Effects Of Caffeine Dose Timing On Total Urine Excretion During Sodium-Aided Hyperhydration Protocols

When used alone, both caffeine and sodium-aided hyperhydration (SAH) can be ergogenic. Although caffeine use in conjunction with SAH promotes diuresis, hyperhydration can be achieved, albeit at lower levels compared to SAH alone. Previous caffeine and SAH work has suggested most of the caffeine induced diuresis occurs within 15 min of consumption of a bolus of caffeine, sodium and water. This response suggests that caffeine-induces diuresis for only 15 min following its consumption, and/or that the diuretic effects of caffeine are dependent on hydration levels. PURPOSE: To determine the effects of caffeine, consumed at different time-points, on diuresis during SAH protocols. METHODS: Subjects were 17 healthy males (23 ± 5 yr, 177 ± 8 cm, 83.4 ± 15.3 kg). Each performed 4, 90 min hyperhydration trials in a randomized, double-blind fashion. Protocols began with a bladder void and measurement of urine specific gravity (USG) followed by ingestion of 15 mL H2O ∙ kg bm-1 with one of four treatments: Placebo (PL), 70.5 mg NaCl ∙ kg bm-1 (Na), or a combination of NaCl and caffeine consumed in two different strategies: 70.5 mg NaCl + 5 mg caffeine ∙ kg bm-1 taken at the start of the trial (NaCaf0), or 70.5 mg NaCl ∙ kg bm-1 taken at the start and 5 mg caffeine ∙ kg bm-1 taken at 75 min of the trial (NaCaf75). After consuming the water, subjects rested for 90 min performing a measured bladder void every 15 min. Total urine excreted (TUE) was expressed as a percentage of the total fluid consumed during the hyperhydration protocols. USG and TUE were compared using one-way repeated measures ANOVA with Sidak post hoc analyses. Levels of significance were set a priori at P \u3c 0.05. RESULTS: USGs were 1.007 ± 0.003 (PL), 1.008 ± 0.003 (Na), 1.007 ± 0.004 (NaCaf0), and 1.009 ± 0.004 (NaCaf75) (P \u3e 0.05). TUE for PL (87 ± 30%) was significantly higher than all other protocols (P \u3c 0.05). TUE for NaCaf0 (73 ± 16%) was significantly higher than Na (56 ± 18%, P = 0.02) and NaCaf75 (52 ± 13% P \u3c 0.01). NSD in TUE was observed between Na and NaCaf75. CONCLUSION: The results reaffirm that, when caffeine is consumed at the beginning of a SAH strategy, hyperhydration can be achieved, but at a lower level compared to SAH without caffeine. The results also suggest that waiting to consume caffeine until 75 min after water is consumed does not result in caffeine induced diuresis during a SAH protocol

Effects of Fluid Consumption Volumes on Fluid Retention during Sodium-Aided Hyperhydration Protocols

Numerous investigations have supported the use of sodium-aided hyperhydration to improve hydration status and exercise performance in the heat. Sodium-aided hyperhydration studies typically utilize fluid volumes ranging from 10 - 25 mL ∙ kg bm-1; however, optimum fluid consumption volumes have not been identified. While it may seem logical that larger fluid consumption volumes would promote greater hyperhydration, excessive expansion of plasma volume could stimulate high-pressure baroreceptors and promote excessive diuresis. PURPOSE: To compare the effects of different fluid consumption volumes on fluid retention during a sodium-aided hyperhydration protocol. METHODS: Urine excretion was measured during four separate sodium-aided hyperhydration protocols in thirteen male subjects (24 ± 4 yrs, 75.2 ± 9.5 kg, 177.0 ± 8.9 cm) who were free from known renal, digestive, and cardiovascular disease. Each protocol began with a complete bladder void and assessment of urine specific gravity (USG). Subjects then consumed one of four different isotonic volumes of sodium and water in three equal doses separated by 45 min. Total water consumptions for the four protocols were 20 mL ∙ kg bm-1 (20), 15 mL ∙ kg bm-1 (15), 10 mL ∙ kg bm-1 (10), and 5 mL ∙ kg bm-1 (5). Subjects remained in the lab for two hours following the consumption of the initial fluid-sodium dose and performed a measure bladder void every 20 min. USGs and total fluid retentions (total fluid consumed – total urine excreted) for each protocol were compared using separate, one-way, repeated measures ANOVA and Sidak post-hoc analyses. RESULTS: USGs for the four protocols were 1.009 ± 0.005 (20), 1.010 ± (0.002), 1.016 ± 0.028 (10), and 1.009 ± 0.005 (5) (P \u3e 0.90), indicating that all subjects were well and similarly hydrated for each protocol. Fluid retentions for the four protocols were 10.8 ± 2.7 mL ∙ kg bm-1 (20), 7.5 ± 2.3 mL ∙ kg bm-1 (15), 5.6 ± 2.5 mL ∙ kg bm-1 (10), and 2.6 ± 1.4 mL ∙ kg bm-1 (5) (P ≤ 0.04). CONCLUSION: Subjects retained approximately 50% of the fluid that they consumed regardless of their fluid consumption volumes. These results suggest that, when consuming 5 – 20 mL ∙ kg bm-1 of fluid during sodium-aided hyperhydration protocols, fluid retention levels increase linearly with an increase in fluid consumption volumes and, to attain the highest level of hyperhydration, at least 20 mL ∙ kg bm-1 of fluid should be consumed

The Effectiveness of Cervical Traction and Exercise in Decreasing Neck and Arm Pain for Patients With Cervical Radiculopathy: A Critically Appraised Topic

Clinical Question: Is there evidence to suggest intermittent cervical traction with cervical and scapular strengthening exercises is more effective in decreasing neck and arm pain when compared with cervical and scapular strengthening exercises alone in nonoperative patients with cervical radiculopathy? Clinical Bottom Line: There is currently inconsistent, high-quality evidence that suggests that the use of intermittent cervical traction in addition to strengthening exercises is more effective at decreasing pain in nonoperative patients with cervical radiculopathy when compared with strengthening alone. Future research should continue to examine long-term outcomes associated with cervical radiculopathy patients who use intermittent cervical traction as an intervention

In Vivo screening and discovery of novel candidate thalidomide analogs in the zebrafish embryo and chicken embryo model systems

This study was supported by a Wellcome Trust-NIH PhD Studentship to SB, WDF and NV. Grant number 098252/Z/12/Z. SB, CHC and WDF are supported by the Intramural Research Program, NCI, NIH. NHG and WL are supported by the Intramural Research Program, NIA, NIH.Peer reviewedPublisher PD

Oral ezatiostat HCl (Telintra®, TLK199) and Idiopathic Chronic Neutropenia (ICN): a case report of complete response of a patient with G-CSF resistant ICN following treatment with ezatiostat, a glutathione S-transferase P1-1 (GSTP1-1) inhibitor

Idiopathic chronic neutropenia (ICN) describes a heterogeneous group of hematologic diseases characterized by low circulating neutrophil levels often associated with recurrent fevers, chronic mucosal inflammation, and severe systemic infections. The severity and risk of complications, including serious infections, are inversely proportional to the absolute neutrophil count (ANC), with the greatest problems occurring in patients with an ANC of less than 0.5 × 109/L. This case report describes a 64-year-old female with longstanding rheumatoid arthritis who subsequently developed ICN with frequent episodes of sepsis requiring hospitalization and prolonged courses of antibiotics over a 4-year period. She was treated with granulocyte colony stimulating factors (G-CSF) but had a delayed, highly variable, and volatile response. She was enrolled in a clinical trial evaluating the oral investigational agent ezatiostat. Ezatiostat, a glutathione S-transferase P1-1 inhibitor, activates Jun kinase, promoting the growth and maturation of hematopoietic progenitor stem cells. She responded by the end of the first month of treatment with stabilization of her ANC (despite tapering and then stopping G-CSF), clearing of fever, and healing of areas of infection. This ANC response to ezatiostat treatment has now been sustained for over 8 months and continues. These results suggest potential roles for ezatiostat in the treatment of patients with ICN who are not responsive to G-CSF, as an oral therapy alternative, or as an adjunct to G-CSF, and further studies are warranted

Transverse-mode coupling in a Kerr medium

We analyze nonlinear transverse mode coupling in a Kerr medium placed in an optical cavity and its influence on bistability and different kinds of quantum noise reduction. Even for an input beam that is perfectly matched to a cavity mode, the nonlinear coupling produces an excess noise in the fluctuations of the output beam. Intensity squeezing seems to be particularly robust with respect to mode coupling, while quadrature squeezing is more sensitive. However, it is possible to find a mode the quadrature squeezing of which is not affected by the coupling.Comment: 11 pages, 6 figures, LaTe

Patient Advocacy in Plastic Surgery: An Underutilized Tool

Summary: Healthcare advocacy is an important tool in the plastic surgeon’s arsenal that stands the potential to improve both patient care and the profession. However, many physicians underestimate the importance and influence that healthcare advocacy has on the profession and feel that they lack the leverage and knowledge to advocate on behalf of themselves, their practices, their patients, and their profession, all of which are untrue. Plastic surgeons are uniquely positioned to advocate based on their clinical acumen, personal experiences with patient care, and their position in the healthcare ecosystem value chain. This article aims to equip plastic surgeons with a general framework of knowledge regarding policy and advocacy. Additionally, the article outlines and discusses recent advocacy efforts related to plastic surgery, and efforts that are on the horizon to provide some context to the relevance of advocacy related to plastic surgery. Finally, we aim to empower plastic surgeons to step into the policy advocacy arena for the betterment of our patients and the professional practice of plastic surgery. (Plast Reconstr Surg Glob Open 2019;7:e2207; doi: 10.1097/GOX.0000000000002207; Published online 3 May 2019.

Art+Politics

For the exhibition Art + Politics, students worked closely with the holdings of Gettysburg College\u27s Special Collections and College Archives to curate an exhibition in Schmucker Art Gallery that engages with issues of public policy, activism, war, propaganda, and other critical socio-political themes. Each of the students worked diligently to contextualize the objects historically, politically, and art-historically. The art and artifacts presented in this exhibition reveal how various political events and social issues have been interpreted through various visual and printed materials, including posters, pins, illustrations, song sheets, as well as a Chinese shoe for bound feet. The students\u27 essays that follow demonstrate careful research and thoughtful reflection on the American Civil War, nineteenth-century politics, the First and Second World Wars, World\u27s Fairs, Dwight D. Eisenhower\u27s campaign, Vietnam-War era protests, and the Cultural Revolution in China. [excerpt]https://cupola.gettysburg.edu/artcatalogs/1009/thumbnail.jp