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Echocardiography can be a useful tool to evaluate athlete's heart in various sports. In this scoping review, we discuss some of the structural and functional changes of the right ventricle across different echocardiographic modes and techniques among individuals engaging in extreme athletic activity. We highlight the role of imaging in the evaluation of athlete's heart and describe similarities and differences between echocardiographic and cardiac MRI features related to acute and chronic athletic activity. We will also review novel echocardiographic parameters including speckle tracking and strain/strain rate imaging. Overall, we aim to present common echocardiographic parameters in elite sports population in order to facilitate better interpretation of their interpretations that may not necessarily be a distinct digression from these common features.

Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. The Impella (Abiomed Inc.) is an axial flow pump on a pigtail catheter that is placed across the aortic valve to unload the left ventricle by delivering non-pulsatile blood flow to the ascending aorta. It is used for high-risk percutaneous coronary intervention and CS.Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance. We review Impella and other percutaneous devices such as intra-aortic balloon pump, TandemHeart, and extracorporeal membrane oxygenation (ECMO) and the evidence supporting their use in the setting of CS.Impella has been proven to be safe and may be superior to other mechanical support devices in CS.

The 2010 Haiti earthquake brought attention to the global need for rapid deployment of disaster relief health care services. In such large-scale disasters, a variety of international organisations provide temporary services until the damaged local health care system recovers. However, the disaster environment can pose operational and temporal challenges that may impede the effectiveness of relief services, and research is needed to provide both theory and methods for improving coordination and collaboration among relief organisations. This study investigates opportunities and barriers for relief organisations to pool complementary resources originating from multiple countries, by examining five case studies that represent the breadth of organizational types, including charter (civilian, military, university-affiliated and public/private), facility type (primary, secondary, and tertiary care), and duration of stay. The study yields a set of research propositions that chart avenues for future studies in thi...

BioMEMS relates to the implementation of Micro-Electro-Mechanical Systems (MEMS), in the biological and medical sphere. BioMEMS sensors are being utilized for many clinical applications, including a wireless urinary pressure system, right heart pressure sensor, and measurements on shearing force on the vascular system An important application of BioMEMS is on Heart failure (HF), a common disease, with a prevalence of 10% or more in persons 70 years of age or older, associated with high morbidity and mortality. HF affects over 5 million people and contributes to over 200,000 deaths a year in the United States alone.The purpose of this paper is to provide a short overview on the successful implementation of BioMEMS sensors in heart failure and vascular medicine. Expert commentary: BioMEMS devices have overcome current limitations in pharmacotherapies for resistant hypertension by electrical modulation of the baroreceeptors. This represents a step towards the development of biomedical micro-devices for those conditions in which pharmacotherapies result poorly effective or elicit unacceptable toxicity.

Objectives: To review and evaluate the role of vitamin D in autoimmune diseases based on current studies.Method: We searched PubMed using keywords such as ‘vitamin D’, ‘autoimmune disease’, and ‘autoimmunity’. We compiled and reviewed various studies including prospective cohorts, cross-sectional studies, longitudinal evaluations, genetic studies, and experimental models that investigated the role of vitamin D in autoimmune diseases.Results: There is evidence based on these various studies that several key autoimmune diseases are modulated by vitamin D. These diseases include, but are not limited to, multiple sclerosis (MS), scleroderma or systemic sclerosis (SSc), autoimmune thyroid diseases, rheumatoid arthritis (RA), and primary biliary cirrhosis (PBC).Conclusions: Although there is evidence for vitamin D as a factor in the pathophysiology of autoimmune diseases, the mechanism for this association has yet to be elucidated. Additional data are needed to corroborate these findings.

RNA interference represents one of the most promising strategies in fighting disease. However, small RNA interference faces substantial challenges for in vivo application due to the inherent instability of the RNA interference molecule. Among the nonviral gene delivery carriers, nanoparticles have attracted interest due to their success in various model systems. Nanomaterials have unique properties compared to conventional bulk materials that may be applicable in this setting. The nanoparticle complex carrying small interference RNA can undergo surface modification to achieve targeted modification for tissue-specific delivery. However, toxicity issues of the delivery systems need to be addressed and they require a pharmacogenomic profile of their own.The authors review pharmacogenomics, toxicogenomics, nanoparticle-based drug delivery, and small interference RNA, with a focus on how logically engineered nanoparticle delivery systems can be used for personalized medicine in malignant tumors.Pharmacogenomics may be helpful in addressing possible individualized drug response for both the gene silencing capability of the delivered siRNA and the nanoparticle drug delivery system as both complete and distinct units. This may be done by assessing variations in gene expressions and single nucleotide polymorphisms. Patient profiling may be key as patient noncompliance due to toxicity plays a major role in treatment failure.

Behcet's disease (BD) is a multisystem disease, in which recurrent aphthous stomatitis (RAS) is a universal finding. We studied the expression of RAS in patients with BD, and the correlation between major or minor RAS and systemic expression and severity of the disease. Thirty-five patients with BD were studied, of whom 13 (37%) had major, 21 (60%) had minor and one (3%) had herpetiform RAS. The frequency of major RAS was significantly higher compared with a control group of patients with idiopathic RAS (37% vs 9%, P < 0.05). The BD patients with major RAS had significantly more relapses of oral ulceration in a year, higher numbers of oral ulcers per relapse, and longer duration of aphthous episodes, compared with patients with minor RAS. Oral ulcers also appeared at a significantly younger age in patients with major than with minor RAS. However, the systemic expression of the disease, as well as the disease severity score, were similar in patients with major and minor RAS. The results of this study indicate that major RAS is common in patients with BD, and is associated with a more severe, repeated and prolonged oral disease. Nevertheless, the presence of major RAS in BD does not predict a more severe systemic illness.

Over the last few years, major health care systems have been trying to control increasing pharmaceutical expenditures by a variety of methods, such as the controversial copayment policy, as essential health expenditures were being jeopardized.To analyze the regulatory intervention of preauthorization on a rofecoxib model in the medical corps of the Israeli Defense Forces (IDF) in terms of indications for prescription, consumption, and cost.Guidelines established by the medical services branch based on current literature and communication with diverse specialists and hospitals were implemented by a general practitioner who checked each rofecoxib prescription that was written for IDF personnel by a specialist. The intervention was initiated in November 2000 and continued until August 2001 and after the study.The study was divided into two parts. The first part was a retrospective monthly, preintervention analysis of computerized medical records of IDF personnel (N = 247) for whom rofecoxib was prescribed. The second was a prospective monthly, postintervention analysis of filled-out guideline forms (N = 250) of approved rofecoxib prescriptions.Patients, were IDF personnel, age 18 to 45, treated in military and civilian outpatient clinics for whom rofecoxib was prescribed.The study took place at the Medical Service Branch of the IDF between August 2000 and August 2001.We demonstrated a significant decrease in average monthly consumption (43.0%) and estimated monthly expenditures (40.84%) of rofecoxib, as well as significant shifts (p0.001) in indications for whom rofecoxib was approved. These shifts (from pre- to postintervention) include the following: others/nonspecified (80 to 12%), known peptic disorder (7 to 32%), peptic complaints (4 to 22%), and rheumatic (8 to 19%).This type of intervention can be cost-effective, can provide quality care, and may be a viable alternative to the controversial and problematic copayment policy.

Miniaturization of devices to micrometer and nanometer scales, combined with the use of biocompatible and functional materials, has created new opportunities for the implementation of drug delivery systems. Advances in biomedical microdevices for controlled drug delivery platforms promise a new generation of capabilities for the treatment of acute conditions and chronic illnesses, which require high adherence to treatment, in which temporal control over the pharmacokinetic profiles is critical. In addition, clinical conditions that require a combination of drugs with specific pharmacodynamic profiles and local delivery will benefit from drug delivery microdevices. This review provides a summary of various clinical applications for state-of-the-art controlled drug delivery microdevices, including cancer, endocrine and ocular disorders, and acute conditions such as hemorrhagic shock. Regulatory considerations for clinical translation of drug delivery microdevices are also discussed. Drug delivery microdevices promise a remarkable gain in clinical outcomes and a substantial social impact. A review of articles covering the field of microdevices for drug delivery was performed between January 1, 1990, and January 1, 2014, using PubMed as a search engine.

Current parenteral administration of drugs suffers from several drawbacks including the requirement of healthcare personnel to administer the drug, the risk of needle stick injuries that may result in the transmission of blood borne pathogens, and patient discomfort. Prefilled devices have emerged as powerful tools to improve parenteral administration of drugs. There are a number of clinical conditions including treatment of endocrine diseases, neurological disorders, autoimmune diseases and emergency medicine where prefilled devices have made major improvements to patient care. Prefilled devices have become an important set of tools for the medical practitioner due to their ease of use and safety, cost effectiveness and patient convenience. This review provides a comprehensive summary of existing prefilled devices, their current clinical uses and corresponding regulatory processes.

Obesity is major health problem. Abdominal obesity is associated with the metabolic syndrome, coronary artery disease (CAD) and heart failure (HF). It is unclear if abdominal obesity is associated with left ventricular (LV) dysfunction independently of hypertension (HTN), CAD and weight among

The damage to medical facilities resulting form the January 2010 earthquake in haiti necessitated the establishment of field tent hospitals. Much of the local medical infrastructure was destroyed or limited operationally when the Fast Israel Rescue and Search Team (FIRST) arrived in Haiti shortly after the January 2010 earthquake. The FIRST deployed small tent hospitals in Port-au-Prince and in 11 remote areas outside of the city. Each tent was set up in less than a half hour. The tents were staffed with an orthopedic surgeon, gynecologists, primary care and emergency care physicians, a physician with previous experience in tropical medicine, nurses, paramedics, medics, and psychologists. The rapidly deployable and temporary nature of the effort allowed the team to treat and educate, as well as provide supplies for, thousands of refugees throughout Haiti. In addition, a local Haitian physician and his team created a small tent hospital to serve the Petion Refugee Camp and its environs. FIRST personnel also took shifts at this hospital.

Introduction Y. Rosen, N. Elman, E. Horowitz Principles of Clinical and Engineering Integration in Hemocompatibility Y. Rosen, N. Elman Medical Applications of Micro-Electro-Mechanical Systems (MEMS) Technology M.A. Huff Nanoparticles to Cross Biological Barriers T. Moore, E. Graham, B. Mattix, and F. Alexis Biomaterials, Dental Materials, and Device Retrieval and Analysis J.E. Lemons Biomaterials and the Central Nervous System: Neurosurgical Applications of Materials Science U.M. Upadhyay Biomaterials in Obstetrics and Gynecology D. Shveiky and Y. Hants Tissue Engineering: Focus on the Cardiovascular System A. Lesman, S. Levenberg Tissue Engineering: Focus on the Musculoskeletal System M. Keeney, L.-H. Han, S. Onyiah, F. Yang Regulatory Challenges in Biomaterials: Focus on Medical Devices P. Gurman, O. Rabinovitz-Harison, T.B. Hunter Innovative Product Development and Technology Adoption for Medical Applications S.M. Jarrett Appendix: Some Examples of FDA-Approved Products P. Gurman

On the 17th of August 1999, an earthquake of 7.4 magnitude on the Richter Scale struck the Marmara region in Turkey causing a massive casualties event with an estimated 2680 deaths and 5300 injuries just at the city of Adapazari alone. A field hospital was set up by the Israel Defense Forces at Adapazari in order to provide temporary medical services until regular medical forces recovered. The aim of the paper is to overview the requirements of the nursing staff at a field hospital based on our experience and analysis of the nursing activity at the field hospital at Adapazari. The methods implemented include interviewing all nurses and many of the doctors who took part in the field hospital as well as a review of medical literature about disasters. We found an inverted nurse:phycisian ratio of 1:1.77, as opposed to a 2.5–3:1 ratio in regular civilian hospitals. The nurses in our field hospital had to work longer and more intensive shifts than in a regular hospital. They had to overcome language barriers and cultural differences, and faced difficult hygiene conditions. Our overview analysis of results brought up several recommendations. Firstly, although it is not possible to predict the number and types of casualties, it is necessary to provide an adequate number of nurses (1–1.5:1 nurse:physician ratio). Furthermore, the nurses should be specialized and rotated as needed. Secondly, the language and cultural barriers should not be undermined despite the abundance of translators. Finally, the hygiene status in a field hospital requires management by nurses with active participation of all members.