Purpose
The role of splenic emptying in O
2
transport during aerobic exercise still remains a matter of debate. Our study compared the differences in spleen volume changes between aerobically trained ...and untrained individuals during step-transition supine cycling exercise at moderate-intensity. We also examined the relationship between spleen volume changes, erythrocyte release, and O
2
uptake parameters.
Methods
Fourteen healthy men completed all study procedures, including a detailed medical examination, supine maximal O
2
uptake (
V
˙
O
2
max.) test, and three step-transitions from 20 W to a moderate-intensity power output, equivalent to
V
˙
O
2
uptake at 90% gas exchange threshold. During these step-transitions pulmonary
V
˙
O
2
p
, near-infrared spectroscopy of the
vastus lateralis
, and cardiovascular responses were continuously measured. In parallel, minute-by-minute ultrasonic measurements of the spleen were performed. Blood samples were taken before and immediately after step-transition cycling.
Results
On average,
V
˙
O
2
max. was 10 mL kg min
−1
(
p
= 0.001) higher in trained compared to their aerobically untrained peers. In response to supine step-transition cycling, the splenic volume was significantly reduced, and the largest reduction (~ 106 to 115 mL, ~ 38%,
p
= 0.001) was similar in both aerobically trained and untrained individuals. Erythrocyte concentration and platelet count transiently increased after exercise cessation, with no differences observed between groups. However, the
vastus lateralis
deoxygenation amplitude was 30% (
p
= 0.001) greater in trained compared to untrained individuals. No associations existed between: (i) spleen volumes at rest (ii) spleen volume changes (%), (iii) resting hematocrit and oxygen uptake parameters.
Conclusion
Greater splenic emptying and subsequent erythrocyte release do not lead to a slower
τ
V
˙
O
2
p
, regardless of individual
V
˙
O
2
max. readings.
The "Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines" (CRUSADE) score emerged as a predictor of major bleeding ...in patients presenting with the acute coronary syndrome. On the other hand, previous studies established the association of dephosphorylated-uncarboxylated Matrix Gla protein (dp-ucMGP) and vitamin K, as well as their subsequent impact on coagulation cascade and bleeding tendency. Therefore, in the present study, we explored if dp-ucMGP plasma levels were associated with CRUSADE bleeding score. In this cross-sectional study, physical examination and clinical data, including plasma dp-ucMGP levels, were obtained from 80 consecutive patients with acute myocardial infarction (AMI). A significant positive correlation was found between CRUSADE bleeding score and both dp-ucMGP plasma levels (r = 0.442,
< 0.001) and risk score of in-hospital mortality (r = 0.520,
< 0.001), respectively. In comparing the three risk groups of risk for in-hospital bleeding, the high/very high-risk group had significantly higher dp-ucMGP levels from both very low/low group (1277 vs. 794 pmol/L,
< 0.001) and the moderate group (1277 vs. 941 pmol/L,
= 0.047). Overall, since higher dp-ucMGP levels were associated with elevated CRUSADE score and prolonged hemostasis parameters, this may suggest that there is a biological link between dp-ucMGP plasma levels and the risk of bleeding in patients who present with AMI.
Purpose
The present study investigated whether larger splenic emptying augments faster excess post-exercise O
2
consumption (EPOC) following aerobic exercise cessation.
Methods
Fifteen healthy ...participants (age 24 ± 4, 47% women) completed 3 laboratory visits at least 48-h apart. After obtaining medical clearance and familiarizing themselves with the test, they performed a ramp-incremental test in the supine position until task failure. At their final visit, they completed three step-transition tests from 20 W to a moderate-intensity power output (PO), equivalent to
V
˙
O
2
at 90% gas exchange threshold, where data on metabolic, cardiovascular, and splenic responses were recorded simultaneously. After step-transition test cessation, EPOC
fast
was recorded, and the first 10 min of the recovery period was used for further analysis. Blood samples were collected before and immediately after the end of exercise.
Results
In response to moderate-intensity supine cycling (
V
˙
O
2
= ~ 2.1 L·min
−1
), a decrease in spleen volume of ~ 35% (
p
= 0.001) was observed, resulting in a transient increase in red cell count of ~ 3–4% (
p
= 0.001) in mixed venous blood. In parallel, mean blood pressure, heart rate, and stroke volume increased by 30–100%, respectively. During recovery, mean τ
V
˙
O
2
was 45 ± 18 s, the amplitude was 2.4 ± 0.5 L·min
−1
, and EPOC
fast
was 1.69 L
·
O
2
. Significant correlations were observed between the percent change in spleen volume and (i) EPOC
fast
(
r
= − 0.657,
p
= 0.008) and (ii) τ
V
˙
O
2
(
r
= − 0.619,
p
= 0.008), but not between the change in spleen volume and (iii)
V
˙
O
2
peak (
r
= 0.435,
p
= 0.105).
Conclusion
Apparently, during supine cycling, individuals with larger spleen emptying tend to have slower
V
˙
O
2
recovery kinetics and a greater EPOC
fast
.
Adropin is a novel pleotropic peptide involved in energy homeostasis, with possible contribution to cardiovascular protection through production of nitric oxide and subsequent blood pressure ...regulation. Given that patients undergoing hemodialysis (HD) are related with high cardiovascular risk, hyperlipidemia, chronic low-grade inflammation, and malnutrition the aim of our study was to investigate serum adropin levels in HD patients to evaluate possible associations with nutritional status and other relevant clinical and laboratory parameters. The study included 70 patients on HD and 60 healthy controls. Serum adropin levels were determined by an enzyme-linked immunosorbent assay in a commercially available diagnostic kit. Serum adropin levels were significantly lower in the HD group compared to the control group (2.20 ± 0.72 vs. 4.05 ± 0.93 ng/mL,
< 0.001). Moreover, there was a significant negative correlation with malnutrition-inflammation score (r = -0.476,
< 0.001), dialysis malnutrition score (r = -0.350,
= 0.003), HD duration (r = -0.305,
= 0.010), and high sensitivity C-reactive protein (hsCRP) (r = -0.646,
< 0.001). Additionally, there was a significant negative correlation between adropin levels and pre-dialysis systolic (r = -0.301,
= 0.011) and diastolic blood pressure (r = -0.299,
= 0.011). These results are implying that adropin is potentially involved in the pathophysiological mechanisms of chronic kidney disease (CKD)/HD and its complications. However, future larger scale longitudinal studies need to further address it.
Catestatin is a pleiotropic peptide with a wide range of immunomodulatory effects. Considering that patients with a severe COVID-19 infection have a major immunological dysregulation, the aim of this ...study was to evaluate catestatin levels in patients with COVID-19 treated in the intensive care unit (ICU) and to compare them between the fatal and non-fatal outcomes. The study included 152 patients with severe COVID-19, out of which 105 had a non-fatal outcome and 47 had a fatal outcome. Serum catestatin levels were estimated by an enzyme-linked immunosorbent assay in a commercially available diagnostic kit. The results show that catestatin levels were significantly lower in the fatal group compared to the non-fatal group (16.6 ± 7.8 vs. 23.2 ± 9.2 ng/mL; p < 0.001). Furthermore, there was a significant positive correlation between serum catestatin levels and vitamin D levels (r = 0.338; p < 0.001) while there was also a significant positive correlation between serum catestatin levels and growth differentiation factor-15 (GDF-15) levels (r = −0.345; p < 0.001). Furthermore, multivariate logistic regression showed that catestatin, GDF-15 and leukocyte count were significant predictors for COVID-19 survival. These findings imply that catestatin could be playing a major immunomodulatory role in the complex pathophysiology of the COVID-19 infection and that serum catestatin could also be a predictor of a poor COVID-19 outcome.
Objective: HYPER-H21-4 was a randomized, triple-blind, crossover study that demonstrated that 5 week cannabidiol (CBD) supplementation reduces average 24h blood pressure (BP) in patients with ...arterial hypertension. The aim of this sub-study was to establish whether CBD elicits significant effect on the brain blood flow and memory in these patients. Design and method: The trial was designed as a triple-blind randomized crossover trial. For this prespecified sub-analysis, we included 15 hypertensive patients. Patients were randomized to receive either oral CBD or placebo for the period of 5 weeks. After a 2-week washout, patients were crossed over to alternate therapy (CBD/placebo) (Figure 1). Patients visited the lab at the start and at the end of each dosing period (four times in total). Magnetic resonance imaging (MRI), with specific focus on measurement of the blood flow through internal carotid artery using 4D flow technique. Variables of interest were mean flow (mL/min) and Pulsatility Index (AU). In addition, at each visit, venous blood samples were obtained. Finally, patients fulfilled a Memory Complaint Questionnaire (MAC-Q) at the start at the end of the study (after 12 weeks). Results: After 5 weeks of CBD supplementation, no significant changes in mean flow (time: P = 0.461, group: P = 0.657, interaction: P = 0.285) or Pulsatility Index (time: P = 0.573, group: P = 0.640, interaction: P = 0.970) in internal carotid artery in comparison to 5 weeks of placebo. In addition, significant reduction after in MAC-Q score was observed (25.8 ± 2.4 vs. 22.6 ± 3.8, P = 0.036), indicating reduced complaint on memory loss. Conclusions: The results of the HYPER-H21-4 trial indicate that chronic CBD supplementation leads to BP reduction. However, despite the fact that CBD supplementation improved self-reported memory abilities, no differences in comparison to placebo were noted in terms of blood flow through internal carotid artery, indicating lack of CBD-mediated effect.
Postoperative cognitive decline (POCD), a very common complication after cardiac surgery, is characterised by impairment of both memory function and intellectual ability as well as being associated ...with increased use of healthcare resources. The investigators focused on the role of the inflammatory response to a surgical procedure as a potential factor involved in the pathogenesis of POCD.
The use of prophylactic dexamethasone to attenuate the inflammatory response was hypothesised to reduce the risk of POCD.
Randomised controlled study.
Single university teaching hospital, from March 2015 to January 2016.
A total of 169 patients scheduled for elective cardiac surgery were enrolled, and 161 patients were included in the analyses.
Patients were randomised to receive a single intravenous bolus of 0.1 mg kg dexamethasone (n = 85) or placebo (n = 84) 10 h before the surgery.
The primary outcome measure in both groups was the incidence of POCD on the 6th day after surgery. The investigators also evaluated the effect of dexamethasone on the incidence of systemic inflammatory response syndrome, postoperative C-reactive protein levels and postoperative serum S100β protein levels.
Compared to the placebo group, the dexamethasone group showed statistically significant reductions in the incidence of POCD (relative risk, 0.43; 95% confidence interval, 0.21 to 0.89; P = 0.02), the incidence of systemic inflammatory response syndrome (30.0 versus 58.0%, P < 0.001) and postoperative C-reactive protein levels (P < 0.001). Postoperative S100β levels were insignificantly lower (P = 0.56) in the dexamethasone group.
Preoperative administration of dexamethasone reduced the inflammatory response and thereby decreased the risk of early POCD after cardiac surgery.
Clinicaltrials.gov identifier: NCT02767713.
The aim of the present study was to investigate whether greater splenic emptying or higher skeletal muscle deoxygenation amplitude (determined by near-infrared spectroscopy, NIRS) contributes to ...higher V̇O
max. during supine cycling. We hypothesized that the reduction in splenic volume, and subsequent manipulations of O
delivery by blood ejected from the spleen, would not contribute to higher V̇O
max. during supine cycling, because this transient increase in circulating red blood cells (RBC's) would be insufficient to increase the O
storage capacity in the blood. Rather, O
uptake during supine cycling in healthy subjects is expected to be limited, at least in part, by skeletal muscle bioenergetics. Here, fourteen healthy young individuals completed all study procedures. On three separate days they underwent a medical examination, supine V̇O
max. test, and three step-transitions from 20 W to a moderate-intensity power output equivalent to V̇O
uptake at 90% gas exchange threshold. During these step-transitions, pulmonary V̇O
, NIRS of the vastus lateralis (VL), and cardiovascular responses (via Finapres) were measured continuously. In parallel, minute-by-minute ultrasound measurements of the spleen were performed. Blood samples were taken before and immediately after the step-transition cycling. Mean V̇O
max. was 46.5±6.5 mL·kg·min
. In response to supine step-transition cycling, spleen volume was significantly reduced (by ~38%, p=.001). Both hematocrit and hemoglobin concentration increased by ~4%, after exercise cessation. There was no correlation between: i)spleen volume at rest, ii) changes in spleen volume (%), iii) hematocrit at rest and V̇O
max. However, a linear, near-significant correlation was observed between VL deoxygenation amplitude and V̇O
max. Apparently, individuals with a higher V̇O
max. are capable of greater O
extraction from the superficial knee extensors, whereas in parallel, greater splenic emptying does not correlate with higher V̇O
max, regardless of the subsequent release of erythrocytes. Therefore, it is reasonable to suggest that maximal O
utilization during supine cycling in healthy young men is limited, in part, by skeletal muscle bioenergetics. REFERENCES: Holmström, PK, Karlsson Ö, Lindblom H, McGawley K, & Schagatay, EK. (2021). Enhanced splenic volume and contraction in elite endurance athletes. J Appl Physiol, 131(2), 474-486, DOI: 10.1152/japplphysiol.01066.2020; Zubac, D, Obad, A, Bosnjak, A, Zec, M, Ivancev, V, Valic, Z. (2021). Spleen emptying does not correlate with faster oxygen kinetics during a step-transition supine cycling. Appl Physiol Nutr Metab. Accepted for publication in Jun 24. doi: 10.1139/apnm-2021-0294.2021.
The aim of this study is to assess the diagnostic utility of serum leucine-rich α-2-glycoprotein 1 (LRG1) in pediatric patients with acute abdominal pain, admitted to the emergency surgical unit, in ...order to make a prompt and accurate diagnosis of acute appendicitis.
Pediatric patients older than 5 years of age who presented to the emergency department from 15 October 2021 to 30 June 2022 with acute abdominal pain and suspected acute appendicitis were prospectively recruited in the study. Demographic and clinical data, as well as operative and postoperative data, were recorded. A total of 92 patients were equally distributed into two groups: children with acute appendicitis who underwent laparoscopic appendectomy and non-appendicitis patients, presenting with non-specific abdominal pain. LRG1 levels were determined using a commercially available LRG1 enzyme-linked immunosorbent assay (ELISA) kit. Serum LRG1 levels, as well as other inflammatory markers (white blood cell count (WBC), C-reactive protein (CRP) and absolute neutrophil count) were compared between groups.
The median level of LRG1 in serum was significantly higher in the group of children with pathohistologically confirmed acute appendicitis than in the control group, at 350.3 µg/mL (interquartile range (IQR) 165.2-560.3) and 25.7 µg/mL (IQR 14.7-36.8) (
< 0.001), respectively. Receiver operating characteristic area under the curve for LRG1 from serum was 1.0 (95% CI 0.96-1.00;
< 0.001) and the value of >69.1 µg/mL was found to perfectly separate acute appendicitis cases from controls. Additionally, as expected, each of the examined laboratory inflammatory markers provided a significantly higher values in the acute appendicitis group compared to the control group: WBC 14.6 × 10
/L (IQR 12.7, 18.7) vs. 7.0 × 10
/L (IQR 5.4, 9.0) (
< 0.001), CRP 16.3 mg/dL (IQR 6.9, 50.4) vs. 2.2 mg/dL (IQR 2, 2) (
< 0.001) and absolute neutrophil count 84.6% (IQR 79.5, 89.0) vs. 59.5% (IQR 51.5, 68.6) (
< 0.001).
LRG1 in the serum was found to be a promising novel biomarker, with excellent differentiation of acute appendicitis from non-appendicitis cases in children presenting with non-specific abdominal pain.
Objective To investigate the effect of nifedipine on testicular torsion-detorsion injury. Materials and Methods Twenty-four adult male Sprague-Dawley rats were randomly divided into 3 groups, each ...containing 8 rats. Rats in the control group underwent a sham operation of the left testis. In the torsion-detorsion (T/D) group, the left testis was twisted at 720° for 3 hours. After 3 hours of reperfusion, at the end of the experiment, the testes were removed. Rats in the treatment group received the same surgical procedure as the T/D group, but nifedipine was administered intraperitoneally (100 μg/kg) 30 minutes before the time of detorsion. Results Unilateral testicular torsion-detorsion caused a significant increase in the malondialdehyde level and apoptosis and caused significant decreases in superoxide dismutase and glutathione peroxidase activities in ipsilateral testes. The rats treated with nifedipine had a significant decrease in malondialdehyde level and apoptosis and had significant increases in superoxide dismutase and glutathione peroxidase activities in ipsilateral testes compared with those of the T/D group. Conclusion These results suggest that biochemical and histological torsion-detorsion injury occurs in the ipsilateral testes after a 3-hour torsion and 3-hour detorsion and that administration of nifedipine before detorsion prevents ischemia/reperfusion cellular damage in the testicular tissue.
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