Project description:IntroductionOur goal was to determine the differences in changes in cardiovascular and cardiorespiratory interaction indicators during a respiratory maneuver with a change in breathing rate in athletes with different types of heart rate regulation.MethodsThe results of a study of 183 healthy men aged 21.2 ± 2.3 years, who were systematically involved in various sports, were analyzed. According to the results of the analysis of the HRV study during spontaneous breathing, the athletes were divided into 4 groups taking into account the type of heart rate regulation (HRR). Group 1 (with type I) consisted of 53 people, group 2 (with type II)-29 people, group 3 (with type III)-85 people, group 4 (with type IV)-16 people. The methodology for studying the cardiorespiratory system included combined measurements of the respiratory and cardiovascular system activity indicators in a sitting position using a spiroarteriocardiorhythmograph. The duration of the study was 6 min.ResultsAccording to changes in cardiorespiratory and cardiovascular interaction indicators during controlled breathing with a frequency of 6 and 15 per minute (CR6 and CR15), it is shown that with a pronounced predominance of parasympathetic influences (type IV) in conditions of excessive cardiorespiratory control and moderate hyperventilation, differences in changes in arterial baroreflex sensitivity (δBRLF and δBRHF) are noted in comparison with other HRR. Athletes with type IV at CR6 in δBRLF significantly differ from athletes with type III (p = 0.026) and do not differ from athletes with type II (p = 0.141). In δBRHF significantly (p = 0.038 and p = 0.043)-from athletes with types I and II. It is shown that with the predominance of sympathetic influences (types I and II), the reactivity of BRS (δBRLF and δBRHF) in response to moderate hyperventilation (CR15) is significantly lower. Changes in the Hildebrandt index and the volume synchronization index additionally differentiate HRR associated with a moderate and pronounced predominance of sympathetic and parasympathetic influences.ConclusionThe use of a respiratory maneuver in a combined study of the cardiorespiratory system in the conditions of current control of athletes showed informativeness in the differentiation of HRR types and states of functional overstrain.
Project description:ObjectiveGlobal lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver (V(RM)) is inversely associated with lung stress and mortality in acute respiratory distress syndrome.DesignSubstudy of an acute respiratory distress syndrome clinical trial on esophageal pressure-guided positive end-expiratory pressure titration.SettingU.S. academic medical center.PatientsForty-two patients with acute respiratory distress syndrome in whom airflow, airway pressure, and esophageal pressure were recorded during the recruitment maneuver.InterventionsA single recruitment maneuver was performed before initiating protocol-directed ventilator management. Recruitment maneuvers consisted of a 30-second breath hold at 40 cm H2O airway pressure under heavy sedation or paralysis. V(RM) was calculated by integrating the flow-time waveform during the maneuver. End-inspiratory stress was defined as the transpulmonary (airway minus esophageal) pressure during end-inspiratory pause of a tidal breath and tidal stress as the transpulmonary pressure difference between end-inspiratory and end-expiratory pauses.Measurements and main resultsV(RM) ranged between 7.4 and 34.7 mL/kg predicted body weight. Lower V(RM) predicted high end-inspiratory and tidal lung stress (end-inspiratory: β = -0.449; 95% CI, -0.664 to -0.234; p < 0.001; tidal: β = -0.267; 95% CI, -0.423 to -0.111; p = 0.001). After adjusting for PaO2/FIO2 and either driving pressure, tidal volume, or plateau pressure and positive end-expiratory pressure, V(RM) remained independently associated with both end-inspiratory and tidal stress. In unadjusted analysis, low V(RM) predicted increased risk of death (odds ratio, 0.85; 95% CI, 0.72-1.00; p = 0.026). V(RM) remained significantly associated with mortality after adjusting for study arm (odds ratio, 0.84; 95% CI, 0.71-1.00; p = 0.022).ConclusionsLow V(RM) independently predicts high lung stress and may predict risk of death in patients with acute respiratory distress syndrome.
Project description:Background: A training program can stimulate physiological, anatomical, and performance adaptations, but these improvements can be partially or entirely reversed due to the cessation of habitual physical activity resulting from illness, injury, or other influencing factors. Purpose: To investigate the effects of detraining on cardiorespiratory, metabolic, hormonal, muscular adaptations, as well as short-term and long-term performance changes in endurance athletes. Methods: Eligible studies were sourced from databases and the library up until July 2023. Included studies considered endurance athletes as subjects and reported on detraining duration. Results: Total cessation of training leads to a decrease in VO2max due to reductions in both blood and plasma volume. Cardiac changes include decreases in left ventricular mass, size, and thickness, along with an increase in heart rate and blood pressure, ultimately resulting in reduced cardiac output and impaired performance. Metabolically, there are declines in lactate threshold and muscle glycogen, increased body weight, altered respiratory exchange ratio, and changes in power parameters. In the short term, there is a decrease in insulin sensitivity, while glucagon, growth hormone, and cortisol levels remain unchanged. Skeletal muscle experiences reductions in arterial-venous oxygen difference and glucose transporter-4. Implementing a partial reduction in training may help mitigate drastic losses in physiological and performance parameters, a consideration when transitioning between training seasons. Conclusion: There is a dearth of data investigating the detraining effects of training reduction/cessation among endurance athletes. Delving deeper into this topic may be useful for professionals and researchers to identify the optimal strategies to minimize these effects.
Project description:BackgroundEndurance sports primarily attract recreational athletes over 35 years, who impose an exceptionally rigorous and sustained demand on their cardiorespiratory systems.ObjectivesThis study aimed to determine the influence of COVID-19 on the cardiovascular, pulmonary, and skeletal muscle function of endurance athletes with exercise intolerance. Secondly, it aimed to compare the exercise response of endurance athletes post-COVID-19 to those unaffected using cardiopulmonary exercise test-related variables.MethodsThis is a prospective observational cohort study of endurance athletes. An exposure group with protracted exercise tolerance underwent a resting lung function test and maximal cardiopulmonary exercise test. These were repeated after eight weeks of endurance training and compared to the published reference values and a control group of athletes unaffected by COVID-19.ResultsThe post-COVID-19 exposure group (n=57), mean age 44.5±8.1years showed a poorer ventilatory threshold (p=0.004), and workload (p=0.05), with higher respiratory exchange ratio (p=0.05) than the control group (n=34), mean age 41.8±7.7 years. Maximal inspiratory pressure improved at follow-up in the COVID-19 group compared to the controls (p=0.03). Increased odds of pulmonary and skeletal muscle limitation to aerobic capacity were found in the COVID-19 group. The COVID-19 group responded positively to endurance training with improved VO2peak (p=0.005), maximal inspiratory pressure (p=0.04), oxygenpulse (p=0.02), and maximal workload (p<0.001).ConclusionCOVID-19 has led to pulmonary and extrapulmonary limitations to exercise capacity. Tailored intensity and duration of physical activity are vital after COVID-19 to restore skeletal muscle health. This multidisciplinary rehabilitation approach will optimise the resumption of participation in long-distance events.
Project description:PurposeTo determine the effects of Kinesio taping (KT) on the biomechanical characteristics of the lower limbs during the 90° cutting maneuver in anterior cruciate ligament (ACL) reconstruction (ACLR) athletes.MethodEighteen ACLR athletes were recruited and subjected randomly to three taping conditions, KT, placebo taping (PT), and no taping (NT), followed by a 90° cutting test. A nine-camera infrared high-speed motion capture system (Vicon, T40, 200 Hz) was used to record the kinematic parameters of the lower limbs during the cutting maneuver, and a three-dimensional dynamometer (Kistler, 1000 Hz) was used to record the kinetic parameters of the lower limbs. A one-way repeated measures analysis of variance was conducted to compare the differences in the lower limb kinematic and kinetic characteristics of ACLR athletes subjected to these interventions.ResultsDuring the landing phase, the knee valgus angle reduced significantly with KT than with NT (95% confidence interval = -1.399 to -0.154; P = 0.025), whereas no significant difference was observed between PT and NT (95% confidence interval = -1.251 to 0.217; P = 0.236). No significant differences were observed in the other kinematic variables among the three taping conditions (P > 0.05). During the landing phase, no significant differences in the kinetic variables were observed among the three taping conditions (P > 0.05).ConclusionsAlthough KT does not improve the kinetic variables of athletes after ACLR during the 90° cutting maneuver, it reduces the knee valgus angle, which could reduce the risk of secondary ACL injury.
Project description:PurposeCannulation of the major papilla is the most challenging part of endoscopic retrograde cholangiopancreatography (ERCP) for which physician-controlled wire-guided cannulation (PCWGC) and assistant-controlled wire-guided cannulation (ACWGC) are used as the cannulation techniques. PCWGC can reportedly save up to about 30% of the labor cost by reducing the number of assistants. This study aims to compare the safety and efficacy of PCWGC and ACWGC.Materials and methodsOf the 2151 patients aged >20 years (4193 cases) who underwent ERCP at Yonsei University Medical Center between January 2015 and December 2016, 989 were included in this study.ResultsAmong efficacy outcomes, cannulation success rate, rate of precut sphincterotomy (PCWGC vs. ACWGC: 21.3% vs. 25.9%), bile duct cannulation time (PCWGC vs. ACWGC: median 3.0 minutes vs. 3.6 minutes), and total procedure time (PCWGC vs. ACWGC: median 13.6 minutes vs. 13.1 minutes) were not significantly different. Among safety outcomes, lower rates of post-ERCP pancreatitis were observed with PCWGC than with ACWGC (PCWGC vs. ACWGC: 5.8% vs. 8.8%, p=0.128). Among other post-ERCP adverse events (bleeding, perforation, and cholangitis), the difference was not significant between the groups. Radiation exposure (total dose area product, PCWGC vs. ACWGC: median 1979.9 µGym² vs. 2062.0 µGym², p=0.194) and ERCP cost excluding labor cost (PCWGC vs. ACWGC: $1576 vs. $1547, p=0.606) were not significantly different.ConclusionRequiring less assistants, PCWGC showed comparable efficacy and safety to ACWGC. PCWGC can be considered as an alternative option, especially in facilities lacking manpower and resources.
Project description:Limited data are available on athlete's heart for rugby athletes. This study aimed to investigate cardiac structure and its relationship with cardiorespiratory fitness in young Japanese rugby athletes. A prospective cross-sectional study using echocardiography and cardiopulmonary exercise testing (CPET) was conducted on 114 male collegiate rugby players. There was a higher prevalence of increased left ventricular (LV), atrial, and aortic dimensions in the young athletes than that in previously published reports, whereas the wall thickness was within the normal range. Anthropometry and CPET analyses indicated that the forwards and backs presented muscular and endurance phenotypes, respectively. Indexed LV and aortic dimensions were significantly larger in the backs than in the forwards, and the dimensions significantly correlated with oxygen uptake measured by CPET. On the four-tiered classification for LV hypertrophy, abnormal LV geometry was found in 16% of the athletes. Notably, the resting systolic blood pressure was significantly higher in athletes with concentric abnormal geometry than in the other geometry groups, regardless of their field positions. Japanese young athletes may exhibit unique phenotypes of cardiac remodeling in association with their fitness characteristics. The four-tiered LV geometry classification potentially offers information regarding the subclinical cardiovascular risks of young athletes.
Project description:The alveolar recruitment maneuver (RM) has been reported to improve oxygenation in acute respiratory distress syndrome (ARDS) and may be related to reduced extravascular lung water (EVLW) in animals. This study was designed to investigate the effects of RM on EVLW in patients with ARDS.An open label, prospective, randomized controlled trial including patients with ARDS was conducted in hospitals in North Taiwan between 2010 and 2016. The patients were divided into 2 groups (with and without RM). The primary endpoint was the comparison of the EVLW index between the 2 groups.Twenty-four patients with ARDS on mechanical ventilator support were randomized to receive ventilator treatment with RM (RM group, n?=?12) or without RM (non-RM group, n?=?12). Baseline demographic characteristics were similar between the 2 groups. After recruitment, the day 3 extravascular lung water index (EVLWI) (25.3?±?9.3 vs 15.5?±?7.3?mL/kg, P?=?.008) and the arterial oxygen tension/fractional inspired oxygen ratio (PaO2/FiO2) (132.3?±?43.5 vs 185.6?±?38.8?mL/kg, P?=?.003) both improved over that of day 1. However, both EVLWI and PaO2/FiO2 did not significantly change from day 1 to 3 in the non-RM group.RM is a feasible method for improving oxygenation and the EVLW index in patients with ARDS, as well as for decreasing ventilator days and intensive care unit stay duration.
Project description:Introduction: The cardiorespiratory optimal point (COP) represents the lowest minute ventilation to oxygen consumption ratio (VE/VO2) and can be estimated during a CPET at submaximal intensity when an exercise test until volitional fatigue is not always advisable (i.e., a conflict zone where you cannot be confident of the security because near-competition, off-season, among other). COP's physiological components have not been wholly described yet. Therefore, this study seeks to identify the determinants of COP in highly trained athletes and its influence on maximum and sub-maximum variables during CPET through principal c omponent analysis (PCA) (explains the dataset's variance). Methods: Female (n = 9; age, 17.4 ± 3.1 y; maximal VO2 [VO2max]), 46.2 ± 5.9 mL/kg/min) and male (n = 24; age, 19.7 ± 4.0 y; VO2max, 56.1 ± 7.6 mL/kg/min) athletes performed a CPET to determine the COP, ventilatory threshold 1 (VT1) and 2 (VT2), and VO2max. The PCA was used to determine the relationship between variables and COP, explaining their variance. Results: Our data revealed that females and males displayed different COP values. Indeed, males showed a significant diminished COP compared to the female group (22.6 ± 2.9 vs. 27.2 ±3.4 VE/VO2, respectively); nevertheless, COP was allocated before VT1 in both groups. Discussion: PC analysis revealed that the COP variance was mainly explained (75.6%) by PC1 (expired CO2 at VO2max) and PC2 (VE at VT2), possibly influencing cardiorespiratory efficiency at VO2max and VT2. Our data suggest that COP could be used as a submaximal index to monitor and assess cardiorespiratory system efficiency in endurance athletes. The COP could be particularly useful during the offseason and competitive periods and the return to the sports continuum.