Principales aplicaciones de la ecografía clínica en cuidados paliativos / Main applications of point-of care ultrasound in palliative care

El uso de la ecografía clínica, entendida como una extensión de la exploración física que ayuda a la toma de decisiones clínicas en tiempo real, se ha generalizado en diversas especialidades médicas y quirúrgicas. En los últimos años, los avances tecnológicos han permitido disponer de ecógrafos de bolsillo, económicamente asequibles, que pueden ser utilizados en el propio domicilio del paciente. En esta revisión se describen las principales aplicaciones de la ecografía clínica en cuidados paliativos, un escenario de potencial utilidad tanto para mejorar la certeza en el diagnóstico de procesos agudos intercurrentes, que producen un impacto en la calidad de vida del paciente, como para guiar la realización de procedimientos invasivos sin necesidad de desplazamientos al medio hospitalario. Para la implantación de la ecografía clínica en cuidados paliativos son necesarios programas formativos con objetivos concretos, definiendo curvas de aprendizaje y estableciendo alianzas con sociedades científicas de reconocida trayectoria docente, asistencial e investigadora para la acreditación de competencias (AU)

Combined with a physical examination, clinical ultrasound offers a valuable complement that can help guide clinical decision-making. In various medical and surgical specialties, it is increasingly used for diagnostic and therapeutic purposes. Due to recent technological advances, smaller and more affordable ultrasound machines are now being developed for use in home hospice care. The purpose of this paper is to describe how clinical ultrasound may be applied in Palliative Care, where it can be a valuable tool to assist the clinician in making better clinical decisions and to assist in accurately guiding palliative procedures. Furthermore, it can be used to identify unnecessary hospitalizations and prevent them from occurring. Training programs with specific objectives are necessary to implement clinical ultrasound in Palliative Care, as well as defining learning curves and promoting alliances with scientific societies that recognize the teaching, care and research trajectory for accreditation of competencies (AU)

[Role of pediatric urologist in the treatment of congenital adrenal hyperplasia: a study of satisfaction and psychosocial aspects]. / Papel del urólogo pediátrico en el tratamiento de la hiperplasia suprarrenal congénita: estudio de satisfacción y aspectos psicosociales.

OBJECTIVE: Study the role of the pediatric urologist in the treatment of CAH and the satisfaction of families and patients to identify the psychosocial aspects that we can improve. MATERIAL AND METHODS: Retrospective study in girls with CAH treated in our center. We reviewed the medical records, analyzing the variables: place of birth, age at diagnosis, surgery, complications and follow up. Analysis of satisfaction and psychosocial aspects by telephone survey. RESULTS: Between 1975-2011, 25 girls with CAH have been treated in our center. Cystoscopy and vaginoscopy was performed before clitoroplasty in 68% (16 girls), adding vulvovaginoplasty in 40% and vaginal descent in the 20%. The mean age was 8.78 +/- 2.30 months. Vaginal stenosis was the main complication (36%), performing introitus plasty in two girls, vaginal expansion in other 2 and dilation of the rest. 15 surveys were made, all expressed satisfaction with treatment, and only 6.67% reported shortages information. With the aesthetic results of the genitoplasty 20% showed dissatisfaction. The family concern was constant at 60%, and sporadic in the rest. 13.3% required psychological support. Currently 80% have normal psychosocial life. CONCLUSION: The HSC requires a multidisciplinary approach right from birth to allow adequate psychosocial development. The pediatric urologist has an important weight in the multidisciplinary treatment. Realizing early feminizing genitoplasty decreases family impact and increases satisfaction. The prolonged follow-up will allow the detection and treatment of complications.

The arylalkylamine-N-acetyltransferase (AANAT) acetylates dopamine in the digestive tract of goldfish: a role in intestinal motility.

Melatonin has been found in the digestive tract of many vertebrates. However, the enzymatic activity of the arylalkylamine-N-acetyltransferase (AANAT) and the hydroxindole-O-methyltransferase (HIOMT), the last two enzymes of melatonin biosynthesis, have been only measured in rat liver. Therefore, the first objective of the present study is to investigate the functionality of these enzymes in the liver and gut of goldfish, analyzing its possible daily changes and comparing its catalytic properties with those from the retina isoforms. The daily rhythms with nocturnal acrophases in retinal AANAT and HIOMT activities support their role in melatonin biosynthesis. In foregut AANAT activity also show a daily rhythm while in liver and hindgut significant but not rhythmic levels of AANAT activity are found. HIOMT activity is not detected in any of these peripheral tissues suggesting an alternative role for AANAT besides melatonin synthesis. The failure to detect functional HIOMT activity in both, liver and gut, led us to investigate other physiological substrates for the AANAT, as dopamine, searching alternative roles for this enzyme in the goldfish gut. Dopamine competes with tryptamine and inhibits retinal, intestinal and hepatic N-acetyltryptamine production, suggesting that the active isoform in gut is AANAT1. Besides, gut and liver produces N-acetyldopamine in presence of acetyl coenzyme-A and dopamine. This production is not abolished by the presence of folic acid (arylamine N-acetyltransferase inhibitor) in any studied tissue, but a total inhibition occurs in the presence of CoA-S-N-acetyltryptamine (AANAT inhibitor) in liver. Therefore, AANAT1 seems to be an important enzyme in the regulation of dopamine and N-acetyldopamine content in liver. Finally, for the first time in fish we found that dopamine, but not N-acetyldopamine, regulates the gut motility, underlying the broad physiological role of AANAT in the gut.

Characterization of two different melatonin binding sites in peripheral tissues of the teleost Tinca tinca.

The aim of the present study was to localize and characterize 2-iodo-melatonin ([(125)I]Mel) binding sites in peripheral tissues of the teleost Tinca tinca. A wide distribution of [(125)I]Mel binding sites in peripheral locations of the tench is found, with highest densities being measured in the heart, gills and kidney, and low density of [(125)I]Mel binding sites in gastrointestinal tract, spleen, liver and gonads. Saturation, kinetics, and pharmacological approaches revealed the presence of, at least, two different [(125)I]Mel binding sites in the tench peripheral tissues. The unique characterized subtype in the heart fulfils all the criteria for a canonical melatonin receptor belonging to MT(1) family (the binding is saturable, reversible, and inhibited by GTP analogs), and gives support for the presence of a functional melatonin receptor in the heart of the tench. In contrast, kinetic and pharmacological studies in the kidney revealed the preponderance of a melatonin binding site belonging to the MT(3)-like receptor subtype. Moreover, the decrease of specific binding in both, heart and kidney membranes, and the decrease of affinity in the kidney, produced by the addition of a non-hydrolysable GTP analog, and sodium cations suggest the presence of G(i/o)-proteins (that mediate inhibition of cAMP formation) coupled to such melatonin binding sites. Our results also point to different G(i/o)-proteins involved in the underlying mechanism of melatonin binding sites activation in the kidney. Additionally, the kinetics of [(125)I]Mel binding in kidney membrane preparations is a highly thermosensitive process, being necessary to perform the assays at 4 °C since the equilibrium was not reached at 25 °C assay temperature. The time needed to complete association of [(125)I]Mel at such low temperature is only 15s, whereas 100s is required to displace [(125)I]Mel specific binding by the unlabeled melatonin in kidney membranes. Present results support previous reports on melatonin effects in the regulation of different physiological functions in teleost (as cardiovascular physiology and osmoregulation) acting through peripheral specific receptors.

Antibody and T-cell responses during acute and convalescent stages of invasive pneumococcal disease.

OBJECTIVE: To understand the pattern of immune responses to pneumococcal proteins during invasive disease as a guide to their development as vaccine candidates. METHODS: The antibody concentration and avidity, as well as frequency of interferon-gamma (IFN-γ)-, interleukin-10 (IL-10)-, and tumor necrosis factor-alpha (TNF-α)-containing CD4+ T-lymphocytes in response to pneumolysin, pneumococcal surface protein A (PspA), and choline-binding protein A (CbpA), during and after invasive pneumococcal disease (IPD) in 20 children were compared to those of 20 healthy matched controls. RESULTS: During the acute phase of IPD, the concentrations of antibodies against these three pneumococcal proteins were lower, whereas the frequencies of IL-10- and TNF-α-producing CD4+ T-cells were higher, compared to values obtained during convalescence and in healthy controls (p < 0.01). In addition, the concentrations of antibodies against the capsular polysaccharides for the serotypes isolated from these patients, were all below the detection level of the assay during both the acute and convalescent phases of IPD. CONCLUSION: These data indicate that the recognition of these antigens by the immune system occurs in variable proportions according to the stage of infection, implying the important role of these in the pathogenesis of IPD, and support their usefulness in vaccine development.

Serotonin-induced contraction in isolated intestine from a teleost fish (Carassius auratus): characterization and interactions with melatonin.

BACKGROUND: Serotonin (5-HT) plays a critical role in several gastrointestinal functions in vertebrates. In teleosts lacking enterochromaffin cells, intestinal 5-HT originates from serotonergic enteric neurons. In the present study, the foregut of a stomachless teleost, the goldfish (Carassius auratus), was used to evaluate the in vitro effect of 5-HT on fish intestinal motility. We also studied the role of melatonin (MEL), an indoleamine sharing the biosynthetic pathway with 5-HT, as regulator of serotonergic activity. METHODS: An organ bath system, with longitudinal strips from the goldfish intestinal bulb attached to an isometric transducer was used to record foregut smooth muscle contractions. KEY RESULTS: Concentration-dependent curves of the contractile response exerted by 5-HT and its agonists, 5-methoxytryptamine (5-MT) and 5-carboxamidotryptamine (5-CT), suggest a receptor-mediated action, supported by the blockade by a general 5-HT antagonist, methysergide. The 5-HT-induced contraction was abolished in the presence of atropine, revealing the involvement of cholinergic transmission in gut actions of 5-HT. Furthermore, MEL inhibited the contractile effect of 5-HT and its agonists by up to 50%, which was counteracted by MEL antagonists. CONCLUSIONS & INFERENCES: We can provisionally propose that at least two different 5-HT receptor subtypes are involved in fish intestinal motility, a 5-HT4-like (5-MT-preferring) and a 5-HT7-like (5-CT- and fluphenazine-sensitive) receptor. In summary, our results indicate that 5-HT regulates the contractile activity of goldfish foregut through specific receptors located in cholinergic neurons, and that MEL can modulate these serotonergic actions through high-affinity membrane receptors.

Circadian clock genes of goldfish, Carassius auratus: cDNA cloning and rhythmic expression of period and cryptochrome transcripts in retina, liver, and gut.

Clock genes are known to be the molecular core of biological clocks of vertebrates. They are expressed not only in those tissues considered central pacemakers, but also in peripheral tissues. In the present study, partial cDNAs for 6 of the principal clock genes (Period 1-3 and Cryptochrome 1-3) were cloned from a teleost fish, the goldfish (Carassius auratus ). These genes showed high homology (approximately 90%) with the respective cDNAs of zebrafish (Danio rerio), the only other teleost from which clock genes have been cloned. The daily expression pattern of each gene in retina, gut, and liver of goldfish was investigated using quantitative RT-PCR and cosinor analysis. All clock genes analyzed in the retina showed circadian rhythmicity; however, only Per 2-3 and Cry 2-3 were rhythmic in goldfish liver and gut. The amplitude and phase of the expression in liver and gut were different from those found in goldfish retina. Such differences suggest that other cues, such as feeding time, may contribute to the entrainment of oscillators in goldfish liver and gut. Our results support the use of goldfish as a teleost model to investigate the location and functioning of the circadian oscillators.

Melatonin receptors in brain areas and ocular tissues of the teleost Tinca tinca: characterization and effect of temperature.

The aim of the present study was to characterize the central melatonin receptors in brain areas and ocular tissues of the teleost Tinca tinca. We investigated the temperature-dependence of 2-iodo-melatonin ([(125)I]Mel) binding in the optic tectum-tegmentum area and the neural retina. The binding of [(125)I]Mel showed a widespread distribution in brain and ocular tissues, with the highest density in the optic tectum-thalamus and the lowest in hindbrain. The [(125)I]Mel affinity was similar in all the studied tissues, and it was on the order of the low pM range. Saturation, kinetic and pharmacological studies showed the presence of a unique MT(1)-like melatonin binding site. In addition, the non-hydrolysable GTP analog, the GTPgammaS, and sodium cations induced a specific binding decrease in the optic tectum and neural retina, suggesting that such melatonin binding sites in the tench are coupled to G protein. Thus, these melatonin binding sites in optic tectum and neural retina fulfil the requirements of a real hormone receptor, the specific binding is rapid, saturable, and reversible, and is inhibited by GTP analogs. Additionally, a clear effect of temperature on such central melatonin receptors was found. Temperature did not modify the B(max) and K(d), but the kinetics of [(125)I]Mel binding resulted in a highly thermosensitive process in both tissues. Both association and dissociation rates (K(+1) and K(-1)) significantly increased with assay temperature (15-30 degrees C), but the K(d) constant (estimated as K(-1)/K(+1)) remained unaltered. In conclusion, this high thermal dependence of the melatonin binding to its receptors in the tench central nervous system supports the conclusion that temperature plays a key role in melatonin signal transduction in fish.

Binding characteristics and daily rhythms of melatonin receptors are distinct in the retina and the brain areas of the European sea bass retina (Dicentrarchus labrax).

Melatonin is synthesized, with a circadian rhythm, in the pineal organ of vertebrates, high levels being produced during the scotophase and low levels during the photophase. The retina also produces melatonin, although in the case of the European sea bass, its secretion pattern appears to be inverted. In the study described here, radioreceptor assay techniques were used to characterize the melatonin binding sites, their regional distribution and their daily variations. Brain and retina membrane preparations were used in all the binding assays and 2-[125I]iodomelatonin ([125I]Mel) as radioligand at 25 degrees C. The specific binding of [125I]Mel was seen to be saturable, reversible, specific and of high affinity. In all the tissues assayed, the power of the ligands to inhibit [125I]Mel binding decreased in the following order: melatonin>>4-P-PDOT>luzindole> or =N-acetylserotonin, which points to the presence of Mel1-like receptors. The inhibition curves of 4-P-PDOT suggested the presence of two different binding sites in the brain areas, but only one type of site of low affinity in the neural retina. No daily variations in [125I]Mel binding capacity (Bmax) or affinity (Kd) were detected in the brain areas, while a clear rhythm in Kd melatonin receptor affinity and Bmax binding capacity was observed in the retina. Kd and Bmax retinal rhythms were out of phase with the lowest Kd and the highest Bmax occurring at scotophase. This result suggests that retinal melatonin is a paracrine factor able to control receptor desensitization during photophase when ocular melatonin is higher in this species.

Influence of muscle strength and total work on exercise-induced plasma growth hormone isoforms in women.

The purpose of this investigation was to determine the influence of physical strength and the ability to do more total work on human growth hormone (GH) variants to a heavy resistance exercise protocol in untrained women. From a distribution of 100 healthy, untrained women, the strongest 10 women (S) and the weakest 10 women (W) were compared for GH responses pre- and post an acute heavy resistance exercise test (AHRET, 6 sets of 10 RM squats, 2 minutes rest between sets). Blood samples were obtained pre-exercise and immediately post-exercise and subsequently analysed in total as well as fractionated by Sephacryl S-100R column chromatography into three molecular weight size classes: fraction A: > 60 kD, fraction B: 30-60 kD, fraction C: < 30 kD. For each total sample as well as each fraction, immunoreactive GH was measured via the Nichols IRMA, while bioactive GH was measured via the hypox rat tibial line bioassay and Diagnostic Systems Laboratory's immunofunctional GH ELISA. No exercise-induced changes or differences between groups were observed in the tibial line bioassay. However, the S group displayed a significantly higher pre-exercise resting value in the total fraction than the W group. Conversely, the W group exhibited a significantly higher pre-exercise value in the smaller molecular weight fraction C. With regards to the immunofunctional and immunoreactive assays, the total fraction, fraction A, and fraction B demonstrated significant (P < or = 0.05) exercise-induced increases in both the S and W group despite no group differences. For the Nichols and immunofunctional assays significant exercise-induced changes were observed in the smaller molecular weight C fraction in the W group but not the S group. However, the S group displayed a significantly higher pre-exercise value in fraction C relative to the W group. These data demonstrate for the first time that differences exist in the GH molecular weight variants between strong and weak untrained women, with the lower molecular weight variants seemingly less responsive to greater amounts of exercise in stronger women, thus suggesting differential regulation of GH molecular weight variants during resistance exercise due to pre-existing physical parameters.

[Alveolar lipoproteinosis, an incidental finding during an unrelated pre-surgical study with inadequate response to complete pulmonary washing]. / Proteinosis alveolar, un hallazgo incidental en un estudio preoperatoiro con respuesta insuficiente al lavado pulmonar completo.

The alveolar lipoproteinosis (ALP) is a rare pulmonary disease, characterized by an excess of phospholipids in the distal airway, and the most symptom of which is dyspnea. 35 years old patient in whom we observed incidentally pulmonary infiltrations in a chest X-ray during a unrelated pre-surgical study. We could not make a definitive diagnosis after further investigations carried out in the Division of Respiratory Medicine. We, therefore, sent this patient to the Division of Chest Surgery for a complementary video-thoracoscopy. Biopsy showed presence of ALP. The ALP is a rare disease that originates diagnosis difficulties, and that often needs lung biopsies to confirm its diagnosis. Once treated, its prognosis is excellent. The safest and most effective treatment is a complete pulmonary washing, that, in our patient, was required 7 months after diagnosis as this patient presented clinical deterioration and worsening in the lung function studies. This treatment did not achieve the expected goal. In the subsequent 6 months, we repeated the same treatment and failed again. We then started a treatment with granulocyte-macrophage-colony stimulating factor (GM-CSF) and obtain good response.

Proteinosis Alveolar, un hallazgo incidental en un estudio preoperatorio con respuesta insuficiente al lavado pulmonar completo / Alveolar lipoproteinosis, an incidental finding during an unrelated pre-surgical study with inadequate response to complete pulmonary washing

La lipoproteinosis alveolar (LPA) es una enfermedad pulmonar difusa poco frecuente, acumulándose un exceso de fosfolípidos en la vía aérea distal, cuyo síntoma más frecuente es la disnea. Paciente de 35 años de edad en la que se observan, como hallazgo incidental durante un estudio preoperatorio, infiltrados pulmonares en una radiografía de tórax. Con las exploraciones físicas y complementarias realizadas en el Servicio de Neumología, no se obtiene un diagnóstico definitivo, por lo que la paciente es remitida al Servicio de Cirugía Torácica para realizar videotoracoscopia diagnóstica. El estudio de las biopsias obtenidas demuestra la presencia de LPA. La LPA es una enfermedad poco frecuente que suele plantear dificultades diagnósticas, y en múltiples ocasiones requiere biopsia pulmonar para obtener el diagnóstico definitivo. El pronóstico global de la enfermedad es excelente con tratamiento. La terapia más segura y efectiva es el lavado pulmonar completo (LPC), que en nuestra paciente fue necesario a los 7 meses del diagnóstico por presentar deterioro clínico así como en los estudios de función pulmonar realizados, con pobre respuesta al mismo. En los 6 meses siguientes se realiza nuevo LPC, sin resultados satisfactorios; iniciándose entonces tratamiento con factor estimulante de colonias de granulocito-macrófagos (GM-CSF), con respuesta favorable (AU)

Effects of an 8-week weight-loss program on cardiovascular disease risk factors and regional body composition.

OBJECTIVE: To determine the influence of weight loss on multiple cardiovascular disease (CVD) risk factors. DESIGN: Overweight women (n = 12; mean 44.2% fat) and men (n = 10; mean 30.7% fat) participated in an 8 week weight-loss program that included dietary, exercise, multi-vitamin/mineral supplementation, and behavior modification components. Measurement of total and regional body composition assessed using dual energy X-ray absorptiometry (DEXA), circumferences and blood sampling for total cholesterol, LDL cholesterol, HDL cholesterol, triacylglycerols, homocysteine, insulin and leptin were performed before and after the weight loss intervention. RESULTS: Subjects increased their physical activity and decreased their energy intake, resulting in a mean decrease in body mass of - 4.3 +/- 3.4 kg in women and -4.7 +/- 3.1 kg in men. Fat accounted for 88 and 58% of the decrease in body mass in men and women, respectively. Proportionally, men lost significantly more fat mass from the trunk region compared to women. Serum total and LDL cholesterol were significantly decreased in men (-11 and -14%, respectively) but not women (-3 and -3%, respectively) and there were no changes in HDL cholesterol and triacylglycerols. Serum leptin was significantly decreased (-36%) and highly correlated to fat mass (r= 0.839). There were no changes in serum insulin and plasma homocysteine. CONCLUSIONS: These data indicate that short-term weight loss resulting from reducing percentage energy from fat, increasing physical activity and vitamin/mineral supplements including folic acid has a favorable effect on regional body composition and total and LDL cholesterol with minimal effects on HDL cholesterol, triacylglycerols, homocysteine and insulin and the effects are greater in men compared to women. Supplementation with folic acid or emphasis on folic acid-rich foods may be an important component of a weight loss program to prevent increases in homocysteine.

[Tuberculosis in elderly patients. Presentation forms]. / Tuberculosis en pacientes ancianos. Formas de presentación.

OBJECTIVE: To analyse the distribution of the forms of presentation of tuberculosis (TPF) in elderly patients. MATERIAL AND METHODS: The medical records of patients diagnosed with tuberculosis attending the Tuberculosis Prevention and Control Unit of the Santiago Health District were reviewed over of six years period. The classification of TPF was: pulmonary forms (P), disease confined to the lung; extrapulmonary forms (EF), disease outside the lung; mixed forms (MF), the presence of both pulmonary and extrapulmonary tuberculosis; disseminated forms (DF), the presence of two or more extrapulmonary locations; and miliary TB, which was defined by a diffuse pulmonary radiographic pattern or diagnosis was undertaken by necropsy. RESULTS: A total of 278 tuberculosis infected patients were observed, 156 (56.2%) were men and 122 (43.8%) women, their mean age was 75.3 years (range 65-95). The distribution of TPF was: 155 (55.8%) P forms; 66 (23.7%) EF, of which 27 (41.0%) were ganglionary location, 12 (18.2%) bone and joint, 8 (12.0%) intestinal, 6 (9.1%) peritoneal, 5 (7.6%) meningeal, and other locations 8 (12.1%); MF 47 cases (16.9%); miliary TB 7 cases (2.5%) and. DF 3 cases (1.1%). None case was observed of HIV infected patient. CONCLUSIONS: Our findings confirm high incidence of extrapulmonary TB in elderly patients. Our experience shows a modification to the classical presentation of the disease, and thus the need for sensitivity in locating the disease.

Clínica de la tuberculosis

Al hablar de tuberculosis tendemos a pensar en la forma pulmonar de la enfermedad; sin embargo, la tuberculosis puede afectar prácticamente a cualquier órgano de la economía. Si bien la forma pulmonar es aún la más frecuente, otras formas como, por ejemplo, la tuberculosis pleural, ganglionar, abdominal (incluyendo aparato digestivo, peritoneo y ganglios), meníngea, osteoarticular y genitourinaria mantienen, por este orden, una incidencia significativa que obliga al médico a tenerlas en cuenta al realizar la valoración de un enfermo con clínica sugerente (AU)

Safety measures of L-carnitine L-tartrate supplementation in healthy men.

The purpose of this investigation was to examine the effects of ingestion of L-CARNIPURE (L-carnitine L-tartrate [LCLT]) on alterations in a complete blood cell profile and in circulating metabolic enzymes. Using a balanced, placebo (P), cross-over design (1 week washout), 10 healthy, active men volunteered and acted as their own control taking either a P or LCLT supplement (3 g.day(-1)) for 3 weeks. Postabsorptive morning blood samples were obtained both before and after 21 days of P and LCLT supplementation. Serum samples were analyzed for clinical chemistries including a complete chemistry panel with markers of liver and renal function along with various minerals and electrolytes. In addition, whole blood was analyzed for a complete blood count with differential. It was determined that there were no statistically significant differences between the LCLT and the placebo conditions for any of the variables examined. The results of this study suggest that LCLT, when used as a dietary supplement, has no adverse effects on metabolic and hematological safety variables in normally healthy men.

Effects of a high-fat diet on postabsorptive and postprandial testosterone responses to a fat-rich meal.

Postprandial testosterone concentrations have been shown to significantly decrease after a fat-rich meal, which may be due to inhibition of testosterone production by chylomicrons. We examined the effects of a high-fat diet known to reduce postprandial chylomicrons on the testosterone response to a fat-rich meal. Total testosterone (TT), free testosterone (FT), cortisol, and insulin responses to a high-fat test meal containing 5.44 MJ (1,300 kcal, 11% carbohydrate, 3% protein, 86% fat) were determined before (week 0) and after (week 8) an 8-week high-fat diet (64% fat) in 11 healthy men. The high-fat diet resulted in significant reductions in postabsorptive and postprandial serum triacylglycerols (55% and 50%, respectively). There were no significant changes in postabsorptive serum TT, FT, and cortisol, but insulin concentrations were significantly (P < or = .05) lower at week 8 (-28%). There was a significant reduction 1 hour after the fat-rich meal for TT (-22%) and FT (-23%), which remained significantly below baseline for 8 hours. Postprandial TT and FT responses were not significantly different after the 8-week high-fat diet. Postprandial serum cortisol concentrations were significantly reduced 1 hour after the meal. There were no significant differences before and after the high-fat diet. Insulin was significantly increased at the 0-, 1-, and 2-hour postprandial time points before and after the high-fat diet. Compared with week 0, insulin concentrations were significantly lower prior to and immediately after the fat-rich meal at week 8. These data indicate a fat-rich meal results in a prolonged reduction in TT and FT concentrations that is not altered by lowering postprandial chylomicrons. Alternative mechanisms (eg, higher uptake at the receptor level of cells) other than chylomicron-induced or insulin-induced inhibition of steroidogenesis are likely responsible for the reduction in TT and FT after a fat-rich meal.

Physiological responses to short-term exercise in the heat after creatine loading.

PURPOSE: This investigation was designed to examine the influence of creatine (Cr) supplementation on acute cardiovascular, renal, temperature, and fluid-regulatory hormonal responses to exercise for 35 min in the heat. METHODS: Twenty healthy men were matched and then randomly assigned to consume 0.3 g.kg(-1) Cr monohydrate (N = 10) or placebo (N = 10) for 7 d in a double-blind fashion. Before and after supplementation, both groups cycled for 30 min at 60-70% VO2(peak) immediately followed by three 10-s sprints in an environmental chamber at 37 degrees C and 80% relative humidity. RESULTS: Body mass was significantly increased (0.75 kg) in Cr subjects. Heart rate, blood pressure, and sweat rate responses to exercise were not significantly different between groups. There were no differences in rectal temperature responses in either group. Sodium, potassium, and creatinine excretion rates obtained from 24-h and exercise urine collection periods were not significantly altered in either group. Serum creatinine was elevated in the Cr group but within normal ranges. There were significant exercise-induced increases in cortisol, aldosterone, renin, angiotensin I and II, atrial peptide, and arginine vasopressin. The aldosterone response was slightly greater in the Cr (263%) compared with placebo (224%) group. Peak power was greater in the Cr group during all three 10-s sprints after supplementation and unchanged in the placebo group. There were no reports of adverse symptoms, including muscle cramping during supplementation or exercise. CONCLUSION: Cr supplementation augments repeated sprint cycle performance in the heat without altering thermoregulatory responses.

Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise.

STUDY DESIGN: A between groups design was used to compare recovery following eccentric muscle damage under 2 experimental conditions. OBJECTIVE: To determine if a compression sleeve donned immediately after maximal eccentric exercise would enhance recovery of physical function and decrease symptoms of soreness. BACKGROUND: Prior investigations using ice, intermittent compression, or exercise have not shown efficacy in relieving symptoms of delayed onset muscle soreness (DOMS). To date, no study has shown the effect of continuous compression on DOMS, yet this would offer a low cost intervention for patients suffering with the symptoms of DOMS. METHODS AND MEASURES: Twenty nonimpaired non-strength-trained women participated in the study. Subjects were matched for age, anthropometric data, and one repetition maximum concentric arm curl strength and then randomly placed into a control group (n = 10) or an experimental compression sleeve group (n = 10). Subjects were instructed to avoid pain-relieving modalities (eg, analgesic medications, ice) throughout the study. The experimental group wore a compressive sleeve garment for 5 days following eccentric exercise. Subjects performed 2 sets of 50 passive arm curls with the dominant arm on an isokinetic dynamometer with a maximal eccentric muscle action superimposed every fourth passive repetition. One repetition maximum elbow flexion, upper arm circumference, relaxed elbow angle, blood serum cortisol, creatine kinase, lactate dehydrogenase, and perception of soreness questionnaires were collected prior to the exercise bout and daily thereafter for 5 days. RESULTS: Creatine kinase was significantly elevated from the baseline value in both groups, although the experimental compression test group showed decreased magnitude of creatine kinase elevation following the eccentric exercise. Compression sleeve use prevented loss of elbow motion, decreased perceived soreness, reduced swelling, and promoted recovery of force production. CONCLUSIONS: Results from this study underline the importance of compression in soft tissue injury management.