Adherence to Mediterranean, Dietary Approaches to Stop Hypertension and Healthy Eating Indices are associated with lower risk of disability among Puerto Rican adults from the longitudinal Boston Puerto Rican Health Study.

BACKGROUND: Emerging evidence suggests that poor dietary quality is an important risk factor for disability. However, few studies have compared adherence to dietary patterns with disability and none among Puerto Rican adults. OBJECTIVES: This study was designed to examine relationships between 3 dietary patterns-including Dietary Approaches to Stop Hypertension (DASH), Mediterranean dietary score (MeDS), and Healthy Eating Index (HEI)-2010-and ∼6-y incidence of activities of daily living (ADL) and instrumental activities of daily living (IADL) disability and to assess potential mediation by handgrip strength. METHODS: Data are from the Boston Puerto Rican Health Study, a longitudinal cohort of Puerto Rican adults aged 45-75 y (N = 1502). Adherence to dietary pattern variables were derived from food frequency questionnaire (FFQ) data averaged at baseline and ∼2 y. Handgrip strength was assessed at baseline. Cox proportional hazards models were used to assess longitudinal associations between DASH, MeDS, and HEI-2010 and incident ∼6-y ADL (and subscales) and IADL disability. Mediation by handgrip strength was also tested. RESULTS: Participants with higher adherence DASH had lower risk of ADL, ADL mobility, and ADL manual dexterity disabilities (hazards ratio [HR]: 0.96; 95% confidence interval [CI]: 0.91, 0.98; HR: 0.96; 95% CI: 0.92, 0.99; and HR: 0.95; 95% CI: 0.92, 0.98, respectively). Higher adherence to MeDS was associated with lower risk of ADL and ADL mobility disabilities (HR: 0.89; 95% CI: 0.81, 0.98; HR: 0.90; 95% CI: 0.82, 1.00), and higher adherence to HEI with lower risk of ADL manual dexterity (HR: 0.98; 95% CI: 0.97, 0.99) in fully adjusted models. Only DASH tended to be associated with IADL (HR: 0.97; 95% CI: 0.94, 1.00). Baseline handgrip strength was a mediator between HEI and ADL manual dexterity (23.7% of the indirect effect was explained through handgrip strength). CONCLUSIONS: Higher adherence to a healthy diet pattern may decrease risk of disability and may be an important prevention strategy for ADL and IADL disability associated with aging.

Changes in Dynamic Balance Ability Among Firefighter Recruits: A Longitudinal Cohort Study.

ABSTRACT: Cornell, DJ, Gnacinski, SL, and Ebersole, KT. Changes in dynamic balance ability among firefighter recruits: A longitudinal cohort study. J Strength Cond Res 38(4): 734-741, 2024-It has been suggested that enhanced balance ability may mitigate the high musculoskeletal injury (MSKI) rate among firefighters, but the longitudinal changes in dynamic balance ability within this tactical athlete population have yet to be characterized. The purpose of this study was to examine the changes in dynamic balance ability of a cohort population of firefighter recruits completing a training academy and their probationary period as active-duty firefighters. Twenty-seven male firefighter recruits completed the modified Star Excursion Balance Test (mSEBT) at the beginning (W1) and at the end of their training academy (W14) and after completing their probationary period as active-duty firefighters (W38). After controlling for age and changes in body fat (BF) over time, significant changes in mSEBTANT ( p < 0.001), mSEBTPL ( p = 0.015), mSEBTPM ( p < 0.001), and mSEBTCOMP ( p = 0.003) were observed across time. Although mSEBTPL performance significantly increased ( p = 0.033) in from W1 to W14, significant decreases in all mSEBT reach directions were observed from W14 to W38 ( p < 0.05), with mSEBTANT ( p < 0.001) and mSEBTCOMP ( p = 0.002) also significantly decreasing from W1 to W38. However, the frequency of right vs. left asymmetries (>4 cm) did not significantly change over time in any mSEBT reach direction ( p > 0.05). Irrespective of age or changes in BF, minimal changes in the dynamic balance ability of firefighter recruits were observed during their training academy, but significant decreases in balance ability were noted by the end of their probationary period.

The Influence of Age and Dynamic Balance on Functional Movement Among Active-Duty Police Officers.

CONTEXT: Although occupational injuries for police officers cannot be prevented, factors that contribute to musculoskeletal injury risk could be better identified to inform preventative interventions. Previous research has supported screening tools such as the functional movement screen (FMS) and Y-Balance Test (YBT) as possible indicators of musculoskeletal injury risk. The purposes of this study are to (1) examine the relationships between age, dynamic balance, and functional movement in police officers and (2) determine how much variance in functional movement is predicted by age and dynamic balance. METHODS: This study was conducted in a university research laboratory as part of an ongoing collaboration with a local police department. All data for the current study were collected across 2 separate laboratory visits within a 14-day period. PARTICIPANTS: Thirty-five active-duty police officers (31 men and 4 women; mean [SD], age 33.4 [9.4] y, height 177.4 [8.0] cm, body mass 88.4 [15.3] kg) volunteered to participate in this study. MAIN OUTCOME MEASURES: Functional movement was assessed using the FMS, and FMS overall scores were calculated. Dynamic balance was assessed via the YBT, and lower quarter Y-Balance Test scores (LQYBT%) were calculated. RESULTS: There was a significant negative correlation between FMS overall score and age (r = -.641, P < .001). Correlations between FMS overall score and LQYBT% and between LQYBT% and age were not statistically significant. Age and LQYBT% scores significantly predicted FMS overall scores (F2,32 = 11.162, P < .001), accounting for 41.1% of the variance in FMS overall scores (R2 = .411) with age being the only significant predictor. CONCLUSIONS: This study confirms that age and FMS overall score have a strong, negative relationship, suggesting that age may be a contributing factor to movement quality and may lead to an increased risk of musculoskeletal injury within this unique population.

Validity of a Smartphone Application in Calculating Measures of Heart Rate Variability.

The purpose of the current study was to determine the concurrent validity of the Elite HRV smartphone application when calculating heart rate variability (HRV) metrics in reference to an independent software criterion. A total of 5 minutes of R−R interval and natural log of root mean square of the successive differences (lnRMSSD) resting HRV data were simultaneously collected using two Polar H10 heart rate monitors (HRMs) in both the seated and supine positions from 22 participants (14 males, 8 females). One H10 HRM was paired with a Polar V800 watch and one with the Elite HRV application. When no artifact correction was applied, significant, but small, differences in the lnRMSSD data were observed between the software in the seated position (p = 0.022), and trivial and nonstatistically significant differences were observed in the supine position (p = 0.087). However, significant differences (p > 0.05) in the lnRMSSD data were no longer identifiable in either the seated or the supine positions when applying Very Low, Low, or Automatic artifact-correction filters. Additionally, excellent agreements (ICC3,1 = 0.938 − 0.998) and very strong to near-perfect (r = 0.889 − 0.997) relationships were observed throughout all correction levels. The Elite HRV smartphone application is a valid tool for calculating resting lnRMSSD HRV metrics.

Functional Movement Quality of Firefighter Recruits: Longitudinal Changes from the Academy to Active-Duty Status.

Approximately half of the injuries experienced by firefighters consist of musculoskeletal injuries (MSKIs). Functional movement quality may be associated with MSKI risk within this tactical athlete population. Previous research indicates that measures of body composition change among firefighter recruits progressing from academy training through active-duty service, but similar changes in functional movement quality have yet to be examined. The purpose of this study was to describe longitudinal changes in functional movement quality of firefighter recruits. Body mass index (BMI), body fat (BF), and Functional Movement Screen (FMS) data were collected from 26 male firefighter recruits at the onset (W1) and completion (W14) of their training academy, and at the completion of their probationary period of active-duty service (W38). After adjusting for changes in BMI and BF across time, significant changes (ps < 0.05) in Composite FMS scores were identified, with significant increases in from W1 to W14 and from W14 to W38, as well as an overall increase from W1 to W38. These results suggest that the development of firefighter-specific skills can decrease the MSKI risk of firefighter recruits by facilitating enhanced functional movement competencies, particularly during tasks that require single-leg movement and core strength and stability.

Relationships between balance and physical fitness variables in firefighter recruits.

BACKGROUND: Research has suggested that balance ability contributes to musculoskeletal injury (MSKI) rates in firefighters. Though the Y-Balance Test (YBT) can predict injury, it is unclear what physical measures inform YBT performance in firefighters. Thus, there is a lack of knowledge regarding best practice for improving balance in firefighters. OBJECTIVE: To evaluate the relationship between the YBT and fitness measures, including body composition, aerobic capacity, functional total-body power, upper and lower-body strength, and movement efficiency, among firefighters. METHODS: Dynamic balance (YBT), body mass index (BMI), body-fat percentage (BF%), fat free mass (FFM), aerobic capacity (VO2max), stair climb (SC), upper (1RMbench) and lower-body (1RMsquat) strength, and Fusionetics™ Movement Efficiency Screen (ME) measures were collected among 35 firefighter recruits. Pearson correlation coefficients were used to examine relationships between YBT and the performance measures. RESULTS: Dynamic balance ability in firefighter recruits is significantly (p < 0.05) related to BMI, lower-body strength, and movement quality, but not with aerobic capacity, stair climb performance, and upper body strength. CONCLUSIONS: Greater YBT performance in firefighter recruits is associated with lower BMI, greater functional movement, and greater lower-body strength. Future research is warranted to incorporate these elements into balance training programs for firefighter recruits.

Patterns of change in cardiovascular risk assessments and ankle brachial index among Puerto Rican adults.

BACKGROUND: Puerto Rican adults have higher odds of peripheral artery disease (PAD) compared with Mexican Americans. Limited studies have examined relationships between clinical risk assessment scores and ABI measures in this population. METHODS: Using 2004-2015 data from the Boston Puerto Rican Health Study (BPRHS) (n = 370-583), cross-sectional, 5-y change, and patterns of change in Framingham Risk Score (FRS) and allostatic load (AL) with ankle brachial index (ABI) at 5-y follow-up were assessed among Puerto Rican adults (45-75 y). FRS and AL were calculated at baseline, 2-y and 5-y follow-up. Multivariable linear regression models were used to examine cross-sectional and 5-y changes in FRS and AL with ABI at 5-y. Latent growth mixture modeling identified trajectories of FRS and AL over 5-y, and multivariable linear regression models were used to test associations between trajectory groups at 5-y. RESULTS: Greater FRS at 5-y and increases in FRS from baseline were associated with lower ABI at 5-y (ß = -0.149, P = 0.010; ß = -0.171, P = 0.038, respectively). AL was not associated with ABI in cross-sectional or change analyses. Participants in low-ascending (vs. no change) FRS trajectory, and participants in moderate-ascending (vs. low-ascending) AL trajectory, had lower 5-y ABI (ß = -0.025, P = 0.044; ß = -0.016, P = 0.023, respectively). CONCLUSIONS: FRS was a better overall predictor of ABI, compared with AL. Puerto Rican adults, an understudied population with higher FRS over 5 years, may benefit from intensive risk factor modification to reduce risk of PAD. Additional research examining relationships between FRS and AL and development of PAD is warranted.

Influence of Body Composition on Post-Exercise Parasympathetic Reactivation of Firefighter Recruits.

Firefighters have a sustained risk for experiencing a sudden cardiac event after completing a fire call. Heart rate recovery (HRR) can be utilized to characterize autonomic nervous system (ANS) recovery and has been linked to cardiac events. Research suggests that body composition influences post-exercise HRR responses in non-firefighter populations. The purpose of this study was to examine the influence of body mass index (BMI), waist circumference (WC), and percent body fat (BF) on the HRR response of firefighter recruits. BMI (kg·m-2), WC (cm), and BF (%) data from 57 firefighter recruits were collected. HRR (b·min-1) data were collected at completion (HR0), as well as 15 (HR15), 30 (HR30), 45 (HR45), 60 (HR60), 120 (HR120), and 180 (HR180) seconds following a submaximal step test, and commonly utilized clinical HRR indices were calculated (ΔHRR30, ΔHRR60, ΔHRR120, and ΔHRR180). After controlling for sex, linear mixed regression models did not identify significant interactions between body composition (ps > 0.05) and HRR response across time. However, significant (ps < 0.05) indirect semi-partial correlations were identified between BF and ΔHRR30 (rsp = -0.31) and ΔHRR60 (rsp = -0.27), respectively. Reducing overall BF (vs. BMI or WC) should be prioritized to improve the post-exercise ANS recovery of firefighter recruits.

Influence of a Training Academy on the Parasympathetic Nervous System Reactivation of Firefighter Recruits-An Observational Cohort Study.

Sudden cardiac death (SCD) is the leading type of line-of-duty death among firefighters. An inability to restore parasympathetic nervous system (PSNS) control after activity is associated with SCD. Post-exercise heart rate recovery (HRR) provides unique insight into reactivation of the PSNS. Thus, the purpose of this study was to examine longitudinal changes in HRR responses of 25 male firefighter recruits. HR data were collected after submaximal exercise at week 1 (W1), week 6 (W6), and week 15 (W15) of their training at an academy. Percent maximal heart rate (%MHR) measures were computed at each HRR time point (%MHR0, %MHR15, %MHR30, %MHR45, %MHR60, %MHR120, %MHR180) and absolute HRR values were calculated at 30 s (ΔHRR30), 60 s (ΔHRR60), 120 s (ΔHRR120), and 180 s (ΔHRR180). After controlling for age and percent body fat, there was no statistically significant interaction between Week × HRR (p = 0.730), and there were no changes in ΔHRR30, ΔHRR60, and ΔHRR120, and ΔHRR180 indices across time. However, %MHR at W6 and W15 was significantly lower than %MHR at W1 at every HRR time point (ps < 0.001). Therefore, although the firefighter recruit training academy elicited positive training adaptations, changes in PSNS reactivation after submaximal activity were not identified.

INFLUENCE OF AN ACUTE BOUT OF SELF-MYOFASCIAL RELEASE ON KNEE EXTENSION FORCE OUTPUT AND ELECTRO-MECHANICAL ACTIVATION OF THE QUADRICEPS.

BACKGROUND: In contrast to static stretching (SS), previous research has demonstrated increases in flexibility after an acute bout of self-myofascial release (SMR) without any subsequent decreases in force output. Previous research has utilized measures of surface electromyography (sEMG) and mechanomyography (MMG) to examine the influence of SS on the electrical and mechanical processes of muscle activation, respectively. However, there is a lack of research examining the potential changes in electro-mechanical muscle activation post-SMR. PURPOSE: To examine the influence of SMR, via an acute bout of foam rolling (FR) to the vastus lateralis (VL), on the expression of knee extension force output and the inter-muscular electro-mechanical activation of the quadriceps musculature. STUDY DESIGN: Randomized crossover trial. METHODS: Twenty (10 males, 10 females) recreationally-active participants with prior FR experience completed both SMR and control (CON) testing protocols during separate testing sessions that were conducted in a randomized order 48 hours apart. During the SMR protocol, participants performed 3 sets of 60 seconds of FR over the VL portion of their quadriceps musculature, with 60 seconds of rest between sets. During the CON protocol, participants quietly sat upright for 10 minutes. Peak knee extension force output -(Forcepeak) data, as well as sEMG and MMG data from the VL and the rectus femoris (RF) were collected during maximal voluntary isometric contractions (MVICs) before and after both testing protocols. Root mean square sEMG and MMG amplitudes were calculated to represent electro-mechanical muscle activation of the VL (VL-sEMGRMS, VL-MMGRMS) and RF (RF-sEMGRMS, RF-MMGRMS) musculature. RESULTS: Repeated measures analyses of variance (RM ANOVAs) identified a significant (p < 0.05) increase in Forcepeak within the SMR protocol among males, but no change among females. No statistically significant changes in any electro-mechanical muscle activation measures were identified pre-to-post-SMR within either sex. CONCLUSION: In contrast to the SS literature body, these results suggest that SMR does not influence the electro-mechanical aspects of muscle activation during MVICs. These results provide support for the absence of decreases in force output post-SMR, but further examination regarding the potential muscle mass influence of SMR on electro-mechanical muscle function remains warranted. LEVEL OF EVIDENCE: 2c.

Contribution of the Autonomic Nervous System to Recovery in Firefighters.

CONTEXT: Sudden cardiac deaths (SCDs) have accounted for nearly half of the line-of-duty deaths among US firefighters over the past 10 years. In 2018, 33% of all SCDs occurred after the end of a fire service call. Researchers have suggested that an imbalance in autonomic nervous system (ANS) regulation of heart rate postcall may interfere with recovery in firefighters. OBJECTIVE: To use heart-rate recovery (HRR) and heart-rate variability (HRV), 2 noninvasive markers of ANS function, to examine the ANS recovery profiles of firefighters. DESIGN: Cross-sectional study. SETTING: Firehouse and research laboratory. PATIENTS OR OTHER PARTICIPANTS: Thirty-seven male career active-duty firefighters (age = 39 ± 9 years, height = 178.8 ± 5.4 cm, mass = 87.9 ± 11.2 kg). MAIN OUTCOME MEASURE(S): Percentage of maximal HR (%MHR) and HRV (natural log of the square root of the mean sum of the squared differences [lnRMSSD]) were collected after both submaximal and maximal exercise protocols during a 10-minute seated recovery. The HRR profiles were examined by calculating the asymptote, amplitude, and decay parameters of the monoexponential HRR curve for each participant. RESULTS: Differences in HRR parameters after 10 minutes of seated recovery were identified after submaximal versus maximal exercise (P < .001). In addition, although ANS was more suppressed after maximal exercise, HRV indicated incomplete recovery, and regardless of the test, recovery %MHR and lnRMSSD values did not return to pretest %MHR and lnRMSSD values. CONCLUSIONS: Our results suggest that the ANS contributions to recovery in active-duty firefighters are exercise-intensity specific, and this is likely an important factor when establishing best-practice recovery guidelines.

A systematic review of penetrating extracranial vertebral artery injuries.

BACKGROUND: Penetrating vertebral artery injuries (VAIs) are rare. Because of their rarity, complex anatomy, and difficult surgical exposures, few surgeons and trauma centers have developed significant experience with their management. The objectives of this study were to review their incidence, clinical presentation, radiologic identification, management, complications, and outcomes and to provide a review of anatomic exposures and surgical techniques for their management. METHODS: A literature search on MEDLINE Complete-PubMed, Cochrane, Ovid, and Embase for the period of 1893 to 2018 was conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Our literature search yielded a total of 181 potentially eligible articles with 71 confirmed articles, consisting of 21 penetrating neck injury series, 13 VAI-specific series, and 37 case reports. Operative procedures and outcomes were recorded along with methods of angiographic imaging and operative management. All articles were reviewed by at least two independent authors, and data were analyzed collectively. RESULTS: There were a total of 462 patients with penetrating VAIs. The incidence of VAI in the civilian population was 3.1% vs 0.3% in the military population. More complete data were available from 13 collected VAI-specific series and 37 case reports for a total of 362 patients. Mechanism of injury data were available for 341 patients (94.2%). There were gunshot wounds (178 patients [49.2%]), stab wounds (131 [73.6%]), and miscellaneous mechanisms of injury (32 [8.8%]). Anatomic site of injury data were available for 177 (49%) patients: 92 (25.4%) left, 84 (23.2%) right, and 1 (0.3%) bilateral. Anatomic segment of injury data were available for 204 patients (56.4%): 28 (7.7%) V1, 125 (34.5%) V2, and 51 (14.1%) V3. Treatment data were available for 212 patients. Computed tomography angiography was the most common imaging modality (163 patients [77%]). Injuries were addressed by operative management (94 [44.3%]), angiography and angioembolization (72 [34%]), combined approaches (11 [5.2%]), and observation (58 [27.4%]). Stenting and repair were less frequently employed (10 [4.7%]). The incidence of aneurysms or pseudoaneurysms was 18.5% (67); the incidence of arteriovenous fistula was 16.9% (61). The calculated mortality in VAI-specific series was 15.1%; in the individual case report group, it was 10.5%. CONCLUSIONS: The majority of VAIs present without neurologic symptoms, although some may present with exsanguinating hemorrhage. Computed tomography angiography should be considered first line to establish diagnosis. Gunshot wounds account for most injuries. The most frequently injured segment is V2. Surgical ligation is the most common intervention, followed by angioembolization, both of which constitute important management approaches.

INTRA-RATER TEST-RETEST RELIABILITY AND RESPONSE STABILITY OF THE FUSIONETICS™ MOVEMENT EFFICIENCY TEST.

BACKGROUND: A new functional movement assessment, known as the Fusionetics- Movement Efficiency (ME) Test, has recently been introduced in the literature. Before the potential clinical utility of the ME Test can be examined, the reliability of this assessment must be established. PURPOSE: To examine the intra-rater test-retest reliability of the Fusionetics- ME Test. STUDY DESIGN: Cross-sectional. METHODS: ME Test data were collected among 23 (6 males, 17 females) university students (mean ± SD, age = 25.96 ± 3.16 yrs; height = 170.70 ± 9.96 cm; weight = 66.89 ± 12.67 kg) during sessions separated by 48 hours (Day 1, Day 2). All participants completed the seven sub-tests of the ME Test: 2-Leg Squat, 2-Leg Squat with Heel Lift, 1-Leg Squat, Push-Up, Shoulder Movements, Trunk Movements, and Cervical Movements. Overall ME Test scores and ME Test scores for each individual sub-test were calculated on a scale of 0 - 100 (worst - best) based on commonly observed movement compensations associated with each sub-test. RESULTS: Intraclass correlation coefficients (ICC3,1) statistics indicated that the intra-rater test-retest reliability of the Overall ME Test and individual sub-tests ranged from fair-to-excellent (ICC3,1 range = 0.55 - 0.84). Statistically significant differences in ME Test scores were identified between Day 1 and Day 2 among the 2-Leg Squat with Heel Lift (p = 0.015) and Cervical Movements (p = 0.005) sub-tests. In addition, a large range in the standard error of the measure (SEM) and minimal detectable change values (MDC90% & MDC95%) were identified within individual sub-tests of the ME Test (SEM range = 7.05 - 13.44; MDC90% range = 16.40 - 31.27; MDC95% range = 19.53 - 37.25), suggesting that the response stability varies among these individual sub-tests. Prevalence-adjusted bias-adjusted kappa statistics (κPABA) suggest that 55 of the 60 (92%) individual movement compensations hold moderate-to-almost perfect intra-rater test-retest reliability (κPABA range = 0.30 - 1.00). CONCLUSIONS: Excellent intra-rater test-retest reliability of the Overall ME Test score was identified, and thus, clinicians can reliably utilize the Fusionetics- ME Test to assess change in functional movement quality across time. However, caution should be taken if utilizing an individual sub-test to assess functional movement quality over time. LEVEL OF EVIDENCE: 2b.

Immunotherapy Plus Cryotherapy: Potential Augmented Abscopal Effect for Advanced Cancers.

Since the 1920s the gold standard for treating cancer has been surgery, which is typically preceded or followed with chemotherapy and/or radiation, a process that perhaps contributes to the destruction of a patient's immune defense system. Cryosurgery ablation of a solid tumor is mechanistically similar to a vaccination where hundreds of unique antigens from a heterogeneous population of tumor cells derived from the invading cancer are released. However, releasing tumor-derived self-antigens into circulation may not be sufficient enough to overcome the checkpoint escape mechanisms some cancers have evolved to avoid immune responses. The potentiated immune response caused by blocking tumor checkpoints designed to prevent programmed cell death may be the optimal treatment method for the immune system to recognize these new circulating cryoablated self-antigens. Preclinical and clinical evidence exists for the complementary roles for Cytotoxic T-lymphocyte-associated protein (CTLA-4) and PD-1 antagonists in regulating adaptive immunity, demonstrating that combination immunotherapy followed by cryosurgery provides a more targeted immune response to distant lesions, a phenomenon known as the abscopal effect. We propose that when the host's immune system has been "primed" with combined anti-CTLA-4 and anti-PD-1 adjuvants prior to cryosurgery, the preserved cryoablated tumor antigens will be presented and processed by the host's immune system resulting in a robust cytotoxic CD8+ T-cell response. Based on recent investigations and well-described biochemical mechanisms presented herein, a polyvalent autoinoculation of many tumor-specific antigens, derived from a heterogeneous population of tumor cancer cells, would present to an unhindered yet pre-sensitized immune system yielding a superior advantage in locating, recognizing, and destroying tumor cells throughout the body.

Neoadjuvant Therapy for Esophageal Adenocarcinoma in the Community Setting-Practice and Outcomes.

There has been an alarming rise in the incidence of esophageal adenocarcinoma which continues to have poor survival rates primarily due to lack of effective chemotherapy and presentation at advanced stages. Over a dozen chemotherapeutic agents are FDA approved for esophageal cancer (EC), and a two or three-drug combination is typically prescribed as first-line therapy for the majority of EC patients, administered either pre or post-operatively with esophageal resection. We have noticed significant variability in adjuvant and neoadjuvant regimens used in the community setting. The aim of this study was to review the various drug regimens used in the neoadjuvant setting for EC patients with adenocarcinoma undergoing resection at a single tertiary referral center in the Midwest. A total of 123 patients (stage II-III) underwent esophageal resection after neoadjuvant treatment at the center. Overall, 18 distinct drug regimens were used in 123 patients including two patients who received targeted therapy. Median survival post-surgery for this group was 11.2 months with no single regimen offering a survival advantage. These results reveal an unclear algorithm of how accepted regimens are prescribed in the community setting as well as a dire need for agents that are more effective. Additionally, it was noted that although proteomic markers have been found to predict drug response to 92% of the FDA-approved drugs in EC (12 of 13), according to pathology reports, molecular diagnostic testing was not used to direct treatment in this cohort. We therefore propose potential strategies to improve clinical outcomes including the use of a robust molecular oncology diagnostic panel and discuss the potential role for targeted chemotherapy and/or immunotherapy in the management of EC patients.

Single versus combined immunoregulatory approach using PD-1 and CTLA-4 modulators in controlling sepsis.

INTRODUCTION: Sepsis is a disease process characterized by an extreme inflammatory response followed by a period of severe immunosuppression. In recent years, there has been improved survival in the initial immune response during systemic inflammatory response syndrome, and compensatory anti-inflammatory response, yet is mostly unchanged with 18-30% mortality during the later stage of sepsis despite numerous Phase 3 clinical trials. Areas covered: This review article presents a critical evaluation of the most promising newer studies aimed at improving the immunosuppressive stage of sepsis. Administration of DHEA/AED/AET show promise in improving survival. Blockade of signaling pathways for PD-1/PD-L1/CTLA-4, and partial blockade of TREM-1 signaling, and modification to sTREM-1 and the JAK/STAT pathway are promising methods of restoring host immune response and improving survival. While there has been significant progress, currently no findings have been translated into effective clinical interventions. Expert commentary: Clinical success by immunomodulation with individual immune mediator is encouraging and should progress to evaluating combined methods of immunoregulation. Since most of the animal studies do not reproduce human sepsis, development of better animal models and moving toward human studies for intervention will lead to the most beneficial findings in translational science.

Changes in Health and Fitness in Firefighter Recruits: An Observational Cohort Study.

PURPOSE: To observe longitudinal changes in health and fitness among firefighter recruits. METHODS: Body composition, aerobic capacity, muscular power, muscular strength, and muscular endurance measures were longitudinally collected among 27 male firefighter recruits (mean ± SD, age = 29.9 ± 4.1 yr; height, 179.8 ± 4.6 cm; body mass, 87.2 ± 9.7 kg) at the beginning (W1) and end (W14) of their firefighter training academy, as well as at the end of their probationary period (W38). RESULTS: Repeated-measures multivariate analyses of variance (RM MANOVA) identified significant changes across time among measures of body composition (F10,17 = 30.390, Λ = 0.053, P < 0.001), aerobic capacity (F6,21 = 55.111, Λ = 0.060, P < 0.001), muscular power (F8,17 = 2.785, Λ = 0.433, P = 0.036), muscular strength (F6,20 = 34.908, Λ = 0.087, P < 0.001), and muscular endurance (F4,23 = 25.983, Λ = 0.181, P < 0.001). Follow-up post hoc analyses indicated that all measures, except muscular power, significantly improved from W1 to W14 (P < 0.05). However, significant decrements in many of these measures were also observed from W14 to W38 (P < 0.05). CONCLUSIONS: The results of the current study suggest that measures of health and fitness among firefighter recruits significantly improved throughout the firefighter training academy (W1 to W14). However, many of these positive physiological adaptations are lost before these recruits finish their probationary period as active-duty firefighters (W14 to W38). These results highlight the importance of developing exercise programming that is designed for the active-duty firefighter cohort population to maintain the beneficial adaptations in health and fitness previously created during the firefighter training academy.

Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head.

BACKGROUND: Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with greater mortality and morbidity than other penetrating traumatic brain injuries (TBIs). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head nonoperatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI. METHODS: PubMed was searched for query terms, and PRISMA guidelines were used. Studies were selected by relevance and inclusion of data regarding etiology, diagnosis, and management of bihemispheric TBI. Case reports, studies not in English, and records lacking information on mechanism or bihemispheric injuries were excluded. RESULTS: Thirteen studies were included and most contained level IV evidence. The mean mortality rate of all head GSWs was 62% in adults and 32% in children. Bihemispheric GSWs had greater mortality rates of 82% in adults and 60% in children. There was a larger proportion of self-inflicted injury in studies with greater rates of bihemispheric injuries. CONCLUSIONS: Bihemispheric injuries have greater mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. Although bihemispheric injuries historically have been considered nonsalvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population.

Resting Heart Rate Variability Among Professional Baseball Starting Pitchers.

Cornell, DJ, Paxson, JL, Caplinger, RA, Seligman, JR, Davis, NA, and Ebersole, KT. Resting heart rate variability among professional baseball starting pitchers. J Strength Cond Res 31(3): 575-581, 2017-The purpose of this study was to examine the changes in resting heart rate variability (HRV) across a 5-day pitching rotation schedule among professional baseball starting pitchers. The HRV data were collected daily among 8 Single-A level professional baseball starting pitchers (mean ± SD, age = 21.9 ± 1.3 years; height = 185.4 ± 3.6 cm; weight = 85.2 ± 7.5 kg) throughout the entire baseball season with the participant quietly lying supine for 10 minutes. The HRV was quantified by calculating the natural log of the square root of the mean sum of the squared differences (lnRMSSD) during the middle 5 minutes of each R-R series data file. A split-plot repeated-measures analysis of variance was used to examine the influence of pitching rotation day on resting lnRMSSD. A statistically significant main effect of rotation day was identified (F4,706 = 3.139, p = 0.029). Follow-up pairwise analyses indicated that resting lnRMSSD on day 2 was significantly (p ≤ 0.05) lower than all other rotation days. In addition, a statistically significant main effect of pitcher was also identified (F7,706 = 83.388, p < 0.001). These results suggest that professional baseball starting pitchers display altered autonomic nervous system function 1 day after completing a normally scheduled start, as day 2 resting HRV was significantly lower than all other rotation days. In addition, the season average resting lnRMSSD varied among participants, implying that single-subject analysis of resting measures of HRV may be more appropriate when monitoring cumulative workload among this cohort population of athletes.