Ulcerative colitis successfully treated with vedolizumab in the presence of comorbid opportunistic infections: a case report.

BACKGROUND: Opportunistic infections associated with immunosuppressive treatments for inflammatory bowel disease pose an important safety concern. Here we report the case of a patient with active ulcerative colitis and cryptococcal pneumonia who was treated with vedolizumab combined with fluconazole. CASE PRESENTATION: A 56-year-old Japanese man with ulcerative colitis and a history of Sweet's syndrome who was taking prednisolone and azathioprine presented with a moderate exacerbation of ulcerative colitis, abdominal pain, diarrhea, and bloody stools along with cytomegalovirus infection. Increasing the prednisolone dose without using antiviral drugs improved cytomegalovirus infection; however, ulcerative colitis did not improve, and cryptococcal pneumonia occurred. Thus, treatment with fluconazole followed by vedolizumab was initiated for ulcerative colitis. The patient gradually recovered and achieved clinical remission without the exacerbation of pneumonia. CONCLUSIONS: We reported the first case of a patient with ulcerative colitis who was treated with vedolizumab and concomitant fluconazole for active cryptococcal pneumonia. Vedolizumab constitutes a high-potential treatment regimen owing to its safety in inflammatory bowel disease associated with opportunistic infections.

Autonomous Vesicle/Sheet Transformation of Cell-Sized Lipid Bilayers by Hetero-Grafted Copolymers.

Lipid bilayer transformations are involved in biological phenomena including cell division, autophagy, virus infection, and vesicle transport. Artificial materials to manipulate membrane dynamics play a vital role in cellular engineering and drug delivery technology that accesses the membranes of cells or liposomes. Transformation from 3D lipid vesicles to 2D nanosheets is thermodynamically prohibited because the apolar/polar interfaces between the hydrophobic bilayer edges and water are energetically unfavorable. We recently reported that cell-sized lipid vesicles (or giant vesicles) can be thoroughly transformed to 2D nanosheets by the addition of the amphiphilic E5 peptide and a cationic graft copolymer. Here, to understand the mechanisms underlying the lipid nanosheet formation, we systematically investigated the structural effects of the cationic copolymers on nanosheet formation. We found that lipid nanosheet formation is controlled in an all-or-nothing manner when the graft content of the copolymer is increased from 5.7 mol % to 7.7 mol %. This finding prompted us to obtain autonomous 2D/3D transformation system. A newly designed hetero-grafted cationic copolymers with thermoresponsive poly(N-isopropylacrylamide) grafts enables spontaneous 3D vesicle/2D nanosheet transformation in response to temperature. These findings would enable us to obtain smart nanointerfaces that trigger cell-sized lipid membrane dynamics in response to diverse stimuli and to create 2D-3D convertible lipid-based biomaterials.

Novel endoscopic marking clip equipped with resin-conjugated fluorescent indocyanine green during laparoscopic surgery for gastrointestinal cancer.

PURPOSE: Intraoperative identification of the cancer location is often difficult to conduct during laparoscopic surgery, especially in early-stage cancers. This study aimed to investigate the feasibility and accuracy of a novel endoscopic clip resin-conjugated fluorescent indocyanine green during laparoscopic surgery for gastrointestinal cancer. METHODS: Preoperative placement of endoscopic marking clips equipped with resin-conjugated fluorescent indocyanine green was performed to determine the resection margin in eight patients with gastrointestinal cancer. During laparoscopic surgery, a dedicated laparoscopic system with a xenon light source was used to detect fluorescence. The evaluation determined whether the fluorescent from the clips was visualized during laparoscopic surgery. RESULTS: Fluorescent signal emitted from ICG in the resin of the clips was detected in six patients from the outer layer of the serosal surfaces of the gastrointestinal tract, and the clips aided in accurate resection line of the organ. There were no significant differences of age, gender, and BMI between the patients in whom we could and could not detect ICG fluorescence. CONCLUSIONS: The results demonstrated the usefulness of a novel clip-equipped fluorescent resin, which is a promising diagnostic tool to detect accurate tumor location during laparoscopic surgery.

Outcomes of Endoscopic Submucosal Dissection for Subepithelial Lesions Localized Within the Submucosa, Including Neuroendocrine Tumors: A Multicenter Prospective Study.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) seems to be a reasonable option for gastrointestinal subepithelial lesions (SELs) localized within the submucosa. Indications for ESD include small neuroendocrine tumors (NETs) and indeterminate SELs. However, the prospective data regarding ESD and surveillance remain unclear. This study was performed to prospectively investigate the outcomes of ESD, including organ-specific outcomes and the mid-term prognosis. METHODS: This prospective multicenter study included 57 patients who underwent ESD for SELs localized within the submucosa [definite NETs (n = 42) and indeterminate SELs (n = 15)]. The efficacy and safety of ESD were evaluated in the whole cohort and in subgroups (NETs and indeterminate SELs). All patients were followed up. RESULTS: The rates of en bloc resection, curative resection, and complications were 98.2%, 66.7%, and 7.7% for the overall population (n=57); 100%, 61.9%, and 2.4% for NETs (n=42); and 93.3%, 80.0%, and 20.0% for indeterminate SELs (n=15), respectively. The rates of curative resection for NETs were poorer in the stomach (20%, n=5) and duodenum (33%, n=3) than in the rectum (71%, n=34). Including 11 of 16 patients with NETs who underwent a conservative approach resulting in non-curative resection, no patients developed tumor recurrence during the follow-up period (median, 24.5 months; range, 1-60 months). ESD followed by surveillance demonstrated acceptable mid-term outcomes for non-curative NETs. CONCLUSIONS: ESD can be an efficient therapy for SELs localized within the submucosa. However, gastric and duodenal ESD for NETs may be limited in terms of its curative and technical aspects. Clinicians should be aware of the potential complications of ESD for indeterminate SELs.

Cationic Copolymer-Chaperoned 2D-3D Reversible Conversion of Lipid Membranes.

Nanosheets have thicknesses on the order of nanometers and planar dimensions in the micrometer range. Nanomaterials that are capable of converting reversibly between 2D nanosheets and 3D structures in response to specific triggers can enable construction of nanodevices. Supra-molecular lipid nanosheets and their triggered conversions to 3D structures including vesicles and cups are reported. They are produced from lipid vesicles upon addition of amphiphilic peptides and cationic copolymers that act as peptide chaperones. By regulation of the chaperoning activity of the copolymer, 2D to 3D conversions are reversibly triggered, allowing tuning of lipid bilayer structures and functionalities.

Outcomes of gastrointestinal defect closure with an over-the-scope clip system in a multicenter experience: An analysis of a successful suction method.

AIM: To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method. METHODS: This retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips (OTSCs) placement. The overall rates of technical success (TSR), clinical success (CSR), complications, and procedure time were analyzed as major outcomes. Subsequently, 56 patients, excluding two cases that used the Anchor device, were divided into two groups: 14 cases of simple suction (SS-group) and 42 cases using the Twin Grasper (TG-group). Secondary evaluation was performed to clarify the predictors of OTSC success. RESULTS: The TSR, CSR, complication rate, and median procedure time were 89.7%, 84.5%, 1.8%, and 8 (range 1-36) min, respectively, demonstrating good outcomes. However, significant differences were observed between the two groups in terms of the mean procedure time (5.9 min vs 14.1 min). The CSR of the SS- and TG-groups among cases with a maximum defect size ≤ 10 mm and immediate or acute refractory bleeding was 100%, which suggests that SS is a better method than TG in terms of time efficacy. The CSR in the SS-group (78.6%), despite the technical success of the SS method (TSR, 100%), tended to decrease due to delayed leakage compared to that in the TG-group (TSR, CSR; 88.1%), indicating that TG may be desirable for leaks and fistulae with defects of the entire layer. CONCLUSION: OTSC system is a safe and effective therapeutic option for gastrointestinal defects. Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success.

Severity of injuries associated with falls in the community dwelling elderly are not affected by fall characteristics and physical function level.

Many elderly people experience difficulty with independent living after injuries associated with falls. This study aimed to examine the influence of fall characteristics and physical function level on the severity of fall related injuries. The surveys were conducted in 1955 community dwelling elderly. The questions regarded the following: fall experience within the past year, fall direction, fall cause, injured parts and degree of injury, and an activity of daily living (ADL) questionnaire from the Ministry of Education, Culture, Sports, Science and Technology Japan. Data of 1850 subjects with available and complete responses were used for analysis. Three hundred and eighty-six (20.9%) elderly people experienced a fall within the past year and 257 (66.7%) were injured. ADL score was significantly higher in the elderly without fall experience than the elderly with fall experience. No significant difference was found in frequency of fall cause and fall direction between the elderly with and without injuries caused by falling. Significant correlations were found between fall direction and fall cause and injured parts (φ=0.49 and 0.32). ADL score of the elderly who fell by leg backlash was significantly lower than that of the elderly who fell by tripping, slipping and staggering. A decrease of ADL affects the rate of falls in the elderly, but not the degree of injury. Fall characteristics may not be related to the extent of fall injury.

Gait characteristics when walking with rounded soft sole shoes.

This study aimed to examine the effect of shoes with a rounded soft sole (Stretch Walker: SW) on gait. Fifteen healthy male (mean age: 23.2) walked under three conditions (SW, Flat-bottomed Shoe: FS, Barefoot: BF). Including walking speed, stance time, step length were selected as temporal-spatial parameters. The angle of hip, knee, and ankle joints during particular phases were selected as kinematic parameters. Walking speed, stance time, step length and flexion angle of the ankle joint at initial contact were greater when wearing either shoe than walking BF; cadence was faster walking BF than wearing either shoe; double support time increased (FS>SW>BF); step width was greater (FS>SW>BF); walking angle was greater wearing the SW than wearing the FS and walking BF; and range of motion and maximum flexion angle of the hip and knee joints were greater wearing the FS than walking BF. In conclusion, wearing the SW with a heel-to-toe rocker and soft sole changes the double support time, step width, and walking angle and increases step length and walking speed compared to walking BF. The difference of the range of motion in hip and knee joints was larger between walking BF and wearing the FS than between walking BF and wearing the SW.

Effect of L-ornithine hydrochloride ingestion on intermittent maximal anaerobic cycle ergometer performance and fatigue recovery after exercise.

L-Ornithine plays an important role in ammonia metabolism via the urea cycle. This study aimed to examine the effect of L-ornithine hydrochloride ingestion on ammonia metabolism and performance after intermittent maximal anaerobic cycle ergometer exercise. Ten healthy young adults (age, 23.8 ± 3.9 year; height, 172.3 ± 5.5 cm; body mass, 67.7 ± 6.1 kg) with regular training experience ingested L-ornithine hydrochloride (0.1 g/kg, body mass) or placebo after 30 s of maximal cycling exercise. Five sets of the same maximal cycling exercise were conducted 60 min after ingestion, and maximal cycling exercise was conducted after a 15 min rest. The intensity of cycling exercise was based on each subject's body mass (0.74 N kg(-1)). Work volume (watt), peak rpm (rpm) before and after intermittent maximal ergometer exercise and the following serum parameters were measured before ingestion, immediately after exercise and 15 min after exercise: ornithine, ammonia, urea, lactic acid and glutamate. Peak rpm was significantly greater with L-ornithine hydrochloride ingestion than with placebo ingestion. Serum ornithine level was significantly greater with L-ornithine hydrochloride ingestion than with placebo ingestion immediately and 15 min after intermittent maximal cycle ergometer exercise. In conclusion, although maximal anaerobic performance may be improved by L-ornithine hydrochloride ingestion before intermittent maximal anaerobic cycle ergometer exercise, the above may not depend on increase of ammonia metabolism with L-ornithine hydrochloride.

The maximal double step length test can evaluate more adequately the decrease of physical function with age, than the maximal single step length test.

The maximal double step length (MDSL) test is a modified version of the maximal step length (MSL) test used to evaluate the dynamic balance related to falls in the elderly. Although this test can evaluate their physical function using movements similar to daily activities as compared to MSL, it has not been clarified whether it can adequately evaluate the activities of daily living (ADL) abilities of the elderly, as they decrease with age. This study aimed to examine the relationship between both MSL and MDSL on age and ADL in elderly subjects. Fifty-seven elderly females who live independently (age 74.8±5.6 years) were recruited. MSL and MDSL were conducted twice after completing an ADL questionnaire. Intra-class correlation coefficients (ICCs) of both tests were high (for MSL: ICC=0.95, for MDSL: ICC=0.81-0.82). Age and ADL significantly correlated to MDSL (age: r=-0.32-0.41, ADL: r=0.28-0.48), but not to MSL (age: r=-0.19, ADL: r=0.15). MDSL has high reliability as it relates to age and ADL. It may be more useful to evaluate ADL required for independent living and prevent falls in the elderly better than MSL.

Selection of useful items for fall risk screening for community dwelling Japanese elderly from the perspective of fall experience, physical function, and age level differences.

This study aimed to examine useful items for screening the fall risk of community dwelling elderly from various perspectives, including fall experience, physical function level, and age level difference. 968 independently living elderly persons over the age of 60 (age: 70.0 ± 7.0) responded to 80 fall risk items representing 7 factors (physical function, fall history, using devices, fear of falling and inactivity, dosing, disease and disability, and environment) and an ADL questionnaire. The high fall risk response rate was calculated for each item and tested for statistical significance among age groups and those with and without fall experience. Cramer's V was calculated to examine the relationship between each item and the ADL. In addition, we selected items with significant differences in the high fall risk response rates between the faller and the non-faller groups, a significant relationship with ADL, and a significant difference among age groups. A total of 40 useful items were selected from each fall risk factor (decrease in physical function: 21 items, fall history: 2 items, device usage: 3 items, fear of falling and inactivity: 5 items, dosing: 0 items, disease and disability: 8 items, and environment: 1 item). Selected items can comprehensively and properly assess the fall risk of the healthy elderly as compared with existing questionnaires.

The relationship of force output characteristics during a sit-to-stand movement with lower limb muscle mass and knee joint extension in the elderly.

This study examined the reliability of ground reaction force (GRF) parameters during sit-to-stand (STS) movements and the relationships between the GRF parameters and lower limb muscle mass and knee extension muscle strength. Fifty elderly females performed an STS movement twice from a chair adjusted to their knee height and the GRF, lower limb muscle mass and isometric knee extension muscle strength were measured. Reliabilities of GRF parameters were high (intra-class correlation coefficient=ICC=0.70-0.95). Parameters on force output during trunk flexion phase (ground reaction force at hip-lift off, sum of force output between beginning of STS movement and hip-lift off) differed significantly between trials, but their effect sizes were small (0.15-0.23). GRF parameters during hip-lift off and knee-hip joint extension phases significantly correlated with knee extension strength (|r|=0.29-0.64) but not lower limb muscle mass. In conclusion, the reliability of GRF during STS movement is good in hip-lift off and knee-hip joint extension phases and these phases relate significantly with lower limb muscle function. These two phases are useful for evaluation of leg muscle function of the elderly.

Relationships between ground reaction force parameters during a sit-to-stand movement and physical activity and falling risk of the elderly and a comparison of the movement characteristics between the young and the elderly.

This study aimed to examine the relationships between ground reaction force during a sit-to-stand (STS) movement and physical activity and falling risk of the elderly and the difference of the movement characteristics between the young and the elderly. Sixty elderly females who can achieve a STS movement by themselves and 30 healthy young females were measured for ground reaction force during STS movement from a chair, adjusted for lower leg length height. The elderly's physical activity and falling risk were also assessed. Physical activity and falling risk significantly correlated with parameters on force exertion during hip lift-off and knee-hip joint extension phases (|r|=0.26-0.41). Significant differences were found in ground reaction force parameters of all phases between the young and the elderly and STS movement of the elderly was suggested to result in poor force exertion and slowing down. The above tendency was noticeable in the hip lift-off and knee-hip joint extension phases. In conclusion, force exertion in hip lift-off and knee-hip joint extension phases of STS movement is related to physical activity and falling risk in the elderly. These phases may be useful to evaluate the elderly's physical activity and falling risk.

A comparison of magnifying chromoendoscopy versus histopathology of forceps biopsy specimen in the diagnosis of minute flat adenoma of the colon.

Having noted a discrepancy between endoscopic and histopathological diagnoses in cases of minute adenomas of the colon, a prospective study was designed to clarify which is appropriate, magnifying chromoendoscopy or histopathology of a specimen obtained by biopsy forceps. A total of 208 patients comprised the study population. The endoscopic diagnoses were performed with magnifying colonoscopies. We separated the detected lesions with type III(L) pit pattern following Kudo's classification into two groups at random: in group A (n = 104) resected specimens were fixed with 20% buffered formalin without being flattened, whereas in group B (n = 104) the resected specimens were flattened using forceps before fixation and the specimens were cut under observation of their surface structure with stereomicroscopy. Comparison of the initial diagnoses between groups A and B showed that a total of 84.6% (88/104) of the lesions were diagnosed to be tubular adenomas histopathologically in group A, compared with 100% (104/104) in group B (P < 0.0001). Results for comparison of the secondary diagnoses between group A and group B showed that 14 of the 16 lesions were diagnosed as tubular adenomas histopathologically. Thereafter, 98.1% (102/104) of the lesions were diagnosed to be tubular adenomas histopathologically in group A (P = 0.4976). In conclusion, high-resolution magnifying chromoendoscopy is an appropriate procedure for the diagnosis of minute adenomas in comparison with histopathology of specimens obtained by biopsy forceps in this prospective study.

Age and sex differences in various stepping movements of the elderly.

AIM: This study aimed to examine sex and age differences of various stepping movements in the elderly and to clarify useful stepping movements for evaluation of their dynamic balance. METHODS: Two hundred and eighty-six healthy elderly subjects who could walk independently (male mean age = 71.2 +/- 7.1 years; female mean age = 71.5 +/- 6.0) performed the following stepping tests: back and forth; up and down with a 5 cm tall step; and in-place stepping matching three tempos (44, 66 and 132 b.p.m.). Step number, single and double support times in the former two stepping tests, and time difference between metronome sound and grounding time in the latter tempo stepping tests were selected as evaluation parameters. RESULTS: An insignificant sex difference was found in all parameters. Hence, the data of men and women was pooled to examine age differences. Significant age differences were found in the step number and double support time of back and forth and up and down stepping tests and in the time difference of three tempo stepping tests. The step number in younger age groups and the support times in older age groups tended to be larger. CONCLUSION: No sex difference was found in evaluation parameters of all stepping tests, and all parameters tended to be superior in the younger elderly. The elderly experienced more difficulty matching slow tempos than fast tempos in the in-place stepping test. The back and forth, up and down and in-place matching tempo stepping tests may be useful for evaluating dynamic balance ability of the elderly.

Effects of room temperature and body position change on cerebral blood volume and center-of-foot pressure in healthy young adults.

This study aimed to examine the effects of room temperature and body position changes on cerebral blood volume, blood pressure and center-of-foot pressure (COP). Cerebral oxygenation kinetics and blood pressure were measured by near infrared spectroscopy (NIRS) and volume-compensation, respectively, in 9 males and 9 females after rapid standing from sitting and supine positions in low (12 degrees C) or normal (22 degrees C) room temperatures. COP was also measured in a static standing posture for 90 s after rapid standing. The total hemoglobin (Hb) decreased just after standing. Blood pressure after standing at normal temperature tended to decrease immediately but at low temperature tended to decrease slightly and then to increase greatly. The decreasing ratio of total Hb and blood pressure upon standing from a supine position at normal room temperatures was the largest of any condition. Total Hb recovered to a fixed level approximately 25 sec after standing from a sitting position and approximately 35 sec after standing from a supine position. All COP parameters after standing tended to change markedly in the supine position compared to the sitting position, especially at normal temperatures. The COP parameters after standing in any condition were not significantly related to the decreasing ratio of total Hb but were related to the recovery time of total Hb after standing. In conclusion, decreasing ratios of total Hb and blood pressure after standing from a supine position at normal temperatures were large and may affect body sway.

Attention of postural control on foot somatosensor disturbance caused by the compression of blood vessels.

This study aimed to compare the center of foot pressure (CFP) during different ischemia periods by cuff compression. Ten healthy young adult males held their CFP for 1 min before and after cuff compression (250 mmHg) of lower limb blood vessels during two different compression periods (10 min and 26 min). Two-point discrimination thresholds and electric stimulus perception thresholds of each subject's right foot sole were measured during cuff compression to examine changes in the perceived level of cutaneous and proprioceptive sensation by blood flow inhibition. In addition, oxygenation kinetics in the anterior tibial muscle tissue was examined by near-infrared spectroscopy during cuff compression. The CFP was evaluated by using 36 parameters. CFP deflection tended to increase after cuff compression and to be larger over a long ischemic time (26 min) as compared with a short ischemic time (10 min). The proprioceptive perception threshold using electric stimulation showed a significant interaction and was higher after 26 min ischemia than at the initial timepoint and after 10 min ischemia. The delta[Oxy Hb/Mb], delta[Deoxy Hb/Mb] and Tissue oxygenation index (TOI) changed significantly after both ischemic conditions than at the initial condition. There was no significant difference in the Tissue oxygenation index and delta[Deoxy Hb/Mb] between both ischemic conditions. Many parameters regarding the deflection velocity and anteroposterior and lateral deflection had significantly larger values after 26 min ischemia than at the initial time point and after 10 min ischemia. Postural deflection may not be affected by the oxygen deficiency of muscle tissues caused by the compression of blood vessels for 10 min, but strongly affected by the cutaneous and proprioceptive sensation disturbances occurring from compression lasting over 10 min.

Simple and easy assessment of falling risk in the elderly by functional reach test using elastic stick.

Dynamic balance ability related to maintaining postural stability during movement is closely tied to fall risk in the elderly. The functional reach (FR) test has been developed to evaluate their dynamic balance. Although a simple and new FR test using an elastic stick has been proposed by modifying the above original FR test, the abilities related to both FR tests are judged to differ because of the large difference in the testing method. This study aimed to compare center of gravity fluctuation, muscle activity and functional reach distance as measured by the original FR test and the elastic stick FR test. First, reach distance, back/forth and right/left moving distance of the center of gravity, and activity of the lower leg muscles (soleus and tibialis anterior) were compared between both tests based on data obtained from 30 young male adults. All parameters except for the right/left moving distance were significantly larger in the elastic stick FR test. Next, the reach distance was examined in both FR tests using 53 elderly subjects; it was significantly longer in the elastic stick FR test, but showed no significant sex difference. The reach distance in both tests was significantly shorter (about 7 cm) in the elderly than in young adults. In conclusion, the elastic stick FR test involves greater leg muscle strength exertion and forward transferring of the center of gravity as compared with the original FR test. Because the elastic stick FR test relates largely to leg muscle function and equilibrium function, it may be more useful for evaluating the dynamic balance ability of the elderly.

Height of chair seat and movement characteristics in sit-to-stand by young and elderly adults.

The height of a chair seat affects the burden on the lower limbs during the sit-to-stand (STS). To develop an objective test to evaluate muscle function of the lower limbs using floor reaction force during a STS, the relationship between chair-seat height and the burden on the lower legs must be assessed. To examine the influence of the chair-seat height, floor reaction forces during a STS performed with 5 chair heights adjusted to each subject's lower leg length were compared. The force production and quickness of movement tended to decrease in the phases of trunk flexion and knee and hip joint extension when performing a STS from a lower chair, when the chair height differed by 20% (6.2 cm) from the lower leg length, and was marked when the difference between chair height and lower leg length became larger. In 52 elderly and 50 young adults, floor reaction forces during a STS performed from a chair of the same height as subjects' lower leg lengths were compared. Elderly persons were inferior in force production (strength) and quickness of movement, which decreased as elderly stood up from a chair of a lower height.

Effect of coffee ingestion on physiological responses and ratings of perceived exertion during submaximal endurance exercise.

This study examined the effect of coffee ingestion on physiological responses and ratings of perceived exertion (RPE) during submaximal endurance exercises by 10 healthy young adults. Participants performed a submaximal endurance cycling exercise corresponding to 60% of maximum oxygen uptake capacity for 60 min. They drank either caffeinated coffee with a caffeine content of 6 mg/kg body-mass of each participant (Caf) or a decaffeinated coffee (Dec) 60 min. before starting exercise. Participants participated in the blind design experiment under both conditions at a one-week interval. Oxygen uptake, respiratory exchange ratio, heart rate, RPE, and plasma lactate concentration were measured during the endurance exercise. The RPE under the Caffeinated coffee condition during the last 60 min. of endurance exercise was significantly lower than that in the Decaffeinated coffee condition. However, no significant differences in any physiological response were observed between conditions. Thus, caffeine ingestion 60 min. before starting exercise had an insignificant effect on the physiological responses, except for RPE during submaximal endurance exercises for 60 min. Caffeine ingestion before endurance exercise of relatively low intensity may have a beneficial effect on psychological responses.