bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Glutamine Administration After Cardiac Surgery on Kidney Damage in Patients at High Risk for Acute Kidney Injury: A Randomized Controlled Trial
Authors: Weiss Raphael , Meersch Melanie , Gerke Mena , Wempe Carola , Schäfers Michael , Kellum John A. , Zarbock Alexander
Published: February 2023

BACKGROUND:

Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with increased morbidity and mortality. However, no specific treatment options are available, emphasizing the need for preventive measures. The aim of this study was to clarify the effect of glutamine on [TIMP2]*[IGFBP7] levels at the end of the intervention period.

METHODS:

In a randomized clinical, double-blind pilot study, 64 eligible cardiac surgery patients at high risk for AKI identified by high urinary [TIMP2]*[IGFBP7] were randomized, and body weight–adapted intravenous glutamine or saline-control was administered continuously for 12 hours postoperatively. The primary outcome was urinary [TIMP2]*[IGFBP7] at the end of the 12-hour study period. Secondary outcomes included kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) at 12 hours, overall AKI rates at 72 hours, free days through day 28 of mechanical ventilation and vasoactive medication, renal recovery at day 90, requirement of renal replacement therapy and mortality each at days 30, 60, and 90, length of intensive care unit (ICU) and hospital stay, and major adverse kidney events consisting of mortality, dialysis dependency, and persistent renal dysfunction (serum creatinine ≥2× compared to baseline value) at day 90 (major adverse kidney event; MAKE90).

RESULTS:

Sixty-four patients (mean age, 68.38 [standard deviation {SD} ± 10.48] years; 10 of 64 women) were enrolled and randomized. Patients received coronary artery bypass graft surgery (32/64), valve surgery (18/64), coronary artery bypass graft and valve surgery (6/64), or other procedures (8/64). Mean on-pump time was 68.38 (standard deviation ± 10.48) minutes. After glutamine administration, urinary [TIMP-2]*[IGFBP7] was significantly lower in the glutamine compared to the control group (primary end point, intervention: median, 0.18 [Q1, Q3; 0.09, 0.29], controls: median, 0.44 [Q1, Q3; 0.14, 0.79]; P = .01). In addition, [KIM-1] and [NGAL] were also significantly lower in the glutamine group. The overall AKI rate within 72 hours was not different among groups: (intervention 11/31 [35.5%] versus control 8/32 [25.0%]; P = .419; relative risk [RR], 0.86% [95% confidence interval {CI}, 0.62–1.20]). There were no differences regarding secondary end points.

CONCLUSIONS:

Glutamine significantly decreased markers of kidney damage in cardiac surgery patients at high risk for AKI. Future trials have to be performed to investigate whether the administration of glutamine might be able to reduce the occurrence of AKI after cardiac surgery.
Molecular Mechanisms and Pathophysiological Pathways of High-Fat Diets and Caloric Restriction Dietary Patterns on Pain
Authors: Liu Jingjing , Wong Stanley Sau Ching
Published: February 2023

Pain perception provides evolutionary advantages by enhancing the probability of survival, but chronic pain continues to be a significant global health concern in modern society. Various factors are associated with pain alteration. Accumulating evidence has revealed that obesity correlates with enhanced pain perception, especially in chronic pain individuals. Existing dietary patterns related to obesity are primarily high-fat diets (HFD) and calorie restriction (CR) diets, which induce or alleviate obesity separately. HFD has been shown to enhance nociception while CR tends to alleviate pain when measuring pain outcomes. Herein, this review mainly summarizes the current knowledge of the effects of HFD and CR on pain responses and underlying molecular mechanisms of the immunological factors, metabolic regulation, inflammatory processes, Schwann cell (SC) autophagy, gut microbiome, and other pathophysiological signaling pathways involved. This review would help to provide insights on potential nonpharmacological strategies of dietary patterns in relieving pain.
Incidence of Postreperfusion Hyperfibrinolysis in Liver Transplantation by Donor Type and Observed Treatment Strategies
Authors: Krom Russell J. , Welsby Ian J. , Fuller Matthew , Barbas Andrew S. , Gao Qimeng , Anwar Imran J. , Dunkman W. Jonathan
Published: February 2023

BACKGROUND:

Hyperfibrinolysis is a possible complication during liver transplantation, particularly immediately after reperfusion.

METHODS:

We performed a retrospective study to examine the incidence, treatment, and resolution of postreperfusion hyperfibrinolysis in patients undergoing liver transplantation at Duke University Hospital from 2015 to 2020.

RESULTS:

Out of 535 patients undergoing liver transplantation, 21 or 3.9%, 95% CI (2.5–5.9), had hyperfibrinolysis after reperfusion. Hyperfibrinolysis occurred in 16 of 511 (3.1%) patients receiving livers from DBD donors, 5 of 18 (27.8%) patients receiving livers from donation after circulatory death (DCD) donors, and 0 of 6 (0.0%) patients receiving livers from living donors. Fibrinolysis was treated with cryoprecipitate (12/21), a combination of cryoprecipitate and tranexamic acid (3/21), or neither (6/21) and resolved within several hours in all cases.

CONCLUSIONS:

Anesthesiologists should be aware of the possibility of postreperfusion hyperfibrinolysis in liver transplantation, particularly with DCD donors, and may consider treatment with cryoprecipitate or tranexamic acid. Further work is needed to identify any potential differences, such as faster resolution of fibrinolysis, between different treatment modalities.
National Survey of Combined Pediatrics-Anesthesiology Residents and Graduates: Factors Contributing to Changing Career Aspirations Over Time
Authors: Liu Jia , Jackson Shawn S. , Xie James , Rowland Matthew J. , Michelson Catherine D.
Published: February 2023

BACKGROUND:

The Dual Pathway for Certification in Pediatrics and Anesthesiology was created in 2011 to develop leaders in caring for children with complex medical and surgical conditions. While existing dual-trained practitioners report continued practice in both pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM), recent surveys of dual pathway trainees have shown that only one-quarter still currently plan to pursue training in PCCM, a change from their initial plans to complete training in both PA and PCCM. The aim of this study was to further characterize the motivations driving shifts in career trajectory during training as well as factors affecting the combined training experience.

METHODS:

We conducted an online mixed-methods survey of all individuals who had matriculated at 1 of the 7 Accreditation Council for Graduate Medical Education–accredited combined pediatrics-anesthesiology residencies from 2011 to 2018. The survey consisted of a 30-item questionnaire addressing training experience, anticipated career trajectory, and respondent demographics. Descriptive statistics were used for closed-format questions. Responses to open-ended questions were systematically analyzed through inductive iterative review by 2 of the authors to elicit a set of overarching themes.

RESULTS:

We achieved a response rate of 85% (n = 53/62) with respondents from 7 of 7 combined residency programs. When asked about career goals, the majority of respondents planned to pursue both PA and PCCM (60%, n = 32) at the start of residency. However, at the time of survey completion, the percentage of respondents who were still planning to (or had already completed) train in both PA and PCCM had decreased to 23% (n = 12). Factors such as lifestyle and length of training contributed more to career choices during/after training compared to before residency. Thematic analysis of open-ended questions regarding transition between specialties, impact of dual training, and general comments revealed 3 major themes: (1) challenges of transitioning between specialties, (2) dual training is mutually beneficial, and (3) the need for an established fellowship training pathway.

CONCLUSIONS:

While there is continued interest in dual training in PA/PCCM for residents who enter the combined pediatrics-anesthesiology residency, factors such as duration of training and lifestyle become more important during residency and alter their career trajectories, often away from PCCM. Optimization of dual-subspecialty fellowship training will be critical to sustaining interest in dual-subspecialty training in PA/PCCM.
Optimal Positioning of Nasopharyngeal Temperature Probes in Infants and Children: A Prospective Cohort Study
Authors: Zhong John W. , Sessler Daniel I. , Mao Guangmei , Jerome Aveline , Chandran Neethu , Szmuk Peter
Published: February 2023

BACKGROUND:

The nasopharynx is an easily accessible core-temperature monitoring site, but insufficient or excessive nasopharyngeal probe insertion can underestimate core temperature. Our goal was to estimate optimal nasopharyngeal probe insertion depth as a function of age.

METHODS:

We enrolled 157 pediatric patients who had noncardiac surgery with endotracheal intubation in 5 groups: (1) newborn to 6 months old, (2) infants 7 months to 1 year old, (3) children 13 to 23 months old, (4) children 2 to 5 years old, and (5) children 6 to 12 years old. A reference esophageal temperature probe was inserted at an appropriate depth based on each patient’s height. A nasopharyngeal temperature probe was inserted from the naris at 10 cm in newborn and infants, 15 cm in children aged 1 to 5 years old, and 20 cm in children who were 6 years or older. The study nasopharyngeal probes were withdrawn 1, 2.5, or 2 cm (depending on age) 10 times at 5-minute intervals. Optimal probe insertion distances were defined by limits of agreement (LOAs) between nasopharyngeal and esophageal temperatures <0.5 °C.

RESULTS:

Optimal nasopharyngeal temperature probe position ranged from 6 to 10 cm in infants up to 6 months old, 7 to 8 cm in infants 7 to 12 months old, 7.5 to 12 cm in children 13 to 23 months old, and 10 to 12 cm in children aged 6 years and older. The 95% LOAs were <0.5 °C for all age categories except the 2- to 5-year-old group where the limits extended from –0.67 °C to 0.52 °C at 9 cm. At the optimal position within each age range, the bias (average nasopharyngeal-to-esophageal temperature difference) was ≤0.1 °C.

CONCLUSIONS:

Nasopharyngeal thermometers accurately measure core temperature, but only when probes are inserted a proper distance, which varies with age. As with much in pediatrics, nasopharyngeal thermometer insertion depths should be age appropriate.
Appropriate Duration of Perioperative Intravenous Administration of Lidocaine to Provide Satisfactory Analgesia for Adult Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials
Authors: Yang Wei , Yan Siyu , Yu Feng , Jiang Chunling
Published: February 2023

BACKGROUND:

Perioperative lidocaine infusion has been reported to alleviate pain intensity after colorectal surgery. However, there is no consensus on whether prolonged lidocaine infusion is more effective than short lidocaine infusion. This meta-analysis aimed to determine an appropriate duration of lidocaine infusion in patients undergoing colorectal surgery.

METHODS:

We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify articles published before December 17, 2021. Randomized controlled trials comparing intravenous lidocaine with placebo for pain relief in patients undergoing colorectal surgery were included. The primary outcome was pain scores (visual analog scale [VAS], 0–10 cm) at 24 hours postoperatively at rest and on movement. Secondary outcomes included pain scores at 12, 48, and 72 hours postoperatively, analgesic consumption (mg), gastrointestinal function return (hour), length of hospital stay (days), and incidence of complications. According to the duration of lidocaine infusion, studies were grouped into infusion for at least 24 hours (prolonged lidocaine infusion) and less than 24 hours (short lidocaine infusion) to assess the impact of lidocaine infusion duration on the outcomes of interests. Quantitative analyses were performed using a random effects model.

RESULTS:

Eleven studies with 548 patients were included. Five studies used prolonged lidocaine infusion, while 6 studies used short lidocaine infusion. Prolonged lidocaine infusion reduced postoperative pain scores versus placebo at 24 hours at rest (mean difference [MD], −0.91 cm; 95% confidence interval [CI], −1.54 to −0.28; P = .02) and on movement (MD, −1.69 cm; 95% CI, −2.15 to −1.22; P < .001), while short lidocaine infusion showed no benefit. Compared with placebo, prolonged lidocaine infusion reduced pain scores at 12 hours at rest and at 12 and 48 hours on movement, but short lidocaine infusion did not. However, there was no significant difference in pain scores between the prolonged and short lidocaine infusion groups at these time points. Compared with placebo, prolonged lidocaine infusion shortened the length of hospital stay (MD, −1.30 days; 95% CI, −1.72 to −0.88; P < .001) and time to first postoperative defecation (MD, −12.51 hours; 95% CI, −22.67 to −2.34; P = .02). There were no differences between groups regarding the other outcomes.

CONCLUSIONS:

The analgesic effect of intravenous lidocaine may depend on the duration of infusion, and our results suggest that lidocaine infusion should be administered for at least 24 hours after colorectal surgery. Since overall evidence quality was low, further high-quality, large-sample trials are needed to explore an optimal lidocaine infusion strategy in patients undergoing colorectal surgery.
Bilateral Pallidal Deep Brain Stimulation in Meige Syndrome: Effects on Motor Function, Neuropsychological Status, and Mood
Authors: Zheng Wentao , Lv Gaoquan , Lu Yunwei , Liu Jiayu , Hao Qingpei , Ding Hu , Liu Yezu , Liu Ruen
Published: February 2023

BACKGROUND:

Bilateral pallidal deep brain stimulation (DBS) has been broadly accepted as a feasible surgical procedure for treating various forms of dystonia, but its effects on motor function, neuropsychological status, and mood in patients with Meige syndrome have rarely been examined.

OBJECTIVE:

To evaluate the effects of bilateral globus pallidus internus DBS (GPi-DBS) on the motor performance, quality of life, neuropsychological status, and mood of patients with primary Meige syndrome.

METHODS:

Between January 2015 and April 2019, the database of 35 patients with Meige syndrome who underwent bilateral GPi-DBS in our institution was retrospectively reviewed. The severity of dystonia, health-related quality of life, cognitive function, and mood were assessed using standardized and validated rating scales at baseline. Repeat assessment of the same domains was performed at 1 year and 3 years after neurostimulation in a similar manner.

RESULTS:

One year and 3 years after bilateral GPi-DBS, Burke-Fahn-Marsden Dystonia Rating Scale movement scores were improved by 65% and 72% and Burke-Fahn-Marsden Dystonia Rating Scale disability scores were improved by 49% and 57%, respectively. The significant improvement in health-related quality of life observed at 1 year was sustained at 3 years. Relative to baseline and to the 1-year assessment, cognitive functions and mood remained stable after 3 years of neurostimulation. No deaths or life-threatening events were reported over the study period.

CONCLUSION:

Bilateral GPi-DBS is a safe and effective approach for medically refractory Meige syndrome that can improve motor function and quality of life without cognitive and mood side effects.
Response to Preoperative Dexamethasone Predicts Postoperative Neurological Improvement of Focal Neurological Deficits in Patients With Brain Metastases
Authors: Bowden Stephen G. , Lopez Ramos Christian G. , Cheaney Barry , Richie Emma , Yaghi Nasser K. , Munger Daniel N. , Mazur-Hart David J. , Tan Hao , Wood Matthew D. , Cetas Justin S. , Dogan Aclan , Raslan Ahmed M. , Han Seunggu J.
Published: February 2023

BACKGROUND:

Steroids are used ubiquitously in the preoperative management of patients with brain tumor. The rate of improvement in focal deficits with steroids and the prognostic value of such a response are not known.

OBJECTIVE:

To determine the rate at which focal neurological deficits respond to preoperative corticosteroids in patients with brain metastases and whether such an improvement could predict long-term recovery of neurological function after surgery.

METHODS:

Patients with brain metastases and related deficits in language, visual field, or motor domains who received corticosteroids before surgery were identified. Characteristics between steroid responders and nonresponders were compared.

RESULTS:

Ninety six patients demonstrated a visual field (13 patients), language (19), or motor (64) deficit and received dexamethasone in the week before surgery (average cumulative dose 43 mg; average duration 2.7 days). 38.5% of patients' deficits improved with steroids before surgery, while 82.3% of patients improved by follow-up. Motor deficits were more likely to improve both preoperatively (P = .014) and postoperatively (P = .010). All 37 responders remained improved at follow-up whereas 42 of 59 (71%) of nonresponders ultimately improved (P < .001). All other clinical characteristics, including dose and duration, were similar between groups.

CONCLUSION:

A response to steroids before surgery is highly predictive of long-term improvement postoperatively in brain metastasis patients with focal neurological deficits. Lack of a response portends a somewhat less favorable prognosis. Duration and intensity of therapy do not seem to affect the likelihood of response.
Integration of Veterans Affairs Medical Centers Into Neurosurgical Residency Programs
Authors: Yearley Alexander G. , Patel Ruchit V. , Rachlin Jacob R. , Gupta Saksham , King Joseph T. , Cosgrove G. Rees , Mooney Michael A.
Published: February 2023

Veterans Affairs (VA) medical centers serve as a unique training environment for US residency programs. In this study, we aim to explore the scope and details of VA integration into neurosurgery resident training. We used data from the Accreditation Council for Graduate Medical Education database to provide an overview of neurosurgery training programs with an active VA affiliation and developed a multi-institutional survey to gather information related to rotation design, operative volume, expectations, and core training values. Of the 116 neurosurgery residency programs, 40 have an active affiliation with a VA medical center (34%). Residents most frequently rotated at the VA during their third postgraduate year, with an average rotation length of 7.5 months (range 2-21). Nearly all programs reported a weekly mix of clinic and operative days (96%), with residents longitudinally following patients throughout their rotations. Attending neurosurgeons from VA-affiliated programs reported operative experience (100%), independent decision-making (89%), and continuity of care (81%) as core values of VA neurosurgery rotations. Surgical volume varied between programs with an average of 13.4 ± 6.4 (SD) cases per month per rotating resident. A significant portion of neurosurgery residency programs in the United States incorporate VA rotations into resident training. Although rotation details vary from program-to-program, shared values include a strong operative experience, independent decision-making, and continuity of care. This analysis provides a comprehensive assessment of VA rotation structure across the country, which is valuable for programs considering implementing a VA rotation into their training program or modifying an existing rotation.
Petrous Carotid to Upper Posterior Circulation Bypass for the Treatment of Basilar Trunk Aneurysm: A Novel High-Flow Intracranial–Intracranial Skull Base Bypass for Posterior Circulation
Authors: Wang Xuan , Tong Xiaoguang , Liu Jie , Shi Minggang , Shang Yanguo , Wang Hu
Published: February 2023

BACKGROUND:

Basilar trunk aneurysms are the most surgically challenging, and the spectrum covers small fusiform to dolichoectatic aneurysms and may lead to rupture, brain ischemia, or direct brainstem compression. The current strategy remains cerebral revascularization coupled with aneurysm trapping. Available bypass options for upper posterior circulation (UPC) are based on (1) different flow volumes from diverse blood supplies and (2) distinct modulation purposes for cerebral revascularization; however, the potential compromise of eloquent perforators of the basilar trunk and the occurrence of fatal brainstem infarcts remain unacceptable.

OBJECTIVE:

The aim is to innovate a high-flow intracranial–intracranial skull base bypass for posterior circulation to afford robust retrograde flow and shorten the graft length.

METHODS:

We retrospectively reviewed our experience in the treatment of a patient with basilar trunk aneurysm and reported a novel bypass alternative supplied by petrous internal carotid artery to augment blood flow to the UPC by a pretemporal approach.

RESULTS:

The postoperative course was uneventful, and there was no pons or midbrain ischemia or other complications. Postoperative computed tomography angiogram revealed the patency of bypass. There was no further development or rerupture observed during follow-up.

CONCLUSION:

Petrous internal carotid artery as a donor site is a reliable bypass modality for UPC. This approach provides the utmost retrograde flow to alleviate the development of dissecting aneurysms, preserves eloquent perforators of the basilar trunk, maintains bypass patency, and shortens the graft course. Therefore, this novel therapeutic alternative could be beneficial for improving the prognosis of basilar trunk aneurysms.
The Lower Limbs of Sprinters Have Larger Relative Mass But Not Larger Normalized Moment of Inertia than Controls
Authors: SADO NATSUKI , ICHINOSE HOSHIZORA , KAWAKAMI YASUO
Published: February 2023

Purpose

Sprinters exhibit inhomogeneous muscularity corresponding to musculoskeletal demand for sprinting execution. An inhomogeneous morphology would affect the mass distribution, which in turn may affect the mechanical difficulty in moving from an inertia perspective; however, the morphological characteristics of sprinters from the inertia perspective have not been examined. Here we show no corresponding differences in the normalized mass and normalized moment of inertia between the sprinters and untrained nonsprinters.

Methods

We analyzed fat- and water-separated magnetic resonance images from the lower limbs of 11 male sprinters (100 m best time of 10.44–10.83 s) and 12 untrained nonsprinters. We calculated the inertial properties by identifying the tissue of each voxel and combining the literature values for each tissue density.

Results

The lower-limb relative mass was significantly larger in sprinters (18.7% ± 0.7% body mass) than in nonsprinters (17.6% ± 0.6% body mass), whereas the normalized moment of inertia of the lower limb around the hip in the anatomical position was not significantly different (0.044 ± 0.002 vs 0.042 ± 0.002 [a. u.]). The thigh relative mass in sprinters (12.9% ± 0.4% body mass) was significantly larger than that in nonsprinters (11.9% ± 0.4% body mass), whereas the shank and foot relative masses were not significantly different.

Conclusions

We revealed that the mechanical difficulty in swinging the lower limb is not relatively larger in sprinters in terms of inertia, even though the lower-limb mass is larger, reflecting their muscularity. We provide practical implications that sprinters can train without paying close attention to the increase in lower-limb mass and moment of inertia.
Descriptive Epidemiology of Cardiorespiratory Fitness in UK Adults: The Fenland Study
Authors: GONZALES TOMAS I. , WESTGATE KATE , HOLLIDGE STEFANIE , LINDSAY TIM , WIJNDAELE KATRIEN , FOROUHI NITA G. , GRIFFIN SIMON , WAREHAM NICK , BRAGE SOREN
Published: February 2023

Introduction

Cardiorespiratory fitness (CRF) is rarely measured in population studies. Most studies of CRF do not examine differences by population subgroups or seasonal trends. We examined how estimated CRF levels vary by anthropometric, sociodemographic, and behavioral characteristics in a population-based cohort of UK adults (the Fenland Study).

Methods

We used a validated submaximal exercise test to obtain CRF estimates (CRFestimated) in 5976 women and 5316 men, residing in the East of England. CRFestimated was defined as estimated maximal oxygen consumption per kilogram total body mass (V̇O2maxtbm) and fat-free mass (V̇O2maxffm). Descriptive statistics were computed across anthropometric and sociodemographic characteristics, and across the year. Progressive multivariable analyses were performed to examine associations with physical activity energy expenditure (PAEE) and body mass index (BMI).

Results

Mean ± SD V̇O2maxtbm was lower in women (35.2 ± 7.5 mL·min−1·kg−1) than men (41.7 ± 7.3 mL·min−1·kg−1) but V̇O2maxffm was similar (women: 59.2 ± 11.6 mL·min−1·kg−1; men: 62.0 ± 10.3 mL·min−1·kg−1). CRFestimated was inversely associated with age but not after adjustment for PAEE. People in more physically demanding jobs were fitter compared with those in sedentary jobs, but this association was attenuated in women and reversed in men after adjustment for total PAEE. Physical activity energy expenditure and BMI were positively associated with CRFestimated at all levels of adjustment when expressed relative to fat-free mass. CRFestimated was 4% higher in summer than in winter among women, but did not differ by season among men.

Conclusions

CRFestimated was inversely associated with age but less steeply than anticipated, suggesting older generations are comparatively fitter than younger generations. Physical activity energy expenditure and BMI were stronger determinants of the variance in CRFestimated than other characteristic including age. This emphasizes the importance of modifiable physical activity behaviors in public health interventions.
UBC-Nepal Expedition: Motor Unit Characteristics in Lowlanders Acclimatized to High Altitude and Sherpa
Authors: RUGGIERO LUCA , MCNEIL CHRIS J.
Published: February 2023

Introduction

With acclimatization to high altitude (HA), adaptations occur throughout the nervous system and at the level of the muscle, which may affect motor unit (MU) characteristics. However, despite the importance of MUs as the final common pathway for the control of voluntary movement, little is known about their adaptations with acclimatization.

Methods

Ten lowlanders and Sherpa participated in this study 7 to 14 d after arrival at HA (5050 m), with seven lowlanders repeating the experiment at sea level (SL), 6 months after the expedition. The maximal compound muscle action potential (Mmax) was recorded from relaxed biceps brachii. During isometric elbow flexions at 10% of maximal torque, a needle electrode recorded the MU discharge rate (MUDR) and MU potential (MUP) characteristics of single biceps brachii MUs.

Results

Compared with SL, acclimatized lowlanders had ~10% greater MUDR, ~11% longer MUP duration, as well as ~18% lower amplitude and ~6% greater duration of the first phase of the Mmax (all P < 0.05). No differences were noted between SL and HA for variables related to MUP shape (e.g., jitter, jiggle; P > 0.08). Apart from lower near-fiber MUP area for Sherpa than acclimatized lowlanders (P < 0.05), no Mmax or MU data were different between groups (P > 0.10).

Conclusions

Like other components of the body, MUs in lowlanders adapt with acclimatization to HA. The absence of differences between acclimatized lowlanders and Sherpa suggests that evolutionary adaptations to HA are smaller for MUs than components of the cardiovascular or respiratory systems.
Effects of 2-Year-Long Maintenance Training and Detraining on 558 Subacute Ischemic Stroke Patients’ Clinical–Motor Symptoms
Authors: TOLLÁR JÓZSEF , VETROVSKY Tomas , SZéPHELYI KLAUDIA , CSUTORÁS BENCE , PRONTVAI NÁNDOR , ÁCS PONGRÁC , HORTOBÁGYI TIBOR
Published: February 2023

Purpose

This study aimed to determine the effects of a 2-yr-long maintenance training (MT) exergaming and detraining (DT) on clinical–motor symptoms in subacute ischemic patients with stroke (PwST). The hypothesis was that MT motor rehabilitation program would further increase the effects of the initial rehabilitation.

Methods

After high-intensity and high-frequency exergaming twice or once a day, 5 times per week for 5 wk (EX2: 50 sessions; EX1: 25 sessions, results reported previously), 558 PwST were randomized to EX2-MT, EX2-DT, EX1-MT, and EX1-DT. MT exergaming consisted of once a day, 3 times per week for 2 yr, and DT did not train. Outcomes were measured at 6, 12, 18, and 24 months. The data were analyzed using longitudinal linear mixed-effects models and general linear hypotheses testing.

Results

Modified Rankin Score (primary outcome), body mass, Mini-Mental State Examination score, Beck Depression Inventory, measures of quality of life, Berg Balance Scale, 6-min walk test, and four measures of center of pressure path tended to retain the initial rehabilitation-induced gains in the MT patients in selected outcomes (especially walking capacity). The scores tended to mildly worsen after DT, partially supporting the hypothesis.

Conclusions

MT successfully maintained, but only in selected variables did it further increase the initial exergaming rehabilitation-induced robust improvements. DT modestly reduced the initial exergaming rehabilitation-induced improvements. MT programs might be needed after initial stroke rehabilitation to reduce subsequent losses of quality of life and further improve clinical–motor symptoms.
Associations between Accelerometer-Measured Physical Activity and Fecal Microbiota in Adults with Overweight and Obesity
Authors: HUGHES RILEY L. , PINDUS DOMINIKA M. , KHAN NAIMAN A. , BURD NICHOLAS A. , HOLSCHER HANNAH D.
Published: February 2023

Purpose

We aimed to assess whether total daily physical activity (PA), PA intensities, sedentary time (ST), and prolonged ST are associated with differences in the gut microbiota composition or short-chain fatty acid (SCFA) profile of adults with overweight or obesity.

Methods

Cross-sectional associations between total daily PA (counts per minute), PA intensities (light and moderate-to-vigorous (MVPA)), ST, prolonged ST, and fecal microbiota composition were assessed in adults (n = 124) between 25 and 45 yr of age with body mass index ≥25 kg·m−2. Fecal microbiota composition was assessed with 16S rRNA gene sequencing. Daily PA and ST were measured with a hip-worn ActiGraph wGT3X-BT accelerometer.

Results

Daily PA volume and intensity were positively associated with relative abundance of Faecalibacterium (P = 0.04) and negatively associated with the abundances of Alistipes, Parabacteroides, and Gemmiger (P = 0.003–0.04) as well as the concentrations of acetate, butyrate, and total SCFA (all P = 0.04). Conversely, ST was negatively associated with abundance of Faecalibacterium but positively associated with the abundances of taxa, including Ruminococcaceae, Parabacteroides, Alistipes, and Gemmiger. Clustering of participants based on whether they met PA recommendations suggested that SCFA profiles differed between individuals who did and did not meet PA recommendations. K-means clustering based on percent of time spent in MVPA and ST also identified differences in fecal microbiota composition between cluster 1 (lower MVPA, higher ST) and cluster 2 (higher MVPA, lower ST), including a higher abundance of Alistipes in cluster 1.

Conclusions

The current analysis suggests a beneficial association of daily PA on the fecal microbiota and a negative association of ST, particularly with respect to the associations of these variables with the genera Faecalibacterium, a butyrate-producing taxon.
Shorter High-Intensity Cycling Intervals Reduce Performance and Perceived Fatigability at Work-Matched but Not Task Failure
Authors: MCCLEAN ZACHARY , IANNETTA DANILO , MACINNIS MARTIN , ABOODARDA SAIED JALAL
Published: February 2023

Introduction

The intensity, duration, and distribution of work and recovery phases during high-intensity interval training (HIIT) modulate metabolic perturbations during exercise and subsequently influence the development of performance fatigability and exercise tolerance. This study aimed to characterize neuromuscular, perceptual, and cardiorespiratory responses to work-to-rest ratio-matched HIIT protocols differing in work and rest interval duration.

Methods

Twelve healthy individuals (six women) first completed a ramp incremental test to determine 90% of peak power output, and then in three randomized visits, they completed three cycling protocols to task failure at 90% of peak power output: (i) 3- to 3-min work-to-passive rest ratio HIIT (HIIT3min), (ii) 1- to 1-min work-to-passive rest ratio HIIT (HIIT1min), and (iii) constant load (CL). Interpolated twitch technique, including maximal voluntary isometric knee extensions and femoral nerve electrical stimuli, was performed at baseline, every 6 min of work, and task failure. Perceptual and cardiorespiratory responses were recorded every 3 min and continuously across the exercises, respectively.

Results

The work completed during HIIT1min (8447 ± 5124 kJ) was considerably greater than HIIT3min (1930 ± 712 kJ) and CL (1076 ± 356) (P < 0.001). At work-matched, HIIT1min resulted in a lesser decline in maximal voluntary contraction and twitch force compared with HIIT3min and CL (P < 0.001). Perceived effort, pain, and dyspnea were least in HIIT1min and HIIT3min compared with CL (P < 0.001). At task failure, HIIT1min resulted in less voluntary activation than HIIT3min (P = 0.010) and CL (P = 0.043), and engendered less twitch force decline than CL (P = 0.021).

Conclusions

Overall, the mitigated physiological and perceptual responses during shorter work periods (HIIT1min) enhance exercise tolerance in comparison to longer work intervals at the same intensity (HIIT3min, CL).
Six Months of Exercise Training Improves Ventilatory Responses during Exercise in Adults with Well-Healed Burn Injuries
Authors: WATSO JOSEPH C. , ROMERO STEVEN A. , MORALEZ GILBERT , HUANG MU , CRAMER MATTHEW N. , JAFFERY MANALL F. , BALMAIN BRYCE N. , WILHITE DANIEL P. , BABB TONY G. , CRANDALL CRAIG G.
Published: February 2023

Introduction

Pulmonary function is lower after a severe burn injury, which could influence ventilatory responses during exercise. It is unclear whether exercise training improves pulmonary function or ventilatory responses during exercise in adults with well-healed burn injuries. Therefore, we tested the hypothesis that exercise training improves pulmonary function and ventilatory responses during exercise in adults with well-healed burn injuries.

Methods

Thirty-nine adults (28 with well-healed burn injuries and 11 non–burn-injured controls) completed 6 months of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we performed comprehensive pulmonary function testing and measured ventilatory responses during cycling exercise. We compared variables using two-way ANOVA (group–time; i.e., preexercise/postexercise training (repeated factor)).

Results

Exercise training did not increase percent predicted spirometry, lung diffusing capacity, or airway resistance measures (time: P ≥ 0.14 for all variables). However, exercise training reduced minute ventilation (V̇
E; time: P ≤ 0.05 for 50 and 75 W) and the ventilatory equivalent for oxygen (V̇
E/V̇O2; time: P < 0.001 for 75 W) during fixed-load exercise for both groups. The ventilatory equivalent for carbon dioxide (V̇
E/V̇CO2) during exercise at 75 W was reduced after exercise training (time: P = 0.04). The percentage of age-predicted maximum heart rate at the ventilatory threshold was lower in adults with well-healed burn injuries before (P = 0.002), but not after (P = 0.22), exercise training. Lastly, exercise training increased V̇
E and reduced V̇
E/V̇O2 during maximal exercise (time: P = 0.005 for both variables).

Conclusions

These novel findings demonstrate that exercise training can improve ventilatory responses during exercise in adults with well-healed burn injuries.
Passive Cycle Training Promotes Bone Recovery after Spinal Cord Injury without Altering Resting-State Bone Perfusion
Authors: YARROW JOSHUA F. , WNEK RUSSELL D. , CONOVER CHRISTINE F. , REYNOLDS MICHAEL C. , BUCKLEY KINLEY H. , KURA JAYACHANDRA R. , SUTOR TOMMY W. , OTZEL DANA M. , MATTINGLY ALEX J. , BORST STEPHEN E. , CROFT SUMMER M. , AGUIRRE J. IGNACIO , BECK DARREN T. , MCCULLOUGH DANIELLE J.
Published: February 2023

Introduction

Spinal cord injury (SCI) produces diminished bone perfusion and bone loss in the paralyzed limbs. Activity-based physical therapy (ABPT) modalities that mobilize and/or reload the paralyzed limbs (e.g., bodyweight-supported treadmill training (BWSTT) and passive-isokinetic bicycle training) transiently promote lower-extremity blood flow (BF). However, it remains unknown whether ABPT alter resting-state bone BF or improve skeletal integrity after SCI.

Methods

Four-month-old male Sprague-Dawley rats received T9 laminectomy alone (SHAM; n = 13) or T9 laminectomy with severe contusion SCI (n = 48). On postsurgery day 7, SCI rats were stratified to undergo 3 wk of no ABPT, quadrupedal (q)BWSTT, or passive-isokinetic hindlimb bicycle training. Both ABPT regimens involved two 20-min bouts per day, performed 5 d·wk−1. We assessed locomotor recovery, bone turnover with serum assays and histomorphometry, distal femur bone microstructure using in vivo microcomputed tomography, and femur and tibia resting-state bone BF after in vivo microsphere infusion.

Results

All SCI animals displayed immediate hindlimb paralysis. SCI without ABPT exhibited uncoupled bone turnover and progressive cancellous and cortical bone loss. qBWSTT did not prevent these deficits. In comparison, hindlimb bicycle training suppressed surface-level bone resorption indices without suppressing bone formation indices and produced robust cancellous and cortical bone recovery at the distal femur. No bone BF deficits existed 4 wk after SCI, and neither qBWSTT nor bicycle altered resting-state bone perfusion or locomotor recovery. However, proximal tibia BF correlated with several histomorphometry-derived bone formation and resorption indices at this skeletal site across SCI groups.

Conclusions

These data indicate that passive-isokinetic bicycle training reversed cancellous and cortical bone loss after severe SCI through antiresorptive and/or bone anabolic actions, independent of locomotor recovery or changes in resting-state bone perfusion.
Interlimb and Intralimb Coordination of Rectus Femoris and Biceps Femoris Muscles at Different Running Speeds
Authors: KAKEHATA GAKU , GOTO YUTA , YOKOYAMA HIKARU , ISO SHIGEO , KANOSUE KAZUYUKI
Published: February 2023

Purpose

The purpose of this study was to investigate the relationship between spatiotemporal variables and the muscle activity of the rectus femoris (RF) and biceps femoris (BF) in both legs at various running speeds.

Methods

Eighteen well-trained male athletes (age: 20.7 ± 1.8 yr) were asked to run for 50 m with 7 different “subjective efforts (SE)” (20%, 40%, 60%, 80%, 90%, 95%, and 100% SE). SE scaled relative to the maximal effort running (100%). The spatiotemporal variables (running speed, step frequency, step length) were measured over the distance from 30 to 50 m. The RF and BF muscle activities were obtained from both legs with wireless electromyography (EMG) sensors. We calculated RF and BF onset/offset timings in both legs (e.g., ipsilateral leg RF is “iRF,” contralateral leg BF is “cBF”), which were expressed as % of a running cycle. Based on those timings, we obtained the EMG timing variables (%), as Switch1 (iBF offset to iRF onset), Switch2 (iRF offset to iBF onset), Scissors1 (cBF onset to iRF onset), and Scissors2 (iRF offset to cBF offset).

Results

running speed was well correlated with the SE, and higher running speed (>9 m·s−1) was achieved with higher step frequency (>4.0 Hz). Relative timings of RF and BF onset/offset (%) appeared earlier and later, respectively, with an increase in running speed. The absolute duration of RF activation (s) was elongated with the decrease in absolute running cycle time (increase in running speed). Both Switch and Scissors showed significant negative correlations with running speed and step frequency.

Conclusions

The RF and BF excitation in both legs, as evidenced by changes in both Switch and Scissors, is coordinated for controlling running speed, as well as step frequency.
Excessive Ethanol Intake in Mice Does Not Impair Recovery of Torque after Repeated Bouts of Eccentric Contractions
Authors: MOSER SAMANTHA E. , BROWN AUSTIN M. , GANJAYI MUNI SWAMY , OTIS JEFFREY S. , BAUMANN CORY W.
Published: February 2023

Purpose

Alcoholics develop muscle atrophy and weakness from excessive ethanol (EtOH) intake. To date, most research has examined outcomes of alcohol-induced atrophy and weakness under basal or unstressed conditions despite physical stress being a normal occurrence in a physiological setting. Therefore, this study set out to determine if recovery of torque is impaired after repetitive bouts of physical stress in skeletal muscle during excessive short-term (experiment 1) and long-term (experiment 2) EtOH consumption.

Methods

Twenty male and female mice were assigned to receive either 20% EtOH in their drinking water or 100% water. Short- and long-term consumption was predetermined to be EtOH intake starting at 4 and 26 wk, respectively. Anterior crural muscles performed repeated bouts of physical stress using in vivo eccentric contractions, with tetanic isometric torque being measured immediately pre- and postinjury. A total of 10 bouts were completed with 14 d between each bout within bouts 1–5 (experiment 1) and bouts 6–10 (experiment 2), and 12 wk between bouts 5 and 6.

Results

Mice consuming EtOH had blood alcohol concentrations up to 270 mg·dL−1. In experiment 1, five bouts of eccentric contractions did not reduce recovery of torque, regardless of sex or EtOH treatment (P ≥ 0.173). Similarly, in experiment 2, preinjury torques did not differ from day 14 values regardless of sex or treatment (P ≥ 0.322). However, there was a group effect in female mice for bouts 6 and 10 during experiment 2, with female EtOH mice being weaker than controls (P ≤ 0.002).

Conclusions

Excessive short- or long-term EtOH misuse in a mouse model did not affect the muscle’s ability to regain strength after repeated bouts of eccentric contractions, suggesting that EtOH may not be as detrimental to recovery as once predicted.
The Time Course of Health, Fitness, and Occupational Performance Changes in Recruits across a Fire Academy
Authors: WOHLGEMUTH KEALEY J. , GERSTNER GENA R. , GIULIANI-DEWIG HAYDEN K. , MOTA JACOB A. , SMITH-RYAN ABBIE E. , RYAN ERIC D.
Published: February 2023

Purpose

The purpose of this study was to examine the time course of health, fitness, and occupational performance changes in firefighter recruits across a fire academy.

Methods

Nineteen recruits (24.9 ± 4.3 yr; 26.7 ± 3.1 kg·m−2) had their body composition, balance, vertical jump (VJ) performance, cardiorespiratory fitness (CRF), upper and lower body strength, hamstrings-to-quadriceps (H/Q) ratio, lower back endurance, and weighted stair climb (SC) performance assessed at the beginning (week 1 [W1]), midpoint (week 15 [W15]), and end (week 30 [W30]) of a fire academy.

Results

The fire academy improved body composition, balance, CRF, leg extension strength, and SC performance from W1 to W15 (P ≤ 0.042) which then plateaued at W30 (P ≥ 0.314). Leg flexion strength and the H/Q ratio decreased from W1 to W15 (P ≤ 0.035) and plateaued at W30 (P ≥ 0.947). Upper body strength was similar at W1 and W15 (P ≥ 0.999), but decreased at W30 (P ≤ 0.033). However, no significant changes occurred across the academy for VJ performance or lower back endurance (P ≥ 0.090).

Conclusions

These findings highlight the positive effect of the academy on body composition, CRF, balance, SC performance, and leg extension strength. However, the decreases in upper body and leg flexion strength, the H/Q ratio, and lack of changes in VJ performance and low back endurance may highlight key areas of need to maximize injury prevention and performance enhancement efforts in the academy. Further, the varied time course of changes may help fire departments identify opportunities to modify exercise programming across their academies.
The Presence of Wind Worsens the Effect of Cold Temperature on Time to Ischemia in Patients with Stable Angina
Authors: BARRY HADIATOU , GAGNON DANIEL , IGLESIES-GRAU JOSEP , LALONGÉ JULIE , JUNEAU MARTIN
Published: February 2023

Purpose

This study tested the hypothesis that the combination of cold temperature and wind further reduces time to ischemia during treadmill stress testing compared with cold temperature alone.

Methods

Eighteen participants (56 ± 9 yr) with stable angina performed four treadmill stress tests in a randomized crossover design at +20°C and −8°C, with and without a 24-km·h−1 headwind. Time to ischemia (≥1-mm ST-segment depression) and angina, rate pressure product, and total exercise duration were determined.

Results

At −8°C, time to ischemia was reduced by 22% (−58 s (−85 to −31 s), P < 0.01) compared with +20°C. The addition of wind at −8°C reduced time to ischemia by a further 15% (−31 s (−58 to −4 s) vs −8°C without wind, P = 0.02). The addition of wind did not affect time to ischemia at +20°C (P = 0.38). Cold temperature and wind did not affect time to angina (P = 0.46 and P = 0.61) or rate pressure product (P = 0.46 and P = 0.09). Total exercise time was reduced in the presence of wind at −8°C (−29 s (−51 to −7 s), P = 0.01), but not at +20°C (P = 0.09).

Conclusions

The presence of wind reduces time to ischemia when exercise stress testing is performed in a cold environment. These results suggest that wind should be considered when evaluating the risks posed by cold weather in patients with coronary artery disease and exercise-induced ischemia.