Acute increases in interleukin (IL)-6 following prolonged exercise are associated with the induction of a transient anti-inflammatory state (e.g., increases in IL-10) that is partly responsible for ...the health benefits of regular exercise. The purposes of this study were to investigate the IL-6–related inflammatory response to high-intensity interval exercise (HIIE) and to determine the impact of exercise intensity and volume on this response. Ten participants (5 males and 5 females) completed 3 exercise bouts of contrasting intensity and volume (LOW, MOD, and HIGH). The HIGH protocol was based upon standard HIIE protocols, while the MOD and LOW protocols were designed to enable a comparison of exercise intensity and volume with a fixed duration. Inflammatory cytokine concentrations were measured in plasma (IL-6, IL-10) and also determined the level of gene expression (IL-6, IL-10, and IL-4R) in peripheral blood. The plasma IL-6 response to exercise (reported as fold changes) was significantly greater in HIGH (2.70 ± 1.51) than LOW (1.40 ± 0.32) (P = 0.04) and was also positively correlated to the mean exercise oxygen uptake (r = 0.54, P < 0.01). However, there was no change in anti-inflammatory IL-10 or IL-4R responses in plasma or at the level of gene expression. HIIE caused a significant increase in IL-6 and was greater than that seen in low-intensity exercise of the same duration. The increases in IL-6 were relatively small in magnitude, and appear to have been insufficient to induce the acute systemic anti-inflammatory effects, which are evident following longer duration exercise.
Diagnosis is characterized as an exercise in classification, where the task is to assign a crop to a risk group as a basis for evidence-based crop protection decision making. Underlying the process ...of diagnostic decision making is Bayesian updating of probabilities. Alongside updating of probabilities, assessments of diagnostic information allow further description of the characteristics of diagnostic tests, and of the predictions made on the basis of test outcomes. This is illustrated analytically, graphically (by means of iso-information contour plots and information graphs) and by discussion of example epidemiological scenarios.
We present a simple flow model and solution to describe ‘horizontal convection’ driven by a gradient of temperature or heat flux along one horizontal boundary of a rectangular box. Following ...laboratory observations of the steady-state convection, the model is based on a localized vertical turbulent plume from a line or point source that is located anywhere within the area of the box and that maintains a stably stratified interior. In contrast to the ‘filling box’ process, the convective circulation involves vertical diffusion in the interior and a stabilizing buoyancy flux distributed over the horizontal boundary. The stabilizing flux forces the density distribution to reach a steady state. The model predictions compare well with previous laboratory data and numerical solutions. In the case of a point source for the plume (the case which best mimics the localized sinking in the large-scale ocean overturning) the thermal boundary layer is much thicker than that given by the two-dimensional boundary layer scaling of H. T. Rossby (Tellus, vol. 50, 1965, p. 242).
This year in Galveston, Texas, Silvia Pierangeli hosts the 13th International Congress on Antiphospholipid Antibodies. Twenty-six years after the first antiphospholipid syndrome meeting, the number ...of interested colleagues has multiplied, and the subject has become more scientifically understood. So also has the clinical picture. In this short contribution, I will highlight a number of clinical observations which may, or may not, contribute to our understanding of antiphospholipid syndrome.
Background:
Mass casualty and multi-victim incidents have increased in recent years due to a number of factors including natural disasters and terrorism. The Association of American Medical Colleges ...(AAMC) recommends that medical students be trained in disaster preparedness and response. However, a majority of United States medical students are not provided such education.
Objective:
The goal of this study was to evaluate the effectiveness of a 1 day, immersive, simulation-based Disaster Day curriculum.
Settings and Design:
Learners were first and second year medical students from a single institution.
Materials and Methods:
Our education provided learners with information on disaster management, allowed for application of this knowledge with hands-on skill stations, and culminated in near full-scale simulation where learners could evaluate the knowledge and skills they had acquired.
Statistical analysis used:
To study the effectiveness of our Disaster Day curriculum, we conducted a single-group pretest-posttest and paired analysis of self-reported confidence data.
Results:
A total of 40 first and second year medical students participated in Disaster Day as learners. Learners strongly agreed that this course provided new information or provided clarity on previous training, and they intended to use what they learned, 97.6% and 88.4%, respectively.
Conclusions:
Medical students’ self-reported confidence of key disaster management concepts including victim triage, tourniquet application, and incident command improved after a simulation-based disaster curriculum. This Disaster Day curriculum provides students the ability to apply concepts learned in the classroom and better understand the real-life difficulties experienced in a resource limited environment.
Background
Infective endocarditis (IE) involving the aortic valve and root is associated with high risk requiring thoughtful surgical decision‐making. The impact of valve and conduit choices and ...patient factors on long‐term outcomes in this patient population is poorly documented.
Methods
From January 1976 to December 2013, 485 patients underwent aortic root and valve replacement at a single institution. Cox's proportional hazard model identified predictors of long‐term survival and cumulative incidence functions were compared to assess need for reoperation with death as a competing risk.
Results
Median age at time of operation was 56.6 years (interquartile range: 23.1) with the indication for operation being endocarditis in 14.6% (n = 71). Stentless root replacement was used in 70% IE versus 34% non‐IE (p < .001). Endocarditis at time of root replacement did not have a significant impact on survival through 15 years (IE: 37.3% vs. non‐IE: 42.5%; log‐rank; p = .13). After multivariable adjustment, survival was similar between patients with and without endocarditis (hazard ratio: 1.1; 95% confidence interval: 0.77, 1.62; p = .57). Freedom from reoperation at 15 years did not vary significantly by endocarditis status (IE: 95.9% vs. non‐IE: 73.6%; p = .07). Among endocarditis patients, freedom from reoperation at 10 years was similar between homograft and stentless bioprosthetic conduits (95.3% vs. 88.5%; log‐rank; K‐sample; p = .46).
Conclusions
In a sample with frequent use of stentless prostheses, aortic root replacement for infective endocarditis had acceptable risk and long‐term survival similar to root replacement for other indications. In the setting of endocarditis, root replacement with homograft or stentless bioprosthetic root has excellent durability through 15 years.
Between November 2013 and August 2014, nine cases of verocytotoxin-producing Escherichia coli O117:H7 VT1 were confirmed in adult men. Further investigation using semi-structured interviews revealed ...that eight cases were United Kingdom (UK)-born men who have sex with men (MSM) who had sexually acquired infection in the UK. Most were HIV-positive with high numbers of sexual partners. This behavioural profile resembles that associated with the recent rapid increase in other sexually acquired infections in MSM.
The quality of the imaging of the main coronary arteries and side branches provided by multidetector row computed tomography (MDCT) may have importance when assessing congenital coronary artery ...anomalies. This review discusses the rationale for using MDCT for this indication and examines the advantages and disadvantages of the technique. Examples of MDCT imaging of congenital coronary artery anomalies are presented. These images provide persuasive evidence to support clinical use of MDCT cardiac imaging in the context of suspected congenital coronary artery anomalies as a first line investigation.
Objective: To examine the hypothesis that testing for new antiphospholipid antibody specificities may help to identify the antiphospholipid syndrome (APS) in patients with systemic lupus ...erythematosus (SLE) with thrombosis who are repeatedly negative for anticardiolipin antibodies (aCL) and/or lupus anticoagulant (LA). Methods: Three groups of patients with SLE were studied: (a) SLE/APS (n = 56): 51 female, mean (SD) age 46 (11) years, fulfilling 1999 Sapporo criteria for the APS; (b) SLE/thrombosis (n = 56): 53 female, age 42.6 (12) years, all with a history of thrombosis and persistently negative for aCL and/or LA; (c) SLE only (n = 56): 53 female, age 40 (11) years, without a history of thrombotic events. aCL and LA were retested in all samples. All patients were tested for anti-β2-glycoprotein I (anti-β2GPI) and antiprothrombin antibodies (aPT) by coating prothrombin on irradiated plates or using phosphatidylserine-prothrombin complex as the antigen (aPS-PT). Results: Anti-β2GPI were only present in patients from the SLE/APS group, all of whom were also positive for aCL. aPT and aPS-PT were also more commonly found in SLE/APS than in SLE/thrombosis or SLE only groups (54% v 5%, p<0.0001 or v 16%, p<0.0001 for aPT and 63% v 2%, p<0.0001 or v 11%, p<0.0001 for aPS-PT, respectively). No differences were found between SLE/thrombosis and SLE only groups (p = 1.5 for β2GPI, p = 0.1 for aPT, and p = 0.1 for aPS-PT). Conclusion: Testing for aPT in patients with SLE with thrombosis, but persistently negative for aCL and LA, may be helpful in some selected cases. Anti-β2GPI are not present in patients who are negative for aCL.
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