Conference Notes 1/29/2025

Rescue Task Force and Tactical Medicine – Dr. O’Brien

  • Tactical Combat Casualty Care (TCCC) “cold zone” vs “warm zone” vs “hot zone”
  • Rescue task force allows for a coordinated response to a situation which cannot be completely handled by a single first response agency
  • (S)MARCH –(S.ecurity) M.assive hemorrhage, A.irway, R.espirations, C.irculation, H.ypothermia
  • Hemostatic gauze: radiopaque, used when not able to apply tourniquet
  • Care Under Fire Priority List
  • Casualty Movement Rescue Plan
  • “High and tight is always right” (for tourniquets)

ABEM Certifying Exam – Dr. Platt

  • Steps
    • Program Director Approval
    • Apply (register May 9 – Oct 9. 
    • Qualifying exam November 3-12, 305 questions
    • Certifying Exam, brand new exam that assesses more competencies than oral exam. In Raleigh, NC. 
      • Half day sessions with 2 case types, clinical care cases and communication and procedures
      • Will be offered 9 times a year
      • Sample cases on ABEM website

13 thoughts on “Conference Notes 1/29/2025

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  3. Nonetheless, the impact of FOR supplementation on circulating myostatin and muscle tissue-level variations
    throughout muscle disuse in people is unknown. In this examine,
    we used a highly specific anti-myostatin peptibody inhibitor of myostatin to judge the function of
    myostatin signaling in hindlimb suspension muscle pathology.
    Myostatin is crucial to the stability of protein synthesis and degradation in skeletal muscle,
    thus myostatin-inhibiting-therapeutics maintain promise to mitigate the deleterious effects of disuse.
    Deletion of Mstn in hindlimb unloaded mice resulted in related muscle
    atrophy as wild-type mice47, whereas others have reported that Mstn deletion increases muscle loss with unloading44.
    Administration of an anti-myostatin antibody attenuated skeletal muscle atrophy and practical losses in skeletal muscle tissue from casted hindlimbs in mice46.
    Myostatin inhibition has additionally demonstrated therapeutic potential in more advanced mouse models
    involving muscle losing with issues including
    muscular dystrophy, cachexia and chemotherapy, and aging34,35,forty eight.

    This research thus sought to elucidate how myostatin is involved in disuse muscle atrophy and
    if myostatin inhibition would possibly function a viable
    therapeutic choice for lost muscle mass and function in spaceflight.

    Additionally, MSTN performs a role in signaling the mitogen-activated protein kinase (MAPK) pathway,
    particularly the c-Jun N-terminal kinase (JNK), p38, and extracellular signal-regulated kinases (ERK) pathways.
    These pathways are identified to inhibit the transcriptions of
    a selection of myogenesis-related genes [27–29].
    Processes that occur in addition to ubiquitin-proteasome-dependent
    proteolysis could have contributed to our results.

    For instance, spaceflight in astronauts71 and hindlimb unloading in grownup mice11 trigger autophagy of
    skeletal muscle cells. Like the ubiquitin-proteosome pathway, autophagy is also
    beneath FoxO regulation and, when activated, promotes
    muscle degeneration. However, autophagy flux is required to protect muscle mass and preserve myofibers72,
    which is postulated to occur by way of stimulation of mTor kinase exercise and protein synthesis11.

    Furthermore, MYF5, MYOD, MYOG, and MRF4 are crucially concerned in directing MSCs to regenerate SM [34].
    MSTN sustains the quiescent state of MSCs by negatively regulating Pax7 and its absence leads to the proliferation of energetic MSCs [35,36].
    Apparently, following muscle damage, Ac-MIF1 and Ac-MIF2-NH2 peptides induced muscle regeneration by inducing the
    protein/mRNA expression of Pax7, MYOD, MYOG, and MYL2. The observed
    will increase in Pax7 and MYOD expression may
    have been due to elevated MSC numbers and subsequent myogenesis due to MSTN inhibition. In addition, reduced ACVRIIB protein expression after Ac-MIF2-NH2
    remedy throughout muscle regeneration indicated that Ac-MIF2-NH2 peptide inhibited MSTN by reducing MSTN binding to ACVRIIB.

    Altogether, these observations counsel Ac-MIF1 and Ac-MIF2-NH2 peptides induce muscle regenerative capability in injured muscle tissue.
    In earlier research, we confirmed FMOD regulates MSTN expression by interacting with
    it and reducing ACVRIIB to MSTN binding affinity, and that lipid
    accumulation in myoblasts was elevated in FMOD knockdown cells
    [10,18].
    Bodybuilders who completed a YK11 cycle reported stronger bones and fewer incidences of
    bone breaking. Epi-Plex by Aggressive Edge Labs boasts 300 mg of epicatechin per serving
    that can help you maximize muscle power, progress, vascularization, and recovery.
    Customers love that it works and discloses precisely
    how a lot of the antioxidant compound they’re getting per serving.

    Follidrone by Black Lion Research makes use of epicatechin and other naturally
    occurring compounds to maximise follistatin manufacturing, inhibit myostatin, and in the end maximize muscular gains.
    Person critiques are usually optimistic,
    nevertheless some individuals are delay by its value and the reality that you could have to take
    a better dose before noticing the total results.
    Epicatechin research have additionally discovered that this compound (along with the rest of catechin class) may help reduce continual
    fatigue syndrome, enhance ldl cholesterol, 
    enhance neurological well being, and even help people residing with muscle
    dystrophy. Plus, multiple studies have proven that consuming more flavanoids in general
    can do every thing from selling longevity to reducing the risk
    of coronary heart illness and dementia.
    Blood serum samples were saved for later evaluation of the anabolic/catabolic hormones
    (active testosterone, free testosterone, and cortisol) through assays in the Exercise and Biochemical Nutrition Laboratory.
    Regardless Of profound claims, little is thought relating to the consequences
    of dietary supplementation of those nutrients on training adaptations in resistance-trained
    topics. Therefore, the purpose of this examine was to examine the results of methoxyisoflavone, ecdysterone, and sulfo-polysaccharide (CSP3)
    supplementation throughout resistance coaching on physique
    composition, markers of catabolism, and training variations.
    Methoxyisoflavone is a member of the flavonoids (isoflavones) household that are primarily obtained in the food plan from soybeans and soy foods [1].
    The two most popular types of methoxyisoflavones available on the
    market are 5-methyl-7-methoxy-isoflavone (Methoxyiso-flavone)
    and 7-Isopropoxyisoflavone (Ipriflavone).
    Any product that might be evaluated on this article, or
    claim that may be made by its producer, isn’t assured or
    endorsed by the publisher. An overview of the techniques for identifying MSTN inhibitors utilizing in silico (virtual
    screening, molecular docking, ADMET, and so on), in vitro, and in vivo approaches.
    We have been working within the SM subject utilizing in silico,
    in vitro, and in vivo techniques with an emphasis on the mechanism answerable
    for SM development and regeneration, for more than a decade.

    With the exception of vitamin D, where a constructive effect may be noticed in those affected by a deficiency,
    the opposite treatments are noted to be both risky or unproven. Myostatin antagonists, peroxisomeproliferator-activated-receptor-δ agonists (GW1516)
    and adenosine monophosphate (AMP) activated protein kinase activators corresponding to AICAR.

    GW1516 was tested in rodents results present stimulated exercise capability solely when utilized
    in combination with train [13].
    Understanding the role of myostatin has vital implications for developing therapies
    to deal with muscle wasting diseases and enhancing athletic
    performance. MSTN is understood to work together with FST,
    GASP-1, GASP-2, decorin, FMOD, and FLRG, which are collectively referred to as MIPs.
    These proteins inhibit the formation of mature MSTN complicated and intervene
    with advanced formation between MSTN and ACVRIIB. Designing short peptides based mostly on the make-up of MIPs provides a possible technique of effective MSTN inhibitors,
    and a few studies indicate that these inhibitory peptides have therapeutic potential for the treatment of a spread of muscular dystrophies (Tsuchida,
    2008). FS I-I (MSTN-specific inhibitor derived from
    FST) supplies an instance of an FST-derived inhibitory peptide and elevated SM mass in mdx/FS I-I mice
    and reduced cell infiltration into muscular tissues (Tsuchida, 2008).

    These findings shouldn’t be interpreted as supportive of any medical use or
    therapeutic benefit since no myostatin inhibitors have yet been permitted as medication wherever
    in the world. Dr Welle printed a examine measuring the have an effect on of myostatin ranges and
    muscle mass in mice. FOR is a non-thermal pasteurized, freeze-dried high proteo-lipid, fertilized egg yolk product.
    It contains 2.4% carbohydrates, 59% fat, 34%
    protein, and three.5% complete ash, with an energy content material of 6.7 kcal/g.
    The ingredients of FOR and placebo have been analyzed using Association of Official Agricultural Chemists (AOAC)
    methodology from a meals evaluation laboratory (Certified Laboratories
    Inc., NY, USA). Participants in FOR-SUPP consumed 19.8 g of FOR every day with breakfast, and the PLA-SUPP
    group consumed 19.8 g of cheese powder that was matched for
    macronutrient and vitality to FOR-SUPP.
    MSTN has been proven to mediate the expression of BAT markers and thermogenic
    genes in WAT, including Ucp1, Prdm16, Pgc-1a,
    Bmp7, Cidea, Cd137, and Tmem26 [134, 140, 141].
    Another possible route of MSTN-mediated BAT formation is the skeletal muscle-derived myokine irisin, which facilitates
    crosstalk between skeletal muscle and adipose tissue to drive thermogenesis and browning and
    is increased with inhibition of MSTN [142, 143]. Additionally, MSTN is secreted in BAT and acts as an adipokine,
    reducing local insulin sensitivity [144]. Moreover,
    MSTN is involved in tissue crosstalk between BAT and
    skeletal muscle by way of transcription factor interferon regulatory
    factor four (IRF4), which regulates adipogenesis by inhibiting MSTN expression [15].
    Expression of IRF4 in BAT is strongly correlated with serum MSTN ranges, with lack of IRF4 inflicting obesity, decreased exercise
    capacity, and elevated serum MSTN [15, 145]. These findings point out a complex interplay between MSTN and adipose
    tissue, highlighting distinct results past these mediated by skeletal muscle.

    Nonetheless, the distinguished catechins found in green tea and cocoa beans are
    promising nutraceuticals to keep a watch on. If you have a little extra cash and want to give epicatechin a shot, go for it —
    but don’t count on a night-and-day distinction or it’s
    going to in all probability disappoint you.
    Chemically talking, epicatechin is an epimer
    of a father or mother molecule known as catechin.
    An in vivo functional assay to quantify the drive produced predominately by the hindlimb
    muscles, the “Hindlimb Exertion Pressure Test” (HEFT), was carried out as beforehand described76.

    Briefly, HEFT evaluates dominant hindlimb muscles used throughout an evoked escape response (electrical stimulus, 1.5 mA, zero.3 s administered
    to the tail) and was designed as a substitute for the more typical grip power measurement.
    Two stimuli are utilized to the tail (with a 2 min rest) which is affixed to a drive transducer; the
    pressure responses were recorded by way of a custom developed Labview™ v7.1 (National Devices Company, Austin, TX)
    code. Soleus MHC-I and MHC-IIa fiber CSA considerably decreased with
    hindlimb suspension, in vehicle-treated groups (NS-P vs HS-P), by −48.4% and −45.8%, respectively.

    For individuals focused on obtaining essentially the
    most direct source of epicatechin with minimal interference from other compounds, Neurogan Health’s pure
    epicatechin capsules might be the higher selection, however this all falls on personal well
    being objectives and dietary preferences. Neurogan Well Being Epicatechin Capsules contain 500 mg of pure epicatechin in vegan-friendly capsules.
    This is among the most potent variations of this product obtainable in the marketplace at a worth point of solely
    $40 for a one-to-two-month provide, depending on the frequency of
    use. It’s challenging to consume effective quantities purely from
    diet, which is the place dietary supplements are obtainable in. The mechanisms concerned
    in myostatin expression are complicated, so that is an oversimplification. †Furthermore, it’s essential to note that
    the Meals and Drug Administration has not verified the efficacy or security claims made about this product.

    Researchers reported ~96 mg of epicatechin in the chocolate,
    but the actual stereoisomer was not reported (+ or –).
    Different researchers discovered no profit to
    ingesting flavanol-containing (specific flavanols not reported) cocoa
    drinks on indices of muscle damage after downhill running (19).
    Regardless Of promising evidence in rodent models,
    the paucity of proof involving (–)-epicatechin supplementation in people subjects in combination with train training is insufficient for interpretation as to if and the way flavanols
    modulate train adaptations. As A End Result Of of the aforementioned observations with (–)-epicatechin supplementation, it has been suggested that it might be useful as a way to increase
    train variations (13). Fifteen days of (–)-epicatechin supplementation alone
    resulted in increased exercise efficiency,
    decreased muscle fatigue, increased muscle capillarity and elevated
    mitochondrial biogenesis in mice (14). In mice selectively
    bred for low running capability, 30 days of (–)-epicatechin supplementation efficiently increased skeletal
    muscle capillarity and mitochondrial biogenesis (15).

    In one other study, (–)-epicatechin supplementation in mice, along
    with treadmill train over the course of eight weeks, elevated angiogenesis and mitochondrial biogenesis (16).

    Protein synthesis and degradation homeostasis are required
    for the maintenance of wholesome muscle mass and for sensitivity to physical
    exercise, hormonal balance, damage, and nutritional status [1].
    The IGF1-Akt-mTOR pathway is a positive regulator of protein synthesis and is counterbalanced by the myostatin—Smad2/3 pathway, which acts as a adverse regulator [5].

    Imbalance within the myostatin—Smad2/3 pathway causes
    muscle atrophy, which, in the context of most cancers, known as cancer cachexia [6].

    Naturally, muscle loss happens from 35 years of age and ~30% loss
    occurs between the ages of 50 and 80 [7]. SM loss is the
    primary characteristic of getting older and illnesses such as weight problems, diabetes, and cancer
    [8,9]. Interleukin-15 (IL-15) is very expressed in SM and has anabolic results on SM protein dynamics (Quinn
    et al., 2002). IL-15 mRNA expression is up-regulated during myoblast differentiation and its administration inhibits the white
    adipose tissue deposition in rodents (Quinn et al., 2005).

    The PLA group consumed equivalent looking capsules containing one hundred mg of cellulose twice
    every day. The complement and placebo were manufactured and blinded by Important Prescribed
    Drugs Inc. (VPX Inc., Weston, FL). He has been formulating,
    consulting, & manufacturing dietary dietary supplements since 1998.

    Alex invented protein customization in 1998 & was the first company to permit consumers to create their very own protein blends.
    He helped create the first supplement to include natural follistatin,
    invented whey protein with egg lecithin, & just lately imported
    the world’s first one hundred pc hydrolyzed whey.

    Moreover, myostatin inhibition prevented muscle weak
    point and muscle loss in mice with Huntington’s Disease, an inherited genetic disorder that
    causes muscles to degenerate over time [17]. In mice with chronic kidney disease,
    inhibiting myostatin slowed the muscle loss caused
    by kidney illness and enhanced the expansion of forearm muscles
    [12]. In people, myostatin levels also usually increase with age, which may contribute to the lack of muscle
    mass throughout aging [6]. Since there isn’t much formal analysis and long-term clinical trials are nonetheless pending, I would advise
    you consult your healthcare skilled earlier than beginning myostatin supplements.

    New research have revealed that parallel to the decreased efficacy of kidney perform in CKD,
    the clearance of circulating components similar to activin A
    decreases. Activin A is a renal soluble factor with pro-cachectic actions which is believed to negatively regulate skeletal muscle mass [118].

    This protein is specifically upregulated in the renal tissue of
    an individual with a uremic state compared to different tissues corresponding
    to liver, muscular, and cardiac tissue which is induced by inhibin beta-A (Inhba).
    This is as a end result of extension of Inhba-producing cells
    throughout CKD growth which are subpopulations of fibroblasts and cells throughout the juxtaglomerular apparatus.
    Latest research has proven that a decreased degree
    of activin A receptor-based signaling in mice
    with CKD hinders CKD-related skeletal muscle losing [119].

    Mimetics are usually designed using the 3D construction of proteins, that are the primary source of energetic peptides, as peptide fragments
    that are designed based on recognized protein–protein interactions
    (PPIs) are the vital thing components in rational drug
    design [28,29]. Due To This Fact, on this study, we aimed to design peptides that promote muscle proliferation and
    differentiation by targeting MSTN to develop a therapeutic various for the treatment of muscle issues.
    Adjustments in amino acid stimulated international myotube protein synthesis were estimated utilizing the floor sensing of translation (SuNSET) technique [31], which measures the
    incorporation of the amino-nucleoside antibiotic puromycin into newly synthesised muscle proteins.
    Cells were stimulated for 3 h with 2 mM L-leucine and 5 mM D-glucose and for the final
    30 min incubated with 1µM puromycin dihydrochloride, as beforehand
    described [25]. Briefly, equal quantities of total protein (determined through Pierce bicinchoninic acid assay) were separated on 12% SDS-PAGE gels, transferred onto PVDF membranes, incubated with anti-puromycin antibody
    (clone 12D10; Millipore, US) and visualized using chemiluminescence.
    Following immunodetection, membranes had been stained with zero.1% Coomassie and digitally imaged.
    Total lane intensity was measured by densitometry and relative protein artificial exercise was estimated because the ratio of
    puromycin-labelled protein intensity to total protein (Coomassie) intensity.

    However, there are several potential downsides to myostatin inhibition in individuals looking for athletic enhancement.
    Creatine and follistatin supplements haven’t been approved by the FDA for medical use.
    Regulations set manufacturing standards for them but don’t assure that they’re secure or effective.
    Some scientists suppose myostatin inhibition should be further researched for probably stopping weight problems
    and diabetes [29, 26]. This impact has largely been seen in animal studies on follistatin, a pure hormone that inhibits myostatin [26, 27, 28].

    Thus, Epi is the primary compound ever famous, to favorably modulate each regulators of muscle progress and
    suggest will increase in energy. From a biomedical perspective, myostatin inhibitors are
    a kind of drug that focus on myostatin, a protein concerned in regulating muscle growth and improvement.
    Myostatin inhibitors work by blocking the exercise of myostatin, which can result in increased muscle mass and power.

    These inhibitors have potential functions in treating muscle-wasting circumstances, such as muscular dystrophy,
    and may be used to reinforce muscle development in athletes and bodybuilders.
    By inhibiting myostatin, these medication can promote muscle hypertrophy and potentially enhance muscle perform.

    Additional work is warranted to establish the full potential of blocking this
    necessary pathway in musculoskeletal unloading and in spaceflight.
    Publicity of astronauts to lowered gravity during spaceflight disrupts homeostasis in musculoskeletal tissues leading to
    atrophy and loss of strength. In each humans and rodents,
    skeletal muscle atrophy during spaceflight predominantly happens in weight-bearing
    hindlimb muscles including these answerable for plantar and dorsiflexion, knee and hip
    extension, and postural control1,2,3.

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