Hispanics comprise one of the fastest-growing segments of the U.S. population. Mexican-American adults are more likely to be overweight, physically inactive, diabetic, and to have higher levels of hypertension than are white adults. However, studies addressing the relationship between physical fitness and coronary artery disease (CAD) risk factors among Mexican-Americans are much less conclusive. Therefore, understanding the etiology of factors influencing resting systolic (SBP) and diastolic blood pressure (DBP) in Hispanic women was the aim of this investigation. SBP, DBP, peak oxygen uptake (peak VO2), weekly physical activity, waist (WC) and hip circumference, blood glucose, and levels of plasma lipids (triglyceride, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol) of 39 Hispanic women age 22 - 51 years were measured. Factors with significant correlation to SBP were age, WC, sagittal diameter, and weight. Similarly, significant correlations were observed between anthropometric indices, age, and DBP. Peak VO2 (r = - 0.53, p < 0.01) and heart rate at maximal effort (r = - 0.34, p ≤ 0.05) were inversely associated to DBP. There was also a strong inverse correlation (r = - 0.53, p < 0.01) between peak VO2 and CAD risk profile (created from one or the combination of: hypertension, obesity, hyperglycemia, dyslipidemia, smoking). Stepwise multiple linear regression revealed that 33 % of the variance in SBP is attributed to age (25 %), and WC (8 %), while DBP is explained by WC alone (26 %). The addition of peak VO2 did not make significant contributions to the variances in SBP or DBP. The findings of this study suggest that central adiposity is an important predictor of resting blood pressure in Hispanic women. The inverse association between aerobic fitness and diastolic blood pressure as well as CAD risk factors suggests that recommendations regarding prevention of hypertension in this population should be based on the interrelationships between physical fitness and obesity.
223 Background: Cardiovascular disease is the leading cause of death in men with prostate cancer. ADT is effective treatment, but can induce loss of skeletal muscle, plus increase central fat, lipids, and insulin resistance. These changes in MetS components may contribute to excess cardiac risk. We tested whether a resistance exercise program, designed to increase skeletal muscle mass, could offset adverse changes in MetS parameters during ADT. Methods: Men on ADT for at least 12 weeks were randomized to exercise (EX) or no exercise (NOEX). EX was supervised, periodized resistance training followed by stretching 3x/week for 12 weeks, 45 min/session. NOEX did home-based stretching 3x/week. Baseline and post-intervention measurements included weight, waist circumference, lean body mass, lipids, insulin, glucose, hsCRP. Quality of life (QOL) was evaluated with FACT-P and BFI, and muscle biopsies were obtained pre- and post-intervention. Mean of changes from baseline were compared between groups using ANCOVA. Results: 24 men (mean age 65; range 49-81) completed protocol with 100% compliance (n = 12 EX, n = 12 NOEX). Baseline PSA ranged from 0 – 8.1 ng/mL and did not change; subjects had been on ADT for a mean of 17 months (range 3-84). In multivariable analysis controlling for baseline muscle mass, age, and ADT duration, the mean change in waist circumference after 12 weeks was significantly different between EX (-2.05 cm +/- 2.82) and NOEX (+0.69 cm +/- 2.01) groups (p = 0.011, t-test). There were no significant differences for other parameters. However, consistent patterns were noted in: mean fasting glucose -4.59 mg/dL in EX compared with +1.12 mg/dL in NOEX (p = 0.21, t-test) and diastolic blood pressure -2.17 mmHg in EX vs +2.0 mmHg in NOEX (p = 0.27, t-test). In the EX group 5/12 had MetS at baseline which remained stable while the NOEX group increased from 2/12 with MetS at baseline to 3/12 post intervention. Analysis of QOL and muscle biopsies are ongoing. Conclusions: Supervised resistance exercise for 12 weeks is feasible and decreases waist circumference in men receiving ADT for prostate cancer. Longer follow-up may reveal additional impacts of resistance training on MetS. Clinical trial information: NCT01909440.
Background: Abdominal pain due to menses (primary dysmenorrhea) is an extremely pervasive and debilitating symptom affecting up to 90% of menstruating individuals. Objective: The objective of this randomized control trial was to investigate the effect of a commercial transcutaneous electrical nerve stimulation unit, Therabody PowerDot ® (Therabody Inc., Los Angeles) on dysmenorrhea compared with non-steroidal anti-inflammatory drug use. Design: This was a randomized cross-over study. Methods: A total of 47 participants agreed to participate in the study, with 34 completing it. Participants completed treatments across three consecutive menstrual cycles in randomized order: single-unit transcutaneous electrical nerve stimulation (Uno), dual unit transcutaneous electrical nerve stimulation (Duo), and non-steroidal anti-inflammatory drug use (Control). Upon onset of dysmenorrhea, participants applied transcutaneous electrical nerve stimulation to their abdomen for a minimum of 30 min. Control participants were instructed to take non-steroidal anti-inflammatory drugs as needed. Surveys were used to record pain before and after treatment. We hypothesized that the PowerDot would decrease self-reported pain scores, and decrease non-steroidal anti-inflammatory drug consumption during menses. Results: Participants experienced a statistically and clinically significant reduction in pain during the Control (−3.52 ± 1.9), Uno (−2.10 ± 1.6), and Duo (−2.19 ± 1.7) cycles ( p < 0.001). The doses of non-steroidal anti-inflammatory drugs consumed during the Control cycle (3.5 ± 2.6), was significantly different as compared with that of Uno (1.5 ± 3.0), or Duo (1.1 ± 2.6) ( p = 0.004). Conclusions: Use of a commercial transcutaneous electrical nerve stimulation unit results in significant decrease in pain. Although not as robust as the relief in pain induced by non-steroidal anti-inflammatory drugs, the adverse events of transcutaneous electrical nerve stimulation are minimal in comparison. Therefore, transcutaneous electrical nerve stimulation appears to be a viable alternative to pain relief from dysmenorrhea. Clinical Trial Registration: NCT05178589
Previously we reported a case of persistent hypotension associated with hypermedullipinemia (Blood Pressure 1992; 1:138–148). The hypermedullipinemia appeared to result from the autonomous secretion of medullipin I (Med I) by renomedullary interstitial cells (RIC's) in the patient's remaining endstage kidney. The patient subsequently died. At autopsy, the remaining kidney contained a yellow mass (1×1 ×0.5 cm) consisting of adipocytes and RIC's, termed a lipomedullipinoma. This mass was extracted and chromatographed by procedures known to yield Med I. Med I was identified following these procedures. Renal tissue outside the yellow mass failed to yield Med I. It appears that the hypermedullipinemia of this case resulted from autonomous, hypersecretion of Med I by the lipomedullipinoma.
PURPOSE: Body composition assessments provide important health information, as excess body fat percentage (BFP) in relation to lean body mass can increase risk of cardiovascular disease and diabetes. While dual-energy x-ray absorptiometry (DXA) is a gold standard measurement of body composition, faster alternatives that do not expose participants to radiation, such as bioelectrical impedance (BIA), can promote awareness and be used to determine training efficacy. In this study, we compared body composition measurements obtained using whole-body plethysmography by the Airmetrix Whole-Body Self-Service Analyzer to those obtained via multifrequency BIA analysis and DXA scanning. METHODS: Twenty-six volunteers (17 female, 36.7 ± 12.3 years of age) were tested on two visits. On the first visit, body composition was assessed under fasted conditions by one Biospace InBody 770 analysis, one DXA scan (GE Lunar iDXA), and at least two Airmetrix tests. The second visit was performed at least 24 hours later, at a different time of day, and after the participant had consumed a meal. Body composition was assessed by one InBody analysis and at least two Airmetrix tests. For all tests, participants wore clothing that was tight and minimal with long hair tied up to minimize extra volume that may interfere with measurements. Shoes, keys, jewelry, and other accessories were removed. RESULTS: The Airmetrix system showed good precision, with a within-visit retest mean range of 0.04 lbs and 0.51% for weight and BFP, respectively. Although there were statistically significant absolute changes in weight and BFP between visits, there was no systematic direction and was therefore likely due to normal physiological fluctuation. Comparing devices, InBody and average Airmetrix BFP measurements were significantly lower than DXA BFP measurements for both visits (p<0.001). Although the Airmetrix system had slightly greater absolute mean percent error compared to InBody (18.8-19.4% vs. 16.8-17.1%, respectively), the difference in errors between devices was not statistically significant (p=0.067). CONCLUSION: The Airmetrix system assess weight and BFP with good precision. Overall, the Airmetrix and InBody devices produce similar results, and both significantly underestimate BFP compared to DXA.
PURPOSE: To investigate changes in mRNA expression of muscle atrophy F-box (MAFbx), p70S6 kinase (p70S6k), forkhead box 3A (FOXO3a) and myogenic differentiation factor (MyoD) at rest and in response to a single bout of concentric or eccentric contractions in young women. METHODS: Twelve recreationally active young women were divided into two groups to perform unilateral, leg extension resistance exercise: 6 (24±0yr, 65±7kg) in the concentric (CON) group performed 10 sets of 10 repetitions of maximal concentric contractions, while 6 (25±1 yr, 59±7kg) in the eccentric (ECC) group performed 10 sets of 10 repetitions of maximal eccentric contractions. Muscle biopsies were taken from the vastus lateralis before and 8 hours after the exercise bout. mRNA from the muscle samples were evaluated using RT PCR and normalized to 18s (house keeping gene). t tests were used to compare gene expression changes within and between groups with significance set at p<0.05. RESULTS: In response to exercise, MAFbx expression decreased by 43±23% (p=0.007) in the CON group, and by 81±13% (p<0.001) in the ECC group. The decrease in MAFbx was significantly different between groups (p=0.007). MyoD expression increased 135±111%, (p=0.03) in the CON group and 61±47% (p=0.025) in the ECC group. p70S6k and FOXO3a demonstrated no significant change in gene expression. CONCLUSIONS: These data indicate that a single bout of maximal CON or ECC training does not influence mRNA gene expression for p70sk6 and FOXO3a. Data also indicate that a single bout of maximal ECC training has greater down regulation of MAFbx, a known regulator of muscle protein breakdown. This suggests that contraction mode may be important in mediating specific myogenic regulatory genes.
Background Older persons often lose muscle mass, strength, and physical function. This report describes the challenges of conducting a complex clinical investigation assessing the effects of anabolic hormones on body composition, physical function, and metabolism during aging. Methods HORMA is a multicenter, randomized double masked study of 65—90-year-old community dwelling men with testosterone levels of 150—550 ng/dL and IGF-1 < 167 ng/dL. Subjects were randomized to transdermal testosterone (5 or 10 g/day) and rhGH (0, 3, or 5 μg/kg/day) for 16 weeks. Outcome measures included body composition by DEXA, MRI, and 2 H 2 O dilution; muscle performance (strength, power, and fatigability), VO2peak, measures of physical function, synthesis/breakdown of myofibrillar proteins, other measures of metabolism, and quality of life. Results Major challenges included delay in startup caused by need for 7 institutional contracts, creating a 142-page manual of operations, orientation and training, creating a 121-page CRF; enrollment inefficiencies; scheduling 16 evaluations/ subject; overnight admissions for invasive procedures and isotope infusions; large data and image management and transfer; quality control at multiples sites; staff turnover; and replacement of a clinical testing site. Impediments were largely solved by implementation of a web-based data entry and eligibility verification; electronic scheduling for multiple study visits; availability of research team members to educate and reassure subjects; more frequent site visits to validate all source documents and reliability of data entry; and intensifying quality control in testing and imaging. The study exceeded the target goal of 108 (n = 112) completely evaluable cases. Two interim DSMB meetings confirmed the lack of excessive adverse events, lack of center effects, comparability of subjects, and that distribution of subjects and enrollment will not jeopardize outcomes or generalizability of results. Conclusions Flexibility and rapidly solving evolving problems is critical when conducting highly complex multicenter metabolic studies. Clinical Trials 2007; 4: 560—570. http://ctj.sagepub.com
To determine whether oxymetholone increases lean body mass (LBM) and skeletal muscle strength in older persons, 31 men 65–80 yr of age were randomized to placebo ( group 1) or 50 mg ( group 2) or 100 mg ( group 3) daily for 12 wk. For the three groups, total LBM increased by 0.0 ± 0.6, 3.3 ± 1.2 ( P < 0.001), and 4.2 ± 2.4 kg ( P < 0.001), respectively. Trunk fat decreased by 0.2 ± 0.4, 1.7 ± 1.0 ( P = 0.018), and 2.2 ± 0.9 kg ( P= 0.005) in groups 1, 2, and 3, respectively. Relative increases in 1-repetition maximum (1-RM) strength for biaxial chest press of 8.2 ± 9.2 and 13.9 ± 8.1% in the two active treatment groups were significantly different from the change (−0.8 ± 4.3%) for the placebo group ( P < 0.03). For lat pull-down, 1-RM changed by −0.6 ± 8.3, 8.8 ± 15.1, and 18.4 ± 21.0% for the groups, respectively (1-way ANOVA, P = 0.019). The pattern of changes among the groups for LBM and upper-body strength suggested that changes might be related to dose. Alanine aminotransferase increased by 72 ± 67 U/l in group 3 ( P < 0.001), and HDL-cholesterol decreased by −19 ± 9 and −23 ± 18 mg/dl in groups 2 and 3, respectively ( P = 0.04 and P = 0.008). Thus oxymetholone improved LBM and maximal voluntary muscle strength and decreased fat mass in older men.
I. Introduction Fueled by the successful government lawsuits against tobacco in the 1990s, a debate began to heat up among legal scholars over whether tort law is being used illegitimately to circumvent the legislative process and regulate various industries or activities. Robert Reich has been credited with coining a phrase to describe the phenomenon, through litigation.1 The debate over through is part of a larger dispute over the proper role of tort law and the civil justice system in American society.2 Critics of through decry its potential to generate suits against entire industries, resulting in damages for unforeseeable events and massive loss liabilities.3 Due to the potentially huge losses, it is feared that in extreme cases, through could lead to market failure and compromise the insurability of certain industries.4 In addition to the disquieting economic threats purportedly raised by through litigation, critics also contend that the lawsuits constitute end runs around the democratic process.5 By avoiding traditional democratic processes, it is suggested that through provides a novel and subversive way of legislating-allowing decisions to be made in secret settlement negotiations, rather than through public congressional debate or the administrative comment process.6 The complaints leveled against through have met some resistance. In response to examples of economically inefficient through litigation, it has been argued that by regulation offers comparably inefficient outcomes.7 Further, rather than deriding the massive economic consequences of through litigation, it has been argued that the economic threat of through offers the ability to reach compromise on intractable political problems by redefining the status quo to force an industry to negotiate with the government.8 Some commentators also take issue with the idea that through is a new, un-American, and undemocratic method of creating policy. Thomas Burke contends that by has deep roots in the structure of American government and American political culture.9 In arguing that before the rise of the administrative state America relied primarily on courts to regulate the economy, Burke refers to Alexis de Tocqueville's statement that [t]here is hardly a political question in the United States that does not sooner or later turn into a judicial one.10 The validity of the arguments regarding regulatory are difficult to assess, despite the increasing attention it has received, because no precise definition of the phenomenon has been offered. While holding obvious rhetorical appeal when used among laypeople, the use of the term through litigation to distinguish a special class of problematic tort lawsuits raises questions in the minds of some legal analysts. As Eric Posner writes, This claim that there is a special class of troubling 'regulation by litigation' cases will strike lawyers as odd.11 Particularly in negligence actions, one of the principal justifications for the tort system is that it acts as an efficient deterrent to breaches of the duty of care.12 Whether imposing civil liability for unreasonably dangerous product design or for medical care below the standard of the applicable medical community, tort law acts as a significant regulatory device by filling the gap between criminal behavior and socially advantageous behavior. In this sense, all tort can be considered through litigation.13 Notwithstanding the common acceptance of a regulatory aspect to all tort litigation, legal commentators addressing through understand it as a subclass of tort law or of civil in general.14 Unfortunately, rather than providing a rigorous definition of the term, the commentators critical of through merely label lawsuits as such and then proceed to attack their regulatory nature. …
PURPOSE: Exercise is a promising strategy to help maintain brain function during aging. Determining the efficacy of exercise interventions requires reliable clinical outcome measures. In addition to measurement error and biological variability, long-term test-retest values can also be influenced by biasing factors - namely aging and practice effects. The purpose of this study was to determine the 12-week test-retest reliability of cognitive and neuroimaging measures in older adults. METHODS: Twenty healthy older adults (14 females, 60-80 years of age) participated in two sessions of cognitive testing and multimodal 3T MRI scanning (Siemens MAGNETOM Prisma). All tests were performed by a single rater separated by a 12-week control period. The NIH Toolbox Cognition Battery (NIHTB-CB) was used to assess fluid and crystallized cognitive function. T-2 FLAIR images were processed for white matter lesion volume (WMLV, ml) using the Lesion Segmentation Toolbox. T-1 MPRAGE images were processed for gray matter volume (GMV, mm3) in 3 subcortical regions using FreeSurfer cortical segmentation. Statistical analyses were performed in SPSS (v.25) including mean percent difference, effect size, paired t-test, and two-way mixed intraclass correlation coefficient (ICC) with absolute agreement. RESULTS: Results are presented in Table 1. There were no significant t-test values indicating good agreement between the two sessions. As expected, reliability was excellent in crystallized cognition and moderate to good in fluid cognition. Last, all brain segmentations showed good to excellent reliability. CONCLUSIONS: The long-term (12-weeks) test-retest reliability of standard cognitive and neuroimaging measures were within an acceptable tolerance for use in future intervention studies. Although fluid cognition has the greatest implications for and neurobiological link to cognitive aging, investigators should consider the greater variability in these measures.
