Continuous Research Articles

Measurements of Arterial Occlusion Pressure Using Hand-Held Devices.

Vehrs, PR, Reynolds, S, Allen, J, Barrett, R, Blazzard, C, Burbank, T, Hart, H, Kasper, N, Lacey, R, Lopez, D, and Fellingham, GW. Measurements of arterial occlusion pressure using hand-held devices. J Strength Cond Res 38(5): 873-880, 2024-Arterial occlusion pressure (AOP) of the brachial artery was measured simultaneously using Doppler ultrasound (US), a hand-held Doppler (HHDOP), and a pulse oximeter (PO) in the dominant (DOM) and nondominant (NDOM) arms of males ( n = 21) and females ( n = 23) using continuous (CONT) and incremental (INCR) cuff inflation protocols. A mixed-model analysis of variance revealed significant ( p < 0.05) overall main effects between AOP measured using a CONT (115.7 ± 10.9) or INCR (115.0 ± 11.5) cuff inflation protocol; between AOP measured using US (116.3 ± 11.2), HHDOP (115.4 ± 11.2), and PO (114.4 ± 11.2); and between males (120.7 ± 10.6) and females (110.5 ± 9.4). The small overall difference (1.81 ± 3.3) between US and PO measures of AOP was significant ( p < 0.05), but the differences between US and HHDOP and between HHDOP and PO measures of AOP were not significant. There were no overall differences in AOP between the DOM and NDOM arms. Trial-to-trial variance in US measurements of AOP was not significant when using either cuff inflation protocol but was significant when using HHDOP and PO and a CONT cuff inflation protocol. Bland-Altman plots revealed reasonable limits of agreement for both HHDOP and PO measures of AOP. The small differences in US, HHDOP, and PO measurements of AOP when using CONT or INCR cuff inflation protocols are of minimal practical importance. The choice of cuff inflation protocol is one of personal preference. Hand-held Doppler of PO can be used to assess AOP before using blood flow restriction during exercise.

Exercise Training Independent of Intensity Lowers Plasma Bile Acids in Prediabetes.

People with obesity have high circulating bile acids (BA). Although aerobic fitness favors low circulating BA, the effect of training intensity before clinically meaningful weight loss on BA is unclear. This study aimed to test the hypothesis that 2 wk of interval (INT) versus continuous (CONT) exercise would lower plasma BA in relation to insulin sensitivity. Twenty-three older adults with prediabetes (ADA criteria) were randomized to 12 work-matched bouts of INT ( n = 11, 60.3 ± 2.4 yr, 32.1 ± 1.2 kg·m -2 ) at 3 min at 50% HR peak and 3 min at 90% HR peak or CONT ( n = 12, 60.8 ± 2.4 yr, 34.0 ± 1.7 kg·m -2 ) at 70% HR peak cycling training for 60 min·d -1 over 2 wk. A 180-min 75-g oral glucose tolerance test (OGTT) was performed to assess glucose tolerance (tAUC), insulin sensitivity (Siis), and metabolic flexibility (RER postprandial -RER fast ; indirect calorimetry). BA ( n = 8 conjugated and 7 unconjugated) were analyzed at 0, 30, and 60 min of the OGTT. Anthropometrics and fitness (V̇O 2peak ) were also assessed. INT and CONT comparably reduced body mass index (BMI; P < 0.001) and fasting RER ( P < 0.001) but raised insulin sensitivity ( P = 0.03). INT increased V̇O 2peak as compared with CONT ( P = 0.01). Exercise decreased the unconjugated BA chenodeoxycholic acid iAUC 60min ( P < 0.001), deoxycholic acid iAUC 60min ( P < 0.001), lithocholic acid iAUC 60min ( P < 0.001), and glycodeoxycholic acid (GCDCA) iAUC 60min ( P < 0.001). Comparable reductions were also seen in the conjugated BA hyodeoxycholic acid iAUC 60min ( P = 0.01) and taurolithocholic acid iAUC 60min ( P = 0.007). Increased V̇O 2peak was associated with lowered UDCA 0min ( r = -0.56, P = 0.02) and cholic acid iAUC 60min ( r = -0.60, P = 0.005), whereas reduced BMI was related to higher GDCA 0min ( r = 0.60, P = 0.005) and GCDCA 0min ( r = 0.53, P = 0.01). Improved insulin sensitivity correlated with lower GCDCA iAUC 60min ( r = -0.45, P = 0.03) and GDCA iAUC 60min ( r = -0.48, P = 0.02), whereas increased metabolic flexibility was related to deoxycholic acid iAUC 60min ( r = 0.64, P = 0.004) and GCDCA iAUC 60min ( r = 0.43, P = 0.05). Short-term training lowers some BA in relation to insulin sensitivity independent of intensity.

A randomised phase 2 study of intermittent versus continuous dosing of dabrafenib plus trametinib in patients with BRAFV600 mutant advanced melanoma (INTERIM)

BackgroundBRAF+MEK inhibitors extend life expectancy of patients with BRAFV600 mutant advanced melanoma. Acquired resistance limits duration of benefit, but preclinical and case studies suggest intermittent dosing could overcome this limitation. INTERIM was a phase 2 trial evaluating an intermittent dosing regimen. MethodsPatients with BRAFV600 mutant advanced melanoma due to start dabrafenib+trametinib were randomised to receive either continuous (CONT), or intermittent (INT; dabrafenib d1–21, trametinib d1–14 every 28 days) dosing. A composite primary endpoint included progression-free survival (PFS) and quality of life (QoL). Secondary endpoints included response rate (ORR), overall survival (OS) and adverse events (AEs). Mutant BRAFV600E ctDNA was measured by droplet digital PCR (ddPCR), using mutant allele frequency of > 1 % as the detection threshold. Results79 patients (39 INT, 40 CONT) were recruited; median age 67 years, 65 % AJCC (7th ed) stage IV M1c, 29 % had brain metastases. With 19 months median follow-up, INT was inferior in all efficacy measures: median PFS 8.5 vs 10.7mo (HR 1.39, 95 %CI 0.79–2.45, p = 0.255); median OS 18.1mo vs not reached (HR 1.69, 95 %CI 0.87–3.28, p = 0.121), ORR 57 % vs 77 %. INT patients experienced fewer treatment-related AEs (76 % vs 88 %), but more grade > 3 AEs (53 % vs 42 %). QoL favoured CONT. Detection of BRAFV600E ctDNA prior to treatment correlated with worse OS (HR 2.55, 95 %CI 1.25–5.21, p = 0.01) in both arms. A change to undetected during treatment did not significantly predict better OS. ConclusionINTERIM findings are consistent with other recent clinical trials reporting that intermittent dosing does not improve efficacy of BRAF+MEK inhibitors.

HPB P40 Laparoscopic spleen-preserving distal pancreatectomy versus laparoscopic distal pancreatectomy with splenectomy: A systematic review and meta-analysis

Abstract Background To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. Methods A systematic search of electronic databases and bibliographic reference lists were conducted. All comparative studies reporting outcomes of IS and CS in hepaticojejunostomy and choledochocholedochostomy were included and their risk of bias were assessed using ROBINS-I tool. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters. Results Ten comparative studies (2 prospective and 8 retrospective) were included which reported 1617 patients of whom 1186 patients underwent Roux-en-Y hepaticojejunostomy (IS:789, CS:397) and the remaining 431 patients underwent duct-to-duct choledochocholedochostomy (IS:168, CS:263). Although use of IS for hepaticojejunostomy was associated with significantly longer anastomosis time (MD:14.15 minutes, p=0.0002) compared to CS, there was no significant difference in overall biliary complications (OR:1.34, p=0.11), bile leak (OR:1.64, p=0.14), biliary stricture (OR:0.84, p=0.65), cholangitis (OR:1.54, p=0.35), or liver abscess (OR:0.58, p=0.40) between two groups. Similarly, use of IS for choledochocholedochostomy was associated with no significant difference in all categories compared to CS. Conclusions Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy seem to have comparable clinical outcomes. The available evidence may be subject to confounding by indication with respect to diameter of bile duct. Future high-quality research is encouraged to report the outcomes with respect to duct diameter and suture material.

Effect of nebuliser and patient interface type on fugitive medical aerosol emissions in adult and paediatric patients

BackgroundOpen circuit aerosol therapy is associated with the potential for fugitive emissions of medical aerosol. Various nebulisers and interfaces are used in respiratory treatments, including the recent consideration of filtered interfaces. This study aims to quantify fugitive medical aerosols from various nebuliser types, in conjunction with different filtered and non-filtered interfaces. MethodsFor both simulated adult and paediatric breathing, four nebuliser types were assessed including; a small volume jet nebuliser (SVN), a breath enhanced jet nebuliser (BEN), a breath actuated jet nebuliser (BAN) and a vibrating mesh nebuliser (VMN). A combination of different interfaces were used including filtered and unfiltered mouthpieces, as well as open, valved and filtered facemasks. Aerosol mass concentrations were measured using an Aerodynamic Particle Sizer at 0.8 m and 2.0 m. Additionally, inhaled dose was assessed. ResultsHighest mass concentrations recorded were 214 (177, 262) µg m−3 at 0.8 m over 45-minute run. The highest and lowest fugitive emissions were observed for the adult SVN facemask combination, and the adult BAN filtered mouthpiece combination respectively. Fugitive emissions decreased when using breath-actuated (BA) mode compared to continuous (CN) mode on the BAN for the adult and paediatric mouthpiece combination. Lower fugitive emissions were observed when a filtered facemask or mouthpiece was used, compared to unfiltered scenarios. For the simulated adult, highest and lowest inhaled dose were 45.1 (42.6, 45.6)% and 11.0 (10.1,11.9)% for the VMN and SVN respectively. For the simulated paediatric, highest and lowest inhaled dose were 44.0 (42.4, 44.8)% and 6.1 (5.9, 7.0)% for the VMN and BAN CN respectively. Potential inhalation exposure of albuterol was calculated to be up to 0.11 µg and 0.12 µg for a bystander and healthcare worker respectively. ConclusionThis work demonstrates the need for filtered interfaces in clinical and homecare settings to minimise fugitive emissions and to reduce the risk of secondary exposure to care givers.

Aerobic adaptations following two iso-effort training programs: an intense continuous and a high-intensity interval.

The intensity of the training stimulus and the effort exerted (regarded as an index of internal load) to complete an exercise session are driving forces for physiological processes and long-term training adaptations. This study compared the aerobic adaptations following two iso-effort, ratings of perceived exertion (RPE)-based training programs, an intense continuous (CON) and a high-intensity interval (INT). Young adults were assigned to a CON (n=11) or an INT (n=13) training group to perform 14 training sessions within 6 weeks. The INT group performed running bouts (9.3±4.4 repetitions) at 90% of peak treadmill velocity (PTV) with bout duration equal to 1/4 of time to exhaustion at this speed (134.2±27.9 s). The CONT group ran (1185.0±487.6 s) at a speed corresponding to -2.5% of critical velocity (CV; 80.1%±3.0% of PTV). Training-sessions were executed until RPE attained 17 on the Borg scale. VO2max, PTV, CV, lactate threshold velocity (vLT), and running economy were assessed pre-, mid-, and post-training. Both CONT and INT methods increased (p<0.05) VO2max (INT: 57.7±8.1-61.41±9.2; CONT: 58.1±7.5-61.1±6.3 mL kg-1 min-1), PTV (INT: 14.6±1.8-15.7±2.1; CONT: 15.0±1.7-15.7±1.8 km h-1), CV (INT: 11.8±1.4-12.8±1.8; CONT: 12.2±1.6-12.9±1.7 km h-1), and vLT (INT: 9.77±1.1-10.8±1.4; CONT: 10.4±1.4-11.0±1.8 km h-1) with no differences (p>0.05) between them; running economy remained unchanged. The continuous training method, when matched for effort and executed at relatively high intensity at the upper boundaries of the heavy-intensity domain (∼80% of PTV), confers comparable aerobic adaptations to those attained after a high-intensity interval protocol following a short-term training period.

Human skeletal muscle mitochondrial responses to single-leg intermittent or continuous cycle exercise training matched for absolute intensity and total work.

There is renewed interest in the potential for interval (INT) training to increase skeletal muscle mitochondrial content including whether the response differs from continuous (CONT) training. Comparisons of INT and CONT exercise are impacted by the manner in which protocols are "matched", particularly with respect to exercise intensity, as well as inter-individual differences in training responses. We employed single-leg cycling to facilitate a within-participant design and test the hypothesis that short-term INT training would elicit a greater increase in mitochondrial content than work- and intensity-matched CONT training. Ten young healthy adults (five males and five females) completed 12 training sessions over 4 weeks with each leg. Legs were randomly assigned to complete either 30 min of CONT exercise at a challenging sustainable workload (~50% single-leg peak power output; Wpeak) or INT exercise that involved 10 × 3-min bouts at the same absolute workload. INT bouts were interspersed with 1min of recovery at 10% Wpeak and each CONT session ended with 10min at 10% Wpeak. Absolute and mean intensity, total training time, and volume were thus matched between legs but the pattern of exercise differed. Contrary to our hypothesis, biomarkers of mitochondrial content including citrate synthase maximal activity, mitochondrial protein content and subsarcolemmal mitochondrial volume increased after CONT (p < 0.05) but not INT training. Both training modes increased single-leg Wpeak (p < 0.01) and time to exhaustion at 70% of single-leg Wpeak (p < 0.01). In a work- and intensity-matched comparison, short-term CONT training increased skeletal muscle mitochondrial content whereas INT training did not.

Effects of prepartum melatonin treatment and suckling on postpartum reproductive performance of Beetal goats under subtropical conditions

The current study determines the effect of prepartum melatonin treatment on postpartum reproductive cyclicity, uterine involution, the onset of estrus, and ovarian activity in restricted or continuous suckled Beetal goats. Forty-six pregnant goats of 110 days gestation were either inserted with melatonin implants (M; n = 24) or left untreated (control, C; n = 22). Each group was subdivided into continuous (CS) and restricted suckling (RS) groups i.e., MCS (n = 11), CCS (n = 11), a ” ”MRS (n = 13), and CRS (n = 11) to monitor estrous response while uterine involution and ovarian activity were monitored in a subset of goats (n = 8 in each group) via transrectal ultrasonography (7.5 MHz transducer) twice a week. Blood BHBA and glucose levels were monitored 40 days before and 28 days after kidding. Data were analyzed using multifactor analysis of variance (ANOVA) designs, Chi-square, and Student’s t-test (SPSS version 20). Estrous response of goats was similar in MRS (30.8 %), CRS (45.4 %), and MCS (18.2 %) groups; however, MRS and CRS goats had better (P < 0.05) estrous response than those of CCS (0 %) goats. Between the groups, the ovulatory response and interval to 1st postpartum estrus were similar (P > 0.05). Melatonin tended to have shortened (P = 0.07) the interval to 1st postpartum ovulation and placental expulsion time (P < 0.05) in melatonin-treated than untreated goats. Melatonin or suckling treatment did not affect Gestation length, kidding time, uterine involution, and regression of caruncles (P > 0.05). BHBA levels were higher (P < 0.05) at 28 days postpartum than 40 days before kidding in all groups; however, glucose levels were similar in all groups except CCS. In conclusion, restricted suckling and prepartum melatonin treatment have more impact on postpartum reproductive performance than prepartum melatonin treatment alone in Beetal goats.

Comparison of Two Cuff Inflation Protocols to Measure Arterial Occlusion Pressure in Males and Females

We measured the arterial occlusion pressure (AOP) in the dominant (DOM) and non-dominant (NDOM) legs of males (n = 20) and females (n = 20), 19–26 years of age, using a continuous (CONT) and incremental (INCR) cuff inflation protocol. ANOVA revealed no significant differences in AOP within (&lt;1 mmHg; p &gt; 0.493) or between (&lt;6 mmHg; p &gt; 0.418) the DOM and NDOM legs in males or females with either CONT or INCR. There were no significant sex differences in AOP in the DOM or NDOM legs when using CONT (&lt;3 mmHg; p &gt; 0.838) or INCR (&lt;3 mmHg; p &gt; 0.856). Measures of AOP are highly reliable, as evidenced by correlation coefficients &gt;0.96 and small mean differences (&lt;1.5 mmHg) between repeated measures. The choice of which cuff inflation protocol to use is one of personal preference. The AOP is not always greater in the dominant or larger leg. Although mean differences in AOP between the two legs was small, actual differences of over 100 mmHg could lead to unsafe and ineffective cuff inflation pressures during BFR if AOP is measured in only one leg. Further investigation of factors that explain difference in AOP between legs and between males and females is warranted. To ensure safe and effective use of BFR during exercise, AOP of both limbs should be measured regularly.

1009: CHARACTERIZING SEDATION/ANALGESIA PRACTICES IN PATIENTS RECEIVING NEUROMUSCULAR BLOCKING AGENTS

Introduction: There are no guideline recommendations regarding sedation/analgesia regimens for patients receiving continuous or frequent boluses of neuromuscular blocking agents (NMBA). As such, clinical practice may vary across institutions and intensive care units (ICU). Due to lack of guidance for sedation/analgesia regimens in patients receiving NMBAs, we surveyed pharmacists caring for adult and pediatric patients to describe sedation/analgesia practices for patients receiving continuous (CI) or frequent boluses of NMBAs. Methods: A 10-question survey was provided to pharmacists via email listservs. The survey first included questions about practice site, comfort using NMBAs, and sedation/analgesia monitoring practices. Respondents then could select all sedation/analgesia regimens they observe, recommend, and consider inappropriate. Results: Of 2,435 pharmacists surveyed, 171 (7.0%) completed the entire survey. Most respondents practiced in the United States (97.9%), cared for adult patients (60.7%), and worked in a medical ICU (81.3%). Most respondents reported monitoring sedation in patients receiving NMBAs (82.6%), with vitals (49%) and bispectral index monitoring (30.3%) being the most common methods. Overall, the most commonly observed and recommended regimens were combination CI benzodiazepine (BZD) + CI opioid (66.7% and 59.3%) followed by propofol + CI opioid (60.8% and 63.5%). Adult pharmacists more commonly observed and recommended combination propofol + CI opioid (91% and 89%) followed by CI BZD + CI opioid (63% and 53%). In contrast, pediatric pharmacists more commonly observed and recommended combination CI BZD + CI opioid (75% and 71%) followed by dexmedetomidine + CI opioid (71% and 54%). Adult pharmacists more frequently deemed regimens including dexmedetomidine as inappropriate, whereas pediatric pharmacists more frequently deemed regimens including propofol as inappropriate. Most respondents would not recommend a monotherapy regimen. Conclusions: Despite lack of guideline recommendations, use of combination therapy with sedation/analgesia was frequently reported; however, the choice of sedation agent was variable. Further research is needed to describe appropriate and effective sedation/analgesia regimens for patients receiving continuous or frequent boluses of NMBAs.

Nonlinear finite element investigation on shear behaviour of simply supported and continuous RC T-beams retrofitted with deep embedded CFRP/steel bars

The shear performances of simply supported (SS) and continuous (CN) reinforced concrete T-beams strengthened with deep embedded (DE) steel or carbon fibre-reinforced polymer bars are compared in this investigation. A nonlinear finite element (NLFE) analysis is performed for this purpose by modelling these beams with the FEM software by validating with the experimental data from the published studies. The experimental and NLFE shear strength values are then compared with those of the available design models to examine the efficacy of these models. Thereafter, the parametric study is conducted to obtain the impact of beam types (SS and CN) on the structural performances. It shows that the DE-strengthened CN beam provides higher shear capacity in comparison to the corresponding SS beam. However, the enhancements of the shear strength of SS beam due to strengthening with DE bars are significantly higher than that of the corresponding CN beam.

The effect of prolonged interval and continuous exercise in the heat on circulatory markers of intestinal barrier integrity.

The purpose of this study was to determine the effect of prolonged high-intensity interval (INT) and moderate-intensity continuous (CONT) treadmill exercise in the heat on markers of enterocyte injury and bacterial endotoxin translocation. Nine males completed 2 h of work-matched exercise in the heat (40°C and 15% RH) as either INT (2min at 80% VO2max and 3min at 30% VO2max) or CONT (~ 50% of VO2max). Blood samples collected pre- and post-exercise were assayed for intestinal fatty acid-binding protein (I-FABP), claudin-3 (CLDN-3), and lipopolysaccharide-binding protein (LBP). I-FABP was significantly increased from pre- to post-exercise in CONT (913.96 ± 625.13 to 1477.26 ± 760.99pg•mL-1; p = 0.014, d = 0.766) and INT (714.59 ± 470.27 to 1547.93 ± 760.99pg•mL-1; p = 0.001, d = 1.160). Pre- to post-exercise changes in I-FABP were not different between CONT and INT (p = 0.088, d = 0.414). LBP was significantly increased from pre- to post-exercise in INT (15.94 ± 2.90 to 17.35 ± 3.26μg•mL-1; p = 0.028, d = 0.459) but not CONT (18.11 ± 5.35 to 16.93 ± 5.39μg•mL-1; p = 0.070, d = 0.226), and pre- to post-exercise changes in LBP were higher in the INT compared to CONT (p < 0.001, d = 1.160). No significant changes were detected from pre- to post-exercise for CLDN-3 in CONT (14.90 ± 2.21 to 15.30 ± 3.07μg•mL-1) or INT (15.55 ± 1.63 to 16.41 ± 2.11μg•mL-1) (p > 0.05). We conclude that prolonged exercise in the heat induces enterocyte injury, but interval (or intermittent) exercise may cause greater bacterial endotoxin translocation which may increase the risk for local and systemic inflammation.

Effects Of Specific Exercise Training During 120 Days Isolation On Physiological Kinetics And Inhibitory Control

PURPOSE: Long-term isolation is known for the detrimental effects of inactivity and decreased external stimuli on physical and cognitive systems, which is relevant for space travel in microgravity but also for pandemic-related isolation periods. Exercise countermeasures are investigated in terrestrial analog settings concerning feasibility, time efficiency, and overall beneficial effects on cardiorespiratory and cognitive fitness (i.e., positive exercise-cognition interaction). In terrestrial settings, interval (INT) and continuous (CON) treadmill exercise showed positive effects on heart rate (HR) and oxygen uptake (V̇O2) capacities and kinetics, but research for space application is still pending. We expected (I) negative effects of isolation on cognitive performance and (II) physical fitness improvements, especially from INT. METHODS: Six participants (34 ± 6 years, 3 females) spent 120 days in isolation on a simulated journey to the moon (SIRIUS-19). 8 weeks of CON, followed by 8 weeks of INT aerobic exercise on a treadmill were conducted in a crossover design. Cardiorespiratory capacities, kinetics (HR, V̇O2), and cognitive performance (Flanker task measuring inhibitory control) were assessed with an exercise protocol, including pseudo-random binary sequences (PRBS), constant work-rate phases (Rest, 3, 6, 9 km h-1, recovery), and incremental exercise for Pre, Post, and five times during isolation (ANOVA: time x phase). RESULTS: Peak values for HR (P = 0.025), V̇O2 (P = 0.012), and respiratory exchange ratio (P = 0.001) had significant time effects with lower values during isolation. Kinetics of HR and V̇O2 improved during the mission with slightly better effects for INT (both p < 0.05). Inhibitory control was not altered by 120 days of isolation. CONCLUSIONS: This study proved the successful implementation of cognitive testing within our endurance exercise test. Positive effects for INT and CON aerobic exercise were confirmed for HR, but not for V̇O2 kinetics during isolation periods. We assume the lack of general physical activity is merely compensated for by the applied exercise countermeasure, at least in 1G contexts. Currently, additional exercise modalities (i.e., strength training, passive treadmill exercise) are investigated during a consecutive 240-day mission (SIRIUS-21).

WE2.7 Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy

Abstract Aims To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. Method s. A systematic search of electronic information sources and bibliographic reference lists were conducted. A combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases was applied. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters. Results Nine comparative studies were included which reported 1061 patients of whom 630 patients underwent Roux-en-Y hepaticojejunostomy (IS:281, CS:309) and the remaining 431 patients underwent duct-to-duct choledochocholedochostomy (IS:168, CS:263). Although use of IS for hepaticojejunostomy was associated with significantly longer anastomosis time (MD:9.82 minutes, p&amp;lt;0.00001) compared to CS, there was no significant difference in overall biliary complications (OR:1.34, p=0.19), bile leak (OR:1.73, p=0.26), biliary stricture (OR:0.77, p=0.64), cholangitis (OR:1.54, p=0.35), or liver abscess (OR:0.58, p=0.40) between two groups. Similarly, use of IS for choledochocholedochostomy was associated with no significant difference in risk of overall biliary complications (OR:0.92, p=0.90), bile leak (OR:1.70, p=0.28) or biliary stricture (OR:1.07, p=0.92) compared to CS. Conclusions Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy seem to have comparable outcomes although the former may be associated with a longer anastomosis time. The available evidence may be subject to confounding by indication with respect to diameter of bile duct. Future high quality research is encouraged to report the outcomes with respect to duct diameter and suture material.

Effects of aerobic exercise in confinement on cardiorespiratory kinetics and cognitive functions – Results from the 4-month SIRIUS-19 isolation project

IntroductionConfinement during sojourns in microgravity affects cardiorespiratory fitness, cognitive parameters, and their interaction with influences on mission success, fitness, and overall well-being. The aim of the experiment was to test the efficacy of two endurance exercise countermeasures to maintain aerobic fitness, indicated by cardiorespiratory kinetics, and cognitive performance during 120 days of confinement. MethodsSix participants (34 ± 6 years, 3 females) spent 120 days in confinement, conducting eight weeks of either continuous (CON) or interval (INT) aerobic treadmill exercise in a crossover design. Heart rate (HR) and oxygen uptake (V˙O2) were assessed with an exercise test protocol, including pseudo-random work rate (WR) changes to determine the respective kinetics before the start of confinement (pre), five times during confinement (mission day (MD) 9(±1), 29(±1), 57(±1), 87(±1), and 117(±1)), and after the termination of the mission phase (post). Additionally, constant WR phases and incremental exercise were part of the protocol. During the constant phases of the exercise protocol, cognitive performance was assessed. ResultsHR kinetics accelerated, and mean HR values during the work rate protocol decreased as the mission progressed (p < 0.05). CON and INT exercise both seemed to speed HR kinetics during the mission, with slightly better effects for INT. Inhibitory control was not altered by 120 days of confinement. ConclusionDetrimental effects on cardiorespiratory fitness and cognitive performance from the lack of general physical activity during confinement were compensated by the applied exercise countermeasure, with no clear advantage for CON or INT exercise.

Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy.

To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. The study protocol was prospectively registered in PROSPERO (registration number: CRD42021286294). A systematic search of MEDLINE, CENTRAL, and Web of Science and bibliographic reference lists were conducted (last search: 14th March 2022). All comparative studies reporting outcomes of IS and CS in hepaticojejunostomy and choledochocholedochostomy were included and their risk of bias was assessed using ROBINS-I tool. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters. Ten comparative studies (2 prospective and 8 retrospective) were included which reported 1617 patients of whom 1186 patients underwent Roux-en-Y hepaticojejunostomy (IS: 789, CS: 397) and the remaining 431 patients underwent duct-to-duct choledochocholedochostomy (IS: 168, CS: 263). Although use of IS for hepaticojejunostomy was associated with significantly longer anastomosis time (MD: 14.15 min, p=0.0002) compared to CS, there was no significant difference in overall biliary complications (OR: 1.34, p=0.11), bile leak (OR: 1.64, p=0.14), biliary stricture (OR: 0.84, p=0.65), cholangitis (OR: 1.54, p=0.35), or liver abscess (OR: 0.58, p=0.40) between two groups. Similarly, use of IS for choledochocholedochostomy was associated with no significant difference in risk of overall biliary complications (OR: 0.92, p=0.90), bile leak (OR: 1.70, p=0.28), or biliary stricture (OR: 1.07, p=0.92) compared to CS. Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy seem to have comparable clinical outcomes. The available evidence may be subject to confounding by indication with respect to diameter of bile duct. Future high-quality research is encouraged to report the outcomes with respect to duct diameter and suture material.

Comparison and integration of CONT17 networks

Among the continuous (CONT) campaigns of very long baseline interferometry (VLBI), CONT17 is a special CONT campaign which comprises three independent networks: two legacy networks, and one VGOS network to mainly check possible biases in network geometry. In this study, we estimate all types of geodetic parameters (station and source coordinates, and Earth orientation parameters (EOP)) within the single networks and compare them to investigate potential network dependent biases. Since the separate networks are technically linked to each other by common parameters, i.e. EOP and common radio source coordinates, they can be regarded as a single network on the Earth and integrated in one common adjustment. Thus, we also estimate the station and source coordinates, and the EOP from the integrated networks and compare them with those of the single networks to check the impact on the geodetic parameters. There are both subtle and large biases (up to 7.1 mm between the legacy networks in the Ty component and 23.3 mm between the legacy and VGOS networks in the D_3 component on the surface of the Earth) between the single networks depending on parameter types. The integrated network eventually compensates those differences. Adding the VGOS network to the legacy networks does not show any significant improvement for the latter. However, the integration can provide the VGOS network with better parameter estimates which is important for the new stations.

Stocking method and monensin supplementation effects on cow and calf performance and pasture productivity

AbstractIn the northeastern United States, pastures are predominantly cool‐season perennial grasses and legumes that are dormant in the summer resulting in a decline in forage nutritive value and availability, commonly referred to as “summer slump.” Strategies to alleviate summer slump may include stocking management or supplementation with or without an ionophore such as monensin to maximize efficiency. A 3‐yr study (n = 32 cow–calf pairs; 718.0 ± of 83.9 kg) was conducted to evaluate the effects of rotational (ROT) or continuous (CONT) stocking method with or without monensin on forage production, pasture nutritive value, and animal production. Continuous and ROT stocking treatments were assigned to eight 2.9‐ha pastures with two replicates/year for 56 grazing days during the summer. Treatments were arranged as a 2 × 2 factorial, and supplements included with or without monensin (200 mg cow−1 daily; Rumensin 90, Elanco Animal Health) delivered once daily (0.45 kg cow−1). Disk meter height was maintained using put‐and‐take animals with four tester cow–calf pairs per pasture. Carrying capacity (CC) and calf average daily gain (ADG) were not influenced by stocking management. Rotational stocking increased cow body weight (BW) change by 6.6 kg. Monensin improved CC by 9% regardless of stocking method but did not affect cow BW change or calf ADG. Based on this study, monensin can improve carrying capacity and stocking rate regardless of stocking method. Implementing rotational stocking may improve pasture health by suppressing weed growth and enhancing forage nutritive value in pastures containing cool‐season perennial forages.

Diurnal regulation of rice N uptake ability under interrupted N supply.

Plants take up nitrogen (N) both day and night. The diurnal variation in N uptake results from interactions between aboveground and belowground tissues. We examined the long-term effects of interrupted N supply (day only or night only) under hydroponic conditions to test whether plant acclimatisation response to the interrupted N supply differs by day or night. Seedlings experienced 32 days under daytime-fed (DF), night-time-fed (NF), or continuous (CT) N supply. The root N uptake rate (NUR) differed between DF and NF from day 3 of treatment, after which NUR was significantly increased (by up to 82%) in DF and NF plants. The increased NUR during each half-day did not fully compensate for lost access to N during the other half-day, resulting in lower N accumulation by the end of the treatment. The reduction was smaller in DF plants than NF plants. The underlying mechanism of diurnal variation of N uptake is discussed in terms of transpiration demand and gene expression in roots.

Accuracy of CGM Systems During Continuous and Interval Exercise in Adults with Type 1 Diabetes.

continuous glucose monitoring systems (CGMs) play an important role in the management of T1D, but their accuracy may reduce during rapid glucose excursions. The aim of study was to assess the accuracy of recent rt-CGMs available in Italy, in subjects with T1D during 2 sessions of physical activity: moderate continuous (CON) and interval exercise (IE). we recruited 22 patients with T1D, on CSII associated or integrated with a CGM, to which a second different sensor was applied. Data recorded by CGMs were compared with the corresponding plasma glucose (PG) values, measured every 5 minutes with the glucose analyzer. To assess the accuracy of the CGMs, we evaluated the Sensor Bias (SB), the Mean Absolute Relative Difference (MARD) and the Clarke error grid (CEG). a total of 2355 plasma-sensor glucose paired points were collected. Both average plasma and interstitial glucose concentrations did not significantly differ during CON and IE. During CON: 1. PG change at the end of exercise was greater than during IE (P = .034); 2. all sensors overestimated PG more than during IE, as shown by SB (P < .001) and MARD (P < .001) comparisons. Classifying the performance according to the CEG, significant differences were found between the 2 sessions in distribution of points in A and B zones. the exercise affects the accuracy of currently available CGMs, especially during CON, suggesting, in this circumstance, the need to maintain blood glucose in a "prudent" range, above that generally recommended. Further studies are needed to investigate additional types of activities.