Sports Medicine Groups 1987

Last year THE PHYSICIAN AND SPORTSMEDICINE published a list of professional organizations and resource groups that represented the growing diversity in the field of sports medicine. The list has since been updated; it now includes 39 organizations and 17 groups and committees that generate sports medicine information. While THE PHYSICIAN AND SPORTSMEDICINE does not endorse any of the groups listed, we do encourage readers to contact the ones that interest them.

Organizations and resource groups are again arranged alphabetically within separate categories. When appropriate, we have given the name of an administrative head along with the chief elected officer. All correspondence should be addressed to the organization or resource group.

Organizations with an emphasis in sports medicine that wish to be added to the list should contact THE PHYSICIAN AND SPORTSMEDICINE, Organizations Project, 4530 W 77th St, Minneapolis MN 55435.     

Cardiovascular safety of liraglutide for the treatment of type 2 diabetes

Introduction: Liraglutide is a GLP-1 RA that is an option for treatment of T2DM. Typical of all new glucose-lowering agents, its CV safety profile is of great interest.

Areas covered: This article outlines the efficacy of the GLP-1 RA liraglutide from RCTs, moving through the pivotal phase 3 LEAD trials, and subsequent meta-analyses to assess CV safety. This review describes evolution of regulatory requirements to obtain safety information through dedicated CVOTs.

Expert opinion: Since the FDA mandated that CV outcomes for new diabetes therapies should be assessed via a dedicated CVOT, opinion of their utility in T2DM evolved from cynicism through to enthusiasm. In LEADER, liraglutide became the second modern glucose-lowering agent to demonstrate significant CV benefit. CVOTs are now providing important answers, highlighting the CV benefits of modern glucose-lowering agents, but also raising several questions, notably whether the effects seen with liraglutide and empagliflozin are class-effects or are unique to these molecules. Furthermore it is unknown if these results in patients with high CV risk are applicable to all patients with T2DM, and should be incorporated into new treatment guidelines. In our view it’s prudent to suggest that CVOT findings cannot currently be extrapolated to the whole T2DM population.     

万古霉素血药谷浓度和临床结局相关性的系统评价和meta分析

目的:研究万古霉素血药谷浓度与死亡率、治疗失败率和肾毒性之间的关系。方法:系统检索Pub Med、Embase、Cochrane图书馆和三个中文数据库（CNKI、CBM和万方数据）,检索时间范围均为建库到2014年1月16日。纳入所有研究万古霉素谷浓度与临床结局相关性的文章,由两位研究者独立提取数据,并采用Newcastle-Ottawa评分评价观察性研究的质量,二分类变量结果选用相对危险比（RRs）和95%可信区间（95%CI）表示,如无统计学异质性则采用固定效应模型。主要终点结局是死亡率和治疗失败率,次要终点结局是肾毒性。结果:共纳入40个队列研究。与万古霉素谷浓度<15 mg·L^-1的患者相比,谷浓度≥15 mg·L^-1的患者的治疗失败率更低（RR=0.83,95%CI:0.70⁰.97,P=0.02）,肾毒性发生率更高（RR=1.99,95%CI:1.56².53,P<0.000 01）;与万古霉素谷浓度<10 mg·L^-1或<20 mg·L^-1相比,万古霉素谷浓度≥10 mg·L^-1或≥20 mg·L^-1与肾毒性发生率增加明显相关;万古霉素谷浓度与死亡率不相关。结论:与万古霉素谷浓度<15 mg·L^-1相比,万古霉素谷浓度≥15 mg·L^-1与降低治疗失败率和肾毒性发生率增加明显相关。当患者的万古霉素谷浓度≥15 mg·L^-1时,应注意患者增加的肾毒性发生风险。     

Longitudinal effects of pregnancy on the pharmacokinetics of theophylline

Summary The effects of pregnancy on the disposition of theophylline were assessed in 10 patients throughout pregnancy and post-partum. The clearance relative to total theophylline concentrations was only slightly affected during the first two trimesters (2.61±0.63 l/h and 2.85±1.05 l/h), while a statistically significant reduction was evident late in pregnancy (2.05±0.49 l/h). Post-partum clearance values (2.16±2.81 l/h) suggest an ongoing suppression relative to pre-pregnancy levels. A similar pattern was evident with clearance values based on free theophylline plasma concentrations (p=0.12). Absolute volume of distribution increased in concert with gestation, suggesting that theophylline partitions into the enlarged tissue spaces. In addition, theophylline binding to plasma proteins decreased, albeit insignificantly, during the second (fraction bound=29%) and third (32%) trimesters compared to post-partum values (41%). Increases in half-life during the third trimester (13.00±2.31 h vs 9.53±3.53 h post-partum) were highly significant. This change reflects the net effect of reduced clearance and increased distribution. Breast feeding had no effect on the disposition of theophylline, although the transfer of this compound into breast milk was confirmed.     

Developmental follow-up in 15-month-old infants of asthmatic vs. control mothers

The purpose of this study was to evaluate mental and psychomotor development in infants of mothers whose asthma was actively managed during pregnancy and to compare the results with those froms infants of non-asthmatic mothers. Bayley Scales were assessed at age 15 ± 3 months in 379 infants of asthmatic mothers and 376 control infants. Relationships were assessed between developmental indices and asthma severity, socioeconomic status, and infant prematurity. No significant differences in developmental indices were observed between infants of asthmatic mothers and control infants. No relationships were identified between developmental indices and maternal asthma severity. In the infants of both asthmatic and control mothers, a lower mean psychomotor developmental index was associated with birth weight < 2,500 g, and a lower mental developmental index with lower socioeconomic status. Hence, infants of asthmatic mothers whose asthma has been actively managed during pregnancy have developmental outcomes at 15 months of age that are similar to those of control infants.     

Association of obesity with pulmonary and nonpulmonary complications of pregnancy in asthmatic women

OBJECTIVE: To evaluate whether maternal obesity is associated with pulmonary and nonpulmonary pregnancy complications in asthmatic women. METHODS: This is a secondary analysis of the prospective cohort Asthma During Pregnancy Study. Asthma patients were classified as having either mild or moderate to severe disease at the beginning of the study. Rates of pulmonary complications of asthma in asthmatic women and rates of nonpulmonary complications of pregnancy among asthma patients and controls, were compared between obese (body mass index > or = 30 kg/m2) and nonobese women. RESULTS: Maternal body mass index and pregnancy outcome data were available for 1,699 of 1,812 asthmatic women and for 867 of 881 controls. Of the asthma subjects, 30.7% (521) were obese compared with 25.5% of the controls, P = .006. Obese women, regardless of whether they had asthma, were more likely to undergo cesarean delivery (OR 1.6, 95% confidence interval [CI]1.3-2.0) to develop preeclampsia or gestational hypertension (OR 1.7 95% CI 1.3-2.3) and gestational diabetes (OR 4.2, 95% CI 2.8-6.3). There were no differences in the rates of overall asthma improvement (20.6% compared with 23.6%, P = .36) or deterioration (33.3% compared with 28.8%, P = .20) between obese and nonobese asthma patients. After adjustment for confounding variables, obesity, not asthma, was associated with nonpulmonary complications of pregnancy, and obesity was associated with an increase in asthma exacerbations as well (OR 1.3, 95% CI 1.1-1.7). CONCLUSION: Obesity is associated with an increased risk of asthma exacerbations during pregnancy. The increased rate of nonpulmonary complications of pregnancy in asthma patients is associated with obesity in this population and not with asthma status. LEVEL OF EVIDENCE: II-1.