Compression Socks Reduce Running-Induced Intestinal Damage.

ABSTRACT: Zadow, EK, Edwards, KH, Kitic, CM, Fell, JW, Adams, MJ, Singh, I, Kundur, A, Johnstone, ANB, Crilly, J, Bulmer, AC, Halson, SL, and, and Wu, SSX. Compression socks reduce running-induced intestinal damage. J Strength Cond Res 36(9): 2461-2464, 2022-Exercise is associated with a reduction in splanchnic blood flow that leads to the disruption of intestinal epithelium integrity, contributing to exercise-induced gastrointestinal syndrome. Strategies that promote intestinal blood flow during exercise may reduce intestinal damage, which may be advantageous for subsequent recovery and performance. This study aimed to explore if exercise-associated intestinal damage was influenced by wearing compression garments, which may improve central blood flow. Subjects were randomly allocated to wear compression socks ( n = 23) or no compression socks (control, n = 23) during a marathon race. Blood samples were collected 24 hours before and immediately after marathon and analyzed for intestinal fatty acid-binding protein (I-FABP) concentration as a marker of intestinal damage. The magnitude of increase in postmarathon plasma I-FABP concentration was significantly greater in control group (107%; 95% confidence interval [CI], 72-428%) when compared with runners wearing compression socks (38%; 95% CI, 20-120%; p = 0.046; d = 0.59). Wearing compression socks during a marathon run reduced exercise-associated intestinal damage. Compression socks may prove an effective strategy to minimize the intestinal damage component of exercise-induced gastrointestinal syndrome.

Deep vein thrombosis in a well-trained masters cyclist, is popliteal vein entrapment syndrome to blame?

Whilst athletes are the epitome of health, venous thromboembolisms (VTE) including deep vein thrombosis and pulmonary embolism have been demonstrated to occur in well-trained athletes. VTE is frequently misdiagnosed and poorly treated within this population, often resulting in career or life-threatening ramifications. Furthermore, VTE risk rises with increasing age (> 40 years), potentially affecting masters athletes. A 44-year-old well-trained male cyclist volunteered to participate in a research project investigating the influence of exercise on haemostasis in well-trained athletes. The cyclist presented with elevated D-Dimer levels both pre- (2251 ng/mL) and post-exercise (2653 ng/mL). The cyclist reported constant mild-pain in the left mid-calf region, with a cold tingling sensation in their left foot. Diagnosis of DVT was confirmed via a DVT squeeze test and Doppler ultrasound, with the clot located in the left popliteal vein. During the research project, the cyclist was exposed to numerous thrombogenic risk factors including travel, dehydration, prolonged sitting and exercise. The DVT in the popliteal vein may have resulted from repetitive movements associated with cycling. Additionally, hypertrophy of the gastrocnemius muscle may have impinged the vein. When diagnosing DVT within a cycling population, PVES should not be overlooked as a contributing factor.

Age difference in efficiency of locomotion and maximal power output in well-trained triathletes.

PURPOSE: The aim of this study was to examine the influence of age on cycling efficiency and sprint power output in well-trained endurance masters athletes. METHODS: The investigation was conducted on 60 healthy well-trained triathletes separated into six separate groups (n = 10) depending on age: 20-29 years old; 30-39 years old; 40-49 years old; 50-59 years old; 60-69 years old; 70 years old. Each participant attended the laboratory on three separate occasions to perform (1) an incremental cycling test, (2) maximal peak sprint power test, involving three 5-s sprint efforts (3) and a 10-min sub-maximal cycling test for determination of cycling efficiency. RESULTS: Cycling efficiency decreased beyond 50 years (50-59 years compared with 20-29 years: -7.3 ± 1.8%; p < 0.05) and continued to decrease beyond 60 years (60-69 years compared with 50-59 years: -10.7 ± 2.4%; p < 0.05), no further decrease was observed after 70 years. A continuous impairment in maximal sprint power output was observed after the age of 50 years leading to an overall decrease of 36% between 20-29 years and >70 years. Significant positive relationships were observed between maximal sprint power output and both cycling efficiency (r(2) = 0.64, p < 0.05) and maximal aerobic power (r(2) = 0.42 and p < 0.05). CONCLUSION: The present data indicates a significant effect of ageing on cycling efficiency and maximal sprint power output after 50 years and a significant relationship was found between these two parameters.

Modulation of Heart Rate Variability and Brain Excitability through Acute Whole-Body Vibration: The Role of Frequency.

This cross-over study aimed to explore effects of acute whole-body vibration (WBV) at frequencies of 5-35 Hz on heart rate variability and brain excitability. Thirteen healthy physically active college students randomly completed eight interventions under the following conditions: static upright standing without vibration (CON), static squat exercise (knee flexion 150°) on the vibration platform (SSE), and static squat exercise (knee flexion 150°) combined with WBV at vibration frequency of 5, 9, 13, 20, 25, and 35 Hz. Five bouts × 30 s with a 30-s rest interval were performed for all interventions. The brain's direct current potentials (DCPs), frequency domain variables (FDV) including normalized low frequency power (nLF), normalized high frequency power (nHF) and the ratio of LF to HF (LF/HF), along with the mean heart rate (MHR) were collected and calculated before and after the WBV intervention. Results suggested that WBV frequency at 5 Hz had a substantial effect on decreasing DCPs [-2.13 µV, t(84) = -3.82, p < 0.05, g = -1.03, large] and nLF [-13%, t(84) = -2.31, p = 0.04, g = -0.62, medium]. By contrast, 20-35 Hz of acute WBV intervention considerably improved DCPs [7.58 µV, t(84) = 4.31, p < 0.05, g = 1.16, large], nLF [17%, t(84) = 2.92, p < 0.05, g = 0.79, large] and the LF/HF [0.51, t(84) = 2.86, p < 0.05, g = 0.77, large]. A strong (r = 0.7, p < 0.01) correlation between DCPs and nLF was found at 5 Hz. In summary, acute WBV at 20-35 Hz principally activated the sympathetic nervous system and increased brain excitability, while 5-Hz WBV activated the parasympathetic nervous system and reduced brain excitability. The frequency spectrum of WBV might be manipulated according to the intervention target on heart rate variability and brain excitability.

Training Medical-Diagnosis Neural Networks on the Cloud with Privacy-Sensitive Patient Data from Multiple Clients.

Artificial neural networks (ANNs) are changing the paradigm in medical diagnosis. However, it remains an open problem how to outsource the model training operations to the cloud while protecting the privacy of distributed patient data. Homomorphic encryption suffers from high overhead over data independently encrypted from numerous sources, differential privacy introduces a high level of noise which drastically increases the number of patient records needed to train a model, while federated learning requires all participants to perform synchronized local training that counters our goal of outsourcing all training operations to the cloud. This paper proposes to use matrix masking for outsourcing all model training operations to the cloud with privacy protection. After outsourcing their masked data to the cloud, the clients do not need to coordinate and perform any local training operations. The accuracy of the models trained by the cloud from the masked data is comparable to the accuracy of the optimal benchmark models that are trained directly from the original raw data. Our results are confirmed by experimental studies on privacy-preserving cloud training of medical-diagnosis neural network models based on real-world Alzheimer's disease data and Parkinson's disease data.

The Value and Role of the Inpatient Rehabilitation Facility: Association of Academic Physiatrists Position Statement.

ABSTRACT: Although healthcare is always changing, the inpatient rehabilitation facility has indispensable and enduring roles in patient care, medical education, and research. For patients with complex medical and functional limitations, inpatient rehabilitation facility-level care fosters recovery and community reintegration and plays a strategic role in optimizing healthcare transitions from acute and to postacute settings. It is an incomparable and distinct zone for interprofessional education: the healthcare system is dependent on the inpatient rehabilitation facility as the epicenter for instruction to healthcare professionals on how to care for patients with complex rehabilitation needs. As healthcare evolves, patients' increasing medical complexity requires ongoing research focused on patients' evolving healthcare needs. The inpatient rehabilitation facility alone offers the requisite infrastructure to support such discovery. In this Association of Academic Physiatrists Position Paper, we provide a fresh perspective on the value proposition of the inpatient rehabilitation facility and advocate for this unique clinical environment as a critical component of contemporary healthcare.

Effects of Time of Day on Pacing in a 4-km Time Trial in Trained Cyclists.

CONTEXT: Time of day has been shown to impact athletic performance, with improved performance observed in the late afternoon-early evening. Diurnal variations in physiological factors may contribute to variations in pacing selection; however, research investigating time-of-day influence on pacing is limited. PURPOSE: To investigate the influence of time-of-day on pacing selection in a 4-km cycling time trial (TT). METHODS: Nineteen trained male cyclists (mean [SD] age 39.0 [10.7] y, height 1.8 [0.1] m, body mass 78.0 [9.4] kg, VO2max 62.1 [8.7] mL·kg-1·min-1) completed a 4-km TT on 5 separate occasions at 08:30, 11:30, 14:30, 17:30, and 20:30. All TTs were completed in a randomized order, separated by a minimum of 2 d and maximum of 7 d. RESULTS: No time-of-day effects were observed in pacing as demonstrated by similar power outputs over 0.5-km intervals (P = .78) or overall mean power output (333.0 [38.9], 339.8 [37.2], 335.5 [31.2], 336.7 [35.2], and 334.9 [35.7] W; P = .45) when TTs were performed at 08:30, 11:30, 14:30, 17:30, and 20:30. Preexercise tympanic temperature demonstrated a time-of-day effect (P < .001), with tympanic temperature higher at 14:30 and 17:30 than at 08:30 and 11:30. CONCLUSION: While a biological rhythm was present in tympanic temperature, pacing selection and performance when completing a 4-km cycling TT were not influenced by time of day. The findings suggest that well-trained cyclists can maintain a robust pacing strategy for a 4-km TT regardless of time of the day.

The relationship between quality of life and swallowing in Parkinson's disease.

Few studies exist in the literature investigating the impact of idiopathic Parkinson's Disease (IPD) on swallow-related quality of life. We therefore aimed in this project to: (1) evaluate swallow-specific quality of life in IPD; (2) delineate potential relationships between IPD duration and severity with swallow-specific quality of life; (3) investigate relationships between swallow-specific quality of life and general health-related quality of life; and (4) investigate relationships between swallow-specific quality of life and depression. Thirty-six patients diagnosed with IPD with and without dysphagia filled out self-report assessments of the SWAL-QOL, Parkinson's Disease Questionnaire-39 (PDQ-39), and Beck Depression Inventory (BDI). A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 10 SWAL-QOL domains. Spearman's Rho correlation analyses were performed between the SWAL-QOL and (1) PDQ-39; (2) Hoehn and Yahr stage; (3) PD disease duration; (4) UPDRS "on" score; and (5) the BDI. The dysphagia swallowing group reported significant reductions compared to the non-dysphagic group for the total SWAL-QOL score (P = 0.02), mental health domain score (P = 0.002) and social domain score (P = 0.002). No relationships existed between swallow-specific quality of life and disease duration or severity. Significant relationships existed between swallow-specific quality of life and general health-related quality of life (r(s) =-0.56, P = 0.000) and depression (r(s) = -0.48, P = 0.003). These exploratory data highlight the psychosocial sequelae that swallowing impairment can have in those with IPD and suggest a possible association between swallowing, social function, and depression.

Pressure ulcers in pediatric patients with spinal cord injury: a review of assessment, prevention, and topical management.

PURPOSE: To provide the wound care practitioner with a review of the assessment, prevention, and management of pressure ulcers in pediatric patients with spinal cord injury. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to:

Reliability of Power Settings of the Wahoo KICKR Power Trainer After 60 Hours of Use.

PURPOSE: To assess the reliability of power-output measurements of a Wahoo KICKR Power Trainer (KICKR) on 2 separate occasions separated by 14 mo of regular use (∼1 h/wk). METHODS: Using the KICKR to set power outputs, powers of 100-600 W in increments of 50 W were assessed at cadences of 80, 90, and 100 rpm that were controlled and validated by a dynamic calibration rig. RESULTS: A small ratio bias of 1.002 (95% limits of agreement [LoA] 0.992-1.011) was observed over 100-600 W at 80-100 rpm between trials 1 and 2. Similar ratio biases with acceptable limits of agreement were observed at 80 rpm (1.003 [95% LoA 0.987-1.018]), 90 rpm (1.000 [0.996-1.005]), and 100 rpm (1.002 [0.997-1.007]). The intraclass correlation coefficient with 95% confidence interval (CI) for mean power between trials was 1.00 (95% CI 1.00-1.00) with a typical error (TE) of 3.1 W and 1.6% observed between trials 1 and 2. CONCLUSION: When assessed at 2 separate time points 14 mo apart, the KICKR has acceptable reliability for combined power outputs of 100-600 W at 80-100 rpm, reporting overall small ratio biases with acceptable LoA and low TE. Coaches and sport scientists should feel confident in the power output measured by the KICKR over an extended period of time when performing laboratory training and performance assessments.

Validity of Power Settings of the Wahoo KICKR Power Trainer.

PURPOSE: To assess the validity of power output settings of the Wahoo KICKR Power Trainer (KICKR) using a dynamic calibration rig (CALRIG) over a range of power outputs and cadences. METHODS: Using the KICKR to set power outputs, powers of 100-999 W were assessed at cadences (controlled by the CALRIG) of 80, 90, 100, 110, and 120 rpm. RESULTS: The KICKR displayed accurate measurements of power of 250-700 W at cadences of 80-120 rpm with a bias of -1.1% (95% limits of agreement [LoA] -3.6% to 1.4%). A larger mean bias in power was observed across the full range of power tested, 100-999 W (4.2%, 95% LoA -20.1% to 28.6%), due to larger biases of 100-200 and 750-999 W (4.5%, 95% LoA -2.3% to 11.3%, and 13.0%, 95% LoA -24.4% to 50.3%), respectively. CONCLUSIONS: Compared with a CALRIG, the KICKR has acceptable accuracy reporting a small mean bias and narrow LoA in the measurement of power output of 250-700 W at cadences of 80-120 rpm. Caution should be applied by coaches and sports scientists when using the KICKR at power outputs of <200 W and >750 W due to the greater variability in recorded power.

Improvement of Sprint Triathlon Performance in Trained Athletes With Positive Swim Pacing.

PURPOSE: To investigate the effect of 3 swim-pacing profiles on subsequent performance during a sprint-distance triathlon (SDT). METHODS: Nine competitive/trained male triathletes completed 5 experimental sessions including a graded running exhaustion test, a 750-m swim time trial (STT), and 3 SDTs. The swim times of the 3 SDTs were matched, but pacing was manipulated to induce positive (ie, speed gradually decreasing from 92% to 73% STT), negative (ie, speed gradually increasing from 73% to 92% STT), or even pacing (constant 82.5% STT). The remaining disciplines were completed at a self-selected maximal pace. Speed over the entire triathlon, power output during the cycle discipline, rating of perceived exertion (RPE) for each discipline, and heart rate during the cycle and run were determined. RESULTS: Faster cycle and overall triathlon times were achieved with positive swim pacing (30.5 ± 1.8 and 65.9 ± 4.0 min, respectively), as compared with the even (31.4 ± 1.0 min, P = .018 and 67.7 ± 3.9 min, P = .034, effect size [ES] = 0.46, respectively) and negative (31.8 ± 1.6 min, P = .011 and 67.3 ± 3.7 min, P = .041, ES = 0.36, respectively) pacing. Positive swim pacing elicited a lower RPE (9 ± 2) than negative swim pacing (11 ± 2, P = .014). No differences were observed in the other measured variables. CONCLUSIONS: A positive swim pacing may improve overall SDT performance and should be considered by both elite and age-group athletes during racing.

Recognition and treatment of depressive symptoms in Parkinson's disease: the NPF dataset.

Depression is a major determinant of Health Related Quality of Life in PD, but there is limited data on physician recognition of depression and treatment efficacy. We used data obtained from the QII dataset of the National Parkinson's Foundation database to determine whether there was an association between depressive symptoms and utilization of antidepressants and/or mental health services (MHS) in a large cohort of PD patients. We found that prevalence of depressive symptoms remained high in the PD population despite improved physician recognition and treatment initiation.

Physiatry practice now and in 2032: how to thrive in the post-health care reform world.

Health care reform is upon us, including changes in models of care delivery and physician and institution compensation. The resulting tsunami of uncertainty offers physiatrists the opportunity to relocate to higher ground and help the specialty thrive as well as to identify the possible quagmires into which practices could sink. For this reason, it is prudent for physiatrists to more carefully consider how their professional lives may be altered in the aftermath of reform. We believe that understanding and preparation will facilitate opportunities and mitigate challenges. In this essay, we will discuss various alternative scenarios that represent population health and health care delivery in the year 2032, the real-world opportunities and challenges for the physiatrist in the present and in the next 2 decades, along with ideas as to how physiatry can thrive in the post-health care reform world.

Steady or not following thalamic deep brain stimulation for essential tremor.

Deep brain stimulation (DBS) has become an important option for medication-refractory essential tremor (ET), but may contribute to worsened gait and falling. This study evaluates impaired gait in a cohort of patients treated with DBS with a retrospective review of ET patients before and after DBS implantation. Factors examined included: age, duration of symptoms, pre-morbid gait difficulties/falls, Fahn-Tolosa-Marin tremorrating scale (TRS) scores at baseline, 6 months post-unilateral DBS implantation, and 6 or 12 months post-bilateral implantation. All implantations targeted the nucleus ventralis intermediate (Vim). Thirty-eight patients (25 males, 13 females) were included. Twenty-five patients (65.8%) underwent unilateral DBS implantation and 13 (34.2%) bilateral. The mean age at surgery was 67.1 years ± 11.4 (range 34-81). The mean disease duration was 31 years ± 18.3 (range 6-67). Fifty-eight percent of patients had worsened gait post-operatively. Seventy percent of patients with unilateral Vim DBS experienced gait worsening while 55% of bilateral DBS patients experienced gait worsening. Patients with worsened gait post-DBS had higher baseline pre-operative TRS scores than those without worsened gait (43.1 points ± 8.4 vs. 33.1 points ± 10.1, p = 0.002) (odds ratio 2.5, p = 0.02). Gait/balance may worsen following DBS for medication refractory ET. Higher baseline TRS score may factor into these issues, although a larger prospective study will be required with a control population. The larger percentage of difficulties observed in unilateral versus bilateral cases likely reflected the bias not to proceed to second-sided surgery if gait/balance problems were encountered.

Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design.

BACKGROUND: Prior promising results have been reported with deep brain stimulation (DBS) of the anterior limb of the internal capsule in cases with severe obsessive compulsive disorder (OCD) who had exhausted conventional therapies. METHODS: In this pilot study, six adult patients (2 male; 4 female) meeting stringent criteria for severe (minimum Yale-Brown Obsessive Compulsive Scale [Y-BOCS] of 28) and treatment-refractory OCD had DBS electrode arrays placed bilaterally in an area spanning the ventral anterior limb of the internal capsule and adjacent ventral striatum referred to as the ventral capsule/ventral striatum. Using a randomized, staggered-onset design, patients were stimulated at either 30 or 60 days following surgery under blinded conditions. RESULTS: After 12 months of stimulation, four (66.7%) of six patients met a stringent criterion as "responders" (> or =35% improvement in the Y-BOCS and end point Y-BOCS severity < or =16). Patients did not improve during sham stimulation. Depressive symptoms improved significantly in the group as a whole; global functioning improved in the four responders. Adverse events associated with chronic DBS were generally mild and modifiable with setting changes. Stimulation interruption led to rapid but reversible induction of depressive symptoms in two cases. CONCLUSIONS: This pilot study suggests that DBS of the ventral capsule/ventral striatum region is a promising therapy of last resort for carefully selected cases of severe and intractable OCD. Future research should attend to subject selection, lead location, DBS programming, and mechanisms underpinning therapeutic benefits.