Hemodynamic and metabolic responses to moderate and vigorous cycle ergometry in men with transtibial amputation

Adults with amputation face barriers to an active lifestyle which attenuates cardiorespiratory fitness. Prior studies in amputees typically involve treadmill walking or arm ergometry, yet physiological responses to leg cycling are less understood. PURPOSE: To assess hemodynamic and metabolic responses to moderate and vigorous cycle ergometry in men with transtibial amputation (TTA), with broader application towards exercise programming. METHODS: Using a randomized within-subjects crossover design, five men with unilateral TTA (age = 39 ± 15 yr) and six able-bodied controls (CON) (age = 31 ± 11 yr) performed two 20 min bouts of cycling differing in intensity.Cardiac output (CO), heart rate (HR), stroke volume (SV), and oxygen consumption (VO2) were measured during moderate intensity continuous exercise (MICE) and high intensity interval exercise (HIIE) using thoracic impedance and indirect calorimetry. RESULTS: In response to MICE and HIIE, HR and VO2 were similar (p \u3e 0.05) between groups. Stroke volume and CO were higher (p \u3c 0.05) in CON which was attributed to their higher body mass. In men with TTA, HIIE elicited peak HR = 88 %HRmax and substantial blood lactate accumulation, representing vigorous exercise intensity. CONCLUSION: Men with TTA show similar responses to MICE and HIIE versus CON.These results provide important insight for developing exercise programs for adults with TTA, and based on similar acute responses versus CON, it appears that moderate and vigorous physical activity recommendations designed for implementation in non-amputees can be applied to men with transtibial amputation

Comparing Physiological Responses During Rowing High Intensity Interval Training (HIIT) versus High Intensity Functional Training (HIFT)

High intensity interval training (HIIT) improves cardiorespiratory fitness, glycemic control, and body composition, yet the majority of studies used cycling which employs a smaller muscle mass. Less data have examined the acute response to whole-body HIIT. PURPOSE: To compare physiological responses between HIIT rowing and high intensity functional training (HIFT). METHODS: Healthy, non-obese men and women (N=18, age=25±8 yr) who are physically active (PA=7±2hr, VO2max=39±8mL/kg/min) underwent graded exercise testing to determine VO₂max and peak power output (PPO) on the rowing ergometer. On two separate days, subjects performed a time-matched bout of HIFT or HIIT rowing. HIIFT required 6 ‘all-out’ sets of 10 push-ups, 10 jump squats, 20 mountain climbers, and 20 body-weight squats separated by 75 s recovery. HIIT rowing consisted of six 1min bouts at 85% PPO with 75 s of recovery. Gas exchange data, heart rate (HR), affective valence, and RPE were obtained during exercise. Blood lactate concentration (BLa) was measured at rest, bout 3, and 5, 10, and 15 min post-exercise. RESULTS: There were significant differences (p2 was higher (p=0.03) with HIIT rowing versus HIFT (1.88 ± 0.51 vs. 1.67 ± 0.35 L/min) as was total O2 (31±8 vs. 28±6L). GroupXtime interactions (pE, and RPE occurred, with higher values demonstrated to HIFT. CONCLUSION: HIFT elicited a higher peak HR, BLa, and RER, suggesting a higher peak cardiovascular stimulus and greater activation of glycolysis, likely due to greater recruitment of fast twitch fibers. Yet, HIIT rowing elicited higher energy expenditure and mean VO2 versus HIFT. The eccentric nature of HIFT may explain the blunted VO2 response, although more studies are needed to verify this result

Fully Endoscopic Microvascular Decompression for Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a chronic, progressive facial pain disorder characterized by severe paroxysmal episodes in the distribution of the trigeminal nerve. The most common cause of (TN) is compression of the trigeminal nerve by a vascular structure within the posterior fossa at the dorsal root entry zone (DREZ). Initially described by Dr. Peter Janetta, microvascular decompression has been clearly demonstrated to be a safe and effective treatment for TN with excellent immediate and long-term pain relief.1 Although neuroimaging has advanced significantly allowing for improved pre-operative visualization of the trigeminal nerve and determination of vascular conflict, most neurosurgeons continue to practice the MVD procedure in a very similar manner to Dr. Janetta’s 1967 description.2 While the retrosigmoid craniotomy and operative microscope allows for an excellent view of the posterior aspect of the trigeminal nerve within the cerebellopontine angle, visualization of the anterior aspect of the nerve is limited. Additionally, adequate visualization of the DREZ may be difficult and require additional retraction of the cerebellum, potentially resulting in complications such as hearing loss and cerebellar injury. As neurosurgical experience with the endoscope has grown, a variety of authors have described performing microvascular decompression with endoscopic assistance which involves using the endoscope to inspect the trigeminal nerve for sites of compression but performing the decompression under the microscope. While the main advantage of the endoscopic approach compared to the microscopic approach is improved visualization of the trigeminal nerve from the DREZ to Meckel’s cave including its inferior, anterior and superior surfaces, evolution of the procedure to a fully endoscopic approach has the additional benefits of being less invasive with minimal soft tissue dissection and cerebellar retraction allowing for reduced patient discomfort and accelerated recovery. In this technical review, we describe our approach to performing a fully endoscopic microvascular decompression including the surgical nuances that allow the procedure to be performed safely and efficiently. Pages 2-

Using Both Sides of Your Brain: The Case for Rapid Interhemispheric Switching

Individual brain hemispheres are often specialized for specific aspects of a behavior. How both sides of the brain coordinate their output to produce a perfectly seamless behavior is not known. Songbirds appear to achieve this by rapidly switching back and forth between hemispheres

A phase 1 study of oral ridaforolimus in pediatric patients with advanced solid tumors

PURPOSE: Ridaforolimus is an investigational, potent, selective mTOR inhibitor. This study was conducted to determine the recommended phase 2 dose (RP2D), maximum tolerated dose, safety, pharmacokinetics, and antitumor activity of oral ridaforolimus in children with advanced solid tumors. EXPERIMENTAL DESIGN: In this phase 1, multicenter, open-label study in children aged 6 to <18 years with advanced solid tumors, ridaforolimus was administered orally for 5 consecutive days/week in 28-day cycles until progression, unacceptable toxicity, or consent withdrawal. Dose started at 22 mg/m2 and increased to 28 mg/m2 and 33 mg/m2, followed by expansion at the RP2D. RESULTS: Twenty patients were treated; 18 were evaluable for dose-limiting toxicities. One dose-limiting toxicity (grade 3 increased alanine aminotransferase) occurred in 1 patient at 33 mg/m2. Dose escalation concluded at 33 mg/m2; the maximum tolerated dose was not determined. The most common treatment-related adverse events (frequency ≥40%) were manageable grade 1-2 stomatitis, thrombocytopenia, hypertriglyceridemia, increased alanine aminotransferase, fatigue, hypercholesterolemia, anemia, and increased aspartate aminotransferase. Ridaforolimus exposure at 28 mg/m2 and 33 mg/m2 exceeded adult target levels. The RP2D for oral ridaforolimus in children was defined as 33 mg/m2. Four patients received at least 4 cycles; 2 with pineoblastoma and diffuse intrinsic pontine glioma had stable disease for 12 and 46 cycles, respectively. CONCLUSIONS: Ridaforolimus is orally bioavailable and well tolerated in children with advanced solid tumors. The RP2D (33 mg/m2, 5 days/week) exceeds the adult RP2D. The favorable toxicity and pharmacokinetic profiles may allow for combination therapy, a promising therapeutic option in pediatric malignancies

Eliminating capability gaps in Wide Area Workflow (WAWF) during contingency operations.

MBA Professional ReportThis paper examines the online Wide Area Workflow-Receipt Acceptance (WAWF-RA) application used across DoD contracting agencies. It explains what WAWF does and its potential benefits to contingency contracting officers. The application works best when certain environmental conditions are met, like adequate IT infrastructure and vendors with a high degree of electronic-commerce (e-commerce) capabilities. Some barriers preventing WAWF's use in contingency contracting are the host nation's poor information technology (IT) infrastructure, low-levels of IT knowledge and skills in poor countries, and minor capability shortfalls in the system itself. Depending on the region, a WAWF variation may be employed for internal operations only. Over time, the local market place can be built up for nearly total WAWF compliance. This research paper provides recommendations on bridging the capability gaps in the WAWF system so that it can be utilized to the maximum extent possible in any country under any conditions. The Department of Defense (DoD) developed online application to provide defense contractors and authorized government personnel the capability to produce and process contract documents such as receiving reports, and invoices over the World Wide Web. The biggest barrier to full implementation of WAWF is the banking systems of unstable countries. One of WAWF's main benefits to contractors and the U.S. Government is its use of electronic currency. Electronic currency is dependant on a stable economy and reliable banking system. Until this problem can be corrected, contingency contractors will continue to maintain and distribute large stockpiles of hard cash.http://archive.org/details/eliminatingcapab1094510197Approved for public release; distribution is unlimited

Yngre kvinnors livssituation vid bröstcancer : The lifesituation of younger women with breast cancer

Bröstcancer utgör den främsta cancerdiagnosen hos kvinnor i Sverige. Stor betydelse för uppkomst av bröstcancer har de kvinnliga könshormonerna. Behandling av bröstcancer sker genom operation, cytostatika, antihormoner och/eller strålning. Behandlingen kan leda till fysisk och psykisk påverkan. Syftet med denna litteraturstudie är att beskriva hur yngre kvinnors livssituation påverkas av bröstcancer samt hur sjuksköterskan kan möta dessa kvinnors behov. Artiklarna till litteraturstudien har sökts fram i databaserna Cinahl, Medline och PsycInfo samt genom manuell sökning och resultatet kom att omfatta 16 artiklar. Dessa artiklar har värderats, bearbetats, analyserats och sedan sammanställts. Resultatet visar att en cancerdiagnos innebär många olika känslor för de yngre kvinnorna, vilket får dem att fungera sämre i det dagliga livet. Förhållandet till familjen förändras och sjukdomen får en stor inverkan på kvinnans yrkesliv och ekonomi. De stora områden som påverkas i samband med bröstcancer hos yngre kvinnor är infertilitet, för tidig menopaus, förändrad kroppsuppfattning samt påverkan av kvinnans sexualitet. Sjuksköterskan har en viktig roll i vården av yngre kvinnor med bröstcancer och kan påverka kvinnan både positivt och negativt. Det framkommer också att behovet av relevant information för kvinnans ålder är stort. När yngre kvinnor drabbas av bröstcancer påverkar det hennes liv på många sätt. Områdena som berörs skiljer sig många gånger från andra grupper med bröstcancer. Detta måste tas hänsyn till inom sjukvården, för att ge optimal vård

A phase 1 study of oral ridaforolimus in pediatric patients with advanced solid tumors

Purpose Ridaforolimus is an investigational, potent, selective mTOR inhibitor. This study was conducted to determine the recommended phase 2 dose (RP2D), maximum tolerated dose, safety, pharmacokinetics, and antitumor activity of oral ridaforolimus in children with advanced solid tumors. Experimental Design In this phase 1, multicenter, open-label study in children aged 6 to <18 years with advanced solid tumors, ridaforolimus was administered orally for 5 consecutive days/week in 28-day cycles until progression, unacceptable toxicity, or consent withdrawal. Dose started at 22 mg/m2 and increased to 28 mg/m2 and 33 mg/m2, followed by expansion at the RP2D. Results: Twenty patients were treated; 18 were evaluable for dose-limiting toxicities. One dose-limiting toxicity (grade 3 increased alanine aminotransferase) occurred in 1 patient at 33 mg/m2. Dose escalation concluded at 33 mg/m2; the maximum tolerated dose was not determined. The most common treatment-related adverse events (frequency ≥40%) were manageable grade 1–2 stomatitis, thrombocytopenia, hypertriglyceridemia, increased alanine aminotransferase, fatigue, hypercholesterolemia, anemia, and increased aspartate aminotransferase. Ridaforolimus exposure at 28 mg/m2 and 33 mg/m2 exceeded adult target levels. The RP2D for oral ridaforolimus in children was defined as 33 mg/m2. Four patients received at least 4 cycles; 2 with pineoblastoma and diffuse intrinsic pontine glioma had stable disease for 12 and 46 cycles, respectively. Conclusions: Ridaforolimus is orally bioavailable and well tolerated in children with advanced solid tumors. The RP2D (33 mg/m2, 5 days/week) exceeds the adult RP2D. The favorable toxicity and pharmacokinetic profiles may allow for combination therapy, a promising therapeutic option in pediatric malignancies