Temporal associations between individual changes in hormones, training motivation and physical performance in elite and non-elite trained men

To advance our understanding of the hormonal contribution to athletic performance, we examined the temporal associations between individual changes in testosterone (T) and/or cortisol (C) concentrations, training motivation and physical performance in elite and non-elite trained men. Two male cohorts classified as elites (n = 12) and non-elites (n = 12) completed five testing sessions over a six-week period. The athletes were tested for salivary T, C, T/C ratio, self-perceived training motivation, countermovement jump (CMJ) height and isometric mid-thigh pull peak force (IMTP PF), after which an actual training workout was performed. The elite men reported higher motivation to train and they produced greater CMJ height overall, whereas the non-elites had higher pooled T levels (p < 0.05). No significant group differences in C concentrations, T/C ratio or IMTP PF were found. The individual changes in T levels were positively associated with training motivation in the elite men only (p = 0.033), but the hormonal and motivation measures did not predict CMJ height or IMTP PF in either group. The monitoring of elite and non-elite men across a short training block revealed differences in T levels, motivation and lower-body power, which may reflect training and competitive factors in each group. Despite having lower T levels, the elite athletes showed better linkage between pre-training T fluctuations and subsequent motivation to train. The nature of the performance tests (i.e. single repetition trials) could partly explain the lack of an association with the hormonal and motivational measures.

Translation of tobacco control programs in schools: findings from a rapid review of systematic reviews of implementation and dissemination interventions

ISSUE ADDRESSED

School-based programs targeting the prevention of tobacco use are a key strategy for reducing the overall tobacco-related mortality and morbidity in the community. While substantial research investment has resulted in the identification of various effective tobacco prevention interventions in schools, this research investment will not result in public health benefits, unless effectively disseminated and implemented. This rapid review aimed to identify effective implementation or dissemination interventions, targeting the adoption of school-based tobacco prevention programs.

METHODS

A systematic search was conducted to identify published systematic reviews that examined the effectiveness of implementation and dissemination strategies for facilitating the adoption of tobacco policies or programs in schools from 1992 to 2012.

RESULTS

The search yielded 1028 results, with one relevant systematic review being identified. The review included two controlled studies examining the implementation and dissemination of tobacco prevention programs and guidelines. The two randomised trials examined the delivery of active face-to-face training to implement a school-based curriculum compared with video-delivered or mail-based training. Improvements in the implementation of the programs were reported for the face-to-face training arm in both trials.

CONCLUSIONS

Little rigorous evidence exists to guide the implementation and dissemination of tobacco prevention programs in schools. SO WHAT? Few systematic reviews exist to inform the implementation of evidence-based tobacco prevention programs in schools. In the absence of a strong evidence base, health care policymakers and practitioners may need to draw on setting-based frameworks or parallel evidence from other settings to design strategies to facilitate the adoption of tobacco prevention initiatives.

Nanomonitors: electrical immunoassays for protein biomarker profiling

Aims: The objective of this research is to develop a ‘point-of-care’ device for early disease diagnosis through protein biomarker characterization. Here, we present label-free, high sensitivity detection of proteins with the use of electrical immunoassays that we call nanomonitors. Materials & methods: The basis of the detection principle lies in the formation of an electrical double layer and its perturbations caused by proteins trapped in a nanoporous alumina membrane over a microelectrode array platform. Results & discussion: High sensitivity and rapid detection of study protein biomarkers for cardiovascular diseases, C-reactive protein (CRP) and myeloperoxidase (MPO) in pure and clinical samples through label-free electrical detection were achieved. CRP and MPO were detected in pure solutions with a lower detection limit of 200 pg/ml and 500 pg/ml, respectively. These two study proteins were also detected from multiplexed samples containing a mixture of both proteins as well as human serum samples. Conclusions: The performance parameters of the nanomonitors, such as speed of detection on the order of minutes, volume of reagents of a few microliters and low cost per assay are comparable to traditional assay methods, such as ELISA. In addition, nanomonitors also provide the advantages of being a label-free technique with large linear dynamic range of detection and a significant reduction in the size of assay, thus making it an ideal candidate for a clinical diagnostic ‘lab-on-a-chip’ device for protein biomarker profiling and hence early disease diagnosis.

Botulinum toxin products overview

The tremendous success of botulinum toxin type A (BOTOX(R), Allergan Inc.) in the cosmetic arena has acted as a stimulus for the development of other neurotoxins. After more than 2 decades of use, BOTOX(R) has become synonymous with wrinkle reduction and is considered to be the one of the most common non-surgical cosmetic procedures performed worldwide. Because of its vast popularity among patients seeking non-invasive methods to achieve facial rejuvenation, physicians from diverse specialties have integrated botulinum toxin injections into their existing practices. Herein, we present an overview of botulinum toxin products for cosmetic applications that have received regulatory approval or are under development.

Electrical Immunoassays toward Clinical Diagnostics: Identification of Vulnerable Cardiovascular Plaque

A technology for electrical detection of protein biomarkers has been developed. It is based on developing high-density, low-volume multiwell plate devices. The scientific core of this technology lies in integrating nanoporous membranes with microfabricated chip platforms. This results in the conversion of individual pores into wells of picoliter volume. Specific antibodies are localized and isolated into individual wells. The formation of the antibody–antigen-binding complex occurs in individual wells. The membrane allows for robust separation among individual wells.

This technology has the capability to achieve near real-time detection with improved sensitivity and selectivity. This is due to the two factors associated with the technology: (1) event-based electrochemical detection process, where the individual step in the formation of the binding complex results in a specific change to the electrochemical conductance due to the pertubation of the electrical double layer at the base of the each well. (2) The nanoporous membrane is an electrical insulator and is structurally robust throughout hence there is improved signal-to-noise ratio and cross-contamination between is minimized.

Another advantage of this technique is the use of electrical signal in protein identification as compared to the use of optical methods; hence, it is a noninvasive and a label-free technique. The signal acquisition is simple and it uses the existing data acquisition and signal analysis methods.

We have demonstrated the use of this technology for addressing a specific clinical problem: identification of vulnerable coronary plaque in the perioperative state.

Utilization of recombinant activated factor VII in southern Ontario in 85 patients with and without haemophilia

Recombinant activated factor VII (rFVIIa) is licensed for the treatment of bleeding in individuals with haemophilia and inhibitors. The use of rFVIIa appears to be increasing, and an increase in unlicensed use is suspected. There are currently few data about the specific indications for its use. The aim of this study was to describe the patterns of utilization of rFVIIa. We performed a retrospective cohort study using rFVIIa infusion data collected prospectively and clinical data collected retrospectively. Patients were identified using a tracking system designed to account for use of all coagulation factor concentrates issued in southern Ontario. Between 1 January 2001 and 31 December 2005, 85 patients received rFVIIa. 1164 infusions were given (8246.4 mg). Haemophilia patients with inhibitors accounted for 82.9% of rFVIIa infused and represented 8.2% of patients. The total amount of rFVIIa used increased each year from 2001 to 2004 and then decreased in 2005. The total number of infusions of rFVIIa administered annually increased. Both on-label and off-label use of rFVIIa increased. The number of patients with haemophilia receiving rFVIIa remained small and constant. The number of patients receiving rFVIIa for off-label indications increased markedly. Most rFVIIa infusions were given for licensed indications; however, these infusions represented <10% of patients treated. Overall, the utilization of rFVIIa is increasing, mostly for approved indications; however, the number of patients being prescribed rFVIIa for off-label indications has increased. The tracking system used in this study is a valuable tool to describe ongoing utilization patterns of rFVIIa.

Trends in the utilization and wastage of coagulation factor concentrates: the application of a regional tracking programme

The Commission of Inquiry on the Blood System in Canada ('Krever Commission', 1997) recommended an active programme of surveillance for all blood products. To describe trends in the utilization of coagulation factor concentrates using a comprehensive factor tracking programme. Between 2001 and 2004 in the region of Southern Ontario, we prospectively tracked all coagulation factor concentrates that were distributed from the national blood supplier, issued by hospitals for inpatient use or for home infusions, infused at hospital facilities or at home and wasted. Discrepancies were reconciled by independent audits. Trends in the utilization of FVIII, FIX and FVIIa concentrates are reported. A total of 466 patients with inherited or acquired bleeding disorders were registered. Utilization of FVIII, FIX and FVIIa increased by an average of 13.7%, 33.2% and 34.2% per year respectively. Most FVIII and FIX infusions were administered at home while most FVIIa infusions were in hospital. The increase in FVIII and FIX usage was attributable to an increase in per-patient use, predominantly for prophylaxis. In total, 1.7% of coagulation factor concentrates was wasted during the study period, at a cost of over 1 million Canadian dollars. Utilization of coagulation factor concentrates increased steadily during the study period. A regional programme to track utilization is feasible and may be used to describe trends, assist planning, and reduce costs by minimizing wastage.

Comparing hand-held computers and paper diaries for haemophilia home therapy: a randomized trial

Treatment of severe haemophilia with factor concentrates is by self-infusion in the home. Adherence to record keeping on paper diaries is poor. A randomized-controlled trial compared adherence with record keeping of paper diaries with hand-held computers. Forty-one individuals with severe haemophilia, were randomized to hand-held computers (n = 22) or paper diaries (n = 19) and followed for 6 months. About 86.2% (679 of 788) of infusions by patients in the computer group were in compliance with the data submission schedule compared with only 48.3% (358 of 741) of infusions by patients using paper diaries (P < 0.0001). The time intervals between infusions and the receipt of data were shorter in the computer group (median 0.25 vs. 25 days respectively, P < 0.0001). Reminder phone calls by the clinic were made less frequently to users of hand-held computers than to users of paper diaries (median one vs. five times, P < 0.0001). Accuracy of data was similar for both methods. Compliance with hand-held computers was superior to paper diaries. The clinic received data from hand-held computers mostly on the same day, and nurses could thereby provide clinical advice more effectively. Although hand-held computers did not result in increased accuracy, errors could be detected and corrected more rapidly. Electronic data can more easily be verified, analysed and summarized than that from paper diaries.

Clinical Use of RESTYLANE

There is no ideal filler, nor will there be a single product that can satisfy all requirements. However, RESTYLANE, a non-animal, stabilized hyaluronic acid (NASHA, Medicis), is a very versatile augmenting agent. It has been in clinical use for 8 years and experience has shown it to be close to the ideal filler in many respects. This review will outline the background to the use of RESTYLANE, and will focus on the clinical use of this material.

Update on the botulinum neurotoxins

The botulinum neurotoxins (BTX) are an exciting group of therapeutic agents with dramatically expanding clinical indications. The US FDA has approved BOTOX (BTX-A, Allergan) and Myobloc (BTX-B, Elan Pharmaceuticals) for the treatment of cervical dystonia. TPP Canada has also approved BOTOX for the treatment of glabellar frown lines. The US FDA is expected to approve this new indication before the end of 2002. These changes will dramatically expand the marketing of BTXs. Concerns about risks and side-effects diminish as clinical experience increases with this "most poisonous of poisons". In particular, the incidence of secondary resistance to the toxin's effect has been dramatically diminished with the reduction of the non-toxic protein in current batches of BOTOX.

Brow lifting and blepharoplasty

This article addresses how one decides whether to do a brow lift or a blepharoplasty using the example of a woman who has paralysis of the frontal branch of her left seventh cranial nerve and complete brow ptosis.

BOTOX use in the mid and lower face and neck

BOTOX is the universally accepted gold standard treatment for upper facial rejuvenation. BOTOX application in the mid and lower face and neck is a more advanced treatment requiring a detailed knowledge of underlying facial muscular anatomy and function as well as the patient's aesthetic desires and an ability to interpret the effects of BOTOX chemodenervation on their function.

Botulinum toxin type A: history and current cosmetic use in the upper face

This article reviews the cosmetic use of botulinum toxin in upper face from both the historic and clinical viewpoints. The published literature and our current experience are outlined. Botulinum toxin type A in the upper face has become an extremely poplular cosmetic procedure and is outstandingly safe.

Botulinum toxin (botox) chemodenervation for facial rejuvenation

A positive attitude toward life at any age is now seen to be consistent with inclusion in all societal activities. A mere increase in years is no longer enough reason for "ageism." Botulinum Toxin (Botox) aesthetic treatments, because of their outstanding effectiveness and safety, can continue to play a positive role in the rebuttal of "ageism."

Improvement of tension-type headache when treating wrinkles with botulinum toxin A injections

Botulinum toxin A has been used to treat a spectrum of neuromuscular diseases. In recent years, it has become an accepted treatment for dynamic facial wrinkles. Following treatment of glabella and forehead wrinkles with botulinum toxin A, 9 of 134 patients coincidentally reported improvement of tension-type headache. We have retrospectively studied this group of patients in whom improvement of facial wrinkles closely paralleled improvement of tension-type headache. This observation suggests a role for muscle action in tension-type headache and a novel treatment.

The adjunctive usage of botulinum toxin

BACKGROUND

Botulinum toxin is a safe, helpful adjunct to many other treatments for facial rejuvenation. Used together, the final result is more polished and refined. In addition, botulinum toxin can be used to maintain the surgical laser results by preventing dynamic facial muscular action re-establishing expressive wrinkles and folds.

OBJECTIVES

We describe the facial areas best treated with botulinum toxin and our adjunctive techniques so that the cosmetic physician can easily incorporate these into their practice.

RESULTS

The aesthetic results are improved with the combination of botulinum toxin and the surgical or laser procedure over either modality alone.

CONCLUSIONS

We believe that there are many new treatment options for combined therapy with botulinum toxin, laser resurfacing, and surgical procedure in periocular and facial rejuvenation that the aesthetic physician can easily incorporate into their practice.

Clinical indications and injection technique for the cosmetic use of botulinum A exotoxin

BACKGROUND

Some wrinkles and unsightly facial expressions are due to overactivity of the underlying facial musculature. Botulinum A exotoxin reversably paralyses selected muscles. Botulinum toxin has been used to correct facial cosmetic concerns.

OBJECTIVES

This paper describes the authors' experience with the cosmetic use of botulinum toxin. The areas that can be treated, the appropriate technique for each area and special considerations such as dose, dilution, and relevant anatomy are discussed.

RESULTS

Our results have been published previously and are referenced in this paper.

CONCLUSIONS

Botulinum toxin is safe and effective in the management of some facial lines and wrinkles. Its use is associated with a high degree of patient and physician satisfaction.

Localized dystrophic periocular calcification: a complication of intralesional corticosteroid therapy for infantile periocular hemangiomas

Two female infants with eyelid hemangiomas developed prickly, rock-hard, subcutaneous crystals following intralesional corticosteroid injections. In each case, the crystals were isocentered on the injection locus and partly eroded the skin, causing local discomfort and inflammation. This complication occurred after two treatment sessions and presented 8 to 9 months after the second injection. An MRI scan showed subcutaneous calcification in the location of the injected orbital hemangioma in one patient. Histopathologic examination confirmed calcification in areas of degenerate hemangioma. There was no recurrence of either hemangioma or calcium deposition following surgical excision. Localized dystrophic calcification may be a late complication of intralesional corticosteroid therapy of periocular hemangiomas.

Treatment of facial furrows and rhytides

Many substances have historically been used to address facial soft tissue defects. Currently in the United States autologous fat and injectable bovine collagen are the most commonly utilized injectable fillers. Additionally, the judicious application of BOTOX in the upper face as well as neck has all but revolutionized the use of filling agents in these locales. While other agents are briefly mentioned, this is an in-depth review of the characteristics and application of autologous fat, bovine collagen.

Pediatric ophthalmology

In the recent pediatric ophthalmology and strabismus literature, there have been some important papers. Topics have included ocular outcomes in children born before 32 weeks of gestation, a practical correlate of Teller visual acuities and visual behavior in a real environment in a severely handicapped child, and a debate on the indications and efficacy of population screening for amblyopia. New information on the creation of refractive errors by earlier eyelid closure than used previously and a new torsionometer represent new sensory information. New information about motor adaptations in strabismus includes a new evaluation of saccade disconjugacy in deep amblyopia and in anisometropia. Spasmus nutans may be a long-term rather than a self-limiting disease, and the debate on neuroimaging in this condition has been evaluated. A subtle predictor of outcome in the surgical treatment of partially accommodative esotropia is presented, as well as an important case report on the treatment of a metabolic cause of strabismus in chronic progressive external ophthalmoplegia with coenzyme Q10. Finally, some information is presented on the treatment of hereditary retinal dystrophies with nonautologous retinal pigment epithelial cell transplants to the subretinal space of the dystrophic retina-the first experimental model of a successful biologic treatment of which I am aware and a possible indicator of future trends in human disease.

Botulinum A exotoxin use in clinical dermatology

Botulinum toxin (BT) prevents the release of acetylcholine at the neuromuscular junction and produces reversible paralysis of striated muscle. This effect was initially used for ophthalmologic indications, particularly strabismus. The idea of using the toxin for purely cosmetic purposes arose from the observation that therapy for facial dystonias markedly decreased lines and wrinkles in the treated areas. The ease of application, high safety profile, and impressive results from the cosmetic use of BT have led to its rapid acceptance by many clinicians. As use of BT increases and its indications expand, an understanding of this therapeutic modality is timely. This article discusses the pharmacologic aspects of BT as well as the methods for administration as they relate to its cosmetic use.

Bloodless castration of lambs: results of a questionnaire

Interviews of nine flockmasters who used bloodless castrators to castrate lambs revealed wide variation in the size of castrator used and the techniques employed. Eight flockmasters used inappropriately sized instruments which were cumbersome to operate and probably applied excessive crushing pressures over an unnecessarily large area of the lambs' scrotums. The methods of restraining lambs were often inefficient in terms of labour requirement. In 11 of 15 flocks, some lambs were not properly castrated and in six flocks, instances of injury and death attributed to castration were reported. Evaluation of bloodless castrators showed that the crushing pressure applied by castrators even those of the same size could vary by over 100%. The requirement for further research into bloodless methods of castration is highlighted as is the urgent need for training for operators.

The treatment of congenital nystagmus with Botox

Clostridium botulinum A exotoxin (Botox) is the most potent toxin known to man. It produces a reversible paralysis of cholinergically innervated muscle, an effect useful in the management of non-accommodative strabismus and various disabling focal dystonias. In the present study, botulinum toxin (Botox) was used to treat congenital nystagmus, injecting the toxin into multiple horizontal rectus muscles at the same treatment session. Three of four patients achieved a significant enough change in acuity to receive daytime-restricted driver's licenses. No treatment was complicated by retrobulbar hemorrhage, ocular perforation, or ptosis. Two patients are continuing the Botox treatments every 3 to 4 months.

Squamous cell carcinoma of the thyroid gland

We present the clinical manifestations and details of treatment and outcome for eight patients with squamous cell cancer arising in the thyroid gland, which is a rare entity. All patients had advanced disease, with primary tumors invading adjacent structures (the trachea, esophagus, and major vessels). In two patients, pulmonary metastases were also present. Six patients died 6 months or less after diagnosis, five from the effects of local disease. Transient palliation was obtained in four patients who underwent partial excision (three patients) and radical radiotherapy (one patient). Two patients remained free of disease at last follow-up more than 4 years after gross total tumor resection and radical radiotherapy and were presumably cured. One patient treated by partial resection and radical radiotherapy died from other causes 17 months later. His disease status was unknown. Complete excision with postoperative radiotherapy may be curative, and debulking followed by external irradiation may provide short-term palliation. Patients with unresectable tumors are best managed by supportive measures only unless a truly effective chemotherapeutic regimen is developed for squamous cell cancer of the head and neck.

Common problems in pediatric ophthalmology

Because in children the neurological connections of sight are still plastic, any condition that is able to cause a reduction of visual acuity will also cause cortical suppression of the input from that eye. Early management of amblyopia is essential to its effective treatment. Prompt recognition of strabismus, nystagmus, dyslexia, retinoblastoma and albinism will also lead to an improved visual prognosis for the affected child. In the child with retinoblastoma, it will also vastly improve the prognosis for life.

Anterior segment ischemia treated with hyperbaric oxygen

Anterior segment ischemia developed in a 62-year-old dysthyroid patient after two-muscle adjustable suture repair of vertical strabismus. Because of a quiescent pulmonary tuberculous focus he was not treated with systemic steroid therapy but rather with hyperbaric oxygen in the controlled environment of our hospital hyperbaric chamber. He tolerated this treatment well, and his acute symptoms almost completely resolved in 3 days. We believe this to be the first reported case of the use of hyperbaric oxygen in the management of anterior segment ischemia. We also believe it is the first reported case of anterior segment ischemia following surgery to two opposing, not contiguous, rectus muscles in dysthyroid ophthalmopathy.

Botulinum toxin for benign essential blepharospasm, hemifacial spasm and age-related lower eyelid entropion

Purified botulinum A exotoxin was used in the treatment of forty seven patients with benign essential blepharospasm, 11 patients with hemifacial spasm and 2 patients with age-related entropion. The treatment was effective in all three groups for an average of 3-4 months when symptoms recurred and repeated chemodenervation with toxin was needed. The commonest complication was transient ptosis with an overall frequency of 7.8%. This incidence increased to 11.1% with toxin doses higher than 25 units per orbicularis. The treatment was well accepted by the patients, who were subsequently able to return to pre-blepharospasm lifestyles.

A pilot study on the use of botulinum toxin in spasmodic torticollis

Dystonic torticollis has been treated with local injections of botulinum toxin in a single blind study of 12 patients. A significant decrease of abnormal movements was recorded, and pain improved. Further studies are desirable to define the optimum dosage and site for injections, and the long term effects of repeated injections.

Quantitative analysis of trace elements in human blood and plasma by energy dispersive X-ray fluorescence

A photon excitation, secondary target x-ray fluorescence system was used to measure concentrations of Cu, Zn, Br and Rb in whole blood and plasma of healthy adults. The samples preparation method and calculated limits of detection of the technique are reported. Correlation statistics for elemental concentrations have been determined. Verification of the results for copper was performed using atomic absorption spectrophotometry.

Vitrectomy in subarachnoid haemorrhage

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