When common things aren't so common: A case report of hepatopulmonary syndrome.

A 60-year-old smoker with a history of liver cirrhosis and chronic obstructive pulmonary syndrome (COPD) presented with hypoxic respiratory failure. This was felt secondary to an exacerbation of COPD. Despite treatment, the patient required 10 L of oxygen to achieve saturations of 88% on ambulation. Interstitial lung disease, pulmonary emboli and pulmonary hypertension were excluded as potential aetiologies of hypoxia. Given the history of cirrhosis, hepatopulmonary syndrome was postulated. Contrast echocardiography suggested an extracardiac shunt; a technetium-99m macroaggregated albumin scan confirmed the diagnosis.

Design of a thrombin resistant human acidic fibroblast growth factor (hFGF1) variant that exhibits enhanced cell proliferation activity.

Acidic fibroblast growth factors (FGF1s) are heparin binding proteins that regulate a wide array of key cellular processes and are also candidates for promising biomedical applications. FGF1-based therapeutic applications are currently limited due to their inherent thermal instability and susceptibility to proteases. Using a wide range of biophysical and biochemical techniques, we demonstrate that reversal of charge on a well-conserved positively charged amino acid, R136, in the heparin binding pocket drastically increases the resistance to proteases, thermal stability, and cell proliferation activity of the human acidic fibroblast growth factor (hFGF1). Two-dimensional NMR data suggest that the single point mutations at position-136 (R136G, R136L, R136Q, R136K, and R136E) did not perturb the backbone folding of hFGF1. Results of the differential scanning calorimetry experiments show that of all the designed R136 mutations only the charge reversal mutation, R136E, significantly increases (ΔTm = 7 °C) the thermal stability of the protein. Limited trypsin and thrombin digestion results reveal that the R136E mutation drastically increases the resistance of hFGF1 to the action of the serine proteases. Isothermal titration calorimetry data show that the R136E mutation markedly decreases the heparin binding affinity of hFGF1. Interestingly, despite lower heparin binding affinity, the cell proliferation activity of the R136E variant is more than double of that exhibited by either the wild type or the other R136 variants. The R136E variant due to its increased thermal stability, resistance to proteases, and enhanced cell proliferation activity are expected to provide valuable clues for the development of hFGF1- based therapeutics for the management of chronic diabetic wounds.

Health behaviour mediates the relationship between Type D personality and subjective health in the general population.

Type D personality is associated with unhealthy behaviour and poor subjective health in the general population. This study investigated whether health behaviour mediates the relationship between Type D and subjective health. There were 217 participants who completed measures of Type D, health-related behaviour, physical symptoms and quality of life. Type D individuals reported significantly less healthy behaviour and significantly poorer subjective health than non-Type Ds. In addition, it was found that health behaviour partially mediates these relationships. The study demonstrates that health behaviour may partly explain the relationship between Type D and poor health outcomes.

Dyslipidemia and Diabetic Macular Edema: A Systematic Review and Meta-Analysis.

TOPIC: A systematic review and meta-analysis of dyslipidemia and diabetic macular edema (DME). CLINICAL RELEVANCE: Diabetic macular edema causes impairment of vision in patients with diabetes, and dyslipidemia has been reported as a risk factor for its development. A systematic review with a meta-analysis was undertaken to examine the evidence of an association between dyslipidemia and DME. METHODS: We defined eligibility criteria as randomized controlled trials (RCTs) and cohort, case-control, and cross-sectional studies reporting on the relationship between blood lipid levels and DME. We performed a literature search in MEDLINE, PubMed, and Embase from inception to September 2014. We used the Newcastle-Ottawa scale to assess the quality of case-control, cross-sectional, and cohort studies, and the Cochrane risk of bias tool for RCTs. RESULTS: The search strategy identified 4959 publications. After screening, we selected 21 articles for review (5 cross-sectional, 5 cohort, 7 case-control, and 4 RCTs). Meta-analysis of case-control studies revealed that mean levels of total serum cholesterol (TC), low-density lipoproteins (LDLs), and serum triglycerides (TGs) were significantly higher in patients with DME compared with those without DME (TC: 30.08; 95% confidence interval [CI], 21.14-39.02; P < 0.001; LDL: 18.62; 95% CI, 5.80-31.43; P < 0.05; TG: 24.82; 95% CI, 9.21-40.42; P < 0.05). Meta-analysis of RCTs did not show significant risk in worsening of hard exudates and severity of DME in the lipid-lowering group compared with placebo (hard exudates: relative risk, 1.00; 95% CI, 0.47-2.11; P = 1.00; DME: relative risk, 1.18; 95% CI, 0.75-1.86; P = 0.48). CONCLUSIONS: Despite evidence from the cohort studies and meta-analysis of the case-control studies suggesting a strong relationship between lipid levels and DME, this was not confirmed by the meta-analysis that included only prospective RCTs. Therefore, given the significant public health relevance of the topic, the relationship between lipid levels and DME deserves further investigation.

Blood lactate, heart rate and rating of perceived exertion responses of elite surf lifesavers to high-performance competition.

A paucity of empirical research exists into surf lifesaving competition from which coaches and athletes may formulate training and recovery strategies. Seventeen (male=9; female=8) high-performance surf lifesavers (21.2+/-3.9 years) contested multiple rounds of team and individual events at a 2-day surf lifesaving competition. Individual events consisted of the multi-discipline ironman (IRON), paddle board (BOARD) and surf swim (SWIM). Blood lactate (BLa), rating of perceived exertion (RPE) and heart rate (HR) were determined following heats, semi-finals and final. IRON HR and RPE following semi-finals (153.0+/-21.6beatsmin(-1) and 14.4+/-1.5) and final (171.0+/-9.1beatsmin(-1) and 19.1+/-0.2) were greater than heats (141.8+/-17.2beatsmin(-1) and 12.0+/-1.9; p<0.05) and final BLa (10.5+/-2.8mmolL(-1)) was greater than heats (5.8+/-3.6mmolL(-1); p<0.05). BOARD BLa and HR were greater after the final (9.0+/-2.8mmolL(-1) and 159.0+/-19.9beatsmin(-1)) compared to heats (4.7+/-2.4mmolL(-1) and 133.0+/-17.1beatsmin(-1); p<0.05). No significant differences were identified for SWIM. RPE-HR relationships were identified for pooled IRON and BOARD results following semi-finals (0.668; p<0.05) and finals (r=0.741; p<0.05). In conclusion, high-performance surf lifesavers employ race strategies with all-out maximal exercise limited to semi-finals and finals.

Physiological responses to 1000-m ergometer time-trial performance in outrigger canoeing.

Graded exercise tests are commonly used to assess peak physiological capacities of athletes. However, unlike time trials, these tests do not provide performance information. The aim of this study was to examine the peak physiological responses of female outrigger canoeists to a 1000-m ergometer time trial and compare the time-trial performance to two graded exercise tests performed at increments of 7.5 W each minute and 15 W each two minutes respectively. 17 trained female outrigger canoeists completed the time trial on an outrigger canoe ergometer with heart rate (HR), stroke rate, power output, and oxygen consumption (VO2) determined every 15 s. The mean (+/- s) time-trial time was 359 +/- 33 s, with a mean power output of 65 +/- 16 W and mean stroke rate of 56 +/- 4 strokes min(-1). Mean values for peak VO2, peak heart rate, and mean heart rate were 3.17 +/- 0.67 litres min(-1), 177 +/- 11 beats min(-1), and 164 +/- 12 beats min(-1) respectively. Compared with the graded exercise tests, the time-trial elicited similar values for peak heart rate, peak power output, peak blood lactate concentration, and peak VO2. As a time trial is sport-specific and can simultaneously quantify sprint performance and peak physiological responses in outrigger canoeing, it is suggested that a time trial be used by coaches for crew selection as it doubles as a reliable performance measure and a protocol for monitoring peak aerobic capacity of female outrigger canoeists.

Effects of a 12-month exercise program on cardiorespiratory health indicators of Vietnam War veterans resident in the tropics.

OBJECTIVE: To measure the effect of a combined aerobic and resistance exercise program on key cardiovascular disease risk factors (i.e. body composition or anthropometry and cardiorespiratory function) of Australian male, Vietnam War veterans living in the tropics. DESIGN: Twelve-month exercise program with assessments at commencement, 3, 6 and 12 months. SETTING: North Queensland regional centre. PARTICIPANTS: Australian male, Vietnam War veterans (n = 164) resident in north Queensland. MAIN OUTCOME MEASURES: Measurement of heart rate, blood pressure, skinfold and girth measurements, exercise heart rate response and estimated aerobic capacity to determine whether the implementation of a simple aerobic and resistance exercise program could positively change selected cardiovascular disease risk factors in Vietnam Veterans. RESULTS: Significant improvements were reported for systolic blood pressure (131.1 (SD 15.7) reduced to 122.7 (12.4) mmHg), diastolic blood pressure (82.7 (9.1) reduced to 76.3 (10.3) mmHg), resting heart rate (73 (11) reduced to 69 (11) bpm), sum of skinfolds (127.5 (40.3) reduced to 99.5 (32.1) mm), waist girth (103.2 (12.0) reduced to 100.5 (12.1) cm), hip girth (105.3 (9.6) reduced to 103.7 (10.4) cm) and aerobic capacity (2.17 (0.39) increased to 2.36 (0.34) L min(-1)). CONCLUSION: Participation in a combined aerobic and resistance training program elicited significant anthropometric and cardiorespiratory benefits that might lead to a decreased risk of developing cardiovascular disease for male Vietnam War veterans resident in rural and regional areas.

Comparison of physiological responses to graded exercise test performance in outrigger canoeing.

The aim of this study was to establish a graded exercise test protocol for determining the peak physiological responses of female outrigger canoeists. Seventeen trained female outrigger canoeists completed two outrigger ergometer graded exercise test protocols in random order: (1) 25 W power output for 2 min increasing by 7.5 W every minute until exhaustion; and (2) 25 W power output for 2 min increasing by 15 W every 2 min to exhaustion. Heart rate and power output were recorded every 15 s. Expired air was collected continuously and sampled for analysis at 15-s intervals, while blood lactate concentration was measured immediately after and 3, 5, and 7 min after exercise. The peak physiological and performance variables examined included peak oxygen uptake (VO2peak), minute ventilation, tidal volume, ventilatory thresholds 1 and 2, respiratory rate, respiratory exchange ratio, heart rate, blood lactate concentration, power output, performance time, and time to VO2peak. There were no significant differences in peak physiological responses, ventilatory thresholds or performance variables between the two graded exercise test protocols. Despite no significant differences between protocols, due to the large limits of agreement evident between protocols for the peak physiological responses, it is recommended that the same protocol be used for all comparison testing to minimize intra-individual variability of results.

Kinematics of the field hockey penalty corner push-in.

The aims of the study were to determine those variables that significantly affect push-in execution and thereby formulate coaching recommendations specific to the push-in. Two 50 Hz video cameras recorded transverse and longitudinal views of push-in trials performed by eight experienced and nine inexperienced male push-in performers. Video footage was digitized for data analysis of ball speed, stance width, drag distance, drag time, drag speed, centre of massy displacement and segment and stick displacements and velocities. Experienced push-in performers demonstrated a significantly greater (p < 0.05) stance width, a significantly greater distance between the ball and the front foot at the start of the push-in and a significantly faster ball speed than inexperienced performers. In addition, the experienced performers showed a significant positive correlation between ball speed and playing experience and tended to adopt a combination of simultaneous and sequential segment rotation to achieve accuracy and fast ball speed. The study yielded the following coaching recommendations for enhanced push-in performance: maximize drag distance by maximizing front foot-ball distance at the start of the push-in; use a combination of simultaneous and sequential segment rotations to optimise both accuracy and ball speed and maximize drag speed.