Whole body cryotherapy and recovery from exercise induced muscle damage: A systematic review

Introduction Cold therapies are used regularly in medicine for their analgesic and anti-inflammatory effects. Whole-body cryotherapy (WBC) involves exposure to air maintained between -110 and -160oC, and is hypothesised to reduce pain, local and systemic inflammation. WBC has recently become popular in an exercise and sporting context as a recovery method after skeletal muscle damage, however, research examining the efficacy of WBC in an athletic context is minimal. This review seeks to summarise the evidence for the effects of WBC on exercise recovery measures. Methods Electronic database searches were conducted from March to April 2013. Six large online databases were used; MEDLINE, SPORTDiscus, Scopus, Web of Science, PubMed and AMED. The search targeted human studies with an exercise task, and WBC intervention. Results included randomised controlled trials (RCT’s), uncontrolled trials and crossover designs. Results A total of 8 studies were included in the review. Two RCT’s, four crossover trials and two uncontrolled trials were identified. Five studies showed WBC had no effect on markers of muscle damage or inflammation post exercise, while 3 studies show a positive effect. Three out of the eight studies measured maximal muscle force production and subjective pain levels following exercise and WBC, with two showing WBC had a positive effect on muscle force recovery and pain. A meta-analysis was not conducted due to the heterogeneity of the studies. Conclusion The current evidence for the efficacy of WBC on exercise recovery is unclear. Published studies report mixed findings, and the study designs make these results difficult to interpret. As WBC is proposed as an aid to recovery in an athletic population, repeated measures of performance, muscle force production and pain are of importance to the athlete, however, are minimally reported in the literature. Cold water immersion (CWI) is widely used in an athletic setting for recovery, and has much literature supporting its use for the reduction of pain post-exercise. Well-designed RCT’s with controlled exercise interventions targeting performance measures are needed, in particular comparison of WBC with CWI data is needed for evaluation

Effects of whole body cryotherapy and cold water immersion on immune and inflammatory markers following exercise induced muscle damage

Introduction: Cold therapies are used regularly in medicine for their analgesic and anti-inflammatory effects. Whole-body cryotherapy (WBC) involves exposure to air maintained between -110 and -160oC, and is hypothesised to reduce pain, local and systemic inflammation. WBC has recently become popular in an exercise and sporting context as a recovery method after skeletal muscle damage. However, research examining the efficacy of WBC in an athletic context is minimal, in particular, studies comparing WBC to currently accepted recovery methods are lacking. Cold water immersion (CWI) is a widely researched and applied method of skeletal muscle recovery in sport science. As yet, no study has compared the proposed new method of WBC and the currently practiced method of CWI. We have designed a randomised control trial to examine the efficacy of WBC, as compared with CWI on recovery from a bout of eccentric muscle damage. Methods: Sixty healthy male subjects will perform skeletal muscle function tests and an eccentric muscle damage protocol of their left quadriceps femoris, using an isokinetic dynamometer. They will then be randomly assigned to one of 3 groups, WBC, CWI or a passive recovery control (PAS). The WBC will expose subjects to -160°C for 3min, using cold air. The CWI condition involves whole body exposure for 3min, in water maintained at 12°C. The PAS will have subjects seated comfortably at room temperature following the exercise protocol. Blood samples, muscle functional measurements and pain reports will be taken before muscle damage, immediately following damage, prior to therapy administration and post therapy. Further follow up measures to be taken 6 h post, 24 h and 7 days post. Blood samples will be analysed for changes in interleukins 6, 8 and 10, creatine kinase and leukocyte population kinetics. Results: Testing is being conducted. Results to be presented at the international society of exercise immunology (ISEI) symposium in September 2013

The design of medical laser surgery dermatology handpieces for radiation control and direct extraction of infectious laser generated plume

Surgical skin treatments such as; laser ablation, laser scalpels, hair removal, tattooed removal etc can all generate direct and secondary optical radiation hazards, however, because they are designed to intentionally destroy human tissue, they also generate gaseous and particulate emissions. This second family often referred to as; surgical smoke, surgical smoke plume and surgical fume, have now been identified as producing viable bio-active aerosols, these by-products now pose infectious hazards to the patient and staff of the operating room. Local extraction is sometimes used to try and reduce the airborne concentration of these byproducts though in virtually all cases the smell of the process is detectable by all. The optical radiation hazard usually dictates the wearing of protective eyewear to provide some level of personal protection. A major health concern to all medical and cosmetic facilities is that of infection control. Surgical smoke is usually overlooked as a source of infection within the operating environment and it has been known since the mid-1980s that the particulate can carry with it live pathogens from the patient which can now be in skin contact or respired by the operating staff. A paper presented by the authors in the Medical Session here at ILSC provides possibly the first quantitative analysis of the hazards the surgeon and other staff are subject to. This paper examines the practical limitations of the existing approaches and provides some simple practical control measures that provide complete radiation containment as well as enable complete particulate and gas extraction without any reliance on any form of personal protection for the patient and operating staff. These designs have now been tested and are shown to offer 100% effective plume extraction and radiation containment

Measuring eWhoring

eWhoring is the term used by offenders to refer to a type of online fraud in which cybersexual encounters are simulated for financial gain. Perpetrators use social engineering techniques to impersonate young women in online communities, e.g., chat or social networking sites. They engage potential customers in conversation with the aim of selling misleading sexual material – mostly photographs and interactive video shows – illicitly compiled from third-party sites. eWhoring is a popular topic in underground communities, with forums acting as a gateway into offending. Users not only share knowledge and tutorials, but also trade in goods and services, such as packs of images and videos. In this paper, we present a processing pipeline to quantitatively analyse various aspects of eWhoring. Our pipeline integrates multiple tools to crawl, annotate, and classify material in a semi-automatic way. It builds in precautions to safeguard against significant ethical issues, such as avoiding the researchers’ exposure to pornographic material, and legal concerns, which were justified as some of the images were classified as child exploitation material. We use it to perform a longitudinal measurement of eWhoring activities in 10 specialised underground forums from 2008 to 2019. Our study focuses on three of the main eWhoring components: (i) the acquisition and provenance of images; (ii) the financial profits and monetisation techniques; and (iii) a social network analysis of the offenders, including their relationships, interests, and pathways before and after engaging in this fraudulent activity. We provide recommendations, including potential intervention approaches.This work was supported by the Engineering and Physical Sciences Research Council (EPSRC) [grant number EP/M020320/1], by MINECO (grant TIN2016-79095-C2-2-R), and by the Comunidad de Madrid (P2018/TCS-4566, co-financed by European Structural Funds ESF and FEDER)

Exercise Intensity and Duration Effects on In Vivo Immunity

PURPOSE: To examine the effects of intensity and duration of exercise stress on induction of in vivo immunity in humans using experimental contact hypersensitivity (CHS) with the novel antigen diphenylcyclopropenone (DPCP). METHODS: Sixty-four healthy males completed either 30 min running at 60% V O2peak (30MI), 30 min running at 80% V O2peak (30HI), 120 min running at 60% V O2peak (120MI), or seated rest (CON). Twenty min later, the subjects received a sensitizing dose of DPCP; and 4 wk later, the strength of immune reactivity was quantified by measuring the cutaneous responses to a low dose-series challenge with DPCP on the upper inner arm. Circulating epinephrine, norepinephrine and cortisol were measured before, after, and 1 h after exercise or CON. Next, to understand better whether the decrease in CHS response on 120MI was due to local inflammatory or T-cell-mediated processes, in a crossover design, 11 healthy males performed 120MI and CON, and cutaneous responses to a dose series of the irritant, croton oil (CO), were assessed on the upper inner arm. RESULTS: Immune induction by DPCP was impaired by 120MI (skinfold thickness -67% vs CON; P < 0.05). However, immune induction was unaffected by 30MI and 30HI despite elevated circulating catecholamines (30HI vs pre: P < 0.01) and greater circulating cortisol post 30HI (vs CON; P < 0.01). There was no effect of 120MI on skin irritant responses to CO. CONCLUSIONS: Prolonged moderate-intensity exercise, but not short-lasting high- or short-lasting moderate-intensity exercise, decreases the induction of in vivo immunity. No effect of prolonged moderate-intensity exercise on the skin's response to irritant challenge points toward a suppression of cell-mediated immunity in the observed decrease in CHS. Diphenylcyclopropenone provides an attractive tool to assess the effect of exercise on in vivo immunity

UKCP18 marine report

Changes in global and regional sea level arise from a wide variety of geophysical processes that operate on different time and space scales (the sea level “jigsaw puzzle”). Global mean sea level (GMSL) rise occurs from thermal expansion of seawater and the addition of water to the ocean from the loss of land-based ice and water. Changes in land-based ice and water storage result in spatial patterns of regional sea level change through the associated impact on Earth’s gravity field and other effects. Local changes in seawater density and ocean circulation also give rise to a spatial pattern of change, which varies markedly among climate models, and is therefore highly uncertain. In addition, the ongoing response of the Earth system to the last deglaciation brings about a spatial pattern of regional sea level change across the UK that is dominated by the effect of vertical land motion. At local scales, the impacts of coastal sea level change typically arise primarily from extreme water level events. These deviations from the regional mean water level are often associated with storm surges and extreme wave conditions combined with the local tide. The UKCP18 sea level work focuses on 21st century projections of: (i) regional time-mean sea level; (ii) changes in surge extremes; (iii) potential changes in tide and surge characteristics; and (iv) changes in local wave climate. In addition, we present exploratory projections of regional time-mean sea level change out to 2300. All projections are rooted in, or traceable to, CMIP5 climate model simulations under the RCP climate change scenarios

A new mild hyperthermia device to treat vascular involvement in cancer surgery

Abstract Surgical margin status in cancer surgery represents an important oncologic parameter affecting overall prognosis. The risk of disease recurrence is minimized and survival often prolonged if margin-negative resection can be accomplished during cancer surgery. Unfortunately, negative margins are not always surgically achievable due to tumor invasion into adjacent tissues or involvement of critical vasculature. Herein, we present a novel intra-operative device created to facilitate a uniform and mild heating profile to cause hyperthermic destruction of vessel-encasing tumors while safeguarding the encased vessel. We use pancreatic ductal adenocarcinoma as an in vitro and an in vivo cancer model for these studies as it is a representative model of a tumor that commonly involves major mesenteric vessels. In vitro data suggests that mild hyperthermia (41–46 °C for ten minutes) is an optimal thermal dose to induce high levels of cancer cell death, alter cancer cell’s proteomic profiles and eliminate cancer stem cells while preserving non-malignant cells. In vivo and in silico data supports the well-known phenomena of a vascular heat sink effect that causes high temperature differentials through tissues undergoing hyperthermia, however temperatures can be predicted and used as a tool for the surgeon to adjust thermal doses delivered for various tumor margins

Derivation of High Spatial Resolution Albedo from UAV Digital Imagery:Application over the Greenland Ice Sheet

Measurements of albedo are a prerequisite for modeling surface melt across the Earth's cryosphere, yet available satellite products are limited in spatial and/or temporal resolution. Here, we present a practical methodology to obtain centimeter resolution albedo products with accuracies of ?5% using consumer-grade digital camera and unmanned aerial vehicle (UAV) technologies. Our method comprises a workflow for processing, correcting and calibrating raw digital images using a white reference target, and upward and downward shortwave radiation measurements from broadband silicon pyranometers. We demonstrate the method with a set of UAV sorties over the western, K-sector of the Greenland Ice Sheet. The resulting albedo product, UAV10A1, covers 280 km2, at a resolution of 20 cm per pixel and has a root-mean-square difference of 3.7% compared to MOD10A1 and 4.9% compared to ground-based broadband pyranometer measurements. By continuously measuring downward solar irradiance, the technique overcomes previous limitations due to variable illumination conditions during and between surveys over glaciated terrain. The current miniaturization of multispectral sensors and incorporation of upward facing radiation sensors on UAV packages means that this technique could become increasingly common in field studies and used for a wide range of applications. These include the mapping of debris, dust, cryoconite and bioalbedo, and directly constraining surface energy balance models.publishersversionPeer reviewe

Biochemical properties of Paracoccus denitrificans FnrP:Reactions with molecular oxygen and nitric oxide

In Paracoccus denitrificans, three CRP/FNR family regulatory proteins, NarR, NnrR and FnrP, control the switch between aerobic and anaerobic (denitrification) respiration. FnrP is a [4Fe-4S] cluster containing homologue of the archetypal O2 sensor FNR from E. coli and accordingly regulates genes encoding aerobic and anaerobic respiratory enzymes in response to O2, and also NO, availability. Here we show that FnrP undergoes O2-driven [4Fe-4S] to [2Fe-2S] cluster conversion that involves up to 2 O2 per cluster, with significant oxidation of released cluster sulfide to sulfane observed at higher O2 concentrations. The rate of the cluster reaction was found to be ~6-fold lower than that of E. coli FNR, suggesting that FnrP can remain transcriptionally active under microaerobic conditions. This is consistent with a role for FnrP in activating expression of the high O2 affinity cytochrome c oxidase under microaerobic conditions. Cluster conversion resulted in dissociation of the transcriptionally active FnrP dimer into monomers. Therefore, along with E. coli FNR, FnrP belongs to the subset of FNR proteins in which cluster type is correlated with association state. Interestingly, two key charged residues, Arg140 and Asp154, that have been shown to play key roles in the monomer-dimer equilibrium in E. coli FNR are not conserved in FnrP, indicating that different protomer interactions are important for this equilibrium. Finally, the FnrP [4Fe-4S] cluster is shown to undergo reaction with multiple NO molecules, resulting in iron nitrosyl species and dissociation into monomers

Developing decision support tools incorporating personalised predictions of likely visual benefit versus harm for cataract surgery:research programme

Background Surgery for established cataract is highly cost-effective and uncontroversial, yet uncertainty remains for individuals about when to proceed and when to delay surgery during the earlier stages of cataract. Objective We aimed to improve decision-making for cataract surgery through the development of evidence-based clinical tools that provide general information and personalised risk/benefit information. Design We used a mixed methodology consisting of four work packages. Work package 1 involved the development and psychometric validation of a brief, patient self-reported measure of visual difficulty from cataract and its relief from surgery, named Cataract Patient-Reported Outcome Measure, five items (Cat-PROM5). Work package 2 involved the review and refinement of risk models for adverse surgical events (posterior capsule rupture and visual acuity loss related to cataract surgery). Work package 3 involved the development of prediction models for the Cat-PROM5-based self-reported outcomes from a cohort study of 1500 patients; assessment of the validity of preference-based health economic indices for cataract surgery and the calibration of these to Cat-PROM5; assessment of patients’ and health-care professionals’ views on risk–benefit presentation formats, the perceived usefulness of Cat-PROM5, the value of personalised risk–benefit information, high-value information items and shared decision-making; development of cataract decision aid frequently asked questions, incorporation of personalised estimates of risks and benefits; and development of a cataract decision quality measure to assess the quality of decision-making. Work package 4 involved a mixed-methods feasibility study for a fully powered randomised controlled trial of the use of the cataract decision aid and a qualitative study of discordant or mismatching perceptions of outcome between patients and health-care professionals. Setting Four English NHS recruitment centres were involved: Bristol (lead centre), Brighton, Gloucestershire and Torbay. Multicentre NHS cataract surgery data were obtained from the National Ophthalmology Database. Participants Work package 1 – participants (n = 822) were from all four centres. Work package 2 – electronic medical record data were taken from the National Ophthalmology Database (final set > 1M operations). Work package 3 – cohort study participants were from Bristol (n = 1200) and Gloucestershire (n = 300); qualitative and development work was undertaken with patients and health-care professionals from all four centres. Work package 4 – Bristol, Brighton and Torbay participated in the recruitment of patients (n = 42) for the feasibility trial and recruitment of health-care professionals for the qualitative elements. Interventions For the feasibility trial, the intervention was the use of the cataract decision aid, incorporating frequently asked questions and personalised estimations of both adverse outcomes and self-reported benefit. Main outcome measures There was a range of quantitative and qualitative outcome measures: questionnaire psychometric performance metrics, risk indicators of adverse surgical events and visual outcome, predictors of self-reported outcome following cataract surgery, patient and health-care practitioner views, health economic calibration measures and randomised controlled trial feasibility measures. Data sources The data sources were patient self-reported questionnaire responses, study clinical data collection forms, recorded interviews with patients and health-care professionals, and anonymised National Ophthalmology Database data. Results Work package 1 – Cat-PROM5 was developed and validated with excellent to good psychometric properties (Rasch reliability 0.9, intraclass correlation repeatability 0.9, unidimensionality with residual eigenvalues ≤ 1.5) and excellent responsiveness to surgical intervention (Cohen delta –1.45). Work package 2 – earlier risk models for posterior capsule rupture and visual acuity loss were broadly affirmed (C-statistic for posterior capsule rupture 0.64; visual acuity loss 0.71). Work package 3 – the Cat-PROM5-based self-reported outcome regression models were derived based on 1181 participants with complete data (R2 ≈ 30% for each). Of the four preference-based health economic indices assessed, two demonstrated reasonable performance. Cat-PROM5 was successfully calibrated to health economic indices; adjusted limited dependent variable mixture models offered good to excellent fit (root-mean-square error 0.10–0.16). The personalised quantitative risk information was generally perceived as beneficial. A cataract decision aid and cataract decision quality measure were successfully developed based on the views of patients and health-care professionals. Work package 4 – data completeness was good for the feasibility study primary and secondary variables both before and after intervention/surgery (data completeness range 100–88%). Considering ability to recruit, the sample size required, instrumentation and availability of necessary health economic data, a fully powered randomised controlled trial (patients, n = 800, effect size 0.2 standard deviations, power 80%; p = 0.05) of the cataract decision aid would be feasible following psychometric refinement of the primary outcome (the cataract decision quality measure). The cataract decision aid was generally well-received by patients and health-care professionals, with cautions raised regarding perceived time and workload barriers. Discordant outcomes mostly related to patient dissatisfaction, with no clinical problem found. Limitations The National Ophthalmology Database data are expected to include some errors (mitigated by large multicentre data aggregations). The feasibility randomised controlled trial primary outcome (the cataract decision quality measure) displayed psychometric imperfections requiring refinement. The clinical occurrence of discordant outcomes is uncommon and the study team experienced difficulty identifying patients in this situation. Future work Future work could include regular review of the risk models for adverse outcomes to ensure currency, and the technical precision of complex-numbers analysis of refractive outcome to invite opportunities to improve post-operative spectacle-free vision. In addition, a fully powered randomised controlled trial of the cataract decision aid would be feasible, following psychometric refinement of the primary outcome (the cataract decision quality measure); this would clarify its potential role in routine service delivery. Conclusions In this research programme, evidence-based clinical tools have been successfully developed to improve pre-operative decision-making in cataract surgery. These include a psychometrically robust, patient-reported outcome measure (Cat-PROM5); prediction models for patient self-reported outcomes using Cat-PROM5; prediction models for clinically adverse surgical events and adverse visual acuity outcomes; and a cataract decision aid with relevant general information and personalised risk/benefit predictions. In addition, the successful mapping of Cat-PROM5 to existing health economic indices was achieved and the performances of indices were assessed in patients undergoing cataract surgery. A future full-powered randomised controlled trial of the cataract decision aid would be feasible (patients, n = 800, effect size 0.2 standard deviations, power 80%; p = 0.05). Trial registration This trial is registered as ISRCTN11309852. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information