Neurobiomarker and body temperature responses to recreational marathon running.

OBJECTIVES: To assess how biomarkers indicating central nervous system insult (neurobiomarkers) vary in peripheral blood with exertional-heat stress from prolonged endurance exercise. DESIGN: Observational study of changes in neuron specific enolase (NSE), S100 calcium-binding protein B (S100ß), Glial Fibrillary Acid Protein (GFAP) and Ubiquitin carboxyl-terminal hydrolase isozyme L1 (UCHL1) at Brighton Marathon 2022. METHODS: In 38 marathoners with in-race core temperature (Tc) monitoring, exposure (High, Intermediate or Low) was classified by cumulative hyperthermia - calculated as area under curve of Time × Tc > 38 °C - and also by running duration (finishing time). Blood was sampled for neurobiomarkers, cortisol and fluid-regulatory stress surrogates, including copeptin and creatinine (at rested baseline; within 30 min of finishing; and at 24 h). RESULTS: Finishing in 236 ±â€¯40 min, runners showed stable GFAP and UCH-L1 across the marathon and next-day. Significant (P < 0.05) increases from baseline were shown post-marathon and at 24 h for S100ß (8.52 [3.65, 22.95] vs 39.0 [26.48, 52.33] vs 80.3 [49.1, 99.7] ng·L-1) and post-marathon only for NSE (3.73 [3.30, 4.32] vs 4.85 [4.45, 5.80] µg·L-1, P < 0.0001). Whilst differential response to hyperthermia was observed for cortisol, copeptin and creatinine, neurobiomarker responses did not vary. Post-marathon, only NSE differed by exercise duration (High vs Low, 5.81 ±â€¯1.77 vs. 4.69 ±â€¯0.73 µg·L-1, adjusted P = 0.0358). CONCLUSIONS: Successful marathon performance did not associate with evidence for substantial neuronal insult. To account for variation in neurobiomarkers with prolonged endurance exercise, factors additional to hyperthermia, such as exercise duration and intensity, should be further investigated.

Physiological and perceptual responses during walking at set and preferred pace in normal and overweight adults.

BACKGROUND: This study aimed to investigate the influence of body weight, exercise modality, and pace on physiological and perceptual responses to determine the relation between perceptual and physiological responses. METHODS: Aerobically untrained, normal weight, and overweight males and females participated. Participants were randomly assigned to one exercise condition for a 1-mile walk. RESULTS: Prescribed pace resulted in a greater physiological stress than self-selected pace (all p < 0.001) through blood lactate (1.3 ± 0.4 vs 1.7 ± 0.5 mmol), systolic blood pressure (128.9 ± 10.3 vs 139.2 ± 13.2 mmHg), heart rate recovery (2.1 ± 1.7 vs 4.5 ± 2.6 min), oxygen consumption (15.1 ± 2.6 vs 18.1 ± 3.6 ml/kg/min), heart rate (111.7 ± 16.6 vs 134.4 ± 8.3 bpm), and energy expenditure (5.5 ± 1.4 vs 6.8 ± 1.7 kcal/min). Overweight individuals exhibited higher values than normal weight for heart rate (113 ± 8.8 vs 125.5 ± 13.2 bpm, p < 0.001), percentage of max heart rate (60.7 vs 69.0%, p < 0.001), percent of VO2peak (42.2 vs 55.6%, p < 0.001), and total energy expenditure (100.9 ± 27.4 vs 114.1 ± 33.5 kcal, p = 0.022). Greater perceived effort was seen on a treadmill (6.3 ± 0.5 vs 12.5 ± 2.0 RPE, p < 0.001) and at prescribed pace (6.5 ± 1.1 vs 8.9 ± 1.9 RPE, p < 0.001). CONCLUSION: A novel finding of this study was the increased physiological stress and perception of effort on a treadmill and at a prescribed pace, while total energy expenditure showed no significant differences. This could indicate an unfavorable perception and less affective response to the treadmill modality. These results indicate exercise at self-selected pace in preferred environments promotes enjoyable experiences with similar health benefits as those during prescribed higher intensity exercise.

Post marathon cardiac troponin T is associated with relative exercise intensity.

OBJECTIVES: This study aimed to investigate whether measures of cardiopulmonary fitness and relative exercise intensity were associated with high sensitivity cardiac troponin T (cTnT) rise after a road marathon. METHODS: Fifty-two marathon runners (age 39±11 years, body mass 76.2±12.9kg, height 1.74±0.09m) attended the laboratory between 2 and 3 weeks prior to attempting the Brighton Marathon, UK. Running economy at 10kmh-1 (RE10) and race pace (RERP), ventilatory threshold (VT) and VO2max tests were completed. CTnT was measured within 48h prior to the marathon and within 10min of completing the marathon, using a high sensitivity assay. Heart rates (HR) were recorded throughout the marathon. RESULTS: Runners demonstrated a significant increase in cTnT over the marathon (pre-race 5.60±3.27ngL-1, post-race 74.52±30.39ngL-1, p<0.001). Markers of endurance performance such as running economy (10kmh-1 223±18mlkg-1km-1; race pace 225±22mlkg-1km-1), VT (38.5±6.4mlkg-1min-1) and V˙O2max (50.9±7.7mlkg-1min-1) were not associated with post-race cTnT. Runners exercise intensity correlated with post-race cTnT (mean HR %VT 104±5%, r=0.50; peak HR %VT 118±8%, r=0.68; peak HR %V˙O2max 96±6, r=0.60, p<0.05) and was different between the low, medium and high cTnT groups (p<0.05). CONCLUSIONS: CTnT increases above reference limits during a marathon. Magnitude of cTnT rise is related to exercise intensity relative to ventilatory threshold and V˙O2max, but not individuals' absolute cardiopulmonary fitness, training state or running history.

Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review.

INTRODUCTION: A growing body of evidence suggests even small rises in serum creatinine (SCr) are of considerable clinical relevance. Given that participants in endurance events are exposed to potential (repeated) renal insults, a systematic review was undertaken to collate current evidence for acute kidney injury (AKI), complicating such events. METHODS: A systematic review of studies and case reports meeting inclusion criteria on Medline and EMBASE (inception to October 2015). Included: studies with markers of renal function before and after endurance or ultraendurance events; case reports of severe AKI. Two reviewers assessed risk of bias using the Newcastle-Ottawa scale. RESULTS: Eleven case report publications (n=27 individuals) of severe AKI, were retrieved, with risk factors including systemic illness or nephrotoxic medications usually identified. From 30 studies of endurance and ultraendurance events, mean rise in SCr was 29 (±12.3) µmol/L after marathon or ultramarathon (17 studies, n=568 participants) events. Where follow-up tests were conducted, SCr returned to baseline within 48 hours. Rises in biomarkers suggest potential parenchymal insult, rather than simply muscle breakdown. However, evidence of long-term deleterious effects is lacking. CONCLUSIONS: Raised levels of SCr are reported immediately after endurance events. It is not clear whether this is either clinically significant, or if repeated participation predisposes to long-term sequelae. The aetiology of severe exercise-associated AKI is usually multifactorial, with risk factors generally identified in the rare cases reported. On-site biochemistry, urine analysis and biomarkers of AKI may help identify collapsed runners who are at significant short-term risk and allow suitable follow-up.

Feral Swine Leptospira Seroprevalence Survey in Hawaii, USA, 2007-2009.

Leptospirosis is considered the most widespread of zoonotic diseases. It was a notifiable disease in the United States until 1995 and was reinstated to the list of nationally notifiable diseases in 2014. During the time of national surveillance, Hawaii consistently led the nation in reported annual incidence rates. Leptospirosis has remained a reportable disease in Hawaii. Significant changes have been documented since the early 1970s in the predominant serogroup infecting humans in Hawaii: infections due to Icterohaemorrhagiae have declined while infections due to Australis have increased. A recent study from Hawaii demonstrated that Australis was an uncommon infecting serogroup for small mammal hosts. Swine have not been previously studied in Hawaii but are well-recognized maintenance hosts for leptospires belonging to the Australis serogroup. This study was undertaken to assess the prevalence of Leptospira antibody in feral swine in Hawaii. From January 2007 through December 2009, blood samples were collected opportunistically from feral swine. Using the microscopic agglutination test, we found antibody titres ≥1 : 100 to leptospires in 272 (33.8%) of 804 feral swine. The most frequently reacting serovars to the swine sera were Icterohaemorrhagiae (Icterohaemorrhagiae serogroup) (41.5%) and Bratislava (Australis serogroup) (33.8%). The high seroprevalence and presumptively infecting serovars suggest a link between swine and human infection.

Classification of Leptospira genomospecies 1, 3, 4 and 5 as Leptospira alstonii sp. nov., Leptospira vanthielii sp. nov., Leptospira terpstrae sp. nov. and Leptospira yanagawae sp. nov., respectively.

The genus Leptospira currently comprises 16 named species. In addition, four unnamed hybridization groups were designated Leptospira genomospecies 1, 3, 4 and 5. These groups represent valid species-level taxa, but were not assigned names in the original description by Brenner et al. [Int J Syst Bacteriol 49, 839-858 (1999)]. To rectify this situation, it is proposed that Leptospira genomospecies 1, genomospecies 3, genomospecies 4 and genomospecies 5 should be classified as Leptospira alstonii sp. nov., Leptospira vanthielii sp. nov., Leptospira terpstrae sp. nov. and Leptospira yanagawae sp. nov., respectively, with strains L. alstonii 79601(T) ( = ATCC BAA-2439(T)), L. vanthielii WaZ Holland(T) ( = ATCC 700522(T)), L. terpstrae LT 11-33(T) ( = ATCC 700639(T)) and L. yanagawae Sao Paulo(T) ( = ATCC 700523(T)) as the type strains. The type strains are also available from the culture collections of the WHO Collaborating Centres in Amsterdam, The Netherlands, and Brisbane, Australia.

Analysis of multilocus sequence typing for identification of Leptospira isolates in Brazil.

A collection of 101 Leptospira isolates was tested by multilocus sequence typing (MLST) and by traditional serotyping. MLST divided the isolates into 4 sequence types (STs), while serotyping classified them into 6 serogroups. Two isolates failed to generate products for some genes by MLST. MLST was less discriminatory than serotyping for uncommonly occurring isolates from humans in Brazil.

Therapeutic hypothermia following out-of-hospital cardiac arrest; does it start in the emergency department?

BACKGROUND: The use of therapeutic hypothermia after cardiac arrest is a well-practised treatment modality in the intensive care unit (ICU). However, recent evidence points to advantages in starting the cooling process as soon as possible after the return of spontaneous circulation (ROSC). There are no data on implementation of this treatment in the emergency department. METHODS: A telephone survey was conducted of the 233 emergency departments in the UK. The most senior available clinician was asked if, in cases where they have a patient with a ROSC after an out-of-hospital cardiac arrest, would therapeutic hypothermia be started in the emergency department. RESULTS: Of the 233 hospitals called, 230 responded, of which 35% would start cooling in the emergency department. Of this 35%, over half (56%) said the decision to start cooling was made by the emergency physician before consultation with the ICU. Also, of the 35% who would begin cooling in the emergency department, 55% would cool only for ventricular fibrillation/ventricular tachycardia, 66% would monitor temperature centrally, and 14% would use specialised cooling equipment. CONCLUSIONS: There is often a delay in getting patients to ICU from the emergency department, and thus the decision not to start cooling in the emergency department may impact significantly on patient outcome. The dissemination of these data may persuade emergency physicians that starting treatment in the emergency department is an appropriate and justifiable decision that is becoming a more accepted practice throughout the UK.

Application of pulsed-field gel electrophoresis for the discrimination of leptospiral isolates in Brazil.

AIMS: Leptospirosis is a public health problem worldwide. Traditionally, microscopic agglutination test (MAT) and cross-agglutinin absorption test (CAAT) are used to identify leptospires. However, these techniques are laborious and time-consuming, requiring the maintenance of a collection of more than 200 reference strains and correspondent rabbit antisera. The purpose of this study was to evaluate the pulsed-field gel electrophoresis (PFGE) method for discrimination of Leptospira serovars. METHODS AND RESULTS: Fourteen clinical isolates of Leptospira spp. were analysed by MAT before being characterized by PFGE. The isolates were compared with a library of 206 different reference Leptospira serovars. All the isolates gave clear profiles with high resolution. PFGE and MAT results were in agreement for all clinical isolates evaluated. Twelve isolates were classified as serovar Icterohaemorrhagiae/Copenhageni by PFGE. By MAT, these isolates were classified as serogroup Icterohaemorrhagiae with titres ranging from 3200 to 25 600. Two isolates were classified as serovar Canicola by PFGE, and as serogroup Canicola by MAT with titres higher than 3200. CONCLUSIONS: PFGE offers the advantages of simple, reliable and reproducible results. SIGNIFICANCE AND IMPACT OF THE STUDY: PFGE provides a convenient tool for the identification of clinical isolates.

Assessing cost effectiveness of empirical and prophylactic therapy for managing leptospirosis outbreaks.

This study evaluates the utility and cost effectiveness of empirical and prophylactic antibiotic treatment of leptospirosis compared with conventional management. We developed decision trees comparing empirical antibiotic treatment (within 4-7 days of symptom onset) or prophylaxis to conventional antibiotic treatment (initiated 7 days post-onset). Costs were calculated using both US and Barbados pricing. Empirical treatment provided slightly lower probability of survival, while prophylactic treatment resulted in slightly higher survival rates. Antibiotic treatment initiated after 4-7 symptomatic days was ineffective in preventing serious health outcomes, but cost less with the exception of azithromycin (US pricing). Empirical treatment in Barbados cost less than conventional treatment. Prophylaxis reduced rare serious health outcomes and resulted in significant cost savings for the United States and Barbados. Prophylactic therapy for high-risk individuals or prompt diagnosis and early treatment (before 4 days of symptoms) appear to be cost-effective approaches to prevent severe complications of leptospirosis.

Volumetric characterization of the Aurora magnetic tracker system for image-guided transorbital endoscopic procedures.

In some medical procedures, it is difficult or impossible to maintain a line of sight for a guidance system. For such applications, people have begun to use electromagnetic trackers. Before a localizer can be effectively used for an image-guided procedure, a characterization of the localizer is required. The purpose of this work is to perform a volumetric characterization of the fiducial localization error (FLE) in the working volume of the Aurora magnetic tracker by sampling the magnetic field using a tomographic grid. Since the Aurora magnetic tracker will be used for image-guided transorbital procedures we chose a working volume that was close to the average size of the human head. A Plexiglass grid phantom was constructed and used for the characterization of the Aurora magnetic tracker. A volumetric map of the magnetic space was performed by moving the flat Plexiglass phantom up in increments of 38.4 mm from 9.6 mm to 201.6 mm. The relative spatial and the random FLE were then calculated. Since the target of our endoscopic guidance is the orbital space behind the optic nerve, the maximum distance between the field generator and the sensor was calculated depending on the placement of the field generator from the skull. For the different field generator placements we found the average random FLE to be less than 0.06 mm for the 6D probe and 0.2 mm for the 5D probe. We also observed an average relative spatial FLE of less than 0.7 mm for the 6D probe and 1.3 mm for the 5D probe. We observed that the error increased as the distance between the field generator and the sensor increased. We also observed a minimum error occurring between 48 mm and 86 mm from the base of the tracker.

Laser range scanning for image-guided neurosurgery: investigation of image-to-physical space registrations.

In this article a comprehensive set of registration methods is utilized to provide image-to-physical space registration for image-guided neurosurgery in a clinical study. Central to all methods is the use of textured point clouds as provided by laser range scanning technology. The objective is to perform a systematic comparison of registration methods that include both extracranial (skin marker point-based registration (PBR), and face-based surface registration) and intracranial methods (feature PBR, cortical vessel-contour registration, a combined geometry/intensity surface registration method, and a constrained form of that method to improve robustness). The platform facilitates the selection of discrete soft-tissue landmarks that appear on the patient's intraoperative cortical surface and the preoperative gadolinium-enhanced magnetic resonance (MR) image volume, i.e., true corresponding novel targets. In an 11 patient study, data were taken to allow statistical comparison among registration methods within the context of registration error. The results indicate that intraoperative face-based surface registration is statistically equivalent to traditional skin marker registration. The four intracranial registration methods were investigated and the results demonstrated a target registration error of 1.6 +/- 0.5 mm, 1.7 +/- 0.5 mm, 3.9 +/- 3.4 mm, and 2.0 +/- 0.9 mm, for feature PBR, cortical vessel-contour registration, unconstrained geometric/intensity registration, and constrained geometric/intensity registration, respectively. When analyzing the results on a per case basis, the constrained geometric/intensity registration performed best, followed by feature PBR, and finally cortical vessel-contour registration. Interestingly, the best target registration errors are similar to targeting errors reported using bone-implanted markers within the context of rigid targets. The experience in this study as with others is that brain shift can compromise extracranial registration methods from the earliest stages. Based on the results reported here, organ-based approaches to registration would improve this, especially for shallow lesions.

A prototype ultrasound-guided laparoscopic radiofrequency ablation system.

BACKGROUND: Advanced laparoscopic procedures, particularly laparoscopic liver resection and ablation, may benefit from image-guided surgery techniques that involve interactive three-dimensional imaging and instrument tracking. METHODS: A prototype system for laparoscopic ultrasound-guided radiofrequency ablation was designed and implemented. This system uses an infrared camera to track instruments and runs on a personal computer. Features of the system include spatially registered ultrasound visualization, volume reconstruction, and interactive targeting. Targeting of accuracy studies was performed by directing a tracked needle to a phantom target. RESULTS: Ultrasound data collection and volume reconstruction can be achieved within minutes and interactively reviewed by the surgeon. Early results with phantom experiments demonstrate a targeting accuracy of 5 to 10 mm. CONCLUSIONS: These results support the further development of this and similar image-guided surgery systems for specific laparoscopic procedures. Eventually, rigorous clinical evaluation will be necessary to prove their value.

Reclassification of Leptospira parva Hovind-Hougen et al. 1982 as Turneriella parva gen. nov., comb. nov.

Analysis of the G+C content, DNA-DNA relatedness to other leptospires and 16S rRNA gene sequence of Leptospira parva showed that this species was not related to other Leptospira species. On the basis of these data, it is proposed that Leptospira parva should be transferred to the genus Turneriella as Turneriella parva gen. nov., comb. nov., with strain H(T) (=NCTC 11395(T)=ATCC BAA-1111(T)) as the type strain.

Ultrasound-to-computer-tomography registration for image-guided laparoscopic liver surgery.

BACKGROUND: The application of image-guided surgery (IGS) to laparoscopic liver resection and ablation is currently limited, but it would assist in intraoperative decision making regarding oncologic margins, ablation probe placement, and ablation tracking. METHODS: Eight spherical surface targets on a liver phantom were imaged with an optically tracked laparoscopic ultrasound (US) probe. Ten US images of each target were registered to computer tomography (CT) images of the phantoms and then mapped to the CT scans. Accuracy of the registration was assessed by comparing the distance between the predicted target location and the position obtained directly from CT. RESULTS: The average localization error was 5.3 mm. The errors resulted primarily from inaccurate US probe tracking but were otherwise insensitive to the variability that arises from manually identifying targets in US and CT images. CONCLUSIONS: The results obtained for US-to-CT registration in a phantom model suggest that further investigations into its clinical use are warranted and that other IGS technologies could be applied to laparoscopic liver surgery as well.

Beam calibration without a phantom for creating a 3-D freehand ultrasound system.

To create a freehand three-dimensional (3-D) ultrasound (US) system for image-guided surgical procedures, an US beam calibration process must be performed. The calibration method presented in this work does not use a phantom to define in 3-D space the pixel locations in the beam. Rather, the described method is based on the spatial relationship between an optically tracked pointer and a similarly tracked US transducer. The pointer tip was placed into the US beam, and US images, physical coordinates of the pointer and the transducer location were simultaneously recorded. US image coordinates of the pointer were mapped to the physical points using two different registration methods. Two sensitivity studies were performed to determine the location and number of points needed to calibrate the beam accurately. Results showed that the beam is most efficiently calibrated with approximately 20 points collected from throughout the beam. This method of beam calibration proved to be highly accurate, yielding registration errors of approximately 0.4 mm.

Evaluation of environmental dose at JCO using luminescence from quartz stimulated by blue light.

The environmental dose due to the recent nuclear accident at JCO, Japan, was estimated using luminescence optically stimulated from unheated quartz. Two methods originally developed for dating analysis, the single aliquot additive dose method and the single aliquot regeneration added dose method, were employed to confirm the dose rate. Consistent results were obtained from both methods and from thermoluminescence measurements. Although the dose rate values had lower precision than can be obtained from heated materials, it is suggested that luminescence from sedimentary quartz can usefully be employed in retrosepective dosimetry.

The process and development of image-guided procedures.

Medical imaging has been used primarily for diagnosis. In the past 15 years there has been an emergence of the use of images for the guidance of therapy. This process requires three-dimensional localization devices, the ability to register medical images to physical space, and the ability to display position and trajectory on those images. This paper examines the development and state of the art in those processes.