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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

While the prevention of acute metabolic decompensation is no longer a serious problem in treating patients with non-insulin-dependent diabetes mellitus (NIDDM), target organ complications can have serious consequences, including blindness, renal failure, neuropathy, amputation, coronary artery disease, and stroke. The bulk of current evidence suggests that these complications can be minimized or perhaps even avoided by carefully monitoring and controlling the patient's blood glucose levels. Although criteria and standards of control differ widely in various centers, in general acceptable-to-good control in the NIDDM patient would consist of average fasting blood glucose (FBG) levels of less than 140 mg/dL and peak postprandial glucoses of less than 220 to 250 mg/dL. Treatment aimed at attaining these blood glucose levels should begin with dietary management and exercise prescription. General health measurements such as control of blood pressure and avoidance of smoking are especially important in the diabetic patient. When these approaches prove ineffectual, the addition of an oral hypoglycemic agent, preferably a second-generation sulfonylurea is indicated. Glipizide and glyburide are both excellent drug choices, although glyburide may cause hypoglycemia in older patients due to its longer half-life and especially in those with renal insufficiency because of accumulation of biologically active metabolites. In certain well-selected cases, the addition of insulin to oral sulfonylurea therapy may offer improved results over the use of either therapeutic modality alone. The advent of self blood glucose monitoring and periodic glycohemoglobin assessments, now well established in diabetic management, represents a major step forward in the endeavor to optimize standards of blood glucose control in the diabetic population.
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PMID:Monitoring and controlling the patient with non-insulin-dependent diabetes mellitus. 354 18

During diving, marine mammals must balance the conservation of limited oxygen reserves with the metabolic costs of swimming exercise. As a result, energetically efficient modes of locomotion provide an advantage during periods of submergence and will presumably increase in importance as the animals perform progressively longer dives. To determine the effect of a limited oxygen supply on locomotor performance, we compared the kinematics and behavior of swimming and diving bottlenose dolphins. Adult bottlenose dolphins (Tursiops truncatus) were trained to swim horizontally near the water surface or submerged at 5 m and to dive to depths ranging from 12 to 112 m. Swimming kinematics (preferred swimming mode, stroke frequency and duration of glides) were monitored using submersible video cameras (Sony Hi-8) held by SCUBA divers or attached to a pack on the dorsal fin of the animal. Drag and buoyant forces were calculated from patterns of deceleration for horizontally swimming and vertically diving animals. The results showed that dolphins used a variety of swimming gaits that correlated with acceleration. The percentage of time spent gliding during the descent phase of dives increased with depth. Glide distances ranged from 7.1+/-1.9 m for 16 m dives to 43.6+/-7.0 m (means +/- s.e.m.) for 100 m dives. These gliding patterns were attributed to changes in buoyancy associated with lung compression at depth. By incorporating prolonged glide periods, the bottlenose dolphin realized a theoretical 10-21 % energetic savings in the cost of a 100 m dive in comparison with dives based on neutral buoyancy models. Thus, modifying locomotor patterns to account for physical changes with depth appears to be one mechanism that enables diving mammals with limited oxygen stores to extend the duration of a dive.
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PMID:The diving physiology of bottlenose dolphins (Tursiops truncatus). II. Biomechanics and changes in buoyancy at depth. 1050 11

This study examined arm and leg coordination and propulsion during the flat breaststroke in nine elite male and eight elite female swimmers over three race paces (200 m, 100 m and 50 m). Coordination was expressed using four temporal gaps (T1, T2, T3, T4), which described the continuity between the propulsive phases of the limbs, as recorded on a video device (50 Hz). Glide duration was denoted T1, the time between the beginning of arm and leg recovery was denoted T2, the time between the end of arm and the leg recovery was denoted T3, and the time between 90 degrees of flexion during arm recovery and 90 degrees during leg recovery was denoted T4. Using these temporal gaps, four stroke phases (propulsion, glide, recovery and leg insweep) could be followed over a complete arm and leg stroke. The total duration of arm and leg propulsion was assessed by a new index of flat breaststroke propulsion (IFBP). Velocity, stroke rate and stroke length were also calculated for each pace. The elite swimmers showed short T2, T3 and T4; moreover, T1 decreased when the pace increased. Expertise in the flat breaststroke was thus characterized by synchronized arm and leg recoveries and increased continuity in the arm and leg propulsions with increasing velocity. Differences between the sexes in the spatio-temporal parameters were possibly due to anthropometric differences (the men were heavier, older and taller than the women) and different motor organization linked to arm and leg coordination (shorter T3, body glide and body recovery, and greater body propulsion and higher IFBP in the men). The men's propulsive actions showed greater continuity, particularly in the sprint. The best men adopted a superposition coordination and thus had the ability to overcome very great active drag. Temporal gap measurement and the IFBP are practical indicators of arm and leg coordination and propulsion that can be exploited by coaches and swimmers to increase the continuity between propulsive actions during the flat breaststroke.
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PMID:A new index of flat breaststroke propulsion: a comparison of elite men and women. 1596 49

The glide is a major part of starts, turns and the stroke cycle in breaststroke. Glide performance, indicated by the average velocity, can be improved by increasing the glide efficiency, that is, the ability of the body to minimise deceleration. This paper reviews the factors that affect glide efficiency. In the first part of the review the sources of resistive force are reviewed including surface friction (skin drag), pressure (form) drag and resistance due to making waves (wave drag). The effect of body surface characteristics on the skin drag, the effect of the depth of the swimmer on wave drag, and the effects of posture and alignment, body size and shape on the form drag are reviewed. The effects of these variables on the added mass, that is, the mass of water entrained with the body are explained. The 'glide factor' as a measure of glide efficiency that takes into account the combined effect of the resistive force and the added mass is described. In the second part methods of quantifying the resistive force are reviewed. Finally, the 'hydro-kinematic method' of measuring glide efficiency is evaluated.
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PMID:Hydrodynamic glide efficiency in swimming. 1954 Jan 61