We are writing in regard to an article published on May 18, 2016, by T. Kawazu et al titled "Aerobic Exercise Combined with Noninvasive Positive Pressure Ventilation Increases Serum Brain-Derived Neurotrophic Factor in Healthy Males."
from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2QzAscI
via IFTTT
Σάββατο 15 Σεπτεμβρίου 2018
Re: Aerobic Exercise Combined with Noninvasive Positive Pressure Ventilation Increases Serum Brain-Derived Neurotrophic Factor in Healthy Males by Kawazu et al
Academy News – September PM&R
As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Our mission is to lead the advancement of physiatry's impact throughout health care. Your Academy will ensure that:
from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2D2wMgE
via IFTTT
A Checklist for Analyzing Data
Understandably, when researchers get data, they are eager to learn what the data have to say regarding the main study hypotheses. This excitement, combined with looming deadlines, can result in researchers skipping the most important steps of a data analysis. For example, researchers might rush to run formal statistical tests that compare their groups before they have properly cleaned and vetted their data. In a proper data analysis, the bulk of an analyst's time is not spent on running final statistical models, but rather on tasks such as cleaning, checking, understanding, and plotting the data.
from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2QzMEtJ
via IFTTT
Reply
We thank Barnett and colleagues for their interest in our study. In their letter to the Editor, they asked for clarification on a number of points. The points are as follows: (1) clarify the inclusion/exclusion criteria, the manner in which subjects were randomized, and if allocation concealment or blinding of any party occurred; (2) clarify the process in determining the intensity level and duration of exercise; (3) clarify the basis by which the authors settled on a 3-week washout period, and if there is evidence to support their claim that the time period was sufficient; (4) provide the data used in their calculations—including the t value, standard error of the mean, and the degrees of freedom—and the manner in which these data were used to conclude a significant effect.
from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2QEHzR8
via IFTTT
Impaired performance of patients with writer’s cramp in complex fine motor tasks
WC is described as a task-specific dystonia and characterized by involuntary contractions of muscles of the hand and arm triggered by writing (Albanese et al., 2013).
from Physiology via xlomafota13 on Inoreader https://ift.tt/2D2A17R
via IFTTT
Reply to “Which small sharp spikes are benign epileptiform transients of sleep?”
We thank Wennberg et al. for their comment (Wennberg et al., 2018) on our recent paper showing that a subset of hippocampal epileptiform discharges are associated with small sharp spikes (SSS) on scalp EEG (Issa et al., 2018). In their letter, Wennberg et al. raise and begin to address the important clinical question of which SSS are benign and which are not.
from Physiology via xlomafota13 on Inoreader https://ift.tt/2Niqdv9
via IFTTT
The study of exercise tests in paroxysmal kinesigenic dyskinesia
Paroxysmal kinesigenic dyskinesia (PKD) is the most common type of the paroxysmal movement disorders, which is characterized by transient and recurrent dystonic or choreoathetoid attacks triggered by sudden voluntary movements (Bruno, et al., 2004, Gardiner, et al., 2015). The knowledge of PKD has been accumulating recently; however, the underlying mechanisms remain mysterious. One hypothesis about PKD is that it could be a central nervous system ionic channelpathy (Bhatia, et al., 2000, Celesia 2001, Chen, et al., 2011), since the attacks are often responsive effectively to the ion channel blockers (Huang, et al., 2015).
from Physiology via xlomafota13 on Inoreader https://ift.tt/2CY5XdK
via IFTTT
Which small sharp spikes are benign epileptiform transients of sleep?
There is no doubt that some spikes in patients with mesial temporal lobe epilepsy can appear on scalp EEG to resemble benign epileptiform transients of sleep (BETS), a.k.a. small sharp spikes, as nicely demonstrated in the recent paper by (Issa et al., 2018).
from Physiology via xlomafota13 on Inoreader https://ift.tt/2NdshVk
via IFTTT
Secondary hypokalemic periodic paralysis as a rare clinical presentation of Conn syndrome
Hypokalemic periodic paralysis (hypoPP) is characterized by episodes of sudden-onset muscle weakness associated with low plasma potassium (<3,5 mmol/l). Since the generalized or focal muscle weakness in hypoPP lasts from a few minutes to several days, diagnostic delay is common and affected patients often receive a diagnosis of functional disorder. Primary hypoPP are a group of hereditary skeletal muscle channelopathies, usually with infantile or juvenile onset of symptoms, that are caused by mutations in CACNA1S or SCN4A genes (Statland and Barohn, 2013) eventually determining an altered muscle excitability and electromechanical coupling.
from Physiology via xlomafota13 on Inoreader https://ift.tt/2CX9TLA
via IFTTT
Applying Human-Centered Design to the Development of an Asthma Essentials Kit for School-Aged Children and Their Parents
This study aimed to design and test an asthma essentials kit to support parent–child shared asthma management. Fourteen children (age range = 7–11 years) with asthma and their parents participated in this study. Development of the asthma essentials kit involved a generative phase, focused on understanding and designing to meet user needs, and an evaluative phase, which entailed narrowing, evaluating, and refining the asthma essentials kit. As is typical in human-centered design, analysis was iterative throughout the design process such that findings informed each subsequent phase.
from Health via xlomafota13 on Inoreader https://ift.tt/2NKeqVR
via IFTTT
Pediatric Provider Education and Use of Long-Acting Reversible Contraception in Adolescents
Pediatric primary care providers prescribe the majority of contraception to adolescents, but they often lack training in long-acting reversible contraception (LARC). Our objective was to assess whether a provider education initiative was associated with a change in LARC use for adolescents.
from Health via xlomafota13 on Inoreader https://ift.tt/2Mz2B07
via IFTTT
Development, Implementation, and Satisfaction With a Nurse Practitioner Professional Ladder: A Children's HospitalExperience
This article describes the development and implementation of a nurse practitioner professional ladder (NPPL) at a large freestanding urban pediatric hospital. The NPPL was created to recognize advanced practice registered nurses and differentiate levels of clinical expertise, role development, leadership, and professional contributions into a three-tiered approach, designated as NP I, NP II, and NP III. The results of a nurse practitioner satisfaction survey at Year 2 and Year 4 after the development of the NPPL are summarized.
from Health via xlomafota13 on Inoreader https://ift.tt/2NKHPPH
via IFTTT
Capsule endoscopy findings for the diagnosis of Crohn’s disease: a nationwide case–control study
Abstract
Background
Capsule endoscopy can be used to identify the early stage of small bowel Crohn's disease (CD). We evaluated significant small bowel capsule endoscopy (SBCE) findings that can lead to early diagnosis of CD.
Methods
We retrospectively accumulated clinical and SBCE data of 108 patients (63 with and 45 without CD). Types of small bowel mucosal injuries, including erosion, ulceration, and cobblestone appearance, and the alignment of diminutive lesions were compared between patients with and without CD. Inter- and intra-observer agreement in the determination of lesions was assessed in 25 pairs of SBCE from the two groups.
Results
Under SBCE, cobblestone appearance (33% vs. 2%, p < 0.0001), longitudinal ulcers (78% vs. 20%, p < 0.0001), and irregular ulcers (84% vs. 60%, p < 0.01) were more frequently found in patients with CD. Linear erosion (90% vs. 38%, p < 0.0001) and irregular erosion (89% vs. 64%, p < 0.005) were also more frequent in patients with CD. Furthermore, circumferential (75% vs. 9%, p < 0.0001) and longitudinal (56% vs. 7%, p < 0.0001) alignment of diminutive lesions, mainly observed in the 1st tertile of the small bowel, was more frequent in patients with CD. Good intra-observer agreement was found for ulcers, cobblestone appearance, and lesion alignment. However, inter-observer agreement of SBCE findings differed among observers.
Conclusions
Circumferential or longitudinal alignment of diminutive lesions, especially in the upper small bowel, may be a diagnostic clue for CD under SBCE, while inter-observer variations should be cautiously considered when using SBCE.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2D0nW36
via IFTTT
Which small sharp spikes are benign epileptiform transients of sleep?
Publication date: Available online 15 September 2018
Source: Clinical Neurophysiology
Author(s): Richard Wennberg, Apameh Tarazi, Dominik Zumsteg
from Physiology via xlomafota13 on Inoreader https://ift.tt/2QxelU4
via IFTTT
Reply to “Which small sharp spikes are benign epileptiform transients of sleep?”
Publication date: Available online 15 September 2018
Source: Clinical Neurophysiology
Author(s): Naoum P. Issa, Somin Lee, Shasha Wu, Sandra Rose, Vernon L. Towle, Peter C. Warnke, Wim van Drongelen, James X. Tao
from Physiology via xlomafota13 on Inoreader https://ift.tt/2Ommn0w
via IFTTT
Reply to “Reconsidering Sham in Transcutaneous Vagus Nerve Stimulation studies”
Publication date: Available online 15 September 2018
Source: Clinical Neurophysiology
Author(s): Marius Keute, Philipp Ruhnau, Tino Zaehle
from Physiology via xlomafota13 on Inoreader https://ift.tt/2QxSgET
via IFTTT
Secondary hypokalemic periodic paralysis as a rare clinical presentation of Conn syndrome
Publication date: Available online 15 September 2018
Source: Clinical Neurophysiology
Author(s): T. Nicoletti, A. Modoni, G. Silvestri
from Physiology via xlomafota13 on Inoreader https://ift.tt/2OoHOhD
via IFTTT
Regional white matter volume abnormalities in first-episode somatization disorder
Publication date: Available online 15 September 2018
Source: International Journal of Psychophysiology
Author(s): Jin Zhao, Qinji Su, Feng Liu, Zhikun Zhang, Ranran Li, Furong Zhu, Renrong Wu, Jingping Zhao, Wenbin Guo
Abstract
Background
Alterations of white matter integrity have been implicated in patients with somatization disorder (SD). However, changes of white matter volume (WMV) remain unclear. This study is designed to examine regional WMV in patients with SD and to investigate the potential relationships between WMV abnormalities and personality traits, cognitive function, and symptom severity.
Methods
We recruited 25 first-episode, drug-naive patients with SD and 28 sex-, age-, and education-matched healthy controls for the study. Personality traits, cognitive function, and symptom severity were assessed for all participants. Data were analyzed with the computational anatomy toolbox (CAT12) methods.
Results
Patients with SD exhibited a significantly increased WMV in the right inferior frontal gyrus (IFG) (t = 4.40094) and a significantly decreased WMV in the left inferior longitudinal fasciculus (ILF) (t = −3.4292) relative to healthy controls. No correlation was found between abnormal WMV and clinical/cognitive variables in the patients.
Conclusions
Our findings suggest the presence of significant regional WMV abnormalities in first-episode, drug-naive patients with SD, which might improve understanding the pathophysiology of SD.
from Physiology via xlomafota13 on Inoreader https://ift.tt/2MB2GQS
via IFTTT
Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care
β-Adrenergic blockade is an important mechanism for reducing morbidity and mortality in patients with hypertension and heart failure. Esmolol has been used widely for its chronotropic and antihypertensive effects. However, there has been recent inquiry regarding perioperative esmolol use and nociceptive modulation. Conventional postoperative analgesic treatment has relied primarily on opioids, which present their own adverse effects and pharmacoepidemiologic repercussions. Esmolol, to date, has not shown any direct analgesic or anesthetic properties; however, recent studies suggest that esmolol may have antinociceptive and postoperative opioid-sparing effects. In this Daring Discourse narrative, we describe the role of esmolol in current perioperative β-blockade guidelines (related to noncardiac surgery), briefly describe studies supporting the antinociceptive effects of esmolol, propose mechanisms for esmolol antinociception, and forecast potential routine esmolol use intraoperatively (as part of a multimodal total intravenous anesthetic) and its effects on opioid sparing. The reading audience of regional anesthesiologists and acute pain medicine physicians is uniquely positioned to take a lead role in promulgating this care advance amid (i) the unwanted effects of the opioid epidemic and (ii) the uncertain notion of whether routine general anesthesia care (with fentanyl) may indirectly be contributing to the epidemic. Accepted for publication April 23, 2018. Address correspondence to: Brian A. Williams, MD, MBA, Department of Anesthesiology, University of Pittsburgh, Suite A-1305 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261 (e-mail: williamsba@anes.upmc.edu). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2QwP9wU
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2QwP9wU
via IFTTT
Comparison of Point-of-Care and Classical Immunoassays for the Monitoring Infliximab and Antibodies Against Infliximab in IBD
Abstract
Objective
The primary objective is to assess whether the POC assays to measure infliximab residual trough level in the serum of IBD patients were non-inferior to the ELISA techniques available on the market, and to determine which of them was the most robust. The second is to compare three different ELISA kits for monitoring anti-infliximab antibodies (ATI).
Methods
The assays were carried out on patients' sera using four ELISA kits from four different suppliers (three with a monoclonal antibody and one polyclonal) and two rapid techniques provided by BÜHLMANN (Quantum Blue®) and R-Biopharm (Ridaquick) for monitoring infliximab levels. ATI were measured by three ELISA sets (Grifols, Theradiag, and R-Biopharm) which have different positivity limits and different units.
Results
We measured infliximab residual level and ATI in the serum of 90 IBD patients (85 treated with infliximab and five with adalimumab). All of the infliximab assays were very well correlated when analyzed with Spearman nonparametric correlation (0.93 ≤ r ≤ 0.99), and the two POC assays were also excellently correlated (r = 0.98). The ATI monitoring kits revealed a correlation ranging from 0.73 to 0.96 when comparing positive and negative patients. When normalizing the quantitative values between the different ELISA tests (expressed arbitrarily by using multiples of the positivity limits defined by each supplier), the Spearman r coefficient ranged from 0.81 to 0.93.
Conclusion
The available evidence allows us to conclude that all of the infliximab monitoring assays correlate well and may be used for IFX monitoring; albeit variations in measured IFX concentration among different assays remain present, these assays could be interchangeable. The ATI monitoring techniques are all capable of detecting ATI-positive patients, but because of the difference in the positivity limits and the measurement units, it is better to follow a patient rate with one definite kit.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2My2rG8
via IFTTT
Is There an Effect of Cannabis Consumption on Acute Pancreatitis?
Abstract
Background and Aim
Twenty-percentage of acute pancreatitis (AP) cases is labeled as idiopathic. Cannabis remains the most frequently used illicit drug in the world. The aim of this study was to identify the prevalence of cannabis use among all patients with a first episode of AP, particularly in those labeled as idiopathic etiology, and determine any effect on AP severity.
Methods
Retrospective cohort of all consecutive patients admitted with a first episode of AP at a large tertiary referral hospital from 01/2013 through 12/2014. AP was identified by ICD9 code, or lipase ≥ 3 times the upper limit of normal and abdominal pain consistent with AP. Cannabis users (CU) were identified via history or urine toxicology.
Results
Four hundred and sixty patients were included. 54% were men, with a mean age of 48 years (range 17–89 years). Forty-eight patients (10%) were identified as CU. After adjusting for admission SIRS, age, and gender, cannabis use was not found to be an independent risk factor for persistent SIRS, AKI, ARDS, pancreatic necrosis, mortality, ICU admission, length of stay, in-hospital infections, nor recurrent AP. Of note, AKI was least common among non-CU compared to CU (OR 0.4; p = 0.02; CI 0.2–0.9) and non-CU had a higher admission BISAP score (≥ 2) compared to CU (OR 2.5; p = 0.009; CI 1.2–4.9).
Conclusion
This is the largest study to date examining cannabis use in AP. Cannabis use was found across almost all etiologies of AP with a prevalence of 10% (48 cases), and in 9% (9 cases) of so-called idiopathic AP cases in this cohort, which could account as an association for approximately 2% of all AP cases. Cannabis use did not independently impact AP severity or mortality.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2QuYbut
via IFTTT
Correction to: Inflammatory Bowel Diseases Can Adversely Impact Domains of Sexual Function Such as Satisfaction with Sex Life
The original version of the article unfortunately contained an error in Results section of Abstract.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2MxViWD
via IFTTT
Potential of Fecal Calprotectin as an Objective Marker to Discriminate Hospitalized Patients with Acute Severe Colitis from Outpatients with Less Severe Disease
Abstract
Background
Acute severe colitis (ASC) is conventionally diagnosed by Truelove and Witts' criteria which are non-specific and can be affected by other pathologic conditions. Fecal calprotectin (FCP) is a gut-specific marker of inflammation which can predict short-term outcomes in patients with ASC. We aimed to define the role of FCP in the diagnosis of ASC.
Methods
This prospective observational cohort study included adult patients (> 18 years) with ulcerative colitis (UC) for whom FCP was measured and was under follow-up from April 2015 to December 2016. Patients were divided into two cohorts: (1) all consecutive hospitalized patients with ASC as defined by Truelove and Witts' criteria; (2) outpatients with active UC (defined by Mayo score) who did not fulfill Truelove and Witts' criteria. FCP levels were compared between the two cohorts, and a cutoff for FCP to diagnose ASC was determined.
Results
Of 97 patients, 49 were diagnosed with ASC (mean age: 36.1 ± 11.9 years, 36 males) and 48 with active UC (mean age: 37.9 ± 12.4 years, 25 males). Median FCP levels were significantly higher in patients with ASC [1776(952–3123) vs 282(43–568) µg/g, p < 0.001] than mild to moderately active UC (n = 48) or moderately active UC [n = 35, 1776(952–3123) vs 332(106–700) µg/g, p < 0.001]. A FCP cutoff of 782 μg/g of stool had excellent diagnostic accuracy, with an area under the curve of 0.92(95% CI 0.87–0.97), sensitivity of 84% and specificity of 88% to differentiate ASC from active UC.
Conclusion
FCP could differentiate ASC from mild to moderate patients with UC, but requires validation before clinical use.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2QxBVzV
via IFTTT
Gut Movements: A Review of the Physiology of Gastrointestinal Transit
Abstract
The well-regulated mechanisms of intestinal transit favor aboral movement of intestinal contents during the formation of normal stool. Electrical pacemakers initiate mechanical smooth muscular propulsion under regulation by the enteric nervous system—a function of the "brain-gut axis." Several unique intestinal motor patterns function in concert to enhance the activities of intestinal transit. Development of pharmacologic targets of intestinal transit mechanisms afford clinicians control in the management of functional gastrointestinal disorders. This review highlights the important physiologic events of intestinal transit, discusses selected pharmacologic and neuromodulators involved in these processes, and provides relevant clinical correlates to physiologic events.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2QxBWUv
via IFTTT
Correction to: Risk Factors for Clostridium difficile Isolation in Inflammatory Bowel Disease: A Prospective Study
The original version of the article unfortunately contained an error in a percentage value in Results section of Abstract.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2Qus4uS
via IFTTT
A Novel Rabbit Model for Benign Biliary Stricture Formation and the Effects of Medication Infusions on Stricture Formation
Abstract
Background
Benign biliary stricture (BBS) is highly refractory. Currently, there is no effective strategy for prevention of BBS recurrence. The aim of this study is to establish a novel BBS rabbit model and to investigate the efficacy of biliary infusion with anti-proliferative medications for treating BBS.
Method
A BBS model was established via surgical injury and biliary infection. The biliary infusion tube was inserted into the common bile duct via the stump of cystic duct after cholecystectomy. Biliary infusions with Rapamycin, Pirfenidone and Fasudil were performed daily during the 4 weeks following the surgery. The wall thickness and luminal area of the bile duct were assessed.
Results
All rabbits formed BBS after surgery. The mortality rate was 13% (8/60) and tube withdrawal rate was 4% (2/48). The thickness of the bile duct wall was significantly reduced; whereas the luminal area of the bile duct was dramatically enlarged in the Rapamycin or the Pirfenidone treated group, compared to the saline treated group. Furthermore, the local treatment significantly decreased the levels of proliferation makers, including PCNA, Collagen I and fibrogenic mediators, including ACTA2 and TGF-beta.
Conclusion
We have established a novel animal model for BBS formation. We have further demonstrated that biliary infusion with Rapamycin or Pirfenidone limits the biliary strictures through inhibiting the proliferation of the bile duct wall in this model. This may represent a new avenue for preventing biliary restenosis.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2My0qdf
via IFTTT
Epstein–Barr Virus Antibody Titers Are Not Associated with Gastric Cancer Risk in East Asia
Abstract
Background
Epstein–Barr virus (EBV)-positive gastric cancers represent a distinct subtype of gastric cancers and account for nearly 10% of the gastric cancer burden, yet risk detection strategies for this cancer subtype are lacking.
Methods
We conducted a nested case–control study where we assayed 4 EBV antigens [viral capsid antigen (VCA), early antigen (EA), Epstein–Barr nuclear antigen (EBNA), and BZLF1-encoded replication activator protein (ZEBRA)] in either sera or plasma from 1447 gastric cancer cases and 1797 controls obtained from seven prospective cohorts representing individuals from the high gastric cancer-risk countries of China, Japan, and Korea.
Results
The prevalence of EBV sero-positivity was universal with the exception of one sero-negative individual, and the highest titers of the EBV antigens VCA (OR 0.95, 95% CI 0.78–1.17), EBNA (OR 0.88, 95% CI 0.72–1.08), EA (OR 0.97, 95% CI 0.79–1.19), and ZEBRA (OR 0.87, 95% CI 0.71–1.07) were not associated with risk of incident gastric cancer. When we stratified these data by H. pylori status, there was no change in the association.
Conclusions
Multiplex serology of the aforementioned EBV antigens in serum may not be a suitable biomarker for predicting gastric cancer risk in East Asian populations.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2QwSkEU
via IFTTT
Long-Term Outcomes of Immunosuppression-Naïve Steroid Responders Following Hospitalization for Ulcerative Colitis
Abstract
Background
Requirement for hospitalization in ulcerative colitis (UC) is a marker of severity of disease. However, the paradigm of when to escalate therapy in such patients and the benefits of early immunomodulator initiation is less well established.
Aim
To examine the benefits of early therapy escalation in immunosuppression-naïve patients hospitalized with severe ulcerative colitis responsive to steroids.
Methods
We identified hospitalized UC patients who were immunosuppression naïve at index hospitalization and responded to intravenous steroids, not requiring medical or surgical rescue therapy. The 'therapy escalated' group comprised of those who were initiated on immunomodulators within 3 months of hospitalization. The need for colectomy at 12 months was compared to the 'not escalated' group who remained on non-immunosuppressive therapy.
Results
Among 133 immunosuppressive naïve patients hospitalized for ulcerative colitis, 13 (9.8%) who responded to intravenous steroids and did not require rescue therapy underwent colectomy by 1 year. Among 123 patients who escalated to either immunomodulators (n = 46, 37%) or remained on non-immunosuppressive therapy (92% on 5-ASA), there was no difference in the need for colectomy at 1 year (10.8 vs. 7.8%; multivariate OR 1.29, 95% CI 0.35–4.74). There was also no difference in the time to colectomy between the two groups (p = 0.55).
Conclusion
Immunosuppression-naïve ASUC patients who respond to intravenous steroids remain at risk for colectomy. Immunomodulator initiation by 3 months did not reduce risk of colectomy at 1 year. There is an important need for prospective studies identifying thresholds for therapy escalation in UC.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2MxFIdA
via IFTTT
Use of Esophageal pH Monitoring to Minimize Proton-Pump Inhibitor Utilization in Patients with Gastroesophageal Reflux Symptoms
Abstract
Background
Due to concerns about long-term PPI use in patients with acid reflux, we aimed at minimizing PPI use, either by avoiding initiating therapy, downscaling to other therapies, or introducing endoscopic or surgical options.
Aims
To examine the role of esophageal ambulatory pHmetry in minimizing PPI use in patients with heartburn and acid regurgitation.
Methods
Retrospective cohort analysis of patients with reflux symptoms, who underwent endoscopy, manometry, and ambulatory pHmetry to define the need for PPI. Patients were classified as: (1) never users; (2) partial responders to PPI; (3) users with complete response to PPI. Patients were then managed as: (1) PPI non-users; (2) PPI-initiated, and (3) PPI-continued.
Results
Of 286 patients with heartburn and regurgitation, 103 (36%) were found to have normal and 183 (64%) abnormal esophageal acid exposure (AET). In the normal AET group, 44/103 had not been treated and were not initiated on PPI. Of the 59 who had previously received PPI, 52 stopped and 7 continued PPI. Hence, PPI were avoided in 96/103 patients (93%). In the abnormal AET group, 61/183 had not been treated and 38 were initiated on PPI and 23 on other therapies. In the 122 patients previously treated with PPI, 24 were not treated with PPI, but with H2RAs, prokinetics, endoscopic, or surgical therapy. Hence, PPI therapy was avoided in 47/183 patients (26%).
Conclusions
In patients with GER symptoms, esophageal pHmetry may avert PPI use in 50%. In the era of caution regarding PPIs, early testing may provide assurance and justification.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2QCJXI6
via IFTTT
Expression of Gastric Markers Is Associated with Malignant Potential of Nonampullary Duodenal Adenocarcinoma
Abstract
Background
Sporadic nonampullary duodenal epithelial tumors (NADETs) are uncommon, and thus their clinicopathological features have not been fully assessed.
Aims
In this study, we have analyzed a series of early sporadic NADETs, focusing on various immunohistological features.
Methods
We conducted a multicenter retrospective analysis of 68 patients with endoscopically resected sporadic NADETs. Associations between immunohistological features and clinicopathological features were statistically analyzed.
Results
The 68 patients consisted of 46 men (68%) and 22 women (32%) with a mean age of 60.7 ± 12.2 years (range 37–85 years). The 68 tumors were composed of 39 adenomas (57%) and 29 early-stage adenocarcinomas (43%). Duodenal adenocarcinomas were larger in size than adenomas and had papillary architecture in their pathological diagnosis with statistical significance. Duodenal adenocarcinomas also demonstrated a significantly higher expression of gastric markers (MUC5AC and MUC6) and a higher MIB-1 index. Duodenal adenomas were contrastively apt to express intestinal markers (MUC2, CDX1 and CDX2). Of the 68 cases analyzed, there were only 3 tumors positive for p53 staining, all of which were adenocarcinoma. When 7 submucosal invasive cancers and 21 intramucosal cancers were compared, submucosal invasion was positively associated with expression of MUC5AC. Also, submucosal invasion showed strong association with double-positivity of MUC5AC and MUC6.
Conclusions
Our results indicate that immunohistochemical evaluation is useful for predicting malignant potential of NADETs, especially focusing on the expression of gastrointestinal markers.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2QwS8Wc
via IFTTT
Genetic screening for macular dystrophies in patients clinically diagnosed with dry age‐related macular degeneration
Clinical Genetics, Volume 0, Issue ja, -Not available-.
from Genetics via xlomafota13 on Inoreader https://ift.tt/2MwSNE1
via IFTTT
Exercise Periodization over the Year Improves Metabolic Syndrome and Medication Use
Purpose We aimed to determine if yearly repeated exercise training reduces metabolic syndrome (MetS) and the use of medicines to control MetS components. Methods Fifty-five MetS individuals were randomized into a TRAIN group that underwent two yearly programs of 16-wk high-intensity interval training or a nonexercising CONT group. We measured the evolution of all five MetS components, cardiorespiratory fitness (assessed by V˙O2PEAK) and medicine use, at baseline (0 months), mid (12 months), and end-point (24 months). Testing took place 8 months after the last training session to assess the chronic effects of training. Results Daily physical activity (wristband activity monitors) and calorie intake (3-d nutritional diary) remained similar to baseline at 1 and 2 yr in each group and were not different between groups. Blood triglycerides and glucose concentrations did not significantly vary in any group. However, waist circumference increased only in CONT after 2 yr (107 ± 2 cm to 111 ± 3 cm; P = 0.004). Mean arterial pressure decreased in TRAIN (101 ± 2 mm Hg to 94 ± 2 mm Hg; P = 0.002), whereas it remained unchanged in CONT (98 ± 2 mm Hg to 99 ± 2 mm Hg; P = 1.000) after 2 yr. Starting from similar levels at baseline, after 2 yr V˙O2PEAK was higher (2.32 ± 0.14 L·min−1 vs 1.98 ± 0.11 L·min−1; P = 0.049) and medicine use lower (1.27 ± 0.22 vs 2.23 ± 0.43; P = 0.043) in TRAIN than CONT. The reduction in MAP in TRAIN commanded a parallel reduction in MetS Z-score from baseline to 2 yr (0.30 ± 0.1 to 0.07 ± 0.1; P = 0.013). Conclusions Two yearly 16-wk high-intensity interval training programs are enough exercise to chronically lower MetS while preventing the reductions in cardiorespiratory fitness associated to aging. Of clinical relevance, yearly exercise training halts the increase in medicine use that occurs in non-exercising MetS individuals.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MyOWWL
via IFTTT
Pulse Oximetry and Arterial Oxygen Saturation during Cardiopulmonary Exercise Testing
Introduction/Purpose Peripheral capillary oxygen saturation (SpO2) is used as surrogate for arterial blood oxygen saturation. We studied the degree of discrepancy between SpO2 and arterial oxygen (SaO2) and identified parameters that may explain this difference. Methods We included patients who underwent cardiopulmonary exercise testing at Cleveland Clinic. Pulse oximeters with forehead probes measured SpO2 and arterial blood gas samples provided the SaO2 both at rest and peak exercise. Results We included 751 patients, 54 ± 16 yr old with 53% of female gender. Bland–Altman analysis revealed a bias of 3.8% with limits of agreement of 0.3% to 7.9% between SpO2 and SaO2 at rest. A total of 174 (23%) patients had SpO2 ≥ 5% of SaO2, and these individuals were older, current smokers with lower forced expiratory volume in the first second and higher partial pressure of carbon dioxide and carboxyhemoglobin. At peak exercise (n = 631), 75 (12%) SpO2 values were lower than the SaO2 determinations reflecting difficulties in the SpO2 measurement in some patients. The bias between SpO2 and SaO2 was 2.6% with limits of agreement between −2.9% and 8.1%. Values of SpO2 ≥ 5% of SaO2 (n = 78, 12%) were associated with the significant resting variables plus lower heart rate, oxygen consumption, and oxygen pulse. In multivariate analyses, carboxyhemoglobin remained significantly associated with the difference between SpO2 and SaO2 both at rest and peak exercise. Conclusions In the present study, pulse oximetry commonly overestimated the SaO2. Increased carboxyhemoglobin levels are independently associated with the difference between SpO2 and SaO2, a finding particularly relevant in smokers.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2QvcqPP
via IFTTT
Isolated “Low” Test Scores Are Often Normal and Valid
No abstract available
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MtMPDO
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MtMPDO
via IFTTT
Cleveland Clinic Postural Stability Index Norms for the Balance Error Scoring System
Introduction Despite the widespread utilization of the Balance Error Scoring System (BESS) in the evaluation of concussion, it has been criticized for its error-based scoring that is susceptible to floor and ceiling effects and substantial inter-rater variability. A biomechanical outcome, Cleveland Clinic Postural Stability Index (CC-PSI), has been developed as an alternative to subjective BESS scoring. The CC-PSI uses inertial sensor data within a mobile device to provide an objective measure of postural sway during the BESS. This project aimed to determine the effect of age and sex on the CC-PSI and report normative values for healthy, active children, adolescents, and young adults. Methods A cross-sectional sample of 6762 student-athletes completed BESS testing. Participants were stratified according to three age groups for each sex. The groups included the following: youth (age, 5–13 yr), males (n = 360), females (n = 246); high school (age, 14–18 yr), males (n = 3743), females (n = 1673); and college (age, 19–23 yr), males (n = 497), females (n = 243). Percentile rankings were determined for each participant to characterize movement of COM in the medial–lateral, anterior–posterior, and trunk rotation directions relative to the entire cohort during the BESS stances. Results Overall, postural stability was worse in youth compared with high school and collegiate athletes. Specifically, the CC-PSI was significantly worse in youth male athletes compared with high school and collegiate male athletes (Pfrom Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2QyxBRh
via IFTTT
Is Daily Composition of Movement Behaviors Related to Blood Pressure in Working Adults?
Introduction To investigate the association of the daily composition of time spent sedentary, in light physical activity and moderate-to-vigorous physical activity and time in bed (movement behaviors) with blood pressure (BP) among white- and blue-collar workers. Methods Systolic BP (SBP), diastolic BP (DBP) and body mass index of 827 workers were objectively measured. Daily composition of movement behaviors was derived from an Actigraph placed on the thigh for 1 to 5 d using the Acti4 software (2012–2013). The composition was expressed as isometric log-ratios. The cross-sectional associations between daily movement behavior composition and BP were investigated using the Compositional Data Analysis approach. The associations were adjusted for age, sex, body mass index, lift/carry duration, medication intake, and job sector. Results Daily composition of time spent in movement behaviors was significantly associated with SBP (F = 2.84, P = 0.04), but not DBP (F = 0.48, P = 0.69). Specifically, time reallocation to sedentary time and light physical activity from the remaining behaviors was deleteriously associated with SBP, whereas time reallocation to time in bed and moderate-to-vigorous physical activity from the remaining behaviors was beneficially associated with SBP. However, the results were only significant for time spent sedentary (P = 0.01) and in bed (P = 0.047). Conclusions Daily composition of movement behaviors is associated with SBP among workers. Spending more time sedentary compared with other behaviors was deleteriously associated with SBP, whereas spending more time in bed was beneficially associated with SBP. How time is spent in different movement behaviors throughout the day is important for BP and needs to be further investigated to be included in future clinical practice guidelines.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MAFVMW
via IFTTT
Residual Force Enhancement Is Attenuated in a Shortening Magnitude-dependent Manner
Introduction The isometric force attained after active stretch is greater than that attained in a purely isometric contraction. This property is referred to as residual force enhancement (RFE). Although RFE is thought to contribute to the enhanced force and power in stretch-shortening cycles (SSCs), it is unclear whether shortening that occurs after active stretch eliminates the RFE induced by active stretch. Therefore, we evaluated the influence of shortening on RFE. Methods Skinned rabbit soleus fibers (N = 43) were used for all tests. Residual force enhancement was compared between the stretch-only condition and the SSC condition. In the SSC conditions, shortening magnitudes were either 1% or 12.5% of fiber length. The final muscle length where RFE was evaluated was 3 μm for all trials. In the SSCs with 12.5% shortening, the isometric force before and after the SSC was also compared. Results Residual force enhancement was similar between the stretch only (7.9% ± 2.7%) and the SSC with 1% shortening condition (7.1% ± 2.9%) (P = 0.316), whereas RFE was smaller in the SSC with 12.5% shortening (3.5% ± 2.4%) than the stretch-only condition (8.4% ± 2.5%) (Pfrom Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2xdl6T3
via IFTTT
Postoperative Orthopedic Rehabilitation
No abstract available
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Qw2MMV
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Qw2MMV
via IFTTT
Hypothermia Decreases O2 Cost for Ex Vivo Contraction in Mouse Skeletal Muscle
Introduction Evidence suggests that the energy efficiency of key ATPases involved in skeletal muscle contractile activity is improved in a hypothermic condition. However, it is unclear how a decrease in temperature affects skeletal muscle O2 consumption (mVO2) induced by muscle contraction. Methods Isolated mouse extensor digitorum longus (EDL) muscles were incubated in a temperature-controlled (37°C or 25°C) bath that included an O2 probe. EDL muscles from one limb were subjected to the measurement of resting mVO2, and the contralateral EDL muscles were used for the measurement of mVO2 with electrically stimulated contraction. For the resting protocol, muscles were suspended at resting tension for 15 min with continuous O2 recordings. For the contraction protocol, EDL muscles underwent 10 electrically stimulated isometric contractions with continuous O2 recordings for 15 min. The rate of O2 disappearance was quantified as micromoles of O2 per minute and normalized to the wet weight of the muscle. Results Resting mVO2 was greater at 37°C than at 25°C, consistent with the idea that lower temperature reduces basal metabolic rate. Electrically stimulated contraction robustly increased mVO2 at both 37°C and 25°C, which was sustained for ~3 min postcontraction. During that period, mVO2 was elevated approximately fivefold at both 37°C and 25°C. Greater contraction-induced mVO2 at 37°C compared with 25°C occurred despite lower force generated at 37°C than at 25°C. Conclusions Together, O2 cost for muscle contraction (force–time integral per O2 consumed) was greater at 37°C than at 25°C. Levels of high-energy phosphates were consistent with greater energy demand at 37°C compared with 25°C. In conclusion, these results indicate that muscle contraction that occurs at subnormal temperature requires less O2 than at 37°C.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MAFJgG
via IFTTT
Isometric versus Dynamic Measurements of Fatigue: Does Age Matter? A Meta-analysis
Purpose The assessment of power changes after fatiguing exercise provides important additional information about neuromuscular function compared with traditional isometric measurements, especially when exploring age-related changes in fatigability. Therefore, the aim of this review was to explore the effects of age on neuromuscular fatigue (NMF) when measured in isometric compared with dynamic contractions. The importance of central and peripheral mechanisms contributing to age-related NMF was discussed. Methods Medline, EMBASE, Cochrane Central Register of Controlled Trials, and SPORT Discus databases were searched. The combination of terms related to the intervention (fatiguing exercise), population (old people) and outcomes (isometric force and power) were used. This meta-analysis was registered on PROSPERO (CRD42016048389). Results Thirty-one studies were included. The meta-analyses revealed that force decrease was greater (there was more NMF) in young subjects than their older counterparts when fatigue was induced by isometric tasks (effect size [ES], 0.913; confidence interval [CI], 0.435–1.391; Pfrom Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Qw2G81
via IFTTT
Moderate Exercise Enhances Endothelial Progenitor Cell Exosomes Release and Function
Purpose Exercise has cardiovascular benefits which might be related to endothelial progenitor cells (EPC). Meanwhile, there is evidence suggesting that EPC-derived exosomes (EPC-EX) promote vascular repair and angiogenesis through their carried microRNA (miR)-126. In this study, we investigated whether exercise could increase the levels of circulating EPC-EX and their miR-126 cargo, and by which promote the protective function of EPC-EX on endothelial cells (EC). Methods Plasma EPC-EX from sedentary, low, or moderate exercise mice, respectively, denoted as EPC-EXS, EPC-EXL, and EPC-EXM, were isolated using microbead-based sorting techniques and characterized by nanoparticle tracking analysis, Western blot, and quantitative real-time polymerase chain reaction assessments of biomarkers and miR-126. High glucose (25 mM) with hypoxia (1% O2) was used for inducing an EC injury model. The injured EC were treated by coculturing with vehicle, EPC-EXS, EPC-EXL, EPC-EXM, or EPC-EXM + anti–miR-126. After that, EC were used for flow cytometry analysis of apoptosis, assessments of tube formation and migration, and measurements of miR-126 level and its downstream sprouty-related protein-1 (SPRED1) and vascular endothelial growth factor (VEGF). Results 1) Isolated EPC-EX positively expressed exosomal markers (CD63 and Tsg101) and EPC markers (CD34 and VEGFR2). 2) Exercise intensity dependently elevated plasma level of EPC, EPC-EX/EPC ratio, and miR-126 expression in EPC and EPC-EX. 3) Injured EC displayed apoptosis increment, angiogenic dysfunction and miR-126 reduction. 4) EPC-EXM had better effects than EPC-EXS and EPC-EXL on alleviating those changes of injured EC, accompanied with SPRED1 downregulation and VEGF upregulation. 5) The effects of EPC-EXM were abolished by miR-126 knockdown. Conclusions Our data demonstrate that exercise can increase EPC-EX release and miR-126 level and enhance the effects of EPC-EX on protecting EC against injury through the SPRED1/VEGF pathway.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2xmC68O
via IFTTT
Magnitude-based Inference: Good Idea but Flawed Approach
No abstract available
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MAFAtE
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MAFAtE
via IFTTT
The Effects of Exercise, Aspirin, and Celecoxib in an Atherogenic Environment
Introduction Optimal vascular function is a hallmark of cardiovascular health. Specifically, the balance of vasoconstricting and vasodilating substances is recognized as a marker of vascular health. One of the greatest challenges to vascular health and vasodilatory balance is tumor necrosis factor alpha (TNFα)-mediated inflammation. Uncovering effective strategies that maintain a vascular environment that is more vasodilatory and antithrombotic in the face of an inflammatory challenge is favorable. Purpose To test the ability of various antithrombotic and provasodilatory treatments, as well as combinations thereof, to prevent unfavorable changes in markers of endothelial dysfunction in human umbilical vein endothelial cells when presented with an inflammatory challenge. Methods Human umbilical vein endothelial cells were pretreated with exercise-like levels of laminar shear stress (LSS), aspirin, celecoxib, and their combination before a TNFα challenge. Western blot analysis as well as colorimetric assays were used to determine levels of endothelial nitric oxide synthase (eNOS) and prostacyclin (6-keto PGF1α)/thromboxane (TXB2) metabolite ratio, respectively. Results Neither aspirin nor celecoxib were effective in preventing TNFα-induced reduction in eNOS. Further, aspirin was unable to maintain baseline levels of prostacyclin/thromboxane ratio in the face of the inflammatory challenge. Laminar shear stress, aspirin/LSS combination, and celecoxib/LSS combination were all able to prevent TNFα-induced alterations in eNOS levels and prostacyclin/thromboxane ratio. Conclusions Effective strategies to maintain a healthy endothelium, and therefore resistance vessel health, need to include exercise-levels of shear stress to be effective.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Qvc3op
via IFTTT
Validation of Step Counters in the Free-living Context
No abstract available
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Mv56jX
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Mv56jX
via IFTTT
Maternal Physical Activity and Sex Impact Markers of Hepatic Mitochondrial Health
Introduction Maternal exercise and physical activity during the gestational period can be protective against maternal high-fat diet–induced hepatic steatosis in older offspring. However, it is unknown whether these protective effects are seen in younger offspring. In this study, we investigated whether maternal physical activity would attenuate maternal western diet (WD)–induced steatosis in young adult rats. Methods Female Wistar rats (7–8 wk of age) were randomized into WD (42% fat, 27% sucrose) or normal chow diet (ND), and further randomized into physical activity (RUN) or sedentary (SED) conditions for a total of four groups. Dams returned to ND/SED conditions after parturition. Postweaning, offspring were maintained in ND/SED conditions for 18 wk. Results Maternal WD-induced increases in male offspring body mass was attenuated in the WD/RUN offspring (Pfrom Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Qw2pSx
via IFTTT
Effects of Strength Training on Postpubertal Adolescent Distance Runners—Corrigendum
No abstract available
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MxO0SP
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MxO0SP
via IFTTT
Adipose Tissue Responses to Breaking Sitting in Men and Women with Central Adiposity
Purpose Breaking prolonged sitting reduces postprandial glucose and insulin concentrations and influences skeletal muscle molecular signaling pathways, but it is unknown whether breaking sitting also affects adipose tissue. Methods Eleven central overweight participants (seven men and four postmenopausal women) 50 ± 5 yr old (mean ± SD) completed two mixed-meal feeding trials (prolonged sitting vs breaking sitting) in a randomized, counterbalanced design. The breaking sitting intervention comprised walking for 2 min every 20 min over 5.5 h. Blood samples were collected at regular intervals to examine metabolic biomarkers and adipokine concentrations. Adipose tissue samples were collected at baseline and at 5.5 h to examine changes in mRNA expression and secretion of selected adipokines ex vivo. Results Postprandial glycemia and insulinemia were attenuated by approximately 50% and 40% in breaking sitting compared with prolonged sitting (iAUC: 359 ± 117 vs 697 ± 218 mmol per 330 min·L−1, P = 0.001, and 202 ± 71 vs 346 ± 150 nmol per 330 min·L−1, P = 0.001, respectively). Despite these pronounced and sustained differences in postprandial glucose and insulin concentrations, adipose tissue mRNA expression for various genes (interleukin 6, leptin, adiponectin, pyruvate dehydrogenase kinase isozyme 4, insulin receptor substrates 1 and 2, phosphoinositide 3-kinase, and RAC-alpha serine/threonine-protein kinase) and ex vivo adipose tissue secretion of interleukin 6, leptin, and adiponectin were not different between trials. Conclusions This study demonstrates that breaking sitting with short bouts of physical activity has very pronounced effects on systemic postprandial glucose and insulin concentrations, but this does not translate into corresponding effects within adipose tissue.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Qw2cPf
via IFTTT
Nitrate Supplement Benefits Contractile Forces in Fatigued but Not Unfatigued Muscle
Purpose Evidence suggests dietary nitrate supplementation enhances low-frequency (≤20 Hz) involuntary, but not voluntary, forces in unfatigued human muscle. We investigated the hypotheses that nitrate supplementation would also attenuate low-frequency fatigue and the loss of explosive voluntary forces in fatigued conditions. Methods In a counterbalanced double-blinded order, 17 male participants completed two experimental trials after 7 d of dietary supplementation with either nitrate-rich (NIT) or nitrate-depleted (PLA) beetroot juice. Each trial consisted of measuring isometric knee extension forces during a series of explosive maximal voluntary contractions (MVC) and involuntary tetanic contractions (at 10, 20 50, and 100 Hz) in unfatigued conditions, followed by a fatigue protocol of 60 MVC and a repeat of the tetanic contractions immediately after the 60 MVC. Results In unfatigued conditions, there was no effect of NIT on any of the measured dependent variables, including maximal voluntary force, explosive impulse, and tetanic peak forces or peak rate of force developments at any frequency. In contrast, the percentage decline in explosive voluntary impulse from the first to the last 6 MVC in the fatigue protocol was lower in NIT (51.1% ± 13.9%) than in PLA (57.3% ± 12.4%; P = 0.039; d = 0.51). Furthermore, low-frequency fatigue determined via the percentage decline in the 20/50-Hz ratio was attenuated in NIT for tetanic peak force (NIT: 12.3% ± 12.0% vs PLA: 17.0% ± 10.1%; P = 0.110; d = 0.46) and tetanic peak rate force development (NIT: 12.3% ± 10.4% vs PLA: 20.3% ± 9.5%; P = 0.011; d = 0.83). Conclusions Nitrate supplementation reduced the decline in explosive voluntary forces during a fatiguing protocol and attenuated low-frequency fatigue, likely due to reduced disruption of excitation–contraction coupling. However, contrary to previous findings, nitrate supplementation had no effect on contractile performance in unfatigued conditions.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MxXbmb
via IFTTT
Glucose Tolerance is Linked to Postprandial Fuel Use Independent of Exercise Dose
Purpose The optimal short-term exercise dose to improve glucose tolerance in relation to metabolic flexibility and/or insulin resistance is unknown. Therefore, we tested if short-term, work-matched continuous (CONT) versus interval (INT) exercise training improves glucose tolerance in part by reducing insulin resistance and increasing metabolic flexibility independent of clinically meaningful fat loss in adults with prediabetes. Methods Subjects (age = 60.9 ± 1.4 yr, body mass index = 33.5 ± 1.1 kg·m−2) were screened for prediabetes using the American Diabetes Association criteria (75 g oral glucose tolerance test [OGTT] and/or HbA1c) and were randomized to 60 min·d−1 of supervised CONT (n = 17, 70% HRpeak) or work-matched INT (n = 14; 90% HRpeak for 3 min and 50% HRpeak for 3 min) exercise for 12 bouts. Fitness (V˙O2peak) and body composition were assessed pre- and postintervention. A 180-min 75-g OGTT was performed, and glucose, insulin, and free fatty acids were collected to calculate glucose tolerance (tAUC180min) and whole-body as well as adipose tissue insulin resistance pre- and postintervention. RER (indirect calorimetry) was also measured at 0, 60, 120, and 180 min of the OGTT to assess fasting and postprandial metabolic flexibility. Results CONT and INT training improved V˙O2peak (L·min−1; P = 0.001) and glucose tolerance (P = 0.01) and reduced fasting RER (P = 0.006), as well as whole-body and adipose insulin resistance (both P = 0.02) with no effect on body fat (P = 0.18). Increased postprandial RER was correlated with reduced glucose tAUC180min (r = −0.38, P = 0.05) and increased 180-min RER related to decreased whole-body insulin resistance (r = −0.42, P = 0.03). Conclusion Independent of exercise dose and fat loss, short-term training improves glucose tolerance in relation to enhanced postprandial fuel use.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2QxZo4e
via IFTTT
Complex Terrain Load Carriage Energy Expenditure Estimation Using Global Positioning System Devices
Introduction Military load carriage can cause extreme energy expenditure (EE) that is difficult to estimate due to complex terrain grades and surfaces. Global Positioning System (GPS) devices capture rapid changes in walking speed and terrain but the delayed respiratory response to movement is problematic. We investigated the accuracy using GPS data in three different equations to estimate EE during complex terrain load carriage. Methods Twelve active duty military personnel (age, 20 ± 3 yr; height, 174 ± 8 cm; body mass, 85 ± 13 kg) hiked a complex terrain trail on multiple visits under different external load conditions. Energy expenditure was estimated by inputting GPS data into three different equations: the Pandolf–Santee equation, a recent GPS-based equation from de Müllenheim et al.; and the Minimum Mechanics model. Minute-by-minute EE estimates were exponentially smoothed using smoothing factors between 0.05 and 0.95 and compared with mobile metabolic sensor EE measurements. Results The Pandolf–Santee equation had no significant estimation bias (−2 ± 12 W; P = 0.89). Significant biases were detected for the de Müllenheim equation (38 ± 13 W; P = 0.004) and the Minimum Mechanics model (−101 ± 7 W; Pfrom Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2MxGbfQ
via IFTTT
High-Intensity Interval or Continuous Moderate Exercise: A 24-Week Pilot Trial
Purpose High-intensity interval training (HIIT) may lead to superior cardiometabolic improvements when compared with moderate-intensity continuous training (MICT). However, adherence to HIIT requires examination. The purpose of this pilot study was to examine moderate-to-vigorous physical activity (MVPA) adherence 24 wk after a brief counseling intervention combined with either HIIT or MICT. Methods Individuals at high risk of type 2 diabetes (T2D) were randomized to HIIT (n = 15) or MICT (n = 17) and completed 10 exercise sessions accompanied by a brief 10-min counseling intervention over a 2-wk period. Objectively measured purposeful MVPA (accelerometry) and cardiorespiratory fitness (V˙O2peak) were assessed at baseline and 24 wk postintervention. Self-regulatory efficacy and task self-efficacy were examined at baseline, postintervention, and 24 wk postintervention. Using an intention-to-treat analysis, change scores were calculated for HIIT and MICT and compared between groups. Results Individuals assigned to HIIT increased their MVPA by 53 min (Cohen's d = 1.52) at 24 wk compared with 19 min in MICT. Both HIIT and MICT increased relative V˙O2peak by 2 and 1 mL·kg−1·min−1, respectively. Participants in both groups increased in their self-regulatory and task self-efficacy postintervention, but both groups demonstrated similar decline at 24 wk. Conclusion This pilot intervention was successful in increasing, and maintaining, free-living MVPA over a 24-wk period in individuals at high risk of T2D. Speculation that HIIT is inappropriate or unattainable for overweight individuals at high risk of T2D may be unfounded.from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Qy2THW
via IFTTT
Role of CYP1A1, ABCG2, CYP24A1 and VDR gene polymorphisms on the evaluation of cardiac iron overload in thalassaemia patients
Objectives Iron-burden-induced arrhythmia and heart failure are among the leading causes of morbidity and mortality in β-thalassaemia major patients. T2* cardiac magnetic resonance remains the only reliable noninvasive method for the heart iron excess assessment. We explored the role of single nucleotide polymorphisms involved in vitamin D metabolism, transport and activity and in deferasirox (DFX) metabolism on cardiac iron burden. Patients and methods One hundred and five β-thalassaemia patients, treated with DFX, were enrolled in the present study. Drug plasma Ctrough was measured by a high-performance liquid chromatography-ultraviolet method. Allelic discrimination was carried out using the real-time PCR. Results CYP1A1*1189 CC, ABCG2 421 GA, CYP24A1 8620 GG and VDR TaqI CC single nucleotide polymorphisms influenced T2* values. Age, serum ferritin, ABCG2 421 GA, ABCG2 1194 +928 TC/CC, CYP24A1 22776 TT and VDR TaqI TC/CC were retained in linear regression model. Conclusion Our results suggested, for the first time, the role of DFX and vitamin D pharmacogenetics on cardiac iron overload.from Genetics via xlomafota13 on Inoreader https://ift.tt/2CZZ37G
via IFTTT
Pharmacogenetic and clinical predictors of response to clopidogrel plus aspirin after acute coronary syndrome in Egyptians
Objectives Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel reduces the risk for recurrent cardiovascular events after acute coronary syndrome (ACS). However, there is significant variation in response to DAPT that may be influenced by both genetic and nongenetic factors. This study aimed to assess the effect of genetic polymorphisms in PON-1, PEAR-1, P2Y12, CES1, and CYP2C19, along with clinical, demographic, and social factors, on variation in response to DAPT in Egyptians. Participants and methods This study included 230 Egyptians treated with clopidogrel 75 mg/day and aspirin 81 mg/day for at least 12 months following their first ACS. Simple and multivariable logistic regression analyses were carried out to identify factors associated with major adverse cardiovascular events (MACE), defined as the occurrence of recurrent ACS, ischemic stroke, stent-related revascularization, or death, in clopidogrel-treated participants. Results Using multivariable logistic regression analysis, the CYP2C19*2 polymorphism was the only genetic predictor of MACE [odds ratio (OR): 2.23, 95% confidence interval (CI): 1.15–4.33, P=0.01]. In addition, proton pump inhibitor use (OR: 4.77, 95% CI: 1.47–15.54, P=0.009) and diabetes (OR: 1.83, 95% CI: 1.03–3.26, P=0.03) were associated with higher cardiovascular risk, whereas statin use was associated with lower risk (OR: 0.43, 95% CI: 0.25–0.76, P=0.003). The contribution of these four genetic and nongenetic factors explained 19% of the variability in risk for MACE in Egyptians treated with DAPT. Conclusion These results highlight that CYP2C19*2, along with diabetes, and use of proton pump inhibitor and statin are important factors jointly associated with variability in clinical response to DAPT following ACS in Egyptians.from Genetics via xlomafota13 on Inoreader https://ift.tt/2NR9VsV
via IFTTT
Fitness Mediates Activity and Sedentary Patterns Associations with Adiposity in Youth
Purpose We aimed to examine the cross-sectional associations of patterns of sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) with total fat mass index (FMI) and abdominal fat mass index (FMIabd) in children, and additionally, to analyze if cardiorespiratory fitness (CRF) mediated these associations. Methods FMI and FMIabd were assessed with DXA in 333 participants (172 girls) aged 9-11 years. MVPA, ST, breaks in sedentary time per sedentary hour (BST/ST) and the number of daily sedentary bouts with various lengths (1-4, 5-9, 10-14, and ≥15 minutes) were assessed with accelerometry and CRF using a maximal cycle test. Hayes' PROCESS macro for SPSS was used for mediation analysis. Results The number of shorter sedentary bouts (1-4 minutes) was inversely associated with FMI (β =-0.108), whereas longer sedentary bouts (5-9 minutes, β=0.169; 10-14 minutes, β=0.193; ≥15 minutes, β=0.377) had a positive association, independent of MVPA (p0.05). CRF was inversely related to total and abdominal adiposity, and a large portion (40.9-65.7%) of the associations of MVPA and sedentary bouts with both FMI and FMIabd were mediated by CRF. Conclusion Time in MVPA and accumulating ST in shorter sedentary bouts is inversely related to adiposity. However, these associations may be mediated by CRF. Emphasis should be given to programs that target increases in MVPA, which may influence CRF while reducing sedentary recreational behaviors. Correspondence: Luís B. Sardinha, PhD, Exercise and Health Laboratory, Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics–University of Lisbon; Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal, Phone: (351) 21 414 91 60; Fax: (351) 21 414 91 93; e-mail: lsardinha@fmh.ulisboa.pt This work was supported by the Portuguese Foundation for Science and Technology (Grant: PTDC/DES/108372/2008). DAS, JPM, and PBJ are supported by a scholarship from the Portuguese Foundation for Science and Technology (grants - DAS SFRH/BPD/92462/2013; JPM: SFRH/BD/85742/2012; PBJ: SFRH/BPD/115977/2016). Conflict of Interest The authors declare that they have no conflict of interest. The results of the present study do not constitute endorsement by ACSM and are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 11 September 2018. © 2018 American College of Sports Medicine
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2My1kpW
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2My1kpW
via IFTTT
Effects of Sprint-Interval and Endurance Respiratory Muscle Training Regimens
Introduction Recently a novel, time-saving respiratory muscle sprint-interval training (RMSIT) was developed. To test the extent to which RMSIT improves respiratory muscle performance compared to a conventional respiratory muscle endurance training (RMET), a novel incremental respiratory muscle test (IncRMT), loading inspiratory and expiratory muscles, was designed to assess performance changes associated with respiratory muscle training (RMT). Methods Healthy, moderately trained males and females (age: 26 ± 5years, V[Combining Dot Above]O2peak: 47 ± 12 ml·min-1·kg-1) were randomized and balanced to 3 groups (RMSIT 5m/5f; RMET 6m/6f; PLAT 5m/6f). Lung function, respiratory muscle strength and IncRMT performance were tested before and after one month of RMT. During the IncRMT, muscle activity and muscle deoxygenation were assessed via surface electromyography and near-infrared spectroscopy of sternocleidomastoid (STERNO), intercostal (INTER) and abdominal (ABDO) muscles. Results Two-way ANOVA revealed a main effect of training for increased maximal voluntary ventilation (P = 0.001) and maximal inspiratory pressure (P = 0.017). Both RMT groups increased work of breathing during training sessions to the same extent (RMSIT: +17.4 ± 8.9kJ, RMET: +26.2 ± 16.1kJ; P = 0.143) with a larger increase in average mouth pressure in RMSIT (RMSIT: +20.0 ± 15.0cmH2O, RMET: +3.3 ± 1.5cmH2O; P = 0.001). After training, IncRMT duration increased in both RMT groups compared to PLAT (RMSIT: +5.6 ± 2.1min; P = 0.0006 vs. PLAT; RMET: +3.8 ± 4.2min; P = 0.020 vs. PLAT). At similar work, only INTER activity during inspiration increased following RMET. Higher performance following RMSIT was associated with higher activity in STERNO and ABDO, while following RMET, STERNO, INTER and ABDO showed higher activity. Conclusion One month of RMSIT and RMET show similar improvements in respiratory muscle performance despite different duration of training sessions. Also, muscular adaptations might differ. Corresponding Author: Prof. Christina M. Spengler, PhD, MD, ETH Zurich, Exercise Physiology Lab, Winterthurerstrasse 190, 8057 Zurich, +41 44 635 50 07. christina.spengler@hest.ethz.ch The partial contribution by CTI (grant no. 15650.1 PFLS-LS) includes a combination of two funding sources, funding provided by the federal granting agency and funding provided by an industrial partner (idiag AG, Switzerland). Neither was involved in any part of the study itself. Results of the present study do not constitute endorsement by ACSM. Results are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 6 September 2018 © 2018 American College of Sports Medicine
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Nf3uAk
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Nf3uAk
via IFTTT
Individual Variability in Waist Circumference and Body Weight in Response to Exercise
Purpose To determine the magnitude of exercise-induced individual variability for waist circumference (WC) and body weight change after accounting for biological variability and measurement error. Determinants of response variability were also considered. Methods Participants (53 ± 7.5 years) were 181 (61% women) adults with abdominal obesity randomized to: control; low amount, low intensity (LALI); high amount, low intensity (HALI); or high amount, high intensity exercise (HAHI) for 24 weeks. Unstructured physical activity was measured by accelerometer. The variability in response to exercise for WC and body weight (SDR) was isolated by subtracting the standard deviations for the change scores in the exercise group from that of the control group. Results The variability of response due to exercise (SDR) for change in WC was 3.1, -0.3 and 3.1 cm for LALI, HALI and HAHI groups, respectively. Corresponding values for body weight were 3.8, 2.0 and 3.5 kg for LALI, HALI and HAHI, respectively. The high amount exercise groups yielded the highest proportion of individuals with a clinically meaningful response. No variables predicted the response to exercise (p>0.05). Conclusions Substantial variability in response to standardized exercise was observed for change in both WC and body weight after accounting for the variability not attributed to exercise. Potential determinants of the interindividual variability in response to exercise remain unclear. Corresponding author: Robert Ross, PhD, R. Kin, FACSM, FAHA, School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, Canada, Kingston, Ontario, Canada, K7L 3N6; E-mail: rossr@queensu.ca; Phone: (613) 533-6583 This study was supported by Canadian Institutes of Health Research (grant OHN-63277). Disclosure: The authors declare no conflict of interest. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 10 September 2018. © 2018 American College of Sports Medicine
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2My16z6
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2My16z6
via IFTTT
Εγγραφή σε:
Αναρτήσεις (Atom)