Targeted effect of ischemic preconditioning on the gas exchange threshold in healthy males and females

Ischemic preconditioning (IPC) appears to improve exercise performance although there is uncertainty about the intensity dependence of this effect. The present study sought to clarify effects of IPC on physiological responses at and below peak oxygen uptake, including the gas exchange threshold (GET). Ten male and female participants completed five cycling ramp tests (10 W/min) to failure, with the final two tests preceded by either IPC (4 × 5 min 220 mmHg bilateral leg occlusions) or SHAM (20 mmHg), in a randomised crossover design. The rates of O2 uptake ( V ˙ O2), carbon dioxide output ( V ˙ CO2), and expired ventilation ( V ˙ E) were measured at rest and throughout exercise. Exercise data were fitted using several functions to identify GET, two ventilatory thresholds and peak V ˙ O2. IPC increased V ˙ O2 at GET by ~ 9% (IPC: 1.89 ± 0.51 L/min, SHAM: 1.73 ± 0.56 L/min; p = 0.055) and power output at GET by ~ 11% (IPC: 133 ± 36 W, SHAM: 120 ± 39 W; p = 0.022). In addition, peak power output increased by 2.4% following IPC (IPC: 217 ± 50 W, SHAM: 212 ± 51 W; p = 0.052), but there was no significant effect of IPC on peak V ˙ O2 (IPC: 2.87 ± 0.68 L/min, SHAM: 2.84 ± 0.73 L/min; p = 0.60) or the ventilatory thresholds. The present results suggest that IPC improves GET and peak power output but not peak V ˙ O2 during a maximal graded test.

Global Survey of the Frequency of Atrial Fibrillation–Associated Stroke

Background and Purpose—

Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.

Methods—

Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.

Results—

Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P <0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF ( r =0.76; P =0.0002).

Conclusions—

This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.

Percutaneous fixation of tibial plateau fractures under arthroscopy: a medium term perspective

INTRODUCTION

Arthroscopically assisted percutaneous internal fixation has found its place in the treatment of Schatzker I-III tibial plateau fractures, with good short-term results reported. The objective of this study was to observe the progression of osteoarthritis at the medium term through clinical and radiological assessment.

PATIENTS AND METHODS

Twenty-seven patients were treated with arthroscopy-assisted percutaneous fixation for stage I-III Schatzker tibial plateau fractures.

RESULTS

Twenty-one patients were reviewed with a mean follow-up of 59.5 months (range, 24-138 months); satisfaction was good except for return to sports activity. The mean IKS score was 85.2 for the knee score and 91 for function. The mean Lysholm score was 86 points, with a mean Tegner activity score of 4. A mean score of 25.5 and 8 points was found for the clinical and radiological Rasmussen scores, respectively; 47.6% of the patients presented early osteoarthritis on radiological evaluation.

DISCUSSION

The medium-term functional results were comparable to the short-term results. The patients were satisfied except for return to sports activity. Age at surgery appears as a prognostic factor for osteoarthritis.

CONCLUSION

Arthroscopic internal fixation remains the technical reference for Schatzker I-III tibial plateau fractures despite the appearance of osteoarthritis, which remains less extensive than in open surgery.

LEVEL OF EVIDENCE

Level IV. Retrospective study.

Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate

We randomized 103 patients over the age of 50 with an unstable closed intra- or extra-articular dorsally displaced distal radius fracture to have either palmar fixed-angle plating (n=50) or 'mixed pinning' (n=53) and compared the clinical and radiological outcomes at 3, 6, 12 and 26 weeks after surgery in a prospective study. Postoperative palmar tilt was significantly better in those stabilized with K-wires, but loss of reduction was statistically less in those stabilized with a plate. At 26 weeks, functional results, assessed by DASH and Herzberg scores, were better in those fixed with a plate.

Soccer half-time strategy influences thermoregulation and endurance performance

AIM

In the first 15 min of the second half in professional soccer, there is a reduction of high intensity distance covered and a high incidence of injuries sustained, possibly due to a reduction in body temperature during the half-time (HT). The aim of this study was to investigate the effect of active and passive re-warm-up strategies on cardiovascular (heart rate, HR) and thermoregulatory stress, and second-half soccer-specific endurance performance (SSEP).

METHODS

Seven professional players performed two intermittent field tests of 16.5 min duration, with a 15 min HT. On separate, randomised occasions, 4 trials were completed during which different HT strategies were undertaken between minutes 7 and 14 of the HT interval. Two passive trials were completed: rest control trial (CON), or players were immersed to the gluteal fold in a hot bath (approximately 40 degrees C-passive heating, PH); in the active trials, players performed at 70% maximum HR, either steady-state non-specific active heating (cycling, NSAH) or intermittent soccer-specific active heating (sprinting repeatedly, SSAH). HR and core temperature (Tc) were measured every 5 min, and body weight was recorded pre and post each trial.

RESULTS

Active re-warm-up strategies maintained SSEP in the second period with respect to CON (P<0.01), whereas PH did not reduce the decrement in performance (P>0.05). Active heating strategies increased HR during HT in comparison to CON, whereas PH did not. During the HT period in the CON trial, T(c) decreased by 0.97+/-0.29 degrees C, PH and SSAH trials did not attenuate this decrease (P>0.01), whereas NSAH increased T(c) in respect to CON (P<0.01). These differences in HR and T(c) between re-warm-up strategies during HT were not apparent at the end of the trials.

CONCLUSION

Active re-warm-up strategies during HT attenuated the decrement in second-half SSEP that was observed during passive trials.

The application of soccer performance testing protocols to the non-elite player

AIM

The application of performance testing for the evaluation of non-elite soccer players has received little attention. The purpose of this investigation was to use tests developed for elite soccer players to evaluate performance in non-elite soccer players and compare performance test results between elite (literature) and non-elite (data) players.

METHODS

Thirteen male soccer players volunteered to participate. The tests included a treadmill VO2max test, 20 m sprint, vertical jump (VJ), 30 s Wingate cycle ergometer test, the Loughborough Intermittent Shuttle Test (LIST), and 2 20-m multi-stage shuttle runs to exhaustion (fatigue test). Actual VO2max (absolute and relative) scores were correlated with the estimated VO2max scores (fatigue test), 20 m sprint, VJ, and 30 s Wingate using a Pearson's product-moment correlation. A paired t-test was conducted on the fatigue test trials.

RESULTS

Non-significant relationships were observed between actual VO2max scores and estimated VO2max from the fatigue test (absolute and relative terms). Non-significant relationships were also observed between peak and average power output (Wingate), 20 m sprint, and VJ. Mean heart rates (HRs) throughout the LIST was 165+/-7 bpm, which represented 88% of HRmax.

CONCLUSIONS

The results of this study demonstrate that to elicit physiological differences between elite and non-elite players, assessment must include both an aerobic and anaerobic component.

[Frankfurt Vaccination Intervention Study--Friva]

The success of the recommendation of vaccinations on the occasion of school-beginner examinations is assessed. The feedback rate of the intervention group amounts to 65%. The recommended vaccinations were carried out at 60% (measles-mumps-rubella) up to 90% (tetanus).

Pain, psychological status, and functional recovery in chronic pain patients on daily opioids: a case comparison

Long-term opioid therapy for chronic benign pain remains controversial. Most studies on the effectiveness of such regimens have been case series or case comparisons and very few randomized placebo-controlled studies are available. Overall, this research has produced mixed results. The current study sought to further explore issues regarding the effectiveness of opioids for chronic pain and to examine the use of adjunctive medications in these patients. A random sample of 100 patients taking daily opioids (Opioid) and 100 taking no opioids (Non-opioid) at evaluation were selected from the patient population of a tertiary care multidisciplinary pain program. Statistical analyses revealed that the two groups did not differ regarding pain type, duration, location, or surgical history. Non-Caucasians were less likely to be taking opioids than Caucasians (p<0.05). Relative to the Non-opioid group, Opioid patients were less frequently taking non-steroidal anti-inflammatories (p<0.01) and were more often taking anxiolytics (p<0.05) and muscle relaxants (p<0.01). Opioid patients reported higher (p<0.05) current pain and more frequently (p<0.05) reported current or past clinical depression or anxiety. No other significant differences were noted on measures of pain, psychological status, or functioning. Statistical removal of the effects of pain differences did not alter the pattern of results for psychological and functional measures. Although the study design employed did not allow determination of causality, it is consistent with previous work which has failed to reveal any advantage to use of daily opioids in the chronic pain population with regard to analgesia, decreased adjunctive medication use, or functional recovery. Well-designed, prospective, randomized studies are needed, but the current results suggest continued caution in the use of daily opioids until such studies become available.

Nominal aphasia following a radical mastoidectomy

A rare complication of a radical mastoid operation is described. Possible reasons for such a complication are mentioned. All clinical manifestations subsided spontaneously.

Vertigo and the pill

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