Prevention and management of intra-operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach

A woman who experiences pain during caesarean section under neuraxial anaesthesia is at risk of adverse psychological sequelae. Litigation arising from pain during caesarean section under neuraxial anaesthesia has replaced accidental awareness under general anaesthesia as the most common successful medicolegal claim against obstetric anaesthetists. Generic guidelines on caesarean section exist, but they do not provide specific recommendations for this area of anaesthetic practice. This guidance aims to offer pragmatic advice to support anaesthetists in caring for women during caesarean section. It emphasises the importance of non-technical skills, offers advice on best practice and aims to encourage standardisation. The guidance results from a collaborative effort by anaesthetists, psychologists and patients and has been developed to support clinicians and promote standardisation of practice in this area.

The novel Mechanical Ventilator Milano for the COVID-19 pandemic

This paper presents the Mechanical Ventilator Milano (MVM), a novel intensive therapy mechanical ventilator designed for rapid, large-scale, low-cost production for the COVID-19 pandemic. Free of moving mechanical parts and requiring only a source of compressed oxygen and medical air to operate, the MVM is designed to support the long-term invasive ventilation often required for COVID-19 patients and operates in pressure-regulated ventilation modes, which minimize the risk of furthering lung trauma. The MVM was extensively tested against ISO standards in the laboratory using a breathing simulator, with good agreement between input and measured breathing parameters and performing correctly in response to fault conditions and stability tests. The MVM has obtained Emergency Use Authorization by U.S. Food and Drug Administration (FDA) for use in healthcare settings during the COVID-19 pandemic and Health Canada Medical Device Authorization for Importation or Sale, under Interim Order for Use in Relation to COVID-19. Following these certifications, mass production is ongoing and distribution is under way in several countries. The MVM was designed, tested, prepared for certification, and mass produced in the space of a few months by a unique collaboration of respiratory healthcare professionals and experimental physicists, working with industrial partners, and is an excellent ventilator candidate for this pandemic anywhere in the world.

South African Society of Anaesthesiologists Perioperative Patient Blood Management Guidelines 2020

Anaesthesiologists regularly request and administer blood components to their patients, a potentially life-saving intervention. All anaesthesiologists must be familiar with the indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematologists and their local haematology blood sciences laboratory is encouraged. In the last decade, there have been considerable changes in approaches to optimal use of blood components, together with the use of alternative products, with a need to update previous guidelines and adapt them for anaesthesiologists working throughout the hospital system.

Open loop control theory algorithms for high-speed 3D MEMS optical switches

There is a world-wide push to create the next-generation all-optical transmission and switching technologies for exascale data centers. In this paper we focus on the switching fabrics. Many different types of 2D architectures are being explored including MEMS/waveguides and semiconductor optical amplifiers. However, these tend to suffer from high, path-dependent losses and crosstalk issues. The technologies with the best optical properties demonstrated to date in large fabrics (>100 ports) are 3D MEMS beam steering approaches. These have low average insertion losses and, equally important, a narrow loss distribution. However, 3D MEMS fabrics are generally dismissed from serious consideration for this application because of their slow switching speeds (∼few milliseconds) and high costs ($100/port). In this paper we show how novel feedforward open loop controls can solve both problems by improving MEMS switching speeds by two orders of magnitude and costs by a factor of three. With these improvements in hand, we believe 3D MEMS fabrics can become the technology of choice for data centers.

Does caffeine ingestion before a short-term sprint interval training promote body fat loss?

We investigated the effect of caffeine ingestion combined with a 2-wk sprint interval training (SIT) on training-induced reductions in body adiposity. Twenty physically-active men ingested either 5 mg/kg of cellulose as a placebo (PLA, n=10) or 5 mg/kg of caffeine (CAF, n=10) 60 min before each SIT session (13×30 s sprint/15 s of rest). Body mass and skinfold thickness were measured pre- and post-training. Energy expenditure was measured at rest, during exercise, and 45 min after exercise in the first SIT session. Body fat was similar between PLA and CAF groups at pre-training (P>0.05). However, there was a significant decrease in body fat after training in the CAF group (−5.9±4.2%, P<0.05) but not in PLA (1.5±8.0%, P>0.05). There was no difference in energy expenditure at rest and during exercise between PLA and CAF groups (P>0.05), but the post-exercise energy expenditure was 18.3±21.4% greater in the CAF than in the PLA group (P<0.05). In conclusion, caffeine ingestion before SIT sessions induced a body fat loss that may be associated with higher post-exercise energy expenditure.

A "human knockout" model to investigate the influence of the α-actinin-3 protein on exercise-induced mitochondrial adaptations

Research in α-actinin-3 knockout mice suggests a novel role for α-actinin-3 as a mediator of cell signalling. We took advantage of naturally-occurring human “knockouts” (lacking α-actinin-3 protein) to investigate the consequences of α-actinin-3 deficiency on exercise-induced changes in mitochondrial-related genes and proteins, as well as endurance training adaptations. At baseline, we observed a compensatory increase of α-actinin-2 protein in ACTN3 XX (α-actinin-3 deficient; n = 18) vs ACTN3 RR (expressing α-actinin-3; n = 19) participants but no differences between genotypes for markers of aerobic fitness or mitochondrial content and function. There was a main effect of genotype, without an interaction, for RCAN1-4 protein content (a marker of calcineurin activity). However, there was no effect of genotype on exercise-induced expression of genes associated with mitochondrial biogenesis, nor post-training physiological changes. In contrast to results in mice, loss of α-actinin-3 is not associated with higher baseline endurance-related phenotypes, or greater adaptations to endurance exercise training in humans.

Extreme angle, tip-tilt MEMS micromirror enabling full hemispheric, quasi-static optical coverage

Beam steering is essential for a variety of optical applications such as communication, LIDAR, and imaging. Microelectromechanical system (MEMS) mirrors are an effective method of achieving modest speeds and angular range at low cost. Typically there are a number of tradeoffs considered when designing a tip-tilt mirror, such as tilt angle and speed. For example, many mirrors are designed to scan at their resonant frequency to achieve large angles. This is effective for a scanning mode; however, this makes the device slow and ineffective as a galvo (quasi-static). Here, we present a magnetic MEMS mirror with extreme quasi-static mechanical tilt angles of ±60° (±120° optical) about two rotation axes. This micromirror enables full hemispheric optical coverage without compromising speed; settling in 4.5 ms using advanced drive techniques. This mirror will enable new applications for MEMS micromirrors previously thought impossible due to their limited angular range and speed.

First Results from the DEAP-3600 Dark Matter Search with Argon at SNOLAB

This Letter reports the first results of a direct dark matter search with the DEAP-3600 single-phase liquid argon (LAr) detector. The experiment was performed 2 km underground at SNOLAB (Sudbury, Canada) utilizing a large target mass, with the LAr target contained in a spherical acrylic vessel of 3600 kg capacity. The LAr is viewed by an array of PMTs, which would register scintillation light produced by rare nuclear recoil signals induced by dark matter particle scattering. An analysis of 4.44 live days (fiducial exposure of 9.87 ton day) of data taken during the initial filling phase demonstrates the best electronic recoil rejection using pulse-shape discrimination in argon, with leakage <1.2×10^{-7} (90% C.L.) between 15 and 31  keV_{ee}. No candidate signal events are observed, which results in the leading limit on weakly interacting massive particle (WIMP)-nucleon spin-independent cross section on argon, <1.2×10^{-44}  cm^{2} for a 100  GeV/c^{2} WIMP mass (90% C.L.).

Effects of a 4-week high-intensity interval training on pacing during 5-km running trial

This study analyzed the influence of a 4-week high-intensity interval training on the pacing strategy adopted by runners during a 5-km running trial. Sixteen male recreational long-distance runners were randomly assigned to a control group (CON, n=8) or a high-intensity interval training group (HIIT, n=8). The HIIT group performed high-intensity interval-training twice per week, while the CON group maintained their regular training program. Before and after the training period, the runners performed an incremental exercise test to exhaustion to measure the onset of blood lactate accumulation, maximal oxygen uptake (VO2max), and peak treadmill speed (PTS). A submaximal constant-speed test to measure the running economy (RE) and a 5-km running trial on an outdoor track to establish pacing strategy and performance were also done. During the 5-km running trial, the rating of perceived exertion (RPE) and time to cover the 5-km trial (T5) were registered. After the training period, there were significant improvements in the HIIT group of ∼7 and 5% for RE (P=0.012) and PTS (P=0.019), respectively. There was no significant difference between the groups for VO2max (P=0.495) or onset of blood lactate accumulation (P=0.101). No difference was found in the parameters measured during the 5-km trial before the training period between HIIT and CON (P>0.05). These findings suggest that 4 weeks of HIIT can improve some traditional physiological variables related to endurance performance (RE and PTS), but it does not alter the perception of effort, pacing strategy, or overall performance during a 5-km running trial.

Beam shaping with tip-tilt varifocal mirror for indoor optical wireless communication

MEMS mirrors are currently used in many applications to steer beams of light. An area of continued research is developing mirrors with varifocal capability that allows the beam to be shaped and focused. In this work, we study the varifocal capability of a 380 μm diameter, thermally actuated MEMS mirror with a ± 40° tip-tilt angle and a radius of curvature between -0.48 mm to 20.5 mm. Light is coupled to the mirror via a single mode optical fiber, similar to an indoor optical wireless communication architecture. The performance of the mirror is characterized with respect to (1) the profile of the reflected beam as the mirror deforms and (2) the mirror's impact when integrated into an optical communication system. We found that the mirror can focus light to a beam with a 0.18° half-angle divergence. Additionally, the ability to change the shape of fiberized light from a wide to narrow beam provides an unmatched level of dynamic control and significantly improves the bit error rate in an optical communication system.

Host Responses to Biofilm

From birth to death the human host immune system interacts with bacterial cells. Biofilms are communities of microbes embedded in matrices composed of extracellular polymeric substance (EPS), and have been implicated in both the healthy microbiome and disease states. The immune system recognizes many different bacterial patterns, molecules, and antigens, but these components can be camouflaged in the biofilm mode of growth. Instead, immune cells come into contact with components of the EPS matrix, a diverse, hydrated mixture of extracellular DNA (bacterial and host), proteins, polysaccharides, and lipids. As bacterial cells transition from planktonic to biofilm-associated they produce small molecules, which can increase inflammation, induce cell death, and even cause necrosis. To survive, invading bacteria must overcome the epithelial barrier, host microbiome, complement, and a variety of leukocytes. If bacteria can evade these initial cell populations they have an increased chance at surviving and causing ongoing disease in the host. Planktonic cells are readily cleared, but biofilms reduce the effectiveness of both polymorphonuclear neutrophils and macrophages. In addition, in the presence of these cells, biofilm formation is actively enhanced, and components of host immune cells are assimilated into the EPS matrix. While pathogenic biofilms contribute to states of chronic inflammation, probiotic Lactobacillus biofilms cause a negligible immune response and, in states of inflammation, exhibit robust antiinflammatory properties. These probiotic biofilms colonize and protect the gut and vagina, and have been implicated in improved healing of damaged skin. Overall, biofilms stimulate a unique immune response that we are only beginning to understand.

Electrothermally actuated tip-tilt-piston micromirror with integrated varifocal capability

MEMS micromirrors have proven to be very important optical devices with applications ranging from steerable mirrors for switches and cross-connects to spatial light modulators for correcting optical distortions. Usually beam steering and focusing are done with different MEMS devices and tilt angles in excess of 10 degrees are seldom obtained. Here we describe a single MEMS device that combines tip/tilt, piston mode and varifocal capability into a single, low cost device with very large tilt angles. Our device consists of a 400 micron diameter mirror driven with thermal bimorphs. We have demonstrated deflection angles of ± 40 degrees along both axes, a tunable focal length which varies between -0.48 mm to + 20.5 mm and a piston mode range of 300 microns - four separately controllable degrees of freedom in a single device. Potential applications range from smart lighting to optical switches and devices for telecom systems.

Single-fiber expression and fiber-specific adaptability to short-term intense exercise training of Na+-K+-ATPase α- and β-isoforms in human skeletal muscle

The Na(+)-K(+)-ATPase (NKA) plays a key role in muscle excitability, but little is known in human skeletal muscle about fiber-type-specific differences in NKA isoform expression or adaptability. A vastus lateralis muscle biopsy was taken in 17 healthy young adults to contrast NKA isoform protein relative abundance between type I and IIa fibers. We further investigated muscle fiber-type-specific NKA adaptability in eight of these adults following 4-wk repeated-sprint exercise (RSE) training, comprising three sets of 5 × 4-s sprints, 3 days/wk. Single fibers were separated, and myosin heavy chain (I and IIa) and NKA (α1-3 and β1-3) isoform abundance were determined via Western blotting. All six NKA isoforms were expressed in both type I and IIa fibers. No differences between fiber types were found for α1-, α2-, α3-, β1-, or β3-isoform abundances. The NKA β2-isoform was 27% more abundant in type IIa than type I fibers (P < 0.05), with no other fiber-type-specific trends evident. RSE training increased β1 in type IIa fibers (pretraining 0.70 ± 0.25, posttraining 0.84 ± 0.24 arbitrary units, 42%, P < 0.05). No training effects were found for other NKA isoforms. Thus human skeletal muscle expresses all six NKA isoforms and not in a fiber-type-specific manner; this points to their different functional roles in skeletal muscle cells. Detection of elevated NKA β1 after RSE training demonstrates the sensitivity of the single-fiber Western blotting technique for fiber-type-specific intervention effects.

Training distress and performance readiness: laboratory and field validation of a brief self-report measure

Three studies were conducted to validate the Training Distress Scale (TDS), a 19-item measure of training-related distress and performance readiness. Study 1 was a randomized, controlled laboratory experiment in which a treatment group undertook daily interval training until a 25% decrement occurred in time-to-fatigue performance. Comparisons with a control group showed that TDS scores increased over time within the treatment group but not in the control group. Study 2 was a randomized, controlled field investigation in which performance capabilities and TDS responses were compared across a high-intensity interval training group and a control group that continued normal training. Running performance decreased significantly in the training group but not in the control group, and scores on the TDS mirrored those changes in performance capabilities. Study 3 examined the relationship between TDS scores obtained over a 2-week period before major swimming competitions and subsequent performance in those competitions. Significantly, better performance was observed for swimmers with low TDS scores compared with those with moderate or high TDS scores. These findings provide both laboratory and field evidence for the validity of the TDS as a measure of short-term training distress and performance readiness.

MC1R genotype as a predictor of early-onset melanoma, compared with self-reported and physician-measured traditional risk factors: an Australian case-control-family study

Background

Melanocortin-1 receptor (MC1R) gene variants are very common and are associated with melanoma risk, but their contribution to melanoma risk prediction compared with traditional risk factors is unknown. We aimed to 1) evaluate the separate and incremental contribution of MC1R genotype to prediction of early-onset melanoma, and compare this with the contributions of physician-measured and self-reported traditional risk factors, and 2) develop risk prediction models that include MC1R, and externally validate these models using an independent dataset from a genetically similar melanoma population.

Methods

Using data from an Australian population-based, case-control-family study, we included 413 case and 263 control participants with sequenced MC1R genotype, clinical skin examination and detailed questionnaire. We used unconditional logistic regression to estimate predicted probabilities of melanoma. Results were externally validated using data from a similar study in England.

Results

When added to a base multivariate model containing only demographic factors, MC1R genotype improved the area under the receiver operating characteristic curve (AUC) by 6% (from 0.67 to 0.73; P < 0.001) and improved the quartile classification by a net 26% of participants. In a more extensive multivariate model, the factors that contributed significantly to the AUC were MC1R genotype, number of nevi and previous non-melanoma skin cancer; the AUC was 0.78 (95% CI 0.75-0.82) for the model with self-reported nevi and 0.83 (95% CI 0.80-0.86) for the model with physician-counted nevi. Factors that did not further contribute were sun and sunbed exposure and pigmentation characteristics. Adding MC1R to a model containing pigmentation characteristics and other self-reported risk factors increased the AUC by 2.1% (P = 0.01) and improved the quartile classification by a net 10% (95% CI 1-18%, P = 0.03).

Conclusions

Although MC1R genotype is strongly associated with skin and hair phenotype, it was a better predictor of early-onset melanoma than was pigmentation characteristics. Physician-measured nevi and previous non-melanoma skin cancer were also strong predictors. There might be modest benefit to measuring MC1R genotype for risk prediction even if information about traditional self-reported or clinically measured pigmentation characteristics and nevi is already available.

Seasonal changes in physical performance and heart rate variability in high level futsal players

The aim of this study was to determine the changes in physical performance and resting heart rate variability (HRV) in professional futsal players during the pre-season and in-season training periods. 11 athletes took part in the study (age=24.3±2.9 years; height=176.3±5.2 cm; weight=76.1±6.3 kg), and performed a repeated-sprint ability (RSA) test [6×40 m (20+20 m with a 180° change of direction) sprints separated by 20 s of passive recovery] and Yo-Yo intermittent recovery test level 1 (Yo-Yo IR1) at 3 different moments (M1=beginning of pre-season; M2=end of pre-season; M3=mid in-season). The HRV indices were assessed at the same moments. After the short pre-season (3-week), mean RSA time (RSAmean) (M1=7.43±0.2 s; M2=7.24±0.2 s; P=0.003), decrement in RSA performance (RSAdecrement) (M1=6.7±0.3%; M2=5.0±0.9%; P=0.001), and Yo-Yo IR1 distance (M1=1.244±298 m; M2=1.491±396 m; P=0.002) were significantly improved (P<0.05). During the in-season (i. e., M3), performance in Yo-Yo IR1 and RSAmean were maintained. In contrast, RSAbest (M2=6.89±0.2 to M3=6.69±0.3; P=0.001) was improved and RSAdecrement (M2=5.0±0.9% to M3=6.6±0.9%; P=0.001) was impaired. At M2, there was an increase in HRV vagal-related indices compared with M1 that was maintained at M3. In conclusion, after a short pre-season, futsal players improved their RSA and Yo-Yo IR1 performance with concomitant improvements in HRV. These indices were maintained during the in-season period while RSAbest was improved and RSAdecrement impaired. Frequent monitoring of these performances and HRV indices may assist with identification of individual training adaptations and/or early signs of maladaption.

Strontium- and magnesium-enriched biomimetic β-TCP macrospheres with potential for bone tissue morphogenesis

During the last two decades, biogenic mineral ions have become important additives in treatments for bone regeneration and repair. Prominent among these is strontium, which is a potent suppressor of osteoclast bone resorption. Another is magnesium, which has a key influence in mineralization processes. The shells of benthic foraminiferans, hydrothermally converted into β-TCP, have been shown to effectively release a number of bone-promoting drugs at clinically relevant levels. In this study we characterized the effects of converted foraminiferan calcium dissolution and the concomitant release profile of intrinsic strontium and magnesium. We tested the effects of strontium- and magnesium-enriched macrospheres on human osteoblast (SaOS-2) and monocytoid (U937) cell lines, which can be induced to express equivalent phagocytic activities to osteoclasts. On dissolution in a biomimetic physiological solution, the macrospheres released biologically significant quantities of calcium and phosphate ions in the first 18 days. At 3 days, during which biogenic mineral ions are released, the number of U937 osteoclast-like monocyte cells decreased, while 4 days later the osteoblast cell number increased. These results show that strontium and magnesium naturally enriched macrospheres are capable of altering the metabolic activities of the cells regulating bone homeostasis. These unique macrospheres are natural origin bone void filler particles that resorb, and release physiologically significant levels of incorporated strontium, magnesium and calcium, which together make a uniquely multifunctional in situ remedy for bone regeneration and repair and the treatment of bone-wasting diseases.

Hot conditions improve power output during repeated cycling sprints without modifying neuromuscular fatigue characteristics

This study investigated the effect of hot conditions on repeated sprint cycling performance and post-exercise alterations in isometric knee extension function. Twelve physically active participants performed 10 × 6-s "all-out" sprints on a cycle ergometer (recovery = 30 s), followed 6 min later by 5 × 6-s sprints (recovery = 30 s) in either a neutral (24 °C/30 %rH) or a hot (35 °C/40 %rH) environment. Neuromuscular tests including voluntary and electrically evoked isometric contractions of the knee extensors were performed before and after exercise. Average core temperature during exercise was higher (38.0 ± 0.1 vs. 37.7 ± 0.1 °C, respectively; P < 0.05) in hot versus neutral environments. Peak power output decreased (-17.9 % from sprint 1 to sprint 10 and -17.0 % from sprint 11 to sprint 15; P < 0.001) across repetitions. Average peak power output during the first ten sprints was higher (+3.1 %; P < 0.01) in the hot ambient temperature condition. Maximal strength (-12 %) and rate of force development (-15 to -26 %, 30-200 ms from the onset of contraction) decreased (P < 0.001) during brief contractions after exercise, irrespectively of the ambient temperature. During brief maximal contractions, changes in voluntary activation (~80 %) were not affected by exercise or temperature. Voluntary activation declined (P < 0.01) during the sustained contraction, with these reductions being more pronounced (P < 0.05) after exercise but not affected by the ambient temperature. Resting twitch amplitude declined (P < 0.001) by ~42 %, independently of the ambient temperature. In conclusion, heat exposure has no effect on the pattern and the extent of isometric knee extensor fatigue following repeated cycling sprints in the absence of hyperthermia.

Prospective parallel randomized trial of the MultiCyte™ ThinPrep(®) imaging system: the Scottish experience

BACKGROUND

Computer-assisted screening of cervical liquid-based cytology (LBC) preparations using the ThinPrep® Imaging System (TIS) has shown improved qualitative and quantitative gains. The use of Multicyte™ has not been described in a well-established national screening programme with a low incidence of high-grade dyskaryosis.

OBJECTIVES

To assess the impact of computer-assisted screening within the Scottish Cervical Screening Programme (SCSP).

METHODS

Two groups of three laboratories, each sharing a ThinPrep® Imager, screened 79 366 slides randomized to test and 90 551 to control arms by laboratory accession. Screeners were not blinded. Standard laboratory reporting profiles of the SCSP, sensitivity, specificity and false-negative rates of all grades of LBC abnormalities with respect to final cytology reports, predictive value for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) on histology; and screening rates were compared for both arms.

RESULTS

Inadequate and negative reporting rates were significantly lower and low-grade reporting rates significantly higher in the imager arm. Imager-assisted screening showed significantly better specificity than manual screening with respect to the final cytology result. There was no evidence of a significant difference in the detection of CIN2+ or CIN3 +. Positive, abnormal and total predictive values (high-grade, low-grade and all abnormal cytology found to be CIN2+, respectively) were similar in both arms. Productivity was significantly higher in the imager arm.

CONCLUSION

  Computer-assisted screening in a well established screening programme showed significantly improved productivity without loss of quality. These findings should inform future policy for cervical screening programmes.

Listening to music in the first, but not the last 1.5 km of a 5-km running trial alters pacing strategy and improves performance

We examined the effects of listening to music on attentional focus, rating of perceived exertion (RPE), pacing strategy and performance during a simulated 5-km running race. 15 participants performed 2 controlled trials to establish their best baseline time, followed by 2 counterbalanced experimental trials during which they listened to music during the first (M start) or the last (M finish) 1.5 km. The mean running velocity during the first 1.5 km was significantly higher in M start than in the fastest control condition (p<0.05), but there was no difference in velocity between conditions during the last 1.5 km (p>0.05). The faster first 1.5 m in M start was accompanied by a reduction in associative thoughts compared with the fastest control condition. There were no significant differences in RPE between conditions (p>0.05). These results suggest that listening to music at the beginning of a trial may draw the attentional focus away from internal sensations of fatigue to thoughts about the external environment. However, along with the reduction in associative thoughts and the increase in running velocity while listening to music, the RPE increased linearly and similarly under all conditions, suggesting that the change in velocity throughout the race may be to maintain the same rate of RPE increase.

Physiological responses to shuttle repeated-sprint running

This study investigated the influence of 180 degrees changes of direction during a repeated-sprint running test on performance, cardiorespiratory variables, muscle deoxygenation and post-exercise blood lactate ([La] (b)) levels. Thirteen team-sport athletes (22+/-3 yr) performed 6 repeated maximal sprints with (RSS, 6 x[2 x 12.5 m]) or without (RS, 6 x 25 m) changes of direction. Best and mean running time, percentage speed decrement (%Dec), pulmonary oxygen uptake ( V O (2)), vastus lateralis deoxygenation (Hb (diff)) and [La] (b) were calculated for each condition. Best and mean times for both protocols were largely correlated (r =0.63 and r =0.78, respectively), and were 'ALMOST CERTAINLY' higher for RSS compared with RS (e. g., 5.30+/-0.17 vs. 4.09+/-0.17 s for mean time, with the qualitative analysis revealing a 100% chance of RSS time being greater than RS). In contrast, %Dec was 'POSSIBLY' lower for RSS (2.6+/-1.2 vs. 3.2+/-1.3%, with a 79% chance of a real difference). Compared with RS, V O (2) (40.4+/-4.2 vs. 38.9+/-3.8 mL x min (-1) x kg (-1), with a 90% chance of a real difference) and [La] (b) (10.0+/-1.7 vs. 9.3+/-2.4 mmol.L (-1), with a 70% chance of a real difference) were 'POSSIBLY' higher. Conversely, there were no differences in Hb (diff) (11.5+/-3.2 vs. 10.9+/-3.0 microM, with the comparison rated as 'UNCLEAR'). To conclude, the present results suggest that the ability to repeat sprints can be considered as a general quality. They also suggest that repeated shuttle sprints might be an effective training practice for eliciting a greater systemic physiological load, but perhaps not a greater loading of the vastus lateralis.

Turning down lipid oxidation during heavy exercise--what is the mechanism?

A high potential for lipid oxidation is a sign of metabolic fitness and is important not only for exercise performance but also for health promotion. Despite considerable progress during recent years, our understanding of how lipid oxidation is controlled remains unclear. The rate of lipid oxidation reaches a peak at 50-60% of V(O2 max) after which the contribution of lipids decreases both in relative and absolute terms. In the high-intensity domain (>60% V(O2 max)), there is a pronounced decrease in energy state, which will stimulate the glycolytic rate in excess of the substrate requirements of mitochondrial oxidative processes. Accumulation of glycolytic products will impair lipid oxidation through an interaction with the carnitine-mediated transfer of FA into mitochondria. Another potential site of control is Acyl-CoA synthetase (ACS), which is the initial step in FA catabolism. The activity of ACS may be under control of CoASH and energy state. There is evidence that additional control points exist beyond mitochondrial influx of fatty acids. The electron transport chain (ETC) with associated feed-back control by redox state is one suggested candidate. In this review it is suggested that the control of FA oxidation during heavy exercise is distributed between ACS, CPT1, and ETC.

A prospective study of glycaemic status in anti-psychotic-treated patients

Anti-psychotic drugs, particularly the second generation, or ;atypical' agents, have been implicated in the development of metabolic dysfunction such as diabetes mellitus. There is a paucity of longitudinal data on the natural history of glucose homeostasis in anti-psychotic-treated patients, and there are no universally accepted strategies for managing worsening glycaemic control in this population. Notwithstanding, several guidelines recommend switching to a ;lower risk' agent if patients develop worsening glycaemic control during anti-psychotic treatment. We prospectively followed a cohort of 106 anti-psychotic-treated patients from across the diagnostic spectrum, and investigated changes in glycaemic status. Between baseline and follow-up assessment (mean follow-up time, 599.3 [SD+/-235.4] days glycaemic status was unchanged in 78 (86.7%) patients; 5 (5.6%) reverted from impaired fasting glucose (IFG) to normoglycaemia in the absence of any pharmacological or lifestyle intervention and all were taking a ;high risk' drug (clozapine or olanzapine). These preliminary data suggest that progression to overt diabetes mellitus is not inevitable in patients who develop IFG during anti-psychotic treatment. Switching to another agent simply on the basis of the development of IFG may not offer any advantage, especially if the mental state is stable.