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Moran D.S.,Oak Ridge Institute for Science and Education | Moran D.S.,Heller Institute of Medical Research | Moran D.S.,Ariel University | McClung J.P.,U.S. Army | And 2 more authors.
Sports Medicine | Year: 2013

Vitamin D is an essential nutrient obtained from the diet and exposure to sunlight. Roles for vitamin D have been established in the function of the cardiovascular, immune, and musculoskeletal systems. An electronic database search was conducted using EMBASE (1967 to August 2012), MEDLINE (1966 to August 2012), SPORTDiscus™ (1975 to August 2012), and the Scientific Electronic Library Online (SciELO) (1998 to August 2012) with no limits of language of publication. Articles that described vitamin D and performance were considered eligible for this review. Recent studies suggest that vitamin D maintains physical performance in athletes and other active populations, e.g., maximal oxygen consumption may be related to vitamin D status. Poor vitamin D status affects muscle strength, and vitamin D may participate in protein synthesis through the actions of the vitamin D receptor in muscle tissue. Vitamin D may protect against overuse injuries, such as stress fracture, through its well-documented role in calcium metabolism. The objective of this manuscript is to review recent evidence regarding the importance of vitamin D for maintaining physical performance, and includes specific examples of how vitamin D supports the cardiovascular, immune, and musculoskeletal systems. © 2013 Springer International Publishing Switzerland.


La Regina M.,Catholic University | Ben-Chetrit E.,Hebrew University of Jerusalem | Gasparyan A.Y.,Yerevan State Medical University | Livneh A.,Heller Institute of Medical Research | And 2 more authors.
Clinical and Experimental Rheumatology | Year: 2013

Objectives. Since the publication of the first reports on the efficiency of colchicine in familial Mediterranean fever (FMF), very few randomised studies have investigated issues related to its long-term use. Thus, different approaches taken by physicians involved in FMF care, are exclusively empiric, emulative, and based on case-reports or case-series. Problems such as colchicine intolerance and colchicine resistance have not been solved yet. This paper aims to evaluate trends in colchicine therapy among physicians taking care of FMF patients around the world. Methods. We conducted a survey by sending questionnaires to FMF research and treatment centres in Europe and Asia. Many issues (such as dosages, schedules, side effects, interactions, efficacy and toxicity monitoring, definition of colchicine intolerance, colchicine resistance and responsiveness, etc) have been investigated. When more than 70% of physicians responded giving similar answers to an item, the response was considered as a "trend". A comparison between answers of physicians from FMF-prevalent and non-prevalent countries was also made. Results. Thirty-five physicians from 11 countries filled the questionnaires, taking care of a total of more than 15000 FMF patients (pts). Different approaches were evident among the various physicians. Statistically significant different approaches between physicians from FMF-prevalent countries with respect to those from non-prevalent countries were found in items like colchicine during pregnancy, severity score and blood tests for disease monitoring. No consensus was found regarding the definition of colchicine resistance. Conclusion. The current study demonstrated significant variations in the strategy of colchicine therapy for FMF around the world and re-emphasised the need for standardised definitions of colchicine resistance and colchicine intolerance. © Clinical and Experimental Rheumatology 2013.


Hadid A.,Tel Aviv University | Epstein Y.,Heller Institute of Medical Research | Epstein Y.,Tel Aviv University | Shabshin N.,Sheba Medical Center | Gefen A.,Tel Aviv University
Journal of Applied Physiology | Year: 2012

Shoulder strain is a major limiting factor associated with load carriage. Despite advances in backpack designs, there are still reports of shoulder discomfort, loss of sensorimotor functions, and brachial plexus syndrome. The current study is aimed at characterizing mechanical loading conditions (strains and stresses) that develop within the shoulder's soft tissues when carrying a backpack. Open MRI scans were used for reconstructing a three-dimensional geometrical model of an unloaded shoulder and for measuring the soft tissue deformations caused by a 25-kg backpack; subsequently, a subject-specific finite element (FE) model for nonlinear, large-deformation stressstrain analyses was developed. Skin pressure distributions under the backpack strap were used as reference data and for verifying the numerical solutions. The parameters of the model were adjusted to fit the calculated tissue deformations to those obtained by MRI. The MRI scans revealed significant compression of the soft tissues of the shoulder, with substantial deformations in the area of the subclavian muscle and the brachial plexus. The maximal pressure values exerted by a 25-kg load were substantial and reached ∼90 kPa. In the muscle surrounding the brachial plexus, the model predicted maximal compressive strain of 0.14 and maximal tensile strain of 0.13, which might be injurious for the underlying neural tissue. In conclusion, the FE model provided some insights regarding the potential mechanisms underlying brachial plexus injuries related to load carriage. The large tissue deformations and pressure hotspots that were observed are likely to result in tissue damage, which may hamper neural function if sustained for long time exposures. Copyright © 2012 the American Physiological Society.


Epstein Y.,Heller Institute of Medical Research | Epstein Y.,Tel Aviv University | Druyan A.,Heller Institute of Medical Research | Druyan A.,Israel Defense Forces | And 2 more authors.
Journal of Strength and Conditioning Research | Year: 2012

Epstein, Y, Druyan, A, and Heled, Y. Heat injury prevention - A military perspective. J Strength Cond Res 26(7): S82-S86, 2012 - Heat-related injuries, and specifically exertional heat stroke, are a significant occupational risk in the armed forces, especially for those soldiers who are rapidly deployed from a temperate climate region to hot climate regions. Traditionally, adaptation to heat was considered as a matter of physiological adaptation. It is clear today that these injuries are mostly avoidable when applying proper education and behavioral adaptations. Education on behavioral adaptation for the prevention of heat injuries should be targeted at the individual and the organization level. This article summarizes the issue of proper preventive measures that should be taken to avoid, or at least minimize, the risk of exertional heat related injuries during military operations and training. © 2012 National Strength and Conditioning Association.


Epstein Y.,Heller Institute of Medical Research | Epstein Y.,Tel Aviv University | Yanovich R.,Heller Institute of Medical Research | Yanovich R.,Israel Defense Forces | And 3 more authors.
European Journal of Applied Physiology | Year: 2013

Anthropometric and physiological factors place the average female soldier at a disadvantage relative to male soldiers in most aspects of physical performance. Aerobic and anaerobic fitness levels are lower in women than in men. Thus, women have a lower overall work capacity and must therefore exert themselves more than men to achieve the same output. The lower weight and fat-free mass and the higher body fat of women are associated with lower muscle strength and endurance, placing them at disadvantage compared with men in carrying out military tasks such as lifting and carrying weights or marching with a load. Working at a higher percentage of their maximal capacity to achieve the same performance levels as men, women tire earlier and are at increased risk of overuse injuries. Their smaller size, different bone geometry and lower bone strength also predispose women to a higher incidence of stress fractures. Although training in gender-integrated groups narrows the gaps in fitness, significant differences between the genders after basic training still remain. Nevertheless, integration of women into military combat professions is feasible in many cases. Some 'close combat roles' will still be an exception, mainly because of the extreme physical demands that are required in those units that are beyond the physiological adaptability capacities of an average female. There is no direct evidence that women have a negative impact on combat effectiveness. Once the gender differences are acknowledged and operational doctrines adjusted accordingly, female soldiers in mixed-gender units can meet the physical standards for the assigned missions. © 2012 Springer-Verlag Berlin Heidelberg.


Ben-Zvi I.,Heller institute of Medical Research | Ben-Zvi I.,Sheba Medical Center | Ben-Zvi I.,Tel Aviv University | Livneh A.,Heller institute of Medical Research | Livneh A.,Tel Aviv University
Israel Medical Association Journal | Year: 2014

Familial Mediterranean fever (FMF) is a genetic auto-inflammatory disease characterized by spontaneous short attacks of fever, elevated acute-phase reactants, and serositis. Approximately 5%-10% of FMF patients do not respond to colchicine treatment and another 5% are intolerant to colchicine because of side effects. Recently, following the discovery of the inflammasome and recognition of the importance of interleukin-1β (IL-1β) as the major cytokine involved in the pathogenesis of FMF, IL-1β blockade has been suggested and tried sporadically to treat FMF, with good results. To date, case reports and small case series involving colchicine-resistant FMF patients and showing high efficacy of IL-1β blockade have been reported. At the Israel Center for FMF at the Sheba Medical Center the first double-blind randomized placebo-controlled trial of anakinra in FMF patients who are resistant or intolerant to colchicines is underway. In this report we discuss the mechanism of colchicine resistance in FMF patients, the data in the literature on IL1β blockade in these patients, and the anakinra trial inclusion criteria and study protocol.


Lidar M.,Heller Institute of Medical Research | Kedem R.O.N.,Heller Institute of Medical Research | Berkun Y.,Heller Institute of Medical Research | Langevitz P.,Heller Institute of Medical Research | Livneh A.V.I.,Heller Institute of Medical Research
Journal of Rheumatology | Year: 2010

Objective. To characterize familial Mediterranean fever (FMF) in Ashkenazi patients, a Jewish subgroup in which FMF has rarely been described before. Methods. A retrospective analysis, comparing demographic, clinical, and genetic measures of the cohort of Ashkenazi Jewish patients with FMF (n = 57), followed at the National Center for FMF in Israel, to age and sex matched patients of Iraqi Jewish (n = 62) and North African Jewish (NAJ; n = 61) origin. Results. Age at disease onset and diagnosis was earlier in NAJ than among Ashkenazi and Iraqi patients. Family history of FMF was described by only 30% of Ashkenazi patients as opposed to the majority of Iraqi and NAJ patients (p = 0.001). The frequency of abdominal and febrile attacks was similar among the 3 groups, while chest and joint attacks were far less common inAshkenazi and Iraqi compared to NAJ patients. A good response to colchicine was noted in a similar proportion of Ashkenazi and Iraqi patients (82-84%) as opposed to only 56% of NAJ patients (p = 0.0001). Proteinuria, renal failure, and amyloidosis were most frequent among the NAJ patients (18, 6.6, and 9.8% compared to 5.3, 0, and 3.5% and 1.6, 0, and 0% in Ashkenazi and Iraqi patients, respectively). Conclusion. Ashkenazi patients with FMF stand at the mildest end of the clinical spectrum of FMF. This is notwithstanding the tendency for amyloidosis, the frequency of which is not trivial and which deserves particular awareness. Copyright © 2010. All rights reserved.


Berkun Y.,Tel Aviv University | Levy R.,Edmond and Lily Safra Childrens Hospital | Hurwitz A.,Edmond and Lily Safra Childrens Hospital | Meir-Harel M.,Edmond and Lily Safra Childrens Hospital | And 5 more authors.
Seminars in Arthritis and Rheumatism | Year: 2011

Objective: Periodic fever, aphthous stomatitis, pharyngitis, and adenopathy (PFAPA) syndrome is a sporadic disease, characterized by periodic attacks of inflammation. Mutations in the MEFV, the gene associated with familial Mediterranean fever (FMF), may lead to subclinical inflammation in asymptomatic carriers and modify the phenotype of some inflammatory diseases. We aimed at investigating the effect of MEFV gene mutations on disease phenotype in PFAPA. Patients and Methods: The cohort of this ongoing prospective study consisted of 124 children with PFAPA syndrome, followed in a single referral center, who were tested for MEFV mutations. Demographic data, clinical characteristics, and disease course of 65 PFAPA patients with and 59 without MEFV mutations (M+ and M-, respectively) were compared. Results: PFAPA attacks in carriers of MEFV mutations were shorter compared with patients without mutations (3.8 ± 1.7 versus 4.8 ± 1.9 days, P < 0.01). The difference was more pronounced in those carrying the M694V mutation. In M+ patients, the rates of patients with regularity of their attacks (49.2%) and oral aphthae (24.6%) were lower, compared with M- patients (74.5% and 43.9%, respectively, P < 0.05 for each of the 2 comparisons). M+ patients needed a lower corticosteroid (beclomethasone) dose to abort the attacks (0.16 ± 0.07mg/kg versus 0.19 ± 0.08, P = 0.028). No differences were observed in all other clinical and laboratory parameters, over a follow-up period of 4.3 years. Conclusion: In PFAPA, MEFV is a modifier gene associated with an attenuated disease severity. © 2011 Elsevier Inc.


Kaplan B.,Heller Institute of Medical Research | Aizenbud B.M.,Elta Systems IAI | Golderman S.,Heller Institute of Medical Research | Yaskariev R.,Institute of Chemical Pathology | And 2 more authors.
Journal of Neuroimmunology | Year: 2010

A new procedure of free light chain (FLC) analysis was developed to assist the diagnosis of multiple sclerosis (MS). In this procedure, Western blotting technique was used to analyze monomeric and dimeric FLCs in the cerebrospinal fluid (CSF) and serum of patients with MS and other neurological diseases. The intensity of immunoreactive FLC bands was quantified by a specially developed software. Analysis of the obtained monomer/dimer patterns of κ and Λ type FLCs allowed the determination of the diagnostically useful FLC parameters. The combined use of three FLC indices accounting for monomeric FLC-κ level and κ/Λ ratio values in the CSF and serum was found to be of promising diagnostic importance for differentiation of MS from other non-MS neurological diseases. © 2010 Elsevier B.V.


Epstein Y.,Heller Institute of Medical Research
Harefuah | Year: 2011

Body temperature regulated within the homeostatic range, is essential for the stability of the "milieu intérieur" and for maintaining intact body functioning. Those individuals in the population who cannot adapt to heat stress and whose body temperature will rise earlier and at a higher rate than expected under predetermined conditions are considered as 'heat intolerant". Patients with deep burns are intolerant to heat because of the injured dermis and the destruction of the imbedded eccrine sweat glands and the peripheral vascular bed and its post-synaptic innervations, which common treatment with split-thickness skin grafts cannot restore. Thus, the extent of the inability to regulate body temperature is associated with the percent of the burnt area - the Larger the affected area, the lower is the ability to thermoregulate. The cumulative data suggest that the state of heat intolerance in deep-burnt patients is a persisting condition and cannot be alleviated by heat acclimation.

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