Blunt cerebrovascular injury (BCVI) is a non-penetrating injury to the carotid and/or vertebral artery that may cause stroke in trauma patients. Historically BCVI has been considered rare but more recent publications indicate an overall incidence of 1–2% in the in-hospital trauma population and as high as 9% in patients with severe head injury. The indications for screening, treatment and follow-up of these patients have been controversial for years with few clear recommendations. In an attempt to provide a clinically oriented guideline for the handling of BCVI patients a working committee was created. The current guideline is the end result of this committees work. It is based on a systematic literature search and critical review of all available publications in addition to a standardized consensus process. We recommend using the expanded Denver screening criteria and CT angiography (CTA) for the detection of BCVI. Early antithrombotic treatment should be commenced as soon as considered safe and continued for at least 3 months. A CTA at 7 days to confirm or discard the diagnosis as well as a final imaging control at 3 months should be performed.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0559-1) contains supplementary material, which is available to authorized users.

This study investigated the effect of prolonged whole-body low-intensity exercise on blood lipids, skeletal muscle adaptations and aerobic fitness. Seven male subjects completed a 32-day crossing of the Greenland icecap on cross-country skies and before and after this arm or leg cranking was performed on two separate days and biopsies were obtained from arm and leg muscle, and venous blood was sampled.During the crossing, subjects skied for 342 AE 42 min/day and body mass was decreased by 7.1 AE 0.7 kg. Peak leg oxygen uptake (4.6 AE 0.2 L/min) was decreased (Po0.05) by 7% whereas peak arm oxygen uptake (3.0 AE 0.2 L/min) remained unchanged. Total and low-density lipoprotein cholesterol (5.0 AE 0.2 and 3.2 AE 0.2 mmol/L) were decreased by 8% and 20%, respectively. Muscle b-hydroxyacyl-CoA dehydrogenase activity was increased with 22% in arm (P 5 0.08) and remained unchanged in leg muscle. Hormone sensitive lipase activity was similar in arm and leg muscle prior to the expedition and was not significantly affected by the crossing.In conclusion, an improved blood lipid profile and thus metabolic fitness was present after prolonged low-intensity training and this occurred in spite of a decreased aerobic fitness and an unchanged arm and leg muscle hormonesensitive lipase activity.The prevalence of lifestyle-related diseases is increasing globally (WHO, 2000). This development is explained in part by decreased daily physical activity, a sedentary behavior and a low aerobic fitness i.e. maximal oxygen uptake (Blair et al., 1989; Prentice & Jebb, 1995;Owen et al., 2000;Booth et al., 2002). Bouchard and colleagues have shown that despite a limited or no increase in maximal oxygen uptake after a longer period with physical training, positive changes in some metabolic variables were observed in all individuals after training (Abbott, 2005). The term metabolic fitness is not well defined, but most often it is associated with blood lipid profile, blood pressure and insulin sensitivity (Gledhill, 1988;Tremblay et al., 1991;Despres, 1994;Tremblay et al., 1999;Bacon et al., 2002;Hills & Byrne, 2004), with the underlying assumption being that the closer to the normal physiological range of healthy young individuals the better the metabolic fitness. Only a few studies have actually used training interventions with regular low-intensity exercise, where aerobic fitness remains unaffected, to study the effect of training/physical activity on metabolic fitness. One study of long-term low-intensity physical activity found increased fat oxidation during upper body exercise and an increased arm muscle oxidative capacity but unchanged aerobic fitness (Helge et al., 2003). Thus, in spite of unchanged aerobic fitness, an improved muscle metabolic capacity was attained. However, under the condition of an unchanged aerobic fitness, it is not clear to what extent improved muscle metabolic capacity will induce improved metabolic fitness. Therefore, the aim of the present study was to investigate the effect of prolonged low-intensity training...

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■ AbstractThe diterpene glycoside stevioside (SVS) and soy bean protein isolate have both been shown to have beneficial effects in diabetes treatment. As they each show different benefits we investigated whether the combination of both substances shows an improvement in the treatment of diabetes in Goto-Kakizaki (GK) rats. Over the course of 4 wk, the rats were fed with the following four test diets (n = 12 per group): 1. Standard carbohydrate-rich laboratory diet (chow), 2. chow + SVS (0.03 g/kg BW/day), 3. 80% SPI + 20% chow and 4. 80% SPI + 20% chow + SVS (0.03 g/kg BW/day). At the end of the course conscious rats underwent an intra-arterial glucose tolerance test (IAGTT) (2.0 g glucose/kg BW). Compared to normal chow diet, stevioside in combination with SPI shows the following beneficial effects in GK rats with mild type 2 diabetes: 1. a 56% reduction in plasma glucose (p < 0.001), 2. a 118% increase in first-phase insulin (p < 0.005), 3. a 20% reduction in glucagons (p < 0.05), 4. a 28% reduction in total cholesterol (p < 0.001), 5. a 13% reduction in FFA (p < 0.01), 6. a 49% reduction in TG (p < 0.001) and 7. a 11% reduction in the systolic blood pressure (p < 0.001). In conclusion, the combination of stevioside and SPI has synergistic positive effects on the characteristic features of the metabolic syndrome, i.e. hyperglycemia, hypertension and dyslipidemia.