Sex differences in specialized pro-resolving lipid mediators and their receptors in abdominal aortic aneurysms.

Objective: In this study, we tested the hypothesis that endogenous expression of specialized pro-resolving lipid mediators (SPMs) that facilitate the resolution of inflammation, specifically Resolvin D1and -D2, as well as Maresin1 (MaR1), can impact abdominal aortic aneurysm (AAA) formation and progression in a sex-specific manner. Methods: SPM expression was quantified in aortic tissue from human AAA samples and from a murine in vivo AAA model via liquid chromatography-tandem mass spectrometry. mRNA expression for SPM receptors FPR2, LGR6, and GPR18 were quantified by real-time polymerase chain reaction. A Student t test with nonparametric Mann-Whitney or Wilcoxon test was used for pair-wise comparisons of groups. One-way analysis of variance after post hoc Tukey test was used to determine the differences among multiple comparative groups. Results: Human aortic tissue analysis revealed a significant decrease in RvD1 levels in male AAAs compared with controls, whereas FPR2 and LGR6 receptor expressions were downregulated in male AAAs compared with male controls. In vivo studies of elastase-treated mice showed higher levels of RvD2 and MaR1 as well as the SPM precursors, omega-3 fatty acids DHA and EPA, in aortic tissue from males compared with females. FPR2 expression was increased in elastase-treated females compared with males. Conclusions: Our findings demonstrate that specific differences in SPMs and their associated G-protein coupled receptors exist between sexes. These results indicate the relevance of SPM-mediated signaling pathways in sex differences impacting the pathogenesis of AAAs.

Resolution of inflammation via RvD1/FPR2 signaling mitigates Nox2 activation and ferroptosis of macrophages in experimental abdominal aortic aneurysms.

Abdominal aortic aneurysm (AAA) formation is characterized by inflammation, leukocyte infiltration, and vascular remodeling. Resolvin D1 (RvD1) is derived from ω-3 polyunsaturated fatty acids and is involved in the resolution phase of chronic inflammatory diseases. The aim of this study was to decipher the protective role of RvD1 via formyl peptide receptor 2 (FPR2) receptor signaling in attenuating abdominal aortic aneurysms (AAA). The elastase-treatment model of AAA in C57BL/6 (WT) mice and human AAA tissue was used to confirm our hypotheses. Elastase-treated FPR2-/- mice had a significant increase in aortic diameter, proinflammatory cytokine production, immune cell infiltration (macrophages and neutrophils), elastic fiber disruption, and decrease in smooth muscle cell α-actin expression compared to elastase-treated WT mice. RvD1 treatment attenuated AAA formation, aortic inflammation, and vascular remodeling in WT mice, but not in FPR2-/- mice. Importantly, human AAA tissue demonstrated significantly decreased FPR2 mRNA expression compared to non-aneurysm human aortas. Mechanistically, RvD1/FPR2 signaling mitigated p47phox phosphorylation and prevented hallmarks of ferroptosis, such as lipid peroxidation and Nrf2 translocation, thereby attenuating HMGB1 secretion. Collectively, this study demonstrates RvD1-mediated immunomodulation of FPR2 signaling on macrophages to mitigate ferroptosis and HMGB1 release, leading to resolution of aortic inflammation and remodeling during AAA pathogenesis.

Efficacy of Alternative Forms of Creatine Supplementation on Improving Performance and Body Composition in Healthy Subjects: A Systematic Review.

ABSTRACT: Fazio, C, Elder, CL, and Harris, MM. Efficacy of alternative forms of creatine supplementation on improving performance and body composition in healthy subjects: a systematic review. J Strength Cond Res 36(9): 2663-2670, 2022-Novel forms of creatine have appeared in the marketplace with substantial claims of improved efficacy compared to creatine monohydrate (CrM). The purpose of this study was to conduct a systematic review on alternative forms of creatine to determine (a) whether they are effective ergogenic aids and (b) whether they outperform CrM. A separate comparison was conducted to determine average cost of various forms of creatine. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Medline, and Google Scholar were systematically reviewed according to PRISMA guidelines. The design of the review was set to answer the PICOS model (subjects, interventions, comparators, outcomes, and study design). Seventeen randomized placebo controlled clinical trials examining exercise performance outcomes and body composition were included in the analysis. Magnesium-creatine chelate and creatine citrate, malate, ethyl ester, nitrate, and pyruvate were the only forms researched in the literature. Of these studies, only 3 studies compared the alternative creatine form to CrM, making it difficult to compare efficacy to CrM. There were no consistent findings of performance enhancement among alternative forms of creatine when compared to placebo. A review of the marketplace shows that CrM is the lowest cost form of creatine. Due to the paucity of studies on alternative forms of creatine as well as high prices on the market of these alternative forms, CrM remains as the most extensively studied form of creatine that shows efficacy, safety, and lowest cost to consumer.

Endothelial pannexin-1 channels modulate macrophage and smooth muscle cell activation in abdominal aortic aneurysm formation.

Pannexin-1 (Panx1) channels have been shown to regulate leukocyte trafficking and tissue inflammation but the mechanism of Panx1 in chronic vascular diseases like abdominal aortic aneurysms (AAA) is unknown. Here we demonstrate that Panx1 on endothelial cells, but not smooth muscle cells, orchestrate a cascade of signaling events to mediate vascular inflammation and remodeling. Mechanistically, Panx1 on endothelial cells acts as a conduit for ATP release that stimulates macrophage activation via P2X7 receptors and mitochondrial DNA release to increase IL-1ß and HMGB1 secretion. Secondly, Panx1 signaling regulates smooth muscle cell-dependent intracellular Ca2+ release and vascular remodeling via P2Y2 receptors. Panx1 blockade using probenecid markedly inhibits leukocyte transmigration, aortic inflammation and remodeling to mitigate AAA formation. Panx1 expression is upregulated in human AAAs and retrospective clinical data demonstrated reduced mortality in aortic aneurysm patients treated with Panx1 inhibitors. Collectively, these data identify Panx1 signaling as a contributory mechanism of AAA formation.

Maresin 1 activates LGR6 signaling to inhibit smooth muscle cell activation and attenuate murine abdominal aortic aneurysm formation.

The specialized pro-resolving lipid mediator maresin 1 (MaR1) is involved in the resolution phase of tissue inflammation. It was hypothesized that exogenous administration of MaR1 would attenuate abdominal aortic aneurysm (AAA) growth in a cytokine-dependent manner via LGR6 receptor signaling and macrophage-dependent efferocytosis of smooth muscle cells (SMCs). AAAs were induced in C57BL/6 wild-type (WT) mice and smooth muscle cell specific TGF-ß2 receptor knockout (SMC-TGFßr2-/- ) mice using a topical elastase AAA model. MaR1 treatment significantly attenuated AAA growth as well as increased aortic SMC α-actin and TGF-ß2 expressions in WT mice, but not SMC-TGFßr2-/- mice, compared to vehicle-treated mice. In vivo inhibition of LGR6 receptors obliterated MaR1-dependent protection in AAA formation and SMC α-actin expression. Furthermore, MaR1 upregulated macrophage-dependent efferocytosis of apoptotic SMCs in murine aortic tissue during AAA formation. In vitro studies demonstrate that MaR1-LGR6 interaction upregulates TGF-ß2 expression and decreases MMP2 activity during crosstalk of macrophage-apoptotic SMCs. In summary, these results demonstrate that MaR1 activates LGR6 receptors to upregulate macrophage-dependent efferocytosis, increases TGF-ß expression, preserves aortic wall remodeling and attenuate AAA formation. Therefore, this study demonstrates the potential of MaR1-LGR6-mediated mitigation of vascular remodeling through increased efferocytosis of apoptotic SMCs via TGF-ß2 to attenuate AAA formation.

Treatment and Outcomes of Aortic Graft Infections Using a Decision Algorithm.

BACKGROUND: Aortic graft infection (AGI) is a rare but devastating complication requiring both explant of the infected prosthesis and lower extremity revascularization. Despite a variety of methods to treat AGI, there is a paucity of evidence that describes comparative outcomes. Moreover, controversy exists surrounding what the optimal repair strategy is with limited descriptions of how these techniques should be employed in this complex group of patients. Therefore, the purpose of this analysis was to review our experience with AGI management while highlighting a practice philosophy that can achieve acceptable outcomes. METHODS: All AGI patients between 2002-2019 were reviewed. The primary end-point was 30-day mortality. Secondary end-points included complications, re-infection, unplanned re-operation and all-cause mortality. Kaplan-Meier methodology was used to estimate time to events. Cox regression models were employed to identify association between patient factors and operative strategy with survival. Subgroup analysis included outcome comparison among four different operative approaches(extra-anatomic bypass with aortic ligation [EAB] and in-situ reconstruction [ISR] using either NAIS, cryopreserved allograft [Cryo], or antibiotic-soaked prosthetic grafts [Other]). RESULTS: 142 patients (male-69%, mean age 67 ± 11 years) were reviewed. Median time to AGI presentation was 52 (IQR 16-128) months. ISR was performed in 70% (n = 99)[ISR: NAIS-49% (n = 49), Cryo, 33% (n = 33) and Other-23% (n = 23)]. EAB was used in 26% (n = 37), of which 57% (n = 21) were staged repairs[no reconstruction, 4%: intraoperative death-2, AGI removal without reconstruction-2]. A graft enteric erosion/fistula was identified in 39% (n = 55). Mean follow-up time was 14 ± 27 (median 2.2[IQR 0.1-16]) months. Overall, 30-day mortality was 21% and 69% (n = 98) experienced a complication. The most common complications were pulmonary (35%;n = 50), vascular (28%;n = 39), gastrointestinal (22%;n = 31) and renal (21%;n = 30). Freedom from re-infection at one and three years was 78 ± 5% and 73 ± 6% while freedom from unplanned re-operation was 50 ± 5% and 40 ± 6%, respectively. Corresponding one- and five-year freedom from all-cause mortality was 67 ± 4% and 53 ± 4%. When stratified by the four different repair strategies, unadjusted rates of postoperative complications and mortality were not different. However, EAB patients had more renal complications. All-cause mortality predictors included age (HR 1.04, 95%CI 1.01-1.1; P = 0.003), CHF (HR 2.7, 1.3-5.7; P = 0.01), and graft enteric erosion/fistula (HR 2.2, 1.3-3.8;P = 0.005) while total graft excision was protective (HR 0.34, 0.2-0.7; P = 0.003). CONCLUSIONS: AGI repair, regardless of operative strategy, results in significant early morbidity, and mortality. The need for unplanned re-operation is common; however, long-term survival is acceptable in appropriately selected patients. Re-infection risk mandates life-long surveillance and consideration of indefinite anti-microbial suppression in certain subgroups. Due to the complexity and intensity of care, all AGI should be treated, when possible, at centers performing high-volume aortic surgery.

Intraoperative hypotension and complications after vascular surgery: A scoping review.

BACKGROUND: Intraoperative hypotension during major surgery is associated with adverse health outcomes. This phenomenon represents a potentially important therapeutic target for vascular surgery patients, who may be uniquely vulnerable to intraoperative hypotension. This review summarizes current evidence regarding the impact of intraoperative hypotension on postoperative complications in patients undergoing vascular surgery, focusing on potentially modifiable procedure- and patient-specific risk factors. METHODS: A scoping review of the literature from Embase, MEDLINE, and PubMed databases was conducted from inception to December 2019 to identify articles related to the effects of intraoperative hypotension on patients undergoing vascular surgery. RESULTS: Ninety-two studies met screening criteria; 9 studies met quality and inclusion criteria. Among the 9 studies that defined intraoperative hypotension objectively, there were 9 different definitions. Accordingly, the reported incidence of intraoperative hypotension ranged from 8% to 88% (when defined as a fall in systolic blood pressure of >30 mm Hg or mean arterial pressure <65). The results demonstrated that intraoperative hypotension is an independent risk factor for longer hospital length of stay, myocardial injury, acute kidney injury, postoperative mechanical ventilation, and early mortality. Vascular surgery patients with comorbid conditions that confer increased vulnerability to hypoperfusion and ischemia appear to be susceptible to the adverse effects of intraoperative hypotension. CONCLUSION: There is no validated, consensus definition of intraoperative hypotension or other hemodynamic parameters associated with increased risk for adverse outcomes. Despite these limitations, the weight of evidence suggests that intraoperative hypotension is common and associated with major postoperative complications in vascular surgery patients.

Pharmacologic inhibition of transient receptor channel vanilloid 4 attenuates abdominal aortic aneurysm formation.

Abdominal aortic aneurysm (AAA) formation is characterized by inflammation, leukocyte infiltration, and vascular remodeling. This study investigates the role of TRPV4 channels, which are transmembrane calcium channels that can regulate vascular tone, in modulating AAA formation. The elastase-treatment model of AAA in C57BL6 (WT) mice and Angiotensin II treatment model in ApoE-/- mice were used to confirm our hypotheses. The administration of a specific TRPV4 antagonist, GSK2193874, in elastase-treated WT mice and in AngII-treated ApoE-/- mice caused a significant attenuation of aortic diameter, decrease in pro-inflammatory cytokines (IL-1ß, IL-6, IL-17, MCP-1, MIP-1α, MIP-2, RANTES, and TNF-α), inflammatory cell infiltration (CD3 + T cells, macrophages, and neutrophils), elastic fiber disruption, and an increase in smooth muscle cell α-actin expression compared to untreated mice. Similarly, elastase-treated TRPV4-/- mice had a significant decrease in AAA formation, aortic inflammation, and vascular remodeling compared to elastase-treated WT mice on Day 14. In vitro studies demonstrated that the inhibition of TRPV4 channels mitigates aortic smooth muscle cell-dependent inflammatory cytokine production as well as decreases neutrophil transmigration through aortic endothelial cells. Therefore, our results suggest that TRPV4 antagonism can attenuate aortic inflammation and remodeling via decreased smooth muscle cell activation and neutrophil transendothelial migration during AAA formation.

Analysis of 4 Years of Injury in Professional Rodeo.

OBJECTIVE: To analyze injury frequency, density, location, type, mechanism of injury (MOI), activity phase of injury, and injury risk in professional rodeo. DESIGN: Retrospective epidemiological review. SETTING: Professional Rodeo Cowboys Association sanctioned rodeos from 2011 to 2014. PARTICIPANTS: Professional Rodeo Cowboys Association competitors competing in bull riding, bareback riding, saddle bronc riding, team roping, tie-down roping, and steer wrestling. MAIN OUTCOME MEASURES: Injury reports were documented by sports medicine personnel. Variables assessed include event, frequency, density, location, type, MOI, activity phase of injury, and injury density. RESULTS: A total of 2305 injuries from 139,098 competitor exposures (CEs) were reported, demonstrating overall injury density of 16.6 injuries per 1000 CEs (95% confidence interval, 0.016-0.017) and overall risk of injury of 1.69%. Rough stock riders accounted for 88.7% of all injuries. Bull riders, bareback riders, and saddle bronc riders demonstrated injury densities of 48.2, 41.1, and 23.2 injuries per 1000 CEs, respectively. Most injuries (62.9%) were sustained by collisions with the ground or animal, or being stomped on by the animal. Contusions, sprains, and concussions were the most frequent injury types (23.1%, 13.6%, and 11.6%, respectively). Neurological components, knees, and shoulders were the most injured body parts (13.4%, 11.1%, and 11.0%, respectively). Most injuries (36.8%) occurred during or immediately after the dismount. CONCLUSIONS: Rough stock events have the greatest risk of injury in professional rodeo, whereas steer wrestling has the greatest risk of injury for timed event athletes. Medical professionals should use these findings to implement prevention programming where possible.

Results of a Multicenter Feasibility Study of an Automated Bedside Glucose Monitoring System in the Burn Intensive Care Setting.

Intensive blood glucose regimens required for tight glycemic control in critically ill burn patients carry risk of hypoglycemia and are ultimately limited by the frequency of which serum glucose measurements can be feasibly monitored. Continuous inline glucose monitoring has the potential to significantly increase the frequency of serum glucose measurement. The objective of this study was to assess the accuracy of a continuous glucose monitor with inline capability (Optiscanner) in the burn intensive care setting. A multicenter, observational study was conducted at two academic burn centers. One hundred and six paired blood samples were collected from 10 patients and measured on the Optiscanner and the Yellow Springs Instrument. Values were plotted on a Clarke Error Grid and mean absolute relative difference calculated. Treatment was guided by existing hospital protocols using separately obtained values. 97.2% of results obtained from Optiscanner were within 25% of corresponding Yellow Springs Instrument values and 100% were within 30%. Mean absolute relative difference was calculated at 9.6%. Our findings suggest that a continuous glucose monitor with inline capability provides accurate blood glucose measurements among critically ill burn patients.

A Systematic Review on the Effectiveness of Active Recovery Interventions on Athletic Performance of Professional-, Collegiate-, and Competitive-Level Adult Athletes.

Ortiz Jr, RO, Sinclair Elder, AJ, Elder, CL, and Dawes, JJ. A systematic review on the effectiveness of active recovery interventions on athletic performance of professional-, collegiate-, and competitive-level adult athletes. J Strength Cond Res 33(8): 2275-2287, 2019-Active recovery (AR) is a popular approach to enhancing athlete recovery from participation through physical action, and it has a perceived benefit in the recovery of athletes' enhancement of postexertional physiological status; however, it is unclear whether these recovery techniques enhance athletic performance. The purpose of this systematic review was to examine the effects of AR interventions conducted postexertion on athletic performance among professional, collegiate, and competitive adult athletes. Articles were collected via 4 online databases restricted to publication in English between 1998 and 2014. After the evaluation of overlap among the databases and abstract review, 150 potential eligible studies remained. Twenty-six articles involving 471 subjects remained after full analysis. The primary exclusion factor was absence of AR types of interest or measures of performance. The review resulted in a wide variety of findings indicating the vagueness in AR approach and outcome measures, making it difficult to draw specific conclusions. The review demonstrated that AR interventions lasting 6-10 minutes revealed consistently positive effects on performance. The appropriate intensity level of AR sessions was inconclusive in the literature; however, blood lactate clearance rate as a recovery marker appeared unreliable. The review suggests that there are positive psychological outcomes from AR sessions, a need to determine if AR should be individualized in its application, and weak evidence regarding the efficacy of postexercise AR, particularly relating to performance. Future research is needed for reliable and accurate markers for fatigue, physiological recovery, performance, and markers of intensity and duration for AR interventions.

Differences in Stress Shoot Performance Among Special Forces Operators Who Participate in a Human Performance Program Versus Those Who Do Not.

BACKGROUND: The purpose of this investigation was to determine if Army Special Operation Forces (ARSOF) Operators who participate in the Tactical Human Optimization, Rapid Rehabilitation and Reconditioning program perform significantly better on a simulated stress shoot scenario than ARSOF Operators who do not participate in the program. METHODS: Deidentified archival data from 64 male ARSOF Operators (mean ± standard deviation: age, 31.1 ± 4.96 years; SOF experience, 3.44 ± 4.10 years) who participated in the Special Forces Advanced Urban Combat stress shoot were assessed to determine if differences in performance existed between program users (n = 25) and nonusers (n = 39). A series of bootstrapped analyses of variance in conjunction with effect-size calculations was conducted to determine if significant mean score differences existed between users and nonusers on raw and total course completion times, high-value target acquisition (positive identification time), and penalties accrued. RESULTS: Small to medium effect sizes were observed between users and nonusers in raw time, penalties, and total time. Although there were no significant differences between users and nonusers, there was less variation in raw time and total time in users compared with nonusers. CONCLUSION: Our findings becomes a question of practical versus statistical significance, because less performance variability while under physical and psychological duress could be life saving for ARSOF Operators.

Physical Fitness Characteristics of High vs. Low Performers on an Occupationally Specific Physical Agility Test for Patrol Officers.

Law enforcement agencies frequently use physical ability tests (PATs) as a method of evaluating occupational performance. These tests are designed to replicate essential occupational tasks frequently performed by officers in the field. The purpose of this study was to determine whether significant relationships exist between the selected physical fitness tests and PAT performance and to determine which of these tests best differentiates between high and low PAT performers. Full-time highway patrol officers (n = 495) submitted self-reported anthropometric data (mean age = 39.6 + 7.7 years) along with fitness assessments taken from their organization's yearly fitness tests. All subjects completed a series of field-based fitness tests, as well as an occupationally specific PAT. Results of the study indicated that the selected tests accounted for almost 69% of the total variance on PAT performance. Overall, the 20-m meter multistage fitness test, 1-minute sit-up performance, and vertical jump height best predicted PAT performance. Furthermore, it was revealed that high performers were significantly more fit in all measures of dynamic fitness when compared with lower performers. No significant differences were discovered in static strength between groups. Strength and conditioning specialists should focus on developing aerobic capacity, trunk muscular endurance, and whole-body anaerobic power to improve PAT and occupational performance.

Paravertebral regional blocks decrease length of stay following surgery for pectus excavatum in children.

PURPOSE: Management of postoperative pain following repair of pectus excavatum has traditionally included thoracic epidural analgesia, narcotics, and benzodiazepines. We hypothesized that the use of intercostal or paravertebral regional blocks could result in decreased inpatient length of stay (LOS). METHODS: We conducted a retrospective cohort study of 137 patients (118 Nuss and 19 Ravitch - Nuss and Ravitch patients were analyzed separately) who underwent surgical repair of pectus excavatum with pain management via epidural, intercostal, or paravertebral analgesia from January 2009-December 2012. Measured outcomes included LOS, pain scores, benzodiazepine/narcotic requirements, emesis, professional fees, hospital cost, and total cost. RESULTS: In the Nuss patients, LOS was significantly reduced in the paravertebral group (p<0.005) and the intercostal group (p<0.005) compared to the epidural group, but was paradoxically countered by a nonsignificant increase in total cost (p=0.09). While benzodiazepine doses/day was not increased in the paravertebral group (p=0.08), an increase was seen in narcotic use (p<0.005). Despite increased narcotic use, no differences were seen in emesis between epidural and paravertebral use. Compared to epidural, pain scores were higher for both intercostal and paravertebral on day one (p<0.005), but equivalent for paravertebral on day three (p=0.62). The Ravitch group was too small for detailed independent statistical analysis but followed the same overall trend seen in the Nuss patients. CONCLUSION: Our use of paravertebral continuous infusion pain catheters for pectus excavatum repair was an effective alternative to epidural analgesia resulting in shorter LOS but not a decrease in overall cost.

Relationship of Two Vertical Jumping Tests to Sprint and Change of Direction Speed among Male and Female Collegiate Soccer Players.

In collegiate level soccer acceleration, maximal velocity and agility are essential for successful performance. Power production is believed to provide a foundation for these speed qualities. The purpose of this study was to determine the relationship of change of direction speed, acceleration, and maximal velocity to both the counter movement jump (CMJ) and squat jump (SJ) in collegiate soccer players. Thirty-six NCAA Division II soccer players (20 males and 16 females) were tested for speed over 10 and 30 m, CODS (T-test, pro agility) and power (CMJ, SJ). Independent t-tests (p ≤ 0.05) were used to derive gender differences, and Pearson's correlations (p ≤ 0.05) calculated relationships between the different power and speed tests. Female subjects displayed moderate-to-strong correlations between 30 m, pro agility and T-test with the CMJ (r = -0.502 to -0.751), and SJ (r = -0.502 to -0.681). Moderate correlations between 10 and 30 m with CMJ (r = -0.476 and -0.570) and SJ (r = -0.443 and -0.553, respectively) were observed for males. Moderate to strong relationships exist between speed and power attributes in both male and female collegiate soccer players, especially between CMJ and maximal velocity. Improving stretch shortening cycle (SSC) utilization may contribute to enhanced sport-specific speed.

A WORKLOAD SELECTION PROCEDURE FOR THE ÅSTRAND-RYHMING TEST FOR WOMEN.

UNLABELLED: The Åstrand-Ryhming Submaximal Bicycle Test is an accurate and widely used test to estimate maximal oxygen consumption. This test requires a participant to maintain a workload over a 6-min. PERIOD: The issue facing many employing this protocol is the identification of an appropriate workload for the cycling regimen. The present study is designed to identify a method for determining an appropriate workload for female participants. A prior study designed a workload selection procedure specifically for men; however, the selection procedure designed for women in this study was better able to elicit a final heart rate (average of minutes five and six) between 165-170 bpm compared to the original Åstrand-Ryhming procedure.

Addressing challenges of training a new generation of clinician-innovators through an interdisciplinary medical technology design program: Bench-to-Bedside.

Graduate medical education has traditionally focused on training future physicians to be outstanding clinicians with basic and clinical science research skills. This focus has resulted in substantial knowledge gains, but a modest return on investment based on direct improvements in clinical care. In today's shifting healthcare landscape, a number of important challenges must be overcome to not only improve the delivery of healthcare, but to prepare future physicians to think outside the box, focus on and create healthcare innovations, and navigate the complex legal, business and regulatory hurdles of bringing innovation to the bedside. We created an interdisciplinary and experiential medical technology design competition to address these challenges and train medical students interested in moving new and innovative clinical solutions to the forefront of medicine. Medical students were partnered with business, law, design and engineering students to form interdisciplinary teams focused on developing solutions to unmet clinical needs. Over the course of six months teams were provided access to clinical and industry mentors, $500 prototyping funds, development facilities, and non-mandatory didactic lectures in ideation, design, intellectual property, FDA regulatory requirements, prototyping, market analysis, business plan development and capital acquisition. After four years of implementation, the program has supported 396 participants, seen the development of 91 novel medical devices, and launched the formation of 24 new companies. From our perspective, medical education programs that develop innovation training programs and shift incentives from purely traditional basic and clinical science research to also include high-risk innovation will see increased student engagement in improving healthcare delivery and an increase in the quality and quantity of innovative solutions to medical problems being brought to market.

The role of screening and prophylactic surgery for malrotation in heterotaxy patients.

PURPOSE: There are no standardized guidelines for screening or management of malrotation in Heterotaxy Syndrome (HS). We sought to review our experience to determine if evidenced based guidelines could be drafted. METHODS: A retrospective chart review was performed at our freestanding children's hospital on all patients under one year of age undergoing a Ladd procedure between 2000 and 2011. In addition, all Heterotaxy patients were reviewed during this period. RESULTS: Twenty-three Heterotaxy patients and seventy-nine Non-Heterotaxy patients underwent a Ladd procedure. Both groups had a high rate of complication. Heterotaxy was associated with significantly higher mortality 30days after Ladd procedure. In our review, we also identified seventy-six HS patients who did not undergo a Ladd procedure. Among these patients, fourteen had normal intestinal anatomy, five had malrotation, and fifty-seven were never evaluated for intestinal malrotation. No patients with intestinal malrotation or unknown intestinal rotation status suffered midgut volvulus. Average follow-up time was 5.1years. CONCLUSIONS: We conclude that prophylactic Ladd procedures in children with Heterotaxy are associated with a high morbidity and mortality. Patients who avoided screening were not exposed to a significant risk of midgut volvulus, and our experience suggests that routine screening of Heterotaxy patients for malrotation should be abandoned.

Myofascial release as a treatment for orthopaedic conditions: a systematic review.

OBJECTIVE: To critically analyze published literature to determine the effectiveness of myofascial release therapy as a treatment for orthopaedic conditions. DATA SOURCES: We searched the following electronic databases: MEDLINE, CINAHL, Academic Search Premier, Cochrane Library, and Physiotherapy Evidence Database (PEDro), with key words myofascial release, myofascial release therapy, myofascial release treatment, musculoskeletal, and orthopedic. No date limitations were applied to the searches. STUDY SELECTION: Articles were selected based upon the use of the term myofascial release in the abstract or key words. Final selection was made by applying the inclusion and exclusion criteria to the full text. Studies were included if they were English-language, peer-reviewed studies on myofascial release for an orthopaedic condition in adult patients. Ten studies were eligible. DATA EXTRACTION: Data collected were number of participants, condition being treated, treatment used, control group, outcome measures and results. Studies were analyzed using the PEDro scale and the Center for Evidence-Based Medicine's Levels of Evidence Scale. DATA SYNTHESIS: Study scores on the PEDro scale ranged from 6 of 10 to 8 of 10. Based on the Levels of Evidence Scale, the case studies (n = 6) were of lower quality, with a rank of 4. Three of the 4 remaining studies were rated at 2b, and the final study was rated at 1b. CONCLUSIONS: The quality of studies was mixed, ranging from higher-quality experimental to lower-quality case studies. Overall, the studies had positive outcomes with myofascial release, but because of the low quality, few conclusions could be drawn. The studies in this review may serve as a good foundation for future randomized controlled trials.

An analysis of undergraduate exercise science programs: an exercise science curriculum survey.

Undergraduate exercise science programs develop curricula by referring to standards set by professional organizations. A web-based survey was administered to 235 institutions with exercise science undergraduate programs to evaluate their adherence to stated curricular guidelines. Results indicate that 29% of institutions considered American College of Sports Medicine (ACSM) Knowledge, skills, and abilities (KSAs); 33% both ACSM and National Association for Sport and Physical Education (NASPE) guidelines; 6% ACSM, NASPE, and National Strength and Conditioning Association (NSCA); 8% ACSM, NASPE, NSCA, and American Society of Exercise Physiologists, and 5% NASPE. The two largest subgroups had good compliance with the areas of exercise physiology, biomechanics, and human anatomy and physiology. However, neither subgroup adhered to the areas of exercise prescription, testing, and implementation; exercise and aging; or exercise with special populations. Regardless of the implemented guideline(s), most institutions placed minimal emphasis on areas related to health promotion and many curricula did not require any field experience.