Physiology of static breath holding in elite apneists

New Findings

• What is the topic of this review?

  This review provides an up-to-date assessment of the physiology involved with extreme static dry-land breath holding in trained apneists.

• What advances does it highlight?

  We specifically highlight the recent findings involved with the cardiovascular, cerebrovascular, and metabolic function during a maximal breath hold in elite apneists.

Abstract

Breath hold related activities have been performed for centuries, but only recently within the last ∼30 years has it emerged as an increasingly popular competitive sport. In apnea sport, people compete in disciplines relating to underwater distances or simply maximal breath hold duration – with the current (oxygen un-supplemented) static breath hold record at 11:35 min. Remarkably, many ultra-elite apneists are able to supress respiratory urges to the point where consciousness fundamentally limits a breath hold duration. Here, arterial oxygen saturations as low as ∼50% have been reported. In such cases, oxygen conservation to maintain cerebral functioning is critical, where responses ascribed to the mammalian dive reflex – e.g., sympathetically mediated peripheral vaconstriction, and vagally mediated bradycardia – are central. In defence of maintaining global cerebral oxygen delivery during prolonged breath holds, the cerebral blood flow may increase by ∼100% from resting values. Interestingly, near the termination of prolonged dry static breath holds, recent studies also indicate that reductions in the cerebral oxidative metabolism can occur, likely attributable to the extreme hypercapnia and irrespective of the hypoxemia. In this review we highlight and discuss the recent data on the cardiovascular, metabolic and particularly cerebrovascular function in competitive apneists performing maximal static breath holds. The physiological adaptation and maladaptation with regular breath hold training are also summarized, and future research areas in this unique physiological field are highlighted, in particular the need to better determine the potential long-term health impacts of extreme breath holding.

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The Influence of Objectively Measured Physical Activity During Pregnancy on Maternal and Birth Outcomes in Urban Black South African Women

Abstract

Objectives Research indicates the beneficial effects of physical activity during pregnancy on maternal health, although controversy still exists regarding its influence on birth outcomes. Little research has been done to objectively measure physical activity during pregnancy in black African women from low-to-middle income countries. The purpose of this study was to examine the association between physical activity and maternal and birth outcomes in this unique population. Methods This observational, longitudinal study assessed total physical activity using a hip-mounted triaxial accelerometer at 14–18 weeks (second trimester, n = 120) and 29–33 weeks (third trimester, n = 90) gestation. Physical activity is expressed as gravity-based acceleration units (mg). Maternal outcomes included both weight and weight gain at 29–33 weeks gestation. Birth outcomes included gestational age, birth weight, ponderal index and Apgar score, measured within 48 h of delivery. Results There was a significant decline in physical activity from the second to the third trimester (12.8 ± 4.1 mg vs. 9.7 ± 3.6 mg, p ≤ 0.01). Physical activity at 29–33 weeks as well as a change in PA was inversely associated with weight change at 29–33 weeks (β = − 0.24; 95% CI − 0.49; − 0.00; p = 0.05 and β = − 0.36; 95% CI − 0.62; − 0.10; p = 0.01, respectively). No significant associations were found between physical activity and birth outcomes. Conclusions for Practice Physical activity during pregnancy may be an effective method to control gestational weight gain, whilst presenting no adverse risk for fetal development, in women from a low-income urban setting.

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Toward a better noninvasive assessment of preejection period: A novel automatic algorithm for B-point detection and correction on thoracic impedance cardiogram

Abstract

Impedance cardiography is the most common clinically validated, noninvasive method for determining the timing of the opening of the aortic valve, an important event used for measuring preejection period, which reflects sympathetic beta-adrenergic influences on the heart. Automatic detection of the exact time of the opening of the aortic valve (B point on the impedance cardiogram) has proven to be challenging as its appearance varies between and within individuals and may manifest as a reversal, inflection, or rapid slope change of the thoracic impedance derivative's (dZ/dt) rapid rise. Here, a novel automatic algorithm is proposed for the detection of the B point by finding the main rapid rise of the dZ/dt signal, which is due to blood ejection. Several conditions based on zero crossings, minima, and maxima of the dZ/dt signal and its derivatives are considered to reject any unwanted noise and artifacts and select the true B-point location. The detected B-point locations are then corrected by modeling the B-point time data using forward and reverse autoregressive models. The proposed algorithm is validated against expert-detected B points and is compared with different conventional methods; it significantly outperforms them by at least 54% in mean error, 30% in mean absolute error, and 27% in standard deviation of error. This algorithm can be adopted in ambulatory studies requiring beat-to-beat evaluation of cardiac hemodynamic parameters over extended time periods where expert scoring is not feasible.

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PharmGKB summary: atazanavir pathway, pharmacokinetics/pharmacodynamics

No abstract available

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Ready, set, go: the bridging of attention to action by acetylcholine in prefrontal cortex

Abstract

Each time we watch for a green light or wait for a safe opportunity to cross the street, we pay attention, often maintaining awareness of multiple cars, cyclists, and pedestrians.

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The songs of silence: cortical suppression and synchronization by layer-specific activation

Abstract

The presence of oscillatory activity within mammalian cortical circuits is one of the oldest and most persistent observations in neurophysiology, dating back at least to the early 20^th century.

This article is protected by copyright. All rights reserved

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Practice Guideline: Approach to the Child with Rhinorrhea

Rhinorrhea is a common pediatric condition that occurs when excess mucous fills the nasal cavity. Rhinorrhea can be seen in any age group and is generally self-limited, but it may be an indication of a more serious illness. When the nasal membranes produce more fluid than can be processed, the nasal passages accumulate fluid. This excess mucous can lead to nasal discharge and impedes the flow of air through the nose. This practice guideline will focus on the diagnosis and management of rhinorrhea in children aged neonate through adolescence.

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Interdisciplinary Approaches to Facilitate Return-to-Driving and Return-to-Work in Mild Stroke: A Position Paper

Publication date: Available online 6 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Suzanne Perea Burns, Jaclyn Schwartz, Shannon Scott, Hannes Devos, Mark Kovic, Ickpyo Hong, Abiodun Akinwuntan
Adults with mild stroke face substantial challenges resuming valued roles in the community. The term "mild" provides false representation of the lived experience for many adults with mild stroke who may continue to experience persistent challenges and unmet needs. Rehabilitation practitioners can identify and consequently intervene to facilitate improved independence, participation, and quality of life by facilitating function and reducing the burden of lost abilities among adults with mild stroke. The [blind task force] identified two important, and often interdependent, goals that frequently arise among adults living with mild stroke that must be addressed to facilitate improved community reintegration: (1) return-to-driving and (2) return-to-work. Adults with mild stroke may not be receiving adequate rehabilitative services to facilitate community reintegration for several reasons but primarily because current practice models are not designed to meet such needs of this specific population. Thus, the [blind task force] convened to review current literature and practice trends to 1) identify opportunities based on the evidence of assessment and interventions, for return-to-driving and return-to-work, and 2) identify gaps in the literature that must be addressed to take advantage of the opportunities. Based on findings, the task force proposes a new interdisciplinary practice model for adults with mild stroke that are too often discharged from the hospital to the community without needed services to enable successful return to driving and work.



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High-Resolution Analysis of the Efficiency, Heritability, and Editing Outcomes of CRISPR/Cas9-Induced Modifications of NCED4 in Lettuce (Lactuca sativa)

CRISPR/Cas9 is a transformative tool for making targeted genetic alterations. In plants, high mutation efficiencies have been reported in primary transformants. However, many of the mutations analyzed were somatic and therefore not heritable. To provide more insights into the efficiency of creating stable homozygous mutants using CRISPR/Cas9, we targeted LsNCED4 (9-cis-epoxycarotenoid dioxygenase4), a gene conditioning thermoinhibition of seed germination in lettuce. Three constructs, each capable of expressing Cas9 and a single gRNA targeting different sites in LsNCED4, were stably transformed into lettuce (Lactuca sativa) cvs. Salinas and Cobham Green. Analysis of 47 primary transformants (T₁)and 368 T₂ plants by deep amplicon sequencing revealed that 57% of T₁ plants contained events at the target site: 28% of plants had germline mutations in one allele indicative of an early editing event (mono-allelic), 8% of plants had germline mutations in both alleles indicative of two early editing events (bi-allelic), and the remaining 21% of plants had multiple low frequency mutations indicative of late events (chimeric plants). Editing efficiency was similar in both genotypes, while the different gRNAs varied in efficiency. Amplicon sequencing of 20 T₁ and more than 100 T₂ plants for each of the three gRNAs showed that repair outcomes were not random, but reproducible and characteristic for each gRNA. Knockouts of NCED4 resulted in large increases in the maximum temperature for seed germination, with seeds of both cultivars capable of germinating >70% at 37°C. Knockouts of NCED4 provide a whole-plant selectable phenotype that has minimal pleiotropic consequences. Targeting NCED4 in a co-editing strategy could therefore be used to enrich for germline-edited events simply by germinating seeds at high temperature.

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AIRVAC 911® Vehicle Exhaust Removal Systems

Air Vacuum Corporations revolutionary AIRVAC 911® Vehicle Exhaust Removal Systems for Fire/EMS are Fully Automatic, Hose & Attachment Free and 100% Effective. Our systems do not require any manual involvement or vehicle/building modifications. Please watch our video and feel free to contact us at 800-540-7264 or www.airvac911.com for more information and a Free Proposal.

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AIRVAC 911® Filter Changes

This brief video shows the ease of removing and replacing the "4-stage" main filter pack for the AIRVAC 911® Engine Exhaust Removal System. For ordering or more information please contact us at 800-540-7264 or www.airvac911.com

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NLR surveillance of essential SEC-9 SNARE proteins induces programmed cell death upon allorecognition in filamentous fungi [Genetics]

In plants and metazoans, intracellular receptors that belong to the NOD-like receptor (NLR) family are major contributors to innate immunity. Filamentous fungal genomes contain large repertoires of genes encoding for proteins with similar architecture to plant and animal NLRs with mostly unknown function. Here, we identify and molecularly characterize patatin-like...

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Unleashing meiotic crossovers in hybrid plants [Genetics]

Meiotic crossovers shuffle parental genetic information, providing novel combinations of alleles on which natural or artificial selection can act. However, crossover events are relatively rare, typically one to three exchange points per chromosome pair. Recent work has identified three pathways limiting meiotic crossovers in Arabidopsis thaliana that rely on the...

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Massive crossover elevation via combination of HEI10 and recq4a recq4b during Arabidopsis meiosis [Genetics]

During meiosis, homologous chromosomes undergo reciprocal crossovers, which generate genetic diversity and underpin classical crop improvement. Meiotic recombination initiates from DNA double-strand breaks (DSBs), which are processed into single-stranded DNA that can invade a homologous chromosome. The resulting joint molecules can ultimately be resolved as crossovers. In Arabidopsis, competing pathways...

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Transcriptome profiling of rubber tree ( Hevea brasiliensis ) discovers candidate regulators of the cold stress response

Abstract

Tropical plant rubber tree (Hevea brasiliensis) is the sole source of commercial natural rubber and low-temperature stress is the most important limiting factor for its cultivation. To characterize the gene expression profiles of H. brasiliensis under the cold stress and discover the key cold stress-induced genes. Three cDNA libraries, CT (control), LT2 (cold treatment at 4 °C for 2 h) and LT24 (cold treatment at 4 °C for 24 h) were constructed for RNA sequencing (RNA-Seq) and gene expression profiling. Quantitative real time PCR (qRT-PCR) was conducted to validate the RNA-Seq and gene differentially expression results. A total of 1457 and 2328 differentially expressed genes (DEGs) in LT2 and LT24 compared with CT were respectively detected. Most significantly enriched KEGG pathways included flavonoid biosynthesis, phenylpropanoid biosynthesis, plant hormone signal transduction, cutin, suberine and wax biosynthesis, Pentose and glucuronate interconversions, phenylalanine metabolism and starch and sucrose metabolism. A total of 239 transcription factors (TFs) were differentially expressed following 2 h or/and 24 h of cold treatment. Cold-response transcription factor families included ARR-B, B3, BES1, bHLH, C2H, CO-like, Dof, ERF, FAR1, G2-like, GRAS, GRF, HD-ZIP, HSF, LBD, MIKC-MADS, M-type MADS, MYB, MYB-related, NAC, RAV, SRS, TALE, TCP, Trihelix, WOX, WRKY, YABBY and ZF-HD. The genome-wide transcriptional response of rubber tree to the cold treatments were determined and a large number of DEGs were characterized including 239 transcription factors, providing important clues for further elucidation of the mechanisms of cold stress responses in rubber tree.

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Profiling of glucose-induced transcription in Sulfolobus acidocaldarius DSM 639

Abstract

Sulfolobus species can grow on a variety of organic compounds as carbon and energy sources. These species degrade glucose to pyruvate by the modified branched Entner–Doudoroff pathway. We attempted to determine the differentially expressed genes (DEGs) under sugar-limited and sugar-rich conditions. RNA sequencing (RNA-seq) was used to quantify the expression of the genes and identify those DEGs between the S. acidocaldarius cells grown under sugar-rich (YT with glucose) and sugar-limited (YT only) conditions. The functions and pathways of the DEGs were examined using gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. Quantitative real-time PCR (qRT-PCR) was performed to validate the DEGs. Transcriptome analysis of the DSM 639 strain grown on sugar-limited and sugar-rich media revealed that 853 genes were differentially expressed, among which 481 were upregulated and 372 were downregulated under the glucose-supplemented condition. In particular, 70 genes showed significant changes in expression levels of ≥ twofold. GO and KEGG enrichment analyses revealed that the genes encoding components of central carbon metabolism, the respiratory chain, and protein and amino acid biosynthetic machinery were upregulated under the glucose condition. RNA-seq and qRT-PCR analyses indicated that the sulfur assimilation genes (Saci_2197–2204) including phosphoadenosine phosphosulfate reductase and sulfite reductase were significantly upregulated in the presence of glucose. The present study revealed metabolic networks in S. acidocaldarius that are induced in a glucose-dependent manner, improving our understanding of biomass production under sugar-rich conditions.

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Development of an anesthetized rat model of exercise hyperpnoea: An integrative model of respiratory control using an equilibrium diagram

New Findings

• What is the central question of this study?

  The lack of useful small animal models for studying exercise hyperpnoea makes it difficult to investigate the underlying mechanisms of exercise-induced ventilatory abnormalities in various disease states.

• What is the main finding and its importance?

  We developed an anesthetized rat model for studying exercise hyperpnoea, using respiratory equilibrium diagram for quantitative characterization of the respiratory chemoreflex feedback system. This experimental model will provide an opportunity to clarify the major determinant mechanisms of exercise hyperpnoea, and will be useful for understanding the mechanisms responsible for abnormal ventilatory responses to exercise in disease models.

Abstract

Exercise-induced ventilatory abnormalities in various disease states seem to arise from pathological changes of the respiratory regulation. Although experimental studies in small animals are essential to investigate the pathophysiologic basis in various disease models, the lack of integrated framework for quantitatively characterizing respiratory regulation during exercise prevents us from resolving these problems. The purpose of this study was to develop an anesthetized rat model for studying exercise hyperpnoea for quantitative characterization of the respiratory chemoreflex feedback system. In 24 anesthetized rats, we induced muscle contraction by stimulating bilateral distal sciatic nerves at low and high voltage to mimic exercise. We recorded breath-by-breath respiratory gas analysis data, and cardiorespiratory responses while running two protocols to characterize the controller and plant of the respiratory chemoreflex. The controller was characterized by determining the linear relationship between end-tidal CO₂ pressure (P_ETCO2) and minute ventilation (V_E), and the plant by the hyperbolic relationship between V_E and P_ETCO2. During exercise, the controller curve shifted upward without change in controller gain, accompanying increased oxygen output. The hyperbolic plant curve shifted rightward and downward depending on exercise intensity as predicted by increased metabolism. Exercise intensity-dependent changes in operating points (V_E and P_ETCO2) were estimated by integrating the controller and plant curves in a respiratory equilibrium diagram. In conclusion, we developed an anesthetized rat model for studying exercise hyperpnoea, using systems analysis for quantitative characterization of the respiratory system. This novel experimental model will be useful for understanding the mechanisms responsible for abnormal ventilatory responses to exercise in disease models.

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Is hypoxia-induced skeletal muscle dysfunction lost in space or just a matter of a time?

Abstract

A key advantage of humans over other animals in terms of maintaining homeostasis in extreme environments is the ability to create microenvironments to suit our physiology.

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SUMO-wrestling the pre-eclamptic placenta

Abstract

Preeclampsia (PE), which complicates ∼14% of pregnancies worldwide (Peters & Flack, 2004), can lead to significant maternal morbidity, fetal and neonatal morbidity and premature birth.

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Mitochondrial OXPHOS genes provides insights into genetics basis of hypoxia adaptation in anchialine cave shrimps

Abstract

Cave shrimps from the genera Typhlatya, Stygiocaris and Typhlopatsa (TST complex) comprises twenty cave-adapted taxa, which mainly occur in the anchialine environment. Anchialine habitats may undergo drastic environmental fluctuations, including spatial and temporal changes in salinity, temperature, and dissolved oxygen content. Previous studies of crustaceans from anchialine caves suggest that they have possessed morphological, behavioral, and physiological adaptations to cope with the extreme conditions, similar to other cave-dwelling crustaceans. However, the genetic basis has not been thoroughly explored in crustaceans from anchialine habitats, which can experience hypoxic regimes. To test whether the TST shrimp-complex hypoxia adaptations matched adaptive evolution of mitochondrial OXPHOS genes. The 13 OXPHOS genes from mitochondrial genomes of 98 shrimps and 1 outgroup were examined. For each of these genes was investigated and compared to orthologous sequences using both gene (i.e. branch-site and Datamonkey) and protein (i.e. TreeSAAP) level approaches. Positive selection was detected in 11 of the 13 candidate genes, and the radical amino acid changes sites scattered throughout the entire TST complex phylogeny. Additionally, a series of parallel/convergent amino acid substitutions were identified in mitochondrial OXPHOS genes of TST complex shrimps, which reflect functional convergence or similar genetic mechanisms of cave adaptation. The extensive occurrence of positive selection is suggestive of their essential role in adaptation to hypoxic anchialine environment, and further implying that TST complex shrimps might have acquired a finely capacity for energy metabolism. These results provided some new insights into the genetic basis of anchialine hypoxia adaptation.

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A new fossil cercopithecid tibia from Laetoli and its implications for positional behavior and paleoecology

Publication date: May 2018
Source:Journal of Human Evolution, Volume 118
Author(s): Myra F. Laird, Elaine E. Kozma, Amandus Kwekason, Terry Harrison
Detailed analyses and comparisons of postcranial specimens of Plio-Pleistocene cercopithecids provide an opportunity to examine the recent evolutionary history and locomotor diversity in Old World monkeys. Studies examining the positional behavior and substrate preferences of fossil cercopithecids are also important for reconstructing the paleoenvironments of Plio-Pleistocene hominin sites. Here we describe a new fossil cercopithecid tibia (EP 1100/12) from the Australopithecus afarensis-bearing Upper Laetolil Beds (∼3.7 Ma) of Laetoli in northern Tanzania. The fossil tibia is attributed to cf. Rhinocolobus sp., which is the most common colobine at Laetoli. In addition to qualitative comparisons, the tibial shape of EP 1100/12 was compared to that of 190 extant cercopithecids using three-dimensional landmarks. Discriminant function analyses of the shape data were used to assess taxonomic affinity and shape variation relating to positional behavior. EP 1100/12 clustered with extant colobines, particularly the large-bodied genera Nasalis and Rhinopithecus. Comparisons reveal that EP 1100/12 belongs to a large-bodied monkey that engaged in arboreal pronograde quadrupedalism. These findings add further support to previous inferences that woodland and forest environments dominated the paleoenvironment of the Upper Laetolil Beds, which supported the diverse community of cercopithecids at Laetoli. The inferred paleoecology and the presence of large-bodied arboreally-adapted monkeys at Laetoli show that A. afarensis had access to a range of diverse habitats, including woodlands and forests. This supports the possibility that A. afarensis, with its potential range of positional capabilities, was able to utilize arboreal settings for food acquisition and refuge from predators.



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Association of Pre-pregnancy BMI and Postpartum Weight Retention Before Second Pregnancy, Washington State, 2003–2013

Abstract

Background Maternal overweight and obesity is one of the most common high-risk obstetric conditions associated with adverse birth outcomes. Smaller studies have suggested that pre-pregnancy body mass index (BMI) is associated with postpartum weight retention. Objective The primary objective of this study was to examine the association between pre-pregnancy BMI status and maternal weight retention. Study design We conducted a population-based retrospective cohort study using Washington State birth certificate data from 2003–2013. We included women who had two sequential births during this time period, with the second birth occurring within 18–36 months of the first singleton delivery date. BMI before a women's first pregnancy ("pre-pregnancy BMI") was categorized as normal (18.5–24.9 kg/m²) and overweight/obese (25–40 kg/m²). Women were classified as having returned to first pre-pregnancy BMI if their BMI before their second pregnancy was no more than 1 kg/m² more compared to their BMI before their first pregnancy. Analyses were stratified by gestational weight gain during the first pregnancy (below, met, exceeded recommended gestational weight gain). Results A total of 49,132 mothers were included in the study. Among women who met their recommended gestational weight gain, compared to mothers with a normal BMI, obese/overweight mothers were less likely to return to their pre-pregnancy BMI (76.5 vs 72.3%; RR_{Obese/Overweight} = 0.88; 95% CI: 0.85–0.92). A similar pattern was observed among women who exceeded their recommended gestational weight gain (62.6 vs 53.2%; RR_{Obese/Overweight} = 0.79, 95% CI: 0.78–0.80). Conclusion Pre-pregnancy BMI in the overweight/obese range is associated with a decreased likelihood of returning to pre-pregnancy BMI. Further research to support women during and after their pregnancy to promote behavior changes that prevent excessive weight gain during pregnancy and weight retention after birth is needed.

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Small peptides, big roles ‒ RALFs regulate pollen tube growth and burst in plant reproduction

Publication date: Available online 5 March 2018
Source:Journal of Genetics and Genomics
Author(s): Li-Yu Chen




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A novel lncRNA, Lnc-OC1, promotes ovarian cancer cell proliferation and migration by sponging miR-34a and miR-34c

Publication date: Available online 6 March 2018
Source:Journal of Genetics and Genomics
Author(s): Fangfang Tao, Xinxin Tian, Mengxi Lu, Zhiqian Zhang
Long non-coding RNAs (lncRNAs) have been reported to be of great importance in tumorigenesis and progression of a variety of cancers. However, the role of lncRNAs in ovarian cancer remains largely unknown. In the present study, we identified a novel lncRNA, LOC100288181 (named as Lnc-OC1), which acted as a key regulator in the development and progression of ovarian cancer (OC). The combined Gene Expression Omnibus (GEO) database analysis revealed that Lnc-OC1 was significantly upregulated in OC tissues and Kaplan-Meier survival analysis confirmed that high Lnc-OC1 expression was associated with poor prognosis of OC patients. Importantly, we also demonstrated that knockdown of Lnc-OC1 suppressed cell proliferation, colony formation, invasion and migration in vitro and inhibited tumorigenicity in vivo. Mechanistically, Lnc-OC1 repressed the expression of endogenous miR-34a and miR-34c as a sponge and vice versa. Moreover, rescue experiments demonstrated that the oncogenic function of Lnc-OC1 at least partially depended on suppressing miR-34a and miR-34c. In conclusion, our results suggest that the Lnc-OC1-miR-34a/34c axis may play a pivotal role in OC and may serve as a potential diagnostic biomarker and a powerful therapeutic target for this terrible disease.



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Peripartum Care for Mothers Diagnosed with Hepatitis B During Pregnancy: A Survey of Provider Practices

Abstract

Objectives Hepatitis B (HBV) remains a significant public health burden, despite effective therapy. Routine HBV screening is recommended during pregnancy to reduce the risk of vertical transmission, but the rates of follow-up care peri-partum are low. The aim of this study was to evaluate physician practices and knowledge regarding HBV in women diagnosed perinatally. Methods A survey was distributed to obstetricians and midwives within the Partners HealthCare system at Brigham and Women's Hospital and Massachusetts General Hospital. Results Of 118 survey respondents (response rate 56%), 97% reported that they always tested for hepatitis B, and 77% referred new diagnoses of HBV during pregnancy to a HBV specialist for further care. Only 10% of respondents reported that there was formal referral mechanism in place to facilitate follow-up care for mothers diagnosed with hepatitis B infection. 91% of survey respondents selected hepatitis B surface antigen as the correct screening test, and 76% selected hepatitis B immune globulin with vaccination for the newborn as the correct prophylaxis regimen. Only 40 and 51% of respondents accurately identified serologies that were consistent with acute and chronic infection, respectively. Conclusions for Practice Routine screening for HBV in this population presents an important opportunity to identify cases and to reduce the public health burden of this disease. Providers were somewhat knowledgeable about HBV, but the lack of formal referral mechanism may explain why HBV follow-up is suboptimal in this healthcare system. Supplemental provider education and formal linkage to care programs may increase rates of follow-up HBV care.

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An Uncommon Cause of Upper Limb Pain: Cervical Perineural (Tarlov) Cyst Chain

No abstract available

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Post stroke depression, a long term problem for stroke survivors

AbstractObjectivesTo ascertain the prevalence of depressive mood and its determinants in the chronic phase after stroke.Design576 consecutive patients were invited to participate 2-5 years after hospitalization for a first-ever stroke. Stroke characteristics at hospitalization were collected retrospectively from medical records. Patients and their caregivers completed questionnaires on depression (Hospital Anxiety and Depression Scale; HADS), socio-demographic characteristics, healthcare usage, daily activities, Quality of Life and caregiver strain. Patients with HADS depression scores

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Association between Spasticity and Functional Impairments during the First Year after Stroke in Korea: The KOSCO Study

ABSTRACTObjectiveTo investigate the correlation between spasticity severity and functional outcomes during the first year after stroke.DesignThe Korean Stroke Cohort for Functioning and Rehabilitation is a large, multicenter, prospective cohort study of all patients with acute first-ever stroke admitted to participating hospitals in nine Korean areas. To investigate the correlation between spasticity severity and functional status measured by using the Institutes of Health Stroke Scale(NIHSS), Modified Barthel Index(MBI), Functional Independence Measurement(FIM), Fugl-Meyer Assessment(FMA), Functional Ambulatory Category(FAC), modified Rankin scale(mRS), and American Speech-Language Hearing Association National Outcome Measurement System Swallowing Scale(ASHA-NOMS), data were analyzed at 3, 6, and 12 months after the occurrence of stroke.ResultsA total of 7359 stroke patients, 3056 patients were finally included. Prevalence rates of spasticity in patients after stroke were 6.8% at 3 months, 6.9% at 6 months and 7.6% at 12 months. The scores of mRS and NIHSS were higher and those of K-MBI, FIM, FMA and ASHA-NOMS were lower in more severe spastic patients, indicating poorer functional outcomes (p

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The effects of gait training using powered lower limb exoskeleton robot on individuals with complete spinal cord injury

Powered exoskeleton can improve the mobility for people with movement deficits by providing mechanical support and facilitate the gait training. This pilot study evaluated the effect of gait training using a n...

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Increased rate of force development during periodized maximum strength and power training is highly individual

Abstract

Maximum strength training induces various improvements in the rate of force development (RFD) on a group level, but no study has investigated inter-individual adaptations in RFD. Fourteen men (28 ± 6 years old) performed the same 10-week maximum strength and then a 10-week power training program. Maximal force and RFD were recorded during maximal isometric leg extension voluntary contractions repeatedly before every 7th training session (2 sessions/week). After the intervention, subjects were retrospectively divided into three groups based on their RFD improvements: (1) improved only during the maximum strength period (MS-responders, + 100 ± 35%), (2) improved only during the power period (P-responders, + 53 ± 27%) or (3) no improvement at all (non-responders, + 3 ± 9%). All groups increased dynamic 1RM equally, but baseline 1RM was greater (p < 0.05) in responder vs non-responder groups. MS-responders had higher electrical stimulation-induced torque at baseline and they improved (+ 35 ± 28%) power production at 50% 1RM load more than P- (− 7 ± 20%, p = 0.052) and non-responders (+ 3 ± 6%, p = 0.066) during the maximum strength training period. MS-responders increased vastus lateralis cross-sectional area (+ 12 ± 9%, p < 0.01) as did P-responders (+ 10 ± 7%, p = 0.07), whereas non-responders were unchanged. Free androgen index (FAI) in responders was higher (+ 34%, p < 0.05) compared to non-responders at baseline. The maximum strength period decreased testosterone (− 17 ± 12; 17 ± 22%), FAI ratio (− 12 ± 14; − 21 ± 23%) and testosterone/cortisol ratio (− 17 ± 25; − 31 ± 20%) in MS and P-responders, respectively. During the P-period hormonal levels plateaued. To conclude, periodized strength training induced different inter-individual physiological responses, and thus RFD development may vary between individuals. Therefore, RFD seems to be a useful tool for planning and monitoring strength training programs for individual neuromuscular performance needs.

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Immunomodulatory Effects of Fentanyl or Dexmedetomidine Hydrochloride Infusion After Allogeneic Heart Transplantation in Mice

Background and Objectives Postoperatively, transplant recipients receive immunosuppressants, as well as sedatives and analgesics. The immunomodulatory effects of these other agents during the induction period following transplantation remain unclear. We aimed to determine whether the agents dexmedetomidine hydrochloride (Dex) and fentanyl (Fen) have immunomodulatory effects during the induction period following heart transplantation (HTx). Methods Fifty mice were used for antinociception tests after administration of Dex and Fen, and T cells from 3 naive animals were used for in vitro lymphocyte transformation test (study 1). Fifty-four B6 mice received HTx from BALB/c mice and were treated with Dex, Fen, or neither (study 2). Thirty-six recipients were used for graft survival data and were humanely killed at the time of cessation of heart graft contraction. The remaining 18 were humanely killed at either postoperative day (POD) 4 or 6 for histologic examination of graft survival, as well as in vitro analysis. Results Based on the results of study 1, daily intraperitoneal administration of Dex at 30 μg/kg or Fen at 0.25 mg/kg was determined to be the optimal dose to induce analgesia without oversedation following HTx. Graft survivals in both Dex- or Fen-treated animals were statistically prolonged compared with control (P

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Muscle Fiber Hypertrophy and Myonuclei Addition: A Systematic Review and Meta-analysis

ABSTRACTIntroductionThe myonuclear domain theory postulates that myonuclei are added to muscle fibres when increases in fibre cross-sectional area (i.e. hypertrophy) are ≥26%. However, recent studies have reported increased myonuclear content with lower levels (e.g. 12%) of muscle fibre hypertrophy.PurposeTo determine whether a muscle fibre hypertrophy "threshold" is required to drive the addition of new myonuclei to existing muscle fibres.MethodsStudies of resistance training (RT), endurance training (ET), with or without nutrient (i.e., protein) supplementation and steroid administration, with measures of muscle fibre hypertrophy and myonuclei number, as primary or secondary outcomes, were considered. Twenty-seven studies incorporating 62 treatment groups and 903 subjects fulfilled the inclusion criteria and were included in the analyses.ResultsMuscle fibre hypertrophy ≤ 10% induces increases in myonuclear content although a significantly higher number of myonuclei are observed when muscle hypertrophy is ~22%. Additional analyses showed that age, sex and muscle fibre type do not influence muscle fibre hypertrophy nor myonuclei addition.ConclusionEven though a more consistent myonuclei addition occurs when muscle fibre hypertrophy is >22%, our results challenge the concept of a muscle hypertrophy threshold as significant myonuclei addition occurs with lower muscle hypertrophy (i.e. 22%, our results challenge the concept of a muscle hypertrophy threshold as significant myonuclei addition occurs with lower muscle hypertrophy (i.e.

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Plasma Metabolite Profiles in Response to Chronic Exercise

AbstractPurposeHigh throughput profiling of metabolic status (metabolomics) allows for the assessment of small-molecule metabolites that may participate in exercise-induced biochemical pathways and corresponding cardiometabolic risk modification. We sought to describe the changes in a diverse set of plasma metabolite profiles in patients undergoing chronic exercise training and assess the relationship between metabolites and cardiometabolic response to exercise.MethodsA secondary analysis was performed in 216 middle-aged abdominally obese men and women ([mean (SD)], 52.4 (8.0) years) randomized into one of four groups varying in exercise amount and intensity for 6 months duration: high amount high intensity, high amount low intensity, low amount low intensity, and control. 147 metabolites were profiled by liquid chromatography-tandem mass spectrometry.ResultsNo significant differences in metabolite changes between specific exercise groups were observed; therefore, subsequent analyses were collapsed across exercise groups. There were no significant differences in metabolite changes between the exercise and control groups after 24 weeks at a Bonferroni-adjusted statistical significance (p

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Caffeine, CYP1A2 Genotype, and Endurance Performance in Athletes

AbstractPurposeMany studies have examined the effect of caffeine on exercise performance, but findings have not always been consistent. The objective of this study was to determine whether variation in the CYP1A2 gene, which affects caffeine metabolism, modifies the ergogenic effects of caffeine in a 10-km cycling time trial.MethodsCompetitive male athletes (n=101; age: 25 ± 4 years) completed the time trial under three conditions: 0, 2 or 4 mg of caffeine per kg body mass, using a split-plot randomized, double-blinded, placebo-controlled design. DNA was isolated from saliva and genotyped for the -163A>C polymorphism in the CYP1A2 gene (rs762551).ResultsOverall, 4 mg/kg caffeine decreased cycling time by 3% (mean ± SEM) versus placebo (17.6 ± 0.1 vs. 18.1 ± 0.1 min, p = 0.01). However, a significant (p C polymorphism in the CYP1A2 gene (rs762551). Results Overall, 4 mg/kg caffeine decreased cycling time by 3% (mean ± SEM) versus placebo (17.6 ± 0.1 vs. 18.1 ± 0.1 min, p = 0.01). However, a significant (p

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Influence of Estradiol Status on Physical Activity in Premenopausal Women

ABSTRACTPurposeTo determine the effects of 5 months of ovarian hormone suppression in pre-menopausal women on objectively measured physical activity (PA).MethodsParticipants (age = 35±8 yr; body mass index = 27±6 kg.m-2) received monthly intramuscular injections of gonadotropin releasing hormone agonist therapy (GnRHAG) which suppresses pituitary gonadotropins and results in suppression of ovarian sex hormones. Women were randomized to receive concurrent transdermal E2 (GnRHAG+E2; n=30) or placebo (GnRHAG+PL, n=31). PA was assessed for 1 week before and during each month of the 5-month intervention using a hip-worn accelerometer (Actical, Mini Mitter Co., Inc., Bend, OR). Estimates of time spent in sedentary, light, and moderate-to-vigorous physical activity (MVPA) were derived using a previously published equation. Subsets of participants in each group were also randomized to a supervised progressive resistance exercise training program.ResultsTotal MVPA tended towards being higher (p=0.08) in the GnRHAG+E2 group at month 4. There were no significant effects of intervention or time in sedentary or light PA. In the subset of women who did not participate in structured exercise training for which Actical data were obtained (N=16 in each group), total MVPA was higher at month 4 (p=0.01).ConclusionPhysical activity levels appear to be maintained at a higher level in women undergoing pharmacological suppression of ovarian function with E2 add back when compared with women treated with placebo. These data provide proof of concept data that E2 contributes to the regulation of PA in humans. However, given the exploratory nature of this study, future confirmatory investigations will be necessary. Purpose To determine the effects of 5 months of ovarian hormone suppression in pre-menopausal women on objectively measured physical activity (PA). Methods Participants (age = 35±8 yr; body mass index = 27±6 kg.m-2) received monthly intramuscular injections of gonadotropin releasing hormone agonist therapy (GnRHAG) which suppresses pituitary gonadotropins and results in suppression of ovarian sex hormones. Women were randomized to receive concurrent transdermal E2 (GnRHAG+E2; n=30) or placebo (GnRHAG+PL, n=31). PA was assessed for 1 week before and during each month of the 5-month intervention using a hip-worn accelerometer (Actical, Mini Mitter Co., Inc., Bend, OR). Estimates of time spent in sedentary, light, and moderate-to-vigorous physical activity (MVPA) were derived using a previously published equation. Subsets of participants in each group were also randomized to a supervised progressive resistance exercise training program. Results Total MVPA tended towards being higher (p=0.08) in the GnRHAG+E2 group at month 4. There were no significant effects of intervention or time in sedentary or light PA. In the subset of women who did not participate in structured exercise training for which Actical data were obtained (N=16 in each group), total MVPA was higher at month 4 (p=0.01). Conclusion Physical activity levels appear to be maintained at a higher level in women undergoing pharmacological suppression of ovarian function with E2 add back when compared with women treated with placebo. These data provide proof of concept data that E2 contributes to the regulation of PA in humans. However, given the exploratory nature of this study, future confirmatory investigations will be necessary. Corresponding Author: Edward L. Melanson, Ph.D. (Ed.melanson@ucdenver.edu)MS 8106, 12801 East 17th Ave, RC1 South RM 7103, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 Grant support: Supported by NIH grants P50 HD073063, R01 AG018198, P30 DK048520, UL1 TR001082, and K01 DK109053. Drs. Melanson, Kohrt, and Schwartz are also supported by resources from the Geriatric Research, Education, and Clinical Center at the Denver VA Medical Center Conflict of Interest: The authors have no conflicts to declare Accepted for Publication: 22 February 2018 © 2018 American College of Sports Medicine

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Dehydration Impairs Cycling Performance, Independently of Thirst: A Blinded Study

ABSTRACTPurposeThe aim of the present study was to examine the effect of dehydration on exercise performance independently of thirst with subjects blinded of their hydration status.MethodsSeven male cyclists (weight: 72±9 kg, body fat: 14±6%, VO2peak: 59.4±6 ml[BULLET OPERATOR]kg-1·min-1) exercised for 2 hours on a cycle ergometer at 55% VO2peak, in a hot-dry environment (35°C, 30% rh), with a nasogastric (NG) tube under euhydrated – non-thirst (EUH-NT) and dehydrated – non-thirst (DEH-NT) conditions. In both trials, thirst was matched by drinking 25 mL of water every 5-min (300 mL[BULLET OPERATOR]h-1). In the EUH-NT trial sweat losses were fully replaced by water via the NG tube (calculated from the familiarization trial). Following the 2-h of steady state, the subjects completed a 5-km cycling time trial at 4% grade.ResultsBody mass loss for the EUH-NT and DEH-NT after the 2-h was -0.2±0.6 and -2.2±0.4%, while after the 5-km time trial was -0.7±0.5 and 2.9±0.4%, respectively. Thirst (35±30 vs. 42±31 mm) and stomach fullness (46±21 vs. 35±20 mm) did not differ at the end of the 2-h of steady state between EUH-NT and DEH-NT trials (P>0.05). Subjects cycled faster during the 5-km time trial in the EUH-NT trial compared to the DEH-NT trial (23.2±1.5 vs. 22.3±1.8 km·h-1, P0.05).ConclusionThese data indicated that hypohydration decreased cycling performance and impaired thermoregulation independently of thirst, while the subjects were unaware of their hydration status. Purpose The aim of the present study was to examine the effect of dehydration on exercise performance independently of thirst with subjects blinded of their hydration status. Methods Seven male cyclists (weight: 72±9 kg, body fat: 14±6%, VO2peak: 59.4±6 ml[BULLET OPERATOR]kg-1·min-1) exercised for 2 hours on a cycle ergometer at 55% VO2peak, in a hot-dry environment (35°C, 30% rh), with a nasogastric (NG) tube under euhydrated – non-thirst (EUH-NT) and dehydrated – non-thirst (DEH-NT) conditions. In both trials, thirst was matched by drinking 25 mL of water every 5-min (300 mL[BULLET OPERATOR]h-1). In the EUH-NT trial sweat losses were fully replaced by water via the NG tube (calculated from the familiarization trial). Following the 2-h of steady state, the subjects completed a 5-km cycling time trial at 4% grade. Results Body mass loss for the EUH-NT and DEH-NT after the 2-h was -0.2±0.6 and -2.2±0.4%, while after the 5-km time trial was -0.7±0.5 and 2.9±0.4%, respectively. Thirst (35±30 vs. 42±31 mm) and stomach fullness (46±21 vs. 35±20 mm) did not differ at the end of the 2-h of steady state between EUH-NT and DEH-NT trials (P>0.05). Subjects cycled faster during the 5-km time trial in the EUH-NT trial compared to the DEH-NT trial (23.2±1.5 vs. 22.3±1.8 km·h-1, P0.05). Conclusion These data indicated that hypohydration decreased cycling performance and impaired thermoregulation independently of thirst, while the subjects were unaware of their hydration status. Corresponding author: Stavros A. Kavouras, PhD, FACSM, Hydration Science Lab, University of Arkansas, HPER 308Q, Fayetteville, AR 72701, USA, E-mail: kavouras@uark.edu The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation and do not constitute endorsement by ACSM. SAK was a scientific consultant for Quest Diagnostics and has active grants from Danone Research. ADS is a scientific consultant for Gatorade Sports Science Institute, the rest of the authors do not have anything to disclose. This study was not funded. Accepted for Publication: 22 February 2018 © 2018 American College of Sports Medicine

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Mesocycles with Different Training Intensity Distribution in Recreational Runners

ABSTRACTPurposeThe aim was to compare mesocycles with progressively increasing workloads and varied training intensity distribution (TID), i.e. high-intensity (HIGH, > 4 mmol·L-1 blood lactate), low-intensity (LOW, 4 mmol·L-1 blood lactate), low-intensity (LOW,

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The Immediate Effect of Foot Orthoses on Subtalar Joint Mechanics and Energetics

ABSTRACTPurposeFoot orthoses maybe used in the management of musculoskeletal disorders related to abnormal subtalar joint (STJ) pronation. However, the precise mechanical benefits of foot orthoses for preventing injuries associated with the STJ are not well understood. The aim of this study was to investigate the immediate effect of foot orthoses on the energy absorption requirements of the STJ and subsequently tibialis posterior (TP) muscle function.MethodsEighteen asymptomatic subjects with a pes planus foot posture were prescribed custom-made foot orthoses made from a plaster cast impression. Participants walked at preferred and fast velocities barefoot, with athletic footwear and with athletic footwear plus orthoses, as three-dimensional motion capture, force data and intramuscular electromyography of the TP muscle were simultaneously collected. Statistical parametric mapping was used to identify time periods across the stride cycle during which footwear with foot orthoses significantly differed to barefoot and footwear only.ResultsDuring early stance, footwear alone and footwear with orthoses significantly reduced TP muscle activation (1 - 12 %), supination moments (3 - 21 %) and energy absorption (5 - 12 %) at the STJ, but had no effect on STJ pronation displacement.ConclusionThe changes in TP muscle activation and STJ energy absorption were primarily attributed to footwear as the addition of foot orthoses provided little additional effect. We speculate that these results are most likely a result of the compliant material properties of footwear. These results suggest that athletic footwear may be sufficient to absorb energy in the frontal plane and potentially reducing any benefit associated with the addition of foot orthoses. Purpose Foot orthoses maybe used in the management of musculoskeletal disorders related to abnormal subtalar joint (STJ) pronation. However, the precise mechanical benefits of foot orthoses for preventing injuries associated with the STJ are not well understood. The aim of this study was to investigate the immediate effect of foot orthoses on the energy absorption requirements of the STJ and subsequently tibialis posterior (TP) muscle function. Methods Eighteen asymptomatic subjects with a pes planus foot posture were prescribed custom-made foot orthoses made from a plaster cast impression. Participants walked at preferred and fast velocities barefoot, with athletic footwear and with athletic footwear plus orthoses, as three-dimensional motion capture, force data and intramuscular electromyography of the TP muscle were simultaneously collected. Statistical parametric mapping was used to identify time periods across the stride cycle during which footwear with foot orthoses significantly differed to barefoot and footwear only. Results During early stance, footwear alone and footwear with orthoses significantly reduced TP muscle activation (1 - 12 %), supination moments (3 - 21 %) and energy absorption (5 - 12 %) at the STJ, but had no effect on STJ pronation displacement. Conclusion The changes in TP muscle activation and STJ energy absorption were primarily attributed to footwear as the addition of foot orthoses provided little additional effect. We speculate that these results are most likely a result of the compliant material properties of footwear. These results suggest that athletic footwear may be sufficient to absorb energy in the frontal plane and potentially reducing any benefit associated with the addition of foot orthoses. Corresponding author: Jayishni Maharaj, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, 4072, Queensland, Australia. Email address: jayishni.m@uq.edu.au The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the ACSM. J.N. Maharaj was supported by a National Health and Medical Research Council postgraduate scholarship, APP1075000. The authors would like to acknowledge Australian Podiatry Education and Research Foundation (APERF) for their financial contribution and ASICS Oceania for providing footwear in kind. The authors declare no conflict of interest. Accepted for Publication: 19 February 2018 © 2018 American College of Sports Medicine

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The Utility of the Total Neuropathy Score as an Instrument to Assess Neuropathy Severity in Chronic Kidney Disease: A Validation Study

Publication date: Available online 6 March 2018
Source:Clinical Neurophysiology
Author(s): Tushar Issar, Ria Arnold, Natalie C.G. Kwai, Bruce A. Pussell, Zoltan H. Endre, Ann M. Poynten, Matthew C. Kiernan, Arun V. Krishnan
ObjectiveTo demonstrate construct validity of the Total Neuropathy Score (TNS) in assessing peripheral neuropathy in subjects with chronic kidney disease (CKD).Methods113 subjects with CKD and 40 matched controls were assessed for peripheral neuropathy using the TNS. An exploratory factor analysis was conducted and internal consistency of the scale was evaluated using Cronbach's alpha. Construct validity of the TNS was tested by comparing scores between case and control groups.ResultsFactor analysis revealed valid item correlations and internal consistency of the TNS was good with a Cronbach's alpha of 0.897. Subjects with CKD scored significantly higher on the TNS (CKD: median, 6, interquartile range, 1-13; controls: median, 0, interquartile range, 0-1; p<0.001). Subgroup analysis revealed construct validity was maintained for subjects with stages 3-5 CKD with and without diabetes.ConclusionsThe TNS is a valid measure of peripheral neuropathy in patients with CKD.SignificanceThe TNS is the first neuropathy scale to be formally validated in patients with CKD.



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Precision of perceived direction of gravity in partial bilateral vestibulopathy correlates with residual utricular function

Publication date: Available online 5 March 2018
Source:Clinical Neurophysiology
Author(s): A. Bürgin, C.J. Bockisch, A.A. Tarnutzer
ObjectiveGait imbalance in patients with bilateral-vestibular-deficiency (BVD) was linked to increased variability in perceived direction of gravity while upright. We hypothesized this to be true also when roll-tilted. Moreover, as utricular input is essential for spatial orientation, we predicted the variability of perceived vertical to correlate inversely with utricular function.MethodsSubjective visual vertical (SVV) and haptic vertical (SHV) were measured in various roll-orientations (0°/±45°/±90°) and postural adjustments along earth-vertical/earth-horizontal were collected in patients with partial BVD (n=10) and healthy controls (n=11). Patients with bilaterally-absent bone-conducted ocular vestibular-evoked myogenic-potentials (oVEMPs) were compared to those with (partially) preserved oVEMPs.ResultsFor the SVV (p<0.001) and SHV (p=0.004) variability was larger in patients than controls. Compared to those with (partially) preserved oVEMPs, patients with bilaterally-absent oVEMPs had higher SVV (p=0.024) and SHV (p=0.006) variability. Self-positioning along earth-horizontal was more variable in BVD-patients compared to controls (p<0.001). Again, variability was higher in those with bilaterally-absent oVEMPs (p=0.032). SVV/SHV-variability was correlated (R²=0.61, slope=1.06 [95%-CI=0.80-1.54]) in BVD-patients.ConclusionWith variability correlating amongst the different paradigms and with oVEMP-responses, this emphasizes the role of bilaterally intact utricular input for precise perception of gravity.SignificanceIn BVD-patients with bilaterally-absent oVEMPs intensified vestibular rehabilitation should be considered.



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Reproductive Life Planning: Raising the Questions

Abstract

Introduction Unintended pregnancy has been a concerning public health problem for decades. As we begin to understand the complexities of pregnancy intention and how women experience these pregnancies, reproductive life planning offers a paradigm shift. Methods Reproductive life planning is a patient-centered approach that places a patient's reproductive preferences—whether concrete or ambivalent—at the forefront of her clinical care. Results This process grants women and men the opportunity to consider how reproduction fits within the context of their broader lives. Within a clinical encounter, reproductive life planning allows counseling and care to be tailored to patient preferences. Discussion Although there is great potential for positive public health impacts in unintended pregnancy, contraceptive use and improved preconception health, the true benefit lies within reinforcing reproductive empowerment. Despite recommendations for universal adoption, many questions remain regarding implementation, equity and outcomes.

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EFNB2 haploinsufficiency causes a syndromic neurodevelopmental disorder

Ephrin B2, one of the ligand of the EphB receptors, is involved in a complex signaling pathway regulating the development of the nervous system, neuronal migration, erythropoiesis and vasculogenesis. We report a patient with a de novo variant in EFNB2 and a family in which segregates a 610-kb deletion at chromosome 13q33 encompassing only ARGLU1 and EFNB2 genes. The de novo variant was observed in a patient with anal stenosis, hypoplastic left ventricle and mild developmental delay. The deletion was identified in 2 sibs with congenital heart defect and mild developmental delay. One of the affected sibs further had myoclonic epilepsy and bilateral sensorineural hearing loss. The carrier mother was apparently asymptomatic. Because EFNB2 is located in the subtelomeric region of 13q chromosome, we reviewed the previous reports of terminal 13q deletion. We suggest that haploinsufficiency of the EFNB2 could be at the origin of several clinical features reported in 13qter deletions, including intellectual disability, seizures, congenital heart defects, anorectal malformation and hearing loss.

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The acute effect of Quercetin on muscle performance following a single resistance training session

Abstract

Purpose

To examine the effect of acute quercetin (Q) ingestion on neuromuscular function, biomarkers of muscle damage, and rate of perceived exertion (RPE) in response to an acute bout of resistance training.

Methods

10 young men (22.1 ± 1.8 years, 24.1 ± 3.1 BMI) participated in a randomized, double-blind, crossover study. Subjects consumed Q (1 g/day) or placebo (PLA) 3 h prior to a resistance training session which consisted of 3 sets of 8 repetitions at 80% of the one repetition maximum (1RM) completed bilaterally for eight different resistance exercises. Electromyographic (EMG) signals were recorded from the knee extensor muscles during maximal isometric (MVIC) and isokinetic voluntary contractions, and during an isometric fatiguing test. Mechanical and EMG signals, biomarkers of cell damage, and RPE score were measured PRE, immediately POST, and 24 h (blood indices only) following the resistance exercise.

Results

After a single dose of Q, the torque–velocity curve of knee extensors was enhanced and after the resistance exercise, subjects showed a lower MVIC reduction (Q: 0.91 ± 6.10%, PLA: 8.66 ± 5.08%) with a greater rate of torque development (+ 10.6%, p < 0.005) and neuromuscular efficiency ratio (+ 28.2%, p < 0.005). Total volume of the resistance exercises was significantly greater in Q (1691.10 ± 376.71 kg rep) compared to PLA (1663.65 ± 378.85 kg rep) (p < 0.05) with a comparable RPE score. No significant differences were found in blood marker between treatments.

Conclusions

The acute ingestion of Q may enhance the neuromuscular performance during and after a resistance training session.

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Implementation and Evaluation of a Recurring Interdisciplinary Community Health Fair in a Remote U.S.–Mexico Border Community

Abstract

The purpose of this project was to design, implement, and assess a recurring interdisciplinary community health fair in an underserved border town. University of California San Diego (UCSD) medical and pharmacy students, under faculty supervision, worked alongside community partners in Calexico, California to implement a health fair two miles from the U.S.–Mexico border. Demographic and screening data were described from 293 participants from 2014 to 2016. Over 90% (269/293) listed Mexico as their country of birth, 82.9% (243/293) were monolingual Spanish speakers, 75.4% (221/293) had an annual household income of ≤ $20,000, and 58.7% (172/293) described their health as fair or poor. Screening revealed 91.1% (265/291) were overweight or obese, 37.8% (109/288) had hypertension, 9.3% (27/289) had elevated blood sugar, and 11.4% (33/289) had elevated total cholesterol levels. This model could be replicated in other training settings to increase exposure to border health issues and connect patients to local health services.

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Cardiorespiratory and perceptual responses to self-regulated and imposed submaximal arm–leg ergometry

Abstract

Purpose

This study compared cardiorespiratory and perceptual responses to exercise using self-regulated and imposed power outputs distributed between the arms and legs.

Methods

Ten males (age 21.7 ± 3.4 years) initially undertook incremental arm-crank ergometry (ACE) and cycle ergometry (CYC) tests to volitional exhaustion to determine peak power output (W_peak). Two subsequent tests involved 20-min combined arm–leg ergometry (ALE) trials, using imposed and self-regulated protocols, both of which aimed to elicit an exercising heart rate of 160 beats min⁻¹. During the imposed trial, arm and leg intensity were set at 40% of each ergometer-specific W_peak. During the self-regulated trial, participants were asked to self-regulate cadence and resistance to achieve the target heart rate. Heart rate (HR), oxygen uptake ( \(\dot {V}_{\text{2}}}\) ), pulmonary ventilation ( \({\dot {V}_{\text{E}}}\) ), and ratings of perceived exertion (RPE) were recorded continuously.

Results

As expected, there were no differences between imposed and self-regulated trials for HR, \(\dot {V}_{\text{2}}}\) _, and \({\dot {V}_{\text{E}}}\) (all P ≥ 0.05). However, central RPE and local RPE for the arms were lower during self-regulated compared imposed trials (P ≤ 0.05). Lower RPE during the self-regulated trial was related to preferential adjustments in how the arms (33 ± 5% W_peak) and legs (46 ± 5% W_peak) contributed to the exercise intensity.

Conclusions

This study demonstrates that despite similar metabolic and cardiovascular strain elicited by imposed and self-regulated ALE, the latter was perceived to be less strenuous, which is related to participants doing more work with the legs and less work with the arms to achieve the target intensity.

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Diaphragmatic paralysis in obese patients in arthroscopic shoulder surgery: consequences and causes

Abstract

Purpose

Ambulatory process in arthroscopic shoulder surgery has boomed over past decades. Some anesthetic techniques such as interscalene block (ISB) and its surrogates are associated with diaphragmatic paralysis and might compromise outpatient procedure.

Hypothesis

This study aims to assess consequences of diaphragmatic paralysis in obese patients.

Methods

This prospective observational study screened patients with body mass index (BMI) ≥ 30 kg/m² undergoing acromioplasty or supraspinatus tendon repair. Surgery was performed using brachial plexus block, and the method of brachial plexus block was left at the discretion of attending anesthesiologists. Post-operative hemidiaphragmatic paralysis was evaluated using M-mode ultrasonography and its consequences on patient ventilation were assessed: occurrence of hypoxic episode defined as oxygen saturation less than 90% (by pulse oximeter) in room air, dyspnea and failure of ambulatory procedure. Causes of diaphragmatic paralysis were also analyzed.

Results

Ninety-one patients were screened, 82 patients were included in this study and 37 patients (45%) presented diaphragmatic paralysis. Compared to patients without diaphragmatic paralysis, diaphragmatic paralysis was associated with dyspnea [10 (27%) versus 1 (2%); p = 0.0019], occurrence of patients presenting at least one hypoxic episode [6 (16%) versus 1 (2%); p = 0.02] and failure of ambulatory process [10 (27%) versus 1 (2%); p = 0.009]. The combination of axillary and suprascapular nerve blocks, but also low volume ISB, was found to be protective against diaphragmatic paralysis when compared to high volume ISB [Odds ratios 0.0019 (0.001–0.026) and 0.0482 (0.008–0.27), respectively; p < 0.001].

Conclusion

In patients with BMI ≥ 30 kg/m² undergoing arthroscopic shoulder surgery, diaphragmatic paralysis is associated with dyspnea, occurrence of hypoxic episodes and failure of ambulatory procedure. High volume ISB and also, to a lesser extent, low volume ISB were found to be responsible for diaphragmatic paralysis.

Trial registry number

Registration n° 2014-202.

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Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan

Abstract

Introduction The Islamic Republic of Pakistan's maternal mortality ratio is particularly high, and the nation ranks 126 out of 149 countries on the Human Development Report-Gender Inequality Index. This is because Pakistani women have low levels of empowerment, make limited economic contributions, and underutilization of maternal health care. The aim of this study is to create a multidimensional index of women's empowerment and assess the association between this index and maternal health care utilization in Pakistan, controlling for individual characteristics and community-level traits. Methods Data from the 2012–2013 Pakistan Demographic and Health Surveys were employed to investigate the relationship between this index and the latent construct of maternal health care utilization. Results Using exploratory factor analysis, four indicators of maternal health care utilization were loaded onto a single latent factor. Multivariate analyses found support for the association between empowerment and health care utilization, despite adjustments for individual and area level factors. Positive associations between education, wealth, and maternal health care utilization were found. Conclusions Although we find support for the association of educational attainment with maternal health care utilization, the multidimensional women's empowerment index was independently a consistent associate of maternal health care utilization. This illustrates a complex mechanism with both—education and empowerment, being necessary for improved maternal health care utilization. Policy makers seeking to improve outcomes should expand their focus beyond simply improving rates of education to examining effects of cultural norms which constrain the independence of women in making decisions about their own health care.

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