Homozygous/compound heterozygote RYR1 gene variants: Expanding the clinical spectrum

Abstract

The ryanodine receptor 1 (RYR1) is a calcium release channel essential for excitation‐contraction coupling in the sarcoplasmic reticulum of skeletal muscles. Dominant variants in the RYR1 have been well associated with the known pharmacogenetic ryanodinopathy and malignant hyperthermia. With the era of next‐generation gene sequencing and growing number of causative variants, the spectrum of ryanodinopathies has been evolving with dominant and recessive variants presenting with RYR1‐related congenital myopathies such as central core disease, minicore myopathy with external ophthalmoplegia, core‐rod myopathy, and congenital neuromuscular disease. Lately, the spectrum was broadened to include fetal manifestations, causing a rare recessive and lethal form of fetal akinesia deformation sequence syndrome (FADS)/arthrogryposis multiplex congenita (AMC) and lethal multiple pterygium syndrome. Here we broaden the spectrum of clinical manifestations associated with homozygous/compound heterozygous RYR1 gene variants to include a wide range of manifestations from FADS through neonatal hypotonia to a 35‐year‐old male with AMC and PhD degree. We report five unrelated families in which three presented with FADS. One of these families was consanguineous and had three affected fetuses with FADS, one patient with neonatal hypotonia who is alive, and one individual with AMC who is 35 years old with normal intellectual development and uses a wheelchair. Muscle biopsies on these cases demonstrated a variety of histopathological abnormalities, which did not assist with the diagnostic process. Neither the affected living individuals nor the parents who are obligate heterozygotes had history of malignant hyperthermia.

from Genetics via xlomafota13 on Inoreader http://bit.ly/2Cqc5Yt
via IFTTT

Risk factors for low back pain with special reference to current smoking

We appreciate Prof Kawada's thoughtful letter regarding our recent review. Prof Kawada focuses on smoking as a potential risk factor for low back pain. We would add that smoking clearly increases the risk of other chronic diseases [1–3], and accordingly, even when there are doubts about whether it increases the risk of low back pain, we should still discourage smoking because it harms other aspects of health.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2DeWwoh
via IFTTT

Meetings Calendar

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2TXv3Nr
via IFTTT

Editorial Board

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2DeDIpd
via IFTTT

Table of Contents

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2TOSR5U
via IFTTT

Risk factors for low back pain with special reference to current smoking

I greatly appreciate the study by Parreira et al., a systematic review on risk factors for low back pain (LBP) or sciatica [1]. The authors conducted an umbrella review and the following adverse risk factors were specified: older age, smoking habit, physical stress on spine by vibration and depression. I have a query with this study with special reference to smoking.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2DfAj9w
via IFTTT

Extensions of BLUP Models for Genomic Prediction in Heterogeneous Populations: Application in a Diverse Switchgrass Sample

Genomic prediction is a useful tool to accelerate genetic gain in selection using DNA marker information. However, this technology typically relies on standard prediction procedures, such as genomic BLUP, that are not designed to accommodate population heterogeneity resulting from differences in marker effects across populations. In this study, we assayed different prediction procedures to capture marker-by-population interactions in genomic prediction models. Prediction procedures included genomic BLUP and two kernel-based extensions of genomic BLUP which explicitly accounted for population heterogeneity. To model population heterogeneity, dissemblance between populations was either depicted by a unique coefficient (as previously reported), or a more flexible function of genetic distance between populations (proposed herein). Models under investigation were applied in a diverse switchgrass sample under two validation schemes: whole-sample calibration, where all individuals except selection candidates are included in the calibration set, and cross-population calibration, where the target population is entirely excluded from the calibration set. First, we showed that using fixed effects, from principal components or putative population groups, appeared detrimental to prediction accuracy, especially in cross-population calibration. Then we showed that modelling population heterogeneity by our proposed procedure resulted in highly significant improvements in model fit. In such cases, gains in accuracy were often positive. These results suggest that population heterogeneity may be parsimoniously captured by kernel methods. However, in cases where improvement in model fit by our proposed procedure is null-to-moderate, ignoring heterogeneity should probably be preferred due to the robustness and simplicity of the standard genomic BLUP model.

from Genetics via xlomafota13 on Inoreader http://bit.ly/2TUQiiO
via IFTTT

Identification of Gene Variants Associated with Melanocyte Stem Cell Differentiation in Mice Predisposed for Hair Graying

Age-related hair graying is caused by malfunction in the regenerative potential of the adult pigmentation system. The retention of hair color over the life of an organism is dependent on the ability of the melanocyte stem cells and their progeny to produce pigment each time a new hair grows. Age-related hair graying is variable in association with genetic background suggesting that quantitative trait loci influencing this trait can be identified. Identification of these quantitative trait loci may lead to the discovery of novel and interesting genes involved in stem cell biology and/or melanogenesis. With this in mind we developed previously a sensitized, mouse modifier screen and discovered that the DBA/1J background is particularly resistant to melanocyte stem cell differentiation in comparison to the C57BL/6J background. Melanocyte stem cell differentiation generally precedes hair graying and is observed in melanocyte stem cells with age. Using quantitative trait loci analysis, we have now identified three quantitative trait loci on mouse chromosomes 7, 13, and X that are associated with DBA/1J-mediated variability in melanocyte stem cell differentiation. Taking advantage of publicly-available mouse sequence and variant data, in silico protein prediction programs, and whole genome gene expression results we describe a short list of potential candidate genes that we anticipate to be involved in melanocyte stem cell biology in mice.

from Genetics via xlomafota13 on Inoreader http://bit.ly/2Dfno7w
via IFTTT

A.I.S.F. 2019

from Gastroenterology via xlomafota13 on Inoreader http://bit.ly/2QTk31z
via IFTTT

Identification of Further Components of an Anticancer Defense System Composed of Small Molecules Present in the Serum

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://bit.ly/2McMd6Q
via IFTTT

Τhe minimum fascia–tumor distance (MFTD) criterion is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

The Diagnostic Performance of Ultrasonography and Computed Tomography in Differentiating Superficial from Deep Lobe Parotid Tumors

Ping‐Chia Cheng  Chih‐Ming Chang  Chun‐Chieh Huang  Wu‐Chia Lo  Tsung‐Wei Huang  Po‐Wen Cheng Li‐Jen Liao

First published: 12 January 2019 https://doi.org/10.1111/coa.13289

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.13289

ePDFPDFTOOLS SHARE

Abstract

Objectives

To validate and compare ultrasound (US) versus computed tomography (CT) criteria in the localization of superficial/deep lobe tumors of the parotid gland.

Design and Setting

This was a retrospective study of diagnostic tests performed from January 2008 to June 2017.

Participants

We included adult patients who were referred for a neck ultrasonography examination due to parotid tumors, and who subsequently underwent parotid surgery.

Main outcome measures

We assessed the location of parotid tumors, comparing the minimum fascia–tumor distance (MFTD) criterion on an US with eight CT criteria. We analyzed receiver operating characteristic (ROC) curves of the MFTD for malignant, benign, and all parotid tumors, and compared the accuracy, sensitivity, and specificity of the optimal MFTD with those of CT anatomical criteria.

Results

A total of 166 parotid tumors were included. The mean (SD) MFTD in superficial lobe tumors was significantly shorter than that of deep lobe tumors (1.2 [0.7] vs 2.8 [1.9] mm, effect size: 1.84; 95% CI, 1.27 to 2.41). The areas under the ROC curve were 0.63 for malignant tumors and 0.88 for benign tumors. The optimal MFTD cut point was 2.4 mm for the 154 benign parotid tumors and the accuracy, sensitivity, and specificity were 90%, 80% and 91%, respectively. For the 136 benign parotid tumors that underwent CT examination, three criteria had an accuracy of over 90% (FNline, tMasseter and Conn's arc), but the sensitivities were all below 50%.

Conclusions

MFTD is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

Harms of Workplace Inspections for Im/Migrant Sex Workers in In-Call Establishments: Enhanced Barriers to Health Access in a Canadian Setting

Abstract

Given shifting sex work criminalization and enforcement in Canada, this study examined worrying about workplace inspections by authorities amongst indoor sex workers in Vancouver (2014–2017). Data were drawn from a community-based prospective cohort of sex workers (AESHA). Bivariate and multivariable logistic regression were used to investigate factors associated with worry about inspections. 23.9% of participants experienced workplace inspections; 51.6% worried about inspections. In multivariable analyses, worrying about inspections was associated with recent im/migration [adjusted odds ratio (AOR) 3.13; 95% confidence interval (CI) 1.77–5.53], police harassment (AOR 3.49; 95% CI 1.92–6.34), and workplace violence (AOR 1.66, 95% CI 1.09–2.51). In a multivariable confounder model, worry was independently associated with barriers to health access (AOR 1.45, 95% CI 1.06–1.98). Im/migrant indoor workers are disproportionately impacted by concerns about workplace inspections, which was independently linked to enhanced barriers to health access. Current criminalization measures may exacerbate health inequities among im/migrant sex workers.

from Health via xlomafota13 on Inoreader http://bit.ly/2MelsiB
via IFTTT

Endoscopic technique for closure of enterocutaneous fistulas

Abstract

Background and objectives

Endoscopic over the scope clip (OTSC) closure represents a new technique for endoscopic management of enteric bleeding and tissue defects such as anastomotic leaks and enterocutaneous (EC) fistulas. We aim to describe our technical approach for OTSC closure of EC fistulas and convey our outcomes.

Methods and procedures

This retrospective review includes ten patients who underwent OTSC application for EC fistulas by surgical endoscopists at a US tertiary care hospital from July 2015 to October 2017. Demographic data, along with type of defect, location, duration of lesion, success or failure of OTSC, and nutritional status were compiled. The ACS NSQIP surgical risk calculator was used to project the risk of mortality, complications, length of stay, and risk of readmission had our patients undergone surgical correction of their fistula.

Results

Overall success for EC fistula closure was 70%. Acute fistulas were closed with a success rate of 86%. Chronic fistulas were closed successfully in only 33% of cases. Of patients successfully closed, NSQIP-predicted rates of mortality, any complication, and median length of stay were 21.1%, 34.5%, and 9.5 days, respectively. With OTSC, these patients experienced 0 mortalities, 0 complications, and had a median length of stay of 4 days.

Conclusion

OTSC is an effective adjunctive measure to improving rates of successful closure of EC fistulas and compromised anastomosis. OTSC conveys a markedly improved procedural risk profile as compared to standard surgical correction.

from Endoscopy via xlomafota13 on Inoreader http://bit.ly/2RYaN0V
via IFTTT

Baby sequencing steps

Baby sequencing steps

Baby sequencing steps, Published online: 16 January 2019; doi:10.1038/s41576-019-0094-6

The BabySeq project, a pilot randomized clinical trial exploring the value of routine genomic sequencing of neonates compared with standard newborn screening, now reports initial results in the American Journal of Human Genetics.

from Genetics via xlomafota13 on Inoreader https://go.nature.com/2AN9h7Z
via IFTTT

Anatomy of the stemmata in the Photuris firefly larva

Abstract

Fireflies (Coleoptera: Lampyridae) have distinct visual systems at different stages of development. Larvae have stemmata and adults have compound eyes. Adults use compound eyes to mediate photic communication during courtship. Larvae do not manifest this behavior, yet they are bioluminescent. We investigated the structure of stemmata in Photuris firefly larvae to identify anatomical substrates (i.e., rhabdomeres) conferring visual function. Stemmata were located bilaterally on the antero-lateral surfaces of the head. Beneath the ~ 130 µm diameter lens, we identified a pigmented eye-cup. At its widest point, the eye-cup was ~ 150 µm in diameter. The optic nerve exited the eye-cup opposite the lens. Two distinct regions, asymmetric in size and devoid of pigmentation, were characterized in stemmata cross-sections. We refer to these regions as lobes. Each lobe contained a rhabdom of a radial network of rhabdomeres. Pairs of rhabdomeres formed interdigitating microvilli contributed from neighboring photoreceptor cell bodies. The optic nerve contained 88 axons separable into two populations based on size. The number of axons in the optic nerve together with distinct rhabdoms suggests these structures were formed from 'fusion stemmata.' This structural specialization provides an anatomical substrate for future studies of visually mediated behaviors in Photuris larvae.

from Physiology via xlomafota13 on Inoreader http://bit.ly/2Mcdpme
via IFTTT

Identification of a novel plant RNA virus species of the genus Amalgavirus in the family Amalgaviridae from chia ( Salvia hispanica )

Abstract

Background

Chia (Salvia hispanica) is a flowering plant in the family Lamiaceae, which produces seeds that are a rich source of various nutritional compounds.

Objective

To identify a novel RNA virus potentially associated with chia.

Methods

Transcriptome data obtained from developing chia seeds were assembled into contigs. Sequence contigs containing an open reading frame (ORF) that showed amino acid identities with a viral RNA-dependent RNA polymerase (RdRp) were identified and analyzed.

Results

A genomic sequence of a novel plant RNA virus named Salvia hispanica RNA virus 1 (ShRV1) was identified in a chia seed transcriptome dataset. The ShRV1 genome sequence has two ORFs that showed high sequence identities with ORFs of known members of the genus Amalgavirus in the family Amalgaviridae. Amalgaviridae is a family of positive-sense double-stranded non-segmented RNA viruses that infect plants, fungi, and animals. The ShRV1 genome encodes two proteins: a putative replication factory matrix-like protein from ORF1 and an RdRp from the fused ORF of ORF1 and ORF2 by a + 1 programmed ribosomal frameshifting (PRF) mechanism. A conserved + 1 PRF motif sequence UUU_CGU was found at the ORF1/ORF2 boundary. A comparison of 31 amalgavirus ORF1 + 2 fusion proteins revealed that only three positions were repeatedly used as a + 1 PRF site during amalgavirus evolution.

Conclusion

ShRV1 is a novel virus found to be associated with chia and may be useful for studying the molecular features of amalgaviruses.

from Genetics via xlomafota13 on Inoreader http://bit.ly/2FtU937
via IFTTT

Body orientation contributes to modeling the effects of gravity for target interception in humans

Key points

It is known that interception of targets accelerated by gravity involves internal models coupled with visual signals. Nonvisual signals related to head and body orientation relative to gravity may also contribute, but their role is poorly understood. In a novel experiment, we asked pitched observers to hit a virtual target approaching with an acceleration that was either coherent or incoherent with their pitch‐tilt. Initially, the timing errors were large and independent of the coherence between target acceleration and observer's pitch. With practice, however, the timing errors became substantially smaller in the coherent conditions. The results show that information about head and body orientation can contribute to modeling the effects of gravity on a moving target. Orientation cues from vestibular and somatosensory signals might be integrated with visual signals in the vestibular cortex, where the internal model of gravity is thought to be encoded.

Abstract

Interception of moving targets relies on visual signals and internal models. Less is known about the additional contribution of nonvisual cues about head and body orientation relative to gravity. We took advantage of Galileo's law of motion along an incline to demonstrate the effects of vestibular and somatosensory cues about head and body orientation on interception timing. Participants were asked to hit a ball rolling in a gutter towards the eyes, resulting in image expansion. The scene was presented in a head‐mounted display, without any visual information about gravity direction. In separate blocks of trials participants were pitched backwards by 20° or 60°, while ball acceleration was randomized across trials so as to be compatible with rolling down a slope of 20° or 60°. Initially, the timing errors were large, independently of the coherence between ball acceleration and pitch angle, consistent with responses based exclusively on visual information since visual stimuli were identical at both tilts. At the end of the experiment, however, the timing errors were systematically smaller in the coherent conditions than the incoherent ones. Moreover, the responses were significantly (P = 0.007) earlier when participants were pitched by 60° than when they were pitched by 20°. Therefore, practice with the task led to incorporation of information about head and body orientation relative to gravity for response timing. Instead, posture did not affect response timing in a control experiment in which participants hit a static target in synchrony with the last of a predictable series of stationary audio‐visual stimuli.

This article is protected by copyright. All rights reserved

from Physiology via xlomafota13 on Inoreader http://bit.ly/2TUT4Vj
via IFTTT

Baby sequencing steps

from Genetics via xlomafota13 on Inoreader https://go.nature.com/2Hgvotb
via IFTTT

Medical Provider Promotion of Oral Health and Women’s Receipt of Dental Care During Pregnancy

Abstract

Objectives Dental care during pregnancy is important. We examined whether promotion of oral health by medical providers during pregnancy and pregnant women's receipt of dental care improved between 2009 and 2012 in California. Methods We used population-based postpartum survey data collected during 2009 (n = 3105) and 2012 (n = 6810) to compare the prevalence of women's reports that, during pregnancy, (a) their medical providers discussed oral health and/or suggested they see a dentist, and (b) they received dental care. Results Between 2009 and 2012, the proportion of women reporting that their medical providers talked about oral health or referred them to a dentist increased significantly overall (from 36 to 42%, and 21–26%, respectively, p < 0.001). The proportion of women with a dental visit during pregnancy also increased, from 38% in 2009 to 42% in 2012 (p < 0.005). The improvements were largely among women of lower income and education levels, those covered by Medi-Cal, and Latinas. Women whose medical providers promoted oral health care were approximately two times more likely to report having had a dental visit during pregnancy, even after adjusting for several potential confounders. Conclusions for Practice Characteristics of women reporting that their medical providers promoted, and that they received, dental care during pregnancy in 2012 suggests that the increases in promotion and use of oral health care were largely concentrated among Medi-Cal recipients. Further improvement is needed for all populations of pregnant women. Both public and private providers need to incorporate promotion of and referral for dental care into routine prenatal care protocols.

from Health via xlomafota13 on Inoreader http://bit.ly/2AYNmLd
via IFTTT

User activity recognition system to improve the performance of environmental control interfaces: a pilot study with patients

Assistive technologies aim to increase quality of life, reduce dependence on care giver and on the long term care system. Several studies have demonstrated the effectiveness in the use of assistive technology ...

from Rehabilitation via xlomafota13 on Inoreader http://bit.ly/2TQwOvJ
via IFTTT

Effects of Repetitive Head Impacts on a Concussion Assessment Battery

Purpose The purpose of this study was to determine the relationship between repetitive head impacts (RHI) and clinical concussion assessments across a season among collegiate football (FB) and women's soccer (WSOC) players. Methods Fifteen male FB and 23 WSOC players participated in this study. Participants were included if they were medically cleared for unrestricted athletic participation. Participants were tested in a university athletic training room on two occasions: pre-season (PRE) and post-season (POST). The outcome measures consisted of Tandem Gait (TG), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), King-Devick (KD), Clinical Reaction Time (CRT), and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). RHI during the season was quantified using the Head Impact Telemetry System (HITS; Simbex, NH) for FB and the Smart Impact Monitor (SIM; Triax Technologies, CT) for WSOC. Independent variables included total number of impacts, average magnitude of peak linear acceleration, cumulative linear exposure, and number of impacts >98g. Results Results from direct-entry multiple regression analyses suggest significant associations between RHI and both Visual Memory (R2=0.670, F=6.487, p=0.002) and TG (R2=0.636, F=3.841, p=0.029) for WSOC and between RHI and KD (R2=0.756, F=5.579, p=0.013) for FB, whereby those with greater exposure performed worse. No other regression analyses within or across groups were significant. Conclusions These data suggest that RHI do not represent clinically meaningful changes on a multifaceted and multimodal concussion assessment battery. However, there may be subtle visual/vestibular impairments as observed by the associations between RHI and Visual Memory/TG among WSOC, RHI and KD among FB. Corresponding Author: Thomas A. Buckley, 100 Discovery Blvd, Newark, DE 19713. Telephone: 302-831-4783. Email: tbuckley@udel.edu This publication was made possible, in part, with support from the Grand Alliance CARE Consortium, funded by the NCAA and the DoD. The USAMRAA, Ford Detrick, MD, USA, is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH-14-2-0151. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the DoD (DHP funds). Conflict of Interests: The authors have no conflicts of interest to disclose. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication: 9 January 2019. © 2019 American College of Sports Medicine

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2RshfxD
via IFTTT

THE MECHANICS OF BREATHING DURING SWIMMING

The thorax undergoes unique conditions while swimming. Hydrostatic pressure from water immersion places an external load on the thorax and increases airway resistance, while the horizontal body position results in central venous engorgement and an associated reduction in lung compliance. The aforementioned factors likely increase the work of breathing (Wb); however, this hypothesis remains untested. Purpose To compare Wb during freestyle swimming relative to cycling, and to characterize the differences in the cardiorespiratory responses to swimming relative to cycling in the same individuals. Methods Eight collegiate swimmers (n=4 male, n=4 female; age= 22±2 y) performed an incremental swim test while tethered to a resistance apparatus. On a separate day subjects performed an incremental cycle test. During swimming and cycling, metabolic and ventilatory parameters were measured using a customized metabolic cart, and inspired Wb was quantified using an esophageal balloon catheter. Results Swimming and cycling elicited statistically similar levels of peak oxygen uptake (3.87±0.92 vs. 4.20±0.83 l·min-1, p=0.143). However, peak minute ventilation (V[Combining Dot Above]E) (118±3 vs. 154±25 l·min-1) and heart rate (164±19 vs. 183±8 beats·min-1) were significantly lower during swimming relative to cycling (both p

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2CtKeXk
via IFTTT

Downhill Running Acutely Elicits Mitophagy in Rat Soleus Muscle

Purpose To investigate the effects of downhill treadmill running on mitochondrial structure/function and expression levels of mitophagy-related proteins in rat skeletal muscle. Methods A total of 48 male adult Sprague-Dawley rats were randomly divided into a control group (C, n=8) and an exercise group (E, n=40). Rats in the E group were exercised on a treadmill down a 16° decline at 16m/min for 90min, and were further divided into 0h(E0), 12h(E12), 24h(E24), 48h(E48) and 72h(E72) post-exercise sub-groups (n=8 each). At each time point the soleus muscle was collected under full anesthesia. Mitochondrial ultrastructural changes in skeletal muscle were observed by a transmission electron microscope. The content of quantitative enzyme citrate synthase (CS) and the activities of mitochondrial respiratory chain Complex II and IV were measured by enzyme-linked immunosorbent assay. Protein expression of skeletal muscle cytochrome c oxidase subunit 1 (COX1), PTEN-induced putative kinase 1 (PINK1) and mitochondrial Parkin, microtubule-associated protein 1 light chain 3 (LC3) were determined by Western blot. Mitochondrial co-localizations with Parkin, ubiquitin (Ub), p62/Sequestosome 1 (p62) and LC3 were measured by the immunofluorescence double labeling technique. Results After downhill treadmill running, the skeletal muscle mitochondrial structure changed dramatically and a large amount of mitophagosomes were observed; the CS content and Complex II activity were significantly lower (p

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2Rwv8uv
via IFTTT

Conditions of Poverty, Parent–Child Interactions, and Toddlers’ Early Language Skills in Low-Income Families

Abstract

Objectives The study examined the relations between parent–child interaction in the first year of life to toddlers' language skills at age 2 years for a sample of children reared in poverty; of specific interest was testing the Family Stress Model, which proposes that the conditions of poverty influence children's language skills through caregiver well-being (e.g., distress, depression) and interaction dysregulation. Methods Participants were from the Kids in Columbus Study, a birth-cohort study of children born to urban families experiencing material hardship. Caregiver questionnaires were collected when the child was 4–7 months to document poverty conditions (maternal hardship, institutional resources), caregiver well-being (depression, distress), and dysregulation in parent–child interactions. The Bayley-III assessed receptive and expressive language skills when the children were 2 years. Results On average, receptive language skills were nearly 1 SD below the normative mean. Path models showed a significant effect of caregiver-child dysregulated interactions on toddlers' language skills, and an indirect effect of maternal distress on parent–child interactions and, in turn, toddlers' language skills. Conclusions for Practice This study confirmed the theoretical Family Stress Model as a viable representation of the effects of poverty on the language skills of toddlers reared in homes experiencing socioeconomic disadvantage.

from Health via xlomafota13 on Inoreader http://bit.ly/2TUThbc
via IFTTT

Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials

BACKGROUND: Perioperative IV dextrose infusions have been investigated for their potential to reduce the risk of postoperative nausea and vomiting. In this meta-analysis, we investigated the use of an intraoperative or postoperative infusion of dextrose for the prevention of postoperative nausea and vomiting. METHODS: Our group searched PubMed, Embase, Cochrane library, and Google Scholar for relevant randomized controlled trials examining the use of perioperative IV dextrose for prevention of postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting (both in the postanesthesia care unit and within the first 24 h of surgery). Secondary outcomes included postoperative antiemetic administration and serum glucose level. RESULTS: Our search yielded a total of 10 randomized controlled trials (n = 987 patients) comparing the use of a perioperative dextrose infusion (n = 465) to control (n = 522). Perioperative dextrose infusion was not associated with a significant reduction in postoperative nausea and vomiting in the postanesthesia care unit (risk ratio = 0.91, 95% CI, 0.73–1.15; P = .44) or within the first 24 h (risk ratio = 0.76, 95% CI, 0.55–1.04; P = .09) of surgery. Although the use of dextrose was associated with a significant reduction in antiemetic administration within the first 24 h (risk ratio = 0.55, 95% CI, 0.45–0.69; P

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2VYHydd
via IFTTT

Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis

BACKGROUND: Erythropoietic-stimulating agents such as erythropoietin have been used as part of patient blood management programs to reduce or even avoid the use of allogeneic blood transfusions. We review the literature to evaluate the effect of preoperative erythropoietin use on the risk of exposure to perioperative allogeneic blood transfusions. METHODS: The study involved a systematic review and meta-analysis of randomized controlled trials evaluating the use of preoperative erythropoietin. The primary outcome was the reported incidence of allogeneic red blood cell transfusions during inpatient hospitalizations. Secondary outcomes included phase-specific allogeneic red blood cell transfusions (ie, intraoperative, postoperative), intraoperative estimated blood loss, perioperative hemoglobin levels, length of stay, and thromboembolic events. RESULTS: A total of 32 randomized controlled trials (n = 4750 patients) were included, comparing preoperative erythropoietin (n = 2482 patients) to placebo (n = 2268 patients). Preoperative erythropoietin is associated with a significant decrease in incidence of allogeneic blood transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI, 0.47–0.73; P

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2QQJOQf
via IFTTT

Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia

Ambulatory arthroscopic anterior cruciate ligament reconstruction is associated with moderate pain, even when nonopioid oral analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are used. Regional analgesia can supplement nonopioid oral analgesics and reduce postoperative opioid requirements, but the choice of regional analgesia technique for anterior cruciate ligament reconstruction remains controversial. Femoral nerve block, adductor canal block, and local instillation analgesia have all been proposed and are supported by some evidence from randomized controlled trials. Consequently, regional analgesia practice in patients undergoing anterior cruciate ligament reconstruction remains mixed. Published systematic reviews were used to identify the regional analgesia modality that would provide a balance between analgesic efficacy and associated potential risks in the setting of nonopioid multimodal analgesic strategies. Based on the evidence available, local instillation analgesia provides the best balance of analgesic efficacy and associated risks (strong recommendation, moderate level of evidence) when used as a component of multimodal analgesic technique in the first 24 hours after outpatient arthroscopic anterior cruciate ligament reconstruction. In the absence of local instillation analgesia, clinicians might use adductor canal block or femoral nerve block (weak recommendation, weak level of evidence). These recommendations have been endorsed by the Society of Ambulatory Anesthesia and approved by its board of directors. Accepted for publication November 05, 2018. Funding: No external funding was provided from any source. No funding was received from the Society for Ambulatory Anesthesia. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Girish P. Joshi, MBBS, MD, FFARCSI, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390. Address e-mail to girish.joshi@utsouthwestern.edu. © 2019 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2VYHiuL
via IFTTT

Essentials of Anesthesia for Neurotrauma, 1st ed

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2QSElYS
via IFTTT

In Response

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2VYHc6n
via IFTTT

Changes in International Normalized Ratio After Plasma Transfusion in Clinical Settings

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2QMP8E9
via IFTTT

Systematic Review and Meta-analysis: Sometimes Bigger Is Indeed Better

Clinicians encounter an ever increasing and frequently overwhelming amount of information, even in a narrow scope or area of interest. Given this enormous amount of scientific information published every year, systematic reviews and meta-analyses have become indispensable methods for the evaluation of medical treatments and the delivery of evidence-based best practice. The present basic statistical tutorial thus focuses on the fundamentals of a systematic review and meta-analysis, against the backdrop of practicing evidence-based medicine. Even if properly performed, a single study is no more than tentative evidence, which needs to be confirmed by additional, independent research. A systematic review summarizes the existing, published research on a particular topic, in a well-described, methodical, rigorous, and reproducible (hence "systematic") manner. A systematic review typically includes a greater range of patients than any single study, thus strengthening the external validity or generalizability of its findings and the utility to the clinician seeking to practice evidence-based medicine. A systematic review often forms the basis for a concomitant meta-analysis, in which the results from the identified series of separate studies are aggregated and statistical pooling is performed. This allows for a single best estimate of the effect or association. A conjoint systematic review and meta-analysis can provide an estimate of therapeutic efficacy, prognosis, or diagnostic test accuracy. By aggregating and pooling the data derived from a systemic review, a well-done meta-analysis essentially increases the precision and the certainty of the statistical inference. The resulting single best estimate of effect or association facilitates clinical decision making and practicing evidence-based medicine. A well-designed systematic review and meta-analysis can provide valuable information for researchers, policymakers, and clinicians. However, there are many critical caveats in performing and interpreting them, and thus, like the individual research studies on which they are based, there are many ways in which meta-analyses can yield misleading information. Creators, reviewers, and consumers alike of systematic reviews and meta-analyses would thus be well-served to observe and mitigate their associated caveats and potential pitfalls. Accepted for publication December 10, 2018. Funding: None. The author declares no conflicts of interest. Reprints will not be available from the author. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2019 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2VWo60U
via IFTTT

Continuous Noninvasive Arterial Pressure Monitoring in Obese Patients During Bariatric Surgery: An Evaluation of the Vascular Unloading Technique (Clearsight system)

BACKGROUND: Continuous monitoring of arterial pressure is important in severely obese patients who are at particular risk for cardiovascular complications. Innovative technologies for continuous noninvasive arterial pressure monitoring are now available. In this study, we compared noninvasive arterial pressure measurements using the vascular unloading technique (Clearsight system; Edwards Lifesciences Corp, Irvine, CA) with invasive arterial pressure measurements (radial arterial catheter) in severely obese patients during laparoscopic bariatric surgery. METHODS: In 35 severely obese patients (median body mass index, 47 kg/m2), we simultaneously recorded noninvasive and invasive arterial pressure measurements over a period of 45 minutes. We compared noninvasive (test method) and invasive (reference method) arterial pressure measurements (sampling rate 1 Hz = 1/s) using Bland-Altman analysis (accounting for multiple measurements per subject), 4-quadrant plot/concordance analysis (2-minute interval, 5 mm Hg exclusion zone), and error grid analysis (calculating the proportions of measurements in risk zones A–E with A indicating no risk, B low risk, C moderate risk, D significant risk, and E dangerous risk for the patient due to the risk of wrong clinical interventions because of measurement errors). RESULTS: We observed a mean of the differences (±SD, 95% limits of agreement) between the noninvasively and invasively assessed arterial pressure values of 1.1 mm Hg (±7.4 mm Hg, −13.5 to 15.6 mm Hg) for mean arterial pressure (MAP), 6.8 mm Hg (±10.3 mm Hg, −14.4 to 27.9 mm Hg) for systolic arterial pressure, and 0.8 mm Hg (±6.9 mm Hg, −12.9 to 14.4 mm Hg) for diastolic arterial pressure. The 4-quadrant plot concordance rate (ie, the proportion of arterial pressure measurement pairs showing concordant changes to all changes) was 93% (CI, 89%–96%) for MAP, 93% (CI, 89%–97%) for systolic arterial pressure, and 88% (CI, 84%–92%) for diastolic arterial pressure. Error grid analysis showed that the proportions of measurements in risk zones A–E were 89.5%, 10.0%, 0.5%, 0%, and 0% for MAP and 93.7%, 6.0%, 0.3%, 0%, and 0% for systolic arterial pressure, respectively. CONCLUSIONS: During laparoscopic bariatric surgery, the accuracy and precision of the vascular unloading technique (Clearsight system) was good for MAP and diastolic arterial pressure, but only moderate for systolic arterial pressure according to Bland-Altman analysis. The system showed good trending capabilities. In the error grid analysis, >99% of vascular unloading technique–derived arterial pressure measurements were categorized in no- or low-risk zones. Accepted for publication October 18, 2018. Sebastian A. Haas, MD, and Daniel A. Reuter, MD, are currently affiliated with the Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany. Funding: Edwards Lifesciences Corp (Irvine, CA) provided the technical equipment for the study. Edwards Lifesciences was not involved in the collection of the data, drafting of the manuscript, or the decision to submit the manuscript for publication. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Dorothea E. Rogge, MD, Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Address e-mail to d.rogge@uke.de. © 2019 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2QSwScz
via IFTTT

Intraoperative Hyperoxia Does Not Reduce Postoperative Pain: Subanalysis of an Alternating Cohort Trial

BACKGROUND: Postoperative pain is common and promotes opioid use. Surgical wounds are hypoxic because normal perfusion is impaired. Local wound ischemia and acidosis promote incisional pain. Some evidence suggests that improving oxygen supply to surgical wounds might reduce pain. We therefore tested the hypothesis that supplemental (80% inspired) intraoperative oxygen reduces postoperative pain and opioid consumption. METHODS: We conducted a post hoc analysis of a large, single-center alternating cohort trial allocating surgical patients having general anesthesia for colorectal surgery to either 30% or 80% intraoperative oxygen concentration in 2-week blocks for a total of 39 months. Irrespective of allocation, patients were given sufficient oxygen to maintain saturation ≥95%. Patients who had regional anesthesia or nerve blocks were excluded. The primary outcome was pain and opioid consumption during the initial 2 postoperative hours, analyzed jointly. The secondary outcome was pain and opioid consumption over the subsequent 24 postoperative hours. Subgroup analyses of the primary outcome were conducted for open versus laparoscopic procedures and for patients with versus without chronic pain. RESULTS: A total of 4702 cases were eligible for analysis: 2415 were assigned to 80% oxygen and 2287 to 30% oxygen. The groups were well balanced on potential confounding factors. Average pain scores and opioid consumption were similar between the groups (mean difference in pain scores, −0.01 [97.5% CI, −0.16 to 0.14; P = .45], median difference in opioid consumption, 0.0 [97.5% CI, 0 to 0] mg morphine equivalents; P = .82). There were also no significant differences in the secondary outcome or subgroup analyses. CONCLUSIONS: Supplemental intraoperative oxygen does not reduce acute postoperative pain or reduce opioid consumption. Accepted for publication November 26, 2018. Funding: This work received internal funding. None of the authors has a personal financial interest in this analysis. B.C. is a recipient of a Fellowship Grant from the American Physicians Fellowship for Medicine in Israel. The authors declare no conflicts of interest. 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 (http://bit.ly/KegmMq). Trial registration: ClinicalTrials.gov number NCT01777568. Reprints will not be available from the authors. Address correspondence to Alparslan Turan, MD, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, P77, Cleveland, OH 44195. Address e-mail to TuranA@ccf.org. © 2019 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2VUR40W
via IFTTT

Quantile Regression and Its Applications: A Primer for Anesthesiologists

Multivariable regression analysis is a powerful statistical tool in biomedical research with numerous applications. While linear regression can be used to model the expected value (ie, mean) of a continuous outcome given the covariates in the model, quantile regression can be used to compare the entire distribution of a continuous response or a specific quantile of the response between groups. The advantage of the quantile regression methodology is that it allows for understanding relationships between variables outside of the conditional mean of the response; it is useful for understanding an outcome at its various quantiles and comparing groups or levels of an exposure on those quantiles. We present quantile regression in a 3-step approach: determining that quantile regression is desired, fitting the quantile regression model, and interpreting the model results. We then apply our quantile regression analysis approach using 2 illustrative examples from the 2015 American College of Surgeons National Surgical Quality Improvement Program Pediatric database, and 1 example utilizing data on duration of sensory block in rats. Accepted for publication December 12, 2018. Funding: None. The authors declare no conflicts of interest. 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 (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to Steven J. Staffa, MS, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115. Address e-mail to steven.staffa@childrens.harvard.edu. © 2019 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2QRIeNJ
via IFTTT

Innovation in Education Research: Creation of an Education Research Core

Within academic medical centers, there is increasing interest among physicians to pursue education as a promotion pathway. Many medical schools and universities offer professional development opportunities for these individuals such as workshops and certificate and advanced degree programs. However, there exists a need for a more personalized support for clinician-educators to be successful in educational scholarship in the health care setting. In 2017, a departmental level educational research community was established within Anesthesiology and Critical Care Medicine at Johns Hopkins University to support faculty, staff, and trainees in creating, completing, and publishing educational scholarship. The research infrastructure includes administrative and institutional review board submission assistance, internal grant support, database management, statistical analysis, and consultation with professional educators. Also, integral to the education core is monthly education lab meetings that allow an opportunity for education researchers to present work in progress, conceive new projects, discuss relevant literature, and cultivate and sustain a community of educational scholars. This innovation in education demonstrates feasibility at a departmental level to successfully support educational research. We have initiated education meetings with a cohort of core education faculty who are interested in an educational promotion track. We present several metrics that can be used to evaluate the effectiveness of the programs similar to this innovation. Accepted for publication November 1, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Deborah A. Schwengel, MD, MEHP, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 1800 Orleans St, Suite 6349H, Baltimore, MD. Address e-mail to Dschwen1@jhmi.edu. © 2019 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2VUiLHo
via IFTTT

Vasopressor Infusion During Prone Spine Surgery and Acute Renal Injury: A Retrospective Cohort Analysis

BACKGROUND: Hypotension is associated with acute kidney injury, but vasopressors used to treat hypotension may also compromise renal function. We therefore tested the hypothesis that vasopressor infusion during complex spine surgery is not associated with impaired renal function. METHODS: In this retrospective cohort analysis, we considered adults who had complex spine surgery between January 2005 and September 2014 at the Cleveland Clinic Main Campus. Our primary outcome was postoperative estimated glomerular filtration rate. Secondarily, we evaluated renal function using Acute Kidney Injury Network criteria. We obtained data for 1814 surgeries, including 689 patients (38%) who were given intraoperative vasopressors infusion for ≥30 minutes and 1125 patients (62%) who were not. Five hundred forty patients with and 540 patients without vasopressor infusions were well matched across 32 potential confounding variables. RESULTS: In matched patients, vasopressor infusions lasted an average of 173 ± 100 minutes (SD) and were given a median dose (1st quintile, 3rd quintile) of 3.4-mg (1.5, 6.7 mg) phenylephrine equivalents. Mean arterial pressure and the amounts of hypotension were similar in each matched group. The postoperative difference in mean estimated glomerular filtration rate in patients with and without vasopressor infusions was only 0.8 mL/min/1.73 m2 (95% CI, −0.6 to 2.2 mL/min/1.73 m2) (P = .28). Intraoperative vasopressor infusion was also not associated with increased odds of augmented acute kidney injury stage. CONCLUSIONS: Clinicians should not avoid typical perioperative doses of vasopressors for fear of promoting kidney injury. Tolerating hypotension to avoid vasopressor use would probably be a poor strategy. Accepted for publication November 13, 2018. Funding: Institutional. The authors declare no conflicts of interest. 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 (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to Daniel I. Sessler, MD, Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Ave, P77, Cleveland, OH 44195. Address e-mail to DS@OR.org. © 2019 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://bit.ly/2QSEhIC
via IFTTT

Effects of Napping on Alertness, Cognitive, and Physical Outcomes of Karate Athletes

Purpose It has been suggested that napping is the best recovery strategy for athletes. However, researches on the impacts of napping on athletic performances are scarce. The aim of this study was to determine the effects of a 30-min nap after a partial sleep deprivation, or a normal night condition, on alertness, fatigue, and cognitive and physical outcomes. Methods Thirteen national-level male karate athletes were randomized to experience nap and no-nap conditions, after either a reference or a partial sleep deprivation night. The nap lasted 30 min at 1:00 PM. The postnap testing session started at 2:00 PM by quantifying subjective alertness and fatigue. Cognitive and physical performances were respectively measured before and after the karate-specific test (KST) by simple reaction time (SRT) test, lower reaction test (LRT), mental rotation test (MRT), squat jump (SJ), and counter movement jump (CMJ) tests. Results After a reference night, the nap improved alertness and cognitive outcomes (SRT, LRT, and MRT). No effects on subjective fatigue and physical performances were found. After a partial-sleep deprivation, the nap restored subjective alertness and the decrement in performances caused by sleep loss in most of the tests (MRT, LRT, and KST), but no effects were observed in subjective fatigue and CMJ. After the fatigue induced by KST, there was an ergogenic effect of the nap on the physical performances (CMJ and SJ), and a partial psychogenic effect on the cognitive performances (LRT). Conclusions A 30-min nap enhances cognitive outcomes. It is also an effective strategy to overcome the cognitive and physical deteriorations in performances caused either by sleep loss or by fatigue induced by exhaustive trainings in the afternoon.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2QOjnKU
via IFTTT

Assessment in Applied Sport Psychology

No abstract available

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FuHEUX
via IFTTT

Role of Relative Malnutrition in Exercise Hypogonadal Male Condition

Objective Exercise hypogonadal male condition is a well-recognized condition in women but much less understood in men. The aim of this case report is to highlight exercise-induced hypogonadotropic hypogonadism in a male who recovered with lifestyle modifications. Methods We report a case of an adolescent male who developed hypogonadotropic hypogonadism secondary to excessive exercise and malnutrition that was followed up for a year without exogenous testosterone supplementation. Informed consent was obtained from the patient for his information to be used in a manuscript submitted to a journal. Results An 18-yr-old adolescent male presented to the clinic with symptoms of fatigue and low endurance, low libido, and lack of morning erections. At the time of his presentation, he was running about 60 miles per week for school cross-country team in addition to cross training with kickboxing. Physical examination was remarkable for low body mass index of 19 kg·m−2 but was otherwise normal. Biochemical workup confirmed hypogonadotropic hypogonadism and a mild pancytopenia. Other pituitary laboratory values and MRI of the brain were unremarkable. Bone marrow biopsy performed for anemia showed features consistent with malnutrition. With a working diagnosis of exercise hypogonadal male condition, he was advised to reduce the frequency and intensity of his exercise and increase calorie intake. Cell counts and testosterone levels normalized, and his symptoms resolved without any further interventions. Conclusion Significant reversible hypogonadism can develop after intensive and prolonged exercise. One of the mechanisms of hypogonadism in endurance athletes performing intensive exercise could be relative malnutrition. Further studies to evaluate the role of nutrition and body mass index in male endurance athletes presenting with hypogonadism are needed to identify the underlying mechanism of this condition.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FGNrq3
via IFTTT

Dynamic Cerebral Autoregulation Is Maintained during High-Intensity Interval Exercise

Introduction High-intensity interval exercise (HIIE) is more effective at increasing metabolic and cardiovascular health compared with moderate-intensity continuous exercise for patients with cardiovascular disease, but exhaustive high-intensity continuous exercise attenuates dynamic cerebral autoregulation (CA). This study assessed the effect of HIIE on dynamic CA. Methods Nine healthy men (age, 24 ± 3 yr; mean ± SD) warmed up at 50%–60% maximal workload (Wmax) for 5 min before HIIE including four 4-min bouts of exercise at 80%–90% Wmax interspaced by four 3-min bouts at 50% to 60% Wmax. Transcranial Doppler determined middle cerebral artery mean blood velocity (MCA Vmean), and brachial artery catheterization determined mean arterial pressure (MAP). Dynamic CA was evaluated by transfer function analysis of changes in MAP and MCA Vmean. Results The HIIE increased MAP (from 92 ± 9 to 104 ± 10 mm Hg; P

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FuU8Mo
via IFTTT

Two-Year Agility Maintenance Training Slows the Progression of Parkinsonian Symptoms

Introduction Parkinson's disease (PD) is a progressive neurodegenerative condition and it is unclear if long-term nonpharmaceutical interventions can slow the progression of motor and nonmotor symptoms and lower drug dose. Methods In a randomized trial, after an initial 3-wk-long, 15-session supervised high-intensity sensorimotor agility exercise (E) program designed to improve postural instability, the exercise+maintenance (E + M, n = 19) group continued to exercise three times per week for 2 yr, whereas E (n = 16), and the no exercise and no maintenance control (C, n = 20) continued habitual living. Eight outcomes were measured before and after the 3-wk initial exercise program and then at 3, 6, 9, 12, 18, and 24 months in all patients. Results The group–time interactions (all P

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FzApu6
via IFTTT

Fitness Mediates Activity and Sedentary Patterns Associations with Adiposity in Youth

Purpose We aimed to examine the cross-sectional associations of patterns of sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) with total fat mass index (FMI) and abdominal FMI (FMIabd) in children, and additionally, to analyze if cardiorespiratory fitness (CRF) mediated these associations. Methods Fat mass index and FMIabd were assessed with dual-energy X-ray absorptiometry in 333 participants (172 girls) age 9 to 11 yr. MVPA, ST, breaks in ST per sedentary hour (BST/ST) and the number of daily sedentary bouts with various lengths (1–4, 5–9, 10–14, and ≥15 min) were assessed with accelerometry and CRF using a maximal cycle test. Hayes' PROCESS macro for SPSS was used for mediation analysis. Results The number of shorter sedentary bouts (1–4 min) was inversely associated with FMI (β = −0.108), whereas longer sedentary bouts (5–9 min, β = 0.169; 10–14 min, β = 0.193; ≥15 min, β = 0.377) had a positive association, independent of MVPA (P 0.05). Cardiorespiratory fitness was inversely related to total and abdominal adiposity, and a large portion (40.9–65.7%) of the associations of MVPA and sedentary bouts with both FMI and FMIabd were mediated by CRF. Conclusions Time in MVPA and accumulating ST in shorter sedentary bouts is inversely related to adiposity. However, these associations may be mediated by CRF. Emphasis should be given to programs that target increases in MVPA, which may influence CRF while reducing sedentary recreational behaviors.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FvUKBx
via IFTTT

Walking Ground Reaction Force Post-ACL Reconstruction: Analysis of Time and Symptoms

Purpose The association between lower-extremity loading and clinically relevant knee symptoms at different time points after anterior cruciate ligament reconstruction (ACLR) is unclear. Vertical ground reaction force (vGRF) from walking was compared between individuals with and without clinically relevant knee symptoms in three cohorts: 24 months post-ACLR. Methods One hundred twenty-eight individuals with unilateral ACLR were classified as symptomatic or asymptomatic, based on previously defined cutoff values for the Knee Osteoarthritis and Injury Outcome Score (24 months post-ACLR [symptomatic, n = 13; asymptomatic, n = 33]). Vertical ground reaction force exerted on the ACLR limb was collected during walking gait, and functional analyses of variance were used to evaluate the effects of symptoms and time post-ACLR on vGRF throughout stance phase (α = 0.05). Results Symptomatic individuals, 24 months post-ACLR, exhibited greater vGRF during both peaks, but lesser vGRF during midstance, compared to asymptomatic individuals. Conclusion Relative to asymptomatic individuals, symptomatic individuals are more likely to underload the ACLR limb early after ACLR (i.e., 24 months). We propose these differences in lower-extremity loading during walking might have implications for long-term knee health, and should be considered when designing therapeutic interventions for individuals with an ACLR.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FDyftx
via IFTTT

The Effect of Dietary Protein on Protein Metabolism and Performance in Endurance-trained Males

Recommendations for dietary protein are primarily based on intakes that maintain nitrogen (i.e., protein) balance rather than optimize metabolism and/or performance. Purpose This study aimed to determine how varying protein intakes, including a new tracer-derived safe intake, alter whole body protein metabolism and exercise performance during training. Methods Using a double-blind randomized crossover design, 10 male endurance-trained runners (age, 32 ± 8 yr; V˙O2peak, 65.9 ± 7.9 mL O2·kg−1·min−1) performed three trials consisting of 4 d of controlled training (20, 5, 10, and 20 km·d−1, respectively) while consuming diets providing 0.94 (LOW), 1.20 (MOD), and 1.83 (HIGH) g protein·kg−1·d−1. Whole body protein synthesis, breakdown, and net balance were determined by oral [15N]glycine on the first and last day of the 4-d controlled training period, whereas exercise performance was determined from maximum voluntary isometric contraction, 5-km time trial, and countermovement jump impulse (IMP) and peak force before and immediately after the 4-d intervention. Results Synthesis and breakdown were not affected by protein intake, whereas net balance showed a dose–response (HIGH > MOD > LOW, P

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FrTqQd
via IFTTT

Health-related Outcomes after a Youth Sport–related Knee Injury

Purpose Active youth are vulnerable to knee injury and subsequent osteoarthritis. Improved understanding of the association between health-related outcomes and history of joint injury could inform osteoarthritis prevention strategies. The purpose of this historical cohort study is to examine the association between youth sport–related knee injury and various clinical, physiological, behavioral, and functional health-related outcomes, 3–10 yr postinjury. Methods Participants included 100 individuals who experienced a youth sport–related knee injury 3–10 yr earlier and 100 age-, sex-, and sport-matched uninjured controls. Outcomes include the following: Knee Injury and Osteoarthritis Outcome Score (KOOS), Intermittent and Constant Osteoarthritis Pain Score, body mass index (BMI), fat mass index (FMI), weekly physical activity, estimated aerobic capacity, hip and knee muscle strength, and dynamic balance. Baseline characteristics were described. Multivariable regression models (95% confidence interval [CI]) were used to evaluate the association between injury history and each outcome, considering the influence of sex and time since injury. Results Participant median age was 22 yr (range, 15–26 yr), and 55% were female. The injured group demonstrated poorer KOOS subscale scores, more total and intermittent pain, higher BMI (1.8 kg·m−2; 95% CI = 0.9–2.6), higher FMI (1.1 kg·m−2; 95% CI = 0.5–1.6), weaker knee extensor (−0.18 N·m·kg−1; 95% CI = −0.33 to −0.02) and flexor (−0.21 N·m·kg−1; 95% CI = −0.30 to −0.11) muscles, and poorer balance than controls. In the previously injured group, female sex was associated with poorer KOOS quality-of-life scores, knee flexor strength, and greater FMI, whereas longer time since injury was associated with poorer KOOS symptoms scores, knee extensor strength, and balance outcomes. Conclusion Youth that suffer a sport-related knee injury demonstrate on average more negative health-related outcomes consistent with future osteoarthritis compared with uninjured matched controls 3–10 yr after injury. These negative outcomes differ by sex and time since injury.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FE4gls
via IFTTT

Comments on “HIIT in the Real World”

No abstract available

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FuU6nK
via IFTTT

Baseline Concussion Clinical Measures Are Related to Sensory Organization and Balance

Purpose This study aimed to examine relationships among baseline demographics, symptom severity, computerized neurocognitive outcomes, and balance performance in collegiate athletes. Methods Collegiate varsity athletes (N = 207, age = 19.3 ± 1.0 yr) participating in an ongoing clinical research program who completed concussion baseline assessments including a demographic questionnaire, a graded symptom checklist, a neurocognitive assessment, and the Sensory Organization Test (SOT) were included in this study. The SOT composite equilibrium score (COMP) and three sensory ratio scores—vestibular (VEST), visual (VIS), and somatosensory (SOM)—were used to describe athletes' overall sensory organization and ability to use input from each sensory system to maintain balance. Separate stepwise multiple linear regression models were performed for each SOT outcome. Total symptom severity level and CNS Vital Signs domain scores served as predictor variables. Results Stepwise regression models for COMP (R2 = 0.18, F4,201 = 11.29, P

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FCOg2W
via IFTTT

Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator Cuff Tears

Purpose The treatment of partial-thickness rotator cuff tears (PTRCT) remains controversial. Few studies have focused on the conservative and new measurements of small to medium PTRCT. The use of sodium hyaluronate (SH) or platelet-rich plasma (PRP) as a method for rotator cuff repair requires further investigation. The aim of this study was to evaluate the combined use of SH and PRP in the treatment of small to medium PTRCT. Study Design A double-blinded randomized trial was used in this study. Methods Individuals with PTRCT detected by clinical examination and magnetic resonance imaging (MRI) were included in this study. The patients were randomly assigned to receive subacromial injections of normal saline, SH, PRP, or SH + PRP once a week for 4 wk. The primary outcome measure was the Constant score, and the secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) and the visual analog scale scores. All of the clinical outcomes were assessed at pretreatment and 1, 3, 6, and 12 months posttreatment. MRI was used to evaluate the evolution of the cuff defect after 1 yr. Results The PRP group and the SH + PRP group showed a significantly higher Constant score and ASES score after the treatments. There were significant differences between the SH + PRP group and the SH or PRP group at 12 months in the Constant, visual analog scale, and ASES scores. MRI results showed that the tear size significantly decreased in both the PRP and the SH + PRP groups, especially in the SH + PRP group. Conclusion Our study provided evidence of the efficacy of PRP injection in the healing of small to medium PTRCT. Moreover, the combined injection of SH and PRP yielded a better clinical outcome than SH or PRP alone.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2VORupE
via IFTTT

Validation of the 6-min Walk Test for Predicting Peak V˙O2 in Cancer Survivors

Purpose To assess the quality of the relationship between V˙O2peak estimated from patient outcomes on the 6-min walk test (6MWT) and the V˙O2peak calculated from patient outcomes on the University of Northern Colorado Cancer Rehabilitation Institute (UNCCRI) treadmill protocol. Methods Cancer survivors (N = 187) completed the UNCCRI treadmill protocol and a 6MWT 1 wk apart in randomized order to obtain V˙O2peak. Values from the UNCCRI treadmill protocol were compared against four common 6MWT V˙O2peak prediction equations. Results All four 6MWT prediction equations significantly (P

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2Frk6Ak
via IFTTT

Survival of the Fastest: The Multivariate Optimization of Performance Phenotypes

Introduction Trade-offs are widespread in biological systems. Any investment in one trait must necessarily limit the investment in other traits. Still, many studies of physiological performance produce positive correlations between traits that are expected to trade-off with one another. Here we investigate why predicted trade-offs may often go unmeasured in studies of human athletes. Methods Triathletes compete in consecutive swimming, cycling, and running events as a single competition, events whose physical demands may be especially prone to generating performance trade-offs. Performance variation in these three events interacts to explain overall variation in athletic performance. Results We show that individual variation in athletic performance can mask trade-offs among disciplines, giving the impression that high-performance triathletes are athletic generalists. Covariance in race performance across the three disciplines was positive in the most elite athletes but became increasingly negative as race times increased. Conclusions These performance trade-offs among the disciplines preclude the realization of a generalist athlete except in the most elite triathletes, a result similar to the "big houses, big cars" phenomenon in life history evolution. This distinction between trait combinations that are favored for optimal performance versus constrained by trade-offs was only apparent when accounting for individual level variation in athletic performance. Our results provide further evidence that meaningful trade-offs may be missed if individual variation in quality is disregarded.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FznwjU
via IFTTT

Physical Activity Associates with Muscle Insulin Sensitivity Postbariatric Surgery

Purpose Bariatric surgery is considered as an effective therapeutic strategy for weight loss in severe obesity. Remission of type 2 diabetes is often achieved after the surgery. We investigated whether increase in self-reported habitual physical activity associates with improved skeletal muscle insulin sensitivity and reduction of fat depots after bariatric surgery. Methods We assessed self-reported habitual physical activity using Baecke questionnaire in 18 diabetic and 28 nondiabetic patients with morbid obesity (median age, 46 yr; body mass index, 42.0 kg·m−2) before and 6 months after bariatric surgery operation. Insulin-stimulated femoral muscle glucose uptake was measured using fluorodeoxyglucose positron emission tomography method during hyperinsulinemia. In addition, abdominal subcutaneous and visceral fat masses were quantified using magnetic resonance imaging and liver fat content using magnetic resonance spectroscopy. Also, serum proinflammatory cytokines were measured. Results Patients lost on average 22.9% of weight during the follow-up period of 6 months (P

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FttRy4
via IFTTT

Metabolic Costs of Standing and Walking in Healthy Military-Age Adults: A Meta-regression

Introduction The Load Carriage Decision Aid (LCDA) is a U.S. Army planning tool that predicts physiological responses of soldiers during different dismounted troop scenarios. We aimed to develop an equation that calculates standing and walking metabolic rates in healthy military-age adults for the LCDA using a meta-regression. Methods We searched for studies that measured the energetic cost of standing and treadmill walking in healthy men and women via indirect calorimetry. We used mixed effects meta-regression to determine an optimal equation to calculate standing and walking metabolic rates as a function of walking speed (S, m·s−1). The optimal equation was used to determine the economical speed at which the metabolic cost per distance walked is minimized. The estimation precision of the new LCDA walking equation was compared with that of seven reference predictive equations. Results The meta-regression included 48 studies. The optimal equation for calculating normal standing and walking metabolic rates (W·kg−1) was 1.44 + 1.94S0.43 + 0.24S4. The economical speed for level walking was 1.39 m·s−1 (~ 3.1 mph). The LCDA walking equation was more precise across all walking speeds (bias ± SD, 0.01 ± 0.33 W·kg−1) than the reference predictive equations. Conclusion Practitioners can use the new LCDA walking equation to calculate energy expenditure during standing and walking at speeds

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FAw4XK
via IFTTT

Type 1 Muscle Fiber Hypertrophy after Blood Flow–restricted Training in Powerlifters

Purpose To investigate the effects of blood flow–restricted resistance exercise (BFRRE) on myofiber areas (MFA), number of myonuclei and satellite cells (SC), muscle size and strength in powerlifters. Methods Seventeen national level powerlifters (25 ± 6 yr [mean ± SD], 15 men) were randomly assigned to either a BFRRE group (n = 9) performing two blocks (weeks 1 and 3) of five BFRRE front squat sessions within a 6.5-wk training period, or a conventional training group (Con; n = 8) performing front squats at 60%–85% of one-repetition maximum (1RM). The BFRRE consisted of four sets (first and last set to voluntary failure) at ~30% of 1RM. Muscle biopsies were obtained from m. vastus lateralis (VL) and analyzed for MFA, myonuclei, SC and capillaries. Cross-sectional areas (CSA) of VL and m. rectus femoris were measured by ultrasonography. Strength was evaluated by maximal voluntary isokinetic torque (MVIT) in knee extension and 1RM in front squat. Results BFRRE induced selective increases in type I MFA (BFRRE: 12% vs Con: 0%, P

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2VORqWW
via IFTTT

Effects of Sprint-Interval and Endurance Respiratory Muscle Training Regimens

Introduction Recently a novel, time-saving respiratory muscle sprint-interval training (RMSIT) was developed. To test the extent to which RMSIT improves respiratory muscle performance compared with a conventional respiratory muscle endurance training (RMET), a novel incremental respiratory muscle test (IncRMT), loading inspiratory and expiratory muscles, was designed to assess performance changes associated with respiratory muscle training (RMT). Methods Healthy, moderately trained males and females (age: 26 ± 5 yr, V˙O2peak: 47 ± 12 mL·min−1·kg−1) were randomized and balanced to three groups (RMSIT 5m/5f; RMET 6m/6f; PLAT 5m/6f). Lung function, respiratory muscle strength, and IncRMT performance were tested before and after 1 month of RMT. During the IncRMT, muscle activity and muscle deoxygenation were assessed via surface EMG and near-infrared spectroscopy of sternocleidomastoid (STERNO), intercostal (INTER), and abdominal (ABDO) muscles. Results Two-way ANOVA revealed a main effect of training for increased maximal voluntary ventilation (P = 0.001) and maximal inspiratory pressure (P = 0.017). Both RMT groups increased work of breathing during training sessions to the same extent (RMSIT: +17.4 ± 8.9 kJ; RMET: +26.2 ± 16.1 kJ; P = 0.143) with a larger increase in average mouth pressure in RMSIT (RMSIT: +20.0 ± 15.0 cm H2O; RMET: +3.3 ± 1.5 cm H2O; P = 0.001). After training, IncRMT duration increased in both RMT groups compared with PLAT (RMSIT: +5.6 ± 2.1 min, P = 0.0006 vs PLAT; RMET: +3.8 ± 4.2 min, P = 0.020 vs PLAT). At similar work, only INTER activity during inspiration increased after RMET. Higher performance after RMSIT was associated with higher activity in STERNO and ABDO, but after RMET, STERNO, INTER, and ABDO showed higher activity. Conclusion One month of RMSIT and RMET shows similar improvements in respiratory muscle performance despite different duration of training sessions. Also, muscular adaptations might differ.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2Fts5gh
via IFTTT

Effects of EPO on Blood Parameters and Running Performance in Kenyan Athletes

Introduction Recombinant human erythropoietin (rHuEpo) administration enhances oxygen carrying capacity and performance at sea level. It remains unknown whether similar effects would be observed in chronic altitude-adapted endurance runners. The aim of this study was to assess the effects of rHuEpo on hematological and performance parameters in chronic altitude-adapted endurance runners as compared to sea level athletes. Methods Twenty well-trained Kenyan endurance runners (KEN) living and training at approximately 2150 m received rHuEpo injections of 50 IU·kg−1 body mass every 2 d for 4 wk and responses compared with another cohort (SCO) that underwent an identical protocol at sea level. Blood samples were obtained at baseline, during rHuEpo administration and 4 wk after the final injection. A maximal oxygen uptake (V˙O2max) test and 3000-m time trial was performed before, immediately after and 4 wk after the final rHuEpo injection. Results Hematocrit (HCT) and hemoglobin concentration (HGB) were higher in KEN compared to SCO before rHuEpo but similar at the end of administration. Before rHuEpo administration, KEN had higher V˙O2max and faster time trial performance compared to SCO. After rHuEpo administration, there was a similar increase in V˙O2max and time trial performance in both cohorts; most effects of rHuEpo were maintained 4 wk after the final rHuEpo injection in both cohorts. Conclusions Four weeks of rHuEpo increased the HGB and HCT of Kenyan endurance runners to a lesser extent than in SCO (~17% vs ~10%, respectively) and these alterations were associated with similar improvements in running performance immediately after the rHuEpo administration (~5%) and 4 wk after rHuEpo (~3%).

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2FDUf7t
via IFTTT

Exercise Increases Mucosal-associated Invariant T Cell Cytokine Expression but Not Activation or Homing Markers

Mucosal-associated invariant T (MAIT) cells have properties of both the innate and adaptive immune systems but are an understudied population within exercise immunology. These lymphocytes aggregate at the mucous membranes, but it is unknown if submaximal exercise alters their circulating numbers or function. Purpose To determine the MAIT cell response to submaximal exercise on activation and homing marker expression and stimulated cytokine production. Methods Twenty healthy, young, recreationally active males cycled for 40 min at 86% of VT after an overnight fast. Peripheral blood mononuclear cells were isolated and labeled to identify specific MAIT cell populations using flow cytometry. Cytokine production after stimulation was also determined. Results Mucosal-associated invariant T cells were 2.9% of T cells and increased to 3.9% after exercise and with recovery whereas cell numbers significantly increased by 91.5% after exercise before returning to resting levels. Chemokine and activation marker absolute cell number significantly increased while expression levels remained constant but the high levels of CCR5 may help direct MAIT cells to sites of inflammation. After stimulation, TNFα expression significantly increased after exercise before returning to baseline with a similar trend for IFNγ. Conclusions The MAIT cell numbers undergo a partial biphasic response after submaximal exercise and appear to be preferentially mobilized within T cells; however, the magnitude of the submaximal response was attenuated relative to maximal exercise. Stimulated MAIT cells increase TNFα expression, indicating greater responsiveness to pathogens after acute exercise.

from Sports Medicine via xlomafota13 on Inoreader http://bit.ly/2Fts3VH
via IFTTT