Impact of ozone-pollution and heat on athletic performance and pulmonary responses

Epidemiological studies have reported that ozone-pollution has a negative impact on human health. This pollutant is associated with high temperatures and is expected to continue to rise with the predicted global warming. People and athletes that exercise outdoors are of particular concern because, the more intense and the more prolonged the activity, the higher the ozone dose delivered to the lungs and potentially the higher the risk for performance impairment, lung function decrement, onset of lung inflammation, lung injury and oxidative stress. The main aim of the studies contained in this thesis was to evaluate the impact of ozone-pollution (0.1 ppm), heat and humidity on well trained runners taking part in an 8 km time trial run. Different end points were investigated for an analysis of the impact on performance outcome, lung function, lung inflammation and oxidative stress. In addition, a second aim was to investigate whether a 2-week supplementation period of vitamin C (500 mg•day-1) and vitamin E (100 IU•day-1) would provide any beneficial effects to the participants. The participants’ lung function was measured by spirometry. Lung inflammation and oxidative stress status were assessed by a variety of markers both in the upper respiratory airways, by nasal lavage, and in the plasma. The markers assessed included: neutrophil count, clara cell protein (CC16), interleukin-8 (IL-8), uric acid, GSH/Protein and trolox equivalent antioxidant capacity. The results showed that the athletes performance was significantly decreased in the hot and humid condition (mean ± SD: 32min 35sec ± 2min 25sec) and in the hot, humid and ozone-polluted condition (33min 09sec ± 2min 44sec) when compared with the ozone alone condition (30min 27sec ± 2min 23sec) and the control condition (30min 15sec ± 1min 58seg). Ozone alone had little effect on the performance variable. The participants’ lung function was not affected by the adverse environmental conditions. Evidence of early lung epithelial injury, however, was observed by an increase in CC16 in the upper respiratory airways immediately after the exercise trial in the hot, humid and ozone-polluted environment; though this was not observed for any other marker of inflammation at this time point. In this same adverse environmental condition, an increase in the GSH/Protein concentration in the upper respiratory airways was found immediately after the exercise. It was observed that the 2-week supplementation protocol improved the runners’ time to complete the 8 km time-trial run in the hot, humid and ozone-polluted environment by 2.6%. In addition, the supplementation was shown to be effective in decreasing the lung inflammation induced by the combination of ozone pollution, heat and intense exercise. This was observed by a smaller increase in the concentration of CC16 in both the upper respiratory airways (0.67 ± 0.5 mg•l-1) and plasma (39.4 ± 17.4 ng•ml-1) in the vitamin treatment compared to the placebo. In addition, in the vitamin treatment the, cortisol concentration (29.2 ± 14.8 ng•ml-1) after the run, the IL-8 concentration (75.8 ± 43.2 pg•ml-1) and neutrophil percentage (22.6 ± 17.2 %) in the airways 6 h after the run were also reduced compared to the values in the placebo treatment (49.9 ± 13.4 ng•ml-1; 126.6 ± 103.2 pg•ml-1; 25.2 ± 22.6 % respectively). Taken into consideration together, these results provide evidence that heat and humidity combined with ozone have a detrimental effect on athletes’ performance in an 8 km time trial, it cannot be discounted that this was simply due to the heat and humidity as there was no differences in the two heat performances. The hot, humid and ozone environment elicited an early epithelial damage characterized by increase in CC16 concentration in the airways. Moreover, an increase in the antioxidant concentration in the upper respiratory airways in that same trial, as indicated by the nasal lavage GSH/protein, suggests a protective mechanism against the oxidative stress stimulated by the high intensity exercise in association with ozone, heat and humidity. Heat and humidity alone had a similar detrimental effect in performance. While, ozone alone had little effect on the variables. In addition, it can be suggested that 2 weeks of a low dosage of vitamin C and E supplementation might present some benefits for the performance outcome and immune system of trained individuals when taking part in a running competition in an ozone-polluted, hot and humid environment. These benefits will, however, depend on the regulation of the antioxidants uptake and metabolism of each subject

Effects of a 10 km race on physiological and immunological responses

Introduction: The number of 10 km running races has been increasing in Brazil and the number of finishers almost triplicated in the last decade. However, there is limited amount of data showing the relationship between this event and the immune system response. Aim: Investigate the effects of a 10 km running race on physiological and immunological response in healthy well trained male volunteers. Methods: Fourteen male participants (32,21 ± 10,24 years old, 78,80 ± 9,30 kg) took part in this study. Ratings of perceived exertion (RPE), visual analog scale (VAS), heart rate (HR) and blood samples were taken before, immediately and 24 hours after the race. Lactate, glucose, creatine kinase (CK) and C-reactive protein (CRP), as well as leukocyte number and subpopulation of T cell (CD4+ and CD8+) were analyzed. Results: Participants completed this race in 49,85 ± 7,04 min. There was a significant increase post-race compared to pre-race for HR (67 ± 9 to 159 ± 21 bpm), RPE (6 ± 0 to 15 ± 2) and lactate (3.6 to 6.6 mmol/dL). Glucose levels did not present any significant changes. CK level did not change immediately after the race, but was higher (131,21 ± 62,50 to 286,85 ± 234,35 U/L ) at the 24 h post-race time point. CRP was lower at 24 h (8,37 ± 2,23 to 4,50 ± 2,28 mg/dL). VAS values changed from 0 (before) to 5,64 ± 2,20 (immediately after) to 2,21 ± 2,86 (24 hours). The number of circulating leukocyte (5,83 ± 0,89 to 9,15 ± 1,77 103/µL), neutrophil (2,96 ± 0,49 to 4,34 ± 0,73 103/µL), lymphocyte (2,21 ± 0,57 to 3,92 ± 1,27 103/µL), monocyte (0,46 ± 0,10 to 0,64 ± 0,23 103/µL) and basophil (0,05 ± 0,02 to 0,09 ± 0,03 103/µL) increased significantly immediately after the race, returning to the basal level in 24 h. There was no difference in circulating eosinophils number. The absolute number of CD4+ (828,5 ± 215,8 to 1063,2 ± 235,3 cell/µL) and CD8+ (766,92 ± 347,79 to 1470,30 ± 782,90 cell/µL) also increased immediately after the race returning to basal in 24 h. Significant reduction of the CD4+/CD8+ lymphocyte subpopulation ratio (1,21 ± 0,45 to 0,85 ± 0,33 cell/µL) was observed post-race returning to basal level at 24 h post-race. Results are presented as mean ± SD. (p\u3c0,0001). Conclusion: These results suggest that a 10 km running race is an intense physical activity and induces physiological changes. In addition, intense running provokes a significantly, although transient, modulation of the immune system, specifically of leukocyte sub-population

Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic

Objective: To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms. Methods: A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study – mostly young adult women holding university degrees. Results: The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively). Conclusion: The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Impact of ozone-pollution and heat on athletic performance and pulmonary responses

Epidemiological studies have reported that ozone-pollution has a negative impact on human health. This pollutant is associated with high temperatures and is expected to continue to rise with the predicted global warming. People and athletes that exercise outdoors are of particular concern because, the more intense and the more prolonged the activity, the higher the ozone dose delivered to the lungs and potentially the higher the risk for performance impairment, lung function decrement, onset of lung inflammation, lung injury and oxidative stress. The main aim of the studies contained in this thesis was to evaluate the impact of ozone-pollution (0.1 ppm), heat and humidity on well trained runners taking part in an 8 km time trial run. Different end points were investigated for an analysis of the impact on performance outcome, lung function, lung inflammation and oxidative stress. In addition, a second aim was to investigate whether a 2-week supplementation period of vitamin C (500 mg•day-1) and vitamin E (100 IU•day-1) would provide any beneficial effects to the participants. The participants' lung function was measured by spirometry. Lung inflammation and oxidative stress status were assessed by a variety of markers both in the upper respiratory airways, by nasal lavage, and in the plasma. The markers assessed included: neutrophil count, clara cell protein (CC16), interleukin-8 (IL-8), uric acid, GSH/Protein and trolox equivalent antioxidant capacity. The results showed that the athletes performance was significantly decreased in the hot and humid condition (mean ± SD: 32min 35sec ± 2min 25sec) and in the hot, humid and ozone-polluted condition (33min 09sec ± 2min 44sec) when compared with the ozone alone condition (30min 27sec ± 2min 23sec) and the control condition (30min 15sec ± 1min 58seg). Ozone alone had little effect on the performance variable. The participants' lung function was not affected by the adverse environmental conditions. Evidence of early lung epithelial injury, however, was observed by an increase in CC16 in the upper respiratory airways immediately after the exercise trial in the hot, humid and ozone-polluted environment; though this was not observed for any other marker of inflammation at this time point. In this same adverse environmental condition, an increase in the GSH/Protein concentration in the upper respiratory airways was found immediately after the exercise. It was observed that the 2-week supplementation protocol improved the runners' time to complete the 8 km time-trial run in the hot, humid and ozone-polluted environment by 2.6%. In addition, the supplementation was shown to be effective in decreasing the lung inflammation induced by the combination of ozone pollution, heat and intense exercise. This was observed by a smaller increase in the concentration of CC16 in both the upper respiratory airways (0.67 ± 0.5 mg•l-1) and plasma (39.4 ± 17.4 ng•ml-1) in the vitamin treatment compared to the placebo. In addition, in the vitamin treatment the, cortisol concentration (29.2 ± 14.8 ng•ml-1) after the run, the IL-8 concentration (75.8 ± 43.2 pg•ml-1) and neutrophil percentage (22.6 ± 17.2 %) in the airways 6 h after the run were also reduced compared to the values in the placebo treatment (49.9 ± 13.4 ng•ml-1; 126.6 ± 103.2 pg•ml-1; 25.2 ± 22.6 % respectively). Taken into consideration together, these results provide evidence that heat and humidity combined with ozone have a detrimental effect on athletes' performance in an 8 km time trial, it cannot be discounted that this was simply due to the heat and humidity as there was no differences in the two heat performances. The hot, humid and ozone environment elicited an early epithelial damage characterized by increase in CC16 concentration in the airways. Moreover, an increase in the antioxidant concentration in the upper respiratory airways in that same trial, as indicated by the nasal lavage GSH/protein, suggests a protective mechanism against the oxidative stress stimulated by the high intensity exercise in association with ozone, heat and humidity. Heat and humidity alone had a similar detrimental effect in performance. While, ozone alone had little effect on the variables. In addition, it can be suggested that 2 weeks of a low dosage of vitamin C and E supplementation might present some benefits for the performance outcome and immune system of trained individuals when taking part in a running competition in an ozone-polluted, hot and humid environment. These benefits will, however, depend on the regulation of the antioxidants uptake and metabolism of each subject.EThOS - Electronic Theses Online ServiceGBUnited Kingdo