Πέμπτη, 11 Οκτωβρίου 2018

Deputy Sheriff/Paramedic - Davis County Sheriff's Office

We have an exciting opening for a Deputy Sheriff/Paramedic with Davis County Sheriff's Office in Utah! View this opportunity at: https://ift.tt/2RJRbdS This position is a unique hybrid position with split responsibilities, including duties of a patrol Deputy Sheriff, and a Paramedic. If you already have an active Utah Paramedic license, we would love to talk to you - applicants ...

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Paramedic Apprentice - Fort Bend County EMS - FORT BEND COUNTY E M S

Provides emergency medical care to the citizens of Fort Bend County as stated in established standards and procedures. Participates in planning of programs, policies or objectives for own work group and department.

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Paramedic Part-Time - Fort Bend County EMS - FORT BEND COUNTY E M S

Working with a senior paramedic, provides emergency medical care to the citizens of Fort Bend County as stated in established standards, procedures and protocols. Participates in planning of programs, policies or objectives for own work group and department.

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Paramedic I - FORT BEND COUNTY E M S

Provides emergency medical care to the citizens of Fort Bend County as stated in established standards and procedures. Participates in planning of programs, policies or objectives for own work group and department.

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Deputy Chief - Operations - Fort Bend County EMS - FORT BEND COUNTY E M S

Manages activities and directs staff to ensure an efficient and effective Operations Division. Plans, organizes, monitors and evaluates the activities of the Operations Division to ensure delivery of emergency medical services to reduce morbidity and mortality. Participates in the planning of programs, policies or objectives for own work group and department.

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EMS Programs Director - Mineral Area College

**QUALIFICATIONS: ** Master's degree preferred. Bachelor of Science degree required from a regionally accredited education institution. Maintain a current paramedic license. Five years of experience as emergency paramedic with a progressive and active EMS provider. At least 2 years of Paramedic Program Director experience. Five years of experience teaching emergency medical technician, paramedic program ...

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Paramedic - Remote Medical International

At Remote Medical International® (RMI), we offer premium medical services to companies across a wide range of industries operating in remote or challenging locations in the US and abroad.Our global team of exceptional medical providers use their skills and expertise to implement leading health and safety initiatives, incorporate preventative health measures, oversee medical evacuations, and practice ...

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PARAMEDIC / E.M.T. DAYTIME HOURS/FT AT MEDICAL OFFICE - Michael Joslyn

Licensed Paramedic or E.M.T. needed for full-time position at exclusive new medical office. Plush offices in Southeast Grand Rapids. No evenings or weekends. Must have positive attitude and be very hard working. Fast-paced, fun office. Work side-by-side our medical doctors. Outstanding communication skills, customer service skills, and phone skills required. $35,000 salary plus monthly bonus potential ...

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Utilization of Chemical Deposition Technique for Preparation of Miniature 170Tm Sources and Preliminary Quality Assessment for Potential Use in Brachytherapy

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Correction to: Retraction of: Tumor Protein D52-Like 2 Accelerates Gastric Cancer Cell Proliferation; 10.10.89/cbr.2014.1766 Cancer Biother Radiopharm 2017;32(10):388. DOI: 10.1089/cbr.2014.1766.retract

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Correction to: Retraction of: Tumor Protein D52-Like 2 Contributes to Proliferation of Breast Cancer Cells; 10.10.89/cbr.2014.1723 Cancer Biother Radiopharm 2017;32(10):387. DOI: 10.1089/cbr.2014.1723.retract

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Exhaustive exercise decreases renal organic anion transporter 3 function

Abstract

This study aimed to investigate the effects of various types of exercise on organic anion transporter 3 (Oat3) function, a major transporter that plays a role in the secretion of a variety of drugs and endogenous compounds. Male Wistar rats were randomly allocated to non-exercise, exhaustive, acute and training exercise groups. The function of Oat3 was assessed by the uptake of [3H]-estrone sulfate ([3H]-ES) into rat renal cortical slices. Acute and training exercises had no effect on [3H]-ES uptake whereas a marked reduction in [3H]-ES uptake occurred immediately after exhaustive exercise. However, the reduction in Oat3 function was gradually recovered at 6 and 24 h after the exercise session. Importantly, the impairment of Oat3 function was associated with a decrease in renal Oat3 protein expression. Our results indicate that exhaustive exercise produces a significant impact on renal organic anion transport function, which in turn could alter the plasma level of drugs and compounds in the body.



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New Approaches in Cognitive Neurobiology: Methods of Molecular Marking and Ex Vivo Imaging of Cognitively Active Neurons

This review addresses the potentials of current methods of molecular ex vivo imaging of neurons involved in episodes of cognitive activity in experimental animals. We describe the principles on which the molecular identification of neurons activated in cognitive tasks are based, special attention being paid to the molecular marking of neuron activity in a single brain during two different cognitive episodes. Methods for double molecular labeling using in situ fluorescence hybridization (catFISH) are described in detail, along with approaches using transgenic animal strains to label neurons involved in cognitive activity via expression of fluorescent proteins within them (the tTA-tetO and TRAP Cre-loxP systems). The main advantages and disadvantages of these approaches are considered. Typical experimental schemes are presented which require specific aspects of working with these methods. A brief review of methods in which they are used to study the neural basis of cognitive activity in different behavioral tasks is presented. The potentials for the development of these approaches for studies of the cellular bases of higher brain functions are discussed.



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Pathological Upper Limb Synergies of Patients with Poststroke Hemiparesis

This review presents current data on possible mechanisms forming synergies in health, particularly at the cortical level. The mechanisms of formation of pathological synergies, taking account of the anatomical and physiological characteristics of the upper limbs and the hypothesis, that synergistic patterns are transformed in patients with spastic hemiparesis are discussed. Current views of the pathophysiological bases of the formation of pathological synergies based on neuroimaging and neurophysiological study data are presented, along with a method for noninvasive stimulation of the brain. The question of the correction and transformation of pathological synergies in rehabilitation practice is discussed. Particular attention is paid to clinical and instrumented evaluation of synergies and the use of validated clinical scales and instrumented methods such as video movement analysis, electromyography, magnetic and contactless tracking systems, and virtual reality technologies.



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Contemporary Algorithms for the Diagnosis and Treatment of Multiple Sclerosis Based on Individual Assessment of Patients’ Status

This review describes current views on the diagnosis of multiple sclerosis (MS), the treatment of exacerbations of MS, and the use of MS disease-modifying drugs. Algorithms for diagnosis and treatment are provided. Particular attention is paid to analysis of the efficacy, tolerance, and safety of contemporary drugs for the treatment of MS.



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Biorhythmological Aspects of Hormonal Regulation

This review presents an analysis of published data and the results of our own studies of the question of the circannual dynamics of hormone levels. This analysis demonstrates the existence of significant disagreements in relation to this problem, generating the need for further studies of circannual variations in the functioning of the body's endocrine system.



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Cytokine Secretion by Splenocytes in Response to Behavior in (C57BL/6 × DBA/2)F1 Mice in Environments with Different Levels of Complexity

We report here our studies of the relationship between mitogen-activated secretion of cytokines by splenocytes and the nature of behavior in (C57BL/6 × DBA/2)F1 mice in environments with different levels of spatial complexity: simple, in the form of the home cage, an enriched cage, and a maze. Increases in aggressive and neurotic manifestations in social conditions occurring only in the enriched environment were accompanied by suppression of the secretion of interleukins IL-2, IL-4, IL-6, and IL-10 independently of their structural-functional properties. The opposite effect, with significant increases in the production of all the cytokines studied, was seen in the case of stereotypical goal-directed behavior in the maze. It is suggested that the cellular elements of the immune system – splenocytes – are involved in mediating the body's highly differentiated adaptive response induced by the social and cognition factors, the extent of which was determined by specific physiological-biochemical systems.



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Neurotropic, Psychoactive, and Analgesic Properties of Benzimidazole and Its Derivatives: Physiological Mechanisms

This review summarizes current data and the results of the authors' own investigations of the neurotropic, psychoactive, and analgesic properties of benzimidazole and its derivatives. Using a series of compounds of this class as a examples, different aspects of the actions of benzimidazoles on the nervous system of lab animals (mollusks, mice, rats, cats) are considered. The efficacy of benzimidazoles is shown to be due to actions on a number of important physiological mechanisms regulating the functional state of nerve cells and neurotransmitter systems, inflammation processes, and pain.



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The Acute Post-Traumatic Period in Rats Is Accompanied by an Anxiety State and a Decrease in the Proportion of REM Sleep

The sequelae of craniocerebral trauma (CCT) were studied using a model based on severe (3–4 atm) lateral hydrodynamic percussion (liquid-percussive brain injury) in male Sprague–Dawley rats. With the aim of detecting the symptoms of anxiety states, the rats' behavior was assessed in the dark-light box and the elevated plus maze test; sleep impairments were detected by recording the electrocorticogram (ECoG) before trauma and during the first week after trauma. The results provided evidence of the post-CCT development of signs of an anxiety state, accompanied by decreases in the proportion of REM sleep and decreases in the amplitude and frequency of the ECoG during this phase.



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Interhemisphere Asymmetry in the Structure of the Hippocampus in Men

Objectives. To study the cytoarchitectonic structure of the hippocampus in men in the left and right hemispheres. Materials and methods. Continuous series of total frontal sections of the cerebral hemispheres were studied in the brains of four men aged 19–30 years. Specimens were stained with cresyl violet by the Nissl method and analyzed using image analysis software. Results. The characteristics of the field profile of pyramidal neurons in field CA1 were determined, along with the distribution density of neurons and glial cells in the left and right hemispheres of male brains. The dimensions of the field profile of pyramidal neurons in hippocampal field CA1 in the right hemisphere were larger and their distribution density was lower as compared with the left hemisphere. Field CA1 in the right hemisphere of men's brains had greater density of total glial cells and a higher ratio of satellite glial cells to the total number of glial cells as compared with the left hemisphere. Conclusions. The gender-related characteristics of the structural organization of the hippocampus in men evidently correlates with the properties of memory in men.



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Effects of the Treatment of Mothers with Multiple Sclerosis Using Disease-Modifying Drugs on Child Development

Objectives. To evaluate the effects of treating mothers with multiple sclerosis disease-modifying drugs (MS DMD) on the physical and mental development of children in the first year of life. Materials and methods. A total of 30 cases of pregnancy ending with live births in patients conceiving after confirmed diagnosis of MS were studied. Mothers not receiving MS DMD at the moment of conception (controls) were treated with interferon-β (IFN) (13 cases) or glatiramer acetate (GA) (10 cases) at conception. Patients were investigated using structured interviews, examination of children with assessment of standard anthropometric indicators and the motor and neuropsychological development scale (WHO Six Milestones), examination of medical records, and statistical analysis. Results and conclusions. The study confirmed data on the negative effects of MS on the growth and development of fetuses and the positive effects of MS DMD treatment in mothers at different periods on anthropometric indicators and child development during the first year of life. These results lead to the conclusion that MS DMD have positive effects not only on the course of illness and the patient herself, but also potentially improve prognoses for future offspring.



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Expression of mGluR2/3 Metabotropic Glutamate Receptors in the Ventrolateral Part of the Solitary Tract Nucleus in Rats During the Early Postnatal Period in Health and in Prenatal Serotonin Deficiency

Objective. to study the dynamics of the expression of mGluR2/3 metabotropic receptors in the ventral and lateral respiratory subnuclei of the solitary tract nucleus (STN) in the early postnatal period in health and after prenatal serotonin deficiency in rats. Materials and methods. Studies were performed on Wistar laboratory rats (n = 19). Tryptophan hydroxylase was inhibited using parachlorophenylalanine. The ventral and lateral respiratory subnuclei of the STN were studied on days 5, 10, and 20. An immunohistochemical method was used to study the distribution of mGluR2 and mGluR3 metabotropic receptors (mGluR2/3). Results. During the first postnatal week, both subnuclei showed high levels of mGluR2/3 expression. During the second week, there was a sharp reduction in mGluR2/3 expression, followed by an increase by the end of the third week. Decreases in serotonin content during the prenatal period affected the intensity of mGluR2/3 expression in both subnuclei of the STN. During the early postnatal period, there was a significant reduction (more than two-fold) in the expression of mGluR2/3 expression at all time pints, this being more marked in the ventral subnucleus. Conclusions. Changes in the level of expression of mGluR2/3 metabotropic glutamate receptors during the early postnatal period occurred in the ventrolateral part of the STN. Serotonin deficiency led to a sharp reduction in the expression of mGluR2/3 receptors in the respiratory subnuclei during the early postnatal period.



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Glutamine Synthetase in Rat Brain Cells

Objective. To use an immunohistochemical method to study glutamine synthetase (GS)-synthesizing brain cells. Materials and methods. Enzyme was detected on frontal rat brain sections (n = 10) using mouse monoclonal antibodies. Specimens were analyzed by light and confocal laser microscopy. Results. GS was found to be expressed in all areas of the brain, mainly by two types of cells, with different structures and topographies. The main type of cell with immunopositive reactions to glial fibrillary acidic protein were identical to astrocytes. The other structural and locational type of cell differed from typical astrocytes. Conclusions. The data obtained here provide evidence that GS is not a selective marker for any particular population of rat brain cells.



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Effects of Nothrombel on Thrombin-Induced Formation of Thrombocyte-Leukocyte Complexes

The effects of Nothrombel on the thrombin-induced formation of thrombocyte-leukocyte complexes (TLC) were studied. Nothrombel was found to produce dose-dependent inhibition of TLC formation. Its activity was greater than that of reference drug aspirin. The 50% inhibition constant (EC50) of Nothrombel was 1.75 μmol/ml, compared with greater than 1.75 μmol/ml for aspirin. The mechanism of inhibition of TLC formation by Nothrombel relates to the ability of this drug to suppress the expression of P-selectin by thrombocytes and the membrane complex GPIb-IX-V on membranes and the mobilization of cytoplasmic calcium in thrombocytes, and, evidently, an inhibitory action on the P2Y12 purine receptors of thrombocytes.



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Bioelectrical Activity in the Sleep–Waking Cycle in Rats after Pilocarpine-Induced Status Epilepticus

Chronic recording of electrograms of the somatosensory, auditory, and visual cortex, the hippocampus, and the caudate nucleus in Krushinskii–Molodkina and Wistar rats was used to study bioelectrical activity in the sleep–waking cycle during the month following pilocarpine-induced status epilepticus. The processes of normalization of behavior and the organization of sleep and waking were completed in animals over the three days following status epilepticus. From day 2 to day 4 after administration of pilocarpine, electrograms of the study structures in all rats at all stages of the sleep–waking cycle showed epileptiform activity in the form of sharp waves, multiple peaks, and peak-wave discharges. Interhemisphere asymmetry in the manifestations of paroxysmal activity was seen in some cases. Spontaneous epileptiform activity on the EEG, in the form of single or grouped peak-wave discharges, was recorded in rats only on the background of waking and slow-wave sleep. The simultaneous presence of different types of epileptiform activity on EEG patterns and the duration of paroxysms on the EEG during the post-status period indicated that exposure to pilocarpine can induce the formation of multiple foci of epileptogenesis in the rat brain, with production of stable paroxysmal syndrome, which has clear similarity with the clinical picture of nonconvulsive status epilepticus in humans.



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A Comparative Placebo-Controlled Clinical Trial of the Efficacy and Safety of Interferon β-1a Formulations for S.C. Administration in Patients with Remitting Multiple Sclerosis: First-Year Results

Objectives. To demonstrate equivalence of the efficacies of the drugs Teberif (BCD-033, interferon β-1a) and Rebif (interferon β-1a) in patients with remitting multiple sclerosis (RMS). Materials and methods. A multicenter, double-blind, placebo-controlled, comparative, randomized phase III trial included 163 patients with diagnoses of MS. Patients were randomized to the Teberif, Rebif, and placebo groups at a ratio of 1:1:1. Results and conclusions. Analysis of efficacy after 52 weeks of the trial demonstrated equivalence between the study drug Teberif and the original formulation Rebif in patients with RMS. Evaluation of primary endpoint results – CUA (combined unique active lesions, i.e., the total number of MRI T1 plaques and new T2 plaques or cases of increases in T2 plaques without double counting) – demonstrated that there were no significant differences (0.727 ± 1.042 and 0.652 ± 1.059, p = 0.7354, Student's t test) between the Teberif and Rebif groups. There were no statistically significant between-group differences in other MRI indicators or measures associated with exacerbations. The safety profile and tolerance of Teberif were satisfactory and comparable with the safety and tolerance profile of Rebif. These data provide evidence of therapeutic equivalence of these drugs, which may provide grounds for the use of the interferon β-1a bioanalog in patients with RMS.



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A Weakened Geomagnetic Field: Effects on Genomic Transcriptiln Activity, Learning, and Memory in Drosophila Melanogaster

Neurodegenerative diseases result from a complex interaction between unfavorable environmental factors and the individual characteristics of the genome which predispose to disease development. Drosophila provides a suitable system for studies of the relationship between genomic organization and chromosomal architecture producing cognitive impairments. We present here the results of complex investigations of the effects of attenuation of the geomagnetic field (by screening) on genomic transcriptional activity, learning ability, and the formation of intermediate-term memory in Drosophila melanogaster. In this stress, a relationship was seen between modifications to transcriptional activity and the structure of the LIMK1 gene – a key enzyme in the actin remodeling cascade. Impairments to intermediate-term memory were seen on exposure to a weak static magnetic field in Canton-S wild-type flies. Conversely, this same stress restored learning ability and memory formation in agnts3 mutants.



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Roles of Rational and Irrational Cognitive Styles in the Reactivity of the α Rhythm in Convergent and Divergent Thinking

The roles of the rational and irrational cognitive styles in changes in the α1 and α2 rhythms were studied in convergent (mental addition) and divergent (heuristic task solving) thinking. Changes in the functional activity of the cerebral cortex in convergent thinking were found to be associated with the extent of the rational cognitive style and affected the reactivity of the low-frequency α1 rhythm mainly in the parietal area of the cortex, while in divergent thinking changes were linked with the irrational style and were present in the posterior areas of the cortex in the wide α1/α2 frequency range. When intuition was dominant, more original solutions to problems corresponded to desynchronization of α biopotentials in the posterior parts of the cortex, while low levels of intuition were associated with synchronization.



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Fluoroquinolone Resistance Mechanisms in Shigella Isolates in Shanghai, China Between 2010 and 2015

Microbial Drug Resistance, Ahead of Print.


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Outcomes of first-line endoscopic management for patients with sigmoid volvulus

Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery.

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Pre-surgery age-adjusted Charlson Comorbidity Index is associated with worse outcomes in acute cholecystitis

Beneficial effects of cholecystectomy in acute cholecystitis (AC) might be weakened by complications. The age-adjusted Charlson Comorbidity Index (CCI) assesses disease relevance in the prediction of one-year mortality.

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Examining the most important and current EMS trends

Our co-hosts are joined by EMS1 columnist and co-founder Kris Kaull to discuss his "30 things in 30 minutes" conference presentation

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Examining the most important and current EMS trends

Our co-hosts are joined by EMS1 columnist and co-founder Kris Kaull to discuss his "30 things in 30 minutes" conference presentation

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A null variant in PUS3 confirms its involvement in intellectual disability and further delineates the associated neurodevelopmental disease

Clinical Genetics, EarlyView.


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Sternal Injuries in Sport: A Review of the Literature

Abstract

Sternal fractures were first described in published literature in the 19th century as a complication of traumatic injury. Though sternal fracture and other sternal injuries have been described in trauma literature, there remains a paucity of literature with regards to sternal injury in sport. Sternal injury may include disruption at the body, manubrium and xiphoid process, or at associated sternoclavicular, manubriosternal, and xiphisternal joints. In the athlete it is imperative to evaluate sternal injury with consideration of potentially devastating cardiothoracic complications. Return-to-play protocols should be individualized, taking into account subjective history, objective physical examination and diagnostics, current clinical guidelines, and individual sport-specific considerations. The literature regarding sternal injury is reviewed, with emphasis on sport-specific pathology, management, and return to play.



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Gold Cross EMS improves safety for patients and medics

AUGUSTA, Ga. — Gold Cross EMS is the first emergency medical service department in the state of Georgia to add the world's first Integrated Patient Transport and Loading System™, the iNʃX®, to their fleet. The iNʃX was developed by FERNO to eliminate lifting during patient transport, enhancing caregiver and patient safety. EMS is one of the most injurious occupations....

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Keep these 2 tips in mind for a successful public access defibrillation program

Cardiac arrest is the third leading cause of death, but it can be stopped with more AED interventions

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International Standardization of the Test of Masticating and Swallowing Solids in Children (TOMASS‐C)

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Orofacial Pain Assessment and Management for Patients with Dementia: A Meta‐Ethnography

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Alleviation of acute dental pain from localized apical periodontitis: a prospective randomized study comparing two emergency treatment procedures

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Influence of lower complete denture use on masseter muscles and masticatory function: a longitudinal study

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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ZFN, TALEN and CRISPR-Cas9 mediated homology directed gene insertion in Arabidopsis: a disconnect between somatic and germinal cells

Publication date: Available online 10 October 2018

Source: Journal of Genetics and Genomics

Author(s): Qiwei Shan, Nicholas J. Baltes, Paul Atkins, Elida R. Kirkland, Yong Zhang, Joshua A. Baller, Levi G. Lowder, Aimee A. Malzahn, John C. Haugner, Burckhard Seelig, Daniel F. Voytas, Yiping Qi



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Regulation of ATM and ATR by SMARCAL1 and BRG1

Publication date: Available online 11 October 2018

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Ramesh Sethy, Radhakrishnan Rakesh, Ketki Patne, Vijendra Arya, Tapan Sharma, Dominic Thangminlen Haokip, Reshma Kumari, Rohini Muthuswami

Abstract

The G2/M checkpoint is activated on DNA damage by the ATM and ATR kinases that are regulated by post-translational modifications. In this paper, the transcriptional co-regulation of ATM and ATR by SMARCAL1 and BRG1, both members of the ATP-dependent chromatin remodeling protein family, is described. SMARCAL1 and BRG1 co-localize on the promoters of ATM and ATR; downregulation of SMARCAL1 and BRG1 results in transcriptional repression of ATM/ATR and overriding of the G2/M checkpoint leading to mitotic abnormalities. On doxorubicin-induced DNA damage, SMARCAL1 and BRG1 are upregulated and these two proteins in turn, upregulate the expression of ATM/ATR. The transcriptional response to DNA damage is feedback regulated by phospho-ATM as it binds to the promoters of SMARCAL1, BRG1, ATM and ATR on DNA damage. The regulation of ATM/ATR is rendered non-functional in Schimke Immuno-Osseous Dysplasia where SMARCAL1 is mutated and in Coffin-Siris Syndrome where BRG1 is mutated. Thus, an intricate transcriptional regulation of DNA damage response genes mediated by SMARCAL1 and BRG1 is present in mammalian cells.



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Immediate effects of transcutaneous electrical nerve stimulation on pain and physical performance in individuals with pre-radiographic knee osteoarthritis: a randomized controlled trial

Publication date: Available online 11 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Kanako Shimoura, Hirotaka Iijima, Yusuke Suzuki, Tomoki Aoyama

Abstract
Objective

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and comprehensive physical function in pre-radiographic knee osteoarthritis.

Design

A single, participant-blinded, randomized controlled trial with pre-post design

Setting

University research laboratory

Participants

Patients with knee pain belonging to Kellgren–Lawrence grade 0 or 1 (n = 50; aged 50–69 years) were randomly assigned to the TENS (n = 25) and sham-TENS groups (n = 25).

Interventions

All participants wore the TENS device under the patella of the symptomatic knee. After measurement, the TENS devices in the TENS group were turned on, and those in the sham-TENS group were not connected.

Main Outcome Measures

The primary outcome measures included the stair climb test, timed up and go (TUG) test, 6-minute walk test (6MWT), and knee pain evaluated using the visual analog scale (VAS) for stair climb test, TUG test, and 6MWT. Secondary outcomes included knee extensor strengths and the two-step test and stand-up test from the locomotive syndrome risk test.

Results

Multiple regression analysis revealed that TENS intervention significantly improved the walk distance and VAS score of the 6MWT, after adjusting for pre-measurement data (distance; p = 0.015, VAS; p = 0.030).ain and the distance walked in

Conclusions

Use of TENS improved the VAS score for p the 6MWT for individuals with Kellgren–Lawrence grade 0 or 1 of the knee. Thus, TENS may be effective for long-distance walking in patients with pre-radiographic knee osteoarthritis.



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Muscle activity pattern dysfunction during sit to stand and stand to sit in the movement system impairment subgroups of low back pain

Publication date: Available online 11 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Neda orakifar, Mohammad Jafar Shaterzadeh-Yazdi, Reza Salehi, Mohammad Mehravar, Neda Namnik

Abstract
Objective

To investigate impairment in the activity pattern of some muscles involved in sit to stand (STD) and stand to sit (STS) among two low back pain (LBP) subgroups of the Movement System Impairment (MSI) model.

Design

Case-control study

Setting

A university medical center

Participants

Fifteen healthy women and twenty-two women with chronic LBP in two subgroups (fifteen into the lumbar extension rotation (LER) and seven into lumbar flexion rotation (LFR)) voluntarily participated in this study.

Interventions

Participants were asked to perform STD and STS at a preferred speed. Surface electromyography (EMG) were measured bilaterally from the internal oblique (IO), lumbar erector spine (ES), medial hamstring (MH) and lateral hamstring (LH) muscles.

Main Outcome Measures

Changes in mean and maximum amplitude, time to peak amplitude, duration of muscle activity and bilateral asymmetry of these variables.

Results

During STD, bilateral asymmetry in mean amplitude of MH in the LER subgroup (p=0.031) and bilateral asymmetry in duration of LH in the LFR subgroup(p=0.026) were exhibited. Also, in this task reduced time to peak left MH activation were found in the LFR subgroup than two other groups (control; p=0.028 / LER; p=0.004). During STS, increased left ES maximum amplitude were observed in the LFR subgroup than LER subgroup (p=0.029). Also, reduced time to peak right ES (p=0.035) and left LH (p=0.038) activation in the LER subgroup than healthy subjects and reduced time to peak left LH activation in LFR subgroup than healthy subjects (p=0.041) were observed during STS.

Conclusions

The differences between the two LBP subgroups may be a result of impairment in the activity pattern of some muscles during functional activity.



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Propofol pharmacokinetic and pharmacodynamic profile and its electroencephalographic interaction with remifentanil in children

Pediatric Anesthesia, EarlyView.


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Correction to: Considerations in the Use of Body Mass Change to Estimate Change in Hydration Status During a 161-Kilometer Ultramarathon Running Competition

In Table 2 of the original publication, an error was made in the calculations for endogenous substrate oxidation which, subsequently, altered the values for total change in body mass.



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Circulating inflammatory markers and colorectal cancer risk: A prospective case-cohort study in Japan

International Journal of Cancer

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Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: A double-blind prospective, randomised study

BACKGROUND Cleft defects are common craniofacial malformations which require early surgical repair. These patients are at high risk of postoperative airway obstruction and respiratory failure. Cleft surgery may require high doses of opioids which may contribute to these complications. OBJECTIVES To compare the effectiveness of proximal and distal approaches to blocking the maxillary nerve in patients undergoing cleft lip or cleft palate surgery. DESIGN Randomised, controlled and double-blind study. SETTING The current study was carried out in Guwahati (Assam, India) between April 2014 and June 2014. PATIENTS A total of 114 patients older than 6 months who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included coagulation disorders, peripheral neuropathy or chronic pain syndrome, infection in the puncture site, allergy to local anaesthetics, lack of consent and language problems or other barriers that could impede the assessment of postoperative pain. INTERVENTIONS Patients were randomly assigned to one of two groups: proximal group (bilateral suprazygomatic maxillary nerve blocks) and distal group (bilateral infraorbital nerve blocks for cleft lip repair and bilateral greater and lesser palatine nerve blocks and nasopalatine nerve block for cleft palate surgery). MAIN OUTCOME MEASURE The primary endpoint was the percentage of patients requiring extra doses of opioids. Secondary endpoints included pain scores, respiratory and nerve block-related complications during the first 24 h. RESULTS In the intra-operative period, there was a significant reduction of nalbuphine consumption in the proximal group (9.1 vs. 25.4%, P = 0.02). The percentage of patients requiring intra-operative fentanyl was lower in the proximal group (16.4 vs. 30.5%, P = 0.07). There were no differences in either postoperative pain scores or in postoperative complications. No technical failure or block-related complications were reported. CONCLUSION Bilateral suprazygomatic maxillary nerve block is an effective and safe alternative to the traditional peripheral nerve blocks for cleft lip and cleft palate surgery, in a mixed paediatric and adult population. Correspondence to Gaston Echaniz, Department of Anesthesiology, Vall d'Hebron Hospital, Department of Surgery, Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron, 119-129, Barcelona 08035, Spain. E-mail: grcechaniz@vhebron.net Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Measurement of forces applied using a Macintosh direct laryngoscope compared with a Glidescope video laryngoscope in patients with predictors of difficult laryngoscopy: A randomised controlled trial

BACKGROUND In patients with predictive features associated with easy direct laryngoscopy, videolaryngoscoy with the GlideScope has been shown to require less force when compared with Macintosh direct laryngoscopy. OBJECTIVE The aim of this study was to compare forces applied with Glidescope vs. Macintosh laryngoscopes in patients with predictive features associated with difficult direct laryngoscopy. DESIGN A prospective randomised study. SETTING Toronto General Hospital, a university tertiary centre in Canada. PATIENTS Forty-four patients aged over 18 years, with one or more features of difficult intubation, undergoing elective surgery requiring single-lumen tracheal intubation. INTERVENTION We measured the force applied to oropharyngeal tissues by attaching three FlexiForce Sensors (A201-25) to the concave surface of Macintosh and GlideScope laryngoscope blades. Anaesthetists or experienced anaesthesia residents performed laryngoscopies with both devices in a randomised sequence. MAIN OUTCOME MEASURES The primary outcome was peak force. The secondary outcomes were average force and impulse force. The latter is the integral of the force over the time during which the force acted. RESULTS Complete data were available for 40 individuals. Peak and average forces decreased with GlideScope (17 vs. 21 N, P = 0.03, and 6 vs. 11 N, P 

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Modified ROTEM for the detection of rivaroxaban and apixaban anticoagulant activity in whole blood

BACKGROUND Rapid detection of the anticoagulant effect of oral factor Xa (FXa) inhibitors may be essential in several emergency clinical situations. Specific assays quantifying the drugs are performed in plasma and require a turnaround time that is too long to be useful in emergency situations. Rotational thromboelastometry (ROTEM) is a whole blood coagulation assay of blood viscoelasticity and could be of interest for FXa inhibitor detection in emergency. However, conventional ROTEM reagents only detect high amounts of inhibitors. OBJECTIVE The aim of this study was first to assess the effect of whole blood components on the viscoelastic measurement of the effects of FXa inhibitors, an second to evaluate whether a modified ROTEM, triggered with a low amount of tissue factor and a saturating amount of phospholipid vesicles, can reliably detect low levels of FXa inhibitor activity in whole blood. DESIGN Diagnostic test study. SETTINGS A university research laboratory. From November 2014 to April 2016. PATIENTS Sixty-six patients: 30 treated with rivaroxaban, 17 with apixaban and 19 without treatment. INTERVENTION ROTEM was triggered with 2.5 pmol l−1 of tissue factor and 10 μmol l−1 of phospholipid vesicles. MAIN OUTCOME MEASURES Modified ROTEM parameters were measured in different experimental conditions: platelet-poor plasma (PPP), platelet-rich plasma, PPP supplemented with fibrinogen and reconstituted whole blood with various haematocrit levels adjusted between 30 and 60%. Modified ROTEM was further validated using whole blood from patients who were either treated or not treated with FXa inhibitors. RESULTS Modified ROTEM allowed detection of as little as 25 ng ml−1 FXa inhibitors in PPP, with at least a 1.4-fold increase of the clotting time (P ≤ 0.02). Neither changes of fibrinogen concentration nor variations of platelet count or haematocrit precluded FXa inhibitor detection. A lengthened modified ROTEM clotting time of more than 197 s allowed detection of FXa inhibitor concentrations above 30 ng ml−1 in whole blood with 90% sensitivity and 85% specificity. CONCLUSION Modified ROTEM may be applicable in emergency situations for the detection of FXa inhibitors in whole blood. Correspondence to Charles M. Samama, MD, PhD, FCCP, Department of Anaesthesia and Intensive Care Medicine, Cochin University Hospital, 27 rue du Faubourg St Jacques, 75014 Paris, France Tel: +33 1 42 34 85 51/+33 6 62 14 86 64; fax: +33 1 58 41 14 15; e-mail: marc.samama@aphp.fr Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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High-Pressure Tactic: Colonic Manometry in Chronic Constipation



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Heavy Coffee Consumption and Risk of Pancreatitis: A Systematic Review and Meta-Analysis

Abstract

Background/Objectives

Heavy consumption of coffee may have a protective effect against pancreatitis although results from previous studies were inconsistent. This meta-analysis was conducted with the aim to summarize all available data.

Methods

This meta-analysis included observational studies that compared the risk of pancreatitis between heavy coffee-drinkers and individuals who were not heavy coffee-drinkers. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.

Results

Out of 219 retrieved articles, four studies with 351,137 participants met the eligibility criteria and were included in the analysis. The risk of pancreatitis among heavy coffee-drinkers was significantly lower than individuals who were not heavy coffee-drinkers with the pooled RR of 0.78 (95% CI 0.67–0.91). The statistical heterogeneity between the studies was insignificant (I2 = 0%).

Conclusions

This meta-analysis demonstrated a significantly decreased risk of pancreatitis among heavy coffee-drinkers. However, further investigations are still required to determine causality and potential clinical application.



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Duodenitis, Diarrhea, and Death in a Patient with AIDS



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Perianal Extramammary Paget’s Disease: More Than Meets the Eye



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CEGP-003 Spray Has a Similar Hemostatic Effect to Epinephrine Injection in Cases of Acute Upper Gastrointestinal Bleeding

Abstract

Background

Endoscopically applicable hemostatic agents have been demonstrated to have high initial hemostasis rates in cases of upper gastrointestinal bleeding (UGIB).

Aims

The authors developed a new hemostatic powder (CEGP-003) and evaluated its hemostatic and ulcer healing effects in UGIB.

Methods

Patients with peptic ulcer or post-endoscopic resection bleeding were randomly assigned to be treated by epinephrine injection or CEGP-003 spray. All patients were placed under observation for 3 days and underwent second-look endoscopy. The primary outcome was initial hemostasis rate, and the secondary outcomes were rebleeding rate and ulcer healing effect.

Results

Seventy-two patients with UGIB were enrolled in this study. Causes of bleeding were peptic ulcer (15, 20.5%), post-endoscopic mucosal resection (11, 15.1%), and post-endoscopic submucosal dissection bleeding (47, 64.4%). Initial hemostasis was achieved in 89.2% (34/37) of patients in the epinephrine group and in 100% (35/35) in the CEGP-003 group (p = 0.115). Rebleeding occurred in 2.7% (1/37) and 8.6% (3/35) in the epinephrine and CEGP-003 groups, respectively (p = 0.35). Three days after endoscopic hemostasis, the ulcer healing effects of epinephrine and CEGP-003 were similar (p = 0.79).

Conclusion

This study shows that CEGP-003 spray has a hemostatic effect similar to epinephrine in terms of initial hemostasis and rebleeding rates. The authors consider CEGP-003 a potential therapeutic tool for UGIB as a definitive or bridge therapy and that it is particularly useful for oozing lesions after endoscopic resection.



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Cecal Insertion Time and the ADR: Patience Is Good for Patients



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Post-ERCP Complications in Dialysis Patients: Cutting One’s Losses or Expanding Possibilities?



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Simple Vascular Architecture Classification in Predicting Pancreatic Neuroendocrine Tumor Grade and Prognosis

Abstract

Background and Aim

Vascularity is a critical feature in the evaluation of pancreatic neuroendocrine tumor (PNET). When done by EUS, contrast agents are recommended. However, vascular architecture (VA) can also be evaluated by routine Doppler flow in EUS without contrast agents. Our aim was to provide a simple VA classification in EUS for PNET grade and prognosis.

Methods

All pathologically proven PNET cases with EUS between 2012 and 2018 were retrospectively analyzed. The Doppler imaging was retrieved for VA classification. Predictive model construction was performed by machine learning algorithms.

Results

A total of 112 PNET cases were evaluated, among which 93 cases were subjected to VA classification. The VA was classified into type A (peritumoral with or without intratumoral vessels [A1 or A2]); type B (only intratumoral vessels); and type C (flow was absent). The VA classification was significantly correlated with tumor grades: 74% type A1 was G1, 73% type B was G2, and 58% type C was G3. Multivariate analysis indicated that elevated serum CA19-9 and type C classification were the independent predictors of G3 tumor. Five machine learning models were constructed, among which random forest was the best one with an AUC of 0.9972. Low-risk patients classified by this model exhibited better prognosis than high-risk patients (p = 0.0087).

Conclusions

In the novel simple VA classification, peritumoral, intratumoral, and absent vessels are prone to be G1, G2, and G3, respectively. Combined with serum CA19-9 and lesion size, the VA classification could predict tumor grade and prognosis in PNET.



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Outcomes of Chronic Pancreatitis in the Emergency Department

Abstract

Objectives

Chronic pancreatitis (CP) is a debilitating chronic illness. We sought to assess the most common reasons patients with CP visit the Emergency Department (ED), the disposition of ED visit [admission, discharge, death], and evaluate predictors of admission and discharge.

Methods

Within the Health Care Utilization Project Nationwide Emergency Department Sample (NEDS), we focused on patients, 18 years and older, presenting to the emergency department with CP (ICD-9 code 577.1) (2006–2009). Model was fitted to predict the likelihood of admission.

Results

Overall, a weighted sample of 638,310 patients visits for CP were identified, of which 399,559 (62.6%) were admitted, 228,523 (35.8%) were discharged from the ED, 5572 (0.9%) discharged against medical advice, and 4656 (0.7%) had an unknown destination. Of those admitted, 4370 (0.7%) died during the hospital episode. The most associated diagnoses for ED visit were diabetes (28.8%), abdominal pain (25.4%), acute pancreatitis (22.5%), cardiac complication (11.1%), infection (10.1%), and dehydration (8.8%). Multivariable analyses revealed that older (OR = 1.02 P < 0.001), sicker patients (Charlson Comorbidity Index ≥ 3, OR = 2.28 P < 0.001), patients presenting with C. difficile colitis (OR = 23.85 P < 0.001), alcohol withdrawal (OR = 6.71 P < 0.001), and acute pancreatitis (OR = 6.46 P < 0.001) were associated with increased odds of hospitalization.

Conclusions

In this national database, our study demonstrates that diabetes, followed by abdominal pain, acute pancreatitis and cardiac complication, were the most common diagnoses associated with ED visits in patients with chronic pancreatitis. Most patients were admitted following the ED visit. Although C. Difficile colitis was a rare associated diagnosis with an ED visit, it was the strongest predictor of admission.



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Changes in iron metabolism during prolonged repeated walking exercise in middle-aged men and women

Abstract

Purpose

The aim of the present study was to assess the effect of prolonged and repeated exercise on iron metabolism in middle-aged adults and to compare differences between sexes.

Methods

50 male (58.9 ± 9.9 year) and 48 female (50.9 ± 11.2 year) individuals were monitored on 4 consecutive days at which they walked on average 8 h and 44 min per day at a self-determined pace. Blood samples were collected 1 or 2 days prior to the start of the exercise (baseline) and every day immediately post-exercise. Samples were analysed for iron, ferritin, haemoglobin, and haptoglobin concentrations.

Results

Plasma iron decreased across days, while ferritin increased across days (both p < 0.001). Haptoglobin showed a decrease (p < 0.001) after the first day and increased over subsequent days (p < 0.001). Haemoglobin did not change after the first day, but increased during subsequent days (p < 0.05). At baseline, 8% of the participants had iron concentrations below minimum reference value (10 µmol/L), this increased to 43% at day 4. There was an interaction between sex and exercise days on iron (p = 0.028), ferritin (p < 0.001) and haemoglobin levels (p = 0.004), but not on haptoglobin levels.

Conclusion

This study showed decreases in iron, increases in ferritin, a decrease followed by increases in haptoglobin and no change followed by increases in haemoglobin. This is most likely explained by (foot strike) haemolysis, inflammation, and sweat and urine losses. These processes resulted in iron levels below minimum reference value in a large number of our participants.



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Effect of 1-week betalain-rich beetroot concentrate supplementation on cycling performance and select physiological parameters

Abstract

Purpose

Betalains are indole-derived pigments found in beet root, and recent studies suggest that they may exert ergogenic effects. Herein, we examined if supplementation for 7 days with betalain-rich beetroot concentrate (BLN) improved cycling performance or altered hemodynamic and serum analytes prior to, during and following a cycling time trial (TT).

Methods

Twenty-eight trained male cyclists (29 ± 10 years, 77.3 ± 13.3 kg, and 3.03 ± 0.62 W/kg) performed a counterbalanced crossover study whereby BLN (100 mg/day) or placebo (PLA) supplementation occurred over 7 days with a 1-week washout between conditions. On the morning of day seven of each supplementation condition, participants consumed one final serving of BLN or PLA and performed a 30-min cycling TT with concurrent assessment of several physiological variables and blood markers.

Results

BLN supplementation improved average absolute power compared to PLA (231.6 ± 36.2 vs. 225.3 ± 35.8 W, p = 0.050, d = 0.02). Average relative power, distance traveled, blood parameters (e.g., pH, lactate, glucose, NOx) and inflammatory markers (e.g., IL-6, IL-8, IL-10, TNFα) were not significantly different between conditions. BLN supplementation significantly improved exercise efficiency (W/ml/kg/min) in the last 5 min of the TT compared to PLA (p = 0.029, d = 0.45). Brachial artery blood flow in the BLN condition, immediately post-exercise, tended to be greater compared to PLA (p = 0.065, d = 0.32).

Conclusions

We report that 7 days of BLN supplementation modestly improves 30-min TT power output, exercise efficiency as well as post-exercise blood flow without increasing plasma NOx levels or altering blood markers of inflammation, oxidative stress, and/or hematopoiesis.



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Mental fatigue does not alter performance or neuromuscular fatigue development during self-paced exercise in recreationally trained cyclists

Abstract

Purpose

The purpose of this study was to investigate the effects of mental fatigue, characterized by a subjective feeling of tiredness, on the development of neuromuscular fatigue during a 4-km cycling time trial (4-km TT).

Methods

Eight recreationally trained male cyclists performed a 4-km TT after either performing a prolonged cognitive task (mental fatigue) or after viewing emotionally neutral documentaries (control). The neuromuscular function of the knee extensors was assessed using electrical nerve stimulation at baseline, before (pre-TT), and after (post-TT) the 4-km TT. Rating of perceived exertion (RPE) and physiological variables were periodically measured during 4-km TT.

Results

Subjective ratings of fatigue increased significantly only after a prolonged cognitive task (P = 0.022). Neuromuscular function at baseline was similar between conditions and remained unchanged at pre-TT. Time to complete the 4-km TT was similar between control (376 ± 27 s) and mental fatigue (376 ± 26 s). There was no significant difference between conditions for RPE, \(~\dot {V}_2}\) , \(\dot {V}{\text{E}}\) , and HR throughout the exercise. The 4-km TT-induced similar decrease (from baseline to post-TT) in maximal voluntary contraction (mental fatigue − 11 ± 10%, control − 16 ± 12%), twitch force (mental fatigue − 26 ± 16%, control − 24 ± 17%), and voluntary activation (mental fatigue − 5 ± 7%, control − 3 ± 2%) for both conditions.

Conclusion

Mental fatigue induced by prolonged cognitive task does not impair performance nor alter the degree of central and peripheral fatigue development during self-paced exercise in recreationally trained cyclists.



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Pulsatile interaction between the macro-vasculature and micro-vasculature: proof-of-concept among patients with type 2 diabetes

Abstract

Purpose

It is widely thought that excess pulsatile pressure from increased stiffness of large central arteries (macro-vasculature) is transmitted to capillary networks (micro-vasculature) and causes target organ damage. However, this hypothesis has never been tested. We sought to examine the association between macro- and micro-vasculature waveform features in patients with type 2 diabetes (i.e., those with elevated stiffness; T2D) compared with non-diabetic controls.

Methods

Among 13 T2D (68 ± 6 years, 39% male) and 15 controls (58 ± 11 years, 40% male) macro-vascular stiffness was determined via aortic pulse wave velocity (aPWV) and macro-vascular waveforms were measured using radial tonometry. Forearm micro-vascular waveforms were measured simultaneously with macro-vascular waveforms via low power laser Doppler fluxmetry. Augmentation index (AIx) was derived on macro- and micro-vascular waveforms. Target organ damage was assessed by estimated glomerular filtration rate (eGFR) and central retinal artery equivalent (CRAE).

Results

aPWV was higher among T2D (9.3 ± 2.5 vs 7.5 ± 1.4 m/s, p = 0.046). There was an obvious pulsatile micro-vascular waveform with qualitative features similar to macro-vasculature pressure waveforms. In all subjects, macro- and micro-vasculature AIx were significantly related (r = 0.43, p = 0.005). In T2D alone, micro-vasculature AIx was associated with eGFR (r = − 0.63, p = 0.037), whereas in controls, macro-vasculature AIx and AP were associated with CRAE (r = − 0.58, p = 0.025 and r = − 0.61, p = 0.015).

Conclusions

Macro- and micro-vasculature waveform features are related; however, micro-vasculature features are more closely related to markers of target organ damage in T2D. These findings are suggestive of a possible interaction between the macro- and micro-circulation.



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Delayed muscle onset soreness in the gastrocnemius muscle attenuates the spinal contribution to interlimb communication

Abstract

Purpose

Delayed onset muscle soreness (DOMS) has been shown to induce changes in muscle activity during walking. The aim of this study was to elucidate whether DOMS also affects interlimb communication during walking by investigating its effect on short-latency crossed responses (SLCRs).

Methods

SLCRs were elicited in two recording sessions by electrically stimulating the tibial nerve of the ipsilateral leg, and quantified in the contralateral gastrocnemius muscle. The second recording session occurred 24–36 h after the participants (n = 11) performed eccentric exercises with the ipsilateral calf.

Results

DOMS caused a decreased magnitude of the spinally mediated component of the SLCR in the contralateral gastrocnemius medialis.

Conclusions

The results of the current study provide insight on the relationship between pain and motor control. Muscle pain affects the spinal pathway mediating interlimb communication, which might result in a reduced ability to maintain dynamical stability during walking.



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Cerebral oxygenation declines but does not impair peak oxygen uptake during incremental cycling in women using oral contraceptives

Abstract

Purpose

To compare prefrontal cortex oxygenation in recreationally-active women using oral contraceptives (WomenOC; n = 8) to women with a natural menstrual cycle (WomenNC; n = 8) during incremental exercise to exhaustion.

Methods

Participants performed incremental cycling to exhaustion to determine lactate threshold 1 (LT1) and 2 (LT2) and peak oxygen uptake (VO2peak). Prefrontal cortex oxygenation was monitored via near-infrared spectroscopy through concentration changes in oxy-haemoglobin (Δ[HbO2]), deoxy-haemoglobin (Δ[HHb]), total-haemoglobin (Δ[tHb]) and tissue saturation index (TSI).

Results

17β-oestradiol and progesterone were lower in WomenOC (35 ± 26; 318 ± 127 pmol·L−1, respectively) than WomenNC (261 ± 156; 858 ± 541 pmol·L−1, respectively). There were no differences in full blood examination results or serum nitric oxide (p > 0.05). However, WomenOC presented lower concentrations in ferric-reducing ability of plasma (− 8%; effect size; ES − 0.52 ± 0.61), bilirubin (− 32%; ES − 0.56 ± 0.62) and uric acid (− 17%; ES − 0.53 ± 0.61). Cardiopulmonary parameters were similar between groups during cycling, including VO2peak (p = 0.99). While there was a significant effect of time on all parameters measured by near-infrared spectroscopy during incremental cycling, there was no effect of OC at LT1, LT2 or exhaustion calculated as a change from baseline (TSI; p = 0.096, Δ[HbO2]; p = 0.143, Δ[HHb]; p = 0.085 and Δ[tHb]; p = 0.226). The change in TSI from LT1 to LT2 was significantly different between groups (WomenNC; mean difference + 2.06%, WomenOC; mean difference − 1.73%; p = 0.003).

Conclusion

Prefrontal tissue oxygenation declined at a lower relative exercise intensity in WomenOC as compared to WomenNC, however, this did not influence VO2peak. The results provide the first evidence for variance in the cerebral oxygenation response to exercise, which may be associated with female sex hormones.



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A multiscale model for the simulation of cerebral and extracerebral blood flows and pressures in humans

Abstract

Purpose

Brain hemodynamics is fundamental for the functioning of the human being. Many biophysical factors affect brain circulation, so that a satisfactory understanding of its behavior is challenging. We developed a mathematical model to simulate cerebral and extracerebral flows and pressures in humans.

Methods

The model is composed of an anatomically informed 1-D arterial network, and two 0-D networks of the cerebral circulation and brain drainage, respectively. It takes into account the pulse-wave transmission properties of the 55 main arteries and the main hydraulic and autoregulation mechanisms ensuring blood supply and drainage to the brain. Proper pressure outputs from the arterial 1-D model are used as input to the 0-D models, together with the contribution to venous pressure due to breathing that simulates the drainage effect of the thoracic pump.

Results

The model we developed is able to link the arterial tree with the venous pathways devoted to the brain drainage, and to simulate important factors affecting cerebral circulation both for physiological and pathological conditions, such as breathing and hypo/hypercapnia. Finally, the average value of simulated flows and pressures is in agreement with the available experimental data.

Conclusions

The model has the potential to predict important clinical parameters before and after physiological and/or pathological changes.



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Effects of endurance cycling training on neuromuscular fatigue in healthy active men. Part II: Corticospinal excitability and voluntary activation

Abstract

This study investigated the effects of 9-week endurance cycling training on central fatigability and corticomotor excitability of the locomotor muscles. Fourteen healthy participants undertook three incremental fatiguing cycling tests to volitional exhaustion (EXH): (i) before training (PRE), (ii) after training at the same absolute power output as PRE (POSTABS) and (iii) after training at the same percentage of V̇O2max as PRE (POSTREL). At baseline (i.e. before cycling), every 5 min during cycling and immediately at EXH, a neuromuscular evaluation including a series of 5-s knee extensions at 100, 75 and 50% of maximal voluntary knee extension (MVC) was performed. During each contraction, transcranial magnetic and peripheral nerve stimuli were elicited to obtain motor evoked potential (MEP), silent period (SP) and compound muscle action potential (Mmax) and to calculate voluntary activation (VA). The MEP·Mmax−1 ratio recorded from vastus lateralis at 100 and 50% MVC did not show any difference between conditions. At 75% MVC, MEP exhibited significantly lower values in POSTABS and POSTREL compared to PRE at baseline (P = 0.022 and P = 0.011, respectively) as well as at 25% of time to EXH of PRE (P = 0.022) for POSTREL. No adaptations, either at baseline or during cycling, were observed for VA and SPs. In conclusion, endurance training may result in some adaptations in the corticomotor responses when measured at rest or with low level of fatigue, yet these adaptations do not translate into attenuation of central fatigue at a similar cycling workload or at exhaustion.



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l -Menthol mouth rinse or ice slurry ingestion during the latter stages of exercise in the heat provide a novel stimulus to enhance performance despite elevation in mean body temperature

Abstract

Purpose

This study investigated the effects of l-menthol mouth rinse and ice slurry ingestion on time to exhaustion, when administered at the latter stages (~ 85%) of baseline exercise duration in the heat (35 °C).

Method

Ten male participants performed four time to exhaustion (TTE) trials on a cycle ergometer at 70% Wmax. In a randomized crossover design, (1) placebo-flavored non-calorific mouth rinse, (2) l-menthol mouth rinse (0.01%), or (3) ice ingestion (1.25 g kg−1), was administered at 85% of participants' baseline TTE. Time to exhaustion, core and skin temperature, heart rate, rating of perceived effort, thermal comfort and thermal sensation were recorded.

Results

From the point of administration at 85% of baseline TTE, exercise time was extended by 1% (placebo, 15 s), 6% (l-menthol, 82 s) and 7% (ice, 108 s), relative to baseline performance (P = 0.036), with no difference between l-menthol and ice (P > 0.05). Core temperature, skin temperature, and heart rate increased with time but did not differ between conditions (P > 0.05). Thermal sensation did not differ significantly but demonstrated a large effect size (P = 0.080; \(\eta _}^{2}\)  = 0.260).

Conclusion

These results indicate that both thermally cooling and non-thermally cooling oral stimuli have an equal and immediate behavioral, rather than physiological, influence on exhaustive exercise in the heat.



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