Submaximal oxygen uptake efficiency slope as a predictor of VO2max in men with cardiovascular disease

Purpose: Although V̇O2 max is considered the gold standard measure of cardiorespiratory fitness (CRF), it can be difficult to attain in patients with cardiovascular disease (CVD). The submaximal oxygen uptake efficiency slope (OUES) integrates cardiovascular, musculoskeletal and respiratory function during incremental exercise into a single index and has been proposed as an alternative and effort independent measure of cardiopulmonary reserve (Baba et al., 1996). The purpose of this study was to examine the relation between V̇O2 max and both submaximal absolute OUES and relative OUES (OUES.kg-1). Methods: A total of 55 men ((mean ± SD) age, 59.08 ± 9.03 yr; VO2 max, 1.94 ± 0.53 L.min-1and 22.73 ± 5.95 mL.kg-1.min-1) were recruited during induction to a community based exercise referral program following completion of phase 2 cardiac rehabilitation. Participants performed a graded exercise test on a cycle ergometer with breath-by-breath open circuit spirometry and a 12 lead ECG. Absolute OUES and OUES.kg-1 were calculated by plotting VO2 in mL.min-1 on the x-axis, and the log transformed VE on the y-axis (VO2 = a log 10 VE + b). Exercise data up to the ventilatory anaerobic threshold (VAT) was included in the analysis. Results: The %V̇O2 max corresponding to the VAT was 55.72 ± 11.81. Absolute OUES and OUES.kg-1 were 2164.42 ± 540.96 and 25.28 ± 5.99, respectively. There was a significant positive correlation between V̇O2 max (L.min-1) and OUES (r= 0.775; p<0.001) and between V̇O2 max (mL.kg-1.min-1) and OUES.kg-1 (r= 0.78; p<0.001). Conclusion: Determination of V̇O2 max is not often feasible in individuals with CVD where maximal exercise testing is contraindicated or when performance may be impaired by pain, dyspnea or angina. The findings from the present study indicate that the OUES and OUES.kg-1 are significantly related to absolute and relative V̇O2 max, respectively and may be used as a valid sub maximal effort independent measure of CRF

Relation between physical activity and oxygen uptake efficiency in men with CVD

Purpose: The oxygen uptake efficiency slope (OUES) represents the rate of increase in V̇O2 in response to a given V̇E during incremental exercise, indicating how effectively oxygen is taken in by the lungs, transported and used in the periphery. OUES, calculated using only submaximal exercise data is identical to the OUES calculated over the entire duration of a cardiopulmonary exercise test (CEPT) , and both maximal and submaximal OUE are significantly related to cardiorespiratory fitness (CRF) measured as V̇O2peak. Currently, little research has been published on how physical activity (PA) assessed by accelerometers is related to submaximal and maximal OUES. The purpose of this study was to determine the relation light (LIPA), moderate (MIPA) and vigorous (VIPA) intensity physical activity and maximal and submaximal OUES in men with cardiovascular disease (CVD). Methods: A total of 56 men (mean ( SD): age of 59.3 ± 9.2 yr., V̇O2 peak (L/min) 2.0 0.50, V̇O2 peak (mL/kg/min) 23.6 5.8, were recruited during an induction to a community-based exercise referral program following completion of phase 2 cardiac rehabilitation program. Participants underwent a graded exercise test on a cycle ergometer with breath by breath open circuit spirometry after which they wore a wrist worn accelerometer (Actigraph) for 7 d. Absolute and relative submaximal and maximal OUES were calculated by plotting V̇O2 in mL/min on the x axis, and the log transformed VE on the y axis (V̇O2 = a log 10 VE + b). Exercise data up to the ventilatory anaerobic threshold and maximal exercise were used to calculate submaximal and maximal OUE, respectively. Results: Participants performed 584.49 73.87 min of daily LIPA, 145.45 60.85 min of MIPA and no daily min of VIPA. There was a significant relation between absolute submaximal OUES (r=0.386; p<0.01), submaximal OUES/Kg (r=0.296; p<0.05) and LIPA. There was a significant relation between maximal OUES (r=0.286; p<0.05), maximal OUES/Kg (r=0.279; p<0.05) and MIPA. Conclusion: Submaximal and maximal OUE are related to levels of LIPA and MIPA, respectively. Submaximal OUES can potentially be used as an objective, effort independent test to estimate LIPA levels among men with CVD

Physical activity patterns and cardiorespiratory fitness in men with cardiovascular disease

Purpose: Cardiorespiratory fitness (CRF) is generally regarded as an objective and reproducible measure of recent habitual physical activity (PA). Considering that the majority of daily PA is performed at light intensity, it is likely that CRF benefits will be detected at submaximal rather than maximal exercise. The purpose of this study was to evaluate daily minutes of light (LIPA), moderate (MIPA) and vigorous (VIPA) intensity physical activity among men with cardiovascular disease (CVD), and to determine the relation between PA and submaximal (oxygen uptake efficiency slope (OUES)) and maximal (V̇O2 peak) indices of CRF. Methods: A total 32 male participants (mean ( SD): age of 60.0 ± 8.7 yr, V̇O2 peak (L/min) 2.0 0.45, V̇O2 peak (mL/kg/min) 23.3 5.7, were recruited during an induction to a community based exercise referral program following completion of phase 2 cardiac rehabilitation. Participants underwent a graded exercise test on a cycle ergometer with breath by breath open circuit spirometry after which they wore a wrist worn accelerometer (Actigraph) for 7 d. Absolute and relative submaximal OUES were calculated by plotting V̇O2 in mL/min on the x axis, and the log transformed VE on the y axis (V̇O2 = a log 10 VE + b). Exercise data up to the ventilatory anaerobic threshold was included in the analysis. Results: Participants performed 589.05 69.41 min of daily LIPA, 161.38 66.16 min of MIPA and no daily min of VIPA. There was no significant relation between peak V̇O2 and either LIPA or MIPA. There was a significant correlation between submaximal OUES (r=0.44; p<0.01) and LIPA. The relation between submaximal OUES/kg and LIPA min almost reached statistical significance (r=0.33; p<0.07). There was no significant relation between MIPA and OUES or OUES/kg. Conclusion: Men with CVD spend the majority (78%) of their day performing LIPA. OUES, a submaximal measure of CRF was related LIPA whereas no relation was found between V̇O2 peak and LIPA

Analysis of shared heritability in common disorders of the brain

ience, this issue p. eaap8757 Structured Abstract INTRODUCTION Brain disorders may exhibit shared symptoms and substantial epidemiological comorbidity, inciting debate about their etiologic overlap. However, detailed study of phenotypes with different ages of onset, severity, and presentation poses a considerable challenge. Recently developed heritability methods allow us to accurately measure correlation of genome-wide common variant risk between two phenotypes from pools of different individuals and assess how connected they, or at least their genetic risks, are on the genomic level. We used genome-wide association data for 265,218 patients and 784,643 control participants, as well as 17 phenotypes from a total of 1,191,588 individuals, to quantify the degree of overlap for genetic risk factors of 25 common brain disorders. RATIONALE Over the past century, the classification of brain disorders has evolved to reflect the medical and scientific communities' assessments of the presumed root causes of clinical phenomena such as behavioral change, loss of motor function, or alterations of consciousness. Directly observable phenomena (such as the presence of emboli, protein tangles, or unusual electrical activity patterns) generally define and separate neurological disorders from psychiatric disorders. Understanding the genetic underpinnings and categorical distinctions for brain disorders and related phenotypes may inform the search for their biological mechanisms. RESULTS Common variant risk for psychiatric disorders was shown to correlate significantly, especially among attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (MDD), and schizophrenia. By contrast, neurological disorders appear more distinct from one another and from the psychiatric disorders, except for migraine, which was significantly correlated to ADHD, MDD, and Tourette syndrome. We demonstrate that, in the general population, the personality trait neuroticism is significantly correlated with almost every psychiatric disorder and migraine. We also identify significant genetic sharing between disorders and early life cognitive measures (e.g., years of education and college attainment) in the general population, demonstrating positive correlation with several psychiatric disorders (e.g., anorexia nervosa and bipolar disorder) and negative correlation with several neurological phenotypes (e.g., Alzheimer's disease and ischemic stroke), even though the latter are considered to result from specific processes that occur later in life. Extensive simulations were also performed to inform how statistical power, diagnostic misclassification, and phenotypic heterogeneity influence genetic correlations. CONCLUSION The high degree of genetic correlation among many of the psychiatric disorders adds further evidence that their current clinical boundaries do not reflect distinct underlying pathogenic processes, at least on the genetic level. This suggests a deeply interconnected nature for psychiatric disorders, in contrast to neurological disorders, and underscores the need to refine psychiatric diagnostics. Genetically informed analyses may provide important "scaffolding" to support such restructuring of psychiatric nosology, which likely requires incorporating many levels of information. By contrast, we find limited evidence for widespread common genetic risk sharing among neurological disorders or across neurological and psychiatric disorders. We show that both psychiatric and neurological disorders have robust correlations with cognitive and personality measures. Further study is needed to evaluate whether overlapping genetic contributions to psychiatric pathology may influence treatment choices. Ultimately, such developments may pave the way toward reduced heterogeneity and improved diagnosis and treatment of psychiatric disorders

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 &lt; 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)

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo