1
|
'Unable to have a proper conversation over the phone about my concerns': a multimethods evaluation of the impact of COVID-19 on routine childhood vaccination services in London, UK. Public Health 2023; 225:229-236. [PMID: 37944278 DOI: 10.1016/j.puhe.2023.09.026] [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] [Received: 02/20/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Investigating the completion rate of 12-month vaccinations and parental perspectives on vaccine services during COVID-19. STUDY-DESIGN Service evaluation including parental questionnaire. METHODS Uptake of 12-month vaccinations in three London general practices during three periods: pre-COVID (1/3/2018-28/2/2019, n = 826), during COVID (1/3/2019-28/2/2020, n = 775) and post-COVID first wave (1/8/2020-31/1/2021, n = 419). Questionnaire of parents whose children were registered at the practices (1/4/2019-1/22/2021, n = 1350). RESULTS Comparing pre-COVID and both COVID cohorts, the completion rates of 12-month vaccines were lower. Haemophilus influenzae type B/meningococcal group C (Hib/MenC) vaccination uptake was 5.6% lower (89.0% vs 83.4%, P=<0.001), meningococcal group B (MenB) booster uptake was 4.4% lower (87.3% vs 82.9%, P = 0.006), pneumococcal conjugate vaccine (PCV) booster uptake was 6% lower (88.0% vs 82.0%, P < 0.001) and measles, mumps and rubella (MMR) vaccine uptake was 5.2% lower (89.1% vs 83.9%, P = 0.003). Black/Black-British ethnicity children had increased odds of missing their 12-month vaccinations compared to White ethnicity children (adjusted odds ratio 0.43 [95% confidence interval 0.24-0.79, P = 0.005; 0.36 [0.20-0.65], P < 0.001; 0.48 [0.27-0.87], P = 0.01; 0.40 [0.22-0.73], P = 0.002; for Hib/MenC, MenB booster, PCV booster and MMR. Comparing pre-COVID and COVID periods, vaccinations coded as not booked increased for MMR (10%), MenB (7%) and PCV booster (8%). Parents reported changes to vaccination services during COVID-19, including difficulties booking and attending appointments and lack of vaccination reminders. CONCLUSION A sustained decrease in 12-month childhood vaccination uptake disproportionally affected Black/Black British ethnicity infants during the first wave of the pandemic. Vaccination reminders and availability of healthcare professionals to discuss parental vaccine queries are vital to maintaining uptake.
Collapse
|
2
|
Making a move in exercise referral: co-development of a physical activity referral scheme. J Public Health (Oxf) 2018; 40:e586-e593. [DOI: 10.1093/pubmed/fdy072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/09/2018] [Indexed: 11/12/2022] Open
|
3
|
Acute cardiovascular responses to resistance exercise in anabolic steroids users: A preliminary investigation. Sci Sports 2018. [DOI: 10.1016/j.scispo.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
4
|
Use of Plasma with High Levels of lonised Calcium in the Production of Model Scale Goagulation Factor Concentrates. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe have attempted to exploit the Ca2+ -dependent stability of factor VIII in producing factor VIII concentrates of higher yield. Plasma levels of ionised calcium were increased in two ways: (a) whole blood collection into half-strength citrate CPD anticoagulant, leading to free Ca2+ levels of ca 120 µM and (b) apheresis collection of plasma which was then recalcified to free Ca2+ levels
of ca 300 µM under heparin cover. Coagulation factor concentrates were prepared using model versions of our industrial scale manufacturing methods. Factor VIII yield was increased through low citrate collection. This did not compromise factor IX yield or thrombogenic potential. Use of recalcified heparinised plasma did not lead to any improvement in factor VIII yield and resulted in a marked drop in factor IX recovery, possibly from interference by
heparin of factor IX binding in ion-exchange chromatography. The benefits accruable through the use of half-strength citrate CPD anticoagulant support the continued evaluation of this preservative in large scale blood collection and fractionation. The deleterious effects of heparin in charge-mediated plasma fractionations may pose serious difficulties in harvesting vitamin K dependent factors.
Collapse
|
5
|
The Effect of 400 µg Inhaled Salbutamol on 3 km Time Trial Performance in a Low Humidity Environment. J Sports Sci Med 2017; 16:581-588. [PMID: 29238260 PMCID: PMC5721190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Abstract
The Objectives of the study were to investigate whether 400 µg inhaled salbutamol influences 3 km running time-trial performance and lung function in eucapnic voluntary hyperpnoea positive (EVH+ve) and negative (EVH-ve) individuals. Fourteen male participants (22.4 ± 1.6yrs; 76.4 ± 8.7kg; 1.80 ± 0.07 m); (7 EVH+ve; 7 EVH-ve) were recruited following written informed consent. All participants undertook an EVH challenge to identify either EVH+ve (↓FEV1>10%) or EVH-ve (↓FEV1<10%). Participants performed three separate 3 km running time-trials in a low-humidity (20-25%) environment on a non-motorized treadmill, 15 minutes following inhalation of salbutamol (400 µg), placebo (non-active inhalant) or control (no inhalant), in a randomized, single-blind, repeated measures design. Forced vital capacity maneuvers were performed at baseline, 10 minutes post inhalation and post time-trial. Time to complete 3 km and lung function data were analyzed using mixed model repeated measures ANOVA. Significance was assumed at p < 0.05. All EVH+ve participants had FEV1 falls from baseline between 10-25% post-challenge. There was no difference in performance time between trial conditions in EVH+ve (1012.7 ± 129.6s; 1002.4 ± 123.1s; 1015.9 ± 113.0s) (p = 0.774) and EVH-ve (962.1 ± 99.2s; 962.0 ± 76.2s; 950.8 ± 84.9s) (p = 0.401) groups for salbutamol, placebo and control trials, respectively. Exercising heart rate was significantly higher (p = 0.05) in the salbutamol trial (183 ± 8 beatsˑmin-1) compared to control (180 ± 9 beatsˑmin-1) with a trend towards significance (p=0.06) in the placebo trial (179 ± 9 beatsˑmin-1) for the pooled groups, no differences were seen between trials in groups individually. There was an increase in FEV1 in both EVH+ve (4.01 ± 0.8L; 4.26 ± 0.7L; 4.25 ± 0.5L) and EVH-ve (4.81 ± 0.4L; 5.1 ± 0.4L; 5.1 ± 0.5L) groups which was significant post-inhalation (p = 0.01; p = 0.02), but not post-time-trial (p = 0.27; p = 0.06), respectively, following salbutamol. EVH+ve participants did not demonstrate significant falls (>10% from baseline) in FEV1 following any time-trial. Administration of 400µg inhaled salbutamol does not improve 3 km time-trial performance in either mild EVH+ve or EVH-ve individuals despite significantly increased HR and FEV1.
Collapse
|
6
|
Image-based closed-loop feedback for highly mono-dispersed microdroplet production. Sci Rep 2017; 7:10545. [PMID: 28874820 PMCID: PMC5585215 DOI: 10.1038/s41598-017-11254-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/21/2017] [Indexed: 11/19/2022] Open
Abstract
Micron-scale droplets isolated by an immiscible liquid can provide miniaturised reaction vessels which can be manipulated in microfluidic networks, and has seen a rapid growth in development. In many experiments, the precise volume of these microdroplets is a critical parameter which can be influenced by many external factors. In this work, we demonstrate the combination of imaging-based feedback and pressure driven pumping to accurately control the size of microdroplets produced in a microfluidic device. The use of fast-response, pressure-driving pumps allows the microfluidic flow to be quickly and accurately changed, while directly measuring the droplet size allows the user to define the more meaningful parameters of droplet size and generation frequency rather than flow rates or pressures. The feedback loop enables the drift correction of pressure based pumps, and leads to a large increase in the mono-dispersity of the droplets produced over long periods. We also show how this can be extended to control multiple liquid flows, allowing the frequency of droplet formation or the average concentration of living cells per droplet to be controlled and kept constant.
Collapse
|
7
|
The practical use of surface electromyography during running: does the evidence support the hype? A narrative review. BMJ Open Sport Exerc Med 2016; 1:e000026. [PMID: 27900124 PMCID: PMC5117013 DOI: 10.1136/bmjsem-2015-000026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2015] [Indexed: 11/07/2022] Open
Abstract
Background/aims Surface electromyography (sEMG) is a commonly used technique to investigate muscle activation and fatigue, which is non-invasive and can allow for continuous measurement. Systematic research on the use of sEMG in the sporting environment has been on-going for many years and predominantly based on cycling and rowing activities. To date there have been no reviews assessing the validity and reliability in sEMG exclusively in running activities specifically during on-field testing. The purpose of this review is to evaluate the use of sEMG in the practical context and whether this be translated to on-field testing. Methods Electronic literature searches were performed using the Cochrane Library, PUBMED, CINAHL and PeDro without restrictions on the study date to identify the relevant current English language literature. Results 10 studies were relevant after title and content review. All the studies identified were all level three evidence based. The general trends of the sEMG activity appear to correlate with running velocity and muscle fatigue seems almost always the consequence of prolonged, dynamic activity. However, these changes are not consistently measured or statistically significant throughout the studies raising the question of the accuracy and reliability when analysing sEMG measurements and making assumptions about the cause of fatigue. Conclusions An agreed consensus when measuring and analysing sEMG data during running activities particularly in field testing with the most appropriate study design and reliable methodology is yet to be determined and further studies are required.
Collapse
|
8
|
High-throughput screening of antibiotic-resistant bacteria in picodroplets. LAB ON A CHIP 2016; 16:1636-43. [PMID: 27033300 DOI: 10.1039/c6lc00180g] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The prevalence of clinically-relevant bacterial strains resistant to current antibiotic therapies is increasing and has been recognized as a major health threat. For example, multidrug-resistant tuberculosis and methicillin-resistant Staphylococcus aureus are of global concern. Novel methodologies are needed to identify new targets or novel compounds unaffected by pre-existing resistance mechanisms. Recently, water-in-oil picodroplets have been used as an alternative to conventional high-throughput methods, especially for phenotypic screening. Here we demonstrate a novel microfluidic-based picodroplet platform which enables high-throughput assessment and isolation of antibiotic-resistant bacteria in a label-free manner. As a proof-of-concept, the system was used to isolate fusidic acid-resistant mutants and estimate the frequency of resistance among a population of Escherichia coli (strain HS151). This approach can be used for rapid screening of rare antibiotic-resistant mutants to help identify novel compound/target pairs.
Collapse
|
9
|
T6 Impact Of Environmental Differences In The Prevalence Of Airway Dysfunction In Elite Athletes: Gb Boxing Vs. Gb Swimming. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
10
|
P753A comprehensive technical assessment of the Athlete's Heart: "The Morganroth Hypothesis" re-visited. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Abstract
A cell is a complex material whose mechanical properties are essential for its normal functions. Heating can have a dramatic effect on these mechanical properties, similar to its impact on the dynamics of artificial polymer networks. We investigated such mechanical changes by the use of a microfluidic optical stretcher, which allowed us to probe cell mechanics when the cells were subjected to different heating conditions at different time scales. We find that HL60/S4 myeloid precursor cells become mechanically more compliant and fluid-like when subjected to either a sudden laser-induced temperature increase or prolonged exposure to higher ambient temperature. Above a critical temperature of 52 ± 1°C, we observed active cell contraction, which was strongly correlated with calcium influx through temperature-sensitive transient receptor potential vanilloid 2 (TRPV2) ion channels, followed by a subsequent expansion in cell volume. The change from passive to active cellular response can be effectively described by a mechanical model incorporating both active stress and viscoelastic components. Our work highlights the role of TRPV2 in regulating the thermomechanical response of cells. It also offers insights into how cortical tension and osmotic pressure govern cell mechanics and regulate cell-shape changes in response to heat and mechanical stress.
Collapse
|
12
|
Moderated Posters session * Insights into the use of contrast stress echocardiography and 3D strain: 14/12/2013, 08:30-12:30 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
13
|
Prevalence of bronchoconstriction induced by eucapnic voluntary hyperpnoea in recreationally active individuals. J Asthma 2013; 51:44-50. [PMID: 23987567 DOI: 10.3109/02770903.2013.838256] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Exercise-induced bronchoconstriction (EIB) is more prevalent in elite athletes than in the general population. Many of these athletes provide a positive eucapnic voluntary hyperpnoea (EVH) challenge without previous diagnosis of EIB. It is unknown whether this is specific to elite athletes or whether the same risk applies to recreationally active individuals. The purpose of this study was to investigate the prevalence of a positive EVH challenge in a population of recreationally active individuals. METHODS 136 recreationally active individuals (Age: 21.9 ± 3.7 years; Height: 175 ± 9 cm; Weight: 70.9 ± 10.0 kg) without previous history of asthma or EIB, volunteered to take part in the study. All participants completed an EVH challenge, which was deemed positive if FEV1 fell ≥10% from baseline at two consecutive time points, and was reversible following inhalation of a short acting β2-agonist. RESULTS 18 of 136 (13.2%) participants had a positive EVH challenge. Of the 18 individuals, the fall in FEV1 from baseline ranged from -12% to -50%. At baseline, percentage predicted FEV1 (97.5 ± 12.5% versus 104.9 ± 10%; p < 0.01), FEV1/FVC ratio (79.5 ± 6.9% versus 87.8 ± 5.5%; p < 0.01), FEF25-75 (3.73 ± 1.00 versus 4.73 ± 1.00 l/s; p < 0.01) and predicted PEF (89.4 ± 8.8% versus 97.5 ± 13.6%; p < 0.05) values for EVH positive participants were significantly lower than EVH negative participants respectively. CONCLUSIONS Overall, 13.2% of recreationally active individuals with no previous history of asthma presented with a positive EVH challenge. Individuals who are recreationally active may benefit from an objective bronchial provocation challenge, given that self-reported symptoms alone only provide a supportive role towards a valid EIB diagnosis.
Collapse
|
14
|
099 MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY DISTINGUISHES PHYSIOLOGICAL FROM PATHOLOGICAL GREY-ZONE LEFT VENTRICULAR HYPERTROPHY. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum. Br J Sports Med 2013; 46 Suppl 1:i51-8. [PMID: 23097480 PMCID: PMC3603779 DOI: 10.1136/bjsports-2011-090838] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Preparticipation screening programmes for underlying cardiac pathologies are now commonplace for many international sporting organisations. However, providing medical clearance for an asymptomatic athlete without a family history of sudden cardiac death (SCD) is especially challenging when the athlete demonstrates particularly abnormal repolarisation patterns, highly suggestive of an inherited cardiomyopathy or channelopathy. Deep T-wave inversions of ≥ 2 contiguous anterior or lateral leads (but not aVR, and III) are of major concern for sports cardiologists who advise referring team physicians, as these ECG alterations are a recognised manifestation of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Subsequently, inverted T-waves may represent the first and only sign of an inherited heart muscle disease, in the absence of any other features and before structural changes in the heart can be detected. However, to date, there remains little evidence that deep T-wave inversions are always pathognomonic of either a cardiomyopathy or an ion channel disorder in an asymptomatic athlete following long-term follow-up. This paper aims to provide a systematic review of the prevalence of T-wave inversion in athletes and examine T-wave inversion and its relationship to structural heart disease, notably HCM and ARVC with a view to identify young athletes at risk of SCD during sport. Finally, the review proposes clinical management pathways (including genetic testing) for asymptomatic athletes demonstrating significant T-wave inversion with structurally normal hearts.
Collapse
|
16
|
The effect of high-intensity aerobic interval training on postinfarction left ventricular remodelling. BMJ Case Rep 2013; 2013:bcr2012007668. [PMID: 23413285 PMCID: PMC3604414 DOI: 10.1136/bcr-2012-007668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is the third in a series of case studies on an individual with normal coronaries who sustained an idiopathic acute myocardial infarction . Bilateral pulmonary emboli almost 2 years post-myocardial infarction (MI) revealed coagulopathy as the cause. The original MI resulted in 16% myocardial scar tissue. An increasing number of patients are surviving MI, hence the burden for healthcare often shifts to heart failure. Accumulating evidence suggests high-intensity aerobic interval exercise (AHIT) is efficacious in improving cardiac function in health and disease. However, its impact on MI scar has never been assessed. Accordingly, the 50-year-old subject of this case study undertook 60 weeks of regular AHIT. Successive cardiac MRI results demonstrate, for the first time, a decrease in MI scar with exercise and, alongside mounting evidence of high efficacy and low risk, suggests AHIT may be increasingly important in future prevention and reversing of disease and or amelioration of symptoms.
Collapse
|
17
|
Do the effects of high intensity 40 km cycling upon left ventricular function and cardiac biomarker during recovery vary with time of day? J Sports Sci 2013; 31:414-23. [DOI: 10.1080/02640414.2012.735369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
18
|
Effects of anabolic steroid use on myocardial perfusion in body-builders: a quantitative cardiovascular magnetic resonance Study. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559818 DOI: 10.1186/1532-429x-15-s1-p145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
19
|
T-wave inversions and the role of de-training in the differentiation of athlete's heart from pathology: is 6 months too long? BMJ Case Rep 2012; 2012:bcr.06.2011.4403. [PMID: 23035157 DOI: 10.1136/bcr.06.2011.4403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Electrocardiographic changes are common in athletes. Differentiation of a physiological from a pathological substrate is important as ECG changes may indicate underlying cardiac disease placing the athlete at increased risk of sudden cardiac death. Deep T-wave inversions are uncommon in Caucasian athletes however; appear more prevalent in black athletes. Irrespective of the ethnic origin of the athlete, deep T-wave inversions require thorough follow-up. At present, 6 months de-training is recommended to assist in the differentiation of physiologic and pathologic changes where a definitive diagnosis is elusive through standard diagnostic techniques. This case study examines findings from a black and a Caucasian athlete presenting with deep T-wave inversions following a brief (ca.3 week) period of de-training resulting in normalisation of T-wave. These cases suggest that a shorter period of time may be sufficient in differentiating physiological from pathological mechanisms for deep T-wave inversions.
Collapse
|
20
|
Cardiac effects of anabolic steroid use amongst recreational body builders - a CMR study. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305148 DOI: 10.1186/1532-429x-14-s1-p186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
21
|
The effect of 800 g and 1600 g inhaled salbutamol on FEV1 in non-asthmatic football players. Br J Sports Med 2011. [DOI: 10.1136/bjsports-2011-090606.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
22
|
The physiological effect of 800 mcg and 1600 mcg inhaled salbutamol during a football specific treadmill run at high ambient temperatures. Br J Sports Med 2011. [DOI: 10.1136/bjsports-2011-090606.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
23
|
Cardiac electromechanical delay is increased during recovery from 40 km cycling but is not mediated by exercise intensity. Scand J Med Sci Sports 2011; 23:224-31. [PMID: 22092882 DOI: 10.1111/j.1600-0838.2011.01376.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2011] [Indexed: 12/16/2022]
Abstract
Cardiac electrical-mechanical delay (cEMD), left ventricular (LV) function, and cardiac troponin I (cTnI) were assessed after 40 km cycle time trials completed at high (HIGH) and moderate (MOD) intensities in 12 cyclists. Echocardiograms and blood samples were collected before, 10, and 60 min after cycling. cEMD as assessed by time from QRS onset to peak systolic (S') tissue velocity was lengthened after both bouts of cycling but was not mediated by cycling intensity (HIGH: 174 ± 52 vs 198 ± 26 ms; MOD: 151 ± 40 vs 178 ± 52 ms, P < 0.05). Global LV systolic function was unaltered by exercise. cEMD from QRS to peak early (E') diastolic tissue velocity was also increased post-exercise (HIGH: 524 ± 95 vs 664 ± 68 ms; MOD: 495 ± 62 vs 604 ± 91 ms, P < 0.05). Indices of LV diastolic function was reduced after cycling but were not mediated by exercise intensity. cTnI was elevated in two participants after HIGH trial (0.06 ug/L; 0.04 ug/L) and one participant after MOD trial (0.02 ug/L). While cEMD is lengthened and LV diastolic function was reduced post-cycling, altering time-trial intensity had little impact upon cEMD, LV function, and cTnI release.
Collapse
|
24
|
Transdermal opioids: are we plastering over the cracks? BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000100.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
25
|
A Unique Case Series of Novel Biomarkers of Cardiac Damage in Cyclists Completing the 4800 km Race Across America (RAAM). Curr Med Chem 2011; 18:3446-51. [DOI: 10.2174/092986711796642616] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 06/06/2011] [Indexed: 11/22/2022]
|
26
|
171 The right ventricle of the endurance athlete: the relationship between morphology and deformation. BRITISH HEART JOURNAL 2011. [DOI: 10.1136/heartjnl-2011-300198.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
27
|
Abstract
The authors previously reported on an active, young male with normal coronaries who sustained an acute myocardial infarction (AMI). The acute cause was a coronary thrombus; however, the cause of this thrombus and a definitive diagnosis remained elusive for 18 months until a new series of events, including symptoms of breathlessness, dizziness and collapse led to acute hospital admission. CT scan revealed numerous deep venous thromboses in the right leg and bilateral pulmonary emboli (PE). Acute pharmacological thrombolysis eliminated breathlessness and significantly reduced the risk of mortality. Clinical consensus suggests a coagulopathy, requiring indefinite treatment with Warfarin. In young individuals presenting with AMI, lifestyle, personal, family and clinical history should be considered and coronary artery disease should not be assumed until further tests have eliminated coagulopathy. In those presenting with breathlessness and a history which includes AMI, a CT scan is indicated to eliminate concerns of venous thromboembolism generally and PE specifically where untreated survival times are short.
Collapse
|
28
|
Abstract
This study examined the cardiac structure and function of a unique cohort of documented lifelong, competitive endurance veteran athletes (>50 yr). Twelve lifelong veteran male endurance athletes [mean ± SD (range) age: 56 ± 6 yr (50-67)], 20 age-matched veteran controls [60 ± 5 yr; (52-69)], and 17 younger male endurance athletes [31 ± 5 yr (26-40)] without significant comorbidities underwent cardiac magnetic resonance (CMR) imaging to assess cardiac morphology and function, as well as CMR imaging with late gadolinium enhancement (LGE) to assess myocardial fibrosis. Lifelong veteran athletes had smaller left (LV) and right ventricular (RV) end-diastolic and end-systolic volumes (P < 0.05), but maintained LV and RV systolic function compared with young athletes. However, veteran athletes had a significantly larger absolute and indexed LV and RV end-diastolic and systolic volumes, intraventricular septum thickness during diastole, posterior wall thickness during diastole, and LV and RV stroke volumes (P < 0.05), together with significantly reduced LV and RV ejection fractions (P < 0.05), compared with veteran controls. In six (50%) of the veteran athletes, LGE of CMR indicated the presence of myocardial fibrosis (4 veteran athletes with LGE of nonspecific cause, 1 probable previous myocarditis, and 1 probable previous silent myocardial infarction). There was no LGE in the age-matched veteran controls or young athletes. The prevalence of LGE in veteran athletes was not associated with age, height, weight, or body surface area (P > 0.05), but was significantly associated with the number of years spent training (P < 0.001), number of competitive marathons (P < 0.001), and ultraendurance (>50 miles) marathons (P < 0.007) completed. An unexpectedly high prevalence of myocardial fibrosis (50%) was observed in healthy, asymptomatic, lifelong veteran male athletes, compared with zero cases in age-matched veteran controls and young athletes. These data suggest a link between lifelong endurance exercise and myocardial fibrosis that requires further investigation.
Collapse
|
29
|
Poster session III * Friday 10 December 2010, 08:30-12:30. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010. [DOI: 10.1093/ejechocard/jeq144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
30
|
Reply. J Am Coll Cardiol 2010. [DOI: 10.1016/j.jacc.2010.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
31
|
Disorders of the Menstrual Cycle in Elite Female Ice Hockey Players and Figure Skaters. BIOL RHYTHM RES 2010. [DOI: 10.1076/brhm.34.3.251.18806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
Exercise-induced cardiac troponin elevation: evidence, mechanisms, and implications. J Am Coll Cardiol 2010; 56:169-76. [PMID: 20620736 DOI: 10.1016/j.jacc.2010.03.037] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 02/19/2010] [Accepted: 03/09/2010] [Indexed: 12/20/2022]
Abstract
Regular physical exercise is recommended for the primary prevention of cardiovascular disease. Although the high prevalence of physical inactivity remains a formidable public health issue, participation in exercise programs and recreational sporting events, such as marathons and triathlons, is on the rise. Although regular exercise training reduces cardiovascular disease risk, recent studies have documented elevations in cardiac troponin (cTn) consistent with cardiac damage after bouts of exercise in apparently healthy individuals. At present, the prevalence, mechanism(s), and clinical significance of exercise-induced cTn release remains incompletely understood. This paper will review the biochemistry, prevalence, potential mechanisms, and management of patients with exercise-induced cTn elevations.
Collapse
|
33
|
Abstract
Energy Expenditure was measured with doubly labelled water technique during heavy sustained exercise with an official finishing team in the Race Across America. Energy Intake was also calculated to produce an energy balance for the race. A team of 4 cyclists (Mean +/-SD age: 37+4 yr; body height: 182+8 cm; body mass: 80.8+6.6 kg) completed the race in a relay fashion. The team completed the race in 6 days 10 h and 51 min. Total mean energy expenditure was found to be 43,401 kcals (181,711 kJ) with a mean daily energy expenditure of 6,420 kcals (26,879 kJ). Total mean energy intake from all food and drink consumed was calculated at 29,506 kcals (123,536 kJ) with a mean daily energy intake of 4 918 kcals (20,591 kJ). This resulted in a total mean energy deficit of 13,878 kcals (58,104 kJ) with a mean daily energy deficit of 1,503 kcals (6,293 kJ). The high energy expenditure highlights the need for correct and practical dietary strategies and challenges nutritionists to devise high energy diets that not only contain the correct macronutrient balance, but are also palatable to the cyclists, thus encouraging a high energy intake.
Collapse
|
34
|
Biological markers of cardiac damage are not related to measures of cardiac systolic and diastolic function using cardiovascular magnetic resonance and echocardiography after an acute bout of prolonged endurance exercise. Br J Sports Med 2009; 45:780-4. [PMID: 19854761 DOI: 10.1136/bjsm.2009.064089] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Seventeen male participants (mean (SD) (range): age 33.5 (6.5) years (46-26 years), body mass 80 (9.2) kg (100-63 kg), height 1.81 (0.06) m (1.93- 1.70 m)) ran a marathon to investigate the relationship between systolic function (using cardiac magnetic resonance (CMR)) and diastolic function (using echocardiography) against biomarkers of cardiac damage. METHODS Echocardiographic and cardiac troponin I (cTnI)/N-terminal pro-B-type natriuretic peptide (NTproBNP) data were collected 24 h premarathon, immediately postmarathon and 6 h postmarathon. CMR data were collected 24 h premarathon and at 6 h postmarathon. RESULTS Body mass was significantly reduced postmarathon (80 (9.2) vs 78.8 (8.6) kg; p<0.001). There was a significant E/A reduction postmarathon (1.11 (0.34) vs 1.72 (0.44); p<0.05) that remained depressed 6 h postmarathon (1.49 (0.43); p<0.05). CMR demonstrated left ventricular end-diastolic and end-systolic volumes were reduced postmarathon, with a preserved stroke volume. Left ventricular ejection fraction 6 h postmarathon significantly increased (64.4% (4.2%) vs 67.4% (5%); p<0.05). There were significant elevations in cTnI (0.00 vs 0.04 (0.03) μg/l; p<0.05) and NTproBNP (37.4 (24.15) ng/l vs 59.34 (43.3) ng/l; p<0.05) immediately postmarathon. Eight runners had cTnI elevations immediately postmarathon above acute myocardial infarction cutoff levels (≥0.03 μg/l). No correlations between cTnI/NTproBNP and measures of diastolic function (E, A, E/A, isovolumic relaxation time, E deceleration time and E/E') or measures of systolic function (stroke volume or ejection fraction) were observed immediately postmarathon or 6 h postmarathon. CONCLUSIONS Biomarkers of cardiac damage after prolonged exercise are not associated with either systolic or diastolic functional measures.
Collapse
|
35
|
Abstract
This study reports the cardiac structure and function of a lifelong male endurance athlete, who has run over 148 000 miles, who presented with symptoms of chest discomfort, dyspnoea and loss of competitive running performance. Importantly, the athlete documented several periods of regular intensive endurance activity while suffering with flu-like symptoms. Cardiovascular MRI demonstrated a pattern of late gadolinium enhancement, which indicated myocardial scarring as a result of previous myocarditis.Myocarditis is a non-ischaemic inflammatory disease of the myocardium associated with cardiac dysfunction and arrhythmogenic substrate. The clinical course of viral myocarditis is mostly insidious with limited cardiac inflammation and dysfunction. However, as in the present case, overwhelming inflammation may occur in a subset of patients leading to myocardial fibrosis due to recurrent inflammation.
Collapse
|
36
|
Acute myocardial infarction in the presence of normal coronaries and the absence of risk factors in a young, lifelong regular exerciser. BMJ Case Rep 2009; 2009:bcr07.2008.0384. [PMID: 21686832 DOI: 10.1136/bcr.07.2008.0384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Around 6% of patients suffering an acute myocardial infarction (AMI) have normal coronary arteries. The mechanisms responsible are not fully known, but include hypercoagulable state, coronary endothelial dysfunction, aortic dissection, inflammation, coronary thrombosis, aortic wall stiffening, cocaine abuse, carbon monoxide poisoning and paradoxical embolism. Here, the case of a lifelong regular exerciser without risk factors for cardiovascular disease who suffered an AMI with normal coronaries is reported. Despite normal cardiac function on left ventriculography and echocardiography, late gadolinium enhancement by cardiac magnetic resonance (CMR) revealed significant cardiac necrosis. The long-term prognosis is favourable with low rates of coronary morbidity and mortality. Acute chest pain should not be considered as benign and warrants medical investigation.
Collapse
|
37
|
|
38
|
The Race Across America: A Cycle Race Or A Sleep Deprivation Challenge? Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000354739.66875.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
39
|
Assessment Of Cardiac Inflammation And Injury Following Prolonged Exercise Using Cardiovascular Magnetic Resonance (CMR) Imaging. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000354655.53414.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
40
|
Interpretation of two-dimensional and tissue Doppler-derived strain ( ) and strain rate data: is there a need to normalize for individual variability in left ventricular morphology? EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:677-82. [DOI: 10.1093/ejechocard/jep037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
41
|
Treat the patient not the blood test: the implications of an increase in cardiac troponin after prolonged endurance exercise. CASE REPORTS 2009; 2009:bcr08.2008.0756. [DOI: 10.1136/bcr.08.2008.0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
42
|
Post-mortem evidence of idiopathic left ventricular hypertrophy and idiopathic interstitial myocardial fibrosis: is exercise the cause? BMJ Case Rep 2009; 2009:bcr08.2008.0758. [PMID: 21686644 DOI: 10.1136/bcr.08.2008.0758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of an experienced, highly trained marathon runner who died suddenly while running. On post-mortem examination, left ventricle hypertrophy and idiopathic interstitial myocardial fibrosis was found. We believe that life-long, repetitive bouts of arduous physical activity resulted in fibrous replacement of the myocardium, causing a pathological substrate for the propagation of fatal arrhythmias.
Collapse
|
43
|
Dynamic control of higher-order modes in hollow-core photonic crystal fibers. OPTICS EXPRESS 2008; 16:17972-17981. [PMID: 18958077 DOI: 10.1364/oe.16.017972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present a versatile method for selective mode coupling into higher-order modes of photonic crystal fibers, using holograms electronically generated by a spatial light modulator. The method enables non-mechanical and completely repeatable changes in the coupling conditions. We have excited higher order modes up to LP(31) in hollow-core photonic crystal fibers. The reproducibility of the coupling allows direct comparison of the losses of different guided modes in both hollow-core bandgap and kagome-lattice photonic crystal fibers. Our results are also relevant to applications in which the intensity distribution of the light inside the fiber is important, such as particle- or atom-guidance.
Collapse
|
44
|
|
45
|
Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 2008; 51:2256-62. [PMID: 18534273 DOI: 10.1016/j.jacc.2007.12.061] [Citation(s) in RCA: 197] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 12/12/2007] [Accepted: 12/17/2007] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate ethnic differences in left ventricular (LV) remodeling between highly-trained athletes of African/Afro-Caribbean (black) and Caucasian (white) athletes. BACKGROUND The upper limits of left ventricular hypertrophy (LVH) are established in white athletes and aid the differentiation of physiologic LVH from hypertrophic cardiomyopathy (HCM). However, there are few data regarding LV remodeling in black athletes, in whom deaths from HCM are more prevalent. METHODS Between 2003 and 2007, 300 nationally ranked black male athletes (mean age 20.5 years) underwent 12-lead electrocardiogram and 2-dimensional echocardiography. The results were compared with 150 black and white sedentary individuals and 300 highly-trained white male athletes matched for age, size, and sport. RESULTS Black athletes exhibited greater LV wall thickness and cavity size compared with sedentary black and white individuals. Black athletes had greater LV wall thickness compared with white athletes (11.3 +/- 1.6 mm vs. 10 +/- 1.5 mm; p < 0.001). In absolute terms, 54 black athletes (18%) had LV wall thickness >12 mm compared with 12 white athletes (4%), and 3% of black athletes exhibited LV wall thickness >/=15 mm compared with none of the white athletes. Black athletes with LVH displayed an enlarged LV cavity and normal diastolic function. CONCLUSIONS Black athletes develop a greater magnitude of LVH compared with white athletes; therefore, extrapolation of conclusions derived from white athletes has the potential of generating false-positive diagnoses of HCM in black athletes.
Collapse
|
46
|
Post-mortem evidence of idiopathic left ventricular hypertrophy and idiopathic interstitial myocardial fibrosis: is exercise the cause? Br J Sports Med 2008; 42:304-5. [PMID: 17720799 DOI: 10.1136/bjsm.2007.038158] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A growing body of evidence reporting altered cardiac function and myocardial damage after arduous exercise, together with the increased prevalence of arrhythmias observed in highly trained athletes, suggests that repetitive bouts of prolonged, arduous exercise may be deleterious to long-term cardiac health. We report the case of an experienced, highly trained marathon runner who died suddenly while running. On post-mortem examination, left ventricle hypertrophy and idiopathic interstitial myocardial fibrosis was found. We believe that life-long, repetitive bouts of arduous physical activity resulted in fibrous replacement of the myocardium, causing a pathological substrate for the propagation of fatal arrhythmias.
Collapse
|
47
|
Physiological upper limits of left ventricular dimensions in highly trained junior tennis players. Br J Sports Med 2008; 41:784-8. [PMID: 17957014 DOI: 10.1136/bjsm.2006.033993] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The differentiation between physiological cardiac enlargement and cardiomyopathy is crucial, considering that most young non-traumatic deaths in sport are due to cardiomyopathy. Currently, there are few data relating to cardiac dimensions in junior elite tennis players. The aim of this study was to define the upper limits of left ventricular dimensions in a large cohort of national adolescent tennis players. METHODS Between 1996 and 2003, 259 adolescent tennis players (152 males), mean (SD) age 14.8 (1.4) years (range 13-19) and 86 healthy age, gender and body surface matched sedentary controls underwent 12-lead ECG and 2D-transthoracic echocardiography. RESULTS Inter-ventricular septal end diastolic dimension (IVSd), left ventricular end diastolic dimension (LVEDd) and left ventricular end diastolic posterior wall dimension (LVPWd) in tennis players were significantly higher than in controls (8.9 mm vs 8.3 mm p<0.001, 48.9 mm vs 47.9 mm p<0.05 and 9 mm vs 8.3 mm p<0.001 respectively), however in absolute terms, the difference did not exceed 7%. None of the tennis players had a wall thickness exceeding 12 mm or a left ventricular cavity size exceeding 60 mm. CONCLUSIONS Tennis players exhibit modest increases in cardiac dimensions, which do not resemble those seen in individuals with cardiomyopathy affecting the left ventricle.
Collapse
|
48
|
|
49
|
Abstract
AIMS Identification of a prolonged, corrected QT (QTc) interval in athletes may be a recommendation for disqualification from competitive sports. However, the prevalence and diagnostic significance of an isolated prolonged QTc in asymptomatic athletes without familial disease is unknown. METHODS AND RESULTS Between 1996 and 2006, 2000 elite athletes (mean age, 20.2 years) underwent 12-lead ECG and 2-D echocardiography. The QT interval was corrected for heart rate (QTc). Athletes with QTc > 460 ms underwent 48 h Holter monitor and an exercise stress test. All athletes with a prolonged QTc interval were offered genetic testing and first-degree relatives were invited for ECG. The QTc was prolonged in seven (0.4%) athletes ranging from 460 to 570 ms. Three athletes had a QTc value of >500 ms and all exhibited one of: paradoxical prolongation of QTc during exercise, a confirmatory genetic mutation, or prolonged QTc in a first-degree relative. In contrast, none of the athletes with a QTc value of <500 ms had any other features to indicate long QT syndrome (LQTS). CONCLUSION The prevalence of prolonged QTc in elite athletes is 0.4%. A QTc of >500 ms is highly suggestive of LQTS. A QTc of <500 ms in the absence of symptoms or familial disease is unlikely to represent LQTS in elite athletes.
Collapse
|
50
|
Altered left ventricular diastolic filling following a marathon is a reproducible phenomenon. Int J Cardiol 2007; 122:87-9. [PMID: 17222472 DOI: 10.1016/j.ijcard.2006.11.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 11/02/2006] [Indexed: 11/25/2022]
Abstract
The present study examined the reproducibility of alterations in left ventricular function and cardiac biomarkers in a cohort of athletes following two marathons, one year apart. Eight participants in the 2004 and 2005 London Marathons were tested pre- and post-race via echocardiography and humoral analysis. Reductions in diastolic filling, unrelated to loading or heart rate, following both marathons were reproducible within individuals, which may be a function of exercise duration. In contrast, exercise-induced cardiac troponin release was inconsistent.
Collapse
|