Search

Supplemental digital content is available in the text., Ingestion of proteins with high leucine content during resistance training (RT) can augment hypertrophy. Some data suggest that a leucine metabolite, β-hydroxy, β-methylbutyrate (HMB), is substantially more anabolically efficacious than leucine. Purpose We aimed to test whether supplementation with HMB versus leucine, added to whey protein, would result in differential muscle hypertrophy and strength gains in young men performing RT. Methods Twenty-six resistance-trained men (23 ± 2 yr) performed 12 wk of RT with three phases. Phase 1: 8 wk of periodized RT (three training sessions per week). Phase 2: 2 wk overreaching period (five sessions per week). Phase 3: 2 wk taper (three sessions per week). Participants were randomly assigned to twice daily ingestion of: whey protein (25 g) plus HMB (1.5 g) (whey+HMB; n = 13) or whey protein (25 g) plus leucine (1.5 g) (whey+leu; n = 13). Skeletal muscle biopsies were performed before and after RT. Measures of fat- and bone-free mass, vastus lateralis (VL) muscle thickness and muscle cross-sectional area (CSA) (both by ultrasound), muscle fiber CSA, and 1-repetition maximum (1-RM) strength tests were determined. Results We observed increases in fat- and bone-free mass, VL muscle thickness, muscle CSA and fiber type CSA and 1-RM strength with no differences between groups at any phase. We observed no differences between groups or time–group interactions in hormone concentrations at any phase of the RT program. Conclusions β-Hydroxy-β-methylbutyrate added to whey did not result in greater increases in any measure of muscle mass, strength, or hormonal concentration compared to leucine added to whey. Our results show that HMB is no more effective in stimulating RT-induced hypertrophy and strength gains than leucine.

Background Higher-protein (HP) diets are advocated for several reasons, including mitigation of sarcopenia, but their effects on kidney function are unclear. Objective This meta-analysis was conducted to determine the effect of HP intakes on kidney function in healthy adults. Methods We conducted a systematic review and meta-analysis of trials comparing HP (≥1.5 g/kg body weight or ≥20% energy intake or ≥100 g protein/d) with normal- or lower-protein (NLP; ≥5% less energy intake from protein/d compared with HP group) intakes on kidney function. Medline and EMBASE databases were searched. Randomized controlled trials comparing the effects of HP with NLP (>4 d duration) intakes on glomerular filtration rate (GFR) in adults without kidney disease were included. Results A total of 2144 abstracts were reviewed, with 40 articles selected for full-text review; 28 of these were analyzed and included data from 1358 participants. Data were analyzed using random-effects meta-analysis (RevMan 5; The Cochrane Collaboration), meta-regression (STATA; StataCorp), and dose-response analysis (Prism; GraphPad). Analyses were conducted using postintervention (post) GFR and the change in GFR from preintervention to post. The post-only comparison showed a trivial effect for GFR to be higher after HP intakes [standardized mean difference (SMD): 0.19; 95% CI: 0.07, 0.31; P = 0.002]. The change in GFR did not differ between interventions (SMD: 0.11; 95% CI: -0.05, 0.27; P = 0.16). There was a linear relation between protein intake and GFR in the post-only comparison (r = 0.332, P = 0.03), but not between protein intake and the change in GFR (r = 0.184, P = 0.33). The main limitation of the current analysis is the unclear risk of selection bias of the included trials. Conclusions Postintervention GFR comparisons indicate that HP diets result in higher GFRs; however, when changes in GFR were compared, dietary protein had no effect. Our analysis indicates that HP intakes do not adversely influence kidney function on GFR in healthy adults.

In order for inhaled corticosteroids to be delivered adequately to the airways they require patients to take them regularly using an effective technique. Patients often have a poor inhaler technique, and this has been shown to result in sub-optimal asthma control. It is important for all clinicians prescribing inhaled medication to be experienced in the correct technique, and take time to train children so that they have mastered corrected inhaler technique. Using Teach to Goal or teach back methodology is a simple and effective way to provide this in the clinic setting. More than one training session is typically needed before children can master correct inhaler technique. Adherence to inhaled therapy has been shown to be sub-optimal in pediatric populations, with studies showing an average rate of around 50%. Subjective methods of measuring adherence have been shown to be inaccurate and overestimate rates. The advent of new technology has allowed adherence rates to be measured electronically, and it has been shown that regular feedback of these data can be effective at improving asthma control. New mobile apps and smart technology aim to engage patients and families with their asthma care. Effective use of these apps in collaboration with health care professionals has a vast potential to improve adherence rates and inhaler technique, resulting in improved asthma control.

β-hydroxy-β-methylbutyrate (HMB) is a leucine metabolite that is purported to increase fat-free mass (FFM) gain and performance in response to resistance exercise training (RET). The aim of this systematic review and meta-analysis was to determine the efficacy of HMB supplementation in augmenting FFM and strength gains during RET in young adults. Outcomes investigated were: total body mass (TBM), FFM, fat mass (FM), total single repetition maximum (1RM), bench press (BP) 1RM, and lower body (LwB) 1RM. Databases consulted were: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica database (Embase), The Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SportDiscus. Fourteen studies fit the inclusion criteria; however, 11 were analyzed after data extraction and funnel plot analysis exclusion. A total of 302 participants (18–45 y) were included in body mass and composition analysis, and 248 were included in the strength analysis. A significant effect was found on TBM. However, there were no significant effects for FFM, FM, or strength outcomes. We conclude that HMB produces a small effect on TBM gain, but this effect does not translate into significantly greater increases in FFM, strength or decreases in FM during periods of RET. Our findings do not support the use of HMB aiming at improvement of body composition or strength with RET.

Purpose of review Skeletal muscle mass with aging, during critical care, and following critical care is a determinant of quality of life and survival. In this review, we discuss the mechanisms that underpin skeletal muscle atrophy and recommendations to offset skeletal muscle atrophy with aging and during, as well as following, critical care. Recent findings Anabolic resistance is responsible, in part, for skeletal muscle atrophy with aging, muscle disuse, and during disease states. Anabolic resistance describes the reduced stimulation of muscle protein synthesis to a given dose of protein/amino acids and contributes to declines in skeletal muscle mass. Physical inactivity induces: Anabolic resistance (that is likely exacerbated with aging), insulin resistance, systemic inflammation, decreased satellite cell content, and decreased capillary density. Critical illness results in rapid skeletal muscle atrophy that is a result of both anabolic resistance and enhanced skeletal muscle breakdown. Summary Insofar as atrophic loss of skeletal muscle mass is concerned, anabolic resistance is a principal determinant of age-induced losses and appears to be a contributor to critical illness-induced skeletal muscle atrophy. Older individuals should perform exercise using both heavy and light loads three times per week, ingest at least 1.2 g of protein/kg/day, evenly distribute their meals into protein boluses of 0.40 g/kg, and consume protein within 2 h of retiring for sleep. During critical care, early, frequent, and multimodal physical therapies in combination with early, enteral, hypocaloric energy (∼10-15 kcal/kg/day), and high-protein (>1.2 g/kg/day) provision is recommended.

Robert W Morton,1,2 Heather E Elphick,2 Elaine Edwards,1 William J Daw,1,2 Noreen S West1 1Cystic Fibrosis Unit, Sheffield Children’s Hospital, 2Academic Unit of Child Health, University of Sheffield, Sheffield, UK Background: Children with cystic fibrosis (CF) often have suboptimal adherence rates to nebulized medication. Adherence barriers cited include forgetting to take the nebulizers, due to busy home and social lives. Text message reminders have been shown to be effective at improving adherence rates in other chronic diseases such as asthma and diabetes. Objective: The objective of this study was to assess the feasibility and efficacy of sending text reminders for a prolonged period of time to children with CF. Materials and methods: Children with CF aged 5–16 years taking at least one medication via a nebulizer with an electronic adherence monitor were consented for the study. Text message reminders were sent to participants and/or parents via the hospital’s automated text service, up to twice a day, for 6months. The adherence rates for the 6-month text period were compared to the previous 6months before the study. Rates were calculated for weekdays, weekends, and school holidays. Results: Seventeen participants were recruited to the study, with a mean age of 12 years and a mean forced expiratory volume in 1 second (FEV1) of 81% predicted. Fifteen children ­completed the 6-month text period, and I-neb data were accurately analyzed for 13 participants. The mean adherence rate in the 6 months receiving texts was 80%, compared to 81% in the prior 6 months. Overall adherence rates on weekdays, weekends, and school holidays were equivalent during the 2 time periods. A subgroup of patients with moderate baseline adherence showed increased adherence during the text period, particularly at weekends. Conclusion: It is feasible to send text message reminders to children with CF, and they are amenable to this approach. Although text reminders do not increase rates in patients with existing optimal adherence, they may be of value in patients with more moderate baseline rates. Keywords: cystic fibrosis, adherence, telehealth

The factors that underpin heterogeneity in muscle hypertrophy following resistance exercise training (RET) remain largely unknown. We examined circulating hormones, intramuscular hormones, and intramuscular hormone-related variables in resistance-trained men before and after 12 weeks of RET. Backward elimination and principal component regression evaluated the statistical significance of proposed circulating anabolic hormones (e.g., testosterone, free testosterone, dehydroepiandrosterone, dihydrotestosterone, insulin-like growth factor-1, free insulin-like growth factor-1, luteinizing hormone, and growth hormone) and RET-induced changes in muscle mass (n = 49). Immunoblots and immunoassays were used to evaluate intramuscular free testosterone levels, dihydrotestosterone levels, 5α-reductase expression, and androgen receptor content in the highest- (HIR; n = 10) and lowest- (LOR; n = 10) responders to the 12 weeks of RET. No hormone measured before exercise, after exercise, pre-intervention, or post-intervention was consistently significant or consistently selected in the final model for the change in: type 1 cross sectional area (CSA), type 2 CSA, or fat- and bone-free mass (LBM). Principal component analysis did not result in large dimension reduction and principal component regression was no more effective than unadjusted regression analyses. No hormone measured in the blood or muscle was different between HIR and LOR. The steroidogenic enzyme 5α-reductase increased following RET in the HIR (P < 0.01) but not the LOR (P = 0.32). Androgen receptor content was unchanged with RET but was higher at all times in HIR. Unlike intramuscular free testosterone, dihydrotestosterone, or 5α-reductase, there was a linear relationship between androgen receptor content and change in LBM (P < 0.01), type 1 CSA (P < 0.05), and type 2 CSA (P < 0.01) both pre- and post-intervention. These results indicate that intramuscular androgen receptor content, but neither circulating nor intramuscular hormones (or the enzymes regulating their intramuscular production), influence skeletal muscle hypertrophy following RET in previously trained young men.

Observing the excitation mechanisms of incompressible transverse waves is vital for determining how energy propagates through the lower solar atmosphere. We aim to show the connection between convectively driven photospheric flows and incompressible chromospheric waves. The observations presented here show the propagation of incompressible motion through the quiet lower solar atmosphere, from the photosphere to the chromosphere. We determine photospheric flow vectors to search for signatures of vortex motion and compare results to {photospheric flows present in} convective simulations. Further, we search for the chromospheric response to vortex motions. Evidence is presented that suggests incompressible waves can be excited by the vortex motions of a strong magnetic flux concentration in the photosphere. A chromospheric counterpart to the photospheric vortex motion is also observed, presenting itself as a quasi-periodic torsional motion. Fine-scale, fibril structures that emanate from the chromospheric counterpart support transverse waves that are driven by the observed torsional motion. A new technique for obtaining details of transverse waves from time-distance diagrams is presented and the properties of transverse waves (e.g., amplitudes and periods) excited by the chromospheric torsional motion are measured., 12 pages, 6 figures, Accepted ApJ

Women who sexually abuse children are rare and case histories are scarce; even less is known about sexually abusive mothers. Due to the number of cases in which women sexually abuse minors, more in-depth studies on this subject are needed. This article examines the clinical files of five women who are currently serving time in Italian prisons for the sexual abuse of children. Records of the abuse cases and other records were utilized. The cases involved varying degrees of participation in the abuse by the mothers, and ranged from active sexual engagement to allowing others to abuse their children. Female perpetrators are likely to be experiencing problems in many areas of their life, including relationship dysfunction and psychological impairment. In three cases women revealed an antisocial personality disorder (ASPD), while in two cases a borderline personality disorder (BPD) was diagnosed according with DSM-IV criteria. Possible motivations for women who molest their children are explored and discussed. The current review shows that most female sex offenders fall into several suggested typology models. Therefore, the existing typologies used to classify female child sex offenders may be insufficient, and more comprehensive exploration of this offender population is needed.

There have been few documented comparisons of serial murder cases committed in the United States with cases occurring internationally. The authors contrasted two unique serial murder series: one in Italy and one in the United States by examining the details of both series, including the M.O., motivation, crime scene interactions, sexual acts performed, and the general backgrounds of both offenders. The comparison revealed a number of similarities. Both offenders specifically targeted elderly women, who were attacked in their residences. The two series involved sexually motivated crimes, although the sexual interactions were different. Both offenders stole objects from their victims after the murders and each kept newspaper accounts of their crimes. In addition, both offenders claimed to have abusive upbringings, including sexual abuse.

Between 1995 and 1997, in the territories of Southern Italy, there were fifteen murders of elderly women over the age of 70 years old. Initially, however, not all the murders were attributed to a single serial killer. The majority of the victims were stabbed multiple times in the neck, except for three cases in which the cause of death was manual strangulation. There was evidence of sexual assault in only one of the cases. All the victims were discovered in their own apartments, which were located on the ground level, with no signs of forced entry. In most of the cases, the offender stole money and/or jewellery. A multi-disciplinary team reviewed the cases during the investigation and created a profile of the killer. The team determined that the method of operation was completely unusual for the local criminal element. They suggested that the perpetrator could be an immigrant, who committed the murders for sexual motivation and who may have been arrested previously for sex-related incidents. On 15th September 1997, a suspect was arrested. He was identified as Ben Mohamed Ezzedine Sebai, a 35-year-old white male, originally from Tunisia. He was charged and convicted of four of the murders and was given a life sentence. In 2005, Sebai confessed to the murders of four additional elderly women, for which nine other people had already been previously tried and convicted, among them, a man who committed suicide in jail. In 2007, Sebai finally confessed to committing fifteen murders that occurred between 1995 and 1997. Sebai also admitted to experiencing sexual gratification at every homicide scene, even though there was no physical proof at most of the crime scenes. The goal of this article is to illustrate a little-known but noteworthy case concerning a serial sexual killer of elderly women that occurred in Southern Italy, highlighting the method of operation, the victim selection process, and the injuries inflicted. The article will also discuss his motivation, the mental health history of the offender, his clinical diagnosis, and his self-reported childhood abuse.