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D 0.27; 95% CI 0.06, 0.49; P = 0.007). Inflammatory and neurotrophic markers did not change in either group. Conclusion In healthy community-dwelling older adults undertaking resistance-based exercise training 3-d/wk, participants who consumed lean red meat in line with current Australian dietary recommendations did not experience any significant additional benefits in the primary outcome measures of muscle mass, strength, or cognitive function compared to participants consuming carbohydrates.This trial is registered with the Australian and New Zealand Clinical Trials Registry as ACTRN12613001153707.Importance Several immune checkpoint inhibitors (ICIs) are approved for use in patients with metastatic renal cell carcinoma (mRCC), but the efficacy and safety of ICI rechallenge in mRCC is unknown. Objective To evaluate the safety and efficacy of ICI rechallenge in patients with mRCC. Design, setting, and participants This multicenter, retrospective cohort study included consecutive patients with mRCC from 9 institutions in the US who received at least 2 separate lines of ICI (ICI-1, ICI-2) between January 2012 and December 2019. Exposure Receipt of an ICI (anticytotoxic T-lymphocyte-associated protein 4, anti-programmed cell death protein 1, or anti-programmed cell death ligand 1), alone or in combination with other therapies, in at least 2 separate lines of therapy for mRCC. Main outcomes and measures Investigator-assessed best overall response and immune-related adverse events. Results A total of 69 patients were included. Median (range) age at diagnosis of mRCC was 61 (36-86) years. Of these, 50 were me study suggest that ICI rechallenge in patients with mRCC may be safe and reasonably efficacious, with an overall response rate of 23%. Data from prospective studies are needed to validate these findings and determine the role of sequential ICI regimens in treatment of mRCC.Context The distribution of physicians across geography and employers has important implications for the delivery of medical services. This study examines how the political beliefs of physicians influence their decisions about where to live and work. Methods Physician relocation and employment patterns are analyzed using a panel constructed from the National Provider Information (NPI) directory. Data on political donations are used to measure the political preferences of physicians. Findings The "ideological fit" between a physician and his or her community is a key predictor of both relocation and employment decisions. A Democratic physician in a predominantly Republican area is twice as likely to relocate as a Republican counterpart living there; the reverse is also true for Republicans living in Democratic areas. Physicians who do not share the political orientation of their colleagues are more likely to change workplaces within the same geographic area. Conclusions Physicians are actively sorting along political lines. Younger physicians have trended sharply to the left and are increasingly drawn to urban areas with physician surpluses and away from rural areas suffering from physician shortages. The findings also help explain why physician shortages are more prevalent among left-leaning specialties, such as psychiatry.Background Multinutrient protein-enriched supplements are promoted to augment the effects of exercise on muscle mass and strength, but their effectiveness in middle-aged women, or whether there are any additional benefits to physical function, remains uncertain. Objectives We aimed to evaluate whether a multinutrient-fortified milk drink (MFMD) could enhance the effects of exercise on functional muscle power (stair climbing) in middle-aged women. Secondary aims were to evaluate the intervention effects on physical function, muscle strength, lean mass (LM), fat mass (FM), bone mineral content (BMC), muscle cross-sectional area (CSA), muscle density, balance, flexibility, aerobic fitness, inflammation, oxidative stress, bone and cartilage turnover, blood pressure, and blood lipids. Methods In this 4-mo, double-blind, placebo-controlled, randomized trial, 244 women (45-65 y) participated in a multimodal resistance-type exercise program 3 d/wk, with random allocation to a twice-daily MFMD containing added proteineffects of exercise on any measures of muscle strength, gait speed, dynamic balance, reaction time, or blood lipids, and there was no effect of either intervention on blood pressure, markers of inflammation, or cartilage turnover. Ex + placebo had a greater improvement in the oxidative stress marker protein carbonyls (P less then 0.01). Conclusions In middle-aged women, daily consumption of an MFMD did not enhance the effects of a multimodal exercise program on the primary outcome of stair climbing ascent power, but did elicit greater improvements in multiple secondary outcomes including various other measures of functional performance, LM, muscle size, FM, balance, aerobic capacity, flexibility, and bone metabolism.This trial was registered at www.anzctr.org.au as ACTRN12617000383369.Background Glabellar soft tissue filler injections have been shown to be associated with a high risk for causing injection related visual compromise. Objectives To identify the course of the superficial branch of the supratrochlear and of the deep branch of the supraorbital artery in relation to the ipsilateral vertical glabellar line and to test whether the artery is located in its depth. Methods 41 healthy volunteers with a mean age of 26.17 ± 9.6 years and a mean BMI of 23.09 ± 2.3 kg/m2 were analyzed. Ultrasound imaging was applied to measure the diameters, distance between skin surface, distance between the midline and distance between vertical glabella lines and the cutaneous projection of supratrochlear/supraorbital arteries at rest and upon frowning. Results The distance between the superficial branch of the supratrochlear artery and the ipsilateral vertical glabellar line was 10.59 ± 4.0 mm in males and 8.21 ± 4.0 mm in females whereas it was 22.38 ± 5.5 mm for the supraorbital artery in males and 20.73 ± 5.6 mm in females. selleck kinase inhibitor Upon frowning, a medial shift in supratrochlear arterial position of 1.63 mm in males and 1.84 mm in females and of 3.9 mm in supraorbital arterial position for both genders was observed. The depth of the supratrochlear artery was 3.34 ± 0.6 mm at rest whereas the depth of the supraorbital artery was 3.54 ± 0.8 mm. Conclusions The hypothesis that injecting soft tissue fillers next to vertical glabellar lines is safe because the artery courses deep to the crease should be rejected. Additionally, the glabella and the supraorbital region should be considered as an area of mobile soft tissues rather than static.
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