Young Athletes: Injuries And Prevention

High profile events like the Olympics bring the hope that witnessing and celebrating dedicated athletes at the top of their game, will inspire young people to take up sport and physical activities that help them develop confidence, lead more satisfying lives, and not least, secure long-term health by reducing their risk for developing chronic illness like diabetes, obesity, cancer and cardiovascular diseases.

But unfortunately, if they don't take appropriate measures, young athletes can instead, end up in pain, on a different path to poor health, due to avoidable sport injury. 

James R. Andrews, a former president of the American Society for Sports Medicine (AOSSM), said in May this year, the US has experienced a tremendous rise in the number of young people taking up sport. Estimates show 3.5 million children aged 14 and under receive medical treatment for sport-related injuries, while high-school athletes account for another 2 million a year.

"This makes sports the leading cause of adolescent injury. Along with time away from school and work, these injuries can have far-reaching effects," said Andrews.

This article looks at some of the common and less common injuries in young athletes. It then reviews a new project that is tracking injuries in Olympic athletes, introduces some ideas about avoiding and minimizing injury, and finishes with a list of tips for preventing sport injury in children.

Common Sport Injuries

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, which is part of the National Institutes of Health in the US, the most common sport injuries are due to accidents, poor training practices or using the wrong gear or equipment. People can also hurt themselves because they are not in shape, or because they don't warm up or stretch enough.

Some injury experts in the US have said they are also seeing more and more young athletes injured because of overuse and doing too much, and this may partially explain the growing numbers that drop out of sport by the eighth grade. The most common sports injuries are:

• Knee injuries,
• Sprains and strains,
• Swollen muscles,
• Achilles tendon injuries,
• Pain along the shin bone, and
• Fractures and dislocations.

While injuries in young athletes are similar to the ones that affect adults, they can't always be treated in the same way because their bodies are not fully developed. 

Take for example knee injury.

One type of knee injury is damage to the anterior cruciate ligament (ACL). This is a severe injury that occurs most often in athletes who play football and other contact sports. 

Twenty years ago, doctors were seeing few children or adolescents with ACL injuries. Today, these injuries are more common because youngsters are taking up sports earlier, and pushing themselves more competitively.

Another reason for the rise in young people with ACL injury, say researchers from the Hospital for Special Surgery (HSS) in New York City, is that more and more young athletes are specializing in one sport, putting them at risk of injuries normally only seen in professional athletes.

But this type of knee injury in young people is a particular concern because it is not easy to repair in growing bodies, for instance ACL reconstructive surgery that works well in adults can potentially cause uneven limb length or other deformities in growing bodies. That is why often the best course has been "benign neglect". However, clinicians are beginning to realize that not operating can also lead to problems, such as early arthritis.

There are alternatives to conventional ACL reconstructive surgery, that have lower risk of damage in growing bodies, such as the All-Inside, All-Epiphyseal ACL Reconstruction (AE), but this is not commonly available.

Clinicians are calling for more research to be done into sports injuries in younger people.

Back and Neck Injuries

Back and neck injuries are much less common in young athletes, but when they occur, they can cause enormous frustration. The athlete must complete a comprehensive and demanding rehabilitation program before returning to competitive sport: in some cases, they may never return to their given sport.

Most back and neck injuries in athletes are sprains of ligaments or strains of muscles. Aside from trauma, these are usually due to athletic overuse, improper body mechanics and technique, being out of condition, or not stretching enough. The athlete will complain of back pain when active and performing, and will feel relief when resting.

But, occasionally, a more serious condition can have similar symptoms. Because of this, proper treatment of back and neck injuries in young athletes should always include a good evaluation by a doctor, using imaging studies when necessary.

According to the North American Spine Society, the more serious back and neck injuries include:

• Spondylolysis and spondylolisthesis: a particular type of defect in the vertebra of the spine (spondylolysis), and where one vertebra slips relative to another (spondylolisthesis). A common cause of back pain in young athletes, particularly gymnasts because they have to twist and hyperextend their spines.


• Stinger (also called "burner" or "nerve pinch"): where forcing the head back and to the side compresses a nerve of the spinal cord in the neck, or where forcing the head sideways away from the shoulder over-stretches the nerves in the neck and shoulder. Most common in football and wrestling, the injury often goes unreported because symptoms can resolve suddenly and quickly. Can recur and lead to persistent pain or arm weakness if not treated.


• Disc injury: a common cause of back pain in adult athletes, much less so among young athletes, it may or may not be associated with sciatica (shooting pain down the leg). Careful diagnosis, including MRI scans, can help to rule out other possible causes that can mimic disc injury in young bodies that are still growing.


• Scheuermann's Disease or juvenile kyphosis: another common cause of back pain in young athletes during puberty that occurs in the mid- as opposed to the lower-back, and leads to a roundness of the back that worsens to a dome shape on bending forwards. Exercises are often not enough to correct this disease, and if wearing a brace does not relieve the pain, surgery may be required, after which it is unlikely the athlete will be able to resume their given sport.

Research on Olympians: the Injury and Illness Performance Project (IIPP)

Although you can't completely eliminate injury and illness, you can look at ways to reduce the risks. This is the purpose of an ambitious and comprehensive national multisport study called the Injury and Illness Performance Project (IIPP).

Beijing 2008 was the first time the International Olympic Committee gathered data on multisport injury, and the Great Britain (GB) squad showed itself to be the best prepared, recording the lowest average injury rate.

Shortly after Beijing, the UK Sport Research & Innovation Team and the English Institute of Sport (EIS) set up the country's first national multisport injury and illness epidemiological study of its kind.

The project started collecting and examining data in 2009 and is still ongoing. Medical and coaching staff from sports national governing bodies send in detailed information about the occurrence of injury and illness in athletes, and their exposure to risk in training and competition.

Rod Jaques, Director of Medical Services at EIS, says it is important to understand the nature of illness and injury incidence before putting in place new treatments.

14 Olympic sports are involved in the study, each with their own set of data on injury incidence, illness prevalence, and associated risk factors. And each sport has a specific set of recommendations for reducing the risk of injury or illness.

Injury-related results from the project show that since 2009:

• 67% of interruptions to training for British athletes from Olympic sports have been because of injury.


• 43% of athletes will get at least one injury per season, some will have several.


• On average, each injury results in a loss of 17 days of training, and 1 missed competition.


• The rate and severity of injury during training is lower than during competition.


• Overall, injuries to the knee, shoulder, hip and lumbar spine present the greatest risk, and the greatest number of total days lost.

EIS Sports Physician Kate Strachan says that the project is a powerful tool because you can turn to an athlete and say, "you have lost X days due to injury last season". This is just as important to take notice of as making sure you have the best kit and training environment and coach.

Paul Jackson, another EIS Sports Physician, works with pentathletes. He says the information on the link between some lower limb injuries and training load has helped them change injury prevention drills. For some pentathletes, "this means not running and fencing on the same day," he adds.

Debbie Palmer-Green, a Research Scientist at the EIS, says the project signifies a new approach that views injury and illness as "performance threats".

Lisfranc fracture: Causes, symptoms, and treatment

A Lisfranc fracture is an injury affecting the middle foot. It is often confused with a sprain because of the similar causes and symptoms.

Diagnosis of a Lisfranc fracture requires a thorough examination and imaging tests. Surgery is needed in some cases, and the injury may take a long time to heal.

Contents of this article:

1. The Lisfranc joint complex
2. Causes
3. Symptoms
4. Diagnosis
5. Treatment
6. Recovery and outlook

The Lisfranc joint complex

The foot is a complex part of the body. It is separated into three areas to make discussion about the individual parts easier.

The hindfoot is composed of the heel and ankle, which support the leg bones. The midfoot is a collection of bones that form the arches in the feet. The forefoot is made up of the five toes and their supporting bones, which are called the metatarsals.

The Lisfranc joint complex is in the midfoot. It is made up of the bones and ligaments that connect the metatarsals to the midfoot.

The bones in the complex give the foot its arch. The bones are held in place by ligaments that stretch both across and down the foot.

Causes

A Lisfranc fracture can often be confused with a simple sprain, as both injuries occur in similar ways.

Lisfranc fractures can happen through simple low-energy injuries, such as twisting the foot when falling. It is commonly seen in football players who stumble over their flexed feet while running.

Lisfranc fractures can also be caused by more serious trauma. Falling from a great height can cause an extensive Lisfranc injury.

Dropping something on the foot while it is flexed may also cause fractures or dislocations in the joints. Being involved in an automobile or motorcycle accident is another cause of Lisfranc injuries.

Symptoms

A Lisfranc injury can occur in the bones, joints, or ligaments of the Lisfranc joint complex in the middle foot. This type of injury is relatively rare and can sometimes be misdiagnosed.

A Lisfranc fracture can cause serious complications if it does not heal properly.

Symptoms of Lisfranc fractures may appear similar to many other foot injuries. This is why it is very important to have any foot injury properly diagnosed.

Common symptoms of Lisfranc injuries include:

• a swollen and painful foot, especially on the top
• pain that worsens when standing or walking
• inability to walk without an aid, such as crutches
• bruising on the top or bottom of the foot

Bruising on the bottom of the foot is an indication of a Lisfranc injury, but bruising does not occur in every case.

A Lisfranc fracture can range from simple to extremely complex, and the symptoms may vary from mild to severe. Lisfranc fractures also tend to damage the cartilage between the midfoot joints.

If the injury is not treated properly, it can lead to increased damage to the cartilage and excessive stress on the other midfoot joints.

Diagnosis

Doctors are likely to take their time to diagnose Lisfranc injuries, as they can easily be misdiagnosed. Diagnosis usually involves both physical examinations and imaging tests.

Physical examination

After discussing the injury and how it happened, a doctor will often do a physical examination of the injured foot.

First, a doctor may look for signs of bruising. Bruising can help indicate where on the foot the injury has occurred. Bruising can be a sign of a ligament tear, blunt trauma, sprain, or fracture.

Doctors may also gently squeeze different areas in the midfoot. A Lisfranc injury will cause tenderness and pain surrounding the area that has been damaged. The doctor will probably also gently bend and twist the front of the foot to check if a person feels pain in their midfoot.

In simple cases, doctors may ask the person to stand on the tiptoes of their injured foot. Doing so puts significant stress on the midfoot. A person may notice pain from even a slight injury here, which can help doctors know what to look for in imaging tests.

A doctor may also check for midfoot injury by holding the toes and moving them up and down, to check for pain. This manipulation puts pressure on the midfoot and will produce pain if there is an injury in the area.

Imaging tests

Imaging tests are the best way to confirm a diagnosis of a Lisfranc injury. Doctors will use one or more imaging tests to look at the bones and tissues in the foot before deciding treatment.

X-rays will show any broken bones, as well as the alignment of the Lisfranc joint complex. If it is out of alignment, it may suggest that there is injury to the ligaments in the area.

Doctors may also position the foot in specific ways to look for ligament damage. They may take X-ray images of the uninjured foot for comparison.

In some cases, CT scans or MRIs will be used. These tests provide a more detailed image of the foot than an X-rays, and are better for looking at softer tissues. They may be more common in cases that could involve surgery.

Treatment

Basic treatment for a foot injury immediately after the injury has occurred is rest, ice, and elevation. Walking on the injured foot should be avoided. A doctor should examine the foot as soon as possible.

The quicker treatment is initiated, the easier it is to reduce the fractures and sometimes an open surgical procedure can be avoided. 

Non-surgical treatment

In some simpler cases of Lisfranc injury, where the ligaments are not completely torn and there are no fractures or dislocations, treatment may include wearing a cast for as little as 6 weeks. During this period, no weight can be put on the injured foot. Afterward, the person will need to wear a weight-bearing cast and have regular follow-ups.

Additional X-rays may be needed to ensure the foot is healing properly. If it is not healing correctly, surgery may still be required.

Surgical treatment

Midfoot injuries that include a bone fracture, joint dislocation or abnormal positioning, or torn ligaments may need surgery. The surgery will vary based on the type and severity of the injury.

Internal fixation surgery is the most common treatment. This type of surgical procedure involves positioning the injured bones correctly and then holding them in place with wires, screws or plates. The plates stay in place until the bones or joints heal, and they are then often surgically removed.

Fusion is another method that may be recommended in cases of severe injury. This involves fusing damaged bones together so they heal as a single bone.

Fusion may reduce motion in the foot, but it can be the best course of action in cases where internal fixation is impractical.

Treatment for a Lisfranc fracture also involves a period of rehabilitation and physical therapy. This is done under supervision from surgeons and therapists to help the person heal at the proper pace. Rehabilitation may take several months overall.

Recovery and outlook

Recovery from a Lisfranc injury depends on its severity and the success of the surgery. Most surgeries will require 6-12 weeks of wearing casts and special walking boots.

Physical therapy and rehabilitation will also take time. Full recovery may occur after a year, but this can vary greatly. It may take longer than a year for athletes to regain their full strength and mobility. It is important to work closely with doctors and refrain from physical activity unless it is approved first.

Lisfranc fractures are serious, and even successful treatments may produce undesired side effects. These problems can include a reduced range of motion or strength, despite a period of rehabilitation.

Arthritis and chronic pain may also occur from damage to the cartilage in the joints.

In view of the seriousness of a Lisfranc injury, it is best to have any foot injury inspected by a doctor and to begin treatment quickly. 

HIIT releases endorphins in the brain

Finnish researchers at the University of Turku have revealed that exercise-induced endorphin release in the brain depends on the intensity of the exercise. Endorphin release induced by exercise may be an important mechanism which affects exercise motivation and maintenance of regular physical activity.

A recent study conducted at Turku PET Centre, University of Turku, shows that the popular high-intensity interval training (HIIT) leads to endorphin release in the brain, which might alleviate the physical and emotional stress caused by the high-intensity exercise. A less demanding, traditional one-hour aerobic exercise does not cause similar endorphin release.

In the study, HIIT significantly increased the release of endorphins and other opioid peptides in the brain areas controlling pain and emotions. In addition, HIIT induced negative feelings in the test subjects, which was associated with higher endorphin release. Although one-hour aerobic exercise did not induce significant release of endorphins, it increased pleasurable feelings and euphoria, which correlated with endorphin release.

- Our results highlight that exercise intensity affects endorphin release and that the brain opioid system is involved in both positive and negative feelings caused by physical exercise performed at different intensities, says Doctoral Candidate Tiina Saanijoki from Turku PET Centre.

- Exercise-induced endorphin release may be an important mechanism which supports exercise motivation and maintenance of regular exercise. At moderate training intensities, the pleasurable sensations caused by the possible release of endorphins may promote habitual exercise. At very high exercise intensities the release of endorphins appears to be linked to increased negative feelings and pain, and may be needed to manage the emotionally and physically demanding challenge. However, such negative feelings may discourage further exercise. Exercise intensity should be taken into account when starting new exercise routines, explains Saanijoki.

The study was conducted using positron emission tomography (PET). The participants were injected with a radioactive compound which binds to their brain's opioid receptors. Radioactivity in the brain was measured with the PET scanner in three conditions: after a 60-min aerobic moderate-intensity exercise session, after a high-intensity interval training (HIIT) session, and after rest.

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Materials provided by University of Turku. Note: Content may be edited for style and length.

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Journal Reference:

1. Tiina Saanijoki, Lauri Tuominen, Jetro J Tuulari, Lauri Nummenmaa, Eveliina Arponen, Kari Kalliokoski, Jussi Hirvonen. Opioid Release after High-Intensity Interval Training in Healthy Human Subjects. Neuropsychopharmacology, 2017; DOI: 10.1038/npp.2017.148

Resistance Training in Youth Improves Athletic Performance: A Systematic Review

PURPOSE:

To perform a systematic review of the highest level of evidence to determine the effect of resistance training interventions on athletic performance in the youth population.

METHODS:

A systematic search of five electronic databases (PubMed, CINAHL, Cochrane, Web of Science, and SPORTDiscus) was conducted in November 2015. All English language, peer-reviewed, randomized control trial journal articles published between 2003 and 2015 that provided a resistance training intervention to a group of typically developing, healthy youth that measured an outcome of athletic performance were included for further review. A review team of three certified professionals independently read blinded articles that met the inclusion criteria and rated them using the Physiotherapy Evidence Database (PEDro) scale. Articles of the highest quality were included for review.

RESULTS:

From a total of 496 articles found, 21 studies were included for review based on inclusion criteria and methodological quality. The variables of strength (13 studies), power (12 studies), running speed (7 studies), sport-specific skill (6 studies), endurance (5 studies), and change-of-direction agility (2 studies) were observed in this review.

CONCLUSIONS:

Supervised resistance training significantly increases power, strength, endurance, running speed, and sport-specific skill within the youth population when compared to a lack of resistance training and/or sport-specific training alone.

[Athletic Training & Sports Health Care. 2017;9(4):184–192.]

Authors

From the Illinois Bone and Joint Institute, Glenview, Illinois (ASV); the Department of Physical Therapy & Athletic Training (KAW, LNM), College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, Massachusetts; and the Edge Sport Enhancement Training, Glenview, Illinois (MS).

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Antigone S. Vesci, PT, DPT, ATC, 924 Burnham Court, Glenview, IL 60025. E-mail: antigone@matsakis.net

Copyright 2017, SLACK Incorporated

Received: March 12, 2016

Accepted: November 23, 2016

10.3928/19425864-20170504-01

Types of stretches

Stretching Techniques and Terms

First let’s review a few important techniques and terms. Even if you’re familiar with stretching, it’s a good idea to double-check your knowledge of this information. Some of these terms are commonly confused and misused.

Static Stretching

Static stretching means a stretch is held in a challenging but comfortable position for a period of time, usually somewhere between 10 to 30 seconds. Static stretching is the most common form of stretching found in general fitness and is considered safe and effective for improving overall flexibility. However, many experts consider static stretching much less beneficial than dynamic stretching for improving range of motion for functional movement, including sports and activities for daily living.

Dynamic Stretching

Dynamic stretching means a stretch is performed by moving through a challenging but comfortable range of motion repeatedly, usually 10 to 12 times. Although dynamic stretching requires more thoughtful coordination than static stretching (because of the movement involved), it is gaining favor among athletes, coaches, trainers, and physical therapists because of its apparent benefits in improving functional range of motion and mobility in sports and activities for daily living.

Note that dynamic stretching should not be confused with old-fashioned ballistic stretching (remember the bouncing toe touches from PE classes?). Dynamic stretching is controlled, smooth, and deliberate, whereas ballistic stretching is uncontrolled, erratic, and jerky. Although there are unique benefits to ballistic stretches, they should be done only under the supervision of a professional because, for most people, the risks of ballistic stretching far outweigh the benefits.

Passive Stretching

Passive stretching means you’re using some sort of outside assistance to help you achieve a stretch. This assistance could be your body weight, a strap, leverage, gravity, another person, or a stretching device. With passive stretching, you relax the muscle you’re trying to stretch and rely on the external force to hold you in place. You don’t usually have to work very hard to do a passive stretch, but there is always the risk that the external force will be stronger than you are flexible, which could cause injury.

Active Stretching

Active stretching means you’re stretching a muscle by actively contracting the muscle in opposition to the one you’re stretching. You do not use your body weight, a strap, leverage, gravity, another person, or a stretching device. With active stretching, you relax the muscle you’re trying to stretch and rely on the opposing muscle to initiate the stretch. Active stretching can be challenging because of the muscular force required to generate the stretch but is generally considered lower risk because you are controlling the stretch force with your own strength rather than an external force.

Better way to measure blood pressure

An estimated 1 in 3 U.S. adults have high blood pressure. Blood pressure levels are often assessed by using automatic blood pressure devices. But these automatic devices are prone to significant errors, sometimes leading to the prescription of blood pressure-lowering medications to patients who don't actually need them. Now researchers at the Jerusalem College of Technology and the Shaare Zedek Medical Center in Israel have developed a method to more accurately measure systolic blood pressure. They present their research findings today at the Cardiovascular Aging: New Frontiers and Old Friends conference in Westminster, Colo.

A systolic blood pressure measurement of 140 mmHg or higher and a diastolic measurement of 90 mmHG or higher (140/90 mmHg) is considered high. Blood pressure is usually assessed using either a manual (auscultatory) or automatic (oscillometry) meter in a doctor's office or hospital. However, these measurements can be affected by "white coat syndrome" -- a patient's fear or anxiety in a doctor's office causes their blood pressure to measure above normal levels. To avoid the white coat effect, at-home automatic measurements taken by the patient may be required, but available oscillometry-based automatic meters offer a low level of accuracy.

"The automatic oscillometric technique is less accurate than the manual auscultatory technique, when both are used in the clinician's office," Meir Nitzan, PhD, the new study's first author, said. Currently available automatic blood pressure measurement devices are commonly off by 10 to 15 mmHg. This is mainly due to indirect determination of the blood pressure from the oscillometric air-pressure wave measurements taken by automatic devices.

A patient with an incorrect high blood pressure diagnosis may be prescribed blood pressure-lowering medication unnecessarily. These medications can cause patients' blood pressure to dip too low (hypotension); elderly patients are especially at risk. Side effects of hypotension can include short-term symptoms such as dizziness and fainting and long-term problems such as insufficient blood supply to vital organs, which can lead to acute kidney injury and cognitive impairment.

The research team has developed a device -- using a technique called photoplethysmography -- to more accurately measure systolic blood pressure. The device uses a pressure cuff wrapped around the arm and an electro-optic probe on the finger. "The finger probe is similar to that of pulse oximeter: It includes a light-source emitting light into the finger and a detector, which measures the light transmitted through the finger," Nitzan explained. "The transmitted light exhibits pulses at the heart rate, due to cardiac-induced blood volume changes in the finger tissue. When the cuff pressure increases to above systolic blood pressure these pulses disappear, and when the cuff pressure decreases to below systolic blood pressure they reappear. This effect enables the determination of systolic blood pressure."

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Long-term diabetes complication: Liver inflammation raises cholesterol levels

Inflammatory processes in the liver lead to elevated cholesterol levels in people with diabetes, thus promoting subsequent vascular diseases. This is the result of a study by scientists of Helmholtz Zentrum München, Technische Universität München (TUM) and the Collaborative Research Center SFB 1118 at Heidelberg University Hospital. The paper, which has now been published in the journal Cell Reports, presents a previously unknown mechanism.

Vascular diseases play a key role among the long-term complications in people with diabetes. Cardiovascular diseases are the most common reason for all hospitalizations, accounting for 75 percent, and these diseases are responsible for fifty percent of all deaths. An important risk factor for atherosclerosis, circulatory disorders and vascular complications is elevated cholesterol.*

"Even if blood glucose levels are well controlled, some people with diabetes have a higher risk of long-term complications. We wanted to understand the underlying cause for this," said metabolism researcher Dr. Mauricio Berriel Diaz, deputy director of the Institute for Diabetes and Cancer (IDC) at Helmholtz Zentrum München. He conducted the study together with Professor Stephan Herzig, director of the IDC and chair of Molecular Metabolic Control at TUM. Herzig is also the co-spokesman of the DFG Collaborative Research Center (SFB) 1118, which is studying the influence of disturbed metabolic processes on long-term diabetes complications at Heidelberg University Hospital.

In their study, the researchers focused on inflammatory processes that are known to occur in many metabolic disorders such as type 2 diabetes and obesity and contribute significantly to long-term complications. Specifically, they concentrated on the inflammatory cytokine TNF-α (tumor necrosis factor α), which is known to induce the production of reactive oxygen species (ROS)** in the liver. The scientists demonstrated that these ROS inactivate the transcription factor complex GAbp (GA-binding protein). In experimental models, this loss in turn inhibited the protein AMPK, an energy sensor of the cell. As a result, excess cholesterol was produced, and typical atherosclerosis symptoms developed.

Key Role in the Maintenance of Hepatic and Systemic Lipid Homeostasis

"Our data suggest that the liver plays a key role in the development of common diabetic vascular diseases," said first author Dr. Katharina Niopek, researcher at the IDC. "GAbp appears to be a molecular regulator at the interface between inflammation, cholesterol homeostasis and atherosclerosis. Without its protective effect, this leads to hypercholesterolemia *** and increased lipid deposition in the arteries."

"Since initial patient data supported our findings, the new signaling pathway -regardless of how well the blood glucose levels of the patient are controlled -- may be a key component in the development of long-term diabetes complications which could be utilized therapeutically," said Herzig, who led the study.

Notes

* Source: Diabetes Information Service "Diabetes und Gefässe" (Diabetes and the Vascular System).

** Reactive oxygen species are oxygen compounds that can cause oxidative stress in cells. These include, for example, oxygen radicals. In the organism, they are produced both in the mitochondria within the framework of cellular respiration, but also through inflammatory processes.

*** Hypercholesterolemia is a lipid metabolism disorder (dyslipidemia) characterized by an elevated cholesterol level in the blood.

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Materials provided by Helmholtz Zentrum München - German Research Center for Environmental Health. Note: Content may be edited for style and length.

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Journal Reference:

1. Katharina Niopek, Bilgen Ekim Üstünel, Susanne Seitz, Minako Sakurai, Annika Zota, Frits Mattijssen, Xiaoyue Wang, Tjeerd Sijmonsma, Yvonne Feuchter, Anna M. Gail, Barbara Leuchs, Dominik Niopek, Oskar Staufer, Maik Brune, Carsten Sticht, Norbert Gretz, Karin Müller-Decker, Hans-Peter Hammes, Peter Nawroth, Thomas Fleming, Michael D. Conkright, Matthias Blüher, Anja Zeigerer, Stephan Herzig, Mauricio Berriel Diaz. A Hepatic GAbp-AMPK Axis Links Inflammatory Signaling to Systemic Vascular Damage. Cell Reports, 2017; 20 (6): 1422 DOI: 10.1016/j.celrep.2017.07.023

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Helmholtz Zentrum München - German Research Center for Environmental Health. "Long-term diabetes complication: Liver inflammation raises cholesterol levels." ScienceDaily. ScienceDaily, 14 August 2017. .