A new technique to analyse threshold-intensities based on time dependent change-points in the ratio of minute ventilation and end-tidal partial pressure of carbon-dioxide production.

The aim of this study was to test the utility and effectiveness of an alternative computational approach to threshold-intensities based on time dependent change-points in minute ventilation divided by end-tidal partial pressure of CO2 (VE/PETCO2) to reveal whether respiratory compensation point (RCP) is a third ventilatory threshold, or not. Ten recreationally active young adults and ten well-trained athletes volunteered to take part in this study. Following incremental ramp tests, gas exchange threshold (GET) and respiratory compensation point (RCP) were respectively evaluated by the slopes of VCO2-VO2 and VE-VCO2 using the Innocor system automatically. Respiratory threshold (RT) was analysed based on time dependent change-points in the VE/PETCO2 using binary segmentation algorithm. Additionally, those intersections were analysed independently by two experienced investigators using a visual identification technique in a double-blind design. According to the results, in the recreationally active group, there were the first (GET1) and the second (GET2) gas exchange thresholds which were identical with the RT1 (139 W; 1.9 L⋅min-1 of VO2; 1.73 L⋅min-1 of VCO2; 49.9 L⋅min-1 of VE versus 139 W; 1.88 L⋅min-1; 1.7 L⋅min-1; 49 L⋅min-1, respectively) and RT2 (186 W; 2.39 L⋅min-1 of VO2; 2.44 L⋅min-1 of VCO2; 66 L⋅min-1 of VE versus 187 W; 2.41 L⋅min-1; 2.49 L⋅min-1; 65.7 L⋅min-1, respectively). However, there were three threshold intensities which were determined by GET1, GET2, and RCP in well-trained athletes. Additionally, RT1, RT2, and RT3 were determined as valid surrogates of the GET1 (194 W; 2.56 L⋅min-1 of VO2; 1.99 L⋅min-1 of VCO2; 57.5 L⋅min-1 of VE versus 192 W; 2.61 L⋅min-1; 1.99 Lmin-1; 57.7 L⋅min-1, respectively), GET2 (267 W; 3.6 L⋅min-1 of VO2; 3.29 L⋅min-1 of VCO2; 94.5 L⋅min-1 of VE versus 266 W; 3.58 L⋅min-1; 3.26 L⋅min-1; 93.4 L⋅min-1, respectively), and RCP (324 W; 4.05 L⋅min-1 of VO2; 4.13 L⋅min-1 of VCO2; 124 L⋅min-1 of VE versus 322 W; 4.02 L⋅min-1; 4.07 L⋅min-1; 122 L⋅min-1, respectively) in well-trained athletes. There were high levels of agreements between the power outputs determined by traditional techniques and newly proposed change-points in RT. All markers were strongly correlated (p < 0.001). It was shown that RT technique can provide an accurate threshold determination. Furthermore, the RCP was observed as a third threshold-intensity for well-trained athletes but not for recreationally active young adults.

Demographic and Clinical Characteristics of Theophylline Exposures between 1993 and 2011.

BACKGROUND: Acute and chronic exposure to theophylline can cause serious signs and symptoms of poisoning. Additionally, with a narrow therapeutic range, toxicity could be observed even with therapeutic doses of theophylline. Epidemiological data on theophylline exposures in our country are extremely limited. The results of our study may improve the clinical management of theophylline poisoning in our country and elsewhere. AIMS: To present aetiological and demographic features, clinical findings and treatment attempts with regard to theophylline exposures reported to Dokuz Eylül University Drug and Poison Information Center (DPIC), between 1993 and 2011. STUDY DESIGN: Descriptive study. METHODS: The data regarding demographics, date, time, type of exposure, route of and reason for exposure, signs and symptoms upon admission, clinical management and outcome were retrospectively evaluated. RESULTS: The DPIC recorded 88,562 poisoning calls between 1993 and 2011; 354 (0.4%) of them were due to theophylline exposure. The mean age of all cases was 24.1±15.4 (range between 1 month and 90 years). Females dominated all age groups (72.6%, 257 females). Intentional exposure was significantly higher in women than in men (88.2% vs. 68.2% for all age groups; p<0.001 for children; p<0.001 for adults; p<0.001 for all age groups). While 60.5% of the cases had no symptoms, severe signs of toxicity were present in 1.9% of theophylline exposure cases during the telephone inquiry. Signs and symptoms were found to be significantly more prevalent in adults than in children (p<0.01). The serum theophylline level was regarded as toxic in 74% (65 toxic levels) of theophylline measured cases. Clinical signs and symptoms were found to be significantly prevalent in cases with toxic theophylline levels (p<0.001). The rate of gastrointestinal decontamination procedures was higher than that of recommended gastrointestinal decontamination procedures by DPIC (83% and 66%, respectively). There were two fatalities (4.6%) associated with chronic theophylline toxicity and theophylline overdose in an acute setting for suicide (a 90 year-old and 25 year-old, respectively). CONCLUSION: Although most of the theophylline exposure cases had no symptoms, some reported serious signs and symptoms of poisoning such as hypokalaemia, tachycardia and hyperglycaemia. DPICs have an important role in the management of theophylline exposure without unnecessary gastrointestinal decontamination procedures.

Mechanically braked elliptical Wingate test: modification considerations, load optimization, and reliability.

The 30-second, all-out Wingate test evaluates anaerobic performance using an upper or lower body cycle ergometer (cycle Wingate test). A recent study showed that using a modified electromagnetically braked elliptical trainer for Wingate testing (EWT) leads to greater power outcomes because of larger muscle group recruitment. The main purpose of this study was to modify an elliptical trainer using an easily understandable mechanical brake system instead of an electromagnetically braked modification. Our secondary aim was to determine a proper test load for the EWT to reveal the most efficient anaerobic test outcomes such as peak power (PP), average power (AP), minimum power (MP), power drop (PD), and fatigue index ratio (FI%) and to evaluate the retest reliability of the selected test load. Delta lactate responses (ΔLa) were also analyzed to confirm all the anaerobic performance of the athletes. Thirty healthy and well-trained male university athletes were selected to participate in the study. By analysis of variance, an 18% body mass workload yielded significantly greater test outcomes (PP = 19.5 ± 2.4 W·kg, AP = 13.7 ± 1.7 W·kg, PD = 27.9 ± 5 W·s, FI% = 58.4 ± 3.3%, and ΔLa = 15.4 ± 1.7 mM) than the other (12-24% body mass) tested loads (p < 0.05). Test and retest results for relative PP, AP, MP, PD, FI%, and ΔLa were highly correlated (r = 0.97, 0.98, 0.94, 0.91, 0.81, and 0.95, respectively). In conclusion, it was found that the mechanically braked modification of an elliptical trainer successfully estimated anaerobic power and capacity. A workload of 18% body mass was optimal for measuring maximal and reliable anaerobic power outcomes. Anaerobic testing using an EWT may be more useful to athletes and coaches than traditional cycle ergometers because a greater proportion of muscle groups are worked during exercise on an elliptical trainer.