Mild obstructive sleep apnoea in females: post hoc analysis of the MERGE randomised controlled trial.

Background: A post hoc analysis of the MERGE trial was conducted, to investigate whether sex differences are evident at the mildest end of the disease spectrum, for symptoms associated with obstructive sleep apnoea (OSA) and the response to continuous positive airway pressure (CPAP) treatment. Methods: MERGE participants with mild OSA (apnoea-hypopnoea index 5-15 events·h-1; American Academy of Sleep Medicine 2012 criteria) were randomised to either CPAP plus standard care (sleep hygiene counselling) or standard care alone for 3 months. Quality of life (QoL) was measured by questionnaires completed before and after the 3 months. This post hoc analysis of participants of the MERGE trial compared the symptom presentation, and response to CPAP, between the sexes. Results: 233 patients were included; 71 (30%) were female. Females were more symptomatic at baseline in all QoL questionnaires. Specifically, females had lower 36-item Short-Form Health Survey (SF-36) Vitality scores (mean±sd 39.1±10.1 versus 44.8±10.3) and higher Epworth Sleepiness Scale (ESS) scores (mean±sd 11.0±4.2 versus 9.5±4.4). Both sexes experienced snoring, but more females reported fatigue and more males reported witnessed apnoeas. All symptoms improved with CPAP for both sexes; however, females had larger improvements in SF-36 Vitality scores, which was the primary outcome of the MERGE trial (mean change 9.4 (95% CI 6.8-12.0) versus 6.0 (95% CI 4.3-7.7); p=0.034), and ESS (mean change -4.1 (95% CI -5.1- -3.0) versus -2.5 (95% CI -3.1- -1.8); p=0.015), after adjustment for baseline scores and CPAP usage. Conclusions: Sex differences are apparent in patients with mild OSA. Females experience worse QoL symptoms than males at presentation to the sleep clinic; however, these improve significantly with CPAP treatment.

A global perspective on collision and non-collision match characteristics in male rugby union: Comparisons by age and playing standard.

This study quantified and compared the collision and non-collision match characteristics across age categories (i.e. U12, U14, U16, U18, Senior) for both amateur and elite playing standards from Tier 1 rugby union nations (i.e. England, South Africa, New Zealand). Two-hundred and one male matches (5911 min ball-in-play) were coded using computerised notational analysis, including 193,708 match characteristics (e.g. 83,688 collisions, 33,052 tackles, 13,299 rucks, 1006 mauls, 2681 scrums, 2923 lineouts, 44,879 passes, 5568 kicks). Generalised linear mixed models with post-hoc comparisons and cluster analysis compared the match characteristics by age category and playing standard. Overall significant differences (p < 0.001) between age category and playing standard were found for the frequency of match characteristics, and tackle and ruck activity. The frequency of characteristics increased with age category and playing standard except for scrums and tries that were the lowest at the senior level. For the tackle, the percentage of successful tackles, frequency of active shoulder, sequential and simultaneous tackles increased with age and playing standard. For ruck activity, the number of attackers and defenders were lower in U18 and senior than younger age categories. Cluster analysis demonstrated clear differences in all and collision match characteristics and activity by age category and playing standard. These findings provide the most comprehensive quantification and comparison of collision and non-collision activity in rugby union demonstrating increased frequency and type of collision activity with increasing age and playing standard. These findings have implications for policy to ensure the safe development of rugby union players throughout the world.

The safety of rugby union, especially the tackle, has previously been questioned but limited data are available to understand the collision and non-collision match characteristics between different age categories and playing standards.The frequency of collision and non-collision match characteristics increase with age and playing standard except for the frequency of scrums and tries which are lowest at the Senior Elite level. The activity of the tackle and ruck are also different between age categories and playing standards.Hierarchical cluster analysis demonstrated clear differences in all and collision match characteristics between junior (i.e. U12, U14, U16), and amateur (i.e. U18 and senior) and elite (i.e. U18 and senior) playing levels.Governing bodies and practitioners should be aware of the differences in collision and non-collision match characteristics by age and playing standard, when reviewing future versions of rugby union.

Effects of long-term removal of sheep-grazing in a series of British upland plant communities: Insights from plant species composition and traits.

Environmental and management pressures are considered a threat for preserving plant communities worldwide. Identification of long-term impacts of changing management practices on plant community composition must, therefore, be a major priority to ensure improvement in conservation value. Land abandonment/wilding is one topical area where there is little available information on long-term impacts. To address this, here, we describe plant species compositional change over relatively long-time scales in a range of four British upland communities (high-level grasslands, intermediate grasslands, blanket bogs and high-level bogs) and its relationships with a series of life-history and plant trait variables. Our aims were to determine whether the business-as-usual sheep grazing practice was maintaining these communities, and if grazing was to be removed as part of abandonment/wilding strategies, would there be a conservation benefit. We used a series of long-term experimental grazing-exclosure studies at twelve sites (>40 years) on the Moor House National Nature Reserve in northern England. Each site consisted of paired plots; i.e. sheep-grazed versus ungrazed. Our results showed that there was relatively little change in dominant plant species with most change occurring within sub-dominant species. Similarly, different temporal responses in plant species richness were detected between the experiments (richness was reduced in three experiments, only one increased). In any case, the vegetation temporal trajectories were moving in similar direction in grazed and ungrazed plots at most sites. Interestingly, blanket bog experiments showed a clear compositional convergence for both grazed and ungrazed plots, although, the between-site differences related to a combination of elevation and past burning testament. Finally, the bryophytes (especially liverworts) and lichens were the groups that contributed most to the reductions in species richness. Moreover, implementation of a no-stock grazing strategy under a land abandonment/wilding approach will not bring about much plant change in the short-term in the plant communities studied here.

Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial.

BACKGROUND: The evidence base for the treatment of mild obstructive sleep apnoea is limited and definitions of disease severity vary. The MERGE trial investigated the clinical effectiveness of continuous positive airway pressure in patients with mild obstructive sleep apnoea. METHODS: MERGE, a multicentre, parallel, randomised controlled trial enrolled patients (≥18 years to ≤80 years) with mild obstructive sleep apnoea (apnoea-hypopnoea index [AHI] ≥5 to ≤15 events per h using either AASM 2007 or AASM 2012 scoring criteria) from 11 UK sleep centres. Participants were assigned (1:1) to either 3 months of continuous positive airway pressure plus standard care (sleep counselling), or standard care alone, by computer-generated randomisation; neither participants nor researchers were blinded. The primary outcome was a change in the score on the Short Form-36 questionnaire vitality scale in the intention-to-treat population of patients with mild obstructive sleep apnoea diagnosed using the American Academy of Sleep Medicine 2012 scoring criteria. The study is registered with ClinicalTrials.gov, NCT02699463. FINDINGS: Between Nov 28, 2016 and Feb 12, 2019, 301 patients were recruited and randomised. 233 had mild obstructive sleep apnoea using AASM 2012 criteria and were included in the intention-to-treat analysis: 115 were allocated to receive continuous positive airway pressure and 118 to receive standard care. 209 (90%) of these participants completed the trial. The vitality score significantly increased with a treatment effect of a mean of 10·0 points (95% CI 7·2-12·8; p<0·0001) after 3 months of continuous positive airway pressure, compared with standard care alone (9·2 points [6·8 to 11·6] vs -0·8 points [-3·2 to 1·5]). Using the ANCOVA last-observation-carried-forward analysis, a more conservative estimate, the vitality score also significantly increased with a treatment effect of a mean of 7·5 points (95% CI 5·3 to 9·6; p<0·0001) after 3 months of continuous positive airway pressure, compared with standard care alone (7·5 points [6·0 to 9·0] vs 0·0 points [-1·5 to 1·5]). Three serious adverse events occurred (one allocated to the continuous positive airway pressure group) and all were unrelated to the intervention. INTERPRETATION: 3 months of treatment with continuous positive airway pressure improved the quality of life in patients with mild obstructive sleep apnoea. These results highlight the need for health-care professionals and providers to consider treatment for patients with mild obstructive sleep apnoea. FUNDING: ResMed Ltd.

Substituted cysteine scanning in D1-S6 of the sodium channel hNav1.4 alters kinetics and structural interactions of slow inactivation.

Slow inactivation in voltage-gated Na+ channels (Navs) plays an important physiological role in excitable tissues (muscle, heart, nerves) and mutations that disrupt Nav slow inactivation can result in pathophysiologies (myotonia, arrhythmias, epilepsy). While the molecular mechanisms responsible for slow inactivation remain elusive, previous studies have suggested a role for the pore-lining D1-S6 helix. The goals of this research were to determine if (1) cysteine substitutions in D1-S6 affect gating kinetics and (2) methanethiosulfonate ethylammonium (MTSEA) accessibility changes in different kinetic states. Site-directed mutagenesis in the human skeletal muscle isoform hNav1.4 was used to substitute cysteine for eleven amino acids in D1-S6 from L433 to L443. Mutants were expressed in HEK cells and recorded from with whole-cell patch clamp. All mutations affected one or more baseline kinetics of the sodium channel, including activation, fast inactivation, and slow inactivation. Substitution of cysteine (for nonpolar residues) adjacent to polar residues destabilized slow inactivation in G434C, F436C, I439C, and L441C. Cysteine substitution without adjacent polar residues enhanced slow inactivation in L438C and N440C, and disrupted possible H-bonds involving Y437:D4 S4-S5 and N440:D4-S6. MTSEA exposure in closed, fast-inactivated, or slow-inactivated states in most mutants had little-to-no effect. In I439C, MTSEA application in closed, fast-inactivated, and slow-inactivated states produced irreversible reduction in current, suggesting I439C accessibility to MTSEA in all three kinetic states. D1-S6 is important for Nav gating kinetics, stability of slow-inactivated state, structural contacts, and state-dependent positioning. However, prominent reconfiguration of D1-S6 may not occur in slow inactivation.

Associations of Circulating Irisin Concentrations With Cardiometabolic Risk Factors Among Children Vary by Physical Activity or Sedentary Time Levels.

Whether irisin concentrations are associated with physical activity (PA) and sedentary time (ST) remains unknown. The role of irisin on cardiometabolic health among children has been contradictory and scarce. This study aimed to examine associations of PA and ST with irisin concentrations and relationships between irisin concentrations and cardiometabolic parameters among children. Additionally, we assessed the interaction between PA or ST and irisin concentrations on cardiometabolic parameters. Basing on a cross-sectional survey of 3,651 general children aged 7-12 years, 575 with different self-reported PA (moderate-vigorous intensity PA ≥ 60 min/day or <150 min/week) and ST (gender-, age-specific ST ≥ 75% or <25% percentile) levels were selected. PA and ST were assessed by the validated international physical activity questionnaires. Fasting blood glucose and lipid profile levels were measured with standard methods by biochemistry analyzer. Plasma irisin concentrations were measured by ELISA. The associations of PA and ST with circulating irisin concentrations were examined by linear regression. Linear regression analysis was also used to estimate associations of circulating irisin concentrations with cardiometabolic variables. Interactions between PA or ST and irisin concentrations on cardiometabolic parameters were calculated using multiple linear regression models with dichotomized factors (low PA and high PA; low ST and high ST). No significant association was observed between circulating irisin concentrations and habitual PA or ST. Irisin concentrations were negatively associated with body mass index (BMI) (ß = -0.220), BMI z-score (ß = -0.098), waist circumference (ß = -0.621), diastolic blood pressure (DBP) (ß = -0.561), and triglyceride (ß = -0.019) in low PA subgroup, and negatively related to fasting blood glucose (ß = -0.040) among high PA subgroup. Moreover, irisin concentrations were negatively associated with BMI (ß = -0.157) and fasting blood glucose (ß = -0.026) only in high ST subgroup (all P < 0.05). We also observed a significant interaction between PA and irisin concentrations on BMI (P interaction = 0.0350), BMI z-score (P interaction = 0.0173), and DBP (P interaction = 0.0068). In summary, irisin concentrations were not associated with habitual PA or ST in children. The negative associations of irisin concentrations with BMI, BMI z-score, and DBP were found only among children being inactive, implying that irisin may contribute to an improvement in health, especially among children with unhealthy lifestyles.

CHLOROPHYLL ALGORITHMS FOR OCEAN COLOR SENSORS - OC4, OC5 & OC6.

A high degree of consistency and comparability among chlorophyll algorithms is necessary to meet the goals of merging data from concurrent overlapping ocean color missions for increased coverage of the global ocean and to extend existing time series to encompass data from recently launched missions and those planned for the near future, such as PACE, OLCI, HawkEye, EnMAP and SABIA-MAR. To accomplish these goals, we developed 65 empirical ocean color (OC) maximum band ratio (MBR) algorithms for 25 satellite instruments using the largest available and most globally representative database of coincident in situ chlorophyll a and remote sensing reflectances. Excellent internal consistency was achieved across these OC 'Version -7' algorithms, as demonstrated by a median regression slope and coefficient of determination (R2) of 0.985 and 0.859, respectively, between 903 pairwise comparisons of OC-modeled chlorophyll. SeaWiFS and MODIS-Aqua satellite-to-in situ match-up results indicated equivalent, and sometimes superior, performance to current heritage chlorophyll algorithms. During the past forty years of ocean color research the violet band (412 nm) has rarely been used in empirical algorithms to estimate chlorophyll concentrations in oceanic surface water. While the peak in chlorophyll-specific absorption coincides with the 443 nm band present on most ocean color sensors, the magnitude of chlorophyll-specific absorption at 412 nm can reach upwards of ~70% of that at 443 nm. Nearly one third of total chlorophyll-specific absorption between 400 and 700 nm occurs below 443 nm, suggesting that bands below 443 nm, such as the 412 nm band present on most ocean color sensors, may also be useful in detecting chlorophyll under certain conditions and assumptions. The 412 nm band is also the brightest band (that is, with the most dominant magnitude) in remotely sensed reflectances retrieved by heritage passive ocean color instruments when chlorophyll is less than ~0.1 mg m-3, which encompasses ~24% of the global ocean. To attempt to exploit this additional spectral information, we developed two new families of OC algorithms, the OC5 and OC6 algorithms, which include the 412 nm band in the MBR. By using this brightest band in MBR empirical chlorophyll algorithms, the highest possible dynamic range of MBR may be achieved in these oligotrophic areas. The terms oligotrophic, mesotrophic, and eutrophic get frequent use in the scientific literature to designate trophic status; however, quantitative definitions in terms of chlorophyll levels are arbitrarily defined. We developed a new, reproducible, bio-optically based index for trophic status based on the frequency of the brightest, maximum band in the MBR for the OC6_SEAWIFS algorithm, along with remote sensing reflectances from the entire SeaWiFS mission. This index defines oligotrophic water as chlorophyll less than ~0.1 mg m-3, eutrophic water as chlorophyll above 1.67 mg m-3 and mesotrophic water as chlorophyll between 0.1 and 1.67 mg m-3. Applying these criteria to the 40-year mean global ocean chlorophyll data set revealed that oligotrophic, mesotrophic, and eutrophic water occupy ~24%, 67%, and 9%, respectively, of the area of the global ocean on average.

Impacts of prescribed burning on Sphagnum mosses in a long-term peatland field experiment.

Understanding fire impacts on peatland vegetation can inform management to support function and prevent degradation of these important ecosystems. However, time since burn, interval between burns and number of past burns all have the potential to modify impacts. Grazing regime may also affect vegetation directly or via an interaction with burning. We used new, comprehensive survey data from a hillslope-scale field experiment initiated in 1954 to investigate the effects of burning and grazing treatments on Sphagnum. Historical data were consulted to aid interpretation of the results. The unburned reference and the most frequently burned (10-year rotation) treatments had greater Sphagnum abundance and hummock height than intermediate treatments (20-year rotation and no-burn since 1954). Abundance of the most common individual species (S. capillifolium, S. subnitens and S. papillosum) followed similar patterns. Light grazing had no impact on Sphagnum-related variables, nor did it interact with the burning treatments.These results suggest that in some cases fire has a negative impact on Sphagnum, and this can persist for several decades. However, fire return interval and other factors such as atmospheric pollution may alter effects, and in some cases Sphagnum abundance may recover. Fire severity and site specific conditions may also influence effects, so we advise consideration of these factors, and caution when using fire as a management tool on peatlands where Sphagnum is considered desirable.

The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects > 3 million people in the UK. Acute exacerbations of COPD (AECOPD) are the second most common reason for emergency hospital admission in the UK. Pulmonary rehabilitation is usual care for stable COPD but there is little evidence for early pulmonary rehabilitation (EPR) following AECOPD, either in hospital or immediately post discharge. OBJECTIVE: To assess the feasibility of recruiting patients, collecting data and delivering EPR to patients with AECOPD to evaluate EPR compared with usual care. DESIGN: Parallel-group, pilot 2 × 2 factorial randomised trial with nested qualitative research and an economic analysis. SETTING: Two acute hospital NHS trusts. Recruitment was carried out from September 2015 to April 2016 and follow-up was completed in July 2016. PARTICIPANTS: Eligible patients were those aged ≥ 35 years who were admitted with AECOPD, who were non-acidotic and who maintained their blood oxygen saturation level (SpO2) within a prescribed range. Exclusions included the presence of comorbidities that affected the ability to undertake the interventions. INTERVENTIONS: (1) Hospital EPR: muscle training delivered at the patient's hospital bed using a cycle ergometer and (2) home EPR: a pulmonary rehabilitation programme delivered in the patient's home. Both interventions were delivered by trained physiotherapists. Participants were allocated on a 1 : 1 : 1 : 1 ratio to (1) hospital EPR (n = 14), (2) home EPR (n = 15), (3) hospital EPR and home EPR (n = 14) and (4) control (n = 15). Outcome assessors were blind to treatment allocation; it was not possible to blind patients. MAIN OUTCOME MEASURES: Feasibility of recruiting 76 participants in 7 months at two centres; intervention delivery; views on intervention/research acceptability; clinical outcomes including the 6-minute walk distance (6WMD); and costs. Semistructured interviews with participants (n = 27) and research health professionals (n = 11), optimisation assessments and an economic analysis were also undertaken. RESULTS: Over 7 months 449 patients were screened, of whom most were not eligible for the trial or felt too ill/declined entry. In total, 58 participants (76%) of the target 76 participants were recruited to the trial. The primary clinical outcome (6MWD) was difficult to collect (hospital EPR, n = 5; home EPR, n = 6; hospital EPR and home EPR, n = 5; control, n = 5). Hospital EPR was difficult to deliver over 5 days because of patient discharge/staff availability, with 34.1% of the scheduled sessions delivered compared with 78.3% of the home EPR sessions. Serious adverse events were experienced by 26 participants (45%), none of which was related to the interventions. Interviewed participants generally found both interventions to be acceptable. Home EPR had a higher rate of acceptability, mainly because patients felt too unwell when in hospital to undergo hospital EPR. Physiotherapists generally found the interventions to be acceptable and valued them but found delivery difficult because of staffing issues. The health economic analysis results suggest that there would be value in conducting a larger trial to assess the cost-effectiveness of the hospital EPR and hospital EPR plus home EPR trial arms and collect more information to inform the hospital cost and quality-adjusted life-year parameters, which were shown to be key drivers of the model. CONCLUSIONS: A full-scale randomised controlled trial using this protocol would not be feasible. Recruitment and delivery of the hospital EPR intervention was difficult. The data obtained can be used to design a full-scale trial of home EPR. Because of the small sample and large confidence intervals, this study should not be used to inform clinical practice. TRIAL REGISTRATION: Current Controlled Trials ISRCTN18634494. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 11. See the NIHR Journals Library website for further project information.

Markers of Bone Health, Bone-Specific Physical Activities, Nutritional Intake, and Quality of Life of Professional Jockeys in Hong Kong.

Weight-making practices, regularly engaged in by horse racing jockeys, have been suggested to impair both physiological and mental health. This study aimed to assess bone health markers, nutritional intake, bone-specific physical activity (PA) habits, and quality of life of professional jockeys in Hong Kong (n = 14), with gender-, age-, and body mass index-matched controls (n = 14). Anthropometric measurements, serum hormonal biomarkers, bone mineral density, bone-specific PA habits, nutritional intake, and quality of life were assessed in all participants. The jockey group displayed significantly lower bone mineral density at both calcanei than the control group (left: 0.50 ± 0.06 vs. 0.63 ± 0.07 g/cm2; right: 0.51 ± 0.07 vs. 0.64 ± 0.10 g/cm2, both ps < .01). Thirteen of the 14 jockeys (93%) showed either osteopenia or osteoporosis in at least one of their calcanei. No significant difference in bone mineral density was detected for either forearm between the groups. The current bone-specific PA questionnaire score was lower in the jockey group than the control group (5.61 ± 1.82 vs. 8.27 ± 2.91, p < .05). Daily energy intake was lower in the jockeys than the controls (1,360 ± 515 vs. 1,985 ± 1,046 kcal/day, p < .01). No significant group difference was found for micronutrient intake assessed by the bone-specific food frequency questionnaire, blood hormonal markers, and quality of life scores. Our results revealed suboptimal bone conditions at calcanei and insufficient energy intake and bone-loading PAs among professional jockeys in Hong Kong compared with healthy age-, gender-, and body mass index-matched controls. Further research is warranted to examine the effect of improved bone-loading PAs and nutritional habits on the musculoskeletal health of professional jockeys.

Influence of adipose tissue mass on bone mass in an overweight or obese population: systematic review and meta-analysis.

CONTEXT: The scientific literature shows conflicting evidence about the relationship between adiposity and bone mass in overweight and obese populations. The aim of this review was to quantify the correlation between adipose mass (absolute and relative) and bone mineral density (BMD) in overweight and obese populations. Three databases were searched electronically. In addition, reference lists of relevant articles were screened. A total of 16 studies, comprising 2587 participants and 75 correlation coefficients were selected for inclusion in the review. Data were extracted from each study using a standardized form. Multilevel modeling indicated opposing relationships between BMD and adiposity: absolute adiposity correlated positively, and relative adiposity negatively, with BMD. Sex and age were the primary moderators of these relationships. Strong evidence supported a negative relationship between relative adipose mass and BMD in men (R = -0.37; 95%CI, -0.57 to -0.12) and in those aged less than 25 years (R = -0.28; 95%CI, -0.45 to -0.08). To prevent bone loss in overweight and obese populations, nutrition- and exercise-based interventions that focus on a controlled reduction of adipose mass with concomitant preservation of lean mass are recommended. : PROSPERO no. CRD42015024313.

New insights in professional horse racing; "in-race" heart rate data, elevated fracture risk, hydration, nutritional and lifestyle analysis of elite professional jockeys.

Weight-making practices have been shown to impair musculoskeletal and physiological function of jockeys. This study investigated the "in-race" heart rate (HR) responses and hydration status during competitive racing, as well as selected physiological and lifestyle parameters of professional jockeys based in Hong Kong. "In-race" HR responses and early morning hydration status of 20 male jockeys were examined in hot and moderate climactic occasions. Additionally, bone mineral density (BMD), dietary intake and lifestyle choices were assessed. Osteopenia was observed in the calcanei of jockeys (left: 0.51 ± 0.06; right: 0.46 ± 0.12 g · cm-2). Energy and protein intake were significantly lower on a race day compared to a non-race day (P < 0.05). "In-race" HRmax values were similar to those from VO2max laboratory tests (186 ± 14 vs. 185 ± 8 bpm). Hypohydration was observed on both racing days. (USG: 1.0247 ± 0.006 and 1.0256 ± 0.0258 mg · L-1 for hot and moderate conditions, respectively). Sauna usage (25.5%) and food restriction (20.4%) were the most common weight-making practices. Current lifestyle choices of jockeys result in suboptimal bone health, hydration status and nutritional intake, which can significantly enhance the fracture risk. Further research should develop exercise and nutrition guidelines for optimising their skeletal health.

Pulse transit time changes in subjects exhibiting sleep disordered breathing.

INTRODUCTION: Pulse Transit Time (PTT) represents a non-invasive marker of sleep fragmentation in OSAS. Little is known regarding PTT in sleepy subjects exhibiting nocturnal Inspiratory Flow Limitation (IFL) in the absence of apneas or desaturation. MATERIALS AND METHODS: The IFL cohort was gender and age matched to subjects with OSAS and a cohort where Sleep Disordered Breathing (SBD)/IFL was absent ("Non Flow Limited" or NFL cohort); PTT Arousal index (PTT Ar) defined by number of PTT arousals per hour. RESULTS: 20 subjects meeting criteria for the IFL cohort were aged and gender matched with OSAS and "NFL" subjects. Females comprised 65% of the IFL cohort; the mean BMI of the IFL cohort was significantly higher than the NFL cohort (34.25 v 28.90; p = 0.016) but not when compared to the OSAS cohort (34.25 v 36.31; p = 0.30). The PTT Ar in the IFL cohort (33.67 h) was significantly higher than the NFL cohort (23.89 h) but significantly lower than the OSAS cohort (55.21 h; F = 8.76; p < 0.001). PTT Ar was found to positively correlate with AHI (CC = 0.46; p < 0.001), ODI (CC = 0.47; p < 0.001) and RDI (CC = 0.49; p < 0.001). Within the IFL cohort, PTT Ar positively correlated with age (CC = 0.501; p = 0.024) but not gender and BMI. CONCLUSION: The PTT Arousal Index increased proportionately with severity of SDB with significantly higher markers of arousal in sleepy subjects exhibiting nocturnal IFL when compared to controls. Subjects exhibiting IFL were predominantly female with an elevated BMI. IFL may thus represent a significant pathogenic entity in the development of daytime sleepiness.

Relationship of BMI to the incidence of hypertension: a 4 years' cohort study among children in Guangzhou, 2007-2011.

BACKGROUND: In China, there has been a dramatic increase in overweight and obesity among children and adolescents in recent decades. However, little longitudinal studies reported BMI in relation to the risk for hypertension among children in China. We examined the longitudinal relations between BMI and hypertension in Chinese schoolchildren via a retrospective cohort study. METHODS: The cohort study was carried out in 7203 children (3821 boys and 3382 girls) in Guangzhou aged 6-8 years, with a continuous 4 years of follow-up. The participants, evaluated by body mass index (BMI), were categorized as thinness, normal weight, overweight, and obesity groups. The age and gender-specific BMI cutoffs newly developed by the Working Group on Obesity in China (WGOC) were used to define overweight and obesity. The thinness was defined by the international age- and gender-specific cut-off points for BMI for thinness grade 1. Hypertension was defined by using percentiles of systolic and diastolic values on the basis of height percentile, age, and gender. The Cox proportional hazards model was used to estimate the single or joint effect of BMI on the risk of hypertension. This study was approved by The Ethical Committee of School of Public Health, Sun Yat-sen University. RESULTS: During a follow-up of 4 years, a shocking high cumulative incidence of hypertension was found in Chinese overweight (50.1 %) and obesity (70 %) schoolchildren. The incidence of children hypertension were markedly higher among overweight and obesity group than normal weight and thinness group (24.3 %, 18.5 % vs 11.1 %, 7.4 %). Compared with the children in the normal weight group, the adjusted HRs and 95 % CIs of developing hypertension in thinness, overweight, and obesity group were 0.972 (0.851, 1.110), 1.313 (1.179, 1.461), and 1.816 (1.634, 2.081), respectively. Additionally, the protective effect of thinness on hypertension was observed in boys 0.808 (0.666, 0.981), but not in girls 1.158 (0.966, 1.389). CONCLUSIONS: The 4-year longitudinal study indicated that the overweight and obesity can predict the higher risk of hypertension in Chinese children, whereas, the thinness predict the lower risk of hypertension only in boys.

A benchmark survey of the common plants of South Northumberland and Durham, United Kingdom.

BACKGROUND: It is obvious to anyone studying plants in the landscape that man-made environmental change is having profound effects on the abundance, distribution and composition of plant communities. Nevertheless, quantifying these changes and estimating the impact of the different drivers of change is extremely difficult. Botanical surveying can potentially provide insights to the changes that are occurring and inform decisions related to conservation, agriculture and forestry policy. However, much of botanical surveying is conducted in such a way that it is not comparable between dates and places. Any comparison of historical and modern data has to account for biases in the recording of different taxonomic groups, geographic biases and varying surveying effort in time. In 2010 botanical recorders in the Vice Counties of Durham and South Northumberland in the United Kingdom decided to conduct a four year survey specifically to benchmark the abundance and distribution of common plants in their counties. It is intended that this survey will provide a relatively unbiased assessment with which to compare future and past surveys of the area and a means to study the drivers of biodiversity change in the North-east of England. NEW INFORMATION: This survey of Durham and South Northumberland has been designed with two goals, firstly to provide information on common vascular plant species and secondly to provide a dataset that will be versatile with respect to the sorts of questions that can be answered with the data. The survey is primarily an occupancy study of 1km(2) grid squares, however, observers were also asked to provide a relative abundance estimate of the species in each grid square. The collection of relative abundance estimate data was an experiment to assess the repeatablity and useablity of such estimates.

Effect of the glycemic index of pre-exercise snack bars on substrate utilization during subsequent exercise.

PURPOSE: To investigate the effect of the glycemic index (GI) of pre-exercise snack bars on substrate utilization during subsequent moderate intensity exercise. METHODS: Fourteen male participants (Age: 27 ± 5 yr; BMI: 22.5 ± 2.7 kg m(-2); [Formula: see text]: 48.7 ± 6.1 mL kg(-1 )min(-1)) completed two trials in a randomized and counterbalanced crossover design. Two iso-caloric snack bars with different GI values (20, LGI versus 68, HGI) were provided to the participants. Ninety minutes later, all participants completed 45 minutes of ergometer cycling at 65% [Formula: see text]. Substrate utilization was measured using indirect calorimetry. RESULTS: During exercise, higher fat oxidation and lower carbohydrate (CHO) oxidation were observed in the LGI trial (LGI versus HGI: CHO, 87.3 ± 20.1 versus 99.2 ± 19.0 g, p < 0.05; Fat, 15.0 ± 5.8 versus 9.7 ± 7.0 g, p < 0.05). CONCLUSION: Compared with an iso-caloric HGI snack bar, pre-exercise LGI snack bar consumption may facilitate a shift of substrate utilization from CHO to fat during subsequent moderate intensity exercise.

The development of aerobic and skill assessment in soccer.

Methods of assessing soccer players' performance have developed significantly in recent times. The fitness profiles and skill levels of a prospective elite soccer player is a valuable resource for coaches in the process of identifying talent. Traditional means to measure aerobic fitness have centred on the 'aerobic capacity' or '&OV0312;O(2max)' test (also known as the maximal oxygen consumption test) but, over time, this has been shown not to be a sensitive measure for specific aspects of soccer in a match situation. Therefore, numerous soccer-specific simulations have been designed to re-create exercise patterns similar to those experienced during a match. Some of these studies have yet to be validated, while others have been shown to result in a similar physiological load to that encountered during regular match play. Further developments have led to specifically designed intermittent sprint tests, which are used as a sensitive tool to accurately measure the fluctuations in players' ability both between and within soccer seasons. Testing procedures have also been developed that incorporate elements of both skill and physical ability. Soccer-specific field tests have been designed, incorporating skill and dynamic movements, and this opens up the possibility of teams testing the aerobic capacity of their elite players using soccer-specific movements. Valid studies assessing soccer-specific skills in an ecologically sound environment have been quite rare until recently. Some test protocols have been deemed largely irrelevant to soccer match play, while others have had limited impact on scientific literature. More recently, skill tests have been developed and shown to be valid and reliable methods of assessing soccer skill performance. Many new skill tests continue to be developed, and some have been shown to be highly reliable, but further study of these relatively novel concepts is required before a more solid recommendation can be made. Overall, while significant work has been completed to date, there is still a need for further focused investigations, which can more closely assess the physiological demands of an elite soccer player, with a particular emphasis on sport-specific exercises during the execution of soccer skills. In this regard, more reliable and specific performance tests can be designed to more efficiently assess soccer players in the future.

Time- and state-dependent effects of methanethiosulfonate ethylammonium (MTSEA) exposure differ between heart and skeletal muscle voltage-gated Na(+) channels.

The substituted-cysteine scanning method (SCAM) is used to study conformational changes in proteins. Experiments using SCAM involve site-directed mutagenesis to replace native amino acids with cysteine and subsequent exposure to a methanethiosulfonate (MTS) reagent such as methanethiosulfonate ethylammonium (MTSEA). These reagents react with substituted-cysteines and can provide functional information about relative positions of amino acids within a protein. In the human heart voltage-gated Na(+) channel hNav1.5 there is a native cysteine at position C373 that reacts rapidly with MTS reagents resulting in a large reduction in whole-cell Na(+) current (I(Na)). Therefore, in order to use SCAM in studies in this isoform, this native cysteine is mutated to a non-reactive residue, e.g., tyrosine. This mutant, hNav1.5-C373Y, is resistant to the MTS-mediated decrease in I(Na). Here we show that this resistance is time- and state-dependent. With relatively short exposure times to MTSEA (<4min), there is little effect on I(Na). However, with longer exposures (4-8min), there is a large decrease in I(Na), but this effect is only found when hNav1.5-C373Y is inactivated (fast or slow) - MTSEA has little effect in the closed state. Additionally, this long-term, state-dependent effect is not seen in human skeletal muscle Na(+) channel isoform hNav1.4, which has a native tyrosine at the homologous site C407. We conclude that differences in molecular determinants of inactivation between hNav1.4 and hNav1.5 underlie the difference in response to MTSEA exposure.