63 Effect of 100-km ultramarathon on N-terminal pro-B-type natriuretic peptide variation

Introduction

The change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels follows strenuous endurance exercise-imposed paradox. Our previous reports showed significant body weight (BW) loss with dehydration was common in ultramarathon runners. The aim of this study is to investigate whether the dehydration and renin-angiotensin-aldosterone system activation possibly contribute to exercise-induced NT-proBNP release.

Methods

Twenty-six participants who finished a 100-km ultramarathon in Taiwan were enrolled. For each participant, blood samples and spot urine samples were collected one week before the race, as well as immediately and 24 hours after the finish. Body weight change was recorded to monitor the hydration status.

Results

Prolonged endurance exercise led to a substantial increase in NT-pro-BNP. Compared to pre-race values, NT-pro-BNP levels significantly increased immediately after the race (24.3 ± 20.2 to 402.9 ± 305.9 pg/mL, p < 0.05) and maintained the lasting high levels till 24 hours after the race finished (143.7 ± 126.1 pg/mL, p < 0.05). The fractional excretion of sodium values were all below 1% in three different time points. The 100-km ultramarathon resulted in significant BW loss, and elevated of renin and aldosterone levels. However, only 24 hours after the race, there was a positive significantly relationship between NT-proBNP and aldosterone levels, but negative significantly relationship between NT-proBNP and BW increase during the recovery phase.

Conclusions

Results of this study showed the mechanism of NT-proBNP release immediate following the race were multifaceted. However, during the recovery phase, rehydration might lead to the decrease of NT-proBNP in the volume depletion state.

Towards early inclusion of children in tuberculosis drugs trials: a consensus statement

Children younger than 18 years account for a substantial proportion of patients with tuberculosis worldwide. Available treatments for paediatric drug-susceptible and drug-resistant tuberculosis, albeit generally effective, are hampered by high pill burden, long duration of treatment, coexistent toxic effects, and an overall scarcity of suitable child-friendly formulations. Several new drugs and regimens with promising activity against both drug-susceptible and drug-resistant strains have entered clinical development and are either in various phases of clinical investigation or have received marketing authorisation for adults; however, none have data on their use in children. This consensus statement, generated from an international panel of opinion leaders on childhood tuberculosis and incorporating reviews of published literature from January, 2004, to May, 2014, addressed four key questions: what drugs or regimens should be prioritised for clinical trials in children? Which populations of children are high priorities for study? When can phase 1 or 2 studies be initiated in children? What are the relevant elements of clinical trial design? The consensus panel found that children can be included in studies at the early phases of drug development and should be an integral part of the clinical development plan, rather than studied after regulatory approval in adults is obtained.