Effects of Exercise Interventions on Estimated Pulse Wave Velocity and Mean Arterial Pressure in Overweight Adults: The Role of Modality.

Background: Estimated pulse wave velocity (ePWV) is mathematically calculated from age and mean arterial pressure (MAP). We examined the effects of high-intensity interval training (HIIT) vs. moderate-intensity continuous training (MICT) on ePWV and MAP in insufficiently active overweight adults. Methods: Using the randomized controlled trial design, thirteen males (27.46 ± 3.80 years old; body mass index (BMI) = 29.61 ± 5.52) randomly completed either two-week HIIT (n = 7) or MICT (n = 6). HIIT consisted of 8 sessions of cycling, 20 min/session with an exercise-to-rest ratio of 10/50 s at ≥ 90% peak heart rate ( HR peak ). MICT consisted of 8 cycling sessions, 40 min/session at 60-75% HR peak . Oscillometric brachial MAP was measured pre- and post-intervention, and ePWV was calculated. Two-way repeated measure analysis of variance examined the effects of time, intervention, and their interactions on ePWV and MAP. Results: Significant time effects were observed for ePWV and MAP, where both measures comparably decreased over time in HIIT and MICT groups (p < 0.05 for all). However, no significant intervention or interaction effects were detected, indicating no superiority of either exercise modality for ePWV or MAP improvements. Conclusions: This study uniquely revealed that two weeks of HIIT or MICT resulted in significant, comparable, and clinically meaningful decreases in ePWV and MAP among insufficiently active overweight adults. As such, overweight adults who have time as a constraint to engage in traditional exercise (i.e., MICT) can accomplish comparable vascular benefits by performing HIIT.

Impact of supra-maximal interval training vs. high-intensity interval training on cardiac auto-regulation response in physically active adults.

PURPOSE: This study aimed to examine the impact of supra-maximal interval training (SMIT) and high-intensity interval training (HIIT) on cardiac auto-regulation response. METHODS: Physically active young adults volunteered to participate in the study with a randomized cross-over counterbalanced design (N = 12). HIIT sessions consisted of 20 bouts of 10 s of exercise followed by 50 s of recovery, totaling 20 min at two different intensities; "all-out (SMIT)" vs. "115-130% Wmax (HIIT)". The cardiac auto-regulation included heart rate variability (HRV) and vascular function. HRV and vascular function were measured at baseline and five different time points after acute exercise. RESULTS: The SMIT was higher in workload (31%), peak heart rate (28%), and rate of perceived exertion (40%) compared with HIIT (all p < 0.001). The R-R interval, NN50, and pNN50 measured until 60 min after acute exercise was higher in the HIIT compared with SMIT (all p < 0.05). The SMIT elicited a greater shift in ln LF/HF ratio immediately after acute exercise (3802%, p < 0.01) and induced a decrease in bilateral ba-PWV at the time point 5 min after acute exercise, persisting until 65 min after (p < 0.05). Yet, HIIT showed no change over time in the frequency domain of HRV and blood vascular tone after cessation of acute exercise. CONCLUSION: Our findings confirmed that SMIT is a more potent modulator of the autonomic nervous system compared with HIIT. Further study is needed to monitor through complete recovery to baseline, to understand acute cardiac auto-regulation response after cessation of various exercise intensities identical interval training protocol.

Leisure time physical activity: a protective factor against metabolic syndrome development.

PURPOSE: Physical activity (PA) is a modifiable factor in preventing/treating cardiometabolic disease. However, no studies have yet compared specific moderate-to-vigorous PA (MVPA) domains with the risk of metabolic syndrome (MetS) in detail. Here, the present study was conducted to examine the impact of different MVPA domains (leisure-time PA (LTPA) vs. occupational PA (OPA) vs. total MVPA) on the risk of MetS in Korean adults. MATERIALS AND METHODS: Data from the 2014 to 2021 Korea National Health and Nutrition Examination Survey were analyzed (N = 31,558). MetS was defined according to the criteria by revised NCEP/ATP-III. The domain-specific MVPA was assessed using the K-GPAQ. The LTPA and OPA status were classified into four categories: (1) 0 min/week, (2) 1 to 149 min/week, (3) 150 to 299 min/week, and 4) ≥ 300 min/week. In addition, the present study calculated total MVPA as a sum of OPA and LTPA and further classified it into six groups; (1) 0 min/week, (2) 1 to 149 min/week, (3) 150 to 299 min/week, (4) 300 to 449 min/week, (5) 450 to 599 min/week, 6) ≥ 600 min/week. RESULTS: The ≥ 300 min/week and the 150 to 299 min/week of LTPA showed better outcomes in cardiometabolic disease risk factors and surrogate markers of insulin resistance compared with the 0 min/week of LTPA regardless of adiposity status. Risk of MetS in ≥ 300 min/week of LTPA was lower than in 0 min/week, 1 to 149 min/week, and 150 to 299. In addition, LTPA was significantly associated with a risk of the MetS in a curvilinear dose-response curve, however, no significant effects of a non-linear relationship between OPA and risk of the MetS. CONCLUSIONS: Our findings showed that LTPA was associated with a risk of MetS with a dose-response curve, whereas no significant non-linear effects were found between OPA and the risk of MetS. Therefore, the MVPA domain is an independent factor of the risk of MetS.

The Impact of Recovery Time on Performance in Division I Collegiate Beach Volleyball Players.

ABSTRACT: Holtgeerts, RN, Gann, J, Jung, HC, and Hey, W. The impact of recovery time on performance in Division I collegiate beach volleyball players. J Strength Cond Res 36(3): 667-673, 2022-The sport of beach volleyball has recently grown significantly at the collegiate level, and collegiate beach volleyball players often practice and compete 5 or 6 days per week during the competitive season. This study examined the effects of the amount of recovery time on performance in Division 1 Collegiate beach volleyball players. Ten female NCAA Division 1 beach volleyball players, aged 20.2 ± 1.23 years, participated in the study. Subjects completed 2 trials consisting of 4 sessions of volleyball play (with a 24-hour recovery trial and 48-hour recovery trial). Trials were randomized and counter balanced. Each trial measured counter-movement jump, 5-10-5 agility time, 3 beach volleyball drills, and scores of a beach volleyball match. Perceived recovery, sleep quality, and rating of perceived exertion were also recorded. The significance level set for the study was p ≤ 0.05. Counter-movement jump showed small but significant increases following the 24-hour recovery period (p ≤ 0.05). 5-10-5 agility test showed significant improvement with the 48-hour recovery period (p ≤ 0.05). Perceived Recovery scores demonstrated significant increases in both recovery periods (p ≤ 0.05). Beach volleyball drill and match performance were not affected by the change in recovery time. These results indicate that, although some physical skills are affected by recovery time, beach volleyball performance as a whole is relatively stable over several days. It is normal for NCAA athletes to play back-to-back days and with little recovery time, and these results indicate that this practice does not negatively affect sport performance.

Effects of Various Work-to-rest Ratios during High-intensity Interval Training on Athletic Performance in Adolescents.

To examine the effect of high-intensity interval training (HIIT) with different work-to-rest ratios on athletic performance in athletes. Forty-seven male Taekwondo athletes (aged 15-18 yrs) were randomly assigned into 3 HIIT groups and a control group. Each group performed 6 and 8 bouts of HIIT: 1) 1:2 (30:60 s), 2) 1:4 (30:120 s), and 3) 1:8 (30:240 s) groups while the control group performed only Taekwondo training program. All HIIT groups completed 10 sessions over 4 weeks. Athletic performance tests including VO2max test, Wingate anaerobic test, vertical jump, and agility T-test were measured at both pre- and post-tests. Two-way repeated measures ANOVA were applied to examine the performance changes between protocols. VO2max improved significantly in all HIIT groups (p<0.01), and the post-hoc test indicated that the only 1:4 group showed significant improvement compared to the control group. The HIIT with 1:4 ratio showed the effective protocol for enhancing anaerobic capacity including relative peak and mean power compared to control (p<0.01). Ten sessions of HIIT involving the 1:4 group, lasting over a brief 4-week period revealed the effective protocol for enhancing both aerobic and anaerobic capacity. Our findings provide practical implications to develop a performance-enhancing program specialized for adolescent Taekwondo athletes.

The elevation training mask induces modest hypoxaemia but does not affect heart rate variability during cycling in healthy adults.

This study examined the acute effects of the elevation training mask (ETM) on haemodynamics and heart rate variability (HRV) at rest, during cycling, and during recovery in healthy adults. Fifteen healthy male (N=9) and female (N=6) adults (27.0 ± 1.14 years) completed two trials with the mask (MASK) and without the mask (CON). The 40-minute cycling exercise protocol included 10-minute phases of (1) rest, (2) 50% of VO2peak cycling, (3) 70% of VO2peak cycling, and (4) recovery. Blood pressure and pulse oximetry saturation (SPO2) were measured at each phase. An Actiwave-Cardio ECG monitor (CamNtech, UK) was used to measure HRV variables including time and frequency domains. A greater response in systolic blood pressure (p=.035) was observed at rest while SPO2 (p=.033) was lower during high-intensity cycling (70% of VO2peak) in the MASK trial. The HRV indices were not different between trials during cycling. However, heart rate (p=.047) was greater while inter-beat interval and sympathovagal balance (the ratio between low-frequency and high-frequency components; ln LF/HF, p=.01) were lower in the MASK than the CON trials during recovery. Wearing an ETM during high-intensity cycling (70% of VO2peak) induces modest hypoxaemia. Although this device did not affect HRV changes during cycling, it seems to delay the cardiac-autonomic recovery from exercise. Healthy adults may be required to perform high-intensity exercise with an ETM to simulate a hypoxic environment, but future studies are needed to determine whether repeated exposure to this condition provides similar benefits as altitude training.

Correcting Vitamin D Insufficiency Improves Some But Not All Aspects of Physical Performance During Winter Training in Taekwondo Athletes.

We investigated the effects of vitamin D3 supplementation on physical performance during winter training in vitamin D insufficient taekwondo athletes. Thirty-five collegiate male and female taekwondo athletes, aged 19-22 years with low serum 25(OH)D concentration (28.8 ± 1.10 nmol/L), were randomly assigned to a vitamin D group (n = 20) or a placebo group (n = 15). Subjects received either a vitamin D3 capsule (5,000 IU/day) or a placebo during 4 weeks of winter training. Blood samples were collected for analyzing serum 25(OH)D concentration. Physical performance tests included Wingate anaerobic test, isokinetic muscle strength and endurance, a countermovement jump test, sit-ups, agility test, and 20-m pacer. Serum 25(OH)D concentrations increased significantly in the vitamin D group (96.0 ± 3.77 nmol/L) after 4 weeks of supplementation, but no changes were found in the placebo group (F = 242.44, p = .000). There were significant interaction effects for anaerobic peak power (F = 7.49, p = .010) and isokinetic knee extension at 180 deg/s (F = 6.08, p = .019). Changes in serum 25(OH)D concentration were positively associated with changes in peak power and isokinetic knee extension at 180 deg/s. However, no significant interaction effects were observed in other performance variables. This study suggests that 4 weeks of vitamin D supplementation elevates serum 25(OH)D concentration to sufficient levels. Correcting vitamin D insufficiency improves some but not all aspects of performance. Thus, efficacy of vitamin D supplementation to enhance performance remains unclear.

Analysis of the anatomical characteristics of the pelvis in Koreans to aid in development of a NOTES platform.

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique affording full-thickness resection of rectal tumors and can also be used as a platform for transrectal access to the peritoneal cavity for NOTES (natural orifice transluminal endoscopic surgery) procedures. The authors investigated the anatomical characteristics of the pelvis in Koreans to develop an ergonomically designed NOTES platform. A total of 256 patients (156 men and 100 women) who underwent pelvic magnetic resonance imaging for evaluating rectal neoplasms were enrolled for analysis. The authors retrospectively reviewed and calculated anatomical lengths and angles on pelvic magnetic resonance images and analyzed differences in pelvic anatomy in terms of patient gender, age, and body mass index. Various angulations were noted from the anal canal to the sacral promontory, attributable to the shape of the sacral bone. Minimal difference in pelvic anatomy was evident between men and women. In conclusions, the authors expect that their data will be useful in the development of ergonomic TEM-NOTES platforms.

Increased risk of cardiometabolic disease in normal-weight individuals with non-alcoholic fatty liver disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity, but there is increasing evidence that not all individuals who are overweight/obese also develop NAFLD. Currently, it is unclear whether normal-weight (Nw) individuals with NAFLD have a higher risk of cardiometabolic disease risk compared with individual sub-groups (Nw and Obesity [Ob]) of non-NAFLD. AIMS: This study aimed to compare the cardiometabolic profiles, cardiovascular disease, and diabetes between Nw vs. Ob with non-NAFLD vs. NAFLD. METHODS: This study utilized the Korea National Health and Nutrition Examination Surveys collected from 2019 to 2021. Individuals were stratified into Nw vs. Ob categories and further divided into non-NAFLD and NAFLD groups based on the hepatic steatosis index and liver fat score (N = 6615). RESULTS: The prevalence of non-NAFLD Nw, non-NAFLD Ob, NAFLD Nw, and NAFLD Ob groups was 36%, 20%, 7%, and 37%, respectively. NAFLD Nw vs. non-NAFLD Ob manifests deteriorated cardiometabolic disease risk profiles and surrogate markers of insulin resistance despite having higher weight, waist circumference, and BMI. In addition, compared to non-NAFLD Nw, individuals with NAFLD Nw had a significantly higher risk of CVDs (738%, p < .001) and diabetes (408%, p < .001), with no difference between NAFLD Nw and NAFLD Ob groups. CONCLUSIONS: Cardiometabolic disease risk is more closely related to NAFLD developments than adiposity status. Therefore, not all overweight/obese individuals have a higher cardiometabolic disease risk, and NAFLD in Nw is an aggressive disease that is associated with cardiometabolic disease risk compared with Ob individuals without NAFLD.

Effects of Aerobic vs. Resistance Exercise on Vascular Function and Vascular Endothelial Growth Factor in Older Women.

This study aimed to investigate the effects of different types of exercise (aerobic vs. resistance) on vascular function and vascular endothelial growth factor in older women. Forty-three older women, aged 65-75 years old, voluntarily participated in this study. All participants were randomly assigned to one of the following three groups: aerobic exercise (AE; n = 14), resistance exercise (RE; n = 15), and control (CG; n = 14) groups. All participants in the exercise groups performed their respective exercises for 60 min/day, three days/week, for 16 weeks. The intensity of aerobic and resistance exercises was determined using the individual heart rate reserve (40-60%) and RPE (12-13), respectively. The vascular function test included the brachial-ankle pulse wave velocity (ba-PWV), carotid artery blood flow volume, and velocity. Participants' blood samples were collected to analyze the vascular endothelial growth factor (VEGF). A significance level of 0.05 was set. Our results showed that ba-PWV improved following both AE (14.5%) and RE groups (11.1%) (all p < 0.05). Increases in carotid blood flow volume (AE: 15.4%, RE: 18.6%) and total artery peak velocity (AE: 20.4%, RE: 17%) were observed in AE and RE groups (p < 0.05), while flow total artery mean velocity (36.2%) and peak velocities (20.5%) were only increased in the aerobic exercise group (p < 0.05). VEGF was increased after resistance exercise (p < 0.05). Overall, aerobic exercise provides greater benefits on vascular function than resistance exercise but further research is needed on VEGF regarding whether this change is associated with vascular function improvement in older women.

Prevalence of combined metabolic health and weight status by various diagnosis criteria and association with cardiometabolic disease in Korean adults.

The purpose of this study was to compare the cardiometabolic disease prevalence and risk factors between individuals categorized as metabolically unhealthy and healthy (MU vs. MH), with normal-weight and obesity (Nw vs. Ob), according to different established criteria for combined metabolic health and weight status; and to assess the optimal metabolic health diagnostic classifications to predict cardiometabolic disease risk factors. Data were obtained from the 2019 and 2020 Korean National Health and Nutrition Examination Surveys. We applied the nine accepted metabolic health diagnostic classification criteria. Statistical analysis was applied to frequency, multiple logistic regression, and ROC curve analysis. The prevalence of MHNw ranged from 24.6% to 53.9%, MUNw from 3.7% to 37.9%, MHOb from 3.4% to 25.9%, and MUOb from 16.3% to 39.1%. For hypertension, the MUNw had an increased risk ranging from 1.90 to 3.24 times compared with MHNw; MHOb ranged from 1.84 to 3.76 times; MUOb ranged from 4.18 to 6.97 times (all p < .05). For dyslipidemia, the MUNw had an increased risk ranging from 1.33 to 2.25 times compared with MHNw; MHOb ranged from 1.47 to 2.33 times; MUOb ranged from 2.31 to 2.67 times (all p < .05). For diabetes, the MUNw had an increased risk ranging from 2.27 to 11.93 times compared with MHNW; MHOb ranged from 1.36 to 1.95 times; MUOb ranged from 3.60 to 18.45 times (all p < .05). Our study findings revealed that AHA/NHLBI-02 and NCEP-02 can be the best diagnostic classifications criteria for cardiometabolic diseases risk factors.

Potential impact of metabolic syndrome on cognitive function in US firefighters.

Objectives: Among US firefighters, sudden cardiac arrest and psychological stress (i.e., PTSD) are the leading cause of on-duty death. Metabolic syndrome (MetSyn) may influence both cardiometabolic and cognitive health. Here, we examined differences in cardiometabolic disease risk factors, cognitive function, and physical fitness in US firefighters with vs. without MetSyn. Materials and methods: One hundred fourteen male firefighters, aged 20 to 60 years, participated in the study. US firefighters with MetSyn vs. non-MetSyn were divided by AHA/NHLBI criteria. Of them, we performed a paired-match analysis with respect to the age and BMI of firefighters with (n = 18) vs. without MetSyn (n = 18). The cardiometabolic disease risk factors included blood pressure, fasting glucose, blood lipid profiles [HDL-C, triglyceride (TG)], and surrogate markers of insulin resistance [TG/HDL-C, TG glucose index (TyG)]. The cognitive test included a psychomotor vigilance task as a measure of reaction time and a delayed-match-to-sample task (DMS) as a measure of memory, using the computer-based Psychological Experiment Building Language Version 2.0 program. The differences between MetSyn and non-MetSyn groups in US firefighters were analyzed using an independent t-test adjusted for age and BMI. In addition, Spearman correlation and stepwise multiple regression were conducted. Results: US firefighters with MetSyn exhibited severe insulin resistance estimated by TG/HDL-C and TyG (Cohen's d > 0.8, all p < 0.01) compared with their age- and BMI-matched counterparts without MetSyn. In addition, US firefighters with MetSyn exhibited higher DMS total time and reaction time compared with non-MetSyn (Cohen's d > 0.8, all p < 0.01). In stepwise linear regression, HDL-C predicted DMS total time (ß = - 0.440, R2 = 0.194, p < 0.05), and TyG (ß = 0.432, R2 = 0.186, p < 0.05) predicted DMS reaction time. Conclusion: US firefighters with vs. without MetSyn were predisposed to metabolic risk factors, surrogate markers of insulin resistance, and cognitive function, even when matched for age and BMI, and there was a negative association between metabolic characteristics and cognitive function in US firefighters. The findings of this study suggest that the prevention of MetSyn may be beneficial to supporting firefighters' safety and occupational performance.

Rapid Spontaneous Resolution of Contralateral Lentiform Acute Subdural Hematoma After Burr Hole Trephination for Chronic Subdural Hematoma.

Although rare, acute subdural hematoma (ASDH) may occur after burr hole trephination (BHT) for chronic subdural hematoma (CSDH). It usually occurs in the hemisphere ipsilateral to the burr hole site and rarely in the hemisphere contralateral to the burr hole site. On computed tomography (CT), SDH is usually crescent-shaped and occasionally lentiform or biconvex, which can be misdiagnosed as epidural hematoma (EDH). In rare cases, ASDH may resolve spontaneously and rapidly. Here, we report a case of rapid spontaneous resolution of contralateral lentiform ASDH after BHT for CSDH in a patient with brain atrophy. A 55-year-old man developed left CSDH 2 months after traumatic brain injury. Left BHT was performed, and a lentiform hematoma, presumed to be EDH, was found in the right frontal region on the CT scan acquired immediately after BHT. On the CT scan acquired 12 hours later, the lentiform hematoma disappeared and spread along the hemisphere. It was presumed to be ASDH. To prevent contralateral ASDH after BHT, slow decompression and minimal gentle or no irrigation should be performed during BHT, particularly in patients with brain atrophy.

Re-Visiting Maximal Heart Rate Prediction Using Cross-Validation in Population Aged 7-55 Years.

The primary purpose of the present study was to re-visit HRmax prediction by two commonly used equations (i.e., Fox's and Tanaka's equation) compared to the direct measured HRmax using the large sample size of Asians. The second aim of the study was to focus on suggesting new equations for the Asian population by separating gender and specific age groups. A total of 672 participants aged from 7 to 55 years were recruited for the study (male: 280 and female: 392), and the maximal graded exercise test with Bruce protocol was used to measure HRmax. All data obtained from the study were analyzed by SPSS 25.0. Additionally, three statistical analysis methods (i.e., Mean Absolute Percent Errors (MAPE), Bland-Altman plots, and equivalence testing) were utilized to confirm the consistency between the measured HRmax and the two prediction equations. The main finding was that two equations showed significant differences in predicting the HRmax of Korean aged from 7 to 55 years. The outcome of children aged from 7 to 14 was a different fit in the agreement compared to other age groups. Fox's equation had the best fit in the average of the difference closer to zero and completely included within the equivalence zone, but females over 15 years old revealed higher errors than males in the values calculated by the two equations compared to the direct measured HRmax. Consequently, the study demonstrated that both equations tended to overestimate the HRmax for males and females over 15 years old, and the two universal equations were not suitable to predict the HRmax of Koreans except for children aged from 7 to 14 years. The new HRmax prediction equations suggested in this study will more accurately predict the HRmax of Asians, and additional analyses should be examined the cross-validity of the developed HRmax equation by age and gender in the future study.

Intergenerational Taekwondo Program: A Narrative Review and Practical Intervention Proposal.

Taekwondo is a modernized martial art that includes various combinations of hand and kicking techniques and core values of Taekwondo philosophy such as courtesy, mutual respect, and self-control. Physical inactivity is highly prevalent among older adults and is a major contributor to health-related problems. Intergenerational physical activity programs are used as an effective tool to make a positive connection between generations and provide additional health benefits for both generations. This review study aimed to examine the theories of intergenerational physical activity programs and propose the Intergenerational Taekwondo Program (ITP). Various theories such as the transtheoretical model, contact theory, social capital theory, situated learning theory, human development theory, personality theory, and whole-person wellness model have been adopted in intergenerational physical activity programs. Our review suggests that to develop the Intergenerational Taekwondo Program, instructors should (1) establishing common goals, (2) understand differences in physical and mental abilities, and (3) offer incentives to encourage participants in physical activity programs. The proposed ITP program has the potential to not just provide unique inherent values and improving physical functions, but also to form generational connections.

Conduction Velocity of Spinal Reflex in Patients with Acute Lateral Ankle Sprain.

Recent literature has highlighted altered spinal-reflex excitability following acute lateral ankle sprain (ALAS), yet there is little information on the conduction velocity of spinal reflex pathways (CV-SRP) in these patients. Therefore, we aimed to investigate the effects of ALAS on the CV-SRP. We employed a cross-sectional study with two groups: ALAS (n = 30) and healthy controls (n = 30). The CV-SRP of the soleus, fibularis longus, and tibialis anterior was assessed using the H-index method. As secondary outcomes, H-reflex and M-wave latencies were assessed as well as acute symptoms including ankle swelling, pain, and self-reported ankle function. Separate group-by-limb ANOVA with repeated measures revealed a significant interaction for soleus CV-SRP (p < 0.001) and H-reflex latency (p < 0.001), showing significant slower CV-SRP and longer H-reflex latency in the involved limb of the ALAS group compared with both limbs in the control group. However, there was no significant interaction or main effect in any other ankle muscles (p > 0.05). A further correlation analysis showed a significant relationship between CV-SRP and acute symptoms, including ankle swelling (r = −0.37, p = 0.048) and self-reported ankle function (r = 0.44, p = 0.017) in ALAS patients. These results suggest a disrupted functionality of the afferent pathway and/or synaptic transmission following ALAS. Level of Evidence: 4.

Successful extracorporeal membrane oxygenation in a patient with central airway obstruction due to an endotracheal mass.

Extracorporeal membrane oxygenation (ECMO) assists blood circulation and gas exchange via a heart-lung machine. ECMO is used mainly in intensive care units as bridging therapy until heart and respiratory failure can be addressed or until transplantation can be performed. ECMO is sometimes used during surgery under general anaesthesia, depending on the patient's underlying diseases and the nature of the operation. If the oxygen supply and carbon dioxide removal capacity are limited, venovenous (VV)-ECMO can be helpful. Here, we describe the use of VV-ECMO for surgical resection of an endotracheal mass through rigid bronchoscopy in a patient who developed decompensating dyspnoea due to central airway obstruction (CAO).

Spinal Reflex Excitability of Lower Leg Muscles Following Acute Lateral Ankle Sprain: Bilateral Inhibition of Soleus Spinal Reflex Excitability.

Neural changes in the ankle stabilizing muscles following ankle sprains are thought to be one contributing factor to persistent ankle dysfunction. However, empirical evidence is limited. Therefore, we aimed to examine spinal reflex excitability of lower leg muscles following acute ankle sprains (AAS). We performed a case-control study with 2 groups consisting of 30 young adults with AAS and 30 aged-matched uninjured controls. Hoffmann reflex (H-reflex) testing was performed to estimate spinal reflex excitability of lower leg muscles: soleus, fibularis longus (FL), tibialis anterior (TA). Maximal H-reflex (Hmax) and motor responses (Mmax) were determined by delivering a series of electrical stimuli at the sciatic nerve. Hmax/Mmax ratios were calculated to represent normalized spinal reflex excitability. Separate group-by-limb analyses of variance (ANOVA) with repeated measures found there were no significant interactions for any of the muscles (SL: F1,56 = 0.95, p = 0.33, FL: F1,51 = 0.65, p = 0.42, TA: F1,51 = 1.87, p = 0.18), but there was a significant main effect of group in the soleus (F1,56 = 6.56, p = 0.013), indicating the Hmax/Mmax ratio of soleus in the AAS group was significantly lower bilaterally (AAS = 0.56 ± 0.19, control = 0.68 ± 0.17, p = 0.013), with no significant group differences in the other muscles (FL: F1,51 = 0.26, p = 0.61, TA: F1,51 = 0.93, p = 0.34). The bilateral inhibition of the soleus spinal reflex excitability following AAS may be significant in that it may explain bilateral sensorimotor deficits (postural control deficits) following unilateral injury, and provide insights into additional therapies aimed at the neural change.

Spinal Intradural Hematoma after Spinal Anesthesia in a Young Male Patient: Case Report and Review of the Literature.

Spinal intradural hematoma (SIH) is a rare condition which can cause neurological sequelae such as permanent motor weakness and sensory loss in the lower extremities. Herein, we describe a case of SIH following spinal anesthesia. The patient was a 30-year-old man who underwent treatment for accessory navicular syndrome at our department. The patient was not receiving anticoagulation therapy, and spinal anesthesia was thus selected. No symptoms of hematoma were observed in the immediate postoperative period, but the patient complained of pain in both buttocks on postoperative day 5. However, neither motor weakness nor sensory loss were observed. Additionally, as the radiating pain extending to the lower extremities typical of neurological pain was not observed, musculoskeletal pain was suspected. Magnetic resonance imaging revealed intradural hematomas at L4-5 and S1. Conservative treatment and follow-up evaluations were performed to ensure that additional neurological sequelae did not occur. Six months after symptom onset, his pain Numeric Rating Scale score was 0, and no other neurological findings were observed. However, in patients who undergo spinal anesthesia, localized pain in the back without other neurological symptoms and lack of radiating pain may be associated with more than musculoskeletal pain. Such patients must be continuously monitored.

Nearly zero reflectance of nano-pyramids and dual-antireflection coating structure for monocrystalline silicon solar cells.

The effect of two-step surface treatment on monocrystalline silicon solar cells was investigated. We changed the nanostructure on pyramidal surfaces by wet nano-texturing so that less light is reflected. The two-step nano-texturing process reduces the average reflectance to about 4% in the 300-1100 nm wavelength region. The use of an antireflection coating resulted in an effective reflectance of 1%. We found that the reflectance obtained by wet nano-texturing was lower than that obtained by conventional alkaline texturing. Thus, we can expect a further increase in the efficiency of silicon solar cells with two-step nano-texturing by a wet chemical process.