Search

Objective: The objective was to investigate the use of an augmented reality headset to remotely train clinicians on medical devices using anatomic models. Design: Disease-specific phantoms were developed to train physicians in mpMRI-guided fusion prostate biopsy, brachytherapy, and rectal spacer insertion. Training was remotely demonstrated using 1-way virtual video conferencing format. Participants responded to an educational content survey. A heads-up display with software and augmented reality was used for remote 2-way training with the proctor and student using on their own phantoms. Setting: The virtual video meeting took place during a prostate cancer conference in 2020, while the augmented reality training occurred in 2021. The proctor and student wore a heads-up display containing a projector and webcam where the ultrasound image was displayed onto a see-through optic along with the physician's hands. The heads-up display allowed the proctor to teach by line-of-sight while the student watched and repeated the steps. Participants: Faculty with expertise with the medical devices used in these procedures provided training to urologists unfamiliar with these techniques. Results: Participants responded that the 1-way training on the phantoms was realistic and mimicked human tissue. A total of 70.9% requested more training or training on the phantoms. The remote training platform was successfully beta tested at the 2 locations in transperineal prostate biopsy and rectal spacer insertion. Conclusion: Remote training using augmented reality eliminates the need for travel. For training programs and workshops, this technology may mitigate the risk of infectious exposures, reduce training cost, and increase proctor availability, allowing training from their own institution or clinic.This investigation qualifies for the Accreditation Council for Graduate Medical Education competency in medical knowledge.

Category: Hindfoot Introduction/Purpose: Adult Acquired Flatfoot Deformity (AAFD) is a common progressive pathology that mainly affects patients after their 50s. Even though it is not clear yet what causes AAFD, the great majority of patients have their talonavicular (TN) joint sub dislocated in one or more planes. According to the severity of the deformity and its flexibility, different surgical procedures can be performed to realign the foot. The deformities usually happen around the TN joint, making it the center of rotation and angulation (CORA). Corrections on the CORA realign deformities in different planes and his concept can be applied to mostly any deformity. The objective of this study is to evaluate clinically and radiographically patients with stage 2 AAFD submitted to isolated TN fusion. Methods: Fifty-four patients (59 feet) from July 2013 to December 2019 with stage 2 AAFD were submitted to isolated TN fusion. All patients had clinical deformity and arch foot collapse associated with pain along the medial hindfoot. Weight-bearing x- rays were performed pre-operatively, the Meary's and calcaneal pitch angles were measured on lateral view and the Talar coverage and Simmon's angle were measured on antero-posterior view. Angles were measured by a fully trained foot and ankle surgeon. Post-operative measurements were done with the same set of images by the same surgeon, one month after the initial measurements. FAAM and VR12 were used to compare patient's clinical status. Patients with previous surgeries on the foot or ankle and patients submitted to other fusions or hindfoot osteotomies were excluded from the study. Gastrocnemius lengthening and toes corrections were not an exclusion criterion. Results: Thirty-seven females and seventeen males were evaluated with a mean age 61 years at the time of surgery. Only the FAAM score significantly improved from pre-operative (FAAM = 48.48, VR-12 Mental = 55.73, VR-12 Physical = 37.25) to most recent mean follow-up of 16.2 months (FAAM = 58.45 (p

Category: Sports Introduction/Purpose: The Broström is the most commonly used Lateral ligament repair for chronic instability, but there is growing evidence that a fairly large percentage will stretch out with time, resulting in recurrent instability. Due to the nature of the repair, rehabilitation is also fairly slow, so not to compromise the tissue during the maturation stage. Currently, the Internal Brace Ligament Augmentation Repair is an accepted augmentation method for management of a Broström procedure. However, to our knowledge, no formally collected outcome data on the procedure has been reported. Hypotheses Augmentation of the Broström repair with an Internal Brace would 1)allow accelerated rehabilitation and return to activity, 2)Will aid in long-term stability of the repair without a tendency to stretch out. Methods: Patients with lateral ankle instability procedures repaired with a Broström and Internal Brace Augmentation were prospectively evaluated at one-time post-operative visit between 6 and 24 months. Patients with concomitant procedures other than debridement were excluded from the study. Outcome measures included demographics; surgical time; AOFAS, FAA, satisfaction, and VAS scores; ROM, Raise Test, and calf strength compared to the contralateral limb; return to sports, and adverse events. Fifteen patients were analyzed for the study from the two sites involved. The cohort includes 4 males and 11 females. 87% of patients were non-smoking cohort with an average BMI 29 ± 6 (range 22 to 44). Average age was 35.9 ± 12.1 years (20 to 56 years). Seven of the procedures were revisions. Furthermore, 60% of the injuries resulted from severe sprains to the involved ankle from normal ADL, while the rest are a result of a sport injury. The mean follow up time was 16.8 ± 6.8 months (range 6-24 months). Results: The complication rate was 7%. The average surgical time was 37 ± 10 minutes (range 20-53 minutes). The average postoperative VAS and Satisfaction scores were 1.5 ± 2.6 and 9.5 ± 1.6, respectively. The time to return to sports was 76 ± 22 days (range 48-122). The average AOFAS was 93.4 ± 10.3. Nine patients reported a 100 total score on the AOFAS. For the FAAM, 14 subjects reported from 90 to 100 on the ADL total score. Fourteen patients were brace free with activity. The objective calf strength examination (actual girth measured) proved not significantly different from the contralateral limb. (p=0.837). 75% of the cohort had a negative anterior drawer at their post op visit. Ankle dorsiflexion comparisons were 9.3 ± 3.0 cm (operative side) and 10.4 ± 3.2 cm (contralateral side); and ankle plantar flexion comparison (goniometer) 38 ± 7 degrees (operative side) and 37 ± 8 degrees (contralateral side). Neither comparison was statistically significant, p = .349 and p = .708, respectively. Conclusion: These results suggest the Internal Brace Augmentation of Broström procedure is safe and efficacious.

The acute clinical syndrome of toxic epidermal necrolysis (TEN) is currently thought to be a distinct clinical – pathological entity typically resulting from drug hypersensitivity. We describe an adult woman who experienced a fulminate pattern of apoptotic epidermal cell injury following tanning bed exposure while taking naproxen that resulted in a clinical presentation having combined features of drug-induced TEN and an infrequently recognized form of bullous cutaneous lupus erythematosus (LE). This case calls attention to the fact that TEN-like injury can occasionally be seen in settings other than drug hypersensitivity (e.g., LE, acute graft versus host disease) and illustrates the need for a unifying concept in this area. We therefore propose the term 'Acute Syndrome of Apoptotic Pan-Epidermolysis (ASAP)' to designate a clinical syndrome that is characterized by life-threatening acute and massive cleavage of the epidermis resulting from hyperacute apoptotic injury of the epidermis. We also review vesiculobullous skin disorders that can be encountered in LE patients and suggest a new classification scheme for such lesions. [ABSTRACT FROM AUTHOR]

Introduction: Body composition standards are set to ensure operational readiness in active-duty military personnel. To meet body composition standards, some individuals, however, may engage in unhealthy weight control behaviors (i.e., weight cycling and disordered eating). The objectives of this review are to: (1) evaluate the evidence regarding body composition and the associations to physical and military specific performance; (2) discuss body composition and potential health consequences; and (3) examine the evidence of weight cycling and disordered eating behaviors in military personnel for weight control., Methods: A systematic search to identify peer-reviewed research articles was conducted in PubMed on 2/20/2023 using Medical Subject Headings (MeSH) including but not limited to "Military Personnel", "Tactical Athlete", "Weight Loss", "Body Composition", and "Weight Cycling"., Results: A total of 225 research articles were identified. The list was narrowed down to articles from the last 20 years (2003-2023) in military personnel. Only studies in which percent body fat was directly measured were included resulting in 17 research articles for this review., Discussion: Evidence-based research is limited on the relationship between body composition and operational readiness. Weight cycling and disordered eating behaviors also has been reported for weight control, yet additional research is needed. Specifically, future research should focus on female service members, racial and ethnic differences, age, and postpartum status and include other service branches (i.e., Air Force and Navy). A comprehensive survey on weight cycling, disordered eating, and weight management would be valuable to determine the prevalence and extent of this issue. This information along with performance data would guide policy makers on the relevance and appropriateness of existing body composition standards., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Cialdella-Kam, Bloedon and Stone.)

Changes in testing behaviors and reporting requirements have hampered the ability to estimate the U.S. SARS-CoV-2 incidence (1). Hybrid immunity (immunity derived from both previous infection and vaccination) has been reported to provide better protection than that from infection or vaccination alone (2). To estimate the incidence of infection and the prevalence of infection- or vaccination-induced antibodies (or both), data from a nationwide, longitudinal cohort of blood donors were analyzed. During the second quarter of 2021 (April-June), an estimated 68.4% of persons aged ≥16 years had infection- or vaccination-induced SARS-CoV-2 antibodies, including 47.5% from vaccination alone, 12.0% from infection alone, and 8.9% from both. By the third quarter of 2022 (July-September), 96.4% had SARS-CoV-2 antibodies from previous infection or vaccination, including 22.6% from infection alone and 26.1% from vaccination alone; 47.7% had hybrid immunity. Prevalence of hybrid immunity was lowest among persons aged ≥65 years (36.9%), the group with the highest risk for severe disease if infected, and was highest among those aged 16-29 years (59.6%). Low prevalence of infection-induced and hybrid immunity among older adults reflects the success of public health infection prevention efforts while also highlighting the importance of older adults staying up to date with recommended COVID-19 vaccination, including at least 1 bivalent dose.* , † ., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

Crenosoma vulpis, the fox lungworm, is a helminth parasite endemic to the fox population of New England. Domestic dogs are susceptible to infection via ingestion of snails and slugs. Two dogs from New England were diagnosed with C. vulpis. The predominant clinical sign in both dogs was a chronic cough. Treatment with steroids and antibiotics only temporarily relieved clinical signs. Thoracic radiographs in both dogs revealed bronchial patterns. Endotracheal washes were performed in each dog revealing marked, mixed inflammation consisting mainly of neutrophils with eosinophils in lesser numbers. Helminth larvae could also be visualized on cytology. A fecal flotation revealed helminth larvae in one dog but failed to identify larvae in the second dog. The diagnosis of C. vulpis was confirmed via PCR analysis and sequencing of samples from both endotracheal washes. One dog was treated with fenbendazole (50 mg/kg PO q24h for 14 days), enrofloxacin (13 mg/kg PO q 24 h for 5 days), and a tapering protocol of prednisone (20 mg PO q12h for 5 days, 20 mg PO q24h for 5 days, then 20 mg PO q48h for 10 days). The second dog was treated with fenbendazole (50 mg/kg PO q24h for 10 days) with an additional 7 days of febantel and two doses of milbemycin, achieving complete resolution of clinical signs. This lungworm is becoming increasingly more prevalent in domestic dogs worldwide and may be more prevalent in New England than previously thought. Veterinary practitioners of New England should include this respiratory helminth as a differential in dogs with respiratory signs, and respiratory washes and Baermann fecal examinations are warranted in dogs presenting with non-specific respiratory clinical signs., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Potassium supplementation has been associated with reduced urinary calcium (Ca) excretion and increased Ca balance. Dietary interventions assessing the impact of potassium on bone are lacking. In this secondary analysis of a study designed primarily to determine blood pressure effects, we assessed the effects of potassium intake from potato sources and a potassium supplement on urinary Ca, urine pH, and Ca balance. Thirty men ( n = 15) and women ( n = 15) with a mean ± SD age and BMI of 48.2 ± 15 years and 31.4 ± 6.1 kg/m 2 , respectively, were enrolled in a cross-over, randomized control feeding trial. Participants were assigned to a random order of four 16-day dietary potassium interventions including a basal diet (control) of 2300 mg/day (~60 mmol/day) of potassium, and three phases of an additional 1000 mg/day (3300 mg/day(~85 mmol/day) total) of potassium in the form of potatoes (baked, boiled, or pan-heated), French fries (FF), or a potassium (K)-gluconate supplement. Calcium intake for all diets was approximately 700-800 mg/day. Using a mixed model ANOVA there was a significantly lower urinary Ca excretion in the K-gluconate phase (96 ± 10 mg/day) compared to the control (115 ± 10 mg/day; p = 0.027) and potato (114 ± 10 mg/day; p = 0.033). In addition, there was a significant difference in urinary pH between the supplement and control phases (6.54 ± 0.16 vs. 6.08 ± 0.18; p = 0.0036). There were no significant differences in Ca retention. An increased potassium intake via K-gluconate supplementation may favorably influence urinary Ca excretion and urine pH. This trial was registered at ClinicalTrials.gov as NCT02697708.

This study compared the acute and chronic impact of citrulline malate (CM) supplementation on muscle contractile properties and fatigue rate of the quadriceps. Eighteen recreationally trained males consumed both a placebo (PL) and CM treatment for two separate dosing periods. The first experimental testing session for each dosing period was considered the baseline day, the second session the acute day, and the third session the chronic day, which followed seven consecutive days of supplementation. All testing sessions included exercising on a cycle ergometer at 50%-60% of their max power output for 30 min followed by performing the Thorstensson test on an isokinetic dynamometer. A two-way (Supplement × Time) analysis of variance with repeated measures resulted in no significant interactions (p > .05) (PL: baseline day, acute day, chronic day vs. CM: baseline day, acute day, chronic day) for peak power (in watts) (469 ± 81, 490 ± 97, 502 ± 99 vs. 464 ± 85, 480 ± 103, 501 ± 81); peak torque (in newton meters) (150 ± 26, 157 ± 32, 161 ± 31 vs. 149 ± 27, 156 ± 33, 161 ± 26); fatigue rate (in percentage) (57 ± 9, 57 ± 10, 58 ± 9 vs. 57 ± 10, 56 ± 9, 58 ± 9); and heart rate (in beats per minute) (156 ± 17, 146 ± 13, 146 ± 9 vs. 155 ± 11, 146 ± 11, 146 ± 9). The results of this study suggest that neither acute nor chronic supplementation of CM had an effect on recovery or fatigue rate of the quadriceps.

Increased potassium intake has been linked to improvements in cardiovascular and other health outcomes. We assessed increasing potassium intake through food or supplements as part of a controlled diet on blood pressure (BP), microcirculation (endothelial function), and potassium and sodium retention in thirty pre-hypertensive-to-hypertensive men and women. Participants were randomly assigned to a sequence of four 17 day dietary potassium treatments: a basal diet (control) of 60 mmol/d and three phases of 85 mmol/d added as potatoes, French fries, or a potassium gluconate supplement. Blood pressure was measured by manual auscultation, cutaneous microvascular and endothelial function by thermal hyperemia, utilizing laser Doppler flowmetry, and mineral retention by metabolic balance. There were no significant differences among treatments for end-of-treatment BP, change in BP over time, or endothelial function using a mixed-model ANOVA. However, there was a greater change in systolic blood pressure (SBP) over time by feeding baked/boiled potatoes compared with control (-6.0 mmHg vs. -2.6 mmHg; p = 0.011) using contrast analysis. Potassium retention was highest with supplements. Individuals with a higher cardiometabolic risk may benefit by increasing potassium intake. This trial was registered at ClinicalTrials.gov as NCT02697708.

Purpose: Combined hormonal contraceptive therapy has been associated with negative bone mineral density outcomes that may be route-dependent [i.e., combined oral contraception (COC) vs. contraceptive vaginal ring (CVR)] and involve the hepatic growth hormone (GH)/insulin-like growth factor-I (IGF-I) axis. The objective of the pilot study was to assess the impact of route of contraceptive administration on IGF-I and procollagen type I N-terminal propeptide (PINP) responses to an IGF-I Generation Test. We hypothesized that the peak rise in IGF-I and PINP concentration and area under the curve (AUC) would be attenuated following COC, but not CVR, use. Methods: Healthy, premenopausal women not taking hormonal contraception were recruited. Women were enrolled in the control group ( n = 8) or randomly assigned to COC ( n = 8) or CVR ( n = 8) for two contraceptive cycles. IGF-I Generation Tests were used as a probe to stimulate IGF-I release and were completed during the pre-intervention and intervention phases. Serum IGF-I and PINP were measured during both IGF-I Generation Tests. The study was registered at ClinicalTrials.gov (NCT02367833). Results: Compared to the pre-intervention phase, peak IGF-I concentration in response to the IGF-I Generation Test in the intervention phase was suppressed in the COC group ( p < 0.001), but not the CVR or Control groups ( p > 0.090). Additionally, compared to the pre-intervention phase, PINP AUC during the intervention phase was suppressed in both COC and CVR groups ( p < 0.001), while no difference was observed in the control group ( p = 0.980). Conclusion: These data suggest that changes in recombinant human GH-stimulated hepatic IGF-I synthesis in response to combined hormonal contraception (CHC) use are dependent on route of CHC administration, while the influence on PINP is route-independent. Future research is needed to expand these results with larger randomized control trials in all age ranges of women who utilize hormonal contraception. Clinical Trial Registration: www.ClinicalTrials.gov registration NCT02367833., (Copyright © 2020 Allaway, Misra, Southmayd, Stone, Weaver, Petkus and De Souza.)

Competing Interests: Potential Conflicts of Interest: None disclosed.

Increased intake of potassium should be promoted to reduce the risk of cardiovascular disease and stroke and to protect against bone loss, but confidence in recommended intakes depends on the strength of the evidence. All public health recommendations are considerably higher than current average intakes. Evidence on which current potassium intake recommendations for the United States, Europe, and globally have limitations. More recent evidence reviewed by the Agency for Healthcare Research and Quality affirms that more evidence is needed to define specific values for optimal potassium intakes. Potassium requirements undoubtedly vary with a number of factors including energy needs, race, and intake of sodium.

Stone, MS, Glenn, JM, Vincenzo, JL, and Gray, M. Comparison of exercise performance in recreationally active and masters athlete women. J Strength Cond Res 32(2): 565-571, 2018-Master athletes (MA) are an understudied, ever-growing cohort. As such, it is important to examine how age affects muscular power and fatigability. Of particular interest is muscular power maintenance and fatigue mitigation of MA compared with young, healthy adults. The purpose of this investigation was to examine the differences in peak power, average power, total work (WRK), and fatigue index (FI) between recreationally active (RA) younger adults and female MA during anaerobic cycling exercise. Two groups, RA (n = 15; 20.6 ± 0.8 years) and MA (n = 17; 50.5 ± 8.6 years), participated in this study. Peak power, APWR, WRK, and FI were measured during a 30-second Wingate maximum anaerobic cycling protocol at a predetermined resistance of 7.5% body mass. Peak power (p = 0.92; RA: 654.1 ± 114.5 W; MA: 658.6 ± 147.6 W), APWR (p = 0.09; RA: 429.8 ± 73.3 W; MA: 384 ± 73.8 W), WRK (p = 0.09; RA: 12,894.3 ± 2,198.3 J; MA: 18,044.3 ± 27,184.9 J), and FI (p = 0.30; RA: 11.8 ± 4.1 W·s; MA: 14 ± 5.2 W·s) were not significantly different between groups. Master athletes produce power and WRK comparable to rates of fatigue among RA. This suggests that MA can maintain physical ability similar to RA in multiple parameters of high-intensity exercise while mitigating fatigue comparably. These data allow for advancements in exercise training and performance outcomes in MA populations. Further research within the MA population is warranted regarding other aspects of exercise and sport performance.

We recently established daily, free-living profiles of the adrenal hormone cortisol, the (primarily adrenal) anabolic precursor dehydroepiandrosterone (DHEA) and the (primarily gonadal) anabolic hormone testosterone in elite military men. A prevailing view is that adrenal and gonadal systems reciprocally modulate each other; however, recent paradigm shifts prompted the characterization of these systems as parallel, cooperative processes (i.e. the "positive coupling" hypothesis). In this study, we tested the positive coupling hypothesis in 57 elite military men by evaluating associations between adrenal and gonadal biomarkers across the day. Salivary DHEA was moderately and positively coupled with salivary cortisol, as was salivary testosterone. Anabolic processes (i.e. salivary DHEA and testosterone) were also positively and reliably coupled across the day. In multivariate models, salivary DHEA and cortisol combined to account for substantial variance in salivary testosterone concentrations across the day, but this was driven almost exclusively by DHEA. This may reflect choreographed adrenal release of DHEA with testicular and/or adrenal release of testosterone, systemic conversion of DHEA to testosterone, or both. DHEA and testosterone modestly and less robustly predicted cortisol concentrations; this was confined to the morning, and testosterone was the primary predictor. Altogether, top-down co-activation of adrenal and gonadal hormone secretion may complement bottom-up counter-regulatory functions to foster anabolic balance and neuronal survival; hence, the "yin and yang" of adrenal and gonadal systems. This may be an adaptive process that is amplified by stress, competition, and/or dominance hierarchy.

Purpose: Citrulline malate (CM) is a nonessential amino acid that increases exercise performance in males. However, based on physiological differences between genders, these results cannot be extrapolated to females. Therefore, the purpose of this investigation was to evaluate effects of acute CM supplementation on upper- and lower-body weightlifting performance in resistance-trained females., Methods: Fifteen females (23 ± 3 years) completed two randomized, double-blind trials consuming either CM (8 g dextrose + 8 g CM) or a placebo (8 g dextrose). One hour after supplement consumption, participants performed six sets each of upper- (i.e., bench press) and lower-body (i.e., leg press) exercises to failure at 80 % of previously established one-repetition maximum. Immediately after each set, repetitions completed, heart rate and rating of perceived exertion (RPE) were recorded., Results: Repeated-measures analysis of variance indicated that subjects completed significantly (p = .045) more repetitions throughout upper-body exercise when consuming CM versus placebo (34.1 ± 5.7 vs. 32.9 ± 6.0, respectively). When consuming CM, similar significant (p = .03) improvements in total repetitions completed were observed for lower-body exercise (66.7 ± 30.5 vs. 55.13 ± 20.64, respectively). Overall RPE score was significantly lower (p = .02) in upper-body exercise when subjects consumed CM versus placebo (7.9 ± 0.3 and 8.6 ± 0.2, respectively). The supplement consumed exhibited no significant effects on heart rate at any time point., Conclusions: Acute CM supplementation in females increased upper- and lower-body resistance exercise performance and decreased RPE during upper-body exercise. These data indicate that athletes competing in sports with muscular endurance-based requirements may potentially improve performance by acutely supplementing CM.

Unlabelled: Citrulline-malate (CM) is a precursor to nitric-oxide (NO) in the NO synthase (NOS) pathway and is suggested to increase exercise performance in younger individuals. With age, NO production decreases and augmented NO production may provide beneficial effects on sports performance among masters athletes (MAs)., Purpose: To examine the effects of acute CM supplementation on grip strength, vertical power, and anaerobic cycling performance in female, MA tennis players., Methods: Seventeen female MA (51 ± 9 years) completed two double-blind, randomized trials consuming CM (12 g dextrose + 8 g CM) and placebo (PLA) (12 g dextrose). One hour after consumption, subjects completed grip strength, vertical power, and Wingate anaerobic cycling assessments in respective order. Maximal and average grip strength, peak and average vertical power, anaerobic capacity, peak power, explosive power, and ability to sustain anaerobic power were calculated from the tests., Results: When consuming CM, participants exhibited greater maximal (p = .042) and average (p = .045) grip strength compared to PLA. No differences existed between trials for peak (p = .51) or average (p = .51) vertical power. For the Wingate, peak power (p < .001) and explosive power (p < .001) were significantly greater when consuming CM compared to PLA. For the ability to sustain power, a significant effect (p < .001) was observed for time within trials, but no significant differences were observed between trials regarding supplement consumed., Conclusions: These data suggest that consuming CM before competition has the potential to improve tennis match-play performance in masters tennis athletes. However, this study utilized a controlled laboratory environment and research evaluating direct application to on-court performance is warranted.

Muscular power decreases with age, and lower-body power relates to overall functional fitness; however, functional lower-body power has not been evaluated in late-middle-aged (LMA) populations., Purpose: To evaluate average and peak lower-body functional power and velocity among sedentary (SED), recreationally active (RA), and masters athlete (MA) LMA adults., Methods: Participants were SED (n = 13, age = 59.3 ± 4.5 years), RA (n = 35, age = 59.6 ± 5.0 years), and MA (n = 26, age = 56.7 ± 5.4 years). Five sit-to-stand trials were completed to assess lower-body functional power. Average/peak power and velocity were calculated for each trial. Power was expressed relatively to account for participant body weight., Results: MA (13.44 ± 2.76 W/kg) had significantly (p < .01) greater peak power compared with SED (9.99 ± 2.70 W/ kg) and RA (9.93 ± 2.30 W/kg). Similar significant (p < .01) differences existed for peak velocity (SED = 1.02 ± 0.22 m/s, RA = 1.04 ± 0.22 m/s, MA = 1.25 ± 0.19 m/s). No differences existed for average power or velocity between groups., Conclusions: Maintaining a competitively active lifestyle results in greater lower-body functional power in LMA adults and may support longitudinal functionality.

Potassium is an essential nutrient. It is the most abundant cation in intracellular fluid where it plays a key role in maintaining cell function. The gradient of potassium across the cell membrane determines cellular membrane potential, which is maintained in large part by the ubiquitous ion channel the sodium-potassium (Na+-K+) ATPase pump. Approximately 90% of potassium consumed (60-100 mEq) is lost in the urine, with the other 10% excreted in the stool, and a very small amount lost in sweat. Little is known about the bioavailability of potassium, especially from dietary sources. Less is understood on how bioavailability may affect health outcomes. Hypertension (HTN) is the leading cause of cardiovascular disease (CVD) and a major financial burden ($50.6 billion) to the US public health system, and has a significant impact on all-cause morbidity and mortality worldwide. The relationship between increased potassium supplementation and a decrease in HTN is relatively well understood, but the effect of increased potassium intake from dietary sources on blood pressure overall is less clear. In addition, treatment options for hypertensive individuals (e.g., thiazide diuretics) may further compound chronic disease risk via impairments in potassium utilization and glucose control. Understanding potassium bioavailability from various sources may help to reveal how specific compounds and tissues influence potassium movement, and further the understanding of its role in health.

Sclerema neonatorum is extremely rare in the 21st century. We report a premature infant managed in a neonatal intensive care unit with delayed development of sclerema neonatorum., (© 2016 Wiley Periodicals, Inc.)

Plaque-like CD34-positive dermal fibromas, also known as medallion-like dermal dendrocyte hamartomas (MDDHs), are a recently recognized group of congenital and acquired spindle cell neoplasms that may appear histologically similar to dermatofibrosarcoma protuberans. Recognizing the clinical heterogeneity of this neoplasm and the subtle pathologic differences are crucial to making the correct diagnosis and avoiding the aggressive surgical intervention required to treat a dermatofibrosarcoma protuberans. We present the case of a 9-year-old girl with an acquired variant of a plaque-like CD34-positive dermal fibroma without clinical epidermal change. Our case expands the clinical spectrum to include an acquired variant of a plaque-like CD34-positive dermal fibroma without clinical epidermal change. Examination of more cases is needed to determine whether all clinical variants are truly subtypes of the same neoplasm or represent distinct CD34-positive spindle cell proliferations., (© 2015 Wiley Periodicals, Inc.)

Beta-alanine (BA) supplementation increases exercise performance due to increases in the intramuscular lactate buffer, carnosine. Females are more sensitive to these increases and results are further pronounced in trained individuals. Baseline intramuscular carnosine levels also naturally decrease with age; therefore, trained older females may experience augmented benefits from BA supplementation. However, the ability of BA to increase lower-body isokinetic strength (ISO) in female masters athletes (MA) is unknown. The purpose of this study was to examine the longitudinal effects of BA supplementation on ISO, handgrip strength (HG), and body composition in female MA cyclists. Twenty-two subjects participated in this double-blind randomized study. Subjects were randomized into 2 groups (placebo [PLA] = 8 g dextrose; BA = 800 mg + 8 g dextrose) and supplemented 4 times per day for 28 days. ISO, HG, and body composition were evaluated at baseline and at the same day/time each week over the 28-day intervention. No differences existed between groups at baseline or at the 7, 14, and 21 days time points for any variables (p > 0.05). When evaluating ISO (isokinetic) after 28 days, total work performed during the final third of the assessment (24.0 vs. -16.8% change) in flexion and average peak torque (5.4 vs. 2.9% change) in extension were significantly increased from baseline in BA compared with PLA (p ≤ 0.05). No differences existed for HG or body composition after supplementation. Twenty-eight days of BA supplementation increased peak torque and work completed, indicating BA improves lower-body exercise performance in female MA.

Importance: Posttransplant lymphoproliferative disorder (PTLD) is an uncommon complication after solid organ transplants and hematopoietic stem cell transplants. Extranodal involvement in PTLD can involve several organ systems, including the central nervous system, bone marrow, lungs, gastrointestinal tract, and skin. Isolated involvement of the skin without systemic involvement in PTLD is rare. Primary cutaneous PTLD is generally categorized as either cutaneous T-cell lymphomas or cutaneous B-cell lymphomas, with variable Epstein-Barr virus (EBV) positivity. Herein, we describe an exceedingly uncommon case of a polymorphic variant of primary cutaneous PTLD., Observations: A woman in her 30s, who received an EBV+ deceased donor kidney transplant, presented with a 2-week history of 2 indurated patches over the lower abdomen. A skin biopsy revealed an atypical lymphoid proliferation with immunohistochemical stains demonstrating a mixed population of both B and T cells that stained strongly positive for EBV-encoded RNA. A bone marrow biopsy and positron emission tomography/computed tomography were negative for systemic involvement. The patient was treated with immunosuppression reduction and rituximab infusions., Conclusions and Relevance: This case highlights a rare polymorphic variant of primary cutaneous EBV-associated PTLD and increases awareness of this uncommon posttransplant complication. Cutaneous PTLD is reviewed, therefore dermatologists are aware of this uncommon disorder.

Lymphomatoid granulomatosis (LG) is a rare Epstein-Barr virus (EBV)-associated B-cell lymphoproliferative disorder presenting in middle adulthood that nearly always affects the lungs and shows cutaneous involvement in up to 50% of cases. Skin lesions are present at the time of diagnosis in roughly one-third of patients and may precede the development of lung lesions in as many as 10-15%. Recognition by both the dermatologist and dermatopathologist is therefore crucial for early and accurate diagnosis. While skin involvement is grossly and microscopically diverse, the disease most commonly presents as erythematous subcutaneous and dermal nodules showing the classic histopathologic triad of transmural lymphocytic angiitis, atypical B-lymphocytes in a polymorphous T-cell background, and necrotic foci within lymphoid aggregates. We present a case of lymphomatoid granulomatosis initially presenting with cutaneous lesions, with an accompanying review of the literature., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)