Search

Background: This review aims to develop comprehensive evidence regarding proteomics in oral cancer initiation, regulation, and progress/inhibition. Material and Methods: A systematic review was carried out of all the reported literature on genomics and proteomics as biomarkers from January 2015 to December 2021 across 3 different search engines- Medline/PubMed, Google Scholar and Scopus. There were 11 articles identified after full test review for protein-based studies of oral cancer after following the PRISMA guidelines. Results: Of the 10 articles maximum of them suggested the role of interleukins (IL-6, 8 and 10) along with TNF-α as salivary protein markers in oral squamous cell carcinoma. All of the proteins showed a rise in their levels in cancer cases compared to healthy cohorts and premalignant cases. The levels of these proteins were also raised significantly in the premalignant cases compared to the healthy patients. Conclusion: A conclusion can be drawn that not all markers are raised; some show low expressions and differ according to type and severity of cancer.

Background: The teaching institution acts as a major place for gaining knowledge with respect to such hazards and incorporation of prevention is the only cure is the onus of the trainers. Hence the current study was carried out with the aim of understanding the extent of knowledge of teaching staff related to occupational hazards and also the institutional environmental facilities that are conducive to the routine of safety and standards for the same accord. Materials and methods: An online survey was conducted among teaching dental staff members across India. A total of 223 participated in the survey. The data was analyzed using Epi info software (CDC, USA) and Chi square test was performed for inferential statistics. Results: There was lesser proportion of participants who reported in affirmative regarding the questions asked to them. All the three aspects of the study- knowledge, attitude and practices were significantly lower among the staff; most answers were incorrect than the standard expected answers. Conclusion: There is less knowledge with regards to the latest and standard norms among many dental practitioners which can be a challenge when it comes to teaching the upcoming generation.

Background: The genetic factors play an essential role in the cell behavior and function in areas affected with cancer, identifying them could help faster risk detection and mitigation of cases that can be easily saved without much therapeutic intervention at the primary stage itself. This review aims to develop comprehensive evidence regarding genomics in oral cancer initiation, regulation, and progress/inhibition. Material and Methods: A systematic review was carried out of all the reported literature on genomics and proteomics as biomarkers from January 2015 to December 2021 across 3 different search engines- Medline/PubMed, Google Scholar and Scopus. There were 61 articles for the genetic components of oral cancer after following the PRISMA guidelines. Results: Among the 61 articles a number of genes were identified which showed either over or under expression in presence of cancer. All of the proteins showed a rise in their levels in cancer cases compared to healthy cohorts and premalignant cases. The levels of these proteins were also raised significantly in the premalignant cases compared to the healthy patients. Conclusion: A conclusion can be drawn that not all gene markers are raised; some show low expressions.

Physical activity and its sustained and purposeful performance – exercise – promote a broad and diverse set of metabolic and cardiovascular health benefits. Regular exercise is the most effective way to improve cardiorespiratory fitness, a measure of one’s global cardiovascular, pulmonary and metabolic health and one of the strongest predictors of future health risk. Here, we describe how exercise affects individual organ systems related to cardiometabolic health, including the promotion of insulin and glucose homeostasis through improved efficiency in skeletal muscle glucose utilization and enhanced insulin sensitivity; beneficial changes in body composition and adiposity; and improved cardiac mechanics and vascular health. We subsequently identify knowledge gaps that remain in exercise science, including heterogeneity in exercise responsiveness. While the application of molecular profiling technologies in exercise science has begun to illuminate the biochemical pathways that govern exercise-induced health promotion, much of this work has focused on individual organ systems and applied single platforms. New insights into exercise-induced secreted small molecules and proteins that impart their effects in distant organs (“exerkines”) highlight the need for an integrated approach towards the study of exercise and its global effects; efforts that are ongoing.

High-throughput proteomics allows researchers to simultaneously explore the roles of thousands of biomarkers in the pathophysiology of diabetes. We conducted proteomic association studies of incident type 2 diabetes and physiologic responses to an intravenous glucose tolerance test (IVGTT) to identify novel protein contributors to glucose homeostasis and diabetes risk. We tested 4,776 SomaScan proteins measured in relation to 18-year incident diabetes risk in participants from the Cardiovascular Health Study (N = 2,631) and IVGTT-derived measures in participants from the HERITAGE Family Study (N = 752). We characterize 51 proteins that were associated with longitudinal diabetes risk, using their respective 39, 9, and 8 concurrent associations with insulin sensitivity index (SI), acute insulin response to glucose (AIRG), and glucose effectiveness (SG). Twelve of the 51 diabetes associations appear to be novel, including β-glucuronidase, which was associated with increased diabetes risk and lower SG, suggesting an alternative pathway to insulin for glucose disposal; and plexin-B2, which also was associated with increased diabetes risk, but with lower AIRG, and not with SI, indicating a mechanism related instead to pancreatic dysfunction. Other novel protein associations included alcohol dehydrogenase-1C, fructose-bisphosphate aldolase-B, sorbitol dehydrogenase with elevated type 2 diabetes risk, and a leucine-rich repeat containing protein-15 and myocilin with decreased risk. Article Highlights Plasma proteins are associated with the risk of incident diabetes in older adults independent of various demographic, lifestyle, and biochemical risk factors. These same proteins are associated with subtle differences in measures of glucose homeostasis earlier in life. Proteins that are associated with lower insulin sensitivity in individuals without diabetes tend to be associated with appropriate compensatory mechanisms, such as a stronger acute insulin response or higher glucose effectiveness. Proteins that are associated with future diabetes risk, but not with insulin insensitivity, tend to be associated with lower glucose effectiveness and/or impaired acute insulin response.

The majority of fast, excitatory synaptic transmission in the central nervous system (CNS) is mediated by α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs), which are glutamate-activated ion channels integral to synaptic plasticity, motor coordination, learning, and memory. AMPARs are multiprotein assemblies comprised of a tetrameric receptor core that co-assembles with a broad range of peripheral auxiliary proteins which shape subcellular localization and signaling properties of the resulting complexes. Structure determination of AMPARs has traditionally relied on recombinant expression systems; however, these methods are not well suited to elucidate the diverse array of AMPAR assemblies that are differentially expressed in mammalian brains. While recent studies of native receptor complexes have advanced our understanding of endogenous assemblies, receptors thus far have only been isolated from rodent brain tissue. Here, we employed an immunoaffinity purification strategy to isolate native AMPARs from the brains of three different mammals - pigs, sheep, and cows. Compared to rodents; pigs, sheep, and cows are from a unique clade of mammals - ungulates, that share a closer genomic identity with humans. We determined the molecular size, overall yield, and purity of native AMPARs isolated from these three mammals, thereby demonstrating that structural determination and biochemical analysis is possible from a clade of mammals evolutionarily distinct from rodents.

AMPA-selective glutamate receptors mediate the transduction of signals between the neuronal circuits of the hippocampus1. The trafficking, localization, kinetics and pharmacology of AMPA receptors are tuned by an ensemble of auxiliary protein subunits, which are integral membrane proteins that associate with the receptor to yield bona fide receptor signalling complexes2. Thus far, extensive studies of recombinant AMPA receptor-auxiliary subunit complexes using engineered protein constructs have not been able to faithfully elucidate the molecular architecture of hippocampal AMPA receptor complexes. Here we obtain mouse hippocampal, calcium-impermeable AMPA receptor complexes using immunoaffinity purification and use single-molecule fluorescence and cryo-electron microscopy experiments to elucidate three major AMPA receptor-auxiliary subunit complexes. The GluA1-GluA2, GluA1-GluA2-GluA3 and GluA2-GluA3 receptors are the predominant assemblies, with the auxiliary subunits TARP-γ8 and CNIH2-SynDIG4 non-stochastically positioned at the B'/D' and A'/C' positions, respectively. We further demonstrate how the receptor-TARP-γ8 stoichiometry explains the mechanism of and submaximal inhibition by a clinically relevant, brain-region-specific allosteric inhibitor.

Citrullinaemia is a urea cycle defect that results from a deficiency of the enzyme arginosuccinate synthetase. Type 1 disease is diagnosed in childhood, whereas type 2 disease is adult onset. But, we report the outcome in a boy (13 years) with citrullinaemia type 2 who received a live donor liver transplant (LDLT) at our centre. One advantage of LDLT over deceased donor liver transplantation is the opportunity to schedule surgery, which beneficially affects neurological consequences. In conclusion, transplantation should be considered to be the definitive treatment for citrullinaemia type 2 at this stage, although some issues remain unresolved.

The coronavirus disease-2019 (COVID-19) pandemic has prompted a dramatic reorganization of health care systems and medical training programs across the United States. At many hospitals, cardiovascular fellows-in-training (FITs) provide front-line clinical care. The traditional cardiovascular

The incidence of cardiogenic shock and the utilization of mechanical circulatory support devices are increasing in the US. In this review we discuss the pathophysiology of cardiogenic shock through basic hemodynamic and myocardial energetic principles. We also explore the commonly used platforms for temporary mechanical circulatory support, their advantages, disadvantages and practical considerations relating to implementation and management. It is through the translation of underlying physiological principles that we can attempt to maximize the clinical utility of circulatory support devices and improve outcomes in cardiogenic shock.

Introduction: To determine clinical parameters that are related to abnormal cardiac symptoms in physically active youth.Methods: We used Simon’s Heart Heartbytes National Youth Cardiac Registry to ...

Introduction: C-reactive protein (CRP) and GlycA are established biomarkers of inflammation. Regular exercise tends to decrease CRP and GlycA levels. However, the molecules underlying CRP and GlycA and their responses to exercise training are less known. Hypothesis: We hypothesized that distinct protein signatures exist for both baseline levels and exercise responsiveness of CRP and GlycA, however with some overlap of proteins across signatures. Methods: Measures were performed before and after 20 weeks of exercise training in 652 Black and White adults from the HERITAGE Family Study. 4,979 circulating proteins were measured using SomaScan. High-sensitivity CRP was measured using automated assays. GlycA was quantified by NMR spectroscopy (LabCorp). Linear mixed models were used to test: 1) Association of baseline proteins with baseline hsCRP and GlycA and 2) Association of change in protein with changes in hsCRP and GlycA. Models were adjusted for age, sex, race, BMI, with family membership as a random variable, with change models also adjusting for baseline trait value. Significance was determined as FDR Results: Baseline levels (r=0.51, p-40 < p < 1.2x10 -08 ), with serum amyloid A-2 and A-1 (SAA2, SAA) among the top 6 hits for 3 of 4 models (Table 1). Conclusions: More unique proteins were associated with GlycA levels at both timepoints, with most hsCRP proteins overlapping with GlycA proteins. Overall, a substantial number of proteins are associated with CRP and GlycA levels regardless of when they are measured, which has potential implications for using proteins as signatures of these inflammatory biomarkers.

Introduction: Elevated plasma triglycerides (TG) are associated with risk of cardiovascular disease and are modifiable through lifestyle interventions such as regular exercise. However, TG responses to regular exercise are characterized by significant inter-individual differences. Hypothesis: We hypothesized that baseline levels of circulating proteins and metabolites are associated with TG response to exercise and can predict exercise-induced changes in plasma TG traits. Methods: We measured circulating proteins (n=4979 proteins) and metabolites (n=300) in 650 Black and White adults of the HERITAGE Family Study who completed 20 weeks of exercise training and had complete data on TG traits. We investigated two TG-related traits that significantly improved with training: fasting TG and large TG-rich lipoprotein particle concentration (LTRLP). The association between baseline analyte values and exercise-induced changes in TG traits were examined using linear mixed models adjusted for age, sex, race, BMI, baseline trait value, and the random effect of family membership. Significance was determined as FDR Results: Regular exercise significantly reduced plasma TG (-1.03±1.3 mmol/L, p=0.01) and LTRLP (-0.24±2.2 nmol/L, p= 0.007), with their training-induced changes moderately correlated (r=0.4, pTable 1 ). Similarly, elastic net regression yielded distinct models of 99 analytes for TG and 315 analytes for LTRLP responses to exercise with accuracy of RMSE=1.28 mmol/L for TG and 2.16 nmol/L for the LTRLP model. Conclusions: We identified panels of proteins and metabolites associated with exercise-induced changes in TG traits and demonstrate, within our data, circulating analytes hold promise for predicting the exercise responsiveness of plasma TG-related traits.

Background Neck of femur fractures result in impaired function for older people. Despite surgery, many patients experience a decrease in functional level and poorer health status after the injury. The objectives of this study were (1) to determine the short-term mobility and hip function of geriatric patients who underwent hip replacement surgery for a displaced neck of femur fracture in our local population and (2) to identify factors which affect the functional outcome of these patients. Methods Patients aged 60 years and above, who were admitted for neck of femur fracture from January 2017 to December 2020, and treated surgically with arthroplasty, were included. Information on patient demography, comorbidities, perioperative data, mobility, hip function and complications were retrospectively collected. Outcome measures used were independent ambulation and recovery of pre-fracture mobility at 1 year after surgery while hip function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain, stiffness, and physical function scores. Factors associated with these outcomes were analyzed. Results 168 patients with a mean age of 75.2 (SD 8.4) years met the inclusion criteria. 32.1% of patients regained their pre-fracture mobility and 59.6% remained independent 1 year after surgery. Logistic regression analysis identified age, gender, surgical procedure, and time to surgery as significant contributors to recovery of pre-fracture mobility. Older age and increasing requirement for postoperative ambulatory aid resulted in worse WOMAC total and physical function scores. No significant differences were observed in patient-reported hip function between those who had a total hip arthroplasty and those who had a hemiarthroplasty. Conclusion Most geriatric patients with displaced neck of femur fractures did not regain pre-fracture mobility despite surgical treatment with arthroplasty.

PURPOSE OF THE REVIEW: Commercial wearable biosensors are commonly used among athletes and highly active individuals, although their value in sports cardiology is not well established. In this review, we discuss the evidence for the current applications of wearables and provide our outlook for promising future directions of this emerging field. RECENT FINDINGS: The integration of routine assessment of physiological parameters, activity data, and features such as electrocardiogram recording has generated excitement over a role for wearables to help diagnose and monitor cardiovascular disease. Presently, however, there are significant challenges limiting their routine clinical use. While studies suggest that wearable-derived data may help guide training, evidence for the use of wearables in guiding exercise regimens for individuals with cardiovascular disease is lacking. Further, there is a paucity of data to demonstrate its efficacy in detecting exercise-related arrhythmias or conditions associated with sudden cardiac death. Further technological developments may lead to a greater potential for wearables to aid in sports cardiology practice. SUMMARY: The ability to collect vast amounts of physiological information can help athletes personalize training regimens. However, interpretation of these data and separating the signal from the noise are paramount, especially when used in a clinical setting. While there are currently no standardized approaches for the use of wearable-derived data in sports cardiology, we outline three domains in which they could guide the care of athletes in the future: (1) optimizing athletic performance (2) guiding exercise in athletes with known cardiovascular disease, and (3) screening for cardiovascular disease.

Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation, respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and non-traditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise and atrial fibrillation. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and atrial fibrillation. Recent advances in molecular profiling technologies (i.e., genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on inter-individual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.

Objectives The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory. Background CA can occur in the cath lab during high-risk percutaneous coronary intervention. While attempting to correct the precipitating cause of CA, several options are available to maintain vital organ perfusion. These include manual chest compressions, mechanical chest compressions, or a percutaneous left ventricular assist device. Methods Eighty swine (58 ± 10 kg) were studied. The left main or proximal left anterior descending artery was occluded. Ventricular fibrillation (VFCA) was induced and circulatory support was provided with 1 of 4 techniques: either manual chest compressions (frequently interrupted), mechanical chest compressions with a piston device (LUCAS-2), an Impella 2.5 L percutaneously placed LVAD, or the combination of mechanical chest compressions and the percutaneous left ventricular assist device. The study protocol included 12 min of left main coronary occlusion, reperfusion, with defibrillation attempted after 15 min of VFCA. Primary outcome was favorable neurological function (CPC 1 or 2) at 24 h, while secondary outcomes included return of spontaneous circulation and hemodynamics. Results Manual chest compressions provided fewer neurologically intact surviving animals than the combination of a mechanical chest compressor and a percutaneous LVAD device (0% vs. 56%; p Conclusions Combining 2 mechanical devices provided superior 24-h survival with favorable neurological recovery compared with manual compressions during moderate duration VFCA associated with an acute coronary occlusion in the animal catheterization laboratory.

Cardiogenic shock (CS) is a condition associated with high mortality rates in which prognostication is uncertain for a variety of reasons, including its myriad causes, its rapidly evolving clinical course and the plethora of established and emerging therapies for the condition. A number of validated risk scores are available for CS prognostication; however, many of these are tedious to use, are designed for application in a variety of populations and fail to incorporate contemporary hemodynamic parameters and contemporary mechanical circulatory support interventions that can affect outcomes. It is important to separate patients with CS who may recover with conservative pharmacological therapies from those in who may require advanced therapies to survive; it is equally important to identify quickly those who will succumb despite any therapy. An ideal risk-prediction model would balance incorporation of key hemodynamic parameters while still allowing dynamic use in multiple scenarios, from aiding with early decision making to device weaning. Herein, we discuss currently available CS risk scores, perform a detailed analysis of the variables in each of these scores that are most predictive of CS outcomes and explore a framework for the development of novel risk scores that consider emerging therapies and paradigms for this challenging clinical entity.

Introduction: Regular exercise beneficially increases plasma HDL-C levels at the group level. However, variation in individual HDL-C responses to exercise highlight a need for predictive biomarkers of exercise response. Hypothesis: We hypothesized that baseline abundance of circulating proteins is predictive of HDL-C response to exercise and that identified proteins are part of a complex biological network of exercise response. Methods: We measured over 5,000 circulating proteins using an aptamer-affinity based platform (SomaScan) in 667 black and white adults from the HERITAGE Family Study. Fasting plasma HDL-C was measured at baseline and following 20 weeks of supervised endurance exercise training. To predict exercise induced changes in HDL-C using baseline abundance of circulating proteins, models were created using LASSO regression and a 70/30 training test data split with 10-fold cross validation. Biological pathways, networks, and functions involving proteins identified in predictive modeling were investigated by ingenuity pathway analysis (IPA) and integrated molecular pathway level analysis (IMPaLA). Results: Regular exercise significantly increased HDL-C in the sample by 1.5 ± 4.6 mg/dL (p Conclusions: Circulating proteins may allow for prediction of exercise induced changes in HDL-C. Additionally, proteins predictive of HDL-C response to exercise are associated with important biological pathways and may provide insights into the molecular mechanisms of the benefits of regular exercise.

Routine exercise confers a plethora of cardiovascular benefits and is inversely associated with the development of coronary artery disease (CAD). However, the cardiovascular stress induced during exercise transiently increases the risk of an adverse cardiac event, particularly in those with underlying CAD. Sports cardiologists commonly encounter older individuals with CAD who engage in high levels of exercise. This chapter will review the burden of CAD in athletes, discuss the initial clinical evaluations, and explore the management of athletes with established CAD. We will consider some unique considerations that pertain to competitive athletes, including eligibility as well as returning to athletic participation after an acute coronary event. Finally, we will deal with the putative mechanisms of cardiac events during exercise and the association between high levels of exercise and coronary artery calcification.

Background: The ACC/AHA currently recommend performing a 14-point cardiovascular (CV) evaluation when screening healthy student-athletes for CV disease. This includes a focused history to assess for cardiac symptoms including exertional chest pain, dyspnea, fatigue, palpitations, and syncope. Though the presence of these symptoms may suggest underlying CV disease, additional factors including hours of weekly physical activity may influence the prevalence of reported symptoms. The relationship between physical activity level and the prevalence of cardiac symptoms has not been fully studied in an adolescent population. Methods: We analyzed the results of 10683 consecutive athlete screenings (median age 15 years) from HeartBytes, a data registry of pre-participation youth CV screenings utilizing the 14-point AHA evaluation. Cardiac symptoms and hours of weekly physical activity were self-reported. Weekly activity level was reported as less than 2 hours, between 2 and 5 hours, between 5 and 10 hours, or as greater than 10 hours. A chi-squared analysis for independence was performed to evaluate the relationship between physical activity level and each cardiac symptom. Results: Chest pain was reported in 5.1% of athletes, and increasing hours of physical activity was associated with less reported pain ( X 2 = 73.01, p X 2 = 120.53, p X 2 = 376.61, p X 2 = 95.34, p X 2 = 5.53, p = 0.24). Conclusion: Increased physical activity is associated with lower rates of reported chest pain, exertional dyspnea, easy fatigability, and palpitations in adolescents. Further studies are needed to clarify the relationship in youth athletes between symptoms and CV health.

The incidence of cardiogenic shock and the utilization of mechanical circulatory support devices are increasing in the US. In this review we discuss the pathophysiology of cardiogenic shock through basic hemodynamic and myocardial energetic principles. We also explore the commonly used platforms for temporary mechanical circulatory support, their advantages, disadvantages and practical considerations relating to implementation and management. It is through the translation of underlying physiological principles that we can attempt to maximize the clinical utility of circulatory support devices and improve outcomes in cardiogenic shock.

Routine moderate-intensity physical activity confers numerous cardiovascular benefits and reduces all-cause mortality. However, the health impact of exercise doses that exceed contemporary physical activity guidelines remains incompletely understood, and an emerging body of literature suggests that high levels of exercise may have the capacity to damage the cardiovascular system. This review focuses on the contemporary controversies regarding high-dose exercise and cardiovascular morbidity and mortality. We discuss the limitations of available studies, explore potential mechanisms that may mediate exercise-related cardiac injury, and highlight the gaps in knowledge for future research.

Aim This study reports a successful minilaparoscopic treatment of a 62 years old male patient with a Grynfeltt hernia, and outlines a new minimally invasive way to do the procedure. A patient presented with a left lumbar herniation of two years duration with no other symptoms. Physical examination showed a 5 cm soft mass on the left lumbar region, which was confirmed as a hernia by an ultrasound. Method A minilaparoscopic approach to surgery was chosen, using a 10 mm trocar inserted in the umbilical region for pneumoperitoneum and the optics, a 3 mm minilaparoscopy trocar inserted in the preperitoneal region in the left iliac region and another 3 mm trocar inserted more dorsally in the lumbar region. Results The polypropylene mesh was placed in the preperitoneal space without need for any mesh fixation. The total time of surgery was 41 min and the patient was discharged on the next day. Conclusion The proposed novel approach is not only feasible, but offers advantages as it appears to be safer, less invasive, cost-effective and above all eminently reproducible.

Rectum is the least common site of involvement by gastrointestinal lymphomas with Burkitt’s lymphoma subtype being even more infrequent, accounting for less than 0.0005% of all primary rectal malignancies. Significance lies in its rarity, the difficulty in distinguishing it from rectal carcinoma, and its not yet standardized treatment protocol. Here, we report a case of primary rectal Burkitt’s lymphoma in a 32-year male with Crohn’s disease on azathioprine, who was successfully managed with laparoscopic low anterior resection with adjuvant intensive chemotherapy. Our case attempts to shows that minimally invasive surgical resection with adjuvant chemotherapy is a viable therapeutic option for rectal lymphomas including the aggressive variants like Burkitt’s lymphoma.

Background Screening electrocardiography (ECG) for athletes is both controversial and rapidly evolving. While identifying an abnormal ECG could detect a serious cardiovascular disease, falsely interpreting a benign ECG pattern as abnormal can lead to unnecessary testing, cost, and anxiety. Though recent refinements of athlete screening ECG criteria have significantly improved its accuracy, in clinical practice physician adherence to these criteria may vary. Methods We analyzed physician adherence to contemporary athlete ECG criteria in a large, national athlete screening registry. 1577 consecutive screening ECGs were independently re- interpreted to assess for physician adherence to Seattle Criteria or International Criteria, respective to the criteria in place when the screening was performed. We further determined the most common ECG interpretations that deviated from these criteria, and analyzed physician characteristics for independent predictors of adherence to published ECG criteria. Results Though overall adherence to contemporary criteria was high, 60.4% of ECGs interpreted as abnormal did not meet athlete ECG criteria for pathology when independently re- read. The most common ECG patterns misinterpreted as abnormal were isolated left ventricular hypertrophy (LVH) and non-pathologic T-wave inversions (TWI). Multivariate regression identified three independent predictors of adherence to athlete ECG criteria: participating in a screening overseen by the organization's medical leadership, electrophysiology specialists and adult cardiologists. Conclusion This study highlights the need for quality control measures and continued clinician education in a controversial and rapidly evolving field. Clinician education for athlete screening ECG criteria should emphasize the recent changes in how TWI and LVH voltage criteria should be interpreted in this patient population.

We provide a framework for formulating exercise prescriptions for those with CAD in order to achieve the “optimal” dose of exercise for each individual. Multiple epidemiological studies demonstrate that exercise is inversely associated with atherosclerotic coronary artery disease (CAD), yet the risk of an acute coronary event is transiently elevated during vigorous exercise. In turn, CAD is the most common cause of exercise-related sudden cardiac death (SCD) in older athletes. When prescribing exercise recommendations for athletes with CAD, we should maintain equipoise between the benefits derived from sports participation and the risk of an adverse cardiac event. Athletes are not immune from atherosclerotic CAD, and we should perform risk assessments regardless of physical and athletic prowess. Cardiopulmonary exercise testing may be a useful tool to develop individualized exercise regimens for athletes with CAD.

The Future of sustainable Mobility is being shaped by trends towards Connected, Autonomous, Shared, Electric (CASE) vehicle technologies. To accelerate the transition from the Internal Combustion Engines (ICEs) Vehicles to Electric Vehicles (EVs), we need to design and offer EVs that have (a) low total cost of operation (TCO), (b) low product - lifecycle cost and (c) high environmental sustainability. The objective of the paper is to demonstrate two strategies of Design to Value (DTV) and Design to Cost (DTC) can enable this transition. The paper suggests methods and opportunities to increase value and reduce cost for native EV Architecture based on innovative design and platform strategy.

The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory.CA can occur in the cath lab during high-risk percutaneous coronary intervention. While attempting to correct the precipitating cause of CA, several options are available to maintain vital organ perfusion. These include manual chest compressions, mechanical chest compressions, or a percutaneous left ventricular assist device.Eighty swine (58 ± 10 kg) were studied. The left main or proximal left anterior descending artery was occluded. Ventricular fibrillation (VFCA) was induced and circulatory support was provided with 1 of 4 techniques: either manual chest compressions (frequently interrupted), mechanical chest compressions with a piston device (LUCAS-2), an Impella 2.5 L percutaneously placed LVAD, or the combination of mechanical chest compressions and the percutaneous left ventricular assist device. The study protocol included 12 min of left main coronary occlusion, reperfusion, with defibrillation attempted after 15 min of VFCA. Primary outcome was favorable neurological function (CPC 1 or 2) at 24 h, while secondary outcomes included return of spontaneous circulation and hemodynamics.Manual chest compressions provided fewer neurologically intact surviving animals than the combination of a mechanical chest compressor and a percutaneous LVAD device (0% vs. 56%; p 0.01), while no difference was found between the 2 mechanical approaches (28% vs. 35%: p = 0.75). Comparing integrated coronary perfusion pressure showed sequential improvement in hemodynamic support with mechanical devices (401 ± 230 vs. 1,337 ± 905 mm Hg/s; p = 0.06).Combining 2 mechanical devices provided superior 24-h survival with favorable neurological recovery compared with manual compressions during moderate duration VFCA associated with an acute coronary occlusion in the animal catheterization laboratory.

Dosage compensation mechanisms equalize the level of X chromosome expression between sexes. Yet the X chromosome is often enriched for genes exhibiting sex-biased, i.e., imbalanced expression. The relationship between X chromosome dosage compensation and sex-biased gene expression remains largely unexplored. Most studies determine sex-biased gene expression without distinguishing between contributions from X chromosome copy number (dose) and the animal’s sex. Here, we uncoupled X chromosome dose from sex-specific gene regulation in Caenorhabditis elegans to determine the effect of each on X expression. In early embryogenesis, when dosage compensation is not yet fully active, X chromosome dose drives the hermaphrodite-biased expression of many X-linked genes, including several genes that were shown to be responsible for hermaphrodite fate. A similar effect is seen in the C. elegans germline, where X chromosome dose contributes to higher hermaphrodite X expression, suggesting that lack of dosage compensation in the germline may have a role in supporting higher expression of X chromosomal genes with female-biased functions in the gonad. In the soma, dosage compensation effectively balances X expression between the sexes. As a result, somatic sex-biased expression is almost entirely due to sex-specific gene regulation. These results suggest that lack of dosage compensation in different tissues and developmental stages allow X chromosome copy number to contribute to sex-biased gene expression and function.