Weeks Of Bed Rest Research Articles

Maternal rest improves growth in small-for-gestational-age fetuses (

Optimal management of fetuses diagnosed as small for gestational age based on an estimated fetal weight of <10th percentile represents a major clinical problem. The standard approach is to increase fetal surveillance with serial biometry and antepartum testing to assess fetal well-being and timing of delivery. Observational studies have indicated that maternal rest in the left lateral position improves maternal cardiac output and uterine blood flow. However, maternal bed rest has not been recommended based on the results of a randomized clinical trial that showed that maternal rest does not improve fetal growth in small-for-gestational-age fetuses. This study was conducted to revisit this question. This study aimed to determine whether maternal bed rest was associated with an increase in the fetal biometric parameters that reflect growth after the diagnosis of a small-for-gestational-age fetus. A retrospective study was conducted on fetuses who were diagnosed as small for gestational age because of an estimated fetal weight of <10th percentile for gestational age. The mothers were asked to rest in the left lateral recumbent position. Fetal biometry was performed 2 weeks after the diagnosis. All fetuses before entry into the study had a previous ultrasound that demonstrated an estimated fetal weight of >10th percentile. To assess the response to bed rest, the change in fetal biometric parameters (estimated fetal weight, head circumference, abdominal circumference, and femur length) after the recommendation of bed rest was computed for 2 periods: (1) before the diagnosis of a weight of <10th percentile vs at the time of diagnosis of a weight of <10th percentile and (2) at the time of diagnosis of a weight of <10th percentile vs 2 weeks after maternal bed rest. For repeated measures, proportions were compared using the McNemar test, and percentile values were compared using the Bonferroni Multiple Comparison Test. A P value of<.05 was considered significant. To describe changes in the estimated fetal weight without bed rest, 2 control groups in which the mothers were not placed on bed rest after the diagnosis of a small-for-gestational-age fetus were included. A total of 265 fetuses were observed before and after maternal bed rest. The following were observed in this study: (1) after 2 weeks of maternal rest, 199 of 265 fetuses (75%) had a fetal weight of >10th percentile; (2) the median fetal weight percentile increased from 6.8 (interquartile range, 4.4-8.4) to 18.0 (interquartile range, 9.5-29.5) after 2 weeks of bed rest; (3) similar trends were noted for the head circumference, abdominal circumference, and femur length. In the groups of patients who were not asked to be on bed rest, a reassignment to a weight of >10th percentile at a follow-up examination only occurred in 7 of 37 patients (19%) in the Texas-Michigan group and 13 of 111 patients (12%) in the Colorado group compared with the bed rest group (199/265 [75%]) (P<.001). Patients who were prescribed 2 weeks of bed rest after the diagnosis of a fetal weight of <10th percentile had an increase in weight of >10th percentile in 199 of 265 fetuses (75%). This increase in fetal weight was significantly higher than that in the 2 control groups in which bed rest was not prescribed. This observation suggests that bed rest improves fetal growth in a subset of patients.

Daily blood flow restriction does not preserve muscle mass and strength during 2weeks of bed rest.

We measured the impact of blood flow restriction on muscle protein synthesis rates, muscle mass and strength during 2weeks of strict bed rest. Twelve healthy, male adults (age: 24±3years, body mass index: 23.7±3.1kg/m2 ) were subjected to 14days of strict bed rest with unilateral blood flow restriction performed three times daily in three 5min cycles (200mmHg). Participants consumed deuterium oxide and we collected blood and saliva samples throughout 2weeks of bed rest. Before and immediately after bed rest, lean body mass (dual-energy X-ray absorptiometry scan) and thigh muscle volume (magnetic resonance imaging scan) were assessed in both the blood flow restricted (BFR) and control (CON) leg. Muscle biopsies were collected and unilateral muscle strength (one-repetition maximum; 1RM) was assessed for both legs before and after the bed rest period. Bed rest resulted in 1.8±1.0kg lean body mass loss (P<0.001). Thigh muscle volume declined from 7.1±1.1 to 6.7±1.0L in CON and from 7.0±1.1 to 6.7±1.0L in BFR (P<0.001), with no differences between treatments (P=0.497). In addition, 1RM leg extension strength decreased from 60.2±10.6 to 54.8±10.9kg in CON and from 59.2±12.1 to 52.9±12.0kg in BFR (P=0.014), with no differences between treatments (P=0.594). Muscle protein synthesis rates during bed rest did not differ between the BFR and CON leg (1.11±0.12 vs. 1.08±0.13%/day, respectively; P=0.302). Two weeks of bed rest substantially reduces skeletal muscle mass and strength. Blood flow restriction during bed rest does not modulate daily muscle protein synthesis rates and does not preserve muscle mass or strength. KEY POINTS: Bed rest, often necessary for recovery from illness or injury, leads to the loss of muscle mass and strength. It has been postulated that blood flow restriction may attenuate the loss of muscle mass and strength during bed rest. We investigated the effect of blood flow restriction on muscle protein synthesis rates, muscle mass and strength during 2weeks of strict bed rest. Blood flow restriction applied during bed rest does not modulate daily muscle protein synthesis rates and does not preserve muscle mass or strength. Blood flow restriction is not effective in preventing muscle atrophy during a prolonged period of bed rest.

A Rare Presentation of Acute Coronary Syndrome, in a Patient of Amputation of Right Forearm: A Case Study.

A patient presented with sudden onset right-sided chest pain in the emergency department. He had a past history of amputation of his right forearm due to trauma 25 years back. Phantom limb pain was suspected, but on investigations, he was diagnosed with acute coronary syndrome with unstable angina. The patient was treated in ICCU ECG and ECHO were done.ECG report showed T wave inversion in V3-V6 precordial leads with ST elevation (fixed change). A coronary angiogram was done and minor CAD was detected(LAD minor blockage). ECHO report showed mild tricuspid regurgitation, concentric LVH, EF-64%. Blood pressure was 150/90mm Hg, pulse rate-103/minute and Trop T was negative on admission in iccu. The patient’s lipid profile, thyroid function test, kidney function tests, FBS, and PPBS was done and reports were normal.. Patient on discharge was advised oral medications like aspirin. clopidogrel, atorvastatin, angiotensin receptor blocker and nitroglycerine tablets. On discharge salt-restricted diet and two weeks of bed rest were advised. The theory of past experiences, denervation hypersensitivity and cortical plasticity might be the contributors of such atypical angina pain presentation which overruled the dermatomal rule. The study highlighted on atypical presentation of ACS as cardiac pain radiated in the right side in a special scenario of amputation of the right upper limb below the elbow. Differential diagnosis : Costochondral chest pain, Dextrocardia, Pericarditis, pneumonia, esophageal disease. The phantom limb component of referred pain radiates to the right side

Early mobilization reduces the medical care cost and the risk of disuse syndrome in patients with acute osteoporotic vertebral fractures

Study designA retrospective observational study. PurposeTo compare two conservative treatments for acute osteoporotic vertebral fractures (OVFs). Overview of literatureSeveral studies have reported conservative treatments for OVFs in terms of using a brace, rehabilitation, and bed rest. However, there is no consensus about the conservative treatment for OVFs. MethodsWe evaluated 68 patients with acute OVF treated in our hospital from 2007 to 2011. Thirty-four patients treated in prolonged bed rest (PBR) regimen underwent rehabilitation wearing a Jewett’s brace after three weeks of bed rest. In contrast, the other 34 patients underwent rehabilitation wearing a Jewett’s brace as soon as possible, which we called a stir-up (SU) regimen. We compared two treatment groups for medical costs, hospital length of stay (LOS), pain according to the numeric rating scale (NRS), the activities of daily living (ADL), and imaging studies. ResultsThe average hospital LOS was significantly shorter in patients treated by the SU regimen, which resulted in the medical costs reduction. There was no significant difference in the NRS through 6 months between the two groups. Although many patients in both groups experienced at least one level reduction in ADL at 6 months after the injury, patients in the SU group tended to maintain their pre-injury ADL, which almost agrees with past reports. In terms of imaging studies, patients in the PBR group showed milder vertebral compression rate over time. Pseudoarthrosis occurred in 2 patients in the SU group, who presented with mild pain, which had little influence on their daily lives. ConclusionWe compared two conservative treatments for OVFs. Early rehabilitation was useful treatment for OVFs to minimize the risk for disuse syndrome, maintain pre-injury ADL status, and reduce the medical costs.

Effects of 8 weeks of bed rest with or without resistance exercise intervention on the volume of the muscle tissue and the adipose tissues of the thigh.

The present study aims to investigate the effects of 8 weeks of bed rest, with or without resistance exercise intervention, on the volumes of muscle tissue and the intramuscular, intermuscular, and subcutaneous adipose tissues of the thigh. Twenty men were included, who were randomly assigned in three groups: resistance exercises group (RE group), resistance exercises with whole‐body vibration group (VRE group), and nonexercise control group (CTR group). The RE and VRE groups performed resistance exercises during 8 weeks of bed rest (3 days per week). Additionally, consecutive axial magnetic resonance images were obtained before and after the bed rest. Using these images, the volumes of the muscle tissue and the intramuscular adipose tissue, intermuscular adipose tissue, and subcutaneous adipose tissue of the thigh were evaluated. No significant time‐by‐group interaction was observed the volumes of the muscle tissue and the intramuscular adipose tissue, intermuscular adipose tissue, and subcutaneous adipose tissue between the RE and VRE groups. Furthermore, the RE and VRE groups were pooled as the resistance exercise intervention group (TR group), wherein their thigh muscle tissue volume was observed to be maintained after the bed rest. However, that of the CTR group significantly decreased. Regarding the thigh intramuscular adipose tissue and intermuscular adipose tissue volumes, no significant difference was observed among the CTR and TR groups. Although subcutaneous adipose tissue volume in the CTR group significantly increased after the bed rest, no changes were observed in that of the TR group. Therefore, the results of the present study suggested that within the 8 weeks of bed rest, adipose tissue adaptation differs depending on the location

Easing the Pain of Being Labeled a “Drug Seeker”: Navigating the Metanarrative of Addiction

Recovery from a labral repair hip surgery typically requires several weeks of bedrest, consistent doses pain medication, and weekly physical therapy. Instead of convalescing, the weeks following my...

Mitochondrial Adaptations in Elderly and Young Men Skeletal Muscle Following 2 Weeks of Bed Rest and Rehabilitation.

The aim of the study was to evaluate the expression levels of proteins related to mitochondrial biogenesis regulation and bioenergetics in vastus lateralis muscle biopsies from 16 elderly and 7 young people subjected to 14 days of bed-rest, causing atrophy, and subsequent 14 days of exercise training. Based on quantitative immunoblot analyses, in both groups a reduction of two key regulators of mitochondrial biogenesis/remodeling and activity, namely PGC-1α and Sirt3, was revealed during bed-rest, with a subsequent up-regulation after rehabilitation, indicating an involvement of PGC-1α-Sirt3 axis in response to the treatments. A difference was observed comparing the young and elderly subjects as, for both proteins, the abundance in the elderly was more affected by immobility and less responsive to exercise. The expression levels of TOM20 and Citrate Synthase, assayed as markers of outer mitochondrial membrane and mitochondrial mass, showed a noticeable sensitivity in the elderly group, where they were affected by bed-rest and rehabilitation recalling the pattern of PGC-1α. TOM20 and CS remained unchanged in young subjects. Single OXPHOS complexes showed peculiar patterns, which were in some cases dissimilar from PGC-1α, and suggest different influences on protein biogenesis and degradation. Overall, exercise was capable to counteract the effect of immobility, when present, except for complex V, which was markedly downregulated by bed-rest, but remained unaffected after rehabilitation, maybe as result of greater extent of degradation processes over biogenesis. Phosphorylation extent of AMPK, and its upstream activator LKB1, did not change after bed-rest and rehabilitation in either young or elderly subjects, suggesting that the activation of energy-sensing LKB1-AMPK signaling pathway was “missed” due to its transient nature, or was not triggered under our conditions. Our study demonstrates that, as far as the expression of various proteins related to mitochondrial biogenesis/remodeling, adaptations to bed-rest and rehabilitation in the two populations were different. The impact of bed-rest was greater in the elderly subjects, where the pattern (decrease after bed rest and recovery following rehabilitation) was accompanied by changes of mitochondrial mass. Modifications of protein abundance were matched with data obtained from gene expression analyses of four public human datasets focusing on related genes.

Mesenchymal Stem Cells and Transforming Growth Factor-β₃ (TGF-β₃) to Enhance the Regenerative Ability of an Albumin Scaffold in Full Thickness Wound Healing.

Pressure ulcers are one of the most common forms of skin injury, particularly in the spinal cord injured (SCI). Pressure ulcers are difficult to heal in this population requiring at least six months of bed rest. Surgical treatment (grafting) is the fastest recovery time, but it still requires six weeks of bed rest plus significant additional costs and a high recurrence rate. A significant clinical benefit would be obtained by speeding the healing rate of a non-surgical treatment to close to that of surgical treatment (approximately doubling of healing rate). Current non-surgical treatment is mostly inactive wound coverings. The goal of this project was to look at the feasibility of doubling the healing rate of a full-thickness defect using combinations of three treatments, for the first time, each shown to increase healing rate: application of transforming growth factor-β3 (TGF-β3), an albumin based scaffold, and mesenchymal stem cells (MSCs). At one week following surgery, the combined treatment showed the greatest increase in healing rate, particularly for the epithelialization rate. Although the target level of a 100% increase in healing rate over the control was not quite achieved, it is anticipated that the goal would be met with further optimization of the treatment.

Understanding myocardial infarction.

Over the last 40 years, our understanding of the pathogenesis of myocardial infarction has evolved and allowed new treatment strategies that have greatly improved survival. Over the years, there has been a radical shift in therapy from passive healing of the infarction through weeks of bed rest to early discharge usually within 2 to 3 days as a result of immediate reperfusion strategies and other guideline-directed medical therapies. Nevertheless, challenges remain. Patients who develop cardiogenic shock still face a high 30-day mortality of at least 40%. Perhaps even more important is how do we identify and prevent patients from developing myocardial infarction in the first place? This article discusses these milestones of therapy and considers important issues for progress in the future.

Physical inactivity and platelet function in humans and brown bears: A comparative study

Physical inactivity increases the risk of thromboembolism. However, good standardized human models on inactivity are in short supply and experimental models are few.Our objective was to investigate how standardized bed rest affects platelet aggregation in humans and to investigate if aggregation is altered in a translational model system – the hibernating brown bear (Ursus arctos). We collected blood from (1) healthy male volunteers participating in a 21-day bed rest study in head-down tilt position (−6°) 24 h a day; (2) free-ranging brown bears captured during winter hibernation and again during active state in summer. We analyzed platelet function using multiple electrode platelet aggregometry. In total, 9 healthy male volunteers (age 31.0 ± 6.4 years) and 13 brown bears (7 females and 6 males, age 2.8 ± 0.6 years) were included. In hibernating bears adenosine diphosphate, arachidonic acid, thrombin receptor activating peptide, and collagen impedance aggregometry tests were all halved compared to summer active state. In human volunteers no statistically significant changes were found between baseline and the end of bed rest. In human male volunteers 3 weeks of bed rest did not affect platelet function. In hibernating brown bears platelet aggregation was halved compared to summer and we hypothesize that this is a protective measure to avoid formation of thrombi under periods of low blood flow.

Excretion of Zinc and Copper Increases in Men during 3 Weeks of Bed Rest, with or without Artificial Gravity

Background: Zinc and copper have many physiologic functions and little or no functional storage capability, so persistent losses of either element present health concerns, especially during extended-duration space missions.Objectives: We evaluated the effects of short-term bed rest (BR), a spaceflight analog, on copper and zinc metabolism to better understand the role of these nutrients in human adaptation to (simulated) spaceflight. We also investigated the effect of artificial gravity on copper and zinc homeostasis.Methods: Zinc and copper balances were studied in 15 men [mean ± SD age: 29 ± 3 y; body mass index (in kg/m2): 26.4 ± 2.2] before, during, and after 21 d of head-down tilt BR, during which 8 of the participants were subjected to artificial gravity (AG) by centrifugation for 1 h/d. Control subjects were transferred onto the centrifuge but were not exposed to centrifugation. The study was conducted in a metabolic ward; all urine and feces were collected. Data were analyzed by 2-factor repeated-measures ANOVA.Results: Urinary zinc excretion values for control and AG groups were 33% and 14%, respectively, higher during BR than before BR, and fecal zinc excretion values for control and AG groups were 36% and 19%, respectively, higher during BR, resulting in 67% and 82% lower net zinc balances for controls and AG, respectively (both P < 0.01), despite lower nutrient intake during BR. Fecal copper values for control and AG groups were 40% and 33%, respectively, higher during BR than before BR (P < 0.01 for both). Urinary copper did not change during BR, but a 19% increase was observed after BR compared with before BR in the AG group (P < 0.05).Conclusions: The increased fecal excretion of copper and zinc by men during BR suggests that their absorption of these minerals from the diet was reduced, secondary to the release of minerals from bone and muscle. These findings highlight the importance of determining dietary requirements for astronauts on space missions and ensuring provision and intake of all nutrients.

Zinc and Copper Balances During Three Weeks of Bed Rest, With or Without an Artificial Gravity Countermeasure

Nutrition remains a key concern for extended‐duration space missions. Zinc and copper are trace minerals with many functions in the body, but both possess little to no storage capability. Zinc and copper balances were studied in 15 male subjects before, during, and after a 21‐d head‐down tilt bed rest study in which 8 participants were subjected to artificial gravity (AG) by centrifugation for 1 h/d. The study was conducted in a general clinical research center with carefully controlled dietary intake and collection of all urine and feces for subsequent analyses. Urine samples were analyzed for copper and zinc by inductively coupled plasma mass spectrometry using a NexION 350D ICP‐MS (Perkin Elmer, Shelton, CT) equipped with collision/reaction cell technology for interference removal. While energy intakes were adjusted to maintain subject mass, subjects in both control (CON) and AG‐treated groups had lower lean body mass after bed rest. Despite lower intake of both minerals during bed rest, both CON and AG subject groups had higher fecal and urinary zinc excretion during bed rest, with a resulting lower net balance of zinc. Urinary copper excretion did not change during bed rest but was higher after bed rest in the AG group. Fecal copper was higher during bed rest compared to pre‐bed rest. Copper balance was unaltered for the CON group but significantly decreased during and after bed rest for the AG group. The increased fecal excretion of these minerals during bed rest suggests that their absorption from the diet was reduced, secondary to the release of minerals from both bone and muscle tissue as zinc and copper are predominantly found in musculoskeletal tissues. These findings highlight the importance of determining nutrient requirements for astronauts on space missions and ensuring provision and intake of all nutrients as we explore beyond low Earth orbit.Support or Funding InformationThis study was funded by the NASA Human Research Program's Human Health Countermeasures Element. This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences, National Institutes of Health. HH was supported by an Arkansas Space Grant Consortium Workforce Development Grant.

PlanHab: Hypoxia counteracts the erythropoietin suppression, but seems to exaggerate the plasma volume reduction induced by 3weeks of bed rest.

The study examined the distinct and synergistic effects of hypoxia and bed rest on the erythropoietin (EPO) concentration and relative changes in plasma volume (PV). Eleven healthy male lowlanders underwent three 21‐day confinement periods, in a counterbalanced order: (1) normoxic bed rest (NBR; PIO 2: 133.1 ± 0.3 mmHg); (2) hypoxic bed rest (HBR; PIO 2: 90.0 ± 0.4 mmHg, ambient simulated altitude of ~4000 m); and (3) hypoxic ambulation (HAMB; PIO 2: 90.0 ± 0.4 mmHg). Blood samples were collected before, during (days 2, 5, 14, and 21) and 2 days after each confinement to determine EPO concentration. Qualitative differences in PV changes were also estimated by changes in hematocrit and hemoglobin concentration along with concomitant changes in plasma renin concentration. NBR caused an initial reduction in EPO by ~39% (P = 0.04). By contrast, HBR enhanced EPO (P = 0.001), but the increase was less than that induced by HAMB (P < 0.01). All three confinements caused a significant reduction in PV (P < 0.05), with a substantially greater drop in HBR than in the other conditions (P < 0.001). Thus, present results suggest that hypoxia prevents the EPO suppression, whereas it seems to exaggerate the PV reduction induced by bed rest.

Kombinierte Salter-Pemberton-Beckenosteotomie

In simple pelvic osteotomy in childhood the aim is for better lateral roofing, a safe centering of the femoral head and tuning between the volumes of the acetabulum and the femoral head. By the combination of anterior modified Pemberton osteotomy with dorsal osteotomy according to Salter these objectives can be achieved. Dysplasia of the acetabulum in patients between 2 years old and adolescence, subluxation and dislocation of the femoral head, also in neurological diseases as cerebral palsy and hypercontainment in Legg-Calvé-Perthes disease. Critically small pelvic bones in toddlers younger than 18 months, children with a delay in skeletal formation. In patients aged more than 15 years if the symphysis is too taut for an effectual pivoting of the acetabulum and the acetabulum has no potential for future maturing. Surgery is carried out by making a skin incision by the iliac crest ending in the middle of the groin, the cartilaginous iliac apophysis is split and the periosteum is elevated from the medial and lateral wall of the ilium to the inner pelvic ring. A K-wire is used to mark the level and the center of the osteotomy and dorsal to the K-wire a straight osteotomy is performed with a Gigli saw and anteriorly an arc-shaped and tilted cut is made with a chisel. The distal iliac fragment is rotated widely outwards and forwards and a triangular bone graft is removed from the anterior part of the iliac crest. The graft is inserted into the opened up osteotomy, three K-wires are used to fix the desired position of the iliac fragments and the two halves of the iliac apophysis are sutured together. After the operation uncooperative children receive a scotch cast for 4 weeks. Cooperative children are mobilized after 3 weeks of bed rest. Partial weight-bearing is allowed after 6 weeks and full weight-bearing after 8-10 weeks. A total of 56 combined Salter-Pemberton pelvic osteotomies were performed in 49 patients from 1999 to 2008. The results of these studies demonstrate that this osteotomy is a safe and effective procedure which enables not only sufficient correction in classical dysplasia of the hip joint but also in high grade dislocation of the hip joint caused by cerebral palsy.

Traumatic Posterior Hip Dislocation with an Ipsilateral Comminuted Femoral Intertrochanteric Fracture: A Case Report

Traumatic Posterior Hip Dislocation with an Ipsilateral Comminuted Femoral Intertrochanteric Fracture: A Case Report

Physical Therapy for the Antepartum Hospitalized Patient With Ehlers-Danlos Syndrome

Background: Antepartum bed rest is prescribed to minimize the risk of preterm delivery, but can lead to muscle weakness, deconditioning, musculoskeletal pain, fatigue, and depression, depending on the duration of bed rest. Study Design: The purpose of this case report is to identify the physical therapist's role in treating a pregnant woman with complications of Ehlers-Danlos syndrome (EDS) who was placed on hospitalized bed rest with resultant back and rib pain. Case Description: A 29-year-old woman, pregnant with twins, was placed on hospitalized bed rest for maternal and fetal monitoring. Medical history included depression, cardiac issues, glucose intolerance, scoliosis, and multiple joint surgeries in the past because of EDS. Within the first 2 weeks of bed rest, significant back and generalized joint pain occurred. This case analysis will discuss the management of her symptoms. Outcomes: The patient was able to successfully manage and reduce, although never fully eliminate, her mechanical and disease-related musculoskeletal back and rib pain, with education, exercise program compliance, proper bed positioning and position adjustments as needed, and therapist/family-assisted soft-tissue mobilization. Discussion: Musculoskeletal pain is common during any pregnancy. A physical therapy program is needed to maintain muscle strength, prevent atrophy, reduce fatigue, support functional endurance, reduce pain, and reduce the risk of blood clot formation for pregnant women with EDS on hospitalized antepartum bed rest.

The effect of exercise training on left ventricular relaxation and diastolic suction at rest and during orthostatic stress after bed rest

A marked reduction in upright stroke volume (SV) contributes substantially to orthostatic intolerance after exposure to spaceflight or bed rest. It is unclear whether slowed left ventricular (LV) relaxation and diastolic suction contribute to the reduction in SV or whether these changes are influenced by exercise training while in bed. Twenty-seven healthy adults completed 5 weeks of -6 deg head-down bed rest (HDBR). During HDBR, nine subjects were sedentary (NOEX), while 18 performed near-daily rowing ergometry (EX). Left ventricular mass, SV, LV end-diastolic volume (LVEDV), pulmonary capillary wedge pressure and Doppler ultrasound indices of LV function were collected pre- and post-HDBR during supine rest (twice) and during reduced LV loading (lower body negative pressure; LBNP) and increased LV loading (saline infusion). Post-HDBR, LV mass increased in the EX group, but decreased in the NOEX group. The reduction in SV and LVEDV during supine rest and LBNP were greater with NOEX in comparison to EX after HDBR. Peak early mitral annular velocity, isovolumic relaxation time, early propagation velocity, a non-invasive index of early diastolic filling and ventricular diastolic suction, and peak global longitudinal early strain rate were slowed during supine rest after HDBR with NOEX; however, these variables were either unaltered or the reduction was less prominent with EX. Doppler ultrasound measures of early diastolic filling, ventricular relaxation and diastolic suction were not significantly affected during LV unloading by LBNP after HDBR in either group. All Doppler indices were restored to pre-HDBR levels in both groups during saline infusion to normalize LV filling pressure after HDBR. It is concluded that Doppler indices of dynamic LV filling were reduced in both groups after HDBR; however, these effects were more pronounced in the NOEX group. Irrespective of group, post-HDBR Doppler parameters were restored when LV filling pressure was increased to pre-HDBR levels during saline infusion. Therefore, the reduction in upright SV after HDBR is more influenced by changes in LV loading conditions, namely left atrial pressure in the setting of LV remodelling, rather than ventricular relaxation and diastolic suction.

The effects of bed-rest and countermeasure exercise on the endocrine system in male adults: evidence for immobilization-induced reduction in sex hormone-binding globulin levels.

There is limited data on the effects of inactivity (prolonged bed-rest) on parameters of endocrine and metabolic function; we therefore aimed to examine changes in these systems during and after prolonged (56- day) bed-rest in male adults. Twenty healthy male subjects underwent 8 weeks of strict bed-rest and 12 months of follow-up as part of the Berlin Bed Rest Study. Subjects were randomized to an inactive group or a group that performed resistive vibration exercise (RVE) during bed-rest. All outcome parameters were measured before, during and after bed-rest. These included body composition (by whole body dual X-ray absorptiometry), SHBG, testosterone (T), estradiol (E2), PRL, cortisol (C), TSH and free T3 (FT3). Serum SHBG levels decreased in inactive subjects but remained unchanged in the RVE group (p<0.001). Serum T concentrations increased during the first 3 weeks of bed-rest in both groups (p<0.0001), while E2 levels sharply rose with re-mobilization (p<0.0001). Serum PRL decreased in the control group but increased in the RVE group (p=0.021). C levels did not change over time (p≥0.10). TSH increased whilst FT3 decreased during bed-rest (p all ≤0.0013). Prolonged bed-rest has significant effects on parameters of endocrine and metabolic function, some of which are related to, or counteracted by physical activity.

Traumatic dislocation of bilateral hips and ankles

Abstract Bilateral traumatic hip dislocation is rare, and pure ankle dislocation without bony fracture is also rare. We present a patient who sustained bilateral hip and bilateral ankle dislocations without associated fracture after a fall from a significant height. Management consisted of immediate closed reduction of bilateral hips and bilateral ankles under conscious sedation in the emergency department, followed by immobilization of the ankles with short leg splints. After 2 weeks of bed rest with skin traction, the patient was initially mobilized in a wheelchair. He was allowed partial weight bearing after 4 weeks. Clinical and radiographic follow-up continued for 2 years after the accident. The patient reported complete disappearance of pain in hips and ankles. Good range of motion of the hips and ankles was also noted. There was no radiographic evidence of avascular necrosis, osteoarthritis, or calcification at 2-year follow-up.

Impact of Bed Rest on Conduit Artery Remodeling

Physical inactivity is a potent stimulus for vascular remodeling, leading to a marked decrease in conduit artery diameter. However, little is known about the impact of physical inactivity on artery wall thickness or wall:lumen ratio or the potential of exercise countermeasures to modify artery wall thickness. The purpose of the study was to examine the impact of 60 days of bed rest, with or without exercise countermeasures, on carotid and superficial femoral artery wall thickness. Eighteen men were assigned to bed rest (second Berlin Bed Rest Study) and randomly allocated to control, resistive exercise, or resistive vibration exercise. Both exercise countermeasures were applied 3 times per week while the subjects were in the supine position on the bed. Sonography was used to examine baseline diameter and wall thickness of the carotid and femoral arteries. Bed rest decreased diameter of the superficial femoral artery (P=0.001) but not the carotid artery (P=0.29). Bed rest induced a significant increase in carotid and superficial femoral artery wall thickness (P=0.007 and 0.03) and wall:lumen ratio (P=0.009 and 0.001). Exercise prevented the increase in wall thickness of the carotid artery. In addition, exercise partly prevented the increased wall:lumen ratio in the superficial femoral artery. In conclusion, 8 weeks of bed rest resulted in approximately 20% increase in conduit artery wall thickness. Exercise countermeasures completely (carotid artery) or partly (superficial femoral artery) abolished the increase in wall thickness. These findings suggest that conduit artery wall thickness, a vascular characteristic associated previously with atherosclerosis, can rapidly adapt to physical inactivity and exercise in humans.