Effects of menthol application on the skin during prolonged immersion in cool and cold water

The aim of the study was to compare the effect of skin surface menthol application on rectal temperature (Tre) during prolonged immersion in cool and cold water. We hypothesized that menthol application would lead to a slower Tre decline due to the reduced heat loss as a consequence of the menthol‐induced vasoconstriction and that this effect would be attenuated during cold‐water immersion. Six male subjects were immersed for 55 minutes in stirred cool (24°C) or cold (14°C) water immediately after attaining a Tre of 38°C by cycling at 60% of maximum heart rate on two occasions: without (ΝM) and with (M) whole‐body skin application of menthol cream. Tre, the proximal‐distal skin temperature gradient, and oxygen uptake were continuously measured. ANOVA with repeated measures was employed to detect differences among variables. Significance level was set at 0.05. The area under the curve for Tre was calculated and was greater in 24°C M (−1.81 ± 8.22 a.u) compared to 24°C NM (−27.09 ± 19.09 a.u., P  = .03, r  = .90), 14°C NM (−18.08 ± 10.85 a.u., P  = .03, r  = .90), and 14°C M (−11.71 ± 12.58 a.u, P  = .05, r  = .81). In cool water, oxygen uptake and local vasoconstriction were increased (P  ≤ .05) by 39 ± 25% and 56 ± 37%, respectively, with menthol compared to ΝM, while no differences were observed in cold water. Menthol application on the skin before prolonged immersion reduces heat loss resulting in a blunted Tre decline. However, such a response is less obvious at 14°C water immersion, possibly because high‐threshold cold‐sensitive fibers are already maximally recruited and the majority of cold receptors saturated.     

Effects of menthol application on the skin during prolonged immersion in swimmers and controls

We hypothesized that menthol application on the skin would enhance vasoconstriction of subjects immersed in cool water, which would reduce heat loss and rectal temperature (Tre) cooling rate. Furthermore, it was hypothesized that this effect would be greater in individuals acclimatized to immersion in 24 °C water, such as swimmers. Seven swimmers (SW) and seven physical education students (CON) cycled at 60% VO₂ max until Tre attained 38 °C, and were then immediately immersed in stirred water maintained at 24 °C on two occasions: without (NM) and with (M; 4.6 g per 100 mL of water) whole‐body skin application of menthol cream. Heart rate, Tre, proximal–distal skin temperature gradient, oxygen uptake (VO₂), electromyographic activity (EMG), and thermal sensation were measured. Tre reduction was similar among SW and CON in NM and CON in M (?0.71±0.31 °C in average), while it was smaller for SW in M (?0.37±0.18 °C, P < 0.01). VO₂ and heart rate were greater in M compared with NM condition (P = 0.01). SW in M exhibited a shift of the threshold for shivering, as reflected in increased VO₂ and EMG activity, toward a higher Tre compared with the other trials. Menthol application on the skin before immersion reduces heat loss, but defends Tre decline more effectively in swimmers than in non‐swimmers.     

Block periodization of strength and endurance training is superior to traditional periodization in ice hockey players

Team sports like ice hockey require high levels of performance in numerous physical characteristics such as strength, power, and endurance. As such, training is associated with a potential interference effect. The present study randomized well‐trained ice hockey players into a block periodization group (BP; n = 8), focusing on the development of either strength and power or endurance on a weekly, undulating basis, and a traditional group (TRAD; n = 8), performing a mixed training model, with simultaneous focus of strength, power, and endurance training every week. During the 6‐week intervention, the two groups performed equal volumes and intensities of both strength, power, and endurance training. BP led to larger improvements than TRAD in knee extension peak torque at 180° s^?1 (6.6 ± 8.7 vs ?4.2% ± 6.3%, respectively; P < 0.05) and maximal oxygen uptake (5.1 ± 3.3 vs 1.1% ± 3.5%, respectively; P < 0.05). There was also a trend toward larger improvements in BP than TRAD in peak torque in knee extension at 60° s^?1 (2.1 ± 2.5 vs ?0.1% ± 2.5%, respectively; P < 0.1, effect size = 0.83) and mean power output during a 30‐s cycling sprint (4.1 ± 2.5 vs ?0.3% ± 5.9%, respectively; P < 0.1, effect size = 0.89). Overall, BP exhibited a moderate to large effect size for all these variables compared to TRAD. The present study suggests that block periodization of strength and endurance training induces superior adaptations in both strength and endurance capacities in well‐trained ice hockey players compared to traditional mixed organization, despite similar training volume and intensity.     

Juxtametallic Bipolar Bone Radiofrequency Ablation: Thermal Monitoring in an Ex-Vivo Model with Specimen MRI and Histopathologic Correlation

PurposeTo measure the ablation zone temperature and nontarget tissue temperature during radiofrequency (RF) ablation in bone containing metal instrumentation versus no metal instrumentation (control group).Materials and MethodsEx vivo experiments were performed on 15 swine vertebrae (control, n = 5; titanium screw, n = 5; stainless steel screw, n = 5). Screws and RF ablation probe were inserted identically under fluoroscopy. During RF ablation (3 W, 5 minutes), temperature was measured 10 mm from RF ablation centerpoint and in muscle contacting the screw. Magnetic resonance (MR) imaging, gross pathologic, and histopathologic analyses were performed on 1 specimen from each group.ResultsAblation zone temperatures at 2.5 and 5 minutes increased by 12.2 °C ± 2.6 °C and 21.5 °C ± 2.1 °C (control); 11.0 °C ± 4.1 °C and 20.0 °C ± 2.9 °C (juxta-titanium screw), and 10.0 °C ± 3.4 °C and 17.2 °C ± 3.5 °C (juxta–stainless steel) screw; differences among groups did not reach significance by analysis of variance (P = .87). Mixed-effects linear regression revealed a statistically significant increase in temperature over time in all 3 groups (4.2 °C/min ± 0.4 °C/min, P < .001). Compared with the control, there was no significant difference in the temperature change over time for titanium (?0.3 °C/min ± 0.5 °C/min, P = .53) or steel groups (?0.4 °C/min ± 0.5 °C/min, P = .38). The mean screw temperature at the final time point did not show a statistically significant change compared with baseline in either the titanium group (?1.2 °C ± 2.3 °C, P = .50) or steel group (2.6 °C ± 2.9 °C, P = .11). MR imaging and pathologic analyses revealed homogeneous ablation without sparing of the peri-hardware zones.ConclusionsAdjacent metallic instrumentation did not affect the rate of or absolute increase in temperature in the ablation zone, did not create peri–metallic ablation inhomogeneities, and did not result in significant nontarget heating of muscle tissue in contact with the metal instrumentation.     

Partial-body cryotherapy (−135°C) and cold-water immersion (10°C) after muscle damage in females

This randomized controlled trial examined the effects of cold-water immersion (CWI), partial-body cryotherapy (PBC), or a passive control (CON) on physiological and recovery variables following exercise-induced muscle damage (EIMD, 5 × 20 drop jumps) in females. Twenty-eight females were allocated to PBC (30 seconds at −60°C, 2 minutes at −135°C), CWI (10 minutes at 10°C), or CON (10 minutes resting). Muscle oxygen saturation (SmO₂), cutaneous vascular conductance (CVC), mean arterial pressure (MAP), and local skin temperature were assessed at baseline and through 60 minutes (10-minute intervals), while delayed onset of muscle soreness (DOMS), muscle swelling, maximum voluntary isometric contraction (MVIC), and vertical jump performance (VJP) were assessed up to 72 hours (24-hour intervals) following treatments. SmO₂ was lower in PBC (Δ-2.77 ± 13.08%) and CWI (Δ-5.91 ± 11.80%) compared with CON (Δ18.96 ± 1.46%) throughout the 60-minute follow-up period (P < .001). CVC was lower from PBC (92.7 ± 25.0%, 90.5 ± 23.4%) and CWI (90.3 ± 23.5%, 88.1 ± 22.9%) compared with CON (119.0 ± 5.1 and 116.1 ± 6.6%, respectively) between 20 and 30 minutes (P < .05). Mean skin temperature was lower from CWI vs PBC (between 10 and 40 minutes, P < .05). Mean skin temperature was higher in CON compared with CWI up to 60 minutes and compared with PBC up to 30 minutes (P < .05). DOMS was lower following both PBC and CWI compared with CON through 72-hour (P < .05), with no difference between groups. No main group differences for swelling, MVIC, and VJP were observed. In conclusion, CWI elicited generally greater physiological effects compared with PBC while both interventions were more effective than CON in reducing DOMS in females, but had no effect on functional measures or swelling.     

Cryotherapy induces an increase in muscle stiffness

Although cold application (ie, cryotherapy) may be useful to treat sports injuries and to prevent muscle damage, it is unclear whether it has adverse effects on muscle mechanical properties. This study aimed to determine the effect of air‐pulsed cryotherapy on muscle stiffness estimated using ultrasound shear wave elastography. Myoelectrical activity, ankle passive torque, shear modulus (an index of stiffness), and muscle temperature of the gastrocnemius medialis were measured before, during an air‐pulsed cryotherapy (−30°C) treatment of four sets of 4 minutes with 1‐minute recovery in between and during a 40 minutes postcryotherapy period. Muscle temperature significantly decreased after the second set of treatment (10 minutes: 32.3±2.5°C; P <.001), peaked at 29 minutes (27.9±2.2°C; P <.001) and remained below baseline values at 60 minutes (29.5±2.0°C; P <.001). Shear modulus increased by +11.5±11.8% after the second set (10 minutes; P =.011), peaked at 30 minutes (+34.7±42.6%; P <.001), and remained elevated until the end of the post‐treatment period (+25.4±17.1%; P <.001). These findings provide evidence that cryotherapy induces an increase in muscle stiffness. This acute change in muscle mechanical properties may lower the amount of stretch that the muscle tissue is able to sustain without subsequent injury. This should be considered when using cryotherapy in athletic practice.     

Thermoregulatory demands of Elite Professional America's Cup Yacht Racing

America's Cup yacht racing predominantly occurs during the summer months under hot and humid conditions, with athletes exposed to the environment for prolonged periods, and yet the thermoregulatory responses to competitive sailing are largely unappreciated. This study aimed to assess the thermoregulatory responses to elite professional big‐boat yacht racing, according to crew position and upwind and downwind sailing. Intestinal (T_core) and skin temperature, fluid balance and regional sweat compositions were measured in two America's Cup crews (n=32) during 100 min of racing. The environmental conditions were as follows: 32 °C, 52% RH and 5 m/s wind speed. Subjective race intensity was moderate. Bowmen recorded the greatest elevation in the heart rate (184 ± 10 beats/min) and T_core (39.2 °C, P<0.01). Both heart rate and T_core were higher during downwind sailing (P<0.001). Regional skin temperatures were significantly different according to site (P=0.05), with tibia being the lowest (33.3 ± 1.2 °C). The mean sweat loss during racing was 1.34 ± 0.58 L/h (range: 0.44–2.40 L/h), with bowmen experiencing the greatest loss of sweat (3.7 ± 0.9% of body mass). The mean fluid intake was highly correlated to sweat loss (r=0.74, P<0.001), with 72 ± 41% of sweat losses replaced. The mean sodium concentration of sweat was 27.2 ± 9.2 mmol/L (range: 12.0–43.5 mmol/L) and the total NaCl loss during sailing was 3.8 ± 2.4 g (range 0.7–10.0 g). America's Cup sailing is a demanding sport that presents considerable challenges to thermoregulation, fluid and electrolyte balance. Certain crew roles (bowmen) present an increased risk of developing exertional heat illness, and for the majority of crew downwind sailing results in greater thermal strain than upwind sailing – which may have implications for clothing selection and boat design.     

Patients with schizophrenia have impaired muscle force‐generating capacity and functional performance

Patients with schizophrenia have impaired physical health. However, evidence of how skeletal muscle force‐generating capacity (FGC), a key component of functional performance, may contribute to the impairment is scarce. Thus, the aim of this study was to investigate the patient groups’ skeletal muscle FGC and its association with functional performance. Leg‐press FGC was assessed along with a battery of functional performance tests in 48 outpatients (28 men, 34 ± 10 years; 20 women, 36 ± 12 years) with schizophrenia spectrum disorder (ICD‐10, F20‐29), and compared with 48 healthy age‐ and gender‐matched references. Results revealed reduced one‐repetition maximum (1RM) in men (?19%, P < .01) and a trend toward reduction in women (?13%, P = .067). The ability to develop force rapidly was also impaired (men: ?30%; women: ?25%, both P < .01). Patients scored worse than healthy references on all physical performance tests (stair climbing: ?63%; 30‐second sit‐to‐stand (30sSTS): ?48%; six‐minute walk test (6MWT): ?22%; walking efficiency: ?14%; and unipedal stance eyes open: ?20% and closed: ?73%, all P < .01). 1RM correlated with 6MWT (r = .45), stair climbing (r = ?.44), 30sSTS (r = .43), walking efficiency (r = .26), and stance eyes open (r = .33) and closed (r = .45), all P < .01. Rapid force development correlated with 6MWT (r = .54), stair climbing (r = ?.49), 30sSTS (r = .45), walking efficiency (r = .26), and stance eyes open (r = .44) and closed (r = .51), all P < .01. In conclusion, skeletal muscle FGC and functional performance are reduced in patients with schizophrenia and should be recognized as important aspects of the patient groups’ impaired health. Resistance training aiming to improve these components should be considered an important part of clinical treatment.     

Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model

Attention has been focused on the importance of anatomical tunnel placement in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the effect of different tunnel positions for single-bundle (SB) ACL reconstruction on knee kinematics. Ten porcine knees were used for the following reconstruction techniques: three different anatomic SB [AM–AM (antero-medial), PL–PL (postero-lateral), and MID–MID] (n = 5 for each group), conventional SB (PL–high AM) (n = 5), and anatomic double-bundle (DB) (n = 5). Using a robotic/universal force–moment sensor testing system, an 89 N anterior load (simulated KT1000 test) at 30, 60, and 90° of knee flexion and a combined internal rotation (4 N m) and valgus (7 N m) moment (simulated pivot-shift test) at 30 and 60° were applied. Anterior tibial translation (ATT) (mm) and in situ forces (N) of reconstructed grafts were calculated. During simulated KT1000 test at 60° of knee flexion, the PL–PL had significantly lower in situ force than the intact ACL (P < 0.01). In situ force of the MID–MID was higher than other SB reconstructions (at 30°: 94.8 ± 2.5 N; at 60°: 85.2 ± 5.3 N; and 90°: 66.0 ± 8.7 N). At 30° of knee flexion, the PL–high AM had the lowest in situ values (67.1 ± 19.3 N). At 60 and 90° of knee flexion the PL–PL had the lowest in situ values (at 60°: 60.8 ± 19.9 N; 90°: 38.4 ± 19.2 N). The MID–MID and DB had no significant in situ force differences at 30 and 60° of knee flexion. During simulated pivot-shift test at 60° of knee flexion, the PL–PL and PL–high AM reconstructions had a significant lower in situ force than the intact ACL (P < 0.01). During simulated KT1000 test at 30, 60, and 90° of knee flexion, the PL–PL and PL–high AM had significantly lower ATT than the intact ACL (P < 0.01). During simulated KT1000 test at 60 and 90°, the MID–MID, AM–AM, and DB had significantly lower ATT than the ACL deficient knee (P < 0.01). During simulated KT1000 test at 90°, every reconstructed knee had significantly higher ATT than the intact knee (P < 0.01). In conclusion, the MID–MID position provided the best stability among all anatomic SB reconstructions and more closely restored normal knee kinematics.     

Good results after fluoroscopic-guided intra-articular injections in the treatment of adhesive capsulitis of the shoulder

The purpose of the present study was the prospective evaluation of the results of fluoroscopic-guided intra-articular cortisone injection series in the treatment of adhesive capsulitis of the shoulder. Twenty-five patients (9 m, 16 w) with a mean age of 49 ± 8 years and stage II frozen shoulder syndrome according to the Reeves classification were treated with an intra-articular cortisone injection series (3 injections at 0, 4, 12, weeks). Clinical examination, ASES score and SF 36 score were performed at 0, 4, 8, 12 weeks, 6 and 12 months. In the results, significant improvements were seen in flexion (99 ± 30°–119 ± 31°, P < .0001), abduction (72 ± 24–99 ± 34°, P < .0001), external rotation (14 ± 16°–28 ± 21°, P < .0001) and internal rotation already at first follow-up after 4 weeks of treatment. The results were confirmed at any other follow-up. ASES score improved from 28 ± 13 to 45 ± 18 after 4 weeks (P < .0001), 59 ± 21 after 8 weeks (P < .0001), 63 ± 25 at 3 months (P < .0001), 64 ± 28 (P < .0001) at 6 months and 73 ± 27 (P < .0001) points at final follow-up after 1 year. Evaluation of the SF-36 Score showed significant improvements in almost all categories (physical and mental) after 4 weeks of treatment (P < .05). In conclusion, a fluoroscopic-guided intra-articular injection series of cortisone is an effective treatment option in frozen shoulder syndrome leading to a fast pain reduction and increased range motion.     

Physical and perceptual cooling: Improving cognitive function,mood disturbance and time to fatigue in the heat

This study investigated the effects of menthol swilling and crushed ice ingestion on cognitive function, total mood disturbance (TMD), and time to fatigue (TTF). Twelve male long-distance runners completed three counterbalanced running trials (3 × 30 minutes at 65% VO_2peak and a TTF run at 100% VO_2peak) in hot, humid conditions (35.3 ± 0.3°C, 59.2 ± 2.5% relative humidity). Trials consisted of precooling with crushed ice ingestion and mid-cooling by menthol swilling (MIX), precooling with water ingestion and mid-cooling by menthol swilling (MENTH), and control (CON). Swilling with either 25 mL of menthol solution or placebo occurred upon entry to the heat, at 15-minute intervals during the run and prior to the TTF run. Core temperature, forehead skin temperature, tympanic temperature, perceived thermal sensation, and TMD were significantly lower with MIX compared with MENTH and CON (P < .05). Thirst was satiated in MIX compared with CON; however, MENTH did not have a significant effect. After 90 minutes of running and post-TTF run, fewer errors occurred in the executive control task (P < .05), as well as decision-making and working memory (P > .05; d = 0.5-0.79) between MIX and CON; however, MENTH had no effect compared with CON. The TTF run was significantly longer with MENTH (34.38%; P = .02) and MIX (39.06%; P = .001) compared with CON, with no difference between MENTH and MIX (P = .618). The physical reduction in core and internal head temperature seen with crushed ice ingestion may lead to improvements in cognitive function; however, both MENTH and MIX were sufficient for improving exercise performance.     

Increased vascular function and superoxide dismutase activity in physically active vs inactive adults living with HIV

This study compared macro‐ and microvascular endothelial function and redox status in active vs inactive HIV‐infected patients (HIVP) under antiretroviral therapy. Using a cross‐sectional design, macro‐ and microvascular reactivity, systemic microvascular density, and oxidative stress were compared between 19 HIVP (53.1 ± 6.1 year) enrolled in a multimodal training program (aerobic, strength and flexibility exercises) for at least 12 months (60‐minutes sessions performed 3 times/wk with moderate intensity) vs 25 sedentary HIVP (51.2 ± 6.3 year). Forearm blood flow during reactive hyperemia (521.7 ± 241.9 vs 361.4% ± 125.0%; P = 0.04) and systemic microvascular density (120.8 ± 21.1 vs 105.6 ± 25.0 capillaries/mm²; P = 0.03) was greater in active than inactive patients. No significant difference between groups was detected for endothelium‐dependent and independent skin microvascular vasodilation (P > 0.05). As for redox status, carbonyl groups (P = 0.22), lipid peroxidation (P = 0.86), catalase activity (P = 0.99), and nitric oxide levels (P = 0.72) were similar across groups. However, superoxide dismutase activity was greater in active vs inactive HIVP (0.118 ± 0.013 vs 0.111 ± 0.007 U/mL; P = 0.05). Immune function reflected by total T CD4 and T CD8 counts (cell/mm³) did not differ between active and inactive groups (P > 0.82). In conclusion, physically active HIVP exhibited similar immune function, but greater macrovascular reactivity, systemic microvascular density, and superoxide dismutase activity than inactive patients of similar age.     

Comparison of left ventricular contraction homogeneity index using SPECT gated blood pool imaging and planar phase analysis

Background  There is growing interest in developing a practical technique to accurately assess ventricular synchrony. We describe a novel 3-dimensional (3D) gated blood pool single photon emission computed tomography (SPECT) approach, from which a contraction homogeneity index (CHI) is derived and compared with planar phase analyses. Methods and Results  Subjects underwent planar and SPECT blood pool acquisition. Planar images were processed for left ventricular ejection fraction computation and phase values. SPECT images were processed by our novel algorithm, with which CHI was computed. Overall, 235 patients (79% male; mean age, 62±11 years) completed the study. Left ventricular ejection fractions were similar by planar (33.5%±13.5%) and 3D (34.7%±12.7%) methods (r=0.83, P<.0001). Mean phase angles for planar and tomographic methods were 126.3°±29.6° and 124.4°±28.7°, respectively (r=0.53, P<.0001). Phase and amplitude signals were incorporated in the CHI, which was non-normally distributed with a median of 73.8% (interquartile range, 58.7%–84.9%). This index minimized the negative impact of dyskinetic wall segments with limited regional motion. The planar heterogeneity index (SDΦ) was 28.2° (interquartile range, 17.5°–46.8°) and correlated inversely with CHI (r=−0.61, P<.0001). Conclusion  The novel 3D dispersion index CHI accounts for both phase delay of a dyssynchronous segment and its magnitude of contraction and is moderately correlated with planar phase analyses. Its potential in cardiac resynchronization therapy remains to be exploited. This work was supported in part by the “Fonds de la Recherche en Santé du Québec” and by a Canada Research Chair.     

A multivariate multilevel analysis of youth motor competence. The Peruvian Health and Optimist Growth Study

We use a multivariate multilevel model to study the links between physical fitness (PF) and gross motor coordination (GMC) and investigate the influence of predictors affecting their levels across age. We sampled 7918 Peruvians, aged 6-15 years, from sea-level, Amazon region and high-altitude. Composite markers of GMC and PF were derived (GMC_z and PF_z, respectively). BMI, biological maturation, and stunting were assessed. School characteristics were obtained via an objective audit. School contexts explained 35% of the associations between PF_z and GMC_z, whereas children's characteristics explained 65% of the total variation. On average, with increasing age, there was a greater increase in GMC_z (β = 0.79 ± 0.04, P < .001) than in PF_z (β = 0.15 ± 0.03, P < .001); boys outperformed girls (PF_z, β = 3.25 ± 0.08, P < .001; GMC_z, β = 1.58 ± 0.09, P < .001); those with lower BMI and ahead in their maturation had higher PF_z (β = −0.13 ± 0.01, P < .001; β = 1.09 ± 0.05, P < .001, respectively) and GMC_z (β = −0.18 ± 0.01, P < .001; β = 0.39 ± 0.06, P < .001, respectively) levels. Stunting was negatively related to PF_z (β = −0.30 ± 0.07; P < .001) and GMC_z (β = −0.30 ± 0.08, P < .001) and high-altitude Peruvians had significantly lower GMC_z (β = −0.93 ± 0.33, P < .001), and those living in the Amazon region had significantly higher PF_z (β = 1.21 ± 0.58, P < .001) compared to those living at sea level. A higher number of students was negatively related to PF_z (β = −0.016 ± 0.006, P < .001) and positively with GMC_z (β = 0.005 ± 0.003, P < .001); the duration of physical education classes was positively associated with PF_z (β = 0.70 ± 0.32, P < .001) and GMC_z (β = 0.46 ± 0.15, P < .001); and the existence of policies for physical activity was only negatively associated with GMC_z (β = −1.17 ± 0.34, P < .001). In conclusion, PF_z and GMC_z were positively correlated and child- and school-level traits predicted their levels.     

Differentiation of FDG-avid loco-regional recurrent and compromised benign lesions after surgery for breast cancer with dual-time point F-18-fluorodeoxy-glucose PET/CT scan

Objective  To evaluate the ability of dual-time point F-18-fluorodeoxy-glucose (FDG) PET/CT scans to differentiate FDG-avid loco-regional recurrent and compromised benign lesions after surgery for breast cancer. Methods  A total of 64 FDG-avid recurrent lesions (local tumor recurrence or lymph node metastases) in 52 patients and 38 FDG-avid compromised benign lesions after surgery in 37 patients were included in the study. FDG PET/CT study was performed at 60 and 120 min after intravenous injection of 3.5 MBq/kg FDG. The maximum SUV (SUVmax) on the early and delayed scans and the percent change of SUVmax (%ΔSUVmax) between the two time points were measured. The optimal differential parameter was determined by receiver-operating characteristic curve analysis. Results  The average early SUVmax, delayed SUVmax and ΔSUVmax% were 4.9 ± 2.6, 6.0 ± 3.6 and 18.2% ± 18.8 in FDG-avid recurrent lesions, and 2.1 ± 0.8, 1.8 ± 1.0 and −17.8% ± 21.3 in FDG-avid benign lesions, respectively. Delayed SUVmax was significantly increased compared with early SUVmax in recurrent lesions (P < 0.0001), while it was decreased in benign lesions (P < 0.0001). All the three parameters in recurrent lesions were significantly higher than those in benign lesions (P < 0.0001). The highest diagnostic accuracy of the differentiation was achieved by the combined use of the optimal parameter of delayed SUVmax > 2.5 and %ΔSUVmax > 0%, with a sensitivity of 90.6%, specificity of 81.5%, accuracy of 87.2%, NPV of 89.2%, and PPV of 83.7%, which were better than the respective values obtained with the use of delayed SUVmax > 2.5 alone or %ΔSUVmax > 0% alone (P < 0.005 and P < 0.05, respectively), and the use of the traditional parameter of early SUVmax > 2.5 (P < 0.005). Conclusions  This approach with SUVmax estimation appears to improve the differentiation between FDG-avid loco-regional recurrent of breast cancer and compromised benign lesions after surgery, since delayed scanning significantly enhances the difference in FDG uptake between these lesions.     

Effects of hydration status during heat acclimation on plasma volume and performance

The impact of hydration status was investigated during a 5‐day heat acclimation (HA) training protocol vs mild/cool control conditions on plasma volume (PV) and performance (20 km time‐trial [TT]). Sub‐elite athletes were allocated to one of two heat training groups (90 min/day): (a) dehydrated to ~2% body weight (BW) loss in heat (35°C; DEH; n = 14); (b) euhydrated heat (35°C; EUH; n = 10), where training was isothermally clamped to 38.5°C core temperature (T_c). A euhydrated mild control group (22°C; CON; n = 9) was later added, with training clamped to the same relative heart rate (~75% HR_max) as elicited during DEH and EUH; thus all groups experienced the same internal training stress (%HR_max). Five‐day total thermal load was 30% greater (P < 0.001) in DEH and EUH vs CON. There were significant differences in the average percentage of maximal work rate (%W_max) across all groups (DEH: 24 ± 6%; EUH: 34 ± 9%; CON: 48 ± 8%W_max) during training required to elicit the same %HR_max (77 ± 4% HR_max). There were no significant differences pre‐to post‐HA between groups for PV (DEH: +1.7 ± 10.1%; EUH: +4.8 ± 10.2%; CON: +5.2 ± 4.0%), but there was a significant pooled group PV increase, as well as a 97% likely pooled improvement in TT performance (DEH: ?1.8 ± 2.8%; EUH: ?1.9 ± 2.1%, CON; ?1.8 ± 2.8%; P = 0.136). Due to a lack of between‐group differences for PV and TT, but pooled group increases in PV and 97% likely group increase in TT performance, over 5 days of intense training at the same average relative cardiac load suggests that overall training stress may also impact significant adaptations beyond heat and hydration stress.     

Prostatic Artery Embolization Using 100–300-μm Trisacryl Gelatin Microspheres to Treat Lower Urinary Tract Symptoms Attributable to Benign Prostatic Hyperplasia: A Single-Center Outcomes Analysis with Medium-Term Follow-up

PurposeTo report medium-term outcomes of prostatic artery embolization (PAE) using 100–300-μm trisacryl gelatin microspheres to treat lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) and to evaluate how cone-beam computed tomography-measured prostate gland volume (PGV), median lobe enlargement (MLE), age, and Charlson Comorbidity Index (CCI) affect these results.Materials and MethodsSeventy-four consecutive patients who underwent PAE from April 2014 through August 2018 were retrospectively reviewed. Patients had International Prostate Symptom Score (IPSS) >12, Quality of Life (QoL) score >2, prostate gland volume (PGV) >40 mL, age older than 45 years, and medical therapy failure. Twelve patients were excluded for bladder pathology or prostate cancer. Patients (n = 62, age = 71.8 ± 9.3 years, CCI = 3.5 ± 1.7, PGV = 174 ± 110 mL) had pre-procedure IPSS = 22.4 ± 5.6, QoL score = 4.4 ± 0.9, and post-void residual (PVR) = 172 ± 144 mL. Post-procedure values were compared to baseline at 1, 3, 6, 12, and 24 months. Associations between outcomes and PGV, MLE, age, and CCI were evaluated. Adverse event recording used Clavien-Dindo classification.ResultsOne month after PAE (n = 37), IPSS improved to 7.6 ± 5.2 (P < .0001) and QoL score improved to 1.7 ± 1.4 (P < .0001). At 3 months (n = 32), improvements continued, with IPSS = 6.4 ± 5.1 (P < .0001), QoL score = 1.2 ± 1.2 (P < .0001), PVR = 53 ± 41 mL (P < .001), and PGV = 73 ± 38 mL (P < .0001). Results were sustained at 6 months (n = 35): IPSS = 6.4 ± 4.1 (P < .0001), QoL score = 1.2 ± 1.2 (P < .0001), PVR = 68 ± 80 mL (P < .0001), PGV = 60 ± 19 mL (P < .001). At 12 months, patients (n = 26) had IPSS = 7.3 ± 5.5 (P < .0001), QoL score = 1.2 ± 0.8 (P <.0001), PVR = 89 ± 117 mL (P < .0001), PGV = 60 ± 48 mL (P < .01). At 24 months, patients (n = 8) had IPSS = 8.0 ± 5.4 (P < .0001), QoL score = 0.7 ± 0.5 (P < .0001), PVR = 91 ± 99mL (P = 0.17), and PGV = 30 ± 5mL (P = .11). Improvements were independent of PGV, MLE, age, and CCI. Two grade II urinary infections occurred.ConclusionsPAE with 100–300-μm microspheres produced sustained substantial improvements in LUTS, PGV, and PVR, which were independent of baseline PGV, MLE, age, or CCI.     

Fluid balance,thermoregulation and sprint and passing skill performance in female soccer players

Ten females performed 90 min of the Loughborough Intermittent Shuttle Test (LIST) on two occasions separated by 7 days. Water [3 mL/kg body mass (BM)] was provided every 15 min during exercise (FL); no fluid was given in the other trial (NF). Participants performed the Loughborough Soccer Passing Test (LSPT) before and every 15 min during the LIST. Core temperature (T_c) was measured throughout using ingestible temperature sensors. Heart rate (HR), blood lactate ([La^?]) and ratings of perceived exertion (RPE) were collected at regular intervals during exercise. Participants experienced greater BM loss in NF (2.2 ± 0.4%) than FL (1.0 ± 0.4%; P<0.001). Sprint performance deteriorated by 2.7% during exercise (P<0.001) but there was no difference between trials (P=0.294). No significant differences in LSPT performance were detected between trials (P=0.31). T_c was higher during exercise in NF and was 38.6 ± 0.3 °C (NF) and 38.3 ± 0.3 °C (FL; P<0.01) after 90 min. HR (P<0.001), [La^?] (P<0.01) and RPE (P=0.009) were higher during exercise in NF. Ingesting water during a 90‐min match simulation reduces the mild dehydration seen in female soccer players when no fluid is consumed. However, there was no effect of fluid ingestion on soccer passing skill or sprint performance.     

Dopamine/noradrenaline reuptake inhibition in women improves endurance exercise performance in the heat

Catecholamine reuptake inhibition improves the performance of male volunteers exercising in warm conditions, but sex differences in thermoregulation, circulating hormones, and central neurotransmission may alter this response. With local ethics committee approval, nine physically active women (mean ± SD age 21 ± 2 years; height 1.68 ± 0.08 m; body mass 64.1 ± 6.0 kg; VO_2peak 51 ± 7 mL/kg/min) were recruited to examine the effect of pre‐exercise administration of Bupropion (BUP; 4 × 150 mg) on prolonged exercise performance in a warm environment. Participants completed a VO_2peak test, two familiarization trials, and two randomized, double‐blind experimental trials. All trials took place during the first 10 days of the follicular phase of the menstrual cycle. Participants cycled for 1 h at 60% VO_2peak followed by a 30‐min performance test. Total work done was greater during the BUP trial (291 ± 48 kJ) than the placebo trial (269 ± 46 kJ, P = 0.042, d = 0.497). At the end of the performance test, core temperature was higher on the BUP trial (39.5 ± 0.4 °C) than on the placebo trial (39.2 ± 0.6 °C, P = 0.021; d = 0.588), as was heart rate (185 ± 9 vs 179 ± 13, P = 0.043; d = 0.537). The results indicate that during the follicular phase of the menstrual cycle, an acute dosing protocol of BUP can improve self‐regulated performance in warm conditions.     

Temperature Measurement During Polymerization of Bone Cement in Percutaneous Vertebroplasty: An In Vivo Study in Humans

Aim of the study was to “in vivo” measure temperature, during percutaneous vertebroplasty (PV), within a vertebral body injected with different bone cements. According to the declaration of Helsinki, 22 women (60–80 years; mean, 75 years) with painful osteoporotic vertebral collapse underwent bilateral transpedicular PV on 22 lumbar vertebrae. Two 10-G vertebroplasty needles were introduced into the vertebra under digital fluoroscopy; a 16-G radiofrequency thermoablation needle (Starburst XL; RITA Medical System Inc., USA), carrying five thermocouples, was than coaxially inserted. Eleven different bone cements were injected and temperatures were measured every 30 s until temperatures dropped under 45°C. After the thermocouple needle was withdrawn, bilateral PV was completed with cement injection through the vertebroplasty needle. Unpaired Student’s t-tests, Kruskal–Wallis test, and Wilcoxon signed rank test were used to evaluate significant differences (p < 0.05) in peak temperatures, variations between cements, and clinical outcome. All procedures were completed without complications, achieving good clinical outcomes (p < 0.0001). Regarding average peak temperature, cements were divided into three groups: A (over 60°C), B (from 50° to 60°C), and C (below 50°C). Peak temperature in Group A (86.7 ± 10.7°C) was significantly higher (p = 0.0172) than that in Groups B (60.5 ± 3.7°C) and C (44.8 ± 2.6°C). The average of all thermocouples showed an extremely significant difference (p = 0.0002) between groups. None of the tested cements maintained a temperature ≥45°C for more than 30 min. These data suggest that back-pain improvement is obtained not by thermal necrosis but by mechanical consolidation only. The relative necrotic thermal effect in vertebral metastases seems to confirm that analgesia must be considered the main intent of PV.