecholamine release. (C) 2016 American College of Sports Medicine

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The Impact of a Healthy Lifestyle on Future Physical Functioning in Midlife Women.

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Purpose: To examine the prospective association between healthy lifestyle behaviors and objectively measured physical function in midlife women. Methods: Participants included 1,769 racially/ethnically diverse women, ages 56-68, from the SWAN (Study of Women's Health Across the Nation) cohort. Physical function was assessed at the 13th follow-up (FU13) visit with the Short Physical Performance Battery (4 meter walk, repeated chair stands, and balance test) and grip strength. A Healthy Lifestyle Score (HLS), which ranged from 0-6, was calculated by averaging as many as three repeated measures of self-reported smoking, physical activity, and diet, all assessed prior to FU13. Multivariable linear and logistic regressions modeled each component of physical performance as a function of HLS and, in separate models, of each lifestyle behavior, adjusted for the other behaviors. Results: In multivariable analyses, the time for the 4 M walk was 0.06 secs faster (p=0.001) for every 1 point increase in the HLS. The time for the repeated chair stands was significantly shorter by about 0.20 seconds. Neither grip strength nor balance problems were significantly associated with the HLS (p=.28, p=0.19 respectively). The model examining the individual health behaviors showed that only physical activity was significantly associated with physical performance. Conclusion: Regular physical activity in early midlife has the potential to reduce the likelihood of physical functional limitations later in midlife. (C) 2016 American College of Sports Medicine

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Triathletes Lose Their Advantageous Pain Modulation under Acute Psychosocial Stress.

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Introduction: Triathletes, who constantly engage in intensely stressful sport, were recently found to exhibit greater pain tolerance and more efficient pain inhibition capabilities than non athletes. However, pain inhibition correlated negatively with retrospective reports of mental stress during training and competition. The aim of the current study was to test pain inhibition capabilities of triathletes under acute, controlled psychological stress manipulation. Methods: Participants were 25 triathletes and ironman triathletes who underwent the measurement of pain-threshold, pain-intolerance, tonic suprathreshold pain and conditioned pain modulation (CPM) before and during exposure to the Montreal Imaging Stress Task (MIST). Perceived ratings of stress and anxiety, autonomic variables and salivary cortisol levels were obtained as indices of stress. Results: The MIST induced a significant stress reaction manifested in the subjective and objective indices. Overall, a significant reduction in pain threshold and in CPM efficacy was observed following the MIST, which reached the baseline levels observed previously in non-athletes. Paradoxically, the magnitude of this stress-induced hyperalgesia (SIH) correlated negatively with the magnitude of the stress response; low stress-responders exhibited greater SIH than high stress-responders. Conclusion: The results suggest that under acute psychological stress, triathletes not only react with SIH and a reduction in pain modulation, but also lose their advantageous pain modulation over non-athletes. The stronger the stress response recorded, the weaker the SIH. It appears that triathletes are not resilient to stress, responding with an increase in the sensitivity to pain as well as a decrease in pain inhibition. The possible effects of athletes' baseline pain profile and stress reactivity on SIH are discussed. (C) 2016 American College of Sports Medicine

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Metabolic Responses to the Yukon Arctic Ultra: Longest and Coldest in the World.

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PURPOSE: The Yukon Arctic Ultra is considered the longest and coldest ultraendurance event in the world. Cold exposure and exercise has been reported to influence circulating levels of myo-, adipo- and hepato-kines that may influence considerable alterations in the regulation of metabolism. The purpose of the study was to evaluate the influence of the Yukon Arctic Ultra (430 mile event) on potential activators of brown fat, metabolites and body composition in healthy individuals. METHODS: Eight male and female participants (mean+/-SEM; age = 44+/-3 yr; BMI = 23.4+/-0.9) were recruited for participation. Blood samples were collected at pre-event, mid event and post-event checkpoints. RESULTS: The temperature during the event ranged from -45[degrees]C to -8[degrees]C. Due to these extremely challenging conditions, 50% of the participants withdrew from competition by the 300 mile mark, and those that surpassed 300 miles lost a significant (p=0.002; p=0.01) amount of body weight (76+/-5 kg to 73+/-4 kg) and fat mass (13+/-1 kg to 12+/-3 kg), respectively. With respect to serum irisin, there was a trend (p=0.06) towards significance from pre-event (1033+/-88 ng/ml), mid-event (1265+/-23 ng/ml) to post-event (1289+/-24 ng/ml). Serum meteorin and fibroblast growth factor-21 remained stable throughout the event. There were no changes in creatinine, acetoacetate, acetate, and valine. Serum lactate decreased (p=0.04) during the event. CONCLUSION: The influence of cold exposure and extreme physical exertion may promote substantial increases in serum irisin, and specific alterations in substrate metabolism that largely preserve skeletal muscle and physiological resilience. (C) 2016 American College of Sports Medicine

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High-Intensity Interval Training Increases Cardiac Output and VO2max.

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Increases in maximal oxygen uptake (VO2max) frequently occur with high-intensity interval training (HIIT), yet the specific adaptation explaining this result remains elusive. PURPOSE: This study examined changes in VO2max and cardiac output (CO) in response to periodized HIIT. METHODS: Thirty nine active men and women (mean age and VO2max = 22.9 +/- 5.4 yr and 39.6 +/- 5.6 mL/kg/min) performed HIIT and 32 men and women (age and VO2max = 25.7 +/- 4.5 yr and 40.7 +/- 5.2 mL/kg/min) were non-exercising controls (CON). The first 10 sessions of HIIT required eight to ten 60 s bouts of cycling at 90 - 110 percent peak power output (PPO) interspersed with 75 s recovery, followed by randomization to one of three regimes (sprint interval training (SIT), high-volume interval training (HIITHI), or periodized interval training (PER) for the subsequent 10 sessions. Before, midway, and at the end of training, progressive cycling to exhaustion was completed during which VO2max and maximal CO (COmax) were estimated. RESULTS: Compared to CON, significant (p

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Knee Joint Loading during Single-Leg Forward Hopping.

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Increased or abnormal loading on the intact limb is thought to contribute to the relatively high risk of knee osteoarthritis (OA) in this limb for individuals with unilateral lower limb loss. This theory has been assessed previously by studying walking, but knee joint loading during walking is often similar between individuals with limb loss and individuals without limb loss, prompting assessment of other movements that may place unusual loads on the knee. One such movement, hopping, is a form of locomotion that individuals with unilateral lower limb loss may situationally use instead of walking, but the mechanical effects of hopping on the intact limb are unknown. Purpose: Compare knee joint kinetics of healthy adults during single-leg forward hopping compared to walking, a more traditional form of locomotion. Methods: Twenty-four healthy adults walked and hopped at self-selected speeds of 1.5 and 2.3 m/s, respectively. Joint moments were calculated using inverse dynamics. A paired Student's t-test was utilized to compare peak, impulse, and loading rate (LR) of knee adduction moment (KAM), and peak knee flexion moment (KFM) between walking and running. Results: Peak KFM and KAM LR were greater during hopping compared to walking (Peak KFM: 20.73 vs.5.51 %BW*Ht, p

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Arterial Stiffness Is Reduced Regardless of Resistance Training Load in Young Men.

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Purpose: Discrepancies regarding the impact of resistance exercise training (RET) on arterial stiffness have led to uncertainty regarding the impact of RET on cardiovascular health. Confounding our understanding in this area are the roles of: load (heavier vs lighter), participant cardiovascular health, and the method of arterial stiffness assessment. We aimed to investigate the effects of a heavier versus a lighter load resistance training protocol on both central and local arterial stiffness in previously-trained young men. Methods: Participants were randomly assigned to a 12-week supervised whole-body RET program consisting of 3 sets of 8-12 repetitions (heavier-load, lower-repetition [LR]; n=16) or 3 sets of 20-25 repetitions (lighter-load, higher-repetition [HR]; n=16) to volitional failure, or a control group who maintained their regular activity habits (CON; n=14). Central arterial stiffness (carotid-femoral pulse wave velocity [cfPWV]), local arterial stiffness (common carotid arterial distensibility), and left ventricular mass were measured prior to and after 12 weeks of RET. Results: There was a reduction in cfPWV in both LR (6.24+/-0.56 vs 5.77+/-0.76 m[middle dot]s-1; p

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Voluntary Running Attenuates Metabolic Dysfunction in Ovariectomized Low-Fit Rats.

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INTRODUCTION: Ovariectomy and high fat diet (HFD) worsen obesity and metabolic dysfunction associated with low aerobic fitness. Exercise training mitigates metabolic abnormalities induced by low aerobic fitness, but whether the protective effect is maintained following ovariectomy and HFD is unknown. PURPOSE: This study determined whether, following ovariectomy and HFD, exercise training improves metabolic function in rats bred for low intrinsic aerobic capacity. METHODS: Female rats selectively bred for low (LCR) and high (HCR) intrinsic aerobic capacity (n=30) were ovariectomized, fed HFD, and randomized to either a sedentary (SED) or voluntary wheel running (EX) group. Resting energy expenditure, glucose tolerance, and spontaneous physical activity were determined midway through the experiment, while body weight, wheel running volume, and food intake were assessed throughout the study. Body composition, circulating metabolic markers, and skeletal muscle gene and protein expression was measured at sacrifice. RESULTS: EX reduced body weight and adiposity in LCR rats (-10% and -50%, respectively; P

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Step-based Physical Activity Metrics and Cardiometabolic Risk: NHANES 2005-06.

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Purpose: To catalog the relationships between step-based accelerometer metrics indicative of physical activity volume (steps/day, adjusted to a pedometer scale), intensity (mean steps/min from the highest, not necessarily consecutive, minutes in a day; peak 30-min cadence) and sedentary behavior (percent time at zero cadence relative to wear time; %TZC) and cardiometabolic risk factors. Methods: We analyzed data from 3388 20+ year-old participants in the 2005-2006 National Health and Nutrition Examination Survey with >=1 valid day of accelerometer data and at least some data on weight, BMI, waist circumference, systolic and diastolic blood pressure, glucose, insulin, HDL-cholesterol, triglycerides, and/or glycohemoglobin. Linear trends were evaluated for cardiometabolic variables, adjusted for age and race, across quintiles of steps/day, peak 30 min-cadence, and %TZC. Results: Median steps/day ranged from 2247-12334 for men and 1755-9824 steps/day for women, and median peak 30-min cadence ranged from 48.1-96.0 for men and 40.8-96.2 steps/min for women, for the 1st and 5th quintiles, respectively. Linear trends were statistically significant (all p

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Combined Exercise Training Improves Glycemic Control in Adult With Cystic Fibrosis.

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Purpose: Glucose abnormality and diabetes are the most common comorbidities in cystic fibrosis (CF). Combined (aerobic & resistance) exercise program in type 2 diabetes patients demonstrated an improvement of glycemic control. The aim of the study was to determine if a combined exercise program is beneficial to improve plasma glucose at 2-h of the oral glucose tolerance test (OGTT) in CF. Method: 18 adult with CF with glucose abnormality were recruited (Clinicaltrial.gov: NTC02127957) and 17 were randomly assigned to a control or exercise group for 12 weeks. VO2max, OGTT, muscular endurance and strength, and quality of life were measured pre and post intervention. Results: 14 participants completed the protocol. Patients in the exercise group improved significantly their 2-h plasma glucose values (-2.34 +/-1.26mmol/L; p

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Unbalanced lateral mandibular deviation associated with TMJ sound as a sign in TMJ disc dysfunction diagnosis

Abstract

The aim was to study the characteristics of lateral mandibular horizontal deviations during opening-closing movements and their association with TMJ sounds of the clicking type. Subjects were 28 healthy volunteers and 38 patients diagnosed with MRI imaging as having TMJ disc dysfunction, 22 with disk displacement without (DD) and 16 as having disc displacement with reduction (DDR). TMJ sounds were recorded with miniature microphones placed in the ear canals, and jaw movements were documented with a kinesiograph. A sign, unbalanced lateral deviation (ubd) was defined as a rapid, short duration, change of jaw movement direction from, and back to, a smooth deviation path in the horizontal plane and associated with TMJ clicking. The hypotheses were that degrees of maximal deviations, proportions of unbalanced deviation (ubd), and of such deviation associated with TMJ sounds (ubdS), differ between healthy subjects and patients with DD or DDR. Comparisons between groups were made using one-way ANOVA and chi-square analysis, as appropriate. No differences were found between groups regarding degree of lateral deviation per se. The proportions of ubd and ubdS were significantly higher in patients with DDR than in healthy subjects and than in patients with DD (p < 0.001) but no such differences were found between healthy subjects and patients with DD. For prediction of DDR the sensitivity and specificity of the sign ubdS were found to be 68.8% and 89.3%. For the sign ubd they were 100.0% and 64.3%. This indicates that the sign ubdS has diagnostic value in screening for DDR.

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Sepsis: Know the signs



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2016 Air Force EMT Rodeo highlights



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Sepsis: Know the signs



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2016 Air Force EMT Rodeo highlights



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Sepsis: Know the signs



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2016 Air Force EMT Rodeo highlights



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Sepsis: Know the signs



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2016 Air Force EMT Rodeo highlights



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Capnography for BLS: Inline Capnography



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Capnography for BLS: Non-Invasive Capnography



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Verification of Frequency in Species of Nontuberculous Mycobacteria in Kermanshah Drinking Water Supplies Using the PCR-Sequencing Method

Microbial Drug Resistance , Vol. 0, No. 0.


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Capnography for BLS: Inline Capnography



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Capnography for BLS: Non-Invasive Capnography



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Capnography for BLS: Getting Started with Capnography

This course is designed to introduce the benefits of capnography use and then review the physiology of respiration and the role of expired CO2 in the respiratory cycle.

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Capnography for BLS: Inline Capnography



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Capnography for BLS: Non-Invasive Capnography



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Capnography for BLS: Getting Started with Capnography

This course is designed to introduce the benefits of capnography use and then review the physiology of respiration and the role of expired CO2 in the respiratory cycle.

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Continuous quadratus lumborum block analgesia for total hip arthroplasty revision

We read with interest the article by Ueshima et al [1] describing the effective use of quadratus lumborum (QL) block for total hip arthroplasty (THA) as part of a multimodal analgesic regimen. The importance of regional anesthesia as the cornerstone of the multimodal technique was highlighted as the most effective treatment method in these cases of primary THA. We describe how this same analgesic technique can be used effectively even for a patient with chronic pain and opioid dependence for perioperative pain management for revision THA.

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Disease genetics: Under pressure — genetics of hypertension

Nature Reviews Genetics. doi:10.1038/nrg.2016.128

Author: Linda Koch



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Mobile elements: Putting the brakes on ageing

Nature Reviews Genetics. doi:10.1038/nrg.2016.129

Author: Denise Waldron



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Transition states and cell fate decisions in epigenetic landscapes

Nature Reviews Genetics. doi:10.1038/nrg.2016.98

Authors: Naomi Moris, Cristina Pina & Alfonso Martinez Arias



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Capnography for BLS: Getting Started with Capnography

This course is designed to introduce the benefits of capnography use and then review the physiology of respiration and the role of expired CO2 in the respiratory cycle.

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Pa. woman charged after assaulting EMT



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Pa. woman charged after assaulting EMT



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Pa. woman charged after assaulting EMT



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Calif. Gov. signs bill to teach CPR in high schools

By EMS1 Staff

SACRAMENTO, Calif. — Governor Jerry Brown signed AB 1719 to teach CPR in schools into law Sept. 24. The new law makes California the 35th state to provide CPR training in high schools, along with Washington, D.C.
 
"As an Emergency Medical Technician for over 30 years, I know that CPR is one of the most important life skills a person can have," Calif. Assemblymember Rodriguez, author of the bill said. "By teaching CPR in high school, we are sending students into the world with essential, life-saving skills."
 
High schools that require a course in health education for graduation will begin to offer instruction in performing CPR in the 2018-2019 school year. Students can be taught the fundamental life-saving skill of hands-only CPR in 30 minutes or less.
 
"I am so glad I learned CPR at a young age because it helped save my friend's life," said 13-year-old Skylar Berry, an American Heart Association volunteer who learned CPR at a camp organized by her local Sacramento Metro Fire department. "We should all be prepared to act in the case of an emergency and I'm happy other students will now get the chance to learn CPR."
 
Berry was at a birthday party when a group playing in the pool realized one of their friends was at the bottom. As they brought him to the surface, Skylar, who was 11 at the time, remembered the CPR training she'd received and immediately sprang into action. Since then, she's been a strong advocate for teaching CPR to her fellow classmates and created the "Stayin' Alive" club at her school to convey the importance of learning the lifesaving skill.
 
With the passage of AB1719, tragedies like the loss of Debbie Wilson's daughter can be averted.  

"If someone who had been near my daughter at the time of her collapse had known how to conduct cardiopulmonary resuscitation, her life could have been saved," said Debbie Wilson, AB 1719 advocate and mother of a 17-year-old daughter who suffered a sudden cardiac arrest during tennis practice. "I want all students to have a chance to learn this life-saving skill so other families don't suffer the same heart-break that ours did."
 
Supporters of the bill included AHA, the American Red Cross, the California Professional Firefighters, the California State Parent Teacher Association, the California School Boards Association and California School Employees Association.
 
"So many lives have been saved because of the heroic act of bystanders who performed CPR. On the other hand, there are just as many stories of people who did not make it because no one nearby took action," said Kathy Magliato, MD, AHA Western States Affiliate Board Member and a cardiothoracic surgeon. "With CPR in Schools, we have the opportunity to create a generation in which teens and young adults in California is trained in CPR as part of their health education and prepared to save lives. AB 1719 will add thousands of qualified lifesavers to our state."



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Calif. Gov. signs bill to teach CPR in high schools

Students can be taught the fundamental life-saving skill of hands-only CPR in 30 minutes or less.

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Pa. woman charged after assaulting EMT



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Pa. bike ride honors EMS personnel who died in line of duty

By Steven Henshaw
The Reading Eagle

HARRISBURG, Pa. — Police officers and firefighters get a lot of recognition for sometimes sacrificing their lives, most notably on 9/11.

But one occupation in emergency services tends to get overlooked for the sacrifices the workers make on the job.

Though they might not rush into burning buildings, emergency medical services personnel endure one adrenaline-pumping, high-stress situation after another on any given day to save lives.

For the past six years, the Pennsylvania EMS Provider Foundation and the state Department of Health's Bureau of Emergency Medical Services has hosted an EMS memorial service in the Capitol in Harrisburg.

For this year's service, held Sept. 12 in the main Rotunda, dozens of EMS professionals arrived in bicycle shorts and matching jerseys commemorating the "Inaugural PA EMS Memorial Bike Ride."

About 25 EMS professionals, including three from Berks County, participated in the three-day, 150-mile bicycle ride that began Sept. 10 at the Flight 93 Memorial in Somerset County near Shanksville.

The ride was to honor the memory of 42 of their EMS brothers and sisters in Pennsylvania lost in the line of duty, said Ed Moreland, chairman of the Pennsylvania EMS Provider Foundation and chief of Spring Township-based Western Berks Ambulance.

Moreland was joined by two local colleagues, Michael Whalen, a former Reading Hospital emergency room nurse who is CEO of Emergency Educators, and paramedic Chris Buckmoyer of Southern Berks Regional EMS.

Moreland, who was one of the speakers in the ceremony, said he lost two co-workers to line-of-duty deaths during his 25-year career. Both suffered heart attacks.

"We're trying to bring home (raise public awareness) that EMS workers are part of public safety work group and don't perhaps get the same recognition that fire and police do," Moreland said.

Recruiting and retaining emergency services workers was the secondary goal of the ride. The group stopped to talk to emergency providers along the way through the scenic hills and valleys of western and central Pennsylvania.

The job of paramedic requires long hours and typically commands lower pay than other emergency workers, making it an increasingly undesirable career choice for young men and women, Moreland said.

The foundation hosts an annual banquet to raise funds for an academic scholarship.

Over the past 10 years, it has awarded more than $35,000 in scholarships to individuals who want to be paramedics, he said.

Moreland said the inaugural ride accomplished both goals.

"It was the largest crowd we've every had at the EMS Memorial Service," Moreland said, adding that the riders were honored to be greeted my many of their colleagues in his field from across the state as well as state officials.

Copyright 2016 the Reading Eagle



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Human COL5A1 polymorphisms and quadriceps muscle-tendon mechanical stiffness in vivo

Purpose: Polymorphisms of the collagen type V alpha 1 chain (COL5A1) gene are purported to influence mechanical properties of collagenous tissues. Our purpose was to assess musculo-tendinous contractile properties of the quadriceps in relation to the genetic influence of mechanical stiffness.. Methods: Eighty, recreationally active males (ages 19–31 y) were assessed for the presence of three genetic polymorphisms associated with COL5A1 stability (rs4919510, rs1536482 and rs12722). Genotypes were determined using real-time polymerase chain reaction. Stiffness and contractile properties of the knee musculotendinous complex were assessed by maximal isometric voluntary contractions, ramp isometric voluntary contractions, electrically stimulated contractile events and ultrasonography. Results: All genotypes groups were able to fully activate their knee extensors (>97%) as assessed by the interpolated twitch technique and presented no differences in muscle-tendon contractile properties at low sub-maximal contraction intensities. For the quadriceps muscle-tendon at moderate ramp contractions of 50 and 60% MVC the rs12722 CT and TT genotypes had ∼30% greater mean stiffness. The rs1536482 AG and GG genotypes showed a similar trend, however, did not achieve statistical significance. Conclusion: Variants of the COL5A1 gene seem to influence quadriceps muscle-tendon stiffness, but do not affect low-level contractile properties.

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PGC-1α1 induces cardiac excitation-contraction coupling phenotype without metabolic remodelling

Abstract

The transcriptional coactivator PGC-1α1 has been identified as a central factor mediating metabolic adaptations of the heart. However, it is still mostly unresolved how much physiological changes in PGC-1α1 expression levels actually contribute to the functional adaptation of the heart. The aim of this study was to characterize the transcriptional and functional effects of physiologically relevant, moderate PGC-1α1 expression in the heart. In vivo and ex vivo physiological analysis shows that expression of PGC-1α1 within a physiological range in mouse heart does not induce the expected metabolic alterations, but instead induces a unique E-C-coupling phenotype recapitulating features typically seen in physiological hypertrophy. Transcriptional screening of PGC-1α1 overexpressing mouse heart and myocyte cultures with higher, acute adenovirus-induced PGC-1α1 expression, highlights PGC-1α1 as a transcriptional coactivator with a number of binding partners in various pathways (like HSFs and circadian clock) through which it acts as a pleiotropic transcriptional regulator in the heart, to both augment and repress the expression of its target genes in a dose-dependent fashion. At low levels of overexpression PGC-1α1 elicits a diverse transcriptional response altering the expression state of circadian clock, heat shock, excitability, calcium signalling and contraction pathways, while metabolic targets of PGC-1α1 are recruited at higher PGC-1α1 expression levels. Together these findings demonstrate that PGC-1α1 elicits a dual effect on cardiac transcription and phenotype. Further, our results imply that the physiological role of PGC-1α1 is to promote a beneficial E-C-coupling phenotype in the heart.

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Synaptic reliability and temporal precision are achieved via high quantal content and effective replenishment: auditory brainstem versus hippocampus

At early stations of the auditory pathway, information is encoded in the precise signal timing and rate. Auditory synapses must maintain the relative timing of events with submillisecond precision even during sustained and high–frequency stimulation. In non–auditory brain regions, e.g. telencephalic ones, synapses are activated at considerably lower frequencies. Central to understanding the heterogeneity of synaptic systems is to elucidate the physical, chemical, and biological factors that determine synapse performance. In this study, we used slice recordings from three synapse types in the mouse auditory brainstem and hippocampus. Whereas the auditory brainstem nuclei experience high–frequency activity in vivo, the hippocampal circuits are activated at much lower frequencies. We challenged the synapses with sustained high–frequency stimulation (60 s for up to 200 Hz) and found significant performance differences. Our results show that auditory brainstem synapses differ considerably from their hippocampal counterparts in several aspects, namely resistance to synaptic fatigue, low failure rate, and exquisite temporal precision. Their high–fidelity performance supports the functional demands and appears to be due to a large size of the readily releasable pool and a high release probability, which together result in a high quantal content. In conjunction with very efficient vesicle replenishment mechanisms, these properties provide extremely rapid and temporally precise signaling required for neuronal communication at early stations of the auditory system, even during sustained activation in the minute range.

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Clinical and genetic aspects of KBG syndrome

KBG syndrome is characterized by short stature, distinctive facial features, and developmental/cognitive delay and is caused by mutations in ANKRD11, one of the ankyrin repeat-containing cofactors. We describe 32 KBG patients aged 2–47 years from 27 families ascertained via two pathways: targeted ANKRD11 sequencing (TS) in a group who had a clinical diagnosis of KBG and whole exome sequencing (ES) in a second group in whom the diagnosis was unknown. Speech delay and learning difficulties were almost universal and variable behavioral problems frequent. Macrodontia of permanent upper central incisors was seen in 85%. Other clinical features included short stature, conductive hearing loss, recurrent middle ear infection, palatal abnormalities, and feeding difficulties. We recognized a new feature of a wide anterior fontanelle with delayed closure in 22%. The subtle facial features of KBG syndrome were recognizable in half the patients. We identified 20 ANKRD11 mutations (18 novel: all truncating) confirmed by Sanger sequencing in 32 patients. Comparison of the two ascertainment groups demonstrated that facial/other typical features were more subtle in the ES group. There were no conclusive phenotype–genotype correlations. Our findings suggest that mutation of ANKRD11 is a common Mendelian cause of developmental delay. Affected patients may not show the characteristic KBG phenotype and the diagnosis is therefore easily missed. We propose updated diagnostic criteria/clinical recommendations for KBG syndrome and suggest that inclusion of ANKRD11 will increase the utility of gene panels designed to investigate developmental delay. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.



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Using a qualitative approach to conceptualize concerns of patients with neurofibromatosis type 1 associated plexiform neurofibromas (pNF) across the lifespan

Neurofibromatosis Type 1 (NF1) plexiform neurofibromas (pNFs) are associated with a variety of symptoms and concerns that affect patients' quality of life (QOL), highlighting the value of incorporating the patients' perspective when evaluating treatment outcomes. To better conceptualize the experience of patients with pNFs, this qualitative study sought to identify the most important outcomes to assess from the perspective of patients, families, and clinicians. Clinicians, patients age 5 years old and above, and parents of patients aged 5–17 years participated in semi-structured interviews to elicit the pNF symptoms/concerns considered most important to assess. The data were analyzed using an iterative coding procedure and the frequency with which symptoms/concerns emerged was tabulated. Eight clinicians, 31 patients, and 17 parents of patients participated in semi-structured interviews. The most frequently reported concerns raised by patients across all age groups included pain, appearance/disfigurement, social activity/role participation, stigma, and anxiety. For parents, physical functioning was the primary concern, followed by pain, social activity/role participation, appearance/disfigurement, and social relationships. The resulting conceptual framework included five domains to represent the most important identified symptoms/concerns: pain, social functioning, physical function impact, stigma, and emotional distress. This conceptual framework describing the symptoms/concerns of patients with pNF can help investigators create a measurement system to improve assessment of aspects of QOL only patients can report on. It may also provide the ability to identify symptoms/concerns that might warrant referrals to various clinical disciplines. © 2016 Wiley Periodicals, Inc.



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Effects of high-intensity interval training on physical capacities and substrate oxidation rate in obese adolescents

Journal of Endocrinological Investigation

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Direct-acting antiviral agents for patients with hepatitis c virus genotype 1 infection are cost saving

Clinical Gastroenterology and Hepatology

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Image quality of mean temporal arterial and mean temporal portal venous phase images calculated from low dose dynamic volume perfusion CT datasets in patients with hepatocellular carcinoma and pancreatic cancer

European Journal of Radiology

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Safety of corticosteroid treatment in rheumatologic patients with markers of hepatitis B viral infection: Pilot evaluation study

JCR: Journal of Clinical Rheumatology

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Researchers investigate new strategy to block growth of colon cancer cells

Boston University School of Medicine

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Standard and double dose intravenous proton pump inhibitor injections for prevention of bleeding after endoscopic resection

Journal of Gastroenterology and Hepatology

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Respiratory-motion artefacts in liver MRI following injection of gadoxetate disodium and gadobenate dimeglumine: An intra-individual comparative study in cirrhotic patients

Clinical Radiology

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Age-associated effect of kestose on Faecalibacterium prausnitzii and symptoms in the atopic dermatitis infants

Pediatric Research

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Identification of novel OCT4 genetic variant associated with the risk of chronic hepatitis B in a Korean population

Liver International

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No detectable resistance to tenofovir disoproxil fumarate in HBeAg+ and HBeAg- patients with chronic hepatitis B after 8 years of treatment

Journal of Viral Hepatitis

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Association between physical activity and inflammatory bowel disease risk: A meta-analysis

Digestive and Liver Diseases

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Tumor characteristics associated with malignant large bowel obstruction in stage IV colorectal cancer patients undergoing chemotherapy

International Journal of Colorectal Disease

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Magnetic resonance tumor regression grade and residual mucosal abnormality as predictors for pathological complete response in rectal cancer postneoadjuvant chemoradiotherapy

Diseases of the Colon and Rectum

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Patient-reported roles, preferences, and expectations regarding treatment of stage I rectal cancer in the cancer care outcomes research and surveillance consortium

Diseases of the Colon and Rectum

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Relation of body mass index to long-term survival after cardiac resynchronization therapy

The American Journal of Cardiology

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Significant individual variation between pathologists in the evaluation of colon cancer specimens after complete mesocolic excision

Diseases of the Colon and Rectum

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Body composition of obese adolescents: Association between adiposity indicators and cardiometabolic risk factors

Journal of Human Nutrition and Dietetics

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Diagnostic value of diffusion-weighted imaging (DWI) for the assessment of the small bowel in patients with inflammatory bowel disease

Clinical Radiology

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Key protein may directly impact development of colon cancer

Boston University School of Medicine

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No difference in overall survival between hospital volumes for patients with colorectal cancer in the netherlands

Diseases of the Colon and Rectum

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Disease genetics: Under pressure — genetics of hypertension



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Mobile elements: Putting the brakes on ageing



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A large cohort study confirming that specific haplotype 4A161PAS is exclusively associated with the Chinese FSHD1

Thumbnail image of graphical abstract

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Successful laparoscopic ligation for massive chylous ascites after rectal cancer surgery

Abstract

A 53-year-old man was readmitted with abdominal distention 2 weeks after undergoing laparoscopic low anterior resection with para-aortic lymphadenectomy for advanced rectal cancer (T4aN1M0, Stage IIIb). Ultrasound revealed massive ascites, and paracentesis revealed chylous fluid with a markedly elevated triglyceride level (1762 mg/dL). Despite conservative management, the fistula remained on postoperative day 120. On percutaneous lymphangiography, the chylous leakage point was clearly visualized at the para-aortic site, and surgical intervention was planned. The abdominal cavity was carefully explored with laparoscopy, and the lymphatic leakage point was detected at the site of previous lymphadenectomy. Leakage was stopped with direct suture ligation and fibrin glue, and the patient was discharged 2 weeks later with no recurrence of the chylous fistula. Surgical intervention can be effective in select patients with a major chylous fistula that persists despite conservative therapy. When the leakage point is localized and detectable on percutaneous lymphangiography, the laparoscopic approach may be feasible.



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