Associations of serum IL-6 with muscle, bone, and adipose tissue in women.

This cross-sectional study examined the associations between serum interleukin-6 (IL-6) and muscle, bone, and fat parameters in recreationally active women. One-hundred forty-five women (48.7 ± 17.8 years; 164.4 ± 7.1 cm; 66.8 ± 10.7 kg; and 24.7 ± 3.9 kg/m2) underwent dual energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) assessments to determine total and regional muscle, bone, and fat parameters. Muscle performance of the knee extensors was examined via isometric, isotonic, and isokinetic dynamometry assessments, and serum IL-6 was measured via enzyme linked immunosorbent assay. Serum IL-6 was inversely associated with thigh muscle cross-sectional area (mCSA, r = -0.28, p < 0.01); isometric strength (r = -0.19, p < 0.05); hip areal bone mineral density [aBMD] (r = -0.18, p < 0.05); trochanter aBMD (r = -0.23, p < 0.01); total body aBMD (r = -0.20, p < 0.05); cortical volumetric bone density at 38 and 66% tibia (r = -0.18 and r = -0.19, respectively, both p < 0.05), and 66% cortical thickness (r = -0.17, p < 0.05). These associations were present after adjusting for age, BMI, and physical activity. Thigh mCSA was significantly lower in the tertile possessing the greatest IL-6 compared to the lowest tertile (p < 0.01); after adjusting for age, body mass index, and physical activity. Collectively, these observations indicate that IL-6 is inversely associated with skeletal muscle and bone parameters independent of relevant confounders. These observations bolster the prognostic value of serum IL-6.

Longitudinal Hydration Assessment in Collegiate Basketball Players Over Various Training Phases.

ABSTRACT: Heishman, AD, Daub, BD, Miller, RM, Freitas, EDS, and Bemben, MG. Longitudinal hydration assessment in collegiate basketball players over various training phases. J Strength Cond Res 35(4): 1089-1094, 2021-To the best of our knowledge, previous literature has not longitudinally examined hydration status in collegiate basketball players. Therefore, the purpose of this investigation was to examine the prepractice hydration status of collegiate basketball players across various training phases for 2 consecutive years. Retrospective analyses examined prepractice urine-specific gravity (USG) assessments obtained from National Collegiate Athletic Association (NCAA) Division I male basketball players during the preseason and competitive season, for 2 consecutive years. The first year (year 1 = Y1) of analysis consisted of 15 athletes and the second year (year 2 = Y2) consisted of 16 athletes, with 8 athletes in both seasons. Hydration status was classified based on the National Athletic Trainers' criteria: (a) euhydrated, USG < 1.020; (b) hypohydrated, USG = 1.020-1.030; and (c) significantly hypohydrated, USG > 1.030. Additional comparisons examined the association of minutes played with hydration status and changes in hydration status for athletes returning from Y1 to Y2. The results indicated 55-65.7% of cases showed levels of significant hypohydration during the preseason and competitive seasons for both years. Preseason hydration status was significantly better than the competitive season (Y1, p = 0.008; Y2, p = 0.005). Despite significant differences in minutes played (p < 0.001), no differences in hydration status were observed. Returning athletes displayed no differences in hydration status between Y1 and Y2. Collegiate basketball players show levels of hypohydration when longitudinally examined across various training phases. Although hydration may be improved in the preseason, alternative factors such as average game minutes played and length in program may not influence hydration status.

Clostridium septicum-infected aortic aneurysm or graft is a deadly diagnosis.

BACKGROUND: Clostridium septicum is an anaerobic, motile, spore-forming, toxin-producing gram-positive bacillus that can lead to rapidly progressive gas gangrene due to the release of alpha toxin. Aortic aneurysm secondary to C. septicum infection is a rare condition with 60 cases reported in the literature; however, we have recently treated several patients with the condition in our large tertiary care and aortic center. METHODS: Blood and tissue culture results collected between January 2005 and January 2018 and maintained in the microbiology laboratory database at the Cleveland Clinic were reviewed to identify those with C. septicum reported. Each was reviewed to determine radiographic or histopathologic correlation with aortic disease. RESULTS: Seven cases of C. septicum aortitis were reviewed. Underlying malignant disease was found in four cases and a history of remote malignant disease in one case. The most common location for infection was the infrarenal abdominal aorta. Vascular surgery had previously been performed in three of the cases. Five of the seven patients underwent operative repair. All patients were treated with ß-lactam antibiotics. The two patients who did not undergo an operation died, which is consistent with the 100% mortality described in the literature. Of the five patients who underwent an operation, there was only one documented survivor and one was lost to follow-up. CONCLUSIONS: In the largest reported case series, only a small percentage of patients with C. septicum-infected aortic aneurysms survived >1 year. In the patients described, those who did not receive an operation had 100% mortality. Earlier recognition and prompt operation with appropriate antimicrobial therapy are needed to improve the outcome of patients diagnosed with this rare infection.

Evaluating the Effects of Underloaded and Overloaded Warm-ups on Subsequent Swing Velocity.

Miller, RM, Heishman, AD, Freitas, EDS, and Bemben, MG. Evaluating the effects of underloaded and overloaded warm-ups on subsequent swing velocity. J Strength Cond Res 34(4): 1071-1077, 2020-Several attempts to identify the optimal on-deck procedure to enhance swing velocity in baseball have been made. However, inconsistent findings continue to constitute much of the body of literature. In addition, the emergence of athlete monitoring in sport has led to the exploration of more sport-specific tasks to potentially identify athlete fatigue and readiness to perform. Therefore, the purpose of this investigation was to examine 3 different bat weight warm-up protocols on subsequent swing velocity and to examine the reliability of swing velocity measurements to allude to its potential a sport-specific athlete monitoring metric. Thirty-two recreational male baseball players 20.3 ± 2.0 years, 179.6 ± 7.1 cm and 89.6 ± 11.1 kg completed the study. Subjects completed 3 testing visits that included warming up with a control bat ([CB] 32 in., 29 oz), plastic bat ([PB] 31 in., 6.4 oz), or heavy bat ([HB] 32 in., 57 oz). Testing visits began with 3 CB swing trials followed by 3 intervention bat trials, then concluded with 3 additional CB swings. Swing velocity was assessed using visual 3D technology. Analyses of variance indicate that after the PB (26.6 ± 2.0 m·s) and CB interventions (26.2 ± 1.7 m·s) significantly faster (p < 0.001) swing velocities were generated when compared with the traditional HB intervention (24.1 ± 2.2 m·s). When assessed for reliability, the average ICC was 0.681 and Cronbach's alpha was 0.95, indicating exceptional reliability. Congruent to previous research, these data bolster the notion that warming up with a HB can hinder swing velocity. However, in contrast to previous research these data suggest that using a PB can increase swing velocity significantly. Furthermore, visual 3D can be designated as an exceptionally reliable device to measure swing velocity.

Countermovement Jump Reliability Performed With and Without an Arm Swing in NCAA Division 1 Intercollegiate Basketball Players.

Heishman, AD, Daub, BD, Miller, RM, Freitas, EDS, Frantz, BA, and Bemben, MG. Countermovement jump reliability performed with and without an arm swing in NCAA Division 1 intercollegiate basketball players. J Strength Cond Res 34(2): 546-558, 2020-The countermovement jump (CMJ) is routinely used in athlete performance to quantify adaptions to training, as well as monitor neuromuscular readiness and fatigue. However, controversy remains in whether to incorporate an arm swing during the CMJ (CMJ AS) or keep the hands placed on the hips (CMJ NAS). Incorporating the arms provides a higher degree of sport-specificity that may yield improved reliability, especially in skilled jumpers. By contrast, the hands-on-hips approach isolates lower extremity force production and eliminates potential arm-swing variation. Therefore, the purpose of this study was to establish the reliability of CMJ typical (CMJ-TYP), CMJ concentric alternative (CMJ-Conc-ALT), and CMJ eccentric alternative (CMJ-Ecc-ALT) variables obtained during the CMJ AS and CMJ NAS. Twenty-two (men = 14, women = 8) NCAA Division 1 collegiate basketball players performed 3 CMJ AS and 3 CMJ NAS on a force plate, in a randomized order. To assess the test-retest reliability, participants returned 1 week later to perform 3 additional CMJ AS and 3 CMJ NAS. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were used to assess intersession and intrasession reliability for the various CMJ variables. A majority of CMJ-TYP and several CMJ-Conc-ALT and CMJ-Ecc-ALT variables exhibited adequate intersession and intrasession reliability (ICC > 0.700 and CV <10%) during both the CMJ AS and the CMJ NAS. Countermovement jump AS may provide more pertinent information about long-term changes in sport-specific performance, whereas the CMJ NAS may be more beneficial for detecting acute changes in neuromuscular fatigue and athlete readiness.

Test-Retest Reliability Between Free Weight and Machine-Based Movement Velocities.

Miller, RM, Freitas, EDS, Heishman, AD, Koziol, KJ, Galletti, BAR, Kaur, J, and Bemben, MG. Test-retest reliability between free weight and machine-based movement velocities. J Strength Cond Res 34(2): 440-444, 2020-Several devices are available to measure muscular power through velocity measurement, including the Tendo FitroDyne. The ability for such devices to produce consistent results is still questioned, and the reproducibility of measurement between free weight and machine exercise has yet to be examined. Therefore, the aim of this investigation was to determine the test-retest reliability for barbell velocity during the bench press (BP) and weight velocity during the 2 leg press (2LP) for loads corresponding to 20-80% of 1 repetition maximum (1RM). Forty recreationally active individuals (22.6 ± 2.5 years; 175.9 ± 10.8 cm; and 76.2 ± 13.2 kg) with a 1RM BP and 2LP of 66.8 ± 32.4 kg and 189.5 ± 49 kg, respectively, volunteered for this study. Subjects completed 1 familiarization visit preceding 3 testing visits, which encompassed 1RM determination and 2 days of velocity testing. Forty-eight hours after 1RM testing, the subjects performed 1 repetition at 20, 30, 40, 50, 60, 70, and 80% of their 1RM for each exercise in randomized order. Subjects returned to the laboratory 1 week later to perform the velocity assessment again in randomized order. Intraclass correlation coefficient (ICC2,1) and relative SEM for the BP and 2LP ranged from 0.56 to 0.98 (3-18.1%) and 0.78 to 0.98 (2.8-7.2%), respectively, and no mean differences were observed between trials. The results suggest high reliability for BP velocity between 30 and 60% 1RM and moderate reliability at 20, 70, and 80% 1RM, while the 2LP displayed high to excellent reliability from 20 to 80% 1RM. Cumulatively, machine-based exercise displayed greater reproducibility; however, additional machine exercises need to be examined to bolster this conclusion.

Monitoring External Training Loads and Neuromuscular Performance for Division I Basketball Players over the Preseason.

Limited research has paralleled concomitant changes in external training load (eTL) and countermovement jump (CMJ) performance. Therefore, this investigation characterized eTL and CMJ performance changes across preseason training in Division 1 male collegiate basketball athletes, while examining the influence of position (Guard vs. Forward/Center) and scholarship status (Scholarship = S vs. Walk-on = WO). During 22 practices, eTL was monitored in 14 male athletes, with weekly CMJs performed to quantify neuromuscular performance (Jump Height [JH], Flight Time:Contraction Time [FT:CT], Reactive Strength Index Modified [RSIMod ]). PlayerLoad per minute was significantly higher during W1 and W2 (5.4 ± 1.3au and 5.3 ± 1.2au, respectively; p < 0.05) compared to subsequent weeks, but no additional differences in eTL parameters across time were observed. Scholarship athletes displayed greater PlayerLoad (S = 777.1 ± 35.6, WO = 530.1 ± 56.20; Inertial Movement Analysis (IMA) IMA_High (S = 70.9 ± 15.2, WO = 41.3 ± 15.2); IMA_Medium (S = 159.9 ± 30.7, WO = 92.7 ± 30.6); and IMA_Low (S = 700.6 ± 105.1, WO = 405 ± 105.0;) (p < 0.05), with no observed differences in eTL by position. Moderate decreases in FT:CT and RSIMod paralleled increased eTL. Significant increases in practice intensity (W1 and W2) did not impact CMJ performance, suggesting athletes could cope with the prescribed training loads. However, moderate perturbations in FT:CT and RSIMod paralleled the weeks with intensified training. Cumulatively, scholarship status appears to influence eTL while player position does not.

Maximal power production as a function of sex and training status.

Maximal muscular power is achieved at lower percentages of maximal strength (1RM); however, this notion has not been elucidated based on sex or training status. Therefore, the purpose of this investigation was to examine the influence of sex and training status on maximal power production. Sixty men and women (resistance trained or untrained) completed 1RM testing for the two-leg press (2LP) and bench press (BP). Participants then returned to perform single repetitions at 20, 30, 40, 50, 60, 70 and 80% of their 1RM to determine muscular power. Factorial analyses determined significant interactions (training status by sex by intensity) for the BP (F=35.6, p<0.001) and 2LP (F=8.2, p<0.001). Subsequent analyses indicated that during the BP trained men produce maximal power between 30-40% 1RM compared to untrained men at 60-70% 1RM. Trained women produced maximal power at 50% 1RM compared to untrained women at 60-70% 1RM. During the 2LP, trained men produced maximal power at 40% 1RM compared to untrained men at 60% 1RM. Trained women produced maximal power at 50% 1RM compared to 60-70% 1RM in untrained women. These data suggest that resistance trained individuals and men display maximal power at a lower relative intensity than untrained individuals and women.

Effects of Blood-Flow Restriction Combined With Postactivation Potentiation Stimuli on Jump Performance in Recreationally Active Men.

Miller, RM, Keeter, VM, Freitas, EDS, Heishman, AD, Knehans, AW, Bemben, DA, and Bemben, MG. Effects of blood-flow restriction combined with postactivation potentiation stimuli on jump performance in recreationally active men. J Strength Cond Res 32(7): 1869-1874, 2018-Whole-body vibration (WBV) and maximum voluntary contractions (MVCs) combined with blood-flow restriction (BFR) to augment postactivation potentiation have yet to be examined. Therefore, the purpose of this investigation was to examine the augmented effects of postactivation potentiation when WBV and MVC are combined with BFR. Twenty men (21.8 ± 2.6 years, 180.5 ± 6.2 cm and 84.5 ± 12.1 kg) completed the study. Participants completed 3 testing sessions in a randomized design that included one of the following: (a) control (CON), (b) WBV and WBV combined with BFR (WBV + BFR), or (c) MVC and MVC combined with BFR (MVC + BFR). Jump height and power were recorded for 3 trials, PRE and POST jump height (cm) mean ± SD for each were as follows: CON 58.9 ± 8.6 and 57.9 ± 8.6, WBV 58.2 ± 8.1 and 59.9 ± 8.1, WBV + BFR 58.7 ± 7.6 and 60.2 ± 8.1, MVC 59.7 ± 7.4 and 60.2 ± 8.6, and MVC + BFR 57.7 ± 7.9 and 59.4 ± 8.1. PRE and POST jump power (W) mean ± SD for each were as follows: CON 1,224.3 ± 221.5 and 1,234.3 ± 189.2, WBV 1,251.1 ± 230.4 and 1,266.1 ± 215.7, WBV + BFR 1,265.8 ± 207.9 and 1,259 ± 223.3, MVC 1,264.7 ± 211.9 and 1,263.5 ± 236.5, and MVC + BFR 1,252.3 ± 222.0 and 1,294.6 ± 256.6. Significant differences were revealed in jump height between the 5 interventions (p < 0.01), WBV (p < 0.01), WBV + BFR (p < 0.01), and MVC + BFR (p < 0.01) revealed significant differences in time but no differences in jump power. In conclusion, the results of this study indicate that WBV, WBV + BFR, and MVC + BFR significantly improve jump height and time in air but not jump power.

Time Course Change in Muscle Swelling: High-Intensity vs. Blood Flow Restriction Exercise.

This study determined the time course for changes in muscle swelling and plasma volume following high (HI) and low-intensity resistance exercise with blood-flow restriction (LI-BFR). Ten male participants (22.1±3.0 yrs) completed three experimental conditions: high-intensity exercise (HI - 80% of 1RM), low-intensity exercise with BFR (LI-BFR -20% of 1RM, and 160 mmHg of BFR), and control (CON - no exercise or BFR). Muscle cross-sectional area (mCSA), muscle thickness, thigh circumference, and percentage change in plasma volume (PV%∆) were measured. mCSA was significantly greater than rest values at 15 min post-exercise (p<0.01) for HI and LI-BFR, and at 75 min post-exercise (p<0.01) for HI. Muscle thickness was significantly greater than rest immediately post-exercise (p<0.01) and 30 min post-exercise (p<0.01) for HI and LI-BFR, and at 60 min post-exercise for HI (p=0.01). Muscle thickness was greater for BFR immediately post-exercise compared to HI (p=0.01) post-exercise. Thigh circumference was significantly greater from rest at 15 min post-exercise (p=0.01) and at 75 min post-exercise for both LI-BFR (p=0.03) and HI (p<0.01). PV%∆ significantly decreased from rest immediately post-exercise for both HI (p<0.01) and LI-BFR (p<0.01). In conclusion, BFR exercise induces changes in muscle swelling and plasma volume similar to those observed at high-intensities.

Antibody responses to influenza vaccine in pre- and post-lung transplant patients.

BACKGROUND: Although pre-transplant immunization is routinely recommended, this recommendation is based on little data. The primary objective of this study was to compare antibody responses in lung transplant patients who received influenza vaccine before the transplant, within the first six months of transplant, between 13 and 60 months post-transplant, and 110 months or beyond transplant. METHODS: This prospective cohort study included 357 total immunization events performed over five yr to measure H1N1, H3N2, and B antibody responses to the influenza vaccine in pre- and post-lung transplant patients. Geometric mean titers, seroprotection (antibody titer at least 1:40), seroconversion (fourfold increase between pre and post), and mean fold increases were compared. RESULTS: The geometric mean titer distributions were different for H3N2 and B (ANOVA; p = 0.002 for both). Pre-transplant antibody concentrations were higher compared to the 13- to 60-month group for H3N2 (corrected p = 0.002) and the healthy group for B (corrected p = 0.001). The ≥110-month group had higher seroconversion rates compared to the 13- to 60-month group for H3N2 and B viruses. CONCLUSION: Lung pre-transplant patients and the long-term survivors have higher responses to the influenza vaccine than early post-transplant and the transplant control groups.

Development and implementation of "handshake rounds": An antibiotic stewardship intervention for hospitalized adult patients with hematologic malignancies.

Objective: To design and implement "handshake rounds" as an antibiotic stewardship intervention to reduce inpatient intravenous (IV) antibiotic use in patients with hematologic malignancies. Design: Quasi-experimental analysis of antibiotic use (AU) and secondary outcomes before and and after handshake rounds were implemented. Setting: Quaternary-care, academic medical center. Patients: Hospitalized adults with hematologic malignancies receiving IV antibiotics. Methods: We performed a retrospective review of a preintervention cohort prior to the intervention. A multidisciplinary team developed criteria for de-escalation of antibiotics, logistics of handshake rounds, and outcome metrics. Eligible patients were discussed during scheduled handshake rounds between a hematology-oncology pharmacist and transplant-infectious diseases (TID) physician. Prospective data were collected over 30 days in the postintervention cohort. Due to small sample size, 2:1 matching was used to compare pre- to and postintervention AU. Total AU in days of therapy per 1,000 patient days (DOT/1,000 PD) was reported. Mean AU per patient was analyzed using Wilcoxon rank-sum test. A descriptive analysis of secondary outcomes of pre- and postintervention cohorts was performed. Results: Total AU was substantially lower after the intervention, with 517 DOT/1,000 PD compared to 865 DOT/1,000 PD before the intervention. There was no statistically significant difference in the mean AU per patient between the 2 cohorts. There was a lower rate of 30-day mortality in the postintervention cohort and rates of ICU admissions were similar. Conclusions: Conducting handshake rounds is a safe and effective way to implement an antibiotic stewardship intervention among high-risk patient population such as those with hematologic malignancies.

Higher rating of perceived exertion and lower perceived recovery following a graded exercise test during menses compared to non-bleeding days in untrained females.

The underrepresentation of the female population in exercise sciences could be attributed, at least in part, to difficulty in appropriately accounting for the effects of the menstrual cycle (MC). Previous studies examining the effects of the MC on aerobic performance and subjective measures of aerobic performance show conflicting results. Purpose: The study examined how the MC affects the objective and subjective measures of aerobic performance within untrained female participants and in comparison with untrained male participants assessed at similar time intervals. Methods: Twenty-one participants (12 females and 9 males) completed a graded exercise test (GXT) on a cycle ergometer. The female participants were tested during their early follicular (EF; menses), ovulatory (O), and mid-luteal (ML) phases of the MC. The male participants were included as the control group and were randomly assigned to a menstrual cycle phase for each visit. During GXT, maximal oxygen consumption (VO2max), respiratory exchange ratio (RER), maximal heart rate (HRmax), peak blood lactate, and rating of perceived exertion (RPE) were determined. Twenty-four hours post-exercise, the perceived recovery status (PRS) was assessed. The MC phase was estimated using basal body temperature (BBT) in the female participants. Results: The male participants obtained a higher peak power and VO2max compared to the female participants (p < 0.05). All objective measures of aerobic performance did not significantly differ across the MC phases or time points that were tested. In the untrained female participants, an effect of the MC phase on RPE was found, with RPE being higher at EF (8.92 ± 0.79) compared to O (7.67 ± 1.23; p < 0.05) and ML (7.75 ± 1.06; p < 0.05). In addition, an effect of the MC phase on PRS was found, with perceived recovery being lower at EF (6.83 ± 0.94) compared to O (8.83 ± 1.12) and ML (8.67 ± 0.65; all p < 0.005) for the untrained female participants. No significant differences in RPE and PRS were found between tests in the untrained male participants. The female participants had lower perceived recovery following EF (6.83 ± 0.94) compared with the male participants (9.00 ± 1.00; p < 0.001). Conclusion: The untrained female participants perceived greater exertion during GXT and impaired recovery following GXT in EF compared to O and ML. These results may be attributed to either a drop in female sex hormone concentrations or discomfort associated with menses. The male participants did not exhibit any changes over time. Future studies using subjective parameters such as perceived exertion to track the internal load of training in the naturally menstruating female population should consider menses.

Risedronate use may blunt appendicular lean mass loss secondary to sleeve gastrectomy: Results from a pilot randomized controlled trial.

Background: Despite robust weight loss and cardiometabolic benefit, lean mass loss following sleeve gastrectomy (SG) confers health risk. Bisphosphonates are a potential therapeutic agent for lean mass maintenance. Thus, our objective was to explore the effect of six months of risedronate (vs placebo) on change in dual energy x-ray absorptiometry (DXA) and computed tomography (CT) derived lean mass metrics in the year following SG. Methods: 24 SG patients were randomized to six months of 150 mg oral risedronate or placebo capsules (NCT03411902). Body composition was assessed at baseline and six months with optional 12-month follow-up using whole-body DXA and CT at the lumbar spine and mid-thigh. Group treatment effects and 95% CIs were generated from a mixed model using contrast statements at six and 12 months, adjusted for baseline values. Results: Of 24 participants enrolled [55.7±6.7 years (mean±SD), 79% Caucasian, 83% women, body mass index (BMI) 44.7±6.3kg/m2], 21 returned for six-month testing, and 14 returned for 12-month testing. Six-month weight loss was -16.3 kg (-20.0, -12.5) and -20.9 kg (-23.7, -18.1) in the risedronate and placebo groups, respectively (p=.057). Primary analysis at six-months revealed a non-significant sparing of appendicular lean mass in the risedronate group compared to placebo [-1.2 kg (-2.3, -0.1) vs -2.1 kg (-3.0, -1.2)]; p=.20. By 12-months, the risedronate group displayed no change in appendicular lean mass from baseline [-0.5 kg (-1.5, 0.6)]; however, the placebo group experienced significantly augmented loss [-2.9 kg (-3.6, -2.1)]. Conclusion: Pilot data indicate risedronate treatment may mitigate appendicular lean mass loss following SG. Further study is warranted.

Intermediate-term effects of intracardiac communications created noninvasively by therapeutic ultrasound (histotripsy) in a porcine model.

The authors have demonstrated that histotripsy (pulsed cavitational ultrasound) can create atrial septal defects and ventricular septal defects (VSDs) in an open-chest canine model transcutaneously through the intact chest of neonatal pigs. To assess the potential untoward effects of these applications, the clinical, systemic, and pathologic effects of histotripsy-induced intracardiac communications were analyzed. Six neonatal pigs received noninvasive ultrasound therapy to their ventricular septa, then were allowed to survive 1 month for evaluation of intermediate-term effects. The results were compared with those of six previous animals killed immediately and three others killed 2-3 days after the procedure. Brain magnetic resonance imaging (MRI) and an assessment of cardiac function were performed with long-term survivors, and pathologic specimens were obtained when the animals were killed. In all 15 animals, VSDs 2-6.5 mm wide were successfully created. No fatalities occurred, and all the animals thrived, achieving normal weight gain by the time they were killed. Brain MRI and lung pathology exhibited no evidence of thromboembolic events. No damage to intervening tissue was observed. Pathologic analysis showed demarcated damage to the ventricular septa. Flanking injury and hemorrhage observed acutely were resolved by 1 month, with tissue remodeling present. Transcutaneous histotripsy is a safe and effective technique for creating intracardiac communications noninvasively without intermediate-term untoward effects. With further refinement and development, histotripsy has the potential to become an effective tool for palliation of congenital heart disease.

Skeletal Muscle Adaptations Following 80 Weeks of Resistance Exercise in Older Adults.

BACKGROUND AND PURPOSE: We followed and documented skeletal muscle adaptations from 4 resistance exercise (RE) prescriptions in older adults over the course of a 2-year, 80-week training study. METHODS: Forty-three older men and women-65.2 (3.5) years, 167.2 (7.5) cm, and 72.5 (14.7) kg-completed one of the following RE prescriptions: high-load 2 days per week (HL2D; n = 12), low-load 2 days per week (LL2D; n = 9), high-load 3 days per week (HL3D, n = 12), or low-load 3 days per week (LL3D, n = 10). High-load prescriptions consisted of 3 sets of 8 repetitions with 80% 1-repetition maximum (1-RM) and low-load prescriptions completed 3 sets of 16 repetitions with 40% 1-RM. Each session consisted of 12 exercises targeting major muscle groups and training loads were adjusted every fifth week to maintain progressive overload. Participants completed 40 weeks of supervised training, had a 2-month break, and then resumed another 40 weeks of supervised training. Bone-free lean body mass (BFLBM) and appendicular lean mass (ALM) were assessed via dual-energy x-ray absorptiometry and muscle cross-sectional area (mCSA) of the rectus femoris with diagnostic ultrasound across the intervention. RESULTS AND DISCUSSION: Groups responded similarly with significant increases in total strength (54.9%), upper body strength (42.7%), lower body strength (61.5%), and specific strength (50.3%, strength/BFLBM) over 80 weeks (all P < .001). Significant increases for BFLBM (3.0%), ALM (3.5%), and mCSA (48.7%) were also observed (all P ≤ .019). The only difference among groups indicated HL3D displaying significantly greater percent increase than LL2D for ALM (P = .043). CONCLUSIONS: Resistance exercise performed 2 or 3 days per week with moderate to heavy loads can improve muscle strength and induce small but perhaps clinically significant increases in BFLBM and mCSA in older adults over a 2-year period of supervised training.

Circulating microRNA responses to acute whole-body vibration and resistance exercise in postmenopausal women.

Evaluating alterations in circulating microRNA (c-miRNA) expression may provide deeper insight into the role of exercise in the attenuation of the negative effects of aging on musculoskeletal health. Currently, there are sparse data on c-miRNA responses to acute exercise in postmenopausal women. The purpose of this study was to characterize the effects of acute bouts of resistance exercise and whole-body vibration on expression of selected c-miRNAs in postmenopausal women aged 65-76 years (n=10). We also examined relationships between c-miRNAs and muscle strength and bone characteristics. This randomized crossover design study compared c-miRNA responses to a bout of resistance exercise (RE) (3 sets 10 reps 70% 1 repetition maximum (1RM), 5 exercises) and a bout of whole-body vibration (WBV) (5 sets 1 min bouts 20Hz 3.38mm peak to peak displacement, Vibraflex vibration platform). DXA was used to measure body composition and areal bone mineral density (aBMD) of the total body, AP lumbar spine, and dual proximal femur. pQCT was used to measure tibia bone characteristics (4%, 38%, 66% sites). Blood samples were collected before exercise (Pre), immediately-post (IP), 60 minutes post (60P), 24 hours (24H), and 48 hours (48H) after exercise to measure serum miR-21-5p, -23a-3p, -133a-3p, -148a-3p (qPCR) and TRAP5b (ELISA). There was a significant modality × time interaction for c-miR-21-5p expression (p=0.019), which decreased from 60P to 24H after WBV only. TRAP5b serum concentrations significantly increased IP then decreased below Pre at 24H for both WBV and RE (p<0.01). Absolute changes in TRAP5b were negatively correlated with c-miR-21-5p fold changes (r= -0.642 to -0.724, p<0.05) for both exercise modalities. There were significant negative correlations between baseline c-miRNAs and bone status variables (r= -0.639 to -0.877, p<0.05). Our findings suggest that whole-body vibration is a sufficient mechanical stimulus for altering c-miR-21-5p expression, whereas a high intensity resistance exercise protocol did not elicit any c-miRNA responses in postmenopausal women. Increases in the bone resorption marker, TRAP5b, were associated with greater downregulation of c-miR-21-5p expression.

A Modular, Kerf-Minimizing Approach for Therapeutic Ultrasound Phased Array Construction.

A novel method for fabricating a modular, kerf-minimizing histotripsy phased array was developed and tested. The method utilizes arbitrarily shaped elements, 3-D printing, water jet cutting, and a thin, 125- [Formula: see text] electrically insulating epoxy coating to maximize aperture utilization while allowing for replacement of individual transducer modules. The method was used to fabricate a 750-kHz truncated circular aperture array (165 mm ×234 mm) transducer with a focal length of 142 mm. The aperture was segmented into 260 arc-shaped modular elements, each approximately 11.5 mm ×11.5 mm, arranged in concentric rings. The resulting aperture utilization was 92%. The full-width-half-maximum (FWHM) focal zone of the array was measured to be 1.6 mm ×1.1 mm ×4.5 mm, and the FWHM electrical steering range was measured to be 38.5 mm ×33 mm 40 mm. The array was estimated to be capable of generating approximately 120-MPa peak negative pressure at the geometric focus. In addition, the array was used to ablate a 5-cm3 volume of tissue with electric focal steering.

Therapeutic ultrasound to noninvasively create intracardiac communications in an intact animal model.

OBJECTIVE: To determine if pulsed cavitational ultrasound therapy (histotripsy) can accurately and safely generate ventricular septal defects (VSDs) through the intact chest of a neonatal animal, with the eventual goal of developing a noninvasive technique of creating intra-cardiac communications in patients with congenital heart disease. BACKGROUND: Histotripsy is an innovative ultrasonic technique that generates demarcated, mechanical tissue fractionation utilizing high intensity ultrasound pulses. Previous work has shown that histotripsy can create atrial septal defects in a beating heart in an open-chest canine model. METHODS: Nine neonatal pigs were treated with transcutaneous histotripsy targeting the ventricular septum. Ultrasound pulses of 5-µsec duration at a peak negative pressure of 13 MPa and a pulse repetition frequency of 1 kHz were generated by a 1 MHz focused transducer. The procedure was guided by real-time ultrasound imaging. RESULTS: VSDs were created in all pigs with diameters ranging from 2 to 6.5 mm. Six pigs were euthanized within 2 hrs of treatment, while three were recovered and maintained for 2-3 days to evaluate lesion maturation and clinical side effects. There were only transient clinical effects and pathology revealed mild collateral damage around the VSD with no significant damage to other cardiac or extra-cardiac structures. CONCLUSIONS: Histotripsy can accurately and safely generate VSDs through the intact chest in a neonatal animal model. These results suggest that with further advances, histotripsy can be a useful, noninvasive technique to create intracardiac communications, which currently require invasive catheter-based or surgical procedures, to clinically stabilize newborn infants with complex congenital heart disease.

The influence of sex, training intensity, and frequency on muscular adaptations to 40 weeks of resistance exercise in older adults.

The purpose of this investigation was to identify the influence that sex, training intensity, and frequency have on long-term resistance exercise (RE) outcomes in older adults. METHODS: One-hundred eleven older adults (men: 41, women: 70) completed either: high-intensity RE 2d/week (HI-2D; n = 29), low-intensity RE 2d/week (LI-2D; n = 32), high-intensity RE 3d/week (HI-3D, n = 20), or low-intensity RE 3d/week (LI-3D, n = 30). HI protocols completed 3 sets of 8 repetitions with 80% one-repetition maximum (1-RM) while LI completed 3 sets of 16 repetitions with 40% 1-RM. Total and regional bone free lean body mass (BFLBM) were assessed via dual-energy x-ray absorptiometry and cross-sectional area (mCSA) of the rectus femoris. RESULTS: mCSA was the only muscle quantity parameter to increase (p = 0.043). Significant trial effects for upper body, lower body, and specific strength were observed (all p < 0.001). Significant sex × time interactions (p < 0.001) were observed for upper and lower body strength, however, men and women displayed similar increases in lower body (45.7 ± 29.6 vs 46.4 ± 34.9%), upper body (33.1 ± 21.0 vs 33.4 ± 24.7%), and specific strength (36.5 ± 28.5 vs 40.1 ± 28.7%). A group × time interaction for lower body strength indicated that at 20-weeks HI-2D and LI-3D displayed greater lower body strength than LI-2D (both p < 0.009), and at 40-weeks HI-2D, HI-3D, and LI-3D displayed significantly greater lower body strength than LI-2D (all p < 0.038). CONCLUSIONS: These observations indicate that older men and women display similar long-term RE outcomes. Additionally, regardless of frequency or intensity, the current prescriptions were effective for increasing strength, however these data suggest HI-2D > LI-2D and LI-3D > LI-2D but similar outcomes among HI-2D, HI-3D, and LI-3D. The variety of effective RE approaches provides flexibility among older adults for selecting a lifestyle intervention that would be most sustainable.