Improvement in Hemodynamic Responses to Metaboreflex Activation after One Year of Training in Spinal Cord Injured Humans

Spinal cord injured (SCI) individuals show an altered hemodynamic response to metaboreflex activation due to a reduced capacity to vasoconstrict the venous and arterial vessels below the level of the lesion. Exercise training was found to enhance circulating catecholamines and to improve cardiac preload and venous tone in response to exercise in SCI subjects. Therefore, training would result in enhanced diastolic function and capacity to vasoconstrict circulation. The aim of this study was to test the hypothesis that one year of training improves hemodynamic response to metaboreflex activation in these subjects. Nine SCI individuals were enrolled and underwent a metaboreflex activation test at the beginning of the study (T0) and after one year of training (T1). Hemodynamics were assessed by impedance cardiography and echocardiography at both T0 and T1. Results show that there was an increment in cardiac output response due to metaboreflex activity at T1 as compared to T0 (545.4 ± 683.9 mL · min(-1) versus 220.5 ± 745.4 mL · min(-1), P < 0.05). Moreover, ventricular filling rate response was higher at T1 than at T0. Similarly, end-diastolic volume response was increased after training. We concluded that a period of training can successfully improve hemodynamic response to muscle metaboreflex activation in SCI subjects

Periapical status in patients affected by osteoporosis: A retrospective clinical study

Objectives: To assess the periapical status in patients with osteoporosis (OP) treated with denosumab (D), bisphosphonates (BPs), or not on medication, and to understand if these conditions influence the prevalence and the progression of apical periodontitis (AP).Material and Methods: Seventy-six patients with OP alone or treated with D, or BPs, formed the study group (O), and those from 76 patients matched for age and sex, without diseases, and not taking medications, constituted the control (C) in this retrospective case-control study. The data from the complete clinical and radiographic examination, medical history, decayed, missing, and filled teeth (DMFT), and periapical index score (PAI) were recorded for each patient. Wilcoxon rank test, chi(2), and Student's t test were used as appropriate.Results: The prevalence of AP was similar in O and C. Furthermore, AP was significantly more frequent in root canal-treated teeth in O patients (p = .03).Conclusions: OP does not appear to be associated with the development of AP. Moreover, the increased prevalence of AP in root canal-treated teeth in O patients highlights a possible relationship between the healing dynamics of the disease post-therapy and the patients' medication. A larger sample is needed to confirm these findings

Diving response after a one-week diet and overnight fasting

Background: We hypothesized that overnight fasting after a short dietary period, especially with carbohydrates, could allow performing breath-hold diving with no restraint for diaphragm excursion and blood shift and without any increase of metabolism, and in turn improve the diving response. Methods: During two separate sessions, 8 divers carried out two trials: (A) a 30-m depth dive, three hours after a normal breakfast and (B) a dive to the same depth, but after following a diet and fasting overnight. Each test consisted of 3 apnea phases: descent, static and ascent whose durations were measured by a standard chronometer. An impedance cardiograph, housed in an underwater torch, provided data on trans-thoracic fluid index (TFI), stroke volume (SV), heart rate (HR) and cardiac output (CO). Mean blood pressure (MBP), arterial O-2 saturation (SaO(2)), blood glucose (Glu) and blood lactate (BLa) were also collected. Results: In condition B, duration of the static phase of the dive was longer than A (37.8 +/- 7.4 vs. 27.3 +/- 8.4 s respectively, P < 0.05). In static phases, mean Delta SV value (difference between basal and nadir values) during fasting was lower than breakfast one (-2.6 +/- 5.1 vs. 5.7 +/- 7.6 ml, P < 0.05). As a consequence, since mean. HR values were equally decreased in both metabolic conditions, mean. CO value during static after fasting was lower than the same phase after breakfast (-0.4 +/- 0.5 vs. 0.4 +/- 0.5 L . min(-1) respectively, P < 0.05). At emersion, despite the greater duration of dives during fasting, SaO(2) was higher than A (92.0 +/- 2.7 vs. 89.4 +/- 2.9 % respectively, P < 0.05) and BLa was lower in the same comparison (4.2 +/- 0.7 vs. 5.3 +/- 1.1 mmol L-1, P < 0.05). Conclusions: An adequate balance between metabolic and splancnic status may improve the diving response during a dive at a depth of 30 m, in safe conditions for the athlete's healt

Mean blood pressure assessment during post-exercise: Result from two different methods of calculation

At rest the proportion between systolic and diastolic periods of the cardiac cycle is about 1/3 and 2/3 respectively. Therefore, mean blood pressure (MBP) is usually calculated with a standard formula (SF) as follows: MBP = diastolic blood pressure (DBP) + 1/3 [systolic blood pressure (SBP) – DBP]. However, during exercise this proportion is lost because of tachycardia, which shortens diastole more than systole. We analysed the difference in MBP calculation between the SF and a corrected formula (CF) which takes into account changes in the diastolic and systolic periods caused by exercise-induced tachycardia. Our hypothesis was that the SF potentially induce a systematic error in MBP assessment during recovery after exercise. Ten healthy males underwent two exercise-recovery tests on a cycle-ergometer at mild-moderate and moderate-heavy workloads. Hemodynamics and MBP were monitored for 30 minutes after exercise bouts. The main result was that the SF on average underestimated MBP by –4.1 mmHg with respect to the CF. Moreover, in the period immediately after exercise, when sustained tachycardia occurred, the difference between SF and CF was large (in the order of -20-30 mmHg). Likewise, a systematic error in systemic vascular resistance assessment was present. It was concluded that the SF introduces a substantial error in MBP estimation in the period immediately following effort. This equation should not be used in this situation

Assessment of the specificity of cardiopulmonary response during tethered swimming using a new snorkel device

This study aimed at comparing maximal oxygen uptake (VO2max), maximal heart rate (HRmax), and anaerobic threshold (AT) obtained from tethered swimming (SW) and three other testing procedures: cycling (CY), running (RU), and arm cranking (AC). Variables were assessed in 12 trained male swimmers by a portable gas analyzer connected to a modified snorkel system to allow expired gases collection during swimming. Athletes exhibited a higher VO2max during the SW test as compared to the CY and the AC tests. There was no significant difference in VO2max between the SW and the RU test, but the Bland and Altman plot highlighted a poor agreement between results. Moreover, AT occurred at higher workloads during SW in comparison to the other tests. These results do not support the use of any unspecific testing procedures to estimate VO2max, HRmax, and AT for swimming

Nervous facilitation in cardiodynamic response of exercising athletes to superimposed mental tasks: implications in depressive disorder

Introduction : Motor commands to perform exercise tasks may also induce activation of cardiovascular centres to supply the energy needs of the contracting muscles. Mental stressors per se may also influence cardiovascular homeostasis. We investigated the cardiovascular response of trained runners simultaneously engaged in mental and physical tasks to establish if aerobically trained subjects could develop, differently from untrained ones, nervous facilitation in the brain cardiovascular centre. Methods : Cardiovascular responses of 8 male middle-distance runners (MDR), simultaneously engaged in mental (colour-word interference test) and physical (cycle ergometer exercise) tasks, were compared with those of 8 untrained subjects. Heart rate, cardiac (CI) and stroke indexes were assessed by impedance cardiography while arterial blood pressures were assessed with a brachial sphygmomanometer. Results : Only in MDR simultaneous engagement in mental and physical tasks induced a significant CI increase which was higher (p<0.05) than that obtained on summing CI values from each task separately performed. Conclusion : Aerobic training, when performed together with a mental effort, induced a CI oversupply which allowed a redundant oxygen delivery to satisfy a sudden fuel demand from exercising muscles by utilizing aerobic sources of ATP, thus shifting the anaerobic threshold towards a higher work load. From data of this study it may also be indirectly stated that, in patients with major depressive disorder, the promotion of regular low-intensity exercise together with mental engagement could ameliorate the perceived physical quality of life, thus reducing their heart risk associated with physical stress

EFFECTS OF SIX MONTHS TRAINING ON PHYSICAL CAPACITY AND METABOREFLEX ACTIVITY IN PATIENTS WITH MULTIPLE SCLEROSIS.

Patients with multiple sclerosis (MS) have an increased systemic vascular resistance (SVR) response during the metaboreflex. It has been hypothesized that this is the consequence of a sedentary lifestyle secondary to MS. The purpose of this study was to discover whether a 6-month training program could reverse this hemodynamic dysregulation. Patients were randomly assigned to one of the following two groups: the intervention group (MSIT, n = 11), who followed an adapted training program: and the control group (MSCTL, n = 10), who continued with their sedentary lifestyle. Cardiovascular response during the metaboreflex was evaluated using the post-exercise muscle ischemia (PEMI) method and during a control exercise recovery (CER) test. The difference in hemodynamic variables such as stroke volume (SV), cardiac output (CO), and SVR between the PEMI and the CER tests was calculated to assess the metaboreflex response. Moreover, physical capacity was measured during a cardiopulmonary test till exhaustion. All tests were repeated after 3 and 6 months (T3 and T6, respectively) from the beginning of the study. The main result was that the MSIT group substantially improved parameters related to physical capacity (+5.31 +/- 5.12 ml-min(-1)/kg in maximal oxygen uptake at T6) in comparison with the MSCTL group (-0.97 +/- 4.89 ml.min(-1)/kg at T6; group effect: p = 0.0004). However, none of the hemodynamic variables changed in response to the metaboreflex activation. It was concluded that a 6-month period of adapted physical training was unable to reverse the hemodynamic dys-regulation in response to metaboreflex activation in these patients

Impact of NOx and NH3 Emission Reduction on Particulate Matter across Po Valley: A LIFE-IP-PREPAIR Study

Air quality in Europe continues to remain poor in many areas, with regulation limits often exceeded by many countries. The EU Life-IP PREPAIR Project, involving administrations and environmental protection agencies of eight regions and three municipalities in Northern Italy and Slovenia, was designed to support the implementation of the regional air quality plans in the Po Valley, one of the most critical areas in Europe in terms of pollution levels. In this study, four air quality modelling systems, based on three chemical transport models (CHIMERE, FARM and CAMx) were applied over the Po Valley to assess the sensitivity of PM2.5 concentrations to NOx and NH3 emission reductions. These two precursors were reduced (individually and simultaneously) from 25% up to 75% for a total of 10 scenarios, aimed at identifying the most efficient emission reduction strategies and to assess the non-linear response of PM2.5 concentrations to precursor changes. The multi-model analysis shows that reductions across multiple emission sectors are necessary to achieve optimal results. In addition, the analysis of non-linearities revealed that during the cold season, the efficiency of PM2.5 abatement tends to increase by increasing the emission reductions, while during summertime, the same efficiency remains almost constant, or slightly decreases towards higher reduction strengths. Since the concentrations of PM2.5 are greater in winter than in summer, it is reasonable to infer that significant emission reductions should be planned to maximise reduction effectiveness

Assessing the impacts and feasibility of emissions reduction scenarios in the Po Valley

This study is focused on a pivotal objective: enhancing air quality and attaining pollutant concentrations in accordance with WHO guidelines. The study extensively evaluates the feasibility of reducing emissions, specifically targeting an 80% decrease in SOX, NOX, PM, NH3, and NMVOC emissions within a limited timeframe. Despite notable emission curtailments of 50% and 80%, the research reveals that recommended pollutant levels are unlikely to be met across most areas of the Po Valley region. Even when implementing the finest available technologies across various sectors, particularly within the Lombardia region, this goal remains unattainable without simultaneous reductions in activity levels. This involves diminishing factors like vehicle miles traveled, energy consumption for heating, and industrial, agricultural, and livestock production. Overall, achieving improved conforming to the new AQG limits is a multifaceted endeavor involving numerous stakeholders and diverse strategies. Successful adherence to Air Quality limits mandates the implementation of Source-Specific emissions standards at the EU level, alignment of the National Emission Reduction Directive with limits specified in the Air Quality Directive, and the formulation of comprehensive Air Quality Plans at national, regional, and local tiers