Short- and long-term performance of risk calculation tools for mortality in patients with acute coronary syndrome.

Background: The mortality rate of acute coronary syndrome (ACS) remains high. Therefore, patients with ACS should undergo early risk stratification, for which various risk calculation tools are available. However, it remains uncertain whether the predictive performance varies over time between risk calculation tools for different target periods. This study aimed to compare the predictive performance of risk calculation tools in estimating short- and long-term mortality risks in patients with ACS, while considering different observation periods using time-dependent receiver operating characteristic (ROC) analysis. Methods: This study included 404 consecutive patients with ACS who underwent coronary angiography at our hospital from March 2017 to January 2021. The ACTION and GRACE scores for short-term risk stratification purposes and CRUSADE scores for long-term risk stratification purposes were calculated for all participants. The participants were followed up for 36 months to assess mortality. Using time-dependent ROC analysis, we evaluated the area under the curve (AUC) of the ACTION, CRUSADE, and GRACE scores at 1, 6, 12, 24, and 36 months. Results: Sixty-six patients died during the observation periods. The AUCs at 1, 6, 12, 24, and 36 months of the ACTION score were 0.942, 0.925, 0.889, 0.856, and 0.832; those of the CRUSADE score were 0.881, 0.883, 0.862, 0.876, and 0.862; and those of the GRACE score 0.949, 0.928, 0.888, 0.875, and 0.860, respectively. Conclusions: The ACTION and GRACE scores were excellent risk stratification tools for mortality in the short term. The prognostic performance of each risk score was almost similar in the long term, but the CRUSADE score might be a superior risk stratification tool in the longer term than 3 years.

Elderly onset atypical Lemierre's syndrome concurrent with a rheumatoid vasculitis sacral ulcer infection: a case report.

BACKGROUND: Typical Lemierre's syndrome is usually secondary to an oropharyngeal infection. Recently, several cases following a primary infection site other than the oropharynx have been reported as atypical Lemierre's syndrome; although, these primary lesions are limited to the head and neck. This is the first case potentially sequential to infectious foci outside the head and neck. CASE PRESENTATION: We describe an atypical Lemierre's syndrome in a 72-year-old woman with rheumatoid arthritis, which occurred during the treatment of Streptococcus anginosus bacteremia acquired from a sacral ulcer infection related to rheumatoid vasculitis. At first, the symptoms resolved after the initial administration of vancomycin for the bacteremia caused by methicillin-resistant Staphylococcus aureus and Streptococcus anginosus that entered via a sacral ulcer. On the 8th day, the patient developed a fever of 40 °C and unexpectedly required 10 L of oxygen due to rapid deterioration of oxygenation temporarily. Immediately contrast-enhanced computed tomography was performed to investigate systemic thrombosis including pulmonary embolism. Afterward, the newly formed thrombi at the right external jugular vein, bilateral internal jugular veins, and the right small saphenous vein were detected, and apixaban was started. On the 9th day, the patient again had an intermittent fever of 39.7 °C, and continuous Streptococcus anginosus bacteremia was revealed; subsequently, clindamycin was administered. On the 10th day, she developed a left hemothorax; consequently, apixaban was discontinued, and a thoracic drain was inserted. She repeatedly had an intermittent fever of 40.3 °C, and contrast-enhanced computed tomography detected an abscess formation at the left parotid gland, pterygoid muscle group, and masseter muscle. After Lemierre's syndrome was diagnosed in combination with the abovementioned jugular vein thrombus, clindamycin was replaced with meropenem, and vancomycin was increased. Swelling of the lower part of the left ear became prominent with delay and peaked at approximately the 16th day. The subsequent treatment course was favorable, and she was discharged on the 41st day. CONCLUSION: Clinicians should consider Lemierre's syndrome as the differential diagnosis of internal jugular vein thrombosis occurring during sepsis, even though an antibiotic is administered or a primary infection site is anything besides the oropharynx.

A case of metastatic endobronchial tumor from uterine leiomyosarcoma.

A 54-year-old woman presented with persistent productive cough, found to have an endobronchial tumor which obstructed the left upper lobe bronchus. Histopathological examination of a transbronchial biopsy of the endobronchial tumor suggested leiomyosarcoma. A positron emission tomography (PET)-CT revealed uterus tumor with moderate uptake of 18F-fluorodeoxyglucose, suggesting uterine malignancies. From the results of histological findings of the resected uterus and the biopsied bronchial specimen, she was diagnosed with uterine leiomyosarcoma and endobronchial metastasis. The systematic use of PET-CT could be useful for patients presenting with tumors that cause endobronchial metastasis of leiomyosarcomas.

Estimation of Cerebral Hemodynamics and Oxygenation During Various Intensities of Rowing Exercise: An NIRS Study.

Purpose: This study aimed to investigate changes in cerebral hemodynamics and oxygenation at moderate, heavy, maximal and supramaximal intensities of rowing exercise. It also examined whether these changes reflect alterations in sensation of effort and mood. We also aimed to examine the effects of peak pulmonary oxygen consumption ( V . O2peak ) on cerebral oxygenation. Methods: Eleven rowers, consisting out of six athletes and five recreational rowers [two female; age, 27 ± 9 years; height, 171 ± 7 cm, body mass, 67 ± 9 kg; V . O2peak , 53.5 ± 6.5 mL min-1 kg-1] rowed a 13-min session separated by 10 and 3 min, at 70 (Ex70%) and 80% of V . O2peak (Ex80%), respectively, on a rowing ergometer, followed by three sessions of 1-min supramaximal exercise (ExSp). After a warm-up at 60% of V . O2peak (ExM), seven male rowers performed a 2,000 m all-out test (Ex2000). Cardiovascular and respiratory variables were measured. Cerebral oxygenation was investigated by near-infrared time-resolved spectroscopy (TRS) to measure cerebral hemoglobin oxygen saturation (ScO2) and total hemoglobin concentration ([HbT]) in the prefrontal cortex (PFC) quantitatively. We estimated the relative changes from rest in cerebral metabolic rate for oxygen (rCMRO2) using TRS at all intensities. During Ex70% and Ex80%, ratings of perceived exertion (RPE) were monitored, and alteration of the subject's mood was evaluated using a questionnaire of Positive-and-Negative-Affect-Schedule after Ex70% and Ex80%. Results: When exercise intensity changed from Ex70% to Ex80%, the sense of effort increased while ScO2 decreased. [HbT] remained unchanged. After Ex70% and Ex80%, a negative mood state was less prominent compared to rest and was accompanied by increases in both ScO2 and [HbT]. At termination of Ex2000, ScO2 decreased by 23% compared to rest. Changes in ScO2 correlated with V . O2peak only during Ex2000 (r = -0.86; p = 0.01). rCMRO2 did not decrease at any intensities. Conclusion: Our results suggest that alterations in the sense of effort are associated with oxygenation in the PFC, while positive changes in mood status are associated with cerebral perfusion and oxygen metabolism estimated by TRS. At exhaustion, the cerebral metabolic rate for oxygen is maintained despite a decrease in ScO2.

Stretch-Shortening Cycle Function of Lower Limbs After Cycling in Triathletes.

ABSTRACT: Takahashi, K, Shirai, Y, and Nabekura, Y. Stretch-shortening cycle function of lower limbs after cycling in triathletes. J Strength Cond Res 36(9): 2610-2614, 2022-Impaired cardiorespiratory response and changes in biomechanical variables occur when running after cycling relative to isolated running. Nevertheless, little is known about the causes of these changes or the training to prevent them. This study aimed (a) to determine whether stretch-shortening cycle (SSC) function decreases after cycling exercise and (b) to determine whether the decreases in SSC function are related to brick training. Eleven male university triathletes performed hopping tests to measure SSC function before and after cycling (30 minutes of cycling at 110% ventilatory threshold). Stretch-shortening cycle function was calculated as the ratio of the jump height to the time spent in contact with the ground (reactive strength index [RSI]). Brick training was evaluated by the total experience of brick training. The RSI significantly decreased after the cycling exercise (-10.7%; p < 0.01), but changes in RSI after cycling did not significantly correlate with the total experience of brick training, despite a large effect size ( p < 0.10; r = 0.62). These results suggest that SSC function decreases after cycling and that brick training is potentially useful for inhibiting decreases in SSC function after cycling.

The effect of a decrease in stretch-shortening cycle function after cycling on subsequent running.

OBJECTIVES: Increased cardiorespiratory responses and changes in muscle activity and running kinematics occur in running after cycling compared with isolated running. Nevertheless, little is known about the causes of these changes. Cycling exercise decreases the stretch-shortening cycle (SSC) function, which can influence subsequent running. This study aimed to clarify whether the decrease in SSC function after cycling causes cardiorespiratory and biomechanical changes in subsequent running. DESIGN: Cross-sectional laboratory study. Participants were divided into two groups based on SSC function: an SSC dec group (those with decreased SSC function after cycling) and an SSC non-dec group (those without decreased SSC function after cycling). METHODS: Eighteen participants (10 triathletes and 8 runners) completed maximal aerobic tests for running and cycling. After these sessions, a submaximal run-cycle-run test was performed to compare between control run (no preceding cycle) and transition run (preceded by cycling). A jump test was administered before and after the submaximal cycling. SSC function was calculated as the ratio of the jump height to the time spent in contact with the ground (reactive strength index). Gas exchange measures, heart rate, and gait parameters were collected throughout the test. RESULTS: Oxygen uptake and ventilation were increased by cycling in the SSC dec group but not in the SSC non-dec group. In both groups, there were no significant differences in the gait parameters between control and transition runs. CONCLUSIONS: The decrease in SSC function after cycling would increase cardiorespiratory responses in subsequent running.

Impact of Hydrostatic Pressure Variations Caused by Height Differences in Supine and Prone Positions on Fractional Flow Reserve Values in the Coronary Circulation.

OBJECTIVES: To examine the influence of hydrostatic pressure on fractional flow reserve (FFR) in vivo. BACKGROUND: Systematic differences in FFR values have been observed previously in the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). It has been suggested that as the hydrostatic pressure variations caused by the height differences between the catheter tip (mean aortic pressure (Pa)) and pressure-wire sensor (mean distal intracoronary pressure (Pd)) are small, intracoronary pressure need not be corrected. METHODS: Resting Pd/Pa and FFR values in 23 patients (27 lesions) were measured and compared in supine and prone positions. These values were corrected by hydrostatic pressure influenced by height levels and compared. Height differences between Pa and Pd were calculated using coronary computed tomography angiographies. RESULTS: In LAD, resting Pd/Pa and FFR values were significantly higher in the prone position than in the supine position (0.97 ± 0.05 vs 0.89 ± 0.04, P < 0.001 (resting Pd/Pa); 0.81 ± 0.09 vs 0.72 ± 0.07, P < 0.001 (FFR)). Conversely, in LCX and RCA, these values were significantly lower in the prone position (LCX: 0.93 ± 0.03 vs 0.98 ± 0.03, P < 0.001 (resting Pd/Pa); 0.84 ± 0.05 vs 0.89 ± 0.04, P < 0.001 (FFR); RCA: 0.91 ± 0.04 vs 0.98 ± 0.03, P=0.005 (resting Pd/Pa); 0.78 ± 0.07 vs 0.84 ± 0.07, P=0.019 (FFR)). FFR values corrected by hydrostatic pressure showed good correlations in the supine and prone positions (R 2 = 0.948 in LAD; R 2 = 0.942 in LCX; R 2 = 0.928 in RCA). CONCLUSIONS: Hydrostatic pressure variations due to height levels influence intracoronary pressure measurements and largely affect resting Pd/Pa and FFR, which might have caused systematic differences in FFR values between the anterior and posterior coronary territories.

Neuromuscular Fatigue and Metabolism during High-Intensity Intermittent Exercise.

PURPOSE: To examine the degree of neuromuscular fatigue development along with changes in muscle metabolism during two work-matched high-intensity intermittent exercise protocols in trained individuals. METHODS: In a randomized, counter-balanced, crossover design, 11 endurance-trained men performed high-intensity intermittent cycle exercise protocols matched for total work and including either multiple short-duration (18 × 5 s; SS) or long-duration (6 × 20 s; LS) sprints. Neuromuscular fatigue was determined by preexercise to postexercise changes in maximal voluntary contraction force, voluntary activation level and contractile properties of the quadriceps muscle. Metabolites and pH were measured in vastus lateralis muscle biopsies taken before and after the first and last sprint of each exercise protocol. RESULTS: Peak power output (11% ± 2% vs 16% ± 8%, P < 0.01), maximal voluntary contraction (10% ± 5% vs 25% ± 6%, P < 0.05), and peak twitch force (34% ± 5% vs 67% ± 5%, P < 0.01) declined to a lesser extent in SS than LS, whereas voluntary activation level decreased similarly in SS and LS (10% ± 2% vs 11% ± 4%). Muscle [phosphocreatine] before the last sprint was 1.5-fold lower in SS than LS (P < 0.001). Preexercise to postexercise intramuscular accumulation of lactate and H was twofold and threefold lower, respectively, in SS than LS (P < 0.001), whereas muscle glycogen depletion was similar in SS and LS. Rate of muscle glycolysis was similar in SS and LS during the first sprint, but twofold higher in SS than LS during the last sprint (P < 0.05). CONCLUSIONS: These findings indicate that, in endurance-trained individuals, multiple long-sprints induce larger impairments in performance along with greater degrees of peripheral fatigue compared to work-matched multiple short-sprints, with these differences being possibly attributed to more extensive intramuscular accumulation of lactate/H and to lower rates of glycolysis during multiple long-sprint exercise.

Caffeine and Bicarbonate for Speed. A Meta-Analysis of Legal Supplements Potential for Improving Intense Endurance Exercise Performance.

A 1% change in average speed is enough to affect medal rankings in intense Olympic endurance events lasting ~45 s to 8 min which for example includes 100 m swimming and 400 m running (~1 min), 1,500 m running and 4000 m track cycling (~4 min) and 2,000 m rowing (~6-8 min). To maximize the likelihood of winning, athletes utilizes legal supplements with or without scientifically documented beneficial effects on performance. Therefore, a continued systematic evidence based evaluation of the possible ergogenic effects is of high importance. A meta-analysis was conducted with a strict focus on closed-end performance tests in humans in the time domain from 45 s to 8 min. These test include time-trials or total work done in a given time. This selection criterion results in a high relevance for athletic performance. Only peer-reviewed placebo controlled studies were included. The often applied and potentially ergogenic supplements beta-alanine, bicarbonate, caffeine and nitrate were selected for analysis. Following a systematic search in Pubmed and SportsDiscuss combined with evaluation of cross references a total of 7 (beta-alanine), 25 (bicarbonate), 9 (caffeine), and 5 (nitrate) studies was included in the meta-analysis. For each study, performance was converted to an average speed (km/h) from which an effect size (ES; Cohens d with 95% confidence intervals) was calculated. A small effect and significant performance improvement relative to placebo was observed for caffeine (ES: 0.41 [0.15-0.68], P = 0.002) and bicarbonate (ES: 0.40 [0.27-0.54], P < 0.001). Trivial and non-significant effects on performance was observed for nitrate (ES: 0.19 [-0.03-0.40], P = 0.09) and beta-alanine (ES: 0.17 [-0.12-0.46], P = 0.24). Thus, caffeine's and bicarbonate's ergogenic effect is clearly documented for intense endurance performance. Importantly, for all supplements an individualized approach may improve the ergogenic effect on performance.