Factors Associated with Musculoskeletal Injuries While Hiking with a Backpack at Philmont Scout Ranch.

INTRODUCTION: Participants at Philmont Scout Ranch embark on 12-d treks with pre-trek physical conditioning and medical clearance by their primary care physician. In this study, we investigated potential contributing factors to self-reported musculoskeletal injuries during a backpack trek. METHODS: This study was a prospective cohort study that used a 3-part survey administered to participants before, during, and after their trek from June through August 2019. Health history and demographic information were retrieved from each hiker's medical record. A logistic regression model was used to assess factors associated with injuries, and odds ratios and 95% confidence intervals were reported. RESULTS: There were 1206 individuals enrolled in this study, and none withdrew from participation. The median age of the participants was 17 y (interquartile range 15-47); 1130 were male, 75 were female, and 1 was of unknown sex. Injuries were reported by 7% (n=88) of participants while in the backcountry, with injuries occurring in various anatomic locations (knee, ankle, leg, foot, hand, arm). Participants without missing data (74%; n=897) were included in the logistical regression analysis to describe factors significantly associated with injury. Factors significantly associated with injury included greater backpack weight to body weight ratio, body mass index greater than 30 kg·m-2, and past injuries that required a doctor visit. CONCLUSIONS: Self-reported injuries while hiking at Philmont Scout Ranch are infrequent and do not often require evacuation or advanced medical care. Camp policies to maintain appropriate backpack weight and counseling of obese and previously injured individuals may mitigate injury occurrence.

Blood Pressure Changes While Hiking at Moderate Altitudes: A Prospective Cohort Study.

Recreational hiking in the mountains is a common activity, whether for a single day or for several days in a row. We sought to measure blood pressure (BP) response during a 10-day trek at moderate-altitude elevation (6500-13,000 feet) and observe for uncontrolled hypertension and/or adverse cardiovascular outcomes. A total of 1279 adult participants completed an observational study of resting BP during a 10-day trek in the Sangre de Cristo mountains. Following initial recruitment, participants were issued a trail data card to record BP measurements at day 0 (basecamp), day 3, day 6 and day 9. BP was measured using a sphygmomanometer and auscultation. Demographic data, height, weight, home altitude, daily water and sports drink intake, existence of pre-arrival hypertension and BP medication class were also recorded. We observed a rise in mean blood pressure for the cohort during all exposures to moderate altitudes. The increases were greatest for individuals with pre-existing hypertension and/or obesity. There were no observed life-threatening cardiovascular events for participants. We conclude that for individuals with a modestly controlled blood pressure of 160/95 mmHg, hiking at a moderate altitude is a safe activity.

Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations.

Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.

Appropriate utilisation of cardiac telemetry monitoring: a quality improvement project.

For hospitals located in the United States, appropriate use of cardiac telemetry monitoring can be achieved resulting in cost savings to healthcare systems. Our institution has a limited number of telemetry beds, increasing the need for appropriate use of telemetry monitoring to minimise delays in patient care, reduce alarm fatigue, and decrease interruptions in patient care. This quality improvement project was conducted in a single academic medical centre in Kansas City, Kansas. The aim of the project was to reduce inappropriate cardiac telemetry monitoring on intermediate care units. Using the 2004 American Heart Association guidelines to guide appropriate telemetry utilisation, this project team sought to investigate the effects of two distinct interventions to reduce inappropriate telemetry monitoring, huddle intervention and mandatory order entry. Telemetry utilisation was followed prospectively for 2 years. During our initial intervention, we achieved a sharp decline in the number of patients on telemetry monitoring. However, over time the efficacy of the huddle intervention subsided, resulting in a need for a more sustained approach. By requiring physicians to input indication for telemetry monitoring, the second intervention increased adherence to practice guidelines and sustained reductions in inappropriate telemetry use.

Persistent PR segment change in malignant pericardial disease.

BACKGROUND: Electrocardiographic changes may manifest in patients with pericardial effusions. PR segment changes are frequently overlooked, but when present, can provide diagnostic significance. The diagnostic value of PR segment changes in determining benign versus malignant pericardial disease in cancer patients with pericardial effusions has not been investigated. We aimed to determine the relationship between PR segment changes and malignant pericardial disease in cancer patients presenting with pericardial effusions. METHODS: Consecutive patients with active malignancy who underwent surgical subxiphoid pericardial window by a single thoracic surgeon between 2011 and 2014 were included in this study. A total of 104 pre- and post-operative ECGs were reviewed, and PR depression or elevation was defined by deviation of at least 0.5 millivolts from the TP segment using a magnifying glass. Pericardial fluid cytology, flow cytometry and tissue biopsy were evaluated. Baseline characteristics and co-morbidities were compared between cancer patients with benign and malignant pericardial effusions. RESULTS: A total of 26 patients with active malignancy and pericardial effusion who underwent pericardial window over the study period were included. Eighteen (69 %) patients had isoelectric PR segments, of whom none (0 %) had evidence of malignant pericardial disease (100 % negative predictive value). Eight (31 %) patients had significant ECG findings (PR segment depression in leads II, III and/or aVF as well as PR elevation in aVR/V1), all 8 (100 %) of whom had pathologically confirmed malignant pericardial disease (100 % positive predictive value). PR segment changes in all 8 patients persisted (up to 11 months) on post-operative serial ECGs. The PR segment changes had no relationship to heart rate or the time of atrial-ventricular conduction. CONCLUSIONS: In patients with active cancer presenting with pericardial effusion, the presence of PR segment changes is highly predictive of active malignant pericardial disease. When present, PR changes typically persist on serial ECGs even after pericardial window.

Expression of Disrupted-In-Schizophrenia-1, a schizophrenia-associated gene, is prominent in the mouse hippocampus throughout brain development.

DISC1 (Disrupted-In-Schizophrenia 1) has been associated with schizophrenia in multiple genetic studies. Studies from our laboratory have shown that Disc1, the mouse ortholog of DISC1, is highly expressed in the dentate gyrus of the hippocampus in the adult mouse brain. Because developmental dysfunction of the hippocampus is thought to play a major role in schizophrenia pathogenesis, and the dentate gyrus is a major locus for adult neurogenesis in the mouse, we investigated Disc1 expression during mouse brain development. Strikingly, Disc1 is strongly expressed in the hippocampus during all stages of hippocampal development, from embryonic day 14 through adulthood. Disc1 mRNA was detected in the dentate gyrus at all stages in which this structure was identifiable, as well as in the cornu ammonis (CA) fields of the hippocampus, the subiculum and adjacent entorhinal cortex, and the developing cerebral neocortex, hypothalamus, and olfactory bulbs, all of which also express Disc1 in the adult mouse brain. In addition, Disc1 mRNA was seen in regions of the developing mouse brain which do not express Disc1 during adulthood, regions including the bed nucleus of the stria terminalis, reticular thalamic nucleus and reuniens thalamic nucleus. These results demonstrate that Disc1 marks the hippocampus from its earliest stages, and suggest that developmental Disc1 dysfunction may lead to defects in hippocampal function that are associated with schizophrenia.

Identification and characterization of a second melanin-concentrating hormone receptor, MCH-2R.

Melanin-concentrating hormone (MCH) is a 19-aa cyclic neuropeptide originally isolated from chum salmon pituitaries. Besides its effects on the aggregation of melanophores in fish several lines of evidence suggest that in mammals MCH functions as a regulator of energy homeostasis. Recently, several groups reported the identification of an orphan G protein-coupled receptor as a receptor for MCH (MCH-1R). We hereby report the identification of a second human MCH receptor termed MCH-2R, which shares about 38% amino acid identity with MCH-1R. MCH-2R displayed high-affinity MCH binding, resulting in inositol phosphate turnover and release of intracellular calcium in mammalian cells. In contrast to MCH-1R, MCH-2R signaling is not sensitive to pertussis toxin and MCH-2R cannot reduce forskolin-stimulated cAMP production, suggesting an exclusive G(alpha)q coupling of the MCH-2R in cell-based systems. Northern blot and in situ hybridization analysis of human and monkey tissue shows that expression of MCH-2R mRNA is restricted to several regions of the brain, including the arcuate nucleus and the ventral medial hypothalamus, areas implicated in regulation of body weight. In addition, the human MCH-2R gene was mapped to the long arm of chromosome 6 at band 6q16.2-16.3, a region reported to be associated with cytogenetic abnormalities of obese patients. The characterization of a second mammalian G protein-coupled receptor for MCH potentially indicates that the control of energy homeostasis in mammals by the MCH neuropeptide system may be more complex than initially anticipated.

Expression of the type I diabetes-associated gene LRP5 in macrophages, vitamin A system cells, and the Islets of Langerhans suggests multiple potential roles in diabetes.

LRP5 is a novel member of the low-density lipoprotein receptor family that is genetically associated with Type 1 diabetes. As a start to defining the normal function of LRP5 and to generate testable hypotheses of its potential role in Type 1 diabetes pathogenesis, we carried out an extensive expression analysis of this gene at the mRNA and protein levels in normal human, monkey, and mouse, as well as in non-obese diabetic (NOD) mice at several stages of diabetes development. In all species, expression of LRP5 was found in four functionally important cell types: the distributed mononuclear phagocyte system, the islets of Langerhans, vitamin A-metabolizing cells, and CNS neurons. Given the critical role of macrophages in the onset and progression of islet cell destruction in Type 1 diabetes and the hypothesized role of retinoids as modifiers of diabetes progression, these findings suggest that LRP5 may confer Type 1 diabetes risk by altering the normal functioning of one or more of these regulatory systems. Specifically, given that the LRP5 polymorphisms associated with diabetes are in the promoter region of the gene, alterations in LRP5 expression may be responsible for diabetes susceptibility and therefore may be potential targets for therapeutic intervention. (J Histochem Cytochem 48:1357-1368, 2000)

Stimulation of the Na(+)-K(+) pump in cultured guinea pig airway smooth muscle cells by serotonin.

The effect of 5-hydroxytryptamine (5-HT) or serotonin on Na(+)-K(+) pump activity of airway smooth muscle was investigated by measuring (86)Rb(+) uptake in cultured guinea pig tracheal smooth muscle cells. (86)Rb(+) uptake consisted of three distinct components, one sensitive to ouabain, one to bumetanide, and one insensitive to either inhibitor. 5-HT induced a concentration-dependent increase in ouabain-sensitive (86)Rb(+) uptake (EC(50) = 21 nM) but had no effect on bumetanide-sensitive uptake, suggesting that it stimulates the Na(+)-K(+) pump but not the Na(+)-K(+)-Cl(-) cotransporter. Ouabain-sensitive uptake also was stimulated by the 5-HT(2A/2C) agonists 2,5-dimethoxy-4-iodoamphetamine and alpha-methyl-5-HT, but not by the 5-HT(1) agonist 5-carboxamidotryptamine, the 5-HT(1A/1B/2C) agonist 1-(3-chlorophenyl)piperazine, or the 5-HT(3) agonist 1-(3-chlorophenyl)biguanide. 5-HT-stimulated (86)Rb(+) uptake was inhibited by the 5-HT(2A) antagonists ketanserin and spiperone, but not by the 5-HT(1A) antagonist NAN 190 or the 5-HT(3) antagonist Y25310. 5-HT-stimulated (86)Rb(+) uptake was inhibited by reducing extracellular Na(+) concentration and by the Na(+)-H(+) exchange inhibitors dimethylamiloride and 5-(N-methyl-N-isobutyl)-amiloride. These observations suggest that 5-HT stimulates the Na(+)-K(+) pump of airway smooth muscle via 5-HT(2A) receptors by a mechanism dependent on Na(+) influx, possibly through the Na(+)-H(+) exchanger. Because stimulation of the Na(+)-K(+) pump produces hyperpolarization, this may represent a negative-feedback mechanism that opposes contraction in response to 5-HT.

Assessment of virus infection in cultured cells using metabolic monitoring.

A rapid, in-process assessment of virus replication is disired to quickly investigate the effects of process parameters on virus infection, and to monitor consistency of process in routine manufacturing of viral vaccines. Live virus potency assays are generally based on plaque formation, cytopathic effect, or antigen production (TCID(50)) and can take days to weeks to complete. Interestingly, when infected with viruses, cultured cells undergo changes in cellular metabolism that can be easily measured. These phenomena appear to be common as they has been observed in a variety of virus-host systems, e.g., in insect cells infected with baculovirus, Vero cells infected with Rotavirus, MRC-5 cells infected with Hepatitis A virus, and MRC-5 cells infected with the Varicella Zoster Virus (VZV). In this article, changes in glycolytic metabolism of MRC-5 cells as a result of CVZ infection are described. Both glucose consumption and lactate production in VZV infected MRC-5 cells are significantly elevated in comparison to uninfected cells. Based on this result, a rapid, in-process assay to follow VZV infection has been developed. The relative increase in lactate production in infected cells (α) increases as the infection progresses and then plateaus as the infection peaks. This plateau correlates with time of peak virus titer and could be used as a harvest triggering parameter in a virus production process.X(u) = cell density of uninfected cellsX(i) = cell density of infected cellsX(T) = total cell densityL(i) = cumulative lactate production in infected culturesL(u) = cumulative lactate production in uninfected culturesq(Li) = specific lactate production of infected cellsq(Lu) = specific lactate production of uninfected cellsk(1), K(2) = constants.

[Pediatric surgery and anesthesia in a day hospital]. / Chirurgie pédiatrique et anesthésie en hôpital de jour.

Day care surgery is an increasing service in our health structures. If we return to the source, we find the first important series has been published in 1906 (8,900 cases) without accident. Child is an ideal patient. So, more than 60% of paediatric surgery could benefit by ambulatory surgery. Recovery of mental abilities following general anaesthesia has not the same significance as in adult. Many studies confirm the safety of paediatric outpatient anaesthesia, but can we assert that children older than five years prefer ambulatory surgery? In the same way, are we sure that the cost cannot be cut and maybe other options used?

[The advantages and limits of the use of desmopressin (Minirin) in stomatology. Apropos 2 young female patients presenting with von Willebrand's disease]. / Intérêts et limites de l'utilisation de la desmopressine (Minirin) en stomatologie. A propos de deux jeunes patientes présentant une maladie de Willebrand.

The authors describe two cases of wisdom tooth germ removal in female adolescents presenting with von Willebrand's disease. The effect of the Minirin injection was studied during a preoperative test and allowed carrying out the operation with normalized hemostasis, without using substitution factors and with no postoperative complications. The authors specify the indications and limitations of the use of desmopressin before surgery.