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Concept: UCI race classifications

48

This study used a within-subjects design to assess the effect of three common cellular telephone (cell phone) functions (texting, talking, listening to music) on planned exercise. Forty-four young adults (n = 33 females, 21.8 ± 1.3 years) each participated in four, separate, 30-minute exercise conditions on a treadmill in a random order. During each condition, the treadmill speed display was covered and grade was fixed at zero. However, participants were able to alter treadmill speed as desired. Throughout the texting and talking conditions, research personnel used a pre-determined script to simulate cell phone conversations. During the music condition, participants used their cell phone to listen to music of their choice. Finally, participants completed a control condition with no cell phone access. For each condition, average treadmill speed, heart rate and liking (via visual analog scale) were assessed. Treadmill speed (3.4 ± 1.3 miles∙hour-1), heart rate (122.3 ± 24.3 beats∙min-1) and liking (7.5 ± 1.5 cm) in the music condition were significantly (p ≤ 0.014) greater than all other conditions. Treadmill speed in the control condition (3.1 ± 1.2 miles∙hour-1) was significantly (p = 0.04) greater than both texting and talking (2.8 ± 1.1 miles∙hour-1 each). Heart rate during the control condition (115.4 ± 22.8 beats∙min-1) was significantly (p = 0.04) greater than texting (109.9 ± 16.4 beats∙min-1) but not talking (112.6 ± 16.1 beats∙min-1). Finally, liking during the talking condition (5.4 ± 2.2 cm) was greater (p = 0.05) than the control (4.3 ± 2.2 cm) but not the texting (5.1 ± 2.2 cm) conditions. In conclusion, using a cell phone for listening to music can increase the intensity (speed and heart rate) and liking of a bout of treadmill exercise. However, other common cell phone uses (texting and talking) can interfere with treadmill exercise and reduce intensity.

Concepts: Sound, UCI race classifications, Mobile phone, Text messaging, Tour de Georgia, Cellular network

28

Objective To study cardiac, sleep-related, and emotional reactions to playing violent (VG) versus nonviolent video games (NVG) in adolescents with different gaming habits. Methods Thirty boys (aged 13-16 years, standard deviation = 0.9), half of them low-exposed (≤1 h/d) and half high-exposed (≥3 h/d) to violent games, played a VG/NVG for 2 hours during two different evenings in their homes. Heart rate (HR) and HR variability were registered from before start until next morning. A questionnaire about emotional reactions was administered after gaming sessions and a sleep diary on the following mornings. Results During sleep, there were significant interaction effects between group and gaming condition for HR (means [standard errors] for low-exposed: NVG 63.8 [2.2] and VG 67.7 [2.4]; for high-exposed: NVG 65.5 [1.9] and VG 62.7 [1.9]; F(1,28) = 9.22, p = .005). There was also a significant interaction for sleep quality (low-exposed: NVG 4.3 [0.2] and VG 3.7 [0.3]); high-exposed: NVG 4.4 [0.2] and VG 4.4 [0.2]; F(1,28) = 3.51, p = .036, one sided), and sadness after playing (low-exposed: NVG 1.0 [0.0] and VG 1.4 [0.2]; high-exposed: NVG 1.2 [0.1] and VG 1.1 [0.1]; (F(1,27) = 6.29, p = .009, one sided). Conclusions Different combinations of the extent of (low versus high) previous VG and experimental exposure to a VG or an NVG are associated with different reaction patterns-physiologically, emotionally, and sleep related. Desensitizing effects or selection bias stand out as possible explanations.

Concepts: Standard deviation, Emotion, UCI race classifications, Deviation, Video game, Tour de Georgia, Nonviolent video game, Standard error

28

The synthetic cannabinoid, UR-144 ((1-pentyl-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)methanone), was identified in commercial ‘legal high’ products (herbal, resin, and powder). Along with this, six related compounds were detected. The most abundant one (2.1) was identified as 4-hydroxy-3,3,4-trimethyl-1-(1-pentyl-1H-indol-3-yl)pentan-1-one, a product of the electrophilic addition of water to the cyclopropane moiety in UR-144. Compound 2.1 was found to be undergo cyclisation which leads to the formation of two additional interconvertable compounds (2.3, tentatively identified as 1-pentyl-3-(4,4,5,5-tetramethyl-4,5-dihydrofuran-2-yl)-1H-indole which is stable only in absence of water and also observed as GC artifact) and 2.2, a protonated derivative of 2.3 which is formed in acidic solutions. The remaining compounds were identified as possible degradation products of the group 2 compounds (4,4,5,5-tetramethyldihydrofuran-2(3H)-one and 1-pentylindoline-2,3-dione) and intermediates or by-products from the synthesis of UR-144 ((1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)methanone, 1-pentyl-1H-indole and 1-(1-pentyl-1H-indol-3-yl)hexan-1-one). Pyrolysis of herbal products containing the group 2 compounds or UR-144 resulted in the formation of 3,3,4-trimethyl-1-(1-pentyl-1H-indol-3-yl)pent-4-en-1-one (3). This was confirmed by separate pyrolysis of 2.1 and UR-144. Also, the two additional minor compounds, 1-(1-pentyl-1H-indol-3-yl)ethanone and 1-(1-pentyl-1H-indol-3-yl)propan-1-one, were detected. Pathways for these transformations are presented. Copyright © 2013 John Wiley & Sons, Ltd.

Concepts: Group, Chemical compound, John Wiley & Sons, Herbalism, UCI race classifications, Cannabinoid, Electrophile, Electrophilic addition

24

Recent technological advances have enabled real-time near-infrared fluorescence cholangiography (NIRFC) with indocyanine green (ICG). Whereas several studies have shown its feasibility, dosing and timing for practical use have not been optimized. We undertook a prospective study with systematic variation of dosing and timing from injection of ICG to visualization. Adult patients undergoing laparoscopic biliary and hepatic operations were enrolled. Intravenous ICG (0.02-0.25 mg/kg) was administered at times ranging from 10 to 180 minutes prior to planned visualization. The porta hepatis was examined using a dedicated laparoscopic system equipped to detect NIRFC. Quantitative analysis of intraoperative fluorescence was performed using a scoring system to identify biliary structures. A total of 37 patients were enrolled. Visualization of the extrahepatic biliary tract improved with increasing doses of ICG, with qualitative scores improving from 1.9 ± 1.2 (out of 5) with a 0.02-mg/kg dose to 3.4 ± 1.3 with a 0.25-mg/kg dose (P < .05 for 0.02 vs 0.25 mg/kg). Visualization was also significantly better with increased time after ICG administration (1.1 ± 0.3 for 10 minutes vs 3.4 ± 1.1 for 45 minutes, P < .01). Similarly, quantitative measures also improved with both dose and time. There were no complications from the administration of ICG. These results suggest that a dose of 0.25 mg/kg administered at least 45 minutes prior to visualization facilitates intraoperative anatomical identification. The dosage and timing of administration of ICG prior to intraoperative visualization are within a range where it can be administered in a practical, safe, and effective manner to allow intraoperative identification of extrahepatic biliary anatomy using NIRFC.

Concepts: Better, Ultraviolet, Improve, Liver, Dose, UCI race classifications, Reference dose, Indocyanine green

10

The study aimed for evaluating the diagnostic value of a 2D Turbo Spin Echo (TSE) magnetic resonance (MR) imaging sequence implanted slice-encoding metal artifact correction (SEMAC) and view-angle tilting (VAT) in patients with spinal instrumentation.Sixty-seven consecutive patients with an average age of 59.7 ± 17.8 years old (range: 32-75 years) were enrolled in this study. Both sagittal, axial T1-weighted and T2-weighted MRI images were acquired with a standard TSE sequence and a high-bandwidth TSE sequence implemented the SEMAC and VAT techniques. Three continuous sections around the instrumentation in axial and sagittal images were selected for quantitative evaluation. The measurement included cumulative areas of signal void on axial images and the length of spinal canal obscuration on sagittal images. Three radiologists independently evaluated all images blindly. The inter-observer reliability was evaluated with inter-class coefficient. We defined patients with discomfortable symptoms caused by spinal instrumentation as spinal instrumentation adverse reaction.Visualizations of all periprosthetic anatomic structures were significantly better for SEMAC-VAT compared with standard imaging. For axial images, the area of signal void at the level of the instrumentation were statistically reduced with SEMAC-VAT TSE sequences than with standard TSE sequences for T2-weighted images (9.9 ± 2.6 cm vs 29.8 ± 14.7 cm, P < 0.001). For sagittal imaging, the length of spinal canal obscuration at the level of the instrumentation was reduced from 5.2 ± 2.0 cm to 1.2 ± 0.6 cm on T2-weighted images (P < 0.001), and from 4.8 ± 2.1 cm to 1.1 ± 0.5 cm on T1-weighted images with SEMAC-VAT sequences (P < 0.001). Interobserver agreement for visualization of anatomic structures and image quality was good for both SEMAC-VAT (k = 0.77 and 0.68, respectively) and standard (k = 0.74 and 0.80, respectively) imaging. The number of abnormal findings noted on SEMAC images (59 findings) was significantly higher than detected on standard images (40 findings). The incidence rate of spinal instrumentation adverse reaction was 38.81%.MR images with SEMAC-VAT can significantly reduce metal artifacts for spinal instrumentation and improve delineation of the instrumentation and periprosthetic region. Furthermore, SEMAC-VAT technique can improve diagnostic accuracy in patients with post-instrumentation spinal diseases.

Concepts: Series, Magnetic resonance imaging, Sequence, Anatomy, Human anatomy, UCI race classifications, Tour de Georgia, Limit of a sequence

9

The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths.

Concepts: Cholesterol, Epidemiology, Disease, Death, Medical statistics, Risk, Blood pressure, UCI race classifications

9

Rationale: Given the inconclusive science on the long-term effects of marijuana exposure on lung function, the increasing tetrahydrocannabinol composition of marijuana over time and the increasing legal accessibility of the substance, continued investigation is needed. Objectives: To determine the association between recent and long-term marijuana smoke exposure with spirometric parameters of lung function and symptoms of respiratory health in a large cohort of U.S. adults. Methods: This is a cross-sectional study of U.S. adults who participated in the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey cycles, using the data from the standardized spirometry and survey questions performed during these years. Measurements and Main Results: In the combined 2007-2010 cohorts, 59.1% had used marijuana at least once in their lifetime and 12.2% had used in the past month. For each additional day of marijuana use in the prior month, there were no associated changes in mean percent predicted FEV1 (0.002% ± 0.04%, P=0.9) but there was an associated increase in mean percent predicted FVC (0.13% ± 0.03%, P<0.01) and decrease in mean FEV1/FVC (-0.1% ± 0.04%, P<0.01). In multivariable regressions, 1-5 and 6-20 joint-years of marijuana use were not associated with an FEV1/FVC < 70% (OR 1.1, 95% confidence interval (CI) 0.7-1.6, P=0.8 and OR 1.2, 95% CI 0.8-1.8, p=0.4, respectively) while > 20 joint-years were associated with a FEV1/FVC <70% (OR 2.1, 95% CI 1.1-3.9, P=0.02). For each additional marijuana joint-year smoked, there was no associated change in mean percent predicted FEV1 (0.02% ± 0.02%, P=1.0), but there was an increase in mean percent predicted FVC (0.07% ± 0.02%, P<0.01) and a decrease in mean FEV1/FVC (-0.03% ± 0.01%, P=0.02). Conclusions: In a large cross-section of U.S. adults, lifetime marijuana use up to 20 joint-years is not associated with adverse changes in spirometric measures of lung health. While > 20 joint-years of marijuana exposure was associated with a two-fold increased odds of a FEV1/FVC < 70%, this was the result of an increase in FVC rather than the disproportional decrease in FEV1 seen with obstructive lung diseases.

Concepts: Epidemiology, Pulmonology, Asthma, Prediction interval, Spirometry, Obstructive lung disease, UCI race classifications, Tour de Georgia

7

High-intensity interval training (HIIT) improves peak power output (PPO) in sedentary aging men but has not been examined in masters endurance athletes. Therefore, we investigated whether a six-week program of low-volume HIIT would (i) improve PPO in masters athletes and (ii) whether any change in PPO would be associated with steroid hormone perturbations. Seventeen male masters athletes (60 ± 5 years) completed the intervention, which comprised nine HIIT sessions over six weeks. HIIT sessions involved six 30-s sprints at 40% PPO, interspersed with 3 min active recovery. Absolute PPO (799 ± 205 W and 865 ± 211 W) and relative PPO (10.2 ± 2.0 W/kg and 11.0 ± 2.2 W/kg) increased from pre- to post-HIIT respectively (P < 0.001, Cohen's d = 0.32-0.38). No significant change was observed for total testosterone (15.2 ± 4.2 nmol/L to 16.4 ± 3.3 nmol/L (P = 0.061, Cohen's d = 0.32)), while a small increase in free testosterone occurred following HIIT (7.0 ± 1.2 ng/dL to 7.5 ± 1.1 ng/dL pre- to post-HIIT (P = 0.050, Cohen's d = 0.40)). Six weeks' HIIT improves PPO in masters athletes and increases free testosterone. Taken together, these data indicate there is a place for carefully timed HIIT epochs in regimes of masters athletes.

Concepts: Cholesterol, Hormone, Estrogen, Testosterone, Steroid, UCI race classifications, High-intensity interval training, Interval training

7

Hurricane Sandy caused extensive physical and economic damage; the long-term mental health consequences are unknown. Flooding is a central component of hurricane exposure, influencing mental health through multiple pathways that unfold over months after flooding recedes. Here we assess the concordance in self-reported and Federal Emergency Management (FEMA) flood exposure after Hurricane Sandy and determine the associations between flooding and anxiety, depression, and post-traumatic stress disorder (PTSD). Self-reported flood data and mental health symptoms were obtained through validated questionnaires from New York City and Long Island residents (N = 1231) following Sandy. Self-reported flood data was compared to FEMA data obtained from the FEMA Modeling Task Force Hurricane Sandy Impact Analysis. Multivariable logistic regressions were performed to determine the relationship between flooding exposure and mental health outcomes. There were significant discrepancies between self-reported and FEMA flood exposure data. Self-reported dichotomous flooding was positively associated with anxiety (ORadj: 1.5 [95% CI: 1.1-1.9]), depression (ORadj: 1.7 [1.3-2.2]), and PTSD (ORadj: 2.5 [1.8-3.4]), while self-reported continuous flooding was associated with depression (ORadj: 1.1 [1.01-1.12]) and PTSD (ORadj: 1.2 [1.1-1.2]). Models with FEMA dichotomous flooding (ORadj: 2.1 [1.5-2.8]) or FEMA continuous flooding (ORadj: 1.1 [1.1-1.2]) were only significantly associated with PTSD. Associations between mental health and flooding vary according to type of flood exposure measure utilized. Future hurricane preparedness and recovery efforts must integrate micro and macro-level flood exposures in order to accurately determine flood exposure risk during storms and realize the long-term importance of flooding on these three mental health symptoms.

Concepts: Selective serotonin reuptake inhibitor, Cognitive behavioral therapy, Posttraumatic stress disorder, Prolonged exposure therapy, Anxiety disorder, UCI race classifications, Sertraline, Tropical cyclone

6

We performed a multistage genome-wide association study including 7,683 individuals with pancreatic cancer and 14,397 controls of European descent. Four new loci reached genome-wide significance: rs6971499 at 7q32.3 (LINC-PINT, per-allele odds ratio (OR) = 0.79, 95% confidence interval (CI) 0.74-0.84, P = 3.0 × 10(-12)), rs7190458 at 16q23.1 (BCAR1/CTRB1/CTRB2, OR = 1.46, 95% CI 1.30-1.65, P = 1.1 × 10(-10)), rs9581943 at 13q12.2 (PDX1, OR = 1.15, 95% CI 1.10-1.20, P = 2.4 × 10(-9)) and rs16986825 at 22q12.1 (ZNRF3, OR = 1.18, 95% CI 1.12-1.25, P = 1.2 × 10(-8)). We identified an independent signal in exon 2 of TERT at the established region 5p15.33 (rs2736098, OR = 0.80, 95% CI 0.76-0.85, P = 9.8 × 10(-14)). We also identified a locus at 8q24.21 (rs1561927, P = 1.3 × 10(-7)) that approached genome-wide significance located 455 kb telomeric of PVT1. Our study identified multiple new susceptibility alleles for pancreatic cancer that are worthy of follow-up studies.

Concepts: Genetics, Cancer, Statistics, Genome-wide association study, Confidence interval, Statistical hypothesis testing, Pancreatic cancer, UCI race classifications