Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report.

INTRODUCTION: Abdominal pain and flank pain cause a significant proportion of emergency department (ED) visits. The diagnosis often remains unclear and is frequently associated with repeat visits to the ED for the same complaint. A rare cause of left upper abdominal and flank pain is compression of the left renal vein between the aorta and the superior mesenteric artery known as nutcracker syndrome. Diagnostic findings on ultrasound include increased left renal vein diameter proximal and peak blood flow velocity increase distal to the superior mesenteric artery. We describe such a patient presenting to an ED repeatedly with severe pain mimicking renal colic before the final diagnosis and intervention occurred. CASE REPORT: A 16-year-old female, long-distance runner presented four times complaining of intractable left upper quadrant abdominal pain radiating to the left flank after exercise. On each visit urinalysis revealed proteinuria and hematuria, and on two visits abdominal computed tomography revealed no kidney stone or dilatation of the collecting system. Ultimately, she was referred to vascular surgery where Doppler ultrasonography was used to diagnose left renal vein compression. Transposition of the left renal vein improved Doppler diameter and flow measurements and eliminated symptoms. CONCLUSION: Emergency physicians must maintain a large list of possible diagnoses during the evaluation of abdominal and flank pain with a repetitive and uncertain etiology. Nutcracker syndrome may mimic other causes of abdominal and flank pain such as renal colic and requires appropriate referral.

A systematic review of the effect of reproductive intention screening in primary care settings on reproductive health outcomes.

Purpose: No recommendations exist for routine reproductive intention screening in primary care. The objective of this systematic review is to assess the effect of reproductive intention screening in primary care on reproductive health outcomes (PROSPERO CRD42015019726). Methods: We performed a systematic search in Ovid Medline, PubMed, CINAHL, Embase, CDR/DARE databases, Web of Science, ISRCTN registry, Clinicaltrials.gov and Cochrane Library. Studies published in English between 2000 and 2017 and whose population was patients of reproductive age (15-49) were included. Studies without a comparison group were excluded. Two independent reviewers assessed eligibility, study quality and abstracted data. Results: Of 24 780 titles and/or abstracts reviewed, nine studies met inclusion criteria: four randomized controlled trials (RCTs) and five observational studies. Two RCTs and one quasi-experimental cohort study showed a statistically significant increase in knowledge related to healthier pregnancy, such as the benefits of folic acid supplementation, and increased risk profiles for those with chronic conditions. Among studies measuring contraceptive use, only one cohort study showed any increase while the RCT and retrospective cohort did not show a statistically significant effect. Neither of the two RCTs that assessed the provision of contraception by primary care providers for those not desiring pregnancy found increased access to contraception, although one found increased documentation of contraception in electronic medical records. Acceptability of reproductive intention screening was measured in seven studies, and participant satisfaction was high in all seven studies. Conclusions: More research is needed to determine whether routine inclusion of reproductive intention screening in primary care is warranted.

The effects of asking a fertility intention question in primary care settings: a systematic review protocol.

BACKGROUND: Planning for pregnancy has been associated with reduced unwanted pregnancies and improved pregnancy outcomes. Despite the benefits of planned pregnancy, there are no guideline recommendations on routine counseling regarding pregnancy intention in primary care settings. The objective of the systematic review is to determine the effectiveness of incorporating questions of pregnancy intention into primary care. METHODS: A systematic search of the literature will be conducted for any studies comparing questions of pregnancy intention in primary care settings with no intervention or a control intervention. Types of studies will include randomized controlled trials, non-randomized trials, and observation studies. Participants will include patients of reproductive age presenting to primary health care settings. Interventions will include any assessment of fertility intention and follow-up care compared with a control group or no intervention. Outcomes will include quantitative data with rates for contraceptive uptake, and any pregnancy related outcome. Databases (Ovid MEDLINE; Pubmed; CINAHL; EMBASE; CDR/DARE databases; Web of Science; ISRCTN registry; Clinicaltrials.gov; Cochrane Library) will be searched from the year 2000 to current. Screening of identified articles and data extraction will be conducted in duplicate by two independent reviewers. Methodological quality will be assessed using the Jadad scale. Methodological quality of observational and non-randomized trials will be assessed using the Newcastle-Ottawa scale. Discrepancies will be resolved by consensus or by consulting a third author. Meta-analyses will be performed if appropriate. DISCUSSION: Determining the effect of including questions of pregnancy intention into primary care can provide evidence for the development of clinical practice guidelines and inform primary care providers if this simple and low-cost intervention should be routinely employed. This review will also identify any gaps in the current literature on this topic and provide direction for future research in this area of study. Systematic Review Registration: PROSPERO CRD42015019726.

Eculizumab is a safe and effective treatment in pediatric patients with atypical hemolytic uremic syndrome.

Atypical hemolytic uremic syndrome (aHUS) is caused by alternative complement pathway dysregulation, leading to systemic thrombotic microangiopathy (TMA) and severe end-organ damage. Based on 2 prospective studies in mostly adults and retrospective data in children, eculizumab, a terminal complement inhibitor, is approved for aHUS treatment. Here we prospectively evaluated efficacy and safety of weight-based dosing of eculizumab in eligible pediatric patients with aHUS in an open-label phase II study. The primary end point was complete TMA response by 26 weeks. Twenty-two patients (aged 5 months-17 years) were treated; 16 were newly diagnosed, 12 had no prior plasma exchange/infusion during current TMA symptomatology, 11 received baseline dialysis and 2 had prior renal transplants. By week 26, 14 achieved a complete TMA response, 18 achieved hematologic normalization, and 16 had 25% or better improvement in serum creatinine. Plasma exchange/infusion was discontinued in all, and 9 of the 11 patients who required dialysis at baseline discontinued, whereas none initiated new dialysis. Eculizumab was well tolerated; no deaths or meningococcal infections occurred. Bone marrow failure, wrist fracture, and acute respiratory failure were reported as unrelated severe adverse events. Thus, our findings establish the efficacy and safety of eculizumab for pediatric patients with aHUS and are consistent with proposed immediate eculizumab initiation following diagnosis in children.

Patient perspectives of a young adult renal clinic: a mixed-methods evaluation.

AIM: We aimed to evaluate a young adult renal clinic (YAC) intervention that included a multidisciplinary clinic and social programme. METHODS: Semi-structured interviews and surveys (Kidney Disease Quality of Life (KDQOL)-36, Time Trade-Off (TTO) and Morisky 8-Item Medication Adherence Questionnaire) were conducted with 15 patients aged 18 to 26 years with chronic kidney disease Stages 1-5, 5D and 5T before and after they attended two YACs. RESULTS: We identified six themes: gaining confidence (encouraging self-expression, exchanging experiential knowledge, helping others, positive reflection and optimism); social connectedness; appreciating a welcoming environment; competing priorities; avoiding the sick identity; and relational boundaries. There were no significant improvements in the overall utility-based quality of life (QOL) scores (TTO: 0.72 (standard deviation (SD): 0.34) and 0.76 (SD: 0.30), P = 0.70) and the proportion of participants achieving medium to high medication adherence (n = 7, 46.7% vs n = 8, 53.3%, P = 0.72). Similar findings were observed for KDQOL domains. CONCLUSION: The impact of the YAC on QOL and adherence is unclear. However, patients can develop coping mechanisms and derive psychosocial benefits such as optimism. Some are conscious about respecting the privacy of others or want to disassociate themselves from the 'disease'. Strategies to strengthen rapport, confidence and sense of 'normality' and to destigmatize the illness may enhance the effectiveness of a YAC.

Repeated Bout Effect in Muscle-Specific Exercise Variations.

A single bout of unaccustomed exercise confers protective effect against muscle damage from a subsequent bout of similar activity, that is, repeated bout effect (RBE). It remains unknown whether varying muscle-specific exercise between sessions alters the magnitude of the RBE. This study examined the effects of muscle-specific exercise variation between consecutive sessions on the RBE. Twenty untrained males (21 ± 2 years) were assigned to one of 2 groups (n = 10 per group): (a) 2 sessions of incline curls, Fixed Exercise or (b) 1 session of incline curls followed by 1 session of preacher curls, Varied Exercise, with 7 days between sessions. Subjects performed 5 sets of 6 repetitions at ∼50% of maximal isometric elbow flexor strength during each session. Changes in maximal voluntary isometric and isokinetic torque, range of motion, muscle soreness, and serum creatine kinase were measured before, immediately after, and 24, 48, 72, and 96 hours after each exercise session, and the changes were compared between bouts and between groups. There were significant time effects (p < 0.05) for isometric maximal voluntary contraction, concentric maximal voluntary contraction, range of motion, and muscle soreness during sessions 1 and 2 with no between-group differences. Both groups demonstrated a significantly faster recovery of range of motion and soreness to baseline levels after session 2 compared with session 1. Overall, our findings suggest that incline curls conferred a protective effect during subsequent preacher curls in a similar way to repeating incline curls; therefore, the RBE was not exercise specific.

Recalcitrant hypocalcaemia in autoimmune enteropathy.

Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy syndrome is a monogenic disorder associated with autoimmune destruction of both endocrine and nonendocrine tissues. The classic triad includes candidiasis, hypoparathyroidism, and Addison disease. Up to 25% of patients with autoimmune polyendocrinopathy candidiasis ectodermal dystrophy syndrome also have gastrointestinal manifestations, which can have an impact on the management of other aspects of the disease. The management of the case discussed was challenging because of the complex interplay between the manifestations and treatment of his hypoparathyroidism, Addison disease, and autoimmune enteropathy. Attempts at management of hypocalcemia were largely unsuccessful until the introduction of immunosuppressive therapy for autoimmune enteropathy. This case supports early consideration of immunosuppression in this condition.

Bone formation is suppressed with multi-stressor military training.

PURPOSE: To determine the effects of US Army Ranger Training, an 8-week, physically demanding program (energy expenditure of 2,500-4,500 kcal/day) with energy restriction (deficit of 1,000-4,000 kcal/day) and sleep deprivation (<4 h sleep/night) on bone metabolism. METHODS: Blood was collected from 22 men (age 24 ± 4 years) before and after training. Follow-up measurements were made in a subset of 8 subjects between 2 and 6 weeks after training. Serum was analyzed for bone formation biomarkers [bone alkaline phosphatase (BAP) and osteocalcin (OCN)], bone resorption biomarkers [C-telopeptide cross-links of type I collagen (CTX) and tartrate-resistant acid phosphatase (TRAP5b)], calcium, parathyroid hormone (PTH), and vitamin D 25(OH)D increased significantly by 37.3 ± 45.2 % with training [corrected]. A repeated-measures ANOVA with time as the only factor was used to analyze data on the subset of 8 subjects who completed follow-up data collection. RESULTS: BAP and OCN significantly decreased by 22.8 ± 15.5% (pre 41.9 ± 10.1; post 31.7 ± 7.8 ng/ml) and 21.0 ± 23.3% (pre 15.0 ± 3.5; post 11.3 ± 2.1 ng/ml), respectively, with training, suggesting suppressed bone formation. OCN returned to baseline, while BAP remained suppressed 2-6 weeks post-training. TRAP5b significantly increased by 57.5 ± 51.6% (pre 3.0 ± 0.9; post 4.6 ± 1.4 ng/ml) from pre- to post-training, suggesting increased bone resorption, and returned to baseline 2-6 weeks post-training. PTH Increased significantly by 37.3 ± 45.2% with training. No changes in CTX, calcium, or PTH were detected. CONCLUSIONS: These data indicate that multi-stressor military training results in increased bone resorption and suppressed bone formation, with recovery of bone metabolism 2-6 weeks after completion of training.

ß-Hydroxy-ß-methylbutyrate improves bone properties and attenuates the depression of protein synthesis during a simulated sustained operation.

OBJECTIVES: Soldiers lose muscle and bone density during sustained operations. We investigated the impact of ß-hydroxy-ß-methylbutyrate (HMB) on bone properties, muscle mass, and markers of skeletal muscle regeneration under simulated military sustained operations. METHODS: Male mice were divided into four groups (10/group): (1) ALT = ad libitum + trained (1h/d for 3 d/wk); (2) ALTH = ALT + HMB (0.5 g/kg BW/d); (3) C = caloric restricted (-30%) + trained (6h/d, 6d/wk); and (4) CH = C + HMB. Assessments included bone mineral density/content by dual-energy X-ray absorptiometry, muscle wet weight (quadriceps) and expression of selected genes regulating muscle mass and protein turnover. Analysis of variances were used with significance set at p < 0.05. RESULTS: Bone mineral content increased in the ALT group (+16%) and decreased in the C group (-32%). Quadriceps muscle mass was lower in C (-27%) and CH (-19%) compared to ALT and ALTH. Myogenin mRNA expression was higher in C than ALT, ALTH and CH. Protein kinase B (Akt) mRNA expression was higher in both C and CH than ALT and ALTH. Mammalian target of rapamycin expression was higher in CH than ALT and ALTH. Muscle RING-finger protein-1 expression was higher in both C and CH than ALT and ALTH. CONCLUSION: HMB intake improved bone properties and attenuated the depression of protein synthesis during a simulated sustained military operation.

Validation of the facial photographic in fetal alcohol spectrum disorder screening and diagnosis.

OBJECTIVE: A prospective study to validate the computer-assisted method of measuring palpebral fissure length and philtrum smoothness using digital patient photographs. These are key diagnostic facial features of Fetal Alcohol Syndrome. PARTICIPANTS: Motherisk Program (including Breaking the Cycle), Hospital for Sick Children, Toronto - a clinical, research and teaching program dedicated to antenatal drug, chemical, and disease risk counseling. 40 children referred for FASD assessment, 21 under 4 years old, 19 were 4 years or older. METHODS/ MATERIALS: Facial measurements were obtained directly from the patient by physicians and compared to those obtained by computer software measurement of photographs of the same patient. OUTCOME MEASURES: Palpebral fissure length and philtrum smoothness. RESULTS: The photographic measurements showed shorter palpebral fissure length than the direct measurements when analyzing all children (25.4±2.3 vs .23.2±2.4mm; p<0.0001), and children under four (n=21, 24.7±2.4 vs. 21.6±1.6mm; p<0.0001). The difference for older children (n=19) did not reach statistical significance. The computer found four false positive cases and no false negative cases of clinically short palpebral fissure (sensitivity=100%, specificity=64%). Direct measurement scores for philtrum smoothness were different from the computer's measurements using the frontal view (p=0.0012) but not using the ¾ view. CONCLUSION: The method of computer-assisted measurement tends to underestimate the true length and, hence, over- diagnose short palpebral fissure, especially in children under four years old. This method may serve as a useful fetal alcohol syndrome screening tool.

High protein diets do not attenuate decrements in testosterone and IGF-I during energy deficit.

OBJECTIVE: Energy deficit (ED) diminishes fat-free mass (FFM) with concomitant reductions in anabolic hormone secretion. A modest increase in protein to recommended dietary allowance (RDA) levels during ED minimally attenuates decrements in insulin-like growth factor-I (IGF-I). The impact of dietary protein above the RDA on circulating anabolic hormones and their relationships with FFM in response to ED are not well described. MATERIALS/METHODS: Thirty-three adults were assigned diets providing protein at 0.8 (RDA), 1.6 (2×-RDA), and 2.4 (3×-RDA) g/kg/d for 31days. Testosterone, sex-hormone binding globulin (SHBG) and IGF-I system components were assessed after a 10-day period of weight-maintenance (WM) and after a 21-day period of ED (40%) achieved by an increase in energy expenditure and decreased energy intake. Associations between the change in FFM and anabolic hormone levels were determined. RESULTS: As compared to WM and regardless of dietary protein intake, total and free testosterone, total IGF-I, and acid-labile subunit decreased (P<0.05), whereas SHBG and IGF binding proteins-1, -2, and -3 increased (P<0.05) during ED. There were no energy-by-protein interactions on any hormones or IGF-I system components measured. Changes in FFM in response to ED were negatively associated with acid-labile subunit (ALS) (r=-0.62, P<0.05) in 2×-RDA; however, no other relationships were observed. CONCLUSION: Consuming a high protein diet does not impact the androgenic and IGF-I system response to ED. These data suggest that the protective effects of high protein diets on FFM during ED are likely not influenced by anabolic hormone concentrations.

Recovery of endocrine and inflammatory mediators following an extended energy deficit.

CONTEXT: Due to current operational requirements, elite soldiers deploy quickly after completing arduous training courses. Therefore, it is imperative that endocrine and inflammatory mediators have fully recovered. OBJECTIVE: Our objective was to determine whether a short-term (2-6 wk) recovery period was sufficient to restore endocrine and inflammatory homeostasis after sustained energy deficit. DESIGN: Before and immediately after the course, serum concentrations of inflammatory and endocrine markers were taken along with anthropometric measures prior to and immediately after the Army Ranger course. In addition, nine soldiers were assessed between 2 and 6 weeks after the course. SETTING: This research occurred in a field setting during an intensive 8-week military training course characterized by high-energy expenditure, energy restriction, and sleep deprivation (U.S. Army Ranger School). PARTICIPANTS: Twenty-three male soldiers (23.0 ± 2.8 y; 177.6 ± 7.9 cm; 81.0 ± 9.6 kg, 16.8 ± 3.9% body fat) participated in this study. INTERVENTIONS: There were no interventions used in this research. OUTCOME MEASURES AND RESULTS: Significant changes occurred in circulating total testosterone (-70%), brain-derived neurotrophic factor (-33%), total IGF-1 (-38.7%), free IGF-1 (-41%), IGF binding protein (IGFBP-6; -23.4%), sex-hormone binding globulin (+46%), thyroid stimulating hormone (+85%), IGFBP-1 (+534.4%), IGFBP-2 (+98.3%), IGFBP-3 (+14.7%), IL-4 (+135%), IL-6 (+217%), and IL-8 (+101%). Significant changes in body mass (-8%), bicep (-14%), forearm (-5%), thigh (-7%), and calf (-2%) circumferences, sum of skinfolds (-52%), and percentage body fat (-54%). All anthropometric, inflammatory, and hormonal values, except T3, were restored to baseline levels within 2-6 weeks after the course. CONCLUSIONS: Endocrine markers and anthropometric measures were degraded, and inflammatory mediators increased after an extended energy deficit. A short-term recovery of 2-6 weeks was sufficient to restore these mediators.

HMB attenuates muscle loss during sustained energy deficit induced by calorie restriction and endurance exercise.

OBJECTIVE: To investigate the efficacy and underlying mechanisms of ß-hydroxy-ß-methylbutyrate (HMB) on body composition, muscle mass and physical performance under catabolic versus normal training conditions. MATERIALS/METHODS: Mice were divided into four groups (n=10/group): (1) ALT=ad libitum+trained (1 h/d for 3 d/wk); (2) ALTH=ALT+HMB (0.5 g/kg BW/d); (3) C=calorie restricted (-30%)+trained (6 h/d, 6 d/wk); and (4) CH=C+HMB. Repeated in vivo assessments included body composition, grip strength and sensorimotor coordination before and after the experimental protocol, while in vitro analyses included muscle wet weights, expression of selected genes and proteins regulating muscle mass, and myofiber cross-sectional area. ANOVAs were used with significance set at p<0.05. RESULTS: ALTH had greater lean mass than ALT and sensorimotor function increased in ALTH, but decreased in ALT under normal training conditions. Grip strength decreased only in C, but was maintained in CH. Gastrocnemius mass and myofiber CSA were greater in CH than C following catabolic conditions. Gastrocnemius atrogin-1 mRNA expression was elevated in C but not in CH compared to all other groups whereas atrogin-1 protein levels showed no significant changes. CONCLUSION: HMB improves body composition and sensorimotor function during normal training and attenuates muscle mass and strength loss during catabolic conditions.

Quality of life of young adults and adolescents with chronic kidney disease.

OBJECTIVE: To elicit utility-based quality of life (QOL) in adolescents and young adults with chronic kidney disease (CKD). STUDY DESIGN: A cross-sectional study was conducted among patients aged 12-25 years with CKD stage 3-5 and 5D from 6 centers in Australia. QOL was measured using a visual analogue scale, and 3 utility-based QOL measures: Health Utilities Index Mark 2 and 3 (HUI2/3), Kidney Disease Quality of Life, incorporating the short form (SF)-12 transformed to SF-6D, and time trade-off (TTO). Multiple linear regression was used to define predictors for TTO QOL weights, SF-6D, and visual analogue scale scores. RESULTS: On a utility scale, with extremes of 0 (death) to 1 (full health), the 27 participants had a mean TTO QOL weight of 0.59 (SD = 0.40), HUI2 of 0.73 (SD = 0.28), HUI3 of 0.74 (SD = 0.26), and SF-6D of 0.70 (SD = 0.14). QOL weights were consistently low across the 4 utility-based instruments with widest variability in TTO responses. Mean QOL weights were higher among predialysis participants. The HUI2 indicated variability in the domain of emotion. From the Kidney Disease Quality of Life measures, decrements were observed in all QOL domains though dialysis patients reported a significantly higher burden attributed to kidney disease. CONCLUSIONS: Adolescent and young adults with CKD report low QOL values. Their utility-based QOL scores imply they are willing to trade considerable life expectancy for perfect health. Holistic care to improve QOL and minimize disease burden are imperative for optimizing health outcomes in young people with CKD, particularly those on dialysis.

Physiological Employment Standards III: physiological challenges and consequences encountered during international military deployments.

Modern international military deployments in austere environments (i.e., Iraq and Afghanistan) place considerable physiological demands on soldiers. Significant physiological challenges exist: maintenance of physical fitness and body composition, rigors of external load carriage, environmental extremes (heat, cold, and altitude), medical illnesses, musculoskeletal injuries, traumatic brain injuries, post-traumatic stress disorder, and environmental exposure hazards (i.e., burn pits, vehicle exhaust, etc.). To date there is very little published research and no comprehensive reviews on the physiological effects of deployments. The purpose of this paper is to overview what is currently known from the literature related mainly to current military conflicts with regard to the challenges and consequences from deployments. Summary findings include: (1) aerobic capacity declines while muscle strength, power and muscular endurance appear to be maintained, (2) load carriage continues to tax the physical capacities of the Soldier, (3) musculoskeletal injuries comprise the highest proportion of all injury categories, (4) environmental insults occur from both terrestrial extremes and pollutant exposure, and (5) post-deployment concerns linger for traumatic brain injury and post-traumatic stress disorder. A full understanding of these responses will assist in identifying the most effective risk mitigation strategies to ensure deployment readiness and to assist in establishment of military employment standards.

Experiences and perspectives of adolescents and young adults with advanced CKD.

BACKGROUND: Young people with advanced chronic kidney disease experience delayed growth and poor psychosocial outcomes. This study aims to elicit the experiences and perspectives of young people waiting for a kidney transplant. METHODS: We conducted semistructured interviews with people aged 12-24 years from 6 Australian renal units. Participants also were asked to complete a journal. Interview transcripts and journal entries were analyzed thematically. RESULTS: 27 individuals participated in the study. 5 major themes were identified: inferiority (impaired body image, failing expectations, sick identity, and being a burden), insecurity (contending with prognostic uncertainty, vulnerability, and doubtful future), injustice (deprived of freedom, victimhood, and lost opportunity), resilience (autonomy and empowerment and maturity), and adjustment mentality (self-blame, reserved optimism, focusing on normality, and self-efficacy). CONCLUSIONS: Young dialysis- and non-dialysis-dependent patients with chronic kidney disease have an impaired sense of self-worth, perceive a precarious future, and feel limited in their physical and psychosocial capacities to have the same potential and opportunity as their healthy peers. Strategies to increase patient autonomy and self-efficacy in treatment management and to manage the emotional burdens of future uncertainties and lifestyle disruptions are needed to protect and promote the health and well-being of young people waiting for a kidney transplant.

Effects of acute caloric restriction compared to caloric balance on the temporal response of the IGF-I system.

OBJECTIVE: Insulin-like growth factor-I (IGF-I) is a key regulator of metabolism during altered energy states. The IGF-I system components respond to prolonged caloric restriction but it is not clear if this system responds similarly to acute caloric restriction. The purpose of this study was to characterize the IGF-I system response to acute caloric restriction with a secondary purpose of determining if two isocaloric diets with different ratios of carbohydrate to fat alter the IGF-I system under conditions of caloric balance. MATERIALS/METHODS: A double-blind, placebo-controlled crossover design was used in which 27 subjects underwent three, 48-h experimental treatments: 1) caloric restriction 2) carbohydrate and 3) carbohydrate/fat. Blood was sampled periodically (6 time points total) for IGF-I (total and free), IGFBPs1-4, insulin and glucose. ANOVAs were used with significance set at P<0.05. RESULTS: Total IGF-I decreased 7% during CR (P=0.051) and remained stable during CHO and CHO/F. Free IGF-I decreased 43% during CR (P<0.05) and remained stable during CHO and CHO/F. IGFBP-1 increased by 445% during CR (P<0.05) compared to CHO and CHO/F with no changes for IGFBP-2, IGFBP-3 and IGFBP-4. There was no change in glucose or insulin during CR over the course of the study. Insulin and glucose increased (P<0.05) after a meal in both the CHO and CHO/F groups with no difference between these two groups. CONCLUSION: Our findings indicate that free IGF-I decreases and IGFBP-1 increases during caloric restriction, but they are not altered with diets differing in carbohydrate and fat content. Changes in free IGF-I and IGFBP-1 are sensitive to caloric restriction, and their measurement may be valuable in monitoring the physiological response to refeeding in those consuming suboptimal calories.

Fabrication of a porous fiber cladding material using microsphere templating for improved response time with fiber optic sensor arrays.

A highly porous optical-fiber cladding was developed for evanescent-wave fiber sensors, which contains sensor molecules, maintains guiding conditions in the optical fiber, and is suitable for sensing in aqueous environments. To make the cladding material (a poly(ethylene) glycol diacrylate (PEGDA) polymer) highly porous, a microsphere templating strategy was employed. The resulting pore network increases transport of the target analyte to the sensor molecules located in the cladding, which improves the sensor response time. This was demonstrated using fluorescein-based pH sensor molecules, which were covalently attached to the cladding material. Scanning electron microscopy was used to examine the structure of the templated polymer and the large network of interconnected pores. Fluorescence measurements showed a tenfold improvement in the response time for the templated polymer and a reliable pH response over a pH range of five to nine with an estimated accuracy of 0.08 pH units.

Beta-hydroxy-beta-methyl-butyrate blunts negative age-related changes in body composition, functionality and myofiber dimensions in rats.

PURPOSE: To determine the effects of 16 wk. of beta-hydroxy-beta-methylbutyrate (HMB) administration on age-related changes in functionality and diffusion tensor imaging (DTI) determined myofiber dimensions. METHODS: Twelve young (44 wk.), 6 middle-aged (60 wk.), 10 old (86 wk.), and 5 very old (102 wk.) male Fisher-344 rat's body composition and grip strength were assessed at baseline. Following, 6 young, 6 middle-aged, 5 old and 5 very old rats were sacrificed for baseline myofiber dimensions and gene transcript factor expression in the soleus (SOL) and gastrocnemius (GAS). The remaining 6 young and 5 old rats were given HMB for 16 wk. and then sacrificed. RESULTS: Fat mass increased in the middle-aged control condition (+49%) but not the middle-aged HMB condition. In addition, fat mass declined (-56%) in the old HMB condition but not the old control condition. Normalized strength declined and maintained respectively in the control and HMB conditions from 44 to 60 wk. and increased (+23%) (p < 0.05) from 86 to 102 wk. in only the HMB condition. Declines occurred in myofiber size in all muscles from 44 to 102 wk. in the control condition(-10 to -15%), but not HMB condition. Atrogin-1 mRNA expression in the SOL and GAS muscles was greater in the 102-wk control condition than all other conditions: SOL (+45%) and GAS (+100%). This elevation was blunted by HMB in the 102 wk. old SOL. There was a condition effect in the SOL for myogenin, which significantly increased (+40%) only in the 102-wk. HMB group relative to the 44-wk. group. CONCLUSIONS: HMB may blunt age-related losses of strength and myofiber dimensions, possibly through attenuating the rise in protein breakdown.