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1.
Dermatol Surg ; 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32205748

RESUMO

BACKGROUND: Keratinocyte cancer (KC) patients benefit from early diagnosis. We describe here the anatomy of head/neck KCs to help guide screening efforts. OBJECTIVE: To examine lesion frequency and anatomic distribution of head and neck KC. METHODS: This retrospective cohort study of 4,770 consecutive pathology reports, 1998 to 2015, analyzes 5,463 head and neck KCs (3,664 basal cell carcinoma [BCC], 1,259 squamous cell carcinoma [SCC], and 540 SCC in situ) from 3,581 patients. RESULTS: Basal cell carcinoma relative tumor density (RTD) was highest on the nose; SCC RTD was highest on the cheek. Basal cell carcinoma-to-SCC ratio was highest on eyelid and lowest on scalp. Temple, ear, and neck SCC predominated in men; nose and cheek SCC in women. Scalp, temple, and ear BCC showed male predominance, while cheek, nose, and chin predominated in women. Left-sided ear SCC in situ and BCC were more common than right-sided ear lesions. CONCLUSION: This study demonstrates gender- and laterality-specific differences that comport with patterns of solar exposure.

2.
J Sports Sci ; : 1-7, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122261

RESUMO

The physical demands of English Premier League soccer goalkeepers were quantified during training and match-play in a two-part study. Goalkeeper-specific micromechanical electrical systems (MEMS) devices, profiled training and match-day activities throughout one competitive week (n=8; part A). Changes in MEMS-derived outputs were also profiled throughout match-play (100 matches; n=8, 18±14 observations per goalkeeper; part B). In part A, goalkeeping-training elicited the most dives (51±11) versus all activities (all p≤0.030) except shooting-training (p=0.069). Small-sided games elicited the fewest (5±3) dives (all p≤0.012). High-speed distance covered in match (103±72 m) was similar to goalkeeping-training (p=0.484), while exceeding shooting-training, small-sided games, pre-match shooting, and pre-match warm-up (all p=0.012). Most changes of direction (34±12) and explosive efforts (70±18) occurred during goalkeeping-training, with values exceeding match (both p=0.012). In part B, between-half reductions in total distance, but increased high-speed changes of direction and explosive efforts, occurred (both p≤0.05). Excluding the number of high jumps, all variables differed from 0-15-min during at least one match epoch, with more dives (1.3±1.4 vs 1.0±1.1) and explosive efforts (2.5±2.4 vs 2.0±1.8) performed between 75-90-min versus 0-15-min (all p<0.05). These data highlight the differing physical demands of various activities performed by professional soccer goalkeepers throughout a competitive week.

3.
PLoS One ; 15(2): e0228790, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32032369

RESUMO

Despite empirical observations suggesting that practitioners value the use of substitutions during soccer match-play, limited research has sought to substantiate such claims. This study used online surveys to assess the perceptions of practitioners within professional soccer about the use and practices of substitutes. Thirty-three practitioners completed one of two surveys (each requiring both open and closed questions to be answered), depending upon whether their primary role related mostly to tactical ('tactical practitioners'; n = 7) or physical ('physical practitioners'; n = 26) aspects of player/team management. Thematic content analysis of responses identified four higher-order themes: 'impact of substitutions', 'planning and communication', 'player preparation and recovery' and 'regulations'. Eighty-five percent of practitioners believed that substitutes are important in determining success during soccer match-play, with the primary justification being the perceived ability of such players to provide a physical and/or tactical impact. However, contextual factors such as the match situation, timing of introduction, and players undergoing adequate pre-pitch-entry preparation, may be important for realising such aims. Although many practitioners believed that there was a need for substitutes to engage in bespoke non-match-day preparations and recovery strategies that differ from starting players, logistical considerations, such as scarcity of resources, often limit their scope. Notwithstanding, 96% of respondents indicated that substitutes frequently perform extra conditioning sessions to account for deficits in high-speed running loads compared with players exposed to a longer period of match-play. Substitutes' pre-match warm-ups are typically led by team staff, however practitioners reported providing varying levels of input with regards to the practices adopted between kick-off and pitch-entry. Uncertainty exists as to the efficacy of current pre-pitch-entry practices, and 100% of practitioners highlighted 'preparatory strategies' as at least a 'moderately important' direction for future research. This study presents novel insights and highlights areas that are considered future research priorities amongst those working in the field.

4.
J Sci Med Sport ; 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31937507

RESUMO

OBJECTIVES: To compare fixed epochs (FIXED) and rolling averages (ROLL) for quantifying worst-case scenario ('peak') running demands during professional soccer match-play, whilst assessing contextual influences. DESIGN: Descriptive, observational. METHODS: Twenty-five outfield players from an English Championship soccer club wore 10-Hz microelectromechanical systems during 28 matches. Relative total and high-speed (>5.5ms-1) distances were averaged over fixed and rolling 60-s to 600-s epochs. Linear mixed models compared FIXED versus ROLL and assessed the influence of epoch length, playing position, starting status, match result, location, formation, and time-of-day. RESULTS: Irrespective of playing position or epoch duration, FIXED underestimated ROLL for total (∼7-10%) and high-speed (∼12-25%) distance. In ROLL, worst-case scenario relative total and high-speed distances reduced from 190.1±20.4mmin-1 and 59.5±23.0mmin-1 in the 60-s epoch, to 120.9±13.1mmin-1 and 14.2±6.5mmin-1 in the 600-s epoch, respectively. Worst-case scenario total distance was higher for midfielders (∼9-16mmin-1) and defenders (∼3-10mmin-1) compared with attackers. In general, starters experienced higher worst-case scenario total distance than substitutes (∼3.6-8.5mmin-1), but lower worst-case scenario high-speed running over 300-s (∼3mmin-1). Greater worst-case scenario total and high-speed distances were elicited during wins (∼7.3-11.2mmin-1 and ∼2.7-7.9mmin-1, respectively) and losses (∼2.7-5.7mmin-1 and ∼1.4-2.2mmin-1, respectively) versus draws, whilst time-of-day and playing formation influenced worst-case scenario high-speed distances only. CONCLUSIONS: These data indicate an underestimation of worst-case scenario running demands in FIXED versus ROLL over 60-s to 600-s epochs while highlighting situational influences. Such information facilitates training specificity by enabling sessions to be targeted at the most demanding periods of competition.

5.
Circulation ; 141(8): 641-651, 2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-31736357

RESUMO

BACKGROUND: The Fontan operation creates a total cavopulmonary connection, a circulation in which the importance of pulmonary vascular resistance is magnified. Over time, this circulation leads to deterioration of cardiovascular efficiency associated with a decline in exercise performance. Rigorous clinical trials aimed at improving physiology and guiding pharmacotherapy are lacking. METHODS: The FUEL trial (Fontan Udenafil Exercise Longitudinal) was a phase III clinical trial conducted at 30 centers. Participants were randomly assigned udenafil, 87.5 mg twice daily, or placebo in a 1:1 ratio. The primary outcome was the between-group difference in change in oxygen consumption at peak exercise. Secondary outcomes included between-group differences in changes in submaximal exercise at the ventilatory anaerobic threshold, the myocardial performance index, the natural log of the reactive hyperemia index, and serum brain-type natriuretic peptide. RESULTS: Between 2017 and 2019, 30 clinical sites in North America and the Republic of Korea randomly assigned 400 participants with Fontan physiology. The mean age at randomization was 15.5±2 years; 60% of participants were male, and 81% were white. All 400 participants were included in the primary analysis with imputation of the 26-week end point for 21 participants with missing data (11 randomly assigned to udenafil and 10 to placebo). Among randomly assigned participants, peak oxygen consumption increased by 44±245 mL/min (2.8%) in the udenafil group and declined by 3.7±228 mL/min (-0.2%) in the placebo group (P=0.071). Analysis at ventilatory anaerobic threshold demonstrated improvements in the udenafil group versus the placebo group in oxygen consumption (+33±185 [3.2%] versus -9±193 [-0.9%] mL/min, P=0.012), ventilatory equivalents of carbon dioxide (-0.8 versus -0.06, P=0.014), and work rate (+3.8 versus +0.34 W, P=0.021). There was no difference in change of myocardial performance index, the natural log of the reactive hyperemia index, or serum brain-type natriuretic peptide level. CONCLUSIONS: In the FUEL trial, treatment with udenafil (87.5 mg twice daily) was not associated with an improvement in oxygen consumption at peak exercise but was associated with improvements in multiple measures of exercise performance at the ventilatory anaerobic threshold. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02741115.

6.
J Strength Cond Res ; 34(1): 145-151, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29210957

RESUMO

Russell, M, Reynolds, NA, Crewther, BT, Cook, CJ, and Kilduff, L. Physiological and performance effects of caffeine gum consumed during a simulated half-time by professional academy rugby union players. J Strength Cond Res 34(1): 145-151, 2020-Despite the prevalence of caffeine (CAF) as an ergogenic aid, few studies have examined the use of caffeinated gums, especially during half-time in team sports. The physiological (blood lactate and salivary hormone concentrations) and performance (repeated sprints and cognitive function) effects of consuming CAF gum during a simulated half-time were examined. Professional academy rugby union players (n = 14) completed this double-blind, randomized, counterbalanced study. After pre-exercise measurements, players chewed a placebo (PLC) gum for 5 minutes before a standardized warm-up and completing repeated sprint testing (RSSA1). Thereafter, during a 15-minute simulated half-time period, players chewed either CAF (400 mg; 4.1 ± 0.5 mg·kg) or PLC gum for 5 minutes before completing a second repeated sprint test (RSSA2). Blood lactate, salivary testosterone and cortisol concentrations, and indices of cognitive function (i.e., reaction time and Stroop test) were measured at baseline, pre-RSSA1, post-RSSA1, pre-RSSA2, and post-RSSA2. Sprint performance was not affected by CAF (p = 0.995) despite slower sprint times after the first sprint of both RSSA tests (all p < 0.002). After half-time, salivary testosterone increased by 70% (+97 ± 58 pg·ml) in CAF vs. PLC (p < 0.001), whereas salivary cortisol remained unchanged (p = 0.307). Cognitive performance was unaffected by time and trial (all p > 0.05). Although performance effects were absent, chewing CAF gum increased the salivary testosterone concentrations of professional rugby union players over a simulated half-time. Practitioners may, therefore, choose to recommend CAF gum between successive exercise bouts because of the increases in salivary testosterone observed; a variable associated with increased motivation and high-intensity exercise performance.

7.
Circ Heart Fail ; 12(12): e006231, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31813281

RESUMO

BACKGROUND: The VANISH trial (Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy) targeted young sarcomeric gene mutation carriers with early-stage hypertrophic cardiomyopathy (HCM) to test whether valsartan can modify disease progression. We describe the baseline characteristics of the VANISH cohort and compare to previous trials evaluating angiotensin receptor blockers. METHODS: Applying a randomized, double-blinded, placebo-controlled design, 178 participants with nonobstructive HCM (age, 23.3±10.1 years; 61% men) were randomized in the primary cohort and 34 (age, 16.5±4.9 years; 50% men) in the exploratory cohort of sarcomeric mutation carriers without left ventricular hypertrophy. RESULTS: In the primary cohort, maximal left ventricular wall thickness was 17±4 mm for adults and Z score 7.0±4.5 for children. Nineteen percent had late gadolinium enhancement on cardiac magnetic resonance. Mean peak oxygen consumption was 33 mL/kg per minute, and 92% of participants were New York Heart Association functional class I. New York Heart Association class II was associated with older age, MYH7 variants, and more prominent imaging abnormalities. Six previous trials of angiotensin receptor blockers in HCM enrolled a median of 24 patients (range, 19-133) with mean age of 51.2 years; 42% of patients were in New York Heart Association class ≥II, and sarcomeric mutations were not required. CONCLUSIONS: The VANISH cohort is much larger, younger, less heterogeneous, and has less advanced disease than prior angiotensin receptor blocker trials in HCM. Participants had relatively normal functional capacity and mild HCM features. New York Heart Association functional class II symptoms were associated with older age, more prominent imaging abnormalities, and MYH7 variants, suggesting both phenotype and genotype contribute to disease manifestations. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01912534.

8.
Curr Diab Rep ; 19(12): 159, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31820163

RESUMO

PURPOSE OF REVIEW: Hyperexpression of classical HLA class I (HLA-I) molecules in insulin-containing islets has become a widely accepted hallmark of type 1 diabetes pathology. In comparison, relatively little is known about the expression, function and role of non-classical subtypes of HLA-I. This review focuses on the current understanding of the non-classical HLA-I subtypes: HLA-E, HLA-F and HLA-G, within and outside the field of type 1 diabetes, and considers the possible impacts of these molecules on disease etiology. RECENT FINDINGS: Evidence is growing to suggest that non-classical HLA-I proteins are upregulated, both at the RNA and protein levels in the pancreas of individuals with recent-onset type 1 diabetes. Moreover, associations between non-classical HLA-I genotypes and age at onset of type 1 diabetes have been reported in some studies. As with classical HLA-I, it is likely that hyperexpression of non-classical HLA-I is driven by the release of diffusible interferons by stressed ß cells (potentially driven by viral infection) and exacerbated by release of cytokines from infiltrating immune cells. Non-classical HLA-I proteins predominantly (but not exclusively) transduce negative signals to immune cells infiltrating at the site of injury/inflammation. We propose a model in which the islet endocrine cells, through expression of non-classical HLA-I are fighting back against the infiltrating immune cells. By inhibiting the activity and function on NK, B and select T cells, the non-classical HLA-I, proteins will reduce the non-specific bystander effects of inflammation, while at the same time still allowing the targeted destruction of ß cells by specific islet-reactive CD8+ T cells.

9.
J Sci Med Sport ; 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31882327

RESUMO

OBJECTIVES: To profile the distances covered during international women's rugby union match-play and assess the duration-specific worst-case scenario locomotor demands over 60-s to 600-s epochs, whilst comparing the values determined by fixed epoch (FIXED) versus rolling average (ROLL) methods of worst-case scenario estimation and assessing positional influences. DESIGN: Descriptive, observational. METHODS: Twenty-nine international women's rugby union players wore 10Hz microelectromechanical systems during eight international matches (110 observations). Total, and per-half, distances were recorded, whilst relative total and high-speed (>4.4ms-1) distances were averaged using FIXED and ROLL methods over 60-600-s. Linear mixed models compared distances covered between match halves, assessed FIXED versus ROLL, and examined the influence of playing position. RESULTS: Players covered ∼5.8kmmatch-1, with reduced distances in the second- versus first-half (p<0.001). For worst-case scenario total (∼8-25%) and high-speed (∼10-26%) distance, FIXED underestimated ROLL. In ROLL, worst-case scenario relative total and high-speed distances reduced from ∼144-161mmin-1 and ∼30-69mmin-1 over 60-s, to ∼8089mmin-1 and ∼516mmin-1 in the 600-s epoch, respectively. Forwards performed less high-speed running over all epochs and covered less total distance during epochs of 60-s, 180-s, 420-s and 480-s, compared with backs. Front row players typically returned the lowest locomotor demands. CONCLUSIONS: This is the first study reporting the positional and worst-case scenario demands of international women's rugby union, and indicates an underestimation in FIXED versus ROLL over 60-s to 600-s epochs. Knowledge of the most demanding periods of women's rugby union match-play facilitates training specificity by enabling sessions to be tailored to such demands.

10.
Case Reports Immunol ; 2019: 1869524, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31737384

RESUMO

We present the case of a 19-year-old female with a mild form of Autosomal Dominant Hyper IgE syndrome (HIES) associated with a loss-of-function mutation in STAT3. Within the first years of life she developed multiple, Staphylococcus aureus associated abscesses in the neck and face requiring frequent incision and drainage. Respiratory tract infections were not a feature of the clinical phenotype and a high resolution thoracic CT scan was unremarkable. Retained dentition was noted but fungal nail disease and recurrent thrush were absent. The total IgE was 970 IU/L, Lymphocyte counts and immunoglobulin levels were normal (IgG borderline 18.5 gr/L). There was suboptimal response to test immunisation with Pneumovax II vaccine. Th17 cell phenotyping revealed low levels of IL-17 expressing cells (0.3% of total CD4 T Cells numbers). Genetic analysis identified a missense mutation, N567D, in a conserved region of the linker domain of STAT3. Functional studies in HEK293 cells reveal that this mutation potently inhibits STAT3 activity when compared to the wildtype protein. This is consistent with other reported mutations in STAT3 associated with HIES. However, surprisingly, the magnitude of inhibition was similar to another STAT3 mutation (V637M) which causes a much more severe form of the disease.

11.
J Int Soc Sports Nutr ; 16(1): 50, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699159

RESUMO

Background In this Position Statement, the International Society of Sports Nutrition (ISSN) provides an objective and critical review of the literature pertinent to nutritional considerations for training and racing in single-stage ultra-marathon. Recommendations for Training. i) Ultra-marathon runners should aim to meet the caloric demands of training by following an individualized and periodized strategy, comprising a varied, food-first approach; ii) Athletes should plan and implement their nutrition strategy with sufficient time to permit adaptations that enhance fat oxidative capacity; iii) The evidence overwhelmingly supports the inclusion of a moderate-to-high carbohydrate diet (i.e., ~ 60% of energy intake, 5-8 g·kg- 1·d- 1) to mitigate the negative effects of chronic, training-induced glycogen depletion; iv) Limiting carbohydrate intake before selected low-intensity sessions, and/or moderating daily carbohydrate intake, may enhance mitochondrial function and fat oxidative capacity. Nevertheless, this approach may compromise performance during high-intensity efforts; v) Protein intakes of ~ 1.6 g·kg- 1·d- 1 are necessary to maintain lean mass and support recovery from training, but amounts up to 2.5 g.kg- 1·d- 1 may be warranted during demanding training when calorie requirements are greater; Recommendations for Racing. vi) To attenuate caloric deficits, runners should aim to consume 150-400 Kcal·h- 1 (carbohydrate, 30-50 g·h- 1; protein, 5-10 g·h- 1) from a variety of calorie-dense foods. Consideration must be given to food palatability, individual tolerance, and the increased preference for savory foods in longer races; vii) Fluid volumes of 450-750 mL·h- 1 (~ 150-250 mL every 20 min) are recommended during racing. To minimize the likelihood of hyponatraemia, electrolytes (mainly sodium) may be needed in concentrations greater than that provided by most commercial products (i.e., > 575 mg·L- 1 sodium). Fluid and electrolyte requirements will be elevated when running in hot and/or humid conditions; viii) Evidence supports progressive gut-training and/or low-FODMAP diets (fermentable oligosaccharide, disaccharide, monosaccharide and polyol) to alleviate symptoms of gastrointestinal distress during racing; ix) The evidence in support of ketogenic diets and/or ketone esters to improve ultra-marathon performance is lacking, with further research warranted; x) Evidence supports the strategic use of caffeine to sustain performance in the latter stages of racing, particularly when sleep deprivation may compromise athlete safety.


Assuntos
Carboidratos da Dieta/administração & dosagem , Ingestão de Energia , Necessidades Nutricionais , Corrida/fisiologia , Fenômenos Fisiológicos da Nutrição Esportiva , Atletas , Desempenho Atlético , Comportamento Competitivo , Proteínas na Dieta/administração & dosagem , Humanos , Resistência Física , Corrida/classificação , Sociedades
12.
Cutis ; 104(2): 114-116, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31603954

RESUMO

Linear basal cell carcinoma (LBCC) is a rare morphologic variant of basal cell carcinoma. We report a case of a patient with a recurrent linear lesion on the supraclavicular neck with prior repeated mild trauma to the area. The patient was diagnosed with recurrent LBCC after a prior excision of an LBCC in the same area. A review of the literature was performed, and the demographics, anatomic location, histologic subtype, treatment methods, and frequency of recurrence for all reported cases of LBCC were summarized. Because of the likelihood of subclinical spread, LBCC should be regarded as a high-risk subtype. As such, Mohs micrographic surgery or excision with complete circumferential peripheral and deep margin assessment is recommended as first-line treatment.


Assuntos
Carcinoma Basocelular/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias Cutâneas/diagnóstico , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs , Recidiva Local de Neoplasia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia
13.
J Strength Cond Res ; 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31498220

RESUMO

Fitzpatrick, JF, Hicks, KM, Russell, M, and Hayes, PR. The reliability of potential fatigue-monitoring measures in elite youth soccer players. J Strength Cond Res XX(X): 000-000, 2019-Monitoring fatigue is of vital importance to practitioners; however, logistics and concerns about reliability may impede the use of certain measures. This study aimed to quantify the reliability of potential measures of fatigue; a subjective wellness questionnaire, jump performance tests, and tri-axial accelerometer variables derived during submaximal shuttle running in elite youth soccer players. A secondary aim was to establish the minimum test duration that could be used for the submaximal shuttle run while maintaining good reliability. Seventeen male youth team players (age: 17.4 ± 0.5 years) were assessed on 2 occasions, spaced 7 days apart. Typical error, coefficient of variation (CV%), interclass correlation (ICC), and minimum detectable change were calculated for a subjective wellness questionnaire, countermovement jump (CMJ), squat jump (SJ) and drop jump contact time (DJ-CT), drop jump height (DJ-JH), and reactive strength (DJ-RSI). A novel submaximal shuttle running test was also used to assess tri-axial accelerometer data reliability. Results suggest that CMJ, SJ, DJ-CT, and DJ-RSI have good test-retest reliability (CV% = 4.5-7.7; ICC = 0.80-0.88); however DJ-JH did not show acceptable reliability (CV% = 6.0; ICC = 0.76). Good reliability was found for all tri-axial accelerometer variables during a 3-minute (2-minute analysis) submaximal shuttle run (CV% = 2.4-8.0; ICC = 0.81-0.95), except for % PlayerLoad anterior-posterior (%PLAP) (CV% = 7.2; ICC = 0.63). The subjective wellness questionnaire demonstrated poor reliability for all items (CV% = 11.2-30.0; ICC = 0.00-0.78). The findings from this study provide practitioners with valuable information about the reliability of a range of potential fatigue-monitoring measures. This can be used to help make accurate decisions about the magnitude of change in these assessments when used in practice.

14.
J Rheumatol ; 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31523046

RESUMO

OBJECTIVE: To describe trends in acute hospital admissions due to gout in England, with rheumatoid arthritis (RA) as a comparator, alongside prescribing trends for common gout medications. METHODS: An ecological study was performed using UK National Health Service (NHS) Digital Hospital Episode Statistics data to calculate the incidence of unplanned admissions with primary diagnoses of gout or RA in adults in England between April 2006 and March 2017. NHS Digital Community Prescription data for allopurinol, febuxostat, and colchicine were considered over a similar period. RESULTS: The incidence of unplanned gout admissions increased by 58.4% over the study period, from 7.9 admissions per 100,000 population in 2006/07 to 12.5 admissions per 100,000 population in 2016/17 (p < 0.0001). Gout admissions increased as a proportion of all hospital admissions, and accounted for 349,768 bed-days cumulatively. Unplanned RA admissions halved over the study period, from 8.6 admissions per 100,000 population in 2006/07 to 4.3 admissions per 100,000 population in 2016/17 (p < 0.0001). Community prescriptions dispensed for allopurinol and colchicine have increased by 71.4% and 165.6%, respectively, since 2006 (p < 0.0001). Febuxostat prescriptions have increased 20-fold since 2010 (p < 0.0001), when prescription data became available. CONCLUSION: Acute gout admissions in England increased between 2006 and 2017, accompanied by increasing prescription of gout therapies. Acute admissions due to RA halved over the same time period. These data call for aggressive target-driven therapy for this highly treatable disease.

15.
Ann Thorac Surg ; 108(6): 1889-1894, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31398358

RESUMO

BACKGROUND: Emerging data across many fields suggest that unique patient characteristics can impact disease manifestation and response to therapy, supporting "precision medicine" approaches and more individualized and targeted therapeutic strategies. In children undergoing congenital heart surgery, current risk models primarily focus on the population level, and their utility in understanding precise characteristics that place individual patients at risk for poor outcome remains unclear. METHODS: We analyzed index surgeries in the Pediatric Cardiac Critical Care Consortium (PC4) registry (August 2014 to May 2016) and utilized a previously constructed model containing patient factors typically included in in-hospital mortality risk models (age, weight, prematurity, chromosomal anomalies/syndromes, preoperative factors, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score). Partitioned variances based on a hierarchical generalized linear model were used to estimate the proportion of variation in mortality explained by these factors. RESULTS: A total of 8406 operations (22 hospitals) were included. We found that only 30% of the total between-patient variation in mortality in our cohort was explained by the patient factors included in our model. Age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score, and preoperative mechanical ventilation explained the greatest proportion of variation. Of the variation that remained unexplained, 95% was attributable to unmeasured patient factors. In stratified analyses, these results were consistent across patient subgroups. CONCLUSIONS: Patient factors typically included in congenital heart surgery risk models explain only a small portion of total variation in mortality. A better understanding of other underrecognized factors is critical in further defining risk profiles and in developing more individualized and tailored therapeutic strategies.

16.
Data Brief ; 25: 104311, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31453292

RESUMO

The placenta is a highly vascular structure composed of both maternal and fetal elements. We have determined that damaging variants in genes responsible for the positive regulation of angiogenesis (PRA) (GO:0045766) that are inherited by the fetus impair fetal growth and placental function in pregnancies involving critical congenital cardiac defects (Russell et al., 2019). In this dataset, we present the specific genetic variants identified, describe the parental origin of each variant where possible and present the analyses regarding the potential effects of parental origin of the variant on placental function and fetal growth. The data presented are related to the research article "Damaging variants in pro-angiogenic genes impair growth in fetuses with cardiac defects" (Russell et al., 2019).

17.
Pediatr Cardiol ; 40(6): 1253-1257, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31263917

RESUMO

Obesity is associated with additional left ventricular hypertrophy (LVH) in adults with hypertrophic cardiomyopathy (HCM). It is not known whether obesity can lead to further LVH in children with HCM. Echocardiographic LV dimensions were determined in 504 children with HCM. Measurements of interventricular septal thickness (IVST) and posterior wall thickness (PWT), and patients' weight and height were recorded. Obesity was defined as a body mass index (BMI) ≥ 99th percentile for age and sex. IVST data was available for 498 and PWT data for 484 patients. Patient age ranged from 2 to 20 years (mean ± SD, 12.5 ± 3.9) and 340 (68%) were males. Overall, patient BMI ranged from 7 to 50 (22.7 ± 6.1). Obesity (BMI 18-50, mean 29.1) was present in 140 children aged 2-19.6 (11.3 ± 4.1). The overall mean IVST was 20.5 ± 9.6 mm and the overall mean PWT was 11.0 ± 8.4 mm. The mean IVST in the obese patients was 21.6 ± 10.0 mm and mean PWT was 13.3 ± 14.7 mm. The mean IVST in the non-obese patients was 20.1 ± 9.5 mm and mean PWT was 10.4 ± 4.3 mm. Obesity was not significantly associated with IVST (p = 0.12), but was associated with increased PWT (0.0011). Obesity is associated with increased PWT but not IVST in children with HCM. Whether obesity and its impact on LVH influences clinical outcomes in children with HCM needs to be studied.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Ventrículos do Coração/patologia , Obesidade/complicações , Septo Interventricular/patologia , Adolescente , Índice de Massa Corporal , Cardiomiopatia Hipertrófica/fisiopatologia , Criança , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Masculino , Adulto Jovem
19.
Nutrients ; 11(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31336992

RESUMO

Honey is a natural substance formed primarily of carbohydrates (~80%) which also contains a number of other compounds purported to confer health benefits when consumed. Due to its carbohydrate composition (low glycaemic index, mostly fructose and glucose), honey may theoretically exert positive effects when consumed before, during or after exercise. This review therefore appraised research examining the effects of honey consumption in combination with exercise in humans. Online database (PubMed, MEDLINE, SPORTDiscus) searches were performed, yielding 273 results. Following duplicate removal and application of exclusion criteria, nine articles were reviewed. Large methodological differences existed in terms of exercise stimulus, population, and the nutritional interventions examined. All nine studies reported biochemical variables, with four examining the effects of honey on exercise performance, whilst five described perceptual responses. Acute supplementation around a single exercise session appeared to elicit similar performance, perceptual, and immunological responses compared with other carbohydrate sources, although some performance benefit has been observed relative to carbohydrate-free comparators. When consumed over a number of weeks, honey may dampen immunological perturbations arising from exercise and possibly improve markers of bone formation. More well-controlled research is required to better understand the role for honey in a food-first approach to exercise nutrition.


Assuntos
Suplementos Nutricionais , Exercício , Mel , Humanos , Fenômenos Fisiológicos da Nutrição
20.
Ann Transl Med ; 7(8): 166, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31168447
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