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[Effect of aerobic endurance exercise on immune function in elderly athletes].

Recently, there have been several reports on the influence of physical activity on immune function. Most of the studies were conducted using maximal exercise in young and middle-aged subjects. Since human immune function undergoes adverse changes with aging, we investigated in the present study whether submaximal, aerobic exercise induces changes in immune function in elderly subjects. Leukocytes, differential blood count, subsets of lymphocytes, CD4/CD8 ratio and immunoglobulins were studied after submaximal aerobic exercise (mean lactate 2.57 + 0.3 mmol/l) in 15 elderly subjects (mean age 68 +/- 5.6 years). These parameters were measured before, immediately after and 4 hours after exercise. Mean hemoglobin was unchanged indicating no hemoconcentration. There was a small increase in mean total lymphocytes (p < 0.05 immediately after exercise), while there was a highly significant increase in leukocyte count both immediately and 4 hours after exercise (p < 0.01). We found a significant correlation between the increase in leukocytes and lactate concentration (p < 0.01, r = 0.784). Lactate levels of all subjects were below 4 mmol/l. These results might indicate that the effect of a single bout of aerobic exercise on immune function depends on the intensity and duration of exercise relative to the level of fitness in elderly subjects. There was a highly significant rise (p < 0.001) in CD4/CD8 ratio 4 hours after exercise. This increase was mainly due to a rise in CD4 cell number whereas T-suppressor cells were almost unchanged. Our data show a possible stimulation of immune function by a submaximal, aerobic exercise in elderly subjects. Further studies are required to clarify whether a stimulation of CD4/CD8 ratio by chronic training gives rise to a reduction of infections in physically active elderly persons.

Aged↗

Upper respiratory tract infections and exercise.

The epidemiological data suggest that endurance athletes are at increased risk for upper respiratory tract infections during periods of heavy training and the 1-2 week period following a marathon or similar event. At present there is no clear indication that chronic alterations in immune function explain this increased risk. Following acute bouts of prolonged heavy endurance exercise, several components of the immune system are suppressed for several hours. This has led to the concept of the "open window" theory described as the 1-9 hour period following prolonged endurance exercise when host defense is decreased and the risk of upper respiratory tract infection is increased.

Adult↗

Improving diabetes care in the primary health setting. The Indian Health Service experience.

PURPOSE: To identify key systems issues from the Indian Health Service (IHS) experience that must be addressed to improve metabolic control among patients with non-insulin-dependent diabetes mellitus (NIDDM) who were followed in primary care settings. DATA SOURCES: Records of diabetic patients seen in IHS facilities in specific geographic regions from 1987 to 1994. STUDY SELECTION: A representative sample of charts from each facility was reviewed yearly to measure key variables. The sampling frame was the number of diabetic patients currently active on the registry and the sample size calculated to measure a 10% change in selected practices at each facility. EXTRACTION: Regional diabetes coordinators reviewed charts or trained local providers to sample and extract data in a standard format. RESULTS: Regional data were examined to show trends in the performance of immunizations and foot examinations and in other variables such as hypertension and metabolic control. The percentage of diabetic patients who received a single dose of pneumococcal vaccine improved from 24% in 1987 to 1988 to 57% in 1994 (P < 0.01 for trend) among diabetic patients in Minnesota, Wisconsin, and Michigan. Rates of yearly comprehensive foot examination increased from 36% to 58% (P < 0.01 for trend) over the same period. In Montana and Wyoming, the percentage of diabetic patients with uncontrolled hypertension (defined as the mean of three systolic blood pressure measurements of > or = 140 mm Hg or diastolic pressure measurements > or = 90 mm Hg, or both, during the previous year) decreased from 36% in 1992 to 25% in 1993 after the regional diabetes coordinator emphasized hypertension control. In 1994, when less emphasis was placed on hypertension, 33% of the diabetic patients had uncontrolled hypertension. Estimates of metabolic control from records of diabetic patients in Washington, Oregon, and Idaho in 1994 showed that 29% of patients had excellent metabolic control (a hemoglobin A1c [HbA1c] level < or = 7.5% or mean blood glucose level < or = 9.2 mmol/L) within the past year; only 9% experienced poor control (a HbA1c level > 12% or mean blood glucose level > 18.9 mmol/L). CONCLUSIONS: The IHS experience shows that standard, ongoing monitoring of key variables allows facilities to improve diabetes care. Simple, reliable methods of defining metabolic control combined with a feedback system in the primary care setting are needed to improve metabolic control in patients with NIDDM.

Diabetes Mellitus, Type 2↗

[Analyses on the risk factors of Measles in Anhui province during 1998 and 1999].

OBJECTIVE: To evaluate the measures targeting measles control. METHODS: Measles cases were studied serologically under AFP surveillance system. RESULTS: The incidence was 1.36/100 000 in 1999. The incidence of children under 5 was 3.65/100 000, with 84.00% and 87.49% reduction, as compared with the incidence in 1991 and 1997 before intensified vaccination campaigns in children aged 1 - 6. The indicators of surveillance showed an improvement in 1999 than that in 1998. CONCLUSION: Training for health staff at county, township, vallage levels played an important role in improving the sensibility and timeliness of measles surveillance system. Routine immunization is a key element in curbing measles outbreaks and reducing measles incidence.

Adolescent↗

Influence of a high carbohydrate diet on the functional activity of 5-HT1B/1D receptors on human peripheral blood lymphocytes during intense military training.

The present study was undertaken to examine the effect of a high carbohydrate diet on the functional activity of 5-HT1B/1D receptors in human peripheral blood lymphocytes, and on serum cortisol and plasma cytokine responses during intense military training. Thirty two male soldiers (mean age: 21 +/- 2 years) were randomly assigned to two groups and received either 3200 kcal/24 h [13440 kJ; habitual diet group (HD)] or 4200 kcal/24 h [17640 kJ, high carbohydrate diet group (HCD)] by adding 1000 kcal (4200 kJ) of fruit jelly to the HD. They took part in a three-week training program followed by a five-day combat course. Blood samples were collected from each group before entry into the commando training and after the five-day combat course. The results of [35S] GTPgammaS binding assays showed that h5-HT1B/1D receptors were desensitized after the training program in the HD group, whereas no change was observed between the beginning and the end of the military training in the HCD group [(HD : IC50 = 100 +/- 14 nM to 544 +/- 178 nM; n = 16) and (HCD: IC50 = 68 +/- 14 nM to 101 +/- 22 nM; n = 16)]. Serum cortisol was only significantly increased after the commando training in the HD group (from 532.2 +/- 30 to 642 +/- 45 nmol.L(-1), p < 0.05), whereas values were not significantly changed in the HCD group (441 +/- 31 to 502 +/- 40 nmol.L(-1)). No changes were observed in IL-10, TNF-alpha and IFN-gamma levels after the training program in either group. Carbohydrate ingestion or additional dietary energy during repeated bouts of high-intensity exercise could attenuate the alterations in immune function via 5-HT1B/1D receptors and the action of 5-HT moduline, an endogenous tetrapeptide (Leu-Ser-Ala-Leu) that specifically modulates the sensitivity of 5-HT1B/1D receptors.

Adult↗

[Effect of dibazol on indices of nonspecific resistance in human subjects in a hermetically sealed enclosure].

Prophylactic administration of dibazol (5 mg/day) prevents a decrease of nonspecific resistance and ensures stable variations of adaptive processes in men working in enclosures for a long time. The positive effect of the drug occurs 10-15 days after the administration and involves a combined action on phagocytosis, blood homeostasis, and skin antimicrobial resistance. The integrated parameters of nonspecific protection of the test subjects who took dibazol are close or even better than the pretest level. For instance, the efficiency of intracellular digestion increases and the microbial content of blood decreases. Coincidentally, the health condition improves and physical work capacity increases. Dibazol also exerts a beneficial effect on the adaptive process and morbidity rate of the subjects. The data obtained suggest that dibazol affects favorably the nonspecific resistance of the human body. In view of this, it can be recommended as a stimulating and training agent.

Adult↗

"Pierced by the arrows of this ghostly world" - a review of arrow wounds in Enga Province.

According to the rural Enga people of the Highlands of Papua New Guinea treatment of wounded warriors is a priority issue in health care. If health services there ignore this, the respect and support of the community could be lost. Important public health programmes such as maternal and child health clinics and immunization programmes would suffer as a consequence, because their promotion is not a community priority at present. Accordingly, the health services should improve the training of health workers in the treatment of arrow wounds which are a common problem as a results of constant clan warfare. If the Enga community appreciated that wounded men received satisfactory treatment in rural centres, it would cooperate better with health workers in preventive health programmes.

Attitude of Health Personnel↗

A Web-based interactive education programme on vaccination for public health officials.

Health and Welfare Training Center of Korean National Institute of Health (KNIH) has developed various education curricula for officials who are involved in the public health or welfare sectors. Still almost all education programmes are off-line based. In off-line settings, both the lecturers and the students should come to NIH from their counties to join the education programmes, and it is impossible for the students to review or to re-practice the education contents. We developed a prototype on-line setting education programmes to provide a more convenient and more effective service to the officials. This web-based interactive education programme consisted of the specific objectives on vaccination for the public health officials who were working for the national immunization programmes. It became a prototype of web-based education and was evaluated by the participants in April, 2001. From the evaluation, we improved the contents and tried to develop more subjects for the officials' training.

Adult↗

Forty years of litigation involving residents and their training: II. Malpractice issues.

The authors reviewed 136 cases of malpractice litigation involving residents or programs of graduate medical education that were reported from 1950 through 1989. Before 1970 malpractice constituted the only area of reported litigation for residents. The number of malpractice cases involving residents increased substantially after 1975, paralleling the growth of malpractice cases nationally. The regional pattern of reported cases involving residents also corresponded with previous findings. Questions of vicarious liability, the applicable standard of care, and residents' supervision were at issue in the great majority of cases. Questions related to judicial procedure, immunity from liability, breach or causation, and informed consent were also litigated. Residents were on the side of the prevailing party in 44% of the cases. Malpractice continues to be the key legal issue facing programs of residency training.

Internship and Residency↗

A large outbreak of streptococcal pyoderma in a military training establishment.

An outbreak of streptococcal pyoderma in a military institution into which fresh susceptible recruits were regularly introduced involved more than 1300 persons over an eighteen-month period. Two M types were responsible for the great majority of the cases and an attack by one conferred immunity to that strain but not to the other. Lesions varied from trivial to disabling. Epidemiological studies indicated that contact -- direct or indirect -- through such things as gymnasium equipment and room dust was the means of transmission. The outbreak was eventually controlled by vigorous case finding, thorough treatment of cases and the strict application of hygienic principles to prevent spread. There were no late complications and throat streptococci were not involved. It is possible to control such an outbreak without isolation or the making of any significant concessions in the training programme even when large numbers of persons are living and working at close quarters.

Follow-Up Studies↗

Radiogenomic MRI biomarkers for noninvasive prediction of GPC3 expression and tumor microenvironment in hepatocellular carcinoma.

BACKGROUND: Glypican-3 (GPC3) is frequently overexpressed in hepatocellular carcinoma (HCC) and plays a key role in immune and metabolic remodeling of the tumor microenvironment. Reliable noninvasive biomarkers for predicting GPC3 status could improve patient stratification and support precision immunotherapy. METHODS: This multicenter retrospective study included 274 patients with pathologically confirmed hepatocellular carcinoma from three institutions, 34 external cases with MRI from The Cancer Imaging Archive, and 363 transcriptomic profiles from The Cancer Genome Atlas. Contrast-enhanced T1-weighted imaging and diffusion-weighted imaging were analyzed. Tumor and peritumoral regions were segmented manually and radiomic features extracted using PyRadiomics. Feature selection was performed with correlation filtering and least absolute shrinkage and selection operator regression. Machine learning classifiers including logistic regression, random forest, support vector machine, k-nearest neighbor, and decision tree were trained with 10-fold cross-validation and tested on independent external cohorts. A radiomics score was calculated for each patient. Radiogenomic analysis correlated radiomics scores with transcriptomic data using weighted gene co-expression network analysis. Hub genes and enriched pathways were identified, and immune infiltration and predicted immunotherapy response were assessed using computational methods. RESULTS: The random forest model using contrast-enhanced T1-weighted imaging achieved an area under the curve of 0.966 in training and 0.935 in internal validation. The integrated contrast-enhanced T1-weighted imaging plus diffusion-weighted imaging model reached an internal validation area under the curve of 0.979. In external testing, the best performance was obtained with a support vector machine model (area under the curve 0.756). Radiomics scores were significantly correlated with GPC3 expression (R&#x2009;=&#x2009;0.78, p&#x2009;<&#x2009;0.05). Transcriptomic analysis identified a 10-gene signature enriched in hypoxia and lipid metabolism pathways that stratified patients into prognostic subgroups (concordance index 0.720, hazard ratio 4.07, p&#x2009;<&#x2009;0.0001). High-risk patients had greater immune infiltration and a lower predicted immune evasion score, suggesting a potential benefit from immunotherapy. CONCLUSIONS: MRI-based radiomics models can noninvasively predict GPC3 expression in hepatocellular carcinoma. Radiomics scores reflect underlying hypoxia and lipid metabolism pathways and stratify patients by prognosis and predicted immunotherapy response. These findings support radiogenomics as a translational approach to imaging-guided precision treatment in hepatocellular carcinoma.

Humans↗

[High immunization rates--how can they be achieved at all?].

High rates of immunization are achieved not only by compulsory vaccination. Strict discipline is necessary as well as motivation of medical assistants and of patients in their social environment. All people have a natural instinct for protecting themselves against risks of life. This instinct can in fact be stimulated by repeated motivation and can be enforced by propaganda. The process of propaganda alone cannot stimulate urges. Strategy of immunization must be standardised in all districts of the Federal Republic. This means: immunisation schedule, information of patients, children and of their parents. This is part of discipline of vaccination, same as is the permanent training of medical staff. They should be sent to seminars and training workshops. Specialist opinions must be differentiated as to whether they are scientists or articulate their own and personal opinion or whether their attitude is conditioned by general medical considerations. Any legal claims arising from vaccination accidents would be decided 'in dubio pro aegroto'.

Child↗

A novel lactylation-related gene signature deciphers the immunosuppressive microenvironment and stratifies precision therapy in colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) remains a leading cause of cancer mortality, largely due to the heterogeneity of the tumor microenvironment (TME) and the limited efficacy of immunotherapy in microsatellite stable (MSS) tumors. Histone lactylation, a post-translational modification derived from the Warburg effect, serves as a critical bridge linking metabolic reprogramming to gene regulation and immune evasion; however, its specific prognostic value and clinical implications in CRC remain to be fully elucidated. METHODS: In this study, we systematically analyzed transcriptome profiling data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) cohorts, supplemented by single-cell RNA sequencing (scRNA-seq) analysis and Human Protein Atlas (HPA) protein-level validation. By integrating univariate Cox regression, Least Absolute Shrinkage and Selection Operator (LASSO) analysis, and multivariate Cox regression, we constructed a novel lactylation-related gene (LRG) risk signature. We extensively evaluated the association between this risk signature and patient prognosis, immune infiltration patterns, somatic mutations, and therapeutic sensitivity. RESULTS: A robust 9-gene prognostic signature (DHRS7, SPR, MBD2, RBM17, CSRP2, S100A4, TMSB4X, TKT, COPS4) was identified and corroborated at the protein level. Patients with high risk scores exhibited significantly worse overall survival (OS) across the training and two independent validation cohorts. Immunogenomic and scRNA-seq analyses revealed that high-risk tumors were characterized by an immunosuppressive and stromal-dense microenvironment-with stromal cells exhibiting the highest lactylation risk scores-enriched with regulatory T cells (Tregs), and frequently harbored PIK3CA mutations. Differential expression analysis indicated that this immune exclusion is structurally maintained by enriched extracellular matrix (ECM) organization and TGF-&#x3b2; signaling. Conversely, low-risk tumors displayed an inflamed phenotype with active antitumor immunity. Pharmacogenomic prediction identified distinct therapeutic stratifications: low-risk patients exhibited significant sensitivity to standard chemotherapeutics (fluorouracil, oxaliplatin) and EGFR/HER2 inhibitors (e.g., lapatinib, erlotinib). In contrast, high-risk patients showed specific vulnerabilities to novel targeted agents, including PI3K pathway inhibitors (TG-100-115, XL765), microenvironment-modulating agents (sildenafil, GANT-61), and epigenetic inhibitors (UNC0638). CONCLUSION: We established a novel lactylation-related risk signature that effectively stratifies CRC patients by prognosis and TME characteristics. By elucidating the crosstalk between metabolic dysregulation, stromal barriers, and immune exclusion, this study provides potential biomarkers and stratified therapeutic strategies-ranging from standard chemotherapy to targeted metabolic and stromal interventions-to optimize precision medicine for CRC patients.

Colorectal cancer↗

The preschool child: developmental themes and clinical issues.

The preschool years are a remarkable period of dramatic growth in the areas of physical, affective, and cognitive development. Physical development is characterized by a slow but steady rate of somatic growth and the mastery of motor skills that facilitate the child's achievement of autonomy and independence. Major themes in affective development include the achievement of autonomy and independence from family, a lessening of attachment to parents and the alleviation of separation anxiety, and the acquisition of impulse control and socialization skills. Cognitive development during the so-called preoperational period is best characterized by the mastery of language. The remarkable developmental gains achieved during this dynamic period culminate in a child who can function independently and competently and begin the major occupation of childhood--attending school. Health maintenance issues during the preschool years directly reflect the child's developmental stage. For example, nutritional issues reflect not only physical growth and motor skills, but also negativism and the child's struggle to achieve autonomy. Similarly, safety and injury prevention related to the "motor-minded" behavior so characteristic of children at this age, as well as the illogical, egocentric thought that predominates during this period of cognitive development. Examples of other stage-related issues addressed during health maintenance visits include discipline and behavior problems, sleep problems and night awakening, and toilet training. The unique aspects of development during the preschool years also have implications for other components of child health maintenance, including developmental screening, procedures and immunizations, and physical assessment. A number of clinical issues are of special significance during the preschool years. For example, the most common causes of children's short stature, constitutional delay in growth and familial short stature, may result in major parental concerns at this time. Recurrent otitis media is an important problem during this period of language acquisition. Among preschool children with urinary tract infections, the risk of an underlying structural anomaly of the urinary tract and the danger of irreversible renal damage is greater than for older children.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

Examining diabetes health benefits in health plans of large employers.

Components of the contract specifications (also known as model purchasing specifications) for diabetes care that were developed by George Washington University (Washington, D.C.) and the Centers for Disease Control and Prevention were applied to 20 health plans from two Fortune 500 companies as well as the Federal Employee Health Benefits Plan to investigate the extent of diabetes-related benefits available to employees. Diabetes-related benefits covered a range of services and supplies that include insulin, physician visits, immunizations, diabetes preventive assessments, foot and eye exams, hemoglobin A1c tests, orthotics, diabetes self-management education, case management, smoking cessation, obesity treatment, and exercise training. The 20 health plans included health maintenance organizations, preferred provider organizations, point of service plans, and one indemnity plan. Services and supplies were assigned to three tiers: tier 1, general diabetes care; tier 2, specialty diabetes care; tier 3, lifestyle services. Services and supplies were considered covered even if they required authorization by the provider (e.g., doctor referral, recommendation, or prescription) or the health plan. Tier 1 services and supplies received more comprehensive coverage by all health plans. Differences in coverage were more notable in tiers 2 and 3 than in tier 1. Tier 3 (lifestyle services) received less coverage than tiers 1 and 2.

Contract Services↗

The NIM revolution.

This paper is dedicated, with great admiration and affection, to a giant of modern science, Ion Baciu. More than a half-century ago, he began to experimentally explore the influence of the central nervous system on the peripheral vascular system including the mysteriously complex actions of phagocytosis and erythropoiesis. To this day, he has never stopped! Other great scientists, in many countries, examining neuro-endocrine-immune interactions (NIM), came and went: Ion Baciu is still at it, all the while writing high-quality textbooks, directing a great research institute, training several generations of young scientists and physicians, publishing many first-rate research reports (in several languages) in diverse scientific journals, working often under very difficult circumstances with inadequate financial resources, and never uttering one word of complaint. This is indeed a most exceptional scientist and an exemplary human being who has set high standards that few will ever equal.

Adjuvants, Immunologic↗