Acute Recovery Research Articles

Effects of synthetic (JWH-018) cannabinoids treatment on spermatogenesis and sperm function

JWH-018 is a synthetic cannabinoid which has been increasingly used by adolescents and adults, and is known to cause severe multi-organ failure. However, little is known about the complications and toxicological effects of JWH-018 on reproduction system. Therefore, the aim of the present study is to investigate the effects of JWH-018 on testis and spermatogenesis. Thirty CD-1 male rats were distributed into six groups, control group (C1 and C2), ethanol group (E1 and E2), and JWH-018 group (JWH1 and JWH2), which were administered 0.9% NaCl, %100 ethanol, and JWH-018 (0.3 mg/kg) respectively for 9 d. We euthanized C1, E1, and JWH1 group mice at day 2 and C2, E2, and JWH2 group mice at 45 d after the last injection to evaluate the acute testis damage and potential recovery of spermatogenesis. The histopathology of seminiferous epithelium was evaluated and organ weight, sperm concentration and motility, membrane integrity, and serum testosterone levels were statistically analyzed. In JWH1, seminiferous tubule degeneration, partial germ cell depletion disorganized seminiferous epitheliums were seen. We also observed significantly decreased sperm concentration, sperm motility, intact membrane, and testosterone levels in JWH1 group compared to other groups. Forty-five days after the JWH-018 treatment, sperm concentration, motility, and testosterone level were increased, suggesting that testis and spermatogenesis can recover. We concluded that the use of JWH-018 may adversely affect male reproductive potential and testis histopathology.

A275 Weight Loss Surgery Post-Op Day 1: Inpatient Behavioral Health Assessment & Intervention

While the behavioral health team is often involved in the pre-surgical bariatric surgery process, the empirical literature to date has done little to address the potential role of the behavioral health team post-operatively. A 2018 article by Pearl, Allison, Tronieri, and Wadden suggested that patients may greatly benefit from post-operative engagement with behavioral health providers to address new or persistent barriers to success. Further, the post-operative engagement of psychologists can allow systematic issues that impact patients throughout the recovery process to be identified and assessed via needs assessments and quality improvement projects. At an urban bariatric and metabolic institute affiliated with a 378-bed medical center, a doctoral-level health psychologist, whose primary responsibilities include: completion of pre-surgical assessments, individual therapy, and facilitation of pre and post-operative group-based interventions, is embedded within the clinic. Yet, still a gap in behavioral health care was identified during the time between surgery date and initial follow-up appointment as patients struggled to adjust to the effects of surgery, the magnitude of the lifestyle changes required, and the interference of mental health symptoms with acute recovery. To address this gap, as of January 2018, the primary psychologist completes an inpatient assessment and brief intervention, as appropriate, for each patient one day post-operatively. Overall, patients and staff have been highly receptive to this process, and medical errors have been reduced. Further details regarding the process of developing this form of billable behavioral health rounding within a health care system will also be addressed.

Dysphagia After Primary Transoral Robotic Surgery With Neck Dissection vs Nonsurgical Therapy in Patients With Low- to Intermediate-Risk Oropharyngeal Cancer

A major goal of primary transoral robotic surgery (TORS) for oropharyngeal cancer is to optimize swallowing outcomes by personalized treatment based on pathologic staging. However, swallowing outcomes after TORS are uncertain, as are the outcomes compared with nonsurgical options. To estimate rates of acute dysphagia and recovery after TORS and to compare swallowing outcomes by primary treatment modality (TORS or radiotherapy). This case series study was a secondary analysis of prospective registry data from 257 patients enrolled from March 1, 2015, to February 28, 2018, at a single academic institution who, according to the AJCC Staging Manual, 7th edition TNM classification, had low- to intermediate-risk human papillomavirus-related oropharyngeal squamous cell carcinoma possibly resectable by TORS. Patients were stratified by primary treatment (75 underwent TORS and 182 received radiotherapy). Modified barium swallow (MBS) studies graded per Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) and the MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) questionnaires were administered at standard intervals. Prevalence and severity of dysphagia were estimated per DIGEST before and after TORS and 3 to 6 months after treatment. Moderate-severe dysphagia (DIGEST grade ≥2) was assessed using logistic regression and compared by primary treatment group. The MDASI swallowing symptom severity item scores during and after radiotherapy were compared using generalized estimating equations by treatment status at the start of radiotherapy, after induction, and after TORS. A total of 257 patients (mean [SD] age, 59.54 [9.07] years; 222 [86.4%] male) were included in the study. Dysphagia severity (per DIGEST) was significantly worse after TORS (r = -0.63; 95% CI, -0.78 to -0.44): 17 patients (22.7%; 95% CI, 13.8%-33.8%) had moderate-severe (DIGEST grade ≥2) acute post-TORS dysphagia significantly associated with primary tumor volume (odds ratio, 1.43; 95% CI, 1.11-1.84). DIGEST improved by 3 to 6 months but remained worse than that at baseline; at 3 to 6 months, the number of patients with DIGEST grade 2 or higher dysphagia was 5 (6.7%; 95% CI, 2.2%-14.9%) after primary TORS and 29 (15.9%; 95% CI, 10.9%-22.1%) after radiotherapy. At the start of radiotherapy, MDASI swallowing symptom severity item scores were significantly worse in the post-TORS group compared with postinduction (mean [SD] change, 2.6 [1.1]) and treatment-naive (mean [SD] change, 1.7 [0.3]) patients. This result inverted at radiotherapy end, and all groups converged at 3 to 6 months. Subacute swallowing outcomes were similar regardless of primary treatment modality among patients with low- to intermediate-risk oropharyngeal squamous cell carcinoma.

How demands and resources impact chronic fatigue in the maritime industry. The mediating effect of acute fatigue, sleep quality and recovery

The aim of the present study was to examine how different work demands and resources characteristic to the maritime industry are related to chronic fatigue in seafarers. Moreover, we investigated the role of different fatigue related processes, such as acute fatigue, sleep problems and inter-shift recovery in explaining the association between work characteristics and chronic fatigue. 199 seafarers working for the marine operations of a large global mining company participated in a cross-sectional survey design. Findings showed that working under time pressure and vigilance demands have differential relationships with chronic fatigue, with vigilance demands showing a stronger association. Moreover, this association was only partially mediated by fatigue processes, indicating that there might be several mechanisms involved. Social support emerged also as a critical job resource that can protect against fatigue, highlighting potential negative implications of current HR and staffing practices in the industry that discourage stable crews and might impair the development of supportive social climates onboard ships. Job autonomy also showed direct negative associations with chronic fatigue. Overall, our findings support the application of job demands – resources models to emphasize the importance of understanding the differential effects of work demands and resources characteristic to the maritime industry environment for seafarers’ chronic fatigue. Shipping companies should therefore consider the impact of these factors when trying to improve safety or wellbeing of the seafarers onboard their ships, given the critical role that chronic fatigue plays for both these outcomes.

Understanding parental perspectives on outcomes following paediatric encephalitis: A qualitative study.

BackgroundEncephalitis, characterised as inflammation of the brain tissue, is an important cause of acquired brain injury in children. Objective clinical outcomes vary significantly between affected patients, however they do not always correlate with quality of life as reported by parents. The aim of this study was to explore how parents experience and interpret outcomes in relation to their child who has been affected by encephalitis.MethodsData were derived from in-depth, semi-structured interviews, with 15 parents of 12 children and young people affected by encephalitis. Paediatric cases were identified from the retrospective arm of the research programme ‘ENCEPH-UK-Understanding and Improving the Outcome of Encephalitis’, and from the prospective UK childhood meningitis and encephalitis cohort study (UK-ChiMES, 2012 to 2016). Data were analysed thematically.ResultsParents’ perspectives on important outcomes for their child and family changed during the different stages of the encephalitis illness trajectory: from acute illness, recovery and rehabilitation, then reintegration into everyday life. Parents’ understanding of their children’s overall outcome was informed by their own experiences, involving comparisons with other children and reflections on their child’s problems before, during and after the acute illness.ConclusionOutcomes in paediatric encephalitis need to be understood in terms of the context of the patient and family experience as well as the timeframe of recovery. The research highlights the need to include more patient, parent and/or carer reported outcome measures during patient assessment, and that assessment should be repeated during recovery as family concerns change. In the longer term, these parameters could be included in clinical and rehabilitation practice to further support child recovery.

Usability and feasibility of multimedia interventions for engaging patients in their care in the context of acute recovery: A narrative review.

PurposeThe purpose of this narrative review was to examine the usability and feasibility of multimedia intervention as a platform to enable patient participation in the context of acute recovery and to discover what outcomes have been measured.Data sourcesA narrative review of primary research articles identified through a search of four electronic databases (MEDLINE, CINAHL, EMBASE and PsycInfo) identified peer‐reviewed research evidence published in English language with no limitation placed on time period or publication type. Two authors independently assessed articles for inclusion. From the 277 articles identified through the search, 10 papers reporting the outcomes of seven studies were included in this review.Review methodsArticles were independently assessed for quality and relevance by two authors. The most appropriate method for data synthesis for this review was a narrative synthesis.ResultsFrom the narrative synthesis of study outcomes, two findings emerged as follows: (a) multimedia interventions are feasible and usable in the context of acute care, and (b) multimedia interventions can improve patients’ perception of care‐related knowledge. Identified gaps included a lack of evidence in relation to the effect of interventions on enhancing patients’ ability to participate in their care and the impact on patients’ health‐related outcomes.ConclusionsIn conclusion, there is some evidence of the feasibility and usability of multimedia interventions in acute care. That is, patients can use these types of platforms in this context and are satisfied with doing so. Multimedia platforms have a role in the delivery of information for patients during acute recovery; however, the effectiveness of these platforms to engage and enhance patients’ capability to participate in their recovery and the impact on outcomes needs to be rigorously evaluated.

Stress adaptation in older adults with and without cognitive impairment: an fMRI pattern-based similarity analysis.

Background: The capacity to adapt to environmental stressors is essential for older adults’ health and well-being. It is unclear how cognitive impairment may disrupt the capacity. Here we examined the relationship between self-perceptions of stress and the neurobiological response to a laboratory model of stress adaptation in amnestic mild cognitive impairment (aMCI), a group at high risk for dementia.Results: aMCI group and cognitively healthy controls did not differ in neurobiological acute stress recovery (indexed by similarity in neural patterns at baseline and after recovery from cognitive challenges). However, compared to controls, aMCI group had significantly lower scores on PSS-PW. Notably, higher PSS-PW was associated with greater acute neural recovery in controls, but not aMCI.Methods: We assessed self-perceptions of stress adaptation with the Perceived Stress Scale subscales, measuring perceived helplessness (i.e., negatively worded items, PSS-NW) and self-efficacy (i.e., positively worded items, PSS-PW) in response to stress. At a subsequent laboratory fMRI visit, we indexed neurobiological stress adaptation by assessing and comparing functional network connectivity at baseline and immediately following, and after recovery from, cognitive challenges.Conclusions: Studying stress adaptation in aMCI may shed light on pathways that contribute to the onset and progress of cognitive deterioration in aging.

The relation between dialysis-requiring acute kidney injury and recovery from end-stage renal disease: a national study

BackgroundApproximately 4–6% of incident end stage renal disease (ESRD) patients in the U.S. recover enough kidney function to discontinue dialysis but there is considerable geographic variation. We undertook this study to investigate whether state-level variations in renal recovery among incident ESRD patients correlated with state-level variations in incidence of acute kidney injury requiring dialysis (AKI-D).MethodsWe conducted a national cross-sectional ecological study at the state-level using data from State Inpatient Databases and U.S. Renal Data System. All hospital admissions and all ESRD patients in 18 US states (AZ, AR, CA, FL, IA, KY, MA, MD, MI, NJ, NM, NY, NV, OR, RI, SC, VT, and WA) were included. Correlation between AKI-D incidence and rate of renal recovery across states was determined using Pearson’s r (overall and in subgroups). We also calculated partial correlations adjusted for sex and age.ResultsAKI-D incidence ranged from 99.0 per million population (pmp) in Vermont to 490.4 pmp in Nevada. Rate of renal recovery among incident ESRD patients ranged from 8.8 pmp in Massachusetts to 29.3 pmp in Florida. A positive correlation between AKI-D incidence and rate of renal recovery among incident ESRD patients at state level was found overall (unadjusted r = 0.67; p = 0.002) and in age, sex, and race subgroups. The overall correlation persisted after adjusting for age (adjusted r = 0.62; p < 0.001) and sex (adjusted r = 0.65; p < 0.001).ConclusionOur findings suggest that AKI-D incidence is an important driver of renal recovery rates among incident ESRD patients.

The Effects of Leucine-Enriched Branched-Chain Amino Acid Supplementation on Recovery After High-Intensity Resistance Exercise.

Of the 3 branched-chain amino acids (BCAA), leucine has arguably received the most attribution for the role of BCAA supplementation in alleviating symptoms of exercise-induced muscle damage and facilitation of acute performance recovery. To examine whether enrichment of a standard BCAA supplement with additional leucine or a standalone leucine (LEU) supplement differentially affects exercise-induced muscle damage and performance recovery compared with a standard BCAA supplement. A total of 22 recreationally active male and female subjects were recruited and assigned to consume a BCAA, leucine-enriched BCAA (LBCAA), or LEU supplement for 11 d. On the eighth day, subjects performed eccentric-based resistance exercise (ECRE). Lower-body mean average and peak power, plasma creatine kinase, soreness, and pain threshold were measured before and 24, 48, and 72h after ECRE. LEU showed decreased mean average power (P = .02) and mean peak power (P = .01) from baseline to 48h post-ECRE, whereas LBCAA and BCAA only trended toward a reduction at 24 hours post-ECRE. At 48h post-ECRE, BCAA showed greater recovery of mean peak power than LEU (P = .04). At 24h post-ECRE, LEU demonstrated a greater increase in plasma creatine kinase from baseline than BCAA (P = .04). Area under the curve for creatine kinase was greater in LEU than BCAA (P = .02), whereas BCAA and LBCAA did not differ. Only LEU demonstrated increased soreness during rest and under muscular tension at 24 and 48 h post-ECRE (P < .05). LBCAA failed to afford any advantages over a standard BCAA supplement for postexercise muscle recovery, whereas a LEU supplement was comparatively ineffective.

Endoscopic transforaminal lumbar interbody fusion without general anesthesia: technical innovations and outcomes.

Innovations in surgical techniques and technologies have enabled spine surgeons to offer patients less morbid alternatives to traditional spine procedures. This review will explore the development of the endoscopic transforaminal lumbar interbody fusion (TLIF) without general endotracheal anesthesia (GETA) and discuss the technical refinements and innovations learned from experiences with this technique. The Awake TLIF employs several key technological innovations: (I) conscious sedation; (II) endoscopic visualization; (III) an expandable interbody device; (IV) recombinant human bone morphogenetic protein; (V) long-acting local analgesia; and (VI) percutaneous instrumentation. Technical refinements, including premedication for prophylaxis against nausea, vomiting, and epistaxis, were made as a result of early experiences with this technique. Results from the first 100 patients to undergo the Awake TLIF demonstrated durable clinical benefit beyond one year postoperatively. Operating time, blood loss, and hospital length of stay averages well below those generally seen with conventional MIS TLIF. Patients achieved a significant reduction in Oswestry Disability Index from baseline of -12.3 points (P<0.0001). In this initial 100 patient cohort, four conversions to GETA were required and four complications resulted, three of which occurred during the first 50 cases. To date, over 200 Awake TLIF cases and the first three-level procedure have been performed. Endoscopic TLIF without the use of general anesthesia is a novel but promising approach for short-segment lumbar fusion. Continued technical innovations will likely afford greater improvements in outcomes, both in the acute and long-term recovery periods.

Response.

Dear Editor-in-Chief, We thank Boullosa et al. (1) for their interest in our study (2), and we appreciate their support in further stimulating discussion in this research area. We are aware that the nonfunctional overreaching “sword of Damocles” is often mentioned with sudden increases in workload. Therefore, all participants in our study completed the short form of the Acute Recovery and Stress Scale (3), and heart rate variability was measured frequently, although neither of these data sets were presented (2). However, we did monitor both data sets and found no impaired, long-lasting recovery–stress state indicating adverse health effects. Our data do not allow us to comment on the assumption by Boullosa et al. (1) that reduced total workload might have induced a better performance outcome in our recreational runners. However, we agree that in order to judge the responses to exercise, an all-day integrative view is required (4), including habitual exercise, which should be addressed in future studies. In rebuttal to the remark that the 3-wk training intensity distribution (TID) of our polarized training group (POL) is not an adequate reproduction of previously described typical polarized TID in recreational and subelite runners as presented by Muñoz et al. (5) and Esteve-Lanao et al. (6), our reply is as follows: We are aware of the different methodological issues surrounding TID quantification, especially comparability between different studies. One solution may be to calculate a “polarization index” (7), which in POL (2) was 1.94 a.u. and slightly higher than the studies quoted by Boullosa et al. (1.87 a.u. [5] and 1.75 a.u. [6]) (1). The difference between the TID of Muñoz et al. (5) (72.9/13.5/13.6%) and our TID (2) (69.7/13.4/16.9%) is that our mean time spent in zone 1 was slightly lower (−3.2%) and higher in zone 3 (+3.3%), but we consider these differences to be minor. Thus, our POL–TID appears somewhat more “polarized” in comparison with the quoted TID (5). The referred TID of Esteve-Lanao et al. (6) presents a rather “pyramidal” TID (80.5/11.8/8.3%), whereas a recalculation (mentioned within the discussion of [6]) revealed a more “polarized” TID (74/11/15%, polarization index = 2.0 a.u.). Therefore, depending on the TID quantification, shifts in the proportion of zones may occur. Nevertheless, both TID calculations by Esteve-Lanao et al. (6) showed more time spent in zone 1 and slightly less time in zone 2 (compared with our recreational runners), which is likely attributable to the substantially greater amount of overall training time of subelite runners. Subelite runners performing >80 km·wk−1 will not or cannot invest too much time in zones 2 and 3 because recovery between frequent demanding training sessions becomes challenging/impossible. We therefore discourage the comparison of TID between (sub)elite and recreational runners. We agree that training time in zone 1 constitutes the greatest proportion within a polarized model in (sub)elite runners. However, optimal TID, especially the proportion of zones 1 and 3, has yet to be identified in both recreational and (sub)elite runners (8). In fact, the individual responses within our three groups are quite heterogenous without conclusive identification of a best practice TID in recreational runners. Future studies with well-designed crossover designs are warranted to address this matter in detail. Christoph Zinner University of Applied Sciences for Police and Administration of Hesse Wiesbaden, GERMANY Integrative & Experimental Exercise Science & Training Institute for Sport Sciences University of Würzburg, GERMANY Daniela Schäfer Olstad Polar Electro Oy Kempele, FINLAND Billy Sperlich Integrative & Experimental Exercise Science & Training Institute for Sport Sciences University of Würzburg, GERMANY

Effects of Sleep Deprivation on Acute Skeletal Muscle Recovery after Exercise.

Sleep is considered essential for muscle recovery, mainly due to its effect on hormone secretion. Total sleep deprivation or restriction is known to alter not only blood hormones but also cytokines that might be related to skeletal muscle recovery. This study aimed to evaluate whether total sleep deprivation after eccentric exercise-induced muscle damage (EEIMD) modifies the profiles of blood hormones and cytokines. In two separate conditions, with a crossover and randomized model, 10 men (age, 24.5 ± 2.9 yr; body mass index, 22.7 ± 2.3 kg·m) performed a unilateral EEIMD protocol that comprised 240 eccentric contractions of the knee extensor muscles using an isokinetic dynamometer. In one condition, a "muscle damage" protocol was followed by 48 h of total sleep deprivation and 12 h of normal sleep (DEPRIVATION). In the other condition, the same muscle damage protocol was conducted, followed by three nights of regular sleep (SLEEP). Isometric muscle voluntary contraction tests and blood samples were collected serially throughout the protocol and analyzed for creatine kinase, free and total testosterone, IGF-1, cortisol, tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, receptor antagonist of IL-1 and IL-10. Muscle voluntary contraction and serum creatine kinase increased equally over the study period in both conditions. From the cytokines evaluated, only IL-6 increased in DEPRIVATION. No differences were detected in testosterone levels between conditions, but IGF-1, cortisol, and cortisol/total testosterone ratio were higher in DEPRIVATION. Total sleep deprivation after EEIMD does not delay muscle strength recovery but modifies inflammatory and hormonal responses.

Role of carbonic anhydrase in acute recovery following renal ischemia reperfusion injury.

Ischemia reperfusion (IR) injury can cause acute kidney injury. It has previously been reported that kidney oxygen consumption (QO2) in relation to glomerular filtration rate (GFR), and thus tubular sodium load, is markedly increased following IR injury, indicating reduced electrolyte transport efficiency. Since proximal tubular sodium reabsorption (TNa) is a major contributor to overall kidney QO2, we investigated whether inhibition of proximal tubular sodium transport through carbonic anhydrase (CA) inhibition would improve renal oxygenation following ischemia reperfusion. Anesthetized adult male Sprague Dawley rats were administered the CA inhibitor acetazolamide (50 mg/kg bolus iv), or volume-matched vehicle, and kidney function, hemodynamics and QO2 were estimated before and after 45 minutes of unilateral complete warm renal ischemia. CA inhibition per se reduced GFR (-20%) and TNa (-22%), while it increased urine flow and urinary sodium excretion (36-fold). Renal blood flow was reduced (-31%) due to increased renal vascular resistance (+37%) without affecting QO2. IR per se resulted in similar decrease in GFR and TNa, independently of CA activity. However, the QO2/TNa ratio following ischemia-reperfusion was profoundly increased in the group receiving CA inhibition, indicating a significant contribution of basal oxygen metabolism to the total kidney QO2 following inhibition of proximal tubular function after IR injury. Ischemia increased urinary excretion of kidney injury molecule-1, an effect that was unaffected by CA. In conclusion, this study demonstrates that CA inhibition further impairs renal oxygenation and does not protect tubular function in the acute phase following IR injury. Furthermore, these results indicate a major role of the proximal tubule in the acute recovery from an ischemic insult.

The Effect of Supplementation of Vitamin D in Neurocritical Care Patients With Hypovitaminosis D: A Randomized Controlled Clinical Trial

Abstract INTRODUCTION Hypovitaminosis D is prevalent in neurocritical care patients, but the potential to improve patient outcome by replenishing vitamin D has not been investigated. This single-center, double-blinded, placebo-controlled, randomized (1:1) clinical trial was designed to assess the effect on patient outcome of vitamin D supplementation in neurocritical care patients with hypovitaminosis D (NCT02881957). METHODS From October 2016 to April 2018, emergently admitted neurocritical care patients with vitamin D deficiency (=20 ng/ml) were randomized to receive vitamin D3 (cholecalciferol, 540 000 IU) (n = 134) or placebo (n = 133). Hospital length of stay (LOS) was the primary outcome; secondary outcomes included intensive care unit (ICU) LOS, repeat vitamin D levels, patient complications, and patient disposition. Exploratory analysis evaluated specific subgroups of patients by LOS, Glasgow Coma Scale (GCS), and Simplified Acute Physiology Score (SAPS II). RESULTS A total of 274 patients were randomized (intent-to-treat) and 267 were administered treatment within 48 hr (as-treated; 61.2% of planned recruitment) and monitored. The mean age of as-treated patients was 54.0 ± 17·2 yr (56.9% male, 77.2% White). After interim analysis suggested a low conditional power for outcome difference (predictive power: 0.12), the trial was halted. For as-treated patients, no significant difference in hospital (10.4 ± 14.5 vs 9.1 ± 7.9 d, P = .4; mean difference = 1.3, 95% CI = −1.5, 4.1) or ICU (ICU: 5.8 ± 7.5 vs 5.4 ± 6.4 d, P = .4; mean difference = .4, 95% CI = −1.3, 2.1) LOS was seen between vitamin D3 and placebo groups. Vitamin D3 supplementation significantly improved repeat serum levels compared with placebo (20.8 ± 9.3 vs 12.8 ± 4.8 ng/ml, P &lt; .001) without adverse side effects. No subgroups were identified by exclusion of LOS outliers or segregation by GCS score, SAPS II score, or severe vitamin D deficiency (=10 ng/ml). CONCLUSION Despite studies showing vitamin D can predict prognosis, supplementation in vitamin D deficient neurocritical care patients did not result in appreciable improvement in outcomes and likely does not play a role in acute clinical recovery.

85 Effects of feed removal on body temperature and intestinal morphology in pigs recovering from acute hyperthermia

Abstract Feed consumption increases body temperature and may delay a return to euthermia and exacerbate intestinal injury following acute hyperthermia recovery in pigs. The study objective was to evaluate the effects of feed removal on body temperature, feeding behavior, and intestinal morphology in pigs exposed to acute hyperthermia and then cooled. Twenty-four gilts (78.53 ± 5.46 kg) were exposed to thermoneutrality (TN; n = 12 pigs; 21.21 ± 0.31°C) for 6 h, or heat stress (HS; 38.51 ± 0.60°C) for 3 h followed by a 3-h recovery period of cooling (HSC; n = 12 pigs; water dousing and TN conditions). Within each temperature treatment, half the pigs were provided feed (F; n = 6 pigs/temperature treatment) and half were not provided feed (NF; n = 6 pigs/temperature treatment). Gastrointestinal (TGI) and vaginal (TV) temperature were recorded every 15 min and pigs were video-recorded to assess feeding behavior. Immediately following the 6 h period pigs were euthanized, and intestinal samples were collected for histology. During the HS period, Tv and TGI were increased overall (P &lt; 0.01; 1.63°C and 2.05°C, respectively) in HSC vs. TN pigs, regardless of feeding treatment. A temperature by feeding treatment by time interaction was detected during the recovery period where TGI was greater (P = 0.03; 0.97°C) for HSC+F compared to HSC+NF pigs from 45–180 min. Feeding behavior was greater overall (P = 0.02; 223.14%) in F vs NF pigs, regardless of temperature treatment. A decrease (P &lt; 0.01) in jejunum and ileum villus height (24.72% and 26.11%, respectively) and villus height to crypt depth ratio (24.40% and 25.52%, respectively) was observed in HSC vs TN pigs, regardless of feeding treatment. Ileum goblet cells were reduced (P = 0.01; 37.87%) in HSC vs TN pigs, regardless of feeding treatment. No other differences were detected for any parameter. In summary, TGI decreased more rapidly following acute hyperthermia when feed was removed.

Comparing Acute Symptoms and Recovery Time Following Sports-Related Concussion Across School Age Groups

Abstract Purpose Despite considerable research on pediatric sports-related concussion (SRC), few studies have analyzed groups from school-age through young adulthood. This study aimed to examine acute symptoms (i.e., emotional, physical, and cognitive) and recovery times across this age range. Methods Participants age 5–25 with SRC (n=611) presented to concussion clinics in the North Texas Concussion Registry within 2 weeks of injury. Subjects were stratified into 4 age groups: early elementary (age 5-9; n=19), late elementary (10–13; n=181), high school (14-17; n=384), and college (18-25; n=39). The Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 Item Scale (GAD-7), and concussion symptom log (Sx log), were administered. ANOVA was used to compare symptom scores and recovery times across groups. Results Differences were found on PHQ-9 scores (p=.05), with the early elementary and high school groups reporting significantly higher levels of depressive symptoms than the late elementary and college groups. No differences were seen on GAD-7 scores. Differences in Sx log severity scores were nonsignificant (p=.09), although scores increased with age (early: M=21.4, late=25.7, high school=30.0, college=35.5). Lastly, recovery time differed across groups (p=.008), with early elementary participants having the longest recovery (M=8.3 days) and the college group having the shortest (M=5.1 days). Conclusion Older age groups reported higher levels of acute post-concussion symptoms and more rapid recovery compared to younger age groups, suggesting that symptomatology and recovery time vary developmentally and the effects of age warrant consideration in young athletes.

B-54 Insights into a Novel Integrated Screening Clinic: Parent Perceptions of Emotional Functioning in Acute Recovery Phase Following Pediatric Neurocritical Care

Abstract Objective Children with traumatic brain injury (TBI) requiring neurocritical care are at high risk for neurocognitive, emotional, physical, and psychosocial difficulties, collectively known as Post-Intensive Care Syndrome. Our study sought to characterize parent ratings of emotional functioning in the acute recovery phase based upon mechanism of injury. Method Twenty children (Mdn = 12.6 years, IQR = 9-15; 65% male) were screened as part of a multidisciplinary follow-up clinic 1-month following hospital discharge. Emotional functioning was assessed using PROMIS Parent Proxy Report for Anxiety and Depression. A brief neurocognitive battery estimated presence of cognitive impairment. MANCOVA was used to compare emotional functioning across injury mechanism (high velocity injury [HVI], 65%; fall, 35%). Results Groups did not differ on age, gender, and presence of cognitive impairment. After controlling for severity, mechanism of injury had a significant effect on both anxiety (p = .026) and depression (p = .004). The HVI group had mildly elevated anxiety (M = 50.5, SD = 12.2) and depression (M = 54.2, SD = 10.6) scores, while the fall group had anxiety (M = 38.0, SD = 6.2) and depression (M = 39.0, SD = 7.3) scores within normal limits. Conclusions In the acute recovery phase following TBI, anxiety and depression symptoms are more common after HVI than falls, even when controlling for severity of injury. The HVI group includes injuries resulting from motor vehicle accidents which may have a broader impact on the family and may explain higher rates of emotional distress in this patient group compared to other mechanisms of TBI. Additional research is needed to further explore variables related to emotional functioning following TBI and how they change over the course of recovery.

Acute Demands and Recovery From Common Interval Training Protocols.

Elmer, DJ, Barron, EN, and Chavez, JL. Acute demands and recovery from common interval training protocols. J Strength Cond Res 35(11): 3041-3049, 2021-The definition of interval training is quite broad, with no accepted procedure for classifying protocols with different workloads and work and recovery interval times. In addition, little is known about the differences in training load and recovery from common interval protocols. The purpose of this study was to evaluate the differences in acute physiological demands and perceived difficulty between 3 common interval training protocols and a moderate, continuous exercise session. Eight subjects completed the training sessions on a cycle ergometer in a randomized order, with at least 1 week between sessions: 30-second/4-minute, 1-minute/1-minute, 4-minute/3-minute, and a 45-minute continuous session. Metabolic variables were measured throughout exercise and 30 minutes of recovery. Training impulse (TRIMP), session-RPE, and RPE-training load were also measured. There were significant differences between protocols, including between interval training protocols, for average V̇o2 (p < 0.001) and heart rate (HR) (p = 0.02), total O2 consumption (p < 0.001), peak lactate (p < 0.001), TRIMP (p = 0.02), session-RPE (p = 0.01), and RPE-training load (p < 0.001). There were no significant differences between interval training protocols for peak V̇o2 or peak HR attained during exercise. There were also no differences in V̇o2 or HR after 5 or 30 minutes of recovery. Blood lactate was only significantly higher after 30 minutes of recovery from the 30-second/4-minute compared with the 4-minute/3-minute protocol (p = 0.001) and the 45-minute session (p < 0.001). These findings show a range of differences in acute physiological demands and perceptions from interval training protocols, which should be accounted for when planning training sessions or research studies or when interpreting past research.

Genetic and lifestyle predictors of ischemic stroke severity and outcome.

Different models that include clinical variables and blood markers have been investigated to predict acute ischemic stroke treatment course and recovery. The aim of the study was to investigate associations between lipid levels, lifestyle factors, hemostatic (F5, F2, SERPINE1, F13A1, and FGB), and atherogenic (APOA5 and ACE) gene variants and acute ischemic stroke (AIS) severity. This study included 250 patients with AIS in which F5, F2, SERPINE1, F13A1, FGB, APOA5, and ACE genotypes were determined. Total cholesterol (TC), high-density cholesterol, low-density cholesterol, and triglycerides concentrations were measured within 24h of the AIS onset. Examination of the neurological deficit was done using National Institutes of Health Stroke Scale/Score (NIHSS). APOA5 genotype [TC + CC] was more frequent (P = 0.026) in patients with the NIHSS score ≥ 21. Univariate regression analysis has shown that triglycerides (OR 0.55, 95% CI 0.34-0.91; P = 0.019), obesity (0.28, 95% CI 0.10-0.73; P = 0.010), age (OR 1.08, 95% CI 1.04-1.13; P < 0.001), and APOA5 genotype (TC + CC) (OR 2.40, 95% CI 1.10-5.25; P = 0.034) are significantly associated with a severe stroke. When all variables were included in model age (OR 1.06, 95% CI 1.01-1.11; P = 0.018), obesity (OR 0.25, 95% CI 0.08-0.77; P = 0.016) and APOA5 genotype (TC + CC) (OR 3.26, 95% CI 1.29-8.23; P = 0.012) remained significant for the risk of severe AIS. APOA5 genotype (TC + CC), age, and obesity could be used as prognostic risk factors for a very severe stroke (NIHSS ≥ 21).

Experiences and Perceptions of Hospitalization and Recovery of Older Adults and Their Caregivers Following Traumatic Brain Injury: "Not Knowing".

The purpose of the current study is to describe the experience and perceptions of older adults and their caregivers following hospitalization for mild or moderate traumatic brain injury (TBI). Qualitative analysis of data obtained in individual semi-structured interviews with older adults and their caregivers (N = 11, five dyads and one individual) was performed to capture the perceptions and experiences of the survivor and their caregivers about the acute injury, hospitalization, and recovery. Data were collected over a 2-month period following discharge from the hospital. Open coding and constant comparative analysis generated codes that were revised throughout the analysis and reformulated into thematic descriptions. As a result, seven interrelated themes were identified. These findings can be used to implement interventions focused on recovery, communication, teaching, patient outcomes, and satisfaction. [Res Gerontol Nurs. 2019; 12(5):227-238].