Hypohydration impairs endurance performance: a blinded study

The general scientific consensus is that starting exercise with hypohydration >2% body mass impairs endurance performance/capacity, but most previous studies might be confounded by a lack of subject blinding. This study examined the effect of hypohydration in a single blind manner using combined oral and intragastric rehydration to manipulate hydration status. After familiarization, seven active males (mean ±SD: age 25± 2 years, height 1.79±0.07, body mass 78.6±6.2, VO2peak 48 ±7 mL.kg.min -1) completed two randomized trials at 34°C. Trials involved an intermittent exercise preload (8x15 min exercise/5 min rest), followed by a 15-min all-out performance test on a cycle ergometer. During the preload, water was ingested orally every 10 min (0.2 mL.kg body mass -1). Additional water was infused into the stomach via a gastric feeding tube to replace sweat loss (EU) or induce hypohydration of ~2.5% body mass (HYP). Blood samples were drawn and thirst sensation rated before, during, and after exercise. Body mass loss during the preload was greater (2.4 ±0.2% vs. 0.1± 0.1%; P < 0.001), while work completed during the performance test was lower (152± 24 kJ vs. 165 ±22 kJ; P < 0.05) during HYP. At the end of the preload, heart rate, RPE, serum osmolality, and thirst were greater and plasma volume lower during HYP (P < 0.05). These results provide novel data demonstrating that exercise performance in the heat is impaired by hypohydration, even when subjects are blinded to the intervention

Iron deficiency for prognosis in acute coronary syndrome – a systematic review and meta-analysis

Background: Iron deficiency (ID) is an important predictor of adverse outcomes in patients with heart failure, however it is unclear whether ID also affects prognosis in patients with acute coronary syndrome (ACS). The aim of this systematic review and meta-analysis was to assess the prognostic value of iron deficiency in patients with ACS. Methods: We searched PubMed, Web of Science, and the Cochrane library and included cohort studies of patients with ACS that were stratified by ID status. There were no restrictions on definition of ACS or ID. Studies were systematically appraised and data extracted by two independent reviewers. Meta-analysis was performed where two or more studies reported on the same pre-determined outcome measure. Results: Seven studies with 2821 participants were identified, reporting a high prevalence of ID in the ACS population. Three studies reported worse long-term outcomes in the ID population, whereas short-term outcomes were heterogeneous across studies. Conclusions: Patients with ID presenting with ACS may have a worse long-term prognosis but more studies are required for confirmation. A role for ID in prognosis of patients with ACS and as a potentially treatable condition may have implication for the current management of this patient population

Effects of intravenous iron replacement therapy on cardiovascular outcomes in patients with heart failure: A systematic review and meta-analysis

(1) Background: Iron deficiency (ID) is an important adverse prognostic marker in patients with heart failure (HF); however, it is unclear whether intravenous iron replacement reduces cardiovascular mortality in this patient group. Here, we estimate the effect of intravenous iron replacement therapy on hard clinical outcomes following the publication of IRONMAN, the largest trial in this field. (2) Methods: In this systematic review and meta-analysis, prospectively registered with PROSPERO and reported according to PRISMA guidelines, we searched PubMed and Embase for randomized controlled trials investigating intravenous iron replacement in patients with HF and co-existing ID. The primary outcome was cardiovascular mortality and secondary outcomes were all-cause mortality, hospitalizations for HF and a combination of the primary outcome and hospitalizations for HF. (3) Results: A total of 1671 items were identified and after removal of duplicates we screened titles and abstracts of 1202 records. Some 31 studies were identified for full-text review and 12 studies were included in the final review. The odds ratio (OR) for cardiovascular death using a random effects model was 0.85 (95% CI 0.69 to 1.04) and for all-cause mortality it was 0.83 (95% CI 0.59 to 1.15). There was a significant reduction in hospitalizations for HF (OR 0.49, 95% CI 0.35 to 0.69) and the combination of hospitalizations for HF and cardiovascular death (OR 0.65, 95% CI 0.5 to 0.85). (4) Conclusions: This review supports the use of IV iron replacement reducing hospitalization rates for HF, however more research is required to determine the effect on cardiovascular mortality and to identify the patient population most likely to benefit

Prognostic value of three iron deficiency definitions in patients with advanced heart failure

Aims: There is uncertainty about the definition of iron deficiency (ID) and the association between ID and prognosis in patients with advanced heart failure. We evaluated three definitions of ID in patients referred for heart transplantation. Methods and results: Consecutive patients assessed for heart transplantation at a single UK centre between January 2010 and May 2022 were included. ID was defined as (1) serum ferritin concentration of <100 ng/ml, or 100–299 ng/ml with transferrin saturation <20% (guideline definition), (2) serum iron concentration ≤13 μmol/L, or (3) transferrin saturation <20%. The primary outcome measure was a composite of all-cause mortality, urgent heart transplantation or need for mechanical circulatory support. Overall, 801 patients were included, and the prevalence of ID was 39–55% depending on the definition used. ID, defined by either serum iron or transferrin saturation, was an independent predictor of the primary outcome measure (hazard ratio [HR] 1.532, 95% confidence interval [CI] 1.264–1.944, and HR 1.595, 95% CI 1.323–2.033, respectively), but the same association was not seen with the guideline definition of ID (HR 1.085, 95% CI 0.8827–1.333). These findings were robust in multivariable Cox regression analysis. ID, by all definitions, was associated with lower 6-min walk distance, lower peak oxygen consumption, higher intra-cardiac filling pressures and lower cardiac output. Conclusions: Iron deficiency, when defined by serum iron concentration or transferrin saturation, was associated with increased frequency of adverse clinical outcomes in patients with advanced heart failure. The same association was not seen with guideline definition of ID

Accountability and Democratic Legitimacy in European Union Economic Governance:From the Euro Crisis to the Pandemic and Beyond

This article looks at the measures that were adopted in response to the euro crisis and the COVID-19 pandemic and their implications for accountability and democratic legitimacy in the area of Economic and Monetary Union (EMU). The discussion begins with the legitimacy issues that were facing the EMU/the European Union in the aftermath of the euro crisis, as well as the accountability and transparency arrangements obtained in the area of European Union economic governance. The focus then shifts to the further evolution of the Economic Union (the “E” of EMU), as triggered by the European Union’s response to the pandemic. The relevant section does not purport to provide a detailed exegesis of the powers of the Unioninstitutions, bodies, offices and agencies (and their domestic-level, principally technocratic, counterparts) in all sub-fields of EMU. It rather aims to illustrate the significance of their ever-expanding tasks, as well as the need for the exercise of those powers to be subject to robust accountability and transparency arrangements. Accordingly, the discussion of the key features of these novel measures is followed by analysis of the accountability arrangements that are enshrined therein or accompany them, as well as their implications for thelegitimacy of EMU/the European Union. It will be shown that, although some progress has been made in terms of accountability and transparency, plenty of gaps remain. The penultimate section will provide a glimpse into what the future may bring for EMU, thereby looking at other suggested reforms that could be implemented in order to further “deepen” EMU. It will be argued that those reform plans emanating from (or under consideration by) the European Union institutions have not always placed enough emphasis on the need for robust accountability and transparency arrangements and that their potentially far-reaching nature bolsters the argument made in this article that such arrangements are indispensable. It will be concluded that our assessment of the degree of accountability and democratic legitimacy in this area varies depending on the aspects of crisis reforms one focuses on. It is further argued that the empowerment of the European Parliament (and, where appropriate, of national parliaments) in EMU matters must continue in the future, especially as more reforms are implemented to ensure a robust EMU framework

Accountability and Democratic Legitimacy in European Union Economic Governance:From the Euro Crisis to the Pandemic and Beyond

This article looks at the measures that were adopted in response to the euro crisis and the COVID-19 pandemic and their implications for accountability and democratic legitimacy in the area of Economic and Monetary Union (EMU). The discussion begins with the legitimacy issues that were facing the EMU/the European Union in the aftermath of the euro crisis, as well as the accountability and transparency arrangements obtained in the area of European Union economic governance. The focus then shifts to the further evolution of the Economic Union (the “E” of EMU), as triggered by the European Union’s response to the pandemic. The relevant section does not purport to provide a detailed exegesis of the powers of the Unioninstitutions, bodies, offices and agencies (and their domestic-level, principally technocratic, counterparts) in all sub-fields of EMU. It rather aims to illustrate the significance of their ever-expanding tasks, as well as the need for the exercise of those powers to be subject to robust accountability and transparency arrangements. Accordingly, the discussion of the key features of these novel measures is followed by analysis of the accountability arrangements that are enshrined therein or accompany them, as well as their implications for thelegitimacy of EMU/the European Union. It will be shown that, although some progress has been made in terms of accountability and transparency, plenty of gaps remain. The penultimate section will provide a glimpse into what the future may bring for EMU, thereby looking at other suggested reforms that could be implemented in order to further “deepen” EMU. It will be argued that those reform plans emanating from (or under consideration by) the European Union institutions have not always placed enough emphasis on the need for robust accountability and transparency arrangements and that their potentially far-reaching nature bolsters the argument made in this article that such arrangements are indispensable. It will be concluded that our assessment of the degree of accountability and democratic legitimacy in this area varies depending on the aspects of crisis reforms one focuses on. It is further argued that the empowerment of the European Parliament (and, where appropriate, of national parliaments) in EMU matters must continue in the future, especially as more reforms are implemented to ensure a robust EMU framework

A Case Study with Williams-Beuren Syndrome

This case study examines the performance of a Greek child with Williams-Beuren syndrome and a group of ten typically developing children whose chronological age is equivalent to the mental age of the WS case. The study concerns the field of pediatrics and linguistics. The comparison among the WS case and the typically developing (TD) children is based on the elicitation Perfective Past Tense Test (PPTT) which examines the distinctions between perfective (simple past) or imperfective (past continuous) forms since the conjugation of simple past involves the existence of the aspectual marker –s as suffix. This distinction is conducted under the model of dual-mechanism account [1] that suggests the existence of marker –s, as result of a rule-based process of participants. This case study brings into effect the assumption that cannot explain the model of “different developmental trajectories” in disordered populations [2]. The present results indicate a clear preference of the WS case to sigmatic forms and an unexpected preference only for Novel non-sigmatic verbs to analogies