Beta-receptor desensitization after a multistage ultralong distance exercise in the desert?

Background

Although cardiac function has been largely investigated during ultra-endurance exercise, few studies addressed to multi-stage endurance race.

Methods

Serial echocardiographic assessment of cardiac function was performed in male healthy subjects during the 2014 Marathon des Sables before the race (T1), at the second (T2) and fifth (T3) arrival (236 km) then after 48h recovery. Analysis were performed by 2 sonographers blind for the results of the other and the time of measure.

Results

Among the 20 athletes, 18 completed the study (mean age 42.4, median 42). RR intervals and (Left ventricular End Diastolic Volume (Simpson) (LVEDV) changed during the race and were correlated (r2 = 0.539, p<0.001); afterload approched by Left Ventricular Meridional Wall Stress (LVMWS) did not change. LV Global Longitudinal Peak Strain (PS) and subepicardial (Epi) PS did not vary. Subendocardial (Endo) LV.PS was lower at T2 /T1, concomitant to a (non-significant) drop in LVEDV; LV strain rate (SR) was lower at T4. RR and LVEDV were higher at T3 than at T2, and higher at T4 compared to T1 and T2. As preload conditions changed during the race, we studied the response of PS and SR to the change in preload (Starling mechanism). EndoPS/LVEDV, LVPS/LVEDV and SR/LVEDV did not change during the race but were lower after recovery.

Conclusions

48h after a multistage ultralong duration exercise, we observed a drop in heart rate and contractility response to preload. The evolution of these parameters could be explained by a beta-receptors desensitization. These data need to be confirmed by other studies.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne ARS Bourgogne Franche Comté Evolution of parameters

[Female voiding dysfunction: Clean intermittent catheterization is not the only option]

Female voiding dysfunction exists but are largely underdiagnosed, especially in France. They can result from two different mechanisms: detrusor underactivity or bladder outlet obstruction, with very different pathophysiology and therapeutic management. There are many different therapeutic options, including surgical treatments, to offer as alternative to clean intermittent catheterization which are often burdensome for patients. Seeking voiding dysfunction in female patients with lower urinary tract symptoms and searching for their etiology to tackle it could lead to a paradigm change in these women: from standardized treatment to individualized treatment. In their practice, nurses can detect warning symptoms suspect of voiding dysfunction, and have thus a role to play in the improvement of patients' screening, education other healthcare providers, and management of female voiding dysfunction.

[Self-assessment of healthcare workers regarding the management of trans people in a university hospital]

INTRODUCTION

Trans people face more barriers when seeking healthcare than the cisgender population probably due to a lack of knowledge, education and comfort of healthcare workers. The purpose of this study was to assess the knowledge and comfort felt by healthcare professionals in managing trans people in a French university hospital.

METHODS

A self-questionnaire was emailed to healthcare professionals working in departments usually involved in the care of trans people in a French university hospital "not specialized" in medical and surgical gender transition. The questionnaire included demographic questions and Likert scales regarding their knowledge and comfort in taking care of trans people. Responses on the 7-point Likert scales were categorized into "low", "medium" and "high" groups, and responses on the 5-point Likert scales were categorized into "in favour", "neutral" and "against" groups.

RESULTS

One hundred and two (29%) healthcare professionals answered the questionnaire. Half worked in surgical departments (urology, plastic surgery, gynecology), 24% worked in medical departments (endocrinology, reproductive medicine, cytogenetics) and 26% worked in psychiatry. The majority (60.3%) rated their level of knowledge as "low" and 39.7% as "medium". Sixteen percent rated their level of comfort in managing trans people as "low", 72.5% as "medium" and 11.5% as "high". A majority (77.5%) were in favor of having the costs of gender transition care covered by the national health insurance system, 16.4% were neutral and 6% were against this idea. Feelings about surgical and hormonal gender transition were overwhelmingly (96.4%) in favour or neutral and 91% were willing to get more training and education to manage trans people.

CONCLUSION

The lack of comfort felt by healthcare professionals in university hospital in managing trans people seems to be related to a lack of knowledge and training in that field and not to a disagreement with the need of transgender healthcare.

LEVEL OF EVIDENCE

3.

A229 PROMOTION OF COLONIC ANASTOMOTIC HEALING WITH PERIOPERATIVE SUPPLEMENTATION WITH OLIGOSACCHARIDES

Background

Colorectal resection is a standard procedure in the management of colorectal cancer (CRC) and inflammatory bowel disease. Anastomotic leak (AL) is a major complication in colorectal resections, and the gut microbiota may play a role in the healing and development of AL. Short-chain fatty acids (SCFAs), namely butyrate, have been involved in anastomotic healing when administered into the bowel via enema. Due to the mechanical stress associated with enemas after the confection of a fresh and fragile anastomosis, other butyrate-increasing strategies are required.

Aims

To promote anastomotic healing and prevent AL by using inulin and galacto-oligosaccharides (GOS) supplementation to modulate the microbiota toward a butyrate-producing profile.

Methods

Mice were fed diets supplemented with inulin, GOS or cellulose, as a non-fermentable control, for two weeks and underwent a proximal colonic anastomosis under general anesthesia. Healing of the anastomosis, both macroscopically and microscopically, was assessed six days after surgery. Epithelial proliferation, mucus production and integrity of the gut barrier were assessed.

Results

Inulin and GOS supplementation increased SCFAs in the colon and were associated with better postoperative weight recovery and macroscopic anastomotic healing. Microscopically, mucosal continuity was promoted by inulin and GOS. Mucus production was found to be similar in all groups. The gut barrier was found to be improved with inulin and GOS as shown by less bacterial translocation.

Conclusions

Inulin and GOS may prevent AL and promote anastomotic healing. This effect appears to be mediated by improved mucosal proliferation.

Funding Agencies

CIHRNatural Sciences and Engineering Research Council of Canada; Institut du cancer de Montréal; Fonds de recherche du Québec en santé

[Cost analysis of GreenLight photoselective vaporization of the prostate versus standard transurethral resection of the prostate: Benefit of ambulatory care]

PURPOSE

To compare the costs associated with GreenLight XPS 180W photoselective vaporization of the prostate (PVP) for an outpatient versus standard transurethral resection of the prostate (TURP) with a three nights hospitalization in a French private hospital.

MATERIAL AND METHODS

A retrospective cost minimization analysis was performed between 2017 and 2019 in a French private hospital for the hospital stays associated with TURP and PVP procedures for benign prostatic hyperplasia (BPH). The peri-operative cost-benefit assessment of the two procedures was analyzed from the establishment's point of view according to the micro-costing method.

RESULTS

871 surgical treatment for BPH had been performed during the period of the study, including 743 photoselective laser vaporization (85%). The average length of stay of patients undergoing TURP was 3,7 days versus 0,9 days for PVP including 64,7% ambulatory. The cost-benefit was more of 500€ per patient in favor of ambulatory PVP compared with TURP in conventional three nights hospitalization for level 1 hospital stays.

CONCLUSION

In this private hospital center, ambulatory PVP seemed more cost-effective than TURP with a three nights hospitalization for a severity level 1 patient. The financial profit for the establishment was mostly due to reduction of the main length of stay and ambulatory care.

LEVEL OF EVIDENCE

3.