Bacterial flora on the white coats of medical students

This study has demonstrated that the white coats of medical students are more likely to be bacteriologically contaminated at points of frequent contact, such as the sleeve and pocket. The organisms identified were principally skin commensals including Staphylococcus aureus. The cleanliness of the coat as perceived by the student was correlated with bacteriological contamination, yet despite this, a significant proportion of students only laundered their coats occassionally. This study supports the view that the students' white coat is a potential source of cross infection on the ward and its design should be modified in order to facilitate hand washing. Hospitals training medical students should consider taking on the burden of providing freshly laundered white coats for the students.

Evidence of a two-step process and pathway dependency in the thermodynamics of poly(diallyldimethylammonium chloride)/poly(sodium acrylate) complexation

Recent studies have pointed out the importance of polyelectrolyte assembly in the elaboration of innovative nanomaterials. Beyond their structures, many important questions on the thermodynamics of association remain unanswered. Here, we investigate the complexation between poly(diallyldimethylammonium chloride) (PDADMAC) and poly(sodium acrylate) (PANa) chains using a combination of three techniques: isothermal titration calorimetry (ITC), static and dynamic light scattering and electrophoresis. Upon addition of PDADMAC to PANa or vice-versa, the results obtained by the different techniques agree well with each other, and reveal a two-step process. The primary process is the formation of highly charged polyelectrolyte complexes of size 100 nm. The secondary process is the transition towards a coacervate phase made of rich and poor polymer droplets. The binding isotherms measured are accounted for using a phenomenological model that provides the thermodynamic parameters for each reaction. Small positive enthalpies and large positive entropies consistent with a counterion release scenario are found throughout this study. Furthermore, this work stresses the importance of the underestimated formulation pathway or mixing order in polyelectrolyte complexation.

Which behaviour change techniques are effective to promote physical activity and reduce sedentary behaviour in adults: a factorial randomized trial of an e- and m-health intervention

BACKGROUND

E- and m-health interventions are promising to change health behaviour. Many of these interventions use a large variety of behaviour change techniques (BCTs), but it's not known which BCTs or which combination of BCTs contribute to their efficacy. Therefore, this experimental study investigated the efficacy of three BCTs (i.e. action planning, coping planning and self-monitoring) and their combinations on physical activity (PA) and sedentary behaviour (SB) against a background set of other BCTs.

METHODS

In a 2 (action planning: present vs absent) × 2 (coping planning: present vs absent) × 2 (self-monitoring: present vs absent) factorial trial, 473 adults from the general population used the self-regulation based e- and m-health intervention 'MyPlan2.0' for five weeks. All combinations of BCTs were considered, resulting in eight groups. Participants selected their preferred target behaviour, either PA (n = 335, age = 35.8, 28.1% men) or SB (n = 138, age = 37.8, 37.7% men), and were then randomly allocated to the experimental groups. Levels of PA (MVPA in minutes/week) or SB (total sedentary time in hours/day) were assessed at baseline and post-intervention using self-reported questionnaires. Linear mixed-effect models were fitted to assess the impact of the different combinations of the BCTs on PA and SB.

RESULTS

First, overall efficacy of each BCT was examined. The delivery of self-monitoring increased PA (t = 2.735, p = 0.007) and reduced SB (t = - 2.573, p = 0.012) compared with no delivery of self-monitoring. Also, the delivery of coping planning increased PA (t = 2.302, p = 0.022) compared with no delivery of coping planning. Second, we investigated to what extent adding BCTs increased efficacy. Using the combination of the three BCTs was most effective to increase PA (x² = 8849, p = 0.003) whereas the combination of action planning and self-monitoring was most effective to decrease SB (x² = 3.918, p = 0.048). To increase PA, action planning was always more effective in combination with coping planning (x² = 5.590, p = 0.014; x² = 17.722, p < 0.001; x² = 4.552, p = 0.033) compared with using action planning without coping planning. Of note, the use of action planning alone reduced PA compared with using coping planning alone (x² = 4.389, p = 0.031) and self-monitoring alone (x² = 8.858, p = 003), respectively.

CONCLUSIONS

This study provides indications that different (combinations of) BCTs may be effective to promote PA and reduce SB. More experimental research to investigate the effectiveness of BCTs is needed, which can contribute to improved design and more effective e- and m-health interventions in the future.

TRIAL REGISTRATION

This study was preregistered as a clinical trial (ID number: NCT03274271 ). Release date: 20 October 2017.

The impact of tryptophan supplementation on sleep quality: a systematic review, meta-analysis, and meta-regression

CONTEXT

L-tryptophan (Trp) has been documented to aid sleep, but a systematic compilation of its effect on sleep quality is still limited.

OBJECTIVE

We assessed the effect of Trp supplementation on sleep quality via meta-analysis and meta-regression. The effects of daily Trp dose (<1 g and ≥1 g) were also assessed.

DATA SOURCES

A database search was done in PubMed, Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane and a total of 18 articles were collected.

DATA EXTRACTION

Extracted data from 4 articles were also analyzed using random-effect meta-analysis and meta-regression. Standardized mean difference (SMD) was used in meta-analysis.

DATA ANALYSIS

Results from the study suggested that Trp supplementation can shorten wake after sleep onset (-81.03 min/g, P = 0.017; SMD, -1.08 min [95%CI, -1.89 to -0.28]). In addition, the group receiving ≥1 g Trp supplementation had a shorter wake after sleep onset than the group with Trp < 1g supplementation (Trp <1 g vs Trp ≥1 g: 56.55 vs 28.91 min; P = 0.001). However, Trp supplementation did not affect other sleep components.

CONCLUSION

Trp supplementation, especially at ≥1 g can help improve sleep quality.

A structural after measurement approach to structural equation modeling

In structural equation modeling (SEM), the measurement and structural parts of the model are usually estimated simultaneously. In this article, we revisit the long-standing idea that we should first estimate the measurement part, and then estimate the structural part. We call this the "structural-after-measurement" (SAM) approach to SEM. We describe a formal framework for the SAM approach under settings where the latent variables and their indicators are continuous. We review earlier SAM methods and establish how they are specific instances of the SAM framework. Decoupled estimation for the measurement and structural parts using SAM possesses three key advantages over simultaneous estimation in standard SEM. First, estimates are more robust against local model misspecifications. Second, estimation routines are less vulnerable to convergence issues in small samples. Third, estimates exhibit smaller finite sample biases under correctly specified models. We propose two variants of the SAM approach. "Local" SAM expresses the mean vector and variance-covariance matrix of the latent variables as a function of the observed summary statistics and the parameters of the measurement model. "Global" SAM holds the parameters of the measurement part fixed while estimating the parameters of the structural part. Our framework includes two-step corrected standard errors, and permits computing both local and global fit measures. Nonetheless, the SAM approach is an estimation strategy, and should not be regarded as a model-building tool. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Synthesis and antineoplastic activity of phenyl-substituted benzenesulfonylhydrazones of 2-pyridinecarboxyaldehyde 1-oxide

A variety of derivatives of 2-pyridinecarboxaldehyde 1-oxide benzenesulfonylhydrazone, containing substituents on the benzene or pyridine rings as well as on the nitrogen atom which is bonded directly to the sulfonyl group, have been synthesized. The antineoplastic activity of these compounds has been assessed in mice bearing either leukemia L1210 or P388. The most potent agents in this series were 2,4-dimethoxy,3,4-dimethoxy-, and 2,4,6-trimethylbenzenesulfonylhydrazone of 2-pyridinecarboxyaldehyde 1-oxide, all causing disappearance of tumors in 20-80% of leukemia-bearing mice.

Irreducible shoulder dislocation - a word of caution

Anterior dislocation of shoulder is usually amenable to closed manipulation. Failure to achieve satisfactory reduction can be due to soft tissue or osseous interposition. We report a case of irreducible anterior shoulder dislocation with the interposition of the musculocutaneous nerve. This required open reduction and release of the musculocutaneous nerve; which was found to be further trapped by the torn long head of biceps.

Skin carotenoids status as a potential surrogate marker for cardiovascular disease risk determination in middle-aged and older adults

BACKGROUND AND AIMS

Upon consumption, carotenoids, which may attenuate cardiovascular disease (CVD) risk, diffuse from the blood and accumulate in the skin. This study aimed to assess the associations between dietary, plasma, and skin carotenoids with CVD risk indicators and to examine the mediational role of plasma carotenoids in the relationship between skin carotenoids status (SCS) and CVD risk.

METHODS AND RESULTS

Dietary, plasma, and skin carotenoids were assessed in a cross-sectional study from a community in Singapore (n = 103) aged 50 to 75 y. Multiple linear regression and binary logistics regression models were used to examine the associations between the carotenoids status with classical CVD risk factors and composite CVD risk indicators. After controlling for covariates, SCS and plasma carotenoids were inversely associated with systolic blood pressure (skin: P < 0.001; plasma: P < 0.05) and diastolic blood pressure (skin: P < 0.001; plasma: P < 0.005). Additionally, each increment of 1000 in SCS was associated with an odds ratio of 0.924 (P < 0.01) for metabolic syndrome diagnosis and 0.945 (P < 0.05) for moderate to high CVD risk classification. Associations between SCS and composite CVD risk indicators were null when adjusted for the corresponding plasma carotenoids, indicating complete mediation. Dietary carotenoids, however, showed no relationship with the CVD risk indicators.

CONCLUSION

Carotenoids bioavailability may be important for cardiovascular protection. SCS, driven by the corresponding plasma carotenoids, could be a potential noninvasive surrogate marker for CVD risk determination in middle-aged and older adults.

CLINICAL TRIAL REGISTRATION

NCT03554954, https://clinicaltrials.gov/.

TRIAL REGISTRATION DATE

13 June 2018.

Nonlinear effect of social interaction quantity on psychological well-being: Diminishing returns or inverted U?

Social contact is an important ingredient of a happy and satisfying life. But is more social contact necessarily better? Although it is well-established that increasing the quantity of social interactions on the low end of its spectrum promotes psychological well-being, the effect of interaction quantity on the high end remains largely unexplored. We propose that the effect of interaction quantity is nonlinear; specifically, at high levels of interaction quantity, its positive effects may be reduced (Diminishing Returns Hypothesis) or even reversed (Inverted U Hypothesis). To test these two competing hypotheses, we conducted a series of six studies involving a total of 161,836 participants using experimental (Study 1), cross-sectional (Studies 2 and 3), daily diary (Study 4), experience sampling (Study 5), and longitudinal survey designs (Study 6). Consistent evidence emerged across the studies supporting the Diminishing Returns Hypothesis. On the low end of the interaction quantity spectrum, increasing interaction quantity enhanced well-being as expected; whereas on the high end of the spectrum, the effect of interaction quantity was reduced or became nearly negligible, but did not turn negative. Taken together, the present research provides compelling evidence that the well-being benefits of social interactions are nearly negligible after moderate quantities of interactions are achieved. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nonlinear mediation analysis with high-dimensional mediators whose causal structure is unknown

With multiple possible mediators on the causal pathway from a treatment to an outcome, we consider the problem of decomposing the effects along multiple possible causal path(s) through each distinct mediator. Under a path-specific effects framework, such fine-grained decompositions necessitate stringent assumptions, such as correctly specifying the causal structure among the mediators, and no unobserved confounding among the mediators. In contrast, interventional direct and indirect effects for multiple mediators can be identified under much weaker conditions, while providing scientifically relevant causal interpretations. Nonetheless, current estimation approaches require (correctly) specifying a model for the joint mediator distribution, which can be difficult when there is a high-dimensional set of possibly continuous and noncontinuous mediators. In this article, we avoid the need to model this distribution, by developing a definition of interventional effects previously suggested for longitudinal mediation. We propose a novel estimation strategy that uses nonparametric estimates of the (counterfactual) mediator distributions. Noncontinuous outcomes can be accommodated using nonlinear outcome models. Estimation proceeds via Monte Carlo integration. The procedure is illustrated using publicly available genomic data to assess the causal effect of a microRNA expression on the 3-month mortality of brain cancer patients that is potentially mediated by expression values of multiple genes.

Dihydroergotoxine kinetics in healthy men after intravenous and oral administration

The kinetics of intravenous and oral dihydroergotoxine mesylate determined in eight healthy male subjects with a radioimmunoassay method incorporating a plasma extraction step to obtain maximal sensitivity and specificity. The intravenous plasma concentration-time curve showed an initial rapid decline (half-life[t1/2] = 3.5 min) and could be fitted to a three-compartment model. The high systemic clearance (20.2 to 28.8 ml x min-1 x kg-1) and large distribution volume, (9.9 to 20.41 x kg-1) were associated with a terminal t1/2 of 9.5 to 18.4 hr. The oral absorption was rapid. (t1/2 = 14.8 min). Absolute bioavailability was 5.3% to 12.4%. The terminal t1/2 and bioavailability were considerably lower than earlier estimates and this can be attributed to the use in these investigations of a more sensitive and specific dihydroergotoxine assay method.

Solid phase indirect radioimmunoassay: standardization and applications in viral serology

In solid phase indirect radioimmunoassay (IRIA) antiviral immunoglobulins (Ig) bind specifically to the viral antigen fixed onto wells of microtiter plates. Radioactively labeled (125I) anti-Ig can be used to detect these antiviral antibodies. The sensitivity of the IRIA depends on the amount of antigen in the microtiter wells and the concentration of the 125I-labeled anti-Ig used. To standardize the assay, a method of antigen titration in the IRIA was devised, using parainfluenza type 1 viruses as antigens. The IRIA provides a means to titrate viral antigens with different biologic activities and antibodies against them. A binding inhibition test (BIT) based on IRIA allows the antigenic analysis of different virus strains, as is demonstrated for two closely related parainfluenza type 1 virus strains.

Antigenic variation among parainfluenza type 1 (Sendai) viruses: analysis of 6/94 virus

6/94 virus, isolated originally from a multiple sclerosis (MS) patient, was compared antigenically with related parainfluenza type 1 strains. These included two Sendai strains of mouse and two Sendai strains of reported human origin as well as the HA2 strain. By standard hemagglutination inhibition (HI) or hemadsorption neutralization (HAD-N) tests or by the complement-fixation (CF) cross-block titration test for detecting surface antigens, 6/94 virus and the Sendai virus strains were indistinguishable from each other but distinct from the HA2 strain. By the kinetic HI test, however, 6/94 virus could be readily differentiated from the Sendai viruses isolated from mice and more closely resembled those recovered from man.

Association Between Dietary Protein Intake and Sleep Quality in Middle-Aged and Older Adults in Singapore

Poor sleep has been associated with the increased risk of developing detrimental health conditions. Diet and certain nutrients, such as dietary protein (PRO) may improve sleep. This cross-sectional study aimed to investigate the relationship between PRO intake, their amino acid components, and sources with sleep quality in middle-aged and older adults residing in Singapore. A dataset of 104 healthy subjects between the age of 50 and 75 years old were used. Collected data included 3-day food record and sleep quality [sleep duration, global sleep score (GSS), sleep latency (SL), and sleep efficiency (SE)]. The collected 3-day food records were extracted for PRO, tryptophan (Trp), and large neutral amino acid (LNAA) intake. PRO intake was further categorized into plant and animal PRO. A multivariate multiple linear regression (MLR) was performed to assess the association between PRO intake and sleep quality. Dietary Trp:LNAA ratio was positively associated with sleep duration (β_total: 108.234 h; p: 0.005) after multiple covariates adjustment. Similarly, plant Trp (β_plant: 2.653 h/g; p: 0.020) and plant Trp:LNAA (β_plant: 54.006 h; p: 0.008) was positively associated with sleep duration. No significant associations were observed for both SL and SE. Sleep duration in middle-aged and older Singaporean adults was positively associated with dietary Trp and Trp:LNAA, especially when obtained from plant sources.

Estimation of Controlled Direct Effects in Longitudinal Mediation Analyses with Latent Variables in Randomized Studies

In a randomized study with longitudinal data on a mediator and outcome, estimating the direct effect of treatment on the outcome at a particular time requires adjusting for confounding of the association between the outcome and all preceding instances of the mediator. When the confounders are themselves affected by treatment, standard regression adjustment is prone to severe bias. In contrast, G-estimation requires less stringent assumptions than path analysis using SEM to unbiasedly estimate the direct effect even in linear settings. In this article, we propose a G-estimation method to estimate the controlled direct effect of treatment on the outcome, by adapting existing G-estimation methods for time-varying treatments without mediators. The proposed method can accommodate continuous and noncontinuous mediators, and requires no models for the confounders. Unbiased estimation only requires correctly specifying a mean model for either the mediator or the outcome. The method is further extended to settings where the mediator or outcome, or both, are latent, and generalizes existing methods for single measurement occasions of the mediator and outcome to longitudinal data on the mediator and outcome. The methods are utilized to assess the effects of an intervention on physical activity that is possibly mediated by motivation to exercise in a randomized study.

Adjusting for Baseline Measurements of the Mediators and Outcome as a First Step Toward Eliminating Confounding Biases in Mediation Analysis

Mediation analysis prevails for researchers probing the etiological mechanisms through which treatment affects an outcome. A central challenge of mediation analysis is justifying sufficient baseline covariates that meet the causal assumption of no unmeasured confounding. But current practices routinely overlook this assumption. In this article, we suggest a relatively easy way to mitigate the risks of incorrect inferences resulting from unmeasured confounding: include pretreatment measurements of the mediator(s) and the outcome as baseline covariates. We explain why adjusting for pretreatment baseline measurements is a necessary first step toward eliminating confounding biases. We hope that such a practice can encourage explication, justification, and reflection of the causal assumptions underpinning mediation analysis toward improving the validity of causal inferences in psychology research.

Confounder selection strategies targeting stable treatment effect estimators

Inferring the causal effect of a treatment on an outcome in an observational study requires adjusting for observed baseline confounders to avoid bias. However, adjusting for all observed baseline covariates, when only a subset are confounders of the effect of interest, is known to yield potentially inefficient and unstable estimators of the treatment effect. Furthermore, it raises the risk of finite-sample bias and bias due to model misspecification. For these stated reasons, confounder (or covariate) selection is commonly used to determine a subset of the available covariates that is sufficient for confounding adjustment. In this article, we propose a confounder selection strategy that focuses on stable estimation of the treatment effect. In particular, when the propensity score (PS) model already includes covariates that are sufficient to adjust for confounding, then the addition of covariates that are associated with either treatment or outcome alone, but not both, should not systematically change the effect estimator. The proposal, therefore, entails first prioritizing covariates for inclusion in the PS model, then using a change-in-estimate approach to select the smallest adjustment set that yields a stable effect estimate. The ability of the proposal to correctly select confounders, and to ensure valid inference of the treatment effect following data-driven covariate selection, is assessed empirically and compared with existing methods using simulation studies. We demonstrate the procedure using three different publicly available datasets commonly used for causal inference.

Comparative antilipidemic effects of various ethyl 5-substituted benzofuran-, 2,3-dihydrobenzofuran-, and 3(2H)-benzofuranone-2-carboxylate analogs of clofibrate in a triton hyperlipidemic rat model

The antilipidemic properties of certain benzofuran-, 2,3-dihydrobenzofuran-, and 3(2H)-benzofuranone-2-carboxylate analogs of clofibrate in a hyperlipidemic rat model are described. The hyperlipidemia was induced by intraperitoneal injection of Triton WR-1339. The results were analyzed in light of structural modifications as well as the lipid solubility of substituted compounds as assessed by a consideration of calculated log P values. Comparisons are made between the activity of these compounds and the activity of related cyclic analogs previously reported. Among the various compounds tested, only the 5-C1 and phenylsybstituted dihydrobenzofurans were selective against elevated serum cholesterol levels in this animal model. The data presented support the hypothesis that the cholesterol and triglyceride lowering activity of clofibrate related analogs in this animal model may be separated through a consideration of log P, conformational, and electronic changes. The proposal is advanced that relatively minor structural modification of clofibrate related analogs may lead to compounds which are not only selective in the Triton model but also to compounds which are likely to exert their effects by differing modes of action.

Reductions in kinesiophobia and distress after pain neuroscience education and exercise lead to favourable outcomes: a secondary mediation analysis of a randomized controlled trial in primary care

ABSTRACT

Pain neuroscience education combined with exercise (PNE + exercise) is an effective treatment for patients with chronic spinal pain. Yet, however, little is known about its underlying therapeutic mechanisms. Thus, this study aimed to provide the first insights by performing a novel mediation analysis approach in a published randomized controlled trial in primary care where PNE + exercise was compared with standard physiotherapy. Four mediators (catastrophizing, kinesiophobia, central sensitization-related distress, and pain intensity) measured at postintervention and 3 outcomes (disability, health-related quality of life, and pain medication intake) measured at 6-month follow-up were included into the analysis. The postintervention measure of each outcome was also introduced as a competing candidate mediator in each respective model. In addition, we repeated the analysis by including all pairwise mediator-mediator interactions to allow the effect of each mediator to differ based on the other mediators' values. Postintervention improvements in disability, medication intake, and health-related quality of life strongly mediated PNE + exercise effects on each of these outcomes at 6-month follow-up, respectively. Reductions in disability and medication intake were also mediated by reductions in kinesiophobia and central sensitization-related distress. Reductions in kinesiophobia also mediated gains in the quality of life. Changes in catastrophizing and pain intensity did not mediate improvements in any outcome. The mediation analyses with mediator-mediator interactions suggested a potential effect modification rather than causal independence among the mediators. The current results, therefore, support the PNE framework to some extent as well as highlight the need for implementing the recent approaches for mediation analysis to accommodate dependencies among the mediators.

Synthesis and pharmacological evaluation of cis-3,4,4a,9a-tetrahydro-1H-pyrano[3,4-b]benzofuran-1-ones. Tricyclic analogues related to the antilipidemic drug clofibrate

The chemistry and pharmacology of two delta-lactones, cis-6-chloro-9a-methyl-3,4,4a,9a-tetrahydro-1H-pyrano[3,4-b]benzofuran-1-one (2) and the 9a-demethyl analogue 3, are reported. Lactones were prepared from dihydrobenzofuran precursors possessing geometrical configurations confirmed both by synthesis and 1H NMR spectroscopy. All cis-dihydrobenzofurans exhibited Jvic = 9.0-10.8 Hz, whereas their trans isomers exhibited Jvic = 5.0--6.0 Hz in agreement with predictions based on the Karplus equation. The pharmacological profiles for 2 and 3 were compared to that of clofibrate (1) in normal male Sprague-Dawley rats. Using equimolar doses (0.4 mmol/kg, po, twice daily for 7 days), 1 exhibited both anticholesterolemic and antitriglyceridemic activity, lactone 2 exhibited only antitriglyceridemic activity, and 3 was inactive as an antilipidemic agent. No correlation was observed for inhibition of hepatic HMG-CoA reductase activity and serum cholesterol lowering.

The isotopic biosignatures of photo- vs. thiotrophic bivalves: are they preserved in fossil shells?

Symbiont-bearing and non-symbiotic marine bivalves were used as model organisms to establish biosignatures for the detection of distinctive symbioses in ancient bivalves. For this purpose, the isotopic composition of lipids (δ13C) and bulk organic shell matrix (δ13C, δ34S, δ15N) from shells of several thiotrophic, phototrophic, or non-symbiotic bivalves were compared (phototrophic: Fragum fragum, Fragum unedo, Tridacna maxima; thiotrophic: Codakia tigerina, Fimbria fimbriata, Anodontia sp.; non-symbiotic: Tapes dorsatus, Vasticardium vertebratum, Scutarcopagia sp.). ∆13C values of bulk organic shell matrices, most likely representing mainly original shell protein/chitin biomass, were depleted in thio- and phototrophic bivalves compared to non-symbiotic bivalves. As the bulk organic shell matrix also showed a major depletion of δ15N (down to -2.2 ‰) for thiotrophic bivalves, combined δ13C and δ15N values are useful to differentiate between thio-, phototrophic, and non-symbiotic lifestyles. However, the use of these isotopic signatures for the study of ancient bivalves is limited by the preservation of the bulk organic shell matrix in fossils. Substantial alteration was clearly shown by detailed microscopic analyses of fossil (late Pleistocene) T. maxima and Trachycardium lacunosum shell, demonstrating a severe loss of quantity and quality of bulk organic shell matrix with time. Likewise, the composition and δ13C-values of lipids from empty shells indicated that a large part of these compounds derived from prokaryotic decomposers. The use of lipids from ancient shells for the reconstruction of the bivalve's life style therefore appears to be restricted.

Intracellular pH in hypoxic smooth muscle

Hypoxia impairs contractility in canine tracheal smooth muscle (TSM). This is attributed to intracellular lactacidosis. The present studies were undertaken to confirm this. Lactate was found to be significantly increased in hypoxic TSM (65.36 +/- 7.37 mg/100 g wet tissue), compared to normoxic (29.83 +/- 5.05). Intracellular pH (pHi) was, however, significantly increased in hypoxic active TSM to 7.71 +/- 0.05 as compared to 7.30 +/- 0.03 in normoxic active muscle. pHi of resting normoxic muscle (7.20 +/- 0.04) was statistically not different from that of resting hypoxic muscle. The pHi's of resting normoxic and active hypoxic muscles were significantly different. These results show that under in vitro, hypoxic conditions: 1) an increase in glycolysis in TSM is indicated by the increased lactate production, 2) there is a surprising, concomitant rise in pHi rather than a decrease as previously expected, and 3) it is mechanical activity of the muscle which leads to this paradoxical result, inasmuch as pHi is unaltered in the resting hypoxic muscle.