Changes in physical performance, body composition and physical training during military operations: systematic review and meta-analysis.

Systematic review and meta-analysis applying PRISMA guidelines with a PICOS format was constructed to provide an overview of changes in physical performance, body composition and physical training in soldiers during prolonged (≥ 3 months) military operations. Twenty-four studies out of the screened 4431 records filled the inclusion criteria. A small decrease in endurance performance was the most consistent finding (Hedge's g [g] - 0.21, 95% CI - 0.01 to - 0.41) while small overall increases in maximal strength of the lower (g 0.33, 95% CI 0.16-0.50) and upper body (g 0.33, 95% CI 0.19-0.46) were observed. In addition, small increases in strength endurance (push-up, g 0.34, 95% CI 0.15-0.52; sit-up g 0.26, 95% CI 0.07-0.44) were observed. The overall changes in body composition were trivial. Heterogeneity in the outcome variables varied mainly between low to moderate. Large inter-individual variations were observed in physical training volume, including decrements especially in endurance training frequency and volume. A reduction in total training load was often associated with negative changes in body composition and physical performance according to the principle of training specificity. Individuals with higher initial fitness level were more susceptible to decrements in their physical performance during operation.

Physical fitness and anthropometrics in Finnish soldiers during their early career: prospective changes during a 3-year follow-up.

INTRODUCTION: Physical fitness is a fundamental capability required of military personnel, but studies focusing on longitudinal changes in physical fitness and anthropometrics in soldiers are lacking. The aim was to evaluate physical fitness and anthropometrics in soldiers during their early career. METHODS: A 3-year prospective study included 180 male soldiers (baseline age 26±2 years) with measures of a 12 min running test, standing long jump, sit-up and push-up tests, and body mass, height and waist circumference (WC). Baseline data were stratified into tertiles, and the changes within each tertile were analysed using dependent t-tests and analysis of variance. RESULTS: 12 min running test distance decreased on average by 2% (-54 m), sit-up performance 3% (-1.5 repetitions (reps)/min), push-up performance 4% (-1.9 reps/min) and standing long jump performance 1% (-2.1 cm) over the 3-year period (p<0.05). Both aerobic and muscular fitness decreased consistently among the highest baseline tertile (12 min running test: -70 m, sit-ups: -3.2 reps/min, push-ups: -7.5 reps/min, standing long jump: -5.5 cm; p<0.001), whereas both aerobic and muscular fitness levels were maintained and push-up performance was improved (p<0.05) in the lowest baseline tertiles. Body mass increased on average by 4% (+3.4 kg) and WC by 4% (+3.9 cm) (p<0.001), and these increases were observed for all baseline tertiles (p<0.05). CONCLUSIONS: Small decrements in physical fitness and anthropometrics exist during the early career of soldiers. The changes in physical fitness differed according to baseline fitness levels. The results indicate that support for exercise training may be needed even in a soldier's early career.

Deep, respiratory tract and ear infections caused by Pseudallescheria (Scedosporium) and Microascus (Scopulariopsis) in Finland. A 10-year retrospective multi-center study.

Deep, respiratory tract and ear infections due to Microascaceae (Pseudallescheria, Scedosporium, Microascus or Scopulariopsis) were studied nationwide in Finland during 1993-2002. The data were based on 52,000 fungal cultures that represented about 50% of all such specimens in Finland and included all Finnish cases of profound immunosuppression. There were 39 cases that were re-evaluated as clinically significant, i.e., three pneumonias, two deep pedal infections and five wound infections, 11 sinusitis and 18 ear infections. The pedal infections and most pneumonias occurred in immunocompromised patients. Most cases, except the ear infections, were due to Pseudallescheria boydii. Two patients had lethal P. boydii pneumonia and a deep P. boydii infection of the foot contributed to a third lethal case. Two of the patients with lethal outcomes had received an allogeneic haematopoietic stem cell transplantation (AHSCT). Two patients with haematological malignancies were cured of deep site infections by a prolonged course of itraconazole. Wound, sinus and ear infections were cured or improved by local surgery or topical therapy. There were 0.8-1.7 cases of any type of infection per million inhabitants per year (MY) and 3.4 cases/1000 AHSCT. Mortality associated with Microascaceae in any type of patient was 0.06-0.12 MY.

Muscle mass and strength, body composition and dietary intake in master strength athletes vs untrained men of different ages.

AIM: The aim of this study was to compare muscle strength and thickness, body composition and dietary intake between master strength athletes and controls. METHODS: Cross-sectional comparison between: 1) young control men (25.7+/-3.4 y; n=10); 2) middle-aged master athletes (52.1+/-4.7 y; n=9); 3) middle-aged control men (51.9+/-3.1 y; n=11); 4) older master athletes (71.8+/-3.8 y; n=8); and 5) older control men (70.6+/-3.3 y; n=10). Athletes had been strength trained for 22.8+/-14.9 y. Maximal isometric strength of the leg extensors was measured with a leg dynamometer, body composition by skin folds, muscle thickness of the vastus lateralis with an ultrasound scanner and dietary intake by food diaries for 4 days. RESULTS: Athletes had more lean body mass than age-matched controls (P<0.001-0.05) and young controls more than older controls (P<0.01). No group differences were observed in the thickness of vastus lateralis. Athletes showed higher absolute strength and strength per vastus lateralis thickness ratio than all control groups (P<0.01-0.001). Body mass adjusted dietary intake did not differ between the strength trained and control men. Dietary intake did not correlate with strength, muscle thickness and lean body mass. CONCLUSION: The present older men with a long-term history of strength training showed greater muscle strength and strength per muscle thickness ratio than the untrained controls. The data support the usefulness of continuous strength training to preserve muscle strength in older men.

Recurrent Sphingomonas paucimobilis -bacteraemia associated with a multi-bacterial water-borne epidemic among neutropenic patients.

A cluster of septicaemias due to several water-related species occurred in a haematological unit of a university hospital. In recurrent septicaemias of a leukaemic patient caused by Sphingomonas paucimobilis, genotyping of the blood isolates by use of random amplified polymorphic DNA-analysis verified the presence of two distinct S. paucimobilis strains during two of the separate episodes. A strain of S. paucimobilis identical to one of the patient's was isolated from tap water collected in the haematological unit. Thus S. paucimobilis present in blood cultures was directly linked to bacterial colonization of the hospital water system. Heterogeneous finger-printing patterns among the clinical and environmental isolates indicated the distribution of a variety of S. paucimobilis clones in the hospital environment. This link also explained the multi-microbial nature of the outbreak.

The effect of structures on indoor humidity--possibility to improve comfort and perceived air quality.

The research presented in this paper shows that moisture transfer between indoor air and hygroscopic building structures can generally improve indoor humidity conditions. This is important because the literature shows that indoor humidity has a significant effect on occupant comfort, perceived air quality (PAQ), occupant health, building durability, material emissions, and energy consumption. Therefore, it appears possible to improve the quality of life of occupants when appropriately applying hygroscopic wood-based materials. The paper concentrates on the numerical investigation of a bedroom in a wooden building located in four European countries (Finland, Belgium, Germany, and Italy). The results show that moisture transfer between indoor air and the hygroscopic structure significantly reduces the peak indoor humidity. Based on correlations from the literature, which quantify the effect of temperature and humidity on comfort and PAQ for sedentary adults, hygroscopic structures can improve indoor comfort and air quality. In all the investigated climates, it is possible to improve the indoor conditions such that, as many as 10 more people of 100 are satisfied with the thermal comfort conditions (warm respiratory comfort) at the end of occupation. Similarly, the percent dissatisfied with PAQ can be 25% lower in the morning when permeable and hygroscopic structures are applied.

Enteral suspension of nifedipine for neonates. Part 2. Stability of an extemporaneously compounded nifedipine suspension.

OBJECTIVE: To investigate the chemical, microbiological and physical stability of an extemporaneously prepared nifedipine oral suspension, packaged in disposable syringes and prepared in a hospital pharmacy for paediatric use. METHODS: Two different suspensions were prepared, from nifedipine tablets and drug powder, by using an autoclaved 1.0% solution of hypromellose as the vehicle. The final theoretical drug concentration was 1 mg/mL. Doses of 1.0 ml were packaged into a 2 ml syringe with a cap. Nifedipine suspensions were stored under three conditions: at room temperature (22 degrees C), in a refrigerator (6 degrees C) protected from light, and at room temperature (22 degrees C) exposed to artificial daylight (400 lux) under controlled circumstances. The nifedipine concentration was measured in suspensions protected from light on days 0, 1, 3, 5, 7, 14, 21 and 28, and in suspensions exposed to light at 0, 3, 6, 18 and 24 h, and on days 2, 3, 5 and 7 after preparation. Nifedipine was analysed by a reproducible and validated stability-indicating HPLC-method. Microbiological and physical stability of the nifedipine suspension samples protected from light were examined for 28 days. RESULTS: Mean nifedipine concentration remained over 90% of the initial concentration throughout the 4-week study period in light-protected unit-dose suspensions, prepared from either crushed tablets or drug powder with hypromellose 1.0%. When exposed to light, however, nifedipine decomposed rapidly. Photodegradation of nifedipine exceeded 25% within 3 h and was essentially complete within 7 days. CONCLUSION: In the University Hospital of Kuopio, newborns have been treated with nifedipine suspension prepared from tablets, and preliminary experiences with administration of suspension have been encouraging. It may also be possible to apply this methodology to other medicines used in paediatrics.

Antifungal activity of some mono, bis and quaternary Mannich bases derived from acetophenone.

The development of resistance to current antifungal therapeutics drives search for new effective agents. Some Mannich bases have antifungal activity, but no information is available regarding the antifungal activity of acetophenone derived Mannich bases. Mono Mannich bases of acetophenone 1-3 were synthesized and converted into their corresponding bis derivatives, 5-7. Representative quaternary derivatives 4 and 8 were also synthesized. Antifungal activities of the compounds were evaluated using some yeasts and dermatophytes in vitro. Mono Mannich base 3 and quaternary compounds 4 and 8 were found to be 2-16 times more potent than the reference compound amphotericin B against dermatophytes: Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum canis. Compounds 4 and 8 were also found to be 2 times more effective compared with amphotericin B against the yeast Saccharomyces cerevisiae. Quaternization procedure improved the biological activity dramatically, whereas conversion of mono Mannich bases to corresponding bis derivatives generally did not affect antifungal activity. Our results suggest that acetophenone derived mono Mannich base 3 and quaternary derivatives 4 and 8 may serve as leading compounds for further studies to develop new antifungal agents with their highly potent antifungal activity.

Microbiological stability of a fentanyl, bupivacaine and clonidine mixture in a 0.9% sodium chloride infusion stored in syringes and reservoirs.

Combinations of extradural opioids and local anesthetic solutions are used in clinical practice, although little information exists on their microbiological or chemical stability. Currently there are no commercially available, prepacked, ready-to-use epidural mixtures of these medications and all mixtures must be prepared by the pharmacist. Epidural analgesic mixtures have been prepared on an as-needed basis. The aim of this study was to investigate the microbiological stability of a fentanyl, bupivacaine and clonidine mixture in a 0.9% sodium chloride infusion (without preservatives), prepared by the pharmacist in order to provide a basis for recommendations on the exchange of containgers (polypropylene syringes and polyvinylchloride [PVC] reservoirs). This mixture maintained microbiological stability for at least 28 days when prepared under aseptic conditions using a laminar air flow station, with a grade A environment and a B background, and using sterile clothes and equipment. During aseptic preparation in a grade A environment, less than 1 colony forming unit (CFU)/m3 and less than 3500 particles greater than 0.5 micrometers with no particle being greater than 5 micrometers, and in a grade B environment less than 10 CFU/m3 and less than 350,000 particles greater than 0.5 micrometers and less than 2,000 particles greater than 5 micrometers are allowed. Putatuive in situ antimicrobial activity of the drug mixture did not interfere with sterility testing. A pH difference was observed over time between the polypropylene syringes and the PVC reservoirs.

Prospective evaluation of Candida antigen and antibody assays for detection of Candida infections in children with malignant disease.

The clinical efficacy of assays for Candida albicans antigens by latex agglutination and for antibodies by indirect haemagglutination were prospectively evaluated in the diagnosis of invasive Candida infections in 38 children suffering from acute leukaemia or other malignant disease. The controls were 74 other patients without any malignancy; 72 of these had no signs or symptoms of fungal infections, but 2 had an invasive C. albicans infection. During a period of 21 months, 302 serum samples were tested by both assays, and the results were compared with clinical and other microbiological data. Invasive fungal infection was diagnosed on clinical grounds in 2 of the immunocompromised children, and periodic gut colonization was demonstrated in 11 of 36 (31%) children in this group. Positive Candida antigen was detected in 14 patients (37%) and a positive antibody titre in 7 patients (18%). Colonization was not correlated with antigen or antibody titre. Compared with the presence of invasive fungal infection, the antibody assay detected all four infections, whereas the antigen assay detected one of the two C. albicans septicaemias. Although the Candida antibody assay performed well, a detectable change in antibody titres appeared only slowly. Thus it was of no clinical help when antifungal treatment was to be considered. Follow-up of antibody titres, however, gave confirmation of the presence of fungal infection as well as the response to antifungal treatment.

Outer Membrane Proteins and Lipopolysaccharides in Pathovars of Xanthomonas campestris.

Variations in the outer membrane proteins (OMPs) and lipopolysaccharides (LPSs) of 54 isolates belonging to 16 different pathovars of Xanthomonas campestris were characterized. OMP samples prepared by sarcosyl extraction of cell walls and LPS samples prepared by proteinase K treatment of sonicated cells were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis in the presence of 4 M urea. In general, the OMP and LPS profiles within each pathovar were very similar but different from the profiles of other pathovars. Heterogeneity in OMP and LPS profiles was observed within X. campestris pv. campestris, X. campestris pv. translucens, and X. campestris pv. vesicatoria. LPSs were isolated from six X. campestris pathovars, which fell into two major groups on the basis of O antigenicity. The O antigens of X. campestris pv. begoniae, X. campestris pv. graminis, and X. campestris pv. translucens cross-reacted with each other; the other group consisted of X. campestris pv. campestris, X. campestris pv. pelargonii, and X. campestris pv. vesicatoria. A chemical analysis revealed a significant difference between the compositions of the neutral sugars of the LPSs of those two groups; the LPSs of the first group contained xylose and a 6-deoxy-3-O-methyl hexose, whereas the LPSs of the other group lacked both sugars.

Class specific antibodies in serodiagnosis of farmer's lung.

The aim of the present study was to determine which microbes and which immunoglobulin (Ig) classes should be included in tests to discriminate between patients with farmer's lung and reference persons. The sera of a group of farmer's lung patients and their spouses were measured for IgG, IgA, IgM, and IgE antibodies against a panel of farmer's lung microbes. The concentrations of IgG, IgA, and IgE antibodies were higher in patients compared with their spouses. The patients were generally positive for antibodies of several Ig classes whereas the spouses had only either IgG or IgA antibodies. A test comprising the determinations of IgG antibodies against T vulgaris and IgA antibodies against A fumigatus would correctly group 94% of the cases in the Finnish farming population. The selection of microbes for other environments needs to be determined locally.

Fungal gut colonization with Candida or Pityrosporum sp. and serum Candida antigen in preterm neonates with very low birth weights.

To evaluate the diagnostic value of gut colonization by yeasts and of candida antigen in serum for predicting fungal infection in very premature neonates, faecal and serum samples were obtained biweekly from 27 newborn babies treated at our neonatal intensive care unit. Altogether 82 sets of serum and faecal samples were obtained. 17 babies were followed for > or = 4 weeks. Blood cultures, both by routine and lysis centrifugation techniques, were performed for bacteria and fungi if infection was suspected. All children were given systemic broad-spectrum antibiotic treatment. Five of the children died, all without evidence of fungal infection. No systemic antifungal treatments were given. Quantitative faecal cultures demonstrated Candida albicans in 3 (11%) (10(3)-10(5) colony forming units/g) and Pityrosporum sp. in 8 (30%) of the preterm neonates. Candida antigen in titre 4 was detected in 1/82 serum samples. The child subsequently died with no other evidence of candida infection. In 56 full term neonates treated at the intensive care unit during the same period and tested by 1 set of samples, faecal colonization with Candida sp. was detected in 2 (4%) and with Pityrosporum sp. in 4 (15%). None were positive for candida antigen. Fungal gut colonization did not lead to clinical infection in the preterm neonates studied. The false positivity rate of the candida antigen test was low (0.7%). The predictive value of the test could not be determined in this study group with no systemic fungal infections. The role of pityrosporum as an inducer of neonatal infections remains to be evaluated.

Changes in the titers of IgG antibodies against farmer's lung antigens in the sera of healthy dairy farmers.

We investigated the effects of exposure to biologic dust on IgG antibody levels of farmers during the indoor feeding season for cattle. The reference group consisted of 90 healthy, nonsmoking teachers. At the beginning of the indoor feeding season, the mean titer of IgG antibodies to A. umbrosus for the farmers was significantly higher than that for the teachers (P less than .001). During the indoor feeding season, the IgG antibody titer of A. umbrosus but not the titers of the other three studied microbes decreased for the farmers. For the teachers, titers of all four microbes decreased. The study confirmed earlier findings that, in Finland, exposure to A. umbrosus is related to cattle raising. The study also shows that during the indoor feeding season for cattle, the quality of hay and bedding materials is reflected in the serum antibody profile of even healthy dairy farmers.

Class-specific antibodies during follow up of patients with farmer's lung.

Sequential serum samples of 13 patients with acute farmer's lung (FL) taken during a follow-up of 18-36 months, were tested for antibodies of immunoglobulin G (IgG), IgA, IgM and IgE classes against Thermoactinomyces vulgaris and Micropolyspora faeni, and compared with contemporary lung function parameters. In the acute phase, antibodies of several Ig classes were present, those of IgG and IgA being most common. At the end of the follow-up, the mean values of all antibody titres were lower than in the acute phase, and antibodies were now mostly of one or two Ig classes only. The reduction in antibody levels was most often detectable in IgG and IgA antibodies against T. vulgaris. Antibody titres correlated inversely with tested lung function parameters, especially IgA antibodies with pulmonary diffusing capacity. Our results show that a follow-up of levels of class-specific antibodies, especially of IgG and IgA gives valuable information on causative microbes and on temporal changes of the exposure.

Comparative immunochemical analysis of five Thermoactinomyces strains.

The antigen structures in mycelial extracts of 4 strains of Thermoactinomyces vulgaris and 1 strain of Thermoactinomyces candidus were compared using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver staining. For immunological characterization, antigens were transferred electrophoretically to nitrocellulose membranes and blotted with T. vulgaris strain-specific antisera and with sera of farmer's lung patients. Cross-reactions between the strains were also studied using immunodiffusion and crossed immunoelectrophoresis. Protein components between 50 and 60 kilodaltons were found to be the most immunogenic. Patient sera showed heterogeneous responses, but all reacted with an antigen at 55 kilodaltons that was also common to all strains studied.

Parabens as antimicrobial preservatives in creams.

Antimicrobial effectiveness of methylparaben and a mixture of methyl- and propylparabens in an oil-in-water cream was studied. How the number of microbes and inclusion of nutrients into the cream affect the effectiveness of these compounds were also investigated, as well as the survival of test microbes in the cream without preservatives. Survival of microbes and antimicrobial effectiveness of parabens against the microbes in the cream were dependent on the species and number of microbes present and also on the amount of nutrients available for the microbes. In spite of the large amount of water, the cream studied did not readily support microbial growth unless the number of microbes was large or nutrients were added. Parabens were not effective antimicrobial agents against the yeast studied. The bacterial species showed different sensitivities to parabens. A mixture of methyl- and propylparabens was more effective than the methylester alone.

Circulating IgG antibodies against fungal and actinomycete antigens in the sera of farmer's lung patients from different countries.

Sixty-nine farmer's lung patients and 28 normal controls from four countries (Finland, Switzerland, Canada and the United States) were investigated for antibody levels against 13 antigens commonly used for the screening panel for hypersensitivity pneumonitis. Of these antigens, eight were from the Medical College of Wisconsin (United States) and five were from the University of Kuopio (Finland). IgG antibodies against these antigens were studied in 97 sera using a sensitive biotin-avidin-linked enzyme immunoassay. The results indicate that the mean antibody titer against Micropolyspora faeni was highest in the United States (U.S.) followed by Finland. Both Finnish and U.S. antigens reacted almost identically against various groups of patients, although the degree of reactivity varied considerably. Higher antibody levels against Thermoactinomyces vulgaris were detected in Finnish patients than patients from other countries while patients from all four countries showed elevated levels of antibodies against T. candidus. This study demonstrates that antigens from identical species, irrespective of geographic origin, reacted similarly. However, variability between antigens of the same species was still considerably significant. Since the microbiological flora of moldy hay varies widely in different regions, the microbial species associated with the disease at a given geographical area has to be determined before selecting antigens for serological studies. The antigens currently used in various laboratories are crude preparations and need to be purified and standardized for dependable results. Until such antigens are available, all antigenic preparations used in the immunological evaluation of patients should be immunochemically characterized for their reproducibility and reliability although the ultimate goal should be to obtain standardized pure antigens for dependable immunodiagnosis of farmer's lung.

Significance of IgG antibodies against environmental microbial antigens in a farming population.

A group of dairy farmers studied 6 years earlier in a field survey was re-surveyed for respiratory symptoms, occupational capability and the presence of antibodies against environmental micro-organisms. Specific IgG antibodies to Micropolyspora faeni, Thermoactinomyces vulgaris, Aspergillus umbrosus and Aspergillus fumigatus were measured by ELISA from the serum samples obtained in the two surveys. Antibody titres remained constant in 70% of both farmers and controls, but where changes took place, the titres against the actinomycete antigens tended to rise, whereas both increases and decreases were detected equally against the Aspergillus antigens. The titre of specific antibody to any of the four micro-organisms, when measured from a single serum specimen, seemed to be of little diagnostic value. Observed changes however, were more diagnostic, in that a fall in titre, especially against the Aspergillus antigens, was closely associated with a definite decrease in exposure, such as after retirement. Increased titres occurred in farmers with continued exposure, and those against the actinomycetes were associated with the appearance of symptoms in previously symptom-free individuals. In a case of farmer's lung which developed in this population during the follow-up period, significant increases were detectable against T. vulgaris and M. faeni.