A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: Physiological capacity compared with the ASA physical status classification system.

BACKGROUND: This pilot study compared the risk predictive value of preoperative physiological capacity (PC: defined by gas exchange measured during cardiopulmonary exercise testing) with the ASA physical status classification in the same patients (n=32) undergoing major abdominal cancer surgery. METHODS: Uni- and multivariate logistic regression models were fitted to measurements of PC and ASA rank data determining their predictive value for postoperative morbidity. Receiver operating characteristic (ROC) curves were used to discriminate between the predictive abilities, exploring trade-offs between sensitivity and specificity. RESULTS: Individual statistically significant predictors of postoperative morbidity included the ASA rank [P=0.038, area under the curve (AUC)=0.688, sensitivity=0.630, specificity=0.750] and three newly identified measures of PC: PAT (% predicted anaerobic threshold achieved, <75% vs > or =75%), DeltaHR1 (heart rate response from rest to the anaerobic threshold), and HR3 (heart rate at the anaerobic threshold). A two-variable model of PC measurements (DeltaHR1+PAT) was also shown to be statistically significant in the prediction of postoperative morbidity (P=0.023, AUC=0.826, sensitivity=0.813, specificity=0.688). CONCLUSIONS: Three newly identified PC measures and the ASA rank were significantly associated with postoperative morbidity; none showed a statistically greater association compared with the others. PC appeared to improve predictive sensitivity. The potential for new unidentified measures of PC to predict postoperative outcomes remains unexplored.

Functional performance status of hematopoietic SCT recipients in the sub-acute phase of recovery.

This study assessed the functional capacity of sub-acute SCT recipients using validated physical performance tests, including 6-min walk distance, repeated sit-to-stand time and 50-ft walk time, and compared these outcomes with those reported for a heterogeneous oncology population. The medical records of 80 consecutive sub-acute SCT recipients not receiving corticosteroids were retrospectively reviewed for demographic, medical and anthropometric information, and outcomes for these physical performance tests administered at the time of initial physiotherapy evaluation. Measures of central tendency, 95% confidence intervals, unpaired t-tests and correlation coefficients were calculated using a SPSS statistical package. SCT recipients completed the 50-ft walk in 10.66+/-4.43 s, repeated sit-to-stand trial in 4.16+/-1.82 s and walked 400.2 m in 6 min. For the timed tests, SCT recipients were approximately twice as fast as a heterogeneous group of oncology patients and walked approximately 50% further in 6 min. No overlap in the 95% confidence intervals for the two groups was observed for any of the tests. These results (1) suggest that reference values describing the functional capacity of a heterogeneous oncology population underestimate the functional capacity of SCT recipients and (2) provide clinically useful reference values for assessing functional capacity of sub-acute SCT recipients referred for physiotherapy.

Effects of visual and auditory cues on gait in individuals with Parkinson's disease.

The purpose of this study was to determine if combining visual and auditory cues has a greater effect on the gait pattern of patients with Parkinson's disease (PD) than the cues applied individually. Twenty-four individuals with idiopathic PD were recruited. Patients, while off antiparkinsonian medications, were measured on a 7.62-m walkway during two trials for each of four conditions performed in random order: without cues, with a visual cue, with an auditory cue and with both cues simultaneously. The auditory cue consisted of a metronome beat 25% faster than the subject's fastest gait speed. Brightly colored parallel lines placed along the walkway at intervals equal to 40% of a subject's height served as the visual cue. Average gait speed, cadence and stride length were calculated for each condition. Gait velocity, cadence and stride length significantly improved (p<005) when cues were used. Visual and auditory cues improved gait performance in patients with PD, but they did so in different ways. Auditory cueing significantly improved cadence, but visual cueing improved stride length. The simultaneous use of auditory and visual cues did not improve gait significantly more than each cue alone.

Health Opportunities with Physical Exercise (HOPE): social contextual interventions to reduce sedentary behavior in urban settings.

Physical activity interventions targeting social and physical environments of the urban poor hold promise in improving health outcomes in underserved communities. This study randomly assigned overweight, sedentary, economically disadvantaged adults to one of three intervention conditions at The Hope and Healing Center, a large inner-city health facility providing numerous options for exercise. Within the tenets of Social Action Theory, the Health Opportunities with Physical Exercise (HOPE) trial will test the efficacy of two behavior change models, social support and patient-provider interaction, to increase physical activity. In addition to a standard care condition, in which patients have open access to Hope and Healing physical activity programming, patients were assigned to one of two behavior change interventions. Those assigned to patient-peer receive face-to-face, systematic and scheduled encouragement from study-trained 'peer' interventionists at the facility. Patients assigned to patient-provider receive face-to-face, systematic and scheduled encouragement provided by study-trained 'provider' interventionists also at the facility. The primary outcomes of change in exercise behavior will be documented by self-reported physical activity and confirmed by fitness testing at baseline, 6, 12 and 24 months during the 1 year of active intervention and 1 year of relapse prevention follow-up. Intervention conditions will be compared on psychosocial mediators including motivational appraisals, ratings of social support, rapport, problem solving and self-efficacy for overcoming barriers to increased physical activity. Novel aspects of this intervention include: (1) delivery of socially based physical activity interventions to an economically disadvantaged urban population, (2) reduction of environmental barriers to be physically active and (3) emphasis on social interactions influencing health habit change. Results of this study have the potential to identify mechanisms of behavior change that could be adopted by physical activity interventions aimed at reducing sedentary behavior and health disparities in high-risk, underserved populations.

Swimming eliminates the weight gain and abdominal fat associated with ovariectomy in the retired breeder rat despite high-fat diet selection.

The effects of swim-training on choice of dietary fat, carbohydrate or protein, weight gain, energy intake, and energy efficiency were examined in ovariectomized and sham-operated retired breeder rats. After a 3 week training period of increased duration, rats swam for 75 min per session (5 days per week) for 4 weeks. Ovariectomized rats gained more weight than sham rats, while swimming reduced weight gain and abdominal fat. As a percentage of total intake, macronutrient choices (weight and energy) were similar for all groups, ovariectomized animals consumed more food and more energy, compared with sham animals. All rats freely chose the majority of their food (g) as carbohydrate and the majority of energy (kJ) as fat. Results indicate that a moderate intensity training program of swimming prevented the weight gain following ovariectomy in older rats despite their excessive caloric intake of fat.

Isolation of human skeletal muscle myosin heavy chain and actin for measurement of fractional synthesis rates.

Using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), we have developed a simple method to isolate myosin heavy chain (MHC) and actin from small (60-80 mg) human skeletal muscle samples for the determination of their fractional synthesis rates. The amounts of MHC and actin isolated are adequate for the quantification of [13C]leucine abundance by gas chromatography-combustion-isotope ratio mass spectrometry (GC-C-IRMS). Fractional synthesis rates of mixed muscle protein (MMP), MHC, and actin were determined in six healthy young subjects (27 +/- 1 yr) after they received a 14-h intravenous infusion (prime = 7.58 micromol/kg body wt, constant infusion = 7.58 micromol. kg body wt-1. h-1) of [1-13C]leucine. The fractional synthesis rates of MMP, MHC, and actin were found to be 0.0468 +/- 0.0048, 0.0376 +/- 0. 0033, and 0.0754 +/- 0.0078%/h, respectively. Overall, the synthesis rate of MHC was 20% lower (P = 0.012), and the synthesis rate of actin was 61% higher (P = 0.060, not significant) than the MMP synthesis rate. The isolation of these proteins for isotope abundance analysis by GC-C-IRMS provides important information about the synthesis rates of these specific contractile proteins, as opposed to the more general information provided by the determination of MMP synthesis rates.

Ovariectomy fails to modify the cardiac myosin isoenzyme profile of adult rats.

Estrogen has been shown to help maintain the elevated expression of the high ATPase myosin isoform, V1, present in the hearts of young rats (< 70 days of age). Because hearts of this age are still undergoing significant maturation, the current study sought to determine if estrogen similarly regulates myosin isoenzyme expression in the mature adult heart. To make this determination, ten month old retired female Sprague-Dawley rats were made estrogen-deficient by ovariectomy (OVAR, n = 8). Sham-operated (CONTR, n = 8) animals served as controls. Nine weeks later, the animals were sacrificed and left ventricular tissue collected. Crude myofibrills were isolated from these samples and electrophoretically separated into the three isoenzymatic forms of cardiac myosin (V1, V2, and V3). OVAR animals were larger than the CONTR group (p < 0.05), but heart weight/body weight ratios were not different between groups. Distribution of myosin among its three isoenzymes was similar between groups (CONTR: V1, 80%, V2, 14%; V3, 6%; OVAR: V1, 77%, V2, 16%, V3, 7%). These data demonstrate that myosin isoenzyme distribution in the adult heart is unaltered by ovariectomy, suggesting that estrogen loses its ability to regulate expression of this protein in the mature heart.

Creatine supplementation enhances intermittent work performance.

To determine the impact of creatine supplementation on high-intensity, intermittent work, 18 participants each performed 2 sets of 4 different work bouts to exhaustion. For 5 days prior to the first set of work bouts, all participants received a placebo (5 g of calcium chloride daily). For the second set of work bouts, 9 participants again received the placebo, while the other 9 received creatine supplementation (18.75 g creatine monohydrate daily for 5 days prior to and 2.25 g creatine daily during testing). The four work bouts in each set consisted of cycling to exhaustion at 150% peak oxygen uptake (VO2peak) either nonstop (A), intermittently for either 60-s work/120-s rest periods (B), 20-s work/40-s rest (C), or 10-s work/20-s rest (D). Creatine supplementation significantly increased (p < .01) the total work time of all bouts. Protocol D showed the greatest increase (> 100%); C increased 61.9%; B increased 61.0%; and A increased 23.5%. These results demonstrate that creatine supplementation significantly extends one's capacity to maintain a specific level of high-intensity, intermittent exercise.

Effects of caffeine ingestion on endurance racing in heat and humidity.

A hot and humid environment can be detrimental to race performance. Caffeine, on the other hand, has been shown to be an ergogenic aid for improving endurance performance. To examine the influence of caffeine ingestion on race performance during high heat stress, seven endurance trained competitive road racers aged between 23 and 51 years (five men, two women) performed three maximal effort 21-km road races outdoors in hot and humid conditions. The caffeine dose, randomly assigned in a double-blind fashion, consisted of either 0, 5, or 9 mg.kg-1 body mass. During each run, the subjects were allowed to drink water ad libitum at each 5-km point. Blood samples were obtained immediately before and after each run and analysed for changes in concentrations of Na+, K+, glucose, lactate, and hematocrit. Pre and postrun data were also collected for body mass and tympanic membrane temperature. Race times were not significantly different among the races or caffeine doses, with the average times within 1.1% of each other. In addition, none of the other variables measured varied significantly among the races or caffeine doses. In summary, caffeine intake did not affect race performance. Therefore it was concluded from our study that caffeine is not of ergogenic benefit in endurance races during high heat stress.

Morderate diabetes alters myosin isoenzyme distribution in cardiac but not skeletal muscle of male rats.

Diabetes is known to alter the myosin phenotype of striated muscle, but the impact of the same diabetic state on different types of striated muscles remains unknown. Therefore, this study determined the myosin isoenzyme profile in the left ventricle, soleus, plantaris, and extensor digitorium longus (EDL) of young male rats made moderately diabetic with streptozotocin, (45 mg/kg, ip). Eight weeks after the single streptozotocin injection, tissues were collected and subsequently electrophoretically analyzed for native myosin isoenzyme distribution. Skeletal muscles were additionally analyzed for myosin heavy chain distribution. Neither the native myosin isoform nor the myosin heavy chain (MHC) distribution profiles of the skeletal muscles were altered by the diabetic state. In contrast, the high ATPase cardiac isoform, VI, was significantly replaced by the low ATPase isoform, V3 (p < 0.05). These results demonstrate that striated muscle responds to a moderate diabetic state in a limited and muscle specific fashion. Significantly, the change in the cardiac myosin isoform profile is comparable to that which occurs in a more severe diabetic state.

Maternal consumption of a low vitamin D diet retards metabolic and contractile development in the neonatal rat heart.

During the fetal and suckling periods of mammalian development, the mother serves as the sole nutritional source for the offspring. As such, the quality of the maternal diet effects growth and development of the offspring during these periods. This study sought to determine if a maternal vitamin D deficiency altered the well characterized development of the neonatal heart. Weaned rat pups (21-day-old) were obtained from mothers who had consumed either a vitamin D-supplemented diet (3000 IU of vitamin D/kg) or a low vitamin D diet (< 200 IU of vitamin D/kg) prior to becoming pregnant and throughout pregnancy and suckling. These pups were sacrificed, hearts excised, and the hearts biochemically analysed for metabolic and contractile protein properties. The pups of dams fed the low vitamin D diet were slightly hypocalcemic relative to those on the supplemented diet (2.28 v 2.41 mumol/l, P < 0.05), had significantly lower body weights (43 v 55 g), heart weights (143 v 174 mg), citrate synthase activity (106 v 147 mumol g-1 min-1), and 3-hydroxyacyl CoA dehydrogenase activity (59 v 91 mumol g-1 min-1). Hexokinase activity (1.98 v 2.02 mumol g-1 min-1), and the distribution of cardiac myosin among its three isoforms (> 85% V1), were unaffected by this dietary deficiency, however myofibrillar protein content was approximately 15% lower in the experimental hearts. These data demonstrate that maternal consumption of a low vitamin D diet results in a general but significant slowing of neonatal cardiac development.

Sodium pivalate reduces cardiac carnitine content and increases glucose oxidation without affecting cardiac functional capacity.

This study determined how selected functional, metabolic, and contractile properties were impacted by sodium pivalate, a compound which creates a secondary carnitine deficiency. Young male rats received either sodium pivalate (20 mM, PIV) or sodium bicarbonate (20 mM, CONTR) in their drinking water. After 11-12 weeks cardiac function and glucose oxidation rates were measured in isolated, perfused working heart preparations. Hearts were also analyzed for carnitine content, activities of hexokinase (HK), citrate synthase (CS), and B-hydroxyacyl CoA dehydrogenase (HOAD), and myosin isoenzyme distribution. Sodium pivalate treatment significantly reduced cardiac carnitine content and increased glucose oxidation but did not alter cardiac functional capacity. HK activity was increased in the PIV group (p < 0.05), and HOAD activity decreased (p < 0.05). CS activity and myosin isoform distribution (VI > 85%) remained unchanged. These results demonstrate that pivalate treatment of this duration and the accompanying carnitine deficiency shift cardiac substrate utilization without compromising cardiac functional capacity.

Effects of long-term cocaine administration and exercise on cardiac metabolism and isomyosin expression.

Although chronic cocaine use is cardiotoxic, its use remains problematic in athletics. Hence adaptive changes induced in the heart by superimposing chronic cocaine use on an exercise training are of interest but remain poorly understood. Therefore this study investigated the effects of cocaine treatment combined with exercise training on the metabolic and contractile properties of the heart. Male Sprague-Dawley rats were assigned to one of four groups: normal sedentary (NS, n = 6), cocaine sedentary (CS, n = 6), normal trained (NT, n = 6), and cocaine trained (CT, n = 6). Trained animals were sprint trained 4 times/week. CS and CT animals received cocaine (25 mg/kg, ip) 6 times/week, 15 min before each exercise bout and 2 additional times per week. After 12 weeks, all animals were sacrificed, and the hearts were removed and analyzed for citrate synthase activity, 3-hydroxyacyl-CoA dehydrogenase activity, Ca(2+)-activated myofibrillar ATPase activity, and myosin isoform distribution. None of the groups demonstrated altered cardiac metabolic properties, but cocaine alone and in conjunction with exercise reduced myofibrillar ATPase activity (p < 0.05) and increased expression of the low ATPase myosin isoform, V3. These data suggest that the potential of the citric acid cycle and beta-oxidation is not sensitive to chronic cocaine treatment, but the distribution of cardiac myosin among its three isoforms is affected. Furthermore, high-intensity treadmill training does not interact with cocaine to further alter these properties.

Prevalence and sociobehavioral correlates of tobacco use among Hispanic children: the Tobacco Resistance Activity Program.

To examine tobacco use patterns and its sociobehavioral correlates among Hispanic in-school youth, a tobacco use and knowledge survey was administered to 660 children from fourth through sixth grade classes, of which 69% (n = 453) were of Hispanic origin. Male Hispanics were more exposed to previous tobacco use (38% vs. 20%, p < .01), reported more current smoking, had more smoking friends, received more cigarette offers, and wanted to try a cigarette compared to females (all p < .05). Also, more previous alcohol use was noted in the previous tobacco users, indicating its potential as a "gateway drug." From multivariate analyses, being offered cigarettes was the strongest environmental indicator of previous tobacco usage, followed by having adult smokers in the house, smoking friends, (all p < .01), and being around other smoking youth (p < .05). This study offers additional knowledge about factors that may cause Hispanic youth to initiate smoking, and suggests the need to address peer and social influences in school-based substance abuse programs.

Exercise capacity of rats remains unaffected by a chronic pressure overload.

OBJECTIVE: The aim was to determine if the adaptive responses of the myocardium to a chronic pressure overload affected cardiovascular performance when evaluated under conditions of increased functional demand. METHODS: Selected female rats were made hypertensive by abdominal aortic constriction. After eight weeks of aortic constriction, cardiovascular responses and work performance were measured during a maximal treadmill exercise bout. RESULTS: Aortic constriction increased mean arterial pressure and the relative quantity of the slow ATPase myosin isoform, V3, relative to untreated controls (p < 0.05). Both groups had similar oxygen consumptions (VO2), heart rates (HR), and oxygen pulses (VO2/HR) at rest and throughout the exercise test. Both groups reached their VO2 max at the same exercise duration and exercise intensity (40.4 m.min-1). Soleus citrate synthase activity was not different between the groups. CONCLUSIONS: These similarities in work capacity, VO2, oxygen pulse, and muscle oxidative capacity suggest (1) that cardiovascular and exercise capacity can both be maintained in spite of the presence of a chronic pressure overload; (2) that after two months of aortic constriction the heart appears to be in a compensated stage of adaptation; and (3) that the cardiac myosin isoenzyme profile may have little direct effect on cardiovascular functional capacity.

Exercise alters cardiac myosin isozyme distribution in obese Zucker and Wistar rats.

Recent evidence suggests that exercise training may significantly increase the expression of the cardiac myosin isozyme V1 in the diabetic heart, a change associated with improved cardiac functional capacity. To test this hypothesis, cardiac myofibrillar adenosinetriphosphatase (ATPase) activity and myosin isozyme profiles were determined in trained and sedentary male hyperinsulinemic obese Zucker (OZT, OZS) and obese Wistar (OWT, OWS) rats. Lean sedentary (LZS, LWS) animals served as age-matched controls. Myofibrillar ATPase activity and the relative quantity of the high-ATPase isozyme V1 was significantly lower in both strains of sedentary obese rats than in the respective lean sedentary controls (P less than 0.05). Both 5 (OZT) and 10 wk (OWT) of moderate treadmill training increased these markers of cardiac myosin biochemistry in the obese animals (P less than 0.05). Thus, endurance exercise training remodels the cardiac isomyosin profile of hyperinsulinemic rats and, in doing so, may enhance cardiac contractility and functional capacity. Such changes may reflect an improvement in glucose availability and utilization in these hearts.

Dietary effects on cardiac metabolic properties in rodents.

Previous studies have shown that dietary provision of carbohydrate can alter cardiac isomyosin distribution in hormonally deficient rats. The main objective of this study was to determine if varying the heart's potential to utilize carbohydrate for energy provision can influence the cardiac isomyosin expression in normal weanling rats. Animals were assigned to one of five groups according to dietary and/or metabolic treatment: (1) mixed-control--(M); (2) high carbohydrate--(H); (3) low carbohydrate--(L); (4) mixed-diet supplemented with oxfenicine, a cardiospecific fatty acid oxidation inhibitor--(MO); and (5) high carbohydrate diet supplemented with oxfenicine--(HO). The results show that 4 weeks of dietary manipulations aimed to either increase or decrease carbohydrate supply to the heart, failed to induce any alterations in either cardiac myosin ATPase activity or isoenzyme pattern. However, extremes in carbohydrate provision altered the metabolic properties of both heart and skeletal muscle. A low carbohydrate diet increased 3-hydroxyacyl CoA dehydrogenase (P less than 0.05) and citrate synthase activities (P less than 0.05) and decreased glycogen content in both heart and soleus muscle; whereas, a high carbohydrate diet, in conjunction with oxfenicine, tended to increase hexokinase activity in these same tissues. These alterations provide indirect evidence that the contributions of both fat and carbohydrate to the energy balance of the heart and skeletal muscle were altered by the imposed dietary interventions. Collectively, these results suggest that although the substrate utilization patterns of the normal weanling heart can be modified via dietary manipulation, such shifts do not exert any regulatory influence on cardiac isomyosin expression.

Apparent influence of metabolism on cardiac isomyosin profile of food-restricted rats.

In addition to thyroid hormone, carbohydrate oxidation appears to influence the relative distribution of rodent cardiac isomyosin (V1, V2, V3), especially in diabetic, thyroid-deficient, and food-restricted animals. To determine whether metabolic variations within the myocardium itself contribute to cardiac isomyosin distribution, food-restricted rats (predominantly V3) were treated with oxfenicine, a cardiospecific inhibitor of fatty acid metabolism. Animals received a mixed diet (50% carbohydrates) ad libitum (FE-M) or in restricted quantities (45% of FE-M; FR-M). Additional food-restricted animals received oxfenicine (75 mg/kg, twice daily) and either a mixed diet (FR-M-OXF) or a high-carbohydrate diet (75% carbohydrates, FR-HC-OXF). After 3 wk, hemodynamic and metabolic measurements were taken, serum 3,5,3'-triiodothyronine (T3) levels were measured, and cardiac citrate synthase (CS) activity and isomyosin distribution (percent V1, V2, V3) was determined. Relative to the FE-M group, thyroid status (CS, T3) was reduced only in the FR-M-OXF and the FR-HC-OXF groups (P less than 0.05). Oxfenicine treatment of food-restricted animals partially preserved the isomyosin profile of the FE-M group (P less than 0.05), suggesting that, within the context of food restriction, cardiac metabolism can influence cardiac isomyosin distribution independently of thyroid status.