Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

BACKGROUND

The subsequent waves of the COVID-19 pandemic in Italy had a major impact on cardiac care.

METHODS

A survey to evaluate the dynamic changes in arrhythmia care during the first five waves of COVID-19 in Italy (first: March-May 2020; second: October 2020-January 2021; third: February-May 2021; fourth: June-October 2021; fifth: November 2021-February 2022) was launched.

RESULTS

A total of 127 physicians from arrhythmia centers (34% of Italian centers) took part in the survey. As compared to 2019, a reduction in 40% of elective pacemaker (PM), defibrillators (ICD), and cardiac resynchronization devices (CRT) implantations, with a 70% reduction for ablations, was reported during the first wave, with a progressive and gradual return to pre-pandemic volumes, generally during the third-fourth waves, slower for ablations. For emergency procedures (PM, ICD, CRT, and ablations), recovery from the initial 10% decline occurred in most cases during the second wave, with some variability. However, acute care for atrial fibrillation, electrical cardioversions, and evaluations for syncope showed a prolonged reduction of activity. The number of patients with devices which started remote monitoring increased by 40% during the first wave, but then the adoption of remote monitoring declined.

CONCLUSIONS

The dramatic and profound derangement in arrhythmia management that characterized the first wave of the COVID-19 pandemic was followed by a progressive return to the volume of activities of the pre-pandemic periods, even if with different temporal dynamics and some heterogeneity. Remote monitoring was largely implemented during the first wave, but full implementation is needed.

Megaripple Migration on Mars

Aeolian megaripples, with 5- to 50-m spacing, are abundant on the surface of Mars. These features were repeatedly targeted by high-resolution orbital images, but they have never been observed to move. Thus, aeolian megaripples (especially the bright-toned ones often referred as Transverse Aeolian Ridges-TARs) have been interpreted as relict features of a past climate. In this report, we show evidence for the migration of bright-toned megaripples spaced 1 to 35 m (5 m on average) in two equatorial areas on Mars indicating that megaripples and small TARs can be active today. The moving megaripples display sand fluxes that are 2 orders of magnitudes lower than the surrounding dunes on average and, unlike similar bedforms on Earth, can migrate obliquely and longitudinally. In addition, the active megaripples in the two study areas of Syrtis Major and Mawrth Vallis show very similar flux distributions, echoing the similarities between dune crest fluxes in the two study areas and suggesting the existence of a relationship between dune and megaripple fluxes that can be explored elsewhere. Active megaripples, together with high-sand flux dunes, represent a key indicator of strong winds at the surface of Mars. A past climate with a denser atmosphere is not necessary to explain their accumulation and migration.

Antimicrobial resistance in N'Djamena (Chad): Four-year experience of the French Forward Medical and Surgical Team engaged in the "Barkhane Operation"

OBJECTIVES

Knowledge of local antimicrobial resistance (AMR) patterns is required for effective empirical treatment of bacterial diseases. Very little is known about current resistance patterns of common pathogenic bacteria in the African region and particularly in the Sahel region. We aimed to describe the local bacterial epidemiology and to determine whether French recommendations for empirical treatment could be implemented.

PATIENTS AND METHODS

We performed a single-center observational study. Data was collected retrospectively from the Forward Medical and Surgical Center (FFMSC) bacterial database from January 2015 to December 2018. All bacteriological analyses, negative or positive, were included.

RESULTS

A total of 2194 samples were analyzed. Infectious diseases were urinary tract infections (20.8%), bone and joint infections (20.4%), skin infections of chronic wounds (13.4%), soft tissue abscesses (13%), and gastroenteritis (10.8%). The most frequent infections were enterobacterial infections (43.6%) and staphylococcal infections (31.1%). The prevalence of AMR was 32.1%. Significantly more ESBL-producing bacteria (41.3%) were observed in the Chadian population than in the French population in N'djamena (6.3%) (P<0.001).

CONCLUSIONS

We reported a high rate of ESBL-producing bacteria in N'Djamena. The use of empirical antibiotic therapies in the FFMSC may thus be questioned: French recommendations cannot be implemented in such setting and the use of carbapenems or new anti-ESBL antibiotics should be considered. Prospective studies are required to conclude.

[Inferior myocardial infarction complicated by complete heart block and cardiac arrest following a gadolinium injection: A case of Kounis syndrome]

Kounis syndrome is an allergic acute coronary syndrome. It occurs on healthy or pathological arteries. Its complications, although often benign, can lead to cardiac arrest and death. Its triggering factors are multiple and include contrast products used in diagnostic imaging. We report the case of an 81 years old patient affected by hepatocellular carcinoma, who presented a type 2 Kounis syndrome with inferior myocardial infarction, complicated by cardiac arrest related to complete heart block following a gadoteric acid injection.

Repeated change-of-direction test for collegiate male soccer players

AIM

The aim of the study was to investigate the applicability of a repeated change-of-direction (RCoD) test for NCAA Division-I male soccer players.

METHODS

The RCoD test consisted of 5 diagonal direction changes per repetition with a soccer ball to be struck at the end. Each player performed 15 repetitions with approximately 10 seconds to jog back between repetitions. Data were collected in two sessions. In the first session, 13 players were examined for heart rate responses and blood lactate concentrations. In the second session, 22 players were examined for the test's ability to discriminate the primary from secondary players (78.0±16.1 and 10.4±13.3 minutes per match, respectively).

RESULTS

Heart rate data were available only from 9 players due to artifacts. The peak heart rate (200.2±6.6 beats∙min-1: 99.9±3.0% maximum) and blood lactate concentration (14.8±2.4 mmol∙L-1 immediately after) resulted in approximately 3.5 and 6.4-fold increases from the resting values, respectively. These values appear comparable to those during intense periods of soccer matches. In addition, the average repetition time of the test was found to discriminate the primary (4.85±0.23 s) from the secondary players (5.10±0.24 s) (P=0.02).

CONCLUSION

The RCoD test appears to induce physiological responses similar to intense periods of soccer matches with respect to heart rate and blood lactate concentration. Players with better average repetition times tend to be those who play major minutes.

Combination of external load and whole body vibration potentiates the GH-releasing effect of squatting in healthy females

In recent years, whole body vibration (WBV) has become an efficient complement or alternative to resistance training. Very limited data on the effects of different WBV protocols on anabolic hormones are available. In this study, we compared the growth hormone (GH), blood lactate (LA), and cortisol responses to different protocols involving WBV. Six healthy women recreationally active performed 10 sets of 12 dynamic squats in the following conditions: squatting alone (S), squatting+vibration (SV), squatting+external load (SE), and squatting+external load+vibration (SEV). All responses at the different stimuli determined acute increases in GH, cortisol, and LA. In particular, GH secretion significantly increased in all 4 conditions immediately after the exercise session compared to other time points. Furthermore, a significantly larger increase was identified following SEV as compared to the other conditions. Cortisol concentrations significantly decreased after S, SV and SE whereas they increased significantly following SEV. LA peaks occurred immediately at the end of each condition. However it reached statistical significance only following SEV. The results of our study demonstrate that the combination of squatting+external load+vibration (SEV) could represent the most suitable modality to potentiate the somatotropic function and, indirectly, to obtain an increase in muscle strength and positive changes in the body composition. Further studies are necessary in order to determine the chronic effects of this exercise modality on the hormonal profile.

Activated zeolite--suitable carriers for microorganisms in anaerobic digestion processes?

Plant cell wall structures represent a barrier in the biodegradation process to produce biogas for combustion and energy production. Consequently, approaches concerning a more efficient de-polymerisation of cellulose and hemicellulose to monomeric sugars are required. Here, we show that natural activated zeolites (i.e. trace metal activated zeolites) represent eminently suitable mineral microhabitats and potential carriers for immobilisation of microorganisms responsible for anaerobic hydrolysis of biopolymers stabilising related bacterial and methanogenic communities. A strategy for comprehensive analysis of immobilised anaerobic populations was developed that includes the visualisation of biofilm formation via scanning electron microscopy and confocal laser scanning microscopy, community and fingerprint analysis as well as enzyme activity and identification analyses. Using SDS polyacrylamide gel electrophoresis, hydrolytical active protein bands were traced by congo red staining. Liquid chromatography/mass spectroscopy revealed cellulolytical endo- and exoglucanase (exocellobiohydrolase) as well as hemicellulolytical xylanase/mannase after proteolytic digestion. Relations to hydrolytic/fermentative zeolite colonisers were obtained by using single-strand conformation polymorphism analysis (SSCP) based on amplification of bacterial and archaeal 16S rRNA fragments. Thereby, dominant colonisers were affiliated to the genera Clostridium, Pseudomonas and Methanoculleus. The specific immobilisation on natural zeolites with functional microbes already colonising naturally during the fermentation offers a strategy to systematically supply the biogas formation process responsive to population dynamics and process requirements.

Analysis of muscle fatigue induced by isometric vibration exercise at varying frequencies

An increase in neuromuscular activity, measured by electromyography (EMG), is usually observed during vibration exercise. The underlying mechanisms are however unclear, limiting the possibilities to introduce and exploit vibration training in rehabilitation programs. In this study, a new training device is used to perform vibration exercise at varying frequency and force, therefore enabling the analysis of the relationship between vibration frequency and muscle fatigue. Fatigue is estimated by maximum voluntary contraction measurement, as well as by EMG mean-frequency and conduction-velocity analysis. Seven volunteers performed five isometric contractions of the biceps brachii with a load consisting of a baseline of 80% of their maximum voluntary contraction (MVC), with no vibration and with a superimposed 20, 30, 40, and 50 Hz vibrational force of 40 N. Myoelectric and mechanical fatigue were estimated by EMG analysis and by assessment of the MVC decay, respectively. A dedicated motion artifact canceler, making use of accelerometry, is proposed to enable accurate EMG analysis. Use of this canceler leads to better interpolation of myoelectric fatigue trends and to better correlation between mechanical and myoelectric fatigue. In general, our results suggest vibration at 30 Hz to be the most fatiguing exercise. These results contribute to the analysis of vibration exercise and motivate further research aiming at improved training protocols.

Visual Skills and Playing Positions of Olympic Field Hockey Players

Many sports require fine spatiotemporal resolution for optimal performance. Previous studies have compared anticipatory skills and the decision-making process in athletes; however, there is little information on visual skills of elite athletes, particularly hockey players. To assess visual skills of Olympic hockey players and analyze differences by playing position, and to analyze improvement of visual skills after training, 21 Olympic field hockey players were pre- and post-tested on 11 visual tasks following a 10-wk. visual training program consisting of computer-based visual exercises. There were no mean differences at pre-test between players of different positions, suggesting that performance on these visual skills was independent of playing position. However, after training, an improvement was seen in all players (when scores were averaged across all 11 visual tasks) with goalkeepers improving significantly more than any other position. This suggests the possibility of improving visual skills even in an elite population.

Electromyographic assessment of muscle fatigue during isometric vibration training at varying frequencies

Resistance exercise is essential to improve or maintain muscle performance. Vibration training has been suggested as an alternative option for muscle conditioning, aiming especially at improving muscle strength and power. Several studies link the effects of vibration training to enhanced neuromuscular stimulation, measured by electromyography (EMG) and typically ascribed to involuntary reflex mechanisms. However, the underlying mechanisms are still unclear, limiting the use of vibration training. This paper proposes additional methods to analyze the mechanisms involved in vibration training. A dedicated measurement setup was realized to relate vibration parameters to muscle fatigue in the biceps brachii. Fatigue is estimated by EMG mean frequency and conduction velocity assessments as well as by maximum voluntary contraction (MVC) force measurements. A modified maximum likelihood algorithm is proposed for the conduction velocity estimation based on high-density EMG recording. Five volunteers performed four isometric contractions of 50 s at 80% MVC with no vibration (control) and with superimposed vibration at 20, 30, and 40 Hz. Fatigue was estimated from the decay of force, EMG mean frequency, and EMG conduction velocity. 30-Hz vibrations represented the most fatiguing stimulus. Our preliminary results also show a better correlation between force and conduction velocity decay than between force and mean frequency decay, indicating the former as a better EMG indicator of fatigue. The proposed methods provide important advancements for the analysis of vibration exercise and guidance towards the definition of optimal training protocols.

Reporting whole-body vibration intervention studies: recommendations of the International Society of Musculoskeletal and Neuronal Interactions

Whole-body vibration (WBV) is receiving increasing interest as a therapeutic modality to improve neuromuscular performance or to increase bone mass or density. In order to help improve the quality of reports about WBV treatment studies, the International Society of Musculoskeletal and Neuronal Interactions (ISMNI) invited experts in the field to provide suggestions on how the intervention should be described in such reports. The recommendations are presented here.

Surface oxidized zirconium total hip arthroplasty head damage due to closed reduction effects on polyethylene wear

Recent case studies of surface oxidized zirconium THA heads removed after attempted, closed reduction have shown significant surface damage that has been suggested as potentially deleterious to polyethylene wear. We obtained 4 clinically retrieved specimens, produced well-characterized surface damage on additional heads, and tested them on a hip simulator. After 1 million cycles, the amount of polyethylene wear was related to the extent of surface damage, the most damaged clinical specimen showing more than 50 times more wear than a new head. Although all heads after failed attempted closed reduction(s) should be replaced, surface oxidized zirconium heads are of particular concern; those patients with a successful, simple closed reduction should be monitored for excessive wear.

Hormonal responses to a single session of wholebody vibration exercise in older individuals

OBJECTIVE

Whole-body vibration (WBV) has been recently suggested as an alternative form of exercise. In this study, the acute effects of a single session of WBV exercise on anabolic hormones in aged individuals were analysed.

DESIGN

A randomised cross-over trial design was used.

SETTINGS

Geriatrics Department, Woodend Hospital.

PARTICIPANTS

20 individuals (9 men and 11 women; median age 70 years (range 66 to 85 years) volunteered in the experiment. Interventions Isometric squat on a platform with vibration or no vibration (control) conditions.

MAIN OUTCOME MEASUREMENTS

Plasma cortisol, testosterone, growth hormone (GH) and insulin-like growth factor 1 (IGF-1) were measured before, immediately after, and 1 and 2 h after the interventions.

REPORTS

A significant difference between treatments (p<0.001) and a time x treatment interaction (p<0.05) was found in IGF-1 levels. Cortisol levels were shown not to be significantly different between treatments (p = 0.43), but a difference over time (p<0.001) and a time6 treatment interaction (p<0.05) were identified. No significant differences were identified in GH and testosterone levels.

CONCLUSIONS

As shown by the results of the study, 5 min of WBV exercise characterised by static squat with a frequency of 30 Hz can be performed by older individuals without apparent signs of stress and/or fatigue. Furthermore, WBV produced an acute increase in the circulating levels IGF-1 and cortisol greater than that observed following the same exercise protocol conducted without vibration.

Processing cereal straws by steam explosion in a pilot plant to enhance digestibility in ruminants

Wheat, barley and oat straws were treated by steam explosion (SE) and then washed with 50g/l NaOH solution. The SE treatment was optimized at batch scale on the basis of carbohydrate recovery. Stocks of fodder (300kg) were produced at 198 degrees C for 2.5min by a continuous reactor and used for in vivo digestibility tests carried out on sheep. The flow-sheet and the mass balances were obtained for the entire process. For the three straws, the water consumption has been 7.3kg/kg of straw. To delignify and improve the digestibility of the straws, 20g of NaOH/kg straw was used. The yield of fodder, lignin and hemicellulose is dependant on the nature of the starting straw. Delignified fodder (insoluble fraction) can be produced with a yield of 0.64, 0.59, 0.55, respectively, from wheat, barley and oat straw. SE improved the digestibility of the straw by 25%; alkaline washing further increased it by 9%. Balanced rations containing, on a DM basis, 1/4 of treated straw, had digestibility coefficients similar to those of commercial rations based on alfalfa.

Whole-body vibration can reduce calciuria induced by high protein intakes and may counteract bone resorption: A preliminary study

Excess protein intake can adversely affect the bone via an increase in calcium excretion, while suitable mechanical loading promotes osteogenesis. We therefore investigated whether vibration exposure could alleviate the bone mineral losses associated with a metabolic acidosis. Ten healthy individuals aged 22 - 29 years (median = 25) underwent three 5-day study periods while monitoring their dietary intake. The study consisted of recording the participants' usual dietary intake for 5 consecutive days. Participants were then randomly divided into two groups, one of which received a protein supplement (2 g x kg(-1) body mass x day(-1); n = 5) and the other whole-body low-magnitude (3.5 g), low-frequency (30 Hz) mechanical vibration (WBV) delivered through a specially designed vibrating plate for 10 min each day (n = 5). Finally, for the third treatment period, all participants consumed the protein supplement added to their normal diet and were exposed to WBV exercise for 10 min per day. Daily urine samples were collected throughout the experimental periods to determine the excretion of calcium, phosphate, titratable acid, urea, and C-telopeptide. As expected, when the participants underwent the high protein intake, there was an increase in urinary excretion rates of calcium (P < 0.001), phosphate (P < 0.003), urea (P < 0.001), titratable acid (P < 0.001), and C-telopeptide (P < 0.05) compared with baseline values. However, high protein intake coupled with vibration stimulation resulted in a significant reduction in urinary calcium (P = 0.006), phosphate excretion (P = 0.021), and C-telopeptide (P < 0.05) compared with protein intake alone, but did not affect titratable acid and urea output. The participants showed no effect of WBV exercise alone on urinary excretion of calcium, phosphate, urea, titratable acid, or C-telopeptide. The results indicate that vibration stimulation can moderate the increase in bone resorption and reduction in bone formation caused by a metabolic acidosis.

Whole body vibration exercise: are vibrations good for you?

Whole body vibration has been recently proposed as an exercise intervention because of its potential for increasing force generating capacity in the lower limbs. Its recent popularity is due to the combined effects on the neuromuscular and neuroendocrine systems. Preliminary results seem to recommend vibration exercise as a therapeutic approach for sarcopenia and possibly osteoporosis. This review analyses state of the art whole body vibration exercise techniques, suggesting reasons why vibration may be an effective stimulus for human muscles and providing the rationale for future studies.

The effects of whole body vibration on humans: dangerous or advantageous?

The effects of whole body vibration (WBV) have been studied extensively in occupational medicine. In particular, it has been shown that when the body undergoes chronically to whole body vibrations spinal degeneration is likely to be one of the deleterious outcomes. Low back pain has been shown to be the leading major cause of industrial disability in the population under the age of 45 years and has been linked to whole body vibration exposure encountered in some industrial settings. Whole body vibration has been recently purposed as an exercise intervention suggesting its effectiveness in increasing force-generating capacity in lower limbs and low back. It has also been reported to be an effective non-pharmacological intervention for patients with low back pain. Relatively short exposure to whole body vibration has been also shown to increase the serum levels of testosterone and growth hormone. The combined effects on the neuromuscular system and endocrine system seem to suggest its effectiveness as a therapeutic approach for sarcopenia and possibly osteoporosis. Due to the danger of long-term exposure to whole body vibration, it is important to develop safe exercise protocols in order to determine exercise programs for different populations.

Bradyrhizobium sp. nodulating the Mediterranean shrub Spanish broom (Spartium junceum L.)

AIMS

The molecular diversity of 25 strains of rhizobia, isolated in Sicily from root nodules of the Mediterranean shrubby legume Spanish broom (Spartium junceum L.), is presented in relation to the known rhizobial reference strains.

METHODS AND RESULTS

Our approach to the study of the S. junceum rhizobial diversity combined the information given by the 16S and the intergenic spacer (IGS) 16S-23S rDNA polymorphic region by obtaining them in a single polymerase chain reaction (PCR) step. The PCR fragment size of the S. junceum isolates was 2400-2500 bp and that of the reference strains varied from 2400 in Bradyrhizobium strains to 2800 in Sinorhizobium strains. Inter- and intrageneric length variability was found among the reference strains. Restriction fragment length polymorphisms (RFLP) analysis allowed us to identify eight genotypes among the S. junceum rhizobia that were clustered into two groups, both related to the Bradyrhizobium lineage. Sequencing of representative strains of the two clusters confirmed these data. The 16S-IGS PCR-RFLP approach, when applied to rhizobial reference strains, allowed very close species (i.e. Rhizobium leguminosarum/R. tropici) to be separated with any of the three enzymes used; however, cluster analysis revealed inconsistencies with the 16S-based phylogenesis of rhizobia.

CONCLUSIONS

Rhizobia nodulating S. junceum in the Mediterranean region belong to the Bradyrhizobium lineage. Our results confirm the resolution power of the 16S-23S rDNA in distinguishing among rhizobia genera and species, as well as the usefulness of the PCR-RFLP method applied to the entire 16S-IGS region for a rapid tracking of the known relatives of new isolates.

SIGNIFICANCE AND IMPACT OF THE STUDY

The present paper is, to our knowledge, the first report on rhizobia nodulating a Mediterranean wild woody legume.

Hormonal responses to whole-body vibration in men

The aim of this study was to evaluate the acute responses of blood hormone concentrations and neuromuscular performance following whole-body vibration (WBV) treatment. Fourteen male subjects [mean (SD) age 25 (4.6) years] were exposed to vertical sinusoidal WBV, 10 times for 60 s, with 60 s rest between the vibration sets (a rest period lasting 6 min was allowed after 5 vibration sets). Neuromuscular performance tests consisting of counter-movement jumps and maximal dynamic leg presses on a slide machine, performed with an extra load of 160% of the subjects body mass, and with both legs were administered before and immediately after the WBV treatment. The average velocity, acceleration, average force, and power were calculated and the root mean square electromyogram (EMGrms) were recorded from the vastus lateralis and rectus femoris muscles simultaneously during the leg-press measurement. Blood samples were also collected, and plasma concentrations of testosterone (T), growth hormone (GH) and cortisol (C) were measured. The results showed a significant increase in the plasma concentration of T and GH, whereas C levels decreased. An increase in the mechanical power output of the leg extensor muscles was observed together with a reduction in EMGrms activity. Neuromuscular efficiency improved, as indicated by the decrease in the ratio between EMGrms and power. Jumping performance, which was measured using the counter-movement jump test, was also enhanced. Thus, it can be argued that the biological mechanism produced by vibration is similar to the effect produced by explosive power training (jumping and bouncing). The enhancement of explosive power could have been induced by an increase in the synchronisation activity of the motor units, and/or improved co-ordination of the synergistic muscles and increased inhibition of the antagonists. These results suggest that WBV treatment leads to acute responses of hormonal profile and neuromuscular performance. It is therefore likely that the effect of WBV treatment elicited a biological adaptation that is connected to a neural potentiation effect, similar to those reported to occur following resistance and explosive power training. In conclusion, it is suggested that WBV influences proprioceptive feedback mechanisms and specific neural components, leading to an improvement of neuromuscular performance. Moreover, since the hormonal responses, characterised by an increase in T and GH concentration and a decrease in C concentration, and the increase in neuromuscular effectiveness were simultaneous but independent, it is speculated that the two phenomena might have common underlying mechanisms.

Adaptive responses of human skeletal muscle to vibration exposure

The aim of this study was to investigate the effects of whole-body vibrations (WBV) on the mechanical behaviour of human skeletal muscle. For this purpose, six female volleyball players at national level were recruited voluntarily. They were tested with maximal dynamic leg press exercise on a slide machine with extra loads of 70, 90, 110 and 130 kg. After the testing, one leg was randomly assigned to the control treatment (C) and the other to the experimental treatment (E) consisting of vibrations. The subjects were then retested at the end of the treatment using the leg press. Results showed remarkable and statistically significant enhancement of the experimental treatment in average velocity (AV), average force (AF) and average power (AP) (P < 0.05-0.005). Consequently, the velocity-force and power-force relationship shifted to the right after the treatment. In conclusion, it was affirmed that the enhancement could be caused by neural factors, as athletes were well accustomed to the leg press exercise and the learning effect was minimized.

Influence of vibration on mechanical power and electromyogram activity in human arm flexor muscles

The aim of this study was to evaluate the influence of vibration on the mechanical properties of arm flexors. A group of 12 international level boxers, all members of the Italian national team, voluntarily participated in the experiment: all were engaged in regular boxing training. At the beginning of the study they were tested whilst performing forearm flexion with an extra load equal to 5% of the subjects' body mass. Following this. one arm was given the experimental treatment (E; mechanical vibration) and the other was the control (no treatment). The E treatment consisted of five repetitions lasting 1-min each of mechanical vibration applied during arm flexion in isometric conditions with 1 min rest between them. Further tests were performed 5 min immediately after the treatment on both limbs. The results showed statistically significant enhancement of the average power in the arm treated with vibrations. The root mean square electromyogram (EMGrms) had not changed following the treatment but, when divided by mechanical power, (P) as an index of neural efficiency, it showed statistically significant increases. It was concluded that mechanical vibrations enhanced muscle P and decreased the related EMG/P relationship in elite athletes. Moreover, the analysis of EMGrms recorded before the treatment and during the treatment itself showed an enormous increase in neural activity during vibration up to more than twice the baseline values. This would indicate that this type of treatment is able to stimulate the neuromuscular system more than other treatments used to improve neuromuscular properties.

Transthoracic DC shock may represent a serious hazard in pacemaker dependent patients

External defibrillation is widely used for the termination of various atrial and ventricular tachyarrhythmias, including pacemaker patients. Our study was intended to evaluate the effects of DC shocks in 36 patients with unipolar pacemakers implanted in the right pectoral region (25 DDD, 10 VVI, 3 AAI). The shocks were delivered with paddles on the anterior surface of the thorax, as far as possible away from the pacemaker. The pacing output was programmed at 0.5 msec and 5 V (25 patients), 4 V (1 patient), and 2.5 V (10 patients). Transient loss of capture occurred in 18 patients (50%). These patients, compared with those without capture failure, received higher peak and cumulative shock energies, respectively, 216 +/- 99 versus 123 +/- 50 joules (P < 0.002) and 352 +/- 62 versus 147 +/- 98 joules (P < 0.004) and had a lower pacemaker pulse amplitude (4.0 +/- 1.2 vs 4.6 +/- 1.0 V, P = 0.11). Failure to capture lasted from 5 seconds to 30 minutes (mean 157 sec). In 15 patients the ventricular stimulation threshold was measured before and serially after cardioversion. A six-fold threshold increase was observed 3 minutes after the shock (P < 0.004) with gradual recovery to nearly baseline values at 24 hours. Transient sensing failure occurred in 7 of the 17 patients in whom it could be evaluated (41%). Furthermore, three cases of shock induced pacemaker malfunctions were observed requiring replacement of the stimulator in two patients. In conclusion, the incidence of loss of capture in pacemaker patients subjected to electrical cardioversion/defibrillation is high.(ABSTRACT TRUNCATED AT 250 WORDS)

Usefulness of transesophageal pacing during exercise for evaluating palpitations in top-level athletes

The aim of this study was to verify the use of transesophageal atrial pacing in reproducing tachyarrhythmias in 22 top-level athletes symptomatic for palpitations, with no evidence of arrhythmias or cardiac anomalies by the standard noninvasive diagnostic techniques. The transesophageal stimulation protocol was divided in 2 sections: at rest and during exercise on the bicycle ergometer in the upright position. Although transesophageal pacing at rest did not induce any arrhythmias in 18 of 22 athletes, during exercise it induced tachyarrhythmias. This occurred in all 16 athletes who had palpitations during physical activity. Electrophysiologic characteristics of induced atrial tachyarrhythmia suggested reentry within the atrioventricular node in 9 of 18 athletes: atrial fibrillation in 5, atrial flutter in 2, orthodromic reciprocating tachycardia due to concealed anomalous pathway in 1, and automatic atrial tachycardia in 1. This study stresses the clinical importance of palpitations during physical exercise and shows that transesophageal pacing performed during exercise is an important diagnostic tool in reproducing the previously described symptoms and in detecting the underlying tachyarrhythmias.