Two weeks of repetitive gut-challenge reduce exercise-associated gastrointestinal symptoms and malabsorption.

Debilitating gastrointestinal symptoms is a common feature of endurance running and may be exacerbated by and/or limit the ability to tolerate carbohydrate intake during exercise. The study aimed to determine whether two weeks of repetitive gut-challenge during running can reduce exercise-associated gastrointestinal symptoms and carbohydrate malabsorption. Endurance runners (n=18) performed an initial gut-challenge trial (GC1) comprising 2-hour running exercise at 60% VO2max (steady state) while consuming a formulated gel-disk containing 30 g carbohydrates (2:1 glucose-fructose, 10% w/v) every 20 minutes, followed by a 1-hour running effort bout. Gastrointestinal symptoms, feeding tolerance, and breath hydrogen (H2 ) were determined along the gut-challenge trial. After GC1, participants were randomly assigned to a blinded carbohydrate (CHO, 90 gCHO hour-1 ) or placebo (PLA, 0 gCHO hour-1 ) gut-training group. This comprised of consuming the group-specific feeding intervention during 1-hour running exercise at 60% VO2max equivalent, daily over a period of two weeks. Participants then repeated the gut-challenge trial (GC2). In GC2, a reduced gut discomfort (P=.012), total (P=.009), upper- (P=.015), and lower-gastrointestinal (P=.008) symptoms, and nausea (P=.05) were observed on CHO, but not PLA. Feeding tolerance did not differ between GC1 and GC2 on CHO and PLA. H2 peak was attenuated in GC2 (6±3 ppm) compared to GC1 (13±6 ppm) on CHO (P=.004), but not on PLA (GC1 11±7 ppm, and GC2 10±10 ppm). The effort bout distance was greater in GC2 (12.3±1.3 km) compared with GC1 (11.7±1.5 km) on CHO (P=.035) only. Two weeks of repetitive gut-challenge improve gastrointestinal symptoms and reduce carbohydrate malabsorption during endurance running, which may have performance implications.

Changes of Hematological Markers during a Multi-stage Ultra-marathon Competition in the Heat.

This study examined the changes in resting hematological variables in ultra-endurance runners throughout a multi-stage ultra-marathon competition, and compared athletes that completed all stages with those that failed to complete at least one stage within the cut-off time of competition. 19 ultra-endurance runners competing in a 230 km multi-stage ultra-marathon, conducted over 5 consecutive days in hot ambient conditions (32-40°C T(max)), volunteered to participate in the study. Each day, whole blood samples were collected prior to stage commencement and analyzed for full cell counts by Coulter counter. Linear increases were observed for leukocytes, monocytes and lymphocytes; with increases until Stage 3 and a decrease thereafter. Granulocytes showed a cubic growth exponent, indicating decrements to baseline after the significant increments until Stage 3. Hemoglobin and hematocrit showed linear decrements throughout the multi-stage ultra-marathon. No changes in erythrocytes and platelets were observed throughout the multi-stage ultra-marathon. Granulocytes, erythrocytes, hemoglobin and hematocrit changes along the multi-stage ultra-marathon differed in runners that completed all stages compared to those who failed to complete at least one stage within the cut-off time. Multi-stage ultra-marathon in the heat has a large impact on hematological responses of ultra-endurance runners associated with altered performance.

The Impact of a 24-h Ultra-Marathon on Circulatory Endotoxin and Cytokine Profile.

The study aimed to determine circulatory endotoxin concentration, cytokine profile, and gastrointestinal symptoms of ultra-endurance runners (UER, n=17) in response to a 24-h continuous ultra-marathon competition (total distance range: 122-208 km) conducted in temperate ambient conditions (0-20 °C) in mountainous terrain. Body mass and body temperature were measured, and venous blood samples were taken before and immediately after competition. Samples were analysed for gram-negative bacterial endotoxin, C-reactive protein, cytokine profile, and plasma osmolality. Gastrointestinal symptoms were also monitored throughout competition. Mean exercise-induced body mass loss was (mean±SD) 1.7±1.8% in UER. Pre- and post-competition plasma osmolality in UER was 286±11 mOsmol·kg(-1) and 286±9 mOsmol·kg(-1), respectively. Pre- to post-competition increases (p<0.05) were observed for endotoxin (37%), C-reactive protein (2832%), IL-6 (3 436%), IL-1ß (332%), TNF-α (35%), IL-10 (511%), and IL-8 (239%) concentrations in UER, with no change in the control group (CON; n=12) observed (p>0.05). Gastrointestinal symptoms were reported by 75% of UER, with no symptoms reported by CON. IL-10 (r=0.535) and IL-8 (r=0.503) were positively correlated with gastrointestinal symptoms. A 24-h continuous ultra-marathon competition in temperate ambient conditions resulted in a circulatory endotoxaemia and pro-inflammatory cytokinaemia, counteracted by a compensatory anti-inflammatory response.

The impact of a 24-h ultra-marathon on salivary antimicrobial protein responses.

Depressed oral respiratory mucosal immunity and increased incidence of upper respiratory symptoms are commonly reported after bouts of prolonged exercise. The current study observed the impact of a 24-h continuous overnight ultra-marathon competition (distance range: 122-208 km; ambient temperature range: 0-20 °C) on salivary antimicrobial protein responses and incidence of upper respiratory symptoms. Body mass, unstimulated saliva and venous blood samples were taken from ultra-endurance runners (n=25) and controls (n=17), before and immediately after competition. Upper respiratory symptoms were assessed during and until 4-weeks after event completion. Samples were analyzed for salivary IgA, lysozyme, α-amylase and cortisol in addition to plasma osmolality. Decreased saliva flow rate (p<0.001), salivary IgA (p<0.001) and lysozyme (p=0.015) secretion rates, and increased salivary α-amylase secretion rate (p<0.001) and cortisol responses (p<0.001) were observed post-competition in runners, with no changes being observed in controls. No incidences of upper respiratory symptoms were reported by participants. A 24-h continuous overnight ultra-marathon resulted in the depression of some salivary antimicrobial protein responses, but no incidences of upper respiratory symptoms were evident during or following competition. Salivary antimicrobial protein synergism, effective management of non-infectious episodes, maintaining euhydration, and (or) favourable environmental influences could have accounted for the low prevalence of upper respiratory symptoms.

The effects of post-exercise feeding on saliva anti-microbial proteins.

The purpose was to determine the effects of a carbohydrate (CHO)-protein (PRO) drink, consumed immediately after endurance exercise on saliva anti-microbial proteins known to be important for host defence. Eleven male runners ran for 2 h at 75% VO2max on two occasions, and immediately post-exercise were provided, in randomised order, either a placebo solution (CON), or a CHO-PRO solution containing 1.2 gCHO·kg-1BM and 0.4 gPRO·kg-1BM (CHO-PRO). Both solutions were flavour and volume equivalent (12 ml·kg- 1BM). Saliva flow rate, lysozyme, α-amylase, and secretory (S) IgA concentrations were determined from unstimulated saliva samples collected pre-exercise, immediately post-exercise and every 30 min until 180 min post-exercise. CHO-PRO ingestion immediately post-exercise resulted in a lower saliva flow rate compared with CON at 30 and 60 min post exercise. Saliva lysozyme concentration increased immediately post-exercise in both trials compared with pre-exercise (P< 0.05), and CHO-PRO ingestion immediately post-exercise resulted in a higher saliva lysozyme concentration in the first hour of recovery compared with CON (125% greater at 30 min; 94% greater at 60 min, P< 0.01). Saliva SIgA concentration decreased below pre-exercise concentrations 90-150 min post-exercise (P< 0.01) with no effect of CHO-PRO. Saliva α-amylase activity was unaffected by exercise or CHO-PRO re-feeding. CHO-PRO re-feeding did not alter the secretion rates of any saliva variables during recovery. In conclusion, immediate re-feeding with CHO-PRO evoked a greater saliva lysozyme concentration during the first hour of recovery after prolonged exercise compared with ingestion of placebo, but had minimal impact upon saliva α-amylase and SIgA responses.

Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease.

BACKGROUND: "Exercise-induced gastrointestinal syndrome" refers to disturbances of gastrointestinal integrity and function that are common features of strenuous exercise. AIM: To systematically review the literature to establish the impact of acute exercise on markers of gastrointestinal integrity and function in healthy populations and those with chronic gastrointestinal conditions. METHODS: Search literature using five databases (PubMed, EBSCO, Web of Science, SPORTSdiscus, and Ovid Medline) to review publications that focused on the impact of acute exercise on markers of gastrointestinal injury, permeability, endotoxaemia, motility and malabsorption in healthy populations and populations with gastrointestinal diseases/disorders. RESULTS: As exercise intensity and duration increases, there is considerable evidence for increases in indices of intestinal injury, permeability and endotoxaemia, together with impairment of gastric emptying, slowing of small intestinal transit and malabsorption. The addition of heat stress and running mode appears to exacerbate these markers of gastrointestinal disturbance. Exercise stress of ≥2 hours at 60% VO2max appears to be the threshold whereby significant gastrointestinal perturbations manifest, irrespective of fitness status. Gastrointestinal symptoms, referable to upper- and lower-gastrointestinal tract, are common and a limiting factor in prolonged strenuous exercise. While there is evidence for health benefits of moderate exercise in patients with inflammatory bowel disease or functional gastrointestinal disorders, the safety of more strenuous exercise has not been established. CONCLUSIONS: Strenuous exercise has a major reversible impact on gastrointestinal integrity and function of healthy populations. The safety and health implications of prolonged strenuous exercise in patients with chronic gastrointestinal diseases/disorders, while hypothetically worrying, has not been elucidated and requires further investigation.

Ventricular assist devices in pediatric cardiac surgery.

BACKGROUND: Early experience in other centers with pediatric assist devices has been favorable. METHODS: Prospectively we examined our first 13 patients between January 1992 and September 1994. RESULTS: Thirteen children underwent ventricular assistance at Royal Alexandra Hospital for Children. Age ranged from 4 days to 30 months, weight from 2.9 kg to 17 kg. Ventricular assistance was employed from 1.5 hours to 190 hours. Of 12 surgical patients, 8 required left ventricular assistance to be weaned from cardiopulmonary bypass after correction of congenital defects, and 4 required support in the postoperative period for refractory low cardiac output. A child was supported after a kick to the chest by a horse caused cardiogenic shock. All 13 patients initially responded to ventricular assistance and 7 remain alive. Of the deaths, 2 were neurologic, 2 due to myocardial failure, and 2 to sepsis. The major complications in the first days were hemorrhage and tamponade. Later problems included thrombosis of the circuit despite systemic heparinization, and a cannula-related tear to the anterior mitral leaflet. The 7 survivors are well after 3 to 32 months. CONCLUSIONS: Despite the mortality and complications, we are encouraged by these results, in the light of almost certain death for all 13 patients without ventricular assistance.

Effects of immediate postexercise carbohydrate ingestion with and without protein on neutrophil degranulation.

The purpose of the study was to determine the effects of carbohydrate (CHO) intake, with and without protein (PRO), immediately after prolonged strenuous exercise on circulating bacterially stimulated neutrophil degranulation. Twelve male runners completed 3 feeding interventions, 1 week apart, in randomized order after 2 hr of running at 75% VO2max. The feeding interventions included a placebo solution, a CHO solution equal to 1.2 g CHO/kg body mass (BM), and a CHO-PRO solution equal to 1.2 g CHO/kg BM and 0.4 g PRO/kg BM (CHO+PRO) immediately postexercise. All solutions were flavor and water-volume equivalent (12 ml/kg BM). Circulating leukocyte counts, bacterially stimulated neutrophil degranulation, plasma insulin, and cortisol were determined from blood samples collected preexercise, immediately postexercise, and every 30 min until 180 min postexercise. The immediate postexercise circulating leukocytosis, neutrophilia, and lymphocytosis (p < .01 vs. preexercise) and the delayed lymphopenia (90 min postexercise, p < .05 vs. preexercise) were similar on all trials. Bacterially stimulated neutrophil degranulation decreased during recovery in control (23% at 180 min, p < .01 vs. preexercise) but remained above preexercise levels with CHO and CHO+PRO. In conclusion, CHO ingestion, with or without PRO, immediately after prolonged strenuous exercise prevented the decrease in bacterially stimulated neutrophil degranulation during recovery.

The effects of a high carbohydrate diet on cortisol and salivary immunoglobulin A (s-IgA) during a period of increase exercise workload amongst Olympic and Ironman triathletes.

The present study observed the effects of a 6-day high carbohydrate (H-CHO) diet on salivary cortisol and IgA during a period of increased exercise workload. Thirty-two competitively trained male triathletes were randomly allocated into a self-selected (SS), or an H-CHO (12 g CHO kgbm (-1) . day (-1)) dietary group. In addition to their training regimes, all subjects performed a 1-hour running exercise bout at 70 % V.O (2max) . d (-1), for six days. Saliva samples were taken pre, immediately post, and morning post-exercise bout on days 1, 4, and 6. The concentrations of s-IgA and cortisol were determined by ELISA assays. There was a significant (p < 0.001) interaction between Group x Time for cortisol, with a marked increase in concentrations occurring in the SS dietary group pre to post exercise, and pre to morning post-exercise (p < 0.01). Conversely, a significant (p = 0.009) Group x Time interaction reflected higher post exercise s-IgA concentrations (p < 0.005) than pre exercise in the H-CHO diet group. Blood glucose concentration decreased pre to post exercise in the SS diet group (p < 0.01), whilst remaining stable in the H-CHO group. It is concluded that the consumption of a high CHO diet throughout a 6-day period of overtraining had a favourable effect on markers of immune activity and thereby reduced the susceptibility of these endurance athletes to upper respiratory tract infection URTI.

Expression of adhesion molecules in chronic B-cell lymphoproliferative disorders.

BACKGROUND AND OBJECTIVE: Abnormalities in the expression of cell adhesion molecules (CAM) are thought to influence the patterns of intranodal growth and hematogeneous spread of malignant cells in chronic lymphoproliferative disorders (LPD). Therefore, the characterization of CAM phenotypic profiles of the neoplastic clones in LPD may help to identify distinct subtypes with prognostic implications. In this work we sought to investigate whether the expression of CAM by circulating malignant cells in patients with B-cell LPD differed from that of normal peripheral blood B-lymphocytes (PBL) and whether the observed phenotypic patterns could be correlated to other biological and clinical parameters of known clinical relevance. DESIGN AND METHODS: Peripheral blood mononuclear cells were obtained from 148 patients with B-cell chronic lymphocytic leukemia (B-CLL), 52 with B-cell non-Hodgkin lymphomas (NHL) and 10 with hairy cell leukemia (HCL). The expression of CAM was analyzed by flow cytometry using monoclonal antibodies against CD49d, CD29, CD11a, CD11b, CD11c, CD18, CD62L, CD54 and CD44. RESULTS: All CAM were detected in normal peripheral blood B-lymphocytes, except CD11c and CD54, which were present in only a minority of cells. Fluorescence mean channel values (FMC) showed that all molecules, with the exception of CD44, were expressed with dim intensity. Emerging patterns of CAM expression, as assessed by FMC values, were observed in different LPD: thus, B-CLL is characterized by a very low expression of CD49d/CD29 and beta 2 integrins. In this disorder, CD49d/CD29, CD11a, and CD54 increase with tumor burden; NHL show high expression of CD29 and CD54; strong expression of all molecules (except CD11a) was found in HCL, particularly CD11c (FMC values 60 times higher than normal). CD62L was faintly expressed in all diagnostic groups, whereas CD11c showed consistently high FMC values. INTERPRETATION AND CONCLUSIONS: The data shows that the phenotypic characterization of LPD can be further refined by the analysis of their patterns of CAM expression which may help to identify distinct subsets within each nosological group.