Oral Prescription Opioids as a High-Risk Indicator for Hepatitis C Infection: Another Step Toward HCV Elimination.

BACKGROUND: The opioid epidemic across the U.S. poses an array of public health concerns, especially HCV transmission. HCV is now widely curable, yet incident rates are increasing due to the opioid epidemic. Despite the established trajectory from oral prescription opioids (OPOs) to opioid use disorder (OUD), OUD to injection drug use (IDU), and IDU to hepatitis C virus (HCV), OPOs are not a defined risk factor (RF) for HCV infection. The objective of this study was to observe rates of HCV testing and Ab reactivity (HCVAb+) in patients receiving OPOs to substantiate them as a RF, ultimately contributing to HCV elimination. METHODS: Data from MedStar Health patients receiving OPOs from 1/2017 to 12/2018 were collected and analyzed using chi-squared or student t-tests and logistic regression for uni- or multi-variable analyses, respectively. Statistical significance was defined as P < .05; Epi Info and SAS v 9·4 were used for statistical analyses; IRB approval was received. RESULTS: There were 115 415 individuals prescribed OPOs over the study period. In this population, 8.6% (932) were HCVAb+ when tested and not previously diagnosed (10 900); 3.4% (3893) had an OUD diagnosis, 20.6% (803) of whom were HCV tested; 25.4% (361) of all HCVAb+ (1421) had an OUD diagnosis. OUD (ORadj 8.53 [7.22-10.07]) was an independent predictor of HCVAb+ in this population. CONCLUSIONS: (1) In a large population prescribed oral opioids, HCVAb+ was 8.6%, higher than our previously published data (2.5%) and the US rate (1.7%); (2) only 20% of patients diagnosed with OUD were tested; and (3) only 25% of HCVAb+ patients were classified with OUD; this suggests underreporting of OUD in this population. Primary Care and Community Health Recommendations: (1) Re-testing for HCV in patients taking OPOs; (2) increased HCV testing among OUD patients; and (3) improved surveillance and reporting of OUD.

Single muscle fiber gene expression with run taper.

This study evaluated gene expression changes in gastrocnemius slow-twitch myosin heavy chain I (MHC I) and fast-twitch (MHC IIa) muscle fibers of collegiate cross-country runners (n = 6, 20±1 y, VO2max = 70±1 ml•kg-1•min-1) during two distinct training phases. In a controlled environment, runners performed identical 8 kilometer runs (30:18±0:30 min:s, 89±1% HRmax) while in heavy training (∼72 km/wk) and following a 3 wk taper. Training volume during the taper leading into peak competition was reduced ∼50% which resulted in improved race times and greater cross-section and improved function of MHC IIa fibers. Single muscle fibers were isolated from pre and 4 hour post run biopsies in heavily trained and tapered states to examine the dynamic acute exercise response of the growth-related genes Fibroblast growth factor-inducible 14 (FN14), Myostatin (MSTN), Heat shock protein 72 (HSP72), Muscle ring-finger protein-1 (MURF1), Myogenic factor 6 (MRF4), and Insulin-like growth factor 1 (IGF1) via qPCR. FN14 increased 4.3-fold in MHC IIa fibers with exercise in the tapered state (P<0.05). MSTN was suppressed with exercise in both fiber types and training states (P<0.05) while MURF1 and HSP72 responded to running in MHC IIa and I fibers, respectively, regardless of training state (P<0.05). Robust induction of FN14 (previously shown to strongly correlate with hypertrophy) and greater overall transcriptional flexibility with exercise in the tapered state provides an initial molecular basis for fast-twitch muscle fiber performance gains previously observed after taper in competitive endurance athletes.

Intermonitor reliability of the GT3X+ accelerometer at hip, wrist and ankle sites during activities of daily living.

The triaxial GT3X+ accelerometer can measure activity counts in the vertical, horizontal right to left, horizontal front to back planes, and can generate a summative score of the three axes represented by vector magnitude (VM). Information on the reliability of the GT3X+ at the hip, wrist and ankle sites, over all axes and VM during activities of daily living (ADL) is lacking in the literature. Forty healthy adults (14 men and 26 women) were randomly assigned to perform 10 of 20 ADL (consisting of sedentary, housework, yard work, locomotive and recreational activities) while wearing two monitors on the hip, wrist and ankle. Subjects performed each ADL over 7 min and the mean activity counts during the last 4 min were used for analyses. Average intraclass correlations between monitors were high for the three sites for each axis and VM (hip: 0.943, 0.857, 0.864 and 0.966, respectively; wrist: 0.994, 0.963, 0.961 and 0.989, respectively; ankle: 0.977, 0.979, 0.927 and 0.986, respectively). These data suggest that GT3X+ accelerometers measurements made from the hip, wrist and ankle sites are reliable during ADL across all axes and VM.

Influence of Differences in Exercise-intensity and Kilograms/Set on Energy Expenditure During and After Maximally Explosive Resistance Exercise.

With resistance exercise, greater intensity typically elicits increased energy expenditure, but heavier loads require that the lifter perform more sets of fewer repetitions, which alters the kilograms lifted per set. Thus, the effect of exercise-intensity on energy expenditure has yielded varying results, especially with explosive resistance exercise. This study was designed to examine the effect of exercise-intensity and kilograms/set on energy expenditure during explosive resistance exercise. Ten resistance-trained men (22±3.6 years; 84±6.4 kg, 180±5.1 cm, and 13±3.8 %fat) performed squat and bench press protocols once/week using different exercise-intensities including 48% (LIGHT-48), 60% (MODERATE-60), and 72% of 1-repetition-maximum (1-RM) (HEAVY-72), plus a no-exercise protocol (CONTROL). To examine the effects of kilograms/set, an additional protocol using 72% of 1-RM was performed (HEAVY-72MATCHED) with kilograms/set matched with LIGHT-48 and MODERATE-60. LIGHT-48 was 4 sets of 10 repetitions (4×10); MODERATE-60 4×8; HEAVY-72 5×5; and HEAVY-72MATCHED 4×6.5. Eccentric and concentric repetition speeds, ranges-of-motion, rest-intervals, and total kilograms were identical between protocols. Expired air was collected continuously throughout each protocol using a metabolic cart, [Blood lactate] using a portable analyzer, and bench press peak power were measured. Rates of energy expenditure were significantly greater (p≤0.05) with LIGHT-48 and HEAVY-72MATCHED than HEAVY-72 during squat (7.3±0.7; 6.9±0.6 > 6.1±0.7 kcal/min), bench press (4.8±0.3; 4.7±0.3 > 4.0±0.4 kcal/min), and +5min after (3.7±0.1; 3.7±0.2 > 3.3±0.3 kcal/min), but there were no significant differences in total kcal among protocols. Therefore, exercise-intensity may not effect energy expenditure with explosive contractions, but light loads (~50% of 1-RM) may be preferred because of higher rates of energy expenditure, and since heavier loading requires more sets with lower kilograms/set.