A Comparison of High and Usual Protein Dosing in Critically Ill Patients With Obesity: A Post Hoc Analysis of an International, Pragmatic, Single-Blinded, Randomized Clinical Trial.

OBJECTIVES: Across guidelines, protein dosing for critically ill patients with obesity varies considerably. The objective of this analysis was to evaluate whether this population would benefit from higher doses of protein. DESIGN: A post hoc subgroup analysis of the effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicenter, pragmatic, registry-based randomized trial. SETTING: Eighty-five adult ICUs across 16 countries. PATIENTS: Patients with obesity defined as a body mass index (BMI) greater than or equal to 30 kg/m 2 ( n = 425). INTERVENTIONS: In the primary study, patients were randomized into a high-dose (≥ 2.2 g/kg/d) or usual-dose protein group (≤ 1.2 g/kg/d). MEASUREMENTS AND MAIN RESULTS: Protein intake was monitored for up to 28 days, and outcomes (time to discharge alive [TTDA], 60-d mortality, days of mechanical ventilation [MV], hospital, and ICU length of stay [LOS]) were recorded until 60 days post-randomization. Of the 1301 patients in the primary study, 425 had a BMI greater than or equal to 30 kg/m 2 . After adjusting for sites and covariates, we observed a nonsignificant slower rate of TTDA with higher protein that ruled out a clinically important benefit (hazard ratio, 0.78; 95% CI, 0.58-1.05; p = 0.10). We found no evidence of difference in TTDA between protein groups when subgroups with different classes of obesity or patients with and without various nutritional and frailty risk variables were examined, even after the removal of patients with baseline acute kidney injury. Overall, 60-day mortality rates were 31.5% and 28.2% in the high protein and usual protein groups, respectively (risk difference, 3.3%; 95% CI, -5.4 to 12.1; p = 0.46). Duration of MV and LOS in hospital and ICU were not significantly different between groups. CONCLUSIONS: In critically ill patients with obesity, higher protein doses did not improve clinical outcomes, including those with higher nutritional and frailty risk.

Leisure Time Physical Activity Levels in Immigrants by Ethnicity and Time Since Immigration to Canada: Findings from the 2011-2012 Canadian Community Health Survey.

New immigrants to Canada are mostly from Asian/South Asian countries currently experiencing low levels of physical activity (PA) and high rates of overweight/obesity. Little is known about the leisure time PA (LTPA) patterns of recent immigrants. Study sample was extracted from Canadian Community Health Survey (2011-2012). Based on reported daily energy expenditure on LTPAs over past 3 months, participants were categorized as physically active, moderately active, and inactive. Likelihood of being physically inactive was estimated for recent immigrants versus established immigrants. Higher proportion of recent immigrants were inactive (60%) compared to established immigrants (53%). Adjusted models estimated a higher likelihood of inactivity among recent immigrants (OR 1.40, 95% CI 1.13, 1.72) versus established immigrants. Inactivity was higher among immigrants of visible minorities, 58.8 versus 46.7% of white immigrants. Recent immigrants of visible minorities are at higher risk of being inactive. This highlights importance of developing programs to increase PA in specific groups of new immigrants.

Chilean miners commuting from sea level to 4500 m: a prospective study.

The development of mining activities in North Chile involves a great number of workers intermittently exposed to high altitude for a long period of time (chronic intermittent hypoxia, CIH). A 2(1/2)-year prospective study aimed to characterize this model of exposure to CIH and to know whether this condition may progressively lead to a chronic pattern. Twenty-nine miners, aged 25 +/- 5 yr, working 7 days at HA (3800 to 4600 m) and resting 7 days at sea level (SL) were studied. Subjects underwent a physical examination, EKG, hematological status, maximal exercise test, ventilatory and cardiac response to hypoxia (F(iO2) = 0.114) at rest and exercise, pulmonary vascular response to hypoxia by echocardiography, and 24-h monitoring of EKG and arterial pressure. Basal evaluations were performed at SL before the first exposure to hypoxia. HA measurements were daily AMS score, sleep status, and 24-h monitoring of EKG and arterial pressure. All these measurements were repeated after a mean period of 12, 19, and 31 months. Hematocrit increased but reached values lower than those observed in chronic permanent exposure. Systemic and pulmonary arterial pressures measured at SL did not change, but were higher in hypoxia. Right ventricle showed a slight dilatation. Exercise performance at SL declined with exposure to CIH to reach a 12.3% decrease after 31 months of CIH, associated with a 6.8% decrease in maximal heart rate. Signs of ventilatory acclimatization were observed after 12 months. Symptoms of AMS and sleep disturbances were still seen on the first 2 days at HA, whatever the time of exposure to CIH. In conclusion, CIH induced a clear acclimatization process. Subjects did not reach a health status comparable to that seen in permanent residents at HA and remained at risk of acute altitude-induced illnesses.

Luxación posterior de cadera en deportes de invierno: reporte de 2 casos y revisión de la literatura / Posterior hip dislocation in winter sports: a report of 2 cases and review of the literature

Presentar 2 casos de luxación traumática de cadera, ocurridos durante una semana en un centro de urgencias de montaña durante la temporada de invierno, asociado a una descripción del manejo de esta dolencia. Materiales y métodos: Se presentan 2 casos de luxación traumática de cadera en esquiadores, junto a una descripción de la epidemiología y el manejo de esta dolencia basado en la literatura disponible. Resultados: Ambos casos presentaron una luxación posterior de cadera izquierda. Fueron diagnosticados y reducidos en pabellón con anestesia general, utilizando la maniobra de Allis. Uno de los pacientes presentó una desinserción del labrum que no requirió cirugía. Discusión: La luxación traumática de cadera es una lesión extremadamente rara entre quienes practican deportes de invierno. La mayoría de los casos son luxaciones posteriores, al igual que las ocurridas con otros eventos traumáticos, aunque entre quienes practican esquí las luxaciones anteriores deben ser también consideradas. Conclusión: La luxación de cadera es una lesión infrecuente entre quienes practican esquí o snowboard, pero es necesario sospecharla debido a sus potenciales complicaciones...

To present 2 cases of traumatic hip dislocation that occurred during a week at a mountain emergency centre during the winter season, as well as a description of its management. Methods: Two cases of traumatic hip dislocation in skiers are presented, along with a description of the epidemiology and management of this condition based on available literature. Results: Both cases were diagnosed as a posterior dislocation of the left hip. Reduction was performed under general anaesthesia, using the Allis manoeuvre in the operating room. One patient had an associated labrum detachment that did not require surgery. Discussion: Traumatic hip dislocation is an extremely rare injury among those who practice winter sports. Most cases are posterior dislocations, as with other traumatic events, but anterior dislocations should also be considered among those who practice skiing. Conclusion: Hip dislocation is an uncommon injury among those who practice skiing or snowboarding and a high level of suspicion is necessary to avoid potential complications...

cAMP-dependent oncogenic action of Rap1b in the thyroid gland.

cAMP signaling leads to activation and phosphorylation of Rap1b. Using cellular models where cAMP stimulates cell proliferation, we have demonstrated that cAMP-mediated activation, as well as phosphorylation of Rap1b, is critical for cAMP stimulation of DNA synthesis. To determine whether Rap1b stimulates mitogenesis in vivo, we have constructed a transgenic mouse where a constitutively active G12V-Rap1b, flanked by Cre recombinase LoxP sites, is followed by the dominant negative S17N mutant. Employing this novel mouse model, we have switched, in a tissue-specific (thyroid) and temporally controlled manner, the expression of Rap1b from a stimulatory to an inhibitory form. These experiments provide conclusive evidence that Rap1b is oncogenic in the thyroid in ways linked to transduction of the cAMP mitogenic signal.