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Introduction Cardiogenic shock (CS) complicates 5%–15% of cases of acute myocardial infarction (AMI) with inpatient mortality greater than 40%. The implementation of standardised protocols may improve clinical outcomes in patients with AMI-CS.Methods and analysis The Durango model is a prospective single-centre registry designed to enable early identification of patients with STEMI-CS to facilitate primary reperfusion therapy with a shock team management algorithm in a rural level II heart attack centre. This prospective registry includes all patients >18 years of age presenting with STEMI with or without CS beginning on 1 February 2023. The primary outcome measures are adherence to model-based documentation of SCAI shock Classification prehospital and in the ED with appropriate STEMI shock alert for AMI and stages C, D, E shock; use of mechanical circulatory support Pre-PCI and door to support time

The primary purpose was to simplify external load data obtained during Division-I (DI) basketball competitions via principal component analysis (PCA). A secondary purpose was to determine if the PCA results were sensitive to load demands of different positional groups (POS). Data comprised 229 observations obtained from 10 men's basketball athletes participating in NCAA DI competitions. Each athlete donned an inertial measurement unit that was affixed to the same location on their shorts prior to competition. The PCA revealed two factors that possessed eigenvalues >1.0 and explained 81.42% of the total variance. The first factor comprised total decelerations (totDEC, 0.94), average speed (avgSPD, 0.90), total accelerations (totACC, 0.85), total mechanical load (totMECH, 0.84), and total jump load (totJUMP, 0.78). Maximum speed (maxSPD, 0.94) was the lone contributor to the second factor. Based on the PCA, external load variables were included in a multinomial logistic regression that predicted POS (Overall model, p < 0.0001; AUCcenters = 0.93, AUCguards = 0.88, AUCforwards = 0.80), but only maxSPD, totDEC, totJUMP, and totMECH were significant contributors to the model's success (p < 0.0001 for each). Even with the high significance, the model still had some issues differentiating between guards and forwards, as in-game demands often overlap between the two positions. Nevertheless, the PCA was effective at simplifying a large external load dataset collected on NCAA DI men's basketball athletes. These data revealed that maxSPD, totDEC, totJUMP, and totMECH were the most sensitive to positional differences during competitions. To best characterize competition demands, such variables may be used to individualize training and recovery regimens most effectively.

Objetivos: Discutir e divulgar o raríssimo Linfoma Não Hodgkin linfoplasmocítico não IgM (ou seja, não macroglobulinemia de Waldenström), mostrando a importância de sua suspeição e diagnóstico diferencial com mieloma múltiplo. Material e métodos: Análise retrospectiva de um caso de Linfoma não Hodgkin linfoplasmocitico IgG em acompanhamento no serviço de hematologia do Hospital Unimed Volta Redonda (HUVR) - RJ. Para a revisão de literatura, foram levantados os mais recentes artigos sobre o tema nas bases de dados do site PEBMED. Resultados – Relatamos o caso de uma paciente de 48 anos, sexo feminino, natural e procedente de Volta Redonda- RJ, enfermeira, sem comorbidades. Foi Internada no HUVR com quadro de dor em coluna lombar há um ano, que tornou-se mais intensa e incapacitante há cerca de 2 meses, avaliada pela neurocirurgia e solicitada ressonância magnética de coluna lombar que mostrou fratura patológica e colapso do corpo da vértebra L3. A ressonância magnética de coluna cérvico-torácica e quadril assim como as Tomografias de Tórax, pescoço e abdome total não apresentavam alterações. Não possuía alterações no hemograma, na função renal ou em nível sérico de cálcio. Eletroforese de proteínas séricas mostrando aumento de beta 2 (2.2 g/dL) e pico monoclonal em beta 2 de 1,67 G/DL. Imunofixação sérica evidenciando componente monoclonal IgG lambda. Dosagem sérica de IgG de 2761 mg/DL. A imunohistoquimica de biópsia de vértebra apresentava 9% de linfo-plasmócitos BCL2 +, BCL6 -, CD3-, CD5-, CD10-, CD20+, CD23-, CD138+, ciclina D1 -, lambda +, kappa-, KI6715%, MUM-1 +. Compatível com Linfoma não Hodgkin B linfoplasmocítico. A biópsia de medula óssea apresentava em 80% de celularidade, moderada quantidade de linfócitos e plasmócitos com o mesmo perfil imunohistoquimico supracitado concluindo Linfoma não-Hodgkin B linfoplasmocítico, com restrição de cadeia leve Lambda. A Imunofenotipagem de medula óssea evidenciava população linfo-plasmocitária equivalente a 9% da celularidade global, com aberrancia fenotípica, CD19+/60%, CD20++, CD38+++, CD45+/30%, CD56++, CD117-, CD138++ e perfil de cadeias leves clonal Lambda: Considerar diagnóstico diferencial com discrasias plasmocitárias e linfoma linfoplasmocítico. As mutações MYD88 e CXCR4 foram negativas. A paciente foi submetida a neurocirurgia (retirada de vértebra L3 e inserção de prótese nesta localização) posteriormente encaminhada à radioterapia e segue em acompanhamento ambulatorial pela hematologia. Discussão: Tipo de Linfoma não-Hodgkin de células B raro, caracterizado pela presença de pequenos linfócitos B, linfócitos plasmocitóides e células plasmáticas com paraproteínas IgG ou IgA. Geralmente envolve a medula óssea, podendo acometer baço e linfonodos. Anemia, Hiperviscosidade, fenômenos autoimunes e sintomas B também podem ser observados. Apresenta maiores taxas de envolvimento extramedular, pior sobrevida global e maior mortalidade em comparação com a macroglobulinemia de Waldenström (MW). O principal diagnóstico diferencial é o mieloma múltiplo (nesse caso de subtipo IgG). A translocação (11,14) possui importante papel em tal diagnóstico diferencial. A mutação MYD88 L265P pode estar presente, embora em uma taxa menor do que na MW clássica e seu status não se correlaciona com manifestações clínicas específicas. Conclusão: O linfoma linfoplasmocítico não IgM é uma doença rara em que diagnóstico precoce e tratamento adequado são imprescindíveis para evitar graves complicações.

Research is emerging on the use of Photobiomodulation therapy (PBMT) and its potential for augmenting human performance, however, relatively little research exists utilizing full-body administration methods. As such, further research supporting the efficacy of whole-body applications of PBMT for behavioral and physiological modifications in applicable, real-world settings are warranted. The purpose of this analysis was to observe cardiorespiratory and sleep patterns surrounding the use of full-body PBMT in an elite cohort of female soccer players. Members of a women’s soccer team in a “Power 5 conference” of the National Collegiate Athletic Association (NCAA) were observed across one competitive season while wearing an OURA Ring nightly and a global positioning system (GPS) sensor during training. Within-subject comparisons of cardiorespiratory physiology, sleep duration, and sleep composition were evaluated the night before and after PBMT sessions completed as a standard of care for team recovery. Compared to pre-intervention, mean heart rate (HR) was significantly lower the night after a PBMT session (p = 0.0055). Sleep durations were also reduced following PBMT, with total sleep time (TST) averaging 40 min less the night after a session (p = 0.0006), as well as significant reductions in light sleep (p = 0.0307) and rapid eye movement (REM) sleep durations (p = 0.0019). Sleep durations were still lower following PBMT, even when controlling for daily and accumulated training loads. Enhanced cardiorespiratory indicators of recovery following PBMT, despite significant reductions in sleep duration, suggest that it may be an effective modality for maintaining adequate recovery from the high stress loads experienced by elite athletes.

As sports technology has continued to develop, monitoring athlete workloads, performance, and recovery has demonstrated boundless benefits for athlete and team success. Specifically, technologies such as global positioning systems (GPS) and heart rate (HR) monitors have granted the opportunity to delve deeper into performance contributors, and how variations may exist based upon context. A team of NCAA Division I women’s soccer athletes were monitored during games throughout one competitive season. Individual athlete, positional groups, and team external and internal workloads were explored for differences based upon game location, opponent ranking, game result, and the final score differential. Game location and opponent ranking were found to have no effect on team-wide absolute or relative external workloads, whereas game result and score differential did. Internal workloads across the team tended to only vary by game half, independent of game context; however, the HR of defenders was determined to be higher during losses as compared to wins (p = 0.0256). Notably, the games that resulted in losses also represented the games with the fewest number of substitutions. These findings suggest high value in monitoring performance and workloads that are characteristic of varying, often multifaceted, contexts. It is hoped that this information can lead to more informed approaches to vital game-time and coaching decisions.

The purpose of this study was to assess the validity of utilizing heart rate to derive an estimate of core body temperature in American Football athletes. This was evaluated by combining commercially available Zephyr Bioharness devices, which includes an embedded estimated core temperature (ECT) algorithm, and an ingestible radio frequency core temperature pill during the highest heat injury risk timepoint of the season, summer training camp. Results showed a concordance of 0.643 and 78% of all data points fell within +/−1.0 °F. When the athletes were split into Upper (>/=6.0%) and Lower (

Background: Improved survival in people with cystic fibrosis (pwCF) presents new complexities of care, including CF-related bone disease, a common complication in older pwCF. The trajectory of bone loss with age in this population remains unclear. The objective of this study was to estimate the average rate of change in bone mineral density (BMD) in adults with CF., Methods: This retrospective study included adults with CF, aged 25-48 years, followed between January 2000 and December 2021. Subjects with at least one dual-energy X-ray absorptiometry (DXA) scan were included. Scans obtained post-transplantation, after the initiation of bisphosphonates or cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy were excluded. The primary outcome was BMD (g/cm2) at the lumbar spine (LS) and femoral neck (FN). A linear mixed-effects model with both random intercept and random slope terms was used to estimate the average annual change in BMD., Results: A total of 1502 DXA scans in 500 adults (average age 28.4y) were included. There was a statistically significant annual decline in BMD of -0.008 gm/cm2/year (95% CI -0.009, -0.007) at the FN and -0.006 gm/cm2/year (95% CI -0.007, -0.004) at the LS. Relative to BMD at age 25, there was a -18.8% decline at the FN by age 48 years and a -11% decline at the LS. Pancreatic insufficient (PI) subjects had a faster rate of decline in BMD compared to pancreatic sufficient (PS) subjects. After adjusting for markers of disease severity, the annual rate of decline remained significant., Conclusions: Individuals with CF experience bone loss at an age when it is not anticipated, thereby entering early adulthood, where further bone loss is inevitable especially with the decrease in estrogen during menopause, with suboptimal BMD. As the CF population ages, it will become very important to consider interventions to maximize bone health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)

Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. This may occur due to external compression, neoplastic invasion of the vessel wall, or internal obstruction with bland or tumor thrombus. Although symptoms are typically mild, SVCS can cause neurologic, hemodynamic, and respiratory compromise. Classic management options include supportive measures, chemotherapy, radiation therapy, surgery, and endovascular stenting. New targeted therapeutics and techniques have also recently been developed, which may have a role in management. Nevertheless, few evidence-based guidelines exist to guide treatment of malignant SVCS, and these recommendations are typically restricted to individual disease sites. Furthermore, there are no recent systematic literature reviews that address this question. Here, we present a theoretical case to frame this clinical problem and synthesize updated evidence published in the past decade relating to the management of malignant SVCS through a comprehensive literature review., (Copyright © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)