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Nathan Goodyear

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-l... - 0 views

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    study finds very low calorie diet reversed diabetes. The greatest weight loss was associated with greatest remission of diabetes at 86% with >15 kg weight loss.
Nathan Goodyear

Effects of aerobic and/or resistance training on body mass and fat mass in overweight o... - 0 views

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    If time is of the essence and weight loss is your greatest concern, cardio is your best approach.  Resistance training would be the least best approach.  Obviously, this should be customized.
Nathan Goodyear

Lifestyle and nutritional imbalances associated with Western diseases: causes and conse... - 0 views

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    This study finds most "western" diseases are the result of environment and only <5% genetic. Evidence is growing that the environment is the largest contributor to disease.  The greatest environment contributor is diet. This is great, because we can change diet...if one wants too. This article also shows are current understanding on how dietary inflammation results in insulin/glucose disruption.
Nathan Goodyear

Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vacc... - 0 views

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    study points to the lower HPV rats with the advent of the HPV vaccine; yet the greatest reduction in  HPV prevalence was in unvaccinated girls.
Nathan Goodyear

Obesity and Severe obesity forecasts through 2030 - 0 views

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    Very real and scary statistics. Obesity is the greatest health problem facing the US today. 42%-51% by 2030...Ouch! Ever seen WALL-E. However, it is not the govt responsibility to control what we eat. Their regulations are in part responsible for this. This needs to be attacked through education, personal responsibility, and changing the way medicine works (of which many of the current medical boards/associations are opposed too).
Nathan Goodyear

Occurrence of pituitary dysfunction following ... [J Neurotrauma. 2004] - PubMed - NCBI - 0 views

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    pituitary dysfunction found in people with TBI.  This study found the greatest effect on HGH.
Nathan Goodyear

Sex Hormones and Age: A Cross-sectional Study of Testosterone and Estradiol and Their B... - 0 views

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    Older men have Estradiol levels that are 3 x that of a post-menopausal women.  The bioavailable levels of Testosterone and Estradiol showed the greatest precipitous decline.
Nathan Goodyear

Circulating Estrone Levels Are Associated Prospectively With Diabetes Risk in Men of th... - 0 views

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    A cross-sectional study of 1,458 men over a 13 years found an increase risk of diabetes incidence with elevated Estradiol and Estrone levels.  The greatest association was found with Estrone.  This should come as no surprise to anybody as type II diabetes is clearly associated with increasing weight and this is the source of 80% of estrogen production in men.
Nathan Goodyear

Exercise-induced right ventricular dysfunction and structural remodelling in endurance ... - 0 views

  • In a cohort of well-trained athletes, we demonstrated that intense endurance exercise causes an acute reduction in RV function that increases with race duration and correlates with increases in biomarkers of myocardial injury
  • no relationship between LV function and biomarker levels
  • focal gadolinium enhancement and increased RV remodelling were more prevalent in those athletes with a longer history of competitive sport, suggesting that repetitive ultra-endurance exercise may lead to more extensive RV change and possible myocardial fibrosis
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  • he cardiac impact of both acute and cumulative exercise is greatest on the RV.
  • Greater reductions in RV function occurred in those athletes competing for a longer duration, suggesting that the heart has a finite capacity to maintain the increased work demands of exercise
  • We enrolled elite and subelite athletes and found a significant association between fitness (VO2max) and the reduction in post-race RVEF
  • Previous investigators have documented reductions in RV function in less trained subjects over the marathon distance
  • cardiac injury is greatest in the least trained
  • Even after many years of detraining, cardiac dilation may not completely regress in elite athletes
  • The focus on well-trained athletes may be of particular relevance, given that they perform exercise of highest intensity and duration most frequently, and, thus, may be at a greater risk of cumulative injury.
  • The lack of correlation between increases in troponin and changes in LV function seen in this study has been previously interpreted as evidence that post-exercise elevations in cardiac biomarkers are benign.
  • a significant correlation between changes in RVEF and post-race biomarker levels and this relationship was even stronger in the athletes who completed the race of longest duration, the ultra-triathlon
  • It has been demonstrated that ventricular load increases with exercise intensity and is greater for the RV than the LV,29 thus potentially explaining why the RV is more susceptible to fatigue after prolonged exercise.
  • BNP release during intense exercise is associated with greater relative increases in RV systolic pressures, but not LV pressures
  • BNP may provide a measure of both acute RV load and the resultant fatigue which occurs when this load is sustained
  • The correlations with RVEF, but not LVEF, provide further evidence of the differential effects of intense exercise on RV and LV function
  • This study demonstrates, for the first time, an association between endurance exercise of increasing duration and structural, functional, and biochemical markers of cardiac dysfunction in highly trained athletes
  • Functional abnormalities were confined to the RV and were largely reversible 1 week following the event
  • there remained a significant minority of athletes in whom there was evidence of myocardial fibrosis in the interventricular septum
  • RV abnormalities may be acquired through cumulative bouts of intense exercise and provides direction for prospective investigations aimed at elucidating whether extreme exercise may promote arrhythmias in some athletes.
  • the acute injury and chronic remodelling of the myocardium both disproportionately affect the RV and it remains possible that the two are linked.
  • focal DGE was confined to the interventricular septum and commonly at the site of RV attachment
  • emerging evidence that intense endurance exercise may be associated with an excess in arrhythmic disorders, the mechanisms for which remain unexplained
  • RVEF (and not LVEF) was reduced in athletes with complex ventricular arrhythmias when compared with healthy athletes and non-athletes without arrhythmias
  • it is premature to conclude that these changes may represent a proarrhythmic substrate
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    Study finds endurance racing results in reduce Right ventricle ejection fraction even in elite athletes.  This post-race RVEF reduction is associated with VO2max.
Nathan Goodyear

Aging, androgens, and the metabolic syndrome in a longitudinal stud... - PubMed - NCBI - 0 views

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    In men, 20-94, lower Total Testosterone and SHBG was found to be associated with a higher incidence of metabolic syndrome.  Abstract only.  The greatest association was found with SHBG.
Nathan Goodyear

Spectrum of metabolic dysfunction in relationship with hyperandrogenemia in obese adole... - 0 views

  • subjects with hyperandrogenemic phenotypes displayed the greatest degree of hyperinsulinemia, β-cell function, and chronic inflammation
  • The rise in serum androgens is accompanied by excess insulin secretion, suggesting that insulin directly stimulates ovarian androgen production
  • The degree of hyperinsulinemia does not seem to be directly correlated with the development of HS
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  • higher androgen and insulin levels stimulate hair growth
  • genetic and epigenetic changes may be involved in the pathogenesis of PCOS
  • HA has been identified as an important risk factor for MS and dyslipidemias in premenopausal women and adolescents
  • In our study, HA was found to be an independent risk factor for MS as previously reported by Coviello et al.
  • obesity and HA, and not insulin resistance, are the major determinants of chronic inflammation and risk of atherosclerosis in adolescents with PCOS
  • use of an inflammation marker may help identify high-risk females with PCOS
  • hyperandrogenemic PCOS phenotypes have greatest degree of hyperinsulinemia, insulin resistance, and inflammation
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    Elevated androgens are associated increasing insulin, insulin resistance, and inflammation (as measured by CRP).
Nathan Goodyear

The endurance triathlon: metabolic changes after each event and dur... - PubMed - NCBI - 0 views

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    Serum lactate elevates early in triathlon.  The greatest increase is associated with the swim event.  Muscle damage progressed through the 3 events (creatine phosphokinase and LDH).  Uric acid levels increased.  Recovery was seen out to 6 days post event.
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Ergonomic Wheelchair - 0 views

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    Lightweight Ergonomic Wheelchair is designed to cradle patients in comfort while reducing risk of pressure sores, relieving pressure, dispersing weight evenly and improving stability. The Ergo Lite Wheelchair is easy to lift and its small size makes it ideal for travel. Weighing only 19.8 lbs., the chair is easy to store and transport. The chair folds down the middle like a standard wheelchair and the backrest also folds down to make the wheelchair even more compact. Also features companion brakes located on handles for added safety and comfort. Ergonomic Wheelchairs are ultra lightweight and have a supportive seating system to provide pressure relief and anti-slippage giving the user excellent stability and posture support. . Better Ergonomic wheelchair for Comfort: Sit for any length of time in a fixed position in a traditional transport chair and it will feel how painful bad ergonomics can be. It is fully reclined 25° angle, which minimizes slumping and sliding. And because of this can be easily adjusted with the push of a button, it can change positions frequently over time, reducing the chance of secondary conditions that may include pressure sores. Designed to Fit Almost Everyone: It is one of the most extensively researched seat profiles specifically design to accommodate users ranging in size from small women to large men, with the greatest amount of comfort and proper posture/spinal support. The Karman wheelchairs are exceptional in both their function and style. With comfort built right into the frame of a wheelchair eliminating the need for a "thick cushion" to add comfort, S-Shape seat allows the wheelchair to be "ergonomically correct" putting into a seating position and comfort conforming to natural body's curves. These chairs are built for comfort and quality to stand the test of time. Ergonomic Wheelchair is Right: Ergonomic Wheelchair is designed for users who will spend a large amount of time in the chair. This wheelchair'
Nathan Goodyear

Clinical Pharmacodynamic Effects of the Growth Hormone Receptor Antagonist Pegvisomant:... - 0 views

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    Pegvisomant shown to provide more GH, IGF-1 suppression compared to octreotide. The doses used were 40, 60, and 80 mg SQ. The higher dose resulted in the greatest suppression.
spineneuro

Dr. Mihir Bapat Best Robotic Spine Surgeon Nanavati Offers Magic Cure to Your Pain - 0 views

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    Dr. Mihir Bapat's best robotic spine surgeon Nanavati offers the greatest variety of MIS procedures in India; he is more than likely to have the right minimally invasive alternative that works for your needs, as he is an expert in minimally invasive spine surgery. Book an appointment just call at +91 9325887033 or you can directly write to doctor dr.mihirbapat@neurospinehospital.com
Nathan Goodyear

Bisphenol A Promotes Human Prostate Stem-Progenitor Cell Self-Renewal and Increases In ... - 0 views

  • these findings show that estrogen stimulates human prostate epithelial stem cell self-renewal and progenitor cell amplification (prostasphere size), with the greatest effects observed at lower E2 doses.
  • Similar to E2, BPA increased prostasphere number and size with significant and maximal effects observed at 10 nM BPA
  • Taken together, these results provide strong evidence that, similar to E2, BPA increases stem cell self-renewal and progenitor amplification in normal human prostate epithelial cells
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  • these findings provide further support that E2 and BPA maintain the stem-like state within the normal prostate epithelial cell population
  • Our previous findings demonstrated that normal prostate stem-progenitor cells within the prostaspheres expressed ERα and ERβ, implicating them as direct targets for E2 and BPA action
  • p-Akt and p-Erk, well established downstream targets of membrane-associated ERs
  • BPA and E2 had equimolar capacity for activation of these rapid signaling pathways in human prostaspheres, thus identifying a dynamic and robust signaling pathway initiated by low-dose BPA exposure in prostate stem-progenitor cells.
  • these findings indicate that both rapid membrane-initiated estrogen action and genomic ER signaling pathways are operative in human prostate progenitor cells.
  • these results document the fact that levels of bioactive BPA in the present study are similar to levels found in human umbilical cord blood and newborns in the general population
  • the present findings identify for the first time that in vivo exposure of the human prostate epithelium to low doses of BPA significantly increases the susceptibility of the human prostate epithelium to hormonal carcinogenesis.
  • The current study provides clear evidence that, similar to E2, normal human prostate stem and progenitor cells are direct targets for BPA action
  • Both hormones increased stem-like cell numbers in primary prostate epithelial cultures in a dose-dependent manner and augmented the number and size of 3-D cultured prostaspheres, markers of stem cell self-renewal and progenitor cell proliferation, respectively
  • signaling pathways engaged by estrogens through these separate receptors are multiple and complex, including both membrane-initiated signaling and genomic activation via ER transcriptional activity
  • Estrogen action is mediated by ERα and ERβ
  • the current results indicate that developmental exposure to BPA, at doses routinely found in humans, significantly increases the cancer risk in human prostate epithelium in response to elevated estrogen levels in an androgen-supported milieu. Because relative estrogen levels rise in aging men, we suggest that humans may be susceptible to BPA-driven prostate disease in a manner similar to that in the rodent models.
  • We propose that early-life perturbations in estrogen signaling including inappropriate exposure to BPA have the potential to amplify and modify the stem-progenitor cell populations within the human prostate gland and, in so doing, alter the normal homeostatic mechanisms that maintain a growth neutral state throughout life
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    Bisphenol A exposure in utero found to increase prostate cancer risk later in life.  This exposure occurred at typical life exposure levels as found in umbilical cord blood sampling,  This occurred through stem cell self-renewal and progenitor amplification
Nathan Goodyear

Hormonal Modulation in Aging Patients with Erectile Dysfunction and Metabolic Syndrome - 0 views

  • Hypogonadism and MetS are strongly associated [12, 13, 16], having even been demonstrated that with the increasing number of MetS parameters there is a proportional raise in the incidence of hypogonadism
  • increasing number of MetS components is inversely associated with T levels
  • the presence of MetS did not prove to be a significant determinant of hypogonadism, as it did not lead to a decline in T levels, in MetS patients with already established hypogonadism, the increasing number of MetS features was associated with further decline in T
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  • In the setting of MetS, hypertriglyceridemia and increased WC have been reported as the most important determinants of hypogonadism
  • recent literature consistently associates obesity not only with higher risk of hypogonadism [4, 6, 27] but also with lower T levels
  • Visceral adiposity has been particularly related with reduction of T and SHBG levels (independent of other metabolic disorders)
  • WC was one of the MetS parameters with the greatest influence in T levels decrease, presenting itself as a strong risk factor for hypogonadism development
  • MetS-related T decline was not accompanied by an increase in pituitary LH levels, suggesting impairment in gonadotropin secretion
  • The molecules behind this smoothing compensatory effect of GnRH/LH are still unknown, but estrogens and insulin, as well as leptin, TNF-α, and other adipokines, were proposed candidates
  • fat stores undertake an increase aromatization of androgens, therefore raising estrogen levels [9, 15], which in turn decrease LH secretion
  • our data contradicts the concept that estradiol exerts a negative feedback on hypothalamic GnRH secretion
  • taking into account that high estradiol levels have already been described as the only abnormality in a subset of patients with ED, the hypothesis that the later might not only be caused by androgen deficiency is becoming increasingly evident
  • it has been reported that the chronic exposure to phosphodiesterase type 5 inhibitors (PDE5i), widely used for the treatment of ED, may influence serum estradiol levels
  • thyroid disorders (specially hyperthyroidism) have been related to ED and hypogonadism, and so must be considered in a sexual-dysfunction setting
  • It is clear from the current literature that collecting a more thorough hormonal panel might be a wise approach to further uncover hormonal relations
    • Nathan Goodyear
       
      outstanding point.  This hits to the point that Low T is the effect not the cause.
  • We concluded that in ED patients with hypogonadism and MetS, the attenuated response of HPG axis (normal or low LH levels) might not always be due to an underlying adiposity-dependent estrogen-raising effect.
  • our findings indicate that ED, aging, and estradiol might have a stronger connection than what is currently described in the literature.
  • this study underlines the importance of the collection of a full hormonal panel in ED men
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    low T strongly associated with metabolic syndrome in men.
Nathan Goodyear

Testosterone Deficiency, Cardiac Health, and Older Men - 0 views

  • Studies have shown pharmacological doses of testosterone to relax coronary arteries when injected intraluminally [39] and to produce modest but consistent improvement in exercise-induced angina and reverse associated ECG changes [40]. The mechanism of action is via blockade of calcium channels with effect of similar magnitude to nifedipine
    • Nathan Goodyear
       
      This directly refutes the recent studies (3) that Testosterone therapy increases cardiovascular events.
    • Nathan Goodyear
       
      Testosterone acts as a calcium channel blocker inducing vasodilation.
  • men with chronic stable angina pectoris, the ischaemic threshold increased after 4 weeks of TRT and a recent study demonstrates improvement continuing beyond 12 months [
  • Exercise capacity in men with chronic heart failure increased after 12 weeks
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  • Studies have shown an inverse relationship between serum testosterone and fasting blood glucose and insulin levels
  • Medications such as chronic analgesics, anticonvulsants, 5ARIs, and androgen ablation therapy are associated with increased risk of testosterone deficiency and insulin resistance
  • Women with T2D or metabolic syndrome characteristically have low SHBG and high free testosterone
    • Nathan Goodyear
       
      This stands in polar opposite of that with men.
  • Hypogonadism is a common feature of the metabolic syndrome
  • The precise interaction between insulin resistance, visceral adiposity, and hypogonadism is, as yet, unclear but the important mechanisms are through increased aromatase production, raised leptin levels, and increase in inflammatory kinins
  • levels of testosterone are reduced in proportion to degree of obesity
  • Men should be encouraged to combine aerobic exercise with strength training. As muscle increases, glucose will be burned more efficiently and insulin levels will fall. A minimum of 30 minutes exercise three times weekly should be advised
  • Testosterone increases levels of fast-twitch muscle fibres
  • By increasing testosterone, levels of type 2 fibres increase and glucose burning improves
  • Weight loss will increase levels of testosterone
  • studies now clearly show that low testosterone leads to visceral obesity and metabolic syndrome and is also a consequence of obesity
  • In the case of MMAS [43], a baseline total testosterone of less than 10.4 nmol/L was associated with a greater than 4-fold incidence of type 2 diabetes over the next 9 years
  • There is high level evidence that TRT improves insulin resistance
  • Low testosterone predicts increased mortality and testosterone therapy improves survival in 587 men with type 2 diabetes
  • A similar retrospective US study involved 1031 men with 372 on TRT. The cumulative mortality was 21% in the untreated group versus 10% ( ) in the treated group with the greatest effect in younger men and those with type 2 diabetes
  • the presence of ED has been shown to be an independent risk factor, particularly in hypogonadal men, increasing the risk of cardiac events by over 50%
  • A recent online publication on ischaemic heart disease mortality in men concluded optimal androgen levels are a biomarker for survival
  • inverse associations between low TT or FT (Table 2) and the severity of CAD
  • A recent 10 year study from Western Australia involving 3690 men followed up from 2001–2010 concluded that TT and FT levels in the normal range were associated with decreased all-cause and cardiovascular mortality, for the first time suggesting that both low and DHT are associated with all-cause mortality and higher levels of DHT reduced cardiovascular risk
  • TDS is associated with increased cardiovascular and all-cause mortality
  • The effect of treatment with TRT reduced the mortality rate of treated cohort (8.4%) to that of the eugonadal group whereas the mortality for the untreated remained high at 19.2%
  • hypogonadal men had slightly increased triglycerides and HDL
  • Men with angiographically proven CAD (coronary artery disease) have significantly lower testosterone levels [29] compared to controls ( ) and there was a significant inverse relationship between the degree of CAD and TT (total testosterone) levels
  • TRT has also been shown to reduce fibrinogen to levels similar to fibrates
  • men treated with long acting testosterone showed highly significant reductions in TC, LDL, and triglycerides with increase in HDL, associated with significant reduction in weight, BMI, and visceral fat
  • Low androgen levels are associated with an increase in inflammatory markers
  • In the Moscow study, C-reactive protein was reduced by TRT at 30 weeks versus placebo
  • In some studies, a decline in diastolic blood pressure has been observed, after 3–9 months [24, 26] and in systolic blood pressure
  • A decline was noted in IL6 and TNF-alpha
  • No studies to date show an increase in LUTS/BPH symptoms with higher serum testosterone levels
  • TRT has been shown to upregulate PDE5 [65] and enhance the effect of PDE5Is (now an accepted therapy for both ED and LUTS), it no longer seems logical to advice avoidance of TRT in men with mild to moderate BPH.
    • Nathan Goodyear
       
      What about just starting with normalization of Testosterone levels first.
  • Several meta-analyses have failed to show a link between TRT and development of prostate cancer [66] but some studies have shown a tendency for more aggressive prostate cancer in men with low testosterone
    • Nathan Goodyear
       
      And if one would have looked at their estrogen levels, I guarantee they would have been found to be elevated.
  • low bioavailable testosterone and high SHBG were associated with a 4.9- and 3.2-fold risk of positive biopsy
  • Current EAU, ISSAM, and BSSM guidance [1, 2] is that there is “no evidence TRT is associated with increased risk of prostate cancer or activation of subclinical cancer.”
  • Men with prostate cancer, treated with androgen deprivation, develop an increase of fat mass with an altered lipid profile
  • Erectile dysfunction is an established marker for future cardiovascular risk and the major presenting symptom leading to a diagnosis of low testosterone
wheelchairindia9

Shower Wheelchair - 0 views

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    Commode chairs are portable toilets, designed to be placed at the bedside of a disabled individual whose activity is very limited. It is typically consist of a frame and a waste receptacle that can be easily removed and emptied. Having such a device close at hand is especially helpful for those too debilitated to make the trip to the bathroom. So, if someone close to needs the support and convenience that commodes can offer, the right place. Adapted and assisted toileting systems help provide independence while being designed to be practical, versatile and comfortable, as well as, easy to clean. These adjustable toilets and commodes can be used as a freestanding commode chair, over the toilet, on the toilet, or as a shower chair. Commode Wheelchair Rainbow 6 Features: Frame Material : M.S.Chrome Plated. Single Seat with center cut commode. Both Option Available In Single Seat. Plastic Commode Seat With Pot. Cushioned Top Cover. Square Pan Commode Pan . Removable Pan. Commode Wheelchair Rainbow 6 Measurements: Frame Style : Foldable Open Position Wheel To Wheel Width In : 26" (Inches) Seat Width : 18" (Inches) Total Width in Closing Position : 11" (Inches) Rear Wheel Size : 24" (Inches) Front Wheel Size : 8" (Inches) Seat to Floor Height : 19" (Inches) Seat Depth : 18" (Inches) Total Height : 34" (Inches) Max User Weight Capacity : 110 (kgs) Net Weight : 19.5 (kgs) Armrest : Fixed Footrest : Fixed Wheel Quality : Rear Tyre Solid Tube Less Rear Wheel Lock : Yes Hand Brakes : No Drop Back Handle : No Providing a wide range of commode wheelchairs which are specially designed for aged and physically challenged people. These wheelchairs can be used for indoor toilet purposes. Fabricated using quality raw material, these wheelchairs are suitable for western as well as Indian toilets. This advanced technology involved wheelchair has a comfortable seat and made of a strong steel frame. This chair is very durable
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