Search

Iron is a vital trace element for energy production and oxygen transportation; importantly, it is essential to athletic performance. Maintaining iron balance is tightly controlled at systemic and cellular levels. This study aimed to determine serum iron tests, hepcidin levels, and cellular iron import and export activities in peripheral blood mononuclear cells (PBMCs) in ultramarathon runners to elucidate the association of systemic inflammation response and iron metabolism.Sixteen amateur runners were enrolled. Blood samples were taken 1 week before, immediately, and 24 h after the run. Plasma hepcidin levels were measured by enzyme-linked immunosorbent assay. The expression levels of divalent metal iron transporter 1 (DMT1), ZRT/IRT-like protein 14 (ZIP14), transferrin receptor 1 (TfR1), and ferroportin (FPN) in PBMCs were measured using real-time quantitative reverse transcription-polymerase chain reaction.Serum iron concentrations and transferrin saturation significantly decreased immediately after the race and dramatically recovered 24 h post-race. Serum ferritin levels had a statistically significant rise immediately after the race and remained high 24 h after the completion of the race. Ultramarathons were associated with increased plasma interleukin-6 concentrations corresponding to the state of severe systemic inflammation and therefore boosted plasma hepcidin levels. The expression levels of DMT1 and FPN mRNA were markedly decreased immediately and 24 h after the race. The ZIP14 and TfR1 mRNA expression in PBMCs significantly decreased immediately after the race and returned to the baseline level at 24 h post-race. Positive significant correlations were observed between plasma hepcidin and ferritin levels.Iron homeostasis and systemic inflammatory response are closely interconnected. Cellular iron import and export mRNA activities in PBMCs were acutely inhibited during an ultramarathon.

There is scant literature to date about the application of point-of-care devices for diagnosis of high-altitude pulmonary edema and clinical management in symptomatic teenagers. Hence, we characterized the early changes in point-of-care assessments to gain a deeper insight into the physiological responses in teenagers during a 3-day trek.

Background The diagnosis of acute mountain sickness, which lacks a reliable and objective diagnostic tool, still depends on the clinical symptoms and signs and remains a major threat and unpredictable disease affecting millions of mountaineers. Objectives To record electroencephalography signals with small, convenient, wireless equipment and to test whether electroencephalography parameters, which are more sensitive and reliable markers, could predict the symptoms of acute mountain sickness. Methods Twenty-five participants were enrolled and separated into two groups to climb Mount Jade in Taiwan. We collected electrocardiography signals and arterial oxygen saturation data at ground, moderate (2,400 m), and high altitude (3,400 m). A spectral analysis of the electrocardiography was performed to assess the study subjects’ electroencephalography activity at different frequencies (α, β, θ, δ) and the mean power frequency of electrocardiography. The clinical symptoms and Lake Louise Acute Mountain Sickness scores of the subjects were recorded for comparison. Results A significant change in the δ power of electroencephalography was recorded in subjects ascending from the ground to a high altitude of 3,400 m in a 4-day itinerary. In addition, between the two groups of subjects with and without acute mountain sickness (Lake Louise Acute Mountain Sickness scores < 3 and ≥ 3), the δ power of electroencephalography at the fronto-parietal 1 and parietal 3 electrodes at moderate altitude as well as the changes of δ power and mean power frequency of electrocardiography over parietal 4 at high altitude showed a significant difference. At moderate altitude, the increasing δ power of electroencephalography at the parietal 4 electrode was related to the headache symptom of acute mountain sickness before ascending to high altitude. Conclusion At moderate altitude, the δ power increase of electroencephalography at the P4 electrode could be a predictor of acute mountain sickness symptoms before ascending to high altitude. Thus, electroencephalography had the potential to identify the risk of acute mountain sickness.

Ultra-marathons are typically held over harsh terrains such as mountains, deserts, or other wilderness, and place severe demands on the physical and psychological capabilities of participants. Adventure-race competitors commonly report hallucinations. The goal of this study was to gain insight into visual hallucinations (VHs) during a mountain ultra-marathon. Thirty-one Taiwanese runners who participated in the 2018 Run Across Taiwan Ultra-Marathon, which spans 246 km with an altitude difference of 3266 m and an overall cut-off time of 44 h, volunteered for this study. Self-reported questionnaires on sleep duration, hallucinatory experiences, clinical symptoms of cold- and heat-related illnesses, and the 2018 Lake Louise Acute Mountain Sickness (AMS) Score were recorded prerace, during the summit, immediately postrace, and 3-days postrace. Hematological samples were collected 1 week before, immediately after, and 3 days after the race. Eight ultra-marathoners (six males and two females; seven finishers and one withdrawer) were recruited. Three out of eight (37.5%) subjects (two males and one female) reported experiencing VHs during the last 60 km. Three out of five (60%) lower-ranked subjects experienced VHs. All eight runners slept for

Our study aimed to (i) utilize novel electrical cardiometry and observe acute changes in cardiac biomarkers among 24-h and 48-h ultra-marathoners, and (ii) examine whether alterations in cardiac responses were associated with the average running speed of these participants. Twenty-four 24-h and sixteen 48-h ultra-marathoners were recruited. Electrical cardiometry in the 2 groups showed significant post-race drops in systolic pressure (24-h: p=0.001; 48-h: p=0.016) and rapid increases in heart rate (24-h, p=0.004; 48-h, p=0.001). Cardiac output increased in 48-h runners (p=0.012) and stroke volume decreased in 24-h runners (p=0.009) at post-test. Six of 20 (30%) 24-h and 4 of 16 (25%) 48-h runners had high-sensitivity troponin T values above the reference interval after the races. N-terminal proB-type natriuretic peptide levels showed a 15-fold increase in 24-h runners and a 10-fold increase in 48-h runners at post-race. There was a positive correlation between delta N-terminal proB-type natriuretic peptide and running mileage (Our study aimed to (i) utilize novel electrical cardiometry and observe acute changes in cardiac biomarkers among 24-h and 48-h ultra-marathoners, and (ii) examine whether alterations in cardiac responses were associated with the average running speed of these participants. Twenty-four 24-h and sixteen 48-h ultra-marathoners were recruited. Electrical cardiometry in the 2 groups showed significant post-race drops in systolic pressure (24-h: p=0.001; 48-h: p=0.016) and rapid increases in heart rate (24-h, p=0.004; 48-h, p=0.001). Cardiac output increased in 48-h runners (p=0.012) and stroke volume decreased in 24-h runners (p=0.009) at post-test. Six of 20 (30%) 24-h and 4 of 16 (25%) 48-h runners had high-sensitivity troponin T values above the reference interval after the races. N-terminal proB-type natriuretic peptide levels showed a 15-fold increase in 24-h runners and a 10-fold increase in 48-h runners at post-race. There was a positive correlation between delta N-terminal proB-type natriuretic peptide and running mileage (

Background Cholesterol metabolism is tightly regulated at the cellular level. This study was to measure the expression levels of ATP-binding cassette transporter A1 (ABCA1) and G1 (ABCG1), scavenger receptor class B type I (SR-BI) and class A (SRA), and CD36 mRNAs in peripheral blood mononuclear cells (PBMCs) in response to 100-km ultramarathon event and determine any correlation between these ABC transporters/scavenger receptor expression levels and plasma cholesterol homeostasis. Materials and methods Twenty-six participants were enrolled. Blood was drawn from each individual 1 week prior, immediately after, and 24 hours after the race. The expression levels of ABCA1, ABCG1, SR-BI, SRA and CD36 in PBMCs were measured by using real-time quantitative reverse transcription polymerase chain reaction. Results Plasma triglyceride levels were significantly increased immediately after the race and dropped at 24-hour post-race compared with pre-race values. The 100-km ultramarathon boosted high-density lipoprotein cholesterol (HDL-C) levels and decreased low-density lipoprotein cholesterol (LDL-C) levels 24-hour post-race. The expression levels of ABCA1, ABCG1 and SR-BI were markedly decreased, whereas that of CD36 was slightly but significantly upregulated in runners' PBMCs immediately after the race. Ultramarathon resulted in immediate large-scale stimulation of inflammatory cytokines with increased plasma interleukin-6 and tumour necrosis factor-alpha levels. Moreover, by using in vitro models with human monocytic cell lines, incubation of runners' plasma immediately after the race significantly downregulated ABCA1 and ABCG1, and upregulated CD36 expression in these cells. Conclusions ABCA1, ABCG1 and CD36 gene expressions in PBMCS might be associated with endurance exercise-induced plasma cholesterol homeostasis and systemic inflammatory response.

BACKGROUND The change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels follows a paradox imposed by strenuous endurance exercise. Previous reports showed significant body weight (BW) loss was common in ultramarathon runners. This study investigated whether the BW change and renin-angiotensin-aldosterone system activation contribute to exercise-induced NT-proBNP release. METHODS A total of 26 participants who finished a 100 km ultramarathon in Taiwan were enrolled. For each participant, blood samples and spot urine samples were collected 1 week before the race, as well as immediately and 24 hours after the finish. BW change was recorded to monitor the hydration status. RESULTS Prolonged endurance exercise led to a substantial increase in NT-proBNP. Compared with prerace values, NT-proBNP levels significantly increased immediately after the race (24.3 ± 20.2 pg/mL to 402.9 ± 305.9 pg/mL, p < 0.05) and maintained high levels until 24 hours after the race (143.7 ± 126.1 pg/mL, p < 0.05). The fractional excretion of sodium values was below 1% in three different time points. The 100 km ultramarathon resulted in significant BW loss and elevated renin and aldosterone levels. However, only 24 hours after the race, a positive significant relationship was found between NT-proBNP and aldosterone levels (p = 0.007, r = 0.267), but a negative significant relationship between NT-proBNP and BW increased during the recovery phase (p < 0.001, r = 0.372). CONCLUSION The mechanism of NT-proBNP release immediately following the race was multifaceted. During the recovery phase, rehydration might lead to the decrease of NT-proBNP. Our observations with regard to aldosterone and NT-proBNP might be in response to help the body maintains hydration state.

Background: In endurance sports, stress, dehydration and release of chemical factors have been associated with red blood cell (RBC) alterations of structure and function, which may contribute to sports anemia, a well-observed phenomenon during long-distance running. Until now, the investigation of the changes of viscoelastic properties of RBC membrane, a decisive factor of RBC deformability to avoid hemolysis, is lacking, especially in an Oriental population. Methods: nineteen runners were prospectively recruited into our study. Hematological parameters were analyzed before and immediately after the 2015 Taipei 24H Ultra-Marathon Festival, Taiwan. Video particle tracking microrheology was used to determine viscoelastic properties of each RBC sample by calculating the dynamic elastic modulus G′(f) and the viscous modulus G″(f) at frequency f = 20 Hz. Results: Haptoglobin, RBC count, hemoglobin, hematocrit, mean cell hemoglobin, plasma free hemoglobin and unsaturated iron-binding capacity values of the recruited runners showed a statistically significant drop in the post-race values. Blood concentration of reticulocyte and ferritin were significantly higher at post-race compared with pre-race. 15 out of the 19 runners had a concurrent change in the elastic and the viscous moduli of their RBCs. Changes in the elastic and the viscous moduli were correlated with changes in the RBC count, hemoglobin and hematocrit. Conclusion: Viscoelasticity properties, the elastic modulus G′(f) and the viscous modulus G″(f) of RBCs are associated with endurance exercise-induced anemia. Keywords: Clinical sports medicine, Red blood cell, Sports anemia, Ultra-marathon, Viscoelastic properties

Background Prolonged endurance exercise is known to cause elevation of cardiac troponin I (cTnI). Previous studies have reported the correlation of several factors with exercise-induced cTnI release. However, the investigation of the predictors for elevated cTnI and postrace kinetics of cTnI after ultramarathon running is lacking, especially in an Oriental population. Methods Twenty-six participants, including eight hepatitis B virus carrier (HBVc) runners, who finished a 100-km ultramarathon in Taiwan were enrolled. For each participant, blood samples were collected 1 week before the race, as well as immediately and 24 hours after the finish. Results The results showed that 19 runners (73.1%) had postrace elevated cTnI levels and eight (30.8%) had elevated cTnI values lasting more than 24 hours after the run. A multiple linear regression analysis demonstrated that the HBV status was a factor related to the high level of cTnI after 24 hours of running ( β =0.03, p =0.08). The recovery of plasma cTnI levels was delayed in ultramarathon runners with latent HBV infection. Among HBVc runners, multiple linear regression analyses showed age ( β =−0.01), previous running experience ( β =−0.06), training distance ( β =0.37), and 4 hours of running distance ( β =−0.04) as significant predictors of higher postrace cTnI levels. Conclusion For most athletes, cTnI values significantly increased immediately following the race in the absence of adverse clinical sequelae, and HBVc runners had higher and prolonged cTnI levels. While several factors are identified for such HBV effects, the specific causes need further elucidation.

Completing an ultramarathon leads to an immediate postrace surge of erythropoietin (EPO). Patients with chronic liver disease may have high plasma EPO concentrations. This study aims to explore whether plasma EPO concentrations vary between hepatitis B virus carrier (HBVc) and non-HBVc runners during long distance running. Blood samples were collected from 8 HBVc and 18 non-HBVc runners at 3 different time points: 1 week before, immediately following, and then 24 h after the 100-km ultramarathon race. Samples were analyzed for plasma EPO levels. EPO concentration had a statistically significant rise immediately after the race (8.7 [7.1–11.9] mU·mL−1 to 23.7 [14.8–37.2] mU·mL−1, P < 0.001) and maintained the high levels 24 h after the race finished (16.7 [11.5–21.0] mU·mL−1, P < 0.001) in all participants. The mean of EPO concentration was 8.9 (5.7–13.2) mU·mL−1 in HBVc runners and was 8.7 (7.7–11.2) mU·mL−1 in non-HBVc runners in the prerace. In HBVc runners, plasma EPO levels were no different at baseline (P = 0.657) and increased in the same fashion in response to ultramarathon compared with non-HBVc runners. Plasma EPO levels between the two groups were not statistically different at any time point. Prolonged endurance exercise led to a significant increase in EPO. A comparable increase in EPO levels was observed in HBVc and non-HBVc runners during and 24 h after 100-km ultramarathon. However, a small sample size might have affected the ability to detect a difference if it does exist.

Brain computed tomography angiography (CTA) is a useful tool for detecting subarachnoid hemorrhage (SAH) and cerebral aneurysms, but less reliably when cerebral aneurysms which are smaller than 2 mm. We present a case of spontaneous SAH and intraventricular hemorrhage (IVH) with negative findings on brain CTA. Due to the clinical presentation and positive neurologic examination, lumbar puncture was performed and xanthochromia of cerebrospinal fluid (CSF) had been noted. Cerebral angiography was performed and showed a small unruptured saccular cerebral aneurysm (

Emission-excitation cross sections for collision processes relevant to krypton-propelled Hall effect and ion thrusters are measured using optical emission spectroscopy in the 350–1000 nm spectral range. Absolute spectral radiances were recorded for collisions between beams of krypton ions (either singly or doubly charged) and electrons with a Kr gas at charged particle energies relevant to electrostatic thruster plasmas. The most prominent emissions observed are in the near-infrared region from a low-lying excited electronic state of neutral Kr. In the case of Kr+/Kr2++Kr systems, the emission-excitation cross section from this low-lying excited electronic state of neutral Kr has a threshold at approximately 12.5 eV in the center-of-mass frame, and it increases with collision energy until 200 eV, where it remains constant through 600 eV. The energy dependence of cross sections for emission from Kr II varies with the colliding charged particle. The threshold for the radiative emission of Kr II is estimated...

To examine the effect of ascent rate on the induction of acute mountain sickness (AMS) in young adults during a climb to Jiaming Lake (3350 m) in Taiwan.Prospective, nonrandomized.Climb from 2370 to 3350 m.Young adults (aged 18 to 26 years) (N = 91) chose to participate in either the fast ascent (3 days; n = 43) or slow ascent (4 days; n = 48) group (1 and 2).Two criteria were used to define AMS. A Lake Louise score ≥3 and Lake Louise criteria [in the setting of a recent gain in altitude, the presence of headache and at least 1 of gastrointestinal discomfort (anorexia, nausea, or vomiting), fatigue or weakness, dizziness or lightheadedness, or difficulty sleeping].Heart rate, blood oxygen saturation (SaO2), and symptoms of AMS were monitored each morning and evening.Baseline characteristics were similar between groups, except for significant differences in history of alcohol consumption (P = 0.009) and climbing experience above 3000 m (P0.001). The incidence of AMS was not associated with the rate of ascent. Acute mountain sickness was most prevalent in group 1 on day 2 in the evening and in group 2 on day 3 in the evening. In both groups, AMS correlated with the initial reduction in SaO2. Body mass index (BMI)24 kg/m was identified as a significant risk factor for AMS.The development of AMS was closely associated with an initial reduction in SaO2. A BMI24 kg/m also contributed to the occurrence of AMS.These findings indicate that factors other than ascent rate should be considered when trying to ameliorate the risk of AMS.

Background Sports anemia is a widely observed phenomenon after prolonged running. There are various factors that contribute to sports anemia, including hemodilution, exercise-induced oxidative stress, iron deficiency, gastrointestinal bleeding, hematuria, and hemolysis resulting from foot-strike and/or from compression of contracting muscles on capillaries. Until now, there has been no published report that describes the overall hematological, urinary, and fecal consequences in Asian male ultramarathoners after a 100-km (62.5-mile) ultramarathon event. Methods A total of 25 male runners were recruited into our study. Blood was drawn 1 week before, immediately after, and then 24 hours subsequent to the race. Hematological samples were analyzed for the anemia phenomenon. Additionally, urinary and fecal samples were collected before and after the race for detection of occult blood. Results The blood hemoglobin and erythropoietin values of the recruited runners showed a statistically significant rise in the immediate post-race values and a rapid drop in values at 24 hours post-race. Blood concentrations of red blood cells and hematocrit were significantly lower at 24 hours post-race compared with pre-race. The white blood cell count, interleukin-6, tumor necrosis factor-alpha, high-sensitivity C-reactive protein, and ferritin all showed significant increases both immediately after and 24 hours post-race compared with pre-race hematological values. There were immediate decreases of both haptoglobin and iron, as well as an increase of total iron-binding capacity levels in post-race blood tests. For both urinary and fecal samples, there was a statistically significant difference between the pre- and post-race results in occult blood. Conclusion Running a 100-km ultramarathon will induce substantial sports anemia, and oxidative stress response, hemolysis, hematuria, and gastrointestinal bleeding are typical factors that contribute to its onset.

To evaluate the prevalence and characteristics of acute kidney injury (AKI) in 100-km ultramarathon runners.Prospective observational study.The 2011 Soochow University ultramarathon, in which each athlete ran for 100 km.All Taiwanese entrants who participated in the 100-km race and lived in the northern part of Taiwan were invited to participate in the study.Acute kidney injury was defined using the Acute Kidney Injury Network criteria. Blood and urine samples were collected 1 week before, immediately after, and 1 day after the race.Immediately after the race, 85% (22) of the 26 subjects were diagnosed with AKI, 65% (16) with moderate dehydration, 23% (6) with muscle cramps, and 12% (3) with hematuria. Body weight was significantly decreased from prerace to all postrace measurements. Plasma levels of potassium ion, creatinine, renin, and aldosterone were significantly elevated immediately after the race and then significantly reduced 1 day after the race. Changes in plasma levels of sodium, creatine kinase, and creatine kinase-MB, as well as urine potassium and creatinine, were indicative of AKI.Transient AKI and muscle cramps are very common in 100-km ultramarathon runners. All transient ultra-runners who developed AKI in this study recovered their renal function 1 day later.Ultramarathon running is associated with a wide range of significant changes in hematological parameters, several of which can be associated with potentially serious renal and physiological abnormalities.

The insertion (I) or deletion (D) polymorphism in the angiotension I converting enzyme gene, (ACE I/D, rs1799752) is associated with human exercise endurance and performance. However, most of the aforementioned studies focus on marathons, swimming, and triathlons, while the ACE polymorphism in ultra-marathoners has not yet been reported. We studied the impact of ACE I/D polymorphism in ultra-marathoners and investigated its relationship with lipid profiles, interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) levels in runners before and after ultra-marathon racing. This observational study used data from a 100-km ultra-marathon in Taipei, Taiwan. Twenty-four male participants were analyzed for their ACE insertion/deletion polymorphism, lipid profiles, hs-CRP, IL-6 in serum immediately before and after ultra-marathon running. In our 24 subjects analyzed, 7, 14, and 3 subjects were of I/I, I/D, and D/D genotypes, respectively. Runners with the D polymorphism (I/D and D/D) showed a trend of better performance in the 100-km ultra-marathon (measured by completion time in minutes, P = .036). In this group, the previous best marathon performance was also significantly better than the I/I group (P = .047). After adjusting for body mass index (BMI), the difference in performance was not significant. Ketone levels, IL-6, and hs-CRP levels were highly increased at immediately and 24-hour post-race. No correlation was found between different ACE polymorphisms and common biochemical parameters examined. We report the first study in the impact of the ACE I/D (rs1799752) on ultra-marathoners. Presence of the D polymorphism in ACE gene is associated with better performance, although the BMI of the runners contribute as a major factor. There was no difference in the biochemical or lipid parameters measured among different ACE polymorphisms.

Background: As laws prohibit gun possession, civilian gunshot wounds (GSW) are relatively rare in Taiwan. Our hospital, Mackay Memorial Hospital, located at Taipei City is surrounded by nightclubs and red-light districts. Due to this unique location, our hospital becomes the first-line trauma center managing gunshot victims in northern Taipei. As few research articles have been published regarding this unique situation, we aimed to analyze the characteristics and the emergency department (ED) length of stay (LOS) of GSW patients in our hospital. Methods: A 6-year retrospective analysis of 27 patients treated for GSW injuries from January 2012 to December 2017 was performed. The patients’ records were reviewed for clinical presentations and the LOS in ED. Results: We found males (96.3%) were injured by guns more often than females (3.7%) in all age groups. The most common injured site was in the extremities (55.6%). With regards to the ER LOS, the average time were 72.2±34.5 minutes for patients with triage I and 207.4±143.9 minutes for patients with triage II. The ED LOS of patients whose Injury Severity Score (ISS) were more than 15 was 59.9±25.6 minutes, and 179.4±119.8 minutes for patients whose ISS score were between 9 to 15, respectively. Among these 27 patients, 13 patients had emergency surgery and their average ED stay time was 131.9±31.2 minutes. Even more, the average ED stay time could be shortened to 88.8±32.3 minutes in the 5 patients with trauma team activation (TTA). Conclusions: TTA in severe GSW patients indeed shortens the ED LOS and might improve the quality of patient care. This is the result of better trauma systems, including advances in care from emergency medical services and the acute care surgical management.

Objective The goal of this study was to assess the optimum diagnostic cutoff value of maximum outer appendiceal diameter on computed tomography (CT) images in patients with suspected acute appendicitis in the emergency department. Methods A total of 328 patients with clinical suspicion of appendicitis were retrospectively reviewed. Evaluation of CT images, and chart review for clinical, laboratory, surgical, and pathologic findings were performed. Logistic regression was used to identify possible predictive factors influencing diagnosis of acute appendicitis. The receiver operating characteristic (ROC) curve was applied to determine the most suitable diagnostic cutoff value of appendiceal diameter for acute appendicitis. Results In a total of 136 patients (41.5%) the diagnosis of acute appendicitis was made; 192 patients (58.5%) had nonacute appendicitis. Mean appendiceal diameter was 12.68 ± 3.31 mm in patients with acute appendicitis and 6.01 ± 1.50 mm in patients without. The appendiceal diameter had a significantly statistical difference to differentiate the presence from the absence of acute appendicitis with an area under the ROC curve of 0.985 (95% confidence interval, 0.973–0.996). An appendiceal diameter cutoff value of 8.15 mm had a sensitivity of 97%, a specificity of 93.2%, and an accuracy of 94.8%. Appendiceal wall enhancement with intravenous contrast medium also had a significantly statistical difference for discriminating patients with acute appendicitis from those without by logistic regression. Conclusion Detection of maximum outer appendiceal diameter and appendiceal wall enhancement with intravenous contrast medium on CT could help differentiate patients with acute appendicitis from those without. An appendiceal diameter greater than 8.15 mm is particularly useful for diagnosis of acute appendicitis.

Background: There have been few studies focusing on the incidence and risk factors for elderly patients undergoing computed tomography (CT) scans with intravascular contrast medium, who develop contrast-induced nephropathy (CIN) in the emergency department (ED). Our objective was to investigate the incidence of and risk factors for, CIN in elderly patients seen in the ED, who receive intravenous contrast media for CT examination. Methods: Patients ≥65 years of age who received contrast-enhanced CT were eligible for inclusion in this retrospective analysis. CIN was defined as an increase in serum creatinine (sCr) ≥0.5 mg/dL 48 to 72 hours after intravenous contrast administration. Multiple logistic regression analysis for risk factors for CIN and Chi-square test were performed for trend analysis for CIN incidence and mortality of different risk scores. Results: A total of 594 patients, with a mean age of 79.8 ± 6.8 years were included. The overall incidence of CIN was 8.6%. In multivariate analyses, CIN was associated with diabetes mellitus [adjusted odds ratio (OR) = 1.93; 95% confidence interval (CI) = 1.04–3.62], precontrast sCr >1.5 mg/dL (OR = 2.72; 95% CI = 1.44–5.13), and acute hypotension (OR = 3.56; 95% CI = 1.29–9.84). CIN and mortality increased with increasing risk score (p 1.5 mg/dL and acute hypotension as risk factors for CIN, and also developed a simple risk score for elderly patients seen in the ED.

This study compares the serological markers between runners who are hepatitis B virus carries (HBVc) and runners who are non-HBVc in a 100-km ultra-marathon race. Blood samples of 8 HBVc and 18 non-HBVc runners were drawn 1 week before, immediately following, and 24 h after the race. Samples were analyzed and compared between the 2 groups for liver function tests, muscle damage markers and oxidative stress cytokines. For HBVc runners, HBV-DNA (hepatitis B virus-deoxyribonucleic acid) levels were also evaluated for virus reactivation. The results demonstrate a statistically significant increase in both immediate and 24-h post-race values for alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), compared with pre-race values. No statistically significant difference was observed between the 2 groups for the values of AST, LDH, CK, hs-CRP, IL-6 and TNF-α either before or after the race. There was also no statistically significant change in the levels of HBV-DNA in HBVc runners. These findings suggest that HBVc runners do not have higher risks of liver function impairment, muscle breakdown and inflammatory response compared to non-HBVc runners in such endurance races.

Introduction The objective is to evaluate the diagnosis of foreign body (FB) ingestion and report on the endoscopic management in Taiwan. Methods This retrospective study enrolled 159 adult patients with confirmed diagnosis of upper gastrointestinal FBs who received endoscopic management in the emergency department. Results The patients’ mean age was 57.0 ± 19.2 years, and 66 (37.7%) of the patients were 65 years or older. Majority had a clear history and symptoms of FB ingestion. However, 9 (5.7%) initially ignored the accidental swallowing of FBs and were diagnosed late. The mean time spent for diagnosis was 1.8 days in those with uncertain history. Only 47.1% of those with radiographic studies had positive findings. Fish bones, press-through package and dentures were the most common culprits in this population of Asian elderly. Majority of FBs were located in the esophagus, especially in the upper third. Endoscopic FB extraction was successful in 96.9% of cases, while surgery was required in only 5 patients. The complication rate was 6.9%, including mucosal laceration (n = 10) and suspected perforation (n = 1), all of which were successfully managed conservatively. There was no death due to FB ingestion or endoscopy. Conclusions In FB ingestion, history usually points toward the diagnosis. Patients with an uncertain history are usually diagnosed late, and plain radiography cannot reliably predict the presence of FB. Endoscopic management is safe and effective for FBs.

Background: To investigate cardiac function measurements and athletic performance by Noninvasive Method with Electrical Cardiometry among elite participants in 24-hour ultra-marathon. Methods: This is a prospective study, where twenty endurance athletes completed 24-hour runs on a 400 m track. Cardiac function measurements were taken a day before, immediately after the race and 24-hour post-race. All enrolled athletes than were classified into four groups according to (I) received intravenous hydration intervention or not, (II) total running distances greater than 200 km or not, (III) body weight (BW) change greater than 3 percent or not, and (IV) blood pressure (BP) declined over 10 percent or not. Both cardiac fatigue phase and recovery phase were than discussed in detail before all subjects divided into groups and after divided into groups, in order to assess cardiac function and performance. Results: Before stratify participants into groups, cardiac fatigue phase of all subjects is represented by a decline in left ventricular ejection time (LVET) (P 200 km) is associated with a decline of LVET comparing to less than 200 km group (P=0.024) in cardiac fatigue phase. Performance is associated with greater BW loss and participants with greater BW loss have a lower thoracic fluid index (P=0.046). No evidence of suggesting clinically significant cardiac function changes were detected. Conclusions: Our current study indicates that the electric Cardiometry device is a useful device in measuring cardiac function during an ultramarathon setting. As well as, strenuous exercise will cause acute reversible clinically non-significant worsening in cardiac function.

A series of 22 primary reaction-control-system engine attitude-control firings were observed from the Maui Space Surveillance Site during the space shuttle STS-115 mission. The firings occurred during a pass over Maui on 19 September 2006 during which the orbiter was in sunlight and the observatory was in darkness. The observed attitude maneuvers maintained the orbiter in an orientation in which its long axis was aligned with the line of sight from the observatory. This ensured that the thrust vectors of all the observed engine firings were perpendicular to the line of sight, providing an optimal side-on observation of the exhaust. The firings ranged between 80 and 320 ms in duration and involved 2 or 3 engines for pitch, roll and yaw adjustments. A 0.328 deg field-of-view acquisition scope of the 3.6 m telescope of the Advanced Electro-Optical System provided unfiltered imagery in the near-ultraviolet visible spectral region. The most interesting white-light features were transients, one observed at engine start up and two at shutdown. The analysis of the transient speeds reveals that the startup transient consists of either unburned propellant droplets or higher-pressure gas evaporated from droplets and that the shutdown transients are attributable to a slightly staggered release of unburned oxidizer and fuel, respectively. The first (oxidizer) shutdown transient is the brightest feature, for which an intensity evolution analysis is conducted. The analysis of the ground-based data is fully consistent with spectral features attributable to primary reaction-control-system engine transients observed in previous measurements from the space shuttle bay using an imager spectrograph.

56pto5p 5 6stransitionsofneutralxenonimpactedbysinglyanddoublychargedxenonions.The cross sections were measured over a laboratory energy-per-charge-number range of 100 to 900 eV, a range that covers typical Hall effect thruster discharge voltages. The cross sections are derived from ion beam luminescence spectraproducedatsingle-collisionconditionsandatpressuresforwhichradiationtrappingeffectswereshowntobe negligible. The Xe cross sections are significantly higher than those of Xe 2 and increase with energy throughout theinvestigatedrange.TheXe 2 crosssectionsplateauatapproximately600eV.Thecrosssectionsareincorporated in a collisional-radiative model. The calculations of near-infrared spectra demonstrate that the sensitivity of the model diagnostic with respect to electron temperature increases with ion energy.

An analysis is presented of positive and negative vacuum electrospray currents from the ionic liquid, [Emim][Im], wetted on a sharp tungsten needle. The source is operated in a cone–jet configuration established with a low extraction voltage of approximately ±1 kV. Emission current and mass flow are measured as a function of the emitter angle with respect to the instrument axis. Mass spectra of field evaporated ions and mass-resolved energy distributions of emitted charges are recorded as a function of emitter angle. The measurements at both source polarities indicate that the cone–jet emits a mixture of ions and charged droplets. While the charged droplets are emitted with a narrow angular distribution centered on axis, the angular distributions of ions are significantly broader than those of the droplets and centered off axis. Pure ion emission is observed at emission angles larger than ∼15°. The main mass spectral peaks are from X ± {[Emim][Im]} n ions (X = Emim or Im for positive and negative polarities, respectively) with n = 0, 1, and 2. Quantum chemical calculations of the n = 0 and 1 ions and the isolated ion pairs are presented, yielding thermochemical information on the observed ionic species. The present results demonstrate that the cone–jet emits droplets from the tip of the jet, and provide direct evidence that ions are produced in an Iribarne–Thomson field-evaporation mechanism at the transition region between the Taylor cone and jet. Electrochemical modification of the cone–jet emitter properties are observed when maintaining the emitter at a positive polarity for a prolonged (minutes to hours) period. New ions emerge consisting of clusters containing a neutralized Im − . The associated current suppression can be mitigated through polarity alternation at 1 Hz. Measurements are also presented with the tungsten needle heated to 373 K, thereby reducing the liquid viscosity and increasing the flow rate. The average mass of the droplets is observed to increase with temperature while the mass distributions of the ions are not found to change noticeably.