RESUMEN
Forty-seven percent of volunteer firefighter line of duty deaths are caused by cardiovascular events. Aggressive cardiovascular disease (CVD) risk factor reduction and improved physical fitness could reduce CVD mortality within this population. We assessed CVD risk factors and physical fitness in a large cohort of volunteer firefighters to help establish a health and fitness profile of this population, which may serve as evidence for the need to initiate programs aimed at reducing morbidity and mortality caused by CVD in the volunteer fire service. Seventy-four male volunteer firefighters were assessed for eight CVD risk factors and anthropometric characteristics. Physical fitness was assessed via push-ups, sit-ups, and the YMCA step test. Sixty-eight percent of the firefighters had two or more CVD risk factors. The sample was considered obese via body fat percentage (25.3 ± 5.7%), 27% were hypertensive, 30% had hypercholesterolemia, and 46% were sedentary. The average number of sit-ups performed was 27.3 ± 10.5, which was ranked in the 25th percentile. The average heart rate after the YMCA step test was 160.2 ± 14.6 bpm, which was ranked very poor. The number of CVD risk factors and poor physical fitness in this cohort of volunteer firefighters was noteworthy. Most volunteer firefighters in our sample were at elevated risk for CVD and had inadequate physical fitness. This evidence conveys the need to initiate physical activity and nutrition outreach programs, led by health and fitness professionals, aimed at reducing firefighter morbidity and mortality within the volunteer fire service.
RESUMEN
BACKGROUND: As hepatic surgery has become safer and more commonly performed, the extent of hepatic resections has increased. When there is not enough expected hepatic reserve to facilitate primary resection of hepatic tumors, a clinical adjunct to facilitating primary resection is portal vein embolization (PVE). PVE allows the hepatic remnant to increase to an appropriate size prior to resection via hepatocyte regeneration; however, PVE is not always successful in facilitating adequate regeneration. One of the strongest trophic factors for hepatocyte regeneration is hepatocyte growth factor (HGF). The purpose of this study was to improve hepatic regeneration with perioperative HGF infusions in an animal model that mimics PVE. METHODS: Portal branch ligation (PBL) in rodents is equivalent to PVE in humans. We performed left-sided PBL in Sprague-Dawley rodents with the experimental group receiving perioperative HGF infusions. Baseline and postoperative liver volumetrics were obtained with CT scanning methods as performed in clinical practice. Baseline and postoperative liver functions were assessed via indocyanine green (ICG) elimination testing. RESULTS: HGF infused rodents had statistically significant increase in all postoperative liver volumetrics. Most clinically relevant were increased right liver volumes (RLV), 14.10 versus 7.85 cm3 (p value 0.0001), and increased degree of hypertrophy (DH %), 159.23 versus 47.11 % (p value 0.0079). HGF infused rodents also had a quick return to baseline liver function, 2.38 days compared to 6.13 days (p value 0.0001). CONCLUSION: Perioperative HGF infusions significantly increase hepatic regeneration following PBL in rodents. Perioperative HGF infusions following PVE are a possible adjunct to increase the amount of patients able to successfully undergo primary resection for hepatic tumors. Further basic science is warranted in examining the use of HGF infusions to increase hepatic regeneration and translating that basic science work to clinical practice.
