Higher rating of perceived exertion and lower perceived recovery following a graded exercise test during menses compared to non-bleeding days in untrained females

The underrepresentation of the female population in exercise sciences could be attributed, at least in part, to difficulty in appropriately accounting for the effects of the menstrual cycle (MC). Previous studies examining the effects of the MC on aerobic performance and subjective measures of aerobic performance show conflicting results. Purpose: The study examined how the MC affects the objective and subjective measures of aerobic performance within untrained female participants and in comparison with untrained male participants assessed at similar time intervals. Methods: Twenty-one participants (12 females and 9 males) completed a graded exercise test (GXT) on a cycle ergometer. The female participants were tested during their early follicular (EF; menses), ovulatory (O), and mid-luteal (ML) phases of the MC. The male participants were included as the control group and were randomly assigned to a menstrual cycle phase for each visit. During GXT, maximal oxygen consumption (VO2max), respiratory exchange ratio (RER), maximal heart rate (HRmax), peak blood lactate, and rating of perceived exertion (RPE) were determined. Twenty-four hours post-exercise, the perceived recovery status (PRS) was assessed. The MC phase was estimated using basal body temperature (BBT) in the female participants. Results: The male participants obtained a higher peak power and VO2max compared to the female participants (p < 0.05). All objective measures of aerobic performance did not significantly differ across the MC phases or time points that were tested. In the untrained female participants, an effect of the MC phase on RPE was found, with RPE being higher at EF (8.92 ± 0.79) compared to O (7.67 ± 1.23; p < 0.05) and ML (7.75 ± 1.06; p < 0.05). In addition, an effect of the MC phase on PRS was found, with perceived recovery being lower at EF (6.83 ± 0.94) compared to O (8.83 ± 1.12) and ML (8.67 ± 0.65; all p < 0.005) for the untrained female participants. No significant differences in RPE and PRS were found between tests in the untrained male participants. The female participants had lower perceived recovery following EF (6.83 ± 0.94) compared with the male participants (9.00 ± 1.00; p < 0.001). Conclusion: The untrained female participants perceived greater exertion during GXT and impaired recovery following GXT in EF compared to O and ML. These results may be attributed to either a drop in female sex hormone concentrations or discomfort associated with menses. The male participants did not exhibit any changes over time. Future studies using subjective parameters such as perceived exertion to track the internal load of training in the naturally menstruating female population should consider menses.

Risedronate use may blunt appendicular lean mass loss secondary to sleeve gastrectomy: Results from a pilot randomized controlled trial

Background

Despite robust weight loss and cardiometabolic benefit, lean mass loss following sleeve gastrectomy (SG) confers health risk. Bisphosphonates are a potential therapeutic agent for lean mass maintenance. Thus, our objective was to explore the effect of six months of risedronate (vs placebo) on change in dual energy x-ray absorptiometry (DXA) and computed tomography (CT) derived lean mass metrics in the year following SG.

Methods

24 SG patients were randomized to six months of 150 mg oral risedronate or placebo capsules (NCT03411902). Body composition was assessed at baseline and six months with optional 12-month follow-up using whole-body DXA and CT at the lumbar spine and mid-thigh. Group treatment effects and 95% CIs were generated from a mixed model using contrast statements at six and 12 months, adjusted for baseline values.

Results

Of 24 participants enrolled [55.7±6.7 years (mean±SD), 79% Caucasian, 83% women, body mass index (BMI) 44.7±6.3kg/m2], 21 returned for six-month testing, and 14 returned for 12-month testing. Six-month weight loss was -16.3 kg (-20.0, -12.5) and -20.9 kg (-23.7, -18.1) in the risedronate and placebo groups, respectively (p=.057). Primary analysis at six-months revealed a non-significant sparing of appendicular lean mass in the risedronate group compared to placebo [-1.2 kg (-2.3, -0.1) vs -2.1 kg (-3.0, -1.2)]; p=.20. By 12-months, the risedronate group displayed no change in appendicular lean mass from baseline [-0.5 kg (-1.5, 0.6)]; however, the placebo group experienced significantly augmented loss [-2.9 kg (-3.6, -2.1)].

Conclusion

Pilot data indicate risedronate treatment may mitigate appendicular lean mass loss following SG. Further study is warranted.

Development and implementation of "handshake rounds": An antibiotic stewardship intervention for hospitalized adult patients with hematologic malignancies

Objective

To design and implement "handshake rounds" as an antibiotic stewardship intervention to reduce inpatient intravenous (IV) antibiotic use in patients with hematologic malignancies.

Design

Quasi-experimental analysis of antibiotic use (AU) and secondary outcomes before and and after handshake rounds were implemented.

Setting

Quaternary-care, academic medical center.

Patients

Hospitalized adults with hematologic malignancies receiving IV antibiotics.

Methods

We performed a retrospective review of a preintervention cohort prior to the intervention. A multidisciplinary team developed criteria for de-escalation of antibiotics, logistics of handshake rounds, and outcome metrics. Eligible patients were discussed during scheduled handshake rounds between a hematology-oncology pharmacist and transplant-infectious diseases (TID) physician. Prospective data were collected over 30 days in the postintervention cohort. Due to small sample size, 2:1 matching was used to compare pre- to and postintervention AU. Total AU in days of therapy per 1,000 patient days (DOT/1,000 PD) was reported. Mean AU per patient was analyzed using Wilcoxon rank-sum test. A descriptive analysis of secondary outcomes of pre- and postintervention cohorts was performed.

Results

Total AU was substantially lower after the intervention, with 517 DOT/1,000 PD compared to 865 DOT/1,000 PD before the intervention. There was no statistically significant difference in the mean AU per patient between the 2 cohorts. There was a lower rate of 30-day mortality in the postintervention cohort and rates of ICU admissions were similar.

Conclusions

Conducting handshake rounds is a safe and effective way to implement an antibiotic stewardship intervention among high-risk patient population such as those with hematologic malignancies.

A Modular, Kerf-Minimizing Approach for Therapeutic Ultrasound Phased Array Construction

A novel method for fabricating a modular, kerf-minimizing histotripsy phased array was developed and tested. The method utilizes arbitrarily shaped elements, 3-D printing, water jet cutting, and a thin, 125- [Formula: see text] electrically insulating epoxy coating to maximize aperture utilization while allowing for replacement of individual transducer modules. The method was used to fabricate a 750-kHz truncated circular aperture array (165 mm ×234 mm) transducer with a focal length of 142 mm. The aperture was segmented into 260 arc-shaped modular elements, each approximately 11.5 mm ×11.5 mm, arranged in concentric rings. The resulting aperture utilization was 92%. The full-width-half-maximum (FWHM) focal zone of the array was measured to be 1.6 mm ×1.1 mm ×4.5 mm, and the FWHM electrical steering range was measured to be 38.5 mm ×33 mm 40 mm. The array was estimated to be capable of generating approximately 120-MPa peak negative pressure at the geometric focus. In addition, the array was used to ablate a 5-cm3 volume of tissue with electric focal steering.

Circulating microRNA responses to acute whole-body vibration and resistance exercise in postmenopausal women

Evaluating alterations in circulating microRNA (c-miRNA) expression may provide deeper insight into the role of exercise in the attenuation of the negative effects of aging on musculoskeletal health. Currently, there are sparse data on c-miRNA responses to acute exercise in postmenopausal women. The purpose of this study was to characterize the effects of acute bouts of resistance exercise and whole-body vibration on expression of selected c-miRNAs in postmenopausal women aged 65-76 years (n=10). We also examined relationships between c-miRNAs and muscle strength and bone characteristics. This randomized crossover design study compared c-miRNA responses to a bout of resistance exercise (RE) (3 sets 10 reps 70% 1 repetition maximum (1RM), 5 exercises) and a bout of whole-body vibration (WBV) (5 sets 1 min bouts 20Hz 3.38mm peak to peak displacement, Vibraflex vibration platform). DXA was used to measure body composition and areal bone mineral density (aBMD) of the total body, AP lumbar spine, and dual proximal femur. pQCT was used to measure tibia bone characteristics (4%, 38%, 66% sites). Blood samples were collected before exercise (Pre), immediately-post (IP), 60 minutes post (60P), 24 hours (24H), and 48 hours (48H) after exercise to measure serum miR-21-5p, -23a-3p, -133a-3p, -148a-3p (qPCR) and TRAP5b (ELISA). There was a significant modality × time interaction for c-miR-21-5p expression (p=0.019), which decreased from 60P to 24H after WBV only. TRAP5b serum concentrations significantly increased IP then decreased below Pre at 24H for both WBV and RE (p<0.01). Absolute changes in TRAP5b were negatively correlated with c-miR-21-5p fold changes (r= -0.642 to -0.724, p<0.05) for both exercise modalities. There were significant negative correlations between baseline c-miRNAs and bone status variables (r= -0.639 to -0.877, p<0.05). Our findings suggest that whole-body vibration is a sufficient mechanical stimulus for altering c-miR-21-5p expression, whereas a high intensity resistance exercise protocol did not elicit any c-miRNA responses in postmenopausal women. Increases in the bone resorption marker, TRAP5b, were associated with greater downregulation of c-miR-21-5p expression.

The Ability of Exercise to Mitigate Caloric Restriction-Induced Bone Loss in Older Adults: A Structured Review of RCTs and Narrative Review of Exercise-Induced Changes in Bone Biomarkers

Despite the adverse metabolic and functional consequences of obesity, caloric restriction- (CR) induced weight loss is often contra-indicated in older adults with obesity due to the accompanying loss of areal bone mineral density (aBMD) and subsequent increased risk of fracture. Several studies show a positive effect of exercise on aBMD among weight-stable older adults; however, data on the ability of exercise to mitigate bone loss secondary to CR are surprisingly equivocal. The purpose of this review is to provide a focused update of the randomized controlled trial literature assessing the efficacy of exercise as a countermeasure to CR-induced bone loss among older adults. Secondarily, we present data demonstrating the occurrence of exercise-induced changes in bone biomarkers, offering insight into why exercise is not more effective than observed in mitigating CR-induced bone loss.

Longitudinal Hydration Assessment in Collegiate Basketball Players Over Various Training Phases

ABSTRACT

Heishman, AD, Daub, BD, Miller, RM, Freitas, EDS, and Bemben, MG. Longitudinal hydration assessment in collegiate basketball players over various training phases. J Strength Cond Res 35(4): 1089-1094, 2021-To the best of our knowledge, previous literature has not longitudinally examined hydration status in collegiate basketball players. Therefore, the purpose of this investigation was to examine the prepractice hydration status of collegiate basketball players across various training phases for 2 consecutive years. Retrospective analyses examined prepractice urine-specific gravity (USG) assessments obtained from National Collegiate Athletic Association (NCAA) Division I male basketball players during the preseason and competitive season, for 2 consecutive years. The first year (year 1 = Y1) of analysis consisted of 15 athletes and the second year (year 2 = Y2) consisted of 16 athletes, with 8 athletes in both seasons. Hydration status was classified based on the National Athletic Trainers' criteria: (a) euhydrated, USG < 1.020; (b) hypohydrated, USG = 1.020-1.030; and (c) significantly hypohydrated, USG > 1.030. Additional comparisons examined the association of minutes played with hydration status and changes in hydration status for athletes returning from Y1 to Y2. The results indicated 55-65.7% of cases showed levels of significant hypohydration during the preseason and competitive seasons for both years. Preseason hydration status was significantly better than the competitive season (Y1, p = 0.008; Y2, p = 0.005). Despite significant differences in minutes played (p < 0.001), no differences in hydration status were observed. Returning athletes displayed no differences in hydration status between Y1 and Y2. Collegiate basketball players show levels of hypohydration when longitudinally examined across various training phases. Although hydration may be improved in the preseason, alternative factors such as average game minutes played and length in program may not influence hydration status.

Skeletal Muscle Adaptations Following 80 Weeks of Resistance Exercise in Older Adults

BACKGROUND AND PURPOSE

We followed and documented skeletal muscle adaptations from 4 resistance exercise (RE) prescriptions in older adults over the course of a 2-year, 80-week training study.

METHODS

Forty-three older men and women-65.2 (3.5) years, 167.2 (7.5) cm, and 72.5 (14.7) kg-completed one of the following RE prescriptions: high-load 2 days per week (HL2D; n = 12), low-load 2 days per week (LL2D; n = 9), high-load 3 days per week (HL3D, n = 12), or low-load 3 days per week (LL3D, n = 10). High-load prescriptions consisted of 3 sets of 8 repetitions with 80% 1-repetition maximum (1-RM) and low-load prescriptions completed 3 sets of 16 repetitions with 40% 1-RM. Each session consisted of 12 exercises targeting major muscle groups and training loads were adjusted every fifth week to maintain progressive overload. Participants completed 40 weeks of supervised training, had a 2-month break, and then resumed another 40 weeks of supervised training. Bone-free lean body mass (BFLBM) and appendicular lean mass (ALM) were assessed via dual-energy x-ray absorptiometry and muscle cross-sectional area (mCSA) of the rectus femoris with diagnostic ultrasound across the intervention.

RESULTS AND DISCUSSION

Groups responded similarly with significant increases in total strength (54.9%), upper body strength (42.7%), lower body strength (61.5%), and specific strength (50.3%, strength/BFLBM) over 80 weeks (all P < .001). Significant increases for BFLBM (3.0%), ALM (3.5%), and mCSA (48.7%) were also observed (all P ≤ .019). The only difference among groups indicated HL3D displaying significantly greater percent increase than LL2D for ALM (P = .043).

CONCLUSIONS

Resistance exercise performed 2 or 3 days per week with moderate to heavy loads can improve muscle strength and induce small but perhaps clinically significant increases in BFLBM and mCSA in older adults over a 2-year period of supervised training.

Use of Metabolomic Profiling to Understand Variability in Adiposity Changes Following an Intentional Weight Loss Intervention in Older Adults

Inter-individual response to dietary interventions remains a major challenge to successful weight loss among older adults. This study applied metabolomics technology to identify small molecule signatures associated with a loss of fat mass and overall weight in a cohort of older adults on a nutritionally complete, high-protein diet. A total of 102 unique metabolites were measured using liquid chromatography-mass spectrometry (LC-MS) for 38 adults aged 65-80 years randomized to dietary intervention and 36 controls. Metabolite values were analyzed in both baseline plasma samples and samples collected following the six-month dietary intervention to consider both metabolites that could predict the response to diet and those that changed in response to diet or weight loss.Eight metabolites changed over the intervention at a nominally significant level: D-pantothenic acid, L-methionine, nicotinate, aniline, melatonin, deoxycarnitine, 6-deoxy-L-galactose, and 10-hydroxydecanoate. Within the intervention group, there was broad variation in the achieved weight-loss and dual-energy x-ray absorptiometry (DXA)-defined changes in total fat and visceral adipose tissue (VAT) mass. Change in the VAT mass was significantly associated with the baseline abundance of α-aminoadipate (p = 0.0007) and an additional mass spectrometry peak that may represent D-fructose, myo-inositol, mannose, α-D-glucose, allose, D-galactose, D-tagatose, or L-sorbose (p = 0.0001). This hypothesis-generating study reflects the potential of metabolomic biomarkers for the development of personalized dietary interventions.

The Acute Physiological Responses to Traditional vs. Practical Blood Flow Restriction Resistance Exercise in Untrained Men and Women

This study compared the acute physiological responses of traditional and practical blood flow restriction resistance exercise (tBFR and pBFR, respectively) and high- and low-load resistance exercise without BFR (HL and LL, respectively), as well as the potential sex differences within the aforementioned exercise methods. Fourteen men and fifteen women randomly completed the following experimental conditions: (1) tBFR, consisting of four sets of 30-15-15-15 repetitions of the bilateral horizontal leg press and knee extension exercises, at 30% of one-repetition maximum (1-RM), with a 13.5 cm wide pneumatic cuff placed at the most proximal portion of each thigh and inflated to a pressure equivalent to 50% of the participant’s total occlusion pressure; (2) pBFR, which was the same as the tBFR condition, except that an elastic band wrapped around the proximal portion of each thigh at a tightness of 7 on a 0 to 10 perceived pressure scale was used to reduce blood flow; (3) LL, same as the tBFR and pBFR protocols, except that no BFR was applied; and (4) HL, consisting of 3 sets of 10 repetitions at 80% of 1-RM, with the same 1-min rest interval between sets and a 3-min rest period between exercises. At baseline, immediately post-, 5 min post-, and 15 min post-exercise, whole-blood lactate (WBL), indices of muscle swelling (muscle thickness and thigh circumference), hematocrit and plasma volume changes, were measured as well as superficial electromyography (sEMG) amplitude during exercise. There were no significant (p > 0.05) differences between the tBFR and pBFR exercise protocols for any of the physiological parameters assessed. However, significantly greater (p < 0.05) WBL and sEMG values were observed for HL compared to the remaining exercise conditions. Finally, males displayed greater WBL levels than females at 15 min post-exercise. Interestingly, males also displayed significantly (p < 0.05) greater sEMG amplitude than females within the low-load trials during leg press, but no significant (p < 0.05) sex differences were observed during knee extension. In conclusion, tBFR and pBFR seemed to be capable of inducing the same acute physiological responses. Furthermore, males displayed greater responses than females for some of the physiological parameters measured.

Countermovement Jump Reliability Performed With and Without an Arm Swing in NCAA Division 1 Intercollegiate Basketball Players

Heishman, AD, Daub, BD, Miller, RM, Freitas, EDS, Frantz, BA, and Bemben, MG. Countermovement jump reliability performed with and without an arm swing in NCAA Division 1 intercollegiate basketball players. J Strength Cond Res 34(2): 546-558, 2020-The countermovement jump (CMJ) is routinely used in athlete performance to quantify adaptions to training, as well as monitor neuromuscular readiness and fatigue. However, controversy remains in whether to incorporate an arm swing during the CMJ (CMJ AS) or keep the hands placed on the hips (CMJ NAS). Incorporating the arms provides a higher degree of sport-specificity that may yield improved reliability, especially in skilled jumpers. By contrast, the hands-on-hips approach isolates lower extremity force production and eliminates potential arm-swing variation. Therefore, the purpose of this study was to establish the reliability of CMJ typical (CMJ-TYP), CMJ concentric alternative (CMJ-Conc-ALT), and CMJ eccentric alternative (CMJ-Ecc-ALT) variables obtained during the CMJ AS and CMJ NAS. Twenty-two (men = 14, women = 8) NCAA Division 1 collegiate basketball players performed 3 CMJ AS and 3 CMJ NAS on a force plate, in a randomized order. To assess the test-retest reliability, participants returned 1 week later to perform 3 additional CMJ AS and 3 CMJ NAS. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were used to assess intersession and intrasession reliability for the various CMJ variables. A majority of CMJ-TYP and several CMJ-Conc-ALT and CMJ-Ecc-ALT variables exhibited adequate intersession and intrasession reliability (ICC > 0.700 and CV <10%) during both the CMJ AS and the CMJ NAS. Countermovement jump AS may provide more pertinent information about long-term changes in sport-specific performance, whereas the CMJ NAS may be more beneficial for detecting acute changes in neuromuscular fatigue and athlete readiness.

Perceptual responses: Clinical versus practical blood flow restriction resistance exercise

The purpose of the current investigation was to compare the acute perceptual responses during low-load resistance exercise (RE) with clinical blood flow restriction (cBFR-RE) and practical blood flow restriction (pBFR-RE), and during conventional low- (LL-RE) and high-load resistance exercise (HL-RE), to determine if these responses differed between young males and females. Twenty-nine participants (14 males: 23.6±2.7years, 25.3±3.1kg/m² and 15 females: 20.3±1.6years, 23.4±1.9kg/m²) completed the following exercise conditions in a randomized design: 1) cBFR-RE, 2) pBFR-RE, 3) HL-RE, and 4) LL-RE. Low-load conditions consisted of 30-15-15-15 repetitions of two-leg press (LP) and knee extension (KE) exercises with 30% one-repetition maximum (1-RM), and HL-RE consisted of 3 sets of 10 repetitions at 80% 1-RM, all with 60s rest intervals. Ratings of perceived exertion (RPE) and discomfort were assessed before exercise and immediately following each set. RPE was significantly higher in HL-RE compared to all low-load conditions for both exercises after each set (all p<0.05). cBFR-RE resulted in significantly greater RPE than pBFR-RE and LL-RE for both exercises for sets 1-4 for LP and sets 2-3 for KE (all p<0.05). Levels of discomfort were similar between cBFR-RE and HL-RE, which tended to be significantly higher than pBFR-RE and LL-RE (p<0.05). Men reported significantly greater RPE than women following sets 2-4 during KE with cBFR-RE and sets 2 and 3 during KE for HL-RE (all p<0.05). Males also reported significantly greater discomfort than women following sets 2-4 for KE LL-RE (p<0.05). Altogether, these data suggest that pBFR-RE may provide a more favorable BFR condition based on perceptual responses and that perceptual responses may differ between sexes across varying resistance exercise conditions.

Acute Physiological Responses to Resistance Exercise With Continuous Versus Intermittent Blood Flow Restriction: A Randomized Controlled Trial

The primary goal of this investigation was to examine the physiological responses of blood flow restriction (BFR) resistance exercise (RE) performed with continuous or intermittent BFR and to compare these results to those from conventional high- and low-load RE without BFR. Fourteen men randomly completed the following experimental trials: (1) low-load RE with continuous BFR (cBFR), (2) low-load RE with intermittent BFR (iBFR), (3) low-load RE without BFR (LI), and (4) conventional high-load RE without BFR (HI). For the cBFR, iBFR, and LI exercise trials, participants performed four sets of 30-15-15-15 repetitions of the bilateral leg press (LP) and knee extension (KE) exercises, at an intensity of 20% of their one-repetition maximum (1-RM), at a 1.5-s contraction speed, and with a 1-min rest period between sets. The only difference between the cBFR and iBFR protocols was that the pressure of the cuffs was released during the rest intervals between sets for the iBFR trial. For the HI trial, participants completed four sets of 10 repetitions of the same exercises, at 70% of 1-RM, with a 1-min rest period between sets, and at the same contraction speed. Muscle activity was assessed during each set using superficial electromyography, as well as changes in blood lactate concentration [La^-] from baseline at 5 min post exercise and in muscle swelling and plasma volume (%ΔPV) at 5 and 15 min post exercise. There were no significant differences in muscle activity (p < 0.05) across the cBFR, iBFR, and LI protocols at any time point, whereas they were all significantly lower than HI. There were also no significant (p < 0.05) differences across the three low-load RE conditions for [La^-],%ΔPV, or muscle swelling. HI elicited significantly (p < 0.05) greater responses than cBFR, iBFR, and LI for all the physiological markers measured. In conclusion, RE combined with cBFR or iBFR induce the same acute physiological responses. However, the largest physiological responses are observed with HI, probably because of the significantly greater exercise volumes. Therefore, releasing the pressure of the restrictive cuffs during the rest periods between sets will not hinder the acute physiological responses from BFR RE.

Monitoring External Training Loads and Neuromuscular Performance for Division I Basketball Players over the Preseason

Limited research has paralleled concomitant changes in external training load (eTL) and countermovement jump (CMJ) performance. Therefore, this investigation characterized eTL and CMJ performance changes across preseason training in Division 1 male collegiate basketball athletes, while examining the influence of position (Guard vs. Forward/Center) and scholarship status (Scholarship = S vs. Walk-on = WO). During 22 practices, eTL was monitored in 14 male athletes, with weekly CMJs performed to quantify neuromuscular performance (Jump Height [JH], Flight Time:Contraction Time [FT:CT], Reactive Strength Index Modified [RSI_Mod ]). PlayerLoad per minute was significantly higher during W1 and W2 (5.4 ± 1.3au and 5.3 ± 1.2au, respectively; p < 0.05) compared to subsequent weeks, but no additional differences in eTL parameters across time were observed. Scholarship athletes displayed greater PlayerLoad (S = 777.1 ± 35.6, WO = 530.1 ± 56.20; Inertial Movement Analysis (IMA) IMA_High (S = 70.9 ± 15.2, WO = 41.3 ± 15.2); IMA_Medium (S = 159.9 ± 30.7, WO = 92.7 ± 30.6); and IMA_Low (S = 700.6 ± 105.1, WO = 405 ± 105.0;) (p < 0.05), with no observed differences in eTL by position. Moderate decreases in FT:CT and RSI_Mod paralleled increased eTL. Significant increases in practice intensity (W1 and W2) did not impact CMJ performance, suggesting athletes could cope with the prescribed training loads. However, moderate perturbations in FT:CT and RSI_Mod paralleled the weeks with intensified training. Cumulatively, scholarship status appears to influence eTL while player position does not.

Clostridium septicum-infected aortic aneurysm or graft is a deadly diagnosis

BACKGROUND

Clostridium septicum is an anaerobic, motile, spore-forming, toxin-producing gram-positive bacillus that can lead to rapidly progressive gas gangrene due to the release of alpha toxin. Aortic aneurysm secondary to C. septicum infection is a rare condition with 60 cases reported in the literature; however, we have recently treated several patients with the condition in our large tertiary care and aortic center.

METHODS

Blood and tissue culture results collected between January 2005 and January 2018 and maintained in the microbiology laboratory database at the Cleveland Clinic were reviewed to identify those with C. septicum reported. Each was reviewed to determine radiographic or histopathologic correlation with aortic disease.

RESULTS

Seven cases of C. septicum aortitis were reviewed. Underlying malignant disease was found in four cases and a history of remote malignant disease in one case. The most common location for infection was the infrarenal abdominal aorta. Vascular surgery had previously been performed in three of the cases. Five of the seven patients underwent operative repair. All patients were treated with β-lactam antibiotics. The two patients who did not undergo an operation died, which is consistent with the 100% mortality described in the literature. Of the five patients who underwent an operation, there was only one documented survivor and one was lost to follow-up.

CONCLUSIONS

In the largest reported case series, only a small percentage of patients with C. septicum-infected aortic aneurysms survived >1 year. In the patients described, those who did not receive an operation had 100% mortality. Earlier recognition and prompt operation with appropriate antimicrobial therapy are needed to improve the outcome of patients diagnosed with this rare infection.

Barbell velocity: a practical and precise method for predicting bench press strength in sedentary women

BACKGROUND

Bench press one-repetition maximum (BP1RM) prediction models offer a timely approach to predict BP1RM while avoiding the limitations with traditional BP1RM testing. Interestingly, no models have determined the ability for a traditional weight, the 20.5 kg barbell, to predict BP1RM strength. Few models have exclusively examined females and sedentary individuals, leaving the accuracy of these models unknown for these populations. Therefore, this investigation sought to examine the ability for 20.5 kg barbell velocity to predict BP1RM in sedentary females.

METHODS

Nineteen sedentary females (21.79±1.43 years, 166.08±7.76 cm, 63.98±7.54 kg, 31.57±4.72 BP1RM) completed BP1RM testing and completed two additional visits to determine 20.5 kg barbell velocity from a single repetition separated by 7-10 days. Nineteen additional females (21.39±1.09 years, 164.31±7.37 cm, 67.34±9.32 kg, 32.75±5.09 BP1RM) served as a cross-validating group completing identical testing procedures.

RESULTS

Regression analyses revealed that 20.5 kg barbell velocity accounted for 95% of the variance in BP1RM strength while presenting marginal standard error (1.34 kg) and mean absolute error (0.97 kg), with similar values observed in the cross-validating group (SEE: 2.13 kg, MAE: 1.56 kg). Predicted BP1RM values were not significantly different from actual BP1RM (P=0.43) nor were measures in barbell velocity between trials 1 and 2 (P=0.57), while displaying high reliability (ICC: 0.81). Measure bias between BP1RM methods was 0.449±1.651kg and the agreement between methods varied between -2.78 kg less and 0.3686 kg greater for 95% of the participants.

CONCLUSIONS

The present data provides an accurate prediction model regarding BP1RM for sedentary females. These findings can reduce the limitations associated with traditional BP1RM testing while providing a practical and accurate BP1RM approximation with marginal error.

Perceptual responses to continuous versus intermittent blood flow restriction exercise: A randomized controlled trial

We investigated the perceptual responses to resistance exercise (RE) with continuous and intermittent blood flow restriction (BFR). Fourteen males randomly completed the following exercise conditions: low-load RE with continuous BFR (cBFR), low-load RE with intermittent BFR (iBFR), low-load RE without BFR (LI), and traditional high-load RE (HI). Participants completed 4 sets of 30-15-15-15 repetitions of bilateral leg press and knee extension exercises during the low-load conditions, at 20% of one-repetition maximum (1-RM), a 1.5‑sec metronome-controlled pace, with a 1-min rest interval between sets; HI consisted of 4 sets of 10 repetitions of the same exercises, at 70% 1-RM, with the same pace and rest interval. Ratings of perceived exertion (RPE) and discomfort were assessed using psychometric scales before exercise and after each set. RPE displayed no significant differences (p > 0.05) between the BFR conditions for either exercise. Additionally, both BFR conditions elicited significantly (p < 0.05) greater RPE than LI and significantly (p <0.05) lower RPE than HI during both exercises. Rating of discomfort displayed no significant differences between BFR conditions during the first two sets of leg press; however, cBFR evoked greater discomfort compared to iBFR during the last two sets. There were no significant (p > 0.05) differences observed between conditions during the knee extension exercise. Rating of discomfort was similar between the BFR and HI conditions and each were significantly greater than LI during both exercises. Therefore, cBFR and iBFR seem to produce similar perceptual responses, which are greater than LI and lower than HI, but similar in regards to discomfort.

Maximal power production as a function of sex and training status

Maximal muscular power is achieved at lower percentages of maximal strength (1RM); however, this notion has not been elucidated based on sex or training status. Therefore, the purpose of this investigation was to examine the influence of sex and training status on maximal power production. Sixty men and women (resistance trained or untrained) completed 1RM testing for the two-leg press (2LP) and bench press (BP). Participants then returned to perform single repetitions at 20, 30, 40, 50, 60, 70 and 80% of their 1RM to determine muscular power. Factorial analyses determined significant interactions (training status by sex by intensity) for the BP (F=35.6, p<0.001) and 2LP (F=8.2, p<0.001). Subsequent analyses indicated that during the BP trained men produce maximal power between 30-40% 1RM compared to untrained men at 60-70% 1RM. Trained women produced maximal power at 50% 1RM compared to untrained women at 60-70% 1RM. During the 2LP, trained men produced maximal power at 40% 1RM compared to untrained men at 60% 1RM. Trained women produced maximal power at 50% 1RM compared to 60-70% 1RM in untrained women. These data suggest that resistance trained individuals and men display maximal power at a lower relative intensity than untrained individuals and women.

The High Precision of Functional and Neuromuscular Measures to Classify Sarcopenia in Older Women

BACKGROUND AND PURPOSE

Previous literature suggests that reductions in appendicular skeletal mass (ASM) may have a greater detrimental effect than total lean body mass regarding the onset and progression of sarcopenia. Unfortunately, limited access to equipment that accurately determines ASM often leads to many individuals remaining undiagnosed and experiencing functional decline. Therefore, the purpose of this investigation was to determine the ability of functional and neuromuscular measures to identify ASM in older women.

METHODS

Forty-one (sarcopenic n = 15) older women underwent body composition analysis via dual-energy X-ray absorptiometry (DXA) and performed the following measures: bench press (BP) 1-repetition maximum strength (1RM), vertical jump height and power, handgrip strength, Timed Up and Go test, Berg Balance Scale testing, and bench press power testing at 20%, 40%, and 60% 1RM.

RESULTS AND DISCUSSION

Regression analyses revealed 3 significant models accounting for 93.8%, 91.1%, and 86.4% of the variance in DXA-derived ASM. Paired-samples t tests revealed no significant differences between model-derived and DXA-derived ASM for each model, and each model was significantly correlated to DXA-derived ASM (P < .001). In addition, each model revealed a strong ability to appropriately classify sarcopenia status, with the area under the curve values ranging from 0.86 to 0.93. The present data indicate that ASM can be determined with high precision by measuring outcome variables such as jump power, body weight, and grip strength in older women.

CONCLUSIONS

Therefore, the present models could be used to identify, screen, or classify older women as sarcopenic, ultimately allowing the implementation of interventions aimed at decreasing the difficulty of activities of daily living and increasing quality of life.

Effects of Blood-Flow Restriction Combined With Postactivation Potentiation Stimuli on Jump Performance in Recreationally Active Men

Miller, RM, Keeter, VM, Freitas, EDS, Heishman, AD, Knehans, AW, Bemben, DA, and Bemben, MG. Effects of blood-flow restriction combined with postactivation potentiation stimuli on jump performance in recreationally active men. J Strength Cond Res 32(7): 1869-1874, 2018-Whole-body vibration (WBV) and maximum voluntary contractions (MVCs) combined with blood-flow restriction (BFR) to augment postactivation potentiation have yet to be examined. Therefore, the purpose of this investigation was to examine the augmented effects of postactivation potentiation when WBV and MVC are combined with BFR. Twenty men (21.8 ± 2.6 years, 180.5 ± 6.2 cm and 84.5 ± 12.1 kg) completed the study. Participants completed 3 testing sessions in a randomized design that included one of the following: (a) control (CON), (b) WBV and WBV combined with BFR (WBV + BFR), or (c) MVC and MVC combined with BFR (MVC + BFR). Jump height and power were recorded for 3 trials, PRE and POST jump height (cm) mean ± SD for each were as follows: CON 58.9 ± 8.6 and 57.9 ± 8.6, WBV 58.2 ± 8.1 and 59.9 ± 8.1, WBV + BFR 58.7 ± 7.6 and 60.2 ± 8.1, MVC 59.7 ± 7.4 and 60.2 ± 8.6, and MVC + BFR 57.7 ± 7.9 and 59.4 ± 8.1. PRE and POST jump power (W) mean ± SD for each were as follows: CON 1,224.3 ± 221.5 and 1,234.3 ± 189.2, WBV 1,251.1 ± 230.4 and 1,266.1 ± 215.7, WBV + BFR 1,265.8 ± 207.9 and 1,259 ± 223.3, MVC 1,264.7 ± 211.9 and 1,263.5 ± 236.5, and MVC + BFR 1,252.3 ± 222.0 and 1,294.6 ± 256.6. Significant differences were revealed in jump height between the 5 interventions (p < 0.01), WBV (p < 0.01), WBV + BFR (p < 0.01), and MVC + BFR (p < 0.01) revealed significant differences in time but no differences in jump power. In conclusion, the results of this study indicate that WBV, WBV + BFR, and MVC + BFR significantly improve jump height and time in air but not jump power.

Acute and Chronic Effects of Whole-Body Vibration on Balance, Postural Stability, and Mobility in Women With Multiple Sclerosis

The acute and chronic effects of whole-body vibration (WBV) on balance, postural stability, and mobility were evaluated in 21 women with relapsing-remitting multiple sclerosis (MS) randomly assigned to control (n = 9) or experimental (n = 12) groups. To assess acute responses, outcome variables were assessed before and immediately after a session of WBV (five 30-second bouts of vibration; frequency 30 Hz; amplitude 3 mm; 1-minute rest intervals) during their first visit (week 1) using field (Timed-Up and Go; 500-m walk; Berg Balance Scale) and laboratory tests (NeuroCom Balance Master and EquiTest System-Sensory Organization Test, Adaptation Test, Limits of Stability, Modified Clinical Test for Sensory Integration of Balance, Unilateral Stance, Tandem Walk, Step/Quick Turn). Acute responses were also measured after their fifth visit for only the Adaptation and Sensory Organization tests. For the chronic responses, participants were exposed to the WBV protocol once a week, for a total of 5 weeks, and then at week 5, were reassessed with the Adaptation and the Sensory Organization tests. Neither acute nor chronic exposure to the WBV protocols used in this study resulted in significant improvements (P > .05) in balance, postural stability, or mobility as assessed by either field or laboratory tests. However, based on promising results from other studies that have used WBV with other clinical populations, either alone or in conjunction with exercise, additional studies that increase the dose of vibration exposure, both acutely and chronically, should be conducted in patients with MS.

Comparing the Acute Effects of Intermittent and Continuous Whole-Body Vibration Exposure on Neuromuscular and Functional Measures in Sarcopenia and Nonsarcopenic Elderly Women

This investigation examined the acute effects of continuous whole-body vibration (CWBV) and intermittent whole-body vibration (IWBV) on neuromuscular and functional measures in women with sarcopenia and nonsarcopenic women. Continuous whole-body vibration was one 6-minute exposure, while IWBV consisted of six 60-second exposures to rest intervals (30 Hz, 2-4 mm amplitude). Factorial analyses revealed group × exposure × time interactions for jump height (JH; F = 10.8, P = .002), grip strength (GS; F = 15.5, P < .001), timed up and go test (F = 11.7, P = .002), and sit and reach test (S&R; F = 9.7, P = .004). Both JH and GS significantly improved post-WBV in women with sarcopenia (P < .001), with post-IWBV significantly greater (P < .001) than post-CWBV. Timed up and go test and S&R significantly improved post-IWBV in both the groups (P < .001) with post-IWBV significantly better than post-CWBV (P < .001). Bench press power at 20% one repetition maximum (1RM) revealed an exposure × time interaction (F = 4.6, P = .04) illuminating that IWBV significantly improved muscular power (P < .001). Bench press power at 40% 1RM revealed group × exposure (F = 6.4, P = .016) and exposure × time interactions (F = 5.8, P = .022). Individuals with sarcopenia significantly increased power output (P < .001) post-IWBV which was significantly greater than post-CWBV (P = .037). Bench press power at 60% 1RM revealed an exposure × time interaction (F = 8.6, P = .006), indicating that power was significantly improved post-IWBV (P = .027) and decreased post-CWBV. Berg Balance scale revealed a time main effect (F = 6.64, P = .015), and pain discomfort was significantly lower post-IWBV. These data indicate IWBV may provide a more efficacious exposure pattern in older women when compared to CWBV.

Antibody responses to influenza vaccine in pre- and post-lung transplant patients

BACKGROUND

Although pre-transplant immunization is routinely recommended, this recommendation is based on little data. The primary objective of this study was to compare antibody responses in lung transplant patients who received influenza vaccine before the transplant, within the first six months of transplant, between 13 and 60 months post-transplant, and 110 months or beyond transplant.

METHODS

This prospective cohort study included 357 total immunization events performed over five yr to measure H1N1, H3N2, and B antibody responses to the influenza vaccine in pre- and post-lung transplant patients. Geometric mean titers, seroprotection (antibody titer at least 1:40), seroconversion (fourfold increase between pre and post), and mean fold increases were compared.

RESULTS

The geometric mean titer distributions were different for H3N2 and B (ANOVA; p = 0.002 for both). Pre-transplant antibody concentrations were higher compared to the 13- to 60-month group for H3N2 (corrected p = 0.002) and the healthy group for B (corrected p = 0.001). The ≥110-month group had higher seroconversion rates compared to the 13- to 60-month group for H3N2 and B viruses.

CONCLUSION

Lung pre-transplant patients and the long-term survivors have higher responses to the influenza vaccine than early post-transplant and the transplant control groups.

Bubble-Induced Color Doppler Feedback for Histotripsy Tissue Fractionation

Histotripsy therapy produces cavitating bubble clouds to increasingly fractionate and eventually liquefy tissue using high-intensity ultrasound pulses. Following cavitation generated by each pulse, coherent motion of the cavitation residual nuclei can be detected using metrics formed from ultrasound color Doppler acquisitions. In this paper, three experiments were performed to investigate the characteristics of this motion as real-time feedback on histotripsy tissue fractionation. In the first experiment, bubble-induced color Doppler (BCD) and particle image velocimetry (PIV) analysis monitored the residual cavitation nuclei in the treatment region in an agarose tissue phantom treated with two-cycle histotripsy pulses at [Formula: see text] using a 500-kHz transducer. Both BCD and PIV results showed brief chaotic motion of the residual nuclei followed by coherent motion first moving away from the transducer and then rebounding back. Velocity measurements from both PIV and BCD agreed well, showing a monotonic increase in rebound time up to a saturation point for increased therapy dose. In a second experiment, a thin layer of red blood cells (RBC) was added to the phantom to allow quantification of the fractionation of the RBC layer to compare with BCD metrics. A strong linear correlation was observed between the fractionation level and the time to BCD peak rebound velocity over histotripsy treatment. Finally, the correlation between BCD feedback and histotripsy tissue fractionation was validated in ex vivo porcine liver evaluated histologically. BCD metrics showed strong linear correlation with fractionation progression, suggesting that BCD provides useful quantitative real-time feedback on histotripsy treatment progression.

Real-time feedback of histotripsy thrombolysis using bubble-induced color Doppler

Histotripsy thrombolysis is a non-invasive, drug-free, image-guided therapy that fractionates blood clots using well-controlled acoustic cavitation alone. Real-time quantitative feedback is highly desired during histotripsy thrombolysis treatment to monitor the progress of clot fractionation. Bubble-induced color Doppler (BCD) monitors the motion after cavitation generated by each histotripsy pulse, which has been found in gel and ex vivo liver tissue to be correlated with histotripsy fractionation. We investigated the potential of BCD to quantitatively monitor histotripsy thrombolysis in real time. To visualize clot fractionation, transparent three-layered fibrin clots were developed. Results indicated that a coherent motion follows the cavitation generated by each histotripsy pulse with a push and rebound pattern. The temporal profile of this motion expands and saturates as treatment progresses. A strong correlation exists between the degree of histotripsy clot fractionation and two metrics extracted from BCD: time of peak rebound velocity (tPRV) and focal mean velocity at a fixed delay (Vf,delay). The saturation of clot fractionation (i.e., treatment completion) matches well the saturations detected using tPRV and Vf,delay. The mean Pearson correlation coefficients between the progression of clot fractionation and the two BCD metrics were 93.1% and 92.6%, respectively. To validate BCD feedback in in vitro clots, debris volumes from histotripsy thrombolysis were obtained at different therapy doses and compared with Vf,delay. There is also good agreement between the increasing and saturation trends of debris volume and Vf,delay. Finally, a real-time BCD feedback algorithm to predict complete clot fractionation during histotripsy thrombolysis was developed and tested. This work illustrates the potential of BCD to monitor histotripsy thrombolysis treatment in real time.

Bad actions or bad outcomes? Differentiating affective contributions to the moral condemnation of harm

Moral condemnation of harmful behavior is influenced by both cognitive and affective processes. However, despite much recent research, the proximate source of affect remains unclear. One obvious contender is empathy; simulating the victim's pain could lead one to judge an action as wrong ("outcome aversion"). An alternative, less obvious source is one's own aversion to performing the action itself ("action aversion"). To dissociate these alternatives, we developed a scale that assessed individual aversions to (a) witnessing others experience painful outcomes (e.g., seeing someone fall down stairs); and (b) performing actions that are harmless yet aversive (e.g., stabbing a fellow actor with a fake stage knife). Across 4 experiments, we found that moral condemnation of both first-person and third-party harmful behavior in the context of moral dilemmas is better predicted by one's aversion to action properties than by an affective response to victim suffering. In a fifth experiment, we manipulated both action aversion and the degree of expected suffering across a number of actions and found that both factors make large, independent contributions to moral judgment. Together, these results suggest we may judge others' actions by imagining what it would feel like to perform the action rather than experience the consequences of the action. Accordingly, they provide a counterpoint to a dominant but largely untested assumption that empathy is the key affective response governing moral judgments of harm.

Healthcare-associated outbreak of meticillin-resistant Staphylococcus aureus bacteraemia: role of a cryptic variant of an epidemic clone

Background

New strains of meticillin-resistant Staphylococcus aureus (MRSA) may be associated with changes in rates of disease or clinical presentation. Conventional typing techniques may not detect new clonal variants that underlie changes in epidemiology or clinical phenotype.

Aim

To investigate the role of clonal variants of MRSA in an outbreak of MRSA bacteraemia at a hospital in England.

Methods

Bacteraemia isolates of the major UK lineages (EMRSA-15 and -16) from before and after the outbreak were analysed by whole-genome sequencing in the context of epidemiological and clinical data. For comparison, EMRSA-15 and -16 isolates from another hospital in England were sequenced. A clonal variant of EMRSA-16 was identified at the outbreak hospital and a molecular signature test designed to distinguish variant isolates among further EMRSA-16 strains.

Findings

By whole-genome sequencing, EMRSA-16 isolates during the outbreak showed strikingly low genetic diversity (P < 1 × 10⁻⁶, Monte Carlo test), compared with EMRSA-15 and EMRSA-16 isolates from before the outbreak or the comparator hospital, demonstrating the emergence of a clonal variant. The variant was indistinguishable from the ancestral strain by conventional typing. This clonal variant accounted for 64/72 (89%) of EMRSA-16 bacteraemia isolates at the outbreak hospital from 2006.

Conclusions

Evolutionary changes in epidemic MRSA strains not detected by conventional typing may be associated with changes in disease epidemiology. Rapid and affordable technologies for whole-genome sequencing are becoming available with the potential to identify and track the emergence of variants of highly clonal organisms.

Histotripsy cardiac therapy system integrated with real-time motion correction

Histotripsy has shown promise in non-invasive cardiac therapy for neonatal and fetal applications. However, for cardiac applications in general, and especially in the adult heart, cardiac and respiratory motion may affect treatment accuracy and efficacy. In this article, we describe a histotripsy-mediated cardiac therapy system integrated with a fast motion tracking algorithm and treatment monitoring using ultrasound imaging. Motion tracking is performed by diamond search block matching in real-time ultrasound images using a reference image of the moving target, refined by Kalman filtering. As proof of feasibility, this algorithm was configured to track 2-D target motion and then electronically adjust the focus of a 1-MHz annular therapy array to correct for axial motion. This integrated motion tracking system is capable of sub-millimeter accuracy for displacements of 0-15 mm and velocities of 0-80 mm/s, with a maximum error less than 3 mm. Tissue phantom tests indicated that treatment efficiency and lesion size using motion tracking over displacements of 0-15 mm and velocities of 0-42 mm/s are comparable to those achieved when treating stationary targets. In vivo validation was conducted in an open-chest canine model, where the system provided 24 min of motion-corrected histotripsy therapy in the live beating heart, generating a targeted lesion on the atrial septum. Based on this proof of feasibility and the natural extension of these techniques to three dimensions, we anticipate a full motion correction system would be feasible and beneficial for non-invasive cardiac therapy.