1
|
Abdelhamid S, Achermann R, Hollinger A, Hauser M, Trutmann M, Gallacchi L, Siegemund M. The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis. Crit Care Med 2024; 52:e234-e244. [PMID: 38502807 PMCID: PMC11008457 DOI: 10.1097/ccm.0000000000006218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES The aim of this study was to analyze the development of albumin administration in patients admitted to the adult ICU. In addition, we assessed the impact of albumin administration on serum hemoglobin concentration. DESIGN We conducted a retrospective single-center study including all patients who were admitted to the ICU from January 2013 to December 2021 and stayed at least 24 hours. SETTING The study was conducted in an academic hospital (University Hospital Basel, Switzerland). PATIENTS A total of 20,927 admissions were included, of which 3748 received albumin at least once during their ICU stay. To analyze volume expansion, 2006 admissions met the inclusion criteria, namely at least two hemoglobin measurements within 12 hours, one albumin delivery, and experienced no bleeding, dialysis, or transfusions during this period. INTERVENTIONS None. MEASUREMENTS We examined the hemoglobin levels before and after albumin administration and compared them with a matched control group to assess the amount and duration of volume expansion. MAIN RESULTS From 2013 to 2021 the proportion of critically ill patients treated with albumin rose from 5.0% to 32.5%. An overproportioned increase in albumin use could be seen in surgical patients (4.7-47.2%) and in those receiving RBC transfusion (13.7-72.6%). In those patients receiving albumin, a significant drop in hemoglobin of around 5 g/L on average could be observed following treatment with albumin. CONCLUSION Hemodilution was observable for at least 12 hours after albumin administration and may have caused a decrease in hemoglobin concentration of greater than 8 g/L when isooncotic albumin solution (5%, 25 g in 500 mL) was administered. This makes albumin, especially in its isooncotic form, an ideal colloid to achieve long-lasting volume expansion. However, RBC transfusions may increase under albumin therapy, as transfusion thresholds may be undershot after albumin administration.
Collapse
Affiliation(s)
- Salim Abdelhamid
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Rita Achermann
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Alexa Hollinger
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Madlaina Hauser
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Maren Trutmann
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Laura Gallacchi
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| |
Collapse
|
2
|
Nørskov MP, Mønsted T, Kimer N, Damgaard M, Møller S. Can Plasma Volume Determination in Cirrhosis Be Replaced by an Algorithm Using Body Weight and Hematocrit? Diagnostics (Basel) 2024; 14:835. [PMID: 38667480 PMCID: PMC11049127 DOI: 10.3390/diagnostics14080835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Patients with cirrhosis often develop hyperdynamic circulation with increased cardiac output, heart rate, and redistribution of the circulating volume with expanded plasma volume (PV). PV determination is part of the evaluation of patients with cirrhosis, but gold-standard methods are invasive, expensive, and time-consuming. Therefore, other estimations of PV would be preferable, and the aim of this study was therefore to study if PV, as assessed by a simplified algorithm based on hematocrit and weight, can replace the gold-standard method. METHODS We included 328 patients with cirrhosis who had their PV assessed by the indicator dilution technique as the gold-standard method (PVI-125). Actual PV was estimated as PVa = (1 - hematocrit)·(a + (b·body weight)). Ideal PV was estimated as PVi = c · body weight, where a, b, and c are constants. RESULTS PVI-125, PVa, and PVi were 3.99 ± 1.01, 3.09 ± 0.54, and 3.01 ± 0.65 (Mean ± SD), respectively. Although PVI-125 correlated significantly with PVa (r = 0.72, p < 0.001), a Bland-Altman plot revealed wide limits of confidence. CONCLUSIONS The use of simplified algorithms does not sufficiently estimate PV and cannot replace the indicator dilution technique.
Collapse
Affiliation(s)
- Martine Prütz Nørskov
- Center of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine 260, Copenhagen University Hospital, 2650 Hvidovre, Denmark; (T.M.); (M.D.); (S.M.)
| | - Thormod Mønsted
- Center of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine 260, Copenhagen University Hospital, 2650 Hvidovre, Denmark; (T.M.); (M.D.); (S.M.)
| | - Nina Kimer
- Gastro Unit, Medical Division, Copenhagen University Hospital, 2650 Hvidovre, Denmark;
| | - Morten Damgaard
- Center of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine 260, Copenhagen University Hospital, 2650 Hvidovre, Denmark; (T.M.); (M.D.); (S.M.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Søren Møller
- Center of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine 260, Copenhagen University Hospital, 2650 Hvidovre, Denmark; (T.M.); (M.D.); (S.M.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| |
Collapse
|
3
|
Krumm B, Lundby C, Hansen J, Bejder J, Sørensen H, Equey T, Saugy J, Botrè F, Faiss R. Yearly intrasubject variability of hematological biomarkers in elite athletes for the Athlete Biological Passport. Drug Test Anal 2024. [PMID: 38291831 DOI: 10.1002/dta.3645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024]
Abstract
Confounding factors including exercise and environments challenge the interpretation of individual Athlete Biological Passports (ABPs). This study aimed to investigate the natural variability of hematological ABP parameters over 1 year in elite athletes compared with healthy control subjects and the validity of a multiparametric model estimating plasma volume (PV) shifts to correct individual ABP thresholds. Blood samples were collected monthly with full blood counts performed by flow cytometry (Sysmex XN analyzers) in 20 elite xc-skiers (ELITE) and 20 moderately trained controls. Individual ABP profiles were generated through Anti-Doping Administration & Management System Training, a standalone version of the ABP's adaptive model developed by the World Anti-Doping Agency. Additionally, eight serum parameters were computed as volume-sensitive biomarkers to run a multiparametric model to estimate PV. Variability in ELITE compared with controls was significantly higher for the Abnormal Blood Profile Scores (P = 0.003). Among 12 Atypical Passport Findings (ATPF) initially reported, six could be removed after correction of PV shifts with the multiparametric modeling. However, several ATPF were additionally generated (n = 19). Our study outlines a larger intraindividual variability in elite athletes, likely explained by more frequent exposure to extrinsic factors altering hematological biomarkers. PV correction for individual ABP thresholds allowed to explain most of the atypical findings while generating multiple new ATPF occurrences in the elite population. Overall, accounting for PV shifts in elite athletes was shown to be paramount in this study outlining the opportunity to consider PV variations with novel approaches when interpreting individual ABP profiles.
Collapse
Affiliation(s)
- Bastien Krumm
- REDs, Research & Expertise in antiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Carsten Lundby
- Section for Health and Exercise Physiology, Inland University of Applied Sciences, Lillehammer, Norway
- Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Joar Hansen
- Section for Health and Exercise Physiology, Inland University of Applied Sciences, Lillehammer, Norway
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Sørensen
- Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Tristan Equey
- Athlete Biological Passport, Science Department, WADA, World Anti-Doping Agency, Montréal, Quebec, Canada
| | - Jonas Saugy
- REDs, Research & Expertise in antiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francesco Botrè
- REDs, Research & Expertise in antiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Raphael Faiss
- REDs, Research & Expertise in antiDoping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
4
|
Vinje V, Bomholt T, Lundby C, Oturai P, Rix M, Lindhard K, Hornum M. Intravascular volumes and the influence on anemia assessed by a carbon monoxide rebreathing method in patients undergoing maintenance hemodialysis. Hemodial Int 2024; 28:40-50. [PMID: 37827985 DOI: 10.1111/hdi.13118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Fluid overload is a major challenge in hemodialysis patients and might cause hypervolemia. We speculated that hemodialysis patients reaching dry weight could have undetected hypervolemia and low hemoglobin (Hb) concentration (g/dL) due to hemodilution. METHODS The study included hemodialysis patients (n = 22) and matched healthy controls (n = 22). Blood volume, plasma volume, red blood cell volume, and total Hb mass were determined using a carbon monoxide (CO)-rebreathing method in hemodialysis patients reaching dry weight and controls. Blood volume measurements were also obtained by a dual-isotope labeling technique in a subgroup for validation purposes. FINDINGS In the hemodialysis group, the median specific blood volume was 89.3 mL/kg (interquartile range [IQR]: 76.7-95.4 mL/kg) and was higher than in the control group (79.9 mL/kg [IQR: 70.4-88.0 mL/kg]; p < 0.037). The median specific plasma volume was 54.7 mL/kg (IQR: 47.1-61.0 mL/kg) and 44.0 mL/kg (IQR: 38.7-49.5 mL/kg) in the hemodialysis and control groups, respectively (p < 0.001). Hb concentration was lower in hemodialysis patients (p < 0.001), whereas no difference in total Hb mass was observed between groups (p = 0.11). A correlation was found between blood volume measured by the CO-rebreathing test and the dual-isotope labeling technique in the control group (r = 0.83, p = 0.015), but not the hemodialysis group (r = 0.25, p = 0.60). DISCUSSION The hemodialysis group had increased specific blood volume at dry weight due to high plasma volume, suggesting a hypervolemic state. However, correlation was not established against the dual-isotope labeling technique underlining that the precision of the CO-rebreathing test should be further validated. The total Hb mass was similar between hemodialysis patients and controls, unlike Hb concentration, which emphasizes that Hb concentration is an inaccurate marker of anemia among hemodialysis patients.
Collapse
Affiliation(s)
- Vårin Vinje
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Bomholt
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Lundby
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Section for Health and Exercise Physiology, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Peter Oturai
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Rix
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Lindhard
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Elali I, Phachu D, Coombs N, Shah M, Dean J, Haider L, Wang Y, Kaplan AA. Membrane-based therapeutic plasma exchange: Proposed techniques for preventing filter failure. J Clin Apher 2023; 38:555-561. [PMID: 37287385 DOI: 10.1002/jca.22065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Therapeutic plasma exchange (TPE) is commonly performed using membrane-based TPE (mTPE) and is prone to filter failure. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We report on 46 patients, with a total of 321 mTPE treatments using the NxStage machine. This was a retrospective study with an aim to evaluate the effect of heparin, pre-filter saline dilution and the impact of total plasma volume exchanged (< 3 L vs. ≥3 L) on the rate of filter failure. Primary outcome was the overall rate of filter failure. Secondary outcomes included factors that may have indirectly influenced the rate of filter failure, including hematocrit, platelet count, replacement fluid (Fresh Frozen Plasma vs. albumin), and access type. RESULTS We found that treatments that received both pre-filter heparin and saline had a statistically significant decrease in filter failure rate as compared to those that received neither (28.6% vs. 5.3%, P = .001), and compared to the treatments that received pre-filter heparin alone (14.2% vs. 5.3%, P = .015). In treatments that received both pre-filter heparin and saline predilution, we noted a significantly higher filter failure rate when the plasma volume exchanged was ≥3 L as compared to those that had <3 L exchanged (12.2% vs. 0.9%, P = .001). CONCLUSIONS Rate of filter failure in mTPE can be reduced by implementing several therapeutic interventions including pre-filter heparin and pre-filter saline solution. These interventions were not associated with any clinically significant adverse events. Despite the above-mentioned interventions, large plasma volume exchanges of ≥3 L can negatively impact filter life.
Collapse
Affiliation(s)
- Ibrahim Elali
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Deep Phachu
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nick Coombs
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Mamta Shah
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jordan Dean
- Division of Nephrology/Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Lalarukh Haider
- UConn Health, Department of Medicine, Division of Nephrology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Yanlin Wang
- Division of Nephrology/Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Andre A Kaplan
- Division of Nephrology/Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| |
Collapse
|
6
|
Jürgens M, Schou M, Hasbak P, Kjaer A, Wolsk E, Zerahn B, Brandt-Jacobsen NH, Gaede P, Rossing P, Faber J, Inzucchi SE, Gustafsson F, Kistorp C. The effects of empagliflozin on measured glomerular filtration rate and estimated extracellular and plasma volumes in patients with type 2 diabetes. Diabetes Obes Metab 2023; 25:2888-2896. [PMID: 37395341 DOI: 10.1111/dom.15183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023]
Abstract
AIMS To investigate the effects of empagliflozin on measured glomerular filtration rate (mGFR), estimated plasma volume (PV) and estimated extracellular volume (ECV) in a cohort of patients with type 2 diabetes (T2D) and high risk of cardiovascular events. MATERIALS AND METHODS In this prespecified substudy of the randomized, placebo-controlled SIMPLE trial, patients with T2D at high risk of cardiovascular events were allocated to either empagliflozin 25 mg or placebo once daily for 13 weeks. The prespecified outcome was between-group change in mGFR, measured by the 51 Cr-EDTA method after 13 weeks; changes in estimated PV and estimated ECV were included. RESULTS From April 4, 2017 to May 11, 2020, 91 participants were randomized. Of these, 45 patients from the empagliflozin group and 45 patients from the placebo group were included in the intention-to-treat analysis. Treatment with empagliflozin reduced mGFR by -7.9 mL/min (95% confidence interval [CI] -11.1 to -4.7; P < 0.001), estimated ECV by -192.5 mL (95% CI -318.0 to -66.9; P = 0.003) and estimated PV by -128.9 mL (95% CI -218.0 to 39.8; P = 0.005) at Week 13. CONCLUSIONS Treatment with empagliflozin for 13 weeks reduced mGFR, estimated ECV and estimated PV in patients with T2D and high risk of cardiovascular events.
Collapse
Affiliation(s)
- Mikkel Jürgens
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Emil Wolsk
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Niels H Brandt-Jacobsen
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Gaede
- Slagelse Hospital, Slagelse, Denmark, University of Southern Denmark, Odense, Denmark
| | - Peter Rossing
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Jens Faber
- Department of Endocrinology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Silvio E Inzucchi
- Yale Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Finn Gustafsson
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Caroline Kistorp
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Moreillon B, Krumm B, Saugy JJ, Saugy M, Botrè F, Vesin JM, Faiss R. Prediction of plasma volume and total hemoglobin mass with machine learning. Physiol Rep 2023; 11:e15834. [PMID: 37828664 PMCID: PMC10570407 DOI: 10.14814/phy2.15834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Hemoglobin concentration ([Hb]) is used for the clinical diagnosis of anemia, and in sports as a marker of blood doping. [Hb] is however subject to significant variations mainly due to shifts in plasma volume (PV). This study proposes a newly developed model able to accurately predict total hemoglobin mass (Hbmass) and PV from a single complete blood count (CBC) and anthropometric variables in healthy subject. Seven hundred and sixty-nine CBC coupled to measures of Hbmass and PV using a CO-rebreathing method were used with a machine learning tool to calculate an estimation model. The predictive model resulted in a root mean square error of 33.2 g and 35.6 g for Hbmass, and 179 mL and 244 mL for PV, in women and men, respectively. Measured and predicted data were significantly correlated (p < 0.001) with a coefficient of determination (R2 ) ranging from 0.76 to 0.90 for Hbmass and PV, in both women and men. The Bland-Altman bias was on average 0.23 for Hbmass and 4.15 for PV. We herewith present a model with a robust prediction potential for Hbmass and PV. Such model would be relevant in providing complementary data in contexts such as the epidemiology of anemia or the individual monitoring of [Hb] in anti-doping.
Collapse
Affiliation(s)
- B. Moreillon
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
- Union Cycliste InternationaleWorld Cycling CentreAigleSwitzerland
| | - B. Krumm
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - J. J. Saugy
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - M. Saugy
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - F. Botrè
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
- Laboratorio AntidopingFederazione Medico Sportiva ItalianaRomeItaly
| | - J. M. Vesin
- Signal Processing Laboratory 2Swiss Federal Institute of TechnologyLausanneSwitzerland
| | - R. Faiss
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| |
Collapse
|
8
|
Willingham BD, Rentería LI, Ragland TJ, Ormsbee MJ. The effects of betaine supplementation on fluid balance and heat tolerance during passive heat stress in men. Physiol Rep 2023; 11:e15792. [PMID: 37604644 PMCID: PMC10442523 DOI: 10.14814/phy2.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Consuming intracellular osmolytes, like betaine (BET), may attenuate symptoms of heat stress. The purpose of this study was to examine the effects of BET supplementation on fluid balance and heat tolerance after a 7-day loading period and during passive heat exposure. METHODS A double-blind, placebo controlled, crossover study compared BET or placebo consumption (50 mg·kg-1 , twice daily) for 7 days in young, recreationally active men (N = 11). RESULTS During the loading period, no significant interactions were found for any marker of fluid balance between or within conditions. During heat exposure, significant time effects but no condition x time interactions, were found for plasma characteristics (i.e., volume, osmolality, sodium, albumin, and total protein). Plasma volume was significantly increased by min 30 in both conditions (PLA: +6.9. ± 5.0%, BET: +10.2 ± 7.4%) and remained elevated for the remainder of the experimental trial, but was not significantly different between conditions. After 60 min of passive heat exposure, both conditions experienced a similar increase in core temperature (PLA: +0.32 ± 0.22°C, BET: +0.31 ± 0.21°C; p = 0.912). CONCLUSIONS Supplemental BET did not improve markers of fluid balance or heat tolerance during 7 days of loading or during passive heat exposure.
Collapse
Affiliation(s)
- Brandon D. Willingham
- Department of KinesiologyCoastal Carolina UniversityConwaySouth CarolinaUSA
- Institute of Sports Sciences & Medicine, Nutrition, and Integrative PhysiologyFlorida State UniversityFloridaUSA
| | - Liliana I. Rentería
- Institute of Sports Sciences & Medicine, Nutrition, and Integrative PhysiologyFlorida State UniversityFloridaUSA
| | - Tristan J. Ragland
- Institute of Sports Sciences & Medicine, Nutrition, and Integrative PhysiologyFlorida State UniversityFloridaUSA
- Department of Kinesiology and HealthRutgers UniversityNew BrunswickNew JerseyUSA
| | - Michael J. Ormsbee
- Institute of Sports Sciences & Medicine, Nutrition, and Integrative PhysiologyFlorida State UniversityFloridaUSA
- Discipline of Biokinetics, Exercise, and Leisure SciencesUniversity of KwaZulu‐NatalDurbanSouth Africa
| |
Collapse
|
9
|
Zhang D, Li Q, Liu J, Ma L, Ye J, Hu G, Li G. Calculated plasma volume status is associated with poor outcomes in acute ischemic stroke treated with endovascular treatment. Front Neurol 2023; 14:1229331. [PMID: 37576016 PMCID: PMC10415678 DOI: 10.3389/fneur.2023.1229331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background and purpose The impact of calculated plasma volume status (PVS) on the prognosis of acute ischemic stroke treated with endovascular treatment (EVT) remains undetermined. This study aimed to investigate the association between PVS and 90 days functional outcomes after EVT. Methods We enrolled patients treated with EVT in the anterior circulation from a prospective registry. The endpoint was a modified Rankin scale score of ≥3 points at 90 days after EVT. We used multivariable logistic regression models to investigate the association between PVS and poor outcomes. We used the restricted cubic spline to present the linearity between PVS and poor outcomes. Results Among the 187 enrolled patients (median age, 65 years; 35.8% women), a total of 81 patients (43.3%) experienced poor outcomes at 90 days. In multivariable analyses, PVS was associated with poor outcomes despite increasing confounding factors (odds ratio, 3.157; 95% confidence interval, 1.942-5.534; P < 0.001). The restricted cubic spline revealed a positive correlation between PVS and the risk of poor outcomes after EVT (P for nonlinearity = 0.021). Conclusion Our study found that an elevated PVS value was associated with poor outcomes after EVT. Further prospective cohorts were warranted to evaluate the utility of PVS in AIS treated with EVT.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Guangzong Li
- Department of Neurology, The Sixth People's Hospital of Chengdu, Chengdu, China
| |
Collapse
|
10
|
Schierbauer J, Wolf A, Wachsmuth NB, Maassen N, Schmidt WFJ. Relationship between Blood Volume, Blood Lactate Quantity, and Lactate Concentrations during Exercise. Metabolites 2023; 13:metabo13050632. [PMID: 37233674 DOI: 10.3390/metabo13050632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
We wanted to determine the influence of total blood volume (BV) and blood lactate quantity on lactate concentrations during incremental exercise. Twenty-six healthy, nonsmoking, heterogeneously trained females (27.5 ± 5.9 ys) performed an incremental cardiopulmonary exercise test on a cycle ergometer during which maximum oxygen uptake (V·O2max), lactate concentrations ([La-]) and hemoglobin concentrations ([Hb]) were determined. Hemoglobin mass and blood volume (BV) were determined using an optimised carbon monoxide-rebreathing method. V·O2max and maximum power (Pmax) ranged between 32 and 62 mL·min-1·kg-1 and 2.3 and 5.5 W·kg-1, respectively. BV ranged between 81 and 121 mL·kg-1 of lean body mass and decreased by 280 ± 115 mL (5.7%, p = 0.001) until Pmax. At Pmax, the [La-] was significantly correlated to the systemic lactate quantity (La-, r = 0.84, p < 0.0001) but also significantly negatively correlated to the BV (r = -0.44, p < 0.05). We calculated that the exercise-induced BV shifts significantly reduced the lactate transport capacity by 10.8% (p < 0.0001). Our results demonstrate that both the total BV and La- have a major influence on the resulting [La-] during dynamic exercise. Moreover, the blood La- transport capacity might be significantly reduced by the shift in plasma volume. We conclude, that the total BV might be another relevant factor in the interpretation of [La-] during a cardio-pulmonary exercise test.
Collapse
Affiliation(s)
- Janis Schierbauer
- Division of Exercise Physiology & Metabolism, University of Bayreuth, 95447 Bayreuth, Germany
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, 95447 Bayreuth, Germany
| | - Alina Wolf
- Division of Exercise Physiology & Metabolism, University of Bayreuth, 95447 Bayreuth, Germany
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, 95447 Bayreuth, Germany
| | - Nadine B Wachsmuth
- Division of Exercise Physiology & Metabolism, University of Bayreuth, 95447 Bayreuth, Germany
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, 95447 Bayreuth, Germany
| | - Norbert Maassen
- Institute of Sports Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Walter F J Schmidt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, 95447 Bayreuth, Germany
| |
Collapse
|
11
|
Aguree S, Murray-Kolb LE, Diaz F, Gernand AD. Menstrual Cycle-Associated Changes in Micronutrient Biomarkers Concentration: A Prospective Cohort Study. J Am Nutr Assoc 2023; 42:339-348. [PMID: 35512771 DOI: 10.1080/07315724.2022.2040399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
To evaluate variations in micronutrient biomarker concentrations and deficiencies across the menstrual cycle in a cohort of healthy women. This prospective cohort study was conducted among healthy women of reproductive age living in the State College area, Pennsylvania, (n = 45). Data collection occurred at the early follicular phase, the late follicular phase, and the midluteal phase. Fasting blood samples were collected to measure micronutrient biomarkers. At the early follicular phase, the mean ± SD concentrations for zinc, copper, magnesium, and retinol were 81.8 ± 16.2 µg/dL, 80.1 ± 12.8 µg/dL, 17.9 ± 1.4 mg/L, and 39.4 ± 9.3 µg/dL, respectively. The geometric mean (95% CI) for manganese, iron and ferritin concentrations were 1.51 [1.21, 1.87] µg/L, 106.7 [90.8, 125.4] µg/dL, and 26.4 [20.5, 34.0] µg/L, respectively. Mean concentrations of zinc and magnesium declined by 6.6% (p = 0.009) and 4.6% (p < 0.001) from the early follicular phase to the midluteal phase, respectively. Other biomarkers remained relatively constant across the cycle. At the early follicular phase, the prevalence of low serum concentrations for zinc, copper, magnesium, manganese, iron, and ferritin was 22%, 7%, 29%, 13%, 14%, and 28%, respectively. Also, in early follicular phase, 36% had anemia, and 13% specifically had iron deficiency anemia. The prevalence of magnesium deficiency was significantly higher at the midluteal phase vs. the early follicular phase (p = 0.025). Our study suggests that while many micronutrient concentrations are relatively constant across the menstrual cycle in healthy women, zinc and magnesium decline, and the prevalence of magnesium deficiency increases. Supplemental data for this article is available online at.
Collapse
Affiliation(s)
- Sixtus Aguree
- Department of Food Science and Human Nutrition, Iowa State University, Ames, Iowa, USA
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Francisco Diaz
- Department of Animal Science, The Pennsylvania State University, University Park, Pennsylvania, USA
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| |
Collapse
|
12
|
Schmidt WFJ, Wachsmuth NB, Romero Pozo MC, Aguilar Valerio MT, Contreras Tapia IC, Vater M, Kaufmann J, Jiménez-Claros JC, Soria R. Possible strategies to reduce altitude-related excessive polycythemia. J Appl Physiol (1985) 2023; 134:1321-1331. [PMID: 37055035 DOI: 10.1152/japplphysiol.00076.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
We sought to determine the effects of three treatments on hemoglobin (Hb) levels in patients with chronic mountain sickness (CMS): 1.) descent to lower altitude, 2.) nocturnal O2 supply, 3.) administration of acetazolamide. Nineteen CMS patients living at an altitude of 3,940 ±130 m participated in the study, which consisted of a three week intervention phase and a four-week post-intervention phase. Six patients spent three weeks at an altitude of 1,050 m (LAG), six received supplemental oxygen for 12 h overnight (OXG) and seven received 250 mg of acetazolamide daily (ACZG). Hemoglobin mass (Hbmass) was determined using an adapted carbon monoxide (CO) rebreathing method before, weekly during, and four weeks post-intervention. Hbmass decreased by 245±116 g (p<0.01) in the LAG and by 100±38 g in OXG, and 99±64 g in ACZG (p<0.05, each), respectively. In LAG, [Hb] decreased by 2.1±0.8 g/dl and hematocrit by 7.4±2.9 % (both p<0.01), whereas OXG and ACZG only trended toward lower values. Erythropoietin concentration ([EPO]) decreased between 81±12 % and 73±21 % in LAG at low altitude (p<0.01) and increased by 161±118 % five days after return (p<0.01). In OXG and ACZG, the [EPO] decrease was ~75 % and ~50 %, respectively, during the intervention (p<0.01). Descent to low altitude (from 3,940 m to 1,050 m) is a fast-acting measure for the treatment of excessive erythrocytosis in CMS patients, reducing Hbmass by 16 % within three weeks. Nighttime oxygen supplementation and daily acetazolamide administration are also effective, but reduce Hbmass by only 6 %.
Collapse
Affiliation(s)
- Walter F J Schmidt
- Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Nadine B Wachsmuth
- Division of Exercise Physiology and Metabolism, University of Bayreuth, Bayreuth, Germany
| | | | | | | | - Marina Vater
- Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Julia Kaufmann
- Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | | | - Rudy Soria
- Instituto Boliviano de Biologia de Altura, Universidad Mayor de San Andres, La Paz, Bolivia
| |
Collapse
|
13
|
Nelson WB, Walker JM, Hansen C, Foote KM, Bexfield NA, Mack GW. The influence of exercise volume and posture on exercise-induced plasma volume expansion. Physiol Rep 2023; 11:e15601. [PMID: 36802178 PMCID: PMC9937781 DOI: 10.14814/phy2.15601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
Acute high-intensity interval exercise is known to expand plasma volume 24 h after exercise. Upright exercise posture plays a role in expanding plasma volume by influencing lymphatic outflow and redistributing albumin while supine exercise does not. We examined if further upright and weight-bearing exercises could further promote plasma volume expansion. We also tested the volume of intervals needed to induce plasma volume expansion. To test the first hypothesis, 10 subjects performed intermittent high-intensity exercise (4 min at 85% V̇O2max , 5 min at 40% V̇O2max repeated 8 times) on separate days on the treadmill and cycle ergometer. For the second study, 10 subjects performed four, six, and eight intervals of the same interval protocol on separate days. Changes in plasma volume were calculated from changes in hematocrit and hemoglobin. Transthoracic impedance (Z0 ) and plasma albumin were assessed while seated before and postexercise. Plasma volume increased 7.3% ± 4.4% and 6.3% ± 3.5% following treadmill and cycle ergometer exercise, respectively. For four, six, and eight intervals, plasma volume increased by 6.6% ± 4.0%, 4.7% ± 2.6%, and 4.2% ± 5.6%, respectively. The increases in plasma volume were similar for both exercise modes and all three exercise volumes. There were no differences in Z0 or plasma albumin content between trials. In conclusion, rapid plasma volume expansion following eight bouts of high-intensity intervals appears to be independent of upright exercise posture (treadmill versus cycle ergometer). Meanwhile, plasma volume expansion was similar after four, six, and eight intervals of cycle ergometry.
Collapse
Affiliation(s)
| | - James M. Walker
- Department of Exercise SciencesBrigham Young UniversityProvoUtahUSA
| | - Crystelle Hansen
- Department of Exercise SciencesBrigham Young UniversityProvoUtahUSA
| | | | | | - Gary W. Mack
- Department of Exercise SciencesBrigham Young UniversityProvoUtahUSA
| |
Collapse
|
14
|
Treiber J, Hausmann CS, Wolter JS, Fischer-Rasokat U, Kriechbaum SD, Hamm CW, Nagel E, Puntmann VO, Rolf A. Native T1 is predictive of cardiovascular death/heart failure events and all-cause mortality irrespective of the patient's volume status. Front Cardiovasc Med 2023; 10:1091334. [PMID: 36865890 PMCID: PMC9971619 DOI: 10.3389/fcvm.2023.1091334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/19/2023] [Indexed: 02/16/2023] Open
Abstract
Background Native T1 has become a pivotal parameter of tissue composition that is assessed by cardiac magnetic resonance (CMR). It characterizes diseased myocardium and can be used for prognosis estimation. Recent publications have shown that native T1 is influenced by short-term fluctuations of volume status due to hydration or hemodialysis. Methods Patients from a prospective BioCVI all-comers clinical CMR registry were included, and native T1 and plasma volume status (PVS) were determined according to Hakim's formula as surrogate markers of patient volume status. The primary endpoint was defined as combined endpoint of cardiovascular death or hospitalization for heart failure events, the secondary endpoint was defined as all-cause mortality. Results A total of 2,047 patients were included since April 2017 [median (IQR); age 63 (52-72) years, 33% female]. There was a significant although weak influence of PVS on native T1 (β = 0.11, p < 0.0001). Patients with volume expansion (PVS > -13%) showed significantly higher values for tissue markers than non-volume-overloaded patients [PVS ≤ -13%; median (IQR); native T1 1,130 (1,095-1,170) vs. 1,123 (1,086-1,166) ms, p < 0.003; and T2 39 (37-40) vs. 38 (36-40) ms, p < 0.0001]. In Cox regression analysis both native T1 and PVS were independently predictive of the primary endpoint and all-cause mortality. Conclusion Despite a weak effect of PVS on native T1, its predictive power was not affected in a large, all-comers cohort.
Collapse
Affiliation(s)
- Julia Treiber
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Carla S. Hausmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Jan Sebastian Wolter
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Ulrich Fischer-Rasokat
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Steffen D. Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Christian W. Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany,Justus Liebig University of Giessen, Giessen, Germany
| | - Eike Nagel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany,Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Valentina O. Puntmann
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany,Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany,Justus Liebig University of Giessen, Giessen, Germany,*Correspondence: Andreas Rolf, ✉
| |
Collapse
|
15
|
Davies A, Akerman AP, Rehrer NJ, Thornton SN, Cotter JD. Limited Effect of Dehydrating via Active vs. Passive Heat Stress on Plasma Volume or Osmolality, Relative to the Effect of These Stressors per Se. Nutrients 2023; 15. [PMID: 36839262 DOI: 10.3390/nu15040904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
The physiological, perceptual, and functional effects of dehydration may depend on how it is incurred (e.g., intense exercise releases endogenous water via glycogenolysis) but this basic notion has rarely been examined. We investigated the effects of active (exercise) heat- vs. passive heat-induced dehydration, and the kinetics of ad libitum rehydration following each method. Twelve fit participants (five females and seven males) completed four trials in randomised order: DEHydration to -3% change in body mass (∆BM) under passive or active heat stress, and EUHydration to prevent ∆BM under passive or active heat stress. In all trials, participants then sat in a temperate-controlled environment, ate a standard snack and had free access to water and sports drink during their two-hour recovery. During mild dehydration (≤2% ∆BM), active and passive heating caused comparable increases in plasma osmolality (Posm: ~4 mOsmol/kg, interaction: p = 0.138) and reductions in plasma volume (PV: ~10%, interaction: p = 0.718), but heat stress per se was the main driver of hypovolaemia. Thirst in DEHydration was comparably stimulated by active than passive heat stress (p < 0.161) and shared the same relation to Posm (r ≥ 0.744) and ∆BM (r ≥ 0.882). Following heat exposures, at 3% gross ∆BM, PV reduction was approximately twice as large from passive versus active heating (p = 0.003), whereas Posm perturbations were approximately twice as large from EUHydration versus DEHydration (p < 0.001). Rehydrating ad libitum resulted in a similar net fluid balance between passive versus active heat stress and restored PV despite the incomplete replacement of ∆BM. In conclusion, dehydrating by 2% ∆BM via passive heat stress generally did not cause larger changes to PV or Posm than via active heat stress. The heat stressors themselves caused a greater reduction in PV than dehydration did, whereas ingesting water to maintain euhydration produced large reductions in Posm in recovery and therefore appears to be of more physiological significance.
Collapse
|
16
|
Helman J, Öberg CM. High versus low ultrafiltration rates during experimental peritoneal dialysis in rats: Acute effects on plasma volume and systemic haemodynamics. Perit Dial Int 2023; 43:84-91. [PMID: 35012402 DOI: 10.1177/08968608211069224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Intradialytic hypotension is a common complication of haemodialysis, but uncommon in peritoneal dialysis (PD). This may be due to lower ultrafiltration rates in PD compared to haemodialysis, allowing for sufficient refilling of the blood plasma compartment from the interstitial volume, but the underlying mechanisms are unknown. Here we assessed plasma volume and hemodynamic alterations during experimental PD with high versus low ultrafiltration rates. METHODS Experiments were conducted in two groups of healthy Sprague-Dawley rats: one group with a high ultrafiltration rate (N = 7) induced by 8.5% glucose and a low UF group (N = 6; 1.5% glucose), with an initial assessment of the extracellular fluid volume, followed by 30 min PD with plasma volume measurements at baseline, 5, 10, 15 and 30 min. Mean arterial pressure, central venous pressure and heart rate were continuously monitored during the experiment. RESULTS No significant changes over time in plasma volume, mean arterial pressure or central venous pressure were detected during the course of the experiments, despite an ultrafiltration (UF) rate of 56 mL/h/kg in the high UF group. In the high UF group, a decrease in extracellular fluid volume of -7 mL (-10.7% (95% confidence interval: -13.8% to -7.6%)) was observed, in line with the average UF volume of 8.0 mL (standard deviation: 0.5 mL). CONCLUSION Despite high UF rates, we found that plasma volumes were remarkably preserved in the present experiments, indicating effective refilling of the plasma compartment from interstitial tissues. Further studies should clarify which mechanisms preserve the plasma volume during high UF rates in PD.
Collapse
Affiliation(s)
- Jakob Helman
- Department of Clinical Sciences Lund, Nephrology Division, Skåne University Hospital, Lund University, Sweden
| | - Carl M Öberg
- Department of Clinical Sciences Lund, Nephrology Division, Skåne University Hospital, Lund University, Sweden
| |
Collapse
|
17
|
Kim YS, Hollmann MW, Van Lieshout JJ. Editorial: Insights in clinical and translational physiology: 2022. Front Physiol 2023; 14:1170997. [PMID: 36960157 PMCID: PMC10028462 DOI: 10.3389/fphys.2023.1170997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
- Yu-Sok Kim
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Amsterdam, Netherlands
- Laboratory for Clinical Cardiovascular Physiology, University of Amsterdam, Amsterdam, Netherlands
| | - Markus W. Hollmann
- Department of Anaesthesiology, University Medical Center (UMC), Amsterdam, Netherlands
| | - Johannes J. Van Lieshout
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Amsterdam, Netherlands
- Department of Internal Medicine, University Medical Center (UMC), Amsterdam, Netherlands
- The David Greenfield Human Physiology Unit, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Pharmacology and Neuroscience, School of Life Sciences, The Medical School, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, United Kingdom
- *Correspondence: Johannes J. Van Lieshout,
| |
Collapse
|
18
|
Keeler JM, Hess HW, Tourula E, Baker TB, Kerr PM, Greenshields JT, Chapman RF, Johnson BD, Schlader ZJ. Increased spleen volume provoked by temperate head-out-of-water immersion. Am J Physiol Regul Integr Comp Physiol 2022; 323:R776-R786. [PMID: 36121146 PMCID: PMC9639762 DOI: 10.1152/ajpregu.00111.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022]
Abstract
This study tested the hypotheses that 1) spleen volume increases during head-out-of-water immersion (HOWI) and returns to pre-HOWI values postdiuresis, and 2) the magnitude of apnea-induced spleen contraction increases when preapnea spleen volume is elevated. Spleen volume was measured before and after a set of five apneas in 12 healthy adults (28 ± 5 yr, 3 females) before, during (at 30 and 150 min), and 20 min after temperate temperature (36 ± 1°C) HOWI. At each time point, spleen length, width, and thickness were measured via ultrasound, and spleen volume was calculated using the Pilström equation. Compared with pre-HOWI (276 ± 88 mL), spleen volume was elevated at 30 (353 ± 94 mL, P < 0.01) and 150 (322 ± 87 mL, P < 0.01) min of HOWI but returned to pre-HOWI volume at post-HOWI (281 ± 90 mL, P = 0.58). Spleen volume decreased from pre- to postapnea bouts at each time point (P < 0.01). The magnitude of reduction in spleen volume from pre- to postapneas was elevated at 30 min of HOWI (-69 ± 24 mL) compared with pre-HOWI (-52 ± 20 mL, P = 0.04) but did not differ from pre-HOWI at 150 min of HOWI (-54 ± 16 mL, P = 0.99) and post-HOWI (-50 ± 18 mL, P = 0.87). Thus, spleen volume is increased throughout 180 min of HOWI, and whereas apnea-induced spleen contraction is augmented after 30 min of HOWI, the magnitude of spleen contraction is unaffected by HOWI thereafter.
Collapse
Affiliation(s)
- Jason M Keeler
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Hayden W Hess
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Erica Tourula
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Tyler B Baker
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Payton M Kerr
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Joel T Greenshields
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Robert F Chapman
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Blair D Johnson
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Zachary J Schlader
- H. H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| |
Collapse
|
19
|
Ahlgrim C, Seiler F, Birkner P, Schoechlin S, Grundmann S, Bode C, Pottgiesser T. Clinically unrecognized plasma volume expansion predicts long-term all-cause-mortality in chronic heart failure. Clin Cardiol 2022; 45:1053-1059. [PMID: 35920821 PMCID: PMC9574737 DOI: 10.1002/clc.23893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Chronic heart failure (CHF) is associated with elevated total blood volume (BV) and distinct phenotypes of total red cell volume (RCV) and plasma volume (PV) elevations. Especially PV expansion during clinical decompensation is linked with adverse clinical outcomes. The role of PV expansion in compensated CHF patients is less clear. Aim of the present study is to investigate the impact of BV parameters on long‐term mortality in CHF patients investigated at a compensated state. Methods and Results BV, PV and RCV were determined in 44 (9 female) compensated CHF patients using an abbreviated carbon monoxide method, who were followed up for 6.0 years, (range: 3.7–6.5 years) for all‐cause mortality. In univariate analysis PV expansion but not BV and RCV predicted all‐cause mortality (p = .021). A cutoff of 1800 ml PV/m² body‐surface area allows stratification for all‐cause mortality (p = .044). PV expansion but not RCV reduction explains the significantly lower hematocrit values of nonsurvivors. Discussion In this pilot study, PV expansion, which was unnoticed from a clinician's perspective, but is indicated by significantly lower hematocrit, appears to be a relevant predictor of long‐term all‐cause mortality. Whether PV expansion constitutes an adverse CHF phenotype and can be targeted by diuretic therapy is currently unclear.
Collapse
Affiliation(s)
- Christoph Ahlgrim
- Department of Cardiology and Angiology II, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Florian Seiler
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Philipp Birkner
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Simon Schoechlin
- Department of Cardiology and Angiology II, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Grundmann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Torben Pottgiesser
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
20
|
McCubbin AJ. Modelling sodium requirements of athletes across a variety of exercise scenarios - identifying when to test and target, or season to taste. Eur J Sport Sci 2022; 23:992-1000. [PMID: 35616504 DOI: 10.1080/17461391.2022.2083526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractEvidence suggests the focus for sodium replacement during exercise should be maintenance of plasma sodium concentration ([Na+]plasma) for any given total body water (TBW) volume. The sodium intake to achieve stable [Na+]plasma given known fluid and electrolyte intakes and losses can be mathematically estimated. Therefore the aim of this investigation was to model sodium requirements of athletes during exercise, observing the influence of sweat rate, exercise duration, body mass, baseline [Na+]plasma and sweat potassium [K+]sweat, and relevance to competition (soccer, elite marathon, and 160 km ultramarathon running). Models were constructed across a range of sweat sodium concentrations ([Na+]sweat) (20-80 mmol·L-1), sweat rates (0.5-2.5 L·h-1) and fluid replacement (10-90% of losses). In the competition-specific scenarios, fluid replacement was calculated to achieve 2% TBW losses. Sodium requirements were driven by fluid replacement (% of losses) and [Na+]sweat, with minimal or no influence of other variables. Replacing sodium was unnecessary in all realistic scenarios modelled for a soccer match and elite marathon. In contrast, the 160 km ultramarathon required ≥47% sodium replacement when [Na+]sweat was ≥40 mmol·L-1 and >80% of fluid losses were replaced. In conclusion, sodium requirements to maintain stable [Na+]plasma during exercise depend on both the proportion of fluid losses replaced, and [Na+]sweat. Only when prolonged exercise is coupled with aggressive fluid replacement (>80%) and whole body [Na+]sweat ≥40 mmol·L-1 does sweat composition testing and significant, targeted sodium replacement appear necessary.
Collapse
Affiliation(s)
- Alan J McCubbin
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| |
Collapse
|
21
|
Schmidt WFJ, Wachsmuth N, Jimenez J, Soria R. Hemoglobin Mass and Blood Volume in Patients With Altitude-Related Polycythemia. Front Physiol 2022; 13:867108. [PMID: 35574463 PMCID: PMC9096560 DOI: 10.3389/fphys.2022.867108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with chronic mountain sickness (CMS) have a high hemoglobin concentration [Hb] due to increased hemoglobin mass (Hbmass) and possibly reduced plasma volume (PV). The values of Hbmass, PV and blood volume (BV) have been described differently, and the relationships between [Hb] and Hbmass or PV are poorly understood. This study obtained representative Hbmass, PV and BV data from healthy, high-altitude residents and CMS patients and quantified the dependency of [Hb] on Hbmass and PV. METHODS Eighty-seven subjects born at high altitude (∼3,900 m) were enrolled. Thirty-four had CMS (CMS), 11 had polycythemia without CMS (intermediate, IM), 20 were healthy highlanders (HH), and 22 living near sea level (SL, 420 m) served as the sea level (SL) control group. Hbmass, PV and BV were determined using a CO-rebreathing method modified for assessing polycythemia patients. Furthermore, [Hb], hematocrit (Hct), plasma erythropoietin concentration [EPO] and blood gas and acid-base status were determined. RESULTS In the HH group, Hbmass was 27% higher (940 ± 105 g) than in the SL group (740 ± 112 g) and 72% (1,617 ± 265 g) lower than in the CMS group. The PV in the HH group was similar to that in the SL group (-6%) and 15% higher than that in the CMS group (p < 0.001). In the HH group, the BV (5,936 ± 673 ml) did not differ from that in the SL group and was 28% lower than in the CMS group (7,606 ± 1075 ml, p < 0.001). Log [EPO] was slightly increased in the CMS group relative to the HH group (p < 0.01). All values in the IM group were between those in the HH and CMS groups. Hbmass and BV were positively correlated, and PV was negatively correlated with peripheral O2 saturation. Increased Hbmass and decreased PV contributed approximately 65 and 35%, respectively, to the difference in [Hb] between the HH (17.1 ± 0.8 g/dl) and CMS (22.1 ± 1.0 g/dl) groups. CONCLUSIONS In CMS patients, the decrease in PV only partially compensated for the substantial increase in Hbmass, but it did not prevent an increase in BV; the decrease in PV contributed to an excessively high [Hb].
Collapse
Affiliation(s)
- Walter F J Schmidt
- Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Nadine Wachsmuth
- Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Jesus Jimenez
- Instituto Boliviano de Biologia de Altura, Universidad Mayor de San Andres, La Paz, Bolivia
| | - Rudy Soria
- Instituto Boliviano de Biologia de Altura, Universidad Mayor de San Andres, La Paz, Bolivia
| |
Collapse
|
22
|
Fiedler J, Šmite Z, Suvi S, Timpmann S, Mooses M, Medijainen L, Unt E, Ööpik V. Impact of sodium citrate ingestion during recovery after strenuous exercise in the heat on heart rate variability: A randomized, crossover study. Physiol Rep 2022; 10:e15280. [PMID: 35510322 PMCID: PMC9069164 DOI: 10.14814/phy2.15280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
Changes in hydration status influence plasma volume (PV) which is associated with post-exercise parasympathetic reactivation. The present study hypothesized that, after dehydrating cycling exercise in the heat (DE), stimulation of PV expansion with sodium citrate (CIT) supplementation would promote heart rate variability (HRV) recovery in endurance-trained men. Twelve participants lost 4% of body mass during DE. During subsequent 16-h recovery, participants consumed water ad libitum (CIT =5.5-L, PLC =5.1-L) and ate prescribed food supplemented with CIT or placebo in a randomized, double-blind, crossover manner. Relative changes in PV were assessed across DE and 16-h recovery. HRV was analyzed before and 16 h after DE in three conditions for altogether four 5-min periods: supine in a thermoneutral environment, supine in the heat (32°C, 46% relative humidity; 2 periods), and standing in the heat. A larger expansion of PV across 16-h recovery occurred in CIT compared to placebo trial (p < 0.0001). However, no between-trial differences appeared in HRV parameters (lnRMSSD, lnSDNN, lnLF/HF) in any 5-min period analyzed before or 16 h after DE (in all cases p > 0.05). Increases in HR (p < 0.001) and lnLF/HF (p = 0.005) and decreases in lnRMSSD (p < 0.001) and lnSDNN (p < 0.001) occurred following DE in both trials. Larger PV expansion induced by CIT supplementation after DE does not improve recovery of HRV at rest and has no influence on HRV responsiveness in endurance-trained men.
Collapse
Affiliation(s)
- Janis Fiedler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Zane Šmite
- Faculty of Biology, Department of Human and Animal Physiology, University of Latvia, Riga, Latvia
| | - Silva Suvi
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Saima Timpmann
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Martin Mooses
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Luule Medijainen
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Eve Unt
- Department of Sports, Medicine, and Rehabilitation, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Tartu, Estonia
| | - Vahur Ööpik
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| |
Collapse
|
23
|
Zdolsek M, Hahn RG. Kinetics of 5% and 20% albumin: A controlled crossover trial in volunteers. Acta Anaesthesiol Scand 2022; 66:847-858. [PMID: 35491239 PMCID: PMC9541965 DOI: 10.1111/aas.14074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
Abstract
Background Albumin for intravenous infusion is marketed in two concentrations, 20% and 5%, but how they compare with regard to plasma volume expansion over time is unclear. Methods In a prospective crossover study, 12 volunteers received 3 ml kg−1 of 20% albumin and, on another occasion, 12 ml kg−1 of 5% albumin over 30 min. Hence, equivalent amounts of albumin were given. Blood was collected on 15 occasions over 6 h. Mass balance and volume kinetics were used to estimate the plasma volume expansion and the capillary leakage of albumin and fluid based on measurements of blood hemoglobin, plasma albumin, and the colloid osmotic pressure. Results The greatest plasma volume expansion was 16.0 ± 6.4% (mean ± SD) with 20% albumin and 19.0 ± 5.2% with 5% albumin (p < .03). The volume expansion with 20% albumin corresponded to twice the infused volume. One third of the 5% albumin volume quickly leaked out of the plasma, probably because of the higher colloid osmotic pressure of the volunteer plasma (mean, 24.5 mmHg) than the albumin solution (19.1 mmHg). At 6 h, the capillary leakage amounted to 42 ± 15% and 47 ± 11% of the administered albumin with the 20% and 5% preparations, respectively (p = .28). The corresponding urine outputs were 547 (316–780) ml and 687 (626–1080) ml (median and interquartile range; p = .24). Conclusion The most important difference between the fluids was a dehydrating effect of 20% albumin when the same albumin mass was administered.
Collapse
Affiliation(s)
- Markus Zdolsek
- Department of Biomedical and Clinical Sciences (BKV) Linköping University Linköping Sweden
| | - Robert G. Hahn
- Research Unit Södertälje Hospital, Södertälje, Sweden, and Karolinska Institutet at Danderyds Hospital (KIDS) Danderyd Sweden
| |
Collapse
|
24
|
Moreillon B, Equey T, Astolfi T, Salamin O, Faiss R. Removal of the influence of plasma volume fluctuations for the athlete biological passport and stability of haematological variables in active women taking oral contraception. Drug Test Anal 2022; 14:1004-1016. [PMID: 34994063 PMCID: PMC9306693 DOI: 10.1002/dta.3218] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 01/06/2023]
Abstract
The haematological module of the athlete biological passport (ABP) monitors longitudinal haematological variations that could be indicative of blood manipulation. This study applied a multi‐parametric model previously validated in elite cyclists to compare inferred and actual PV variations, whereas the potential influence of the oral contraceptive pill (OCP) cycle on the ABP blood biomarkers and plasma volume (PV) in 14 physically active women taking OCPs was also investigated. Blood and serum samples were collected each week for 8 weeks, and the ABP haematological variables were determined according to the World Anti‐Doping Agency guidelines. Transferrin (sTFN), ferritin (FERR), albumin (ALB), calcium (Ca), creatinine (CRE), total protein (TP) and low‐density lipoprotein (LDL) were additionally computed as ‘volume‐sensitive’ variables in a multivariate analysis to determine individual estimations of PV variations. Actual PV variations were indirectly measured using a validated carbon monoxide rebreathing method. We hypothesised ABP markers to be stable during a standard OCP cycle and estimated PV variations similar to measured PV variations. Measured PV variations were in good agreement with the predictions and allowed to explain an atypical passport finding (ATPF). The ABP biomarkers, Hbmass and PV were stable over 8 weeks. Significant differences occurred only between Week 7 and Week 1, with lower levels of haemoglobin concentration ([Hb]), haematocrit (HCT) and red blood cell count (RBC)(−4.4%, p < 0.01; −5.1%, p < 0.01; −5.2%, p < 0.01) and higher levels of PV at week 7 (+9%, p = 0.05). We thus concluded that estimating PV variations may help interpret individual ABP haematological profiles in women.
Collapse
Affiliation(s)
- Basile Moreillon
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | | | - Tiffany Astolfi
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Research and Expertise in anti-Doping sciences (REDs), University of Lausanne, Lausanne, Switzerland
| | - Olivier Salamin
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Research and Expertise in anti-Doping sciences (REDs), University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Research and Expertise in anti-Doping sciences (REDs), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
25
|
Kissling LS, Akerman AP, Campbell HA, Prout JR, Gibbons TD, Thomas KN, Cotter JD. A crossover control study of three methods of heat acclimation on the magnitude and kinetics of adaptation. Exp Physiol 2021; 107:337-349. [PMID: 34957632 DOI: 10.1113/ep089993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS Central question to the study? Are primary indices of heat adaptation (e.g., expansion of plasma volume and reduction in resting core temperature) differentially affected by the three major modes of short-term heat acclimation, i.e., exercise in the heat, hot water immersion and sauna? Main finding and its importance? The three modes elicited typical adaptations expected with short-term heat acclimation, however these were not significantly different between modes. This comparison has not previously been done and highlights that individuals can expect similar adaptation to heat regardless of the mode used. ABSTRACT Heat acclimation (HA) can improve heat tolerance and cardiovascular health. The mode of HA potentially impacts the magnitude and time course of adaptations, but almost no comparative data exist. We therefore investigated adaptive responses to three common modes of HA, particularly with respect to plasma volume. Within a crossover repeated-measures design, 13 physically-active participants (5 female) undertook four, 5-d HA regimes (60 min/d) in randomised order, separated by ≥4 wk. Rectal temperature (Tre ) was clamped at neutrality via 36.6C (thermoneutral) water immersion (TWI; i.e., control condition), or raised by 1.5°C via heat stress in 40°C water (HWI), Sauna (55°C, 52% RH), or exercise in humid heat (40°C, 52% RH; ExH). Adaptation magnitude was assessed as the pooled response across days 4 to 6, while kinetics was assessed via the 6-d time series. Plasma volume expansion was similar in all heated conditions but only higher than TWI in ExH (by 4%, p = 0.036). Approximately two thirds of the expansion was attained within the initial 24 h and was moderately related to that present on day 6, regardless of HA mode (r = 0.560-0.887). Expansion was mediated by conservation of both sodium and albumin content, with little evidence for these having differential roles between modes (p = 0.706 and 0.320, respectively). Resting Tre decreased by 0.1-0.3°C in all heated conditions, and SBP decreased by 4 mm Hg, but not differentially between conditions (p≥0.137). In conclusion, HA mode did not substantially affect the magnitude or rate of adaptation in key resting markers of short-term HA. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Lorenz S Kissling
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Ashley P Akerman
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.,Department of Surgical Sciences, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Holly A Campbell
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.,Department of Surgical Sciences, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Jamie R Prout
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Travis D Gibbons
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.,Department of Surgical Sciences, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Kate N Thomas
- Department of Surgical Sciences, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| |
Collapse
|
26
|
Guinot PG, Nguyen M, Duclos V, Berthoud V, Bouhemad B. Oral Water Has Cardiovascular Effects Up to 60 min in Shock Patients. Front Cardiovasc Med 2021; 8:803979. [PMID: 34988132 PMCID: PMC8722716 DOI: 10.3389/fcvm.2021.803979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/29/2021] [Indexed: 11/05/2022] Open
Abstract
Aim: Little is known about the cardiovascular effects of oral water intake in shock patients. This study was designed to assess the effect of oral water on stroke volume and blood pressure during a 1-h time period. Method and Results: This open-label, randomized clinical trial included patients admitted to intensive care with acute circulatory failure. Three ICU units at the anesthesia and critical care department of the Dijon Bourgogne University Hospital. Patients were randomized 1:1 to an intervention or standard care group. The intervention group received 500 ml of oral water while the standard care group received intravenous administration of 500 ml of physiological saline solution. Baseline SV did not differ between the two groups (36 ml [28;51] vs. 38 ml [30;51], p = 0.952). The number of patients who were fluid responders did not differ between the two groups [n = 19 (76%) vs. n = 18 (72%), p = 1]. The median change in stroke volume during the three time points did not differ between the two groups (p < 0.05). In the intervention group, blood pressure increased up to 60 min. In the control group, blood pressure quickly increased at the end of fluid expansion, then returned close to baseline value at 60 min. Conclusion: Shock patients who were administered oral water experienced improvements in blood pressure and blood flow up to 60 min when compared with patients who received intravenous saline solution. Further studies are warranted to confirm these effects. Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT03951519.
Collapse
Affiliation(s)
- Pierre-Grégoire Guinot
- Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, Dijon, France,University of Burgundy Franche Comté, LNC UMR1231, Dijon, France,*Correspondence: Pierre-Grégoire Guinot
| | - Maxime Nguyen
- Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, Dijon, France,University of Burgundy Franche Comté, LNC UMR1231, Dijon, France
| | - Valerian Duclos
- Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Vivien Berthoud
- Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Belaid Bouhemad
- Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, Dijon, France,University of Burgundy Franche Comté, LNC UMR1231, Dijon, France
| | | |
Collapse
|
27
|
Travers G, González-Alonso J, Riding N, Nichols D, Shaw A, Périard JD. Exercise Heat Acclimation With Dehydration Does Not Affect Vascular and Cardiac Volumes or Systemic Hemodynamics During Endurance Exercise. Front Physiol 2021; 12:740121. [PMID: 34867447 PMCID: PMC8633441 DOI: 10.3389/fphys.2021.740121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/18/2021] [Indexed: 11/14/2022] Open
Abstract
Permissive dehydration during exercise heat acclimation (HA) may enhance hematological and cardiovascular adaptations and thus acute responses to prolonged exercise. However, the independent role of permissive dehydration on vascular and cardiac volumes, ventricular-arterial (VA) coupling and systemic hemodynamics has not been systematically investigated. Seven males completed two 10-day exercise HA interventions with controlled heart rate (HR) where euhydration was maintained or permissive dehydration (-2.9 ± 0.5% body mass) occurred. Two experimental trials were conducted before and after each HA intervention where euhydration was maintained (-0.5 ± 0.4%) or dehydration was induced (-3.6 ± 0.6%) via prescribed fluid intakes. Rectal (Tre) and skin temperatures, HR, blood (BV) and left ventricular (LV) volumes, and systemic hemodynamics were measured at rest and during bouts of semi-recumbent cycling (55% V̇O2peak) in 33°C at 20, 100, and 180 min. Throughout HA sweat rate (12 ± 9%) and power output (18 ± 7 W) increased (P < 0.05), whereas Tre was 38.4 ± 0.2°C during the 75 min of HR controlled exercise (P = 1.00). Neither HA intervention altered resting and euhydrated exercising Tre, BV, LV diastolic and systolic volumes, systemic hemodynamics, and VA coupling (P > 0.05). Furthermore, the thermal and cardiovascular strain during exercise with acute dehydration post-HA was not influenced by HA hydration strategy. Instead, elevations in Tre and HR and reductions in BV and cardiac output matched pre-HA levels (P > 0.05). These findings indicate that permissive dehydration during exercise HA with controlled HR and maintained thermal stimulus does not affect hematological or cardiovascular responses during acute endurance exercise under moderate heat stress with maintained euhydration or moderate dehydration.
Collapse
Affiliation(s)
- Gavin Travers
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Centre for Human Performance and Rehabilitation, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - José González-Alonso
- Centre for Human Performance and Rehabilitation, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Nathan Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - David Nichols
- Sport Development Centre, Loughborough University, Loughborough, United Kingdom
| | - Anthony Shaw
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Julien D Périard
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT, Australia
| |
Collapse
|
28
|
Matsuba I, Takihata M, Takai M, Maeda H, Kubota A, Iemitsu K, Umezawa S, Obana M, Kaneshiro M, Kawata T, Takuma T, Takeda H, Machimura H, Mokubo A, Motomiya T, Asakura T, Kikuchi T, Matsuzawa Y, Ito S, Miyakawa M, Terauchi Y, Kanamori A. Effects of 1-year treatment with canagliflozin on body composition and total body water in patients with type 2 diabetes. Diabetes Obes Metab 2021; 23:2614-2622. [PMID: 34338409 DOI: 10.1111/dom.14508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 01/14/2023]
Abstract
AIM To characterize the long-term changes in body composition associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. MATERIALS AND METHODS In this multicentre, single-arm, open-label study, 107 patients with type 2 diabetes were treated with canagliflozin 100 mg, as add-on therapy, for 12 months. Body composition was measured with a body composition analyser (T-SCAN PLUS) using the impedance method to prospectively analyse changes in body components, including percentage of body fat, body fat mass, total body water, muscle mass and mineral mass. Estimated plasma volume (PV) was calculated using the Kaplan formula. RESULTS Body weight showed a significant decrease from 1 month to 12 months of treatment with canagliflozin, with a higher rate of decrease in body fat in body composition. A significant decrease in mineral mass was also observed, but its rate was low. Following treatment with canagliflozin, changes in total body water did not affect intracellular water, and a significant decrease in extracellular water, including plasma components, was observed early and was sustained up to 12 months. Protein mass, a component of muscle mass, was not affected, with only a slight decrease in water volume observed. CONCLUSIONS Canagliflozin decreased extracellular fluid and PV in addition to decreasing fat in the body via calorie loss resulting from urinary glucose excretion. This study suggested that SGLT2 inhibitors might reduce body weight by regulating fat mass or water distribution in the body and might have cardiac and renal protective effects by resetting the homeostasis of fluid balance.
Collapse
Affiliation(s)
- Ikuro Matsuba
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Masahiro Takihata
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Masahiko Takai
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Hajime Maeda
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Akira Kubota
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Kotaro Iemitsu
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Shinichi Umezawa
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Mitsuo Obana
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Mizuki Kaneshiro
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Takehiro Kawata
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Tetsuo Takuma
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Hiroshi Takeda
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Hideo Machimura
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Atsuko Mokubo
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Tetsuya Motomiya
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Taro Asakura
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Taisuke Kikuchi
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Yoko Matsuzawa
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Shogo Ito
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Masaaki Miyakawa
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University, Yokohama, Japan
| | - Akira Kanamori
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan
| |
Collapse
|
29
|
Miller WL, Strobeck JE, Grill DE, Mullan BP. Blood volume expansion, normovolemia, and clinical outcomes in chronic human heart failure: more is better. Am J Physiol Heart Circ Physiol 2021; 321:H1074-H1082. [PMID: 34676782 PMCID: PMC9095049 DOI: 10.1152/ajpheart.00336.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Expansion in blood volume (BV) is a well-recognized response to arterial underfilling secondary to impaired cardiac output in heart failure (HF). However, the effectiveness of this response in terms of outcomes remains inadequately understood. Prospective analysis was undertaken in 110 patients with HF hospitalized and treated for fluid overload. BVs were measured in a compensated state at the hospital discharge using the indicator-dilution methodology. Data were analyzed for composite 1-year HF-related mortality/first rehospitalization. Despite uniform standard of care, marked heterogeneity in BVs was identified across the cohort. The cohort was stratified by BV expansion greater than or equal to +25% above normal (51% of cohort), mild-moderate expansion (22%), and normal BV (27%). Kaplan-Meier (K-M) survival estimates and regression analyses revealed BV expansion (greater than or equal to +25%) to be associated with better event-free survival relative to normal BV (P = 0.038). Increased red blood cell mass (RBCm; RBC polycythemia) was identified in 43% of the overall cohort and 70% in BV expansion greater than or equal to +25%. K-M analysis demonstrated polycythemia to be associated with better outcomes compared with normal RBCm (P < 0.002). Persistent BV expansion to include RBC polycythemia is common and, importantly, associated with better clinical outcomes compared with normal total BV or normal RBCm in patients with chronic HF. However, compensatory BV expansion is not a uniform physiological response to the insult of HF with marked variability in BV profiles despite uniform standard of care diuretic therapy. Therefore, recognizing the variability in volume regulation pathophysiology has implications not only for impact on clinical outcomes and risk stratification but also potential for informing individualized volume management strategies.NEW & NOTEWORTHY The novel findings of this study demonstrate that intravascular volume profiles among the patients with chronic heart failure (HF) vary substantially even with similar clinical compensation. Importantly, a profile of blood volume (BV) expansion (compared with a normal BV) is associated with lower HF mortality/morbidity. Furthermore, RBC polycythemia is common and independently associated with improved outcomes. These observations support BV expansion with RBC polycythemia as a compensatory mechanism in chronic HF.
Collapse
Affiliation(s)
- Wayne L Miller
- Department of Cardiovascular Medicine, Heart-Lung Center, Hawthorne, New Jersey
| | | | - Diane E Grill
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Brian P Mullan
- Division of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
30
|
Krečak I, Zekanović I, Holik H, Morić Perić M, Coha B, Gverić-Krečak V. Estimating plasma volume using the Strauss-derived formula may improve prognostication in polycythemia vera. Int J Lab Hematol 2021; 44:e69-e71. [PMID: 34581007 DOI: 10.1111/ijlh.13716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 01/24/2023]
Affiliation(s)
- Ivan Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
| | - Ivan Zekanović
- Department of Internal Medicine, General Hospital Zadar, Zadar, Croatia
| | - Hrvoje Holik
- Department of Internal Medicine, 'Dr. Josip Benčević' General Hospital, Slavonski Brod, Croatia.,School of Medicine, University of Osijek, Osijek, Croatia
| | | | - Božena Coha
- School of Medicine, University of Osijek, Osijek, Croatia
| | - Velka Gverić-Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
| |
Collapse
|
31
|
Abstract
Supplemental Digital Content is available in the text. The optimal method to assess fluid overload in acute respiratory distress syndrome is not known, and current techniques have limitations. Plasma volume status has emerged as a noninvasive method to assess volume status and is defined as the percentage alteration from ideal plasma volume. We hypothesized that plasma volume status would suggest the presence of significant excess volume and therefore correlate with mortality in acute respiratory distress syndrome.
Collapse
Affiliation(s)
- Shannon E Niedermeyer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R Scott Stephens
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas S Metkus
- Divisions of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
32
|
Babariya SP, Vivero A, Peedin A, Karp JK. Therapeutic plasma exchange in patients with severe obesity (BMI >40): A survey of practices in the United States. J Clin Apher 2021; 36:802-807. [PMID: 34355813 DOI: 10.1002/jca.21931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of obesity in the United States is estimated at 42.4% and expected to increase over the next decade. Therefore, understanding how to best perform certain medical procedures on severely obese (SO) patients is a necessity. This study presents results on the current methods of performing therapeutic plasma exchange (TPE) on SO patients. This paper aims to contribute to the existing literature by providing new insights into calculating plasma volume (PV) for TPE in SO patients. METHODS Blood Bank/Apheresis Directors at all institutions with pathology residency and/or blood banking/transfusion medicine fellowship programs were asked to complete a 5-question online survey about their institutional policies regarding TPE in SO patients. Survey data were analyzed to determine if institutions have policies in place to calculate PV in SO patients. RESULTS Out of the 144 institutions contacted, 45 (31%) completed the survey. Nine (20%) institutions had a policy to calculate PV differently for SO patients, 7 (16%) reported a specific body mass index (BMI) above which they alter PV calculation, and 7 (16%) reported a maximum volume exchanged in SO patients. CONCLUSION A minority of responding institutions had specific policies in place to calculate PV for TPE in SO patients. Practice patterns for calculating PV for TPE in SO patients varied, with some institutions adjusting PV calculations and others setting a maximum volume to be exchanged regardless of BMI. These findings highlight the need for establishing a clear method of calculating PV in SO patients.
Collapse
Affiliation(s)
| | - Angelica Vivero
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexis Peedin
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
33
|
Seoudy H, Saad M, Salem M, Allouch K, Frank J, Puehler T, Salem M, Lutter G, Kuhn C, Frank D. Calculated Plasma Volume Status Is Associated with Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2021; 10:jcm10153333. [PMID: 34362114 PMCID: PMC8346970 DOI: 10.3390/jcm10153333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Calculated plasma volume status (PVS) reflects volume overload based on the deviation of the estimated plasma volume (ePV) from the ideal plasma volume (iPV). Calculated PVS is associated with prognosis in the context of heart failure. This single-center study investigated the prognostic impact of PVS in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: A total of 859 TAVI patients had been prospectively enrolled in an observational study and were included in the analysis. An optimal cutoff for PVS of −5.4% was determined by receiver operating characteristic curve analysis. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization within 1 year after TAVI. Results: A total of 324 patients had a PVS < −5.4% (no congestion), while 535 patients showed a PVS ≥ −5.4% (congestion). The primary endpoint occurred more frequently in patients with a PVS ≥ −5.4% compared to patients with PVS < −5.4% (22.6% vs. 13.0%, p < 0.001). After multivariable adjustment, PVS was confirmed as a significant predictor of the primary endpoint (HR 1.53, 95% CI 1.05–2.22, p = 0.026). Conclusions: Elevated PVS, as a marker of subclinical congestion, is significantly associated with all-cause mortality and heart failure hospitalization within 1 year after TAVI.
Collapse
Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
| | - Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
| | - Mostafa Salem
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
| | - Kassem Allouch
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
- Department of Cardiac and Vascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Mohamed Salem
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
- Department of Cardiac and Vascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Christian Kuhn
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
- Correspondence: ; Tel.: +49-(0)4-31500-22801
| |
Collapse
|
34
|
Pokora I, Sadowska-Krępa E, Wolowski Ł, Wyderka P, Michnik A, Drzazga Z. The Effect of Medium-Term Sauna-Based Heat Acclimation (MPHA) on Thermophysiological and Plasma Volume Responses to Exercise Performed under Temperate Conditions in Elite Cross-Country Skiers. Int J Environ Res Public Health 2021; 18:6906. [PMID: 34199101 PMCID: PMC8297353 DOI: 10.3390/ijerph18136906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
The influence of a series of ten sauna baths (MPHA) on thermophysiological and selected hematological responses in 14 elite cross-country skiers to a submaximal endurance exercise test performed under thermoneutral environmental conditions was studied. Thermal and physiological variables were measured before and after the exercise test, whereas selected hematological indices were studied before, immediately after, and during recovery after a run, before (T1) and after sauna baths (T2). MPHA did not influence the baseline internal, body, and skin temperatures. There was a decrease in the resting heart rate (HR: p = 0.001) and physiological strain (PSI: p = 0.052) after MPHA and a significant effect of MPHA on systolic blood pressure (p = 0.03), hematological indices, and an exercise effect but no combined effect of treatments and exercise on the tested variables. A positive correlation was reported between PSI and total protein (%ΔTP) in T2 and a negative between plasma volume (%ΔPV) and mean red cellular volume (%ΔMCV) in T1 and T2 in response to exercise and a positive one during recovery. This may suggest that MPHA has a weak influence on body temperatures but causes a moderate decrease in PSI and modifications of plasma volume restoration in response to exercise under temperate conditions in elite athletes.
Collapse
Affiliation(s)
- Ilona Pokora
- Department of Physiological-Medical Sciences, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72a, 40-065 Katowice, Poland;
| | - Ewa Sadowska-Krępa
- Department of Physiological-Medical Sciences, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72a, 40-065 Katowice, Poland;
| | - Łukasz Wolowski
- Doctoral Studies, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72a, 40-065 Katowice, Poland; (Ł.W.); (P.W.)
| | - Piotr Wyderka
- Doctoral Studies, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72a, 40-065 Katowice, Poland; (Ł.W.); (P.W.)
| | - Anna Michnik
- The Silesian Centre for Education and Interdisciplinary Research, Faculty of Science and Technology, University of Silesia in Katowice, 75 Pułku Piechoty 1A, 41-500 Chorzow, Poland; (A.M.); (Z.D.)
| | - Zofia Drzazga
- The Silesian Centre for Education and Interdisciplinary Research, Faculty of Science and Technology, University of Silesia in Katowice, 75 Pułku Piechoty 1A, 41-500 Chorzow, Poland; (A.M.); (Z.D.)
| |
Collapse
|
35
|
Meylan CMP, Bowman K, Stellingwerff T, Pethick WA, Trewin J, Koehle MS. The Efficacy of Heat Acclimatization Pre-World Cup in Female Soccer Players. Front Sports Act Living 2021; 3:614370. [PMID: 34113844 PMCID: PMC8185056 DOI: 10.3389/fspor.2021.614370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/06/2021] [Indexed: 11/25/2022] Open
Abstract
The efficacy of a 14-day field-based heat acclimatization (HA) training camp in 16 international female soccer players was investigated over three phases: phase 1: 8 days moderate HA (22. 1°C); phase 2: 6 days high HA (34.5°C); and phase 3: 11 days of post-HA (18.2°C), with heart rate (HR), training load, core temp (Tc), and perceptual ratings recorded throughout. The changes from baseline (day−16) in (i) plasma volume (PV), (ii) HR during a submaximal running test (HRex) and HR recovery (HRR), and (iii) pre-to-post phase 2 (days 8–13) in a 4v4 small-sided soccer game (4V4SSG) performance were assessed. Due to high variability, PV non-significantly increased by 7.4% ± 3.6% [standardized effect (SE) = 0.63; p = 0.130] from the start of phase 1 to the end of phase 2. Resting Tc dropped significantly [p < 0.001 by −0.47 ± 0.29°C (SE = −2.45)], from day 1 to day 14. Submaximal running HRR increased over phase 2 (HRR; SE = 0.53) after having decreased significantly from baseline (p = 0.03). While not significant (p > 0.05), the greatest HR improvements from baseline were delayed, occurring 11 days into phase 3 (HRex, SE = −0.42; HRR, SE = 0.37). The 4v4SSG revealed a moderate reduction in HRex (SE = −0.32; p = 0.007) and a large increase in HRR (SE = 1.27; p < 0.001) from pre-to-post phase 2. Field-based HA can induce physiological changes beneficial to soccer performance in temperate and hot conditions in elite females, and the submaximal running test appears to show HRex responses induced by HA up to 2 weeks following heat exposure.
Collapse
Affiliation(s)
- César M P Meylan
- Physical Performance Department, Canada Soccer, Ottawa, ON, Canada.,Division of Sports Medicine and School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,Canadian Sport Institute Pacific, Victoria, BC, Canada
| | - Kimberly Bowman
- Division of Sports Medicine and School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Trent Stellingwerff
- Division of Sports Medicine and School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,Canadian Sport Institute Pacific, Victoria, BC, Canada
| | | | - Joshua Trewin
- Physical Performance Department, Canada Soccer, Ottawa, ON, Canada.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Michael S Koehle
- Division of Sports Medicine and School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
36
|
Mandić M, Forsgren MF, Romu T, Widholm P, Sundblad P, Gustafsson T, Rullman E. Interval-induced metabolic perturbation determines tissue fluid shifts into skeletal muscle. Physiol Rep 2021; 9:e14841. [PMID: 33904652 PMCID: PMC8077120 DOI: 10.14814/phy2.14841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/23/2022] Open
Abstract
Intense interval exercise has proven to be as effective as traditional endurance exercise in improving maximal oxygen uptake. Shared by these two exercise regimes is an acute reduction in plasma volume, which is a suggested stimulus behind exercise-induced increases in blood volume and maximal oxygen uptake. This study aimed to link exercise-induced metabolic perturbation with volume shifts into skeletal muscle tissue. Ten healthy subjects (mean age 33 ± 8 years, 5 males and 5 females) performed three 30 s all-out sprints on a cycle ergometer. Upon cessation of exercise magnetic resonance imaging, 31 Phosphorus magnetic resonance spectroscopy and blood samples were used to measure changes in muscle volume, intramuscular energy metabolites and plasma volume. Compared to pre-exercise, muscle volume increased from 1147.1 ± 35.6 ml to 1283.3 ± 11.0 ml 8 min post-exercise. At 30 min post-exercise, muscle volume was still higher than pre-exercise (1147.1 ± 35.6 vs. 1222.2 ± 6.8 ml). Plasma volume decreased by 16 ± 3% immediately post-exercise and recovered back to - 5 ± 6% after 30 min. Principal component analysis of exercise performance, muscle and plasma volume changes as well as changes in intramuscular energy metabolites showed generally strong correlations between metabolic and physiological variables. The strongest predictor for the volume shifts of muscle and plasma was the magnitude of glucose-6-phosphate accumulation post-exercise. Interval training leads to large metabolic and hemodynamic perturbations with accumulation of glucose-6-phosphate as a possible key event in the fluid flux between the vascular compartment and muscle tissue.
Collapse
Affiliation(s)
- Mirko Mandić
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael F Forsgren
- AMRA Medical AB, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Per Widholm
- AMRA Medical AB, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Patrik Sundblad
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Gustafsson
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Rullman
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
37
|
Astolfi T, Crettaz von Roten F, Kayser B, Saugy M, Faiss R. The Influence of Training Load on Hematological Athlete Biological Passport Variables in Elite Cyclists. Front Sports Act Living 2021; 3:618285. [PMID: 33817634 PMCID: PMC8012815 DOI: 10.3389/fspor.2021.618285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
The hematological module of the Athlete Biological Passport (ABP) is used in elite sport for antidoping purposes. Its aim is to better target athletes for testing and to indirectly detect blood doping. The ABP allows to monitor hematological variations in athletes using selected primary blood biomarkers [hemoglobin concentration (Hb) and reticulocyte percentage (Ret%)] with an adaptive Bayesian model to set individual upper and lower limits. If values fall outside the individual limits, an athlete may be further targeted and ultimately sanctioned. Since (Hb) varies with plasma volume (PV) fluctuations, possibly caused by training load changes, we investigated the putative influence of acute and chronic training load changes on the ABP variables. Monthly blood samples were collected over one year in 10 male elite cyclists (25.6 ± 3.4 years, 181 ± 4 cm, 71.3 ± 4.9 kg, 6.7 ± 0.8 W.kg-1 5-min maximal power output) to calculate individual ABP profiles and monitor hematological variables. Total hemoglobin mass (Hbmass) and PV were additionally measured by carbon monoxide rebreathing. Acute and chronic training loads-respectively 5 and 42 days before sampling-were calculated considering duration and intensity (training stress score, TSSTM). (Hb) averaged 14.2 ± 0.0 (mean ± SD) g.dL-1 (range: 13.3-15.5 g·dl-1) over the study with significant changes over time (P = 0.004). Hbmass was 1030 ± 87 g (range: 842-1116 g) with no significant variations over time (P = 0.118), whereas PV was 4309 ± 350 mL (range: 3,688-4,751 mL) with a time-effect observed over the study time (P = 0.014). Higher acute-but not chronic-training loads were associated with significantly decreased (Hb) (P <0.001). Although individual hematological variations were observed, all ABP variables remained within the individually calculated limits. Our results support that acute training load variations significantly affect (Hb), likely due to short-term PV fluctuations, underlining the importance of considering training load when interpreting individual ABP variations for anti-doping purposes.
Collapse
Affiliation(s)
- Tiffany Astolfi
- REDs, Research and Expertise in Anti-Doping Sciences, University of Lausanne, Lausanne, Switzerland.,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | | | - Bengt Kayser
- ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Martial Saugy
- REDs, Research and Expertise in Anti-Doping Sciences, University of Lausanne, Lausanne, Switzerland.,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- REDs, Research and Expertise in Anti-Doping Sciences, University of Lausanne, Lausanne, Switzerland.,ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
38
|
Lundgren KM, Aspvik NP, Langlo KAR, Braaten T, Wisløff U, Stensvold D, Karlsen T. Blood Volume, Hemoglobin Mass, and Peak Oxygen Uptake in Older Adults: The Generation 100 Study. Front Sports Act Living 2021; 3:638139. [PMID: 33870187 PMCID: PMC8048070 DOI: 10.3389/fspor.2021.638139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/17/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose: To investigate the association between blood volume, hemoglobin mass (Hbmass), and peak oxygen uptake (VO2peak) in healthy older adults. Methods: Fifty fit or unfit participants from the prospective randomized Generation 100 Study (n = 1,566) were included (age- and sex-specific VO2peak above or below average values). Blood, plasma, and erythrocyte volume and Hbmass were tested using the carbon monoxide rebreathing method within 1 week after VO2peak testing. Results: Mean age, BMI, Hbmass, blood volume, and VO2peak were 73.0 ± 2.1 years, 24.8 ± 3.3 kg·m2, 10.0 ± 1.7 g·kg−1, 76.4 ± 11.8 mL·kg−1, and 33.5 ± 8.4 mL·kg−1·min−1. VO2peak in fit and unfit participants and women and men were 38.6 ± 6.5 and 25.8 ± 3.8 mL·kg−1·min−1, 30.7 ± 7.6 mL·kg−1·min−1, and 35.5 ± 8.5 mL·kg−1·min−1, respectively. Women were shorter (Δ14 cm), leaner (Δ13 kg), and with less muscle mass (Δ9%) than men (P < 0.05). Relative erythrocyte volume and Hbmass were lower in women, and blood and erythrocyte volume and Hbmass were higher in the fit participants (P < 0.05). Hbmass and erythrocyte volume explained 40 and 37%, respectively, of the variability in VO2peak, with a limited effect of physical-activity adjustment (40 and 38%, respectively). Blood and plasma volume explained 15 and 25%, respectively, of VO2peak variability, and the association was strengthened adjusting for physical activity (25 and 31%, respectively), indicating a training-dependent adaptation in plasma but not erythrocyte volume (p ≤ 0.006). Conclusions: Blood and plasma volumes were moderately associated with VO2peak in healthy older men and women, and the association was strengthened after adjustment for physical activity. Hbmass and erythrocyte volume were strongly associated with VO2peak but unrelated to physical activity.
Collapse
Affiliation(s)
- Kari Margrethe Lundgren
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nils Petter Aspvik
- Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Knut Asbjørn Rise Langlo
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tonje Braaten
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Ulrik Wisløff
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,School of Human Movement and Nutrition Science, University of Queensland, Brisbane, QLD, Australia
| | - Dorthe Stensvold
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Trine Karlsen
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| |
Collapse
|
39
|
Brix B, Sery O, Onorato A, Ure C, Roessler A, Goswami N. Biology of Lymphedema. Biology (Basel) 2021; 10:biology10040261. [PMID: 33806183 PMCID: PMC8065876 DOI: 10.3390/biology10040261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
Simple Summary Lymphedema is a chronic, debilitating disease of the lymphatic vasculature. Although several reviews focus on the anatomy and physiology of the lymphatic system, this review provides an overview of the lymphatic vasculature and, moreover, of lymphatic system dysfunction and lymphedema. Further, we aim at advancing the knowledge in the area of lymphatic system function and how dysfunction of the lymphatic system—as seen in lymphedema—affects physiological systems, such as the cardiovascular system, and how those might be modulated by lymphedema therapy. Abstract This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.
Collapse
Affiliation(s)
- Bianca Brix
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria; (B.B.); (A.R.)
| | - Omar Sery
- Faculty of Science, Masaryk University, Kotlářská 2, 61137 Brno, Czech Republic;
| | | | - Christian Ure
- Wolfsberg Clinical Center for Lymphatic Disorders, Wolfsberg State Hospital, KABEG, 9400 Wolfsberg, Austria;
| | - Andreas Roessler
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria; (B.B.); (A.R.)
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria; (B.B.); (A.R.)
- Correspondence: ; Tel.: +43-316-385-73852
| |
Collapse
|
40
|
Affiliation(s)
- Michiel Ewalts
- Bangor School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Tony Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Alexander T Friend
- Bangor School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| |
Collapse
|
41
|
Imamura T, Narang N, Combs P, Siddiqi U, Mirzai S, Stonebraker C, Bullard H, Simone P, Jeevanandam V. Impact of plasma volume status on mortality following left ventricular assist device implantation. Artif Organs 2020; 45:587-592. [PMID: 33236371 DOI: 10.1111/aor.13878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/18/2020] [Accepted: 11/20/2020] [Indexed: 01/18/2023]
Abstract
Worsening systemic congestion is often the central trigger of hospitalization in patients with heart failure. However, accurate assessment of congestion is challenging. The prognostic impact of systemic congestion following durable continuous-flow left ventricular assist device (LVAD) implantation remains unknown. Consecutive patients who received durable continuous-flow LVAD implantation between January 2014 and June 2017 and were followed for 1 year were included. The association of preoperative plasma volume status, which was calculated using patients' body weight and hematocrit and expressed as a deviation from ideal plasma volume, with 1-year mortality following LVAD implantation was investigated. In total, 186 patients (median 57 years and 138 males) were included. Baseline plasma volume status was -30.1% (-37.1%, -19.4%) on median. Eighty-eight patients (47%) had higher plasma volume status (>-29.8%), and their 1-year survival was significantly lower than those without (67% vs. 87%, P = .001). High plasma volume status was an independent predictor of 1-year death with an adjusted hazard ratio of 4.52 (95% confidence interval 1.52-13.5). Baseline systemic congestion, as defined by the high plasma volume status, was associated with higher mortality following durable continuous-flow LVAD implantation. The implication of improving preoperative plasma volume remains an area of needed investigation.
Collapse
Affiliation(s)
- Teruhiko Imamura
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.,Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | | | - Pamela Combs
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Umar Siddiqi
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Saeid Mirzai
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Corinne Stonebraker
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Heather Bullard
- Department of Pharmacy, University of Chicago Medical Center, Chicago, IL, USA
| | - Pamela Simone
- Department of Pharmacy, University of Chicago Medical Center, Chicago, IL, USA
| | | |
Collapse
|
42
|
Robach P, Lundby C. Plasma volume contraction at altitude: where does the plasma go? J Physiol 2020; 599:1013-1014. [PMID: 33289082 DOI: 10.1113/jp281028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Paul Robach
- National School for Mountain Sports, site of the National School for Skiing and Mountaineering (Ecole Nationale de Ski et d'Alpinisme), Chamonix, France
| | - Carsten Lundby
- Innland University of Applied Sciences, Lillehammer, Norway
| |
Collapse
|
43
|
Abstract
OBJECTIVE Positive fluid balance is common among critically ill patients and leads to worse outcomes, particularly in sepsis, acute respiratory distress syndrome, and acute kidney injury. Restrictive fluid infusion and active removal of accumulated fluid are being studied as approaches to prevent and treat fluid overload. Use of human albumin solutions has been investigated in different phases of restrictive fluid resuscitation, and this narrative literature review was undertaken to evaluate hypoalbuminemia and the roles of human serum albumin with respect to hypovolemia and its management. METHODS PubMed/EMBASE search terms were: "resuscitation," "fluids," "fluid therapy," "fluid balance," "plasma volume," "colloids," "crystalloids," "albumin," "hypoalbuminemia," "starch," "saline," "balanced salt solution," "gelatin," "goal-directed therapy" (English-language, pre-January 2020). Additional papers were identified by manual searching of reference lists. RESULTS Restrictive fluid administration, plus early vasopressor use, may reduce fluid balance, but in some cases fluid overload cannot be entirely avoided. Deresuscitation, with fluid actively removed through diuretics or ultrafiltration, reduces duration of mechanical ventilation and intensive care unit stay. Combining hyperoncotic human albumin solution with diuretics increases hemodynamic stability and diuresis. Hyperoncotic albumin corrects hypoalbuminemia and raises colloid osmotic pressure, limiting edema formation and potentially improving endothelial function. Serum levels of albumin relative to C-reactive protein and lactate may predict which patients will benefit most from albumin therapy. CONCLUSIONS Hyperoncotic human albumin solution facilitates restrictive fluid therapy and the effectiveness of deresuscitative measures. Current evidence is mostly from observational studies, and more randomized trials are needed to better establish a personalized approach to fluid management.
Collapse
Affiliation(s)
- Christian J Wiedermann
- Institute of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology, Hall (Tyrol), Austria
| |
Collapse
|
44
|
Otsuka H, Sakoda N, Uehata A, Sato T, Sakurai K, Aoki H, Yamagiwa T, Iizuka S, Inokuchi S. Indications for early plasma transfusion and its optimal use following trauma. Acute Med Surg 2020; 7:e593. [PMID: 33209332 PMCID: PMC7659524 DOI: 10.1002/ams2.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 11/29/2022] Open
Abstract
Aim This study aimed to evaluate the effect of plasma transfusion before urgent hemostasis initiation on in‐hospital mortality in hemodynamically unstable patients with severe trauma. Methods This retrospective observational study of patients admitted to hospital between January 2011 and January 2019 grouped patients according to whether plasma transfusion was initiated before (Before group) or after (After group) hemostasis initiation. Patients with severe trauma who were unable to wait for plasma transfusion and had started hemostasis before the plasma infusion were excluded. We used multivariable logistic regression analysis to determine the effect of plasma transfusion before the initiation of urgent hemostasis on in‐hospital mortality. Results We included 47 and 73 patients in the Before and After groups, respectively. Blunt trauma was more common, and the D‐dimer levels and Injury Severity Score were significantly higher in the Before group than in the After group (median D‐dimer, 57.5 versus 38.1 μg/mL; P = 0.040; median Injury Severity Score, 50 versus 34; P < 0.001). Plasma given before hemostasis initiation was associated with significantly lower in‐hospital mortality (adjusted odds ratio, 0.27; 95% confidence interval, 0.078–0.900; P = 0.033) in contrast with the total plasma volume given in the first 6 or 24 h. Conclusion Plasma transfusion before hemostasis initiation could be an important factor for improving outcomes in hemodynamically unstable patients with blunt trauma, high D‐dimer levels, or a high Injury Severity Score.
Collapse
Affiliation(s)
- Hiroyuki Otsuka
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| | - Naoki Sakoda
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| | - Atsushi Uehata
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| | - Toshiki Sato
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| | - Keiji Sakurai
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| | - Hiromichi Aoki
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| | - Takeshi Yamagiwa
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| | - Shinichi Iizuka
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| | - Sadaki Inokuchi
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Isehara City Japan
| |
Collapse
|
45
|
Breetveld NM, Alers R, Geerts L, van Kuijk SMJ, van Dijk AP, van der Vlugt MJ, Heidema WM, van Neer J, van Empel VPM, Brunner‐La Rocca H, Scholten RR, Ghossein‐Doha C, Spaanderman MEA. Low Plasma Volume and Increased Pressure Load Relate to Concentric Left Ventricular Remodeling After Preeclampsia: A Longitudinal Study. J Am Heart Assoc 2020; 9:e015043. [PMID: 32924785 PMCID: PMC7792392 DOI: 10.1161/jaha.119.015043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/18/2020] [Indexed: 12/31/2022]
Abstract
Background During uncomplicated pregnancy, left ventricular remodeling occurs in an eccentric way. In contrast, during preeclamptic gestation, the left ventricle hypertrophies concentrically, concurrent with loss in circulatory volume and increased blood pressure. Concentric cardiac structure persists in a substantial proportion of women and may be associated with pressure and volume load after preeclampsia. We hypothesize that low volume load, as indicated by plasma volume (PV) after preeclampsia and increased pressure load, is associated with remote concentric remodeling. Methods and Results In this longitudinal cohort study, we included 100 formerly preeclamptic women. Two visits were performed: at 0.8 years postpartum and at 4.8 years postpartum. During visit 1, we measured blood pressure and PV (I125 dilution technique, low PV ≤48 mL/kg lean body mass). During the second visit, we assessed cardiac geometry by cardiac ultrasound. Concentric remodeling was defined as relative wall thickness >0.42 and left ventricular mass index ≤95 g/m2. We adjusted multivariable analysis for primiparity, systolic blood pressure, PV mL/kg lean body mass, and antihypertensive medication at visit 1. Low PV is associated with remote concentric remodeling (odds ratio [OR], 4.37; 95% CI, 1.06-17.40; and adjusted OR, 4.67; 95% CI, 1.02-21.42). Arterial pressure load (systolic, diastolic, and mean arterial pressure) is also associated with development of concentric remodeling (OR, 1.15 [95% CI, 0.99-1.35]; OR, 1.24 [95% CI, 0.98-1.58]; and OR, 1.20 [95% CI, 0.98-1.47], respectively). Conclusions In former preeclamptic women, development toward left ventricular concentric remodeling is associated with low volume load and increased pressure load.
Collapse
Affiliation(s)
- Nicolette M. Breetveld
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Robert‐Jan Alers
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Lauren Geerts
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Arie P. van Dijk
- Department of CardiologyRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Wieteke M. Heidema
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Jolijn van Neer
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | | | | | - Ralph R. Scholten
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Chahinda Ghossein‐Doha
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Marc E. A. Spaanderman
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| |
Collapse
|
46
|
Fudim M, Lerman JB, Page C, Alhanti B, Califf RM, Ezekowitz JA, Girerd N, Grodin JL, Miller WL, Pandey A, Rossignol P, Starling RC, Tang WHW, Zannad F, Hernandez AF, O'connor CM, Mentz RJ. Plasma Volume Status and Its Association With In-Hospital and Postdischarge Outcomes in Decompensated Heart Failure. J Card Fail 2020; 27:297-308. [PMID: 33038532 DOI: 10.1016/j.cardfail.2020.09.478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prior analyses suggest an association between formula-based plasma volume (PV) estimates and outcomes in heart failure (HF). We assessed the association between estimated PV status by the Duarte-ePV and Kaplan Hakim (KH-ePVS) formulas, and in-hospital and postdischarge clinical outcomes, in the ASCEND-HF trial. METHODS AND RESULTS The KH-ePVS and Duarte-ePV were calculated on admission. We assessed associations with in-hospital worsening HF, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality. There were 6373 (89.2%), and 6354 (89.0%) patients who had necessary characteristics to calculate KH-ePVS and Duarte-ePV, respectively. There was no association between PV by either formula with in-hospital worsening HF. KH-ePVS showed a weak correlation with N-terminal prohormone BNP, and with measures of decongestion such as body weight change and urine output (r < 0.3 for all). Duarte-ePV was trending toward an association with worse 30-day (adjusted odds ratio 1.07, 95% confidence interval [CI] 1.00-1.15, P = .058), but not 180-day outcomes (adjusted hazard ratio 1.03, 95% CI 0.97-1.09, P = .289). A continuous KH-ePVS of >0 (per 10-unit increase) was associated with improved 30-day outcomes (adjusted odds ratio 0.75, 95% CI 0.62-0.91, P = .004). The continuous KH-ePVS was not associated with 180-day outcomes (adjusted hazard ratio 1.05, 95% CI 0.98-1.12, P = .139). CONCLUSIONS Baseline PV estimates had a weak association with in-hospital measures of decongestion. The Duarte-ePV trended toward an association with early clinical outcomes in decompensated HF, and may improve risk stratification in HF.
Collapse
Affiliation(s)
- Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph B Lerman
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Courtney Page
- Duke Clinical Research Institute, Durham, North Carolina
| | - Brooke Alhanti
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wayne L Miller
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | | | | | - Faiez Zannad
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
| |
Collapse
|
47
|
Haider T, Diaz-Canestro C, Pentz B, Montero D. Intravascular albumin loss is strongly associated with plasma volume withdrawal in dialysis patients. Hemodial Int 2020; 25:86-93. [PMID: 32996274 DOI: 10.1111/hdi.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Low circulating albumin closely predicts mortality in end-stage renal disease (ESRD) patients. The cause(s) of hypoalbuminemia (hALB) in ESRD patients remains to be elucidated. The aim of the present study was to determine the role of plasma volume (PV) withdrawal in the reduction of total circulating albumin and essential blood solutes induced by hemodialysis (HD). METHODS PV determined with high-precision automated carbon monoxide-rebreathing, total circulating as well as concentration of plasma albumin and electrolytes were assessed prior to and after 4-hour HD in 10 ESRD patients. FINDINGS Baseline PV ranged from 3.5 to 6.2 l. After HD, PV was decreased by 689 ± 566 mL (-16%) (P = 0.004). Total circulating albumin was largely reduced after HD (170.8 ± 35.1 vs. 146.1 ± 48.9 g, P = 0.008), while albumin concentration was unaltered. According to a strong linear relationship (r = 0.91, P < 0.001), one-third of total circulating albumin is lost from the intravascular compartment for every liter of PV removed. Similar results were found regarding Na+ and Ca2+ electrolytes. DISCUSSION Total circulating albumin, but not albumin concentration, is substantially reduced by HD in proportion to the amount of PV removed from the circulation. This study highlights the potential contributing role of PV withdrawal to hALB in ESRD patients.
Collapse
Affiliation(s)
- Thomas Haider
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Candela Diaz-Canestro
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Brandon Pentz
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - David Montero
- University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|
48
|
Wenge-Dangschat J, Steinhöfel I, Coenen M, Tuchscherer A, Hammon HM, Bachmann L. Changes in fluid and acid-base status of diarrheic calves on different oral rehydration regimens. J Dairy Sci 2020; 103:10446-10458. [PMID: 32981730 PMCID: PMC7516393 DOI: 10.3168/jds.2020-18245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Abstract
The administration of oral rehydration solutions (ORS) is an effective method to treat dehydration and acidosis in calves suffering from diarrhea. The ORS can be prepared in water or milk. The aim of the present study was to elucidate how fluid and acid-base balance change after feeding milk compared with ORS prepared in water or milk to diarrheic calves. Calves (n = 30) with naturally acquired diarrhea were sequentially assigned in a 2:1 ratio to the following pretreatments: milk and water-ORS (pretreatment 1; n = 20 calves) or milk-ORS (pretreatment 2; n = 10 calves), respectively. The assignment was done on the day of diarrhea diagnosis. On d 3 ± 1 following assignment to pretreatment group, and after a fasting period of 9 h, diarrheic calves were subjected to the following treatments: 2 L of milk (pretreatment 1; n = 10 calves), water-ORS (pretreatment 1; n = 10 calves), or milk-ORS (pretreatment 2; n = 10 calves). Blood samples were taken before and at several time points until 6 h after feeding. Plasma protein, osmolality, and electrolytes were determined and a blood gas analysis was performed. Change in plasma volume was calculated according to plasma protein, and water intake during the experimental period was recorded. Plasma volume was increased 30 min after feeding water-ORS or milk but the increase was less pronounced after feeding milk compared with water-ORS. After feeding milk-ORS, no significant increase in plasma volume could be detected. Because of the pretreatment, plasma osmolality was higher in calves fed milk-ORS, but no change in plasma osmolality after feeding was detected. No difference in water consumption between the treatment groups was noted within the observed 6-h period. The pH was increased after feeding milk-ORS, whereas water-ORS and milk-feeding did not increase pH in blood. Pretreatment with milk-ORS resulted in higher baseline d-lactate concentration, but feeding milk-ORS reduced d-lactate values after feeding. In calves with diarrhea, plasma volume increased more quickly and to a greater extent after feeding water-ORS; thus, we recommend treating diarrheic calves with water-ORS before supplying milk. Nevertheless, diarrheic calves need milk to fulfill their energy needs. The administration of ORS in milk combined with free water access is more advisable than feeding milk exclusively because milk has no alkalinizing ability and contains less sodium. However, the effects of milk-ORS feeding on d-lactate levels in diarrheic calves need further elucidation.
Collapse
Affiliation(s)
- J Wenge-Dangschat
- Institute for Animal Nutrition, Nutrition Disease and Dietetics, Faculty of Veterinary Medicine, University of Leipzig, 04109 Leipzig, Germany
| | - I Steinhöfel
- Department of Animal Production, Saxon State Office for Environment, Agriculture and Geology, 04886 Köllitsch, Germany
| | - M Coenen
- Institute for Animal Nutrition, Nutrition Disease and Dietetics, Faculty of Veterinary Medicine, University of Leipzig, 04109 Leipzig, Germany
| | - A Tuchscherer
- Leibniz Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - H M Hammon
- Leibniz Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - L Bachmann
- Leibniz Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany.
| |
Collapse
|
49
|
Schaefer AK, Poschner T, Andreas M, Kocher A, Laufer G, Wiedemann D, Mach M. Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery. Biomedicines 2020; 8:E363. [PMID: 32961736 DOI: 10.3390/biomedicines8090363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 01/31/2023] Open
Abstract
Since risk assessment prior to cardiac surgery is based on proven but partly unsatisfactory scores, the need for novel tools in preoperative risk assessment taking into account cardiac decompensation is obvious. Even subclinical chronic heart failure is accompanied by an increase in plasma volume. This increase is illustrated by means of a plasma volume score (PVS), calculated using weight, gender and hematocrit. A retrospective analysis of 187 consecutive patients with impaired left ventricular function undergoing mitral valve surgery at a single centre between 2013 and 2016 was conducted. Relative preoperative PVS was generated by subtracting the ideal from actual calculated plasma volume. The study population was divided into two cohorts using a relative PVS score > 3.1 as cut-off. Patients with PVS > 3.1 had a significantly higher need for reoperation for bleeding/tamponade (5.5% vs. 16.7%; p = 0.016) and other non-cardiac causes (9.4% vs. 21.7%; p = 0.022). In-hospital as well as 6-month, 1-year and 5-year mortality was significantly increased in PVS > 3.1 (6.3% vs. 18.3%; p = 0.013; 9.4% vs. 23.3%; p = 0.011; 11.5% vs. 23.3%; p = 0.026; 18.1% vs. 33.3%; p = 0.018). Elevated PVS above the defined cut-off used to quantify subclinical congestion was linked to significantly worse outcome after mitral valve surgery and therefore could be a useful addition to current preoperative risk stratification.
Collapse
|
50
|
Berry CW, Wolf ST, Murray B, Kenney WL. Hydration Efficacy of a Milk Permeate-Based Oral Hydration Solution. Nutrients 2020; 12:E1502. [PMID: 32455677 DOI: 10.3390/nu12051502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/27/2022] Open
Abstract
Milk permeate is an electrolyte-rich, protein- and fat-free liquid with a similar carbohydrate and mineral content to that of milk. Its hydration efficacy has not been examined. The beverage hydration index (BHI) has been used to compare various beverages to water in terms of post-ingestion fluid balance and retention. Our purpose was to compare the BHI (and related physiological responses) of a novel milk permeate solution (MPS) to that of water and a traditional carbohydrate–electrolyte solution (CES). Over three visits, 12 young subjects consumed 1 L of water, CES, or MPS. Urine samples were collected immediately post-ingestion and at 60, 120, 180, and 240 min. BHI was calculated by dividing cumulative urine output after water consumption by cumulative urine output for each test beverage at each time point. The BHI for MPS was significantly higher at all time points compared to water (all p < 0.001) and CES (all p ≤ 0.01) but did not differ between CES and water at any time point. Drinking 1 L of MPS resulted in decreased cumulative urine output across the subsequent 4 h compared to water and CES, suggesting that a beverage containing milk permeate is superior to water and a traditional CES at sustaining positive fluid balance post-ingestion.
Collapse
|