P10.18.A Replication of previous GWAS identifies TERT and near EGFR SNVs as risk factors in EPIC glioma patients: a nested case-control study

Background

Gliomas, the most common malignant primary brain tumors in adults, typically have a poor prognosis irrespective of medical care. Previous large genome-wide association studies (GWAS) have identified 27 single-nucleotide variants (SNVs) that are significantly associated with glioma. However, most of the GWAS are conducted by case-control study designs, it is therefore prone to bias when rapidly lethal cases don’t have chance to be included in the study. This study aims to replicate the previous GWAS findings using prospective study design.

Material and Methods

We conducted a nested case-control study within the European Prospective Investigation into Cancer (EPIC) cohort from 7 European countries. GSA-MD Infinium global screening array was used for genotyping. Some subjects were genotyped by other platforms previously. In total, 468 glioma patients and 481 controls were included. The genotypes of 27 SNVs were extracted and for ungenotyped SNVs, datasets were imputed using SHAPEIT v4.1.3 and IMPUTE5 v1.1.5 based on the Haplotype Reference Consortium (Release 1.1) reference panel. Conditional logistic regression model was used to investigate the additive effect of SNVs on the risk of glioma.

Results

21 SNVs showed a consistent direction of effect with previous studies, whereas 6 SNVs did not (ORs between 0.72-0.99 and not significant). After adjusting for multiple testing, two SNVs, rs10069690 (TERT), and rs75061358 (near EGFR) were significantly associated with glioma risk. We observed that prominent OR (2.23, 95%CI=1.49-3.33) of rs75061358 in our study compared to the result from previous GWAS, which implied rs75061358 might be not only a risk factor but also affect survival. Different risk direction was observed for rs77633900 in ETFA gene (OR=0.72, 95%CI=0.51-1.01).

Conclusion

Our findings further confirmed the genetic role on the etiology of glioma in the European population. The potential biases from the previous GWAS are required to be elucidated.

Technological readiness and implementation of genomic-driven precision medicine for complex diseases

The fields of human genetics and genomics have generated considerable knowledge about the mechanistic basis of many diseases. Genomic approaches to diagnosis, prognostication, prevention and treatment - genomic-driven precision medicine (GDPM) - may help optimize medical practice. Here, we provide a comprehensive review of GDPM of complex diseases across major medical specialties. We focus on technological readiness: how rapidly a test can be implemented into health care. Although these areas of medicine are diverse, key similarities exist across almost all areas. Many medical areas have, within their standards of care, at least one GDPM test for a genetic variant of strong effect that aids the identification/diagnosis of a more homogeneous subset within a larger disease group or identifies a subset with different therapeutic requirements. However, for almost all complex diseases, the majority of patients do not carry established single-gene mutations with large effects. Thus, research is underway that seeks to determine the polygenic basis of many complex diseases. Nevertheless, most complex diseases are caused by the interplay of genetic, behavioural and environmental risk factors, which will likely necessitate models for prediction and diagnosis that incorporate genetic and non-genetic data.

Prediagnostic transcriptomic markers of Chronic lymphocytic leukemia reveal perturbations 10 years before diagnosis

BACKGROUND

B-cell lymphomas are a diverse group of hematological neoplasms with differential etiology and clinical trajectories. Increased insights in the etiology and the discovery of prediagnostic markers have the potential to improve the clinical course of these neoplasms.

METHODS

We investigated in a prospective study global gene expression in peripheral blood mononuclear cells of 263 incident B-cell lymphoma cases, diagnosed between 1 and 17 years after blood sample collection, and 439 controls, nested within two European cohorts.

RESULTS

Our analyses identified only transcriptomic markers for specific lymphoma subtypes; few markers of multiple myeloma (N = 3), and 745 differentially expressed genes in relation to future risk of chronic lymphocytic leukemia (CLL). The strongest of these associations were consistently found in both cohorts and were related to (B-) cell signaling networks and immune system regulation pathways. CLL markers exhibited very high predictive abilities of disease onset even in cases diagnosed more than 10 years after blood collection.

CONCLUSIONS

This is the first investigation on blood cell global gene expression and future risk of B-cell lymphomas. We mainly identified genes in relation to future risk of CLL that are involved in biological pathways, which appear to be mechanistically involved in CLL pathogenesis. Many but not all of the top hits we identified have been reported previously in studies based on tumor tissues, therefore suggesting that a mixture of preclinical and early disease markers can be detected several years before CLL clinical diagnosis.

Cognitive ability in early adulthood is associated with later suicide and suicide attempt: the role of risk factors over the life course

BACKGROUND

Cognitive ability/intelligence quotient (IQ) in youth has previously been associated with subsequent completed and attempted suicide, but little is known about the mechanisms underlying the associations. This study aims to assess the roles of various risk factors over the life course in explaining the observed relationships.

METHOD

The present investigation is a cohort study based on data on IQ test performance and covariates, recorded on 49 321 Swedish men conscripted in 1969-1970, at ages 18-20 years. Information on suicides and hospital admissions for suicide attempt up to the age of 57 years, childhood and adult socio-economic position, and adult family formation, was obtained from linkage to national registers.

RESULTS

Lower IQ was associated with increased risks of both suicide and suicide attempt during the 36 years of follow-up. The associations followed a dose-response pattern. They were attenuated by approximately 45% in models controlling for social background, mental ill-health, aspects of personality and behavior, adult socio-economic position and family formation. Based on one-unit decreases in IQ test performance on a nine-point scale, the hazard ratios between ages 35 and 57 years were: for suicide 1.19 [95% confidence interval (CI) 1.13-1.25], fully adjusted 1.10 (95% CI 1.04-1.18); and for suicide attempt 1.25 (95% CI 1.20-1.31), fully adjusted 1.14 (95% CI 1.09-1.20).

CONCLUSIONS

Cognitive ability was found to be associated with subsequent completed and attempted suicide. The associations were attenuated by 45% after controlling for risk factors measured over the life course. Psychiatric diagnosis, maladjustment and aspects of personality in young adulthood, and social circumstances in later adulthood, contributed in attenuating the associations.

Association of PHB 1630 C>T and MTHFR 677 C>T polymorphisms with breast and ovarian cancer risk in BRCA1/2 mutation carriers: results from a multicenter study

BACKGROUND

The variable penetrance of breast cancer in BRCA1/2 mutation carriers suggests that other genetic or environmental factors modify breast cancer risk. Two genes of special interest are prohibitin (PHB) and methylene-tetrahydrofolate reductase (MTHFR), both of which are important either directly or indirectly in maintaining genomic integrity.

METHODS

To evaluate the potential role of genetic variants within PHB and MTHFR in breast and ovarian cancer risk, 4102 BRCA1 and 2093 BRCA2 mutation carriers, and 6211 BRCA1 and 2902 BRCA2 carriers from the Consortium of Investigators of Modifiers of BRCA1 and BRCA2 (CIMBA) were genotyped for the PHB 1630 C>T (rs6917) polymorphism and the MTHFR 677 C>T (rs1801133) polymorphism, respectively.

RESULTS

There was no evidence of association between the PHB 1630 C>T and MTHFR 677 C>T polymorphisms with either disease for BRCA1 or BRCA2 mutation carriers when breast and ovarian cancer associations were evaluated separately. Analysis that evaluated associations for breast and ovarian cancer simultaneously showed some evidence that BRCA1 mutation carriers who had the rare homozygote genotype (TT) of the PHB 1630 C>T polymorphism were at increased risk of both breast and ovarian cancer (HR 1.50, 95%CI 1.10-2.04 and HR 2.16, 95%CI 1.24-3.76, respectively). However, there was no evidence of association under a multiplicative model for the effect of each minor allele.

CONCLUSION

The PHB 1630TT genotype may modify breast and ovarian cancer risks in BRCA1 mutation carriers. This association need to be evaluated in larger series of BRCA1 mutation carriers.

Primary brain tumours and specific serum immunoglobulin E: a case-control study nested in the European Prospective Investigation into Cancer and Nutrition cohort

BACKGROUND

Case-control studies suggest that patients with allergic diseases have a lower risk of developing glioma but not meningioma or schwannoma. However, those data can be differentially biased. Prospective studies with objective measurements of immunologic biomarkers, like immunoglobulin E (IgE), in blood obtained before cancer diagnosis could help to clarify whether an aetiological association exists.

METHODS

The present case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) measured specific serum IgE as a biomarker for the most common inhalant allergens in 275 glioma, 175 meningioma and 49 schwannoma cases and 963 matched controls using the ImmunoCAP specific IgE test. Subjects with an IgE level ≥0.35 kUA/l (kilo antibody units per litre) were classified as sensitized by allergens. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by adjusted conditional logistic regression models for each tumour subtype. The effect of dose-response relationship was assessed in five increasing IgE level categories to estimate P-values for trend.

RESULTS

The risk of glioma was inversely related to allergic sensitization (OR = 0.73; 95% CI 0.51-1.06), especially pronounced in women (OR = 0.53; 95% CI 0.30-0.95). In dose-response analyses, for high-grade glioma, the lowest OR was observed in sera with the highest IgE levels (P for trend = 0.04). No association was seen for meningioma and schwannoma.

CONCLUSION

The results, based on serum samples prospectively collected in a cohort study, provide some support for the hypothesis that individuals with allergic sensitization are at reduced risk of glioma and confirm results from previous case-control studies.

Genetic variations in VEGF and VEGFR2 and glioblastoma outcome

Vascular endothelial growth factor (VEGF) and its receptors (VEGFR) are central components in the development and progression of glioblastoma. To investigate if genetic variation in VEGF and VEGFR2 is associated with glioblastoma prognosis, we examined blood samples from 154 glioblastoma cases collected in Sweden and Denmark between 2000 and 2004. Seventeen tagging single nucleotide polymorphisms (SNPs) in VEGF and 27 in VEGFR2 were genotyped and analysed, covering 90% of the genetic variability within the genes. In VEGF, we found no SNPs associated with survival. In VEGFR2, we found two SNPs significantly associated to survival, namely rs2071559 and rs12502008. However, these results are likely to be false positives due to multiple testing and could not be confirmed in a separate dataset. Overall, this study provides little evidence that VEGF and VEGFR2 polymorphisms are important for glioblastoma survival.

Self-Efficacy Beliefs Predict Sustained Long-Term Sick Absenteeism in Individuals With Chronic Musculoskeletal Pain

Recovery beliefs are assumed to predict rehabilitation outcomes and return-to-work in various clinical conditions but are less frequently assessed in musculoskeletal disorders. We tested the hypothesis that recovery beliefs constitute a risk factor for sustained long-term sick absenteeism in men and women suffering from nonspecific chronic musculoskeletal disorders. A total of 233 subjects with a recent or ongoing experience of long-term sick leave were included in a prospective design. Subjects answered a postal baseline questionnaire and were followed up via register data for 1 year. Multivariate logistic regression analyses indicated that subjects with negative recovery beliefs (OR: 2.41; CI: 1.22-4.77), low sense of mastery (OR: 2.08; CI: 1.27-3.40), perceived high mental demands at work (OR: 1.77; CI: 1.05-2.99), and prior experiences of long-term sick absenteeism (OR: 1.86; CI: 1.02-3.37) had an increased probability of receiving sickness benefits at follow-up. We conclude that prolonged sickness absence contributes strongly to increase patients' sense of helplessness, lower self-efficacy, and hinder future work return. To improve work return, patients' maladaptive beliefs should be clarified and challenged early in the rehabilitation process.

Self-efficacy beliefs predict sustained long-term sick absenteeism in individuals with chronic musculoskeletal pain

Recovery beliefs are assumed to predict rehabilitation outcomes and return-to-work in various clinical conditions but are less frequently assessed in musculoskeletal disorders. We tested the hypothesis that recovery beliefs constitute a risk factor for sustained long-term sick absenteeism in men and women suffering from nonspecific chronic musculoskeletal disorders. A total of 233 subjects with a recent or ongoing experience of long-term sick leave were included in a prospective design. Subjects answered a postal baseline questionnaire and were followed up via register data for 1 year. Multivariate logistic regression analyses indicated that subjects with negative recovery beliefs (OR: 2.41; CI: 1.22-4.77), low sense of mastery (OR: 2.08; CI: 1.27-3.40), perceived high mental demands at work (OR: 1.77; CI: 1.05-2.99), and prior experiences of long-term sick absenteeism (OR: 1.86; CI: 1.02-3.37) had an increased probability of receiving sickness benefits at follow-up. We conclude that prolonged sickness absence contributes strongly to increase patients' sense of helplessness, lower self-efficacy, and hinder future work return. To improve work return, patients' maladaptive beliefs should be clarified and challenged early in the rehabilitation process.

Substrate utilization during prolonged exercise with ingestion of 13C-glucose in acute hypobaric hypoxia (4,300 m)

Energy substrate oxidation was measured using indirect respiratory calorimetry combined with tracer technique in five healthy young male subjects, during a 80-min exercise period on ergocycle with ingestion of 140 g of (13)C-labelled glucose, in normoxia and acute hypobaric hypoxia (445 mmHg or 4,300 m), at the same relative [77% V(.-)((O)(2)(max))] and absolute workload (161+/-8 W, corresponding to 77 and 54% V(.-)((O)(2)(max)) in hypoxia and normoxia). The oxidation rate of exogenous glucose was not significantly different in the three experimental situations: 21.4+/-2.9, 20.2+/-1.2 and 17.2+/-0.6 g over the last 40 min of exercise at approximately 77 and approximately 54% V(.-)((O)(2)(max)) in normoxia and in hypoxia, respectively, providing 12.5+/-1.5, 16.8+/-1.1 and 14.9+/-1.1% of the energy yield, although ingestion of glucose during exercise resulted in a higher plasma glucose concentration in hypoxia than normoxia. The contribution of carbohydrate (CHO) oxidation to the energy yield was significantly higher in hypoxia (92.0+/-2.1%) than in normoxia for both a given absolute (75.3+/-5.2%) and relative workload (78.1+/-1.8%). This greater reliance on CHO oxidation in hypoxia was entirely due to the significantly larger contribution of endogenous glucose oxidation to the energy yield: 75.9+/-1.7% versus 66.6+/-3.3 and 55.2+/-3.7% in normoxia at the same relative and absolute workload.

Effects of fluid ingestion on cognitive function after heat stress or exercise-induced dehydration

This study investigated the effects of heat exposure, exercise-induced dehydration and fluid ingestion on cognitive performance. Seven healthy men, unacclimatized to heat, were kept euhydrated or were dehydrated by controlled passive exposure to heat (H, two sessions) or by treadmill exercise (E, two sessions) up to a weight loss of 2.8%. On completion of a 1-h recovery period, the subjects drank a solution containing 50 g l(-1) glucose and 1.34 g l(-1) NaCl in a volume of water corresponding to 100% of his body weight loss induced by dehydration. (H1 and E1) or levels of fluid deficit were maintained (H0, E0). In the E0, H0 and control conditions, the subject drank a solution containing the same quantity of glucose diluted in 100 ml of water. Psychological tests were administered 30 min after the dehydration phase and 2 h after fluid ingestion. Both dehydration conditions impaired cognitive abilities (i.e. perceptive discrimination, short-term memory), as well as subjective estimates of fatigue, without any relevant differences between the methods. By 3.5 h after fluid deficit, dehydration (H0 and E0) no longer had any adverse effect, although the subjects felt increasingly tired. Thus, there was no beneficial effect of fluid ingestion (H1 and E1) on the cognitive variables. However, long-term memory retrieval was impaired in both control and dehydration situations, whereas there was no decrement in performance in the fluid ingestion condition (H1, E1).

Comparison of passive heat or exercise-induced dehydration on renal water and electrolyte excretion: the hormonal involvement

The effects of hydromineral hormones and catecholamines on renal water and electrolyte excretion were examined during and after dehydration induced by either passive heat or exercise. Eight healthy young Caucasian subjects participated in three separate trials, each including three consecutive phases. Phases 1 and 3 involved a 90-min period at rest in a thermoneutral environment, while phase 2 involved a 120-min period designed to provide: (1) euhydration (control trial), (2) passive heat-induced dehydration of 2.8% body mass, or (3) exercise-induced dehydration of 2.8% body mass. During the two dehydration procedures, the decreases in urine flow and sodium excretion were more marked during exercise (P < 0.05). An increase in plasma catecholamines occurred only during exercise, together with a reduction in creatinine clearance and more marked increases in plasma renin and aldosterone than during passive heat exposure (P < 0.05). Although plasma vasopressin was elevated during the two dehydration procedures, urine osmolality did not change and, moreover, free water clearance increased during exercise (P < 0.05). Plasma levels of atrial natriuretic peptide increased markedly only during exercise compared to the other trials (P < 0.05). After the dehydration procedures, urine flow decreased again and urine osmolality increased markedly (P < 0.05), while plasma vasopressin remained elevated. These results suggest that sympathoadrenal activation during exercise plays a major role in the more marked reduction in diuresis and natriuresis than during passive heat exposure. Despite high plasma vasopressin concentrations during the two dehydrating events, the observed antidiuresis was not due to an increased renal concentrating ability, and the vasopressin was more effective after the dehydration procedures.

[Sports and extreme conditions. Cardiovascular incidence in long term exertion and extreme temperatures (heat, cold)]

During ultra-endurance exercise, both increase in body temperature and dehydration due to sweat losses, lead to a decrease in central blood volume. The heart rate drift allows maintaining appropriate cardiac output, in order to satisfy both muscle perfusion and heat transfer requirements by increasing skin blood flow. The resulting dehydration can impair thermal regulation and increase the risks of serious accidents as heat stroke. Endurance events, lasting more than 8 hours, result in large sweat sodium chloride losses. Thus, ingestion of large amounts of water with poor salt intake can induce symptomatic hyponatremia (plasma sodium < 130 mEq/L) which is also a serious accident. Heat environment increases the thermal constraint and when the air humidity is high, evaporation of sweat is compromise. Thus, thermal stress becomes uncompensable which increases the risk of cardiovascular collapse. Cold exposure induces physiological responses to maintain internal temperature by both limiting thermal losses and increasing metabolic heat production. Cold can induce accidental hypothermia and local frost-bites; moreover, it increases the risk of arrhythmia during exercise. Some guidelines (cardiovascular fitness, water and electrolyte intakes, protective clothing) are given for each extreme condition.

Trapezius muscle activity, neck and shoulder pain, and subjective experiences during monotonous work in women

The electromyographic (EMG) activity patterns of 18 female supermarket employees reporting neck and shoulder pain were compared with those of 6 of their female colleagues reporting no pain when doing cash-register work. It was found that the EMG activity of the trapezius muscle tended to show a lack of low and high levels among pain subjects, and that the time the trapezius muscle was at rest was longer in the group reporting no pain. In the non-dominant side, the muscle rest time was significantly longer (P < 0.05) in the group reporting no pain, and this group also showed a larger EMG activity difference between the dominant and non-dominant sides, indicating a less static bilateral muscle activation. Self-reports of negative experiences (stressed, exhausted and tense) were somewhat higher in the group reporting pain, while positive experiences during work (concentrated, stimulated and happy) appeared to be similar in the two groups of supermarket employees.

Surface EMG and psychophysiological stress reactions in women during repetitive work

In order to understand the high prevalence of musculoskeletal disorders associated with stressful work, it is important to explore the relationship between muscle activity and psychophysiological stress responses. The present real-life study examines surface trapezius electromyographic (sEMG) activity, heart rate, blood pressure, and levels of urinary catecholamines and salivary cortisol among 31 female employees working at supermarkets, where the prevalence of neck and shoulder disorders is high (60-70%). As expected, the results show that psychophysiological arousal was high during work. Significant correlations were found between self-reports indicating negative stress (stressed, exhausted, tense) and sEMG activity during work. No significant correlations were found between self-reports of positive reactions (stimulated, concentrated, happy) and sEMG activity. No associations were found between sEMG activity and pain or between negative stress ratings and pain. Objectively measured workload and physiological stress responses did not correlate significantly with sEMG activity. Thus, our data indicate that perceived negative stress may have a specific influence on muscle activity, which may be of importance for musculoskeletal disorders in jobs with low-to-moderate physical load and negative psychosocial factors.

Use of bioelectrical impedance analysis to estimate body fluid compartments after acute variations of the body hydration level

Physiological measurements including body mass, plasma osmolality, natremia, plasma volume measured by Evans Blue dilution, and total body water (TBW) and extracellular water (ECW) volumes estimated by bioelectrical impedance analysis (BIA) were recorded in eight healthy young Caucasian subjects before and after acute variations of their body hydration state on four separate occasions: 1) euhydration or control trial (C); 2) heat-induced dehydration of 2.8% body mass (D); 3) exercise-induced dehydration of 2.8% body mass (E); and 4) glycerol-hyperhydration (H). Heart rate, rectal and mean skin temperatures were also recorded throughout the experiment. The main result of the study is that BIA only half predicted the body water loss after exercise, although conditions were standardized (electrode placement, side of the body, limb position, posture, and ambient temperature). Differences in body temperatures cannot explain such an unexpected result, nor did the study of plasma osmolality and sodium concentration. If BIA appears to adequately predict changes in TBW after heat-induced dehydration and glycerol hyperhydration, further studies including measures of TBW and ECW by dilution tracer methods would be necessary to establish the validity of using the BIA method to measure such changes and to interpret ECW variations.

Personal sampling in parallel with open-face filter cassettes and IOM samplers for inhalable dust--implications for occupational exposure limits

Parallel personal sampling was carried out with the open-face filter cassette and the IOM sampler for inhalable dust for nine types of organic dust. Parallel samples numbering 749 were obtained from 152 plants. Extremely large values and outliers were disregarded, and the remaining data for each type of dust were divided into subsets according to type of product or work task, and analyzed with the aid of linear regression. The coefficient of regression for each subset ranged between 0.2 and 0.7. Hypothetical occupational exposure limits (OELs) for inhalable dust were calculated based on the linear relation obtained between the dust concentrations measured with the open-face filter cassette and the IOM sampler. The fraction of person days with time-weighted average (TWA) concentrations exceeding the calculated hypothetical OELs for inhalable dust was obtained from the distribution of measured TWA inhalable dust concentrations. Based on the results of this study and the difference in sampling efficiency for large particles between the two samplers, it was concluded that the numerical value of the OEL for inhalable dust may be set at approximately twice the numerical value of the corresponding limit value for "total dust." Additional consideration of recently discovered health effects, and technical and economical factors may result in other numerical values of future OELs for inhalable dust.

Determination of the velocity associated with VO2max

PURPOSE

The theoretical velocity associated with VO2max (vVO2max) defined by Daniels (1985) is extrapolated from the submaximal VO2-velocity relationship. VO2 is generally determined by assuming that the aerobic response reacts like a linear first-order system at the beginning of square-wave exercise with a steady-state reached by the 4th minute. However, at supra-ventilatory threshold work rates, the steady state in VO2 is delayed or not attained.

METHODS

The present study was carried out to compare three values for vVO2max determined with Daniels' method, but with VO2 either measured at the 4th minute (vVO2max4), the 6th minute (vVO2max6), or after the attainment of the true steady-state (vVO2maxSS). The metabolic response during square-wave exercise at each of the three vVO2max were also assessed.

RESULTS

These velocities were significantly different (P < 0.05), but vVOmaxSS and vVO2max6 were highly correlated (r = 0.98; P < 0.05). Blood lactate concentrations measured after exercise at velocities very close to the three vVO2max were similar and the end-exercise VO2 were not different from VO2max, but the time required to elicit 95% VO2max during these three square-wave tests were significantly different.

CONCLUSION

Therefore, when vVO2max is determined by extrapolation from the submaximal VO2-velocity relationships, submaximal VO2 should be measured beyond the 6th minute of square-wave exercise (at least if it takes 30 s to reach the desired velocity) to ensure that all vVO2max reported in future studies describe a similar quantitative index.

Influence of Variations in Body Hydration on Cognitive Function

Abstract Eight healthy men, unacclimated to heat, were submitted to variations in body hydration. The subjects were kept euhydrated, dehydrated by controlled passive hyperthermia or exercise on a treadmill up to a weight loss of 2.8%, or hyperhydrated using a solution containing glycerol, with a total ingested volume equal to 21.4 ml/kg of body weight. On completion of a 90-min recovery period, the subjects were assigned a pedaling exercise on an arm-crank ergometer. Psychological tests were administered 30 min after the phase of hydration variation and 15 min after the arm crank exercise. Both dehydration conditions impaired cognitive abilities (i.e., perceptive discrimination, psycho-motor skills, and short-term memory) as well as subjective estimates of fatigue, without any relevant differences between them. Short-term memory was significantly greater following hyperhydration when compared to euhydration (P < .05). Following arm crank exercise, further effects of dehydration were found for tracking performance only (P < .05). Moreover, long-term memory was impaired in both control and dehydration situations, whereas there was no decrement in performance in the hyperhydration condition.

Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers

This study examined psychological and physiological stress, as well as muscle tension and musculoskeletal symptoms, among 72 female supermarket cashiers. Stress levels were found to be significantly elevated at work, as reflected in the catecholamines, blood pressure, heart rate, electromyographic (EMG) activity, and self-reports. Fifty cashiers (70%) suffering from neck-shoulder pain (trapezius myalgia) were found to have higher EMG activity at work and reported more tension after work. Women who kept a diary for 1 week and reported more musculoskeletal pain (above the median) were older, had higher blood pressure, and reported more work stress and psychosomatic symptoms. The elevated stress levels at work are consistent with data from workers involved in other types of repetitive tasks and can be important for the high prevalence of neck and shoulder symptoms among the cashiers.

Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers

This study examined psychological and physiological stress, as well as muscle tension and musculoskeletal symptoms, among 72 female supermarket cashiers. Stress levels were found to be significantly elevated at work, as reflected in the catecholamines, blood pressure, heart rate, electromyographic (EMG) activity, and self-reports. Fifty cashiers (70%) suffering from neck-shoulder pain (trapezius myalgia) were found to have higher EMG activity at work and reported more tension after work. Women who kept a diary for 1 week and reported more musculoskeletal pain (above the median) were older, had higher blood pressure, and reported more work stress and psychosomatic symptoms. The elevated stress levels at work are consistent with data from workers involved in other types of repetitive tasks and can be important for the high prevalence of neck and shoulder symptoms among the cashiers.

Plasma volume changes during and after acute variations of body hydration level in humans

This study examined plasma volume changes (deltaPV) in humans during periods with or without changes in body hydration: exercise-induced dehydration, heat-induced dehydration and glycerol hyperhydration. Repeated measurements of plasma volume were made after two injections of Evans blue. Results were compared to deltaPV calculated from haematocrit (Hct) and blood haemoglobin concentration ([Hb]). Eight well-trained men completed four trials in randomized order: euhydration (control test C), 2.8% dehydration of body mass by passive controlled hyperthermia (D) and by treadmill exercise (60% of their maximal oxygen uptake, VO2max) (E), and hyperhydration (H) by glycerol ingestion. The Hct, [Hb], plasma protein concentrations and plasma osmolality were measured before, during and after the changes in body hydration. Different Hct and [Hb] reference values were obtained to allow for posture-induced variations between and during trials. The deltaPV values calculated after two Evans blue injections were in good agreement with deltaPV calculated from Hct and [Hb]. Compared to the control test, mean plasma volume declined markedly during heat-induced dehydration [-11.4 (SEM 1.7)%] and slightly during exercise-induced dehydration [-4.2 (SEM 0.9)%] (P < 0.001 compared to D), although hyperosmolality was similar in these two trials. Conversely, glycerol hyperhydration induced an increase in plasma volume [+7.5 (SEM 1.0)%]. These results would indicate that, for a given level of dehydration, plasma volume is dramatically decreased during and after heat exposure, while it is better maintained during and after exercise.

Effects of acute hypobaric hypoxia on the appearance of ingested deuterium from a deuterium oxide-labelled carbohydrate beverage in body fluids of humans during prolonged cycling exercise

To determine whether or not acute hypobaric hypoxia alters the rate of water absorption from a carbohydrate beverage ingested during exercise, six men cycled for 80 min on three randomly assigned different occasions. In one trial, exercise was performed in hypoxia (barometric pressure, P(B) = 594 hPa, altitude 4,400 m) at an exercise intensity selected to elicit 75% of the individual's maximal oxygen uptake (VO2max) previously determined in such conditions. In the two other experiments, the subjects cycled in normoxia (P(B) = 992 hPa) at the same absolute and the same relative intensities as in hypoxia, which corresponded to 55% and 75%, respectively, of their VO2max determined in normoxia. The subjects consumed 400 ml of a 12.5% glucose beverage just prior to exercise, and 250 ml of the same drink at 20, 40 and 60 min from the beginning of exercise. The first drink contained 20 ml of deuterium oxide to serve as a tracer for the entry of water into body fluids. The heart rate (HR) during exercise was higher in hypoxia than in normoxia at the same absolute exercise intensity, whereas it was similar to HR measured in normoxia at the same relative exercise intensity. Both in normoxia and hypoxia, plasma noradrenaline concentrations were related to the relative exercise intensity up to 40 min of exercise. Beyond that duration, when exercise was performed at the highest absolute power in normoxia, the noradrenaline response was higher than in hypoxia at the same relative exercise intensity. No significant differences were observed among experimental conditions, either in temporal profiles of plasma D accumulation or in elimination of water ingested in sweat. Conversely, elimination in urine of the water ingested appeared to be related to the severity of exercise, either high absolute power or the same relative power combined with hypoxia. We concluded that water absorption into blood after drinking a 12.5% glucose beverage is not altered during cycling exercise in acute hypobaric hypoxia. It is suggested that the elimination of water ingested in sweat and urine may be dependent on local circulatory adjustments during exercise.

Influence of the oxygen uptake slow component on the aerobic energy cost of high-intensity submaximal treadmill running in humans

During high-intensity running, the oxygen uptake (VO2) kinetics is characterised by a slow component which delays the attainment of the steady-state beyond the 3rd min of exercise. To assess if the aerobic energy cost of running measured at the 3rd min (C3) adequately reflects the variability of the true aerobic energy cost measured during the steady-state (Css), 13 highly-trained runners completed sessions of square-wave running at intensities above 80% maximal oxygen uptake (VO2max) on a level treadmill. To evaluate the time at which the steady-state VO2 was attained (tss), the VO2 responses were described using a general double-exponential equation and tss was defined as the time at which VO2 was less than 1% below the asymptotic value given by the model. All the subjects achieved a steady state for intensities equal to or greater than 92% VO2max, and 8 out of 13 achieved it at 99% VO2max. In all cases, tss was less than 13 min. For intensities greater than 85% VO2max, Css was significantly higher than C3 and was positively related to %VO2 max (r=0.44; P < 0.001) while C3 remained constant. The C3 only explained moderately the variability of Css (0.39 < r2 < 0.72, depending on the velocity or the (relative intensity at which the relationship was calculated). Moreover, the excess aerobic energy cost of running the (difference between Css and C3) was well predicted by age (0.90 < r2 < 0.93). Therefore, when the aerobic profile of runners is evaluated, it is recommended that their running efficiencies at velocities which reflect their race intensities should be determined, with VO2 data being measured at the true steady-state.

Effects of hydration state on hormonal and renal responses during moderate exercise in the heat

The effects of hydromineral hormones and catecholamines on renal concentrating ability at different hydration states were examined in five male volunteers while they performed three trials. Each of these trials comprised a 60-min exercise bout on a treadmill (at 50% of maximal oxygen uptake) in a warm environment (dry bulb temperature, 35 degrees C; relative humidity, 20-30%). In one session, subjects were euhydrated before exercise (C). In the two other sessions, after thermal dehydration (loss of 3% body mass) which markedly reduced plasma volume (PV) and increased plasma osmolality (osm[pl]), the subjects exercised either not rehydrated (Dh) or rehydrated (Rh) by drinking 600 ml of mineral water before and 40 min after the onset of exercise. During exercise in the Dh compared to C state, plasma renin, aldosterone, arginine vasopressin (AVP), noradrenaline and adrenaline concentrations were increased (P < 0.05). A reduction in creatinine clearance and urine flow was also observed (P < 0.05) together with a decrease in urine osmolality, osmolar clearance and sodium excretion, while free water clearance increased (P < 0.05). However, compared to Dh, Rh partially restored PV and osm(pl) and induced a marked reduction in the time courses of both the plasma AVP and catecholamine responses (P < 0.05). Values for renal water and electrolyte excretion were intermediate between those of Dh and C. Plasma atrial natriuretic peptide presented similar changes whatever the hydration state. These results demonstrate that during moderate exercise in the heat, renal concentrating ability is paradoxically reduced by prior dehydration in spite of high plasma AVP levels, and might be the result of marked activation of the sympatho-adrenal system. Rehydration, by reducing this activation, could partially restore the renal concentrating ability despite the lowered plasma AVP.

Effects of various beverages on the hormones involved in energy metabolism during exercise in the heat in previously dehydrated subjects

The objective of our study was to examine the effects of beverage content on hormone responses involved in fuel substrate metabolism (catecholamines, insulin and glucagon) in previously dehydrated subjects exercising at a moderate intensity in the heat. Six healthy men walked for 60-min on five occasions at 50% maximal oxygen uptake in a warm environment (dry bulb temperature 35 +/- 0.2 degrees C, relative humidity 20%). On each occasion, the subjects were dehydrated before exercise (loss of 2% body mass) by passive controlled hyperthermia, which led to a reduction in plasma volume (PV) of about -5% to -9%. In one session, the subjects exercised without rehydration (Dh). In the other sessions, four beverages (650 ml) were given just before the exercise: mineral water (W), a 60 g x l(-1) glucose and 1.2 g x l(-1) NaCl solution (GS), a 60 g x l(-1) maltodextrin solution, and a 60 g x l(-1) maltodextrin and 1.2 g x l(-1) NaCl solution. Compared to Dh and W, carbohydrate supply with or without NaCl induced a higher glycaemia (P < 0.05), a reduced increase in plasma adrenaline concentration (P < 0.05) and a higher plasma insulin concentration (P < 0.05), which lowered plasma free fatty acids and glycerol concentrations (P < 0.05). The lesser increase in plasma noradrenaline concentrations observed during GS compared to Dh and W sessions can be explained by a larger correction in PV which might have induced better haemodynamic conditions. However, the increase in plasma glucagon with carbohydrate supply--compared to Dh and W (P < 0.05)--remains unexplained.

Plasma myosin and creatine kinase time-course after a concentric-eccentric field exercise

The effect of a concentric (uphill run)-eccentric (downhill run) field exercise of 22.3 km long was examined in five healthy male volunteers to compare the time course of changes in plasma creatine kinase (CK) activity and beta myosin heavy chain (beta MHC) concentration observed during the recovery. CK and beta MHC were examined in blood sampled before exercise, immediately and 5 hours after exercise ceased. Screenings were conducted 1, 2, 3, 4, 5 and 7 days later. For every subject, the peak of plasma CK was transient and observed within the first 24 hours of recovery. In contrast to CK changes, plasma beta-MHC elevation was delayed and the peak, also transient, was observed the second or the third day after the exercise. The highly significant relationship between individual values of CK and beta MHC (P < 0.001) demonstrates that beta MHC could be used as a marker of skeletal muscle damage after acute exercise.

Effects of different carbohydrate-electrolyte beverages on the appearance of ingested deuterium in body fluids during moderate exercise by humans in the heat

To determine whether different forms of glucose (free and polymer) associated with sodium chloride influence the rate of water absorption during exercise in the heat, six men took part in five trials. Each trial included a passive heating session which resulted in a 2% loss of body mass, followed by 1h of treadmill exercise (at 50% of maximal oxygen uptake) in warm conditions (dry bulb temperature 35 degrees C, relative humidity 20%-30%). Immediately before exercise, the subjects were given either no fluid or a volume equal to 50% of the fluid previously lost (about 650 ml), chosen from among four D2O-labelled beverages: mineral water, a 6% glucose-electrolyte solution (GS), a 6% maltodextrin solution and a 6% maltodextrin-electrolyte solution. No significant differences were observed among these various beverages so far as temporal accumulation of deuterium in plasma, sweat and urine was concerned. During GS, the plasma volume was completely restored and the drifts of heart rate and rectal temperature were less marked than during other trials. These results would suggest that rehydration with GS was more efficient, probably because of an internal redistribution of water. The proportion of ingested water was twice as high in sweat as it was in urine. These findings may reflect the essential part played by circulatory adjustments in the transfer of plasma water into sweat and urine.

Psychophysiological stress and emg activity of the trapezius muscle

Although it is generally assumed that mental stress induces muscular tension, the experimental data have, so far, been inconclusive. Likely explanations for these inconsistent findings are (a) too small subject samples in some experiments, (b) the use of only one type of stress stimulation, and (c) the lack of objective (physiological) measurements documenting the stress-inducing properties of the experimental treatment. Furthermore. the effect of mental stress and physical load separately, versus the combined influence of physical and mental load on muscular tension, has not been investigated earlier. Therefore, the aim o f the present experiment was lo examine the effects of mental stress as well as of physical load, separately and in combination, on perceived stress, physiological stress responses, and on muscular tension as reflected in electromyographical (EMG) activity of the trapezius muscle. Sixty two female subjects were individually exposed to mental arithmetic, the Stroop color word test (CWT), the cold pressor test, standardized test contractions (TCs), and the CWT combined with a TC. Compared to baseline, the stress session induced significant increases in systolic and diastolic blood pressure, heart rate, urinary catecholamines, salivary cortisol, and self-reported stress. Each of the two mental stress tests induced a significant increase in EMG activity. The CWT caused a rise in EMG activity also during the TC, which was significantly more pronounced than the increase induced by the CWT alone. Blood pressure responses and self-reported stress followed the same pattern as the EMG activity. The results are consistent with the assumption that psychological stress plays a role in musculoskeletal disorders by increasing muscular tension both in low-load work situations and in the absence of physical load. It is also indicated that the stress-induced increase in muscular tension is accentuated on top of a physical load.

Effect of ingestion pattern on rehydration and exercise performance subsequent to passive dehydration

Six male volunteers performed three tests, each comprising a passive heating session to obtain dehydration (loss of 2.6% body mass), followed by exercise on a treadmill until exhaustion (50% of maximal oxygen consumption) in a warm environment (dry bulb temperature 35 degrees C, relative humidity 20%-30%). In one test, the subjects exercised without rehydration (Dh). In the two other tests, 50% of the fluid lost in the dehydration session was replaced by drinking mineral water given either in one amount [913 (SEM 23) ml] before the exercise (Rh1) or divided into four equal portions [228 (SEM 5) ml] before the exercise and on three occasions at 15-min intervals during exercise (Rh4). Rehydration increased exercise duration in Rh1 compared to Dh [112 (SEM 7) min and 82 (SEM 3) min, respectively; P < 0.05]. The difference was not significant with Rh4 [103 (SEM 9) min]. A restoration of the time course of changes in plasma volume, plasma osmolality, heart rate and rectal temperature occurred immediately in Rh1 and as delayed in Rh4 until after 60 min of exercise. Our results demonstrated that the swift replacement of the fluid loss in the dehydrated subjects was beneficial to exercise performance by rapidly correcting the disturbances in body fluid balance.

Fluid-regulating and sympathoadrenal hormonal responses to peak exercise following cardiac transplantation

Orthotopic heart transplantation results in cardiac denervation that can disrupt the normal regulation of hydromineral balance. This study compared the exercise-induced variations in plasma osmolality; atrial natriuretic peptide (ANP), arginine vasopressin (AVP), norepinephrine (NE), epinephrine (E), and dopamine (DA) concentrations; and plasma renin activity (PRA) of six cardiac transplant recipients (HTX) and six healthy age-matched controls (C) submitted to graded upright maximal cycling. Venous blood samples were obtained at rest, at submaximal (70% O2 uptake) and peak exercise, and after 10 and 30 min of sitting recovery. Peak O2 uptake was not different between groups despite lower maximal heart rate in HTX (136 +/- 6 vs. 183 +/- 9 beats/min). Baseline plasma ANP and PRA were higher in HTX (203 +/- 55 pg/ml and 29.9 +/- 7.4 ng.ml-1 x h-1) than in C (71 +/- 17 pg/ml and 5.4 +/- 0.96 ng.ml-1 x h-1); AVP was lower in HTX than in C (1.1 +/- 0.3 vs. 3.2 +/- 0.8 pg/ml; P < 0.05); and circulating E, NE, and DA were not different between groups. Exercise resulted in more marked increases in HTX than in C for ANP (300 vs. 100%), AVP (2,000 vs. 300%), NE (860 vs. 500%), and DA (611 vs. 187%) but not for PRA and a higher E response in C than in HTX (455 vs. 1,258%). These observations confirm that the potential for ANP release to central volume loading is independent of intact cardiac innervation. The exaggerated AVP response in HTX could, however, reflect the absence of inhibitory influences consecutive to denervation.(ABSTRACT TRUNCATED AT 250 WORDS)

Physiological deactivation after two contrasting tasks at a video display terminal: learning vs repetitive data entry

Two contrasting 90 min VDT work situations were simulated in the laboratory: (1) a machine-paced, repetitive data entry task; and (2) a stimulating, self-paced learning task with successive feedback. Thirty non-smoking male students (20-34 years), without previous experience of VDT work, participated individually in each condition on two consecutive days (balanced order) and in a task-free baseline condition. Self-reports and successive measurements (ambulatory recordings) of systolic and diastolic blood pressure and heart rate were obtained during work and during a subsequent 60 min period of deactivation. Urine samples were obtained after each period for the determination of catecholamines and cortisol. In the baseline condition, measurements were obtained at corresponding times of the day. As expected, the data entry task was associated with self-reports of boredom, irritation, and unpleasantness; the learning task wtih alertness, interest, and ability to concentrate. Similar elevations of physiological measurements occurred in both work situations. However, differences between conditions were found after work. Following data entry, deactivation was slower in five of the six variables (significant for epinephrine).

Exertional heatstroke and muscle metabolism: an in vivo 31P-MRS study

An impairment of muscle energy metabolism has been suggested as a predisposing factor for, as well as a consequence of exertional heatstroke (EHS). Thirteen young men were investigated 6 months after a well-documented EHS using 31Phosphorus Magnetic Resonance Spectroscopy (31P-MRS). The relative concentrations of ATP, phosphocreatine (PCr), inorganic phosphate (Pi), phosphomonoesters (PME), and the intracellular pH (pHi) were determined at rest, during a graded standardized exercise protocol (360 active plantar flexions) and during recovery. Also the leg tissue blood flow was determined by venous occlusion plethysmography during the MRS procedure. Sixteen age-matched healthy male volunteers served as control group. In resting muscle, there were no significant differences between the groups as regards pHi, Pi/PCr, and ATP/PCr+Pi+PME ratios. During steady state exercise conditions, effective power outputs were similar for both groups at each level of exercise: 20, 35, and 50% of maximal voluntary contraction (MVC) of the calf muscle. No significant differences were shown between the two groups in Pi/PCr, pHi, or changes of leg blood flow at each level of exercise. At 50% MVC, Pi/PCr was 0.48 +/- 0.08 vs 0.47 +/- 0.05 (P = 0.96), pHi was 6.94 +/- 0.03 vs 6.99 +/- 0.02, respectively (P = 0.13). Finally, the rate of PCr resynthesis during recovery was not significantly different between the two groups: t1/2 PCr = 0.58 +/- 0.07 vs 0.50 +/- 0.05 min, respectively (P = 0.35). Therefore, no evidence of an impairment of muscle energy metabolism was shown in the EHS group during a standardized submaximal exercise using 31P-MRS performed 6 months after an EHS.

Animal experiments on the allergenicity of d-limonene--the citrus solvent

With the increasing use of d-limonene as a substitute for chlorinated hydrocarbons, chlorofluorocarbons (CFC) and other organic solvents, a demand has arisen for more knowledge of the health effects of this substance. The aim of the present study was to investigate the allergenic effect of d-limonene on skin. The sensitizing potential of d-limonene and the influence of air exposure on its allergenicity were studied in guineapigs. d-Limonene of high purity gave no significant allergic reactions, while d-limonene exposed to air for 2 months sensitized the animals. Gas chromatographic analyses indicated that the content of limonene oxide in limonene increased with prolonged air exposure. It is concluded that allergenic compounds are formed from d-limonene upon prolonged air exposure. Products containing d-limonene should therefore be kept in cold storage in closed vessels. Manual handling should be avoided, or gloves worn, in order to reduce the risk of sensitization.