Release of ANP and fat oxidation in overweight persons during aerobic exercise in water.

Exercise in water compared to land-based exercise (LE) results in a higher release of natriuretic peptides, which are involved in the regulation of exercise-induced adipose tissue lipolysis. The present study was performed to compare the release of atrial natriuretic peptide (ANP) and free fatty acids (FFA) during prolonged aerobic water-based exercise (WE) with the release after an identical LE. 14 untrained overweight subjects performed 2 steady state workload tests on the same ergometer in water and on land. Before and after exercise, venous blood samples were collected for measuring ANP, FFA, epinephrine, norepinephrine, insulin and glucose. The respiratory exchange ratio (RER) was determined for fat oxidation.The exercises resulted in a significant increase in ANP in LE (61%) and in WE (177%), and FFA increased about 3-fold in LE and WE with no significant difference between the groups. Epinephrine increased, while insulin decreased similarly in both groups. The RER values decreased during the exercises, but there was no significant difference between LE and WE. In conclusion, the higher ANP concentrations in WE had no additional effect on lipid mobilization, FFA release and fat oxidation. Moderate-intensity exercises in water offer no benefit regarding adipose tissue lipolysis in comparison to LE.

Asthma tests in the assessment of military conscripts.

BACKGROUND: Respiratory diseases such as asthma may affect individuals' fitness for military service. In order to assess fitness for military service in subjects with asthma symptoms at conscription, objective and reliable tests are needed. OBJECTIVE: To prospectively determine the diagnostic value of the mannitol and methacholine bronchial provocation test (BPT) as well as exhaled nitric oxide in assessing physician-diagnosed asthma in a group of Swiss Armed Forces conscripts. METHODS: Questionnaire, spirometry, BPT with methacholine and mannitol, exhaled nitric oxide (FeNO) and skin prick testing were conducted in 18-20-year-old male conscripts. Asthma was diagnosed by a military physician not involved in this study according to the medical record, results of BPT, current respiratory symptoms and use of asthma medication. RESULTS: Two hundred and eighty four subjects participated in the study. Complete data for the BPT with methacholine, mannitol and measurement of FeNO were available on 235 subjects. Forty-two conscripts (17.9%) had physician-diagnosed asthma. The sensitivity/specificity of mannitol to identify physician-diagnosed asthma was 41%/93% and for methacholine it was 43%/92%. Using a cut-off point of 36.5 p.p.b., FeNO had a similar negative predictive value to rule out physician-diagnosed asthma as BPT with mannitol or methacholine. CONCLUSION: BPT with mannitol has a sensitivity and specificity similar to methacholine for the diagnosis of physician-diagnosed asthma in military conscripts but is less costly to perform without the need to use and maintain a nebulizer.

Human alveolar macrophage fibronectin: synthesis, secretion, and ultrastructural localization during gelatin-coated latex particle binding.

Human pulmonary alveolar macrophages synthesized and secreted several characteristic high molecular weight proteins for at least 7 d in vitro. Immunoprecipitates of medium and cell lysates from metabolically labeled cultures with specific anti-human plasma fibronectin IgG contained one major labeled polypeptide of molecular weight 440,000 (unreduced) or 220,000 (reduced). An identical polypeptide in conditioned medium from radiolabeled macrophages bound specifically to gelatin-Sepharose, demonstrating that alveolar macrophages synthesized and secreted a molecule immunologically and functionally similar to fibronectin. Fibronectin was the major newly synthesized and secreted polypeptide of freshly harvested alveolar macrophages. Pulse-chase experiments revealed that newly synthesized fibronectin was rapidly secreted into medium, approximately 50 percent appearing by 1 h and 80 percent by 8 h. Immunoperoxidase staining using antifibronectin F(ab')(2)-peroxidase conjugates revealed the majority of immunoreactive fibronectin to be intracellular, localized to endoplasmic reticulum and Golgi apparatus. No extracellular matrix fibronectin was visualized, and cell surface staining was rarely seen, usually appearing only at sites where cells were closely apposed and not at sites of macrophage-substrate attachment. Similar immunostaining of fibroblast cultures revealed cell surface-associated fibrillar fibronectin. Ultrastructural localization of fibronectin during binding and phagocytosis of gelatin-coated and plain latex particles revealed fibronectin only on gelatin-latex beads and at their cell binding sites. Neigher plain latex beads nor their cell membrane binding sites stained for fibronectin. These results demonstrate that fibronectin is a major product of human alveolar macrophages, is rapidly secreted, and is localized at cell membrane binding sites for gelatin-coated particles. In view of the known binding properties of fibronectin, it may serve as an endogenous opsonic factor promoting the binding of staphylococcus, denatured collagen, fibrin, or other macromolecules to macrophages in the lower respiratory tract.

Increase in immune activation, vascular endothelial growth factor and erythropoietin after an ultramarathon run at moderate altitude.

The present study was performed to investigate the effects of exhaustive long lasting exercise at moderate altitude on the time course of serum immunomodulatory peptides, vascular endothelial growth factor (VEGF) and serum erythropoietin (EPO). Thirteen well trained runners participated at the Swiss Alpine Marathon of Davos (distance 67 km, altitude difference 2300 m). Interleukin-6 was significantly elevated in the first 2h after the run. In contrast, tumor necrosis factor-alpha and both soluble tumor necrosis factor-a receptors I and II were increased after exercise termination and showed sustained serum concentrations the following days. Neopterin, a serum marker for the activation of the cellular immune system, was increased until day two after the run. Immediately after the run VEGF was significantly elevated and further increased 2.4-fold until day five post exercise (p = 0.005). EPO was also increased after exercise but reached its maximum 2 h after the run (2-fold increase; p = 0.004) and decreased thereafter. The main findings of our study are that prolonged strenuous exercise at moderate altitude induced a significant long lasting increase in serum VEGF and EPO which was accompanied by an activation of the immune system.

Competition performance and basal nocturnal catecholamine excretion in cross-country skiers.

UNLABELLED: Objective techniques to determine whether an athlete is optimally prepared for a competition are virtually nonexistent. Preparedness for sports competition is commonly judged through the experience of the athletes and their coaches. Evidence from overtraining studies suggests that catecholamine (Cat) excretion rates may correlate with performance in athletes. PURPOSE: We therefore attempted to determine whether a relationship existed between performances of world-class cross-country skiers and basal nocturnal Cat excretion (BNCE). METHOD: During the Cross-Country Skiing World Championships, we determined BNCE in nine cross-country skiers of the Swiss national team by measuring free Cat concentration (dopamine = D, norepinephrine = NE, epinephrine = E) in morning urine samples, using high performance liquid chromatography. Expert judgments of competition performance (ECP) were assessed by two experienced professional coaches of the national team by using an 11-step scale. RESULTS: The BNCE correlated significantly with ECP in cross-country skiers (r2 = 0.84 and P < for NE; r2 = 0.86 and P < 0.001 for D). Athletes who had their best absolute competition results (ACR) showed the highest NE and D concentrations. CONCLUSION: These data suggest that competitive cross-country skiers with higher D and NE excretion may reach better competition levels compared with those with lower levels. Measures of BNCE provide objective information about competition performance, which may benefit athletes in their precompetition preparation.

Occupational exposure to inhalative irritants and methacholine responsiveness.

OBJECTIVES: Occupational exposures to inhalative irritants have been associated with an increased reporting of respiratory symptoms in previous studies. Methacholine responsiveness represents a continuous measure of airway responsiveness. As such, it may be less subject to recall bias and more sensitive to detecting effects of occupational exposure on airways. Such effects may be stronger among atopic persons. The objective of the study was to examine the relationship between self-reports of occupational exposure to dusts, gases, vapors, aerosols, and fumes and methacholine responsiveness. METHODS: A sample was studied of never smokers (N=3044) chosen randomly from 8 areas in Switzerland. Atopy was defined as any positive skin test to 8 inhalative allergens. Nonspecific bronchial reactivity was tested using methacholine chloride and quantified by calculating the slope of the dose-response. RESULTS: The methacholine slopes were 19% [95% confidence interval (95% CI) 6-32] higher for never smokers with exposure to dusts, fumes, vapors, gases, or aerosols than for the unexposed group. When only atopic never smokers were examined. the increase was larger (37%, 95% CI 7-75), and for persons with >2 positive skin prick tests the effect was still higher (42%, 95% CI -1.5-104). Exposure to vapors and aerosols was strongly associated with increased methacholine slopes among the atopic subjects. CONCLUSIONS: Occupational exposure, particularly to dusts and fumes, was associated with increased bronchial reactivity in never smokers in this study. The magnitude of the effect was larger among atopic subjects.

Off seasonal and pre-seasonal assessment of circulating energy sources during prolonged running at the anaerobic threshold in competitive triathletes.

OBJECTIVES: To compare changes in circulating energy sources during prolonged exercise in off season (OS) and pre-season (PS) training of triathletes. METHODS: Nine athletes of the Swiss national triathlon team (three female, mean (SD) age 28.7 (4.9) years, height 169.8 (6.0) cm, weight 57.0 (6.2) kg, VO(2)max 66.5 (5.3) ml/min/kg; six male, mean (SD) age 24.0 (4.1) years, height 181.4 (6.9) cm, weight 73.5 (6.0) kg, VO(2)max 75.9 (4.9) ml/min/kg) were tested twice (2.5 months apart) during a 25 km aerobic capacity test run at the end of the OS and just before the season. The average training load during the OS was 9.9 h/week, and this increased to 14.4 h/week in the PS. With heart rates as reference, exercise intensity during the aerobic capacity test was 97.0 (4.9)% of the anaerobic threshold and 91.2 (4.5)% of VO(2)max. Blood samples were collected before, during, and after the aerobic capacity test. Samples were collected every 5 km during three minute rest intervals. RESULTS: Blood was analysed for triglyceride (TG), free fatty acids, cholesterol, high density lipoprotein cholesterol, glucose, insulin, lactate, and changes in plasma volume. A two factor (season by distance) repeated measures analysis of variance revealed an increase in capacity for prolonged exercise in the PS by a decrease in running intensity during the aerobic capacity test (% of speed at 2.0 mmol/l lactate threshold, p = 0.008), an increase in running speed at the anaerobic threshold (p = 0.003) and at 4.0 and 2.0 mmol/l (p<0.001) of the lactate threshold. A significant season by distance interaction was found for TG (p<0.001). TG concentrations peaked at 5 km and decreased logarithmically throughout the OS (1.48 (0.34) to 0.86 (0.20) mmol/l) and PS (1.90 (0.31) to 0.73 (0.18) mmol/l) tests. From the OS to the PS, there was an increase in the difference in TG at 5-15 km with a concomitant increase at 2.0 mmol/l of the lactate threshold. The peak TG concentrations at 5 km followed by a logarithmic decrease suggest that TG may also provide circulating energy. A greater logarithmic decrease in TG occurred in the PS than in the OS, indicating a higher rate of use. There was an increase in the difference in TG at 5-15 km similar to the increase in the speed at 2.0 mmol/l of the lactate threshold between the two seasons. Glucose, insulin, lactate, and free fatty acids were similar in the two seasons. CONCLUSION: Free fatty acid and TG concentrations were much higher than expected, and the two training seasons showed significantly different patterns of TG concentration during prolonged running. These responses may be related to aerobic capacity of prolonged exercise.

Effects of prolonged strenuous endurance exercise on plasma myosin heavy chain fragments and other muscular proteins. Cycling vs running.

BACKGROUND: This study evaluates creatine kinase, myosin heavy chain, and cardiac troponin blood levels following three types of exercise: 1) short-distance uphill or downhill running; 2) alpine ultramarathon; and 3) alpine long-distance cycling. EXPERIMENTAL DESIGN: Comparative field study; follow-up up to 10 days. SETTING: Department of Sports Medicine. All biochemical markers were analysed at the Department of Medical Chemistry and Biochemistry. PATIENTS OR PARTICIPANTS: Subjects included healthy, trained males (N = 53). All subjects were nonsmokers and free from medication prior to and during the study. Each volunteer was an experienced runner or cyclist, who had at least once successfully finished the Swiss Alpine Marathon of Davos or the Otztal-Radmarathon before. INTERVENTIONS: Running or cycling. MEASURES: Plasma concentrations of creatine kinase, myosin heavy chain fragments and cardiac troponins were measured to diagnose skeletal and cardiac muscle damage, respectively. RESULTS: Skeletal muscle protein release is markedly different between uphill and downhill running, with very little evidence for muscle damage in the uphill runners. There is considerable muscle protein leakage in the ultramarathoners (67 km distance; 30 km downhill running). In contrast, only modest amounts of skeletal muscle damage are found after alpine long-distance cycling (230 km distance). CONCLUSIONS: This study proves that there is slow-twitch skeletal muscle fiber damage after prolonged strenuous endurance exercise and short-distance downhill running. Exhaustive endurance exercise involving downhill running and short-distance downhill running lead to more pronounced injury than strenuous endurance exercise involving concentric actions. From our results there is no reason for suggesting that prolonged intense exercise may induce myocardial injury in symptom-less athletes without cardiac deseases.

SAPALDIA: methods and participation in the cross-sectional part of the Swiss Study on Air Pollution and Lung Diseases in Adults.

SAPALDIA--the Swiss Study on Air Pollution and Lung Diseases in Adults--focuses on the long term health effects of low to moderate levels of air pollutants as typically seen in different parts of Switzerland. The aim of the SAPALDIA cross-sectional study carried out in 1991 was to determine the prevalence of bronchial asthma, chronic bronchitis and allergic conditions in the adult population of Switzerland and to identify and to determine the respective importance of potentially influencing factors. These could be both personal (smoking habits, allergy status, family history, occupation) and environmental (outdoor and indoor pollution, aeroallergens, climate). A further aim of the cross-sectional study consisted in the identification of individuals susceptible to present symptoms during a two year observation period and to be included in the SAPALDIA follow-up study. This technical report represents the methodological documentation for the cross-sectional study of SAPALDIA. The instruments and the methods of standardisation are presented and discussed. The medical examination consisted of a computerised interview using a standardised questionnaire, the taking of a blood sample for serological tests, allergy skin testing, the measurement of end expiratory CO and body height, and pulmonary function testing followed by methacholine challenge testing or bronchodilatation testing. The pattern of participation and the 9651 participants of the study, representing 59.3% of the sample, are described. Based on information on non-participants gained by telephone interviews and mailed short questionnaires, possible selection biases are quantified and discussed.

[Rehabilitation in COPD]. / Rehabilitation bei COPD.

Pulmonary rehabilitation (PR) is an important tool in the treatment of COPD patients. It is now clearly established that PR improves exercise capacity, reduces symptoms and improves quality of life in COPD patients. There is further evidence that the programmes also improve survival and reduce medical consumption. Pulmonary rehabilitation programmes are multidisziplinary and consist of exercise training (endurance, power), chest physiotherapie, education, psychosocial and nutritional support. Patients with poor exercise capacity, peripheral muscle weakness, severe complaints and poor quality of life seem to profit most from in- and outpatients rehab programmes. The type of rehabilitation depends on the severity of symptoms, the competence of the rehab-team and the local possibilities.

[Doping-related problems in clinical practice]. / Dopingprobleme in der ärztlichen Praxis.

The complexity of the new antidoping regulations of the International Olympic Committee (IOC), the International Federations (IF) and the National Olympic Committees (NOC) rises a lot of problems in handling the prescriptions of medication in athletes in the daily practice. In addition, several countries have passed antidoping laws which makes the prescription and the delivery of doping agens illegal. This may have severe consequences for the prescribing doctors. It is therefore the goal of the article to inform the practitioning doctors about the new antidoping regulations and their impact on prescribing or delivering potential doping agens to athletes. It will focus on the new dopinglists, the different doping control systems, the problems with the pharmacological treatment of certain diseases as asthma and the necessary reports which have to be sent to the NOC's or the IF's after prescribing certain medications or methods.

[Bronchial asthma and sports]. / Asthma bronchiale und Sport.

Physical exercise can induce an acute attack in most asthmatics. Exercise-induced asthma (EIA) is therefore a common clinical presentation of bronchial asthma. EIA is likely a consequence of bronchial hyperreactivity whereby alterations in bronchial osmolarity, heat-loss by hyperventilation and physical activity per se are discussed as pathogenic triggers. Clinical presentation, pathogenesis and diagnosis of exercise-induced asthma are summarized. Pharmacologic and non-pharmacologic possibilities are covered in some depth. In this context the value of sports-therapy in treatment of asthma is redefined. The possibilities and limitations for this form of treatment are explained.

[Tuberculosis therapy 1990]. / Tuberkulosetherapie 1990.

The goal of modern therapy of tuberculosis is the rapid killing of all bacilli with potent and relatively atoxic antituberculous drugs. Currently available first-line drug regimens are highly effective, well tolerated and relatively easily administered. The addition of Pyrazinamide enables the minimum treatment period to be shortened to six months (two months Isoniazid, Rifampin, Pyrazinamide and four months Isoniazid, Rifampicin). This article reviews the available first-line drugs in treatment of tuberculosis, the rationale for the recommended chemotherapeutic regimens, the follow-up of treated patients and special issues related to the treatment of extrapulmonary tuberculosis and tuberculosis in HIV-infected patients.

[Acute deterioration of the CO diffusion capacity following exposure to ski-wax vapors]. / Akute Verschlechterung der CO-Diffusionskapazität nach Exposition mit Skiwachsdämpfen.

In cross country skiing use of hot wax is of importance. 90% of the active swiss cross country skiers have their own, self maintained equipment. Long unprotected exposure to hot wax fumes may cause disturbance of lung function. To examine short lasting disturbance in pulmonary function, CO-diffusion capacity and dynamic and static lung volumes in five healthy human subjects after exposure for one hour to hot wax (containing Paraffin and Cera-F) were determined. The subjects complained about burning eyes and tears, sore throat and coughing. Immediately after exposure all subjects showed a significant decrease of the CO-diffusion capacity of 10.6% (SEM 3.9), related to the ventilated alveolar space (DCOSB/VA). Maximal decrease of 13.6% (SEM 2.4) was after 90 min. After 24 hours the reduction persisted with 9.4% (SEM 2.1). The dynamic and static lung volumes remained unchanged. In summary a reduction of the CO-diffusion capacity after inhalative hot wax exposure was observed for at least 24 hours.

[Patients with lung diseases and sports]. / Lungenpatient und Sport.

Lung patients are suffering from dyspnea. These symptoms make any physical exertion unpleasant, and patients become sedentary. This behaviour leads to a deconditioning of the cardiocirculatory and muscular system which renders activity even more unpleasant, thus reinforcing the sedentary life style. This downward spiral can be interrupted by a program of progressive exercise which should be adapted to the type and severity of the pulmonary disease. In this context, the value of sport therapy in the treatment of asthma bronchiale and COPD is redefined. The possibilities and limitations for this form of treatment are explained.

[Fiberoptical transbronchial lung biopsy. Results of 25 consecutive cases]. / Fiberoptische transbronchiale Lungenbiopsie. Resultate von 25 konsekutiven Fällen.

Transbronchial lung biopsy using fiberoptic bronchoscope under fluoroscopic guidance was performed in 25 consecutive patients. 13 patients had diffuse lung disease and 12 exhibited infiltrates or nodules without endobronchial lesions. Satisfactory specimens were obtained in 22 of 25 cases. Diagnosis was accurate in 84% of diffuse and 58% of localized lung disease cases. The over-all diagnostic accuracy was 72%. 11 patients had malignant and 7 patients non-malignant interstitial diseases. In 4 patients with abnormal chest radiographs, normal lung biopsies were obtained. There were no serious complications. The fiberoptic transbronchial biopsy technique can be recommended as a safe and well tolerated method with a good diagnostic yield and a low complication rate. The indication, technique, prophylaxis for complications and problems of interpreting small biopsy specimens are considered.