Torsade de Pointes : a diagnostic pitfall

Torsade de pointes is an unusual arrhythmia which is found in certain well defined clinical situations. The authors present two cases of Torsade de pointes which were admitted on two consecutive days, where the diagnosis was not immediately appreciated. It is important that one should become familiar with the E.C.G. appearance and be aware of the possible aetiology so that appropriate treatment can be initiated.peer-reviewe

The influence of acute variable resistance loading on subsequent free-weight maximal squat performance

Elastic bands attached to a loaded barbell during a squat exercise create a variable resistance (VR), thus changing the mechanical loading and stress placed through the musculoskeletal system. Preconditioning the neuromuscular system using near-maximal or maximal voluntary contractions (MVC) can induce a phenomenon known as post-activation potentiation (PAP) to enhance performance to ‘supramaximal’ levels. However, the potentiating effects of VR on subsequent free-weight resistance (FWR) squat performance have not been examined. Thus, the aim of the present study was to examine the influence of VR exercise using elastic bands on subsequent FWR squat performance. Sixteen recreationally active men (age = 26.0 ± 7.8 yr, height = 1.7 ± 0.2 m, mass 82.6 ± 12.7 kg) experienced in squatting (>3yr) volunteered for the study after giving written informed consent; ethical approval was granted from the University of Northampton. Subjects’ 1-RM were determined then on two subsequent days either a 3-RM FWR (control) or a 3-RM VR (experimental) squat exercise was performed at 85% 1-RM (35% of the load generated from band tension in the VR condition). Five minutes later, motion analysis recorded knee joint kinematics during a subsequent FWR 1-RM squat, with vastus medialis, vastus lateralis, rectus femoris and semitendinosus electromyograms (EMG) simultaneously recorded. Paired t-tests were used to determine significance, accepted at p0.05) or EMG amplitude (5.9%; p>0.05) occurred. No subjects increased 1-RM in the FWR condition, however 13 of 16 (81%) increased 1-RM by ~10% following VR. Preconditioning the neuromuscular system using VR significantly increased 1-RM without changes in knee extensor muscle activity or knee flexion angle, however eccentric and concentric velocities were reduced. Thus, VR can potentiate the neuromuscular system to enhance subsequent maximal lifting performance. The lack of change in EMG suggests that changes in muscle activity were small or non-existent, which may be explained by force-velocity effects (slower movement = larger forces). Alternatively a greater activation of hip musculature (not measured in the present study) may allow a greater total lower limb force to be developed. Regardless, as 1-RM increased greater lower-limb loading occurred, thus VR potentiated the neuromuscular system and could enhance training stimuli

The influence of 6 weeks of maximal eccentric plantarflexor training on muscle-tendon mechanics

Resistance training can influence muscle-tendon properties including strength, flexibility, stretch tolerance and muscle-tendon stiffness; however the specific influence of eccentric-only training is unknown. Therefore, the aims of the present study were to examine the effects of a 6-week maximal eccentric resistance training programme on isometric plantarflexor moment (MVC), dorsiflexion range of motion (ROM), stretch tolerance (peak passive moment), muscle and tendon stiffness and running economy. Thirteen recreationally active men (age = 20.0 ± 0.9 yr, mass = 75.9 ± 8.5 kg, height = 1.8 ± 0.1 m) volunteered for the study after giving written informed consent; ethical approval was granted from the University of Northampton. Training was performed twice weekly for six weeks and consisted of 5 sets of 12 repetitions of 3-s maximal eccentric contractions at 10°•s-1 from 20° plantarflexion to 10° dorsiflexion. Maximal isometric plantarflexor moment, dorsiflexion ROM, stretch tolerance, and muscle, tendon and muscle-tendon unit (MTU) stiffness were measured using isokinetic dynamometry, real-time ultrasound and 3D motion analyses before and after the training. Running economy (VO2) was determined at a running speed equating to 70%VO2max using online gas analysis. Repeated measures t-tests were used to determine significant differences between pre- and post-training data, significance accepted at p0.05). Analysis of ultrasound data revealed a significant decrease in muscle stiffness (20.6%; p0.05). While the training-induced increase in plantarflexor strength was expected, the substantial increases in ROM, stretch tolerance and tendon stiffness, and the reduction in passive muscle stiffness, were important and novel findings. Interestingly, when measured during passive stretch, MTU stiffness remained unchanged while tendon stiffness increased and muscle stiffness decreased. These disparate findings have clear implications for testing methodologies, and indicate that imaging techniques must be utilised in order to examine the effects of interventions on specific tissues. As the training clearly enhanced the capacity of the muscle to tolerate both tissue loading and deformation, which are commonly associated with muscle strain injury, these data have clear implications for both muscular performance and injury risk

Recommendations for high intensity upper body exercise testing

Introduction: For given submaximal and maximal peak power outputs aerobic responses to upper body exercise are different to those for lower body exercise (Sawka, 1986: Exercise & Sport Sciences Reviews, 14, 175-211). However, much less is known regarding responses to exercise intensities at and around peak oxygen up take (VO2peak). Purpose: The purpose of this study was to determine the metabolic responses during arm crank ergometry (ACE) below, at and above peak oxygen uptake and to help establish exercise testing guidelines for high intensity upper body exercise. Methods: Following institutional ethical approval fourteen male students (Age 21.1, s = 6.1 years and 2.44 s=0.44 VO2peak) volunteered to take part in this study. Each participant exercised on a table mounted cycle ergometer (Monark 894E, Monark Exercise AB, Sweden). After habituation peak minute power (PMP) was calculated from an incremental test. Subsequently each participant completed four continuous work tests (CWT) to volitional exhaustion at 80%, 90%, 100% and 110% of PMP. All tests were completed at 70 rev∙min-1 with a minimum of 48-h between tests and the order was counterbalanced. Each CWT was preceded by a 5 min warm-up, loaded with a mass corresponding to the participants 80% PMP for 20 s at minutes 2, 3 and 4. Oxygen uptake (VO2), respiratory exchange ratio (RER), heart rate (HR) and ratings of perceived exertion for the arms (local (RPEL) and cardiorespiratory strain (RPECR) were recorded at 1 min, 2 min and at volitional exhaustion. The EMG responses at three sites (flexor carpi ulnaris, biceps brachii and triceps brachii lateral) were recorded using double-differential (16-3000 Hz bandwidth, x300 gain), bipolar, active electrodes (MP-2A, Linton, Norfolk, UK). Electromyographic data were sampled at 1000 Hz and filtered using a 20 to 500 Hz band-pass filter (MP150 Data Acquisition and AcqKnowledge 4.0, Biopac, Goleta, CA). The EMG signals for each muscle were root mean squared (RMS) with a 500-ms sample window. The signal was then normalised, prior to each CWT, as a percentage of the mean of 3 sets of 10 duty cycles completed during the warm-up (see above) when the participants 80% PMP for 20 s was applied. Time to exhaustion (Tlim) was recorded as the performance outcome measure. Data for Tlim were analysed using one-way analysis of variance. Differences in EMG, VO2, RER, HR, RPEL and RPECR were analysed using separate two-way analysis of variance with repeated measures (trial x time). All analyses were performed using the Statistical Package for Social Sciences ( 17.0; SPSS Inc., Chicago, IL). Individual differences in means were located using Bonferroni post-hoc correction. Significance was accepted at P < 0.05. Results: As resistive load increased Tlim decreased (611 s=194, 397 s=99, 268 s=90, 206 s=67s, respectively; P < 0.001, ES = 0.625). Post-hoc analysis revealed that Tlim using 80%PMP was longer than for 90%, 100% and 110% PMP trials (P < 0.001) and 90% was longer than both 100% and 110% PMP trials (P = 0.079, P = 0.001). At exhaustion VO2 was similar across trials (P = 0.413, ES = 0.053), although 80% PMP VO2 tended to be less (2.10 s=0.32 l·min-1) than for 90% (2.29 s=0.37), 100% (2.33 s=0.49) and 110% (2.26 s=0.34). Also, 80% PMP VO2 was less than VO2peak (P = 0.013). There were differences in RER at Tlim (P < 0.001, ES = 0.593) with values increasing with % PMP (1.15 s=0.07, 1.26 s=0.07, 1.36 s=0.10, 1.40 s=0.09, respectively). There were no differences across trials for HR at Tlim (~173 (12); P = 0.834, ES = 0.016) and HR was proportional to %PMP at 1 min, and 2 min. For flexor carpi ulnaris there was an increase in activation as exercise intensity increased (P < 0.001, ES = 0.245). There were a similar responses for biceps brachii and triceps brachii demonstrating an increase in activation with exercise intensity (P <0.001, ES = 0.137, P < 0.001, ES = 0.163, respectively). No differences for RPEL and RPECR were observed at Tlim. Discussion: There was a clear response of Tlim with intensity as expected for lower body exercise (Hill et al., 2002: Medicine and Science in Sports and Exercise, 34(4), 709-714). Despite differences in Tlim across exercise intensities VO2, HR and RPE were similar at exhaustion indicating a functional cardiorespiratory maximum had been reached. As indicated by the RER an increased activation of the anaerobic metabolism with greater exercise intensities (100% and 110%) is likely and therefore this may represent a greater anaerobic component at these two intensities. The increase in EMG activity with intensity could indicate an increase activity with an increase in exercise intensity. Conclusion: It is recommended that due to the combination of muscle activation, oxygen uptake and Tlim that an exercise intensity of 90% or 100% of PMP could be used for high intensity upper body exercise testing

Importance of descending skill for performance in fell races: a statistical analysis of race results

The ratio of uphill pace to downhill pace in a foot race up and down a single mountain is used as a measure of a competitor's descending skills-those qualities which are needed for fast descent but not for ascent. For the set of competitors in each of 44 races on seven courses of differing gradients and terrain roughnesses, we calculate the variance of this pace ratio and do linear regressions of pace ratio on finish time and on competitors' age. The variances tend to be greater for races on steeper and rougher terrain, indicating a greater influence of descending skills on actual descent speeds in these races. The regression analysis shows a clear negative correlation with finish time, indicating that faster finishers tend to be those with better descending skills, but there is little evidence of correlation with age. Significant differences between the sexes are only found in races on the most difficult terrain, where men display better descending skills than women

Pace and critical gradient for hill runners: an analysis of race records

Route choice through mountainous terrain requires a knowledge of how pace (the reciprocal of speed) varies with gradient of ascent or descent. To model this variation for runners, we analyse record times for 91 uphill and 15 downhill races or race stages. The pace is modelled as a nonlinear function of gradient and a linear function of race duration, using ordinary least squares to obtain a best fit. For the gradient-dependence, six functional forms are compared, of which a quartic is found to fit the data best; however, at steep gradients the quartic model is unrealistic and it may be argued that a linear model is more appropriate. Critical gradients, at which a runner's vertical speed (uphill or downhill) is maximised, may be calculated from a nonlinear model, although it appears that there is no uphill critical gradient within the range of our dataset. © 2012 American Statistical Association

The thermal boundary layer due to viscous dissipation in impulsively started Poiseuille flow

Viscous dissipation occurs in the boundary layers on the walls of a channel in which a flow is accelerated from rest by the sudden imposition of a pressure gradient. We analyse the thermal boundary layer due to this dissipative heating, obtaining numerical solutions and also asymptotic solutions for the cases of both large and small Prandtl number, with both isothermal and adiabatic wall conditions. With large Pr the temperature rise is controlled by the viscous layer, so is independent of Pr and of the wall condition. With small Pr heat is conducted away from the viscous layer more rapidly, so the temperature rise is reduced as Pr decreases

Thermobaric flow

Simple model flows demonstrating the combined effect of thermobaricity with either salinity variations or nonlinear temperature-dependence in the equation of state of water are investigated. An inviscid flow exhibits a three-layer behaviour, resulting in the formation of a mid-depth temperature maximum, such as is observed in some high-latitude oceans and deep lakes. This may be subsequently overtaken by nonlinear frontogenesis, which in the viscous case is shown to generate a thermal bar. Thermobaricity shifts the thermal bar towards the colder water, and initially produces a slope in the downwelling plume, but this transient feature disappears as the dominant frontogenesis tilts the plume backto the vertical

Pressure work and viscous dissipation in the equations of thermal convection in a vertical channel

Equations for fully developed flow in a vertical channel have been solved, taking into account viscous dissipation, and using formulations with and without pressure work. Perturbation solutions are used to distinguish the effects of viscous dissipation from pressure work. Viscous dissipation has very little effect on free convection flows driven by temperature differences or heat fluxes at the channel walls, but it may play a major role in forced convection

Frontogenesis in gravity-driven flows with non-uniform density gradients

A horizontal density gradient may be steepened to form a front if the horizontal flow which it drives is convergent. This convergence may be caused by an initial nonlinearity in the density gradient (as described by Simpson & Linden 1989). A quadratic density profile is analysed to illustrate the mechanism, and it is shown how the flow and the density profile interact to intensify and concentrate the front near a horizontal boundary. Linear and curved density profiles in a container of finite length are also studied: the most favourable location for frontogenesis is found to be where the flow emerges into a region of significant curvature after passing through a maximum of the density gradien