Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy

We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm³. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.

[Vascularized bone transfer of scapula apophysis]

The vascularized bone transfer of the scapular apophysis was described for the first time by Gilbert and Téot (1982) [1]. The growing pattern of this specific apophysis has large capacity and the plasticity during remodeling is unique. Primarily used for mandibular reconstruction, the scapular crest is also suitable for humeral or femoral reconstruction as well as for carpal stabilization in radial hand malformation, which is considered to be the main clinical indication. The radial hand malformation is characterized by an insufficient ulnar carpal stabilization which leads to luxation and radial deviation of the carpus. Using the vascularized scapular transfer in volar apposition to the ulnar, it enables enlarging the contact surface area with the carpus, thus stabilizing the wrist. Due to the preserved epiphyseal vascularization, good remodeling and integration of the scapular crest is achieved until consolidation takes place.

Severe peritonitis due to Balantidium coli acquired in France

The case reported here concerns an alcoholic pork-butcher who presented with severe colitis with peritonitis, caused by the only ciliate protozoan capable of infecting humans, Balantidium coli. This parasite is common in a variety of domestic and wild mammals, mainly pigs; however, its prevalence rate in humans is very low--particularly in industrialised, northern countries, including France. The infection is most frequently acquired by ingesting food or water contaminated by pig faeces, and it may be asymptomatic or may cause acute diarrhoea. Specific antibiotic treatment is efficacious, and it is important to consider the risk of this parasitic disease in susceptible patients presenting with bloody diarrhoea.

Effect of endurance training on oestrogen receptor alpha expression in different rat skeletal muscle type

It is well known that oestrogens exert muscle anabolic and metabolic effects. Oestrogens act via specific oestrogen receptor (ER) proteins. The mainly represented oestrogen receptor alpha messenger ribonucleic acid subtype (ER(alpha) mRNA) was described in various tissues including the skeletal muscle. Moreover, it has been shown that endurance training significantly increases ER(alpha) mRNA levels in the female rat gastrocnemius muscle. The aim of this study was to determine if this training programme also modifies ER(alpha) mRNA levels in muscles with different typology, the soleus (slow twitch muscle), extensor digitorum longus (fast twitch muscle) and gastrocnemius (intermediate muscle). So far, two groups of Wistar female rats were set up: untrained (u) (n = 7), and trained (e) (n = 7). The endurance training programme was performed for 7 weeks, 5 days per week and consisted of 1 h of continuous running on an adapted motor-driven treadmill involving progressive intensity and gradient of the treadmill. Three different skeletal muscles, extensor digitorum longus (E), gastrocnemius (G) and soleus (S), were isolated and weighed in the untrained (Eu, Gu and Su) and trained group (Ee, Ge and Se). Semi-quantification of ER(alpha) mRNA levels was performed by the reverse transcriptase-polymerase chain reaction (RT-PCR) technique. In order to attest the efficiency of our endurance training programme, the citrate synthase activity (CS) of each muscle was measured by a fluorimetric method. The CS activity was significantly increased with training in the gastrocnemius [100.00 +/- 4.99% in Gu (n = 6) vs. 138.10 +/- 8.82% in Ge (n = 6), P < 0.01] and in the soleus [100.00 +/- 2.92% in Su (n = 7) vs. 115.90 +/- 3.71% in Se (n = 7), P < 0.01] but not in the extensor digitorum longus [100.00 +/- 1.87% in Eu (n = 7) vs. 96.90 +/- 1.55% in Ee (n = 7)]. Concerning the influence of muscle type on ER(alpha) mRNA level (1) in the untrained group, the ER(alpha) mRNA level was significantly higher in soleus muscle compared with gastrocnemius and extensor digitorum longus muscles [0.43 +/- 0.04 in Su (n = 7) compared with 0.31 +/- 0.03 in Gu (n = 6) and 0.21 +/- 0.03 in Eu (n = 7), P < 0.05; P < 0.05); 2] in the trained group, the ER(alpha) mRNA level was significantly higher insoleus and gastrocnemius muscles compared with extensor digitorum longus muscle [0.43 +/- 0.06 in Se (n = 7) and 0.49 +/- 0.05 in Ge (n = 6) vs. 0.12 +/- 0.01 in Ee (n = 7), P < 0.05; P < 0.05]. Indeed, after training, the ER(alpha) mRNA level significantly increased in gastrocnemius muscle [0.31 +/- 0.03 in Gu(n = 6) vs. 0.49 +/- 0.05 in Ge (n = 6), P < 0.01], significantly decreased in extensor digitorum longus [0.21 +/- 0.03 in Eu (n = 7) vs. 0.12 +/- 0.01 in Ee (n = 7), P < 0.01] and was not significantly modified in soleus [0.43 +/- 0.04 in Su (n = 7) vs. 0.43 +/- 0.06 in Se (n = 7)]. The differences in ER(alpha) mRNA level between trained and untrained animals indicate training-induced effects that are specific to the skeletal muscle type.

[Portable ultrasonographic device and bladder dysfunction management in stroke patients]

OBJECTIVE

To determine the usefulness of a portable ultrasonographic device in the management and rehabilitation of stroke patients' bladder voiding impairment in the early stage and to propose a well-fitted screening protocol.

MATERIAL AND METHOD

A prospective observational study of 33 inpatients admitted into our stroke rehabilitation program. A urinary elimination assessment protocol defines the criteria of intermittent catheterization. The determination of bladder volume was performed with a Bladderscan BVI 3000 portable ultrasonographic device.

RESULTS

Urinary retention was present in ten of the 33 patients at admission, who were started on one or many intermittent catheterizations. Retention was resolved for seven of them at discharge. The portable ultrasonographic device allows a very accurate bladder volume assessment, especially useful in at-risk patients: those with cognitive impairments, diabetes mellitus, and prestroke urinary pathology. A new version of our first screening protocol increases the ability to detect patients with true urinary retention. Results are discussed according to the literature data.

CONCLUSION

The portable ultrasonographic device is a simple and noninvasive tool, useful for diagnosis, follow-up and therapy guidance of urinary retention after stroke. An adapted protocol is proposed in order to assess and rehabilitate this trouble. The goal is to avoid long-term catheterization and its linked infectious risk.

Effect of endurance training on oestrogen receptor alpha transcripts in rat skeletal muscle

Endurance training induces, in female rats, alterations of oestrous cycle with decrease in plasma oestradiol levels. Moreover, it is well known that oestradiol concentrations modify oestrogen receptor levels. In order to further explain the effects of oestrogens on skeletal muscles, we hypothesized that endurance training modifies the levels of oestrogen receptor alpha messenger ribonucleic acid (ER alpha mRNA) in rat gastrocnemius muscle. Wistar rats were separated into four groups: male controls (C(m)) (n=7), female controls (C(f)) (n=6), male trained (E(m)) (n=7) and female trained (E(f)) (n=6). The endurance training programme was performed for 7 weeks, 5 days week-1 and consisted of 1 h of continuous running on an adapted motor-driven treadmill. At the end of the training session, the gastrocnemius muscle was isolated, weighed and semiquantification of ER alpha mRNA was performed using the reverse transcriptase-polymerase chain reaction (RT-PCR) technique. The citrate synthase (CS) activity of the gastrocnemius muscle was measured by a fluorimetric method. The CS activity of the male and female gastrocnemius muscle, respectively, 100 +/- 7% in C(m) (n=7) vs. 120 +/- 14% in E(m) (n=6, P < 0.01) and 100 +/- 13% in C(f) (n=6) vs. 138 +/- 23% in E(f) (n=6, P < 0.01) was significantly increased after 7 weeks of training. The ER alpha mRNA levels were significantly increased in E(f) compared with C(f) (0.49 +/- 0.15 vs. 0.31 +/- 0.11, P < 0.01) but not in E(m) compared with C(m) (0.37 +/- 0.15 vs. 0.37 +/- 0.13). In conclusion, these results demonstrate that 7 weeks of endurance training increased the level of transcripts encoding ER alpha in rats with the increase restricted to the females.

Lactate transport in rat sarcolemmal vesicles after a single bout of submaximal exercise

We investigated the effects of a single bout of non-exhaustive exercise (25 m x min(-1), 10% grade, for 30 min) on the initial rates of lactate uptake in rat skeletal muscle sarcolemmal vesicles and the monocarboxylate transporter 1 (MCT1) content in isolated hindlimb muscles in relation to the exercise-induced oxidative stress. The exercise led to a decrease in red gastrocnemius and red vastus lateralis muscle glycogen content by 74% and 83%, respectively, and an increase in blood lactate concentration from 1.67 +/- 0.15 to 3.44 +/- 0.47 mM (p < 0.05). Initial rates of lactate uptake were measured in zero-trans conditions, at pH 7.4, for 1, 10, 30 and 100 mM external lactate concentrations. Lactate transport capacity was significantly decreased at 1 mM in the exercised group (p < 0.05), while a non-significant trend towards an increase was observed at 10, 30 and 100 mM. We failed to obtain any change in soleus, red tibialis anterior and white gastrocnemius muscle MCT1 content (p>0.05), and no evidence of exercise-induced oxidative stress in terms of muscle malondialdehyde content and glutathione peroxidase and superoxide dismutase activities was observed after the 30 min exercise bout. These results indicate that a single bout of submaximal exercise, which did not induce an increase in muscle MCT1 content and apparent oxidative stress, decreased lactate transport capacity at low physiological concentration. Although the changes are small and independent of a MCT1-facilitated lactate transport regulation, we suggest that another MCT isoform with different kinetic properties from MCT1 could be present in the sarcolemma and responsible for lactate exchange alterations.

Lactate transport activity in rat skeletal muscle sarcolemmal vesicles after acute exhaustive exercise

The effect of a single bout of exhaustive exercise on muscle lactate transport capacity was studied in rat skeletal muscle sarcolemmal (SL) vesicles. Rats were assigned to a control (C) group (n = 14) or an acutely exercised (E) group (n = 20). Exercise consisted of treadmill running (25 m/min, 10% grade) to exhaustion. SL vesicles purified from C and E rats were sealed because of sensitivity to osmotic forces. The time course of 1 mM lactate uptake in zero-trans conditions showed that the equilibrium level in the E group was significantly lower than in the C group (P < 0.05). The initial rate of 1 mM lactate uptake decreased significantly from 2.44 +/- 0.22 to 1.03 +/- 0.08 nmol. min(-1). mg protein(-1) (P < 0.05) after exercise, whereas that of 50 mM lactate uptake did not differ significantly between the two groups. For 100 mM external lactate concentration ([lactate]), exhaustive exercise increased initial rates of lactate uptake (219.6 +/- 36.3 to 465.4 +/- 80.2 nmol. min(-1). mg protein(-1), P < 0.05). Although saturation kinetics were observed in the C group with a maximal transport velocity of 233 nmol. min(-1). mg protein(-1) and a Michealis-Menten constant of 24.5 mM, saturation properties were not seen after exhaustive exercise in the E group, because initial rates of lactate uptake increased linearly with external [lactate]. We conclude that a single bout of exhaustive exercise significantly modified SL lactate transport activity, resulting in a decrease in 1 mM lactate uptake and was associated with alterations in the saturable properties at [lactate] above 50 mM. These results suggest that changes in sarcolemmal lactate transport activity may alter lactate and proton exchanges after exhaustive exercise.

Between 21 and 34 years of age, aging alters the catecholamine responses to supramaximal exercise in endurance trained athletes

The purpose of this study was to determine the effect of aging and training on the adrenaline (A) and noradrenaline (NA) responses during the Wingate-test in three age groups of subjects: 21 year old untrained subjects (21U), 21 year old endurance trained (21T) (national elite runners), 34 year old endurance trained (34T) (national elite runners). Performances during the test were judged using the usual parameters of peak power (Wmax) and mean power (W) expressed in absolute or relative values. A and NA responses were measured at rest (A0 and NA0) immediately at the end of the exercise (Amax and NAmax) and after 5 minutes recovery (A5 and NA5). Plasma maximal lactate (La(max)) was determined 3 minutes after the end of the exercise. Wmax, W and La(max) were always significantly lower in 34T compared to 21T and 21U. The catecholamine responses were similar in 21T and 21U. Inversely, a significantly lower value of Amax was observed in 34T (2.01 +/- 0.5 nmol x l(-1)) compared to 21U (3.62 +/- 0.3 nmol x l(-1)) associated with a significantly higher value of NA(max) in 34T versus 21T and 21U. Thus, the Amax/NA(max) ratio was found to be significantly lower in the older subjects versus both 21T and 21U. All these findings indicated that endurance training did not affect the sympathoadrenergic responses to a supramaximal exercise and suggested that only one decade may reduce the capacity of the medulla to secrete adrenaline and therefore the adrenal medulla responsiveness to the sympathetic nervous activity.

Noninvasive skeletal muscle lactate detection between periods of intense exercise in humans

We investigated whether localized 1H nuclear magnetic resonance spectroscopy (NMRS) using stimulated echoes (STEAM) with a long mixing time (t(m)) allowed the suppression of the fat signal and detection of lactate in skeletal muscle. The 1H NMRS sequence was first validated in three isolated and perfused rabbit biceps brachii muscles. Spectra were obtained on a wide-bore spectrometer using a dual-tuned probe (1H and 31P). Death was simulated by ceasing the muscle perfusion, which allowed post-mortem changes to be followed. During and after the simulated death, changes in levels of pH and in content of energy-rich compounds were observed with 31P NMRS. Our results showed an inverse linear relationship between pH and lactate in each of the three rabbits (r = 0.93, P < 0.001; r = 0.92, P < 0.01; r = 0.89, P < 0.01) and a decrease in phosphocreatine and concomitant increase in lactate. We then investigated whether this sequence allowed repeated detection of lactate in human soleus muscle during the recovery between periods of intense exercise (force-velocity test, F-v test). Seven subjects mean age 25.1 (SEM 0.8) years participated in this study. Soleus muscle lactate was detected at rest and for 3 min 30 s of the 5-min recovery between periods using a 2.35-T 40-cm bore magnet spectrometer. Arm venous plasma lactate concentration was measured at rest, during the F-v test when the subject stopped pedalling (S1), and at the end of each 5-min recovery between periods (S2). Results showed that the venous plasma lactate concentration at S1 and S2 increased significantly from the beginning of the F-v test to peak anaerobic power (W(an,peak)) (P < 0.001). The spectra showed that muscle lactate resonance intensity rose markedly when W(an,peak) was achieved. The muscle lactate resonance intensity plotted as a percentage of the resting value increased significantly at W(an,peak) compared with submaximal braking forces (P < 0.05). We concluded from these results that localized 1H NMRS using STEAM with a long t(m) allows suppression of the fat signal and repeated detection of lactate on isolated perfused skeletal muscle in animals and between periods of intense exercise in humans.

Changes in maximal exercise ventilation and breathing pattern in boys during growth: a mixed cross-sectional longitudinal study

The aim of this mixed cross-sectional longitudinal study covering a total age range of 11-17 years, i.e. the entire pubertal growth period, was (1) to specify the changes in maximal breathing pattern during incremental exercise; (2) to determine what parts of the changes are due to anthropometric characteristics, physical fitness and inspiratory or expiratory muscle strength; and (3) to determine if the role of these variables is identical before, during and after pubertal growth spurt. This study was conducted in 44 untrained schoolboys separated into three groups, with an initial age of 11.2 +/- 0.2 years for group A, 12.9 +/- 0.25 years for group B, and 14.9 +/- 0.26 years for group C. These children were subsequently followed for 3 years, during the same time period each year. The maximal inspiratory and expiratory pressures (PI max and PE max) were used as an index of the respiratory muscle strength. During an incremental exercise test, maximal ventilation (VE max), tidal volume (VT max), breathing frequency (fmax), inspiratory and expiratory times (tI max and tE max) and mean inspiratory flow (VT/tI max) were measured at maximal oxygen uptake (VO2max). Our study showed that there was a marked increase with age in VE max, VT max, and VT/tI max, and no significant changes in fmax, tI max and tE max. PI max and PE max showed a general trend towards an increase between 11 and 17 years. The study of the linear correlations between maximal breathing pattern and the anthropometric characteristics, physical fitness and inspiratory or expiratory muscle strength showed that, in the three groups of children, (1) lean body mass was the major determinant of VE max, VT max and VT/tI max and the relationships were significantly different before, during and after the pubertal growth spurt; (2) physical fitness was the main determinant of tI max, tE max and fmax before and after the pubertal growth spurt; and (3) maximal respiratory strength did not play a significant role. In conclusion, this mixed cross-sectional longitudinal study showed, at maximal exercise, a significant increase in VE max during growth due only to a significant increase in VT max and VT/tI max, and that the relationships of anthropometric characteristics and physical fitness with maximal breathing pattern change during growth.

Effect of 2-chloropropionate on initial lactate uptake by rat skeletal muscle sarcolemmal vesicles

2-Chloropropionate (2-CP) is a halogenated monocarboxylic acid generally used to decrease blood lactate concentration in various metabolic states. To investigate whether it has an inhibitory effect on sarcolemmal lactate transport, we compared the initial rate of lactate transport in sarcolemmal membrane vesicles purified from 20 male Wistar rats with and without 2-CP. Transport by these vesicles was measured as uptake of L-(+)-[U-14C]lactate under pH gradient-stimulated cis inhibition. The time courses of 1 mM L-(+)-lactate uptake into vesicles both with and without 10 mM 2-CP (L- or D-) displayed saturation kinetics. Lactate uptake values were lower with 10 mM L-2-CP and 10 mM D-2-CP in comparison to the control values. Both 10 mM L-2-CP and 10 mM D-2-CP significantly inhibited 1 mM L-(+)-lactate uptake (55.8 +/- 9.1 and 53.5 +/- 12.1%, respectively; P < 0.001), whereas a smaller inhibition was observed with a higher lactate concentration of 50 mM (40.2 +/- 11.2 and 38.7 +/- 12.4%; P < 0.001 and P < 0.05, respectively). However, a higher D-2-CP concentration (50 mM) increased the inhibition of pH-stimulated 1 mM L-(+)-lactate uptake (77.0 +/- 9.4%; P < 0.001). D-2-CP had a trans-stimulation effect on the initial rate of lactate efflux of 1 mM L-(+)-lactate compared with baseline efflux (9.5 +/- 0.8 vs. 5.1 +/- 0.4 nmol.min-1.mg protein-1; P < 0.05). 2-CP significantly inhibited the initial rate of lactate uptake in skeletal muscle sarcolemmal membrane vesicles. This result suggests that 2-CP is a nonstereoselective substrate of the lactate muscle carrier that impairs lactate transport.

Lactate kinetics during passive and partially active recovery in endurance and sprint athletes

We investigated the effects of passive and partially active recovery on lactate removal after exhausting cycle ergometer exercise in endurance and sprint athletes. A group of 14 men, 7 endurance-trained (ET) and 7 sprint-trained (ST), performed two maximal incremental exercise tests followed by either passive recovery (20 min seated on cycle ergometer followed by 40 min more of seated rest) or partially active recovery [20 min of pedalling at 40% maximal oxygen uptake (VO2max) followed by 40 min of seated rest]. Venous blood samples were drawn at 5 min and 1 min prior to exercise, at the end of exercise, and during recovery at 1, 2, 3, 4, 5, 6, 8, 10, 15, 20, 30, 40, 50, 60 min post-exercise. The time course of changes in lactate concentration during the recovery phases were fitted by a bi-exponential time function to assess the velocity constant of the slowly decreasing component (tau 2) expressing the rate of blood lactate removal. The results showed that at the end of maximal exercise and during the 1st min of recovery, ET showed higher blood lactate concentrations than ST. Furthermore, ET reached significantly higher maximal exercise intensities [5.1 (SEM 0.5) W.kg-1 vs 4.0 (SEM 0.3) W.kg-1, P < 0.05] and VO2max [68.4 (SEM 1.1) ml.kg-1.min-1 vs 55.5 (SEM 5.1) ml.kg-1.min-1, P < 0.01]. There was no significant difference between the two groups during passive recovery for tau 2. During partially active recovery, tau 2 was higher than during passive recovery for both groups (P < 0.001), but ET recovered faster and sooner than ST (P < 0.05). Compared to passive recovery, the tau 2 measured during partially active recovery was increased threefold in ET and only 1.5-fold in ST. We concluded that partially active recovery potentiates the enhanced ability to remove blood lactate induced by endurance training.

Effects of active recovery on plasma lactate and anaerobic power following repeated intensive exercise

The purpose of this study was to investigate the effects of active recovery (AR) on plasma lactate concentration [La] and anaerobic power output as measured during repeated bouts of intense exercise (6 s) against increasing braking forces. Ten male subjects performed two randomly assigned exercise trials: one with a 5-min passive recovery (PR) after each exercise bout and one with a 5-min active recovery (AR) at a workload corresponding to 32% of maximal aerobic power. Blood samples were taken at rest, at the end of each exercise bout (S1) and at the 5th minute between bout-recovery (S2) for plasma lactate assay. During the tests, [La]S1 was not significantly different after AR and PR, but [La]S2 was significantly lower after AR for power outputs obtained at braking forces 6 kg (5.66 +/- 0.38 vs 7.56 +/- 0.51 mmol.l-1) and peak anaerobic power (PAnP) (6.73 +/- 0.61 vs 8.54 +/- 0.89 mmol.l-1). Power outputs obtained at 2 and 4 kg did not differ after AR and PR. However, when compared with PR, AR induced a significant increase in both power outputs at 6 kg (842 +/- 35 vs 798 +/- 33 W) and PAnP (945 +/- 56 vs 883 +/- 58 W). These results showed that AR between bouts of intensive exercise decreased blood lactate concentration at high braking forces. This decrease was accompanied by higher anaerobic power outputs at these forces.

Lactate uptake by skeletal muscle sarcolemmal vesicles decreases after 4 wk of hindlimb unweighting in rats

We investigated the effects of 4 wk of hypodynamia on the rate of lactate transport in skeletal muscle sarcolemmal vesicles from control and hindlimb-suspended rats. Characterization of the sarcolemmal preparations was achieved with a marker enzyme (K+-p-nitrophenylphosphatase) and measurement of 1 mM [U-14C]lactate transport activity under zero-trans conditions with or without a pH gradient or the transport inhibitor alpha-hydroxycinnamate. Preparations from the two groups were not significantly different concerning yield and purification. Based on these results, we used this model to analyze the lactate transport activity after hypodynamia by tail suspension. Hindlimb suspension caused a shift from slow to fast myosin heavy chain isoforms in soleus muscles with a 40% decrease in the citrate synthase activity (from 35.3 +/- 3.7 to 21.4 +/- 2.1 mu mol x g-1 x min-1; P < 0.05). Lactate (1 mM) uptake in vesicles from the two groups was a function of time, and the rate after hindlimb suspension was significantly decreased in the suspended compared with the control group (2.25 +/- 0.44 and 3.50 +/- 0.26 nmol x min-1 x mg protein-1, respectively; P < 0.05). These differences were not observed for a higher lactate concentration (50 mM). These results suggest that the level of physical activity plays a role in the regulation of sarcolemmal lactate transport activity implicated in the exchanges of lactate between producing and utilizing cells, organs, and tissues, which are major ways of carbohydrate energy distribution in humans and others species.

Lactate uptake by forearm skeletal muscles during repeated periods of short-term intense leg exercise in humans

We investigated the role of the forearm skeletal muscles in the removal of lactate during repeated periods of short-term intensive leg exercise, i.e. a force-velocity (FV) test known to induce a marked accumulation of lactate in the blood. The leg FV test was performed by seven untrained male subjects. Arterial and venous blood samples for determination of arterial ([la-]a) and venous ([la-]v) plasma lactate concentrations were concomitantly taken at rest before the test, during the FV test at the end of each period of intensive exercise just before the 5-min between-sprint recovery period, and after the completion of the test at 2, 4, 6, 8, 10, 15, and 20 min of the final recovery. The arteriovenous difference in concentration for plasma lactate ([la-]a-v) was determined for each blood sample. During the test, [la-]a and [la-]v increased significantly (P < 0.001; P < 0.001) with significantly higher values for [la-]a (P < 0.001). At the onset of the test, [la-]a-v became positive and increased up to a braking force of 6 kg, correlating significantly with [la-]a (r = 0.61, P < 0.001) with power (r = 0.58, P < 0.001) during the test. At the end of the test, [la-]a, [la-]v and [la-]a-v decreased (P < 0.001; P < 0.001; P < 0.001 respectively) but were still higher than the basal values after 20-min of passive recovery. In conclusion, forearm skeletal muscles would seem to have been involved in the removal of lactate from the blood during the leg FV test, with an increase in lactate uptake proportional to the increase in plasma lactate concentration and power.

Aerobic and anaerobic contribution to Wingate test performance in sprint and middle-distance runners

We investigated the aerobic and anaerobic contributions to performance during the Wingate test in sprint and middle-distance runners and whether they were related to the peak aerobic and anaerobic performances determined by two commonly used tests: the force-velocity test and an incremental aerobic exercise test. A group of 14 male competitive runners participated: 7 sprinters, aged 20.7 (SEM 1.3) years, competing in 50, 100 and 200-m events and 7 middle-distance runners, aged 20.0 (SEM 1.0) years, competing in 800, 1,000 and 1,500 m-events. The oxygen uptake (VO2) was recorded breath-by-breath during the test (30 s) and during the first 20 s of recovery. Blood samples for venous plasma lactate concentrations were drawn at rest before the start of the test and during the 20-min recovery period. During the Wingate test mean power (W) was determined and three values of mechanical efficiency, one individual and two arbitrary, 16% and 25%, were used to calculate the contributions of work by aerobic (Waer,ind,16%,25%) and anaerobic (Wan,ind,16%,25%) processes. Peak anaerobic power (Wan,peak) was estimated by the force-velocity test and maximal aerobic energy expenditure (Waer,peak) was determined during an incremental aerobic exercise test. During the Wingate test, the middle-distance runners had a significantly greater VO2 than the sprinters (P < 0.001), who had significantly greater venous plasma lactate concentrations (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Semi-quantitative analysis of 3-phase bone scintigraphy data in algodystrophy of the limbs]

Three-phase bone scanning of the extremities (foot or hand) was performed in 40 normal subjects and in 56 patients with an unequivocal clinical diagnosis of reflex sympathetic dystrophy. Ten patients were in the "cold" or atrophic stage of the disease process, whereas 46 were in the "hot" or acute phase. The scintigraphic parameters studied were the ratios of tracer activity in the affected side over the healthy side established for blood flow (BF), blood pool (BP), early vasculo-tissular fixation (EF), and late bone fixation (LF). In the controls, blood flow, blood pool, and early fixation showed considerable interindividual variation and only the variation of late fixation remained within narrow limits. Among the patients, those at the hot stage of the disease had significantly higher values for all four parameters than those at the cold stage. The group at the cold stage did not differ from the controls except for a significantly higher late fixation value. Furthermore, among hot stage patients, 15% to 25% had normal or diminished blood flow, blood pool and early fixation values. At the cold stage of the disease, radionuclide parameters were similar in affected feet and hands, whereas at the hot stage values at the feet were double those at the hands. Finally, statistical analysis revealed that late fixation was most closely correlated with early fixation, which in turn was most close correlated with blood pool. The clinical and pathophysiological significance of these data is discussed.

Effects of 2-chloropropionate on venous plasma lactate concentration and anaerobic power during periods of incremental intensive exercise in humans

We investigated the effects of a stimulation of pyruvate dehydrogenase (PDH) activity induced by 2-chloropropionate (2-CP) on venous plasma lactate concentration and peak anaerobic power (W an, peak) during periods (6 s) of incremental intense exercise, i.e. a force-velocity (F-v) test known to induce a marked accumulation of lactate in the blood. The F-v test was performed twice by six subjects according to a double-blind randomized crossover protocol: once with placebo and once with 2-CP (43 mg.kg-1 body mass). Blood samples were taken at ingestion of the drug, at 10, 20, and 40 min into the pretest period, at the end of each period of intense exercise, at the end of each 5-min recovery period, and after completion of the F-v test at 5, 10, 15, and 30 min. During the F-v test, venous plasma lactate concentrations with both placebo and 2-CP increased significantly when measured at the end of each period of intense exercise (F = 33.5, P < 0.001), and each 5-min recovery period (F = 24.6, P < 0.001). Venous plasma lactate concentrations were significantly lower with 2-CP at the end of each recovery period (P < 0.01), especially for high braking forces, i.e. 8 kg (P < 0.05), 9 kg (P < 0.02), and maximal braking force (P < 0.05). After completion of the F-v test, venous plasma lactate concentrations were also significantly lower with 2-CP (P < 0.001). The percentage of lactate decrease between 5- and 30-min recovery was significantly higher with 2-CP than with the placebo [59 (SEM 4)% vs 44.6 (SEM 5.5)%, P < 0.05]. Furthermore, W an, peak was significantly higher with 2-CP than with the placebo [1016 (SEM 60) W vs 957 (SEM 55) W, P < 0.05]. In conclusion, PDH activation by 2-CP attenuated the increase in venous plasma lactate concentration during the F-v test. Ingestion of 2-CP led to an increased W an, peak.

Anaerobic and aerobic components during arm-crank exercise in sprint and middle-distance swimmers

The purpose of this investigation was to compare anaerobic and aerobic components measured during arm exercise in sprint and middle-distance swimmers and to investigate whether the peak anaerobic power:peak aerobic power ratio (W(an),peak:Waer,peak) was related to specialization for the event and to performance. The W(an0,peak, force at zero velocity (F0), and velocity at zero-force (v0), Waer,peak, peak oxygen uptake (VO2peak), and ventilatory threshold (Thv) were compared during arm exercise tests in sprint (group I, n = 8) and middle-distance (group II, n = 9) competitive male swimmers. Anaerobic indices were estimated by the force-velocity test, an anaerobic test using incremental braking forces; aerobic indices were measured during an incremental aerobic exercise test (30 W.min-1). The W(an),peak and Waer,peak were greater in group I [828 (SEM 70) W; 236 (SEM 12) W] than in group II [678 (SEM 28) W; 230 (SEM 5) W], but the differences were not significant. There were also no significant differences observed between the mean values of F0, v0, VO2peak, and Thv. The W(an0,peak:Waer,peak, however, was significantly higher in sprint swimmers (t = 3.08, P < 0.01). In seven of the swimmers, who had recently performed both the 100-m and 400-m front crawl, a relationship existed between their swim time and the W(an),peak:Waer,peak (100 m: r = -0.80, P < 0.05 and 400 m: r = +0.75, P < 0.05). In conclusion, during arm-crank exercise, we did not observe significant differences in anaerobic and aerobic components between sprint and middle-distance swimmers.(ABSTRACT TRUNCATED AT 250 WORDS)

Maximal anaerobic power: relationship to anthropometric characteristics during growth

The purpose of this study was to determine the effects of age in relation to anthropometric characteristics upon maximal anaerobic power of legs in sixty-nine young boys aged 11 to 19 years. Maximal anaerobic power (Wmax) was measured by the force-velocity test. Lean body mass (LBM) was determined from all four skin-fold thickness measurements, leg volume (LV) was estimated by anthropometric method, and anthropometric measurements were used to determine total muscular mass (TMM). Wmax increased significantly (F = 44.1, p less than 0.001) between 11 and 19 years and was correlated with LV (r = 0.84) and TMM (r = 0.88). It was most highly correlated with LBM (r = 0.94), which best explained the percentage of the total variance of Wmax (88%). Normalized Wmax (Wmax/LBM) also increased significantly between 11 and 19 years (F = 21.9, p less than 0.001). In conclusion, Wmax determined by the force-velocity test was closely related to anthropometric characteristics, especially LBM, during the growth period. Furthermore, even when corrected for lean body mass, maximal anaerobic power was always found to increase. This suggests that other undetermined factors, in addition to the amount of lean tissue mass, may explain the increase of Wmax during the force-velocity test.

Normalization of stress and delayed thallium-201 myocardial SPECT: where is the normal reference area?

We describe an unusual uptake pattern in a thallium SPECT study performed after dipyridamole infusion in a patient with a documented history of prior inferior infarction and recent typical chest pain. The stress study exhibited maximum uptake in the inferior wall. The delayed study showed an inferior defect more consistent with the notion of inferior necrosis, with a maximum uptake in the anterior wall. The authors propose a pathophysiologic interpretation consistent with coronary angiography findings, based on the assumption of coronary steal suggested by the occurrence of chest pain at the end of the dipyridamole infusion. The problem of selecting myocardial normal reference area(s) necessary to normalization prior to quantitative comparison stress and delayed studies is discussed.

Correlations between M-mode markers of left ventricular hypertrophy and radionuclide angiographic indices of left ventricular diastolic function in mild to moderate hypertension

This study was undertaken to determine the correlations between left ventricular hypertrophy and left ventricular diastolic function in mild to moderate essential hypertension. M-mode echocardiography and rest equilibrium radionuclide angiography were performed in 53 hypertensive subjects. The following M-mode echocardiographic parameters were measured: interventricular septal thickness, posterior wall thickness, left ventricular mass index, left atrial diameter and relative wall thickness. The following radionuclide angiography parameters were measured: ejection fraction, peak filling rate, time to peak filling rate, first third filling fraction and atrial contribution to total filling. Weak correlations were shown between left ventricular diastolic function and the M-mode echocardiographic parameters. The peak filling rate was negatively correlated with the interventricular septal thickness (r = -0.345; P less than 0.05), with the sum of the interventricular septal thickness and the posterior wall thickness (r = -0.395; P less than 0.01), with the left atrial diameter (r = -0.345; P less than 0.05), and with the relative wall thickness (r = -0.297; P less than 0.05). The time to peak filling rate was positively correlated with the left ventricular mass index (r = + 0.310; P less than 0.05) and with the left atrial diameter (r = + 0.323; P less than 0.05). These findings suggest that diastolic abnormalities in hypertensive heart disease are only in part related to the degree of left ventricular hypertrophy.

[Study of left ventricular diastolic function using pulsed Doppler in myocardial infarct in hypertensive subjects]

To determine if impairment of left ventricular filling is influenced by acute myocardial infarction in patients with arterial hypertension, left ventricular diastolic function was assessed by pulsed doppler echocardiography in 46 patients (pts) subdivided into four groups (Gr): G.1 (n = 12 pts) with acute myocardial infarction and hypertensive heart disease. G.2 (n = 12 pts) acute myocardial infarction without arterial hypertension. G.3 (n = 10 pts) arterial hypertension without history of coronary artery disease. G.4 (n = 12 pts) healthy subjects. Coronary angiography and left ventricular cineangiogram was performed in 24 pts (G.1 + G.2). Peak mitral flow velocity (cm/s) in early diastole (E), atrial systole (A), A/E and int A/int E ratios were measured by pulsed doppler. Age and heart rate were statistically similar in all groups. No difference was found among G.1 and G.2 in ejection fraction, and left ventricular segmental kinetic. (tables; see text) Conclusion left ventricular filling is impaired in pts with arterial hypertension and in pts with acute myocardial infarction; acute myocardial infarction increase the impairment of left ventricular diastolic function in pts with hypertensive heart disease.

[Hemodynamic and hormonal study of electronarcosis and neuroleptanalgesia. Clinical study in 17 surgical patients]

The blocking effect of electropharmaceutical anesthesia (EPA) and neuroleptanalgesia (NLA) on adrenergic and hormonal reactions to abdominal surgery were compared in 17 ASA class I to III randomized patients. This study was intended to define the indications for each of these techniques in patients with heart diseases. Each individual received the same anesthetic premedication and induction and was submitted to iterative identical measurements and biological dosages. Before and during surgery, both groups were catheterized with a Swan-Ganz and a radial catheter. Blood sampling for catecholamines, cortisol, glycemia, blood gases dosages were regularly drawn. Electrical stimulation was performed in the EPA group, and fentanyl injections were repeated in the NLA group patients only. The same doses of pancuronium and droperidol were given to every patient. A circulatory hyperkinesia and hyperadrenergia were observed during surgery in all of the subjects but, during EPA, the tachycardia, the cardiac index and the rate-pressure product were higher than during NLA. The body temperature increased towards normal in EPA, not in NLA. Adrenergic and hormonal levels were equal in both groups. The slow variations of all the important parameters demonstrate that the measured phenomenons have a long time-course what legitimates this kind of prolonged on-the-spot observation. The role of droperidol, pancuronium and fentanyl in the observed variations is discussed. The characteristic high hyperkinesia in EPA may be due partly to an inefficacious analgesia because of the fentanyl suppression after induction, partly to the preserved thermogenesis partly to a direct effect of the electrical stimulation on cerebral tissues.

Treatment of cirrhotic hepatic encephalopathy with L-dopa. A controlled trial

It has been suggested that hepatic encephalopathy could be due to the accumulation of false neurotransmitters and that the administration of a neurotransmitter precursor such as L-dopa would be beneficial to cirrhotic patients with hepatic encephalopathy. A prospective randomized controlled study was carried out to determine whether L-dopa has any effect on the course of cirrhotic hepatic encephalopathy. L-Dopa, L-Dopa and dopa-decarboxylase inhibitor, or placebo was given orally for 7 days to 75 cirrhotic patients with hepatic encephalopathy. The effect was assessed by clinical parameters as well as serial electroencephalograms. There was no statistically significant difference with respect to clinical improvement or deterioration in patients treated with either L-dopa or L-dopa and dopa-decarboxylase inhibitor or placebo. It is concluded that L-dopa is ineffective in the treatment of cirrhotic hepatic encephalopathy. Inefficacy was not due to late onset of treatment, to poor intestinal absorption of L-dopa, to destruction of L-dopa in the blood, or to impaired passage of L-dopa into the cerebrospinal fluid.