Σάββατο, 4 Αυγούστου 2018

Effects of two aerobic exercise training protocols on parameters of oxidative stress in the blood and liver of obese rats

Abstract

We evaluated the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) protocols on the alterations in oxidative stress parameters caused by a high-fat diet (HFD), in the blood and liver of rats. The HFD enhanced thiobarbituric acid reactive substances (TBA-RS) and protein carbonyl content, while reducing total sulfhydryl content and catalase (CAT) and glutathione peroxidase (GSH-Px) activities in the blood. Both training protocols prevented an increase in TBA-RS and protein carbonyl content, and prevented a reduction in CAT. HIIT protocol enhanced SOD activity. In the liver, HFD didn't alter TBA-RS, total sulfhydryl content or SOD, but increased protein carbonyl content and CAT and decreased GSH-Px. The exercise protocols prevented the increase in protein carbonyl content and the MICT protocol prevented an alteration in CAT. In conclusion, HFD elicits oxidative stress in the blood and liver and both protocols prevented most of the alterations in the oxidative stress parameters.



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Resveratrol and/or exercise training counteract aging-associated decline of physical endurance in aged mice; targeting mitochondrial biogenesis and function

Abstract

Mitochondrial dysfunction and decreased mitochondrial content are hallmarks of aging that leads to decreased physical endurance. Our aim was to explore the anti-aging effect of resveratrol (RSVT) supplementation, a polyphenol, and/or exercise training, started at an older age, on improving physical activity, therefore, help in frailty avoidance and promotion of healthy aging in elderly. Eighteen-month-old aged mice received RSVT (15 mg/kg/day) and/or exercise trained for 4 weeks showed significant longer time to exhaustion with decreased blood lactate and free fatty acids levels associated with improved oxidative stress evidenced by decreased gastrocnemius muscle lipid peroxidation and increased antioxidant enzymes activities, catalase and superoxide dismutase, when compared to aged mice control group. These changes were accompanied by over-expression of skeletal muscle peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) mRNA, the master regulator of mitochondrial biogenesis, and increased muscle citrate synthase activity, a marker for mitochondrial function. These findings may provide evidence for improved physical endurance by RSVT supplementation or exercise training with better results of their combination, even at an older age, through increasing mitochondrial biogenesis and function. Increased muscle PGC-1α mRNA expression and citrate synthase enzyme activity in addition to improved aging-associated oxidative damage were among the mechanisms involved in this protection.



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Correction to: Effects of exergaming on cardiovascular risk factors and adipokine levels in women

Abstract

The original article was corrected.



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Early-life stress induces motor coordination dysfunction in adult mice

Abstract

Although child abuse has become a serious social problem in most countries, the neural mechanisms by which it induces adulthood mental disorders is not yet fully understood. Mice exposed to early-life stresses, such as maternal deprivation (MD) during lactation, are a good model for studying the effects of neglect of humans in early life. Early-life stress induces structural/functional changes of neurons in the hippocampus, prefrontal cortex, and amygdala, and causes mental disorders in adulthood. In this study, we found motor coordination dysfunction in male MD mice. We also found that the expression levels of the aminomethylphosphonic acid receptor subunits GluA1 and GluA3 were high in the cerebellum of male MD mice. The basal activity of the cerebellum detected by field-potential analysis was higher in male MD mice than in male control mice. Caloric stimulation increased the activity of the cerebellum of control mice, but it did not significantly increase the activity of the cerebellum in male MD mice. We concluded that early-life stress induced a functional change in the cerebellum of MD mice and that this change induced motor coordination dysfunctions.



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Effects of exergaming on cardiovascular risk factors and adipokine levels in women

Abstract

The aim of this study was to examine the effects of exergaming on the cardiovascular risk factors and adipokine levels of women engaged in the music video game Just Dance using the Xbox 360 Kinect console. Triglycerides, total cholesterol, HDL, LDL, FFA, CRP, TNF-α, Il-1β, IL-6, leptin, and resistin were measured in sedentary women before and 1 month after the practice of exergaming. We also evaluated anthropometric parameters. Our results indicate that total serum cholesterol, triglycerides, and LDL were reduced by 64, 29, and 12%, respectively. HDL levels were not altered in the conditions of this study. A significant decrease was also found in the concentrations of TNF-α (57%), CRP (84.7%), resistin (68.4%), leptin (35%), FFA (90%), body mass index (10.5%), fat percentage (10.9%), weight (5.6%), abdominal circumference (2.3%), hip circumference (2.5%), and waist circumference (1.9%) after the training period. We concluded that exergaming was successful in reducing body fat, serum adipokine levels, and lipid profiles, thus reducing cardiovascular risks for women.



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Renal response to anaphylaxis in anesthetized rats and isolated perfused rat kidneys: roles of nitric oxide

Abstract

We determined the renal responses to anaphylaxis and the effects of a nitric oxide synthesis inhibitor, l-NAME, in anesthetized rats and isolated perfused rat kidneys. After the ovalbumin antigen injection, the sensitized rats showed transient and substantial decreases in mean blood pressure and renal blood flow and an increase in renal vascular resistance. Creatinine clearance, a measure of renal function, decreased to 53% baseline at 2 h after antigen. l-NAME pretreatment significantly enhanced the antigen-induced renal vasoconstriction and renal dysfunction. Moreover, plasma creatinine levels significantly increased only in the l-NAME pretreated rats. Separately, in isolated perfused kidneys, we observed the antigen-induced renal vasoconstriction and its augmentation by l-NAME. In conclusion, the renal vascular response to the antigen is vasoconstriction, which is enhanced by l-NAME in both isolated perfused rat kidneys and anesthetized rats; it is accompanied by renal dysfunction, which is also augmented by l-NAME.



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Neuroprotective effect of treadmill exercise possibly via regulation of lysosomal degradation molecules in mice with pharmacologically induced Parkinson’s disease

Abstract

Dysfunction of mitophagy, which is a selective degradation of defective mitochondria for quality control, is known to be implicated in the pathogenesis of Parkinson's disease (PD). However, how treadmill exercise (TE) regulates mitophagy-related molecules in PD remains to be elucidated. Therefore, we aimed to investigate how TE regulates α-synuclein (α-syn)-induced neurotoxicity and mitophagy-related molecules in the nigro-striatal region of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-mice. Our data showed that TE exhibited a significant restoration of tyrosine hydroxylase and motor coordination with suppression of α-syn expression, hallmarks of PD, possibly via up-regulation of lysosomal degradation molecules, LAMP-2 and cathepsin L, with down-regulation of p62, LC3-II/LC3-I ratio, PINK1 and parkin in the substantia nigra of MPTP mice. Therefore, these results suggest that treadmill exercise can be used as a non-invasive intervention to improve the pathological features and maintain a healthier mitochondrial network through appropriate elimination of defective mitochondria in PD.



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Firefighter-Paramedic - Anchorage Fire Department

**Example of Duties: ** Under the direction of the Fire Captain, provide fire, rescue, and emergency medical care services. As an emergency medical technician or paramedic, examine, treat, care for, and transport sick and injured patients. Complete reports and maintain records. Prevent, combat, and extinguish fires. Provide rescue services. Perform apparatus and station maintenance duties. Complete ...

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Critical Care Transport Paramedic – Vitalink - New Hanover Regional Medical Center

**Critical Care Transport Paramedic – Vitalink** Essential Responsibilities: · Provides high quality patient care and safe medical transport to sick and injured patients in all age groups · Uses an interdisciplinary model to work with the Airlink/Vitalink Staff Nurse and other appropriate medical personnel to establish and prioritize a plan of care consistent with approved treatment protocols, policies ...

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Advanced EMT - New Hanover Regional Medical Center

**Advanced EMT** The Advanced EMT provides **high quality patient care and safe medical transport to sick and injured patients in all age groups, primarily in a non-emergent setting**. · Patient care will be consistent with approved treatment protocols · Communicates and coordinates the patient's care in an interdisciplinary model

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Staff Nurse – Vitalink - New Hanover Regional Medical Center

**Staff Nurse – Vitalink** The Staff RN **provides high quality patient care and safe medical transport to sick and injured patients in all age groups**. _Essential Responsibilities:_ · Collaborates with team and initiates care plan based on patient assessment and significant other input/data. · Continuously reviews and revises plan as needed per patient's condition. · Maintains thorough patient care ...

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Paramedic - EMS - New Hanover Regional Medical Center

**Paramedic - EMS** Full-Time The Staff Paramedic provides **high quality patient care and safe medical transport to sick and injured patients in all age groups**. · Develops a plan of care for each patient that is consistent with approved treatment protocols, policies and procedures. · Responsible for the operation of emergency vehicles

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EMT - Grand Junction Fire

**THE DEPARTMENT**The City of Grand Junction is now accepting applications to fill current vacancies and create a pool for future vacancies. The Grand Junction Fire Department is the largest career fire department between Denver and Salt Lake City. The GJFD is a self-sufficient organization providing a variety of services. The department serves 649 square miles of Mesa County and is also the area's ...

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Entry & Lateral Firefighter/Paramedi - Grand Junction Fire Department

**THE DEPARTMENT**The City of Grand Junction is now accepting applications to fill current vacancies and create a pool for future vacancies. The Grand Junction Fire Department is the largest career fire department between Denver and Salt Lake City. The GJFD is a self-sufficient organization providing a variety of services. The department serves 649 square miles of Mesa County and is also the area's ...

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Entry & Lateral Firefighter/Paramedic - Grand Junction Fire Department

**THE DEPARTMENT**The City of Grand Junction is now accepting applications to fill current vacancies and create a pool for future vacancies. The Grand Junction Fire Department is the largest career fire department between Denver and Salt Lake City. The GJFD is a self-sufficient organization providing a variety of services. The department serves 649 square miles of Mesa County and is also the area's ...

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Paramedic - Grand Junction Fire Department

**THE DEPARTMENT**The City of Grand Junction is now accepting applications to fill current vacancies and create a pool for future vacancies. The Grand Junction Fire Department is the largest career fire department between Denver and Salt Lake City. The GJFD is a   self-sufficient organization providing a variety of services. The department serves 649 square miles of Mesa County and is also the area's ...

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Paramedic - Full Time - Scurry County EMS

Full time position open with a county EMS service providing all patient care, emergency and non-emergency, for Scurry County and all cities therein. The Paramedic will provide quality patient care in a professional and efficient manner, in conjunction with medical guidelines provided, within the appropriate scope of practice for their certification. Our service offers county benefits, numerous training ...

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Downregulation of lncRNA MALAT1 contributes to renal functional improvement after duodenal-jejunal bypass in a diabetic rat model

Abstract

Ameliorated renal function has been reported after bariatric surgery, but the mechanisms underlying this phenomenon are not well-studied. To investigate whether the long non-coding RNA (lncRNA) MALAT1 mediates the amelioration of diabetic nephropathy after duodenal-jejunal bypass (DJB) surgery, rats were assigned randomly into four groups: diabetic (DM) group, DM with DJB surgery group, DM with sham surgery group, and healthy control group. Food intake, body weight, oral glucose tolerance test (OGTT), urine albumin excretion rate (UAER), and glomerular filtration rate (GFR) were measured and histological examination of renal sections was performed. For in vitro study, HK-2 cells were cultured under various glucose concentrations following MALAT1 siRNA transfection. Expression levels of MALAT1, SAA3, IL-6, and TNF-α in rat renal tissues or HK-2 cell lines were evaluated by qRT-PCR and/or ELISA. Results showed DJB surgery improved the renal function of diabetic rats, as indicated by ameliorated UAER and GFR and attenuated glomerular hypertrophy. Expression of MALAT1 and its downstream target SAA3 was significantly downregulated in renal tissues after DJB, which in turn decreased the expression of the pro-inflammatory cytokines IL-6 and TNF-α. Knockdown of MALAT1 in HK-2 cell lines further confirmed that expression levels of SAA3, IL-6, and TNF-α were regulated by MALAT1 under both low- and high-glucose conditions. Our findings suggest that MALAT1 is implicated in the improvement of renal function after DJB through regulation of its downstream targets SAA3, IL-6, and TNF-α.



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Physical training improves thermogenesis and insulin pathway, and induces remodeling in white and brown adipose tissues

Abstract

Physical training (PT) has been considered as a treatment in metabolic syndrome (MS), since it induces thermogenic activity in brown (BAT) and white (WAT) adipose tissues. We evaluated the therapeutic effect of PT on activity of WAT and BAT in rats with MS induced by high-fat diet (30% lard) for 13 weeks and submitted, for the last 6 weeks, to swimming or kept sedentary (SED) rats. MS-SED rats compared to control diet (CT-SED) rats showed low physical fitness and high levels of glucose, insulin, homeostasis evaluation of insulin resistance (HOMA-IR), homeostasis evaluation of the functional capacity of β-cells (HOMA-β), and blood pressure. The gastrocnemius muscle decreased in peroxisome proliferator-activated receptor gamma coactivator 1-alpha and beta (PGC-1α, PGC-1β), and uncoupled protein 2 and 3 (UCP2 and UCP3) expressions. Both WAT and BAT increased in the adipocyte area and decreased in blood vessels and fibroblast numbers. WAT increased in expression of pro-inflammatory adipokines and decreased in anti-inflammatory adipokine and adiponectin. WAT and gastrocnemius showed impairment in the insulin signaling pathway. In response to PT, MS rats showed increased physical fitness and restoration of certain biometric and biochemical parameters and blood pressure. PT also induced thermogenic modulations in skeletal muscle, WAT and BAT, and also improved the insulin signaling pathway. Collectively, PT was effective in treating MS by inducing improvement in physical fitness and interchangeable effects between skeletal muscle, WAT and BAT, suggesting a development of brown-like adipocyte cells.



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Voluntary exercise opposes insulin resistance of skeletal muscle glucose transport during liquid fructose ingestion in rats

Abstract

We have recently reported that male rats given liquid fructose ingestion exhibit features of cardiometabolic abnormalities including non-obese insulin resistance with impaired insulin signaling transduction in skeletal muscle (Rattanavichit Y et al. Am J Physiol Regul Integr Comp Physiol 311: R1200-R1212, 2016). While exercise can attenuate obesity-related risks of cardiometabolic syndrome, the effectiveness and potential mechanism by which exercise modulates non-obese insulin resistance have not been fully studied. The present investigation evaluated whether regular exercise by voluntary wheel running (VWR) can reduce cardiometabolic risks induced by fructose ingestion. Moreover, the potential cellular adaptations following VWR on key signaling proteins known to influence insulin-induced glucose transport in skeletal muscle of fructose-ingested rats were investigated. Male Sprague-Dawley rats were given either water or liquid fructose (10% wt/vol) without or with access to running wheel for 6 weeks. We demonstrated that VWR restored insulin-stimulated glucose transport in the soleus muscle by improving the functionality of several signaling proteins, including insulin-stimulated IRβ Tyr1158/Tyr1162/Tyr1163 (82%), IRS-1 Tyr989 (112%), Akt Ser473 (56%), AS160 Thr642 (76%), and AS160 Ser588 (82%). These effects were accompanied by lower insulin-stimulated phosphorylation of IRS-1 Ser307 (37%) and JNK Thr183/Tyr185 (49%), without significant changes in expression of proteins in the renin-angiotensin system. Intriguingly, multiple cardiometabolic abnormalities were not observed in fructose-ingested rats with access to VWR. Collectively, this study demonstrates that the development of cardiometabolic abnormalities as well as insulin resistance of skeletal muscle and defective signaling molecules in rats induced by fructose ingestion could be opposed by VWR.



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FPS-ZM1 and valsartan combination protects better against glomerular filtration barrier damage in streptozotocin-induced diabetic rats

Abstract

Despite the effectiveness of renin-angiotensin blockade in retarding diabetic nephropathy progression, a considerable number of patients still develop end-stage renal disease. The present investigation aims to evaluate the protective potential of FPS-ZM1, a selective inhibitor of receptor for advanced glycation end products (RAGE), alone and in combination with valsartan, an angiotensin receptor blocker, against glomerular injury parameters in streptozotocin-induced diabetic rats. FPS-ZM1 at 1 mg/kg (i.p.), valsartan at 100 mg/kg (p.o.), and their combination were administered for 4 weeks, starting 2 months after diabetes induction in rats. Tests for kidney function, glomerular filtration barrier, and podocyte slit diaphragm integrities were performed. Combined FPS-ZM1/valsartan attenuated diabetes-induced elevations in renal levels of RAGE and phosphorylated NF-κB p65 subunit. It ameliorated glomerular injury due to diabetes by increasing glomerular nephrin and synaptopodin expressions, mitigating renal integrin-linked kinase (ILK) levels, and lowering urinary albumin, collagen type IV, and podocin excretions. FPS-ZM1 also improved renal function as demonstrated by decreasing levels of serum cystatin C. Additionally, the combination also alleviated indices of renal inflammation as revealed by decreased renal monocyte chemoattractant protein 1 (MCP-1) and chemokine (C-X-C motif) ligand 12 (CXCL12) expressions, F4/80-positive macrophages, glomerular TUNEL-positive cells, and urinary alpha-1-acid glycoprotein (AGP) levels. These findings underline the benefits of FPS-ZM1 added to valsartan in alleviating renal glomerular injury evoked by diabetes in streptozotocin rats and suggest FPS-ZM1 as a new potential adjunct to the conventional renin-angiotensin blockade.



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Effects of branched-chain amino acids on muscles under hyperammonemic conditions

Abstract

The aim was to determine the effects of enhanced availability of branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) on ammonia detoxification to glutamine (GLN) and protein metabolism in two types of skeletal muscle under hyperammonemic conditions. Isolated soleus (SOL, slow-twitch) and extensor digitorum longus (EDL, fast-twitch) muscles from the left leg of white rats were incubated in a medium with 1 mM ammonia (NH3 group), BCAAs at four times the concentration of the controls (BCAA group) or high levels of both ammonia and BCAA (NH3 + BCAA group). The muscles from the right leg were incubated in basal medium and served as paired controls. L-[1-14C]leucine was used to estimate protein synthesis and leucine oxidation, and 3-methylhistidine release was used to evaluate myofibrillar protein breakdown. We observed decreased protein synthesis and glutamate and α-ketoglutarate (α-KG) levels and increased leucine oxidation, GLN levels, and GLN release into medium in muscles in NH3 group. Increased leucine oxidation, release of branched-chain keto acids and GLN into incubation medium, and protein synthesis in EDL were observed in muscles in the BCAA group. The addition of BCAAs to medium eliminated the adverse effects of ammonia on protein synthesis and adjusted the decrease in α-KG found in the NH3 group. We conclude that (i) high levels of ammonia impair protein synthesis, activate BCAA catabolism, enhance GLN synthesis, and decrease glutamate and α-KG levels and (ii) increased BCAA availability enhances GLN release from muscles and attenuates the adverse effects of ammonia on protein synthesis and decrease in α-KG.



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PEDIATRIC AUTOIMMUNE LIVER DISEASE AND EXTRA-HEPATIC IMMUNE-MEDIATED COMORBIDITIES

Autoimmune liver disease (AILD) includes autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC). AILD is often associated with other extra-hepatic immune-mediated disorders (EDs), but there are few pediatric studies available to date. In this study we evaluated the association between AILD and EDs in our pediatric series.

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Incidence and prevalence of eosinophilic oesophagitis increase continiously in adults and children in Central Spain: A 12-year population-based study

To update population-based incidence, prevalence and trends for eosinophilic oesophagitis (EoE) in children and adults over the past decade.

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MELD is the Only Predictor of Short-Term Mortality in Cirrhotic Patients with C. difficile Infection

Clostridium difficile infection (CDI) is the most common nosocomial infection in the US and cirrhotic patients have increased risk for poor outcome.

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Gastric lanthanum phosphate deposition masquerading as white globe appearance



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Congenital biliary atresia in an infant born to hepatitis B mother treated with telbivudine before and during pregnancy



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Overview on the management of diverticular disease by Italian General Practitioners

Although very common in Western countries, poor epidemiological data on diverticular disease (DD) is available from the family practice.

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Malignant and pre-malignant colorectal lesions in forty-year olds: is earlier inception of screening warranted?



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Strength and stability of EEG functional connectivity predict treatment response in infants with epileptic spasms

Publication date: Available online 4 August 2018

Source: Clinical Neurophysiology

Author(s): Daniel W. Shrey, Olivia Kim McManus, Rajsekar Rajaraman, Hernando Ombao, Shaun A. Hussain, Beth A. Lopour

Abstract
Objective

Epileptic spasms (ES) are associated with pathological neuronal networks, which may underlie characteristic EEG patterns such as hypsarrhythmia. Here we evaluate EEG functional connectivity as a quantitative marker of treatment response, in comparison to classic visual EEG features.

Methods

We retrospectively identified 21 ES patients and 21 healthy controls. EEG data recorded before treatment and after ≥10 days of treatment underwent blinded visual assessment, and functional connectivity was measured using cross-correlation techniques. Short-term treatment response and long-term outcome data were collected.

Results

Subjects with ES had stronger, more stable functional networks than controls. After treatment initiation, all responders (defined by cessation of spasms) exhibited decreases in functional connectivity strength, while an increase in connectivity strength occurred only in non-responders. There were six subjects with unusually strong pre-treatment functional connectivity, and all were responders. Visually assessed EEG features were not predictive of treatment response.

Conclusions

Changes in network connectivity and stability correlate to treatment response for ES, and high pre-treatment connectivity may predict favorable short-term treatment response. Quantitative measures outperform visual analysis of the EEG.

Significance

Functional networks may have value as objective markers of treatment response in ES, with potential to facilitate rapid identification of personalized, effective treatments.



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A correlation study of continuously monitored gamma dose rate and meteorological conditions

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 192

Author(s): Yan-Jun Huang, Zhi-Hong Shang-Guan, Feng Zhao, Ming-Gui Lin, Xiang-Dong Sha, Dun-Ye Luo, Qian Chen, Kai Peng

Abstract

In this paper, the correlations between the continuously monitored gamma dose rate (GDR) and meteorological parameters, including precipitation, air temperature, relative humidity, air pressure, wind direction, and wind speed, were analyzed by using one year of the hourly dataset from a monitoring system with ten stations. The correlation coefficients are varied by the range of each meteorological parameter. Precipitation would enhance the GDR up to 84%, which is highly related to precipitation intensity and ground type. Strong and positive correlation between the GDR and light precipitation was identified, while the correlation was reduced with increasing of precipitation. Air temperature could cause a fluctuation of the average GDR within the range 1.8–5.3 nGy h−1, and different correlation characteristics were indicated for low and high air temperature. The GDR was positively correlated with relative humidity, though relative humidity is inversely correlated with air temperature. Correlations between the GDR and air pressure were mainly negative. Diurnal variations between the GDR and the air temperature, relative humidity, and air pressure were also analyzed. The wind played an important role also in the fluctuation of the GDR with the GDR difference up to 2.00 nGy h−1 averaged from the sixteen wind-directions. Lower GDR can be found in the direction of prevailing wind because of the dilution effect of the radon progenies in the surface air. In this paper, some exploratory interpretation of physical influence mechanisms of meteorological parameters on the GDR was also presented, which suggests further work should be carried out to explore the variation and correlation principle.



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Evaluating the progressive cardiovascular health benefits of short-term high-intensity interval training

Abstract

Purpose

High-intensity training is recognised as a time-efficient way of improving aerobic fitness. However, there is a lack of consensus regarding the temporal nature of adaptation response and which peripheral and cardiac changes occur using the same exercise stimulus and protocol. Therefore, this study aimed to evaluate the progression of vascular and cardiac changes over a 6-week training period.

Methods

Twelve healthy males (age 21 ± 2 years; 42.5 ± 8.3 ml min−1 kg−1) participated in a high-intensity training programme consisting of 1-min sprints, interspersed with 2 min active recovery, 3 days/week for 6 weeks on a cycle ergometer. Cardiac, vascular, blood lipids and VO2max measurements were taken at 0, 3 and 6 weeks and compared against a participant-matched control group (age 21 ± 2 years; 37.7 ± 8.3 ml min−1 kg−1).

Results

There was a significant improvement in VO2max (42.5 ± 8.3–47.4 ± 8.5 ml min−1 kg−1; p = 0.009) in the training group and a significant decrease in systolic blood pressure (8%) from 0 to 6 weeks (p = 0.025). There was a small yet significant decrease in ejection fraction and increased end-systolic volume in both groups over time (p = 0.01) with no significant interaction effect (p > 0.05). A between-group difference in peak velocity of early diastolic mitral annular motion was also observed (p = 0.01). No improvements were seen in blood lipid profiles, central arterial stiffness and cardiometabolic risk score.

Conclusions

Six weeks of high-intensity training increases aerobic fitness and is enough to stimulate initial reductions in peripheral pressure, but not sufficient to elicit structural and functional cardiac changes, reduce arterial stiffness or lower CV risk.



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Analgesic effects of methadone and magnesium following posterior spinal fusion for idiopathic scoliosis in adolescents: a randomized controlled trial

Abstract

Purpose

To provide optimal conditions for neurophysiological monitoring and rapid awakening, remifentanil is commonly used during pediatric spinal surgery. However, remifentanil may induce hyperalgesia and increase postoperative opioid requirements. We evaluated the potential of methadone or magnesium to prevent remifentanil-induced hyperalgesia.

Methods

Using a prospective, randomized, blinded design, adolescents presenting for posterior spinal fusion to treat idiopathic scoliosis were assigned to receive desflurane with remifentanil alone (REMI), remifentanil + methadone (MET) (0.1 mg/kg IV over 15 min), or remifentanil + magnesium (MAG) (50 mg/kg bolus over 30 min followed by 10 mg/kg/h). Primary outcomes were opioid requirements and postoperative pain scores. Secondary outcomes included intraoperative anesthetic requirements, neurophysiological monitoring conditions, and emergence times.

Results

Data analysis included 60 patients. Total opioid requirement (hydromorphone) in the REMI group (received perioperatively and on the inpatient ward) was 0.34 ± 0.11 mg/kg compared to 0.26 ± 0.10 mg/kg in the MET group (95% confidence interval (CI) of difference: − 0.14, − 0.01; p = 0.035). The difference in opioid requirements between the REMI and MET group was related to intraoperative dosing (0.04 ± 0.02 mg/kg vs. 0.02 ± 0.01 mg/kg; 95% CI of difference: − 0.01, − 0.02; p = 0.003). No difference was noted in pain scores, and no differences were noted when comparing the REMI and MAG groups.

Conclusion

With the dosing regimens in the current study, the only benefit noted with methadone was a decrease in perioperative opioid requirements. However, given the potential for hyperalgesia with the intraoperative use of remifentanil, adjunctive use of methadone appears warranted.



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Neonatal Abstinence Syndrome (NAS) in Southwestern Border States: Examining Trends, Population Correlates, and Implications for Policy

Abstract

Introduction Neonatal abstinence syndrome (NAS) is withdrawal syndrome in newborns following birth and is primarily caused by maternal drug use during pregnancy. This study examines trends, population correlates, and policy implications of NAS in two Southwest border states. Materials and Methods A cross-sectional analysis of Hospital Inpatient Discharge Data (HIDD) was utilized to examine the incidence of NAS in the Southwest border states of Arizona (AZ) and New Mexico (NM). All inpatient hospital births in AZ and NM from January 1, 2008 through December 31, 2013 with ICD9-CM codes for NAS (779.5), cocaine (760.72), or narcotics (760.75) were extracted. Results During 2008–2013 there were 1472 NAS cases in AZ and 888 in NM. The overall NAS rate during this period was 2.83 per 1000 births (95% CI 2.68–2.97) in AZ and 5.31 (95% CI 4.96–5.66) in NM. NAS rates increased 157% in AZ and 174% in NM. NAS newborns were more likely to have low birth weight, have respiratory distress, more likely to have feeding difficulties, and more likely to be on state Medicaid insurance. AZ border region (border with Mexico) had NAS rates significantly higher than the state rate (4.06 per 1000 births [95% CI 3.68–4.44] vs. 2.83 [95% CI 2.68–2.97], respectively). In NM, the border region rate (2.09 per 1000 births [95% CI 1.48–2.69]) was significantly lower than the state rate (5.31 [95% CI 4.96–5.66]). Conclusions Despite a dramatic increase in the incidence of NAS in the U.S. and, in particular, the Southwest border states of AZ and NM, there is still scant research on the overall incidence of NAS, its assessment in the southwest border, and associated long-term outcomes. The Healthy Border (HB) 2020 binational initiative of the U.S.-Mexico Border Health Commission is an initiative that addresses several public health priorities that not only include chronic and degenerative diseases, infectious diseases, injury prevention, maternal and child health but also mental health and addiction. The growing opioid epidemic and rise in NAS cases in the Southwest border, as partially shown in this study, provides another opportunity to track health illnesses and outcomes in the Southwest border, especially because there are targeted resources through High Intensity Drug Trafficking Areas (HIDTA) funding.



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The Acute Metabolic and Vascular Impact of Interrupting Prolonged Sitting: A Systematic Review and Meta-Analysis

Abstract

Objective

The aim was to conduct a systematic review and meta-analysis analyzing the impact of up to 24 h of prolonged sitting on postprandial glucose, insulin and triglyceride responses, blood pressure and vascular function, in comparison to sitting interrupted with light- to moderate-intensity physical activity.

Methods

To be included, studies had to examine the impact of prolonged sitting lasting < 24 h in apparently healthy males or females of any age. Studies were identified from searches of the MEDLINE, CINAHL and SportDISCUS databases on July 6, 2016. Study quality was assessed using the Downs and Black Checklist; publication bias was assessed via funnel plot.

Results

Forty-four studies met the inclusion criteria for the systematic review; of these, 20 were included in the meta-analysis, which compared prolonged sitting to the effects of interrupting sitting with regular activity breaks on postprandial glucose, insulin and triglycerides. When compared to prolonged sitting, regular activity breaks lowered postprandial glucose (d = − 0.36, 95% confidence interval [CI] − 0.50 to − 0.21) and insulin (d = − 0.37, 95% CI − 0.53 to − 0.20), but not triglyceride responses (d = 0.06, 95% CI − 0.15 to 0.26). Subgroup analyses indicated reductions in postprandial triglyceride responses only occurred 12–16 h after the intervention. The magnitude of the reductions in glucose, insulin or triglyceride response was not modified by the intensity of the activity breaks, the macronutrient composition of the test meal, or the age or body mass index of participants.

Conclusion

Prolonged sitting results in moderate elevations in postprandial glucose and insulin responses when compared to sitting interrupted with activity breaks.

PROSPERO ID

CRD42015020907.



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SpyCatcher: Use of a Novel Cholangioscopic Snare for Capture and Retrieval of a Proximally Migrated Biliary Stent



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Can Specialized Pro-resolving Mediators Deliver Benefit Originally Expected from Fish Oil?

Abstract

Purpose of the Review

Fish oil (FO) supplementation has historically been used by individuals suffering from cardiovascular disease and other inflammatory processes. However, a meta-analysis of several large randomized control trials (RCTs) suggested FO conferred no benefit in reducing cardiovascular risk. Skeptics surmised that the lack of benefit was related to FO dose or drug interactions; therefore, the widely accepted practice of FO consumption was brought into question.

Recent Findings

Thereafter, Serhan et al. identified specialized pro-resolving mediators (SPMs) to be one of the bioactive components and mechanisms of action of FO. SPMs are thought to enhance resolution of inflammation, as opposed to classic anti-inflammatory agents which inhibit inflammatory pathways. Numerous diseases, including persistent Inflammation, immunosuppression, and catabolic syndrome (PICS), are rooted in a burden of chronic inflammation. SPMs are gaining traction as potential therapeutic agents used to resolve inflammation in cardiovascular disorders, inflammatory bowel disease, sepsis, pancreatitis, and acute respiratory distress syndrome (ARDS).

Summary

This narrative reviews the history of FO and the various studies that made the health benefits of FO inconclusive, as well as an overview of SPMs and their use in specific disease states.



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Evolution of Clinical Trials in Inflammatory Bowel Diseases

Abstract

Purpose of Review

Since the first clinical trial of cortisone in ulcerative colitis in 1955, remarkable progress has been made in the design and conduct of clinical trials in inflammatory bowel diseases (IBD). In this review article, we will discuss evolution of clinical trials in IBD over the last 3–5 years.

Recent Findings

Recognizing limitations intrinsic to clinical disease activity indices in IBD, regulatory authorities have recommended evaluating co-primary endpoints of patient-reported outcomes and endoscopic disease activity in clinical trials. Biomarker-enriched trial enrolment and central endoscopy reading have emerged as critical events in trial recruitment and outcome assessment and have driven placebo response rates down. While trials of novel biologic therapies and advanced small molecules continue at an accelerated pace, pragmatic comparative efficacy trials of treatment strategy aimed at optimizing current therapies (such as early combined immunosuppression [REACT], tight disease control [CALM], therapeutic drug monitoring [TAXIT, TAILORIX]) have directly informed clinical practice. With emphasis on value-based care and population health management, multi-pronged remote monitoring, self-management, and telemedicine approaches in the era of smartphones have re-emerged with promise. Non-conventional therapies such as fecal microbiota transplantation, though still experimental, have provided insight into disease pathogenesis and offered hope for microbial manipulation strategies for treating these complex diseases.

Summary

Clinical trials have rapidly evolved over the last 5 years not only focusing on novel therapies but also optimizing existing treatment approaches and population health management. Over the next decade, these trials will continue to advance the field, and be readily translatable into clinical practice.



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Intensive Pharmacy Care Improves Outcomes of Hepatitis C Treatment in a Vulnerable Patient Population at a Safety-Net Hospital

Abstract

Background

Treatment of hepatitis C virus (HCV) with direct-acting antiviral (DAA) regimens has resulted in high rates of sustained virologic response (SVR). Treatment of vulnerable populations may be improved by incorporating an on-site intensive specialty pharmacy (ON-ISP).

Aims

To describe outcomes of HCV treatment at a safety-net hospital and proportion of subjects achieving SVR for those using the ON-ISP compared to an off-site pharmacy (OFF-SP).

Methods

A retrospective cohort study of 219 subjects treated for HCV with DAA at Boston Medical Center was conducted. Subject characteristics, virologic response, and pharmacy services used were recorded. We used multivariable logistic regression to test the association between ON-ISP and SVR after adjusting for covariates.

Results

SVR occurred in 71% of subjects by intention-to-treat (73% among ON-ISP users vs 57% among OFF-SP users) and 95% completing treatment per-protocol (96% among ON-ISP users vs 87% among OFF-SP users). Adjustment for age, sex, ethnicity, insurance, fibrosis, prior treatment, and MELD revealed an increased likelihood of SVR among users of ON-ISP: OR 6.0 (95% CI 1.18–31.0). No significant difference in treatment delay or adverse events was seen among users of either pharmacy type.

Conclusions

HCV treatment with DAA was well tolerated, but the rate of SVR was low (71%) compared to trials. This was due to loss to follow-up, as the per-protocol rate of SVR was much higher (95%). Use of ON-ISP was associated with an increase in SVR and may be valuable for improving care for vulnerable populations.



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