Τρίτη, 20 Φεβρουαρίου 2018
Comparison between Corticosteroid and Lidocaine Injection in the Treatment of Tennis Elbow: A Randomized, Double-Blinded, Controlled Trial
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Effects of anodal transcranial direct current stimulation on somatosensory recovery after stroke: a randomized controlled trial
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Letter to the editor involving the article ‘’Comparison Between Corticosteroids and Lidocaine Injection in the Treatment of Tennis Elbow: A Randomised, Double-Blinded, Controlled Trial”
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Characterizing Intervention Strategies Used in Community-Based Mental Health Care for Infants and Their Families
Mental health interventions for infants typically target high-risk groups and can prevent long-term negative outcomes. Despite federal initiatives promoting early intervention, minimal research has examined usual care services for infants, which is important to improve routine care. The current study characterized usual care practices in infant mental health through the adaptation and administration of a provider survey. Providers (n = 126) reported using a wide range of intervention strategies and few intervention programs with varied evidence. Findings can inform future research to identify quality improvement targets of usual mental health care for high-risk infants and their families.
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Foreign-Born Blacks Experience Lower Odds of Obesity but Higher Odds of Diabetes than US-Born Blacks in New York City
Research is limited on the health of foreign-born Blacks (FBBs), who are often grouped with African Americans. This study compared obesity and diabetes odds in FBBs and US-born Blacks (USBBs) in NYC. Analyzing the 2009–2013 NYC Community Health Survey (3701 FBBs and 6297 USBBs), weighted multivariate logistic regression examined odds of obesity and diabetes, adjusting for age, gender, education, income, marital status, children < 18, BMI (for diabetes only) and duration of residence. FBBs had lower odds of obesity [OR 0.62 (95% CI 0.54, 0.72)] and greater odds of diabetes [OR 1.24 (95% CI 1.01, 1.52)] compared to USBBs. FBBs had 1.4 times the odds of diabetes at overweight status, compared to USBBs [OR 1.40 (95% CI 1.01, 1.95)]. Living in the US ≥ 10 years was not associated with odds of obesity and diabetes. Future research should seek to uncover unique risk profiles of sub-ethnic groups in the African diaspora.
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Reduced arterial vasodilation in response to hypoxia impairs cerebral and peripheral oxygen delivery in hypertensive men
This study investigated whether hypertension impairs isocapnic hypoxia (IH)-induced cerebral and skeletal muscle hyperemia to an extent that limits oxygen supply. Oxygen saturation (Oxymetry), mean arterial pressure (MAP, photoplethysmography), muscle sympathetic nerve activity (MSNA, microneugraphy), and femoral (FA), internal carotid (ICA) and vertebral (VA) artery blood flow (BF, Doppler ultrasound) were quantified in 9 normotensive (NT, 40 ± 11 yrs., systolic (SP) 119 ± 7 mmHg and diastolic pressure (DP) 73 ± 6 mmHg) and 9 hypertensive men (HT, 44 ± 12 yrs., SP 152 ± 11 mmHg and DP 90 ± 9 mmHg) during 5 min of normoxia (NX – 21% O2) and IH (10% O2). Total cerebral blood flow (tCBF), brain (CDO2) and leg (LDO2) oxygen delivery were estimated. IH provoked similar oxygen desaturation without changing MAP. ICA perfusion increased in both groups during IH. However, VA and FA BF only increased in NT. Thus, IH-induced increase in tCBF was smaller in HT. CDO2 only increased in NT and LDO2 decreased in HT. Furthermore, IH evoked a greater increase in HT MSNA. Changes in MSNA were inversely related to FA BF, LDO2 and end-tidal oxygen tension. In conclusion, hypertension disturbs regional and total cerebrovascular and peripheral responses to IH and consequently limits oxygen supply to the brain and skeletal muscle. While increased chemoreflex-induced sympathetic activation may explain impaired peripheral perfusion, attenuated vasodilatory signalling in the posterior cerebrovasculature seems responsible for the small increase in tCBF when HT were exposed to IH.
This article is protected by copyright. All rights reserved
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“Anthropometric prediction of visceral adipose tissue in persons with motor complete spinal cord injury”
Spinal cord injury (SCI) results in increased accumulation of visceral adipose tissue (VAT). Anthropometrics may provide an alternative to estimate VAT cross section area (CSA) compared to magnetic resonance imaging (MRI).
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Considerations for Exercise Prescription in Patients with Bone Metastases: A Comprehensive Narrative Review
Metastatic disease is a frequent complication of advanced cancer, with bone representing one of the most common sites of metastatic occurrence. Patients with bone metastases receive long-term systemic treatments which have a significant attritional impact on muscle strength, fatigue and physical functioning. Physical rehabilitation involving exercise and physical activity prescription has a considerable role in counteracting these changes however exercise is often perceived as a contraindication in the presence of bone metastases due to concerns about aggravating skeletal related events.
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Footwear-Generated Dynamic Biomechanical Manipulation and Perturbation Training for Chronic Nonspecific Low Back Pain
Home-based therapy optimizing biomechanics and neuromuscular control is increasingly recognized as a treatment option for chronic nonspecific low back pain (CNSLBP). However, its impact on pain, function and gait is limited among patients in a metropolitan area.
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Evaluation of performance-based outcome measures for the upper limb: a comprehensive narrative review
Objective performance-based outcome measures (OMs) have the potential to provide unbiased and reproducible assessments of limb function. However, very few of these performance-based OMs have been validated for upper limb (UL) prosthesis users. OMs validated in other clinical populations (e.g. neurological or musculoskeletal conditions) could be used to fill gaps in existing performance-based OMs for UL amputees. Additionally, a joint review might reveal consistent gaps across multiple clinical populations.
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Human arm joints reconstruction algorithm in rehabilitation therapies assisted by end-effector robotic devices
End-effector robots are commonly used in robot-assisted neuro-rehabilitation therapies for upper limbs where the patient's hand can be easily attached to a splint. Nevertheless, they are not able to estimate a...
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16p11.2 transcription factor MAZ is a dosage-sensitive regulator of genitourinary development [Genetics]
Genitourinary (GU) birth defects are among the most common yet least studied congenital malformations. Congenital anomalies of the kidney and urinary tract (CAKUTs) have high morbidity and mortality rates and account for ∼30% of structural birth defects. Copy number variation (CNV) mapping revealed that 16p11.2 is a hotspot for GU...
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Global changes of H3K27me3 domains and Polycomb group protein distribution in the absence of recruiters Spps or Pho [Genetics]
Polycomb group (PcG) proteins maintain the silenced state of key developmental genes in animals, but how these proteins are recruited to specific regions of the genome is still poorly understood. In Drosophila, PcG proteins are recruited to Polycomb response elements (PREs) that include combinations of sites for sequence specific DNA...
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In individuals with autism spectrum disorder (ASD), de novo mutations have previously been shown to be significantly correlated with lower IQ but not with the core characteristics of ASD: deficits in social communication and interaction and restricted interests and repetitive patterns of behavior. We extend these findings by demonstrating in...
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General amino acid control in fission yeast is regulated by a nonconserved transcription factor, with functions analogous to Gcn4/Atf4 [Genetics]
Eukaryotes respond to amino acid starvation by enhancing the translation of mRNAs encoding b-ZIP family transcription factors (GCN4 in Saccharomyces cerevisiae and ATF4 in mammals), which launch transcriptional programs to counter this stress. This pathway involves phosphorylation of the eIF2 translation factor by Gcn2-protein kinases and is regulated by upstream...
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Detection of aneuploidy in patients with cancer through amplification of long interspersed nucleotide elements (LINEs) [Genetics]
Aneuploidy is a feature of most cancer cells, and a myriad of approaches have been developed to detect it in clinical samples. We previously described primers that could be used to amplify ∼38,000 unique long interspersed nucleotide elements (LINEs) from throughout the genome. Here we have developed an approach to...
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Publication date: April 2018
Source:Journal of Human Evolution, Volume 117
Author(s): Andrew Best, Jason M. Kamilar
Sweating is an unusual thermoregulatory strategy for most mammals, yet is critical for humans. This trait is commonly hypothesized to result from human ancestors moving from a forest to a warmer and drier open environment. As soft tissue traits do not typically fossilize, this idea has been difficult to test. Therefore, we used a comparative approach to examine 15 eccrine gland traits from 35 primate species. For each trait we measured phylogenetic signal, tested three evolutionary models to explain trait variation, and used phylogenetic models to examine how traits varied in response to climate variables. Phylogenetic signal in traits varied substantially, with the two traits exhibiting the highest values being gland distribution on the body and percent eccrine vs. apocrine glands on the body. Variation in most traits was best explained by an Ornstein-Uhlenbeck model suggesting the importance of natural selection. Two traits were strongly predicted by climate. First, species with high eccrine gland glycogen content were associated with habitats exhibiting warm temperatures and low rainfall. Second, species with increased capillarization were associated with high temperature. Glycogen is a primary energy substrate powering sweat production and sodium reabsorption in the eccrine gland, and increased capillarization permits greater oxygen, glucose and electrolyte delivery. Thus, our results are evidence of natural selection for increased sweating capacity in primate species with body surface eccrine glands living in hot and dry climates. We suggest that selection for increased glycogen content and capillarization may have been part of initial increases in hominin thermoregulatory sweating capacity.
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Publication date: Available online 20 February 2018
Source:International Journal of Psychophysiology
Author(s): Joucla Coralie, Nicolier Magali, Giustiniani Julie, Brunotte Gaelle, Noiret Nicolas, Monnin Julie, Magnin Eloi, Pazart Lionel, Moulin Thierry, Haffen Emmanuel, Vandel Pierre, Gabriel Damien
One of the most basic and person-specific affective responses to music is liking. The present investigation sought to determine whether liking was preserved during spontaneous auditory imagery. To this purpose, we inserted two-second silent intervals into liked and disliked songs, a method known to automatically recreate a mental image of these songs. Neural correlates of musical preference were measured by high-density electroencephalography in twenty subjects who had to listen to a set of five pre-selected unknown songs the same number of times for two weeks. Time frequency analysis of the two most liked and the two most disliked songs confirmed the presence of neural responses related to liking. At the beginning of silent intervals (400–900 ms and 1000–1300 ms), significant differences in theta activity were originating from the inferior frontal and superior temporal gyrus. These two brain structures are known to work together to process various aspects of music and are also activated when measuring liking while listening to music. At the end of silent intervals (1400–1900 ms), significant alpha activity differences originating from the insula were observed, whose exact role remains to be explored. Although exposure was controlled for liked and disliked songs, liked songs were rated as more familiar, underlying the strong relationship that exists between liking, exposure, and familiarity.
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How struggling adult readers use contextual information when comprehending speech: Evidence from event-related potentials
Publication date: March 2018
Source:International Journal of Psychophysiology, Volume 125
Author(s): Shukhan Ng, Brennan R. Payne, Elizabeth A.L. Stine-Morrow, Kara D. Federmeier
We investigated how struggling adult readers make use of sentence context to facilitate word processing when comprehending spoken language, conditions under which print decoding is not a barrier to comprehension. Stimuli were strongly and weakly constraining sentences (as measured by cloze probability), which ended with the most expected word based on those constraints or an unexpected but plausible word. Community-dwelling adults with varying literacy skills listened to continuous speech while their EEG was recorded. Participants, regardless of literacy level, showed N400 effects yoked to the cloze probability of the targets, with larger N400 amplitudes for less expected than more expected words. However, literacy-related differences emerged in an earlier time window of 170–300 ms: higher literacy adults produced a reduced negativity for strongly predictable targets over anterior channels, similar to previously reported effects on the Phonological Mapping Negativity (PMN), whereas low-literacy adults did not. Collectively, these findings suggest that in auditory sentence processing literacy may not notably affect the incremental activation of semantic features, but that comprehenders with underdeveloped literacy skills may be less likely to engage predictive processing. Thus, basic mechanisms of comprehension may be recruited differently as a function of literacy development—even in spoken language.
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Sevoflurane is commonly used in general anesthesia for premature neonates. The main mechanism of retinopathy of prematurity (ROP) is increased levels of vascular endothelial growth factor (VEGF). For the investigation of sevoflurane's effect on angiogenesis, the angiogenesis and VEGF expression in the retina were measured after administering sevoflurane in an oxygen-induced retinopathy mice model.
Materials and methods
The mice were divided into the normoxic group (Nc and Ns group; n = 6) and the ROP group (C, Rc, and Rs group; n = 6). Rc group were exposed to 75% oxygen for 5 days beginning on postnatal day (P) 7, and then returned to room air. Age-matched mice in the C group were exposed to room air. To observe angiogenesis of the retina, the mice were sacrificed on P16. The Rs group was exposed to 2 vol% sevoflurane for 2 h on P12, P13, and P14 with 40% oxygen.
The angiogenic area and the spreading distance of vessels on P4 were statistically decreased in the Ns group, compared to the Nc group. The avascular area on P16 was significantly increased and the expression of VEGF was suppressed in the Rs group compared to the Rc group.
Sevoflurane can inhibit retinal angiogenesis via suppressing VEGF expression in an OIR mice model with exposure to relative hypoxia. Nevertheless, it is still difficult to apply the results of this study immediately to humans because of the heterogeneity of responses to sevoflurane.
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Obese rats supplemented with bitter melon display marked shifts in the expression of genes controlling inflammatory response and lipid metabolism by RNA-Seq analysis of colonic mucosa
Obesity is known to induce pathological changes in the gut and diets rich in complex carbohydrates that resist digestion in the small bowel can alter large bowel ecology. The purposes of this study were to identify the effects of bitter melon powder (BMP) on the global gene expression pattern in the colon mucosa of obese rats. Obese rats were fed a high-fat diet and treated without or with BMP for 8 weeks. Genome-wide expression profiles of the colon mucosa were determined by RNA sequencing (RNA-Seq) analysis at the end of experiment. A total of 87 genes were identified as differentially expressed (DE) between these two groups (fold change > 1.2). These results were further validated by quantitative RT-PCR, confirming the high reliability of the RNA-Seq. Interestingly, DE genes implicated in inflammation and lipid metabolism were found to be downregulated by BMP in the colon. Network between genes and the top 15 KEGG pathways showed that PRKCβ (protein kinase C beta) and Pla2g2a (phospholipase A2 group IIA) strongly interacted with surrounding pathways and genes. Results revealed that BMP supplement could remodel key colon functions by altering transcriptomic profile in obese rats.
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Long-term neurophysiological and clinical response in patients with chronic inflammatory demyelinating polyradiculoneuropathy treated with subcutaneous immunoglobulin
Publication date: Available online 19 February 2018
Author(s): Giovanni Cirillo, Vincenzo Todisco, Gioacchino Tedeschi
Objectiveto assess the long-term effects of subcutaneous immunoglobulin (SCIg) on neurophysiological and clinical parameters in patients affected by chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).Methods16 drug-naïve CIDP patients, fulfilling the clinical and neurophysiological criteria for typical CIDP, were treated with one cycle of intravenous immunoglobulin (IVIg) (0.4g/kg/day for 5 consecutive days) and then shifted to the subcutaneous treatment (SCIg) (0.4g/kg/week) after 4 weeks. Patients were evaluated i) at the diagnosis (t0), ii) after 4 weeks since the last IVIg infusion (t1), and iii) after long-term treatment with SCIg (t2=12 months; t3=24 months) by 1) neurophysiological parameters of nerve conduction studies and 2) clinical assessment scales for evaluation of a) strength, by medical research council (MRC) sum score, b) sensory functions, by inflammatory neuropathy care and treatment (INCAT) sensory sum score and c) disability, by overall disability sum score (ODSS).Resultslong-term SCIg treatment induced a significant improvement of neurophysiological parameters, in particular primary demyelinating features of nerve conduction, and clinical variables. Correlation analysis showed 1) a direct positive correlation between the MRC sum score and the amplitude of the distal compound muscle action potential (dCMAP) amplitude, 2) an inverse correlation between dCMAP amplitude and ODSS score, and 3) an inverse correlation between sensory nerve action potential (SNAP) amplitude and the INCAT sensory sum score.Conclusionsour findings revealed a significant long-term effect of the SCIg treatment on the neurophysiological parameters, associated with improvement of global strength, sensory deficits and overall disability in patients with CIDP.Significanceearly start of the SCIg treatment after IVIg infusions induced a significant and long-term improvement of clinical and neurophysiological parameters in CIDP patients.
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Creatine kinase level and its relationship with quantitative electromyographic characteristics in amyotrophic lateral sclerosis
Publication date: Available online 20 February 2018
Author(s): Hongfei Tai, Liying Cui, Mingsheng Liu, Yuzhou Guan, Xiaoguang Li, Dongchao Shen, Kang Zhang, Shuangwu Liu, Shuang Wu, Qingyun Ding, Youfang Hu
ObjectiveTo explore the relationship between serum creatine kinase (CK) level and electromyographic characteristics in patients with amyotrophic lateral sclerosis (ALS).MethodsTwo hundred thirty-eight consecutive ALS patients were enrolled. All patients underwent electrophysiological study with a consistent approach. We calculated a compound muscle action potential (CMAP) sum score, and spontaneous potentials were graded from 0 to 4 depending on their density and distribution. We tested for any independent correlation of the CK levels with CMAP sum score, mean spontaneous potential (MSP) score, F wave persistence or conduction velocity.ResultsThe median serum CK level was 151 U/L. Log CK was independently correlated with MSP score (β=0.07, 95% CI: 0.01-0.14, p=0.032) and F persistence (β=-0.0013, 95% CI: -0.00251 to -0.0002, p=0.02) but not with CMAP sum score or F wave conduction velocity. When stratified by sex, the correlation of log CK with MSP score and F persistence was significant in male but not female patients.ConclusionsThe results support that lower motor neuron loss and muscle denervation are associated with elevated CK levels of ALS patients.SignificanceThe severity of lower motor neuron loss and denervation might be involved in pathophysiological mechanisms of CK elevation in ALS patients.
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Stimulus dependent neural oscillatory patterns show reliable statistical identification of Autism Spectrum Disorder in a face perceptual decision task
Publication date: Available online 20 February 2018
Author(s): João Castelhano, Paula Tavares, Susana Mouga, Guiomar Oliveira, Miguel Castelo-Branco
ObjectiveElectroencephalographic biomarkers have been widely investigated in autism, in the search for diagnostic, prognostic and therapeutic outcome measures. Here we took advantage of the information available in temporal oscillatory patterns evoked by simple perceptual decisions to investigate whether stimulus dependent oscillatory signatures can be used as potential biomarkers in Autism spectrum disorder (ASD).MethodsWe studied an extensive set of stimuli (9 categories of faces) and performed data driven classification (Support vector machine, SVM) of ASD vs. Controls with features based on the EEG power responses. We carried out an extensive time-frequency and synchrony analysis of distinct face categories requiring different processing mechanisms in terms of non-holistic vs. holistic processing.ResultsWe found that the neuronal oscillatory responses of low gamma frequency band, locked to photographic and abstract two-tone (Mooney) face stimulus presentation are decreased in ASD vs. the control group. We also found decreased time-frequency (TF) responses in the beta band in ASD after 350ms, possibly related to motor preparation. On the other hand, synchrony in the 30-45Hz band showed a distinct spatial pattern in ASD. These power changes enabled accurate classification of ASD with an SVM approach. SVM accuracy was approximately 85%. ROC curves showed about 94% AUC (area under the curve). Combination of Mooney and Photographic face stimuli evoked features enabled a better separation between groups, reaching an AUC of 98.6%.ConclusionWe identified a relative decrease in EEG responses to face stimuli in ASD in the beta (15-30Hz; >350ms) and gamma (30-45Hz; 55-80Hz; 50-350ms) frequency ranges. These can be used as input of a machine learning approach to separate between groups with high accuracy.SignificanceFuture studies can use EEG time-frequency patterns evoked by particular types of faces as a diagnostic biomarker and potentially as outcome measures in therapeutic trials.
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Publication date: Available online 19 February 2018
Author(s): Sarah Schnitzler, Christian Johannes Hartmann, Stefan Jun Groiss, Lars Wojtecki, Alfons Schnitzler, Jan Vesper, Jan Hirschmann
ObjectiveTo assess whether high frequency oscillations (HFOs, >150Hz), known to occur in basal ganglia nuclei, can be observed in the thalamus.MethodsWe recorded intraoperative local field potentials from the ventral intermediate nucleus (VIM) of the thalamus in patients with Essential Tremor (N=16), Parkinsonian Tremor (3), Holmes Tremor (2) and Dystonic Tremor (1) during implantation of electrodes for deep brain stimulation. Recordings were performed with up to five micro/macro-electrodes that were simultaneously advanced to the stereotactic target.ResultsThalamic HFOs occurred in all investigated tremor syndromes. A detailed analysis of the Essential Tremor subgroup revealed that medial channels recorded HFOs more frequently than other channels. The highest peaks were observed 4 mm above target. Macro- but not microelectrode recordings were dominated by peaks in the slow HFO band (150-300 Hz), which were stable across several depths and channels.ConclusionHFOs occur in the thalamus and are not specific to any of the tremors investigated. Their spatial distribution is not homogeneous, and their appearance depends on the type of electrode used for recording.SignificanceThe occurrence of HFOs in the thalamus of tremor patients indicates that HFOs are not part of basal ganglia pathophysiology.
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This study compared cardio-pulmonary responses between incremental concentric and eccentric cycling tests, and examined factors affecting the maximal eccentric cycling capacity.
On separate days, nine men and two women (32.6 ± 9.4 years) performed an upright seated concentric (CON) and an eccentric (ECC) cycling test, which started at 75 W and increased 25 W min−1 until task failure. Gas exchange, heart rate (HR) and power output were continuously recorded during the tests. Participants also performed maximal voluntary contractions of the quadriceps (MVC), squat and countermovement jumps.
Peak power output was 53% greater (P < 0.001, g = 1.77) for ECC (449 ± 115 W) than CON (294 ± 61 W), but peak oxygen consumption was 43% lower (P < 0.001, g = 2.18) for ECC (30.6 ± 5.6 ml kg min−1) than CON (43.9 ± 6.9 ml kg min−1). Maximal HR was not different between ECC (175 ± 20 bpm) and CON (182 ± 13 bpm), but the increase in HR relative to oxygen consumption was 33% greater (P = 0.01) during ECC than CON. Moderate to strong correlations (P < 0.05) were observed between ECC peak power output and CON peak power (r = 0.84), peak oxygen consumption (r = 0.54) and MVC (r = 0.53), while no significant relationships were observed between ECC peak power output and squat as well as countermovement jump heights.
Unexpectedly, maximal HR was similar between CON and ECC. Although ECC power output can be predicted from CON peak power output, an incremental eccentric cycling test performed after 3–6 familiarisation sessions may be useful in programming ECC training with healthy and accustomed individuals.
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As ageing and increased body fat are the signs of insulin resistance, we have studied whether the presence of Pro12Ala and C1431T of peroxisome proliferator-activated receptor gamma 2 gene and Trp64Arg of beta 3-adrenergic receptor gene may predispose to the hyperglycaemia development in postmenopausal women, who have never undergone hypoglycaemic treatment. The distributions of selected allele and genotype frequencies were determined by the PCR–RFLP method in normo- and hyperglycaemic, who have never been diagnosed and treated for diabetes mellitus were measured. The amount of body fat and lean body mass (LBM) were assessed by the bioimpedance method and nutritional habits by 7-day dietary recall. There were no differences between the distribution of genotypes and the allele frequencies of the Pro12Ala, C1431T and Trp64Arg polymorphisms in normo- and hyperglycaemic women. Hyperglycaemic women were characterized by visceral obesity, hypertension, higher serum insulin and triglycerides, higher intake of fat and lower consumption of complex carbohydrates and B vitamins. Normoglycaemic women with Pro12Pro polymorphism acquired higher energy from dietary fat (p < 0.0276) and lower energy from carbohydrates (p < 0.0480) than normoglycaemic Ala12 carriers. Subjects with Pro12Pro polymorphism and LBM > 58% of total body mass or with Trp64Trp and normal triglycerides have higher chance of normoglycaemia. Genotyping for Pro12Ala and Trp64Arg polymorphism in postmenopausal women may have the clinical benefit of predicting hyperglycaemia, thereby contributing to the prevention of diabetes mellitus development in the future. However, not only the genetic background but also the dietary habits (intake of fat, carbohydrates and B vitamins) determine the risk of hyperglycaemia.
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Exploring Preconception Care: Insurance Status, Race/Ethnicity, and Health in the Pre-pregnancy Period
Objective To measure the association of preconception health insurance status with preconception health among women in New York City, and examine whether this association is modified by race/ethnicity. Methods Using data from the New York City Pregnancy Risk Assessment Monitoring System 2009–2011 (n = 3929), we created a "Preconception Health Score" (PHS) capturing modifiable behaviors, healthcare services utilization, pregnancy intention, and timely entry into prenatal care. We then built multivariable logistic regression models to measure the association of PHS with health insurance status and race/ethnicity. Results We found PHS to be higher among women with private insurance (7.3 ± 0.07) or public insurance (6.3 ± 0.08) before pregnancy than no insurance (5.9 ± 0.09) (p < .001). However, when stratified by race/ethnicity, the positive association of PHS with insurance was absent in the non-white population. Conclusions for Practice Having health insurance during the pre-pregnancy period is associated with greater health among white women, but not among black or Hispanic women in NYC.
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