Effect of Graded Targeted Temperature Management on Cerebral Glucose Spatiotemporal Characteristics after Cardiac Arrest.

Cardiac arrest (CA) is a fatal disease with high rates of neurological impairment. At present, targeted temperature management (TTM) is the only strategy with firm clinical evidence to prove its effectiveness. However, there is still controversy on the implementation of TTM, particularly on its depth, with a lack of elucidated underlying therapeutic mechanisms. Six Wistar rats were subjected to 8 min asphyxia-CA and randomly divided into TTM at 33oC(n=3) or 35° C groups (n=3). The spatiotemporal characteristics of cerebral glucose metabolism after CA were investigated by 18F-FDG microPET/CT. Myelin Basic Protein (MBP) immunofluorescence staining was used to assess acute injury and recovery of oligodendrocytes. Functional recovery was evaluated using the neurological deficit score (NDS). There was a significant improvement in functional recovery by NDS (p < 0.05) in the 33oC group compared with the 35° C group. Glucose metabolism of the 33° C group was higher than that of the 35oC group early after resuscitation (within 10 minutes). Immunofluorescence analysis showed that positive MBP signals in the cortex and hippocampus in the 33oC group were greater than in the 35oC group. In conclusion, compared to 35oC TTM, 33° C TTM changed the spatiotemporal characteristics of brain glucose metabolisms with improved neurological function, which may be through oligodendrocyte participation.

Metabolic heterogeneous zone assessed by 18 FDG-PET is predictive of postablation mortality in patients with ventricular tachycardia.

PURPOSE: We sought to study the predictive value of the metabolic heterogeneous zone (HZ) as determined by 18 Fluorodeoxyglucose (18 FDG) positron emission tomography (PET) viability studies in ventricular tachycardia (VT) patients. METHODS: PET studies utilizing 82 Rubidium (82 Rb) tracer for perfusion and 18 FDG tracer for viability were analyzed using PMOD (PMOD Technologies) and further analyzed using 684-segment plots. 18 FDG uptake was normalized to the area with maximal perfusion on the rest 82 Rb study. Metabolic scar, HZ, and healthy segments were defined with perfusion-normalized 18 FDG uptake between 0%-50%, 50%-70%, and >70%, respectively. RESULTS: Thirty-four VT patients (age, 63 ± 12 years) were evaluated with 18 FDG-PET viability study. Most (n = 31) patients underwent VT ablation. Patients were categorized to HZ < median versus HZ ≥ median based on a median HZ area size of 21.0 cm2 . HZ size was significantly larger in the deceased group than the alive group (35.2 cm2 vs. 18.1 cm2 , p = .01). Deaths were significantly higher in HZ ≥ 21 cm2 group than HZ < 21 cm2 group (58.8% vs. 11.8%, p = .005). Survival analysis showed significantly higher mortality in the HZ ≥ 21 cm2 group than the HZ < 21 cm2 group (HR = 4.1, 95% CI: 1.3-12.6, p = .016). In a multivariable analysis, HZ was found to be an independent predictor for all-cause mortality (HR = 1.07, 95% CI: 1.02-1.12, p = .01) CONCLUSIONS: Increased HZ size of myocardium was associated with increased mortality. Metabolic HZ quantification may be of value in risk stratification and management of ischemic and nonischemic patients with VT.

Effects of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus: A systematic review and meta-analysis.

INTRODUCTION: Previous evidence has shown significant effects of exercise, cognitive and dual-task training for improving cognition in healthy cohorts. The effects of these types of interventions in type 2 diabetes mellitus is unclear. The aim of this research was to systematically review evidence, and estimate the effect, of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus. METHOD: Electronic databases including PubMed, EMBASE, CINAHL, PsycINFO, SPORTDiscus, and MEDLINE were searched for ongoing and completed interventional trials investigating the effect of either an exercise, cognitive or dual-task intervention on cognition in type 2 diabetes mellitus. RESULTS: Nine trials met the inclusion criteria-one dual-task, two cognitive, and six exercise. Meta-analyses of exercise trials showed no significant effects of exercise on measures of executive function (Stroop task, SMD = -0.31, 95% CI -0.71-0.09, P = 0.13, trail making test part A SMD = 0.28, 95% CI -0.20-0.77 P = 0.25, trail making test part B SMD = -0.15, 95% CI -0.64-0.34 P = 0.54, digit symbol SMD = 0.09, 95% CI -0.39-0.57 P = 0.72), and memory (immediate memory SMD = 0.20, 95% CI -0.28-0.69, P = 0.41 and delayed memory SMD = -0.06, 95% CI -0.55-0.42, P = 0.80). A meta-analysis could not be conducted using cognitive or dual-task data, but individual trials did report a favourable effect of interventions on cognition. Risk of bias was considered moderate to high for the majority of included trials. CONCLUSIONS: Meta-analyses of exercise trials identified a small effect size (0.31), which whilst not significant warrants further investigation. Larger and more robust trials are needed that report evidence using appropriate reporting guidelines (e.g. CONSORT) to increase confidence in the validity of results. TRIAL REGISTRATION: Protocol was registered (CRD42017058526) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO).

Comparison of Velocity-Based and Traditional Percentage-Based Loading Methods on Maximal Strength and Power Adaptations.

Dorrell, HF, Smith, MF, and Gee, TI. Comparison of velocity-based and traditional percentage-based loading methods on maximal strength and power adaptations. J Strength Cond Res 34(1): 46-53, 2020-This study explored the effects of velocity-based training (VBT) on maximal strength and jump height. Sixteen trained men (22.8 ± 4.5 years) completed a countermovement jump (CMJ) test and 1 repetition maximum (1RM) assessment on back squat, bench press, strict overhead press, and deadlift, before and after 6 weeks of resistance training. Participants were assigned to VBT or percentage-based training (PBT) groups. The VBT group's load was dictated through real-time velocity monitoring, as opposed to pretesting 1RM data (PBT). No significant differences were present between groups for pretesting data (p > 0.05). Training resulted in significant increases (p < 0.05) in maximal strength for back squat (VBT 9%, PBT 8%), bench press (VBT 8%, PBT 4%), strict overhead press (VBT 6%, PBT 6%), and deadlift (VBT 6%). Significant increases in CMJ were witnessed for the VBT group only (5%). A significant interaction effect was witnessed between training groups for bench press (p = 0.004) and CMJ (p = 0.018). Furthermore, for back squat (9%), bench press (6%), and strict overhead press (6%), a significant difference was present between the total volume lifted. The VBT intervention induced favorable adaptations in maximal strength and jump height in trained men when compared with a traditional PBT approach. Interestingly, the VBT group achieved these positive outcomes despite a significant reduction in total training volume compared with the PBT group. This has potentially positive implications for the management of fatigue during resistance training.

Effectiveness of Whey Protein Hydrolysate and Milk-Based Formulated Drinks on Recovery of Strength and Power Following Acute Resistance Exercise.

Intensive resistance exercise can result in exercise-induced-muscle-damage, which commonly leads to reductions in acute muscle function. Post-exercise ingestion of carbohydrate-protein mixtures intends to attenuate these effects. This study aimed to compare the effectiveness of whey protein hydrolysate and milk-based formulated drinks on recovery of muscle function following resistance exercise. Thirty resistance-trained males were randomly assigned to either whey hydrolysate and dextrose drink (WH), milk-based drink (MB) or flavored-dextrose (CHO), and performed baseline assessments of perceived-muscle-soreness, the countermovement jump, the seated-medicine-ball throw and isokinetic assessment of the knee extensors and flexors maximal strength. Subsequently, participants performed resistance exercise consisting of various multi-joint barbell exercises. Following resistance exercise participants then consumed either WH (533 Kcal, 32.6 g Protein, 98.3 g Carbohydrate, 1.1 g Fat), MB (532 Kcal, 32.8 g Protein, 98.4 g Carbohydrate, 0.6 g Fat) or CHO (531 Kcal, 0 g Protein, 132.7 g Carbohydrate, 0 g Fat). All assessments were repeated 24 and 48 h post-resistance exercise. Muscle soreness was markedly increased at 24 h and 48 h in all groups (p < 0.001). However, for dynamic power measures (countermovement jump, seated-medicine-ball throw), CHO experienced a decrease for the countermovement jump only at 48 h, whereas WH and MB experienced significant decreases across the countermovement jump and the seated-medicine-ball throw (p < 0.05). All groups experienced significant decreases in isokinetic-extension torque at both 24 h and 48 h; however, flexion torque was decreased for CHO only at these time points (p < 0.05). Consumption of WH or MB did not enhance recovery of dynamic power-producing ability or soreness compared to CHO. Based on within-group effects WH and MB ingestion had seemingly marginal to small positive effects on recovery of isokinetic strength, however, there were no between-group differences for these variables.

Validity and reliability of a linear positional transducer across commonly practised resistance training exercises.

This study investigated the validity and reliability of the GymAware PowerTool (GPT). Thirteen resistance trained participants completed three visits, consisting of three repetitions of free-weight back squat, bench press, deadlift (80% one repetition maximum), and countermovement jump. Bar displacement, peak and mean velocity, peak and mean force, and jump height were calculated using the GPT, a three-dimensional motion capture system (Motion Analysis Corporation; 150 Hz), and a force plate (Kistler; 1500 Hz). Least products regression were used to compare agreeability between devices. A within-trial one-way ANOVA, typical error (TE; %), and smallest worthwhile change (SWC) were used to assess reliability. Regression analysis resulted in R2 values of >0.85 for all variables excluding deadlift mean velocity (R2 = 0.54-0.69). Significant differences were observed between visits 3-2 for bench press bar displacement (0.395 ± 0.055 m; 0.383 ± 0.053 m), and deadlift bar displacement (0.557 ± 0.034 m; 0.568 ± 0.034 m). No other significant differences were found. Low to moderate TE (0.6-8.8%) were found for all variables, with SWC ranging 1.7-7.4%. The data provides evidence that the GPT can be used to measure kinetic and kinematic outputs, however, care should be taken when monitoring deadlift performance.

Ventricular Tachycardia (VT) Substrate Characteristics: Insights from Multimodality Structural and Functional Imaging of the VT Substrate Using Cardiac MRI Scar, 123I-Metaiodobenzylguanidine SPECT Innervation, and Bipolar Voltage.

Postischemic adaptation results in characteristic myocardial structural and functional changes in the ventricular tachycardia (VT) substrate. The aim of this study was to compare myocardial structural and functional adaptations (late gadolinium enhancement/abnormal innervation) with detailed VT mapping data to identify regional heterogeneities in postischemic changes. Methods: Fifteen patients with ischemic cardiomyopathy and drug-refractory VT underwent late gadolinium enhancement cardiac MRI (CMR), 123I-metaiodobenzylguanidine SPECT, and high-resolution bipolar voltage mapping to assess fibrosis (>3 SDs), abnormal innervation (<50% tracer uptake), and low-voltage area (<1.5 mV), respectively. Three-dimensional reconstructed CMR/123I-metaiodobenzylguanidine models were coregistered for further comparison. Results: Postischemic structural and functional adaptations in all 3 categories were similar in size (reported as median [quartile 1-quartile 3]: CMR scar, 46.1 cm2 [33.1-86.9 cm2]; abnormal innervation, 47.8 cm2 [40.5-68.1 cm2]; and low-voltage area, 29.5 cm2 [24.5-102.6 cm2]; P > 0.05). However, any single modality underestimated the total VT substrate area defined as abnormal in at least 1 of the 3 modalities (76.0 cm2 [57.9-143.2 cm2]; P < 0.001). Within the total VT substrate area, regions abnormal in all 3 modalities were most common (25.2%). However, significant parts of the VT substrate had undergone heterogeneous adaptation (abnormal in <3 modalities); the most common categories were "abnormal innervation only" (18.2%), "CMR scar plus abnormal innervation only" (14.9%), and "CMR scar only" (14.6%). All 14 VT channel/exit sites (0.88 ± 0.74 mV) were localized to myocardium demonstrating CMR scar and abnormal innervation. This specific tissue category accounted for 68.3% of the CMR scar and 31.2% of the total abnormal postischemic VT substrate area. Conclusion: Structural and functional imaging demonstrated regional heterogeneities in the postischemic VT substrate not appreciated by any single modality alone. The coexistence of abnormal innervation and CMR scar may identify a particularly "proarrhythmic" adaptation and may represent a potential novel target for VT ablation.

The effect of time-of-flight and point spread function modeling on 82Rb myocardial perfusion imaging of obese patients.

BACKGROUND: The effect of time-of-flight (TOF) and point spread function (PSF) modeling in image reconstruction has not been well studied for cardiac PET. This study assesses their separate and combined influence on 82Rb myocardial perfusion imaging in obese patients. METHODS: Thirty-six obese patients underwent rest-stress 82Rb cardiac PET. Images were reconstructed with and without TOF and PSF modeling. Perfusion was quantitatively compared using the AHA 17-segment model for patients grouped by BMI, cross-sectional body area in the scanner field of view, gender, and left ventricular myocardial volume. Summed rest scores (SRS), summed stress scores (SSS), and summed difference scores (SDS) were compared. RESULTS: TOF improved polar map visual uniformity and increased septal wall perfusion by up to 10%. This increase was greater for larger patients, more evident for patients grouped by cross-sectional area than by BMI, and more prominent for females. PSF modeling increased perfusion by about 1.5% in all cardiac segments. TOF modeling generally decreased SRS and SSS with significant decreases between 2.4 and 3.0 (P < .05), which could affect risk stratification; SDS remained about the same. With PSF modeling, SRS, SSS, and SDS were largely unchanged. CONCLUSION: TOF and PSF modeling affect regional and global perfusion, SRS, and SSS. Clinicians should consider these effects and gender-dependent differences when interpreting 82Rb perfusion studies.

A dedicated breast-PET/CT scanner: Evaluation of basic performance characteristics.

PURPOSE: Application of advanced imaging techniques, such as PET and x ray CT, can potentially improve detection of breast cancer. Unfortunately, both modalities have challenges in the detection of some lesions. The combination of the two techniques, however, could potentially lead to an overall improvement in diagnostic breast imaging. The purpose of this investigation is to test the basic performance of a new dedicated breast-PET/CT. METHODS: The PET component consists of a rotating pair of detectors. Its performance was evaluated using the NEMA NU4-2008 protocols. The CT component utilizes a pulsed x ray source and flat panel detector mounted on the same gantry as the PET scanner. Its performance was assessed using specialized phantoms. The radiation dose to a breast during CT imaging was explored by the measurement of free-in-air kerma and air kerma measured at the center of a 16 cm-diameter PMMA cylinder. Finally, the combined capabilities of the system were demonstrated by imaging of a micro-hot-rod phantom. RESULTS: Overall, performance of the PET component is comparable to many pre-clinical and other dedicated breast-PET scanners. Its spatial resolution is 2.2 mm, 5 mm from the center of the scanner using images created with the single-sliced-filtered-backprojection algorithm. Peak NECR is 24.6 kcps; peak sensitivity is 1.36%; the scatter fraction is 27%. Spatial resolution of the CT scanner is 1.1 lp/mm at 10% MTF. The free-in-air kerma is 2.33 mGy, while the PMMA-air kerma is 1.24 mGy. Finally, combined imaging of a micro-hot-rod phantom illustrated the potential utility of the dual-modality images produced by the system. CONCLUSION: The basic performance characteristics of a new dedicated breast-PET/CT scanner are good, demonstrating that its performance is similar to current dedicated PET and CT scanners. The potential value of this system is the capability to produce combined duality-modality images that could improve detection of breast disease. The next stage in development of this system is testing with more advanced phantoms and human subjects.

Status of cardiovascular PET radiation exposure and strategies for reduction: An Information Statement from the Cardiovascular PET Task Force.

Cardiovascular positron emission tomography (PET) imaging provides high-quality visual and quantitative myocardial perfusion and function images. In addition, cardiovascular PET can assess myocardial viability, myocardial inflammatory disorders such as cardiac sarcoid, and infections of implanted devices including pacemakers, ventricular assist devices, and prosthetic heart valves. As with all nuclear cardiology procedures, the benefits need to be considered in relation to the risks of exposure to radiation. When performed properly, these assessments can be obtained while simultaneously minimizing radiation exposure. The purpose of this information statement is to present current concepts to minimize patient and staff radiation exposure while ensuring high image quality.

The Influence of Mid-Event Deception on Psychophysiological Status and Pacing Can Persist across Consecutive Disciplines and Enhance Self-paced Multi-modal Endurance Performance.

Purpose: To examine the effects of deceptively aggressive bike pacing on performance, pacing, and associated physiological and perceptual responses during simulated sprint-distance triathlon. Methods: Ten non-elite, competitive male triathletes completed three simulated sprint-distance triathlons (0.75 km swim, 500 kJ bike, 5 km run), the first of which established personal best "baseline" performance (BL). During the remaining two trials athletes maintained a cycling power output 5% greater than BL, before completing the run as quickly as possible. However, participants were informed of this aggressive cycling strategy before and during only one of the two trials (HON). Prior to the alternate trial (DEC), participants were misinformed that cycling power output would equal that of BL, with on-screen feedback manipulated to reinforce this deception. Results: Compared to BL, a significantly faster run performance was observed following DEC cycling (p < 0.05) but not following HON cycling (1348 ± 140 vs. 1333 ± 129 s and 1350 ± 135 s, for BL, DEC, and HON, respectively). As such, magnitude-based inferences suggest HON running was more likely to be slower, than faster, compared to BL, and that DEC running was probably faster than both BL and HON. Despite a trend for overall triathlon performance to be quicker during DEC (4339 ± 395 s) compared to HON (4356 ± 384 s), the only significant and almost certainly meaningful differences were between each of these trials and BL (4465 ± 420 s; p < 0.05). Generally, physiological and perceptual strain increased with higher cycling intensities, with little, if any, substantial difference in physiological and perceptual response during each triathlon run. Conclusions: The present study is the first to show that mid-event pace deception can have a practically meaningful effect on multi-modal endurance performance, though the relative importance of different psychophysiological and emotional responses remains unclear. Whilst our findings support the view that some form of anticipatory "template" may be used by athletes to interpret levels of psychophysiological and emotional strain, and regulate exercise intensity accordingly, they would also suggest that individual constructs such as RPE and affect may be more loosely tied with pacing than previously suggested.

Effects of Resistance Band Exercise on Vascular Activity and Fitness in Older Adults.

This study investigated the effects of a low to moderately intense resistance-band exercise intervention on cutaneous microvascular function in an older population. 18 sedentary healthy participants (age: 58±5) were assessed for their upper and lower-limb endothelial cutaneous vascular conductance using laser Doppler fluximetry with endothelial-dependent (80 µl acetylcholine chloride), and -independent vasodilation (80 µl sodium nitroprusside). In addition, participants underwent a range of functional assessments (cardiopulmonary fitness, strength, flexibility), and completed a perceived quality of life questionnaire. Participants were randomised into 2 groups: Exercise (EX) and Control (CON), and followed either an 8-week self-supervised home-based resistance-band intervention or maintained their habitual lifestyle. Following post-intervention assessment (n=16; EX=7, CON=9), EX improved acetylcholine-chloride-mediated endothelial-dependent vasodilation within the lower limb (cutaneous vascular conductance at 2 000 µCb; P<0.01), but without associated changes in the upper limb. Exercise, compared to CON, significantly affected sodium-nitroprusside-mediated independent vasodilation in the upper limb (P<0.01) at 2 000 µCb, but without associated changes in the lower limb. Of functional assessments, only lower limb strength and flexibility improved for EX (P<0.05). EX experienced positive changes within global measures of General Health, Bodily Pain and Energy/Fatigue (P<0.05). An 8-week home-based resistance-band exercise programme improves age-provoked microcirculatory endothelial vasodilation, but without concomitant changes in cardiopulmonary and anthropometric measures.

TandemPET- A High Resolution, Small Animal, Virtual Pinhole-Based PET Scanner: Initial Design Study.

Mice are the perhaps the most common species of rodents used in biomedical research, but many of the current generation of small animal PET scanners are non-optimal for imaging these small rodents due to their relatively low resolution. Consequently, a number of researchers have investigated the development of high-resolution scanners to address this need. In this investigation, the design of a novel, high-resolution system based on the dual-detector, virtual-pinhole PET concept was explored via Monte Carlo simulations. Specifically, this system, called TandemPET, consists of a 5 cm × 5 cm high-resolution detector made-up of a 90 × 90 array of 0.5 mm × 0.5 mm × 10 mm (pitch= 0.55 mm) LYSO detector elements in coincidence with a lower resolution detector consisting of a 68 × 68 array of 1.5 mm × 1.5 mm × 10 mm LYSO detector elements (total size= 10.5 cm × 10.5 cm). Analyses indicated that TandemPET's optimal geometry is to position the high-resolution detector 3 cm from the center-of-rotation, with the lower resolution detector positioned 9 cm from center. Measurements using modified NEMA NU4-2008-based protocols revealed that the spatial resolution of the system is ~0.5 mm FWHM, after correction of positron range effects. Peak sensitivity is 2.1%, which is comparable to current small animal PET scanners. Images from a digital mouse brain phantom demonstrated the potential of the system for identifying important neurological structures.

High Concordance Between Mental Stress-Induced and Adenosine-Induced Myocardial Ischemia Assessed Using SPECT in Heart Failure Patients: Hemodynamic and Biomarker Correlates.

UNLABELLED: Mental stress can trigger myocardial ischemia, but the prevalence of mental stress-induced ischemia in congestive heart failure (CHF) patients is unknown. We characterized mental stress-induced and adenosine-induced changes in myocardial perfusion and neurohormonal activation in CHF patients with reduced left-ventricular function using SPECT to precisely quantify segment-level myocardial perfusion. METHODS: Thirty-four coronary artery disease patients (mean age±SD, 62±10 y) with CHF longer than 3 mo and ejection fraction less than 40% underwent both adenosine and mental stress myocardial perfusion SPECT on consecutive days. Mental stress consisted of anger recall (anger-provoking speech) followed by subtraction of serial sevens. The presence and extent of myocardial ischemia was quantified using the conventional 17-segment model. RESULTS: Sixty-eight percent of patients had 1 ischemic segment or more during mental stress and 81% during adenosine. On segment-by-segment analysis, perfusion with mental stress and adenosine were highly correlated. No significant differences were found between any 2 time points for B-type natriuretic peptide, tumor necrosis factor-α, IL-1b, troponin, vascular endothelin growth factor, IL-17a, matrix metallopeptidase-9, or C-reactive protein. However, endothelin-1 and IL-6 increased, and IL-10 decreased, between the stressor and 30 min after stress. Left-ventricular end diastolic dimension was 179±65 mL at rest and increased to 217±71 after mental stress and 229±86 after adenosine (P<0.01 for both). Resting end systolic volume was 129±60 mL at rest and increased to 158±66 after mental stress (P<0.05) and 171±87 after adenosine (P<0.07), with no significant differences between adenosine and mental stress. Ejection fraction was 30±12 at baseline, 29±11 with mental stress, and 28±10 with adenosine (P=not significant). CONCLUSION: There was high concordance between ischemic perfusion defects induced by adenosine and mental stress, suggesting that mental stress is equivalent to pharmacologic stress in eliciting clinically significant myocardial perfusion defects in CHF patients. Cardiac dilatation suggests clinically important changes with both conditions. Psychosocial stressors during daily life may contribute to the ischemic burden of CHF patients with coronary artery disease.

Effects of deceptive running speed on physiology, perceptual responses, and performance during sprint-distance triathlon.

OBJECTIVE: This study examined the effects of speed deception on performance, physiological and perceptual responses, and pacing during sprint-distance triathlon running. METHODS: Eight competitive triathletes completed three simulated sprint-distance triathlons (0.75 km swim, 20 km bike, 5 km run) in a randomised order, with swimming and cycling sections replicating baseline triathlon performance. During the first 1.66 km of the run participants maintained an imposed speed, completing the remaining 3.33 km as quickly as possible. Although the participants were informed that initially prescribed running speed would reflect baseline performance, this was true during only one trial (Tri-Run100%). As such, other trials were either 3% faster (Tri-Run103%), or 3% slower (Tri-Run97%) than baseline during this initial period. RESULTS: Performance during Tri-Run103% (1346±108 s) was likely faster than Tri-Run97% (1371±108 s), and possibly faster than Tri-Run100% (1360±125 s), with these differences likely to be competitively meaningful. The first 1.66 km of Tri-Run103% induced greater physiological strain compared to other conditions, whilst perceptual responses were not significantly different between trials. CONCLUSIONS: It appears that even during 'all-out' triathlon running, athletes maintain some form of 'reserve' capacity which can be accessed by deception. This suggests that expectations and beliefs have a practically meaningful effect on pacing and performance during triathlon, although it is apparent that an individual's conscious intentions are secondary to the brains sensitivity to potentially harmful levels of physiological and perceptual strain.

Recent advances in cardiac SPECT instrumentation and system design.

Recent advances in clinical cardiac SPECT instrumentation are reviewed from a systems perspective. New hardware technologies include pixelated scintillator and semiconductor detector elements; photodetectors such as position-sensitive photomultiplier tubes (PSPMT), avalanche photodiodes (APD) and silicon photomultipliers (SiPM); and novel cardiac collimation methods. There are new approaches for positioning detectors and controlling their motion during cardiac imaging. Software technology advances include iterative image reconstruction with modeling of Poisson statistics and depth-dependent collimator response. These new technologies enable faster acquisitions, the lowering of administered activity and radiation dose, and improved image resolution. Higher sensitivity collimators are a significant factor enabling faster acquisitions. Several clinical systems incorporating new technologies are discussed and different system designs can achieve similar performance. With detector elements such as APDs, SiPMs and semiconductors that are insensitive to magnetic fields, the potential for cardiac SPECT imagers that are MRI compatible opens up new frontiers in clinical cardiac research and patient care.

Scalar-linear increases in perceived exertion are dissociated from residual physiological responses during sprint-distance triathlon.

OBJECTIVE: This study examined how residual fatigue affects the relationship between ratings of perceived exertion (RPE), physiological responses, and pacing during triathlon performance. METHODS: Eight male triathletes completed a sprint-distance triathlon (750m swim, 20kmcycle and 5km run) and isolated 5km run on separate days. RPE, core temperature (Tcore), heart rate and blood lactate concentration [BLa(-)] were recorded during both, in addition to performance time and speed. RESULTS: Triathlon run time (1248±121s) was significantly slower than the isolated run (1167±90s) (p<0.01). Significant differences were observed at the start of the two conditions for all physiological measures (Heart rate 162±4 vs 154±5 beatsmin(-1); Tcore 38.3±0.8 vs 36.7±0.6C; [BLa(-)] 9.1±2.8 vs 2.1±0.4mmolL(-1), for triathlon and isolated run, respectively, p<0.05). No significant differences were observed for initial RPE (p=0.083), rate of RPE increase (p=0.412), or final RPE (p=0.329) between run trials. CONCLUSIONS: The maintenance of a scalar-linear increase in RPE by the brain remains the primary mechanism for pace regulation during both single and multi-modal endurance performance, with physiological responses being only indirectly related to this process. The apparent absence of any RPE 'resetting' between disciplines suggests that during shorter distance multi-sport performances (60-90 min) a cognitive pacing strategy for the entire event is employed. However, as subtle alterations in RPE development between disciplines were observed the existence of discipline-specific RPE 'templates' should not be discounted.