Effects of long-term aerobic exercise on EPOC

This study sought to determine the influence of 16 months of progressive aerobic exercise on excess postexercise oxygen consumption (EPOC) and the extent EPOC contributed to weight management. Twenty-five overweight/obese women and 16 overweight/obese men participated in a 16-month exercise program (moderate-intensity treadmill walking) that progressed across the first 26 weeks to 5 days.wk(-1), 45 min.session(-1), and 75% HRR. Three-hour EPOC was measured at baseline, 9 months, and 16 months by indirect calorimetry in response to an exercise session (treadmill walking), in which energy expenditure (EE) was estimated from the participant's previous 10 exercise sessions. For women, EPOC was 7.5 +/- 4.9, 9.6 +/- 7.6, and 6.5 +/- 6.5 L at baseline, 9 months, and 16 months, respectively (p > 0.05). For men, EPOC increased from baseline (11.8 +/- 6.8 L) to 9 months (13.5 +/- 8.6 L) (p < 0.05) with no further increase at 16 months (13.5 +/- 11.0 L). Change in EPOC was correlated with change in EE at 9 months (r = 0.65; p < 0.05) and 16 months (r = 0.58; p < 0.05) for men but not women. Progressive long-term exercise significantly influenced EPOC in overweight/obese men but not women. Change in volume of exercise likely explained the increase in energy expenditure during EPOC in men. EPOC contributed modestly to EE compared to the exercise itself.     

Validation of a shortened electronic version of the environmental symptoms questionnaire

The purpose of this study was to validate a shortened (11-item) electronic version of the 67-item paper and pencil Environmental Symptoms Questionnaire (ESQ-III) to assess acute mountain sickness (AMS). Thirty-three volunteers (means +/- SE; 28 +/- 1 yr; 74 +/- 2 kg) were given both the paper and pencil and electronic versions of the ESQ (IPAQ 5550, Hewlett Packard, Palo Alto, CA) to complete one after the other at residence altitude (RA) and after 24-h (PP24), 48-h (PP48), and 72-h (PP72) exposure to 4300 m on the summit of Pikes Peak (PP). The AMS-Cerebral (AMS-C) weighted factor score was calculated from responses to the same 11 items for each version of the ESQ. If AMS-C was >or=0.7, then the individual was classified as having AMS. There were no differences in the AMS-C scores between the paper and pencil and electronic versions of the ESQ at RA (0.05 +/- 0.01 vs. 0.05 +/- 0.02), PP24 (0.76 +/- 0.16 vs. 0.74 +/- 0.15), PP48 (0.61 +/- 0.15 vs. 0.53 +/- 0.14), and PP72 (0.34 +/- 0.09 vs. 0.34 +/- 0.09).There were no differences in the incidence of AMS between the paper and pencil and electronic versions of the ESQ at RA (0% vs. 0%), PP24 (33% vs. 36%), PP48 (27% vs. 27%), and PP72 (21% vs. 21%). The relationships between AMS-C calculated from the two versions of the ESQ at RA (r = 0.43; p = 0.01), PP24 (r = 0.92; p = 0.0001), PP48 (r = 0.82; p = 0.0005), and PP72 (r = 0.95; p = 0.0001) were significant. The relationships between the incidence of AMS calculated from the two version of the ESQ at RA (k = 0.90; p = 0.01), PP24 (k = 0.90; p = 0.01), PP48 (k = 0.91; p = 0.01), and PP72 (k = 0.92; p = 0.01) were significant. Our findings suggest that the shortened electronic version can be substituted for the paper and pencil version of the ESQ to assess AMS.     

Testicular function after radioiodine therapy for thyroid carcinoma

Radiotherapy can cause infertility in both men and women. However, few data are available concerning the effects of radioiodine therapy for thyroid carcinoma on testicular function. We investigated 25 men (age 23-73 years) with differentiated thyroid carcinoma in a longitudinal prospective trial. Follicle-stimulating hormone (FSH), inhibin B, luteinising hormone (LH) and testosterone were measured before (n = 25) and 3 months (n = 11), 6 months (n = 18), 12 months (n = 22), and 18 months (n = 18) after radioiodine therapy [radioiodine dose (mean +/- SEM): 9.8+/-0.89 GBq]. Before therapy, FSH was 5.4+/-0.77 IU/l; it increased significantly (P<0.001) to 21.3+/-2.4 IU/l after 6 months and fell to 7.4+/-1.3 IU/l after 18 months (normal range: 1.8-9.2 IU/l). Inhibin B was significantly decreased (P<0.001) from 178+/-25.3 pg/ml before therapy to 22.2+/-5.5 pg/ml after 3 and 29.4+/-5.7 pg/ml after 6 months and rose to 154+/-23.3 pg/ml after 18 months (normal range 75-350 pg/ml). LH and testosterone were within the normal range during the whole study (1.6-9.2 IU/l and 10.4-34.7 nmol/l, respectively). LH was significantly increased (P<0.001) from 2.8+/-0.33 IU/l before therapy to 5.9+/-0.69 IU/l 6 months after therapy and then fell slowly to 4.0+/-0.45 IU/l after 18 months. Total testosterone was significantly increased (P<0.01) from 12.8+/-0.99 nmol/l at baseline to 19.8+/-1.7 nmol/l after 12 months and 19.6+/-1.7 nmol/l after 18 months. The testosterone/LH ratio (normal range: 3.3-17.9 nmol/IU) fell from 5.8+/-0.66 nmol/IU to 3.0+/-0.36 nmol/IU after 3 months (P<0.01); it remained close to the latter value after 6 months (3.4+/-0.49 nmol/IU) and then rose to 5.5+/-0.6 nmol/IU after 18 months. In conclusion, 3 and 6 months after radioiodine therapy all patients showed elevated FSH and decreased inhibin B levels, reflecting severely impaired spermatogenesis. At the same time a compensated insufficiency of the Leydig cell function was observed. Eighteen months after the last radioiodine therapy, mean values of gonadal function had completely recovered.     

Effects of pegfilgrastim on normal biodistribution of 18F-FDG: preclinical and clinical studies.

The purpose of this study was to evaluate the effects of pegfilgrastim, a long-acting granulocyte colony-stimulating factor, on the normal biodistribution of (18)F-FDG in an animal model and in humans. METHODS: Two groups of 12 rats received a single subcutaneous injection of either normal saline or pegfilgrastim. One, 7, 14, and 21 d after injection, biodistribution studies were performed 1 h after (18)F-FDG injection. Sixteen breast cancer patients underwent baseline (18)F-FDG PET/CT and, approximately 1 wk after receiving 1 dose of docetaxel and adjunctive pegfilgrastim, follow-up (18)F-FDG PET/CT (scan 2). Standardized uptake values corrected for lean body mass (SUL) were determined for several normal organs before and after therapy. RESULTS: In rats, bone marrow (18)F-FDG uptake (standardized uptake value) was higher in the pegfilgrastim group 1 d after injection (mean +/- SD, 8.3 +/- 4.1 vs. 2.5 +/- 0.2, P < 0.05), whereas (18)F-FDG uptake in blood was lower (0.41 +/- 0.06 vs. 0.49 +/- 0.01, P < 0.05). In patients, mean SUL was higher in bone marrow (4.49 +/- 1.50 vs. 1.33 +/- 0.22, P < 0.0001), spleen (3.29 +/- 0.83 vs. 1.23 +/- 0.23, P < 0.0001), and liver (1.45 +/- 0.25 vs. 1.31 +/- 0.23, P = 0.01) but lower in brain (4.18 +/- 0.76 vs. 5.14 +/- 1.44, P < 0.01) on scan 2 than on the baseline scan. CONCLUSION: In both the animal model and humans, pegfilgrastim markedly increased bone marrow uptake of (18)F-FDG and reduced (18)F-FDG uptake in some normal tissues. These profound alterations in (18)F-FDG biodistribution induced by pegfilgrastim must be considered when one is evaluating quantitative (18)F-FDG PET scans for tumor response to therapy.     

Fluorine- 18-fluorodeoxyglucose positron emission tomography for assessment of patients with unresectable recurrent or metastatic lung cancers after CT-guided radiofrequency ablation: Preliminary results

OBJECTIVES: We compared the diagnostic value of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) with that of computed tomography (CT) following radiofrequency ablation (RFA) of inoperable recurrent or metastatic cancers in the lung. METHODS: Twelve patients (9 males and 3 females; 5 had recurrent lung cancer and the other 7 had metastatic nodules from a variety of primary cancers) were treated by RFA for 17 pulmonary nodules. FDG-PET was performed before and 2 months after RFA, and the mean standardized uptake value (SUV) was calculated. The response evaluation was based on the percent reduction relative to the baseline and the absolute values of SUV on FDG-PET performed at 2 months after RFA. We compared the response evaluations made based on findings of FDG-PET and CT at 2 and > or =6 months (mean 10.2) after RFA. RESULTS: The percent reduction in uptake at 2 months was significantly lower in nodules considered progressive (69.6 +/- 18.6%) than nonprogressive disease (38.7 +/- 12.5%; p < 0.01) based on CT findings at > or =6 months after RFA. The absolute SUV at 2 months was significantly higher in nodules considered progressive (2.61 +/- 0.75) than nonprogressive disease (1.05 +/- 0.67; p < 0.01) based on CT findings at > or =6 months post-RFA. CONCLUSION: Although our pilot study comprised few cases of various histopathological types of cancers in the lung, the results suggest that FDG-PET could predict regrowth on subsequent follow-up CT. Regrowth could be diagnosed earlier by FDG-PET than by CT, and nodules with residual uptake and with <60% reduction of uptake relative to baseline on FDG-PET at 2 months after ablation might require additional therapy.     

Smoking effect on exercise response kinetics of oxygen uptake and related variables

The effects of smoking on the kinetics of oxygen uptake (VO2), carbon dioxide production (VCO2), ventilation (Ve) and heart rate (HR) in the transition from rest to steady-state submaximal exercise was investigated in 6 female and 4 male smokers (32 +/- 8 yrs). The subjects underwent two counter-balanced treadmill tests at 60% of their maximal VO2, lasting 10 min each: one following a 24-hr smoking abstinence, and one immediately after smoking three cigarettes without prior abstinence. Physiological variables were measured at rest and every 30 sec throughout each test. The time required for a given variable to rise from its respective resting baseline to half of its steady-state value (t1/2) was calculated for VO2, VCO2, Ve and HR. Smoking abstinence was associated with t1/2 values of 32 +/- 8, 42 +/- 12, 43 +/- 10, and 30 +/- 9 sec for VO2, VCO2, Ve, and HR, respectively. Smoking significantly (p less than 0.01) lengthened those values to 51 +/- 12, 58 +/- 11, 54 +/- 8, and 41 +/- 10 sec. Concurrently, smoking raised the baseline (resting) values of HR (p less than 0.01) and of Ve, VCO2, O2 pulse (O2P), and both systolic and diastolic blood pressures (p less than 0.05). During steady-state exercise only HR values were elevated by smoking (p less than 0.01), while O2P values were lowered (p less than 0.05). These findings indicate that smoking considerably retards physiological responses to submaximal exercise.     

Resting serum antioxidant status is positively correlated with peak oxygen uptake in endurance trained runners

BACKGROUND: This study tested the hypothesis that the ability to scavenge free radicals in serum was compromised in trained runners. METHODS: Experimental design: peak VO2, the ability to scavenge free radicals in serum and the plasma concentration of malondialdehyde (MDA) were assessed in 18 male runners. Participants: subject characteristics (mean +/- SEM) were height 1.77 +/- 0.01 m, mass 71.4 +/- 1.2 kg, age 31 +/- 1 years and weekly training distance 45 +/- 5 km.week-1. Measures: venous blood samples were collected at rest. Serum total antioxidant capacity (TAC) was determined using a chemiluminescent technique. This involved the oxidation of luminol, in a reaction catalysed by horseradish peroxidase. Serum antioxidant protection was quantified relative to a soluble vitamin E analogue (Trolox) and expressed as Trolox equivalents (Trolox Eq.). MDA was determined using a highly specific assay, using HPLC with fluorimetric detection. Peak VO2 was determined from expired gas measurements collected during an incremental running test on a motorised treadmill. Data were analysed using Pearson correlations. RESULTS: Serum TAC was 500 +/- 26 mumol Trolox Eq.l-1, with a plasma MDA concentration of 1.5 +/- 0.1 mmol.l-1 and serum urate concentration of 274 +/- 12 mmol.l-1. Peak VO2 was 63 +/- 1 ml.kg-1.min-1. Significant correlations were observed between peak VO2 and serum TAC (r = 0.365, p < 0.05); peak VO2 and serum urate (r = 0.463, p < 0.05) and serum urate and serum TAC (r = 0.807, p < 0.001). Plasma MDA and serum TAC were not significantly correlated (r = 0.026, p > 0.05). CONCLUSIONS: These data demonstrate that the ability to quench free radicals in serum in increased in relation to the maximum ability to consume oxygen, however this response does not appear to provide any additional protection against peroxidative damage at rest.     

Troglitazone improves whole-body insulin resistance and skeletal muscle glucose use in type II diabetic patients.

Recently, troglitazone has emerged as an insulin sensitizer for the treatment of type II diabetes. However, its effect on skeletal muscle glucose use (SMGU) has not been studied. METHODS: To investigate the effect of troglitazone on SMGU in patients with type II diabetes, we undertook skeletal muscle (18)F-FDG PET dynamic imaging under insulin clamping before and after administration of SMGU to 20 patients with type II diabetes. Data were compared with those for 12 age-matched healthy volunteers. RESULTS: The whole-body glucose disposal rate (GDR) was significantly lower in patients (29.9 +/- 9.83 micromol/min/kg) than in control subjects (55.6 +/- 16.5 micromol/min/kg, P < 0.01), as was the SMGU (patients, 3.27 +/- 2.17 micromol/min/kg; control subjects, 10.9 +/- 6.4 micromol/min/kg; P < 0.01). After the therapy, GDR significantly improved in patients (29.3 +/- 14.6 micromol/min/kg, P < 0.05), as did SMGU (5.06 +/- 2.11 micromol/min/kg, P < 0.05). When results for patients with and without hypertension were separately analyzed, a significant improvement in SMGU after troglitazone was seen in both normotensive and hypertensive patients (normotensive [n = 10]: baseline, 3.67 +/- 2.89 micromol/min/kg; after therapy, 5.28 +/- 2.61 micromol/min/kg; P < 0.05; hypertensive [n = 10]: baseline, 2.89 +/- 1.22 micromol/min/kg; after therapy, 4.72 +/- 1.39 micromol/min/kg; P < 0.05). GDR in patients with and without hypertension was significantly improved by troglitazone (normotensive: baseline, 17.9 +/- 10.2 micromol/min/kg; after therapy, 31.9 +/- 15.9 micromol/min/kg; P < 0.01; hypertensive: baseline, 39.6 +/- 15.1 micromol/min/kg; after therapy, 47.7 +/- 23.8 micromol/min/kg; P < 0.05). The plasma free fatty acid concentration during insulin clamping was not changed by troglitazone (baseline, 1.1 +/- 0.86 mEq/L; after therapy, 0.93 +/- 0.65 mEq/L; P = not significant). CONCLUSION: Troglitazone can improve whole-body insulin resistance through the improvement of SMGU but not through a decline in plasma free fatty acid concentration in patients with type II diabetes with or without hypertension.     

Simultaneous cardiac mechanics and phosphorus-31 NMR spectroscopy during global myocardial ischemia and reperfusion in the intact dog

To investigate the high-energy phosphate metabolic correlates of left ventricular (LV) dysfunction during the onset and recovery from severe, global myocardial ischemia in vivo, seven preinstrumented closed-chest dogs had ECG-gated phosphorus-31 (31P) NMR-spectroscopy (NMR-S) studies performed and LV micromanometer and sonomicrometer data measured before, during, and every 5 min following severe occlusive global myocardial ischemia. Ischemic LV + dP/dtmax fell from 2396 +/- 576 mm Hg/s at baseline to 2185 +/- 478 mm Hg/s (p less than 0.05) and did not normalize until after 30 min of reperfusion. LV ejection fraction (EF) decreased significantly (0.32 +/- 0.07 EF units to 0.12 +/- 0.13 EF units; p less than 0.05) and did not recover by 30 min of reperfusion (0.27 +/- 0.09 units; P less than 0.05 vs baseline). Simultaneous 31P NMR-S studies demonstrated excellent beta-ATP signal-to-noise (10 +/- 4:1). Myocardial acidosis occurred during global ischemia (delta pH = -0.22 +/- 0.23 units; p less than 0.05), with recovery at 30 min of reperfusion. Inorganic phosphate/phosphocreatine ratio (Pi/PCr) increased significantly during ischemia (0.46 +/- 0.07 to 0.61 +/- 0.07; P less than 0.05), with delayed normalization of this ratio at 30 min of reperfusion. beta-ATP peak area did not change during ischemia. Pi/PCr and LV contractility (+dP/dtmax) were significantly correlated at baseline (r = -0.70) and during global ischemia (r = -0.78; p less than 0.01), but not during recovery (r = 0.006; p = NS). Therefore, the simultaneous evaluation of high-fidelity hemodynamic data and topical 31P NMR-S can be performed in the intact state.     

Decreasing patellar tendon stiffness during exercise therapy for patellar tendinopathy is associated with better outcome

ObjectivesTo assess the associations between: 1) baseline patellar tendon stiffness and clinical outcome after exercise therapy in athletes with patellar tendinopathy and 2) the change in patellar tendon stiffness and clinical outcome during progressive tendon-loading exercise therapy and eccentric exercise therapy.DesignRandomized controlled trial.MethodsAthletes with patellar tendinopathy aged 18-35 years, playing tendon-loading sports at least 3 times per week were randomized in a 1:1 ratio between progressive tendon-loading exercise therapy and eccentric exercise therapy for 24 weeks. Patellar tendinopathy was diagnosed clinically, and confirmed by ultrasound. Patellar tendon stiffness (kilopascal, kPa) was assessed using shear-wave elastography. Clinical outcome was assessed using the validated Victorian Institute of Sports Assessment (VISA-P; range 0-100) questionnaire. Both were assessed at baseline, 12 and 24 week follow-up. Adjusted general linear, mixed-linear models and Generalized Estimating Equations were used.ResultsWe included 76 athletes (58 men, mean age 24 ± 4 years). No association was found between baseline stiffness and VISA-P after 24 weeks (p = 0.52). Decreased stiffness (adjusted mean difference = 10 kPa (95% CI: 4-15) was significantly associated with improved clinical outcome at 12 weeks in all athletes (p = 0.02), and at both 12 and 24 weeks (p = 0.01) in athletes allocated to progressive tendon-loading exercise therapy.ConclusionsPatellar tendon stiffness, assessed with shear-wave elastography, is unsuitable to use as a single predictive measurement for clinical outcome. Decreasing stiffness during the course of exercise therapy is associated with improved clinical outcome in athletes recovering from patellar tendinopathy.     

Differences in physical fitness and throwing velocity among elite and amateur male handball players

This study compared physical characteristics (body height, body mass [BM], body fat [BF], and free fatty mass [FFM]), one repetition maximum bench-press (1RM (BP)), jumping explosive strength (VJ), handball throwing velocity, power-load relationship of the leg and arm extensor muscles, 5- and 15-m sprint running time, and running endurance in two handball male teams: elite team, one of the world's leading teams (EM, n = 15) and amateur team, playing in the Spanish National Second Division (AM, n = 15). EM had similar values in body height, BF, VJ, 5- and 15-m sprint running time and running endurance than AM. However, the EM group gave higher values in BM (95.2 +/- 13 kg vs. 82.4 +/- 10 kg, p < 0.05), FFM (81.7 +/- 9 kg vs. 72.4 +/- 7 kg, p < 0.05), 1RM (BP) (107 +/- 12 kg vs. 83 +/- 10 kg, p < 0.001), muscle power during bench-press (18 - 21 %, p < 0.05) and half squat (13 - 17 %), and throwing velocities at standing (23.8 +/- 1.9 m . s (-1) vs. 21.8 +/- 1.6 m . s (-1), p < 0.05) and 3-step running (25.3 +/- 2.2 m . s (-1) vs. 22.9 +/- 1.4 m . s (-1), p < 0.05) actions than the AM group. Significant correlations (r = 0.67 - 0.71, p < 0.05 - 0.01) were observed in EM and AM between individual values of velocity at 30 % of 1RM (BP) and individual values of ball velocity during a standing throw. Significant correlations were observed in EM, but not in AM, between the individual values of velocity during 3-step running throw and the individual values of velocity at 30 % of 1RM (BP) (r = 0.72, p < 0.05), as well as the individual values of power at 100 % of body mass during half-squat actions (r = 0.62, p < 0.05). The present results suggest that more muscular and powerful players are at an advantage in handball. The differences observed in free fatty mass could partly explain the differences observed between groups in absolute maximal strength and muscle power. In EM, higher efficiency in handball throwing velocity may be associated with both upper and lower extremity power output capabilities, whereas in AM this relationship may be different. Endurance capacity does not seem to represent a limitation for elite performance in handball.     

Exercise training and intensity does not alter vascular volume responses in women

PURPOSE: The effect of endurance training on vascular volumes in females has received little research attention. Further, the effect of exercise training intensity on vascular volumes is unknown. Therefore, we investigated the hypothesis that greater hematologic changes would be induced in women by higher exercise intensity during endurance training. METHODS: There were 26 healthy, sedentary adult females with the following characteristics (mean +/- SD): maximal oxygen consumption (VO2max) = 30.0+/-6.6 ml x kg(-1) x min(-1); age = 32+/-5 yr; body mass index (BMI) = 23.7+/-3.6 kg x m(-2)) who were randomly assigned to control (CON, n = 8); high intensity (HI, 80% of VO2max, n = 10), or low intensity (LO, 40% of VO2max, n = 8) cycle ergometer training groups. Training, conducted 3-5 (3.37+/-0.05) d x wk(-1) for 12 wk, was supervised. Estimated exercise energy expenditure was equated across training groups, progressing from 150-375 kcal per session (mean +/- SE across training weeks = 298+/-0.34 and 297+/-0.37 kcal per session for HI and LO, respectively). Plasma volume (PV, T-1824 dilution); calculated total blood (TBV) and red cell volumes (RCV); calculated total hemoglobin (THb); erythropoietin concentration ([Epo]) and selected hematologic variables were measured at baseline and weeks 2, 4, 8 and 12 of training. RESULTS: The observed relative (percent) changes in PV, TBV, RCV and THb from pre-training baseline values were not statistically significant. Decreases (p < 0.05) in hematocrit (Hct), hemoglobin ([Hb]) and RBC count were observed in both training groups. Mean corpuscular Hb (MCH) and Hb concentration (MCHC) increased (p < 0.05) during training. [Epo] was decreased at week 2 compared with baseline (p < 0.03), but was similar to baseline at weeks 4, 8 and 12. CONCLUSIONS: Within the limits of this study, endurance training did not increase PV, TBV, RCV and THb in previously sedentary females regardless of the intensity of training.     

Exercise training in women with heart disease: influence of hormone replacement therapy

PURPOSE: To examine the central and peripheral cardiovascular effects of exercise training in postmenopausal women with CAD with and without hormone replacement therapy (HRT and N-HRT). METHODS: Thirty-eight female cardiac patients referred for cardiac rehabilitation were divided into HRT ( N= 18) or N-HRT (N = 20) groups. Peak oxygen uptake (VO2) peak and ventilatory anaerobic thresholds (AT) were determined, in addition to submaximal cardiac output (Q). Peripheral measures of resting and peak ischemic blood flows (BF) were also measured. Measurements were all repeated after 12 and 26 wk of exercise training consisting of 1 h of walking at 75-80% of the measured VO2peak at baseline (T1) for 5 d.wk(-1). RESULTS: VO2peak mL.kg(-1).min(-1) at baseline (14.9 +/- 0.4) increased by 5% after 12 wk (15.6 +/- 0.4) and significantly by 15% (17.2 +/- 0.5) after 26 wk of exercise training (P < 0.001). The HRT group was significantly younger than the N-HRT group (58 vs 65 yr; P < 0.01) and had significantly higher VO2peaks at baseline (15.7 vs 14.2 mL.kg(-1).min(-1); P < 0.05), yet either did not influence changes in other variables. At fixed submaximal work rates, there was a significant training bradycardia ( P < 0.01), but insignificant changes in Q or stroke volume regardless of HRT status. Resting and peak ischemic calf BF and vascular conductance increased significantly ( P < 0.001) at 12 and 26 wk, with no difference found according to HRT status. CONCLUSIONS: The cardiovascular responses to training in postmenopausal women with CAD appear to be consistent regardless of HRT status and dominated by peripheral adaptations.     

Validity of simple field tests as indicators of match-related physical performance in top-level professional soccer players

The aim of this study was to examine the construct validity of selected field tests as indicators of match-related physical performance. During the competitive season, eighteen professional soccer players (age 26.2 +/- 4.5 yrs, mass 80.8 +/- 7.8 kg, and height 181.9 +/- 3.7 cm) completed an incremental running field test to exhaustion, a vertical-jump and a repeated-sprint ability (RSA) test. Match physical performance was quantified during official matches using a video-computerized, semi-automatic, match analysis image recognition system, (ProZone, Leeds, UK). The selected measures of match physical performance were: total distance covered (TD), high intensity running (HIR: > 14.4 km . h (-1)), very high intensity running (VHIR:> 19.8 km . h (-1)), sprinting (> 25.2 km . h (-1)) and top running speed. Significant correlations were found between peak speed reached during the incremental field test and TD (r = 0.58, R (2) = 0.34; p < 0.05), HIR (r = 0.65, R (2) = 0.42; p < 0.01) and VHIR (r = 0.64, R (2) = 0.41; p < 0.01). Significant correlations were also found between RSA mean time and VHIR (r = - 0.60, R (2) = 0.36; p < 0.01) and sprinting distance (r = - 0.65, R (2) = 0.42; p < 0.01). Significant differences were found between the best and worst group as defined by the median split technique for peak speed (TD = 12 011 +/- 747 m vs. 10 712 +/- 669, HIR = 3192 +/- 482 m vs. 2314 +/- 347 m, and VHIR = 1014 +/- 120 vs. 779 +/- 122 m, respectively; p < 0.05) and RSA mean time (VHIR = 974 +/- 162 m vs. 819 +/- 144 m, and sprinting = 235 +/- 56 vs. 164 +/- 58 m, respectively; p < 0.05). In conclusion, this study gives empirical support to the construct validity of RSA and incremental running tests as measures of match-related physical performance in top-level professional soccer players.     

Hemobahn stent-grafts for treatment of femoropopliteal arterial obstructions: midterm results of a prospective trial

PURPOSE: To report a prospective study to evaluate safety, effectiveness, and midterm patency of self-expanding stent-grafts in patients with femoropopliteal occlusive disease. MATERIALS AND METHODS: Sixty-three Hemobahn stent-grafts were used in 52 patients for treatment of medium- or long-segment (>3 cm) occlusions (82.7%) and stenoses (17.3%) of the femoropopliteal artery. The mean length of vessel segments covered was 10.9 cm +/- 5.13. Follow-up with documentation of clinical symptoms, assessment of Rutherford clinical stage of peripheral vascular disease, and color-coded duplex sonography was performed at discharge, at 1, 3, 6, 12, 18, and 24 months after implantation, and yearly thereafter. Mean follow-up duration was 23.8 months +/- 6.9 (range, 8-36 mo). Follow-up data at 12 and 24 months after treatment were available for 47 of 52 (90.4%) and 31 of 52 patients (59.6%), respectively. RESULTS: Device implantation was technically successful in all 52 patients, yielding an overall technical success rate of 100%. Procedure-related complications were observed in 12 of 52 patients (23.1%) and consisted of distal embolization (n = 4, 7.7%), minor groin hematoma (n = 7, 13.5%), and arteriovenous fistula (n = 1, 1.9%), but prolonged hospitalization and further medical, interventional, or surgical measures were not required. Stent-graft placement induced an initial improvement of the mean resting ankle-brachial index from 0.54 +/- 0.12 to 0.89 +/- 0.14 (P <.01). Primary patency rates at 12 and 24 months were 78.4% +/- 5.8 and 74.1% +/- 6.2, respectively. Primary assisted patency rates were 82.4% +/- 5.3 at 12 months and 80.3% +/- 5.6 at 24 months. Secondary patency rates at 12 and 24 months were 88.3% +/- 4.5 and 83.2% +/- 5.5, respectively. There was no significant difference (log-rank test, P >.3) between primary patency rates in patients grouped according to lengths of implanted grafts (ie, length of the treated lesions). CONCLUSION: Endovascular placement of Hemobahn stent-grafts for percutaneous treatment of medium- to long-segment high-grade stenoses and occlusions of the femoropopliteal artery is a safe procedure with excellent initial success rates and promising midterm results.     

Microcirculation of the ankle after Cryo/Cuff application in healthy volunteers

The aim of the study was to assess the combination of compression and cryotherapy (Cryo/Cuff ankle device) on parameters of ankle microcirculation in healthy volunteers over 30 min. In 21 volunteers (12 males, 29 +/- 10 years [incl. females], BMI 24 +/- 3) the Cryo/Cuff ankle device (AIRCAST, Summit, NJ, USA) was applied with continuous assessment of parameters of ankle microcirculation, such as tissue oxygen saturation (SO2), relative postcapillary venous filling pressures (rHb), and microcirculatory blood flow at 2- and 8-mm tissue depths during 30 min with the Oxygen-to-see System, a laser-Doppler-spectrophotometry-system (LEA Medizintechnik, Giessen, Germany). Superficial tissue oxygen saturation (SO2, 48 +/- 19 %) immediately dropped to 23 +/- 15 % (-52 %, p < 0.05) within the first 2 min after Cryo/Cuff activation with a consecutive slow decrease to 32 +/- 23 % (- 32 %, p < 0.05 vs. baseline) after 30 min. Deep SO2 (8 mm, 69 +/- 5 %) did not change within 30 min of Cryo/Cuff application (70 +/- 4 %, n.s.). Superficial postcapillary venous filling pressures (61 +/- 17 relative units) showed an immediate and sustained decrease after Cryo/Cuff application within four minutes to 37 +/- 18 relative units (-39 %, p < 0.05). Deep postcapillary venous filling pressures (85 +/- 20 relative units) dropped within the first four minutes of Cryo/Cuff application to 68 +/- 19 relative units (-20 %, p < 0.05). Superficial microcirculatory blood flow (21 +/- 36 relative units) decreased significantly to 7 +/- 5 relative units after 30 min (-69 %, p < 0.05 vs. baseline). Deep microcirculatory blood flow at 8 mm tissue depth (63 +/- 43 relative units) significantly decreased over the 30 min to 39 +/- 23 relative units (-47 %, p < 0.05 vs. baseline). Using the Oxygen-to-see system we could demonstrate significant effects of the Cryo/Cuff device on the ankle level in healthy volunteers with reduced superficial tissue oxygen saturation with preserved deep tissue oxygen saturation, reduced superficial and deep postcapillary venous filling pressures, and reduced superficial and deep microcirculatory blood flow as a function of time. Further clinical studies are mandatory to elucidate the effects of the Cryo/Cuff device on the microcirculatory environment in injured ankles.     

Effect of intramyocardial injection of autologous bone marrow-derived mononuclear cells on perfusion, function, and viability in patients with drug-refractory chronic ischemia.

Intramyocardial injection of bone marrow cells has been proposed as a new therapeutic option for patients with chronic ischemic heart disease. We investigated whether autologous bone marrow-derived mononuclear cell injection into the myocardium of patients with drug-refractory ischemia reduces anginal symptoms, improves left ventricular (LV) function, increases myocardial perfusion, and alters the extent of scar tissue. METHODS: In 25 patients (mean age +/- SD, 64 +/- 10 y; 21 male) with drug-refractory angina pectoris (Canadian Cardiovascular Society [CCS] class III-IV), despite optimized medical therapy and without options for conventional revascularization, bone marrow was aspirated from the iliac crest. Mononuclear cell injections were targeted at myocardial regions with stress-induced ischemia on gated (99m)Tc-tetrofosmin SPECT. Anginal symptoms were reassessed at 3- and 6-mo follow-up. At baseline and 3-mo follow-up, gated (99m)Tc-tetrofosmin SPECT and (18)F-FDG SPECT were performed to assess LV function, LV volumes, myocardial perfusion (stress and rest, 17-segment model), and extent of scar tissue. RESULTS: Mean CCS score improved from 3.4 +/- 0.6 at baseline to 2.3 +/- 0.6 at 3 mo (P < 0.01) and remained unchanged at 6 mo (2.3 +/- 0.6; P < 0.01 vs. baseline and P = not significant [NS] vs. 3 mo). Gated (99m)Tc-tetrofosmin SPECT demonstrated an increased LV ejection fraction (from 47.6% +/- 13.5% to 54.1% +/- 16.9%; P < 0.01) and a reduced LV end-systolic volume (from 81 +/- 68 mL to 75 +/- 70 mL; P < 0.01). Segmental regional wall thickening increased from 34% +/- 12% at baseline to 39% +/- 17% at 3-mo follow-up (P = 0.01). The number of segments with stress-inducible ischemia per patient decreased from 4.6 +/- 3.2 to 2.0 +/- 2.6 (P < 0.01). Both segmental stress and segmental rest score improved, although the improvement in stress score was more pronounced (decrease in segmental stress score 0.22 +/- 0.20 vs. decrease in segmental rest score 0.04 +/- 0.06; P < 0.01). Myocardial perfusion improved in 53% of the injected segments and in 13% of the noninjected segments (P < 0.01). The percentage of myocardial segments with some extent of scar remained unchanged at 3-mo follow-up (13% vs. 12%; P = NS). CONCLUSION: Autologous bone marrow-derived mononuclear cell injection in patients with drug-refractory angina and chronic ischemia improves anginal symptoms, increases LV function, and predominantly enhances myocardial stress perfusion in injected segments, whereas the extent of myocardial scar tissue remains unchanged.     

Loss of myocardial CK-MB into the circulation following 3.5 hours of swimming in a rat model

The purpose of this study was to document alterations of creatine kinase-B (CK-B) in the left and right ventricles of rats and CK-MB release into the circulation following a single bout of stressful prolonged intense exercise. Male Sprague-Dawley rats, with 8% bodyweight attached to each tail, were forced to swim 3.5 hours and were then sacrificed immediately (0 h PS), 3 hours (3 h PS), 24 hours (24 h PS), and 48 hours (48 h PS) post swimming, respectively. Sedentary (control) rats were sacrificed at rest. Serum CK-MB mass increased 2.1 times (8.9 microg/L; p < 0.01 vs. controls of 4.3 microg/L) and 1.4 times (6.0 microg/L; P < 0.01 vs. controls) at 0 h PS, and 3 h PS, respectively, and returned to baseline at 24 h PS. Western blot analysis indicated that CK-B of the right ventricle decreased 14% (p < 0.05), 20% (p < 0.01), and 12% (p < 0.05) at 3h PS, 24h PS and 48h PS, respectively. The CK-B of the left ventricles decreased 34% (p < 0.05) at 0 h PS, returned to baseline at 3 h PS, and was increased 39% (P < 0.01) at 48 h PS. Our findings demonstrate that a single bout of stressful, prolonged, intense exercise resulted in CK-B subunit loss from the myocardium, resulting in increased serum CK-MB concentrations, an indication of myocardial injury.     

De novo femoropopliteal stenoses: endovascular gamma irradiation following angioplasty--angiographic and clinical follow-up in a prospective randomized controlled trial

PURPOSE: To assess and report the follow-up results of a randomized controlled trial on centered endovascular gamma irradiation performed after percutaneous transluminal angioplasty (PTA) for de novo femoropopliteal stenoses. MATERIALS AND METHODS: Thirty patients who underwent PTA for de novo femoropopliteal stenoses were randomly assigned to undergo 14-Gy centered endovascular irradiation (irradiation group, n = 15) or no irradiation (control group, n = 15). Intraarterial angiography was performed 6, 12, and 24 months after treatment; duplex ultrasonography (US), the day before and after PTA and 1, 3, 6, 9, 12, 18, and 24 months later. Treadmill tests and interviews were performed the day before PTA and 1, 3, 6, 9, 12, 18, and 24 months later. Results of angiography, duplex US, treadmill tests, and interviews were evaluated with the nonpaired t or the Fisher exact test. RESULTS: Baseline characteristics did not differ significantly between the two groups. Mean absolute individual changes in degree of stenosis, compared with the degrees of stenosis shortly after PTA, in the irradiation group versus in the control group were -10.6% +/- 22.3 versus 39.6% +/- 24.6 (P <.001) at 6 months, -2.0% +/- 34.2 versus 40.6% +/- 32.6 (P =.002) at 12 months, and 7.4% +/- 43.2 versus 37.7% +/- 34.5 (P =.043) at 24 months. The rates of target lesion restenosis at 6 (P =.006) and 12 (P =.042) months were significantly lower in the irradiation group. The numbers of target lesion re-treatments were similar between the groups, but target vessel re-treatments were more frequent in the irradiation group. There were no significant differences in interview or treadmill test results between the two groups at t test analysis. CONCLUSION: The degree of stenosis was significantly reduced 6, 12, and 24 months after angioplasty of de novo femoropopliteal stenoses in the patients who underwent endovascular irradiation.     

Chemoradiation of Unresectable Pancreatic Carcinoma: Impact of Pretreatment Hemoglobin Level on Patterns of Failure

AIM: To evaluate, in patients with locally advanced pancreatic carcinoma undergoing concomitant chemoradiation, the impact of pretreatment hemoglobin (Hb) concentration on the outcome in terms of clinical response, local control, metastasis-free survival, disease-free survival, and overall survival. PATIENTS AND METHODS: 30 patients undergoing concomitant chemoradiation (5-fluorouracil [5-FU], 1,000 mg/m(2)/day, continuous i.v. infusion days 1-4 of radiotherapy) and external beam radiotherapy (50.4-59.4 Gy) were divided into two groups based on pretreatment median Hb value (11.5 g/dl). The potential prognostic factors examined besides Hb concentration were: tumor site (head vs body-tail), sex (female vs male), cN (cN0 vs nC1), dose of external beam radiotherapy (50.4 Gy vs 59.4 Gy), presence of jaundice at diagnosis (yes vs no), weight loss at diagnosis (> or = 5 kg vs < 5 kg), epigastric-lumbar pain at diagnosis (yes vs no), maximum tumor diameter (< 40 mm vs > or = 40 mm). RESULTS: Pretreatment Hb ranged between 9.6 and 15.0 g/dl. No statistically significant differences were observed as for clinical response and local control between patients with an Hb < or = 11.5 g/dl and those with an Hb > 11.5 g/dl. Metastasis-free survival was 5.1 months in patients with an Hb < or = 11.5 g/dl and 10.7 months in patients with an Hb > 11.5 g/dl (p = 0,010). Median actuarial disease-free survival was 5.1 and 10.2 months in patients with an Hb < or = 11.5 and > 11.5 g/dl, respectively (p = 0.026). Median actuarial overall survival was 7.5 and 10.3 months in patients with an Hb < or = 11.5 and > 11.5 g/dl; respectively (p = 0.039). On multivariate analysis, Hb concentration at diagnosis was the only factor prognostically correlated with metastasis-free survival (p = 0.026), disease-free survival (p = 0.032), and overall survival (p = 0.048). CONCLUSION: In a group of patients with locally advanced pancreatic carcinoma treated with chemoradiation, a significant correlation was observed between pretreatment Hb levels and metastasis-free survival, disease-free survival, and overall survival.