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Elbanna AG, Shoman W, Elheneidy MAR, Elsawy I, Kantar A, Fasseeh N. Evaluation of screening tools for primary ciliary dyskinesia in Egypt: single center study. Multidiscip Respir Med 2024; 19. [PMID: 38963223 PMCID: PMC11229824 DOI: 10.5826/mrm.2024.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/30/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a chronic respiratory illness that places significant strain on the healthcare system due to the complexity and expense of its diagnosis and treatment methods. The diagnostic process typically requires skilled technicians and an assortment of intricate, costly, and time-consuming approaches. Implementing screening tools can enhance efficiency by focusing the diagnostic process on those strongly suspected of having PCD. Tools such as the PCD Rule (PICADAR), North America Criteria Defined Clinical Features (NA-CDCF), the Clinical Index Score (CI), and the newly proposed CInew13 could potentially serve as useful screening tools. This study aims to examine the effectiveness of these tools individually, compare their performance against each other, and assess their results relative to prior research. METHODS We conducted a diagnostic accuracy test on 83 Egyptian patients referred to Alexandria University Children's Hospital for potential PCD diagnosis between January 2015 and December 2022. The scores obtained from the screening tools were calculated and assessed. RESULTS Of the initial group, 10 patients were ruled out because they fit other diagnostic parameters. Forty-three cases received a confirmed diagnosis, while 30 did not. Notably, the confirmed cases consistently scored higher on our screening tools than those that remained unconfirmed (p <.001, for all tested scores). We used receiver operating characteristic curves to assess and compare the effectiveness of each tool. The NA-CDCF had the smallest area under curve 0.736 (95% confiedence interval 0.619-0.832); in contrast, the CI score had the largest 0.898 (95% confidence interval 0.808-0.957). CONCLUSION All the tools tested were effective in identifying suitable patients for PCD testing at statistically significant levels. However, the PICADAR and NA-CDCF scores' performance did not significantly differ in the current study. The CI and CInew13 scores, on the other hand, outperformed both.
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Affiliation(s)
- Amr G Elbanna
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Walaa Shoman
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Moushira A R Elheneidy
- Department of Histology and Cell Biology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ihab Elsawy
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi University and Research Hospitals, Ponte San Pietro-Bergamo, Italy
| | - Nader Fasseeh
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Elgabarty AT, Elmahallawy AS, Ibraheam AA, Oraby MS. Closure of oroantral fistula using platelet rich fibrin with endoscopic middle meatal antrostomy. BMC Oral Health 2024; 24:698. [PMID: 38880902 PMCID: PMC11180408 DOI: 10.1186/s12903-024-04409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Oroantral fistula (OAF) involves pathological, epithelialized, and unnatural communication between the maxillary sinus and oral cavity. Recently, functional endoscopic sinus surgery has provided minimally invasive treatment options with fewer postoperative complications. The aim of the study was to evaluate the one-stage endoscopic middle meatal antrostomy (EMMA) technique with the application of a platelet-rich fibrin membrane (PRF) for OAF closure and maxillary sinusitis relief. PATIENTS AND METHODS Patients who suffered from OAF with odontogenic sinusitis were included in this study. Complete excision of the epithelial tract and any necrotic tissue was performed with proper curettage. Then, EMMA was performed with simultaneous closure of the OAF by the application of PRF membranes that were fixed by sutures and covered with an acrylic splint. Patients were clinically evaluated for OAF closure, pain level, and symptom relief. Additionally, the size of the bone defect was measured with the aid of computed tomography (CT) preoperatively and after 24 weeks postoperatively. RESULTS This study included nine eligible patients with a mean age of 38 years. The data were collected, tabulated, and statistically analyzed. Soft tissue healing and bone formation occurred in all patients who achieved maxillary sinusitis relief without any complications. Additionally, pain was significantly lower on the 7th postoperative day than on the 1st postoperative day, according to the statistical analysis of the results (p < .001). CONCLUSIONS One-stage EMMA with the application of PRF membranes and acrylic splint represents a reliable alternative technique for OAF closure and maxillary sinusitis relief that is associated with a lower incidence of complications and minimal postoperative pain. TRIAL REGISTRATION The trial was registered on 28/02/2024, at clinicaltrials.gov (ID: NCT06281873).
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Affiliation(s)
- Amira Tarek Elgabarty
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Champlion St, Azrite, Alexandria, Egypt.
| | - Ahmed Salah Elmahallawy
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Champlion St, Azrite, Alexandria, Egypt
| | - Ahmed Aly Ibraheam
- Otorhinolaryngology and skull base surgery Department, Faculty of Medicine, Alexandria University, Champlion St, Azrite, Alexandria, Egypt
| | - Mona Samy Oraby
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Champlion St, Azrite, Alexandria, Egypt
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Rosenberg AJ, Anderson GK, McKeefer HJ, Bird J, Pentz B, Byman BRM, Jendzjowsky N, Wilson RJ, Day TA, Rickards CA. Hemorrhage at high altitude: impact of sustained hypobaric hypoxia on cerebral blood flow, tissue oxygenation, and tolerance to simulated hemorrhage in humans. Eur J Appl Physiol 2024:10.1007/s00421-024-05450-1. [PMID: 38489034 DOI: 10.1007/s00421-024-05450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
With ascent to high altitude (HA), compensatory increases in cerebral blood flow and oxygen delivery must occur to preserve cerebral metabolism and consciousness. We hypothesized that this compensation in cerebral blood flow and oxygen delivery preserves tolerance to simulated hemorrhage (via lower body negative pressure, LBNP), such that tolerance is similar during sustained exposure to HA vs. low altitude (LA). Healthy humans (4F/4 M) participated in LBNP protocols to presyncope at LA (1130 m) and 5-7 days following ascent to HA (3800 m). Internal carotid artery (ICA) blood flow, cerebral delivery of oxygen (CDO2) through the ICA, and cerebral tissue oxygen saturation (ScO2) were determined. LBNP tolerance was similar between conditions (LA: 1276 ± 304 s vs. HA: 1208 ± 306 s; P = 0.58). Overall, ICA blood flow and CDO2 were elevated at HA vs. LA (P ≤ 0.01) and decreased with LBNP under both conditions (P < 0.0001), but there was no effect of altitude on ScO2 responses (P = 0.59). Thus, sustained exposure to hypobaric hypoxia did not negatively impact tolerance to simulated hemorrhage. These data demonstrate the robustness of compensatory physiological mechanisms that preserve human cerebral blood flow and oxygen delivery during sustained hypoxia, ensuring cerebral tissue metabolism and neuronal function is maintained.
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Affiliation(s)
- Alexander J Rosenberg
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
- Physiology Department, Midwestern University, Downers Grove, IL, USA
| | - Garen K Anderson
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Haley J McKeefer
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | | | | | - Nicholas Jendzjowsky
- University of Calgary, Calgary, AB, Canada
- Institute of Respiratory Medicine & Exercise Physiology, The Lundquist Institute at UCLA Harbor Medical, Torrance, CA, USA
| | | | | | - Caroline A Rickards
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA.
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Curran-Everett D. Primer on reporting statistics: kayaks and walking trees once more. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:1-2. [PMID: 37969076 DOI: 10.1152/advan.00231.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, United States
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Harrison PW, James LP, Jenkins DG, Holmberg PM, Kelly VG. Effects of Repeated Jump Testing and Diurnal Changes on Subsequent Countermovement Jump and Squat Jump Output and Force-Time Characteristics. J Strength Cond Res 2024; 38:174-179. [PMID: 38085626 DOI: 10.1519/jsc.0000000000004703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ABSTRACT Harrison, PW, James, LP, Jenkins, DG, Holmberg, PM, and Kelly, VG. Effects of repeated jump testing and diurnal changes on subsequent countermovement jump and squat jump output and force-time characteristics. J Strength Cond Res 38(1): 174-179, 2024-The aim of this brief study was to investigate the effects of repeated jump testing on performance over 2 consecutive days while considering the possibility of diurnal changes. Fourteen male subjects and 14 recreationally active female subjects completed countermovement jump (CMJ) and squat jump (SJ) testing on 5 occasions (baseline [0,800], 5 minutes [0,820], 8 hours [1,600], 24 hours [0,800], and 32 hours [1,600]) over 32 hours. An additional rested baseline test was conducted on a separate day in the afternoon (1,600) to compare jump performance between morning and afternoon baseline values. Excluding small decreases in CMJ height at 24 hours (p = 0.292, Cliff's delta = -0.225) in male subjects and similar decreases in CMJ height at 5 minutes (p = 0.034, Cliff's delta = -0.245) in addition to SJ height:contraction time at 32 hours (p = 0.126, Cliff's delta = 0.153) in female subjects, findings generally showed no changes in jump performance over multiple assessments. Squat jump metrics may have showed small improvements between morning and afternoon baseline values in male subjects (SJ height:contraction time [p = 0.030, Cliff's delta = 0.225]) and female subjects (SJ height [p = 0.013, Cliff's delta = 0.173] and SJ height:contraction time [p = 0.091, Cliff's delta = 0.163)]. As jump performance was largely unaffected by repeated jump testing, the present findings support the use of monitoring practices and research designs that require multiple jump assessments within acute periods (∼32 hours).
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Affiliation(s)
- Peter W Harrison
- School of Human Movement and Nutrition Sciences, University of Queensland, Saint Lucia, Queensland, Australia
- Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Lachlan P James
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - David G Jenkins
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Applied Sports Science Technology and Medicine Research Centre, Swansea University, Swansea, Wales; and
| | - Patrick M Holmberg
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vincent G Kelly
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Harrison PW, James LP, Jenkins DG, McGuigan MR, Holmberg PM, Kelly VG. The Effects of Low-Load Squat Jump and Maximal Isometric Priming Exercise on Muscular Performance and Perceptual State. J Strength Cond Res 2024; 38:1-9. [PMID: 38085618 DOI: 10.1519/jsc.0000000000004524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ABSTRACT Harrison, PW, James, LP, Jenkins, DG, McGuigan, MR, Holmberg, PM, and Kelly, VG. The effects of low-load squat jump and maximal isometric priming exercise on muscular performance and perceptual state. J Strength Cond Res 38(1): 1-9, 2024-The aim of this study was to examine responses at 3 and 27 hours after low-load jump squat (LL) and maximal isometric half-squat (ISO) priming stimuli. Fifteen resistance-trained males performed LL (4 × 3 at 20% 1 repetition maximum [1RM]), ISO (4 × 3 seconds), and control (CON) activities (standardized warm-up) in a randomized and counterbalanced order. Countermovement jump (CMJ) and isometric midthigh pull tests were conducted to assess performance changes after priming and CON activities. No clear changes in CMJ measures were found after priming activities compared with CON. However, small effect size improvements were found after priming stimuli completed on the same day. A 2.9% decrease in concentric phase duration (CI = 0.3-5.9, p = 0.333, Cliff's delta = -0.156) and a 9.1% increase in RSImod (CI = 0.2-12.3, p = 0.151, Cliff's delta = -0.218) occurred at 3 hours after LL compared with CON. Braking phase duration (CI = 0.8-10.6, p = 0.333, Cliff's delta = -0.213) was 2.9% shorter at 3 hours after ISO compared with CON. No clear changes in isometric peak force occurred after priming activities compared with CON. Additionally, questionnaires were completed to assess perceptual state and perceived effectiveness of the priming stimulus to influence performance. An increase in the "effect of activity" was perceived at 3 hours after LL and ISO (p = 0.013-0.044, Cliff's delta = 0.578-0.6) and at 27 hours after ISO (p = 0.99, Cliff's delta = 0.173) compared with CON. An increase in "muscular heaviness" was also reported at 3 hours after ISO compared with CON (p = 0.199, Cliff's delta = 0.320). The collective findings suggest limited benefits over the day after LL and ISO priming stimuli. However, as there was substantial variation in individual responses, the relative nature of priming responses should be considered when prescribing similar strategies in practical environments.
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Affiliation(s)
- Peter W Harrison
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Queensland, Australia
- Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Lachlan P James
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - David G Jenkins
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Queensland, Australia
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Applied Sports Science Technology and Medicine Research Centre, Swansea University, Swansea, Wales
| | - Michael R McGuigan
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand; and
| | - Patrick M Holmberg
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vincent G Kelly
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Queensland, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Watso JC, Cuba JN, Boutwell SL, Moss JE, Bowerfind AK, Fernandez IM, Cassette JM, May AM, Kirk KF. Acute nasal breathing lowers diastolic blood pressure and increases parasympathetic contributions to heart rate variability in young adults. Am J Physiol Regul Integr Comp Physiol 2023; 325:R797-R808. [PMID: 37867476 PMCID: PMC11178300 DOI: 10.1152/ajpregu.00148.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect cardiovascular health. It is unknown whether the route of breathing (nasal vs. oral) affects prognostic cardiovascular variables. Because nasal breathing can improve other physiological variables (e.g., airway dilation), we hypothesized that nasal compared with oral breathing would acutely lower blood pressure (BP) and improve heart rate variability (HRV) metrics. We tested 20 adults in this study [13 females/7 males; age: 18(1) years, median (IQR); body mass index: 23 ± 2 kg·m-2, means ± SD]. We compared variables between nasal- and oral-only breathing (random order, five min each) using paired, two-tailed t tests or Wilcoxon signed-rank paired tests with significance set to P < 0.05. We report the median (interquartile range) for diastolic BP and means ± SD for all other variables. We found that nasal breathing was associated with a lower mean BP (nasal: 84 ± 7 vs. oral: 86 ± 5 mmHg, P = 0.006, Cohen's d = 0.70) and diastolic BP [nasal: 68(8) vs. oral: 72(5) mmHg, P < 0.001, Rank-biserial correlation = 0.89] but not systolic BP (nasal: 116 ± 11 vs. oral: 117 ± 9 mmHg, P = 0.48, Cohen's d = 0.16) or heart rate (HR; nasal: 74 ± 10 vs. oral: 75 ± 8 beats·min-1, P = 0.90, Cohen's d = 0.03). We also found that nasal breathing was associated with a higher high-frequency (HF) contribution to HRV (nasal: 59 ± 19 vs. oral: 52 ± 21%, P = 0.04, Cohen's d = 0.50) and a lower low frequency-to-HF ratio at rest (nasal: 0.9 ± 0.8 vs. oral: 1.2 ± 0.9, P = 0.04, Cohen's d = 0.49). These data suggest that nasal compared with oral breathing acutely 1) lowers mean and diastolic BP, 2) does not affect systolic BP or heart rate, and 3) increases parasympathetic contributions to HRV.NEW & NOTEWORTHY There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect prognostic cardiovascular variables. However, the potential effects of the breathing route on prognostic cardiovascular variables are unclear. These data suggest that nasal compared with oral breathing 1) lowers mean and diastolic blood pressure (BP), 2) does not affect systolic BP or heart rate (HR), and 3) increases parasympathetic contributions to heart rate variability (HRV). These data suggest that acute nasal breathing improves several prognostic cardiovascular variables.
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Affiliation(s)
- Joseph C Watso
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Jens N Cuba
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Savannah L Boutwell
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Justine E Moss
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Allison K Bowerfind
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Isabela M Fernandez
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Jessica M Cassette
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Allyson M May
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Katherine F Kirk
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
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Abdelsamee KS. Short-term outcomes of double omentopexy in one anastomosis gastric bypass surgery: A controlled clinical trial. Niger J Clin Pract 2023; 26:1483-1490. [PMID: 37929524 DOI: 10.4103/njcp.njcp_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose This study aims to assess the efficacy of implementing a novel technique of reinforcement of gastric pouch and remnant stomach staple line with Double Omentopexy (DO) in patients undergoing One-Anastomosis Gastric Bypass (OAGB) surgery and evaluate its impact in reducing the early postoperative complications. Materials and Methods The 123 patients were allocated into two groups: 61 in the standard OAGB group and 62 in OAGB with DO group. The primary outcomes are postoperative complications (including early postoperative bleeding, leakage, gastric twist, reflux, etc.) and hospital stay. The secondary outcome is excess body weight loss. Follow-up visits were planned after discharge: at two weeks, two months, and three months postoperatively. Results Postoperative complications were significantly lower, 3 (4.84%) in OAGB with DO compared with 10 (16.39%) in standard OAGB (P =0.037). There was no statistically significant difference in the incidence of early postoperative bleeding, deep vein thrombosis, biliary reflux, and gall bladder stone (P >.05). No patient had leakage in either group. The mean operative time was significantly longer (68.66 ± 6.68 min) in OAGB with the DO group when compared with the standard OAGB group (62.16 ± 7.54 min) (P <.001). Conclusion Applying the DO technique may be a good measure to be added during OAGB to decrease the incidence of potential postoperative complications, especially the rate and severity of bleeding.
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Affiliation(s)
- K S Abdelsamee
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abdelsamee KS, Matar M, Khalil MM. Short-term outcomes of reduced versus conventional ports in sleeve gastrectomy: A controlled clinical trial. Niger J Clin Pract 2023; 26:1472-1482. [PMID: 37929523 DOI: 10.4103/njcp.njcp_23_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Aim The study aims to compare the short-term outcomes of reduced ports sleeve gastrectomy versus conventional five ports sleeve gastrectomy in postoperative weight loss, morbidity rate, pain, and resolution of obesity-related diseases. Materials and Methods One hundred forty patients were equally allocated to reduced ports (n = 70) and conventional ports (5 ports) Laparoscopic Gastrectomy groups. The primary outcomes are postoperative pain by numeric rating score, cosmetic visual analog score, satisfaction visual analog score, operative time, and hospital stay. The secondary outcomes are postoperative complications and comorbidity resolution. Results The numeric rating score for pain assessment was statistically significantly lower in the reduced ports group compared with the conventional ports group at 2, 6, 12, and 24 hours, postoperatively (P < .001). Cosmetic visual analog score was statistically significantly higher in the reduced ports group compared with conventional ports group at 2 and 3 months follow-up (P < .001 and P = .008, respectively). Patient satisfaction visual analog score was statistically significantly higher in the reduced ports group than the conventional ports group at 2 and 3 months follow-up (P < .001 and P = .032, respectively). Conclusion Reduced ports laparoscopic sleeve gastrectomy is safe and feasible in patients with body mass index (BMI) up to 50 kg/m2. It is cosmetically well appreciated with noticeable patient satisfaction. It should be practiced with regularity. Further trials should be considered in patients with high BMI (>50 kg/m2).
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Affiliation(s)
- K S Abdelsamee
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
| | - M Matar
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
| | - M M Khalil
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
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Alabbadi AA, Abdalla EM, Hanafy SA, Yousry TN. A comparative study of CAD/CAM fabricated polyether ether ketone and fiber-glass reinforcement composites versus metal lingual retainers under vertical load (an in vitro study). BMC Oral Health 2023; 23:583. [PMID: 37605187 PMCID: PMC10441729 DOI: 10.1186/s12903-023-03268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Retainer is a necessary procedure when orthodontic treatment complete to avoid relapse due to periodontal fiber elasticity and to allow for alveolar bone regeneration. Compare the influence of vertical force on the failure of three fixed retainers: CAD/CAM polyether ether ketone (PEEK), CAD/CAM fiber glass reinforced composites (FRCs), and lingual retainer wire "Bond-A-Braid™". MATERIALS AND METHODS One hundred and eight maxillary first premolars teeth were randomly allocated to three groups: Group A (CAD/CAM PEEK), Group B (CAD/CAM FRC), and Group C (lingual retainer wire " Bond-A-Braid™"). These retainers were bonded using Assure Plus Bonding Resin and GO TO Paste. For each specimen, a loading cycling and thermocycling machine was used. The failure debonding forces were measured on the interproximal segments using a universal testing machine with a cross-head speed of 1 mm/min. The adhesive remnant index (ARI) was calculated after identifying types of failure with a stereomicroscope at (X 20) magnification. RESULTS Group B and group C showed the highest failure bonding forces, with a mean of 209.67 ± 16.15 and 86.81 ± 4.59 N, respectively. However, Group A had a statistically significant lower bond failure force, with a mean value of 45.73 ± 4.48 N. At baseline, there was a statistically significant difference in connector retainer displacement between the three studied groups (p < .001). The ARI score was not statistically significant (p < .001) between the three study groups; for groups A and B, the ARI was predominantly score 3, and group C showed a mixed score of 2 and 3. The failure mode of retainers was investigated using an optical stereomicroscope. In group B, there was a cohesive breakdown in the retainer, and groups A and C exhibited failures primarily in the adhesive at the retainer interface. CONCLUSION All groups differed significantly, with group A having the lowest debonding force and group B having the highest. Furthermore, there was not a substantial variation in ARI, but there was a significant difference in connector retainer displacement and the types of failure amongst the three groups.
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Affiliation(s)
- Abdullah A. Alabbadi
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champolion street, P. O. Box: 21521, Azarita, Alexandria Egypt
| | - Essam M. Abdalla
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champolion street, P. O. Box: 21521, Azarita, Alexandria Egypt
| | - Seham A. Hanafy
- Department of Dental Biomaterials, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Tarek N. Yousry
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champolion street, P. O. Box: 21521, Azarita, Alexandria Egypt
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Foster J, Mckenna ZJ, Atkins WC, Jarrard CP, Crandall CG. Aging Increases Enterocyte Damage during a 3-Hour Exposure to Very Hot and Dry Heat: A Preliminary Study. BIOLOGY 2023; 12:1088. [PMID: 37626974 PMCID: PMC10451985 DOI: 10.3390/biology12081088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
Profound heat stress can damage the gastrointestinal barrier, leading to microbial translocation from the gut and subsequent systemic inflammation. Despite the greater vulnerability of older people to heat wave-related morbidity and mortality, it is unknown if age modulates gastrointestinal barrier damage and inflammation during heat stress. Therefore, the aim of this study was to determine if aging impacted enterocyte damage and systemic inflammatory responses to a 3-h exposure to very hot and dry (47 °C, 15% humidity) heat with accompanying activities of daily living (intermittent activity at 3 METS). Data from 16 young (age 21 to 39 years) and 16 older (age 65 to 76 years) humans were used to address this aim. In each group, log-transformed plasma concentrations of intestinal fatty acid binding protein (I-FABPlog), interleukin-8 (IL-8log), and tissue factor (TFlog) were assessed as indices of enterocyte damage, systemic inflammation, and blood coagulation, respectively, before and after the 3-h heat exposure. In the younger cohort, I-FABPlog concentration did not increase from pre to post heat exposure (p = 0.264, d = 0.20), although it was elevated in the older group (p = 0.014, d = 0.67). The magnitude of the increase in I-FABPlog was greater in the older participants (p = 0.084, d = 0.55). Across all participants, there was no correlation between the change in core temperature and the change in IFABPlog. There was no change in IL-8log in the younger group (p = 0.193, d = 0.23) following heat exposure, but we observed a decrease in IL-8log in the older group (p = 0.047, d = 0.48). TFlog decreased in the younger group (p = 0.071, d = 0.41), but did not change in the older group (p = 0.193, d = 0.15). Our data indicate that I-FABPlog concentration (an index of enterocyte damage) is increased in older humans during a 3-h extreme heat exposure. Future studies should determine whether this marker reflects increased gastrointestinal barrier permeability in older individuals during heat exposure.
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Affiliation(s)
- Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
| | - Zachary J. Mckenna
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
| | - Whitley C. Atkins
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
| | - Caitlin P. Jarrard
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
| | - Craig G. Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
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12
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Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Jaffery MF, Balmain BN, Wilhite DP, Babb TG, Crandall CG. Six Months of Exercise Training Improves Ventilatory Responses during Exercise in Adults with Well-Healed Burn Injuries. Med Sci Sports Exerc 2023; 55:765-776. [PMID: 36729937 PMCID: PMC10106361 DOI: 10.1249/mss.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Pulmonary function is lower after a severe burn injury, which could influence ventilatory responses during exercise. It is unclear whether exercise training improves pulmonary function or ventilatory responses during exercise in adults with well-healed burn injuries. Therefore, we tested the hypothesis that exercise training improves pulmonary function and ventilatory responses during exercise in adults with well-healed burn injuries. METHODS Thirty-nine adults (28 with well-healed burn injuries and 11 non-burn-injured controls) completed 6 months of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we performed comprehensive pulmonary function testing and measured ventilatory responses during cycling exercise. We compared variables using two-way ANOVA (group-time; i.e., preexercise/postexercise training (repeated factor)). RESULTS Exercise training did not increase percent predicted spirometry, lung diffusing capacity, or airway resistance measures (time: P ≥ 0.14 for all variables). However, exercise training reduced minute ventilation ( V̇E ; time: P ≤ 0.05 for 50 and 75 W) and the ventilatory equivalent for oxygen ( V̇E /V̇O 2 ; time: P < 0.001 for 75 W) during fixed-load exercise for both groups. The ventilatory equivalent for carbon dioxide ( V̇E /V̇CO 2 ) during exercise at 75 W was reduced after exercise training (time: P = 0.04). The percentage of age-predicted maximum heart rate at the ventilatory threshold was lower in adults with well-healed burn injuries before ( P = 0.002), but not after ( P = 0.22), exercise training. Lastly, exercise training increased V̇E and reduced V̇E /V̇O 2 during maximal exercise (time: P = 0.005 for both variables). CONCLUSIONS These novel findings demonstrate that exercise training can improve ventilatory responses during exercise in adults with well-healed burn injuries.
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Affiliation(s)
- Joseph C. Watso
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
| | - Steven A. Romero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, TX
| | - Gilbert Moralez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mu Huang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
- Office of Science, Medicine, and Health, American Heart Association, Dallas, TX
| | - Matthew N. Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Manall F. Jaffery
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Bryce N. Balmain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Daniel P. Wilhite
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Tony G. Babb
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Craig G. Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
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13
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Watso JC, Huang M, Hendrix JM, Belval LN, Moralez G, Cramer MN, Foster J, Hinojosa-Laborde C, Crandall CG. Comparing the Effects of Low-Dose Ketamine, Fentanyl, and Morphine on Hemorrhagic Tolerance and Analgesia in Humans. PREHOSP EMERG CARE 2023; 27:600-612. [PMID: 36689353 PMCID: PMC10329983 DOI: 10.1080/10903127.2023.2172493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Hemorrhage is a leading cause of preventable battlefield and civilian trauma deaths. Ketamine, fentanyl, and morphine are recommended analgesics for use in the prehospital (i.e., field) setting to reduce pain. However, it is unknown whether any of these analgesics reduce hemorrhagic tolerance in humans. We tested the hypothesis that fentanyl (75 µg) and morphine (5 mg), but not ketamine (20 mg), would reduce tolerance to simulated hemorrhage in conscious humans. Each of the three analgesics was evaluated independently among different cohorts of healthy adults in a randomized, crossover (within drug/placebo comparison), placebo-controlled fashion using doses derived from the Tactical Combat Casualty Care Guidelines for Medical Personnel. One minute after an intravenous infusion of the analgesic or placebo (saline), we employed a pre-syncopal limited progressive lower-body negative pressure (LBNP) protocol to determine hemorrhagic tolerance. Hemorrhagic tolerance was quantified as a cumulative stress index (CSI), which is the sum of products of the LBNP and the duration (e.g., [40 mmHg x 3 min] + [50 mmHg x 3 min] …). Compared with ketamine (p = 0.002 post hoc result) and fentanyl (p = 0.02 post hoc result), morphine reduced the CSI (ketamine (n = 30): 99 [73-139], fentanyl (n = 28): 95 [68-130], morphine (n = 30): 62 [35-85]; values expressed as a % of the respective placebo trial's CSI; median [IQR]; Kruskal-Wallis test p = 0.002). Morphine-induced reductions in tolerance to central hypovolemia were not well explained by a prediction model including biological sex, body mass, and age (R2=0.05, p = 0.74). These experimental data demonstrate that morphine reduces tolerance to simulated hemorrhage while fentanyl and ketamine do not affect tolerance. Thus, these laboratory-based data, captured via simulated hemorrhage, suggest that morphine should not be used for a hemorrhaging individual in the prehospital setting.
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Affiliation(s)
- Joseph Charles Watso
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida, USA
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas, USA
| | - Joseph Maxwell Hendrix
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Luke Norman Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew Nathaniel Cramer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Craig Gerald Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Carr JM, Ainslie PN, MacLeod DB, Tremblay JC, Nowak-Flück D, Howe CA, Stembridge M, Patrician A, Coombs GB, Stacey BS, Bailey DM, Green DJ, Hoiland RL. Cerebral O 2 and CO 2 transport in isovolumic haemodilution: Compensation of cerebral delivery of O 2 and maintenance of cerebrovascular reactivity to CO 2. J Cereb Blood Flow Metab 2023; 43:99-114. [PMID: 36131560 PMCID: PMC9875354 DOI: 10.1177/0271678x221119442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study investigated the influence of acute reductions in arterial O2 content (CaO2) via isovolumic haemodilution on global cerebral blood flow (gCBF) and cerebrovascular CO2 reactivity (CVR) in 11 healthy males (age; 28 ± 7 years: body mass index; 23 ± 2 kg/m2). Radial artery and internal jugular vein catheters provided measurement of blood pressure and gases, quantification of cerebral metabolism, cerebral CO2 washout, and trans-cerebral nitrite exchange (ozone based chemiluminescence). Prior to and following haemodilution, the partial pressure of arterial CO2 (PaCO2) was elevated with dynamic end-tidal forcing while gCBF was measured with duplex ultrasound. CVR was determined as the slope of the gCBF response and PaCO2. Replacement of ∼20% of blood volume with an equal volume of 5% human serum albumin (Alburex® 5%) reduced haemoglobin (13.8 ± 0.8 vs. 11.3 ± 0.6 g/dL; P < 0.001) and CaO2 (18.9 ± 1.0 vs 15.0 ± 0.8 mL/dL P < 0.001), elevated gCBF (+18 ± 11%; P = 0.002), preserved cerebral oxygen delivery (P = 0.49), and elevated CO2 washout (+11%; P = 0.01). The net cerebral uptake of nitrite (11.6 ± 14.0 nmol/min; P = 0.027) at baseline was abolished following haemodilution (-3.6 ± 17.9 nmol/min; P = 0.54), perhaps underpinning the conservation of CVR (61.7 ± 19.0 vs. 69.0 ± 19.2 mL/min/mmHg; P = 0.23). These findings demonstrate that the cerebrovascular responses to acute anaemia in healthy humans are sufficient to support the maintenance of CVR.
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Affiliation(s)
- Jay Mjr Carr
- Centre for Heart, Lung and Vascular Health, University of British Columbia - Okanagan Campus, School of Health and Exercise Sciences, Kelowna, B.C., Canada, V1V 1V7
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, University of British Columbia - Okanagan Campus, School of Health and Exercise Sciences, Kelowna, B.C., Canada, V1V 1V7
| | - David B MacLeod
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Joshua C Tremblay
- Centre for Heart, Lung and Vascular Health, University of British Columbia - Okanagan Campus, School of Health and Exercise Sciences, Kelowna, B.C., Canada, V1V 1V7
| | - Daniela Nowak-Flück
- Centre for Heart, Lung and Vascular Health, University of British Columbia - Okanagan Campus, School of Health and Exercise Sciences, Kelowna, B.C., Canada, V1V 1V7
| | - Connor A Howe
- Centre for Heart, Lung and Vascular Health, University of British Columbia - Okanagan Campus, School of Health and Exercise Sciences, Kelowna, B.C., Canada, V1V 1V7
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Alexander Patrician
- Centre for Heart, Lung and Vascular Health, University of British Columbia - Okanagan Campus, School of Health and Exercise Sciences, Kelowna, B.C., Canada, V1V 1V7
| | - Geoff B Coombs
- Centre for Heart, Lung and Vascular Health, University of British Columbia - Okanagan Campus, School of Health and Exercise Sciences, Kelowna, B.C., Canada, V1V 1V7.,School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Nedlands, Western Australia
| | - Ryan L Hoiland
- Centre for Heart, Lung and Vascular Health, University of British Columbia - Okanagan Campus, School of Health and Exercise Sciences, Kelowna, B.C., Canada, V1V 1V7.,Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.,Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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15
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Kumar RA, Hahn D, Kelley RC, Muscato DR, Shamoun A, Curbelo-Bermudez N, Butler WG, Yegorova S, Ryan TE, Ferreira LF. Skeletal muscle Nox4 knockout prevents and Nox2 knockout blunts loss of maximal diaphragm force in mice with heart failure with reduced ejection fraction. Free Radic Biol Med 2023; 194:23-32. [PMID: 36436728 PMCID: PMC10191720 DOI: 10.1016/j.freeradbiomed.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
Patients with heart failure with reduced ejection fraction (HFrEF) experience diaphragm weakness that contributes to the primary disease symptoms of fatigue, dyspnea, and exercise intolerance. Weakness in the diaphragm is related to excessive production of reactive oxygen species (ROS), but the exact source of ROS remains unknown. NAD(P)H Oxidases (Nox), particularly the Nox2 and 4 isoforms, are important sources of ROS within skeletal muscle that contribute to optimal cell function. There are reports of increased Nox activity in the diaphragm of patients and animal models of HFrEF, implicating these complexes as possible sources of diaphragm dysfunction in HFrEF. To investigate the role of these proteins on diaphragm weakness in HFrEF, we generated inducible skeletal muscle specific knockouts of Nox2 or Nox4 using the Cre-Lox system and assessed diaphragm function in a mouse model of HFrEF induced by myocardial infarction. Diaphragm maximal specific force measured in vitro was depressed by ∼20% with HFrEF. Skeletal muscle knockout of Nox4 provided full protection against the loss of maximal force (p < 0.01), while the knockout of Nox2 provided partial protection (7% depression, p < 0.01). Knockout of Nox2 from skeletal myofibers improved survival from 50 to 80% following myocardial infarction (p = 0.026). Our findings show an important role for skeletal muscle NAD(P)H Oxidases contributing to loss of diaphragm maximal force in HFrEF, along with systemic pathophysiological responses following myocardial infarction.
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Affiliation(s)
- Ravi A Kumar
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, United Kingdom
| | - Dongwoo Hahn
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Rachel C Kelley
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; Endocrine Society, Washington, D.C, USA
| | - Derek R Muscato
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Alex Shamoun
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Nuria Curbelo-Bermudez
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - W Greyson Butler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Svetlana Yegorova
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Terence E Ryan
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Leonardo F Ferreira
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.
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16
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Rosenberg AJ, Kay VL, Anderson GK, Luu ML, Barnes HJ, Sprick JD, Alvarado HB, Rickards CA. The reciprocal relationship between cardiac baroreceptor sensitivity and cerebral autoregulation during simulated hemorrhage in humans. Auton Neurosci 2022; 241:103007. [PMID: 35716525 PMCID: PMC10424721 DOI: 10.1016/j.autneu.2022.103007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/07/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
A reciprocal relationship between the baroreflex and cerebral autoregulation (CA) has been demonstrated at rest and in response to acute hypotension. We hypothesized that the reciprocal relationship between cardiac baroreflex sensitivity (BRS) and CA would be maintained during sustained central hypovolemia induced by lower body negative pressure (LBNP), and that the strength of this relationship would be greater in subjects with higher tolerance to this stress. Healthy young adults (n = 51; 23F/28M) completed a LBNP protocol to presyncope. Subjects were classified as high tolerant (HT; completion of -60 mmHg LBNP stage, ≥20-min) or low tolerant (LT; did not complete -60 mmHg LBNP stage, <20-min). R-R intervals (RRI), systolic arterial pressure (SAP), mean arterial pressure (MAP), and middle cerebral artery velocity (MCAv) were measured continuously. Cardiac BRS was calculated in the time domain (ΔHR/ΔSAP) and frequency domain (RRI-SAP low frequency (LF) transfer function gain), and CA was calculated in the time domain (ΔMCAv/ΔMAP) and frequency domain (MAP-mean MCAv LF transfer function gain). There was a moderate relationship between cardiac BRS and CA for the group of 51 subjects in both the time (R = -0.54, P < 0.0001) and frequency (R = 0.61, P < 0.001) domains; there was a stronger relationship in the HT group (R = 0.73) compared to the LT group (R = 0.31) in the frequency domain (P = 0.08), but no difference between groups in the time domain (HT: R = -0.73 vs. LT: R = -0.63; P = 0.27). These findings suggest that an interaction between BRS and CA may be an important compensatory mechanism that contributes to tolerance to simulated hemorrhage in young healthy adults.
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Affiliation(s)
- Alexander J Rosenberg
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA; Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, University of Illinois at Chicago, IL, USA; Physiology Department, Midwestern University, IL, USA
| | - Victoria L Kay
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Garen K Anderson
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - My-Loan Luu
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Haley J Barnes
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Justin D Sprick
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA; Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Hannah B Alvarado
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA; Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Caroline A Rickards
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA.
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Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Johnson E, Crandall CG. Six months of unsupervised exercise training lowers blood pressure during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries. J Appl Physiol (1985) 2022; 133:742-754. [PMID: 35952345 PMCID: PMC9484988 DOI: 10.1152/japplphysiol.00181.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
Exercise training reduces cardiovascular disease risk, partly due to arterial blood pressure (BP) lowering at rest and during fixed-load exercise. However, it is unclear whether exercise training can reduce BP at rest and during exercise in adults with well-healed burn injuries. Therefore, the purpose of this investigation was to test the hypothesis that 6 mo of unsupervised exercise training reduces BP at rest and during lower-body cycle ergometry in adults with well-healed burn injuries. Thirty-nine adults (28 with well-healed burn injuries and 11 controls) completed 6 mo of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we measured BP at rest, during fixed-load submaximal exercise (50 and 75 W), during fixed-intensity submaximal exercise (40% and 70% of V̇o2peak), and during maximal exercise on a lower-body cycle ergometer. We compared cardiovascular variables using two-way ANOVA (group × pre/postexercise training [repeated factor]). Adults with well-healed burn injuries had higher diastolic BP at rest (P = 0.04), which was unchanged by exercise training (P = 0.26). Exercise training reduced systolic, mean, and diastolic BP during fixed-load cycling exercise at 75 W in adults with well-healed burn injuries (P ≤ 0.03 for all), but not controls (P ≥ 0.67 for all). Exercise training also reduced mean and diastolic BP during exercise at 40% (P ≤ 0.02 for both), but not at 70% (P ≥ 0.18 for both), of V̇o2peak. These data suggest that a 6-mo unsupervised exercise training program lowers BP during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries.NEW & NOTEWORTHY Adults with well-healed burn injuries have greater cardiovascular disease morbidity and all-cause mortality compared with nonburn-injured adults. We found that exercise training reduced blood pressure (BP) during fixed-load cycling at 75 W and during moderate, but not vigorous, intensity cycling exercise in adults with well-healed burn injuries. These data suggest that 6 mo of unsupervised exercise training provides some degree of cardioprotection by reducing BP responses during submaximal exercise in well-healed burn-injured adults.
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Affiliation(s)
- Joseph C Watso
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida
| | - Steven A Romero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Gilbert Moralez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas
| | - Matthew N Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Elias Johnson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Craig G Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
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18
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Leak RK, Schreiber JB. Mechanistic Research for the Student or Educator (Part I of II). Front Pharmacol 2022; 13:775632. [PMID: 35847028 PMCID: PMC9283720 DOI: 10.3389/fphar.2022.775632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Many discoveries in the biological sciences have emerged from observational studies, but student researchers also need to learn how to design experiments that distinguish correlation from causation. For example, identifying the physiological mechanism of action of drugs with therapeutic potential requires the establishment of causal links. Only by specifically interfering with the purported mechanisms of action of a drug can the researcher determine how the drug causes its physiological effects. Typically, pharmacological or genetic approaches are employed to modify the expression and/or activity of the biological drug target or downstream pathways, to test if the salutary properties of the drug are thereby abolished. However, experimental techniques have caveats that tend to be underappreciated, particularly for newer methods. Furthermore, statistical effects are no guarantor of their biological importance or translatability across models and species. In this two-part series, the caveats and strengths of mechanistic preclinical research are briefly described, using the intuitive example of pharmaceutical drug testing in experimental models of human diseases. Part I focuses on technical practicalities and common pitfalls of cellular and animal models designed for drug testing, and Part II describes in simple terms how to leverage a full-factorial ANOVA, to test for causality in the link between drug-induced activation (or inhibition) of a biological target and therapeutic outcomes. Upon completion of this series, students will have forehand knowledge of technical and theoretical caveats in mechanistic research, and comprehend that “a model is just a model.” These insights can help the new student appreciate the strengths and limitations of scientific research.
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Affiliation(s)
- Rehana K. Leak
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, United States
- *Correspondence: Rehana K. Leak,
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19
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Watso JC, Belval LN, Cimino FA, Orth BD, Hendrix JM, Huang M, Johnson E, Foster J, Hinojosa-Laborde C, Crandall CG. Low-dose morphine reduces tolerance to central hypovolemia in healthy adults without affecting muscle sympathetic outflow. Am J Physiol Heart Circ Physiol 2022; 323:H89-H99. [PMID: 35452317 PMCID: PMC9190738 DOI: 10.1152/ajpheart.00091.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
Hemorrhage is a leading cause of preventable battlefield and civilian trauma deaths. Low-dose (i.e., an analgesic dose) morphine is recommended for use in the prehospital (i.e., field) setting. Morphine administration reduces hemorrhagic tolerance in rodents. However, it is unknown whether morphine impairs autonomic cardiovascular regulation and consequently reduces hemorrhagic tolerance in humans. Thus, the purpose of this study was to test the hypothesis that low-dose morphine reduces hemorrhagic tolerance in conscious humans. Thirty adults (15 women/15 men; 29 ± 6 yr; 26 ± 4 kg·m-2, means ± SD) completed this randomized, crossover, double-blinded, placebo-controlled trial. One minute after intravenous administration of morphine (5 mg) or placebo (saline), we used a presyncopal limited progressive lower-body negative pressure (LBNP) protocol to determine hemorrhagic tolerance. Hemorrhagic tolerance was quantified as a cumulative stress index (mmHg·min), which was compared between trials using a Wilcoxon matched-pairs signed-rank test. We also compared muscle sympathetic nerve activity (MSNA; microneurography) and beat-to-beat blood pressure (photoplethysmography) during the LBNP test using mixed-effects analyses [time (LBNP stage) × trial]. Median LBNP tolerance was lower during morphine trials (placebo: 692 [473-997] vs. morphine: 385 [251-728] mmHg·min, P < 0.001, CI: -394 to -128). Systolic blood pressure was 8 mmHg lower during moderate central hypovolemia during morphine trials (post hoc P = 0.02; time: P < 0.001, trial: P = 0.13, interaction: P = 0.006). MSNA burst frequency responses were not different between trials (time: P < 0.001, trial: P = 0.80, interaction: P = 0.51). These data demonstrate that low-dose morphine reduces hemorrhagic tolerance in conscious humans. Thus, morphine is not an ideal analgesic for a hemorrhaging individual in the prehospital setting.NEW & NOTEWORTHY In this randomized, crossover, placebo-controlled trial, we found that tolerance to simulated hemorrhage was lower after low-dose morphine administration. Such reductions in hemorrhagic tolerance were observed without differences in MSNA burst frequency responses between morphine and placebo trials. These data, the first to be obtained in conscious humans, demonstrate that low-dose morphine reduces hemorrhagic tolerance. Thus, morphine is not an ideal analgesic for a hemorrhaging individual in the prehospital setting.
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Affiliation(s)
- Joseph C Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Frank A Cimino
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Bonnie D Orth
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Joseph M Hendrix
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elias Johnson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carmen Hinojosa-Laborde
- United States Army Institute of Surgical Research, Joint Base San Antonio Fort Sam Houston, Houston, Texas
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
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20
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Watso JC, Belval LN, Cimino Iii FA, Orth BD, Hendrix JM, Huang M, Johnson E, Foster J, Hinojosa-Laborde C, Crandall CG. Low-Dose Morphine Reduces Pain Perception and Blood Pressure, but Not Muscle Sympathetic Outflow, Responses During the Cold Pressor Test. Am J Physiol Heart Circ Physiol 2022; 323:H223-H234. [PMID: 35714174 PMCID: PMC9273278 DOI: 10.1152/ajpheart.00092.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Our knowledge about how low-dose (analgesic) morphine affects autonomic cardiovascular regulation is primarily limited to animal experiments. Notably, it is unknown if low-dose morphine affects human autonomic cardiovascular responses during painful stimuli in conscious humans. Therefore, we tested the hypothesis that low-dose morphine reduces perceived pain and subsequent sympathetic and cardiovascular responses in humans during an experimental noxious stimulus. Twenty-nine participants (14F/15M; 29±6 y; 26±4 kg•m-2, mean ± SD) completed this randomized, crossover, placebo-controlled trial during two laboratory visits. During each visit, participants completed a cold pressor test (CPT; hand in ~0.4 °C ice bath for two minutes) before and ~35 minutes after drug/placebo administration (5 mg IV morphine or saline). We compared pain perception (100 mm visual analog scale), muscle sympathetic nerve activity (MSNA; microneurography; 14 paired recordings), and beat-to-beat blood pressure (BP; photoplethysmography) between trials (at both pre- and post-drug/placebo time points) using paired, two-tailed t-tests. Before drug/placebo infusion, perceived pain (p=0.92), Δ MSNA burst frequency (n=14, p=0.21), and Δ mean BP (p=0.39) during the CPT were not different between trials. After the drug/placebo infusion, morphine versus placebo attenuated perceived pain (morphine: 43±20 vs. placebo: 57±24 mm,p<0.001) and Δ mean BP (morphine: 10±7 vs. placebo: 13±8 mmHg,p=0.003), but not Δ MSNA burst frequency (morphine: 10±11 vs. placebo: 13±11 bursts/minute,p=0.12), during the CPT. Reductions in pain perception and Δ mean BP were only weakly related (r=0.34,p=0.07; post-morphine CPT minus post-placebo CPT). These data provide valuable information regarding how low-dose morphine affects autonomic cardiovascular responses during an experimental painful stimulus.
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Affiliation(s)
- Joseph C Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Frank A Cimino Iii
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Bonnie D Orth
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Joseph M Hendrix
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Elias Johnson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | | | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, United States
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21
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Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Jaffery MF, Balmain BN, Wilhite DP, Babb TG, Crandall CG. Adults with well-healed burn injuries have lower pulmonary function values decades after injury. Physiol Rep 2022; 10:e15264. [PMID: 35581737 PMCID: PMC9114657 DOI: 10.14814/phy2.15264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023] Open
Abstract
Sub-acute (e.g., inhalation injury) and/or acute insults sustained during a severe burn injury impairs pulmonary function. However, previous work has not fully characterized pulmonary function in adults with well-healed burn injuries decades after an injury. Therefore, we tested the hypothesis that adults with well-healed burn injuries have lower pulmonary function years after recovery. Our cohort of adults with well-healed burn-injuries (n = 41) had a lower forced expiratory volume in one second (Burn: 93 ± 16 vs. Control: 103 ± 10%predicted, mean ± SD; d = 0.60, p = 0.04), lower maximal voluntary ventilation (Burn: 84 [71-97] vs. Control: 105 [94-122] %predicted, median [IQR]; d = 0.84, p < 0.01), and a higher specific airway resistance (Burn: 235 ± 80 vs. Control: 179 ± 40%predicted, mean ± SD; d = 0.66, p = 0.02) than non-burned control participants (n = 12). No variables were meaningfully influenced by having a previous inhalation injury (d ≤ 0.44, p ≥ 0.19; 13 of 41 had an inhalation injury), the size of the body surface area burned (R2 ≤ 0.06, p ≥ 0.15; range of 15%-88% body surface area burned), or the time since the burn injury (R2 ≤ 0.04, p ≥ 0.22; range of 2-50 years post-injury). These data suggest that adults with well-healed burn injuries have lower pulmonary function decades after injury. Therefore, future research should examine rehabilitation strategies that could improve pulmonary function among adults with well-healed burn injuries.
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Affiliation(s)
- Joseph C. Watso
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- Department of Applied Clinical ResearchSchool of Health ProfessionsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Steven A. Romero
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- Department of Physiology & AnatomyUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Gilbert Moralez
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- Department of Applied Clinical ResearchSchool of Health ProfessionsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Mu Huang
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- Department of Applied Clinical ResearchSchool of Health ProfessionsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Matthew N. Cramer
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Manall F. Jaffery
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Bryce N. Balmain
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Daniel P. Wilhite
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Tony G. Babb
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Craig G. Crandall
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
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22
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Găină MA, Szalontay AS, Ștefănescu G, Bălan GG, Ghiciuc CM, Boloș A, Găină AM, Ștefănescu C. State-of-the-Art Review on Immersive Virtual Reality Interventions for Colonoscopy-Induced Anxiety and Pain. J Clin Med 2022; 11:jcm11061670. [PMID: 35329993 PMCID: PMC8949336 DOI: 10.3390/jcm11061670] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colonoscopy related fear impairs the current gold standard screening of colorectal cancer. Compared to other minimally invasive procedures for cancer screening, colonoscopy-induced anxiety exceeds the procedure through bowel preparation. Immersive virtual reality's (iVR) role in alleviating the complex stress-pain relationship encountered during medical procedures is directly proportional to the rising affordability of state-of-the-art Head-Mounted-Displays (HMDs). OBJECTIVE to assess the effect of iVR on patients' colonoscopy-induced anxiety and pain. MATERIALS AND METHODS A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase and Scopus databases up to January 2022. Clinical trials evaluating anxiety as an outcome were included without language restriction. RESULTS Four clinical trials were included: three on the patients' intraprocedural anxiety and one on patient education. Intraprocedural iVR interventions for colonoscopy-induced anxiety and pain revealed a similar effect as conventional sedation, while a statistically significant reduction was reported for non-sedated patients. iVR patient education improved the quality of bowel preparation and reduced patient anxiety before colonoscopy. CONCLUSIONS The current research highlights the need to use high-end HMDs and appropriate interactive iVR software content for colonoscopy-induced anxiety. Methodological frameworks regarding the eligibility of participants, double-blinding and randomization of iVR studies can facilitate the development of iVR implementation for anxiety and pain management.
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Affiliation(s)
- Marcel-Alexandru Găină
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
- Correspondence:
| | - Andreea Silvana Szalontay
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Gabriela Ștefănescu
- Medical Semiology and Gastroenterology, Department of Medicine I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (G.Ș.); (G.G.B.)
- 2nd Gastroenterology Ward, Saint “Spiridon” County Hospital, Independence Bvd. No 1, 700111 Iasi, Romania
| | - Gheorghe Gh Bălan
- Medical Semiology and Gastroenterology, Department of Medicine I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (G.Ș.); (G.G.B.)
- 2nd Gastroenterology Ward, Saint “Spiridon” County Hospital, Independence Bvd. No 1, 700111 Iasi, Romania
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Department of Morpho-Functional Sciences II, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Alexandra Boloș
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Alexandra-Maria Găină
- 1st Neurology Ward, Hospital of Neurosurgery “Prof. Dr. Nicolae Oblu” Iasi, 2 Ateneului Street, 700309 Iasi, Romania;
| | - Cristinel Ștefănescu
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
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23
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Watso JC, Huang M, Belval LN, Cimino FA, Jarrard CP, Hendrix JM, Hinojosa-Laborde C, Crandall CG. Low-dose fentanyl reduces pain perception, muscle sympathetic nerve activity responses, and blood pressure responses during the cold pressor test. Am J Physiol Regul Integr Comp Physiol 2022; 322:R64-R76. [PMID: 34851729 PMCID: PMC8742733 DOI: 10.1152/ajpregu.00218.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our knowledge about how low-dose (analgesic) fentanyl affects autonomic cardiovascular regulation is primarily limited to animal experiments. Notably, it is unknown if low-dose fentanyl influences human autonomic cardiovascular responses during painful stimuli in humans. Therefore, we tested the hypothesis that low-dose fentanyl reduces perceived pain and subsequent sympathetic and cardiovascular responses in humans during an experimental noxious stimulus. Twenty-three adults (10 females/13 males; 27 ± 7 yr; 26 ± 3 kg·m-2, means ± SD) completed this randomized, crossover, placebo-controlled trial during two laboratory visits. During each visit, participants completed a cold pressor test (CPT; hand in ∼0.4°C ice bath for 2 min) before and 5 min after drug/placebo administration (75 μg fentanyl or saline). We compared pain perception (100-mm visual analog scale), muscle sympathetic nerve activity (MSNA; microneurography, 11 paired recordings), and beat-to-beat blood pressure (BP; photoplethysmography) between trials (at both pre- and postdrug/placebo timepoints) using paired, two-tailed t tests. Before drug/placebo administration, perceived pain (P = 0.8287), ΔMSNA burst frequency (P = 0.7587), and Δmean BP (P = 0.8649) during the CPT were not different between trials. After the drug/placebo administration, fentanyl attenuated perceived pain (36 vs. 66 mm, P < 0.0001), ΔMSNA burst frequency (9 vs. 17 bursts/min, P = 0.0054), and Δmean BP (7 vs. 13 mmHg, P = 0.0174) during the CPT compared with placebo. Fentanyl-induced reductions in pain perception and Δmean BP were moderately related (r = 0.40, P = 0.0641). These data provide valuable information regarding how low-dose fentanyl reduces autonomic cardiovascular responses during an experimental painful stimulus.
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Affiliation(s)
- Joseph C. Watso
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,3Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luke N. Belval
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Frank A. Cimino
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Caitlin P. Jarrard
- 3Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph M. Hendrix
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,4Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carmen Hinojosa-Laborde
- 5United States Army Institute of Surgical Research, Joint
Base San Antonio, San Antonio, Texas
| | - Craig G. Crandall
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas,3Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
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24
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Kelley RC, Betancourt L, Noriega AM, Brinson SC, Curbelo-Bermudez N, Hahn D, Kumar RA, Balazic E, Muscato DR, Ryan TE, van der Pijl RJ, Shen S, Ottenheijm CAC, Ferreira LF. Skeletal myopathy in a rat model of postmenopausal heart failure with preserved ejection fraction. J Appl Physiol (1985) 2022; 132:106-125. [PMID: 34792407 PMCID: PMC8742741 DOI: 10.1152/japplphysiol.00170.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for ∼50% of all patients with heart failure and frequently affects postmenopausal women. The HFpEF condition is phenotype-specific, with skeletal myopathy that is crucial for disease development and progression. However, most of the current preclinical models of HFpEF have not addressed the postmenopausal phenotype. We sought to advance a rodent model of postmenopausal HFpEF and examine skeletal muscle abnormalities therein. Female, ovariectomized, spontaneously hypertensive rats (SHRs) were fed a high-fat, high-sucrose diet to induce HFpEF. Controls were female sham-operated Wistar-Kyoto rats on a lean diet. In a complementary, longer-term cohort, controls were female sham-operated SHRs on a lean diet to evaluate the effect of strain difference in the model. Our model developed key features of HFpEF that included increased body weight, glucose intolerance, hypertension, cardiac hypertrophy, diastolic dysfunction, exercise intolerance, and elevated plasma cytokines. In limb skeletal muscle, HFpEF decreased specific force by 15%-30% (P < 0.05) and maximal mitochondrial respiration by 40%-55% (P < 0.05), increased oxidized glutathione by approximately twofold (P < 0.05), and tended to increase mitochondrial H2O2 emission (P = 0.10). Muscle fiber cross-sectional area, markers of mitochondrial content, and indices of capillarity were not different between control and HFpEF in our short-term cohort. Overall, our preclinical model of postmenopausal HFpEF recapitulates several key features of the disease. This new model reveals contractile and mitochondrial dysfunction and redox imbalance that are potential contributors to abnormal metabolism, exercise intolerance, and diminished quality of life in patients with postmenopausal HFpEF.NEW & NOTEWORTHY Heart failure with preserved ejection fraction (HFpEF) is a condition with phenotype-specific features highly prevalent in postmenopausal women and skeletal myopathy contributing to disease development and progression. We advanced a rat model of postmenopausal HFpEF with key cardiovascular and systemic features of the disease. Our study shows that the skeletal myopathy of postmenopausal HFpEF includes loss of limb muscle-specific force independent of atrophy, mitochondrial dysfunction, and oxidized shift in redox balance.
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Affiliation(s)
- Rachel C Kelley
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Lauren Betancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Andrea M Noriega
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Suzanne C Brinson
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Nuria Curbelo-Bermudez
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Dongwoo Hahn
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Ravi A Kumar
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Eliza Balazic
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Derek R Muscato
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Terence E Ryan
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Robbert J van der Pijl
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
- Department of Physiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Shengyi Shen
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
| | - Coen A C Ottenheijm
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
- Department of Physiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leonardo F Ferreira
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
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25
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Rosenberg AJ, Kay VL, Anderson GK, Luu ML, Barnes HJ, Sprick JD, Rickards CA. The impact of acute central hypovolemia on cerebral hemodynamics: does sex matter? J Appl Physiol (1985) 2021; 130:1786-1797. [PMID: 33914663 DOI: 10.1152/japplphysiol.00499.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Trauma-induced hemorrhage is a leading cause of disability and death due, in part, to impaired perfusion and oxygenation of the brain. It is unknown if cerebrovascular responses to blood loss are differentiated based on sex. We hypothesized that compared to males, females would have reduced tolerance to simulated hemorrhage induced by maximal lower body negative pressure (LBNP), and this would be associated with an earlier reduction in cerebral blood flow and cerebral oxygenation. Healthy young males (n = 29, 26 ± 4 yr) and females (n = 23, 27 ± 5 yr) completed a step-wise LBNP protocol to presyncope. Mean arterial pressure (MAP), stroke volume (SV), middle cerebral artery velocity (MCAv), end-tidal CO2 (etCO2), and cerebral oxygen saturation (ScO2) were measured continuously. Unexpectedly, tolerance to LBNP was similar between the sexes (males, 1,604 ± 68 s vs. females, 1,453 ± 78 s; P = 0.15). Accordingly, decreases (%Δ) in MAP, SV, MCAv, and ScO2 were similar between males and females throughout LBNP and at presyncope (P ≥ 0.20). Interestingly, although decreases in etCO2 were similar between the sexes throughout LBNP (P = 0.16), at presyncope, the %Δ etCO2 from baseline was greater in males compared to females (-30.8 ± 2.6% vs. -21.3 ± 3.0%; P = 0.02). Contrary to our hypothesis, sex does not influence tolerance, or the central or cerebral hemodynamic responses to simulated hemorrhage. However, the etCO2 responses at presyncope do suggest potential sex differences in cerebral vascular sensitivity to CO2 during central hypovolemia.NEW & NOTEWORTHY Tolerance and cerebral blood velocity responses to simulated hemorrhage (elicited by lower body negative pressure) were similar between male and female subjects. Interestingly, the change in etCO2 from baseline was greater in males compared to females at presyncope, suggesting potential sex differences in cerebral vascular sensitivity to CO2 during simulated hemorrhage. These findings may facilitate development of individualized therapeutic interventions to improve survival from hemorrhagic injuries in both men and women.
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Affiliation(s)
- Alexander J Rosenberg
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas.,Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, University of Illinois at Chicago, Illinois
| | - Victoria L Kay
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Garen K Anderson
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - My-Loan Luu
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Haley J Barnes
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Justin D Sprick
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas.,Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Caroline A Rickards
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
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Time Course of Neuromuscular, Hormonal, and Perceptual Responses Following Moderate- and High-Load Resistance Priming Exercise. Int J Sports Physiol Perform 2021; 16:1472-1482. [PMID: 33761461 DOI: 10.1123/ijspp.2020-0646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/14/2020] [Accepted: 11/07/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to map responses over 32 hours following high-load (HL) and moderate-load (ML) half-squat priming. METHODS Fifteen participants completed control, HL (87% 1RM), and ML (65% 1RM) activities in randomized, counterbalanced order. Countermovement jump (CMJ), squat jump (SJ), saliva testosterone, saliva cortisol, and perceptual measures were assessed before and 5 minutes, 8 hours, 24 hours, and 32 hours after each activity. Results are presented as percentage change from baseline and 95% confidence interval (CI). Cliff delta was used to determine threshold for group changes. RESULTS SJ height increased by 4.5% (CI = 2.2-6.8, Cliff delta = 0.20) 8 hours following HL. CMJ and SJ improved by 6.1% (CI = 2.1-7.8, Cliff delta = 0.27) and 6.5% (CI = 1.2-11.8, Cliff delta = 0.30), respectively, 32 hours after ML. No clear diurnal changes in CMJ or SJ occurred 8 hours following control; however, increases of 3.9% (CI = 2.9-9.2, Cliff delta = 0.26) and 4.5% (CI = 0.9-8.1, Cliff delta = 0.24), respectively, were observed after 32 hours. Although diurnal changes in saliva hormone concentration occurred (Cliff delta = 0.37-0.92), the influence of priming was unclear. Perceived "physical feeling" was greater 8 hours following HL (Cliff delta = 0.36) and 32 hours after ML and control (Cliff delta = 0.17-0.34). CONCLUSIONS HL priming in the morning may result in small improvements in jump output and psychophysiological state in the afternoon. Similar improvements were observed in the afternoon the day after ML priming.
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King M, Ball D, Weston M, McCunn R, Gibson N. Initial fitness, maturity status, and total training explain small and inconsistent proportions of the variance in physical development of adolescent footballers across one season. Res Sports Med 2021; 30:283-294. [PMID: 33650436 DOI: 10.1080/15438627.2021.1888106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To investigate how initial fitness, maturity status, and training time explain changes in physical performance across one season. Eighty-eight adolescent male footballers, representing four age categories (Under 15 [n = 12], Under 14 [n = 21], Under 13 [n = 25], Under 12 [n = 30]), were tested using physical performance tests (20 m sprint, change of direction, squat jump and yo-yo intermittent recovery test level 1 [YYIRTL1]) and maturity offset at the season start (Test 1) and end (Test 2). Multiple regression determined the proportion of variance in test score changes, explained by three predictor variables: initial fitness (i.e., Test 1), maturity offset change, and training time. With combined categories, predictor variables explained 0.051 to 0.297 of the variance in physical performance score changes. Analysing age categories separately, predictor variables explained 0.047 to 0.407 (20 m sprint), 0.202 to 0.626 (change of direction), 0.336 to 0.502 (squat jump), and 0.196 to 0.777 (YYIRTL1) of variance in test score changes. Of the limited differences in relative predictor contribution, Test 1 was the strongest predictor of test score change. Initial fitness, maturity status change, and training time explain small and inconsistent proportions of variance in adolescent footballers' physical development across one season.
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Affiliation(s)
- Michael King
- School of Health and Life Sciences, The University of the West of Scotland, Glasgow, UK.,Oriam:Scotland's Sports Performance Centre, Heriot-Watt University, Edinburgh, UK
| | - Derek Ball
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Matthew Weston
- School of Health and Life Sciences, Teeside University, Middlesbrough, UK
| | - Robert McCunn
- Oriam:Scotland's Sports Performance Centre, Heriot-Watt University, Edinburgh, UK
| | - Neil Gibson
- City architect and transformational design, Blacktown City Council, Sydney
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Rosenberg AJ, Kay VL, Anderson GK, Sprick JD, Rickards CA. A comparison of protocols for simulating hemorrhage in humans: step versus ramp lower body negative pressure. J Appl Physiol (1985) 2021; 130:380-389. [PMID: 33211600 DOI: 10.1152/japplphysiol.00230.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lower body negative pressure (LBNP) elicits central hypovolemia, and it has been used to simulate the cardiovascular and cerebrovascular responses to hemorrhage in humans. LBNP protocols commonly use progressive stepwise reductions in chamber pressure for specific time periods. However, continuous ramp LBNP protocols have also been utilized to simulate the continuous nature of most bleeding injuries. The aim of this study was to compare tolerance and hemodynamic responses between these two LBNP profiles. Healthy human subjects (N = 19; age, 27 ± 4 y; 7 female/12 male) completed a 1) step LBNP protocol (5-min steps) and 2) continuous ramp LBNP protocol (3 mmHg/min), both to presyncope. Heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), middle and posterior cerebral artery velocity (MCAv and PCAv), cerebral oxygen saturation (ScO2), and end-tidal CO2 (etCO2) were measured. LBNP tolerance, via the cumulative stress index (CSI, summation of chamber pressure × time at each pressure), and hemodynamic responses were compared between the two protocols. The CSI (step: 911 ± 97 mmHg/min vs. ramp: 823 ± 83 mmHg/min; P = 0.12) and the magnitude of central hypovolemia (%Δ SV, step: -54.6% ± 2.6% vs. ramp: -52.1% ± 2.8%; P = 0.32) were similar between protocols. Although there were no differences between protocols for the maximal %Δ HR (P = 0.88), the %Δ MAP during the step protocol was attenuated (P = 0.05), and the reductions in MCAv, PCAv, ScO2, and etCO2 were greater (P ≤ 0.08) when compared with the ramp protocol at presyncope. These results indicate that when comparing cardiovascular responses to LBNP across different laboratories, the specific pressure profile must be considered as a potential confounding factor.NEW & NOTEWORTHY Ramp lower body negative pressure (LBNP) protocols have been utilized to simulate the continuous nature of bleeding injuries. However, it unknown if tolerance or the physiological responses to ramp LBNP are similar to the more common stepwise LBNP protocol. We report similar tolerance between the two protocols, but the step protocol elicited a greater increase in cerebral oxygen extraction in the presence of reduced blood flow, presumably facilitating the matching of metabolic supply and demand.
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Affiliation(s)
- Alexander J Rosenberg
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Victoria L Kay
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Garen K Anderson
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Justin D Sprick
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas.,Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Caroline A Rickards
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
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Kumar RA, Kelley RC, Hahn D, Ferreira LF. Dietary nitrate supplementation increases diaphragm peak power in old mice. J Physiol 2021; 598:4357-4369. [PMID: 33460123 DOI: 10.1113/jp280027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/14/2020] [Indexed: 02/01/2023] Open
Abstract
KEY POINTS Respiratory muscle function declines with ageing, contributing to breathing complications in the elderly. Here we report greater in vitro respiratory muscle contractile function in old mice receiving supplemental NaNO3 for 14 days compared with age-matched controls. Myofibrillar protein phosphorylation, which enhances contractile function, did not change in our study - a finding inconsistent with the hypothesis that this post-translational modification is a mechanism for dietary nitrate to improve muscle contractile function. Nitrate supplementation did not change the abundance of calcium-handling proteins in the diaphragm of old mice, in contrast with findings from the limb muscles of young mice in previous studies. Our findings suggest that nitrate supplementation enhances myofibrillar protein function without affecting the phosphorylation status of key myofibrillar proteins. ABSTRACT Inspiratory muscle (diaphragm) function declines with age, contributing to ventilatory dysfunction, impaired airway clearance, and overall decreased quality of life. Diaphragm isotonic and isometric contractile properties are reduced with ageing, including maximal specific force, shortening velocity and peak power. Contractile properties of limb muscle in both humans and rodents can be improved by dietary nitrate supplementation, but effects on the diaphragm and mechanisms behind these improvements remain poorly understood. One potential explanation underlying the nitrate effects on contractile properties is increased phosphorylation of myofibrillar proteins, a downstream outcome of nitrate reduction to nitrite and nitric oxide. We hypothesized that dietary nitrate supplementation would improve diaphragm contractile properties in aged mice. To test our hypothesis, we measured the diaphragm function of old (24 months) mice allocated to 1 mm NaNO3 in drinking water for 14 days (n = 8) or untreated water (n = 6). The maximal rate of isometric force development (∼30%) and peak power (40%) increased with nitrate supplementation (P < 0.05). There were no differences in the phosphorylation status of key myofibrillar proteins and abundance of Ca2+-release proteins in nitrate vs. control animals. In general, our study demonstrates improved diaphragm contractile function with dietary nitrate supplementation and supports the use of this strategy to improve inspiratory function in ageing populations. Additionally, our findings suggest that dietary nitrate improves diaphragm contractile properties independent of changes in abundance of Ca2+-release proteins or phosphorylation of myofibrillar proteins.
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Affiliation(s)
- Ravi A Kumar
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Rachel C Kelley
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Dongwoo Hahn
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Leonardo F Ferreira
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
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30
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Koretz RL. The Nuts and Bolts of Critically Appraising Observational and Randomized Controlled Studies. Nutr Clin Pract 2021; 36:549-559. [PMID: 33395501 DOI: 10.1002/ncp.10620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/21/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ronald L Koretz
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
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