Exercise,Intestinal Absorption,and Rehydration

ＫＥＹＰＯＩＮＴＳ1.Ｔｈｅｐｒｏｘｉｍａｌｓｍａｌｌｉｎｔｅｓｔｉｎｅ(ｄｕｏｄｅｎｕｍ＆ｊｅｊｕｎｕｍ)ｉｓｔｈｅｐｒｉｍａｒｙｓｉｔｅｏｆｆｌｕｉｄａｂｓｏｒｐｔｉｏｎ .Ｉｔａｂｓｏｒｂｓａｂｏｕｔ 50 %ｔｏ 60 %ｏｆａｎｙｇｉｖｅｎｆｌｕｉｄｌｏａｄ .Ｔｈｅｃｏｌｏｎｏｒｌａｒｇｅｉｎｔｅｓ ｔｉｎｅａｂｓｏｒｂｓａｐｐｒｏｘｉｍａｔｅｌｙ 80ｔｏ 90 %ｏｆｔｈｅｆｌｕｉｄｉｔｒｅ ｃｅｉｖｅｓ ,ｂｕｔａｃｃｏｕｎｔｓｆｏｒｏｎｌｙａｂｏｕｔ 15%ｏｆｔｈｅｔｏｔａｌｆｌｕｉｄｌｏａｄ .2 .Ｉｎｔｅ…     

Gorham-Stout disease and generalized lymphatic anomaly—clinical, radiologic, and histologic differentiation

Purpose

Gorham-Stout disease (GSD) is a rare vascular disorder of lymphatic origin characterized by progressive osteolysis. Generalized lymphatic anomaly (GLA) is a multisystem disorder that also commonly affects bone. We hypothesized that Gorham-Stout disease is different from other osseous lymphatic anomalies. We proposed to discriminate these entities by analyzing findings on skeletal imaging.

Methods

Clinical data, imaging studies, and histopathologic findings were retrospectively reviewed in patients presenting to our Vascular Anomalies Center with lymphatic anomalies of bone.

Findings

Within a cohort of 51 patients with lymphatic disorder and radiological evidence of bony involvement, two distinct categories emerged. Nineteen patients met the imaging criteria for GSD: progressive osteolysis with resorption and cortical loss. Thirty-two were categorized as GLA: Discrete radiolucencies and increasing numbers of bone affected over time, but without evidence of progressive osteolysis. The ribs were the most common site in both groups, followed by the cranium, clavicle, and cervical spine in GSD, and thoracic spine, humerus, and femur in GLA. Fewer bones were involved in GSD, with relative sparing of the appendicular skeleton. Associated infiltrative soft tissue abnormality was seen in 18 in GSD, but only six with GLA. Macrocystic lymphatic malformations were identified in 14 with GLA, but none with GSD.

Conclusions

There are significant radiological differences between GSD and GLA, although there are some overlapping features. The major distinguishing characteristic is the progressive osteolysis seen in GSD. Findings suggestive of GLA are more extensive involvement, particularly of the appendicular skeleton, presence of discretemacrocystic lymphatic malformations and visceral organ lesions.     

Diabetes, Exercise and Competitive Sports

KEYPOINTS Peoplewithdiabetesmellitus—rapidlyapproachingone-thirdoftheUSpopulation—eithercannotproduce insulin(Type1DM)ortheinsulintheyproduceisin effectiveinstimulatingtheuptakeofbloodsugar(glu cose)intothebody’scells(Type2DM).According ly,ifdiabetesisuntreated,bloodsugarrisestodan gerouslyhighlevelsthatcaneventuallycauseblind ness,nervedamage,andothercomplications.Bloodsugarcanbecontrolledbytheappropriatead ministrationofinsulinandotherdrugsand/orbythe manipulationofdietarycarbohydra…     

Naming, blaming and shaming?

Few doctors at the centre of complaints or disciplinary proceedings wish to be publicly named. Publication of a doctor's name can adversely affect his or her reputation, patients, and family members, even if the allegation is ultimately not upheld. Yet, there is a strong public interest in freedom of speech and transparency of complaints and disciplinary processes. In determining whether to grant name suppression, complaints agencies and disciplinary tribunals are required to balance competing public and private interests. In New Zealand, the Health and Disability Commissioner has responsibility for investigating complaints about the quality of medical care. The Commissioner's current practice is not to publicly name doctors under investigation, or even those who are found to have breached a patient's rights. This approach fits well the non-punitive, rehabilitative focus of New Zealand's medical regulatory system. In the rare cases where a matter reaches the threshold for disciplinary action, the balance tips in favour of disclosure.     

Ultra-triathlon—Pacing,performance trends,the role of nationality,and sex differences in finishers and non-finishers

Ultra-triathlons are defined as triathlons longer than the traditional Ironman distance and became more popular in the last two decades; however, scarce scientific evidence of these events are available. Therefore, we aimed to investigate the trends of performance, pacing, nationality, sex differences, and rate of non-finishers in ultra-triathlons. Data from 1985 to 2018 were collected including Double Iron, Triple Iron, Quintuple Iron, and Deca Iron ultra-triathlons. Different pacing patterns by event and sex were observed (P < .05); athletes spent less %time in swimming and cycling, and more %time in running as the distance of event was longer; women spent more %time in cycling and less% time in running in Double and Triple. Performance analysis showed a negative trend over time for men and women since 1985. Switzerland, France, and Germany were the fastest nations in ultra-triathlons. The frequency of North Americans competing in Europe was very low (<5%), whereas Europeans often competed in North America (~25%). The rate of non-finishers between sexes was similar in all races with the exception of Deca Iron ultra-triathlon, which was much greater (~20%) for women. Non-finishers had slower race times in swimming and cycling splits than finishers. In conclusion, ultra-triathletes should redistribute their energy among swimming, cycling, and running depending on their sex and distance of race. Performance in ultra-triathlons has been decreasing in men and women over the years, but sex difference in performance remained. Europeans were the fastest ultra-triathletes and compete in Europe and North America. Additionally, non-finishers were slower swimmers and cyclists than finishers.     

Fibrous dysplasia and McCune–Albright syndrome: Imaging for positive and differential diagnoses,prognosis, and follow-up guidelines

Purpose

The radiologist plays a critical role at all steps of the management of patients with fibrous dysplasia (FD) and McCune–Albright syndrome (MAS). The development of a standardized approach to the management of FD/MAS is crucial given the low incidence and multiple clinical presentations of these conditions. Our aim was to develop recommendations for bone imaging in FD/MAS management.

Materials and methods

The establishment of National Reference Centers in France as part of a Health Ministry program for orphan diseases has triggered the development of recommendations for the clinical management of FD/MAS. We used a well-established robust methodological approach involving an extensive literature review by a multidisciplinary working group (20 healthcare professionals) and scoring by a peer-review group (20 healthcare professionals different from the 20 previous ones). There were four phases: a systematic literature review, drafting of initial recommendations, peer-review of this initial draft, and drafting of the final recommendations.

Results

Fifty-seven specific recommendations are provided as key points for the diagnosis, prognosis, and follow-up of patients with FD/MAS. Issues of special interest are highlighted in the discussion, and areas in which future research is needed are identified.

Conclusion

We believe the dissemination of these recommendations within the radiology community may facilitate communication between radiologists and other healthcare providers, thereby substantially improving the management of patients with these rare but potentially disabling conditions.     

Mapping the war: gender,health, and the medical profession in France and Germany, 1914–1918

This article compares the gender and health politics of the German and the French medical professions, which incorporated military command structures into their civilian self-conception. Mobilized doctors committed themselves to the new circumstances and opportunities offered by the war. They applied the established military spatial ‘map’ which distinguished between the male-dominated front and the female-dominated home front and turned it into an epidemiological map, identifying danger zones which arose from points of contact between men and women. The analysis singles out two case studies: the rapid spread of venereal disease and psychiatric disorders. These case studies allow for a comparative analysis of the following questions: How did doctors assess the impacts of the war on the individual and the society as a whole? How did they view the war’s impact on conventional gender orders, individual and national health? And how did they see their own role as a part of an independent civilian profession?     

YfilerⓇ Plus population samples and dilution series: stutters,analytic thresholds,and drop-out probabilities

International Journal of Legal Medicine - The Yfiler Ⓡ Plus Amplification Kit amplifies 27 Y chromosomal small tandem repeat (STR) markers. The kit has five-fluorescent dye chemistry and the...     

Hypoxia-related molecules HIF-1α, CA9, and osteopontin

Purpose

A high expression of hypoxia-inducible factor-1 alpha (HIF)-1α, carbonic anhydrase 9 (CA9), and osteopontin appears to be a strong prognostic indicator in many malignancies; however, their role is unclear in high-grade gliomas.

Patients and methods

HIF-1α, CA9, and osteopontin levels in tissue specimens of 92 patients with high-grade glioma were evaluated by immunohistochemistry.

Results

Patients with a high expression of cytoplasmic and nuclear HIF-1α, CA9, and osteopontin had significantly shorter overall survival. The expression results of these markers were combined to form a hypoxic profile, and high hypoxic scores (expression of two or three markers) were significantly correlated to poorer overall survival. In multivariate analysis, high hypoxic score-1 (cytoplasmic HIF-1α, CA9, and osteopontin) was the only independent negative prognostic factor for survival (p?=?0.028).

Conclusion

Our results showed that a combination of hypoxic markers is more robust than a single marker for predicting survival in high-grade glioma. It may be necessary to utilize the hypoxic score in selecting patients for targeted therapy in the future.     

3 Tesla MR neurography—technique,interpretation, and pitfalls

MRI has been used for almost two decades for the evaluation of peripheral nerve disorders. This article highlights the relative advantages and disadvantages of 3T MR neurography in the evaluation of peripheral neuropathies. The authors also describe the high-resolution MR neurography technique on 3T MRI, along with the approach to its interpretation that has evolved at one institution.     

Chronotype and self?reported sleep,alertness, and mental health in U.S. sailors

Service members are at risk for sleep and psychological conditions affecting their readiness. Chronotype ("morningness" or "eveningness") is strongly associated...     

Organ distribution of 4-MEC,MDPV, methoxetamine and α-PVP: comparison of QuEChERS and SPE

Purpose

An organ distribution investigation was carried out on two deceased (A and B) who consumed 4-methylethcathinone (4-MEC), methylenedioxypyrovalerone (MDPV), methoxetamine (MXE) and α-pyrrolidinopentiophenone (α-PVP).

Methods

The detection of the aforementioned drugs in the specimens was performed on a liquid chromatography–tandem mass spectrometry system. Two different extraction methods were compared with each other—a quick, easy, cheap, effective, rugged and safe (QuEChERS) approach and an automated Instrument Top Sample Preparation-solid phase extraction (ITSP-SPE). Standard addition method was used to quantify the drugs.

Results

4-MEC, MDPV and MXE were detected in all collected tissues and body fluids of the two deceased. α-PVP was also detectable in deceased A. Deceased A showed femoral blood concentrations of 97 µg/L 4-MEC, 396 µg/L MDPV, 295 µg/L MXE and 4 µg/L α-PVP measured after extraction by QuEChERS and 118 µg/L 4-MEC, 342 µg/L MDPV, 385 µg/L MXE and 4 µg/L α-PVP measured after ITSP-SPE. Deceased B revealed heart blood concentrations of 8 µg/L 4-MEC, 3 µg/L MDPV and 2 µg/L MXE after extraction by QuEChERS and 8 µg/L 4-MEC and 1 µg/L MXE after ITSP-SPE.

Conclusions

Both preparation techniques were suitable for quantifying NPS in organ tissues and body fluids. With respect to the autopsy findings, the cause of death of deceased A was determined to be an acute intoxication with NPS. No certain cause of death could be ascertained for deceased B.

     

Sleep,sedentary activity,physical activity,and cognitive function among older adults: The National Health and Nutrition Examination Survey, 2011–2014

ObjectivesWe aimed to estimate the association of sleep, sedentary activity and physical activity with cognitive function among older adults, with consideration of the competing nature between variables of activity status.DesignCross-sectional study.MethodsA total of 3086 older adults (60 years or older) in the 2011–2014 National Health and Nutrition Examination Survey were included. The Global Physical Activity Questionnaire was used to measure self-reported time for sedentary activity, walking/bicycling and moderate-to-vigorous physical activity (MVPA). Cognitive function was examined using the CERAD Word Learning subtest (memory), Digit Symbol Substitution Test (executive function/processing speed), and Animal Fluency Test (language). Sleep duration was obtained via interview. Isotemporal substitution models using multivariable linear regression were applied to examine the associations of replacing sleep, sedentary activity, walking/bicycling, MVPA with each other and cognitive function, stratified by sleep duration per night (≤7 h, >7 h).ResultsAmong participants with sleep duration ≤7 h/night, replacing 30 min/day of sedentary activity with 30 min/day of MVPA or 30 min/day was associated with better cognition. Among participants with sleep duration >7 h/night, replacing 30 min/day of sleep with 30 min/day of sedentary activity, walking/bicycling, or MVPA was associated with better cognition.ConclusionsReplacing sedentary activities with MVPA was associated with favorable cognitive function among older adults sleeping no longer than 7 h/night, and replacing excessive sleep with sedentary or physical activities was associated with favorable cognition. Future research is expected to examine the associations of replacing different activity status on long-term cognitive outcomes in longitudinal studies.