Clinical Outcomes After Acute Coronary Syndromes or Revascularization Among People Living With HIV: A Systematic Review and Meta-Analysis.

Importance: Clinical outcomes after acute coronary syndromes (ACS) or percutaneous coronary interventions (PCIs) in people living with HIV have not been characterized in sufficient detail, and extant data have not been synthesized adequately. Objective: To better characterize clinical outcomes and postdischarge treatment of patients living with HIV after ACS or PCIs compared with patients in an HIV-negative control group. Data Sources: Ovid MEDLINE, Embase, and Web of Science were searched for all available longitudinal studies of patients living with HIV after ACS or PCIs from inception until August 2023. Study Selection: Included studies met the following criteria: patients living with HIV and HIV-negative comparator group included, patients presenting with ACS or undergoing PCI included, and longitudinal follow-up data collected after the initial event. Data Extraction and Synthesis: Data extraction was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Clinical outcome data were pooled using a random-effects model meta-analysis. Main Outcome and Measures: The following clinical outcomes were studied: all-cause mortality, major adverse cardiovascular events, cardiovascular death, recurrent ACS, stroke, new heart failure, total lesion revascularization, and total vessel revascularization. The maximally adjusted relative risk (RR) of clinical outcomes on follow-up comparing patients living with HIV with patients in control groups was taken as the main outcome measure. Results: A total of 15 studies including 9499 patients living with HIV (pooled proportion [range], 76.4% [64.3%-100%] male; pooled mean [range] age, 56.2 [47.0-63.0] years) and 1 531 117 patients without HIV in a control group (pooled proportion [range], 61.7% [59.7%-100%] male; pooled mean [range] age, 67.7 [42.0-69.4] years) were included; both populations were predominantly male, but patients living with HIV were younger by approximately 11 years. Patients living with HIV were also significantly more likely to be current smokers (pooled proportion [range], 59.1% [24.0%-75.0%] smokers vs 42.8% [26.0%-64.1%] smokers) and engage in illicit drug use (pooled proportion [range], 31.2% [2.0%-33.7%] drug use vs 6.8% [0%-11.5%] drug use) and had higher triglyceride (pooled mean [range], 233 [167-268] vs 171 [148-220] mg/dL) and lower high-density lipoprotein-cholesterol (pooled mean [range], 40 [26-43] vs 46 [29-46] mg/dL) levels. Populations with and without HIV were followed up for a pooled mean (range) of 16.2 (3.0-60.8) months and 11.9 (3.0-60.8) months, respectively. On postdischarge follow-up, patients living with HIV had lower prevalence of statin (pooled proportion [range], 53.3% [45.8%-96.1%] vs 59.9% [58.4%-99.0%]) and ß-blocker (pooled proportion [range], 54.0% [51.3%-90.0%] vs 60.6% [59.6%-93.6%]) prescriptions compared with those in the control group, but these differences were not statistically significant. There was a significantly increased risk among patients living with HIV vs those without HIV for all-cause mortality (RR, 1.64; 95% CI, 1.32-2.04), major adverse cardiovascular events (RR, 1.11; 95% CI, 1.01-1.22), recurrent ACS (RR, 1.83; 95% CI, 1.12-2.97), and admissions for new heart failure (RR, 3.39; 95% CI, 1.73-6.62). Conclusions and Relevance: These findings suggest the need for attention toward secondary prevention strategies to address poor outcomes of cardiovascular disease among patients living with HIV.

Retrospective Review on the Safety and Efficacy of Nitrofurantoin for the Treatment of Cystitis in the Veteran Population With or Without Renal Insufficiency.

BACKGROUND: The emergence of antimicrobial resistance in uropathogens has generated interest in the use of nitrofurantoin in controversial populations, such as in males and those with renal dysfunction. The purpose of this study was to compare the efficacy and safety of nitrofurantoin for the treatment of cystitis in males and females with variable degrees of renal dysfunction. METHODS: A retrospective chart review was conducted in adult patients who received nitrofurantoin for acute cystitis in the outpatient setting. The primary outcome was clinical cure compared between males and females and across various renal function groups (creatinine clearances [CrCl] >60 mL/min, 30-60 mL/min, and <30 mL/min) following nitrofurantoin treatment. The secondary outcome was adverse events. RESULTS: A total of 446 patients were included, with 278 females and 168 males. The overall clinical cure rate was 86.5% (95% CI, 83.0%-89.4%; n = 386). The clinical cure rate did not vary between genders (odds ratio [OR], 0.6; 95% CI 0.35-1.04; P = .085) or between patients with a CrCl >60 mL/min compared with those with CrCl 30-60 mL/min (OR, 1.01; 95% CI, 0.40-2.44; P = 1). The 1 patient with a CrCl <30 mL/min was not included in the analysis. A history of benign prostatic hyperplasia (OR, 0.5; 95% CI, 0.26-0.99; P = .045) or cirrhosis (OR, 0.21; 95% CI, 0.06-0.82; P = .025) was associated with decreased odds of clinical cure. Adverse events occurred in 2% (n = 9) of patients. CONCLUSIONS: There was no statistically significant difference in clinical cure with nitrofurantoin between genders or various renal functions.

Adherence to clinical practice guidelines for the treatment of candidemia at a Veterans Affairs Medical Center.

OBJECTIVES: The primary objective of this study was to examine the appropriateness of candidemia management at a Veterans Affairs Medical Center as recommended by the 2009 Infectious Diseases Society of America (IDSA) guidelines for treatment of Candida infections. METHODS: A retrospective analysis of 94 adult patients with blood cultures positive for Candida spp. was performed. Patients were stratified by severity of disease into two groups: non-neutropenic, mild-moderate disease (Group 1, n = 54, 56%) and non-neutropenic, moderate-severe disease (Group 2, n = 40, 42%). RESULTS: Adherence to the IDSA recommendations for recommended antifungal drug, dose, and duration of therapy was low in both groups (16.7% in Group 1 and 17.5% in Group 2). Although adherence was not associated with higher clinical resolution of infection (P = 0.111), it was associated with a significantly lower mortality rate (P = 0.001) when compared to variance from the guidelines at 6 weeks. CONCLUSION: Although adherence to published guidelines for treating patients with candidemia was suboptimal at our institution, patients that were managed based on the guidelines had a statistically lower mortality rate.

Methicillin-Resistant Staphylococcus aureus in Foot Osteomyelitis.

BACKGROUND: Conflicting studies exist regarding the impact of methicillin-resistant Staphylococcus aureus (MRSA) on increased time to wound healing, future need for surgical procedures, and likelihood of treatment failure in patients with diabetic foot osteomyelitis. The purpose of this study is to determine the overall significance of MRSA in predicting treatment failure in bone infections of the foot and to determine an appropriate pre-operative and empiric post-operative antibiotic regimen. PATIENTS AND METHODS: Patients presenting with an initial episode of "probable" or "definite" foot osteomyelitis were included for review and analysis if the following criteria were met: (1) Osteomyelitis occurred in the foot (i.e., distal to the malleoli of the ankle); episodes occurring above the ankle were excluded. (2) Patients received either no antibiotics or only oral antibiotics for long-term treatment; episodes managed with long-term parenteral antibiotics were excluded. (3) The infection was managed initially with medical therapy or conservative surgical therapy; episodes managed with major (above-ankle) amputation as the initial treatment were excluded. The primary objective of this study was to assess whether episodes of foot osteomyelitis associated with MRSA resulted in treatment failure more frequently than not. RESULTS: Of 178 episodes included in the study, 50 (28.1%) episodes had treatment failure. Median time-to-treatment failure was 60 days (range 7-598 days). In 28.1% (9/32 episodes) in which treatment failure occurred and 39.0% (41/105) episodes in which no treatment failure occurred, MRSA was present. The presence of MRSA was not significantly associated with treatment failure (p = 0.99). CONCLUSIONS: The presence of MRSA in bone culture and whether antibiotic use had anti-MRSA activity was not associated with increased treatment failure of diabetic foot osteomyelitis in our institution. Empiric antibiotic coverage of MRSA may not be necessary for many patients presenting with foot osteomyelitis.

Prevalence of bronchoconstriction induced by eucapnic voluntary hyperpnoea in recreationally active individuals.

OBJECTIVE: Exercise-induced bronchoconstriction (EIB) is more prevalent in elite athletes than in the general population. Many of these athletes provide a positive eucapnic voluntary hyperpnoea (EVH) challenge without previous diagnosis of EIB. It is unknown whether this is specific to elite athletes or whether the same risk applies to recreationally active individuals. The purpose of this study was to investigate the prevalence of a positive EVH challenge in a population of recreationally active individuals. METHODS: 136 recreationally active individuals (Age: 21.9 ± 3.7 years; Height: 175 ± 9 cm; Weight: 70.9 ± 10.0 kg) without previous history of asthma or EIB, volunteered to take part in the study. All participants completed an EVH challenge, which was deemed positive if FEV1 fell ≥10% from baseline at two consecutive time points, and was reversible following inhalation of a short acting ß2-agonist. RESULTS: 18 of 136 (13.2%) participants had a positive EVH challenge. Of the 18 individuals, the fall in FEV1 from baseline ranged from -12% to -50%. At baseline, percentage predicted FEV1 (97.5 ± 12.5% versus 104.9 ± 10%; p < 0.01), FEV1/FVC ratio (79.5 ± 6.9% versus 87.8 ± 5.5%; p < 0.01), FEF25-75 (3.73 ± 1.00 versus 4.73 ± 1.00 l/s; p < 0.01) and predicted PEF (89.4 ± 8.8% versus 97.5 ± 13.6%; p < 0.05) values for EVH positive participants were significantly lower than EVH negative participants respectively. CONCLUSIONS: Overall, 13.2% of recreationally active individuals with no previous history of asthma presented with a positive EVH challenge. Individuals who are recreationally active may benefit from an objective bronchial provocation challenge, given that self-reported symptoms alone only provide a supportive role towards a valid EIB diagnosis.

Diurnal variation in the salivary melatonin responses to exercise: relation to exercise-mediated tachycardia.

Salivary melatonin concentration is an established marker of human circadian rhythmicity. It is thought that melatonin is relatively robust to the masking effects of exercise. Nevertheless, the extent and even the direction of exercise-related change is unclear, possibly due to between-study differences in the time of day exercise is completed. Therefore, we aimed to compare melatonin responses between morning and afternoon exercise, and explore the relationships between exercise-related changes in melatonin and heart rate. At 08:00 and 17:00 hours, seven male subjects (mean ± SD age, 27 ± 5 years) completed 30 min of cycling at 70% peak oxygen uptake followed by 30 min of rest. Light intensity was maintained at ~150 lx. Salivary melatonin (ELISA) and heart rate were measured at baseline, 15 min during exercise, immediately post-exercise and following 30 min recovery. Melatonin was ≈15 pg ml(-1) higher in the morning trials compared with the afternoon (P = 0.030). The exercise-related increase in melatonin was more pronounced (P = 0.024) in the morning (11.1 ± 8.7 pg ml(-1)) than in the afternoon (5.1 ± 5.7 pg ml(-1)). The slope of the heart rate-melatonin relationship was significantly (P = 0.020) steeper in the morning (0.12 pg ml(-1) beats(-1 )min(-1)) than in the afternoon (0.03 pg ml(-1) beats(-1 )min(-1)). In conclusion, we report for the first time that the masking effect of moderate-intensity exercise on melatonin is approximately twice as high in the morning than the afternoon. The much steeper relationship between heart rate and melatonin changes in the morning raises the possibility that time of day alters the relationships between exercise-mediated sympathetic nervous activity and melatonin secretion.

Effects of micro-enterprise services on HIV risk behaviour among female sex workers in Kenya's urban slums.

This study assessed individual-level effects of adding micro-enterprise services to a peer-mediated HIV/AIDS intervention among 227 female sex workers (FSWs) in Kenya. Survey data were collected in May-July 2003 and July-August 2005. Two-thirds of participants had operational businesses by end-line survey. Nearly half reported to have stopped sex work. Self-reported weekly mean number of all sexual partners changed from 3.26 (SD 2.45) at baseline to 1.84 (SD 2.15) at end-line survey (P < 0.001). Weekly mean number of casual partners did not change significantly. Weekly mean number of regular partners changed from 1.96 (SD 1.86) to 0.73 (SD 0.98) over the follow-up period (P < 0.001). Consistent condom use with regular partners increased by 18.5% and remained above 90% with casual partners. Micro-enterprise services may empower FSWs by giving them an alternative livelihood when they wish to exit or reduce reliance on sex work. Determinants of successful business operation by FSWs deserve further research.

Sexual behavior of female sex workers and access to condoms in Kenya and Uganda on the Trans-Africa highway.

Female sex workers and their clients remain a high risk core group for HIV in Africa. We measured sexual behavior of a snowball sample of female sex workers (FSW) along the Trans Africa highway from Mombasa, Kenya to Kampala, Uganda and surveyed the availability of male condoms at 1,007 bars and lodgings in Kenya along the highway trucking stops where transactional sex occurs. There were 578 FSW one month sex diaries analyzed, 403 from Kenya and 175 from Uganda. Kenyan FSW had a median of 45 sexual acts per 28 days compared to 39 sex acts per 28 days by Ugandan FSW (P < 0.05). Condom use by FSW for all sexual liaisons was 79% in Kenya compared to 74% in Uganda. In multivariate analysis, adjusting for repeated measures, Kenyan FSW were more likely to use a condom by an adjusted odds ratio of 2.54 (95% confidence interval 1.89-3.41) compared to Ugandan FSW. Condom use with regular clients was 50.8% in Uganda compared with 68.7% in Kenya (P < 0.01). The number of sex workers reporting 100% condom use was 26.8% in Kenya and 18.9% in Uganda (P < 0.01). Bars and lodges in Kenya compared to Uganda were more likely to: have condom dispensers, 25% versus 1%, respectively (P < 0.01); distribute or sell condoms, 73.9% versus 47.6% (P < 0.01); and have more weekly condom distribution, 4.92 versus 1.27 condoms per seating capacity (P < 0.01). Our data indicate that in both countries condom use for FSW is suboptimal, particularly with regular partners, and greater condom use by Trans African highway FSW in Kenya compared to Uganda may be related to availability. Targeted interventions are warranted for FSW and truck drivers to prevent transmission in this important core group.

Athletes' knowledge and views on OTC medication.

A questionnaire was administered to elite athletes from Australia, Canada, the UK, and the USA representing 10 Olympic sports in order to explore knowledge and understanding of over-the-counter (OTC) medication since the removal of many of these substances from the World Anti-Doping Agency (WADA) Prohibited List, in 2004. Athletes demonstrated limited knowledge and understanding. Around half (50.5 %) knew the penalty incurred following a doping violation involving a banned OTC stimulant. The terms Monitoring Program and Specified Substance List were understood by 43.3 % and 67.5 % of respondents, respectively. Overall, the status of substances in relation to the Prohibited List was correctly identified in just 35.1 % of cases. As a whole, athletes were of the opinion that OTC stimulants posed a risk to health, were performance enhancing and that their use was against the spirit of sport. They were undecided as to whether these drugs should be returned to the Prohibited List. Elite athletes require targeted education programmes that will enable them to make informed decisions on the potential of OTC medications for therapeutic or performance enhancing purposes.

Skin substitutes in burn care.

UNLABELLED: The history on the use of graft material aside from skin for both partial- and full-thickness burns was sought. METHODS: Medline and Google searches were performed using the key words: skin graft, skin substitute, allograft, homograft, xenograft, heterograft, autograft, burn grafting, and burn coverage. Articles retrieved were visually scanned for applicability and those thought to apply were reviewed as were appropriate references obtained within the articles. CONCLUSION: There have been several technological advances in the grafting of burns with synthetic materials, but autograft remains the standard to which all other graft resources must be compared.

Skin grafting in burns.

The purpose of this article is to review the history of skin grafting in burn injuries. A Medline and Google search were performed on the key words, skin graft, autograft, allograft, xenograft, burn surgery, burn excision, and burn grafting. The articles were reviewed and the additional references were provided by the bibliographies of these articles, which were also reviewed. The history of skin grafting in burn injury is traced from before the birth of Christ to present day. The first publication of successful skin grafts for wounds was authored by Swiss surgeon J.L. Reverdin in 1869. Progression in graft improvement was slow. The 1930s brought mechanical dermatomes into practice, while the mechanical mesher was not introduced until the 1960s. Finally, the practice of early excision and grafting, which is the cornerstone of burn care today, became common practice.

Caffeine consumption amongst British athletes following changes to the 2004 WADA prohibited list.

This study was undertaken to examine self-reported caffeine consumption and reasons for its use, amongst UK athletes, following its removal from the 2004 World Anti-Doping Agency (WADA) Prohibited List. A convenience sample of track and field athletes (n = 193) and cyclists (n = 287) completed a postal or Web-based questionnaire. Messages were posted on athletics and cycling club Web sites and mailing lists to direct athletes to the Web-based questionnaire. Postal questionnaires were distributed at domestic sporting events. A higher proportion of cyclists (59.9 %) compared with track and field athletes (32.6 %) consumed caffeine to enhance performance (p < 0.001). A higher proportion of elite as opposed to sub-elite athletes representing cycling (p = 0.031) and athletics (p = 0.010) used caffeine to enhance performance. Of all caffeine containing products used, coffee, energy drinks, pharmaceutical preparations and caffeinated sports supplements were most prevalent. Results revealed that amongst UK athletes, the intention to use caffeine as an ergogenic aid was high, and that use was more widespread and accepted in competitive sport, especially at elite level, when compared to recreational sport.

Bright light and thermoregulatory responses to exercise.

The thermoregulatory responses to morning exercise after exposure to different schedules of bright light were examined. At 07:00 h, six males ran on two occasions in an environmental chamber (temperature = 31.4 +/- 1.0 degrees C, humidity = 66 +/- 6 %) for 40 min at 60 % of maximal oxygen uptake. Participants were exposed to bright light (10,000 lux) either between 22:00 - 23:00 h (BT (low)) or 06:00 - 07:00 h (BT (high)). Otherwise, participants remained in dim light (< 50 lux). It was hypothesized that BT (low) attenuates core temperature during morning exercise via the phase-delaying properties of evening bright light and by avoiding bright light in the morning. Evening bright light in BT (low) suppressed (p = 0.037) the increase in melatonin compared to dim light (1.1 +/- 11.4 vs. 15.2 +/- 19.7 pg x ml (-1)) and delayed (p = 0.034) the core temperature minimum by 1.46 +/- 1.24 h. Core temperature was 0.20 +/- 0.17 degrees C lower in BT (low) compared to BT (high) during the hour before exercise (p = 0.036), with evidence (p = 0.075) that this difference was maintained during exercise. Conversely, mean skin temperature was 1.0 +/- 1.7 degrees C higher during the first 10 min of exercise in BT (low) than in BT (high) (p = 0.030). There was evidence that the increase in perceived exertion was attenuated in BT (low) (p = 0.056). A chronobiologically-based light schedule can lower core temperature before and during morning exercise in hot conditions.

Sexual and treatment-seeking behaviour for sexually transmitted infection in long-distance transport workers of East Africa.

OBJECTIVE: To investigate the sexual and treatment-seeking behaviour for sexually transmitted infection (STI) in long-distance transport workers of East Africa. METHODS: A health-seeking behaviour survey was carried out at four sites on the Mombasa-Kampala trans-Africa highway (n = 381). The questionnaires probed details of STI knowledge, symptoms and care-seeking behaviour. In one site at the Kenya-Uganda border, a sexual patterning matrix was used (n = 202) to measure sexual behaviour in truck drivers and their assistants over the 12-month period before the interview. RESULTS: Over half of the sexual acts of long-distance transport workers over 12 months were with female sex workers, with an annual average of 2.8 sexual partners. Condom use was reported at 70% for liaisons with casual partners. 15% of truckers had had a self-reported STI and one-third exhibited high-risk sexual behaviour in the previous year. Of those with an STI, 85% had symptoms when on the road and 77.2% sought treatment within 1 week of onset of symptoms. 94% of drivers and 56% of assistants sought treatment for STI in a private health facility or pharmacy. The cost of private facilities and pharmacies was not significantly higher than in the public sector. Waiting times were three times longer in the public sector. Only 28.9% of patients completed their medication courses as prescribed. CONCLUSIONS: Truck drivers and their assistants in East Africa have high rates of reported STIs and many continue to exhibit high-risk sexual behaviour. The transport workers studied here favoured private health facilities because of convenience and shorter waiting times.

Mapping transactional sex on the Northern Corridor highway in Kenya.

Even in generalized HIV/AIDS epidemics, vulnerable populations such as sex workers and truckers require special attention in programming. Combining a number of elicitation methods, centred on Geographical Information Systems (GIS) mapping, the Kenyan section of the Northern Corridor highway was studied to characterize the 'hot spots' where transactional sex is concentrated and to provide estimates of numbers of truckers and sex workers and the volumes of transactional sex taking place on the highway. An average of 2400 trucks park overnight at the 39 hot spots identified. These spots have an estimated sex worker population of 5600 women. Analysis of 403 sex worker diaries shows an average of 13.6 different clients and 54.2 sex acts in a month. Condom use is 69% in liaisons with regular clients and 90% with casual clients. The use of GIS is demonstrated at regional and local scales. The 'bridge population' of clients of sex workers, containing a wide rage of occupations, supports the concept of programming for 'vulnerable places' as well as vulnerable groups.

Using diaries to measure parameters of transactional sex: an example from the Trans-Africa highway in Kenya.

Conventional methods of elicitation have severe limitations where sensitive information is being sought, resulting from both self-disclosure and recall bias. The use of diaries largely circumvents both of these problems. Four hundred and three female sex workers based on a section of the Trans-Africa Highway in Kenya completed standard diaries for consecutive 28-day periods. Variables measured included numbers and types of different clients, condom use, occupation of client, movement patterns and days of menses. Mean numbers of sexual partners, liaisons and sex acts and inter-relationships between the variables measured are analysed. The study affirms the value of diaries as an elicitation method for studying transactional sex in a resource-poor setting. Usable diaries were received from 70% of those who had agreed to participate in the study. The diaries yield detailed quantitative data that describe the characteristics and dynamics of transactional sex on a major highway in Africa and provide information that may be used to estimate HIV transmission rates.

Over-the-counter drug use amongst athletes and non-athletes.

AIM: Many over-the-counter (OTC) drugs used in the symptomatic relief of upper respiratory tract (URT) conditions are banned by sports governing bodies. It would appear therefore that athletes are being penalised for practising conventional pharmacological methods in the management of common ailments. The aim was to identify any differences between athletes and non-athletes and amongst athletic groups, with respect to the prevalence of URT conditions and the use of OTC drugs to treat such conditions. METHODS: Questionnaires were distributed at domestic and international athletics meetings and at university lectures and tutorials. Respondents (n=401) represented both track and field athletes (n=199) and non-athletes (n=202). RESULTS: No differences were found between athletes and non-athletes and between elite and non-elite athletes in terms of the frequency of episodes of URT conditions reported in the previous year. A higher proportion of elite, as opposed to non-elite athletes did not take OTC medicines (p=0.028) and of those that did take OTC medicines a higher proportion of elite athletes (68%) as opposed to non-elite (32%) took those not containing sympathomimetics, banned by the International Olympic Committee (IOC). Athletes were found to have greater knowledge of IOC banned OTC drugs (p=0.002) and within this group, elite athletes were most knowledgeable (p=0.0003). Although most respondents (81%) believed that OTC drugs should not be prohibited in sport, athletes made up the greatest proportion in support of prohibition (23.5% as opposed to 14.4% of non-athletes) with elite as opposed to non-elite most in favour (p=0.0181). CONCLUSION: These results suggest that URT conditions are no more prevalent between athletes and non-athletes or between endurance and power athletes. Athletes competing at the highest level tended to avoid OTC medicines or those containing IOC banned drugs and were most knowledgeable in terms of banned OTC drugs and most in favour of their prohibition suggesting that the control mechanisms in place are only reaching elite athletes.

Physiological, subjective and performance effects of pseudoephedrine and phenylpropanolamine during endurance running exercise.

The aim of the study was to assess the effect of maximal therapeutic dosing of sympathomimetic amines found in over-the-counter (OTC) decongestant preparations on endurance running. Following familiarisation and a graded exercise test to determine maximal oxygen uptake (VO2 max), trained male runners (n = 8) completed four exercise sessions each separated by a minimum of one week. Each session was comprised of 20 min of sub-maximal treadmill running (70 % VO2 max) followed by a 5,000-m time trial on the treadmill under drug, placebo or control conditions. Drugs were administered in their commercial format over the 36-hour period prior to testing in the manufacturer's recommended maximal doses (i. e. 25 mg of phenylpropanolamine and 60 mg of pseudoephedrine four times daily). During sub-maximal endurance running no statistical differences were observed in heart rate, VO2, minute ventilation, respiratory exchange ratio, blood lactate, glucose or non-esterified fatty acids (NEFA) or ratings of perceived exertion with respect to the treatment administered. Similarly there were no statistical differences according to the condition during the 5,000-m running time trial, in terms of heart rate, ratings of perceived exertion, time of completion and pre and post exercise blood lactate, glucose or NEFA. The results indicate that in maximal, multiple therapeutic doses both pseudoephedrine or phenylpropanolamine as present in common OTC decongestant formulations do not affect, nor possess any ergogenic properties with regard to, endurance running.

Stage-specific apoptosis, developmental delay, and embryonic lethality in mice homozygous for a targeted disruption in the murine Bloom's syndrome gene.

Bloom's syndrome is a human autosomal genetic disorder characterized at the cellular level by genome instability and increased sister chomatid exchanges (SCEs). Clinical features of the disease include proportional dwarfism and a predisposition to develop a wide variety of malignancies. The human BLM gene has been cloned recently and encodes a DNA helicase. Mouse embryos homozygous for a targeted mutation in the murine Bloom's syndrome gene (Blm) are developmentally delayed and die by embryonic day 13.5. The fact that the interrupted gene is the homolog of the human BLM gene was confirmed by its homologous sequence, its chromosomal location, and by demonstrating high numbers of SCEs in cultured murine Blm-/- fibroblasts. The proportional dwarfism seen in the human is consistent with the small size and developmental delay (12-24 hr) seen during mid-gestation in murine Blm-/- embryos. Interestingly, the growth retardation in mutant embryos can be accounted for by a wave of increased apoptosis in the epiblast restricted to early post-implantation embryogenesis. Mutant embryos do not survive past day 13.5, and at this time exhibit severe anemia. Red blood cells and their precursors from Blm-/- embryos are heterogeneous in appearance and have increased numbers of macrocytes and micronuclei. Both the apoptotic wave and the appearance of micronuclei in red blood cells are likely cellular consequences of damaged DNA caused by effects on replicating or segregating chromosomes.