The effects of acute hypoxia on tissue oxygenation and circulating alarmins in healthy adults.

The binding of high-mobility group box-1 (HMGB-1) to the membrane receptor for advanced glycation end-products (mRAGE) is a key early mediator of non-infectious inflammation and its triggers include ischaemia/hypoxia. The effects of acute hypoxia on soluble RAGE (sRAGE) are unknown. Fourteen healthy adults (50 % women; 26.6+/-3.8 years) were assessed at baseline normoxia (T0), followed by four time-points (T90, 95, 100 and 180 min) over three hours of continuous normobaric hypoxia (NH, 4,450 m equivalent) and again 60 min after return to normoxia (T240). A 5-min exercise step test was performed during NH at T90. Plasma concentrations of HMGB-1, sRAGE VCAM-1, ICAM-1, VEGF IL-8 and IL-13 were measured using venous blood. Arterial and tissue oxygen saturations were measured using pulse oximetry (SpO(2)) and near-infrared spectroscopy (StO(2)), respectively. NH led to a significant reduction in SpO(2), StO(2), sRAGE and VEGF, which was compounded by exercise, before increasing to baseline values with normoxic restoration (T240). NH-exercise led to a paired increase in HMGB-1. sRAGE inversely correlated with HMGB-1 (r=-0.32; p=0.006), heart rate (r=-0.43; p=0.004) but was not linked to SpO(2) or StO(2). In conclusion, short-term NH leads to a fall in sRAGE and VEGF concentrations with a transient rise post NH-exercise in HMGB-1.

Energy expenditure of rugby players during a 14-day in-season period, measured using doubly labelled water.

Criterion data for total energy expenditure (TEE) in elite rugby are lacking, which prediction equations may not reflect accurately. This study quantified TEE of 27 elite male rugby league (RL) and rugby union (RU) players (U16, U20, U24 age groups) during a 14-day in-season period using doubly labelled water (DLW). Measured TEE was also compared to estimated, using prediction equations. Resting metabolic rate (RMR) was measured using indirect calorimetry, and physical activity level (PAL) estimated (TEE:RMR). Differences in measured TEE were unclear by code and age (RL 4369 ± 979; RU 4365 ± 1122; U16, 4010 ± 744; U20, 4414 ± 688; U24, 4761 ± 1523 Kcal day- 1). Differences in PAL (overall mean 2.0 ± 0.4) were unclear. Very likely differences were observed in RMR by code (RL 2366 ± 296; RU 2123 ± 269 Kcal day- 1). Differences in relative RMR between U20 and U24 were very likely (U16, 27 ± 4; U20, 23 ± 3; U24, 26 ± 5 Kcal kg- 1 day- 1). Differences were observed between measured and estimated TEE, using Schofield, Cunningham and Harris-Benedict equations for U16 (187 ± 614, unclear; - 489 ± 564, likely and - 90 ± 579, unclear Kcal day- 1), U20 (- 449 ± 698, likely; - 785 ± 650, very likely and - 452 ± 684, likely Kcal day- 1) and U24 players (- 428 ± 1292; - 605 ± 1493 and - 461 ± 1314 Kcal day- 1, all unclear). Rugby players have high TEE, which should be acknowledged. Large inter-player variability in TEE was observed demonstrating heterogeneity within groups, thus published equations may not appropriately estimate TEE.

Power supplies and equipment for military field research: lessons from the British Service Dhaulagiri Research Expedition 2016.

INTRODUCTION: The British Service Dhaulagiri Research Expedition (BSDMRE) took place from 27 March to 31 May 2016. The expedition involved 129 personnel, with voluntary participation in nine different study protocols. Studies were conducted in three research camps established at 3600, 4600 and 5140 m and involved taking and storing blood samples, cardiac echocardiography and investigations involving a balance plate. Research in this remote environment requires careful planning in order to provide a robust and resilient power plan. In this paper we aim to report the rationale for the choices we made in terms of power supply, the equipment used and potential military applicability. METHODS: This is a descriptive account from the expedition members involved in planning and conducting the medical research. RESULTS: Power calculations were used to determine estimates of requirement prior to the expedition. The primary sources used to generate power were internal combustion engine (via petrol fuelled electric generators) and solar panels. Having been generated, power was stored using lithium-ion batteries. Special consideration was given to the storage of samples taken in the field, for which electric freezers and dry shippers were used. All equipment used functioned well during the expedition, with the challenges of altitude, temperature and transport all overcome due to extensive prior planning. CONCLUSIONS: Power was successfully generated, stored and delivered during the BSDMRE, allowing extensive medical research to be undertaken. The challenges faced and overcome are directly applicable to delivering military medical care in austere environments, and lessons learnt can help with the planning and delivery of future operations, training exercises or expeditions.

The Reliability of a Pre-Loaded Treadmill Time-Trial in Moderate Normobaric Hypoxia.

The purpose of this study was to assess the reliability of a pre-loaded 1 500-m treadmill time trial, conducted in moderate normobaric hypoxia. 8 trained runners/triathletes (24±3 years, 73.2±8.1 kg, 182.5±6.5 cm, altitude specific V˙O2max: 52.9±5.5 ml·kg(-1)·min(-1)) completed 3 trials (the first as a familiarisation), involving 2, 15-min running bouts at 45% and 65% V˙O2max, respectively, and a 1 500-m time trial in moderate normobaric hypoxia equivalent to a simulated altitude of 2 500 m (FiO2~15%). Heart rate, arterial oxygen saturation, skeletal muscle and cerebral tissue oxygenation (StO2), expired gas ( V˙O2 and V˙CO2), and ratings of perceived exertion were monitored. Running performance (Trial 1: 352.7±40; Trial 2: 353.9±38.2 s) demonstrated a low CV (0.9%) and high ICC (1). All physiological variables demonstrated a global CV≤4.2%, and ICC≥0.87, with the exception of muscle (CV 10.4%; ICC 0.70) and cerebral (CV 4.1%; ICC 0.82) StO2. These data demonstrate good reliability of the majority of physiological variables and indicate that a pre-loaded 1 500-m time trial conducted in moderate normobaric hypoxia is a highly reliable test of performance.

Evaluation of movement and physiological demands of rugby league referees using global positioning systems tracking.

The use of global positioning systems (GPS) technology within referees of any sport is limited. Therefore, the purpose of the current study was to evaluate the movement and physiological demands of professional rugby league referees using GPS tracking analysis. Time-motion analysis was undertaken on 8 referees using 5-Hz GPS devices and heart rate monitors throughout a series of Super League matches. 44 data sets were obtained with results identifying similar total distance covered between first and second half periods with a significant (P=0.004) reduction in the number of high velocity efforts performed between 5.51-7.0 m.s-1 (1st=21±8, 2nd=18±8). Mean distance covered from greatest to least distance, was 3 717±432 m, 3 009±402 m, 1 411±231 m, 395±133 m and 120±97 m for the following 5 absolute velocity classifications, respectively; 0.51-2.0 m.s-1; 2.1-4.0 m.s-1: 4.01-5.5 m.s-1; 5.51-7.0 m.s-1; <7.01 m.s-1. Heart rate was significantly (P<0.001) greater in the first (85.5±3.4% maxHR) compared to the second (82.9±3.8% maxHR) half. This highlights the intermittent nature of rugby league refereeing, consisting of low velocity activity interspersed with high velocity efforts and frequent changes of velocity. Training should incorporate interval training interspersing high velocity efforts of varying distances with low velocity activity while trying to achieve average heart rates of ~ 84% maxHR to replicate the physiological demands.

Reliability of a high-intensity endurance cycling test.

This study assessed the reproducibility of performance and selected metabolic variables during a variable high-intensity endurance cycling test. 8 trained male cyclists (age: 35.9 ± 7.7 years, maximal oxygen uptake: 54.3 ± 3.9 mL·kg - 1·min - 1) completed 4 high-intensity cycling tests, performed in consecutive weeks. The protocol comprised: 20 min of progressive incremental exercise, where the power output was increased by 5% maximal workload (Wmax) every 5 min from 70% Wmax to 85% Wmax; ten 90 s bouts at 90% Wmax, separated by 180 s at 55% Wmax; 90% Wmax until volitional exhaustion. Blood samples were drawn and heart rate was monitored throughout the protocol. There was no significant order effect between trials for time to exhaustion (mean: 4 113.0 ± 60.8 s) or total distance covered (mean: 4 6126.2 ± 1 968.7 m). Total time to exhaustion and total distance covered showed very high reliability with a mean coefficient of variation (CV) of 1.6% (95% Confidence Intervals (CI) 0.0 ± 124.3 s) and CV of 2.2% (95% CI 0.0 ± 1904.9 m), respectively. Variability in plasma glucose concentrations across the time points was very small (CV 0.46-4.3%, mean 95% CI 0.0 ± 0.33 to 0.0 ± 0.94 mmol·L - 1). Plasma lactate concentrations showed no test order effect. The reliability of performance and metabolic variables makes this protocol a valid test to evaluate nutritional interventions in endurance cycling.

Psychosocial and pharmacologic predictors of satisfaction with intravenous patient-controlled analgesia.

Despite intravenous patient-controlled analgesia's (IV-PCA) increasing popularity, the psychological and pharmacological factors upon which patient satisfaction with IV-PCA are based are unknown. Sixty-eight women scheduled for abdominal hysterectomy completed a series of questionnaires measuring emotional distress, locus of control, perceived support, and optimism before their surgery. Postoperative ratings of pain intensity, emotional distress, anticipated recovery time, nightmares, and satisfaction with IV-PCA were taken 1 and 3 days after surgery. A nurse observer rated perceived anxiety, estimated recovery, and satisfaction with IV-PCA. Cumulative and hourly IV-PCA use and dose/demand ratio were obtained. Degree of dissatisfaction with IV-PCA was significantly correlated with pain intensity, nightmares, patient's perceptions of support, expectations of recovery, preoperative anxiety, and postoperative depression. Dose/demand ratio and hourly analgesic usage were significantly related to pre- and postoperative emotional distress factors. Perioperative management of anxiety, perceptions, and expectations may prove valuable in improving pain control and satisfaction with IV-PCA.

Extraosseous blood supply to the neonatal femoral head.

The extraosseous blood supply to the femoral head was studied by microdissection of latex-injected vessels in 19 neonatal hips. The fetuses were of black African descent. Although the general pattern was similar to that described by previous investigators, in seven of the specimens the largest contribution to the blood supply of the femoral head was from the inferior gluteal artery. To the authors' knowledge, this has not been noted before, but other studies generally have used techniques that would not demonstrate this source. This pattern may represent a genetic variation in the blood supply to the hip, a theory that has been presented to account for differences among races in the incidence of some vascular diseases of the hip joint, e.g., Perthes' disease.

Tension and creep phenomena in peripheral nerve.

Tension introduced into peripheral nerves during their surgical repair may reduce the success of this procedure. Two mechanical factors are important; the tension required to effect a repair, and the rate at which this tension changes after surgery. These two factors have been investigated in the rat sciatic nerve. The results show an increasing resistance to elongation of the nerves with increasing tension. Under a constant elongation the tension in the nerves reduces by about 30 per cent in the first 10 minutes and by a small amount in the following 20 minutes.

Long-term follow-up of Perthes' disease treated nonoperatively.

Forty-six patients with Perthes disease treated nonoperatively were reviewed 10 to 43 years later. The median follow-up was 17 years. The patients were analyzed according to sex, age of onset, quantity of head involvement, type of treatment, duration of treatment, functional end result based on the Harris hip scale, and anatomic end result based on Mose templete evaluation. Most patients were treated with an ischial weight-bearing brace. The anatomic results of this treatment tended to be poor, probably worse than no treatment at all. In general, poor results were correlated with late onset, greater quantity of head involvement, and lateral subluxation of the femoral head. As reported in other series, the anatomic results did not correlate well with the functional results, only two patients having Harris hip scales below 70.

Effects of dichloromethylene diphosphonate, ethane-1-hydroxy-1,1-diphosphonate, and rickets in rats.

This study compared bone remodeling, bone mineralization, and parathyroid hormone secretion in rats treated with ethane-1-hydroxy-1,1-diphosphonate (EHDP) or dichloromethylene diphosphonate (Cl2MDP). The results were compared with findings in rachitic and control rats. In addition, calcification was induced in the skin by administration of lead acetate intravenously and polymyxin B subcutaneously; the efficacies of EHDP and Cl2MDP in preventing the calcific plaque were compared. Both the serum biochemical values and the morphologic findings indicate that Cl2MDP and EHDP influence bone and mineral metabolism differently. Even with the relatively large doses used in this study, Cl2MDP had a minor or no effect while EHDP had a marked effect that, in general, is undersirable. EHDP caused increase in circulating immunoreactive parathyroid hormone to levels greater than those in rachitic rats. Both diphosphonates appear to have a similar effect on the ectopic mineralization produced by calciphylaxis, suggesting that Cl2MDP may be the agent of choice in this problem because the undersirable side-effects would be avoided.

Angiography in the diagnosis of osteoid-osteoma of the hand.

Angiographic findings characteristic of osteoid-osteoma are described in two cases of osteoid-osteoma of the bones of the wrist. While the etiology of the disease is not understood, a developmental relationship between the osteoid-osteoma nidus and increased vascularity is suggested.