Determination of the lactate threshold and maximal blood lactate steady state intensity in aged rats

The reliability of the lactate threshold (LT) determined in aged rats and its, validity to identify an exercise intensity corresponding to the maximal blood lactate steady state (MLSS) were analyzed. Eighteen male aged Wistar rats (similar to 365 days) were submitted to two incremental swimming tests until exhaustion, consisting of an initial load corresponding to 1% of body mass (BM) and increments of 1% BM at each 3-min with blood lactate ([lac]) measurements. The LT was determined by visual inspection (LT(V)) as well by applying a polynomial function on the [lac]/workload ratio (LT(P)) by considering the vertices of the curve. For the MLSS, twelve animals were submitted, on different days, to 3-4 exercise sessions of 30-min with workload corresponding to 4, 5 or 6% BM. The MLSS was considered the highest exercise intensity at which the [lac] variation was not higher than 0.07 mM.min(-1) during the last 20-min. No differences were observed for the test-retest results (4.9 +/- 0.7 and 5.0 +/- 0.8 %BM for LTv; and 6.0 +/- 0.6 and 5.8 +/- 0.6 %BM for LTp) that did not differ from the MLSS (5.4 +/- 0.5 %BM). The LT identified for aged rats in swimming, both by visual inspection and polynomial function, was reliable and did not differ from the MLSS. Copyright (C) 2009 John Wiley & Sons, Ltd.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Treinamento de natação na intensidade do limiar anaeróbio melhora a aptidão funcional de ratos idosos Swimming training at anaerobic threshold intensity improves the functional fitness of older rats

Os efeitos do treinamento aeróbio em intensidade relativa ao limiar de lactato (LL) foram analisados em 15 ratos idosos (~448 dias de vida). Os grupos de animais treinados (n=9) e controle (n=6) foram submetidos a um teste antes e após quatro semanas de treinamento. O teste incremental consistiu de uma carga inicial de 1% do peso corporal e incrementos de 1% a cada três minutos, com mensurações de lactato sanguíneo para identificação do LL por inspeção visual do ponto de inflexão da curva. O programa de treinamento consistiu de 30 minutos de natação/dia, cinco dias/semana, com sobrecarga de 5% do peso corporal (PC), ou controle sem exercício. Foi observado aumento significativo na intensidade do LL após o treinamento (pré = 4,5 ± 1,1 vs. Pós = 5.4 ± 0.9% PC). A carga máxima atingida ao final do teste incremental aumentou significativamente de 39,7 ± 7,5g no pré para 48,4 ± 10,5g no pós treinamento, sem mudanças para o grupo controle (44,7 ± 8 vs. 45,3 ± 9,3g). O peso corporal do grupo treinado não apresentou diferença como resultado de quatro semanas de natação em intensidade correspondente ao LL (641,0 ±62,0 para 636,0 ± 72.7g; p>0.05). Por outro lado, o grupo não treinado aumentou significativamente o PC de 614,0 ± 8,0 para 643,0 ± 74,1g. A carga máxima atingida expressa tanto em valores absolutos como relativos (%PC) aumentou significativamente após o treinamento. Conclui-se que quatro semanas de treinamento de natação em intensidade correspondente ao limiar de lactato resultou em uma melhora da aptidão aeróbia e na manutenção do peso corporal em ratos idosos.<br>The effects of aerobic training at the lactate threshold (LT) intensity were analyzed in fifteen older rats (~448 days old). Both the trained (n = 9) and control (n = 6) groups were submitted to an incremental exercise test before and after four weeks of training. The incremental exercise test consisted of an initial load of 1% BM and 1% increments at each 3-min with blood lactate measurements. The LT was determined by visual inspection of the blood lactate breakpoint. The training program comprised of 30-min swimming/day, 5 days/week, loaded with 5% body mass (BM), or control without exercise. Significant increase on the LT intensity after training (pre = 4.5 ± 1.1 vs. post = 5.4 ± 0.9% BM). The maximal workload reached at the end of incremental test increased significantly from 39.7 ± 7.5 g on pre to 48.4 ± 10.5 g at post training, with no changes for the control group (44.7 ± 8 vs. 45.3 ± 9.3 g). The body mass of the trained group did not change as a result of 4 weeks of swimming at LT intensity (641.0 ± 62.0 to 636.0 ± 72.7 g; p > 0.05). On the other hand, the untrained group increased significantly the BM from 614.0 ± 80.0 to 643.0 ± 72.7 g. The maximal workload, as expressed both in relation to absolute and relative values (i.e. %BM) increased significantly only as a result of training. It was concluded that four weeks of swimming training at LT intensity resulted in aerobic fitness improvement and body mass maintenance of older rats

Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System

© 2022 The authors.OBJECTIVE Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty. METHODS A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine. RESULTS In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Overall, surgical fixation was recommended more often for A4 than A3 fractures in all four scenarios (p &lt; 0.001). CONCLUSIONS The subaxial cervical spine should not be considered a single unified entity. Both A3 and A4 fracture subtypes were more likely to be surgically managed at the cervicothoracic junction than the upper or middle subaxial cervical regions. The authors also determined that treatment strategies for A3 and A4 subaxial cervical spine fractures varied significantly, with the latter demonstrating a greater likelihood of operative management. These findings should be reflected in future subaxial cervical spine trauma algorithms.N

An international validation of the AO spine subaxial injury classification system

Purpose To validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions. Methods A live webinar was organized in 2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (? = 0-0.20), fair (? = 0.21-0.40), moderate (? = 0.41-0.60), substantial (? = 0.61-0.80), or excellent (? = &gt; 0.80) as determined by the Landis and Koch classification. Results A total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (? = 0.87), while fracture subtype (? = 0.80) and facet injury were substantial (? = 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (? = 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (? = 0.76). Conclusion The AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit