Histamine, mast cell tryptase and post-exercise hypotension in healthy and collapsed marathon runners.

PURPOSE: Heat stress exacerbates post-exercise hypotension (PEH) and cardiovascular disturbances from elevated body temperature may contribute to exertion-related incapacity. Mast cell degranulation and muscle mass are possible modifiers, though these hypotheses lack practical evidence. This study had three aims: (1) to characterise pre-post-responses in histamine and mast cell tryptase (MCT), (2) to investigate relationships between whole body muscle mass (WBMM) and changes in blood pressure post-marathon, (3) to identify any differences in incapacitated runners. METHODS: 24 recreational runners were recruited and successfully completed the 2019 Brighton Marathon (COMPLETION). WBMM was measured at baseline. A further eight participants were recruited from incapacitated runners (COLLAPSE). Histamine, MCT, blood pressure, heart rate, body temperature and echocardiographic measures were taken before and after exercise (COMPLETION) and upon incapacitation (COLLAPSE). RESULTS: In completion, MCT increased by nearly 50% from baseline (p = 0.0049), whereas histamine and body temperature did not vary (p > 0.946). Systolic (SBP), diastolic (DBP) and mean (MAP) arterial blood pressures and systemic vascular resistance (SVR) declined (p < 0.019). WBMM negatively correlated with Δ SBP (r = - 0.43, p = 0.046). For collapse versus completion, there were significant elevations in MCT (1.77 ± 0.25 µg/L vs 1.18 ± 0.43 µg/L, p = 0.001) and body temperature (39.8 ± 1.3 °C vs 36.2 ± 0.8 °C, p < 0.0001) with a non-significant rise in histamine (9.6 ± 17.9 µg/L vs 13.7 ± 33.9 µg/L, p = 0.107) and significantly lower MAP, DBP and SVR (p < 0.033). CONCLUSION: These data support the hypothesis that mast cell degranulation is a vasodilatory mechanism underlying PEH and exercise associated collapse. The magnitude of PEH is inversely proportional to the muscle mass and enhanced by concomitant body heating.

[Special features of water structure formation in biosystems according to dielkometric data].

Experimental data on dielectric function and dielectric loss tangent in living and non-living water-containing systems have been discussed from the viewpoint of our earlier concept on energy transfer in living systems and the role of water in this process. Estimates have been made of a mean length of fractal quasi-crystals, representing the form of biomolecules hydration in the living system; the expected lengths of these quasicrystals are of order of 1000 H2O molecules. It is concluded that the peaks at the curve of frequency dependence of dielectric loss tangent in living systems is due to water sub-system, but not biomolecular vibrations.

Reflex syncope in the UK Armed Forces.

INTRODUCTION: Reflex syncope is the most common subtype of syncope and, despite not being associated with increased mortality, often results in significant morbidity and costly diagnostics. Reflex syncope can be of concern for certain occupational groups and may be exacerbated by some occupations. Reflex syncope in the military is anecdotally common but the extent in the UK Armed Forces (UKAF) is unknown. The aim of this study was to assess the incidence and prevalence of reflex syncope in the UKAF. METHODS: A retrospective search of the Defence Medical Information Capability Programme using prespecified read-codes was performed at defence primary healthcare centres over the period of 1 January 2019 to 1 January 2020. Data were obtained on 76 103 service personnel (SP) (53% of the UKAF). RESULTS: The overall syncope case rate for the UKAF was 10.5 per 1000 person-years (p-yrs). In comparing services there was a significantly increased risk of syncope in the British Army (10.7 per 1000 p-yrs) compared with the Royal Air Force (8.6 per 1000 p-yrs) (p=0.0365), SP who served overseas (16.7 per 1000 p-yrs) in comparison with UK medical centres (10.3 per 1000 p-yrs) (p<0.0001), and British Army units that regularly took part in State Ceremonial and Public Duties (15.8 per 1000 p-yrs vs 10.2 per 1000 p-yrs) (p=0.0035). Army training units conferred a significantly reduced risk of syncope (p<0.0001). CONCLUSIONS: These data are the first to define the incidence and prevalence of syncope in the UKAF. Orthostasis and heat are probable triggers, although recruits are potentially protected. These data offer opportunities to improve the health and well-being of SP, with economic, logistical and reputational benefits for the UKAF. Further research to identify personnel at risk of future syncopal events may allow for targeted use of countermeasures.

Risk factors for reflex syncope in the British Army.

INTRODUCTION: Reflex syncope in the UK Armed Forces is reportedly higher than comparable militaries and civilian populations and is significantly more common in soldiers who take part in State Ceremonial and Public Duties (SCPD) compared with other British Army service personnel (SP). This study aimed to investigate individual susceptibility factors for syncope in soldiers who regularly take part in SCPD. METHODS: A retrospective cohort study was performed in 200 soldiers who perform SCPD. A questionnaire was undertaken reviewing soldiers' medical history and circumstances of any fainting episodes. A consented review of participants' electronic primary healthcare medical record was also performed. Participants were divided into two groups (syncope, n=80; control, n=120) based on whether they had previously fainted. RESULTS: In the syncope group orthostasis (61%) and heat (35%) were the most common precipitating factors. The most common interventions used by soldiers were to maintain hydration (59%) and purposeful movements (predominantly 'toe wiggling'; 55%). 30% of participants who had previously fainted did not seek definitive medical attention. A history of migraines/headaches was found to increase the risk of reflex syncope (OR 8.880, 1.214-218.8), while a history of antihistamine prescription (OR 0.07144, 0.003671-0.4236), non-white ethnicity (OR 0.03401, 0.0007419-0.3972) and male sex (OR 0.2640, 0.08891-0.6915) were protective. CONCLUSION: This is the first study, in the British Army, to describe, categorise and establish potential risk factors for reflex syncope. Orthostatic-mediated reflex syncope is the most common cause in soldiers who regularly perform SCPD and this is further exacerbated by heat exposure. Soldiers do not use evidence-based methods to avoid reflex syncope. These data could be used to target interventions for SP who have previously fainted or to prevent fainting during SCPD.

[ERIAD mass spectrometry (electrospray with controlled fragmentation) is the common method for metallomics and biochemistry of elementoorganic molecules].

The physical aspects of the ERIAD method (electrospray with controlled fragmentation) in terms of the problems of metallomics and biochemistry of elementoorganic compounds have been considered. It was shown that the method is well suited to study the objects of this class since it enables one to change from the molecular to the elemental analysis merely by changing the voltage between the nozzle and the skimmer. In the regime of molecular analysis, it is possible to determine the mass of the molecule as a whole and decipher its structure by controlled fragmentation, and in the regime of elemental analysis the number of atoms of heteroelements incorporated in the molecule can be quantified.

Hyperbaric oxygen, oxidative stress, NO bioavailability and ulcer oxygenation in diabetic patients.

BACKGROUND: Hyperbaric oxygen therapy (HBO2) increases tissue oxygenation, thus serving as an adjunct therapy for diabetic wounds. However, in some patients there is insufficient increase in tissue O2. AIMS: To investigate the pathophysiology of insufficient HBO2 and the possible role of N-acetylcysteine (NAC). METHODS: Prospective, randomized, cross-over trial included 50 diabetic patients with non-healing ulcers. Each patient received two treatments with 100% oxygen/2ATA. NAC was administered i.v. at one of the two treatments. Basal and post-treatment peri-wound transcutaneous O2 (TcPO2) pressure, malondialdehyde (MDA), total anti-oxidant status (TAOS) and nitric oxide (NO) were assessed. An ulcer oxygenation increase above 200 mmHg was accepted as sufficient. RESULTS: During HBO2, 17 patients (34%) demonstrated insufficient increase in TcPO2. Concomitantly, their TAOS and NO decreased, while MDA increased. NAC administration attenuated these parameters, thus improving the HBO2 outcome. In those affected by NAC, the cure rate was 75%. By contrast, in 66% of patients with sufficient increase in TcPO2 TAOS was increased and MDA decreased irrespective of NAC administration. The cure rate in this subgroup was 82%. CONCLUSIONS: Insufficient increase of ulcer oxygenation during HBO2 results from exaggerated oxidative stress and decreased NO bioavailability. NAC administration-induced modulation of both parameters and may improve ulcer oxygenation during HBO2.

[Mechanism of intermolecular energy transfer and reception of ultralow action by chemical and biological systems].

A novel concept of intermolecular energy transfer and reception of the ultralow action in living systems is proposed. The concept is based on the methods of nonlinear mathematical physics used in description of energy movement along molecular chains and on quantum mechanical ideas concerning signal formation in anisotropic media. A concept of a molecular cell as an indivisible structural unit and a constituent of a biological (chemical) system has been put forward and substantiated, which manifests collective features of the unity of molecules, physical fields, and energetically strained bound water media in processes of energy transfer and reception. Both intermolecular energy transfer and amplification of the ultralow action has been shown to be the components of a unified energy process in a living system, and the physical basis of both processes is the unity of molecules and water-field media in a molecular cell.

Improved quality of life with hyperbaric oxygen therapy in patients with persistent pelvic radiation-induced toxicity.

AIMS: We report the results of hyperbaric oxygen therapy (HBOT) used in the treatment of radiation-induced persistent side-effects after the irradiation of pelvic tumours. MATERIALS AND METHODS: Between January 2001 and December 2005, 13 women (median age 60.3 years) with radiation combined proctitis/cystitis (n=6), longstanding vaginal ulcers and fistulas (n=5) and longstanding skin injuries (n=2) underwent HBOT in a multiplace chamber for a median of 27 sessions (range 16-40). The treatment schedule was HBOT 100% oxygen, at 2 absolute atmospheres, for 90 min, once a day. For radiation-induced toxicity grading we used the National Cancer Institute Common Toxicity Criteria (CTC) grading system, before and after HBOT. RESULTS: Thirteen patients underwent an adequate number of HBOT sessions. The mean CTC grading score before HBOT was 3.3+/-0.75, whereas the mean CTC grading score after HBOT was 0.3+/-0.63. The scores showed a significant improvement after HBOT (P=0.001; exact Wilcoxon signed-rank test). Rectal bleeding ceased in five of six patients with proctitis and dysuria resolved in six of seven cystitis patients. Macroscopic haematuria stopped in seven of seven patients. Scar complications resolved in two of two patients. None reported HBOT-associated side-effects. CONCLUSION: HBOT is apparently safe and effective in managing radiation-induced late side-effects, such as soft tissue necrosis (skin and vagina), cystitis, proctitis and fistulas.

Crystallisation in basaltic magmas revealed via in situ 4D synchrotron X-ray microtomography.

Magma crystallisation is a fundamental process driving eruptions and controlling the style of volcanic activity. Crystal nucleation delay, heterogeneous and homogeneous nucleation and crystal growth are all time-dependent processes, however, there is a paucity of real-time experimental data on crystal nucleation and growth kinetics, particularly at the beginning of crystallisation when conditions are far from equilibrium. Here, we reveal the first in situ 3D time-dependent observations of crystal nucleation and growth kinetics in a natural magma, reproducing the crystallisation occurring in real-time during a lava flow, by combining a bespoke high-temperature environmental cell with fast synchrotron X-ray microtomography. We find that both crystal nucleation and growth occur in pulses, with the first crystallisation wave producing a relatively low volume fraction of crystals and hence negligible influence on magma viscosity. This result explains why some lava flows cover kilometres in a few hours from eruption inception, highlighting the hazard posed by fast-moving lava flows. We use our observations to quantify disequilibrium crystallisation in basaltic magmas using an empirical model. Our results demonstrate the potential of in situ 3D time-dependent experiments and have fundamental implications for the rheological evolution of basaltic lava flows, aiding flow modelling, eruption forecasting and hazard management.

Real-time three-dimensional echocardiography: a novel technique to quantify global left ventricular mechanical dyssynchrony.

BACKGROUND: Left ventricular (LV) mechanical dyssynchrony (LVMD) has emerged as a therapeutic target using cardiac resynchronization therapy (CRT) in selected patients with chronic heart failure. Current methods used to evaluate LVMD are technically difficult and do not assess LVMD of the whole LV simultaneously. We developed and validated real-time 3D echocardiography (RT3DE) as a novel method to assess global LVMD. METHODS AND RESULTS: Eighty-nine healthy volunteers and 174 unselected patients referred for routine echocardiography underwent 2D echocardiography and RT3DE. RT3DE data sets provided time-volume analysis for global and segmental LV volumes. A systolic dyssynchrony index (SDI) was derived from the dispersion of time to minimum regional volume for all 16 LV segments. Healthy subjects and patients with normal LV systolic function had highly synchronized segmental function (SDI, 3.5+/-1.8% and 4.5+/-2.4%; P=0.7). SDI increased with worsening LV systolic function regardless of QRS duration (mild, 5.4+/-0.83%; moderate, 10.0+/-2%; severe LV dysfunction, 15.6+/-1%; P for trend <0.001). We found that 37% of patients with moderate to severe LV systolic dysfunction had significant dyssynchrony with normal QRS durations (SDI, 14.7+/-1.2%). Twenty-six patients underwent CRT. At long-term follow-up, responders demonstrated reverse remodeling after CRT with a significant reduction in SDI (16.9+/-1.1% to 6.9+/-1%; P<0.0001) and end-diastolic volume (196.6+/-17.3 to 132.1+/-13.5 mL; P<0.0001) associated with an increase in LV ejection fraction (17+/-2.2% to 31.6+/-2.9%; P<0.0001). CONCLUSIONS: RT3DE can quantify global LVMD in patients with and without QRS prolongation. RT3DE represents a novel technique to identify chronic heart failure patients who may otherwise not be considered for CRT.

Characterisation of sleep disturbances in postural orthostatic tachycardia syndrome: a polysomnography-based study.

BACKGROUND AND AIM: Postural orthostatic tachycardia syndrome (PoTS) has been frequently associated with sleep disturbances but objective sleep data are lacking. In addition, although regional autonomic denervation has been described, less is known about autonomic nervous activity overnight in these patients. PATIENTS/METHODS: A full polysomnography and heart rate variability were performed on 37 patients diagnosed with PoTS . In addition, a multiple sleep latency test (MSLT) was conducted on a subgroup of patients with excessive daytime sleepiness. RESULTS: The polysomnographic data did not show major pathological findings except the percentage spent in rapid eye movement (REM) sleep which was slightly reduced at 18.4%. The MSLT did not confirm excessive daytime sleepiness as median mean sleep latency was 14.4 min (11.8-17.5). When comparing patients with and without subjective daytime sleepiness, it was found that the latter had a reduced parasympathetic activation at night as expressed by the average high frequency [6936.5 ms(2) (6028.2-8675.5) vs. 4689.5 (3922.7-7685.2) p < 0.05]. CONCLUSION: Patients with PoTS do not exhibit polysomnographic findings consistent with relevant sleep pathologies nor objective daytime sleepiness. Subjective daytime sleepiness is associated with enhanced activation of the parasympathetic nervous system.

Electrospray mass spectrometry with controlled in-source atomization (ERIAD) as a promising elemental method: evaluation of analytical features.

Electrospray ionization with controlled in-source fragmentation and atomization (ERIAD) is promising method for mass-spectrometric elemental analysis. This paper concerns the main analytical features and necessary instrumentation for ERIAD. The method is shown to be effective for more than 70 elements of the periodic table: those that present as cations in a water solution. It shows a high absolute sensitivity with a low spread from Li to U, and a detection limit of tens of parts per trillion. The soft ionization used results in the absence of plasma chemical reaction products, typical for inductively coupled plasma mass spectrometry, and the spectra are nearly free from interferences. The method does not require a high resolution and can be used for samples with an artificial isotopic content. The method is essentially valid for radiochemistry and metallomics, as it has the possibility to combine measurements of chemical, elemental, and even isotopic content simultaneously.

Correlation of perceptual performance and activities of daily living in stroke patients.

Twenty-five male stroke patients were assessed with the use of a battery of perceptual tests (Gross Visual Skills [Baum, 1981]. Adult Visual-Perceptual Assessment [Baylor University Medical Center, Occupational Therapy Department, 1980], Manikin and Feature Profile subtests of the Arthur Point Scale of Performance Tests [Arthur, 1943; Buros, 1974, 1978], Judgment of Line Orientation [Benton, Varney, & DeS. Hamsber, 1978], Bender Visual Motor Gestalt Test [Bender, 1946], Haptic Visual Discrimination Test [McCarron & Dial, 1976, 1979a, 1979b], Block Design and Object Assembly subtests of the Wechsler Adult Intelligence Scale-Revised [Wechsler, 1981], and Test of Three-Dimensional Constructional Praxis [Benton, 1973a; Benton & Fogel, 1962]). Also administered was the Klein-Bell ADL Scale (Klein & Bell, 1982) to measure performance of activities of daily living. The research questions were as follows: (a) To what extent did this sample of stroke patients differ from the nomative samples on perceptual performance? (b) To what extent did any tests of perceptual performance correlate with performance of activities of daily living? and (c) What, if any, instruments were more useful in discriminating the perceptual performance of stroke patients from that of normative samples? The results indicated that stroke patients showed significant deficits in perceptual performance, some of which correlated with activities of daily living performance. Patients with right hemispheric lesions performed similarly to those with left hemispheric lesions except on the Haptic Visual Discrimination Test.

Hyperbaric oxygen therapy for nonhealing vasculitic ulcers.

BACKGROUND: Cutaneous nonhealing ulceration is a threatening manifestation of vasculitis. Hyperbaric oxygen (HBO), frequently used as adjuvant therapy for patients with ischaemic ulcers, exerts additional beneficial effects on the vascular inflammatory response. AIM: To evaluate the effect of HBO on vasculitis-induced nonhealing skin ulcers. METHODS: The study population comprised 35 patients aged >or= 18 years with severe, nonhealing, vasculitis-induced ulcers that had not improved following immunosuppressive therapy. Baseline ulcer tissue oxygenation was evaluated at room air concentration (21% O2), at 1 atmosphere absolute (ATA) breathing 100% O2, and at 2 ATA breathing 100% O2. The baseline treatment protocol consisted of a 4-week course of 100% O2 for 90 min at 2 ATA, five times/week. RESULTS: The mean baseline ulcer tissue oxygenation (3.1 +/- 2.4 kPa at room air concentration), was significantly increased to 13.9 +/- 11.9 kPa at 1 ATA breathing 100% O2 (P < 0.001), and subsequently increased further to 59.1 +/- 29.8 kPa at 2 ATA breathing 100% O2 (P < 0.001). At the end of the hyperbaric therapy, 28 patients (80%) demonstrated complete healing, 4 (11.4%) had partial healing and 3 (8.6%) had no improvement. None of the patients had any side-effects related to the HBO therapy. CONCLUSION: HBO therapy may serve as an effective safe treatment for patients with vasculitis having nonhealing skin ulcers. Further studies are needed to evaluate its role as primary therapy for this group of patients.

[Predictors of tibial head transposition in the therapy of varus knee osteoarthritis]. / Prädiktoren der Tibiakopfumstellung in der Therapie der Varusgonarthrose.

PURPOSE: The aim of this study was to find predictors for the clinical outcome in patients who underwent a high tibial osteotomy (HTO). METHOD: Between 1984 and 1996 a high tibial valgus osteotomy was performed in 155 patients with genu varum. 133 HTO patients were available for follow-up at an average postoperative time of 9.3 +/- 3.0 years. The degree of osteoarthritis was evaluated by radiological (Kellgren) and arthroscopic scoring systems (Outerbridge). Survival time of HTO was estimated using Kaplan-Meier survivorship analysis. RESULTS: The survival rate of HTO was 95 % after 5 years and 77 % after 10 years. In the medial compartment of knee joints with a preoperative Outerbridge stage III/IV or Kellgren stage III/IV the survival rate of HTO was significantly lower when compared to stages 0/I/II (p < 0.05). Age, sex, tibial malalignment and severity of osteoarthritis in the lateral compartment had no influence on survival rates. The pre-postoperative comparison of radiologically visible signs of osteoarthritis showed mainly either no (46.5 %) or only small (50.5 %) progression. We found that patients who underwent a HTO had good and very good clinical outcomes. CONCLUSION: We identified severity of preoperative radiological osteoarthritis and intraoperative chondromalacia as predictors of survival rate.

Osteonecrosis: an overuse injury of the shoulder in paraplegia: case report.

The shoulder of the wheelchair dependent paraplegic is subject to overuse injury with subsequent pain. The major overuse syndromes observed include soft tissue injuries and secondary degenerative arthritis. This report presents a case in which bilateral osteonecrosis of the humeral heads was found to be the source of pain in the shoulders of an active paraplegic without any evidence of disease or medical treatment associated with the development of osteonecrosis. Osteonecrosis should be entertained in the differential diagnosis of overuse injuries of the shoulder in paraplegia.

Abdominal pain in quadriparesis: myofascial syndrome as unsuspected cause.

This is a case report of a 47-year-old man with C6 quadriparesis who presented with tenderness in the right lower quandrant of his abdomen which was diagnosed as iliocostalis myofascial syndrome. Diagnosis of nephrolithiasis and appendicitis were considered, but the complete blood count, abdominal x-ray, intravenous pyelogram, and sonogram were all normal. His symptoms became progressively more severe over the ensuing 2-week period. Examination at that time revealed extreme tenderness to light touch in the right lower quandrant, right flank, and right posterior subcostal area. A trigger point in the right iliocostalis muscle referred pain to the right lower quandrant. In the absence of evidence of internal derangement a diagnosis of iliocostalis myofascial syndrome was made. A 3-day course of "spray and stretch" to the iliocostalis cleared the symptoms. This case illustrates that myofascial syndrome should be considered in the differential diagnosis of soft tissue pain in the patient with spinal cord injury and sensory sparing.