The use of regional, low dose streptokinase in recently thrombosed arterial grafts

Between August 1983 and January 1985, 20 patients aged 33-77 years, with occluded lower limb bypass grafts, were on 23 occasions treated with streptokinase via intra-arterial infusion. Streptokinase (5000 units/h) was effective in clearing occluded grafts in 15 patients on 16 occasions. The median duration of occlusion in these patients was 5 days and the median duration of streptokinase infusions was 24 h. Completion angiography following streptokinase thrombolysis revealed five graft stenoses and 12 outflow stenoses or occlusions. In two grafts no cause for graft failure could be identified. These results permitted the surgeon to make an accurate pre-operative assessment of the definitive therapy required to ensure graft patency.     

Familial clustering in burnout: a twin-family study

BACKGROUND: Research on risk factors for burnout has mainly focused on circumstances at work and on personal characteristics. The aim of this study was to investigate whether burnout clusters within families and, if so, whether this is due to genetic influences or to environmental factors shared by family members. Finally, we tried to identify specific risk factors for burnout. METHOD: In 2707 twins, 736 of their siblings and 575 of their spouses from a population-based twin-family sample, burnout was measured using a self-report questionnaire. Correlations in burnout scores were obtained for monozygotic and dizygotic twin pairs and sibling pairs conditional on the pairs' sex. Correlations for twins and their spouses were derived conditional on the length of the relationship. RESULTS: In the final model, correlations of the monozygotic and dizygotic twin pairs and sibling pairs were significantly different from zero, but not significantly different from each other. The correlation was estimated at 0.22. The correlation between spouses was also significant. This was mainly due to the group with a relationship longer than 5 years in which the correlation was 0.24. Burnout scores were higher in subjects whose parents had a high level of education. CONCLUSIONS: There is familial clustering for burnout due to environmental factors shared by family members, explaining 22 % of the variance. Genetic factors do not seem to be of importance. The significant correlation between spouses supports the conclusion that common environment plays a role in burnout. A high parental education is one of the familial risk factors.     

The renin–angiotensin system in kidney development: role of COX‐2 and adrenal steroids

Recent data from studies in rodents with targeted gene disruption and pharmacological antagonists have shown that the renin–angiotensin–aldosterone system (RAAS) and cyclooxygenase type‐2 (COX‐2) are necessary for late stages of kidney development. The present review summarizes data on the developmental changes of RAAS and COX‐2 and the pathways by which they are activated; their possible interplay and the mechanisms by which they affect kidney development. Intrarenal and circulating renin and angiotensin II (ANG II) are stimulated at birth in most mammals. In rats, renin and ANG II stay significantly elevated in the suckling period while aldosterone stabilizes at an adult level. COX‐2 is stimulated in thick ascending limb of Henle's loop in the suckling period at a time when urine concentrating ability is not developed. Data suggest that this induction is mediated by combined low plasma glucocorticoid concentration and by a low NaCl intake. Studies with selective inhibitors of COX‐2 and COX‐2 null mice show that COX‐2 activity stimulates renin secretion from JG‐cells during postnatal kidney development and that lack of COX‐2 activity leads to pathological change in cortical architecture and eventually to renal failure. In the postnatal period, ANG II initiates and maintains pelvic and ureteric contractions necessary for urine flow. Lack of ANG II in the neonatal period is thought to cause injury by a chronic increase of renal pelvic pressure. Aldosterone is crucial for survival and growth in the neonatal period through its effects on sodium reabsorption and the intrarenal sensitivity to aldosterone is increased in the postnatal period. Final maturation of the kidney occurs through an intimate interplay between a low dietary sodium intake and a non‐responsive HPA‐axis which stimulates cortical COX‐2 activity. COX‐2 supports increased activity of the RAAS and may contribute to a low concentrating ability.     

Why multiple small subunits (Y2 and Y4) for yeast ribonucleotide reductase? Toward understanding the role of Y4

Ribonucleotide reductases (RNRs) catalyze the conversion of nucleotides to deoxynucleotides. Class I RNRs are composed of two homodimeric subunits: R1 and R2. R1 is directly involved in the reduction, and R2 contains the diferric-tyrosyl radical (Y*) cofactor essential for the initiation of reduction. Saccharomyces cerevisiae has two RNRs; Y1 and Y3 correspond to R1, whereas Y2 and Y4 correspond to R2. Y4 is essential for diferric-Y* formation in Y2 from apoY2, Fe(2+), and O(2). The actual function of Y4 is controversial. Y2 and Y4 have been further characterized in an effort to understand their respective roles in nucleotide reduction. (His)(6)-Y2, Y4, and (His)(6)-Y4 are homodimers, isolated largely in apo form. Their CD spectra reveal that they are predominantly helical. The concentrations of Y2 and Y4 in vivo are 0.5-2.3 microM, as determined by Western analysis. Incubation of Y2 and Y4 under physiological conditions generates apo Y2Y4 heterodimer, which can form a diferric-Y small middle dot when incubated with Fe(2+) and O(2). Holo Y2Y4 heterodimer contains 0.6-0.8 Y* and has a specific activity of 0.8-1.3 micromol.min.mg. Titration of Y2 with Y4 in the presence of Fe(2+) and O(2) gives maximal activity with one equivalent of Y4 per Y2. Models for the function of Y4 based on these data and the accompanying structure will be discussed.     

Renal renin secretion as regulator of body fluid homeostasis

The renin–angiotensin system is essential for body fluid homeostasis and blood pressure regulation. This review focuses on the homeostatic regulation of the secretion of active renin in the kidney, primarily in humans. Under physiological conditions, renin secretion is determined mainly by sodium intake, but the specific pathways involved and the relations between them are not well defined. In animals, renin secretion is a log-linear function of sodium intake. Close associations exist between sodium intake, total body sodium, extracellular fluid volume, and blood volume. Plasma volume increases by about 1.5 mL/mmol increase in daily sodium intake. Several lines of evidence indicate that central blood volume may vary substantially without measurable changes in arterial blood pressure. At least five intertwining feedback loops of renin regulation are identifiable based on controlled variables (blood volume, arterial blood pressure), efferent pathways to the kidney (nervous, humoral), and pathways operating via the macula densa. Taken together, the available evidence favors the notion that under physiological conditions (1) volume-mediated regulation of renin secretion is the primary regulator, (2) macula densa mediated mechanisms play a substantial role as co-mediator although the controlled variables are not well defined so far, and (3) regulation via arterial blood pressure is the exception rather than the rule. Improved quantitative analyses based on in vivo and in silico models are warranted.     

Injuries in Professional Male Soccer Players in the Netherlands: A Prospective Cohort Study

Context:Injuries are a major adverse event in a soccer player''s career. Reducing injury incidence requires a thorough knowledge of the epidemiology of soccer injuries.Objective:To investigate the incidence and characteristics of injuries in the Dutch premier soccer league.Design:Cohort study.Setting:The Dutch premier soccer league.Results:A total of 286 injuries were recorded, affecting 62.7% of the players. The overall injury incidence was 6.2 injuries per 1000 player-hours, 2.8 in training sessions and 32.8 in matches. Most of the recorded injuries were acute (68.5%). Eight percent of the injuries were classified as recurrent. Injuries were most likely to be located in the lower extremities (82.9%). Injury time loss ranged from 1 to 752 days, with a median of 8 days. Knee injuries had the greatest consequences in terms of days of absence from soccer play (on average, 45 days). The most common diagnosis was muscle/tendon injury of the lower extremities (32.9%).Conclusions:Injury risk in the Dutch premier soccer league is high, especially during matches. Preventive measures should focus on the most common diagnoses, namely, muscle/tendon injuries of the lower extremities.Key Words: football, incidence, epidemiology, elite athletes

Key Points

• Injury risk in the Dutch premier soccer league is high; during 1 season, 62.7% of the players sustained an injury.
• Injuries most often affected the lower extremities (groin, posterior thigh, knee, lower leg/Achilles tendon, and ankle).
• Recurrent injuries caused longer absences than did first-time injuries, and knee injuries had the greatest consequences in time lost from soccer play.
• Preventive measures should focus on the most common diagnoses, namely, muscle/tendon injuries of the lower extremities.

Soccer is the sport with the greatest participation globally.¹ More than 200 million people from 203 nations are members of the Federation of International Football Associations (FIFA), while the Union of European Football Associations (UEFA) has 23 million members in 51 countries.² Outdoor soccer was played by 2635 clubs and approximately 60 500 teams in the Netherlands during the 2011–2012 season. There are currently more than 1.2 million licensed members of the Royal Netherlands Football Association, 45% of whom are adult males.³To obtain a good ranking in competition, soccer players have to be talented, well trained, and healthy, so injuries are a major adverse event in a soccer player''s career. Medical and surgical treatment and rehabilitation interrupt the player''s activity for a period ranging from a few weeks to several months.² If many injuries are sustained, team results can suffer.⁴ Reducing the injury incidence and increasing player safety requires a thorough knowledge of the epidemiology of soccer injuries.⁵ One major problem in the epidemiologic assessment of soccer injuries, however, is the methodologic inconsistency among studies. For example, injury definitions and methods for data collection and recording often differ considerably among studies.^6,7Investigations that describe injury risk and injury patterns in professional soccer have typically been conducted during tournaments,^8–11 have involved only teams at the highest European level,^10,12 have covered only part of a season,¹³ or were related to only 1 team.^14,15 Limited published research has included data on injuries within 1 national professional male soccer competition and involving multiple teams. Hence, little is known about the differences among countries in injury risk and injury patterns in professional male soccer players. During the last 10 years, acute and overuse injuries during matches and training sessions within national professional male soccer competitions have been recorded in Denmark¹³ and Sweden.^16–18 In view of the differences in performance level, medical support, match frequencies, and climate, it is plausible that the incidence and severity of soccer injuries may differ between Scandinavian and other European soccer leagues.¹⁸ Therefore, our study aimed to prospectively record injuries in the Dutch premier soccer league to investigate the incidence and characteristics of injuries in male professional soccer players during 1 entire soccer season.