Evaluation of fitness level by the oxygen uptake efficiency slope after a short-term intermittent endurance training

Several indicators are used as indices of cardiorespiratory reserve. Among them, oxygen uptake (VO(2)) at peak and ventilatory threshold (VAT) levels are the most common used. In the present study, endurance training was used to evaluate and compare the usefulness of a new index, the Oxygen Uptake Efficiency Slope (OUES) as an alternative to the previous ones. Fifteen physical education student women participated in the study (8 as a trained group [T: age (mean +/- SD) 21.9 +/- 3.3 y, height 165.1 +/- 5.5 cm, weight 60.4 +/- 3.3 kg] and 7 as a control group [C: age 21.7 +/- 1.9 y, height 165.4 +/- 7.2 cm, weight 59.6 +/- 8.6 kg]). Before and after 6 weeks of the Square-Wave Endurance Exercise Test (SWEET) training program or daily activities, they performed an incremental test (30 W/3 min) on a cycle ergometer to determined VO(2), power output and parameters associated with breathing efficiency (the respiratory equivalents, and the ventilatory dead space to tidal volume ratio [Vd/Vt]) at peak- and VAT-levels. The slope of the relationship between ventilation and carbon dioxide production was also calculated. OUES, derived from the logarithmic relationship between VO(2) and minute ventilation (V(E)), was determined at 75 % (OUES75), 90 % (OUES90) and 100 % (OUES100) of exercise duration. After endurance training in T, VO(2) and power output were significantly improved at peak- and VAT-levels while all breathing efficiency indices remained unchanged. No changes were observed in C after 6 weeks. Despite significant correlation between OUES values and VO(2) at peak- and VAT-levels, OUES75, OUES90 and OUES100 did not significantly change after endurance training. While VO(2) and power output at peak- and VAT-levels increased in all T, training-induced changes in OUES appeared more variable. We concluded that OUES was not sufficiently sensitive to highlight improvement of cardiorespiratory reserve after endurance training whereas VO(2) at peak and VAT levels did.     

Reproducibility of sagittal pelvic tilt measurements in normal subjects using digital inclinometry

Standing sagittal pelvic tilt posture is widely assessed qualitatively, yet no efficient non-invasive quantitatively method is available for measuring pelvic tilt position or its amplitude. The main objective of the current study was to assess the intra- and inter-tester reproducibility of digital inclinometry-based (DI) measurements of pelvic tilt in healthy subjects. Pelvic inclination was measured while standing in neutral position (NP), maximal anterior pelvic tilt (APT) and maximal posterior pelvic tilt (PPT) which served for calculating the total pelvic tilt (TPT) range of motion (TPT=PPT-APT). On two separate test occasions two convenience samples of healthy women and men (N=15 in each) were each measured by two different testers. In both groups the intra-tester reproducibility indices of NP, APT, PPT and TPT were acceptable as revealed by high and significant ICCs and low standard error of measurements (SEM). In women the inter-tester reproducibility indices, of the same variables, were high as distinguished by no significant differences between testers and high and significant ICCs. In men, significant differences were found in APT and PPT but the between-testers TPT scores were similar. Collectively these findings indicate that pelvic inclinometry yields acceptable reproducibility which in the light of the facility of the method may render it an efficient clinical tool.     

Variability of insulin-stimulated myocardial glucose uptake in healthy elderly subjects

The aim of this study was to assess regional and global variability of insulin-stimulated myocardial glucose uptake in healthy elderly subjects and to evaluate potentially responsible factors. Twenty men with a mean age of 64 years, no history of cardiovascular disease, and normal blood pressure, bicycle exercise test, electrocardiogram and echocardiography were studied [ P(coronary artery disease) <5%]. Whole-body insulin sensitivity and insulin-stimulated myocardial glucose uptake were measured during hyperinsulinaemic euglycaemic glucose clamp with fluorine-18 fluorodeoxyglucose, and myocardial rest and hyperaemic blood flow during dipyridamole infusion were measured with nitrogen-13 ammonia and positron emission tomography in 16 left ventricular myocardial segments. Intra-individual and inter-individual variability of insulin-stimulated myocardial glucose uptake [relative dispersion = (standard deviation/mean)] was 13% and 29% respectively. Although inter-individual variability of glucose uptake and blood flow at rest was of the same magnitude, no correlation was found between these measures. Regional and global insulin-stimulated myocardial glucose uptake correlated linearly with whole-body insulin sensitivity ( r=0.51, P<0.05 and r=0.56, P<0.01). The strongest independent association by multivariate linear regression analysis was found between myocardial glucose uptake and hyperaemic blood flow ( r=0.63, P<0.005). We conclude that in healthy elderly subjects, insulin-stimulated myocardial glucose uptake is homogeneous throughout the left ventricle, but has moderate inter-individual variability. Inter-individual variability of insulin-stimulated myocardial glucose uptake is primarily explained by variability in coronary vascular reactivity and tissue insulin sensitivity.     

Reproducibility of corticospinal diffusion tensor tractography in normal subjects and hemiparetic stroke patients

Purpose

The reproducibility of corticospinal diffusion tensor tractography (DTT) for a guideline is important before longitudinal monitoring of the therapy effects in stroke patients. This study aimed to establish the reproducibility of corticospinal DTT indices in healthy subjects and chronic hemiparetic stroke patients.

Materials and methods

Written informed consents were obtained from 10 healthy subjects (mean age 25.8 ± 6.8 years), who underwent two scans in one session plus the third scan one week later, and from 15 patients (mean age 47.5 ± 9.1 years, 6–60 months after the onset of stroke, NIHSS scores between 9 and 20) who were scanned thrice on separate days within one month. Diffusion-tensor imaging was performed at 3 T with 25 diffusion directions. Corticospinal tracts were reconstructed using fiber assignment by continuous tracking without and with motion/eddy-current corrections. Intra- and inter-rater as well as intra- and inter-session variations of the DTT derived indices (fiber number, apparent diffusion coefficient (ADC), and fractional anisotropy (FA)) were assessed.

Results

Intra-session and inter-session coefficients of variations (CVs) are small for FA (1.13–2.09%) and ADC (0.45–1.64%), but much larger for fiber number (8.05–22.4%). Inter-session CVs in the stroke side of patients (22.4%) are higher than those in the normal sides (18.0%) and in the normal subjects (14.7%). Motion/eddy-current correction improved inter-session reproducibility only for the fiber number of the infarcted corticospinal tract (CV reduced from 22.4% to 14.1%).

Conclusion

The fiber number derived from corticospinal DTT shows substantially lower precision than ADC and FA, with infarcted tracts showing lower reproducibility than the healthy tissues.     

Endogenous thyroid-stimulating hormone and radioactive iodine uptake in normal subjects

In 105 normal volunteers, 52 male and 53 female, mean age 45 (range, 20-68), serum thyroid-stimulating hormone (TSH) (1.46 ± 0.7; range, 0.43-3.87 microUI/mL) and 24-hour thyroid radioactive iodine uptake (RAIU) (16.15% ± 4.78% range, 6.45%-30.08%) were measured. Additionally, TSH was 1.18 ± 0.5 microUI/mL for 20 to 29 year-olds and 1.59 ± 0.9 microUI/mL for 60 to 68 year old (P = 0.037). RAIU was 18.30 ± 4.5 for 20 to 29-year-olds and 14.92 ± 3.1 for 60 to 68 year-olds (P = 0.009). TSH trends positively and RAIU at 24 hours correlates negatively with aging of the pituitary axis.     

Reproducibility studies with 11C-DTBZ, a monoamine vesicular transporter inhibitor in healthy human subjects.

The reproducibility of (+/-)-alpha-[11C] dihydrotetrabenazine (DTBZ) measures in PET was studied in 10 healthy human subjects, aged 22-76 y. METHODS: The scan-to-scan variation of several measures used in PET data analysis was determined, including the radioactivity ratio (target-to-reference), plasma-input Logan total distribution volume (DV), plasma-input Logan Bmax/Kd and tissue-input Logan Bmax/Kd values. RESULTS: The radioactivity ratios, plasma-input Bmax/Kd and tissue-input Bmax/Kd all have higher reliability than plasma-input total DV values. In addition, measures using the occipital cortex as the reference region have higher reliability than the same measures using the cerebellum as the reference region. CONCLUSION: Our results show that DTBZ is a reliable PET tracer that provides reproducible in vivo measurement of striatal vesicular monoamine transporter density. In the selection of reference regions for DTBZ PET data analysis, caution must be exercised in circumstances when DTBZ binding in the occipital cortex or the cerebellum may be altered.     

Reproducibility of muscle oxygen saturation

The present study evaluated the reproducibility of tissue oxygenation in relation to oxygen consumption (VO2) across cycle exercise intensities in a test-retest design. 12 subjects (25.7±2.1 years; 24.7±1.9 kg · m(-2)) twice performed an incremental bicycle exercise protocol, while tissue oxygen saturation (StO2) in the vastus lateralis muscle was monitored by a commercially available NIRS unit and VO2 determined by an open-circuit indirect calorimetric system. Coefficients of variation across rest, workloads corresponding to 25, 50 and 75% of individual maximum capacity, and maximum load were 5.8, 4.6, 6.1, 8.0, 11.0% (StO2) and 7.6, 6.0, 3.7, 3.4, 3.1% (VO2), respectively. 95 % CI of relative test-retest differences ranged from -5.6 to +5.4% at 25% load to -17.2 to +7.5% at maximum load for StO2 and from -7.3 to +7.7% at rest to -3.3 to +3.2% at maximum load for VO2. With advancing exercise intensity, within-subject variability of StO2 was augmented, whereas VO2 variability slightly attenuated. NIRS measurements at higher workloads need to be interpreted with caution.     

Effects of Hemopure on maximal oxygen uptake and endurance performance in healthy humans

Haemoglobin-based oxygen carriers (HBOCs) such as Hemopure are touted as a tenable substitute for red blood cells and therefore potential doping agents, although the mechanisms of oxygen transport of HBOCs are incompletely understood. We investigated whether infusion of Hemopure increased maximal oxygen uptake (V.O 2max) and endurance performance in healthy subjects. Twelve male subjects performed two 4-minute submaximal exercise bouts equivalent to 60 % and 75 % of V.O (2max) on a cycle ergometer, followed by a ramped incremental protocol to elicit V.O (2max). A crossover design tested the effect of infusing either 30 g (6 subjects) or 45 g (6 subjects) of Hemopure versus a placebo. Under our study conditions, Hemopure did not increase V.O (2max) nor endurance performance. However, the infusion of Hemopure caused a decrease in heart rate of approximately 10 bpm (p=0.009) and an average increase in mean ( approximately 7 mmHg) and diastolic blood pressure ( approximately 8 mmHg) (p=0.046) at submaximal and maximal exercise intensities. Infusion of Hemopure did not bestow the same physiological advantages generally associated with infusion of red blood cells. It is conceivable that under exercise conditions, the hypertensive effects of Hemopure counter the performance-enhancing effect of improved blood oxygen carrying capacity.     

Reproducibility and repeatability of 99Tcm-HMPAO rCBF SPET in normal subjects at rest using brain atlas matching

The aim of this study was to assess regional cerebral blood flow (rCBF) in normal subjects at rest using 99Tcm-HMPAO single photon emission tomography (SPET). Analysis of reproducibility and repeatability was performed both before and after normalization of flow data. Six healthy volunteers were examined, three times each, according to a routine rCBF protocol. A computerized brain atlas was used to evaluate flow data in eight selected regions. The overall reproducibility of rCBF was evaluated from two scans performed at an average interval of 3 months. Repeatability was evaluated from two scans, 3 h apart and without re-injection of 99Tcm-HMPAO. For the normalized (relative) flow data, the reproducibility was +/- 1.3% and the repeatability +/- 2.2% (i.e. methodological errors dominate). For the non-normalized flow data, the corresponding values were +/- 14.8% and +/- 5.9%. rCBF SPET with 99Tcm-HMPAO is highly reproducible provided that the flow data are normalized. The variation in flow between individuals at one point in time and 3 months later was less than +/- 5% for all brain regions.     

Oxygen uptake efficiency slope in coronary artery disease: clinical use and response to training

The Oxygen Uptake Efficiency Slope (OUES), a new parameter derived from respiratory gas analysis, has been suggested as a submaximal index of cardiopulmonary functional reserve. We evaluated the clinical application and the effect of physical training on the OUES in patients with coronary artery disease (CAD). Maximal cycle-ergometer testing with respiratory gas analysis (breath-by-breath) was performed in 590 patients with CAD and again after three months of physical training in 425 patients. OUES was determined from the linear relation of oxygen uptake (V.O (2)) vs. the logarithm of pulmonary ventilation (V (E)) during exercise, i.e. V.O (2) = a log (10) V (E) + b, where a is the OUES. The ventilatory anaerobic threshold (VAT) and the slope of the relation of V (E) nu carbon dioxide production (V.CO (2)) (V (E)-V.CO (2) slope) were also determined. Correlation coefficients of the relation from which OUES was derived in individuals averaged 0.975 +/- 0.024 (mean +/- SD) when calculated from data up to a respiratory gas exchange ratio of 1.0. Submaximal OUES was marginally lower (5.4 +/- 7.9 %, p < 0.05) than the OUES calculated from 100 % of respiratory exercise data. Of all submaximal parameters, submaximal OUES (r = 0.837, p < 0.001) and VAT (r = 0.860, p < 0.001) correlated best with peak V.O (2), followed by V (E)-V.CO (2) slope (r = - 0.469, p < 0.001). OUES was lower in patients who underwent coronary artery bypass grafting as compared with patients after coronary angioplasty (p < 0.05). Peak V.O (2) and OUES increased significantly (p < 0.001) after training with 24 +/- 19.2 % and 20.9 +/- 19.3 %, respectively. Changes in peak V.O (2) correlated better with changes in OUES and in VAT (r = 0.61 and r = 0.55, p < 0.001, respectively) than with changes in V (E)-V.CO (2) slope (r = - 0.171, p < 0.001). The submaximal OUES is clinically useful for the quantification of exercise performance and is sensitive to physical training in patients with CAD.     

应用钆塞酸增强MRI对健康受试者肝脏摄取转运功能的可视化研究

摘要目的研究肝脏特异性人类有机阴离子转运多肽(OATP)1B1和OATP1B3的遗传多态性是否对体外肝细胞摄取钆塞酸产生影响,以及与功能相关的遗传多态性是否为影响健康受试者在钆塞酸增强MRI中肝脏强化的混杂因素。     

B-type natriuretic peptide in healthy subjects after exposure to hyperbaric oxygen at 2.5 ATA

INTRODUCTION: B-type natriuretic peptide (BNP) is a cardiac hormone used as a marker of cardiac dysfunction with diuretic and vasodilating properties secreted by the ventricles in response to wall stress. Hyperbaric oxygen (HBO) exposure is known to induce hemodynamic effects in humans which can be complicated by acute pulmonary edema. The aim of this study was to investigate if HBO has any effects on the secretion of BNP in healthy human subjects. METHODS: Eight healthy volunteers underwent the following HBO protocol in a hyperbaric chamber: compression to 2.5 atmospheres absolute (ATA); 45 min breathing 100% oxygen; 5 min breathing air; another 45 min in 100% oxygen; then decompression to atmospheric pressure. A venous blood sample was drawn before entering the chamber (To), immediately at the end of the treatment (T1), and at 5 h from To (T2). BNP concentration was determined using a rapid point-of-care immunoassay. Non-parametric statistics were used to analyze data. RESULTS: No difference in BNP levels was found between T0 and T1 or T2. DISCUSSION: The findings of this preliminary study show that in healthy subjects a single HBO exposure does not significantly modify BNP plasma levels. We hypothesize that this can be the net result between the stimulating effect of the HBO-induced vasoconstriction and the direct inhibitory effect on BNP secretion of myocyte hyperoxia. We conclude that HBO does not modify BNP secretion in healthy volunteers and that the direct effect of extreme hyperoxia on BNP secretion deserves further investigation.     

Maximal oxygen uptake and lactate metabolism are normal in chronic fatigue syndrome.

PURPOSE: Previous studies in chronic fatigue syndrome (CFS) have reported reductions in maximal oxygen uptake (VO(2max)), yet often the testing procedures have not followed accepted guidelines, and gender data have been pooled. The present study was undertaken to reevaluate exercise capacity in CFS patients by using "gold standard" maximal exercise testing methodology and stratifying results on a gender basis. METHODS: Sixteen male and 17 female CFS patients and their gender-, age-, and mass-matched sedentary controls performed incremental exercise to volitional exhaustion on a stationary cycle ergometer while selected cardiorespiratory and metabolic variables were measured. RESULTS: VO(2max) in male CFS patients was not different from control values (CFS: 40.5 +/- 6.7; controls: 43.3 +/- 8.6; mL x kg(-1) x min(-1)) and was 96.3 +/- 17.9% of the age-predicted value, indicating no functional aerobic impairment (3.7 +/- 17.9%). In female CFS patients, VO(2max) was lower than control values (CFS: 30.0 +/- 4.7; controls: 34.2 +/- 5.6; mL x kg(-1) x min(-1), P = 0.002), but controls were higher than the age-predicted value (112.6 +/- 15.4%, P = 0.008) whereas the CFS patients were 101.2 +/- 20.4%, indicating no functional aerobic impairment (-1.2 +/- 20.4%). Maximal heart rate (HR(max)) in male CFS patients was lower than their matched controls (CFS: 184 +/- 10; controls: 192 +/- 12; beats x min(-1); P = 0.016) but was 99.1 +/- 5.5% of their age-predicted value. In female CFS patients, HR(max) was not different from controls (CFS: 183 +/- 11; controls: 186 +/- 10; beats x min(-1)) and was 98.9 +/- 5.1% of the age-predicted value. The VO(2) at the lactate threshold (LT) in each gender group, whether expressed in mL x kg(-1) x min(-1) or as a percentage of VO(2max), was not different between CFS patients and controls. CONCLUSIONS: In contrast to most previous reports, the present study found that VO(2max), HR(max), and the LT in CFS patients of both genders were not different from the values expected in healthy sedentary individuals of a similar age.     

Reproducibility of diffusion tensor imaging in normal subjects: an evaluation of different gradient sampling schemes and registration algorithm

Introduction

Diffusion tensor imaging (DTI) is very useful for investigating white matter integrity in ageing and neurological disorders; thus, evaluating its reproducibility under different acquisition protocols and analysis methods may assist in the design of clinical studies.

Methods

To measure the reproducibility of DTI in normal subjects, this study include (1) depicting the reproducibility of DTI measurements in commonly used regions-of-interest analysis by intraclass correlation coefficient (ICC) and coefficient of variation (CV), (2) evaluating and comparing inter and intrasession test-retest reproducibility, and (3) illustrating the effect of the number of diffusion-encoding directions (NDED) and registration algorithms on measurement reproducibility.

Results

DTI measurements exhibit high reproducibility, with overall (430/480) ICC?≥?0.70, (478/480) within-subject CV (CV_ws) ≤10.00 % and between-subject CV (CV_bs) ranging from 1.32 to 13.63 %. Repeated measures ANOVAs and paired t tests were conducted to compare inter and intrasession reproducibility with different diffusion sampling schemes and registration algorithms. Our results also confirmed that increasing the NDED could improve the accuracy and reproducibility of DTI measurements. In addition, we compared reproducibility indices that were derived using different registration algorithms, and a tensor-based deformable registration yielded the most reproducible results. Finally, we found that increasing the NDED could reduce the difference between the reproducibility of measurement derived using different registration algorithms and between the reproducibility of intersession and intrasession.

Conclusion

Our results suggest that the choice of DTI acquisition protocol and post-processing methods can influence the accurate estimation and reproducibility of DTI measurements and should be considered carefully for clinical applications.     

Measurement of oxygen uptake in the non-steady-state

The purpose of these experiments was to develop and validate an open-circuit technique for measurement of gas exchange during the transition from rest to constant load steady-state exercise. The design of the open-circuit system employed to measure gas exchange in these experiments used a mixing chamber to collect the subject's expired ventilation where fractions of O2 and CO2 were determined via electronic gas analyzers. A gasometer was used to measure inspired ventilation and the analog signals from the two gas analyzers and the gasometer were sent to a microcomputer for computation of VO2. In calculating VO2, the mixed expired gas concentrations were matched with ventilatory volume using a previously determined time delay. To determine the validity of the open-circuit system, four subjects performed a series of 16 rest-to-work transitions on a cycle ergometer. In eight of the experiments, serial measurements of VO2 were obtained every 20 s for 3 min using the open-circuit mixing chamber system while the additional eight experiments used the Douglas bag technique. No significant difference (p greater than 0.05) existed between VO2 values calculated by the two techniques. Mean differences in VO2 between the two techniques during the first three 20-s measurement periods were 6, 53, and 63 ml, respectively. Using the Douglas bag technique as the standard, this represents a relative measurement error of 0.1%, 4.5%, and 3.6%, respectively, at the above time intervals. These data demonstrate that an open-circuit system employing a mixing chamber and the appropriate time delay to match expired gas fractions and ventilation is a sensitive means of measurement of VO2 in the non-steady-state.