Usefulness of diffusion-weighted magnetic resonance imaging for evaluating the effect of hemostatic radiotherapy for unresectable gastric cancer

Abstract

There are several reports that vouch for the usefulness of diffusion-weighted image (DWI) in making a diagnosis before treatment. However, no study has evaluated the effect of radiotherapy (RT) for unresectable gastric cancer. In the present case report, we evaluated the effectiveness of RT using DWI. An 81-year-old man was hospitalized with a broken bone and then diagnosed with advanced gastric cancer with breeding. He had chorionic renal failure and surgery was impossible. Further, contrast-enhanced computed tomography and magnetic resonance imaging (MRI) were not performed due to renal failure, whereas palliative RT was performed. We followed up the patient using blood test and MRI (DWI) to estimate whether bleeding had stopped or not after radiotherapy. Hemostasis effect was found after 2 weeks of RT. In DWI examination, there was a decrease in the tumor signal intensity 30 days after RT. Similarly, at day 60, the tumor signal intensity further decreased on DWI and the blood test results indicated no progression of anemia. At 4 months after the RT, the patient died because of respiratory failure without any bleeding. DWI is useful not only for the initial diagnosis but also for evaluating the effectiveness of RT.

Trial registration: National clinical study registered number: UMIN000026362.

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Acute gastritis caused by concurrent infection with Epstein–Barr virus and cytomegalovirus in an immunocompetent adult

Abstract

Herein, we describe an extremely rare case of gastritis due to concurrent infection with Epstein–Barr virus (EBV) and cytomegalovirus (CMV) occurring in an immunocompetent adult. The patient was a 35-year-old man who presented with slight fever, nausea, anorexia, weight loss for 3 weeks, mild transaminitis, and leukocytosis with atypical lymphocytes in peripheral blood. The clinical presentation and elevated IgM titers to both EBV-VCA and CMV strongly suggested infectious mononucleosis syndrome caused by co-infection with EBV and CMV. A computed tomographic scan of the abdomen showed diffuse thickening of the gastric wall mimicking linitis plastica, and upper endoscopy revealed thickened and eroded mucosa throughout the stomach. Histologic examination of gastric biopsies showed a dense lymphoid and neutrophilic infiltrate in the lamina propria with erosion. In situ hybridization assay revealed many lymphocytes positive for EBV-encoded RNA. Moreover, immunohistochemistry using an anti-CMV monoclonal antibody identified some CMV-positive cells (i.e. foveolar epithelium and endothelium). We finally diagnosed this case as gastric involvement in infectious mononucleosis, and the patient recovered without the administration of antiviral drugs. To our knowledge, this is the first reported case of gastritis co-infected with EBV and CMV, as a manifestation of infectious mononucleosis in an immunocompetent adult.

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Emergence of a complex movement pattern in an unfamiliar food place by foraging ants

Abstract

Although visual cues are essential for navigation in ants, few studies address movement dynamics in ants when they search and forage after finding food in an unfamiliar environment. Here I introduced Japanese wood ants to an unfamiliar food location by capturing individuals leaving their nest. The food was located at the centre of a straight, narrow, open-top channel. Next, I determined the segment lengths of the foraging paths of the ants between consecutive U-turns. I found that individuals travelled along characteristic and complex paths if they detected a visual landmark. This movement property was not detectable when individuals foraged in the channel without any visual landmarks. These results reveal the movement dynamics of ants when they encounter food in a novel place.

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Evaluating the psychometric properties of two-item and four-item short forms of the Japanese Pain Self-Efficacy Questionnaire: a cross-sectional study

Abstract

Purpose

The Pain Self-Efficacy Questionnaire is a valid measure assessing self-efficacy in individuals with chronic pain. Short-form versions of the measure have been developed to decrease the assessment burden. However, few studies have evaluated the psychometric properties of the short forms in languages other than English. The aim of this study was to evaluate two 2-item short forms and one 4-item short form of the Japanese Pain Self-Efficacy Questionnaire in terms of internal consistency, criterion validity, structural validity, and construct validity.

Methods

This was a cross-sectional study. Data from 150 individuals with mixed chronic pain at a pain management center in a university hospital were extracted from clinical records and analyzed. The data included the information of the original version and short forms of the Japanese Pain Self-Efficacy Questionnaire, and other pain-related measures assessing pain intensity, pain interference, anxiety, depression and pain catastrophizing.

Results

Item statistics supported the item selection for each of the three short forms. All the short forms demonstrated adequate internal consistency and criterion validity. With respect to construct validity, one of the 2-item short forms failed to meet the criterion regarding the change in the magnitude of correlation with a depression scale. The 4-item short form met all the criteria including structural validity.

Conclusion

The study findings provide evidence for the reliability and validity of 2- and 4-item versions of the Japanese Pain Self-Efficacy Questionnaire for use in clinical and research settings.

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Active Commuting and Multiple Health Outcomes: A Systematic Review and Meta-Analysis

Abstract

Background

Active commuting is associated with greater physical activity, but there is no consensus on the actual beneficial effects of this type of physical activity on health outcomes.

Objective

To examine the association between active commuting and risk of all-cause mortality, incidence and mortality from cardiovascular diseases, cancer and diabetes through meta-analysis.

Methods

A comprehensive search of MEDLINE, Embase, Google Scholar, Web of Science, The Cochrane Library, Transport Research International Documentation database, and reference lists of included articles was conducted. Only prospective cohort studies were included.

Results

Twenty-three prospective studies including 531,333 participants were included. Participants who engaged in active commuting had a significantly lower risk of all-cause mortality [relative risk (RR) 0.92, 95% CI 0.85–0.98] and cardiovascular disease incidence (RR 0.91; 95% CI 0.83–0.99). There was no association between active commuting and cardiovascular disease mortality and cancer. Participants who engaged in active commuting had a 30% reduced risk of diabetes (RR 0.70; 95% CI 0.61–0.80) in three studies after removal of an outlying study that affected the heterogeneity of the results. Subgroup analyses suggested a significant risk reduction (− 24%) of all-cause mortality (RR 0.76; 95% CI 0.63–0.94) and cancer mortality (− 25%; RR 0.75; 95% CI 0.59–0.895) among cycling commuters.

Conclusion

People who engaged in active commuting had a significantly reduced risk of all-cause mortality, cardiovascular disease incidence and diabetes.

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Firing properties of ventral medullary respiratory neurons in sino‐aortic denervated rats

New Findings

What is the central question of this study?

After sino‐aortic denervation (SAD) rats present normal levels of mean arterial pressure (MAP), high MAP variability and changes in breathing. However, mechanisms involved in SAD‐induced respiratory changes and their impact on the modulation of sympathetic activity remain unclear. Herein, we characterized the firing frequency of medullary respiratory neurons after SAD.

What is the main finding and its importance?

SAD‐induced prolonged inspiration was associated with a reduced interburst frequency of Pre‐I/I and an increased long‐term variability of Late‐I neurons, but no changes were observed in the Ramp‐I and Post‐I neurons. This imbalance in the respiratory network may contribute to the modulation of sympathetic activity after SAD.

Abstract

In previous studies we documented that after sino‐aortic denervation (SAD) in rats there are significant changes in the breathing pattern, but no significant changes in sympathetic activity and mean arterial pressure (MAP) compared with Sham‐operated rats. However, the neural mechanisms involved in the respiratory changes after SAD and the extent to which they may contribute to the observed normal sympathetic activity and MAP remain unclear. Here, we hypothesized that after SAD, rats present with changes in the firing frequency of the ventral medullary inspiratory and post‐inspiratory neurons. To test this hypothesis, male Wistar rats underwent SAD or Sham surgery and 3 days later were surgically prepared for an in situ preparation. The duration of inspiration significantly increased in SAD rats. During inspiration, the total firing frequency of Ramp‐I, Pre‐I / I, and Late‐I neurons was not different between groups. During post‐inspiration, the total firing frequency of Post‐I neurons was also not different between groups. Furthermore, the data demonstrate a reduced interburst frequency of Pre‐I/I and an increased long‐term variability of Late‐I neurons in SAD compared with Sham rats. These findings indicate that the SAD‐induced prolonged inspiration was not accompanied by alterations in the total firing frequency of the ventral medullary respiratory neurons, but it was associated with changes in the long‐term variability of Late‐I neurons. We suggest that the timing imbalance in the respiratory network in SAD rats may contribute to the modulation of presympathetic neurons after removal of baroreceptor afferents.

This article is protected by copyright. All rights reserved

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Metabolomics for the mountains; bring on the biomarkers!

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Is postponed laparoscopic appendectomy justified for patients with acute appendicitis?

Abstract

Introduction

Recent meta‐analyses revealed that laparoscopic appendectomy (LA) is a feasible procedure even for patients with complicated appendicitis. More than a few patients with acute appendicitis arrive at the hospital during night shifts and have their operation postponed for various reasons. However, the feasibility and disadvantages of this so‐called "postponed laparoscopic appendectomy" (PLA) remain controversial.

Methods

We included 149 patients who underwent LA for acute appendicitis within 48 h of diagnosis between January 2013 and May 2018. Patients were divided into an immediate LA group (patients who underwent LA within 4 h of diagnosis, n = 84) and a PLA group (patients who underwent LA 4–48 h after diagnosis, n = 65). Comparisons were made between these groups.

Results

The preoperative characteristics of the patients in the immediate LA and PLA groups were not significantly different. Operative time was significantly longer in the PLA group than in the LA group (92.5 ± 40.8 vs 78.1 ± 29.7 min, P = 0.012). The incidence of postoperative complications (grade II or higher) was significantly greater in the PLA group than in the LA group (32.3% vs 17.8%, P = 0.041). Multivariate analysis revealed that a preoperative CT finding of periappendiceal fluid (P = 0.005, odds ratio = 4.71) and surgery 4–48 h after diagnosis (P = 0.005, odds ratio = 4.425) were independent risk factors of postoperative complications (grade II or higher).

Conclusions

For patients with acute appendicitis, surgeons should perform immediate LA, if that is the patient's preferred surgical treatment, as long as there is no special reason to postpone surgery.

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Randomized controlled trial of mechanical bowel preparation for laparoscopy‐assisted colectomy

Abstract

Introduction

The benefit of mechanical bowel preparation (MBP) before open colon surgery has been debated over the last decade. The aim of this randomized controlled trial was to evaluate the effect of MBP on the outcome of patients who underwent elective laparoscopic colectomy.

Methods

Patients who were scheduled to undergo elective laparoscopic colon resection with primary anastomosis were randomly allocated to a preoperative MBP group (either two bottles of sodium phosphate or 2‐L polyethylene glycol) or a no‐MBP group. Anastomotic leakage and other complications such as surgical‐site infection and extra‐abdominal complications were recorded postoperatively.

Results

In this study, 122 patients were recruited and randomly allocated to the MBP group (n = 62) or the no‐MBP group (n = 60). Demographic and clinical characteristics were not significantly different between the two groups. The rate of abdominal complications, including anastomotic leak and surgical‐site infection, was 16.2% in the MBP group and 18.3% in the no‐MBP group (P = 0.747). Anastomotic leakage occurred in four patients (6.5%) in the MBP group and in two patients (3.3%) in no‐MBP group (P = 0.680). About 29% of patients in the MBP group still had either liquid or solid content in the bowel. No significant difference was found between the length of hospital stay in the MBP group and the no‐MBP group (9.0 ± 2.9 vs 8.4 ± 1.9 days, P = 0.180).

Conclusions

Elective laparoscopic colectomy without MBP is safe and offers acceptable postoperative morbidity.

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Classic solutions to a modern problem: Exercise training improves metabolic disorders in offspring from fathers on a high fat diet

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Issue Information

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Ih contributes to increased motoneuron excitability in restless legs syndrome

Key points

Restless legs patients complain about sensory and motor symptoms leading to sleep disturbances. Symptoms include painful sensations, urge to move and involuntary leg movements. The responsible mechanisms of restless legs syndrome are still not known, but current studies indicate an increased neuronal network excitability. Reflex studies indicate the involvement of spinal structures. Peripheral mechanisms have not been investigated so far. Here, we provide evidence of increased HCN channel‐mediated inward rectification in motor axons. The excitability of sensory axons was not changed. We conclude that in restless legs syndrome increased HCN current in motoneurons may play a pathophysiological role, and that these channels could represent a valuable target for pharmaceutical intervention.

Abstract

Restless legs syndrome is a sensorimotor network disorder. So far, the responsible pathophysiological mechanisms are poorly understood. Here, we provide evidence that the excitability of peripheral motoneurons contributes to the pathophysiology of restless legs syndrome. In vivo excitability studies on motor and sensory axons of the median nerve were performed on patients with idiopathic restless legs syndrome (iRLS) who were not currently on treatment. The iRLS patients had greater accommodation in motor but not sensory axons to long‐lasting hyperpolarization than age‐matched healthy subjects, indicating greater inward rectification in iRLS. The most reasonable explanation is that HCN channels open at less hyperpolarized membrane potentials, a view supported by mathematical modelling. The half‐activation potential for HCN [hyperpolarization‐activated cyclic nucleotide‐gated] channels (Bq) was the single best parameter that accounted for the difference between normal controls and iRLS data. A 6‐mV depolarization of Bq reduced the discrepancy between the normal control model and the iRLS data by 92.1%

Taken together, our results suggest for the first time an increase in excitability of motor units in iRLS which could enhance the likelihood of leg movements. The abnormal axonal properties are consistent with other findings that the peripheral system is part of the network involved in iRLS.

This article is protected by copyright. All rights reserved

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The relationships and interactions between age, exercise and physiological function

Abstract

This brief review focuses on the relationships and interactions between human ageing, exercise and physiological function. It explores the importance of the selection of participants for ageing research, the strengths and deficiencies of both cross‐sectional and longitudinal studies and the complexities involved in understanding time‐dependent, lifelong physiological processes. As being physically active is crucial to fostering healthy ageing, it is essential that participants in health and ageing research are defined in terms of their physical activity / exercise status as well as other lifestyle factors. Comparisons of exercisers with non‐exercisers has suggested that there is a mosaic of regulation of ageing both within and across physiological systems. We suggest that four broad categories exist which encompass this regulation. These are i) systems and indices that are age‐dependent, but activity independent; ii) systems that are age‐dependent, but also malleable by exercise; iii) systems that are not age affected but are altered by exercise and iv) systems that are neither age nor activity dependent. We briefly explore the concept of a mosaic of regulation in a selection of physiological systems that include skeletal muscle, the immune and endocrine systems and cognitive function and how these categories fit within the broad framework of understanding the physiology of human ageing.

Schematic to depict how healthy or diseased ageing phenotypes are the product of the interaction and regulation of physiological systems that can broadly be grouped into 4 categories on the basis of their malleability or otherwise to exercise and to the ageing process.

This article is protected by copyright. All rights reserved

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Relevance of peripheral cholinesterase activity on postoperative delirium in adult surgical patients (CESARO): A prospective observational cohort study

BACKGROUND The cholinergic system is considered to play a key role in the development of postoperative delirium (POD), which is a common complication after surgery. OBJECTIVES To determine whether peri-operative acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are associated with the development of POD in in-hospital surgical patients, and raise hypotheses on cholinergic regulatory mechanisms in POD. DESIGN A prospective multicentre observational study by the Peripheral Cholinesterase-activity on Neurocognitive Dysfunctions in Surgical Patients (CESARO) study group. SETTING Nine German hospitals. PATIENTS Patients of at least 18 years of age scheduled for inpatient elective surgery for a variety of surgical procedures. A total of 650 patients (mean age 61.5 years, 52.8% male) were included. METHODS Clinical variables, and peripheral AChE and BuChE activities, were assessed throughout the peri-operative period using bedside point-of-care measurements (one pre-operative and two postoperative measurements). POD screening was conducted postoperatively for at least 24 h and up to the third postoperative day using a validated screening tool (nursing delirium screening scale). RESULTS In all, 179 patients (27.5%) developed POD within the early postoperative phase. There was a lower BuChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.07, P = 0.091), on postoperative day 1 (Cohen's r = 0.12, P = 0.003) and on postoperative day 2 (Cohen's r = 0.12, P = 0.002). In contrast, there was a significantly higher AChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.10, P = 0.012), on postoperative day 1 (Cohen's r = 0.11, P = 0.004) and on postoperative day 2 (Cohen's r = 0.13, P = 0.002). After adjusting for covariates in multiple logistic regression, a significant association between both BuChE and AChE activities and POD was not found. However, in the multivariable analysis using the Generalized Estimating Equation, cholinesterase activities showed that a decrease of BuChE activity by 100 U L−1 increased the risk of a delirium by approximately 2.1% (95% CI 1.6 to 2.8%) and for each 1 U g−1 of haemoglobin increase in AChE activity, there was a 1.4% (95% CI 0.6 to 2.2%) increased risk of POD. CONCLUSION Peri-operative peripheral cholinesterase activities may be related to the development of POD, but the clinical implications remain unclear. Further studies, in homogeneous patient groups with a strict protocol for measurement time points, are needed to investigate the relationship between cholinesterase activities and POD. TRIAL REGISTRATION www.clinicaltrials.gov. Identifier NCT01964274. Correspondence to Claudia D. Spies, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353 Berlin, Germany Tel: +49 30 450 551001; e-mail: claudia.spies@charite.de 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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Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial

BACKGROUND Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications. OBJECTIVES The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care. DESIGN A randomised controlled study. SETTING Two Swedish university hospitals, between October 2011 and October 2015. PATIENTS Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency. INTERVENTION A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min−1 m−2 and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg. MAIN OUTCOME MEASURE The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list. RESULTS Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P 

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Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl−1. RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P 

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Ultrasound-guided vs. palpation-guided techniques for radial arterial catheterisation in infants: A randomised controlled trial

BACKGROUND The usefulness of ultrasound-guided techniques for radial arterial catheterisation has been well identified; however, its usefulness has not been completely evaluated in infants under 12 months of age, who are generally considered the most difficult group for arterial catheterisation. OBJECTIVE We evaluated whether ultrasound guidance would improve success rates and reduce the number of attempts at radial arterial catheterisation in infants. DESIGN A randomised, controlled and patient-blinded study. SETTING Single-centre trial, study period from June 2016 to February 2017. PATIENTS Seventy-four infants undergoing elective cardiac surgery. INTERVENTION Patients were allocated randomly into either ultrasound-guided group (group US) or palpation-guided group (group P) (each n=37) according to the technique applied for radial arterial catheterisation. All arterial catheterisations were performed by one of two experienced anaesthesiologists based on group assignment and were recorded on video. MAIN OUTCOME MEASURES The primary endpoint was the first-pass success. The number of attempts and total duration of the procedure until successful catheterisation were also analysed. RESULTS The first-pass success rate was significantly higher in the group US than in the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were needed for successful catheterisation in the group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median [IQR] procedural time (s) until successful catheterisation in the two groups was not significantly different (102 [49 to 394] vs. 218 [73 to 600], P = 0.054). CONCLUSION The current study demonstrated that the ultrasound-guided technique for radial arterial catheterisation in infants effectively improved first-pass success rate and also reduced the number of attempts required. TRIAL REGISTRATION ClinicalTrials.gov NCT02795468. Correspondence to Jong-Hwan Lee, MD, PhD, Associate Professor, Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea Tel: +82 2 3410 1928; fax: +82 2 3410 0361; e-mail: jonghwanlee75@gmail.com © 2018 European Society of Anaesthesiology

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Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-sectional study using the Korean National Health and Nutrition Examination Surveys

Physical activity, such as muscle strengthening and aerobic exercise, has been found to be effective for low back pain (LBP). However, the association between weekly walking duration and LBP in the general population remains poorly understood.

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Evaluation of a Combined Approach to the Correction of Congenital Cervical or Cervicothoracic Scoliosis

An anteroposterior combined approach has been used for the treatment of congenital cervical or cervicothoracic scoliosis. However, its outcomes and surgical risks have not been clarified.

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Pediatric Delirium: Early Identification of Barriers to Optimize Success of Screening and Prevention

Pediatric delirium has a 25% prevalence rate in the pediatric intensive care unit. The purpose of this project was to evaluate the impact/effect of implementing nonpharmacologic nursing bundles on the incidence of pediatric delirium. It is not yet known whether or not bundles consistently reduce the incidence of delirium.

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Infant Immunizations in Pediatric Critical Care: A Quality Improvement Project

Infants with congenital heart disease can be critically ill; prolonged hospitalization is common. The purpose of this project was to create and then evaluate the efficacy of education programs for staff nurses and medical providers aimed at improving infant immunization administration during hospitalization for congenital heart disease.

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Machine learning algorithms for activity recognition in ambulant children and adolescents with cerebral palsy

Cerebral palsy (CP) is the most common physical disability among children (2.5 to 3.6 cases per 1000 live births). Inadequate physical activity (PA) is a major problem effecting the health and well-being of ch...

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Transcranial direct current stimulation (tDCS) for upper limb rehabilitation after stroke: future directions.

Transcranial Direct Current Stimulation (tDCS) is a potentially useful tool to improve upper limb rehabilitation outcomes after stroke, although its effects in this regard have shown to be limited so far. Addi...

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5 Keys to implementing new technology in EMS

Solving a clear challenge, identifying champions and following these implementation steps will make change easier

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5 Keys to implementing new technology in EMS

Solving a clear challenge, identifying champions and following these implementation steps will make change easier

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Calif. cop saves newborn baby with CPR

Officer Gregory Palomo responded to a call about a woman screaming for help and found that she had just given birth to a newborn who wasn't breathing

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EMS World Expo Quick Take: Implementing prehospital point-of-care ultrasound

Examining the hardware and software requirements, and where P-POCUS fits into the EMS scope of practice

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How to buy EMS medical equipment

When purchasing medical products consider discounts, bulk purchasing and current customer references

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Enough is enough: 5 ways to end bullying in fire and EMS

We need to do more to improve the care and compassion we show to our fire and EMS brethren

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Female Genital Cutting: Clinical knowledge, Attitudes, and Practices from a Provider survey in the US

Abstract

Migration from countries where female genital cutting (FGC) is practiced means women's healthcare providers need to meet this population's unique healthcare needs. We explored providers' FGC-related experience, knowledge of the cultural practice, prior training, attitudes towards medicalization, including reinfibulation, and clinical practice. An online, 53-question survey to a multidisciplinary sample of women's health providers in the US were recruited by email via professional organizations, medical departments, and the authors' professional networks. From a total of 508 usable surveys, nearly half of respondents did not receive formal FGC training, but a majority had cared for FGC-affected women in their practice. A 'know-do' gap existed with managing infibulated patients; and surgical defibulation procedures were not routinely offered. Most respondents (79%, n = 402) reported a desire for additional education. Women's healthcare providers in the US, regardless of disciplinary backgrounds, are inadequately prepared to meet the needs of FGC-affected women. To address these, FGC content needs to be embedded in educational and training curricula, and ongoing clinical mentorship made available.

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Evaluation of EDTA- and DPA-Based Microdilution Phenotypic Tests for the Detection of MCR-Mediated Colistin Resistance in Enterobacteriaceae

Microbial Drug Resistance, Ahead of Print.


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Luteolin Showed a Resistance Elimination Effect on Gentamicin by Decreasing MATE mRNA Expression in Trueperella pyogenes

Microbial Drug Resistance, Ahead of Print.


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Antimicrobial Susceptibility and Clonal Relationship of Tetracycline Resistance Genes in netF-Positive Clostridium perfringens

Microbial Drug Resistance, Ahead of Print.


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Myths and Facts of In-Office Regenerative Procedures for Tendinopathy: Literature Review

Tendinopathy carries a large burden of musculoskeletal disorders seen in both athletes and aging population. Treatment is often challenging, and progression to chronic tendinopathy is common. Physical therapy, NSAIDs, and corticosteroid injections have been the mainstay of treatment but are not optimal given that most tendon disorders appear to involve degenerative changes in addition to inflammation. The field of regenerative medicine has taken the forefront, and various treatments have been developed and explored including prolotherapy, platelet rich plasma (PRP), stem cells, and percutaneous ultrasonic tenotomy. However, high-quality research with standardized protocols and consistent controls for proper evaluation of treatment efficacy is currently needed. This will make it possible to provide recommendations on appropriate treatment options for tendinopathy. Corresponding Author: Kentaro Onishi, DO, 3471 Fifth Avenue, LSK Building, Suite 201, Pittsburgh, PA 15213. Phone number: 412-246-5334. Fax number: 412-692-4410. Email: onishik2@upmc.edu Author Disclosures: This work was supported in part by the National Institutes of Health under award numbers AR065949 and AR070340 (JHW) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Personalized DNA methylomics

Personalized DNA methylomics

Personalized DNA methylomics, Published online: 15 November 2018; doi:10.1038/s41576-018-0076-0

A study in Nature Medicine reports the DNA methylome and transcriptome of an individual, and suggests that changes in the methylome and transcriptome might be associated with chronic and acute health conditions, respectively.

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Two-Day Residence at 2500 m to 4300 m Does Not Affect Subsequent Exercise Performance at 4300 m

PURPOSE To determine the efficacy residing for two days at various altitudes while sedentary (S) or active (A; ~90 min hiking 2•day-1) on exercise performance at 4300m. METHODS SL resident men (n=45) and women (n=21) (mean±SD; 23±5 yr; 173±9 cm; 73±12 kg; VO2peak= 49±7 ml•kg-1•min-1) were randomly assigned to a residence group and, S or A within each group: 2500m (n=11S, 8A); 3000m (n=6S, 12A); 3500m (n=6S, 8A); or 4300m (n=7S, 8A). Exercise assessments occurred at SL and 4300 m after 2 days residence and consisted of 20 min of steady-state (SS) treadmill walking (45±3% SL VO2peak) and a 5-mile, self-paced running time-trial (TT). Arterial oxygen saturation (SpO2) and heart rate (HR) were recorded throughout exercise. Resting SpO2 was recorded at SL, at 4 and 46 hrs of residence, and at 4300 m prior to exercise assessment. To determine if 2-day altitude residence improved 4300 m TT performance, results were compared to estimated performances using a validated prediction model. RESULTS For all groups, resting SpO2 was reduced (P

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Anticipated Task Difficulty Provokes Pace Conservation and Slower Running Performance

Purpose Models of self-paced endurance performance suggest that accurate knowledge of the exercise end-point influences pace-related decision-making. No studies have examined the effects of anticipated task difficulty during equidistant endurance activities. Accordingly, the purpose of this study was to investigate the effects of anticipated task difficulty on pacing, psychological, and physiological responses during running time-trials. Methods Twenty-eight trained runners completed three self-paced 3000 m time-trials. The first was a baseline (BL) time-trial completed on a 0% treadmill gradient. Time-trials 2 and 3 were counterbalanced. Before a known incline (KI) time-trial, anticipated to be more difficult, subjects were accurately informed that the gradient would increase to 7% for the final 800 m. Before an equivalent, unknown incline (UI) time-trial subjects were deceptively informed that the gradient would remain at 0% throughout. Results Expressed relative to BL, running speed was 2.44% slower (d = -0.47) over the first 2200 m during KI than UI. Effort perception, affective valence, heart rate, and blood lactate did not differ between time-trials. Initial running speed during KI was related to pre-trial motivation, pre-trial vigor, perceived effort, and affective valence (all r ≥ .382). No such relationships existed during UI. More subjects also reported a conscious focus on pacing during KI. Conclusion An anticipated increase in task difficulty provoked pace conservation during 3000 m running time-trials. The reduced pace may have resulted from greater task uncertainty and consciously aware, effort- and affect-based decisions to conserve energy and maintain hedonic state during KI. The findings add to theoretical understandings of factors that influence pacing during endurance activity. Consequently, recommendations to minimize the potentially deleterious effects of anticipated increases in task difficulty are provided. Corresponding author details: Dr Noel E. Brick. School of Psychology, Ulster University, Cromore Road, Coleraine, Northern Ireland, UK. BT52 1SA. Telephone: +44 (0)28 71675366. Email: n.brick@ulster.ac.uk. ORCHID: 0000-0002-3714-4660 This study received no sources of funding. The authors have no conflicts of interest to report. The results do not constitute endorsement by the ACSM and are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication October 2018. © 2018 American College of Sports Medicine

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Single versus Split Dose of Iron Optimizes Haemoglobin Mass Gains at 2106 m Altitude

PURPOSE To determine if a single versus a split equivalent daily dose of elemental iron was superior for haemoglobin mass (Hbmass) gains at altitude, while minimizing gastrointestinal (GI) discomfort. METHODS Twenty-four elite runners attended a 3.1 ± 0.3 week training camp (Flagstaff, AZ; 2106 m). A two-group design, randomized and stratified to baseline Hbmass, sex and ferritin (>30 μ/L), was implemented daily as: 1) single dose of 1 x 200 mg (PM only, SINGLE) vs; 2) split dose of 2 x 100 mg (AM & PM; SPLIT) elemental iron (ferrous fumarate). Hbmass and venipuncture assessments were completed upon arrival and departure (± 2 days) from camp for ferritin, hepcidin and erythroferrone (ERFE) concentrations. Validated food frequency (FFQ), GI-distress, menstrual blood loss (MBL) and training questionnaires were implemented throughout. Univariate analysis was used to compare Hbmass; with baseline ferritin, dietary iron intake, MBL and training volume used as covariates. RESULTS Both conditions increased Hbmass from baseline (p0.05). CONCLUSION A single nightly 200 mg dose of elemental iron was superior to a split dose for optimizing Hbmass changes at altitude in runners over a ~3 week training camp. Corresponding Author: Rebecca Hall, University of the Sunshine Coast, School of Health and Sports Sciences, 90 Sippy Downs Dr, Sippy Downs, QLD 4556, Australia. +61 (0)407 404 333; RCH010@student.usc.edu.au Funding, logistical support and testing for this research was gratefully received from B2Ten, Athletics Canada, the Canadian Sports Institute Pacific, University of Western Australia, Western Australian Institute of Sport and the University of California at Los Angeles. The authors of this study declare that results are presented honestly, clearly and without fabrication, falsification or inappropriate data manipulation. Results of this study do not constitute endorsement by ACSM. CONFLICTS OF INTEREST: E.N. is a stockholder and consultant for Intrinsic LifeSciences and Silarus Therapeutics. The remaining authors have no conflicts of interest to declare. Accepted for publication November 2018. © 2018 American College of Sports Medicine

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Physiological and Perceived Exertion Responses during Exercise: Effect of β-blockade

Purpose This study investigated the effect of β-blockade on physiological and perceived exertion (RPE) responses during incremental treadmill exercise. Methods Sixteen healthy participants (n=8 men; age 25.3±4.6 y) performed a maximal treadmill exercise test following ingestion of 100 mg Metoprolol or placebo, with a double-blind, randomised and counter-balanced design. Heart rate (HR), ventilatory and gas exchange variables were measured continuously, and participants reported RPE at the end of each minute. Physiological and RPE responses during each condition were compared at the ventilatory threshold (VT), respiratory compensation point (RCP) and at maximal exercise using repeated measures ANOVA. Linear regression modelled relationships between perceived exertion and physiological variables. Results The HR and V[Combining Dot Above]O2 at the VT, RCP and maximal exercise were all significantly lower following β-blockade (p<.05 however when standardised to within condition peak values differences were no longer significant. the rpe associated with vt was higher following vs p but lower at maximal exercise vs. increases in relative hr greater and remained significant expressed hr. there difference growth of relationship between v dot above across conditions though origin conclusions although resulted a reduction exercising for given intensity unchanged. not affected by results provide evidence that is useful reliable measure testing prescription patients prescribed therapy. correspondence: braden l mitchell school health sciences university south australia gpo box adelaide sa email: braden.mitchell blm supported an australian government research training program scholarship. this study are presented clearly honestly without fabrication falsification or inappropriate data manipulation. present do constitute endorsement acsm. accepted publication november american college sports medicine>

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Neurophysiological effects of continuous cortical stimulation in epilepsy – spike and spontaneous ECoG activity

Publication date: Available online 14 November 2018

Source: Clinical Neurophysiology

Author(s): Karin Westin, Brian Lundstrom, Jamie Van Gompel, Gerald Cooray

Abstract

Objective

The effect of continuous subthreshold cortical stimulation (CSCS) over the seizure onset zone (SOZ) in epilepsy was analyzed to delineate the affected physiological processes.

Method

ECoG data was recorded over SOZ and adjacent regions in patients (n=7) with refractory-epilepsy. Data was reviewed before and during 2 Hz cortical electrical stimulation. Group differences were estimated using ANOVA and correlation with Pearson's r.

Results

CSCS reduced background ECoG power at SOZ (p<0.05), increased spectral coherence (p<0.05) and reduced spike rate (p<0.01) over all recorded sites. Spectral power and coherence (p<0.01) correlated with spike rate at SOZ but not with each other at any location. Spike morphology correlated with spike-rate over all recorded sites (p<0.0001) and with spectral power and coherence at SOZ (p<0.01).

Conclusion

This study shows changes in cortical electrophysiology during CSCS over the SOZ where spike rate reduction correlated with two independent electrophysiological parameters, background power and coherence. These results suggest the possibility of a causal relationship between spectral power, coherence and interictal spikes which may be related to seizure rate.

Significance

Improved understanding of the effect of electrical stimulation on epileptic tissue could suggest improvements in stimulation paradigms to reduce seizure frequency.

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Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials

Publication date: Available online 14 November 2018

Source: Clinical Neurophysiology

Author(s): D.B. MacDonald, C. Dong, R. Quatrale, F. Sala, S. Skinner, F. Soto, A. Szelényi

Abstract

Intraoperative somatosensory evoked potentials (SEPs) provide dorsal somatosensory system functional and localizing information, and complement motor evoked potentials. Correct application and interpretation require in-depth knowledge of relevant anatomy, electrophysiology, and techniques. It is advisable to facilitate cortical SEPs with total intravenous propofol–opioid or similarly favorable anesthesia. Moreover, SEP optimization is recommended to enhance surgical feedback speed and accuracy by maximizing signal-to-noise ratio (SNR); it consists of selecting highest-SNR peripheral and cortical derivations while omitting low-SNR channels. Confounding factors causing non-surgical SEP reduction should be excluded before issuing a warning. It is advisable to facilitate their identification with peripheral SEP controls and cortical SEP systemic controls whenever possible. Warning criteria should adjust for baseline drift and reproducibility. The recommended adaptive warning criterion is visually obvious amplitude reduction from recent pre-change values and clearly exceeding trial-to-trial variability, particularly when abrupt and focal. Acquisition and interpretation should be done by qualified technical and professional level personnel. Indications for SEP monitoring include intracranial, posterior fossa, and spinal neurosurgery, as well as orthopedic spine, cerebrovascular, and descending aortic surgery. Indications for SEP mapping include sensorimotor cortex and dorsal column midline identification. Future advances could modify current recommendations.

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Influence of typicality in category-based fear generalization: Diverging evidence from the P2 and N400 effect

Publication date: Available online 14 November 2018

Source: International Journal of Psychophysiology

Author(s): Yi Lei, Jinxia Wang, Haoran Dou, Yiwen Qiu, Hong Li

Abstract

The conceptual properties of a conditional stimulus could contribute to human fear generalization, but how typicality influences fear generalization involving different conceptual hierarchies remains unclear. This study used event-related potential technology to investigate this in four categories of generalized stimulus (GS). We divided the GS into four categories: inferior typical members of conditioned stimulus (CS+) (TCS+), inferior atypical members of CS+ (ATCS+), inferior typical members of CS- (TCS-), and inferior atypical members of CS- (ATCS-). The CS+ groups elicited a larger P2 versus the CS- groups suggesting that aversive stimuli can automatically capture attention with timely avoidance of danger. Stimulus type (CS+; CS-) and typicality (typical; atypical) showed an interaction with N400. The elicited N400 was larger for atypical than typical members in CS- groups, but not in CS+ groups. Fear emotion elicited by CS+ may feature restrained semantic networks, dissipating typicality effects. Separate processing stages may modulate category-based fear generalization, with P2 representing first-stage low-level perceptual processing, and N400 second-stage high-level cognitive processing.

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Low-dose imipramine for refractory functional dyspepsia: A randomised, double-blind, placebo-controlled trial

The Lancet: Gastroenterology & Hepatology

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An improved method for radium-isotopes quartet determination by alpha-particle spectrometry by using 225Ra (229Th) as isotopic tracer

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): S.M. Pérez-Moreno, M.J. Gázquez, M. Casas-Ruiz, E.G. San Miguel, J.P. Bolívar

Abstract

A new method for the determination of radium quartet (^{223,224,226,228}Ra) in environmental samples by alpha-particle spectrometry with PIPS detectors is described. This uses ²²⁵Ra as yield tracer, in equilibrium at the beginning with ²²⁹Th. Thorium is removed from the sample by using AG1X8 anion-resin, and then radium isotopes are isolated and purified with a cation-exchange column Biorad AG50X8, verifying that Ac has been fully removed from the sample to ensure the good evaluation of the Ra yield (average decontamination factor > 92%). Finally, the counting source of radium is obtained by micro-precipitation with BaSO₄. This method produces high spectral resolution (<35 keV), and quantitative Ra recoveries (>70%). In this new method, NH₄Ac in 0.1 M HNO₃ is used to remove the ²²⁵Ac contained in the sample in order to avoid its future spectral interference in the yield calculation. The method has been validated by using certified reference samples with known concentrations of radium isotopes.

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Estimation of radon diffusivity tensor for fractured rocks in cave mines using a discrete fracture network model

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): K.M. Ajayi, K. Shahbazi, P. Tukkaraja, K. Katzenstein

Abstract

This study develops a numerical model for predicting radon effective diffusivity tensor for fractured rocks using a two dimensional discrete fracture network (DFN) model. This is motivated by the limitations of existing techniques in predicting the radon diffusion coefficient for the fractured zones of cave mines. These limitations include access to the fractured zones for the purpose of conducting field studies as well as replication of the degree of fracturing in these zones for laboratory studies. The caving of a rock mass involves the fracturing and breaking of intact and naturally fractured rock, which creates migration pathways for radon gas trapped within uranium-rich rock. Therefore, this study develops a stochastic DFN model with equations derived from radon transport to predict diffusivity. Our simulation results reveal the establishment of a representative elementary volume (REV) for diffusivity tensor; approximately equal principal and cross diffusivity magnitudes for each of the DFN domain; a range of diffusivity with porosity (calculated based on the fractures in the domain); and a significant effect of fracture density on diffusivity tensor. These results are essential in developing proactive measures for mitigation of radon gas in cave mines.

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Personalized DNA methylomics

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Immediate effects of immersive biofeedback on gait in children with cerebral palsy

Publication date: Available online 14 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Adam T.C. Booth, Annemieke I. Buizer, Jaap Harlaar, Frans Steenbrink, Marjolein M. van der Krogt

Objective

To investigate the immediate response to avatar-based biofeedback on three clinically important gait parameters; step length, knee extension and ankle power, in children with cerebral palsy (CP).

Design

Repeated measures design.

Setting

Rehabilitation clinic.

Participants

Twenty-two children with spastic paresis (10y4m±3y1m), able to walk without assistive devices.

Intervention

Children walked on a treadmill with virtual reality environment. Following baseline gait analysis, they were challenged to improve aspects of gait. Children visualized themselves as an avatar, representing movement in real-time. They underwent a series of two-minute trials receiving avatar based biofeedback on step length, knee extension and ankle power. To investigate optimization of biofeedback visualization, additional trials in which knee extension was visualized as a simple bar with no avatar; and a further trial with avatar alone, and no specific biofeedback were carried out.

Main outcome measures

Gait pattern, as measured by joint angles, powers and spatiotemporal parameters, were compared between baseline and biofeedback trials.

Results

Participants were able to adapt gait pattern with biofeedback, in an immediate response, reaching large increases in ankle power generation at push-off (37.7%) and clinically important improvements in knee extension (7.4^o) and step length (12.7%). Biofeedback on one parameter had indirect influence on other aspects of gait.

Conclusion

Children with CP show capacity in motor function to achieve improvements in clinically important aspects of gait. Visualizing biofeedback with an avatar was subjectively preferential compared to a simplified bar presentation of knee angle. Future studies are required to investigate if observed transient effects of biofeedback can be retained with prolonged training to test whether biofeedback-based gait training may be implemented as a therapy tool.

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Gait Impairments in Patients without Lower Limb Hypertonia Early after Stroke are Related to Weakness of Paretic Knee Flexors

Publication date: Available online 14 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): John W. Chow, Dobrivoje S. Stokic

Abstract

Objective

To describe gait characteristics of patients without clinical evidence of lower limb hypertonia within 2 months of stroke and explore the relationship between gait and residual motor function.

Design

Cohort study.

Setting

Motion analysis laboratory in a tertiary-care free-standing rehabilitation hospital.

Participants

Consecutive sample of 73 eligible inpatients (first-known stroke <2 months post-onset, walking independently, modified Ashworth score of 0 in the paretic lower limb) and 27 healthy controls.

Interventions

Not applicable.

Main Outcome Measures

Gait speed, stride/step length and cadence, stance time, single/double support time, and associated symmetry measures in patients at self-selected normal speed and controls at very-slow speed (51.1±32.6 and 61.9±21.8 cm/s, respectively, P=.115); Fugl-Meyer lower extremity motor score (FM-LE) and isometric knee flexion/extension strength in patients.

Results

Except the stride/step cadence, all temporospatial parameters significantly differed between the stroke and control participants. Furthermore, significantly greater asymmetries were found in the patients for the overall stance time, initial double-support and single-support times, and step cadence, reflecting smaller values in the paretic than non-paretic limb. Most temporospatial parameters moderately-to-strongly correlated with the gait speed (|r|: .72-.94, P<.0001), FM-LE (|r|: .42-.62, P≤.0005), and paretic knee flexor strength (|r|: .47-.57, P≤.0004).

Conclusions

Gait of patients without clinical evidence of lower limb hypertonia within 2 months of stroke is characterized by many temporospatial deviations and asymmetries. The self-selected normal gait speed, FM-LE, and paretic knee flexor strength can discriminate gait impairments in these patients shortly before inpatient discharge. It remains to be determined whether the observed relationships between paretic knee flexor strength and gait measures warrant the development of interventions for strengthening of the paretic knee flexors in order to improve gait early after stroke.

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The impact of hand proportions on tool grip abilities in humans, great apes and fossil hominins: A biomechanical analysis using musculoskeletal simulation

Publication date: December 2018

Source: Journal of Human Evolution, Volume 125

Author(s): Ameline Bardo, Laurent Vigouroux, Tracy L. Kivell, Emmanuelle Pouydebat

Abstract

Differences in grip techniques used across primates are usually attributed to variation in thumb-finger proportions and muscular anatomy of the hand. However, this cause-effect relationship is not fully understood because little is known about the biomechanical functioning and mechanical loads (e.g., muscle or joint forces) of the non-human primate hand compared to that of humans during object manipulation. This study aims to understand the importance of hand proportions on the use of different grip strategies used by humans, extant great apes (bonobos, gorillas and orangutans) and, potentially, fossil hominins (Homo naledi and Australopithecus sediba) using a musculoskeletal model of the hand. Results show that certain grips are more challenging for some species, particularly orangutans, than others, such that they require stronger muscle forces for a given range of motion. Assuming a human-like range of motion at each hand joint, simulation results show that H. naledi and A. sediba had the biomechanical potential to use the grip techniques considered important for stone tool-related behaviors in humans. These musculoskeletal simulation results shed light on the functional consequences of the different hand proportions among extant and extinct hominids and the different manipulative abilities found in humans and great apes.

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Proposal of a new tDCS safety screening tool: TSST (Transcranial direct current stimulation Safety Screening Tool)

No abstract available

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Cost-effectiveness of a high-intensity rapid access outpatient stroke rehabilitation program

A common strategy to improve cost-effectiveness in healthcare is to offer outpatient care instead of in-hospital care. Toronto Rehabilitation Institute developed an outpatient high-intensity fast-track (FT) stroke rehabilitation program aimed at discharging inpatient stroke rehabilitation patients earlier or bypassing inpatient rehabilitation altogether. This cost-effectiveness analysis compares FT rehabilitation within 1 week of discharge with no FT in a single healthcare payer system. Patient costs and outcomes over a 12-week time horizon were included. Using individual-level FT data from April 2015 to March 2016, incremental cost-effectiveness ratios (ICERs) (with 95% confidence interval) were estimated using regression. Subgroup analysis was completed for patients entering FT directly from inpatient rehabilitation and acute stroke care. Uncertainty was assessed using a cost-effectiveness acceptability curve with a range of willingness-to-pay values ($0–1000 per inpatient day saved). ICER (95% confidence interval) estimate for patients entering FT from inpatient rehabilitation was $404 ($270–620) per inpatient day saved. ICER estimate for direct from acute care admissions was $37 ($20–55) per day saved. At willingness-to-pay of $698 (cost of one alternate level of care day in acute care awaiting rehabilitation), the probability of FT being cost-effective was 99.2 and 100% for patients from inpatient rehabilitation and acute stroke care, respectively. From a single healthcare payer perspective, FT is a cost-effective method of providing appropriate rehabilitation intensity for stroke patients early on, and likely to provide savings to the healthcare system upstream through fewer days awaiting rehabilitation admission. *Alan K.H. Tam and Stephen Mac contributed equally to this study. Correspondence to Alan Tam, MD, 10-107, 550 University Avenue, Toronto, Ontario, Canada M5G 2A2 Tel: +1 416 597 3422 x3865; fax: +1 416 597 7107; e-mail: alan.tam@uhn.ca Received October 17, 2018 Accepted October 20, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Response

No abstract available

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Effect of Unintentional Boosting on Exercise Performance in a Tetraplegic Athlete

Boosting is the induction of autonomic dysreflexia (AD) to reflexively activate otherwise dormant thoracolumbar sympathetic circuitry to "boost" the capacity of the cardiovascular system and enhance exercise performance. AD is a life-threatening condition unique to individuals with spinal cord injury (SCI) characterized by a sudden increase in sympathetic activity below the level of the SCI. Here we report on the temporal HR response to an episode of unintentional boosting during a validated field-based exercise performance test in an athlete with tetraplegia. An athlete with SCI (C6 motor-complete, sensory-incomplete) completed a 20 ×20 m repeated sprint field test on two consecutive days. During the 13th sprint on day 2, the athlete unintentionally boosted via bladder overdistension. Average HR when boosted (i.e., sprints 14–20) was considerably higher than before boosting (141 ± 4 vs 116 ± 7 bpm) and compared with corresponding sprints on day 1 (141 ± 4 bpm vs 120 ± 1 bpm). Average time to complete 20 m sprints when boosted was also faster than the corresponding sprints on day 1 (6.70 ± 0.05 s vs 6.87 ± 0.05 s). This case report highlights the immediate effect of boosting on HR and field-based exercise performance and supports the suggestion that exercise performance in athletes with SCI is limited by cardiovascular capacity.

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Biceps Femoris Long-Head Architecture Assessed Using Different Sonographic Techniques

Purpose To assess the repeatability of, and measurement agreement between, four sonographic techniques used to quantify biceps femoris long head (BFlh) architecture: (i) static-image with linear extrapolation; extended field-of-view (EFOV) with linear ultrasound probe path (linear-EFOV), using either (ii) straight or (iii) segmented analyses; and (iv) EFOV with nonlinear probe path and segmented analysis (nonlinear-EFOV) to follow the complex fascicle trajectories. Methods Twenty individuals (24.4 ± 5.7 yr; 175 ± 0.8 cm; 73 ± 9.0 kg) without history of hamstrings strain injury were tested in two sessions separated by 1 h. An ultrasound scanner coupled with 6-cm linear probe was used to assess BFlh architecture in B-mode. Results The ultrasound probe was positioned at 52.0% ± 5.0% of femur length and 57.0% ± 6.0% of BFlh length. We found an acceptable repeatability when assessing BFlh fascicle length (ICC3,k = 0.86–0.95; SEM = 1.9–3.2 mm) and angle (ICC3,k = 0.86–0.97; SEM = 0.8°–1.1o) using all sonographic techniques. However, the nonlinear-EFOV technique showed the highest repeatability (fascicle length ICC3,k = 0.95; fascicle angle, ICC3,k = 0.97). The static-image technique, which estimated 35.4% ± 7.0% of the fascicle length, overestimated fascicle length (8%–11%) and underestimated fascicle angle (8%–9%) compared with EFOV techniques. Also, the rank order of individuals varied by approximately 15% between static-image and nonlinear-EFOV (segmented) when assessing the fascicle length. Conclusions Although all techniques showed good repeatability, absolute errors were observed using static-image (7.9 ± 6.1 mm for fascicle length) and linear-EFOV (between 3.7 ± 3.0 and 4.2 ± 3.7 mm), probably because the complex fascicle trajectories were not followed. The rank order of individuals for fascicle length and angle were also different between static-image and nonlinear-EFOV, so different muscle function and injury risk estimates could likely be made when using this technique.

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Range of Extension Correlates with Posterior Capsule Length after Knee Remobilization

Introduction Knee injuries are common in sports, and postinjury immobilization is often required to protect healing tissues and alleviate pain, but both the injury and the immobilization can lead to a knee contracture. Knee flexion contractures limit performance. Previous research has identified posterior knee capsule fibrosis as a contributor to immobility-induced knee flexion contractures. This study aims to measure posterior knee capsule length at various durations of remobilization after knee immobilization and to correlate with the recovery of knee range of motion. Methods Two hundred fifty-nine male Sprague-Dawley rats had one knee extra-articularly immobilized in flexion with a Delrin® plate at a 45° angle for one of six durations: 1, 2, 4, 8, 16, or 32 wk, followed by spontaneous remobilization after plate removal, which lasted zero, one, two, and four times the duration of immobilization. The contralateral knees served as controls. The posterior knee capsule length was measured by histomorphometry. These measures were correlated with previously published range of motion data from the same cohort of specimens. Results Knees immobilized for 1 and 2 wk partially recovered posterior capsule length (P > 0.05). Knees immobilized beyond 2 wk failed to recover posterior capsule length, irrespective of the duration of remobilization (P

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A 9-Month Jumping Intervention to Improve Bone Geometry in Adolescent Male Athletes

Purpose Sports have different effects on bone development and effective interventions to improve bone health of adolescent athletes are needed. The purpose of the study was to investigate the effect of a 9-month jumping intervention on bone geometry and metabolism in adolescent male athletes. Methods Ninety-three adolescent (14.1 yr old) male swimmers (SWI), footballers (FOO), and cyclists (CYC) were randomized to intervention and sport (INT-SWI = 19, INT-FOO = 15, and INT-CYC = 14) or sport only (CON-SWI = 18, CON-FOO = 15, and CON-CYC = 12) groups. Cross-sectional area, cross-sectional moment of inertia (CSMI), and section modulus (Z) at the femoral neck were assessed using hip structural analysis and trabecular texture of the lumbar spine using trabecular bone score. Bone mineral content (BMC) at femoral neck and lumbar spine was assessed using dual-energy x-ray absorptiometry. Serum N-terminal propeptide of procollagen type I, isomer of the carboxy-terminal telopeptide of type 1 collagen, total serum calcium, and 25-hydroxyvitamin D were analyzed. Results INT-CYC acquired significantly higher lumbar spine BMC (4.6%) and femoral neck BMC (9.8%) than CON-CYC. INT-CYC acquired significantly higher cross-sectional area (11.0%), CSMI (10.1%), and trabecular bone score (4.4%) than CON-CYC. INT-SWI acquired significantly higher femoral neck BMC (6.0%) and CSMI (10.9%) than CON-SWI. There were no significant differences between INT-FOO and CON-FOO in any bone outcomes. N-terminal propeptide of procollagen type I significantly decreased in CON-SWI, INT-FOO, CON-FOO, and CON-CYC. Carboxy-terminal telopeptide of type 1 collagen significantly decreased in CON-SWI and CON-CYC. The 25-hydroxyvitamin D significantly increased in INT-CYC, CON-CYC, INT-FOO, and CON-FOO. Conclusions A 9-month jumping intervention improved bone outcomes in adolescent swimmers and cyclists, but not in footballers. This intervention might be used by sports clubs to improve bone health of adolescent athletes.

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Acute High-Intensity Exercise Impairs Skeletal Muscle Respiratory Capacity

Purpose The effect of an acute bout of exercise, especially high-intensity exercise, on the function of mitochondrial respiratory complexes is not well understood, with potential implications for both the healthy population and patients undergoing exercise-based rehabilitation. Therefore, this study sought to comprehensively examine respiratory flux through the different complexes of the electron transport chain in skeletal muscle mitochondria before and immediately after high-intensity aerobic exercise. Methods Muscle biopsies of the vastus lateralis were obtained at baseline and immediately after a 5-km time trial performed on a cycle ergometer. Mitochondrial respiratory flux through the complexes of the electron transport chain was measured in permeabilized skeletal muscle fibers by high-resolution respirometry. Results Complex I + II state 3 (state 3CI + CII) respiration, a measure of oxidative phosphorylation capacity, was diminished immediately after the exercise (pre, 27 ± 3 ρm·mg−1·s−1; post, 17 ± 2 ρm·mg−1·s−1; P

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Response

No abstract available

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Long-Term Links between Physical Activity and Sleep Quality

Purpose Findings from cross-sectional research indicate that the relationship between sleep quality and physical activity is mixed. For research that does indicate a significant association, the interpretation of the finding most often is that physical activity leads to better sleep, or less frequently, that better sleep leads to more involvement in physical activity (see sleep deprivation studies). Cross-sectional studies, however, are not able to assess the direction of these effects, and experimental studies have tested only one direction of the effects. Longitudinal studies, with their focus on temporal order, are needed to specifically examine the link between sleep and physical activity as well as the direction of effects. The current study had three goals: to examine 1) the longitudinal relationship between sleep and physical activity, 2) the direction of effects, and 3) whether emotion regulation mediates the relationship between sleep and physical activity. Methods Participants included a sample of 827 (Mage at baseline = 19.04 yr, SD = 0.92 yr, 73.88% female) students at a university in Southwestern Ontario, who took part in a larger longitudinal survey that started in their first year of university. Participants were surveyed annually for 3 yr (2011, 2012, 2013; retention, 83.9%). Measures assessed sleep quality, physical activity, emotion regulation, and involvement in sports clubs. Results A cross-lagged autoregressive path analysis revealed that sleep quality indirectly predicted increased high-, moderate-, and low-intensity physical activity over time through its positive effect on emotion regulation. Moderate levels of physical activity indirectly predicted sleep quality over time through emotion regulation. Conclusions Overall, there appears to be support for a bidirectional relationship between sleep and physical activity over time (at least for moderate physical activity) but only indirectly through emotion regulation.

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Exercise Timing in Type 2 Diabetes Mellitus: A Systematic Review

Purpose The timing of exercise relative to meal consumption has recently been identified as potentially moderating the effectiveness of exercise on glycemic responses in type 2 diabetes mellitus (T2DM). The aim of this study was to systematically review the literature related to exercise timing, relative to meal consumption, and glycemic control in individuals with T2DM. Methods Systematic searches in PubMed, EMBASE, CINAHL, Cochrane Library, and ClinicalTrials.gov Registry databases were performed to identify articles published in English from inception to October 2017. Two authors independently extracted data and evaluated the quality of studies using the Cochrane Collaboration Data Collection Form and the Cochrane Collaboration Risk of Bias Assessment Tool, respectively. A qualitative synthesis was performed on the included studies, and results summarized in tables. Results Nineteen randomized controlled trials with a total of 346 participants were included. Improvements in glycemia (glucose concentrations and glucose area under the curve) and insulin area under the curve appeared more consistent when exercise was performed during the postmeal period as compared with the premeal period; however, this observation was largely based on indirect comparisons between studies. Conclusions There is some evidence from randomized controlled trials that exercise performed 30 min after meal consumption may convey greater improvements in glycemic control for individuals with T2DM. However, there are only two studies that have directly assessed the role of exercise timing on glycemic management, and adopted methodologies are heterogeneous. Future low-risk trials in this field are warranted.

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Associations between Changes in Activity and Sleep Quality and Duration over Two Years

Purpose Insufficient physical activity (PA) and inadequate sleep quality (SQ) and sleep duration (SD) are highly prevalent behaviors that increase the risk of developing many chronic health conditions. Evidence regarding bidirectional relationships between PA, SQ, and SD is inconsistent. As changes in one of these behaviors may impact on the other, it is important to understand the nature of the bidirectional relationship between PA and sleep. Therefore, the aim of this study was to examine the relationship between changes in PA, SQ, and SD over a 2-yr period in middle-age adults. Methods Participants were adults age 42 to 72 yr from Brisbane, Australia. Mail surveys were used to assess PA, SQ, SD, sociodemographic and health characteristics in 2011 and 2013 (n = 3649). Multinomial logistic regression analyses were conducted to examine the relationships between patterns of change in PA, SQ, and SD over the 2 yr. Results Improving or maintaining good SQ was associated with increasing or maintaining PA and maintaining PA was associated with maintaining or increasing SQ (P

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Sex Differences in Training Loads during British Army Basic Training

Purpose To compare training loads between men and women during 14 wk of British Army standard entry basic training. Methods Thirty-one male (mean ± SD: age, 21 ± 4 yr; height, 1.78 ± 0.08 m; mass, 77.1 ± 10.5 kg) and 28 female (age, 22 ± 4 yr; height, 1.65 ± 0.05 m; mass, 63.9 ± 8.9 kg) British Army recruits had external (distance) and internal (HR, training impulse [TRIMP], RPE) training loads measured during weeks 1, 2, 6, 12, and 13 of basic training. Total energy expenditure was measured during weeks 1 to 2 and weeks 12 to 13. Results Daily distance was higher for men than women (13,508 ± 666 vs 11,866 ± 491 m, respectively, P

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Genomewide Association Study of Leisure-Time Exercise Behavior in Japanese Adults

Purpose Although several genetic factors may play a role in leisure-time exercise behavior, there is currently no evidence of a significant genomewide association, and candidate gene replication studies have produced inconsistent results. Methods We conducted a two-stage genomewide association study and candidate single-nucleotide polymorphisms (SNP) association study on leisure-time exercise behavior using 13,980 discovery samples from the Japan Multi-Institutional Collaborative Cohort (J-MICC) study, and 2036 replication samples from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center-2 study. Leisure-time physical activity was measured using a self-administered questionnaire that inquired about the type, frequency and duration of exercise. Participants with ≥4 MET·h·wk−1 of leisure-time physical activity were defined as exhibiting leisure-time exercise behavior. Association testing using mixed linear regression models was performed on the discovery and replication samples, after which the results were combined in a meta-analysis. In addition, we tested six candidate genetic variants derived from previous genomewide association study. Results We found that one novel SNP (rs10252228) located in the intergenic region between NPSR1 and DPY19L1 was significantly associated with leisure-time exercise behavior in discovery samples. This association was also significant in replication samples (combined P value by meta-analysis = 2.2 × 10−9). Several SNP linked with rs10252228 were significantly associated with gene expression of DPY19L1 and DP19L2P1 in skeletal muscle, heart, whole blood, and the nervous system. Among the candidate SNP, rs12612420 in DNAPTP6 demonstrated nominal significance in discovery samples but not in replication samples. Conclusions We identified a novel genetic variant associated with regular leisure-time exercise behavior. Further functional studies are required to validate the role of these variants in exercise behavior.

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Peak Ventilation Reference Standards from Exercise Testing: From the FRIEND Registry

Purpose Cardiopulmonary exercise testing (CPX) provides valuable clinical information, including peak ventilation (V˙Epeak), which has been shown to have diagnostic and prognostic value in the assessment of patients with underlying pulmonary disease. This report provides reference standards for V˙Epeak derived from CPX on treadmills in apparently healthy individuals. Methods Nine laboratories in the United States experienced in CPX administration with established quality control procedures contributed to the Fitness Registry and the Importance of Exercise National Database from 2014 to 2017. Data from 5232 maximal exercise tests from men and women without cardiovascular or pulmonary disease were used to create percentiles of V˙Epeak for both men and women by decade between 20 and 79 yr. Additionally, prediction equations were developed for V˙Epeak using descriptive information. Results V˙Epeak was found to be significantly different between men and women and across age groups (P

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School Physical Activity Intervention Effect on Adolescents’ Performance in Mathematics

Purpose The primary aim of this study was to test the effect of a school-based physical activity intervention on adolescents' performance in mathematics. A secondary aim was to explore potential mechanisms that might explain the intervention effect. Methods The Activity and Motivation in Physical EDucation intervention was evaluated using a two-arm cluster randomized controlled trial in 14 secondary schools located in low socioeconomic areas of Western Sydney, Australia. Study participants (n = 1173) were grade 8 students (mean age = 12.94 yr, SD = 0.54). The multicomponent intervention was designed to help teachers maximize students' opportunities for moderate-to-vigorous physical activity (MVPA) during physical education (PE) and enhance students' motivation toward PE. Mathematics performance was assessed as part of national testing in grade 7, which was the year before the trial began and then again in grade 9. Potential mediators were: (i) proportion of PE lesson time that students spent in MVPA and leisure time MVPA (%), measured using Actigraph GT3X+ accelerometers, and (ii) students' self-reported engagement (behavioral, emotional, and cognitive) during mathematics lessons. Mediators were assessed at baseline (grade 8) and follow-up (grade 9, 14–15 months after baseline). Results The effect of the intervention on mathematics performance was small-to-medium (β = 0.16, P

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Response

No abstract available

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Appropriate Amount of Regular Exercise Is Associated with a Reduced Mortality Risk

Purpose This study aimed at investigating whether there is a continuous dose–response relationship between the amount of physical activity (PA) and longevity benefit. Methods We evaluated the records of 23,257,723 Koreans age ≥20 yr who had undergone one biennial medical evaluation by the National Health Insurance Corporation. Participants with ≥20 min of vigorous or ≥30 min of moderate PA or walking were stratified into four groups: 0 d·wk−1; 1–3 d·wk−1; 4 to 5 d·wk−1; and 6–7 d·wk−1. After calculating total metabolic equivalent task-hours per week (MET·h·wk−1), we created eight categories of MET-hours per week (0, 0.1–4.9, 5.0–9.9, 10.0–14.9, 15.0–19.9, 20.0–24.9, 25.0–29.9, and ≥30.0). Multivariate Cox proportional hazard analyses were performed. Results A reverse J-shaped risk curve was observed, with the lowest mortality risk in the participants exercising 4 to 5 d·wk−1 (reference). Participants who did not exercise at all and those who exercised with a PA frequency of 1 to 3 d·wk−1 or 6 to 7 d·wk−1 showed a significantly increased mortality risk compared with the reference group. When we repeated the Cox analysis among the 8 MET·h·wk−1 categories with the participants reporting 20.0 to 24.9 MET·h·wk−1 of PA as the reference group, we found that those with physical inactivity and 25.0–29.9 or ≥30.0 MET·h·wk−1 of PA showed a higher mortality risk than the reference group. These relationships were persistently observed after adjustment for confounders. Conclusions An appropriate amount of regular exercise in each specific type of PA was associated with the lowest risk of mortality. The inactive participants showed an increased mortality risk, and daily PA did not show any additional benefit in the mortality risk.

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Berne and Levy Physiology, 7th Edition

No abstract available

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Blunted Cardiac Output from Overtraining Is Related to Increased Arterial Stiffness

Purpose Moderate overtraining has been characterized by decreased exercising HR and recently decreased exercising stroke volume (SV), independent of alterations to blood volume. The aim of this study was to assess changes in arterial stiffness and central hemodynamics, and their relationship to exercising SV, after 3 wk of overload training. Methods Twenty-six cyclists and triathletes completed 3 wk of either regular training (CON; n = 13) or overload training (OL; n = 13). Testing took place before (PRE) and after regular or overload training (POST). Resting measures included brachial blood pressure, HR, carotid–femoral pulse wave velocity (PWV) to assess arterial stiffness, and carotid pulse wave analysis to assess wave reflections and central hemodynamics. An incremental cycle test was used to assess peak power, maximal HR, and maximal lactate to assess overtraining status. Cardiac output (Q˙), SV, and HR were assessed using cardiac impedance. Results Resting arterial stiffness was unaltered in CON but increased with OL after increased training (CON −0.1 ± 0.6 m·s−1 vs OL +0.5 ± 0.8 m·s−1, P = 0.04). Resting blood pressure and central hemodynamics, including aortic pressures, augmentation index, and subendocardial viability ratio, did not change (all P > 0.05). Maximal SV (CON +3 mL vs OL −9 mL, P = 0.04), HR (CON −2 ± 4 bpm vs OL −9 ± 3 bpm, P

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Sport and Triad Risk Factors Influence Bone Mineral Density in Collegiate Athletes

Purpose Athletes in weight-bearing sports may benefit from higher bone mineral density (BMD). However, some athletes are at risk for impaired BMD with female athlete triad (Triad). The purpose of this study is to understand the influence of sports participation and Triad on BMD. We hypothesize that athletes in high-impact and multidirectional loading sports will have highest BMD, whereas nonimpact and low-impact sports will have lowest BMD. Triad risk factors are expected to reduce BMD values independent of sports participation. Methods Two hundred thirty-nine female athletes participating in 16 collegiate sports completed dual-energy x-ray absorptiometry (DXA) scans to measure BMD z-scores of the lumbar spine (LS) and total body (TB). Height and weight were measured to calculate body mass index (BMI). Triad risk assessment variables were obtained from preparticipation examination. Mean BMD z-scores were compared between sports and by sport category (high-impact, multidirectional, low-impact, and nonimpact). Multivariable regression analyses were performed to identify differences of BMD z-scores accounting for Triad and body size/composition. Results Athlete populations with lowest average BMD z-scores included synchronized swimming (LS, −0.34; TB, 0.21) swimming/diving (LS, 0.34; TB, −0.06), crew/rowing (LS, 0.27; TB, 0.62), and cross-country (LS, 0.29; TB, 0.91). Highest values were in gymnastics (LS, 1.96; TB, 1.37), volleyball (LS, 1.90; TB, 1.74), basketball (LS, 1.73; TB, 1.99), and softball (LS, 1.68; TB, 1.78). All Triad risk factors were associated with lower BMD z-scores in univariable analyses; only low BMI and oligomenorrhea/amenorrhea were associated in multivariable analyses (all P

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Differences within Elite Female Tennis Players during an Incremental Field Test

Purpose To compare technical and physiological responses between junior and professional female players during an incremental field test to exhaustion specific to tennis. Methods Twenty-seven female players (n = 14 and 13 for juniors and professionals, respectively) completed an incremental field test to exhaustion specific to tennis, which consisted of hitting alternatively forehand and backhand strokes at increasing ball frequency (ball machine) every minute. Ball accuracy and ball velocity were determined by radar and video analysis for each stroke, in addition to cardiorespiratory responses (portable gas analyzer). Results The stage corresponding to the second ventilatory threshold (+20.0%, P = 0.027), time to exhaustion (+18.9%, P = 0.002) and maximum oxygen uptake (+12.4%, P = 0.007) were higher in professionals than in juniors. The relative percentage of maximal HR was lower at both the first (−4.7%, P = 0.014) and the second (−1.3%, P = 0.018) ventilatory thresholds in professionals. Backhand ball velocity was the only technical parameter that displayed larger (+7.1%, P = 0.016) values in professionals. Conclusions Compared with juniors, female professional tennis players possess higher exercise capacity, maximal and submaximal aerobic attributes along with faster backhand stroke velocities during an incremental field test specific to tennis.

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