Factors associated with limited exercise capacity and feasibility of high intensity interval training in people with mild to moderate Parkinson's disease

Background/Aims: Fitness and function can improve with exercise in people with Parkinson's disease. Animal models suggest that exercise may also have a neuroprotective effect, with higher intensity exercise being more beneficial than lower intensity exercise. However, in people with Parkinson's disease the factors limiting exercise capacity are not fully understood and it is unclear whether training at very high intensities would be safe, feasible and acceptable. Methods: Eighteen people with Parkinson's disease were recruited to explore respiratory and neuromuscular factors that may limit exercise capacity. In a purposive subgroup of 6 participants able to achieve &gt;75% of their predicted maximum heart rate the feasibility of undertaking six high intensity interval training sessions over 3 weeks was tested. Their experience was further explored in a focus group. Results: Lower exercise capacity was associated with lower limb flexor muscle strength (r2=0.51) but not with disease severity or respiratory function. There were no adverse events or drop-outs in those taking part in the exercise regimen. Improvements were seen in fitness, health related quality of life, activity levels, walking speed, muscle strength and cycle endurance. Participants reported that they enjoyed high intensity, supervised exercise. High intensity interval training may be feasible and safe. Conclusions: We concluded that high intensity interval training has the potential to be a safe and acceptable mode of exercise in this patient group. </jats:sec

Human plague: An old scourge that needs new answers

Yersinia pestis, the bacterial causative agent of plague, remains an important threat to human health. Plague is a rodent-borne disease that has historically shown an outstanding ability to colonize and persist across different species, habitats, and environments while provoking sporadic cases, outbreaks, and deadly global epidemics among humans. Between September and November 2017, an outbreak of urban pneumonic plague was declared in Madagascar, which refocused the attention of the scientific community on this ancient human scourge. Given recent trends and plague’s resilience to control in the wild, its high fatality rate in humans without early treatment, and its capacity to disrupt social and healthcare systems, human plague should be considered as a neglected threat. A workshop was held in Paris in July 2018 to review current knowledge about plague and to identify the scientific research priorities to eradicate plague as a human threat. It was concluded that an urgent commitment is needed to develop and fund a strong research agenda aiming to fill the current knowledge gaps structured around 4 main axes: (i) an improved understanding of the ecological interactions among the reservoir, vector, pathogen, and environment; (ii) human and societal responses; (iii) improved diagnostic tools and case management; and (iv) vaccine development. These axes should be cross-cutting, translational, and focused on delivering context-specific strategies. Results of this research should feed a global control and prevention strategy within a “One Health” approach

Decreased tibial nerve movement in patients with failed back surgery syndrome and persistent leg pain

Purpose To measure and compare the total and normalised tibial nerve movements during forward bending in patients with and without failed back surgery syndrome (FBSS) and persistent leg pain following anatomically successful lumbar decompression surgery and demonstrated no psychological stress. Nerve pathomechanics may contribute to FBSS with persistent leg pain following anatomically successful lumbar decompression surgery