Respiratory problems in rowers: outcomes from a systematic assessment of an elite squad.

OBJECTIVES: To characterise the respiratory health of elite rowers using a systematic screening approach to assess respiratory health (SARAH) and identify the associations between SARAH findings and acute respiratory illness (ARI) and chest wall injury (CWI). METHODS: A systematic screening approach was conducted in a cohort of elite rowers. The assessment employed validated respiratory questionnaires and multiple physiological measures. An analysis of ARI and CWI incidence and burden from the 18 months before the SARAH assessment was conducted. RESULTS: Full respiratory surveillance was completed in 48 rowers (50% female, aged 27 [25-28] years). The incidence and burden of ARI were similar between male and female rowers. The incidence of CWI was greater in female rowers compared to males (1.6 versus 0.4 per 1000 athlete training days, respectively; incidence rate ratio of 4.3, 95% C.I. 1.5 to 12.2, p=0.005) and more common in younger rowers with greater lung function. SARAH detected at least one respiratory problem in 39 (81%) rowers, and two or more problems in 26 (54%). Sino-nasal problems (44%), allergy-related problems (42%) and breathing pattern disorder (42%) were the most prevalent problems identified. Exercise-associated cough was reported in 34 (71%) rowers, with objective evidence of asthma found in only five (10%). CONCLUSIONS: In elite rowers, respiratory problems, including ARI and CWI, are common and impact health. A systematic screening approach identifies multiple underlying respiratory problems, presenting the opportunity to optimise athlete health and improve training availability.

No sex differences in oxygen uptake or extraction kinetics in the moderate or heavy exercise intensity domains.

The integrative response to exercise differs between sexes, with oxidative energy contribution purported as a potential mechanism. The present study investigated whether this difference was evident in the kinetics of oxygen uptake (V̇o2) and extraction (HHb + Mb) during exercise. Sixteen adults (8 males, 8 females, age: 27 ± 5 yr) completed three experimental visits. Incremental exercise testing was performed to obtain lactate threshold and V̇o2peak. Subsequent visits involved three 6-min cycling bouts at 80% of lactate threshold and one 30-min bout at a work rate of 30% between the lactate threshold and power at V̇o2peak. Pulmonary gas exchange and near-infrared spectroscopy of the vastus lateralis were used to continuously sample V̇o2 and HHb + Mb, respectively. The phase II V̇o2 kinetics were quantified using monoexponential curves during moderate and heavy exercise. Slow component amplitudes were also quantified for the heavy-intensity domain. Relative V̇o2peak values were not different between sexes (P = 0.111). Males achieved ∼30% greater power outputs (P = 0.002). In the moderate- and heavy-intensity domains, the relative amplitude of the phase II transition was not different between sexes for V̇o2 (∼24 and ∼40% V̇o2peak, P ≥ 0.179) and HHb + Mb (∼20 and ∼32% ischemia, P ≥ 0.193). Similarly, there were no sex differences in the time constants for V̇o2 (∼28 s, P ≥ 0.385) or HHb + Mb (∼10 s, P ≥ 0.274). In the heavy-intensity domain, neither V̇o2 (P ≥ 0.686) or HHb + Mb (P ≥ 0.432) slow component amplitudes were different between sexes. The oxidative response to moderate- and heavy-intensity exercises did not differ between males and females, suggesting similar dynamic responses of oxidative metabolism during intensity-matched exercise.NEW & NOTEWORTHY This study demonstrated no sex differences in the oxidative response to moderate- and heavy-intensity cycling exercise. The change in oxygen uptake and deoxyhemoglobin were modeled with monoexponential curve fitting, which revealed no differences in the rate of oxidative energy provision between sexes. This provides insight into previously reported sex differences in the integrative response to exercise.

Feasibility of continuous bronchoscopy during exercise in the assessment of large airway movement in healthy subjects.

Excessive dynamic airway collapse (EDAC) is a recognized cause of exertional dyspnea arising due to invagination of the trachea and/or main bronchi. EDAC is typically assessed by evaluating large airway movement with forced expiratory maneuvers. This differs from the respiratory response to exercise hyperpnea. We aimed to evaluate large airway movement during physical activity, with continuous bronchoscopy during exercise (CBE), in healthy subjects and compare findings with resting bronchoscopic maneuvers and imaging techniques. Twenty-eight individuals were recruited to complete two visits including treadmill-based CBE, to voluntary exhaustion, and cine magnetic resonance imaging (MRI) with forced expiratory maneuvers at rest. Twenty-five subjects [aged 29 (26-33) yr, 52% female] completed the study (n = 2 withdrew before bronchoscopy, and one was unable to tolerate insertion of bronchoscope). The majority (76%) achieved a peak heart rate of >90% predicted during CBE. The procedure was prematurely terminated in five subjects (n = 3; elevated blood pressure and n = 2; minor oxygen desaturation). The CBE assessment enabled adequate tracheal visualization in all cases. Excessive dynamic airway collapse (tracheal collapse ≥50%) was identified in 16 subjects (64%) on MRI, and in six (24%) individuals during resting bronchoscopy, but in no cases with CBE. No serious adverse events were reported, but minor adverse events were evident. The CBE procedure permits visualization of large airway movement during physical activity. In healthy subjects, there was no evidence of EDAC during strenuous exercise, despite evidence during forced maneuvers on imaging, thus challenging conventional approaches to diagnosis.NEW & NOTEWORTHY This study demonstrates that large airway movement can be visualized with bronchoscopy undertaken during vigorous exercise. This approach does not require sedation and permits characterization of the behavior of the large airways and the tendency toward collapse during upright, ambulatory exercise. In healthy individuals, the response pattern of the large airways during exercise appears to differ markedly from the pattern of airway closure witnessed during forced expiratory maneuvers, assessed via imaging.

[Quality assurance of rehabilitation by the German pension insurance: an overview]. / Ein aktueller Überblick zur Reha-Qualitätssicherung der Rentenversicherung.

The German pension insurance has in recent years developed a comprehensive programme for quality assurance in rehabilitation, and has implemented the programme into routine practice. Different aspects of rehabilitation are evaluated with differentiated instruments. Issues dealt with inter alia include the quality of rehabilitative care in a narrower sense, the structure and organisation of the rehabilitation centres, as well as quality from the patients' perspective. On the whole, positive results predominate. Big differences in quality however have been found between the rehabilitation centres. The data collections and data evaluations carried out make a continuous process of quality assurance reporting possible for use by rehabilitation centres and pension insurance agencies. This will enable targeted initiatives for quality improvement. The methods and procedures of quality assurance are enhanced at regular intervals, and the scope of quality assurance is extended. Thus, rehab quality assurance is also expanded to cover ambulant rehabilitation or rehabilitation of children and young people.

The ONTAI study - a survey on antimicrobial dosing and the practice of therapeutic drug monitoring in German intensive care units.

PURPOSE: Optimization of antibiotic therapy is still urgently needed in critically ill patients. The aim of the ONTAI survey (online survey on the use of Therapeutic Drug Monitoring of antibiotics in intensive care units) was to evaluate which strategies intensive care physicians in Germany use to improve the quality of antibiotic therapy and what role a Therapeutic Drug Monitoring (TDM) plays. METHODS: Among the members of the German Society for Anaesthesiology and the German Society for Medical Intensive Care Medicine and Emergency Medicine, a national cross-sectional survey was conducted using an online questionnaire. RESULTS: The questionnaire was completely answered by 398 respondents. Without TDM, prolonged infusion was judged to be the most appropriate dosing regimen for beta lactams. A TDM for piperacillin, meropenem and vancomycin was performed in 17, 22 and 75% of respondents, respectively. For all beta lactams, a TDM was requested more often than it was available. There was great uncertainty as to the optimal pharmacokinetic/pharmacodynamic index for beta-lactams. 86% of the respondents who received minimal inhibitory concentrations adapted the therapy accordingly. CONCLUSION: German intensive care physicians are convinced of TDM for dose optimization. However, practical implementation, the determination of MICs and defined target values are still lacking.

[Peri-operative adjustment and treatment of diabetes mellitus]. / Perioperative Einstellung und Behandlung des Diabetes mellitus.

In all disciplines of operative medicine the number of patients who suffer from diabetes mellitus is increasing dramatically. The reason is that nowadays up to 10% of the population is suffering from this disease. These patients must be treated with respect to the diabetes and also subsequent related conditions to prevent peri-operative complications. A special problem is that many patients do not know that they are suffering from diabetes. Pre-operatively and during the peri-operative course the coordinated efforts of surgeons, anaesthesiologists and diabetes specialists are essential to reach an optimal result. In all hospitals obligatory algorithms must be established for the treatment of these patients.

New application for haplotype-specific extraction: Separation of mitochondrial DNA mixtures.

A particularly challenging aspect of forensic casework is the accurate interpretation of samples that contain DNA from more than one contributor, since DNA analysis of specific identification markers often results in ambiguous mixed profiles. Physically separating the various haploid components of a diploid or polyploid DNA sample or of a specimen containing DNA from multiple individuals can resolve this problem. We adapted and combined previously developed methods of haplotype-specific extraction (HSE) to separate and analyze mitochondrial DNA (mtDNA) in samples containing DNA from two individuals. After optimizing conditions and probes, we performed HSE to separate mitochondrial DNA mixtures, which manifest as mixed nucleotide calls at single base positions. We were able to subsequently identify the DNA of the two individuals by sequencing. Based on our findings from this proof-of-concept experiment, this novel assay will be useful for distinguishing among the mtDNA of individuals in mixed DNA samples.

Prediction of postdexamethasone cortisol levels by serum sodium levels in patients with major depression.

The authors analyzed the dexamethasone suppression test (DST) results of 54 patients with major depressive disorder in relation to their pre-DST levels of cholesterol, sodium, potassium, and blood glucose, which are thought to have adrenocorticotrophic links. Discriminant analysis revealed that sodium alone was a significant predictor of nonsuppression. Validation of the predictive power of sodium could minimize the need for DST administration.

Dexamethasone suppression test: use of two different dexamethasone doses.

The endocrinologic methods used in the dexamethasone suppression test (DST) for depression were examined, by employing two different doses of dexamethasone (0.5 or 1.0 mg) at 11 p.m. Nonsuppression to the 1.0 mg DST (plasma cortisol criterion value of 5 micrograms/dl) was seen in 33% of major depressives and in 15% of schizophrenics. A similar result was obtained with the 0.5 mg DST when 12 micrograms/dl was employed as the plasma cortisol criterion value. Plasma cortisol levels 33 hours postdexamethasone did not distinguish between major depressives and schizophrenics.

Dextroamphetamine treatment of mania.

Five of six acutely manic patients treated with dextroamphetamine experienced a 50% or greater reduction in their mania severity scores. Side effects were noted in only one patient. The treatment results suggest that dextroamphetamine might be useful in the treatment of mania.

Spontaneous expulsion of lipoma per rectum occurring with colonic intussusception.

The spontaneous expulsion of lipoma per rectum is an extremely rare phenomenon. The present case report describes this event in a patient with lower abdominal pain and bleeding per rectum leading to exploratory laparotomy. At surgery, a large intussuscepting ulcerated submucosal lipoma remnant was identified in the transverse colon. This unusual presentation of colonic lipoma is discussed and the pertinent literature is reviewed.

Borderline personality disorder: interrater reliability of the diagnostic interview for borderlines.

Three interviewers, working in pairs and using the Diagnostic Interview for Borderlines (DIB), interviewed three samples of 10 adult psychiatric inpatients. The two members of each interviewer pair alternated in the role of interviewer. Each member of the interviewer pairs completed the interview schedule and scored the protocol according to the instructions provided by the authors of the DIB. Interrater reliability was determined for each interviewer pair using the Kappa statistic. Reliability values were at about the level reported recently by Spitzer, Forman, and Nee (1979) for DSM-III axis I diagnoses in general. Additional statistical analyses were performed to determine whether there were patient sex differences on DIB scores, whether the two male interviewers differed from the female interviewer in their ratings of male or female patients, and whether experience differences among the three interviewers were reflected in their rating of patients. Among the latter analyses, the only significant finding was that in the interviewer pair consisting of a very experienced male psychiatrist and a male first year psychology graduate student, the former rated male patients as less borderline than did the latter. No other difference was found among raters, or between sex of patient and interviewer sex or amount of clinical experience. It was concluded that the DIB is sufficiently reliable for use in clinical research.

High potassium-induced activation of choline-acetyltransferase in human neocortex: implications and species differences.

The role of electrical and potassium (K(+))-induced depolarisation on choline-acetyltransferase (ChAT) activity in human and mouse neocortical slices was studied. When [3H]-ACh release was evoked by two K(+) stimulations in human neocortex, the mean S(2)/S(1) ratio was significantly below unity. ChAT inhibitors, like bromo-acetylcholine and ocadaic acid, raised this ratio by 79 and 63%, respectively, suggesting that the diminished S(2)/S(1) value in the absence of ChAT inhibitors reflected an increased ChAT activity at S(2) following K(+) depolarisation at S(1). When stimulated electrically, however, the S(2)/S(1) ratio in human neocortex was near unity and ocadaic acid remained without effect. In parallel experiments on mouse neocortical slices, the S(2)/S(1) ratio was near unity in both electrically or K(+)-evoked [3H]-ACh release and was not altered by ChAT inhibition. ChAT activity following K(+) depolarisation was also determined directly. ChAT activation in human neocortical slices was highest at 10 and 20mM K(+). ChAT activity in mouse neocortical tissue was not altered by K(+) depolarisation. These results suggest that in human, but not in mouse, neocortex ChAT activity may be increased due to ongoing K(+) depolarisation. This increase of ChAT activity supports a cholinergic degeneration hypothesis which has been entitled "autocannibalism" by Wurtman [TINS 15 (1992) 177].

Dexamethasone-induced sodium influx in human lymphocytes.

We evaluated the direct effects of glucocorticoids on intracellular sodium content and cellular transport systems. Cytosolic free sodium concentration ([Na+]i) was measured in intact human lymphocytes using the sodium-sensitive fluorescent dye sodium-binding benzofuran-isophthalate. Administration of dexamethasone for 60 min increased lymphocytic [Na+]i from 17.6 +/- 2.0 mmol/L to 24.3 +/- 3.9 nmol/L (n = 12; P < 0.01). The dexamethasone-induced [Na+]i increase was abolished in the absence of extracellular sodium, by mifepristone and by actinomycin D. The dexamethasone-induced [Na+]i increase was also seen after inhibition of Na+,K(+)-ATPase by 1 mmol/L ouabain. The present results indicate that dexamethasone produces a trans-plasma membrane sodium influx probably by early occurring genomic effects.

Adjuvant radiotherapy in the surgical treatment of the carcinoma of the cervix.

Treatment results of 1,092 patients with operated cervical cancer, covered by a cooperative program including the Departments of Obstetrics and Gynecology of four universities, were analysed. Standardized surgical procedures and histological processing of the surgical specimens were employed throughout. The indication to postoperative radiotherapy was different in the different university departments. In order to carry out a realistic comparison of the achieved treatment results, not the clinical staging, but the tumour extension histologically determined on the surgical specimen, was taken into account. In cases presenting a continuous tumour growth corresponding to histological Stage Ib, the 5-year-survival rates achieved were 90.5% and 95.6% for patients only operated, or operated and subjected to radiation therapy, respectively. In cases of continuous tumour growth corresponding to histological Stage II, the 5-year-survival rates were 79.5% following surgery only, and 83.1% after surgery and radiation. The differences between the corresponding survival rates were not statistically significant. The further proof of tumour parameters and the formation of twin pairs, revealed that the prognosis of patients presenting unfavourable tumour criteria could not be influenced by a postoperative radiation therapy.

[The significance of mammographic symptoms in clinically occult findings]. / Zur Wertigkeit der mammographischen Röntgensymptome bei klinisch okkulten Befunden.

The significance of various radiographic signs in 183 patients with clinically occult breast disease is described. 30.6% had a carcinoma of the breast or a carcinoma in situ. The radiological features have varying predictive values and there is variation in the incidence of lymph node metastases. It is considered useful to classify the radiological appearances under the headings of round foci, star-shaped opacities, diffuse opacities, opacities with calcification and groups of micro-calcification. Despite the early diagnosis, 24% of patients already had lymph node metastases.

Carcinoma of the cervix and pregnancy.

A simultaneous occurrence of carcinoma of the cervix and pregnancy is uncommon. In a cooperative study a total of 1092 patients treated for cervical cancer were examined. Forty of these women were either pregnant at the time of surgery or were operated on postpartum. The course of the disease for these patients was compared to that of 426 non-pregnant women with cervical cancer. The analysis of tumor grading and tumor growth revealed no remarkable differences. Remarkable, however, was the increased frequency of blood vessel invasion observed in pregnant patients, particularly in puerperal patients. Also the percentage of macrometastases was higher in puerperal and/or postpartum patients. These findings might explain the worse prognosis for these women.

Melanoma of the vulva.

This study evaluated the prognostic value of different morphologic tumor parameters in 13 cases of malignant melanoma. Tumor thickness correlated well with survival. The prognostic index--tumor thickness multiplied by the number of mitoses per square millimeter--was useful in predicting metastasis risk.

[Radiography used during operations for biopsies of non-palpable lesions of the breast which have been suspected because of mammography (author's transl)]. / Radiographie per-opératoire de biopsie des lésions du sein non palpables suspectes à la mammographie.

In order to prove that non-palpable lesions of the breast that have been removed after suspicion from mammography have been removed completely it is appropriate to X-ray during the operation of biopsy in order to make a diagnosis. Tests carried out with the X Faxitron X-ray apparatus on 369 patients show that even X-ray departments that carry out mammography and do not have specialised equipment can with quite modest means use this reliable technique for diagnosis.