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Snohomish, WA, United States

Getzin A.R.,Cayuga Medical Center | Milner C.,Cayuga Medical Center | La Face K.M.,Family Medicine
Current Sports Medicine Reports

Participation in ultraendurance events has been increasing. Appropriate nutrition in training and fueling while racing within the confines of gastrointestinal tolerability is essential for optimal performance. Unfortunately, there has been a paucity of studies looking at this special population of athletes. Recent field studies have helped to clarify appropriate fluid intake and dispel the myth that moderate dehydration while racing is detrimental. Additional current nutrition research has looked at the role of carbohydrate manipulation during training and its effect on macronutrient metabolism, as well as of the benefits of the coingestion of multiple types of carbohydrates for race fueling. The use of caffeine and sodiumingestion while racing is common with ultraendurance athletes, but more research is needed on their effect on performance. This article will provide the clinician and the athlete with the latest nutritional information for the ultraendurance athlete. Copyright © 2011 by the American College of Sports Medicine. Source

Restituto P.,Servicio de Bioquimica | Varo J.J.,Family Medicine | Varo N.,Servicio de Bioquimica
American Journal of Physiology - Endocrinology and Metabolism

The proinflammatory and proatherogenic mediator, soluble CD40 ligand (CD40L), is increased in the metabolic syndrome (MS) and released from platelets. We hypothesized that adiponectin modulates platelet function, and we sought to evaluate the association of adiponectin and sCD40L levels with platelet aggregation in MS and the effects of adiponectin on platelet aggregation and activation. Platelet aggregation and circulating adiponectin, sCD40L and P-selectin were determined in 30 controls and 30 patients with MS. Also, in vitro studies were performed in platelet-rich plasma from nine healthy volunteers. Adiponectin receptors were demonstrated by Western blotting and flow cytometry. ADP and epinephrine platelet aggregation was measured after preincubation with adiponectin. sCD40L and P-selectin secretion was measured in the supernatants by ELISA. Patients with MS had higher sCD40L and P-selectin than controls (5.96 ± 0.50 vs. 4.28 ± 0.41 ng/ml, P < 0.05, and 151 ± 8 vs. 122 ± 9 ng/ml, P < 0.05). By contrast, adiponectin was lower in patients with MS than in controls (5.25 ± 0.30 vs. 7.35 ± 0.34 μg/ml, P < 0.001). Higher platelet aggregation was found in MS. Adiponectin inversely correlated with P-selectin (R = -0.35, P = 0.009), sCD40L (r = -0.24, P = 0.05) and epinephrine and collagen induced aggregation (r = -0.80, P = 0.005; r = -0.70, P = 0.011). Platelets express the receptors for adiponectin. Platelet aggregatory response to epinephrine and ADP significantly decreased following preincubation with adiponectin (96 ± 4 vs. 23 ± 3%, P < 0.001, and 102 ± 9 vs. 85 ± 9%, P = 0.004). Adiponectin prevented platelet sCD40L release (1.63 ± 0.15 vs. 2.04 ± 0.20 ng/ml, P < 0.001). Enhanced platelet aggregation and activation markers are found in MS associated with low adiponectin concentrations. Novel evidence is provided demonstrating that adiponectin has antithrombotic properties, since it inhibits platelet aggregation and platelet activation. Copyright © 2010 the American Physiological Society. Source

Tsou M.-T.,Family Medicine
International Journal of Gerontology

Background/Purpose: Sleep symptoms can predict the development of metabolic syndrome (MetS) in the general population. This study focuses on the association between commonly reported sleep symptoms and MetS, a key cardiovascular disease risk factor in the elderly population living in northern Taiwan. Methods: A cross-sectional survey was conducted among elderly people (age≥65 years) who underwent a health examination for senior citizens from March 2009 to November 2009. A total of 1181 participants (433 men, 36.7%; 748 women, 63.3%) were surveyed. MetS was defined using the modified Adult Treatment Panel III (ATP III). They had completed a sleep questionnaire and MetS evaluation. Logistic regression examined the relationship between MetS syndrome and its components according to individual sleep symptoms and insomnia syndrome. Results: A specific symptom of insomnia, difficulty falling asleep (DFA), but not a syndromic definition of insomnia, was significantly associated with MetS. Insomnia duration was not associated with the risk of MetS. DFA increased the risk of abdominal obesity, hyperglycemia, and hypertriglycemia. Frequent waking from sleep or due to dreams increased the risk of abdominal obesity. Sleeping difficulty increased the risk of hypertension. Other insomnia symptoms (nonrefreshing sleep) were not associated with the increased risk of any MetS factors. Conclusion: DFA is associated with the risk of MetS in the elderly community. Insomnia symptoms, including DFA, sleeping difficulty, and frequent waking from sleep or dreams increased the odds ratio (OR) of risk factors. Evaluating sleep symptoms can help identify individuals that are at risk of MeS. © 2015. Source

Gucuk S.,Family Medicine | Uyeturk U.,Abant Izzet Baysal University
Asian Pacific Journal of Cancer Prevention

Aims: To evaluate breast self examination (BSE) practice and the effect of a training program conducted by healthcare professionals on BSE. Materials and Methods: Women were randomized into control and test groups with both groups completing a questionnaire and three independent interviews where their BSE practices were evaluated. Results: In all, 39.5% of the participants were previously provided information on BSE by healthcare professionals while 25.8% had no knowledge of BSE prior to enrollment. Compared to those informed about BSE through other means such as television, radio, and the internet, the scores of the first, second, and third visits were higher (p<0.05) in individuals who received BSE education from healthcare professionals and hospitals. Conclusions: BSE training provided by healthcare professionals may increase early breast cancer diagnosis and treatment rates by improving BSE awareness and practice. Source

Ulla-Rocha J.L.,Digestive Disease Service | Vilar-Cao Z.,Family Medicine | Sardina-Ferreiro R.,Internal Medicine
Therapeutic Advances in Gastroenterology

Objectives: The objective of this study was to evaluate the role and benefits of endoscopic ultrasonography (EUS) in the management of postoperative intra-abdominal fluid collections after attempted curative surgery for abdominal cancer.Methods: The authors retrospectively analysed the Endobase from 1 July 2007 to 30 January 2011 for patients with a postoperative intra-abdominal fluid collection who had undergone EUS-guided drainage and the placement of a stent. The data analysed included the demographics, type of surgery and clinical indications of each patient as well as their clinical and radiological findings.Results: Six patients (three men and three women; mean age, 61.8 years [range, 38-78 years]) with intra-abdominal and pelvic fluid collections after abdominal surgery for cancer had undergone EUS-guided internal drainage. All procedures had been performed using linear EUS guidance and 8-Fr stent drainage catheters ('one step device', Giovannini, NWOA system Needle-Wire, Cook). The collection types included perigastric abscess (n = 3), perigastric hematoma and rectal hematoma (n = 1), perirectal biloma (n = 1), and perirectal abscess (n = 1). Patients had undergone the following types of surgery: lower-anterior rectal resection (n = 2), Whipple's duodenopancreatectomy type (n = 1), total gastrectomy (n = 1), splenectomy (n = 1), and distal pancreatectomy (n = 1). The number of stents inserted for each collection was one (five patients) and two (one patient).Conclusions: EUS-guided drainage and stenting provide another option for the management of postoperative collections. It allows access to areas that are difficult to reach with the CT-guided approach and it can be performed accurately, efficiently and safely. In addition to this, the internal nature of the drainage offers patients more comfort. © SAGE Publications 2011. Source

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