Kg-1 Min-1 Research Articles

Modelling metabolic performance in paediatric obstructive sleep disordered breathing: A case-control study.

Paediatric obstructive sleep disordered breathing (OSDB) has a considerable impact on cardiovascular physiology, but the consequences on children's basal metabolism and response to exercise are far from being known. The objective was to propose model estimations for paediatric OSDB metabolism at rest and during exercise. A retrospective case-control analysis of data from children submitted to otorhinolaryngology surgery was performed. The heart rate (HR) was measured, while oxygen consumption (VO2) and energy expenditure (EE) at rest and during exercise were obtained using predictive equations. The results for the patients with OSDB were compared with controls. A total of 1256 children were included. A total of 449 (35.7%) had OSDB. The patients with OSDB showed a significantly higher resting heart rate (94.55 ± 15.061 bpm in OSDB vs. 92.41 ± 15.332 bpm in no-OSDB, p = 0.041). The children with OSDB showed a higher VO2 at rest (13.49 ± 6.02 mL min-1kg-1 in OSDB vs. 11.55 ± 6.83 mL min-1kg-1 in no-OSDB, p = 0.004) and a higher EE at rest (67.5 ± 30.10 cal min-1kg-1 in OSDB vs. 57.8 + 34.15 cal min-1kg-1 in no-OSDB, p = 0.004). At maximal exercise, patients with OSDB showed a lower VO2max (33.25 ± 5.82 mL min-1kg-1 in OSDB vs. 34.28 ± 6.71 in no-OSDB, p = 0.008) and a lower EE (166.3 ± 29.11 cal min-1kg-1 in OSDB vs. 171.4 ± 33.53 cal min-1kg-1 in no-OSDB, p = 0.008). The VO2/EE increment with exercise (Δ VO2 and Δ EE) was lower in OSDB for all exercise intensities (p = 0.009). This model unveils the effect of paediatric OSDB on resting and exercise metabolism. Our findings support the higher basal metabolic rates, poorer fitness performance, and cardiovascular impairment found in children with OSDB.

Energy expenditure and intensity of ritual jumping-dancing in male Maasai.

Traditional jumping-dance rituals performed by Maasai men involve prolonged physical exertion that may contribute significantly to overall physical activity level. We aimed to objectively quantify the metabolic intensity of jumping-dance activity and assess associations with habitual physical activity and cardiorespiratory fitness (CRF). Twenty Maasai men (18-37 years) from rural Tanzania volunteered to participate in the study. Habitual physical activity was monitored using combined heart rate (HR) and movement sensing over 3 days, and jumping-dance engagement was self-reported. A 1-h jumping-dance session resembling a traditional ritual was organized, during which participants' vertical acceleration and HR were monitored. An incremental, submaximal 8-min step test was performed to calibrate HR to physical activity energy expenditure (PAEE) and assess CRF. Mean (range) habitual PAEE was 60 (37-116) kJ day-1 kg-1 , and CRF was 43 (32-54) mL O2 min-1 kg-1 . The jumping-dance activity was performed at an absolute HR of 122 (83-169) beats·min-1 , and PAEE of 283 (84-484) J min-1 kg-1 or 42 (18-75)% when expressed relative to CRF. The total PAEE for the session was 17 (range 5-29) kJ kg-1 , ~28% of the daily total. Self-reported engagement in habitual jumping-dance frequency was 3.8 (1-7) sessions/week, with a total duration of 2.1 (0.5-6.0) h/session. Intensity during traditional jumping-dance activity was moderate, but on average sevenfold higher than habitual physical activity. These rituals are common, and can make a substantial contribution to overall physical activity in Maasai men, and thus be promoted as a culture-specific activity to increase energy expenditure and maintain good health in this population.

Hemoglobin mass and performance responses during 4 weeks of normobaric "live high-train low and high".

To investigate whether 4 weeks of normobaric "live high-train low and high" (LHTLH) causes different hematological, cardiorespiratory, and sea-level performance changes compared to living and training in normoxia during a preparation season. Nineteen (13 women, 6 men) cross-country skiers competing at the national or international level completed a 28-day period (∼18 h day-1 ) of LHTLH in normobaric hypoxia of ∼2400 m (LHTLH group) including two 1 h low-intensity training sessions per week in normobaric hypoxia of 2500 m while continuing their normal training program in normoxia. Hemoglobin mass (Hbmass ) was assessed using a carbon monoxide rebreathing method. Time to exhaustion (TTE) and maximal oxygen uptake (VO2max ) were measured using an incremental treadmill test. Measurements were completed at baseline and within 3 days after LHTLH. The control group skiers (CON) (seven women, eight men) performed the same tests while living and training in normoxia with ∼4 weeks between the tests. Hbmass in LHTLH increased 4.2 ± 1.7% from 772 ± 213 g (11.7 ± 1.4 g kg-1 ) to 805 ± 226 g (12.5 ± 1.6 g kg-1 ) (p < 0.001) while it was unchanged in CON (p = 0.21). TTE improved during the study regardless of the group (3.3 ± 3.4% in LHTLH; 4.3 ± 4.8% in CON, p < 0.001). VO2max did not increase in LHTLH (61.2 ± 8.7 mL kg-1 min-1 vs. 62.1 ± 7.6 mL kg-1 min-1 , p = 0.36) while a significant increase was detected in CON (61.3 ± 8.0-64.0 ± 8.1 mL kg-1 min-1 , p < 0.001). Four-week normobaric LHTLH was beneficial for increasing Hbmass but did not support the short-term development of maximal endurance performance and VO2max when compared to the athletes who lived and trained in normoxia.

Permissive hypoventilation equally effective to maintain oxygenation as positive pressure ventilation after porcine class III hemorrhage and whole blood resuscitation.

Prehospital anesthesia may lead to circulatory collapse after severe hemorrhage. It is possible that permissive hypoventilation, refraining from tracheal intubation and accepting spontaneous ventilation, decreases this risk, but it is not known if oxygen delivery can be maintained. We investigated the feasibility of permissive hypoventilation after class III hemorrhage and whole blood resuscitation in three prehospital phases: 15 min on-scene, 30 min whole blood resuscitation, and 45 min after. 19 crossbred swine, mean weight 58.5 kg, were anesthetized with ketamine/midazolam and hemorrhaged to a mean (SD) 1298 (220) mL (33%) and randomized to permissive hypoventilation (n = 9) or positive pressure ventilation with FiO2 21% (n = 10). In permissive hypoventilation versus positive pressure ventilation, indexed oxygen delivery (DO2 I) decreased to mean (SD) 4.73 (1.06) versus 3.70 (1.13) mL min-1 kg-1 after hemorrhage and increased to 8.62 (2.09) versus 6.70 (1.56) mL min-1 kg-1 at completion of resuscitation. DO2 I, indexed oxygen consumption (VO2 I), and arterial saturation (SaO2 ) did not differ. Permissive hypoventilation increased the respiratory rate and increased pCO2 . Positive pressure ventilation did not deteriorate circulation. Cardiac index (CI), systolic arterial pressure (SAP), hemoglobin (Hb), and heart rate did not differ. Permissive hypoventilation and positive pressure ventilation were equally effective to maintain oxygen delivery in all phases. A respiratory rate of 40 was feasible, showing no signs of respiratory fatigue for 90 min, indicating that whole blood resuscitation may be prioritized in select patients with severe hemorrhage and spontaneous breathing.

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.

Assessing cardiorespiratory fitness relative to sex improves surgical risk stratification.

To what extent sex-related differences in cardiorespiratory fitness (CRF) impact postoperative patient mortality and corresponding implications for surgical risk stratification remains to be established. To examine this, we recruited 640 patients (366 males vs. 274 females) who underwent cardiopulmonary exercise testing prior to elective colorectal surgery. Patients were defined high risk if peak oxygen uptake was <14.3mL kg-1 min-1 and ventilatory equivalent for carbon dioxide at 'anaerobic threshold' >34. Between-sex CRF and mortality was assessed, and sex-specific CRF thresholds predictive of mortality was calculated. Seventeen percent of deaths were attributed to sub-threshold CRF, which was higher than established risk factors for cardiovascular disease (CVD). The group (independent of sex) exhibited a 5-fold higher mortality (high vs. low risk patients hazard ratio=4.80, 95% confidence interval 2.73-8.45, p < 0.001). Females exhibited 39% lower CRF (p < 0.001) with more classified high risk than males (36 vs. 23%, p=0.001), yet mortality was not different (p=0.544). Upon reformulation of sex-specific CRF thresholds, lower cut-offs for mortality were observed in females, and consequently, fewer (20%) were stratified with sub-threshold CRF compared to the original 36% (p < 0.001). Low CRF accounted for more deaths than traditional CVD risk factors, and when CRF was considered relative to sex, the disproportionate number of females stratified unfit was corrected. These findings support clinical consideration of 'sex-specific' CRF thresholds to better inform postoperative mortality and improve surgical risk stratification.

Salivary clearance of caffeine in children.

Measurement of salivary caffeine (1,3,7-trimethylpurine-2,6-dione or 1,3,7-trimethylxanthine) clearance can, in principle, be used to assess hepatic function, diagnose chronic hepatic disease and conduct investigations of substrates of hepatic cytochrome P450 (CYP) isozymes in children, without recourse to venepuncture. However, little is known about childhood sexual dimorphism of hepatic CYP isoforms. Furthermore, the association, if any, between salivary caffeine clearance and age in children has not hitherto been established. The aims of this study were to assess whether salivary caffeine clearance differs between boys and girls and whether it varies with age during childhood. Following at least 24h' abstinence from dietary caffeine, nine boys (mean (standard error) age 9.6 (1.1) y) and eight girls (mean age 11.0 (1.2) y), none of whom was a smoker or suffered from chronic hepatic disease, ingested an oral caffeine dose titrated by body mass, namely 3mgkg-1. Salivary samples collected two and 14h later underwent spectrophotometric caffeine analysis. The boys and the girls were age matched. The mean caffeine clearance in the boys was 2.47 (0.33) mL min-1 kg-1, while that in the girls was 2.20 (0.31) mL min-1 kg-1 (p=0.56). The salivary caffeine clearance was negatively correlated with age (r=-0.59, p=0.01). Stratification by sex appears to be unnecessary when considering childhood salivary caffeine clearance or when conducting investigations in children of CYP1A2 and xanthine oxidase substrates. Furthermore, childhood salivary caffeine clearance is negatively correlated with age.

Responses to exercise in systemicsclerosis-associated interstitial lung disease.

Pulmonary complications in systemic sclerosis (SSc) significantly increase morbidity and mortality. Our aim was to determine the factors limiting exercise capacity in SSc patients with and without interstitial lung disease (ILD), and to identify and quantify abnormalities during exercise that might assist in clinical assessment of this complication. Fifteen patients with SSc and ILD(SSc-ILD) were compared with 10 patients with SSc without ILD and 9age- and sex-matched normal volunteers. Subjects performed symptom-limited incremental treadmill exercise with online measurement of respiratory gas exchange, arterial blood gas sampling and measurement of neurohormones in venous blood. Patients with SSc-ILD had lower exercise capacity than SSc patients without ILD or normal subjects (peak oxygen consumption (PV̇O2 ) (17.1 [4.2] vs. 22.0 [4.7] and 23.0 [5.4] ml kg-1 min-1 , respectively, mean [SD], p < 0.01 ANOVA), but PV̇O2 did not correlate with static pulmonary function measurements. Ventilatory equivalent for CO2 (V̇E/V̇CO2 ; nadir) was higher in SSc-ILD patients than the other two groups (36.6 [8.0] vs. 29.9 [4.4] and 30.0 [2.5], p < 0.005) as were peak exercise dead-space tidal volume ratio (0.44 [0.06] vs. 0.26 [0.09] and 0.26 [0.05], p < 0.001) and peak exercise alveolar-arterial difference (28.9 [16.9] vs. 18.8 [14.0] and 11.5 [6.9] mmHg, p < 0.05). Atrial natriuretic peptide was elevated in both SSc patient groups. SSc-ILD results in lower exercise capacity than SSc without ILD, and abnormalities of gas exchange are seen. The possible use of cardiopulmonary exercise testing to identify disease and quantify impairment in SSc-ILD merits further study.

Impact of a Self-Autonomous Evaluation Station and Personalized Training Algorithm on Quality of Life and Physical Capacities in Sedentary Adults: Randomized Controlled Trial.

Physical inactivity is a major risk factor for noncommunicable diseases and a leading cause of premature death. The World Health Organization (WHO) recommends at least 150 minutes of moderate intensity physical activity (PA) weekly, regardless of age, gender, or personal habits. However, in both sports performance and clinical settings, personalized training (PT) regimens have shown superior efficacy over general guidelines. We hypothesized that an automatic PT program, informed by initial physical evaluations, would increase overall quality of life, quality of sleep, and physical capabilities and reduce fatigue and depression compared with adherence to WHO recommendations. This 5-month, randomized, single-blinded controlled trial involved 112 sedentary or minimally active participants, divided randomly into PT and free training (FT) groups. Physical capabilities and subjective measures such as quality of life, sleep, depression, and fatigue were evaluated for both groups. After 1 month, both groups were asked to perform 150 minutes of PA per week for 4 months; the PT group could either follow a "virtual coach" on a mobile app to follow some personalized PA or do what they would like, while the FT group was to follow the general PA recommendations of the WHO. We did not find any group×time interaction for PA duration or intensity, physical qualities, and subjective measures. However, considering both groups together, there was a significant pretest and posttest time effect for duration of PA (18.2 vs 24.5 min/d of PA; P<.001), intensity (2.36 vs 3.11; P<.001), and workload (46.8 vs 80.5; P<.001). Almost all physical qualities were increased pretest and posttest (ie, estimated VO2max 26.8 vs 29 mL min-1 kg-1; P<.001; flexibility 25.9 vs 26.9 cm; P=.049; lower limb isometric forces 328 vs 347 Nm; P=.002; reaction time 0.680 vs 0.633 s; P<.001; power output on cyclo-ergometer 7.63 vs 7.82 W; P<.003; and balance for the left and right leg 215 vs 163 mm2; P<.003 and 186 vs 162 mm2; P=.048, respectively). Finally, still considering the PT and FT groups together, there were significant pretest to posttest improvements in the mental component of quality of life using the 12-item Short Form Health Survey (41.9 vs 46.0; P<.006), well-being using the Warwick-Edinburgh Mental Well-Being Scale (48.3 vs 51.7; P<.002), depression using the Center for Epidemiologic Studies Depression Scale (15.5 vs 11.5; P=.02), and fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue (37.1 vs 39.5; P=.048). The individualized training was not more effective than the general recommendations. A slight increase in PA (from 18 to 24 min/d) in sedentary or poorly active people is enough for a significant increase in physical capabilities and a significant improvement in quality of life, well-being, depression, and fatigue. ClinicalTrials.gov NCT04998266; https://clinicaltrials.gov/study/NCT04998266.

Sodium bicarbonate reverts electrophysiologic cardiotoxicity of ropivacaine faster than lipid emulsions in a porcine model.

Ropivacaine has been described as a safer local anaesthetic (LA); however, serious cardiotoxic accidents have been reported. Intravenous-lipid-emulsion (ILE) therapy during LA intoxication seems to act as an antidote. Sodium bicarbonate is the standard treatment for sodium channel blocker drug toxicity. We compared both antidotes on the reversion of electrophysiologic toxicity induced by ropivacaine. Ropivacaine 5mg kg-1 was administered in 24 pigs, and 3min later, the animals received ILE: 1.5ml kg-1 + 0.25 ml kg-1 min-1 (ILE group); sodium bicarbonate: 2mEq kg-1 + 1mEq kg-1 h-1 (NaHCO3 group); saline solution (CTL group). Electrophysiological parameters were evaluated for 30 min. The area under the curve (AUC) for the first 5 or 30 min was compared between groups. Ropivacaine induced a lengthening of the PR interval by 17% (P= 0.0001), His-ventricle-interval by 58% (P= 0.001), sinus QRS complex by 56% (P= 0.0001), paced QRS at 150 bpm by 257% (P= 0.0001), and at 120 bpm by 143% (P= 0.0001) in all groups. At 5min after treatment, sinus QRS in the NaHCO3 group was shorter than that in the CTL group (AUCQRS5 , P= 0.003) or ILE group (AUCQRS5 , P= 0.045). During the first minute, seven of the animals in the NaHCO3 group vs. two in the ILE or 0 in the CTL group recovered more than 30% of the sinus QRS previously lengthened by ropivacaine (P= 0.003). Sodium bicarbonate reversed the electrophysiological toxicity of ropivacaine faster than ILE and control groups.

Pupillometry pain index during day care anesthesia using remifentanil: comparison of perioperative analgesic consumption in a double blind RCT

Background: Communication is impossible in sedated patients. Nowadays there is no single best technology to measure nociception during anesthesia. Objectives: The primary outcome parameter was the postoperative pain intensity queried as pain intensity by numeric rating scale and the amount of pain killer usage. Our hypothesis was that patients with a good titrated remifentanil administration peroperative should have less pain and less need of pain medication. Secondary outcome parameters were the characteristics of the pupillometry introducing a pupillometry pain index chart to individual titrate remifentanil dosage. Tertiary outcome parameters were nausea and vomiting, length of stay at the post anesthesia care unit and health state index. Design and setting: In a single center double blind randomized controlled trial we evaluated if pupillometry controlled use of remifentanil is better than free choice administration of remifentanil by anesthesiologists. Fifty-five patients undergoing elective day care surgery were enrolled. A pupillometry pain index score chart was introduced for remifentanil administration guidance. Methods: After induction, a first pupillary reflex dilation (PRD) measurement was performed using pupillometry. A second identical evaluation was performed six minutes after remifentanil administration and adapted every 10 minutes. Remifentanil dosage was adjusted following the pupillometry pain index score (intervention group) or by the discretion of the anesthesiologist (control group). Results: No statistically significant difference was found in pain intensity and pain killer usage at postoperative day one. The pupillometry pain index chart was usable. Although both groups received 0.21 mcg kg-1 min-1 remifentanil. No Statistically significant difference in opioïd induced side effects, nor health state index was seen. Conclusion: This study showed no additional value for PRD assessment in response to remifentanil administration during daycare procedures with our protocol to titrate remifentanil. A pupillometry pain index score chart could be implemented. Further research to lower the remifentanil administration within this protocol is needed. (Ethics Committee EC17/28/319 of the University Hospital of Antwerp. Registration at clinicaltrials.gov NCT03248908.)

MOLECULAR DOCKING STUDY OF COMPOUND ISOLATED FROM COCCINIA GRANDIS (L.) VOIGT

Compound (9Z, 12Z)-octadeca-9, 12-dienoic acid (CGHY 02) was isolated from Coccinia grandis (L.) Voigt n-butanol extract by column chromatography. A molecular docking study against human pancreatic alpha-amylase enzyme (PDB: 3OLE) yielded a good docking score of -112.37 Kcal mol-1, indicating a high affinity of the compound to the receptor via hydrogen bonds, electrostatic interactions and hydrophobic interactions. The hydrogen bond was observed between the hydroxyl group of the compound and glutamine 8, whereas the carbonyl group and C5-C9 chain of the compound revealed steric interactions with glutamine 8 and aspartate 402, respectively. In vitro alpha-amylase inhibition of (CGHY 02) demonstrated remarkable inhibition (68.47 %) at low concentration (100 µL mL-1) compared to standard acarbose. Moreover, in silico ADME analysis of the compound exhibited 92.282 % gastrointestinal absorption, skin permeability, activity as a substrate for CYP2D6 and CYP3A4 enzymes resulting in better metabolism and 1.936 (logn ml min-1 kg-1) of total clearance of the compound. In silico toxicity predicted carcinogenicity, mutagenicity via PreADMET online server and hepatotoxicity and skin irritations via pkCSM online platforms. Antidiabetic potential of (CGHY 02) is attributed through inhibition of human pancreatic alpha amylase enzyme.

Effects of plyometric training on different 8-week training intensity distributions in well-trained endurance runners.

The aim of this four-armed parallel group randomized-controlled trial was to evaluate if plyometric training could have different effects on running performance and physiological adaptations depending on the training intensity distribution (TID) in an 8-week intervention in endurance athletes. Sixty well-trained male runners (age: 34 ± 6 years, relative ⩒O2peak : 69 ± 3ml kg-1 min-1 ) were recruited and allocated to a pyramidal (PYR), pyramidal + plyometric training (PYR + PLY), polarized (POL), and polarized + plyometric training (POL + PLY) periodization. The periodization patterns were isolated manipulations of TID, while training load was kept constant. Participants were tested pre- and post-intervention for body mass, velocity at 2 and 4 mmol·L-1 of blood lactate concentration (vBLa2, vBLa4), absolute and relative ⩒O2peak and 5-km running time trial performance, counter movement jump and squat jump. There were significant group × time interactions for vBla4 (p=0.0235), CMJ (p=0.0234), SJ (p=0.0168), and 5-km running time trial performance (p=0.0035). Specifically, vBla4 and 5-km running time trial performance showed the largest post-intervention improvements in PYR + PLY (2.4% and 1.6%) and POL + PLY (2.1% and 1.8%), respectively. No significant interactions were observed for body mass, absolute and relative ⩒O2peak , peak heart rate, lactate peak and rating of perceived exertion. In conclusion, an 8-week training periodization seems to be effective in improving performance of well-trained endurance runners. Including plyometric training once a week appeared to be more efficacious in maximizing running performance improvements, independently from the TID adopted.

Analgesic efficacy of ultrasound-guided transversus abdominis plane block in dogs undergoing ovariectomy.

In medicine, the transversus abdominis plane (TAP) block has been shown as an effective method of analgesia in several surgical procedures. In this context, this prospective, randomized, blinded study aimed to evaluate the analgesic efficacy of TAP block, guided by ultrasound in female dogs submitted to ovariectomy. Therefore, 32 animals randomly assigned in two groups (n = 16) were used. Groups consisted of TAP block control (TBC) which received water injection (0.2 ml kg-1 point), and TAP block bupivacaine (TBB) which received bupivacaine (0.2 ml kg-1 point at 0.25%); both groups were submitted to four-point approach. Animals were pre-medicated with acepromazine (0.03 mg kg-1) and meperidine (2 mg kg-1) IM, propofol was used as anesthetic induction (3-5 mg kg-1) IV, and isoflurane was used to maintain. To standardize groups, the animals received a continuous infusion of remifentanil (0.2μg kg-1 min) and rocuronium (0.6 mg kg-1) IV in the intraoperative period. Variables measured were the heart and respiratory rates, blood pressure, temperature, peripheral oxyhemoglobin saturation, exhaled carbon dioxide concentration, exhaled isoflurane concentration, serum cortisol, analgesia, and sedation. Before the pre-anesthetic medication (Baseline) and 1, 2, 4, 6, and 8 h after extubation, pain and sedation were assessed using a numeric rating scale (NRS), Glasgow composite measure pain scale (GCMPS-SF), and sedation scale. Moreover, serum cortisol was measured at different moments. The results show that in the intraoperative period, there was no significant difference between groups. After surgery, in TBC, 13 out of 16 animals required analgesic rescue, whereas, in TBB, this occurred only in one animal. Regarding the measurement of serum cortisol, the TBC group showed a significant difference when compared to the baseline time in the traction of the first ovary (p < 0.0001), 2 h (p = 0.0441), and 8 h (p = 0.0384) after extubation. In TBB, cortisol showed a significant increase only in the traction of the first ovary and 2 h after extubation (p < 0.0001). The technique using ultrasound-guided TAP block in two points approach by hemiabdomen with 0.2 ml kg-1 bupivacaine 0.25% was effective in providing post-operative analgesia in dogs undergoing ovariectomy.

Cardiopulmonary Exercise Testing as a Predictor of Postoperative Outcome in Patients Undergoing Oesophageal Cancer Surgery Following Neoadjuvant Chemotherapy.

Neoadjuvant chemotherapy improves resectability rates of oesophageal cancer, but the process may also take a toll on the patients' exercise capacity and may adversely affect the postoperative outcomes. It can be assessed objectively using cardiopulmonary exercise testing. Patients with oesophagus cancer performed a baseline test and a second test after neoadjuvant chemotherapy during the week preceding oesophagectomy. They were followed up for postoperative complications, length of hospital stay, and 30-day mortality. Thirty-three patients completed the study. The mean pre-chemotherapy peak oxygen uptake (VO2 peak) was 1128.39 ± 202.79 mL min-1 (19.46 ± 3.06 mL kg-1 min-1 ) which declined to 1010.33 ± 195.56 mL min-1 (17.24 ± 2.55 mL kg-1 min-1 ) in the postchemotherapy period (P < .001). Pre-chemotherapy anaerobic threshold was 906.85 ± 176.81 mL min-1 (15.54 ± 2.24 mL kg-1 min-1 ) which declined to 764.76 ± 158.79 mL min-1 (13.01 ± 2.22 mL kg-1 min-1 ) (P < .001) in the post-chemotherapy period. Six patients developed complications of modified Clavien-Dindo grade 3 and above. Two (6.1%) patients succumbed to complications within 30 days. The mean anaerobic threshold in patients who suffered complications modified Clavien-Dindo grade ≥3 was 693.33 ± 140.99 mL min-1 (11.2 ± 1.17 mL kg-1 min-1 ) while patients with mild to moderate complications had a mean anaerobic threshold 13.41 ± 2.21 mL kg-1 min-1 (P < .006). An optimal cut off value for anaerobic threshold was 12.5 mL kg-1 min-1 Conclusion: Cardiopulmonary exercise testing accurately predicts outcomes in cancer oesophagus patients who undergo neoadjuvant chemotherapy followed by surgery.

Methodological considerations for the determination of VO2max in healthy men.

A square-wave verification bout to confirm maximal oxygen uptake ([Formula: see text]O2max) from a graded exercise test (GXT) has been recommended. This study ascertained if a verification bout is necessary to determine [Formula: see text]O2max in moderately trained men. Ten men (24 ± 4years) completed familiarization and two treadmill GXTs, followed by a submaximal verification bout to determine [Formula: see text]O2GXT and [Formula: see text]O2verification (highest [Formula: see text]O2 from each testing method). After completing the GXT, subjects rested for 5min then performed a verification bout at 90% speed and 50% incline at termination of the GXT. The analyses included a 2-way repeated-measures ANOVA, intra-class correlation coefficients (ICC2,1), standard errors of the measurement (SEM), minimal differences (MD), and coefficients of variation (CoV). There was no test (test 1 vs test 2) × method (GXT vs verification) interaction (p = 0.584), or main effect for test (p = 0.320), but there was a main effect for method (p = 0.011). The [Formula: see text]O2GXT (50.9±3.0mL·kg-1·min-1) was greater than [Formula: see text]O2verification (46.9 ± mL·kg-1·min-1). The [Formula: see text]O2GXT (ICC = 0.988, SEM = 1.0mL·kg-1 min-1, MD = 2.9mL kg-1 min-1, CoV = 2.03%) and [Formula: see text]O2verification (ICC = 0.976, SEM = 1.0mL·kg-1 min-1, MD = 2.7mL·kg-1·min-1, CoV = 2.03%) demonstrated "excellent" reliability. No subject exceeded the MD for [Formula: see text]O2GXT test-retest or for [Formula: see text]O2verification test-retest, but 50% of subjects had a [Formula: see text]O2GXT that was greater than the [Formula: see text]O2verification (> MD). While [Formula: see text]O2GXT and [Formula: see text]O2verification demonstrated excellent reliability, [Formula: see text]O2GXT from a stand-alone GXT provided higher estimates of [Formula: see text]O2 and, therefore, should be considered [Formula: see text]O2max. The lack of test-retest differences in [Formula: see text]O2GXT above the MD indicated that subjects achieved their highest [Formula: see text]O2 ([Formula: see text]O2max) from a standalone GXT. Therefore, the verification bout may not be required to confirm [Formula: see text]O2max in this population.

Low-dose adjuvant dexmedetomidine did not decrease propofol sedation requirements in children undergoing gastrointestinal endoscopy.

Propofol is the cornerstone of deep sedation during pediatric esophagogastroduodenoscopy (EGD), though adjuvant dexmedetomidine may provide propofol-sparing benefits. The objective of the study was to evaluate whether adjuvant dexmedetomidine decreases the total propofol dose in pediatric patients undergoing EGD. This single-center, retrospective, cohort study evaluated the total propofol dose in pediatric patients undergoing EGD with and without the use of adjuvant dexmedetomidine. Secondary outcomes included the change in hemodynamics across the perioperative continuum and post-procedure recovery time. A multivariable general linear regression was performed to identify associated variables for recovery time post-procedure. A total of 159 patients were included in the study; 88 patients received dexmedetomidine and propofol (DEX-PRO), and 71 patients received propofol only (PRO). The median [interquartile range (IQR)] propofol dose in the DEX-PRO group was 0.26 [IQR, 0.17-0.36] mg kg-1 min-1 which was not significantly different than the PRO group at 0.27 [IQR, 0.21-0.34] mg kg-1 min-1 , p=0.730. Evaluation of secondary end points showed the DEX-PRO group had more cases of post-anesthesia care unit (PACU) hypotension (61% vs. 34%, p=0.001) and a longer recovery time (32.9 ± 14.1 vs. 25.6 ± 10.8 min, p < 0.001) versus the PRO group, respectively. Multivariable linear regression demonstrated that age and the use of dexmedetomidine were associated with prolonged recovery. Adjuvant dexmedetomidine did not reduce propofol requirements compared with propofol alone in pediatric patients undergoing EGD. More hypotension and a longer postoperative recovery time were also seen in patients receiving adjuvant dexmedetomidine for their endoscopic procedure.

Differential contribution of alpha and beta cell dysfunction to impaired fasting glucose and impaired glucose tolerance.

People with isolated impaired fasting glucose (IFG) have normal beta cell function. We hypothesised that an increased glucose threshold for beta cell secretion explains IFG. We used graded glucose infusion to examine the relationship of insulin secretion rate (ISR) and glucagon secretion rate (GSR) with rising glucose. We studied 39 non-diabetic individuals (53 ± 2 years, BMI 30 ± 1 kg/m2), categorised by fasting glucose and glucose tolerance status. After an overnight fast, a variable insulin infusion was used to maintain glucose at ~4.44 mmol/l (07:00 to 08:30 hours). At 09:00 hours, graded glucose infusion commenced at 1 mg kg-1 min-1 and doubled every 60 min until 13:00 hours. GSR and ISR were calculated by nonparametric deconvolution from concentrations of glucagon and C-peptide, respectively. The relationship of ISR with glucose was linear and the threshold for insulin secretion in isolated IFG did not differ from that in people with normal fasting glucose and normal glucose tolerance. GSR exhibited a single-exponential relationship with glucose that could be characterised by G50, the change in glucose necessary to suppress GSR by 50%. G50 was increased in IFG compared with normal fasting glucose regardless of the presence of impaired or normal glucose tolerance. These data show that, in non-diabetic humans, alpha cell dysfunction contributes to the pathogenesis of IFG independently of defects in insulin secretion. We also describe a new index that quantifies the suppression of glucagon secretion by glucose.

High-intensity Training And A Low-caloric-diet Improves Maximal Oxygen Consumption And Body Composition In Overweight Adults

Obesity and low cardiorespiratory fitness are global challenges causing a massive burden on the health care system worldwide. Thus, efficient exercise and nutritional interventions are warranted. PURPOSE: We investigate the effect of high-intensity training executed as full body circuit training and a calorie-restricted diet plan on cardiorespiratory fitness and body composition in overweight sedentary adults. METHODS: Sedentary overweight men (n = 34) and women (n = 46) were recruited. The selection criteria were a sedentary lifestyle for the last five years, an age range of 25-55 yrs and a body mass index >25. The study was a randomized controlled trial, where participants were randomized gender-specifically into a high-intensity training group (HIT; age 38 ± 9 (25-54) yrs; height 174 ± 10 cm; weight 96.1 ± 19.3 kg; n = 40) and control group (CON; age 39 ± 7 (27-52) yrs, height 168 ± 8 cm, weight 89.9 ± 17.2 kg; n = 40). HIT completed full-body high-intensity circuit training with 2-4 weekly sessions combined with a calorie-restricted dietary plan for 8 wks. CON had no training or lifestyle changes in the same interval. VO2max-tests and body composition assessments were performed at baseline and post-intervention. RESULTS: VO2max was 2.3 ± 0.6 and 2.1 ± 0.5 L⸱min-1 at baseline in HIT and CON respectively and did not change during the intervention period. However, VO2max adjusted for body weight improved (P < 0.05) by ~7% in HIT (24.5 ± 5.1 vs 25.7 ± 5.5 ml⸱min-1⸱kg-1) during the intervention period with greater (P < 0.05) change score than CON where a reduction (P < 0.05) of ~5% (24.1 ± 5.1 vs 22.6 ± 4.6 ml⸱min-1⸱kg-1) was observed. Body weight decreased (P < 0.05) by 5.9 ± 3.2 kg post-intervention in HIT with higher (P < 0.05) change score than CON (+0.3 ± 1.6 kg). Also, BMI declined (P < 0.05) from 31.8 ± 5.5 to 29.9 ± 4.4 kg/m2 in HIT only. Body fat content was also lowered (P < 0.05) from 32.0 ± 9.5% at baseline to 30.9 ± 9.3% post-intervention in HIT with a greater change score compared to CON. No change was observed in skeletal muscle mass in neither HIT nor CON. CONCLUSION: High-intensity training performed as full body circuit training combined with a caloric-restricted diet over an eight-week period moderately improved body weight adjusted VO2max, but induced a marked weight loss and reduction in body fat content in overweight sedentary adults.

A Comparison Of Running Economy Across Seven Carbon-Plated Racing Shoes

Advancements in running shoe technology, particularly in the Nike Vaporfly, have been shown to improve running economy. Other brands have now also developed new, advanced shoes with a carbon-fiber plate and thicker, new midsole foams. However, none of these new shoes have been compared to the Vaporfly. PURPOSE: Compare the effects of 7 different carbon-plated shoes and 1 traditional racing shoe on running economy. METHODS: Seven carbon-plated shoes: Hoka Rocket X (Hoka RX), Saucony Endorphin Pro (Saucony EP), Nike Alphafly (Nike AF), Asics Metaspeed Sky (Asics MS), Nike Vaporfly 2 (Nike VF2), New Balance RC Elite (New Bal RC), Brooks Hyperion Elite 2 (Brooks HE2), and 1 traditional shoe: Asics Hyperspeed (Asics HS) were tested in 12 male runners (5 k best: 16.0 ± 0.7 min) on two visits. Shoes were tested in a random sequence over 8 x 5-minute trials (16 km‧hr-1; 5-minute rest between trials) on visit 1, and in the reverse/mirrored order for visit 2. Metabolic and running mechanics data were collected and averaged across visits. A repeated-measures ANOVA was used to compare dependent variables across shoe conditions along with follow-up pairwise comparisons. RESULTS: VO2 (ml‧kg-1‧min-1; % change from Asics HS) was significantly different across shoes. Hoka RX (51.67 ± 2.07; -0.08 ± 1.04%) and Brooks HE2 (51.42 ± 1.72; -0.53 ± 0.90%) did not differ from Asics HS (51.71 ± 2.02). While Saucony EP (50.93 ± 1.82; -1.48 ± 0.72%) and New Bal RC (50.99 ± 1.83; -1.37 ± 0.78%) were statistically better than Asics HS, they were inferior to Nike AF (50.13 ± 1.86; -3.03 ± 1.48%), Nike VF2 (50.29 ± 1.72; -2.72 ± 1.02%), and Asics MS (50.39 ± 1.71; -2.52 ± 1.08%). In terms of running mechanics, statistically significant differences were limited. However, cadence (steps‧min-1) was significantly lower in the Nike AF (174.6 ± 10.4) than the Asics HS (176.5 ± 10.3). CONCLUSION: Only the Nike AF and Asics MS matched the previously established Nike VF2 in running economy improvements. From these data, it appears the advantages conferred by new running shoe advancements are not fully shared across the competitive running shoe market.