Evidence for the participation of the stimulated sympathetic nervous system in the regulation of carnitine blood levels of soccer players during a game

Catecholamines and carnitine blood levels are closely implicated with training. The aim of the study was to investigate the effect of sympathetic nervous system stimulation on carnitine and its fraction levels during training. Blood was obtained from 14 soccer players pregame, at intermission, and postgame. Catecholamines were measured with high-performance liquid chromatography methods; muscle enzymes creatine kinase and lactate dehydrogenase as well as lactate, pyruvate, and total antioxidant status with commercial kits; and carnitine and fraction levels with tandem mass spectrometry. Total antioxidant status (2.97 ± 0.13 vs 0.96 ± 0.10 mmol/L, P < .01) as well as free carnitine levels (20.47 ± 4.0 vs 12.30 ± 2.8 μmol/L, P < .001) were remarkably decreased especially postgame. Total acylcarnitines (5.20 ± 1.8 vs 9.42 ± 3.0 μmol/L, P < .001) and especially total very long-chain acylcarnitines (0.80 ± 0.01 vs 1.85 ± 0.03 μmol/L, P < .001) as well as catecholamine levels (adrenaline: 230 ± 31 vs 890 ± 110 pmol/L, P < .01; noradrenaline: 1.53 ± 0.41 vs 3.7 ± 0.6 nmol/L, P < .01) were significantly increased in players postgame. A statistically significant inverse correlation was found between adrenaline and free carnitine (r = −0.51, P < .01); and a positive correlation was found between adrenaline, total acylcarnitines (r = 0.58, P < .01), and total long-chain acylcarnitine (r = 0.49, P < .01). The significant positive correlation of adrenaline levels with total acylcarnitine and total long-chain acylcarnitine blood levels in athletes as well as the inverse correlation with free carnitine levels may indicate participation of the stimulated sympathetic nervous system in the regulation of some carnitine fraction levels during exercise.     

A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: an application to Greek prefectures

Objectives

The purpose of this study is to measure the Greek public healthcare delivery efficiency from a regional perspective by applying conditional nonparametric models.

Methods

The study reviews the existing literature on performance measurement and proposes models on these grounds. By using data envelopment analysis (DEA) and free disposal hull (FDH) models, the performance of public health delivery services of the Greek prefectures is evaluated. The efficiency levels of the Greek prefectures are compared and analyzed in a regional context. By using convex and non-convex models alongside with bootstrap techniques and conditional full frontier applications the paper develops models for regional public health delivery policy evaluation.

Results

The paper shows that higher levels of GDP per capita (GDPc) have a negative influence on the efficiency of regional healthcare delivery, indicating that regional economic growth does not ensure better healthcare delivery service. Furthermore the results reveal that population density increases the prefectures’ efficiency of public health provision, indicating the over-supply of health services by urban hospitals. Finally, several healthcare delivery inefficiencies have been reported among the Greek prefectures emphasizing a poor state of healthcare delivery.

Conclusions

The results indicate that after the reform of the Greek national healthcare system in 2000-2002, the absence of a unified healthcare policy was accompanied with misallocation of healthcare resources among the Greek prefectures creating socioeconomic health inequalities.     

Penetrating cardiac wounds: A comparison of different therapeutic methods.

The management of penetrating wounds of the heart has been controversial. During the last 10 years we have used 3 different therapeutic approaches for the treatment of these wounds and the obtained results comprise this report. From 1964 to 1974 we treated 102 patients, four of whom expired immediately after their arrival to the clinic. The remaining 98 patients were divided into five groups according to their clinical presentation and treatment. Group I, 17 patients (14 with stab and 3 with bullet wound) seen with cardiac tamponade from 1964 to 1967 were treated first with pericardiocentesis and then were operated upon if pericardiocentesis yielded no results or if cardiac tamponade recurred. Fourteen patients recovered and three died, with an overall mortality of 17.5% Group II, 34 patients (23 with stab and 11 with bullet wound) were seen with cardiac tamponade from 1968 to 1971. The patients with stab wound were managed the same as group I patients and those with bullet wound were operated upon immediately. Twenty-nine recovered and 5 died, with an overall mortality of 14.7%. Group III, 20 patients (12 with stab and 8 with bullet wound) were seen with cardiac tamponade from 1972 to 1974. All of them were operated upon immediately and pericardiocentesis was used in this group only to provide time for a safe operation. Nineteen recovered and one died, with an overall mortality of 5%. Group IV, 20 patients (5 with stab and 15 with bullet wound) with massive bleeding, were operated upon immediately. Ten (4 out of the 5 with stab and 6 out of the 15 with bullet wound) recovered, with a mortality rate of 50%. Group V, seven patients were seen throughout the study period without bleeding or cardiac tamponade. Some of them were operated upon electively and others are being followed and all have done well. This study suggests (1) that patients with penetrating wound of the heart and cardiac tamponade or bleeding will derive better results if they are operated upon as soon as possible and if pericardiocentesis is used to provide time for a safe operation and (2) that those with other manifestations should be evaluated and if their lesion is significant, they should be operated upon electively.     

Two-stage flexor tendon reconstruction in zone II using a silicone rod and a pedicled intrasynovial graft

PURPOSE: To evaluate the results of a modified Paneva-Holevich technique for flexor tendon reconstruction in zone II. METHODS: Twenty patients (22 digits) with poor prognosis injuries (Boyes grade 2-5) were reconstructed. The technique included placing a silicone rod and creating a loop between the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) in the first stage and reflecting the latter as a pedicled graft through the pseudosheath created around the silicone rod in the second stage. RESULTS: After a follow-up period of at least 1 year (mean, 50 mo) the rate of good and excellent results was 82% according to the Buck-Gramco scale and 73% using the modified Strickland scale. CONCLUSIONS: These results compare favorably with those using the classic (Hunter) 2-stage reconstructions with a silicone rod and a free tendon graft. Apart from technical versatility, additional advantages of the technique include using a local intrasynovial graft, the absence of donor site morbidity, and a low rate of postreconstruction tendon ruptures and tenolysis.     

An in vivo and in vitro study of erythrocyte membrane acetylcholinesterase, (Na+, K+)-ATPase and Mg2+-ATPase activities in basketball players on alpha-tocopherol supplementation. The role of L-carnitine

BACKGROUND & AIMS: Vitamin E (alpha-tocopherol, alpha-Te) and carnitine reduce lipid peroxidation. THE AIM WAS TO: To investigate the erythrocyte membrane acetylcholinesterase (AChE), Na+, K+-ATPase and Mg2+-ATPase activities in basketball players with or without alpha-Te supplementation, before and after training. In vitro, we aimed to find out any additional effect of L-carnitine (L-C) on the modulated enzyme activities. SUBJECTS AND METHODS: Blood was obtained from 10 players before (group A), after exercise (group B) and after 1 month on alpha-Te (200 mg/24 h orally) supplementation before (group C) and after the game (group D). Lactate, pyruvate, muscle enzyme activities and total antioxidant status (TAS) were measured with commercial kits. Catecholamines and alpha-Te were determined with HPLC methods and membrane enzyme activities spectrophotometrically. RESULTS: Lactate, pyruvate, muscle enzymes and catecholamine levels were increased (P<0.001) in all groups after training. Alpha-Te levels and Mg2+-ATPase activity remained unaltered before and after exercise. TAS was decreased in the groups after the game. AChE activity was increased in group B (P<0.01) and decreased in group D (P<0.01). After the exercise, Na+, K+-ATPase activity was increased in group B and remained unaltered in group D. In vitro incubation of membranes from group D with L-C resulted in a partially restoration of the membrane AChE activity, whereas Na+, K+-ATPase and Mg2+-ATPase activities were found unchanged. CONCLUSIONS: Alpha-Te supplementation in basketball players results in an increase of TAS and AChE activity, whereas the other enzyme activities were found unchanged. L-C addition may restore AChE activity, which was modulated by training in players on alpha-Te.     

Laparoscopic common bile duct exploration after failed endoscopic stone extraction

BACKGROUND: Our objective was to present the technical aspects and results of laparoscopic common bile duct (CBD) exploration following failed endoscopic stone extraction. METHOD: From April 1997 to December 2006, 32 patients were referred to us after unsuccessful attempts at endoscopic CBD stone extraction. Transcholedochal laparoscopic CBD exploration was used in all patients. Previous operations, several pathologic entities, and stone impaction were studied as potential predictors of failure of the laparoscopic approach. RESULTS: Previous operations, cholangitis, anatomic abnormalities, and stone impaction were the principal reasons for failure of endoscopic retrograde cholangiopancreatography (ERCP). Stone extraction under direct laparoscopic choledochotomy was achieved in 20 of 31 patients (64.51%). Biliary stents were inserted in 7 patients (21.8%) and T tubes were placed in 21 patients (65.6%). Five laparoscopic choledochoduodenostomies were performed. There were 11 conversions to open surgery. Morbidity was 12.5%. CONCLUSIONS: Laparoscopic choledochotomy is an efficacious procedure in dealing with unsuccessful endoscopic CBD clearance.     

Evaluation of bioefficacy of three Citrus essential oils against the dengue vector Aedes albopictus (Diptera: Culicidae) in correlation to their components enantiomeric distribution

Laboratory experiments were conducted to study the bioefficacy against Ae. albopictus of three Citrus essential oils, derived from peels of Citrus sinensis, Citrus limon, and Citrus paradise and of their components. Chiral gas chromatography analysis revealed the dominant occurrence of R-(+)-limonene and (?)-??-pinene in all three essential oils while in the case of lemon oil ??-terpinene, neral, and geranial detected also among other components. The tested Citrus essential oils were toxic against mosquito larvae with LC₅₀ values ranging from 25.03 to 37.03?mg?l^?1. Among citrus essential oils components tested, ??-terpinene was the most toxic (LC₅₀?=?20.21?mg?l^?1) followed by both enantiomeric forms of limonene (LC₅₀?=?35.99 and 34.89?mg?l^?1, for R-(+)-limonene and S-(?)-limonene, respectively). The delayed toxic effects after exposure of larvae to sublethal (LC₅₀) doses were also investigated for citrus essential oils and their major component R-(+)-limonene, indicating a significant reduction of pupal survival. In repellent bioassays, lemon essential oil, S-(?)-limonene, citral (mixture of neral\geranial) and (+)-??-pinene were the most effective compared with other citrus essential oils and components against adult mosquitoes. Repellent bioassays also revealed that limonenes and ??-pinenes showed an isomer dependence repellent activity. Finally, according to enantiomeric distribution of limonene and ??- and ??-pinene, the repellency of lemon essential oil is possibly attributed to the presence of citral.     

How adherent to treatment with azathioprine are patients with Crohn's disease in long-term remission?

BACKGROUND: Patients with longstanding quiescent Crohn's disease on azathioprine usually maintain an excellent quality of life but are also concerned about long-term safety. This may affect adherence to treatment. The aim of the present study was to assess the adherence to azathioprine in a cohort of patients with Crohn's disease in long-term remission. METHODS: Thirty patients with Crohn's disease in remission on azathioprine for > or =48 months were enrolled in the study. All were asked to record the number of azathioprine tablets they consumed daily. Notes were kept every other month for 6 months. Adherence was defined as consumption of > or =80% of medication. RESULTS: Most patients (18/28, 74.3%) were not adherent to treatment. The mean (+/-SD) daily dose of azathioprine in adherent and nonadherent patients was 145 +/- 45 mg and 102 +/- 20 mg, respectively. However, there were no significant differences between the 2 groups in the mean IBDQ score and mean Crohn's Disease Activity Index (CDAI) score, both throughout the entire study and at each time point of the study. Male gender, single status, and consumption of >5 concomitant medications were associated with nonadherence. CONCLUSIONS: Most patients with Crohn's disease in longstanding remission had low self-reported adherence to azathioprine. Both male gender and single status were associated with nonadherence to azathioprine, whereas disease factors were not related to self-reported adherence. Patients considered nonadherent to treatment maintained disease remission and a quality of life similar to patients who were adherent to treatment.