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Introduction/Purpose: Regular exercise may offset age-associated increases in inflammatory cytokines and reduce the risk of developing diseases with an inflammatory etiology by exerting 'anti-inflammatory' effects. Toll-like receptor 4 (TLR4) signaling stimulates inflammatory cytokine production, and may explain the 'anti-inflammatory' effect attributed to regular exercise. Therefore, the purpose of the present study was to compare the effect of acute (3 sets, 9 exercises, 10 repetitions at 80% of the 1-repetition maximum) and chronic resistance exercise on TLR4 and inflammatory cytokines.Methods: Venous blood samples were collected from trained (TR, N = 10) and untrained (UT, N = 10) older (65-80 yr) postmenopausal women: before (PRE), immediately post (POST), and 2 h (2H), 6 h (6H), and 24 h (24H) after completion of exercise. Cell-surface expression of TLR4 (two-color immunofluorescent cytometry), LPS (25 [mu]g[middle dot]mL-1)-stimulated cytokine production (ELISA), plasma cytokines (ELISA), and mRNA expression of TLR4 and cytokines (RT-PCR) were determined for each sample.Results: TR had 124% less cell-surface TLR4 expression than UT (P < 0.05). A significant time effect was found for LPS-stimulated IL-6, IL-1[beta], and TNF-[alpha], where 6H was significantly greater than all other samples. No significant effects were found for plasma (IL-6 and TNF-[alpha]) or mRNA expression (IL-6, TNF-[alpha], and IL-1[beta]) of inflammatory cytokines. When subjects were grouped according to cell-surface TLR4 expression (HI and LO), LPS-stimulated TNF-[alpha] (302%), IL-1[beta] (209%), and IL-6 (167%) production was greater for HI than LO (P < 0.05).Conclusion: Regularly exercising older women expressed less cell-surface TLR4 but did not have lower plasma levels or produce less LPS-stimulated inflammatory cytokines at rest or in response to a single bout of resistance exercise. TLR4 changes may explain the 'anti-inflammatory' effect that has recently been attributed to chronic (2x wk-1 for previous 24 months) resistance exercise training. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess perceptions of exercise professionals regarding obesity. A three page, 25-item survey was mailed to a random sample of 500 certified Health Fitness Instructors, Exercise Test Technologists, and Exercise Specialists from a certification list provided by the American (College of Sports Medicine (ACSM). The return rate was 66%. Most exercise professionals (74%) supervised or worked directly with obese clients in an exercise/fitness setting. The majority of exercise professionals believed that normal weight is very important to a person's health, that physical activity is very important in the treatment of obesity, that they should be role models by maintaining normal weight, that they are obligated to counsel obese persons concerning the health risks of obesity, that they are very competent to prescribe exercise programs for weight loss, and that counseling obese persons on exercise for weight loss is professionally gratifying. The majority of exercise professionals also believed sedentary lifestyles, poor eating behavior, excessive calorie consumption, and psychological problems play a major role in most obesity. Exercise professionals reported that they received most of their information on weight control from textbooks, college classes, scientific journals, workshops/seminars, and past experience. [ABSTRACT FROM AUTHOR]

The provision of life-sustaining ventilation, such as tracheostomy to critically ill patients, is commonly performed. However, the utilization of tracheostomy or extubation after a withdrawal of treatment decision is debated. There is a dearth of practical information available to aid clinical decision making because withdrawal of treatment is a challenging scenario for all concerned. This is further complicated by medicolegal and ethical considerations. Care of the 'hopelessly ill' patient should be based on daily evaluation and comfort making it impossible to fit into general algorithms. Although respect for autonomy is important in healthcare, it is limited for patients in an unconscious state. Beneficence remains the basis for withdrawing treatment in futile cases and underpins the 'doctrine of double effect.' This article presents a relevant clinical case of hypoxic brain injury where a question of withdrawal of treatment arose and examines the ethical, clinical, and medicolegal considerations inherent in such cases, including beneficence, nonmaleficence, and the 'sanctity of life doctrine.' In addition, the considerations of prognosis for recovery, patient autonomy, patient quality of life, and patient family involvement, which are central to decision making, are addressed. The varying legal frameworks that exist internationally regarding treatment withdrawal are also described. Good ethics needs sound facts, and despite the lack of legal foundation in several countries, withdrawal of treatment remains practiced, and the principles described within this article aim to aid clinician decision making during such complex and multifaceted end-of-life decisions. © 2010 Elsevier Inc. All rights reserved. [ABSTRACT FROM AUTHOR]

Description In this review, we argue that exercise (physical activity) be monitored as a vital sign since no other basic sign or symptom provides as much information about a patient's health status. The influence of regular exercise on patient health is indisputable, with strong evidence to show the power of exercise to mitigate chronic disease and improve overall health. Several simple tools, such as Physical Activity as a Vital Sign and Exercise as a Vital Sign are available to assess patient physical activity. When properly applied, there is evidence to support the efficacy of these tools, but there are barriers that prevent broad inclusion in primary care, among which are time and provider knowledge. In our review, we also discussed the value of physician-led lifestyle discussions with patients and found they view these discussions favorably. There is also evidence that physicians who exercise are more likely to have these lifestyle discussions with their patients, but the proportion of physicians who exercise regularly is fairly low. We believe physicians' awareness of their patients' sedentary lifestyles should prompt a prescription to increase physical activity, but additional in-clinic support and community resources need to be in place for patients to get a regular dose., Competing Interests: Conflicts of Interest: The authors declare they have no conflicts of interest., (© 2024 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Coronary artery calcium (CAC) scoring is an important prognostic tool for personalized cardiovascular preventive care and has recently been incorporated into American College of Cardiology/American Heart Association guidelines. CAC provides direct visualization and quantification of CAC burden for risk stratification and primary prevention of cardiovascular events in an asymptomatic population. CAC scoring is recommended for individuals with intermediate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and selective populations with borderline ASCVD risk. In this review, we outline the interpretation of CAC scores for predicting the risk of cardiovascular events, and we highlight the guidelines for starting statin and potentially starting aspirin therapy. A CAC score of 0 is the strongest negative predictive factor for cardiovascular disease (CVD), and a 0 score can successfully de-risk a patient. On the contrary, higher CAC scores correlate with worse cardiovascular prognostic outcomes. The CAC scan is a widely available and reproducible means for an early look at the atherosclerotic burden, and it can help strategize early interventions. The CAC interpretation and the decision to start treatment need to be personalized based on individual risk factors. We believe the emerging literature supports our contention that the CAC score can be used more broadly to improve the prophylaxis and treatment of a wider range of apparently healthy patients., Competing Interests: Conflicts of Interest Dr Alexander discloses speaking honoraria from Janssen Pharmaceuticals. Drs Flynn, Hussain, and Mahmood declare no conflicts of interest., (© 2023 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Description Atrial fibrillation (AF) remains the most common arrhythmia worldwide and is expected to affect approximately 12 million individuals in the United States alone by 2030. Thromboembolic events remain a feared complication of AF and should be treated and risk-stratified utilizing the CHA 2 DS 2 -VASc scoring system. Other complications of AF span a wide spectrum from impaired quality of life (QoL) to an increase in all-cause mortality. Rate control strategies consist of controlling the ventricular rate and have been shown to be a safe and effective strategy for asymptomatic AF patients. In patients who are plagued with symptoms leading to impaired QoL or a decrease in exercise capacity, rhythm control with antiarrhythmic drugs or catheter ablation may be suitable options. Mortality benefits when comparing rate versus rhythm control remain equivocal when comparing multiple studies over the past decade., Competing Interests: Conflicts of Interest Dr Alexander discloses speaking honoraria from Janssen Pharmaceuticals., (© 2023 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Description Case reports play an essential role in the dissemination of knowledge in medicine. A published case is typically an unusual or unexpected presentation in which the outcomes, clinical course, and prognosis are linked to a literature review in order to place the case into the appropriate context. Case reports are a good option for new writers to generate scholarly output. This article can serve as a template for writing a case report, which includes instructions for creating the abstract and crafting the body of the case report-introduction, case presentation, and discussion. Instructions for writing an effective cover letter to the journal editor are also provided as well as a checklist to help authors prepare their case reports for submission., Competing Interests: Conflicts of Interest The authors declare that they have no conflicts of interest., (© 2023 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Background: Oxytocin protocols are employed to induce uterine contractions and progressive cervical changes, but they are associated with adverse maternal and neonatal outcomes. The aim of this study was to determine whether compliance with a checklist-based protocol for oxytocin administration was associated with changes in neonatal and maternal outcomes., Methods: A retrospective cohort study of 86,786 pregnant women undergoing term (> 37 weeks) induction of labor between January 2015 and December 2017 was performed. Systemwide training in the use of an oxytocin administration protocol was provided to obstetricians and nurses. Pre-use and in-use oxytocin checklists were incorporated into each unit's policies and procedures. Subsequently, charts were reviewed and individually audited by an obstetric nurse who scored each record based on the documentation of variables in an oxytocin administration protocol and ranked adherence as complete or absent. Primary outcomes were postpartum hemorrhage, neonatal ICU (NICU) admission, and delivery by cesarean section. Bivariate analyses (t-tests) were performed on adherent and nonadherent groups for comparison of selected demographic variables and the primary outcome variables. Logistic regression was completed on the primary outcome variable with eight covariates., Results: Among patients with complete adherence to the oxytocin administration protocol, the rate of cesarean section in the unadjusted analysis was 16.20%, compared to 18.54% for those with incomplete adherence; the rates of postpartum hemorrhage were 2.64% vs. 3.14%, respectively, and the rates of NICU admission were 3.03% vs. 3.86%, respectively. In the multivariable logistic regression, complete protocol adherence was associated with significantly lower odds of postpartum hemorrhage (adjusted odds ratio [OR] 0.85, 95% confidence interval [CI] 0.76-0.94) but higher odds of Cesarean section (adjusted OR 1.07, 95% CI 1.01-1.13); the adjusted OR for NICU admission was 0.90, which did not reach statistical significance (95% CI 0.81-1.00). Among the covariates, nulliparity and elective induction were the strongest predictors of the primary outcomes of cesarean section, postpartum hemorrhage, and NICU admission., Conclusion: Adherence to the oxytocin administration protocol was associated with a decrease in postpartum hemorrhage but an increased risk of delivery by cesarean section., (Copyright © 2022. Published by Elsevier Inc.)

Description Among the pillars of science is the galvanizing process of peer review. Editors of medical and scientific publications recruit specialty leaders to evaluate the quality of manuscripts. These peer reviewers help to ensure that data are collected, analyzed, and interpreted as accurately as possible, thereby moving the field forward and ultimately improving patient care. As physician-scientists, we are given the opportunity and responsibility to participate in the peer review process. There are many benefits to engaging in the peer review process including exposure to cutting-edge research, growing your connection with the academic community, and fulfilling the scholarly activity requirements of your accrediting organization. In the present manuscript, we discuss the key components of the peer review process and hope that it will serve as a primer for the novice reviewer and as a useful guide for the experienced reviewer., Competing Interests: Conflicts of Interest The authors declare that they have no conflicts of interest., (© 2022 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Background: We conducted a retrospective cohort study on COVID-19 patients with and without dementia by extracting data from the HCA Healthcare Enterprise Data Warehouse between January-September 2020., Aims: To describe the role of patients' baseline characteristics specifically dementia in determining overall health outcomes in COVID-19 patients., Methods: We grouped in-patients who had ICD-10 codes for dementia (DM) with age and gender-matched (1:2) patients without dementia (ND). Our primary outcome variables were in-hospital mortality, length of stay, Intensive Care Unit (ICU) admission, ICU-free days, mechanical ventilation (MV) use, MV-free days and 90-day re-admission., Results: Matching provided similar age and sex in DM and ND groups. BMI (median, 25.8 vs. 27.6) and proportion of patients who had smoked (23.3 vs. 31.3%) were lower in DM than in ND patients. The median (IQR) Elixhauser Comorbidity Index was higher in dementia patients 7 (5-10) vs. 5 (3-7, p < 0.01). Higher mortality was observed in DM group (30.8%) vs. ND group (26.4%, p < 0.01) as an unadjusted univariate analysis. The 90-day readmission was not different (32.1 vs. 31.8%, p = 0.8). In logistic regression analysis, the odds of dying were not different between patients in DM and ND groups (OR = 1.0; 95% CI 0.86-1.17), but the odds of ICU admissions were significantly lower for dementia patients (OR = 0.58, 95% CI 0.51-0.66)., Conclusions: Our data showed that COVID-19 patients with dementia did not fare substantially worse, but in fact, fared better when certain metrics were considered., Competing Interests: Authors ASy, AB, ASh, and PV were employed by Advent Health. Authors JA, BC, MF, and RK were employed by HCA Healthcare., (Copyright © 2022 Vekaria, Syed, Anderson, Cornett, Bourbia, Flynn, Kashyap and Shah.)

TMPRSS13 is a member of the type II transmembrane serine protease (TTSP) family. Here we characterize a novel post-translational mechanism important for TMPRSS13 function: proteolytic cleavage within the extracellular TMPRSS13 stem region located between the transmembrane domain and the first site of N-linked glycosylation at asparagine (N)-250 in the scavenger receptor cysteine rich (SRCR) domain. Importantly, the catalytic competence of TMPRSS13 is essential for stem region cleavage, suggesting an autonomous mechanism of action. Site-directed mutagenesis of the 10 basic amino acids (four arginine and six lysine residues) in this region abrogated zymogen activation and catalytic activity of TMPRSS13, as well as phosphorylation, cell surface expression, and shedding. Mutation analysis of individual arginine residues identified R223, a residue located between the low-density lipoprotein receptor class A domain and the SRCR domain, as important for stem region cleavage. Mutation of R223 causes a reduction in the aforementioned functional processing steps of TMPRSS13. These data provide further insight into the roles of different post-translational modifications as regulators of the function and localization of TMPRSS13. Additionally, the data suggest the presence of complex interconnected regulatory mechanisms that may serve to ensure the proper levels of cell-surface and pericellular TMPRSS13-mediated proteolysis under homeostatic conditions., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

Description Attention to detail, persistence, and striving for perfection...but never quite achieving it. These are attributes I put into my career as a researcher and are remarkably similar to the skills I apply to boat building. What you see pictured are thousands of imperfections that, I humbly assert, coalesce into something extraordinarily beautiful., Competing Interests: Conflicts of Interest The author declares he has no conflicts of interest., (© 2021 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

We endeavored to examine relationships between circulating monocyte phenotype and cardio-metabolic disease risk, in healthy, older adults. We performed a secondary data analysis on men and women, 55-75 yr, who were assigned to groups based on cardio-metabolic risk factors other than age. Subject in the low risk group (n = 16, 12 females) had fewer than three risk factors. Subjects in the elevated risk group (n = 29, 19 females) had three or more risk factors. Along with baseline screening for fitness and body composition, resting blood samples were assessed for markers of inflammation including: monocyte phenotype (inflammatory monocytes), monocyte cell-surface TLR4 expression, and serum C-reactive protein. The low risk group had a smaller (19.3% difference; p < 0.0001) waist circumference and lower body fat weight (36.3%; p < 0.0001), but higher V̇0 2 max (45.5%; p = 0.0019). There were no mean differences (p > 0.05) between the low and elevated risk groups for BMI, serum cholesterol, fasting glucose, or leg press 1RM. The low risk group had lower CRP (114.7%, p = 0.0002), higher CD14 + CD16 - (classical) monocytes (6.7%; p = 0.0231) and fewer CD14 + CD16 + (inflammatory) monocytes (46.2%; p = 0.0243) than the elevated risk group. The low risk group also had a lower percentage of CD14 + CD16 - monocytes that were positive for TLR4 (14.0%; p = 0.0328). Older men and women with fewer cardio-metabolic risk factors had lower serum and cellular markers of inflammation and higher aerobic capacity., (Copyright © 2021. Published by Elsevier Inc.)

Age-associated hyper-inflammation or "inflamm-aging" has been linked to the development of chronic diseases and characterized as an unavoidable aspect of aging. However, the inflamm-aging model does not adequately address the potential anti-inflammatory effects of exercise training and the potential for exercise to ameliorate several age-related diseases. In this brief review, we introduce a new paradigm- inflamm-inactivity -that describes a potent counter-measure to age-associated inflammatory illness.

Australian guidelines recommend the tuberculin skin test (TST) as the preferred test for latent tuberculosis infection (LTBI) with interferon-gamma release assay (IGRA) as a supplemental test to improve specificity. For many years the chest radiograph has been used to interpret a TST in the 5-9 mm range. The chest radiograph is known to predict subsequent reactivation of tuberculosis (TB). We report a retrospective database review of the Migrant Screening Clinic at Western Health Footscray Hospital during the period April 2010 to November 2011. Of 129 migrants under 35 years of age with TST 5-14 mm, IGRA was positive in 37 (28.7%). IGRA was positive in 7.7% of those with TST 5-9 mm and chest radiograph not suggestive of TB disease, 28.6% in those with TST 5-9 mm and chest radiograph that was suggestive of TB disease, and 39.5% in those with TST 10-14 mm (? 2 trend=12.5, p=0.0004). There were 21 (16%) of 129 persons who had a negative IGRA but both TST >= 5 mm and a chest radiograph suggestive of TB disease. These data support existing recommendations to use the chest radiograph when interpreting a TST of 5-9 mm and recommending treatment of LTBI., (This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or by email to copyright@health.gov.au.)

Background: Breast cancer continues to be the most commonly diagnosed cancer in women globally. Early detection, diagnosis and treatment of breast cancer are key to better outcomes. Since many women will discover a breast cancer symptom themselves, it is important that they are breast cancer aware i.e. have the knowledge, skills and confidence to detect breast changes and present promptly to a healthcare professional., Objectives: To assess the effectiveness of interventions for raising breast cancer awareness in women., Search Methods: We searched the Cochrane Breast Cancer Group's Specialised Register (searched 25 January 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12) in the Cochrane Library (searched 27 January 2016), MEDLINE OvidSP (2008 to 27 January 2016), Embase (Embase.com, 2008 to 27 January 2016), the World Health Organization's International Clinical Trials Registry Platform (ICTRP) search portal and ClinicalTrials.gov (searched 27 Feburary 2016). We also searched the reference lists of identified articles and reviews and the grey literature for conference proceedings and published abstracts. No language restriction was applied., Selection Criteria: Randomised controlled trials (RCTs) focusing on interventions for raising women's breast cancer awareness i.e. knowledge of potential breast cancer symptoms/changes and the confidence to look at and feel their breasts, using any means of delivery, i.e. one-to-one/group/mass media campaign(s)., Data Collection and Analysis: Two authors selected studies, independently extracted data and assessed risk of bias. We reported the odds ratio (OR) and 95% confidence intervals (CIs) for dichotomous outcomes and mean difference (MD) and standard deviation (SD) for continuous outcomes. Since it was not possible to combine data from included studies due to their heterogeneity, we present a narrative synthesis. We assessed the quality of evidence using GRADE methods., Main Results: We included two RCTs involving 997 women: one RCT (867 women) randomised women to receive either a written booklet and usual care (intervention group 1), a written booklet and usual care plus a verbal interaction with a radiographer or research psychologist (intervention group 2) or usual care (control group); and the second RCT (130 women) randomised women to either an educational programme (three sessions of 60 to 90 minutes) or no intervention (control group). Knowledge of breast cancer symptomsIn the first study, knowledge of non-lump symptoms increased in intervention group 1 compared to the control group at two years postintervention, but not significantly (OR 1.1, 95% CI 0.7 to 1.6; P = 0.66; 449 women; moderate-quality evidence). Similarly, at two years postintervention, knowledge of symptoms increased in the intervention group 2 compared to the control group but not significantly (OR 1.4, 95% CI 0.9 to 2.1; P = 0.11; 434 women; moderate-quality evidence). In the second study, women's awareness of breast cancer symptoms had increased one month post intervention in the educational group (MD 3.45, SD 5.11; 65 women; low-quality evidence) compared to the control group (MD -0.68, SD 5.93; 65 women; P < 0.001), where there was a decrease in awareness. Knowledge of age-related riskIn the first study, women's knowledge of age-related risk of breast cancer increased, but not significantly, in intervention group 1 compared to control at two years postintervention (OR 1.8; 95% CI 0.9 to 3.5; P < 0.08; 447 women; moderate-quality evidence). Women's knowledge of risk increased significantly in intervention group 2 compared to control at two years postintervention (OR 4.8, 95% CI 2.6 to 9.0; P < 0.001; 431 women; moderate-quality evidence). In the second study, women's perceived susceptibility (how at risk they considered themselves) to breast cancer had increased significantly one month post intervention in the educational group (MD 1.31, SD 3.57; 65 women; low-quality evidence) compared to the control group (MD -0.55, SD 3.31; 65 women; P = 0.005), where a decrease in perceived susceptibility was noted. Frequency of Breast CheckingIn the first study, no significant change was noted for intervention group 1 compared to control at two years postintervention (OR 1.1, 95% CI 0.8 to 1.6; P = 0.54; 457 women; moderate-quality evidence). Monthly breast checking increased, but not significantly, in intervention group 2 compared to control at two years postintervention (OR 1.3, 95% CI 0.9 to 1.9; P = 0.14; 445 women; moderate-quality evidence). In the second study, women's breast cancer preventive behaviours increased significantly one month post intervention in the educational group (MD 1.21, SD 2.54; 65 women; low-quality evidence) compared to the control group (MD 0.15, SD 2.94; 65 women; P < 0.045). Breast Cancer AwarenessWomen's overall breast cancer awareness did not change in intervention group 1 compared to control at two years postintervention (OR 1.8, 95% CI 0.6 to 5.30; P = 0.32; 435 women; moderate-quality evidence) while overall awareness increased in the intervention group 2 compared to control at two years postintervention (OR 8.1, 95% CI 2.7 to 25.0; P < 0.001; 420 women; moderate-quality evidence). In the second study, there was a significant increase in scores on the Health Belief Model (that included the constructs of awareness and perceived susceptibility) at one month postintervention in the educational group (mean 1.21, SD 2.54; 65 women) compared to the control group (mean 0.15, SD 2.94; 65 women; P = 0.045).Neither study reported outcomes relating to motivation to check their breasts, confidence to seek help, time from breast symptom discovery to presentation to a healthcare professional, intentions to seek help, quality of life, adverse effects of the interventions, stages of breast cancer, survival estimates or breast cancer mortality rates., Authors' Conclusions: Based on the results of two RCTs, a brief intervention has the potential to increase women's breast cancer awareness. However, findings of this review should be interpreted with caution, as GRADE assessment identified moderate-quality evidence in only one of the two studies reviewed. In addition, the included trials were heterogeneous in terms of the interventions, population studied and outcomes measured. Therefore, current evidence cannot be generalised to the wider context. Further studies including larger samples, validated outcome measures and longitudinal approaches are warranted.

The proportion of eligible persons identified who are tested for latent tuberculosis (TB), offered treatment, and complete treatment are performance indicators in tuberculosis control. We report a retrospective database review of the Migrant Screening Clinic, Department of Respiratory and Sleep Disorders Medicine at Western Health Footscray Hospital during the years 1996-2006. Of 7,225 migrants aged less than 35 years, tuberculin skin testing (TST) was performed for 3,589 (49.7%), including 2,641 (65.6%) of 4,024 migrants under 35 years with an abnormal chest radiograph, and 2,297 (59.0%) of 3,893 migrants born in a high-burden country. Of 3,589 persons with both chest radiograph and TST results, 1,487 (41.4%) were referred for follow-up, including 81.3% of those with TST ≥10 mm. Outcome data were available for 1,047 persons considered for treatment of latent TB, of whom 12.5% did not attend an initial appointment, 21.6% attended and were not offered treatment, 65.9% attended and were offered treatment, and 41.7% completed treatment for latent TB. The Victorian program for treatment of latent TB in migrants has testing, treatment offer and treatment completions rates similar to other published studies. The impact on TB control is limited by the small proportion of migrants referred to this program.

Purpose: Exercise training reduces systemic inflammation in weight-stable people, but concurrent diet-induced body weight loss is not well studied. We hypothesized that resistance training would decrease inflammatory monocyte percentage and improve biomarkers associated with disease risk, independent of weight loss., Methods: Forty physically inactive (PI) subjects (58.0 ± 5.7 years; BMI 30.1 ± 4.3 kg m(-2)) completed baseline testing, and 26 of these subjects completed 12-week of resistance training exercises while consuming either their usual, weight-maintenance diet (RE, n = 14) or an energy-restricted diet (RE-ER, n = 12). Nine physically active (PA) subjects served as a comparison group (60.1 ± 6.1 years; BMI 25.8 ± 3.1 kg m(-2))., Results: At baseline, circulating CD14+CD16+ monocyte percentage, C-reactive protein, and cholesterol were higher in PI vs. PA. Post-intervention, RE subjects had a ~35 % decrease in circulating CD14+CD16+, and a lower LPS-stimulated TNFα and IL-6 production, while RE-ER subjects had lower cholesterol than RE., Conclusions: These findings indicate that resistance training is an effective means for older, overweight adults to reduce systemic inflammation. The unexpected lack of response with concurrent energy restriction underscores the need for further research on the use of resistance training and diet to reduce inflammation.

The purpose of this study was to observe exercise training-induced effects on adiponectin, leptin, and ghrelin. Twenty-nine older, healthy participants were classified as physically active (comparison group: N = 15, 70.9 ± 1.2 years) or physically inactive (exercise group: N = 14, 70.5 ± 1.4 years). Exercise group participants completed 12 weeks of combined aerobic and resistance exercise training, whereas comparison group participants maintained their current level of exercise and served as a physically active comparison group. Monocyte phenotype, as well as serum ghrelin, leptin, adiponectin, and soluble tumor necrosis factor receptor II were analyzed prior to and following the 12-week period. Ghrelin and adiponectin increased 47% and 55%, respectively, in exercise group participants following exercise training. Percent change in ghrelin (post and pre) was negatively correlated with the percent change in CD14+CD16+ monocytes (post and pre) in exercise group participants. Despite no changes in body mass, these data contribute to evidence for the anti-inflammatory effects of exercise., (© The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background & Aims: The impact of vitamin D supplementation in overweight and obese adults during resistance training on body composition, muscle function, and glucose tolerance was investigated., Methods: Twenty-three overweight and obese (age: 26.1±4.7 y; BMI: 31.3±3.2 kg/m(2); 25-hydroxyvitamin D: 19.3±7.2 ng/mL) adults were recruited for participation in a double-blind, placebo-controlled trial. Participants were randomly divided into vitamin D (VitD, 4000 IU/d; 5 females, 5 males) and placebo (PL; 7 females, 6 males) groups. Both groups completed 12 weeks of resistance training. 25-hydroxyvitamin D, parathyroid hormone, body composition, and glucose tolerance were assessed at baseline and 12 weeks. Muscle function (strength and power) was assessed at baseline, 4, 8, and 12 weeks., Results: During the intervention, 25-hydroxyvitamin D increased and parathyroid hormone decreased in the VitD group (P<0.05). Peak power was significantly increased at 4 weeks in the VitD group only (P<0.05). Regression analysis revealed an inverse association between the change in 25-hydroxyvitamin D with the change in waist-to-hip ratio (R(2)=0.205, P=0.02). No other improvements were observed with supplementation., Conclusions: Vitamin D supplementation in overweight and obese adults during resistance training induced an early improvement in peak power, and elevated vitamin D status was associated with reduced waist-to-hip ratio., Clinical Trial Registration Number: NCT01199926., (Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

The purpose of this study was to examine the effects of vitamin D supplementation on inflammatory biomarkers in overweight and obese adults participating in a progressive resistance exercise training program. Twenty-three (26.1 ± 4.7 years) overweight and obese (BMI 31.3 ± 3.2 kg/m2) adults were randomized into a double-blind vitamin D supplementation (Vit D 4,000 IU/day; female 5, male 5) or placebo (PL, female 7; male 6) intervention trial. Both groups performed 12 weeks (3 days/week) of progressive resistance exercise training (three sets of eight exercises) at 70-80% of one repetition maximum. Whole-blood lipopolysaccharide (LPS)-stimulated tumor necrosis factor (TNF) α production as well as circulating C-reactive protein (CRP), TNFα, interleukin 6 (IL-6), and alanine aminotransferase (ALT) were assessed at baseline and after the 12-week intervention. No main effects of group or time were detected for circulating CRP, TNFα, IL-6, and ALT. As expected, when PL and Vit D groups were combined, there was a significant correlation between percent body fat and CRP at baseline (r = 0.45, P = 0.04), and between serum 25OHD and CRP at 12 weeks (r = 0.49, P = 0.03). The PL group had a significant increase in 25 μg/ml LPS + polymixin B-stimulated TNFα production (P = 0.04), and both groups had a significant reduction in unstimulated TNFα production (P < 0.05) after the 12-week intervention. Vitamin D supplementation in healthy, overweight, and obese adults participating in a resistance training intervention did not augment exercise-induced changes in inflammatory biomarkers.

Introduction: Cystic fibrosis (CF) is of particular importance in Ireland as the Irish population has both the highest incidence (2.98/10,000) and the highest carrier rate (1 in 19) in the world. Primary immunodeficiency has not been previously reported as co-existing with CF., Case Report: We report a unique case of CF associated with a primary immunodeficiency syndrome--common variable immunodeficiency (CVID)., Discussion: Our patient has CF, CVID and the additional comorbidity of Aspergers syndrome. The challenges inherent in diagnosing and treating such a case are outlined herein and the successful management of this case is evidenced by the well-preserved lung function of our patient.

Background:   Hospital clinicians are increasingly expected to practice evidence-based medicine (EBM) in order to minimize medical errors and ensure quality patient care, but experience obstacles to information-seeking. The introduction of a Clinical Informationist (CI) is explored as a possible solution., Aims:   This paper investigates the self-perceived information needs, behaviour and skill levels of clinicians in two Irish public hospitals. It also explores clinicians' perceptions and attitudes to the introduction of a CI into their clinical teams., Methods:   A questionnaire survey approach was utilised for this study, with 22 clinicians in two hospitals. Data analysis was conducted using descriptive statistics., Results:   Analysis showed that clinicians experience diverse information needs for patient care, and that barriers such as time constraints and insufficient access to resources hinder their information-seeking. Findings also showed that clinicians struggle to fit information-seeking into their working day, regularly seeking to answer patient-related queries outside of working hours. Attitudes towards the concept of a CI were predominantly positive., Conclusion:   This paper highlights the factors that characterise and limit hospital clinicians' information-seeking, and suggests the CI as a potentially useful addition to the clinical team, to help them to resolve their information needs for patient care., (© 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.)

Statin treatment and exercise training can reduce markers of inflammation when administered separately. The purpose of this study was to determine the effect of rosuvastatin treatment and the addition of exercise training on circulating markers of inflammation including C-reactive protein (CRP), monocyte toll-like receptor 4 (TLR4) expression, and CD14+CD16+ monocyte population size. Thirty-three hypercholesterolemic and physically inactive subjects were randomly assigned to rosuvastatin (R) or rosuvastatin/exercise (RE) groups. A third group of physically active hypercholesterolemic subjects served as a control (AC). The R and RE groups received rosuvastatin treatment (10 mg/d) for 20 weeks. From week 10 to week 20, the RE group also participated in an exercise training program (3d/wk). Measurements were made at baseline (Pre), week 10 (Mid), and week 20 (Post), and included TLR4 expression on CD14+ monocytes and CD14+CD16+ monocyte population size as determined by 3-color flow cytometry. Serum CRP was quantified by enzyme-linked immunosorbent assay. TLR4 expression on CD14+ monocytes was higher in the R group at week 20. When treatment groups (R and RE) were combined, serum CRP was lower across time. Furthermore, serum CRP and inflammatory monocyte population size were lower in the RE group compared with the R group at the Post time point. When all groups (R, RE, and AC) were combined, TLR4 expression was greater on inflammatory monocytes (CD14+CD16+) compared with classic monocytes (CD14+CD16⁻) at all time points. In conclusion, rosuvastatin may influence monocyte inflammatory response by increasing TLR4 expression on circulating monocytes. The addition of exercise training to rosuvastatin treatment further lowered CRP and reduced the size of the inflammatory monocyte population, suggesting an additive anti-inflammatory effect of exercise., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Literature examining the effects of aerobic exercise training on excess postexercise oxygen consumption (EPOC) is sparse. In this study, 9 male participants (19-32 yr) trained (EX) for 12 wk, and 10 in a control group (CON) maintained normal activity. VO(2max), rectal temperature (T(re)), epinephrine, norepinephrine, free fatty acids (FFA), insulin, glucose, blood lactate (BLA), and EPOC were measured before (PRE) and after (POST) the intervention. EPOC at PRE was measured for 120 min after 30 min of treadmill running at 70% VO(2max). EX completed 2 EPOC trials at POST, i.e., at the same absolute (ABS) and relative (REL) intensity; 1 EPOC test for CON served as both the ABS and REL trial because no significant change in VO(2max) was noted. During the ABS trial, total EPOC decreased significantly (p < .01) from PRE (39.4 ± 3.6 kcal) to POST (31.7 ± 2.2 kcal). T(re), epinephrine, insulin, glucose, and BLA at end-exercise or during recovery were significantly lower and FFA significantly higher after training. Training did not significantly affect EPOC during the REL trial; however, epinephrine was significantly lower, and norepinephrine and FFA, significantly higher, at endexercise after training. Results indicate that EPOC varies as a function of relative rather than absolute metabolic stress and that training improves the efficiency of metabolic regulation during recovery from exercise. Mechanisms for the decreased magnitude of EPOC in the ABS trial include decreases in BLA, T(re), and perhaps epinephrine-mediated hepatic glucose production and insulin-mediated glucose uptake.

Introduction/purpose: Inflammatory cytokines are associated with age- and inactivity-related diseases. We examined the influence of moderate- to high-intensity resistance trainings (RT) on inflammatory cytokines (interleukin 6 (IL-6) and 1beta (IL-1beta) and tumor necrosis factor alpha (TNF-alpha)) in circulation and lipopolysaccharide (LPS)-stimulated whole blood in elderly women., Method: Previously sedentary women (72 +/- 6.1 yr) were grouped according to their hormone replacement regimen: traditional estrogen/progesterone (HRT, n = 12), selective estrogen receptor modulator (SER, n = 7), no hormone replacement (NHR, n = 9), or nonexercise control group taking no hormone replacement (CON, n = 7). Participants in the HRT, SER, and NHR groups trained (three sets, 10 exercises at eight-repetition maximum (8RM)) 3 d x wk(-1), whereas participants in the CON group maintained their "normal" activity for 10 wk. Participants performed a bout of resistance exercise (RE at 8RM; HRT, SER, and NHR groups) or sat quietly (CON) before (BT) and after (AT) RT to assess the influence of training on the acute responses to RE. Blood samples were obtained preexercise (PR), postexercise (PO), and 2 h postexercise (2H; same time points for resting CON)., Results: Hormone status had no influence on dependent variables, so HRT, SER, and NHR groups were collapsed into one exercise group (EX, n = 28) and compared with CON. RT significantly reduced resting serum TNF-alpha level by 37%. RT also reduced LPS-stimulated production of IL-6, IL-1beta, and TNF-alpha at all time points (PR, PO, and 2H; per monocyte). Acute RE transiently increased plasma TNF-alpha, but blunted the circadian increase in LPS-stimulated inflammatory cytokines observed in CON. The blunting effect in EX was significantly greater AT compared with BT. RE also resulted in an increase in plasma IL-6, which was significantly reduced AT (BT: PR = 1.6 +/- 0.5, PO = 2.8 +/- 0.5; AT: PR = 1.8 +/- 0.3, PO = 2.4 +/- 0.3)., Conclusions: We found that 10 wk of moderate- to high-intensity RT 1) reduced the systemic inflammatory milieu and 2) abrogated exercise-induced circulating IL-6 in previously sedentary elderly women.

Statin treatment and exercise training can improve lipid profile when administered separately. The efficacy of exercise and statin treatment combined, and its impact on myalgia and serum creatine kinase (CK) have not been completely addressed. The purpose of this study was to determine the effect of statin treatment and the addition of exercise training on lipid profile, including oxidized low-density lipoprotein (oxLDL), and levels of CK and alanine transaminase. Thirty-one hypercholesterolemic and physically inactive subjects were randomly assigned to rosuvastatin (R) or rosuvastatin/exercise (RE) group. A third group of physically active hypercholesterolemic subjects served as an active control group (AC). The R and RE groups received rosuvastatin treatment (10 mg/d) for 20 weeks. From week 10 to week 20, the RE group also participated in a combined endurance and resistive exercise training program (3 d/wk). Lipid profile was determined for all subjects at week 0 (Pre), week 10 (Mid), and week 20 (Post). The CK and alanine transaminase levels were measured at the same time points in the RE and R groups and 48 hours after the first and fifth exercise bout in the RE group. Each RE subject was formally queried about muscle fatigue, soreness, and stiffness before each training session. Total, LDL, and oxLDL cholesterol was lower in the RE and R groups at Mid and Post time points when compared with Pre. Oxidized LDL was lower in the RE group compared with the R group at the Post time point. When treatment groups (R and RE) were combined, high-density lipoprotein levels were increased and triglycerides decreased across time. Creatine kinase increased in the RE group 48 hours after the first exercise bout, but returned to baseline levels 48 hours after the fifth exercise bout. Rosuvastatin treatment decreased total, LDL, and oxLDL cholesterol. The addition of an exercise training program resulted in a further decrease in oxLDL. There was no abnormal sustained increase in CK or reports of myalgia after the addition of exercise training to rosuvastatin treatment.

Purpose: 1) To examine the effect of a 12-wk endurance exercise training program on RMR and 2) to provide insight into the mechanisms responsible for alterations in RMR that may occur after exercise training., Methods: Male participants (19-32 yr) in an exercise group (EX; n = 9) performed jogging and/or running 3-4 d x wk(-1), 25-40 min per session, at 60%-80% VO2max, whereas subjects in a control group (CON; n = 10) maintained their normal activity patterns. Body composition, VO2max, RMR, epinephrine, norepinephrine, total thyroxine, free thyroxine, insulin, free fatty acids, and glucose were measured before and after the intervention., Results: Training resulted in a significant increase in VO2max in EX (46.2 +/- 1.2 to 51.0 +/- 1.3 mL x kg(-1) x min(-1), P < 0.001). Absolute and relative values for RMR did not significantly change in EX after training. Mean values for epinephrine, norepinephrine, total thyroxine, insulin, and glucose did not significantly change in either group; however, free thyroxine decreased significantly after training in EX (P = 0.04). Training also resulted in a significant increase in free fatty acid concentration in EX (0.37 +/- 0.03 to 0.48 +/- 0.04 mmol x L(-1), P < 0.001). RMR in CON decreased significantly when expressed as an absolute value (P < 0.01) and relative to body weight (P < 0.01), fat-free mass (P < 0.01), and fat mass (P = 0.04)., Conclusions: The mechanism for the decrease in CON is unknown, but it may be related to seasonal variations in RMR. Training may have prevented a similar decline in RMR in EX and may be related to a training-induced increase in fat oxidation.

Infertility rates among males with cystic fibrosis (CF) approximate 97%. No information is currently available within Ireland determining an understanding of fertility issues and the best methods of information provision to this specialized group. This study aimed to determine understanding and preferred approaches to information provision on fertility issues to Irish CF males. A Descriptive Study utilizing prospective coded questionnaires was mailed to a male CF cohort (n=50). Sections included demographics, fertility knowledge & investigation. Response rate was 16/50 (32%). All were aware that CF affected their fertility. More than two-thirds (n=11) were able to provide explanations whilst only one-third (n=5) provided the correct explanation. Significant numbers stated thoughts of marriage and a future family. Half have discussed fertility with a healthcare professional (HCP). Mean age of discussion was 21.9 years. One third preferred an earlier discussion. The commonest first source for information was written material which was also the preferred source. Three-quarters requested further information preferring again, written material. Significant gaps in sex education of Irish CF males exist. Discussion should be initiated by HCPs and centre-directed written material devised to address deficiencies.

This study examined the influences of age and chronic physical activity status on appetite and mood state. Groups of younger inactive, younger active, older inactive, and older active men and women completed questionnaires each waking hour, rating appetite and mood state for 1 day. Maximal oxygen consumption was 20% lower in older than in younger (p < 0.001) subjects, and 32% lower in inactive than in active (p < 0.001) subjects. Mean hunger (older, 4 +/- 1; younger, 5 +/- 1 arbitrary units (AU); p < 0.01) and desire to eat (older, 3 +/- 1; younger, 4 +/- 1 AU; p < 0.01) were lower in older than in younger subjects. Nadir arousal was higher for the active subjects (active, 3 +/- 1; inactive, 2 +/- 1 AU; p < 0.05). Nadir arousal, nadir pleasantness, and mean pleasantness were higher for the older subjects (p < 0.05). Physical activity status does not influence appetite or the age-associated declines in hunger or desire to eat. The increased nadir arousal of the physically active and older groups is consistent with these subjects experiencing less extreme sleepiness.

Purposes: (1) To compare the Lafayette Instruments (LI) skinfold caliper to the Lange (L) and Harpenden (H) calipers using a diverse subject population. (2) To determine the validity of the LI caliper in a subset of subjects by comparing body compositions from skinfold thicknesses to those measured by hydrostatic weighing (HW) and air displacement plethysmography (ADP). (3) To compare measurements obtained by experienced (EX) and inexperienced (IX) technicians using all three calipers., Methods: Skinfold measurements were performed by both EX and IX technicians using three different calipers on 21 younger (21.2 ± 1.5 yrs) and 20 older (59.2 ± 4 yrs) subjects. Body compositions were calculated using the Jackson-Pollock seven-site and three-site formulas. HW and ADP tests were performed on a subset of subjects (10 younger, 10 older)., Results: No significant differences existed between LI and L or H when measurements were made by EX. Further, the LI-EX measurements were highly correlated to both H-EX and L-EX. No significant differences existed in the subgroup between LI-EX and HW or ADP. Skinfold determinations made by EX and IX were similar., Conclusions: Similar body compositions determined using LI, H, and L suggest that LI determines body composition as effectively as H and L. High correlations between the three calipers support this notion. Similar results between LI and HW/ADP subgroup suggest that the LI caliper may be a valid method of measuring body composition. Overall, performance by IX was similar to EX and suggests similar ease of use for all three calipers.

Exercise training or higher levels of physical activity are known to exert anti-inflammatory effects. CD14+CD16+ monocytes are potent producers of inflammatory proteins, and elevated levels of these "inflammatory" monocytes have been implicated in disease development. Little is known about the influence of exercise training on this cell population. On the basis of their physical activity pattern, male and female subjects, 65-80 years old, were assigned to a physically active (PA; n=15) or inactive (PI; n=15) group. The PI group performed 12 weeks (3 days/week) of endurance (20 min at 70-80% heart-rate reserve) and resistance exercise training (eight exercises, two sets at 70-80% of one repetition maximum). Subjects in the PA group maintained their habitual activity level. Flow cytometry was used to determine monocyte phenotype and monocyte TLR4 expression. ELISAs were used to measure whole blood, LPS-stimulated TNF-alpha production, and serum C-reactive protein (CRP). At baseline, the PA group had a lower percentage of CD14+CD16+ monocytes and lower unstimulated production of TNF-alpha than the PI group. CD14+CD16+ monocyte percentage and 1 ng/ml LPS-stimulated TNF-alpha production were reduced after the PI group underwent 12 weeks of exercise training. PI subjects also had higher TLR4 expression on classical monocytes, but there were no significant exercise training-induced changes in monocyte TLR4 expression. The PA group had significantly lower serum CRP than the PI group. Physical activity was associated with lower CD14+CD16+ monocyte percentage and LPS-stimulated TNF-alpha production. Exercise training-induced reductions in CD14+CD16+ monocytes may contribute to the anti-inflammatory effects of exercise training.

To examine the influence of acute resistive exercise and "hormone status" on cytokine profile, 35 postmenopausal women (72 +/- 6.2 yr) underwent a moderate-high-intensity resistive exercise bout or rested. There were 4 groups: no hormone replacement (NHR, n = 9), hormone replacement (HRT, n = 12), selective estrogen receptor modulator (SER, n = 7), or resting control (no hormone replacement, CON, n = 7). NHR, HRT, and SER exercised (3 sets, 10 exercises @ 80 % 1RM). Blood was collected pre-exercise (PR), postexercise (PO), and two hours (2H) postexercise (same times for CON). Blood was diluted 1 : 10 in culture medium and incubated (37 degrees C, 5 % CO2, 24 h) with lipopolysaccharide (LPS, 25 microg . ml (-1)). Serum and supernatant from LPS-stimulated blood were analyzed for IL-6, IL-1 beta, and TNF-alpha using ELISA. Resistive exercise increased PO serum IL-6, and PO LPS-stimulated IL-6 and IL-1 beta in the exercise groups (HRT, NHR, SER collapsed; EX, n = 28). LPS-stimulated IL-1 beta remained elevated at 2H in EX and was significantly higher than PR in CON at 2H. Expressed per monocyte, EX had significantly lower IL-1 beta and TNF-alpha LPS-stimulated production at PO and 2H compared to CON, indicating an exercise-induced blunting of an apparent diurnal response on cytokine production. In postmenopausal women, acute resistive exercise increased circulating IL-6, but reversed an apparent diurnal increase in LPS-stimulated IL-1 beta and TNF-alpha production with no influence of hormone replacement or raloxifene.

Purpose: The purpose of this study was to examine the influence of a 12-wk exercise training program on inflammatory cytokine and C-reactive protein (CRP) concentrations. A secondary purpose was to determine whether training-induced changes in cytokines and CRP were influenced by age., Methods: Twenty-nine younger (18-35 yr) and 31 older (65-85 yr) subjects were assigned to young physically active (YPA, N = 15; 25 +/- 5 yr), young physically inactive (YPI, N= 14; 25 +/- 4.7 yr), old physically active (OPA, N = 14; 71 +/- 4 yr), or old physically inactive (OPI, N = 17; 71 +/- 4 yr) groups. The inactive groups completed 12 wk (3 d.wk) of aerobic and resistance exercises, and the physically active control groups continued their normal exercise programs. Blood samples were collected before and after the 12-wk period, and the concentrations of serum CRP, plasma interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1 beta (IL-1beta) were determined using separate ELISA., Results: Control (YPA and OPA) estimated VO2max was unchanged. Exercise training increased estimated VO2max an average of 10.4% and increased strength by an average of 38.1% in both PI groups. Serum CRP decreased with training (YPI and OPI) groups and was not different from the YPA and OPA groups after training. Plasma IL-6 and IL-1beta did not change, whereas TNF-alpha was higher than YPI and YPA at baseline and after the intervention period., Conclusion: These results support the use of combined aerobic/resistance training as a modality to reduce the risk of cardiovascular disease development as defined by a decrease in serum CRP concentration in healthy humans.

Background: The accurate measurement of body composition changes is important when evaluating the efficacy of medical nutrition therapy and weight management programs, yet is not well documented in older women., Objective: We compared methods of estimating energy-restriction-induced body composition changes in postmenopausal women., Design: 27 women (59 +/- 8 y; BMI 29.0 +/- 2.9 kg/m2; mean +/- SD) completed a 9-wk energy restriction period (5233 kJ/d, (1250 kcal/d)). Changes in % body fat (delta%BF), fat mass (deltaFM), and fatfree mass (deltaFFM) were measured by hydrostatic weighing (HW), air-displacement plethysmography (ADP), dual-energy x-ray absorptiometry (DXA), and deuterium oxide dilution (D2O). The Baumgartner et al. (Am J Clin Nutr 53:1345-1353, 1991) four-compartment (4C) model with body volume from HW was the criterion method. The 4C model with body volume from ADP was also compared. Regression equations were developed based on 4CHW (dependent variable) utilizing results of change (POST-PRE) for each method., Results: The women lost 6.8 +/- 3.2 kg; 9% of baseline weight. Based on 4CHW, the body composition changes were -2.4 +/- 4.5 delta%BF, -4.7 +/- 3.3 kg deltaFM, and -2.6 +/- 4.4 kg deltaFFM. No differences were detected by ANOVA for delta%BF, deltaFM, and deltaFFM among 4CHW, HW, ADP, DXA, D2O, and 4CADP. Bland-Altman limits of agreement showed differences between methods that ranged from 14.5 to -14.1 delta%BF, 7.8 to -8.1 kg deltaFM, and 7.5 to -8.4 kg deltaFFM for individuals. A bias was shown with 4CADP overestimating delta%BF (1.4 %) and FM (0.6 kg) and underestimating deltaFFM (-1.2 kg) compared to 4CHW. The regression model was acceptable for %BF (4CADP, 2CHW, and 2CD2O); FM and FFM (4CADP, 3CDXA, 2CHW, and 2CD2O), but not for other estimates of %BF, FM, FFM., Conclusions: These body composition assessment methods may be used interchangeably to quantify changes in % body fat, fat mass, and fat-free mass with weight loss in groups of postmenopausal women. 4CADP overestimates delta%BF and underestimates deltaFFM. When utilizing one of these comparison methods (4CADP, 3CDXA, 2CHW, 2CD2O) to quantify changes in fat mass and fat-free mass for an individual postmenopausal woman, regression equations may be used to relate the data to 4CHW.

The list of diseases with a known inflammatory etiology is growing. Cardiovascular disease, osteoporosis, diabetes, geriatric cachexia, and Alzheimer's disease have all been shown to be linked to or exacerbated by aberrantly regulated inflammatory processes. Nevertheless, there is mounting evidence that those who are physically active, or who become physically active, have a reduction in biomarkers associated with chronic inflammation. There was strong early consensus that exercise-induced reductions in inflammation were explained by body mass index or body fatness, but recent studies provide support for the contention that exercise has body fat-independent anti-inflammatory effects. With few exceptions, the anti-inflammatory effects of exercise appear to occur regardless of age or the presence of chronic diseases. What remains unclear are the mechanisms by which exercise training induces these anti-inflammatory effects, but there are several intriguing possibilities, including release of endogenous products, such as heat shock proteins; selective reduction of visceral adipose tissue mass or reducing infiltration of adipocytes by macrophages; shift in immune cell phenotype; cross-tolerizing effects; or exercise-induced shifts in accessory proteins of toll-like receptor signaling. However, future research endeavors are likely to uncover additional potential mechanisms, and it could be some time before functional mechanisms are made clear. In summary, the potential anti-inflammatory influences of exercise training may provide a low-cost, readily available, and effective treatment for low-grade systemic inflammation and could contribute significantly to the positive effects of exercise training on chronic disease.

Objective: The primary aim of this study was to assess the effects of dietary protein intake on energy restriction (ER)-induced changes in body mass and body composition. Clinical markers of metabolic and cardiovascular diseases were also measured., Design: 54 postmenopausal women, age 58 +/- 2 y, body mass index 29.6 +/- 0.8 kg/m(2), were assigned to one of four groups. For 9 weeks, three ER groups ate a 1000 kcal/d lacto-ovo vegetarian basal diet plus 250 kcal/d of either beef (BEEF, n = 14), chicken (CHICKEN, n = 15), or carbohydrate/fat foods (CARB (lacto-ovo), n = 14), while a control group (CON, n = 11) consumed their habitual diets., Results: Energy intake was lower in the ER groups compared to CON (BEEF, 1114 +/- 155 kcal/d, CHO: PRO: FAT, 46:24:30 % of energy intake; CHICKEN, 1098 +/- 203 kcal/d, 51:25:24; CARB 1158 +/- 341 kcal/d, 59:17:24; CON, 1570 +/- 633 kcal/d, 47:20:33), but did not differ among ER groups. For all ER subjects combined, body mass (-6.7 +/- 2.4 kg, 9 %), fat mass (-4.6 +/- 1.9 kg, 13 %), and fat-free mass (-2.1 +/- 1.1 kg, 5 %) decreased. These responses did not differ among the ER groups, except for body mass (CHICKEN -7.9 +/- 2.6 kg(a); BEEF -6.6 +/- 2.7 kg(a,b); CARB -5.6 +/- 1.8 kg(b); CON -1.2 +/- 1.2 kg(c); values with a difference superscript differ, p < 0.05). From PRE (week 0) to POST (week 9), total and LDL cholesterol decreased approximately 12%, with no differences among groups. Triacylglycerol, HDL cholesterol, C-reactive protein (CRP), glucose, insulin, leptin, and adiponectin were not changed over time or differentially affected by diet., Conclusions: Overweight postmenopausal women can achieve significant weight loss and comparable short-term improvements in body composition and lipid-lipoprotein profile by consuming either a moderate-protein (25% of energy intake) poultry- or beef-containing diet or a lacto-ovo vegetarian protein (17% of energy intake) diet.

Introduction: Exercise has been shown to lower blood natural killer cell concentration and activity for up to 24-h after exercise; however, the mechanism underlying this effect is not clearly defined. We have speculated that an exercise-induced change in T-cell control of NK cells is at least partly responsible for the post-exercise suppression. As a follow-up to our previous research, the purpose of this study was to examine the T and NK cells responses during and following moderate/high-intensity endurance exercise., Methods: Eight male subjects (20+/-1 y; VO(2peak)=67.22+/-2.79 mL.kg(-1).mL(-1)) were recruited to complete two 1-h (75-80% VO(2peak)) cycling trials in a random counterbalanced order: carbohydrate (CHO) and placebo (PLA). Venous blood samples were collected before (PRE), immediately (POST), 2-h (2H), and 4-h (4H) after exercise. NK (CD3(-)/56(+)) and activated NK (CD3(-)/56(+)/69(+)) number were measured using flow cytometry. NK cell activity (NKCA) was determined using both a (51)Cr release assay (NKCA-51) and activated NK cell number (NKCA-69). Whole blood samples were stimulated with IL-2, IFN-gamma, IL-4, IL-12, and no stimulation for 12-h and then analyzed for NK cell activity using a (51)Cr release assay (NKCA-51)., Results: Leukocyte counts and unstimulated NKCA were not different between CHO and PLA; however, exercise significantly increased NKCA (P<.05). Fold change in IL-2, IFN-gamma, and IL-2+IFN-gamma-stimulated NKCA were significantly greater in CHO compared to PLA (P<.05). No effect of drink was found for IL-4, IL-12, and IL-4+IL-12-stimulated NKCA., Discussion: The fold change in IL-2-stimulated NKCA is consistant with our previous published work. The drink effect for Th1 (but not Th2) cytokines suggests they may play a more significant role in modulating NKCA following a strenuous bout of aerobic exercise when CHO is consumed.

The purpose of this study was to test the effect of acute dairy calcium intake on exercise energy metabolism and endurance performance. Trained female runners completed two trials. Each trial consisted of a 90-min glycogen depletion run followed by a self-paced 10K time trial, conducted one hour after consumption of a high dairy (500 mg Ca+2) or low dairy (80 mg Ca+2) meal. During the 90-min run, blood samples and respiratory gases were collected. No treatment main effects of acute dairy intake were found for respiratory exchange ratio (RER), calculated fat oxidation, lactate, glycerol, or 10K time. Following this protocol, acute dairy calcium intake did not alter fat utilization or endurance performance in trained female runners.

Evidence is emerging that exercise training has anti-inflammatory effects. Our early finding that blood cultures from trained subject had a reduced responsiveness to lipopolysaccharide led to a series of studies in which we measured toll-like receptor 4--the primary signaling receptor for lipopolysaccharide. The toll-like receptor 4 expression was consistently lower in physically active subjects compared with inactive subjects and reduced after training in previously inactive subjects.

Objective: Physical age, energy restriction (ER), and weight loss have been reported to suppress indices of innate immunity, which may increase the risk of illness. To evaluate these interactions, we recruited older, postmenopausal women (50 to 80 years) to fill one of the following 9-week ER (1250 kcal/d) groups: beef [n = 14; reported intakes 46% carbohydrate (CHO):24% protein (PRO):30% fat], chicken (n = 15; 51% CHO:25% PRO:24% fat), or CHO (n = 14; 59% CHO:17% PRO:24% fat), or a non-intervention control (n = 11)., Research Methods and Procedures: Fasting blood was collected before and after ER to determine leukocyte phenotype, neutrophil oxidative burst capacity, natural killer cell activity, stimulated interleukin-2 and interferon-gamma production, and blood zinc and iron concentrations., Results: No significant effects of ER (8.6% weight loss) or PRO quantity and source were found for the majority of indices of innate immunity. Small but significant (p < 0.05) declines in interleukin-2 production were found in the chicken and CHO groups only; however, the clinical significance of this finding is not known., Discussion: In the present study, 9 weeks of moderate ER did not suppress immunity in postmenopausal women. Also, contrary to our hypothesis, differential zinc and iron intakes did not significantly alter immunity.

Background: Chronic inflammation has been implicated in the development of cardiovascular disease, diabetes mellitus, cachexia, and osteoporosis. Regular physical activity has been purported to possess "anti-inflammatory" properties which may limit chronic inflammation. Recently, we hypothesized that toll-like receptor 4 (TLR4) may play a role in activity-induced modulation of inflammation. Therefore, the purpose of this study was to determine the association between age, physical activity status, biomarkers of inflammation, and TLR4., Methods: Male and female participants (n = 84) were recruited to fill one of the following groups: young (18-30 years), active; young, inactive; old (60-80 years), active; or old, inactive. To assess physical activity status, participants completed a Paffenbarger Physical Activity Questionnaire and a modified Balke submaximal treadmill test. After grouping and screening, participants were given a standard mixed diet to consume 24 hours prior to arriving at the laboratory. Participants were instructed to consume all food by 10 pm the night prior to blood sampling (8-hour fast). Following 30 minutes of seated rest in a quiet room, venous blood samples were collected. Lipopolysaccharide-stimulated inflammatory cytokine production and plasma high-sensitivity C-reactive protein (hsCRP) were determined by enzyme-linked immunosorbent assay, and TLR4 expression was determined by flow cytometry., Results: Lipopolysaccharide-stimulated interleukin-6, interleukin-1beta, and tumor necrosis factor-alpha production, TLR4 expression, and hsCRP were significantly lower in active compared to inactive participants (p <.05). Also, older participants had significantly higher hsCRP than young participants had (p <.05)., Conclusions: The findings of the present study support previous reports which infer that acute exercise or a physically active lifestyle may possess anti-inflammatory properties. Also this study, along with previous work from our laboratory, suggests that TLR4 may play a role in regulating the link between inflammatory cytokine production and a physically active lifestyle.

Aim: The purpose of this study was to examine whether training status and plasma hormones (estradiol--E2, progesterone--P, luteinizing hormone--LH, and follicle-stimulating hormone--FSH) have an effect on selected immune indexes during or following an acute bout of exercise., Methods: Seven female triathletes (TRI) and 7 recreationally active (REC) females were randomly assigned to rest (RE) and exercise (EX) trials during the late-follicular menstrual phase (LF). The EX was 1 hour of cycling at 63.1+/-6% VO2peak (TRI) and 61+/-5.1% VO2peak (REC) and RE was 1 hour of sitting. Blood was drawn for both trials at baseline (0H), 1 hour (1H), and at 3 hours (3H)., Results: Positive correlations were found between E2 and CD19+ cells for both groups as well as P and CD8+ cells for the REC group. E2 increased during EX and returned to baseline at 3HEX for both groups, however, LH remained elevated at 3HEX for REC. There were significant exercise time effects for CD3+, CD4+, CD8+, and CD3- CD16+ CD56+ cells. The NCMC and 1:1 were elevated at 1HEX for both groups and returned to baseline by 3HEX. During RE, CD3- CD16+ CD56+ cell numbers for both groups and NCMC for REC remained elevated at 3HRE., Conclusions: E2 and P correlated with CD19+ and CD8+ cells, respectively. Although there were transient exercise-induced changes in immune indexes and E2 and LH, with LH remaining elevated at 3HEX for REC, both training groups elicited similar responses for plasma hormones, lymphocyte subpopulations, and NCMC.

Aim: Delayed onset of muscle soreness (DOMS) often results from unaccustomed exercise or exercise that involves heavy eccentric loading of skeletal muscle. Chondroitin sulfate (CS) has been reported to possess anti-inflammatory and analgesic properties and has been used widely in the treatment of osteoarthritis. Based on these findings, the investigators sought to determine whether CS supplementation might reduce DOMS symptoms associated with eccentric arm exercise., Methods: Sixteen non-resistance-trained males participated in a double-blind protocol. Subjects consumed 3,600 mg x day-1 of encapsulated CS or placebo for 14 days preceding the exercise protocol and during 48 hours of follow-up measurements. Subjects performed a maximum of 50 eccentric contractions of the elbow flexors against a resistance that was 120% of the concentric one-repetition maximum., Results: Significant time effects were present for soreness, relaxed elbow extension (joint angle), and creatine kinase; all measures were significantly altered 48 hours after the exercise session. No effects were present for complement system fragment C3a and prostaglandin E2. No significant treatment or interaction effects were detected for any of the variables., Conclusions: CS supplementation was not found to be effective in the prevention of DOMS, nor did it influence biochemical indices of inflammation and muscle damage following heavy eccentric loading of the arm flexors.