RESUMO
BACKGROUND: Cholesterol metabolism is tightly regulated at the cellular level. This study was to measure the expression levels of ATP-binding cassette transporter A1 (ABCA1) and G1 (ABCG1), scavenger receptor class B type I (SR-BI) and class A (SRA), and CD36 mRNAs in peripheral blood mononuclear cells (PBMCs) in response to 100-km ultramarathon event and determine any correlation between these ABC transporters/scavenger receptor expression levels and plasma cholesterol homeostasis. MATERIALS AND METHODS: Twenty-six participants were enrolled. Blood was drawn from each individual 1 week prior, immediately after, and 24 hours after the race. The expression levels of ABCA1, ABCG1, SR-BI, SRA and CD36 in PBMCs were measured by using real-time quantitative reverse transcription polymerase chain reaction. RESULTS: Plasma triglyceride levels were significantly increased immediately after the race and dropped at 24-hour post-race compared with pre-race values. The 100-km ultramarathon boosted high-density lipoprotein cholesterol (HDL-C) levels and decreased low-density lipoprotein cholesterol (LDL-C) levels 24-hour post-race. The expression levels of ABCA1, ABCG1 and SR-BI were markedly decreased, whereas that of CD36 was slightly but significantly upregulated in runners' PBMCs immediately after the race. Ultramarathon resulted in immediate large-scale stimulation of inflammatory cytokines with increased plasma interleukin-6 and tumour necrosis factor-alpha levels. Moreover, by using in vitro models with human monocytic cell lines, incubation of runners' plasma immediately after the race significantly downregulated ABCA1 and ABCG1, and upregulated CD36 expression in these cells. CONCLUSIONS: ABCA1, ABCG1 and CD36 gene expressions in PBMCS might be associated with endurance exercise-induced plasma cholesterol homeostasis and systemic inflammatory response.
Assuntos
Transportadores de Cassetes de Ligação de ATP/genética , Corrida de Maratona/fisiologia , RNA Mensageiro/metabolismo , Receptores Depuradores/genética , Transportador 1 de Cassete de Ligação de ATP/genética , Membro 1 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Adulto , Atletas , Antígenos CD36/genética , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Humanos , Leucócitos Mononucleares/metabolismo , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Receptores Depuradores Classe A/genética , Receptores Depuradores Classe B/genética , Triglicerídeos/sangueRESUMO
Our study aimed to (i) utilize novel electrical cardiometry and observe acute changes in cardiac biomarkers among 24-h and 48-h ultra-marathoners, and (ii) examine whether alterations in cardiac responses were associated with the average running speed of these participants. Twenty-four 24-h and sixteen 48-h ultra-marathoners were recruited. Electrical cardiometry in the 2 groups showed significant post-race drops in systolic pressure (24-h: p=0.001; 48-h: p=0.016) and rapid increases in heart rate (24-h, p=0.004; 48-h, p=0.001). Cardiac output increased in 48-h runners (p=0.012) and stroke volume decreased in 24-h runners (p=0.009) at post-test. Six of 20 (30%) 24-h and 4 of 16 (25%) 48-h runners had high-sensitivity troponin T values above the reference interval after the races. N-terminal proB-type natriuretic peptide levels showed a 15-fold increase in 24-h runners and a 10-fold increase in 48-h runners at post-race. There was a positive correlation between delta N-terminal proB-type natriuretic peptide and running mileage (rs=0.629, p=0.003) in 24-h ultra-marathoners. In conclusion, stroke volume and cardiac output showed inconsistent changes between the 2 groups. Average running speed has a significant effect on post-exercise elevation in cardiac biomarkers.
Assuntos
Biomarcadores/sangue , Coração/fisiologia , Corrida de Maratona/fisiologia , Adulto , Atletas , Débito Cardíaco , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Volume Sistólico , Troponina T/sangueRESUMO
Completing an ultramarathon leads to an immediate postrace surge of erythropoietin (EPO). Patients with chronic liver disease may have high plasma EPO concentrations. This study aims to explore whether plasma EPO concentrations vary between hepatitis B virus carrier (HBVc) and non-HBVc runners during long distance running. Blood samples were collected from 8 HBVc and 18 non-HBVc runners at 3 different time points: 1 week before, immediately following, and then 24 h after the 100-km ultramarathon race. Samples were analyzed for plasma EPO levels. EPO concentration had a statistically significant rise immediately after the race (8.7 [7.1-11.9] mU·mL-1 to 23.7 [14.8-37.2] mU·mL-1, P < 0.001) and maintained the high levels 24 h after the race finished (16.7 [11.5-21.0] mU·mL-1, P < 0.001) in all participants. The mean of EPO concentration was 8.9 (5.7-13.2) mU·mL-1 in HBVc runners and was 8.7 (7.7-11.2) mU·mL-1 in non-HBVc runners in the prerace. In HBVc runners, plasma EPO levels were no different at baseline (P = 0.657) and increased in the same fashion in response to ultramarathon compared with non-HBVc runners. Plasma EPO levels between the two groups were not statistically different at any time point. Prolonged endurance exercise led to a significant increase in EPO. A comparable increase in EPO levels was observed in HBVc and non-HBVc runners during and 24 h after 100-km ultramarathon. However, a small sample size might have affected the ability to detect a difference if it does exist.
Assuntos
Eritropoetina , Vírus da Hepatite B , Corrida de Maratona , Portador Sadio , HumanosRESUMO
Ultra-marathons are typically held over harsh terrains such as mountains, deserts, or other wilderness, and place severe demands on the physical and psychological capabilities of participants. Adventure-race competitors commonly report hallucinations. The goal of this study was to gain insight into visual hallucinations (VHs) during a mountain ultra-marathon. Thirty-one Taiwanese runners who participated in the 2018 Run Across Taiwan Ultra-Marathon, which spans 246 km with an altitude difference of 3266 m and an overall cut-off time of 44 h, volunteered for this study. Self-reported questionnaires on sleep duration, hallucinatory experiences, clinical symptoms of cold- and heat-related illnesses, and the 2018 Lake Louise Acute Mountain Sickness (AMS) Score were recorded prerace, during the summit, immediately postrace, and 3-days postrace. Hematological samples were collected 1 week before, immediately after, and 3 days after the race. Eight ultra-marathoners (six males and two females; seven finishers and one withdrawer) were recruited. Three out of eight (37.5%) subjects (two males and one female) reported experiencing VHs during the last 60 km. Three out of five (60%) lower-ranked subjects experienced VHs. All eight runners slept for <30 min during the race. None of the runners presented with headache either during or after the race to meet the criteria for AMS. None of the runners suffered an abnormal thermoregulatory response or a hypoglycemic episode throughout the ultra-marathon. The changes in blood osmolality immediately postrace were subclinical, despite being statistically significant. Among the three runners with VHs, none presented with severe dehydration or dysnatremia immediately postrace. High-altitude exposure, hyper/hypothermia, dehydration, dysnatermia, or hypoglycemia did not seem to contribute to hallucination onset in our subjects during the event. VHs of ultra-marathoners may be associated with excessive physical exertion and sleep deprivation.
Assuntos
Altitude , Corrida de Maratona , Feminino , Alucinações/epidemiologia , Alucinações/etiologia , Humanos , Masculino , TaiwanRESUMO
BACKGROUND: Clinical situations in intensive care units (ICUs) change rapidly, and many factors may prolong the length of stay (LOS) of patients. OBJECTIVES: The objectives of the study were to examine the effects of implementing an electronic-ICU (e-ICU) and an informatics system in an ICU on the LOS of patients and quality of care. METHODS: We evaluated the implementation of a technology electronic dashboard-ICU (TED-ICU) system to upload automatically physiological information and clinical data within the critical care unit for providing real-time information to the care team. Furthermore, TED-ICU software automatically performed Sequential Organ Failure Assessment (SOFA) every 48 h. If a patient's SOFA score decreased by more than 2 points, there was an automatic reminder for transferring patients to the general ward. We prospectively collected data for this study from the ICU before and after implementing the e-ICU. RESULTS: In total, 2248 patients were admitted to our ICU during the study period (1147 and 1101 patients before and after TED-ICU implementation, respectively). Demographic characteristics and in-hospital mortality rates did not differ significantly between the two groups, and the LOS decreased from 7.26 to 5.53 days (p < 0.01). CONCLUSION: Implementing an informatics system (TED-ICU) and care bundle in ICUs can reduce the LOS.
Assuntos
Sistemas de Informação Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Pacotes de Assistência ao Paciente , Qualidade da Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/normas , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos ProspectivosRESUMO
BACKGROUND: Emergency medical services (EMSs) are used by approximately 383,000 patients with out-of-hospital sudden cardiac arrest (SCA) in the United States. Hence, it is crucial to implement automated external defibrillator (AED) programs to prepare responders for an SCA emergency. Taiwanese pass legislature to enforce AED installation in 8 mandatory areas since 2013. Our study investigated the efficacy of the policy regarding AED installation. MATERIALS AND METHODS: We collected data of patients who had sudden cardiac arrest (SCA) in pre-hospital settings, and received resuscitative efforts, including cardiopulmonary resuscitation or defibrillation with AEDs. The data were from July 11, 2013 to July 31, 2015. In total, 209 adult patients were documented by on-site caregivers of different facilities, and a report was mailed to the central health and welfare unit. RESULTS: Schools, large-scale gathering places, and special institutions used AEDs the most, accounting for 33 (15.3%) cases. From non-mandatory AED areas, long-term care facilities had the maximum cases of AED use (32 cases; 14.9%). With commuting stations as a reference, long-distance transport had the lowest odds ratio (OR) of 0.481 (95% confidence interval [CI], 0.24-0.962). The OR for schools, large-scale gathering places, and special institutions was 4.474 (95% CI: 2.497-8.015). Regarding failure of return of spontaneous circulation (ROSC), the OR for the ≥80-year age group was higher than that for the 20-39-year age group. CONCLUSIONS: The policy regarding the legislation to install AEDs in mandatory areas improved AED accessibility. Elderly patients aged ≥80â¯years have a higher rate of ROSC failure.
Assuntos
Fatores Etários , Desfibriladores/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Equipamentos e Suprimentos/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Parada Cardíaca Extra-Hospitalar/mortalidade , Adulto , Idoso , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência/legislação & jurisprudência , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taiwan/epidemiologiaRESUMO
BACKGROUND: Appropriate utilization of intensive care unit (ICU) beds are essential. Patients with critical illness who have do not resuscitate (DNR) have a reduced priority of intensive care. However, the possibility of recovery/survival is ambiguous and multifactorial. OBJECTIVE: To deliberate the characteristics and outcomes of critical illness in patients with prior DNR who were admitted to the emergency department (ED)-ICU. METHOD: This was a retrospective cohort study conducted between April 2015 and November 2015 in a university-based hospital. Non-traumatic patients with DNR admitted to ED-ICU from ED were included. RESULTS: Seventy-eight non-trauma patients with prior DNR status were included in the final analysis. 51.3% (40/78) patients were male with median age 83 (IQR: 75-89) years. The median APACHE II score was 24.5 (IQR: 20-30). 50% (39/78) of the DNR patients survived to discharge. Patients who survived to discharge had lower APACHE II score (23 (IQR: 20-28) vs. 28 (18-38), p = 0.028). There was no significant difference in age, gender, and Charlson index. ROC curves were constructed, generating a cut-off of the APACHE II score at 29.5 for determining survival to discharge (AUC = 0.644, p = 0.028). In multivariate Cox proportional model, APACHE II score above 29.5 was an independent predictor for mortality. (Hazard ratio = 2.46; 95% confidence interval: 1.04-5.83, p = 0.042). CONCLUSION: Our study found that 50% of patients with prior DNR on ICU admission survived to discharge, indicating that aggressive care is not definitely futile. Further prospective studies are required to evaluate the cost-effectiveness and patients' and/or families' satisfaction of the ICU admission of DNR patients.
Assuntos
Estado Terminal/mortalidade , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Ordens quanto à Conduta (Ética Médica) , APACHE , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/organização & administração , Feminino , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Análise Multivariada , Estudos Retrospectivos , Análise de Sobrevida , Taiwan/epidemiologiaRESUMO
INTRODUCTION: RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients. METHODS: This was a retrospective cohort study conducted in emergency department intensive care units (ED-ICU) between April 2015 and November 2015. Elderly patients (≥65years old) who were admitted to the ED-ICU with a diagnosis of severe sepsis and/or septic shock were included. The demographic data, biochemistry data, qSOFA, and APACHE II score were compared between survivors and nonsurvivors. RESULTS: A total of 117 patients was included with mean age 81.5±8.3years old. The mean APACHE II score was 21.9±7.1. In the multivariate Cox proportional hazards model, RDW level was an independent variable for mortality (hazard ratio: 1.18 [1.03-1.35] for each 1% increase in RDW, p=0.019), after adjusting for CCI, any diagnosed malignancy, and eGFR. The AUC of RDW in predicting mortality was 0.63 (95% confidence interval [CI]: 0.52-0.74, p=0.025). In subgroup analysis, for qSOFA <2, nonsurvivors had higher RDW levels than survivors (17.0±3.3 vs. 15.3±1.4%, p=0.044). CONCLUSIONS: In our study, RDW was an independent predictor of in-hospital mortality in elderly patients with sepsis. For qSOFA scores <2, higher RDW levels were associated with poor prognosis. RDW could be a potential parameter used alongside the clinical prediction rules.
Assuntos
Unidades de Terapia Intensiva , Sepse/sangue , Idoso , Idoso de 80 Anos ou mais , Contagem de Eritrócitos , Índices de Eritrócitos , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/mortalidade , Taxa de Sobrevida/tendências , Taiwan/epidemiologiaRESUMO
Heart rate variability (HRV) is often used to assess the risk of cardiovascular disease, and data on this can be obtained via electrocardiography (ECG). However, collecting heart rate data via photoplethysmography (PPG) is now a lot easier. We investigate the feasibility of using the PPG-based heart rate to estimate HRV and predict diseases. We obtain three months of PPG-based heart rate data from subjects with and without hypertension, and calculate the HRV based on various forms of time and frequency domain analysis. We then apply a data mining technique to this estimated HRV data, to see if it is possible to correctly identify patients with hypertension. We use six HRV parameters to predict hypertension, and find SDNN has the best predictive power. We show that early disease prediction is possible through collecting one's PPG-based heart rate information.
Assuntos
Frequência Cardíaca/fisiologia , Hipertensão/diagnóstico , Fotopletismografia/métodos , Processamento de Sinais Assistido por Computador , Dispositivos Eletrônicos Vestíveis , Diagnóstico Precoce , Eletrocardiografia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Monitorização AmbulatorialRESUMO
Blood testing for endogenous small metabolites to determine physiological and biochemical states is routine for laboratory analysis. Here we demonstrate that by combining the commercial direct analysis in real time (DART) ion source with an ion trap mass spectrometer, native cholesterol in its free alcohol form is readily detected from a few hundred nanoliters of human serum loaded onto chromatography paper. Deuterium-labeled cholesterol was used as the internal standard to obtain the absolute quantity of the endogenous cholesterol. The amount of the cholesterol measured by this paper-loaded DART mass spectrometry (pDART-MS) is statistically comparable with that obtained by using commercially available fluorometric-enzymatic assay and liquid chromatography/mass spectrometry. Furthermore, sera from 21 participants at three different time points in an ultramarathon were collected to obtain their cholesterol levels. The test requires only very minimal sample preparation, and the concentrations of cholesterol in each sample were acquired within a minute.
Assuntos
Colesterol/sangue , Papel , Colesterol/química , Cromatografia Líquida , Humanos , Espectrometria de Massas , Fatores de TempoRESUMO
BACKGROUND/PURPOSE: The Modified Early Warning Score (MEWS) reflects the physiological changes of cardiac arrest and has been used in identifying patient deterioration. Physiological reserve capacity is an important outcome predictor, but is seldom reported due to recording limitations in cardiac arrest patients. The aim of the study was to evaluate whether periarrest MEWS could be a further prognostic factor in in-hospital cardiac arrest. METHODS: This was a retrospective cohort study of nontrauma adult patients who had experienced in-hospital cardiac arrest during emergency department stays at an urban, 2600-bed tertiary medical center in Taiwan from February 2011 to July 2013. Data regarding patients' characteristics, Charlson Comorbidity Score, MEWS score before events, mode of arrest, and outcome details were extracted following the Utstein guidelines for uniform reporting of cardiac arrest. RESULTS: During the 30-month period, 234 patients suffered in-hospital cardiac arrest during emergency department stays, and 99 patients with periarrest MEWS were included in the final analysis. The MEWS at triage did not differ significantly between survival-to-discharge and mortality groups (3.42 ± 2.2 vs. 4.02 ± 2.65, p = 0.811). Periarrest MEWS was lower in the survival-to-discharge group (4.41 ± 2.28 vs. 5.82 ± 2.84, p = 0.053). In multivariate logistic regression analysis, periarrest MEWS was an independent predictors for survival to discharge. A rise in periarrest MEWS reduced the chance of survival to discharge by 0.77-fold (95% confidence interval: 0.60-0.97, p = 0.028). CONCLUSION: The simplest MEWS system not only can be used as a prevention measure, but the periarrest MEWS could also be considered as an independent predictor of mortality after in-hospital cardiac arrest.
Assuntos
Parada Cardíaca/diagnóstico , Parada Cardíaca/fisiopatologia , Mortalidade Hospitalar , Triagem/métodos , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , TaiwanRESUMO
OBJECTIVE: To evaluate the prevalence and characteristics of acute kidney injury (AKI) in 100-km ultramarathon runners. DESIGN: Prospective observational study. SETTING: The 2011 Soochow University ultramarathon, in which each athlete ran for 100 km. PARTICIPANTS: All Taiwanese entrants who participated in the 100-km race and lived in the northern part of Taiwan were invited to participate in the study. MAIN OUTCOME MEASURES: Acute kidney injury was defined using the Acute Kidney Injury Network criteria. Blood and urine samples were collected 1 week before, immediately after, and 1 day after the race. RESULTS: Immediately after the race, 85% (22) of the 26 subjects were diagnosed with AKI, 65% (16) with moderate dehydration, 23% (6) with muscle cramps, and 12% (3) with hematuria. Body weight was significantly decreased from prerace to all postrace measurements. Plasma levels of potassium ion, creatinine, renin, and aldosterone were significantly elevated immediately after the race and then significantly reduced 1 day after the race. Changes in plasma levels of sodium, creatine kinase, and creatine kinase-MB, as well as urine potassium and creatinine, were indicative of AKI. CONCLUSIONS: Transient AKI and muscle cramps are very common in 100-km ultramarathon runners. All transient ultra-runners who developed AKI in this study recovered their renal function 1 day later. CLINICAL RELEVANCE: Ultramarathon running is associated with a wide range of significant changes in hematological parameters, several of which can be associated with potentially serious renal and physiological abnormalities.
Assuntos
Injúria Renal Aguda/epidemiologia , Desidratação/epidemiologia , Hematúria/epidemiologia , Cãibra Muscular/epidemiologia , Corrida/lesões , Injúria Renal Aguda/sangue , Injúria Renal Aguda/urina , Adulto , Aldosterona/sangue , Estudos de Coortes , Creatina Quinase/sangue , Creatina Quinase Forma MB/sangue , Creatinina/sangue , Creatinina/urina , Desidratação/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cãibra Muscular/sangue , Potássio/sangue , Prevalência , Estudos Prospectivos , Renina/sangue , Sódio/sangue , Taiwan/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To examine the effect of ascent rate on the induction of acute mountain sickness (AMS) in young adults during a climb to Jiaming Lake (3350 m) in Taiwan. DESIGN: Prospective, nonrandomized. SETTING: Climb from 2370 to 3350 m. PARTICIPANTS: Young adults (aged 18 to 26 years) (N = 91) chose to participate in either the fast ascent (3 days; n = 43) or slow ascent (4 days; n = 48) group (1 and 2). ASSESSMENT OF RISK FACTORS: Two criteria were used to define AMS. A Lake Louise score ≥3 and Lake Louise criteria [in the setting of a recent gain in altitude, the presence of headache and at least 1 of gastrointestinal discomfort (anorexia, nausea, or vomiting), fatigue or weakness, dizziness or lightheadedness, or difficulty sleeping]. MAIN OUTCOME MEASURES: Heart rate, blood oxygen saturation (SaO2), and symptoms of AMS were monitored each morning and evening. RESULTS: Baseline characteristics were similar between groups, except for significant differences in history of alcohol consumption (P = 0.009) and climbing experience above 3000 m (P < 0.001). The incidence of AMS was not associated with the rate of ascent. Acute mountain sickness was most prevalent in group 1 on day 2 in the evening and in group 2 on day 3 in the evening. In both groups, AMS correlated with the initial reduction in SaO2. Body mass index (BMI) >24 kg/m was identified as a significant risk factor for AMS. CONCLUSIONS: The development of AMS was closely associated with an initial reduction in SaO2. A BMI >24 kg/m also contributed to the occurrence of AMS. CLINICAL RELEVANCE: These findings indicate that factors other than ascent rate should be considered when trying to ameliorate the risk of AMS.
Assuntos
Doença da Altitude/epidemiologia , Sobrepeso/epidemiologia , Oxigênio/metabolismo , Adolescente , Adulto , Doença da Altitude/fisiopatologia , Índice de Massa Corporal , Exercício Físico , Frequência Cardíaca , Humanos , Oximetria , Prevalência , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Comportamento Sedentário , Taiwan , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Rescuers that undergo acute ascent without acclimatization can experience acute mountain sickness. Although performing cardiopulmonary resuscitation (CPR) for a short period requires intensive effort at sea level, performing CPR at high altitude is even more exhausting and can endanger the rescuer. Therefore, we conducted a pilot study to compare the quality of resuscitation in health professionals at high altitude (3100 m) and that at sea level. METHODS: Thirty-eight participants were asked to performed continuous chest compression CPR (CCC-CPR) for 5 minutes at sea level and at high altitude. Cardiopulmonary resuscitation recording technology was used to objectively quantify the quality of the chest compressions (CCs), including the depth and rate thereof. RESULTS: At high altitude, rescuers showed a statistically significant decrease in blood oxygen saturation and an increase in systolic blood pressure, diastolic blood pressure, heart rate, and fatigue, as measured with the Borg score, after CCC-CPR compared with resting levels. The analysis of the time-dependent deterioration in the quality of CCC-CPR showed that the depth of CCs declined from the mean depth of the first 30 seconds after CCC-CPR to that at more than 120 seconds after CCC-CPR at both sea level and high altitude. The average number of effective CCs declined after CCC-CPR was performed for 1 minute at sea level and high altitude. CONCLUSIONS: The quality of CC rapidly declined at high altitude. At high altitude, the average number of effective CC decreases; and this decrease became significant after continuous CCs had been performed for 1 minute.
Assuntos
Altitude , Pressão Sanguínea/fisiologia , Reanimação Cardiopulmonar/normas , Fadiga/fisiopatologia , Pessoal de Saúde , Massagem Cardíaca/normas , Frequência Cardíaca/fisiologia , Adulto , Doença da Altitude/fisiopatologia , Feminino , Humanos , Masculino , Oximetria , Projetos Piloto , Fatores de Tempo , Adulto JovemRESUMO
Physical exercise requires integrated autonomic and cardiovascular adjustments to maintain homeostasis. We aimed to observe acute posture-related changes in blood pressure, and apply a portable noninvasive monitor to measure the heart index for detecting arrhythmia among elite participants of a 246-km mountain ultra-marathon. Nine experienced ultra-marathoners (8 males and 1 female) participating in the Run Across Taiwan Ultra-marathon in 2018 were enrolled. The runners' Heart Spectrum Blood Pressure Monitor measurements were obtained in the standing and supine positions before and immediately after the race. Their high-sensitivity troponin T and N-terminal proB-type natriuretic peptide levels were analyzed 1 week before and immediately after the event. Heart rate was differed significantly in the immediate postrace assessment compared to the prerace assessment, in both the standing (Pâ =â .011; dâ =â 1.19) and supine positions (Pâ =â .008; dâ =â 1.35). Postural hypotension occurred in 4 (44.4%) individuals immediately postrace. In 3 out of 9 (33.3%) recruited finishers, the occurrence of premature ventricular complex signals in the standing position was detected; premature ventricular complex signal effect was observed in the supine position postrace in only 1 participant (11.1%). Premature ventricular complex signal was positively correlated with running speed (Pâ =â .037). Of the 6 individuals who completed the biochemical tests postrace, 2 (33.3%) had high-sensitivity troponin T and 6 (100%) had N-terminal proB-type natriuretic peptide values above the reference interval. A statistically significant increase was observed in both the high-sensitivity troponin T (Pâ =â .028; dâ =â 1.97), and N-terminal proB-type natriuretic peptide (Pâ =â .028; dâ =â 2.91) levels postrace compared to prerace. In conclusion, significant alterations in blood pressure and heart rate were observed in the standing position, and postexercise (postural) hypotension occurred among ultra-marathoners. The incidence of premature ventricular complexes was higher after the race than before.
Assuntos
Sistema Nervoso Autônomo , Pressão Sanguínea , Frequência Cardíaca , Corrida de Maratona , Peptídeo Natriurético Encefálico , Troponina T , Humanos , Feminino , Masculino , Sistema Nervoso Autônomo/fisiologia , Frequência Cardíaca/fisiologia , Corrida de Maratona/fisiologia , Adulto , Troponina T/sangue , Pessoa de Meia-Idade , Pressão Sanguínea/fisiologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Taiwan , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Hipotensão Ortostática/fisiopatologia , Postura/fisiologiaRESUMO
OBJECTIVE: The objective of this study is to determine the association between the duration of high-altitude (>3000 m) pre-exposure and acute mountain sickness (AMS) incidence. METHODS: A prospective observational study was conducted on 2 random days each month from April 2007 to March 2008 at Paiyun Lodge (3402 m), Jade Mountain, Taiwan. Demographic data, prior AMS history, symptoms, and scores and the days and times of high-altitude pre-exposure within the preceding 2 months were obtained from lowland (<1500 m) trekkers. RESULTS: Totally, 1010 questionnaires were analyzed; 106, 76, and 828 trekkers had pre-exposure lasting at least 3 days (group 1), less than 3 days (group 2), and 0 days (group 3), respectively. Acute mountain sickness incidence was significantly higher in groups 2 and 3 than in group 1 (21.70%, 35.53%, 37.08%, respectively; P = .008). Logistic regression analysis indicated a significantly lower AMS risk in group 1 (group 1, P = .004; odds ratio [OR], 0.479; 95% confidence interval [CI], 0.290-0.791; group 2, P = .226; OR, 0.725; 95% CI, 0.430-1.221). In group 1, 28 and 78 trekkers had single and intermittent multiple pre-exposure, respectively. There was no difference in the incidence or severity of AMS symptoms between single and intermittent multiple pre-exposure (AMS, P = .838; headache, P = .891; dizziness or lightheadedness, P = .414; fatigue and/or weakness, P = .957; gastrointestinal symptoms, P = .257; difficulty sleeping, P = .804; AMS score, P = .796). CONCLUSIONS: High-altitude pre-exposure lasting at least 3 days within the preceding 2 months was associated with a significant lower AMS incidence during a subsequent ascent among Jade Mountain trekkers.
Assuntos
Aclimatação , Doença da Altitude/etiologia , Montanhismo , Doença Aguda , Adulto , Doença da Altitude/epidemiologia , Doença da Altitude/prevenção & controle , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Taiwan , Fatores de TempoRESUMO
BACKGROUND: Iron is a vital trace element for energy production and oxygen transportation; importantly, it is essential to athletic performance. Maintaining iron balance is tightly controlled at systemic and cellular levels. This study aimed to determine serum iron tests, hepcidin levels, and cellular iron import and export activities in peripheral blood mononuclear cells (PBMCs) in ultramarathon runners to elucidate the association of systemic inflammation response and iron metabolism. METHODS: Sixteen amateur runners were enrolled. Blood samples were taken 1 week before, immediately, and 24 h after the run. Plasma hepcidin levels were measured by enzyme-linked immunosorbent assay. The expression levels of divalent metal iron transporter 1 (DMT1), ZRT/IRT-like protein 14 (ZIP14), transferrin receptor 1 (TfR1), and ferroportin (FPN) in PBMCs were measured using real-time quantitative reverse transcription-polymerase chain reaction. RESULTS: Serum iron concentrations and transferrin saturation significantly decreased immediately after the race and dramatically recovered 24 h post-race. Serum ferritin levels had a statistically significant rise immediately after the race and remained high 24 h after the completion of the race. Ultramarathons were associated with increased plasma interleukin-6 concentrations corresponding to the state of severe systemic inflammation and therefore boosted plasma hepcidin levels. The expression levels of DMT1 and FPN mRNA were markedly decreased immediately and 24 h after the race. The ZIP14 and TfR1 mRNA expression in PBMCs significantly decreased immediately after the race and returned to the baseline level at 24 h post-race. Positive significant correlations were observed between plasma hepcidin and ferritin levels. CONCLUSION: Iron homeostasis and systemic inflammatory response are closely interconnected. Cellular iron import and export mRNA activities in PBMCs were acutely inhibited during an ultramarathon.
Assuntos
Ferro , Corrida de Maratona , Humanos , Ferritinas , Hepcidinas/sangue , Hepcidinas/metabolismo , Inflamação/etiologia , Ferro/metabolismo , Leucócitos Mononucleares/metabolismo , Corrida de Maratona/fisiologia , RNA MensageiroRESUMO
BACKGROUND: While there are several studies on marathon injuries worldwide, there are no related studies on the Taipei Marathon regarding the rescue time of onsite injury cases, the incidence of out-of-hospital cardiac arrest (OHCA) cases, and the success rate of recovery of spontaneous circulation (ROSC). This study aims to fill that gap. HYPOTHESIS: The rescue time onsite of contact injury cases was in the prime time for lifesaving. STUDY DESIGN: Descriptive epidemiological study. LEVEL OF EVIDENCE: Level 2c. METHODS: This is a retrospective study of numerical and timeflow data using descriptive statistics. Our data were obtained from records of the Taipei Marathon from 2013 to 2021. These included (1) notification data, (2) the time record of the emergency care personnel in contact with patients, (3) incidence of OHCA, (4) the success rate of ROSC, (5) the location of occurrence of OHCA, and (6) emergency medical service capacity and configuration. RESULTS: The average time taken for first contact was 1.56 minutes in OHCA cases, and the total incidence rate of OHCA in 9 years was 4 people per 100,000 people, with a 100% ROSC success rate. Further, the location of OHCA cases was mostly in Q4 of the race (66.67%), followed by Q3 (22.22%) and Q2 (1.11%). The average number of emergency care personnel per marathon was 78, spread across 6 rescue and 6 medical stations and equipped with 8 ambulances and 35 automated external defibrillators. CONCLUSION: Shortening the arrival time of medical personnel to the scene and implementing a complete chain of survival can improve survival rates. Other ways to provide faster and more timely emergency rescue services require further study. CLINICAL RELEVANCE: Contact with patients as soon as possible, timely implementation of cardiopulmonary resuscitation, and use of an automated external defibrillator are the basic requirements of the chain of survival theory.