6-min Test Research Articles

Upper Extremity Exercise Capacity and Muscle Oxygenation in Patients With Primary Ciliary Dyskinesia.

Patients with primary ciliary dyskinesia (PCD) have a reduction in exercise capacity from the early stages. Although there are studies investigating these patients' lower extremity exercise capacity using various methodologies, there needs to be more research on the functional exercise capacity of the upper extremities. This study aimed to compare pulmonary function, upper extremity functional exercise capacity, muscle oxygenation, muscle strength, and physical activity level in children with PCD and controls. Twenty-seven children with PCD and 26 controls were included. Pulmonary function (spirometry), upper extremity functional exercise capacity (6-min pegboard and ring test (6PBRT), muscle oxygenation (Moxy device), deltoid muscle strength (dynamometer), and physical activity level (metabolic holter) were assessed. Patients' FVC%, FEV1%, FEV1/FVC, PEF%, FEF25%-75%, deltoid muscle strength (%) were statistically decreased compared with controls (p < 0.05). The 6PBRT ring count, deltoid muscle oxygen saturations, and total hemoglobin levels were similar in both groups (p > 0.05). Pulmonary function deteriorates and upper extremity muscle strength decreases in children with PCD. The upper extremity exercise capacity of these patients remains preserved. However, upper extremity resting muscle oxygen saturation is lower in children compared to healthy children. Most patients and healthy children are inactive. The upper extremity exercise capacity possibly declines due to deteriorating pulmonary function as the patients get older, which needs to be investigated routinely. Both upper-lower extremity aerobic exercise training applied consistently and physical activity counseling as part of their pulmonary rehabilitation program should be considered in children with PCD.

Effect of Acute Hypoxia Exposure on the Availability of A1 Adenosine Receptors and Perfusion in the Human Brain.

In animal studies it has been observed that the inhibitory neuromodulator adenosine is released into the cerebral interstitial space during hypoxic challenges. Adenosine's actions on the A1 adenosine receptor (A1AR) protect the brain from oxygen deprivation and overexertion through adjustments in cerebral blood flow, metabolism, and electric activity. Methods: Using 8-cyclopentyl-3-(3-[18F]fluoropropyl)-1-propylxanthine ([18F]CPFPX), a PET tracer for the A1AR, we tested the hypothesis that hypoxia-induced adenosine release reduces A1AR availability in the human brain. Furthermore, we investigated whether this response is associated with altered brain perfusion and psychomotor vigilance. Ten healthy volunteers completed a 110-min bolus-plus-constant-infusion [18F]CPFPX PET/MRI hybrid experiment including a 30-min interval of normobaric hypoxia with peripheral oxygen saturation between 70% and 75%. We obtained blood samples to calculate metabolite-corrected steady-state A1AR distribution volumes and measured gray matter brain perfusion via arterial spin labeling in high temporal resolution. A 3-min psychomotor vigilance test was conducted every 10 min, and heart rate and peripheral blood oxygen saturation were continuously measured. Results: In all 7 examined brain regions, hypoxia reduced A1AR availability significantly (e.g., frontal lobe, 13.5%; P = 0.0144) whereas gray matter brain perfusion increased (e.g., frontal lobe, 42.5%; P = 0.0007). Heart rate increased by 19% (P = 0.0039). Mean reaction speed decreased by 4.3% (P = 0.0021). Conclusion: Our study is the first, to our knowledge, to demonstrate that acute hypoxia, corresponding to a mean altitude of 5,500 m (18,000 ft), reduces A1AR availability in the human brain. The finding is consistent with hypoxia-induced cerebral adenosine release leading to increased A1AR occupancy.

Validity and Reliability of the 6-min Pegboard and Ring Test in Patients With Duchenne Muscular Dystrophy.

Tests for assessing upper extremity (UE) functional capacity in patients with Duchenne muscular dystrophy (DMD) are limited. This study aimed to evaluate the validity and reliability of the 6-min pegboard and ring test (6PBRT) as a practical tool for this purpose. Children with DMD (n = 22) were evaluated using the 6PBRT for UE functional capacity, the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) for functionality, the Pediatric Quality of Life Inventory (PedsQL) for quality of life, and a dynamometer for handgrip strength and UE muscle strength. The 6PBRT showed excellent test-retest reliability, with an intraclass correlation coefficient (ICC) of 0.978 (95% confidence interval, 0.946-0.984). A very strong positive correlation was observed between the test and retest 6PBRT mean scores (r = 0.981). The mean 6PBRT score exhibited moderate-to-strong correlations with handgrip strength (r = 0.653, r = 0.646, right/left, respectively), muscle strength (shoulder flexors [r = 0.793, r = 0.797, right/left, respectively], shoulder abductors (r = 0.763, r = 0.743, right/left, respectively), elbow flexors [r = 0.743, r = 0.755, right/left, respectively]), mean Q-DASH score (r = -0.555), and mean PedsQL score (r = 0.611). The 6PBRT appears to be a valid and reliable measure for assessing upper extremity functional capacity in patients with DMD. This test is suitable for patients who are able to lift both hands above their heads. NCT06174025.

Plasma and salivary hormone responses to a 30-min exercise stress test in young, healthy, physically active females.

Overreaching, a consequence of intensified training, is used by athletes to enhance performance. A blunted hormonal response to a 30-min interval exercise stress test (55/80) has been shown in males after intensified training, highlighting cortisol and testosterone as potential biomarkers of overreaching. Despite accounting for ~50% of the population, studies into hormonal responses to exercise in females are lacking. The menstrual cycle and oral contraceptives profoundly affect hormonal responses, necessitating separate investigations into the female response to the same exercise-stress test. On three separate visits, 13 females (6 oral contraceptive users, 7 eumenorrheic) completed a VO2max test, resting control trial, and 55/80 stress test. The 55/80 involves alternating between 1 min at 55% VO2max and 4 min at 80% VO2max. Blood and saliva were collected pre, post, and 30 min post-55/80, and at coinciding time points during the resting control trial. Plasma progesterone, estrogen, and plasma and salivary cortisol and testosterone were analyzed via ELISA. A significant elevation of salivary and plasma cortisol (~141% and ~87%, respectively, p < 0.001), salivary testosterone (~93%, p < 0.001), and plasma progesterone (~58%, p = 0.004) were evident from pre- to post-55/80. Plasma testosterone remained unchanged. Hormonal responses were attenuated in oral contraceptive users. The 55/80 induces hormonal elevations in females, similar in magnitude as males.

Is there a critical rate of torque development?

The objective of this study was to test the hypothesis that neuromuscular fatigue influences the rate of torque development (RTD) in a similar manner to isometric torque. Nine men participated in this study and performed 5-min all-out isometric tests for knee extensors (KE) and plantar flexors (PF) muscles, to determine the end-test torque (ET) and the critical rate of torque development (critical RTD). Additionally, participants performed submaximal constant-torque tests to task failure for KE and PF muscles. Both maximal voluntary contraction and RTD exhibited hyperbolic behavior and reached an asymptote at the end of the 5-min all out isometric test with similar relative values (KE 29.5 ± 5.6% MVC and PF 50.9 ± 2.9% MVC and KE 25.1 ± 3.6 to 28.5 ± 4.4% RTD and PF 48.4 ± 6.5 to 52.4 ± 5.8% RTD). However, both % MVC and % RTD were statistically different between muscle groups (P < 0.05), even when normalized by muscle volume (P < 0.05). Torque and RTD after the constant-torque test were similar to the values of ET and critical RTD (P > 0.05), respectively. In this study, it was observed that neuromuscular fatigue affects RTD and torque similarly, with the magnitude of this effect varying according to the muscle size.

Reduced Lower Body Muscular Strength and Endurance among Adult Survivors of Childhood Cancer.

Introduction: Impaired physical fitness is a possible late effect among adult survivors of childhood cancer (ASCC). Our study describes lower body muscular strength and endurance among ASCC using the 1-minute sit-to-stand (1-min STS) test, compares them with the general population, identifies risk factors, and describes changes over time.Methods: In a prospective multicenter cohort study, we invited ASCC ≥18 years of age at study, diagnosed between ages 0-20 treated in five pediatric oncology centers across Switzerland from 1976-2017 who survived ≥5 years for a 1-min STS test. We collected information about lifestyle, medical history, and previous cancer treatment. Using population-based Swiss reference values, we calculated age- and sex-adjusted z-scores for 1-min STS performance and assessed the association between risk factors and 1-min STS test using multivariable linear regression. We fitted a multilevel linear model to describe the longitudinal course of 1-min STS performance.Results: We included 338 CCS of 1048 invited ASCC (participation rate 32%) with median age at study of 34 years (interquartile range 26-41). Compared with the general population, mean 1-min STS z-score was half a standard deviation lower (-0.52; 95% CI -0.64 to -0.40). Obesity (B = -0.56; 95% CI -0.97 to -0.16), cumulative cisplatin dose (B = -0.12; 95% CI -0.21 to -0.02), and cumulative cranial radiotherapy dose (B = -0.10; 95% CI -0.19 to -0.01) were associated with reduced 1-min STS performance. There was no change in 1-min STS z-scores over time (B = 0.02; 95% CI -0.05 to 0.09).Conclusions : We found evidence for reduced lower body strength and endurance among ASCC, suggesting the need for counseling and effective training and rehabilitation programs for maintaining daily functioning, improving cardiovascular health, and reducing morbidity for ASCC.

Proposed shorter duration protocols for measuring resting energy expenditure utilizing whole-room indirect calorimetry.

Sixty minutes is currently the shortest testing duration for 24-h resting energy expenditure (24-h REE) utilizing whole-room indirect calorimetry. Show that recalculated 30-min extrapolated 24-h REE from previously published 60-min metabolic data are valid. Propane consumption linearity was determined through an 8-h combustion test. Thereafter, metabolic data for 24-h extrapolated ventilation rates of oxygen (VO2; l/d), carbon dioxide (VCO2; l/d), respiratory quotient (RQ; VCO2/VO2), and REE (MJ/d) from ten 60-min propane combustion tests were recalculated to reflect a 30-min testing duration. A similar analysis was performed utilizing data from 60-min subject metabolic measurements within a whole-room indirect calorimeter (4597 liters) specific for measuring resting energy expenditure (REE). Statistical (p < 0.05) comparisons between recalculated and original 60-min metabolic data were determined by SPSS (version 29). Propane consumption during a combustion test was found to be linear for up to 8-h. Furthermore, no differences existed between propane stoichiometry and combustion for any of the extrapolated 24-h metabolic parameters when recalculated from 60-min propane combustion data to reflect a 30-min duration. Finally, similar results were obtained for all recalculated subject metabolic data. Recalculated extrapolated 24-h metabolic data derived from a 30-min testing duration appear to be valid. This suggests that whole-room indirect calorimetry could be an adjunct for various weight loss or other programs where accurate metabolic measurements are required.

Fatiguing high-intensity intermittent exercise depresses maximal Na+-K+-ATPase activity in human skeletal muscle assessed using a novel NADH-coupled assay.

The Na+-K+-ATPase is a critical regulator of ion homeostasis during contraction, buffering interstitial K+ accumulation, which is linked to muscle fatigue during intense exercise. Within this context, we adopted a recently reported methodology to examine exercise-induced alterations in maximal Na+-K+-ATPase activity. Eighteen trained healthy young males completed a repeated high-intensity cycling protocol consisting of three periods (EX1-EX3) of intermittent exercise. Each period comprised 10 × 45-s cycling at ~ 105% Wmax and a repeated sprint test. Muscle biopsies were sampled at baseline and after EX3 for determination of maximal in vitro Na+-K+-ATPase activity. Blood was drawn after each period and in association with a 2-min cycling test at a standardized high intensity (~ 90% Wmax) performed before and after the session to assess plasma K+ accumulation. Further, a 5-h recovery period with the ingestion of carbohydrate or placebo supplementation was implemented to explore potential effects of carbohydrate availability before sampling a final biopsy and repeating all tests. A ~ 12% reduction in maximal Na+-K+-ATPase activity was demonstrated following EX3 compared to baseline (25.2 ± 3.9 vs. 22.4 ± 4.8μmol·min-1·g-1 protein, P = 0.039), which was sustained at the recovery time point (~ 15% decrease compared to baseline to 21.6 ± 5.9μmol·min-1·g-1 protein, P = 0.008). No significant effect of carbohydrate supplementation was observed on maximal Na+-K+-ATPase activity after recovery (P = 0.078). In conclusion, we demonstrate an exercise-induced depression of maximal Na+-K+-ATPase activity following high-intensity intermittent exercise, which was sustained during a 5-h recovery period and unrelated to carbohydrate availability under the present experimental conditions. This was shown using a novel NADH coupled assay and confirms previous findings using other methodological approaches.

Increased fatigability and impaired skeletal muscle microvascular reactivity in adults with obstructive sleep apnea: a cross-sectional study

BackgroundSympathetic nervous system hyperactivity and chronic intermittent nocturnal hypoxia in individuals with obstructive sleep apnea (OSA) predispose them to microvascular impairment, which may contribute to increased daytime muscle fatigue. This study aimed to assess microvascular reactivity of the skeletal muscle, examine fatigability, and determine the relationship between fatigability and microvascular reactivity in adults with OSA.MethodsTwenty-six participants were allocated into two groups—those with OSA and those without i.e. non-OSA. Each group comprised of 13 individuals who underwent an arterial occlusion test on their non-dominant leg. The percentage change of maximal hyperemic response (MHR) and the time to achieve MHR (tM) of both the total myoglobin/hemoglobin (∆[Hbtot]) and the oxygenated myoglobin/hemoglobin (∆[HbO2]) signals from near-infrared spectroscopy were calculated to examine microvascular reactivity. In addition, a 10-min walk test was performed to assess performance and perceived fatigability.ResultsThe OSA group demonstrated a reduced in ∆[Hbtot]MHR (150.9 ± 16.2% vs. 235.8 ± 72.7%, p = 0.006), ∆[HbO2]MHR (131.4 ± 8% vs. 161.7 ± 10.6%, p = 0.001) and increased ∆[Hbtot]tM (80.5 ± 13.1 s vs. 47.7 ± 9.9 s, p < 0.001), ∆[HbO2]tM (85.2 ± 22.4 s vs. 52.1 ± 5.9 s, p = 0.001) compared to the non-OSA group. In addition, participants in the OSA group experienced greater perceived (6 ± 1 vs. 2.8 ± 0.1, p = 0.001) and performance fatigability (1.1 ± 0.1 vs. 0.9 ± 0.1, p = 0.001) compared to adults in the non-OSA group. Moreover, both performance and perceived fatigability were significantly associated with microvascular reactivity parameters (all p < 0.05).ConclusionMicrovascular dysfunction, as determined by an attenuated post-occlusive reactive hyperemia, is observed in individuals with OSA that may contribute to increased fatigability in these individuals.

Association of Physical Fitness with Leisure Time Physical Activity in Individuals with Spinal Cord Injury

Abstract Background: Physical fitness of persons with spinal cord injury (SCI) is related to their upper limb strength and range of motion. A change in these factors may impact their participation in physical fitness, and consequently leisure time activities. The objective of the study was to examine an association of physical fitness with leisure time physical activity (LTPA) in people with SCI. Materials and Methods: This was a cross-sectional observational study conducted among 30 male and female participants with SCI. Physical fitness and LTPA were assessed using a 6-min push test and physical activity recall assessment for people with SCI, respectively. Spearman’s Rank correlation coefficient was used to estimate the correlation between physical fitness and LTPA in persons with SCI. Results: The mean age of the participants was 33.6 ± 7.73) years. This study found a positive weak to no correlation between physical fitness and LTPA in individuals with SCI (r s = 0.1008) that was statistically nonsignificant (P &gt; 0.596). In this study, 28 (93.33%) participants had good physical fitness, and 19 (63.33%) participants performed LTPA for 20 min or more in a day, whereas 11 (36.67%) performed less than 20 min per day. Conclusion: Though most of the participants had good physical fitness, they performed only exercise-based activities such as walking with orthosis, pushups exercises, and resistance training exercises for upper limb muscles in their leisure time. They did not participate in LTPA such as sports, gardening, swimming, and other recreational activities. Furthermore, studies can be done to understand the perception of physiotherapists and SCI individuals toward the participation of LTPAs.

Comparing the effects of Swiss-ball training and virtual reality training on balance, mobility, and cortical activation in individuals with chronic stroke: study protocol for a multi-center randomized controlled trial

BackgroundBalance and mobility deficits are major concerns in stroke rehabilitation. Virtual reality (VR) training and Swiss-ball training are commonly used approaches to improve balance and mobility. However, no study has compared the efficacy of VR training, Swiss-ball training, and their combination in improving balance and mobility function or investigated cortical activation and connectivity in individuals with stroke.MethodsA prospective, single-blinded, parallel-armed, multi-center randomized controlled trial with factorial design will be conducted. Seventy-six participants aged 30–80 years with stroke will be recruited. Participants will be allocated to one of the four groups: (A) the VR training + Swiss-ball training + conventional physical therapy group; (B) the Swiss-ball training + conventional physical therapy group; (C) the VR training + conventional physical therapy group; or (D) the conventional physical therapy group. All participants will receive 50 min of training per day, 5 times per week, for a total of 4 weeks. The primary outcomes will be balance and mobility measures. Secondary outcomes will include the 10-min walk test, dynamic gait index, and cortical activation. Outcomes will be measured on three occasions: at baseline, after the training, and at the 4-week follow-up.DiscussionThis trial will provide evidence to determine whether there are differences in clinical outcomes and cortical activation following two different types of exercise programs and their combination, and to elucidate the recovery mechanisms of balance and mobility function in individuals with stroke.Trial registrationChinese Clinical Trial Registry reference: www.chictr.org.cn (No. ChiCTR2400082135). Registered on May 24, 2024.

Multicenter Validation of the English Version of the Dépistage Cognitif de Québec: a Cognitive Screening Tool for Atypical Dementias.

Early detection of atypical dementia remains difficult partly because of the absence of specific cognitive screening tools. This creates undue delays in diagnosis and management. The Dépistage Cognitif de Québec (DCQ; dcqtest.org) was developed in French and later validated in participants with atypical syndromes. We report the validation of the English version. This multicentre prospective validation study was conducted in 10 centers across Canada and the United States on 260 English-speaking participants aged over 50. We translated and modified the original French DCQ to add targeted stimuli to the Visusopatial Index and social cognition vignettes to the Behavioral Index. A backward translation was performed and equivalence between languages was assessed by administering both tests to 30 bilingual participants. Mean DCQ total score (out of 100) was 95.0 (SD = 3.6). Spearman's correlation coefficient showed a strong and significant correlation (r = 0.49, p < .001) with the Montreal Cognitive Assessment. Test-retest reliability was good (Spearman's coefficient = 0.72, p < .001) and interrater reliability, excellent (intraclass correlation = 0.97, p < .001). Normative data shown in percentiles were stratified by age and education for a population-based sample of 260 English-speaking controls aged between 50 and 87years old. Similar to the French version, the English DCQ proved to be a valid cognitive screening test. The original version was very sensitive to detect atypical dementias such as primary progressive aphasias, Alzheimer's disease' variants and syndromes along the frontotemporolobar degeneration spectrum. This 20-min test can be administered à la carte and offers an alternative to detailed comprehensive neuropsychological evaluations.

Friend or foe: effects of social experience and genetic line on responses of young gilts in a social challenge paired interaction test

The increased focus on group housing of sows in commercial pig production emphasises the importance of saving appropriate gilts which later become sows that are well-adapted to group housing systems. This study aimed to assess the short-term effects of social mixing experience and genetic line on social and exploration responses of young gilts in standardised 3-min social challenge paired interaction tests. The study included 96 gilts, from 26 litters, of two different genetic lines (Swedish Yorkshire and Dutch Yorkshire). These lines were chosen because the dam lines have been selected in group-housed and individual stall systems, respectively, a background which was hypothesised to have modified their social behaviour over time. The gilts were subjected to different early (opportunity to co-mingle with piglets in the neighbouring farrowing pen vs. no opportunity to co-mingle) and late (mixed with unfamiliar piglets at weaning vs. kept with familiar littermates after weaning) social mixing treatments, to test whether the enhanced social experience was beneficial in a socially challenging situation. Paired interaction tests were conducted at 5 and 20 weeks of age, and social and exploration behaviour of the gilts was recorded and analysed. The results showed that Swedish Yorkshire gilts explored the pen fittings more than Dutch Yorkshire gilts during the 5-week test, whereas Dutch Yorkshire gilts explored the pen fittings more than Swedish Yorkshire gilts during the 20-week test. No differences in play behaviour were found during the 5-week test, but in the 20-week test, gilts with early social mixing experience in their farrowing pen showed more locomotor play behaviour than gilts without this experience. Overall, these results suggest that genetic line and early social mixing experience can influence the social and exploration behaviours of young gilts in paired interaction tests. There was no support for the hypothesis that genetic selection in different housing systems has altered social behaviour, but it may have affected the level of exploration behaviour. There was little support for our prediction that early social experience has beneficial effects in a socially challenging situation.

Comparison between Ultrasound Guided Femoral Nerve Block versus IPACK Block (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) in Patients Undergoing Total Knee Replacement on Postoperative Ambulation and Pain

Abstract Background Total knee replacement (TKR) is a well-known popular surgical procedure for knee diseases, including end-stage knee osteoarthritis that causes severe postoperative pain and prolonged immobility. TKR is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority. Aim of the Work The current study aims to assess the IPACK block concerning postoperative ambulation as a primary outcome and analgesic efficacy as a secondary outcome when compared with femoral nerve block following TKR. Patients and Methods This study is a randomized controlled clinical trial was conducted on 40 random patients who were scheduled to undergo total knee replacement and were divided into 2 equal groups: Group A: Patients in group A (n = 20) received spinal anesthesia followed by FNB block at the beginning of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions, Group B: Patients in group B (n = 20) received spinal anesthesia followed by IPACK at the beginning of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions. Results As for the comparison between effect of the IPACK block and FNB regarding ambulation and postoperative pain in TKR, it showed that there is significance regarding ambulation that was delayed in FNB than IPACK using TUG test and 10-min walk test, but regarding VAS score that was used to assess postoperative pain and its intensity, it showed that FNB has more analgesic effect concerning IPACK block with less total analgesics consumption (in mg.) over 24-hour period post-operative. Conclusion Our study showed that there was delayed ambulation in FNB than in IPACK using the TUG test and 10-min walk test, but regarding the VAS score that was used to assess postoperative pain and its intensity, it showed that FNB has more analgesic effect concerning IPACK block with less total analgesics consumption (in mg.) over 24-hour period post-operative.

Design and development of an IoT-based trolley for weighing the patient in lying condition.

An immobile patient cannot be weighed on a stand-on weighing machine, i.e., a bathroom scale. They have to get weighed while lying, which is not easy. The main objective of this research is to design a medical apparatus that measures the patient's weight in a lying condition. To achieve this the apparatus is designed as a stretcher to carry the patient in and around the hospital. The stretcher has four load cells to measure the patient's weight; it can bear a weight of 500 kg and has a self-weight of 20 kg. A Microcontroller unit (MCU) is embedded into the apparatus to weigh the patient lying on it. The stretcher comprises the top frame, middle frame, and base frame. The top frame can be detached and mounted back to the middle frame; this will help the medical personnel shift the patients from a medical bed. The middle frame is a plate structure where the four load cells are mounted at the corners of the lower plate. The upper plate functions as a pressure plate on the load cell. The base plate has four heavy-duty wheels that can bear the load. The middle frame and base frame, together, form a single structure, giving mobility to the structure. A control panel is employed with reset, tare, and on-off buttons to control the embedded platform. The LCD panel on the side of the apparatus shows the weight when the patient is placed on top of the apparatus. A prototype trolley equipped with a wireless data logging system was tested on 10 healthy participants. The device accurately measured weight within ±50 g across a scale range of 2-140 kg, with data captured every 30 s over a 5-min testing period. Wireless communication was successfully demonstrated over a 100-m range. The important add-on feature of this work is the apparatus is connected to the internet, transforming it into an IoT-based medical device.

Vitamin D combined with whole-body vibration training for the treatment of osteo-sarcopenia: study protocol for a randomized controlled trial.

Osteo-sarcopenia (OS) has become a global public health problem and a frontier research problem, as a combination of sarcopenia (SP) and osteoporosis (OP) diseases. The clinical performances include muscle weakness, systemic bone pain, standing difficulty, even falls and fractures, etc., which seriously affect the patient's life and work. The pathological mechanism of the OS may be the abnormal metabolism which disrupts the equilibrium stability of the musculoskeletal system. Therefore, this study combined vitamin D (Vit. D) and whole-body vibration training (WBVT) to intervene in subjects of OS, aiming to evaluate the effectiveness and safety of the diagnosis and treatment protocol and to explore the efficacy mechanism. We propose a multicenter, parallel-group clinical trial to evaluate the efficacy and safety of Vit. D combined with WBVT intervention in OS. Subjects who met the inclusion or exclusion criteria and signed the informed consent form would be randomly assigned to the WBVT group, Vit. D group, or WBVT+ Vit. D group. All subjects will be treated for 1 month and followed up after 3 and 6 months. The primary outcomes are lumbar bone mineral density (BMD) and appendicular skeletal muscle mass (ASM) measured by dual-energy X-ray absorptiometry (DXA) and handgrip strength measured by grip strength meter. Secondary outcomes include serum markers of myostatin (MSTN), irisin and bone turnover markers (BTM), SARC-CalF questionnaire, 1-min test question of osteoporosis risk, patient health status (evaluated by the SF-36 health survey), physical performance measurement that includes 5-time chair stand test, 6-m walk, and the short physical performance battery (SPPB). If Vit. D combined with WBVT can well relieve OS symptoms without adverse effects, this protocol may be a new treatment strategy for OS. After therapeutic intervention, if the serum marker MSTN/irisin is significant, both have the potential to become sensitive indicators for screening OS effective drugs and treatments, which also indicates that WBVT combined with Vit. D plays a role in improving OS by regulating MSTN/irisin. Chinese Clinical Trial Registry ChiCTR2400082269 . Registered on March 26, 2024.

Steep uphill cycling using repeated transitions between seated and standing positions results in a lower blood-lactate concentration than continuous use of either seated or standing position.

This study investigated whether repeated transitions between seated and standing positions has a different physiological response compared to continuous use of either seated position or standing position during steep uphill cycling among elite cyclists. Ten elite male cyclists completed three 5-min treadmill cycling tests at an inclination of 6.8° with constant individual-based speed resulting in a work intensity close to the aerobic threshold. During the first and third test, the participants used standing position (ST test) and seated position (SE test) or vice versa, whereas in the second test, they made repeated transitions between standing and seated positions every 10 s (RT test). The last 2 min of each test was used to measure the mean values of oxygen uptake (V̇O2) and respiratory exchange ratio, which were used to calculate the metabolic rate (MR) and gross efficiency (GE). Additionally, the blood-lactate concentration before and after (Lapost) each test was determined. One-way repeated measures ANOVA was used to determine the effect of cycling position on the physiological response. No significant differences between tests were observed for the variables related to aerobic energy expenditure (i.e., V̇O2, MR and GE), whereas the RT test was associated with a significantly lower Lapost compared to the ST and SE tests. Steep uphill cycling, at an intensity close to the aerobic threshold, with repeated transitions between standing and seated positions, did not have a higher oxygen consumption; instead, the blood-lactate concentration was lower during the RT test compared to that under continuous use of either seated or standing position.

Effect of aerobic exercise program on neuropathic pain and quality of life in person with paraplegia: study protocol for a randomized controlled trial

BackgroundIndividuals with spinal cord injury (SCI) often suffer from neuropathic pain which is often disabling and negatively affects function, participation, and quality of life (QoL). Pharmacological treatments lack efficacy in neuropathic pain reduction hence studying alternatives to drug treatment is necessary. Preclinical evidence of various aerobic exercises has shown positive effects on neuropathic pain but scientific studies investigating its effect in the SCI human population are limited.MethodologyThis study is a double-blind, parallel, two-group, randomized controlled trial with an interventional study design that aims to evaluate the effectiveness of aerobic exercise program on neuropathic pain and quality of life (QoL) in individuals with chronic paraplegia. Thirty individuals with chronic paraplegia with the neurological level of injury from T2 to L2 will be recruited from the rehabilitation department at a super specialty hospital based on the inclusion criteria. Using a 1:1 allocation ratio, the participants will be randomly assigned to one of the two groups. The intervention group will perform high-intensity interval training (HIIT) aerobic exercise using an arm ergometer based on their peak heart rate, and the control group will perform free-hand arm aerobic exercise. In both groups, the intervention will be delivered as 30-min sessions, four times a week for 6 weeks.Outcome measuresInternational Spinal Cord Injury Pain Basic Data Set Version 3.0 will be used for diagnosing and assessing neuropathic pain and its interference with day-to-day activities, mood, and sleep. The International Spinal Cord Society (ISCoS) QoL basic data set will be used to assess QoL, and 6-min push test distance will be used to assess peak heart rate and aerobic capacity.DiscussionThe effectiveness of the aerobic exercise program will be assessed based on the changes in neuropathic pain score and its interference with day-to-day activities, mood, sleep, QoL, and aerobic capacity after 3 weeks mid-intervention and after 6 weeks post-intervention. The trial will provide new knowledge about the effectiveness of the aerobic exercise program in improving neuropathic pain and QoL in individuals with chronic paraplegia.Trial registrationClinical Trials Registry-India CTRI/2023/08/056257. Registered on 8 August 2023.

Optimization of Venom-Induced Consumption Coagulopathy Management with Blood Component Transfusion

Snake envenomation, particularly in Southeast Asia, often results in venom-induced consumption coagulopathy (VICC), a life-threatening condition characterized by severe bleeding and coagulopathy. Despite its clinical significance, management protocols for VICC remain under-researched, especially in resource-limited settings. A 30-year-old male was bitten by a green snake and presented with severe symptoms, including epistaxis, hematemesis, melena, hemoptysis, and hematuria. The diagnosis was confirmed with a 20-min whole blood clotting test. Initial treatment involved transfusion of thrombocyte concentrate (TC) and fresh frozen plasma (FFP), with specific anti-snake venom (ASV) administered 19 h postbite. VICC management is challenging. The initial administration of ASV is the key treatment to neutralize procoagulant toxins, but in the absence of ASV, the administration of FFP, TC, and packed red blood cells (PRCs) can be utilized to manage coagulopathy and as supportive measures based on patient’s clinical findings. The timing and combination of these treatments are crucial in optimizing the results. Proper diagnosis of VICC involves a thorough clinical assessment and diagnostic testing. Management of VICC requires prompt administration of ASV and management tailored to the patient’s condition and available resources. This case report aims to examine the management strategies of VICC, specifically the role of blood component transfusion, and highlight the challenges of treatment in resource-limited settings.

Teaching medical students ultrasound-guided needle aspiration of synthetic cysts: effect of a formalin-embalmed cadaver simulation model

BackgroundStandard training for ultrasound-guided cyst needle aspiration is currently performed on live patients during residency. This practice presents risk of iatrogenic injury to patients and provides a high-stress learning environment for medical trainees. Simulation training using synthetic cysts in a formalin-embalmed cadaver model may allow for realistic, practical, and effective training free from patient risk.MethodsThirty first-year medical students viewed an orientation video, then attended a skills workshop to perform cyst needle aspiration in formalin-embalmed cadaver tissue under ultrasound guidance. Participants were randomly assigned to one of three ultrasound-trained instructor-types which included a medical student, clinical anatomist, or an ultrasound fellowship trained emergency medicine physician. After training, participants underwent a 5-min skills test to assess their ability to drain a synthetic cyst independently. Pre- and post-training self-confidence surveys were administered.ResultsUltrasound images of synthetic cysts in formalin-embalmed tissue were clear and realistic in appearance, and sonographic needle visualization was excellent. Participants took an average of 161.5 s and 1.9 attempts to complete the procedure. Two of the 30 participants could not complete the procedure within the time limit. Participants’ self-reported confidence with respect to all aspects of the procedure significantly increased post-training. Mean confidence scores rose from 1.2 (95% CI 0.96 to 1.39) to 4.4 (95% CI 4.09 to 4.53) (P < 0.0001) Procedure time, number of attempts, performance scores, and self-confidence outcomes were not significantly affected by instructor type.ConclusionsThe use of synthetic cysts in formalin-embalmed cadaveric tissue is feasible, realistic, and efficacious for the teaching of ultrasound-guided needle aspiration to novice medical trainees. This simulation training method can be delivered effectively by multiple instructor types and may allow medical trainees to increase their tactical skill and self-confidence prior to performing ultrasound-guided cyst needle aspiration on live patients.