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Key messages • The power of internet search engines is due to databases that relate websites to key search phrases • Medline and SPORTDiscus are the most comprehensive literature databases to search in the sports medicine field • Medline order female cialis 10mg line, in its PubMed version 10 mg female cialis amex, is available free of charge on the internet • Citation databases are used to file reference details when writing a scientific paper and to automatically format the bibliography when submitting the original or revised paper • A relational database is the most powerful type of program to track injury records or injury-related details in a clinical setting Sample examination questions Multiple choice questions (answers on p 561) 1 A relational database is: A A database program that is related to another program in an Office Suite B A database where the data is stored in multiple tables that are linked by relationships between them C A program such as a spreadsheet that is used as a database D A program such as Lotus Notes, which can run queries on data E Data outside a database that is related to data within a database 2 SPORTDiscus differs from Medline in that: A It is available on the world wide web B It is available free of charge 41 Evidence-based Sports Medicine C It contains a greater number of sports medicine journals in its database D It is more commonly used E It does not provide abstracts of references within the database 3 Which of the following programs are citation databases? You would like to write a scientific paper that compares the injury rates from the different types of sport that are played at the university. Describe three ways in which you could use a database to help you conduct this study and write a paper for submission to a scientific journal. As a sports medicine researcher, why is it important that you have an idea which of the journals are included in PubMed? References 1 Haynes B, McKibbon K, Walker C, Ryan N, Fitzgerald D, Ramsden M. Online access to MEDLINE in clinical settings: a study of use and usefulness. Using the world wide web to conduct epidemiological research: an example using the National Basketball Association. The evolving role of the librarian in evidence-based medicine. Creating local bibliographic databases: new tools for evidence-based health care. A multivariate risk analysis of selected playing surfaces in the National Football League: 1980 to 1989. Intrinsic and Extrinsic Risk Factors for Anterior Cruciate Ligament Injury in Australian Footballers. DOMHNALL MACAULEY Introduction Soft tissue injuries are the most common in sports medicine practice. Searching for research evidence to support the principles underlying this mnemonic causes problems. When you ask for how long one should apply ice, how often it should be applied and for what duration, there is little agreement.

Tests showed that the TCA cycle to malate generic 10mg female cialis mastercard, leaving the oxaloacetate levels too low for citrate synthase his plasma free fatty acid level was elevated purchase female cialis 10mg fast delivery, to synhesize citrate (see Fig. The acetyl CoA enters the pathway for and his plasma -hydroxybutyrate level was ketone body synthesis instead of the TCA cycle. The Although ketone bodies are being produced at a high rate, their metabolism in increased NADH/NAD ratio from ethanol other tissues is restricted by the supply of acetate, which is the preferred fuel. Thus, consumption inhibited the TCA cycle and the blood concentration of ketone bodies may be much higher than found under shifted acetyl CoA from fatty acid oxidation normal fasting conditions. LACTIC ACIDOSIS, HYPERURICEMIA, AND HYPOGLYCEMIA Another consequence of the very high NADH/NAD ratio is that the balance in the lactate dehydrogenase reaction is shifted toward lactate, resulting in a lacticacido- sis (see Fig. The elevation of blood lactate may decrease excretion of uric acid (see Fig. Consequently patients with gout (which results from precipitated uric acid crystals in the joints) are advised not to drink excessive amounts of ethanol. Increased degradation of purines also may contribute to hyperuricemia. The increased NADH/NAD ratio also can cause hypoglycemia in a fasting indi- vidual who has been drinking and is dependent on gluconeogenesis to maintain blood glucose levels (Fig. Alanine and lactate are major glu- coneogenic precursors that enter gluconeogenesis as pyruvate. The high NADH/NAD ratio shifts the lactate dehydrogenase equilibrium to lactate, so that pyruvate formed from alanine is converted to lactate and cannot enter gluconeoge- nesis. The high NADH/NAD ratio also prevents other major gluconeogenic precursors, such as oxaloacetate and glycerol, from entering the gluconeogenic pathway. In contrast, ethanol consumption with a meal may result in a transient hyper- glycemia, possibly because the high NADH/NAD ratio inhibits glycolysis at the glyceraldehyde-3-P dehydrogenase step. Acetaldehyde Toxicity Many of the toxic effects of chronic ethanol consumption result from accumula- tion of acetaldehyde, which is produced from ethanol both by alcohol dehydroge- nases and MEOS. Acetaldehyde accumulates in the liver and is released into the blood after heavy doses of ethanol (Fig. It is highly reactive and binds cova- lently to amino groups, sulfhydryl groups, nucleotides, and phospholipids to form “adducts.

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Fructose Metabolism by the accumulated fructose 1-phosphate order 10mg female cialis fast delivery. The inhibition of gluconeogenesis results in Fructose is metabolized by conversion to glyceraldehyde-3-P and dihydroxyace- lactic acidosis cheap female cialis 10mg without prescription. The steps par- The accumulation of fructose 1-phos- allel those of glycolysis. The first step in the metabolism of fructose, as with phate also substantially depletes the phos- glucose, is phosphorylation. Fructokinase, the major kinase involved, phospho- phate pools. The fructokinase reaction uses rylates fructose in the 1-position. Fructokinase has a high Vmax, and rapidly phos- ATP at a rapid rate such that the mitochon- phorylates fructose as it enters the cell. The fructose 1-phosphate formed is not dria regenerate ATP rapidly, which leads to a an intermediate of glycolysis but rather is cleaved by aldolase B to dihydroxy- drop in free phosphate levels. The low levels of phosphate release inhibition of AMP acetone phosphate (an intermediate of glycolysis) and glyceraldehyde. Glycer- deaminase, which converts AMP to inosine aldehyde is then phosphorylated to glyceraldehyde-3-P by triose kinase. The nitrogenous base droxyacetone phosphate and glyceraldehyde 3-phosphate are intermediates of of IMP (hypoxanthine) is degraded to uric the glycolytic pathway and can proceed through it to pyruvate, the TCA cycle, acid. The lack of phosphate and depletion of and fatty acid synthesis. Alternately, these intermediates can also be converted to adenine nucleotides lead to a loss of ATP, fur- glucose by gluconeogenesis. In other words, the fate of fructose parallels that of ther contributing to the inhibition of biosyn- glucose. The pathway for the conversion of fructose to dihydroxy- CH2OH acetone phosphate and glyceraldehyde 3-phosphate is shown in blue. These two compounds Sorbitol are intermediates of glycolysis and are converted in the liver principally to glucose, glyco- (polyol) gen, or fatty acids.

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Ethanol-stimulated increases of endoplasmic reticulum enzymes also favors triacylglycerol formation buy generic female cialis 20 mg on line. Thus discount female cialis 20 mg overnight delivery, acetyl CoA oxidation in the TCA cycle is inhibited. Fatty acids that are oxidized are converted to acetyl CoA and subsequently to ketone bodies (acetoacetate and -hydroxybutyrate). Enough NADH is generated from Al Martini’s admitting physician oxidation of ethanol and fatty acids that there is no need to oxidize acetyl CoA in suspected an alcohol-induced ketoacidosis superimposed on a the TCA cycle. The very high NADH/NAD ratio shifts all of the oxaloacetate in starvation ketoacidosis. Tests showed that the TCA cycle to malate, leaving the oxaloacetate levels too low for citrate synthase his plasma free fatty acid level was elevated, to synhesize citrate (see Fig. The acetyl CoA enters the pathway for and his plasma -hydroxybutyrate level was ketone body synthesis instead of the TCA cycle. The Although ketone bodies are being produced at a high rate, their metabolism in increased NADH/NAD ratio from ethanol other tissues is restricted by the supply of acetate, which is the preferred fuel. Thus, consumption inhibited the TCA cycle and the blood concentration of ketone bodies may be much higher than found under shifted acetyl CoA from fatty acid oxidation normal fasting conditions. LACTIC ACIDOSIS, HYPERURICEMIA, AND HYPOGLYCEMIA Another consequence of the very high NADH/NAD ratio is that the balance in the lactate dehydrogenase reaction is shifted toward lactate, resulting in a lacticacido- sis (see Fig. The elevation of blood lactate may decrease excretion of uric acid (see Fig. Consequently patients with gout (which results from precipitated uric acid crystals in the joints) are advised not to drink excessive amounts of ethanol. Increased degradation of purines also may contribute to hyperuricemia.