Could "cellular exercise" be the missing ingredient in a healthy life? Diets, caloric restriction, and exercise-induced hormesis.

Overnutrition is a poor dietary habit that has been correlated with increased health risks, especially in the developed world. This leads to an imbalance between energy storage and energy breakdown. Many biochemical processes involving hormones are involved in conveying the excess of energy into pathologic states, mainly atherosclerosis, hypertension, cardiovascular diseases, and diabetes. Diverse modalities of regular exercise have been shown to be beneficial, to varying extents, in overcoming the overnutrition comorbidities. Cellular exercises and hormesis are triggered by dietary protocols that could underlie the cellular mechanisms involved in modulating the deleterious effects of overnutrition through activation of specific cellular signal pathways. Of interest are the oxidative stress signaling, nuclear factor erythroid-2, insulin-like growth factor-1, AMP-activated protein kinase as well as sirtuins and nuclear factor-κB. Therefore, the value of intermittent fasting diets as well as different diet regimens inducing hormesis are evaluated in terms of their beneficial effects on health and longevity. In parallel, important effects of diets on the immune system are explored as essential components that can undermine the overall health outcome. Additionally, the subtle but relevant relation between diet and sleep is investigated for its impact on the cardiovascular system and quality of life. The aim of this review is to focus on how calorie restriction triggers multiple molecular pathways that ultimately lead to hormetic effects resulting in cell longevity and resistance to cardiovascular disease, stroke, and cancer.

Alcoholism: A Multi-Systemic Cellular Insult to Organs.

Alcohol abuse can affect more than the heart and the liver. Many observers often do not appreciate the complex and differing aspects of alcohol's effects in pathophysiologies that have been reported in multiple organs. Chronic alcohol abuse is known to be associated with pathophysiological changes that often result in life-threatening clinical outcomes, e.g., breast and colon cancer, pancreatic disease, cirrhosis of the liver, diabetes, osteoporosis, arthritis, kidney disease, immune system dysfunction, hypertension, coronary artery disease, cardiomyopathy, and can be as far-reaching as to cause central nervous system disorders. In this review article, we will discuss the various organs impacted by alcohol abuse. The lack of clear guidelines on the amount and frequency of alcohol intake, complicated by personal demographics, make extrapolations to real-life practices at best difficult for public health policy-makers.

Optimizing CT Pulmonary Angiogram Utilization in a Community Emergency Department: A Pre- and Postintervention Study.

PURPOSE: Optimizing the utilization of CT pulmonary angiogram (CTPA) for the diagnosis and workup of acute chest pain can provide an opportunity to reduce unnecessary radiation and health care system expense. METHODS: An attempt to improve CTPA utilization began by measuring overall department and clinician-specific utilization. This was bolstered by retrospectively evaluating patient charts for pulmonary embolism scoring criteria and D-dimer utilization so as to better understand gaps in diagnostic workup. The department-wide and individualized metrics were then provided to each emergency department clinician and differences between the pre- and postintervention data were evaluated. RESULTS: The percentage of positive CTPAs did not change significantly at 8.7% and 9.2% in the pre- and postintervention groups, respectively. Similarly, the workup of patients based on retrospective PERC and Wells-score criteria did not significantly improve after the intervention. However, the percentage of CTPAs ordered on low D-dimer patients did decrease significantly post-intervention. Further observational analysis uncovered marked variability in clinician ordering behavior and diagnostic rates. CONCLUSIONS: Overall, such an intervention seems to have a limited, though not insignificant, impact on the workup of suspected pulmonary embolism. Calculating provider-specific utilization metrics allows both the radiologist and clinician to better understand opportunities to improve health care delivery.

Teaching cost-conscious medicine: impact of a simple educational intervention on appropriate abdominal imaging at a community-based teaching hospital.

BACKGROUND: Rising costs pose a major threat to US health care. Residency programs are being asked to teach residents how to provide cost-conscious medical care. METHODS: An educational intervention incorporating the American College of Radiology appropriateness criteria with lectures on cost-consciousness and on the actual hospital charges for abdominal imaging was implemented for residents at Scripps Mercy Hospital in San Diego, CA. We hypothesized that residents would order fewer abdominal imaging examinations for patients with complaints of abdominal pain after the intervention. We analyzed the type and number of abdominal imaging studies completed for patients admitted to the inpatient teaching service with primary abdominal complaints for 18 months before (738 patients) and 12 months following the intervention (632 patients). RESULTS: There was a significant reduction in mean abdominal computed tomography (CT) scans per patient (1.7-1.4 studies per patient, P < .001) and total abdominal radiology studies per patient (3.1-2.7 studies per patient, P  =  .02) following the intervention. The avoidance of charges solely due to the reduction in abdominal CT scans following the intervention was $129 per patient or $81,528 in total. CONCLUSIONS: A simple educational intervention appeared to change the radiologic test-ordering behavior of internal medicine residents. Widespread adoption of similar interventions by residency programs could result in significant savings for the health care system.

CT imaging: radiation risk reduction--real-life experience in a metropolitan outpatient imaging network.

The exponential growth of CT imaging has been fueled by recent technical advances, improved diagnostic accuracy, and medicolegal pressures. CT imaging has replaced many more invasive and expensive tests and has proven itself an indispensable part of diagnostic medicine. This growth in CT imaging, however, has also been accompanied by an unavoidable increased cumulative radiation exposure to the general public. It is important to fully understand the risks and benefits of and alternatives to CT imaging so that an informed decision can be made. A number of simple strategies may be used to minimize radiation exposure during CT imaging. These include protocol redesign and CT dose adjustments on the basis of each patient's body mass index, limiting length of coverage and multiphase examinations, and iterative reconstruction. At Imaging Healthcare Specialists, a highly successful program of radiation dose reduction was created, and dose savings of up to 90% have been achieved in select patients while maintaining diagnostic image quality. The approach is simple, reproducible, and inexpensive.