The effects of creatine supplementation combined with resistance training on regional measures of muscle hypertrophy: a systematic review with meta-analysis.

The purpose of this paper was to carry out a systematic review with meta-analysis of randomized controlled trials that examined the combined effects of resistance training (RT) and creatine supplementation on regional changes in muscle mass with direct imaging measures of hypertrophy. Moreover, we performed regression analyses to determine the potential influence of covariates. We included trials of at least 6 weeks in duration that examined the combined effects of creatine supplementation and RT on site-specific direct measures of hypertrophy (magnetic resonance imaging [MRI], computed tomography [CT] or ultrasound) in healthy adults. A total of 44 outcomes were analyzed across 10 studies that met inclusion criteria. Univariate analysis of all standardized outcomes showed a pooled mean estimate of 0.11 (95% Credible Interval [CrI]: -0.02 to 0.25) providing evidence of a very small effect favoring creatine supplementation when combined with RT, compared to RT and placebo. Multivariate analyses found similar small benefits for the combination of creatine supplementation and RT on changes in upper and lower body muscle thickness (0.10-0.16 cm). Analyses of moderating effects indicated a small superior benefit for creatine supplementation on younger compared to older adults (0.17 [95% CrI: -0.09 to 0.45]). In conclusion, results suggest that creatine supplementation combined with RT promotes a small increase in direct measures of skeletal muscle hypertrophy in both the upper and lower body

Exercise-related changes in lower body regional muscle development .

This study had 2 primary aims (1) compare the effects of multi-joint vs. single-joint lower body exercise on regional muscular development of the quadriceps, and; (2) compare the effects of exercises performed at different knee-joint angles on hypertrophy of the triceps surae. Thirty young, resistance-trained participants unilaterally performed a combination of the following lower body exercises: leg press, leg extension, straight-leg toe press, and seated calf raise. The participants' right legs were randomly allocated to perform 1 of the following 4 conditions: (1) leg press and straight-leg toe press; (2) leg-press and seated calf raise; (3) leg extension and straight-leg toe press; (4) leg extension and seated calf raise. Based on the allocated condition, the contralateral leg performed the other 2 exercises included in the protocol. Training was carried out twice per week on non-consecutive days for 8 weeks. Point estimates for the rectus femoris outcomes favored the single-joint exercise intervention with posterior probabilities ranging from 0.910 ≤ p ≤ 0.990. In contrast, point estimates for the vastus lateralis outcomes favored the multi-joint exercise intervention with posterior probabilities ranging from 0.875 ≤ p ≤ 0.994. Regarding the triceps surae, the point estimate favored straight-leg plantar flexion for muscle thickness of the medial gastrocnemius (p = 0.991), with equivocal results observed for the lateral gastrocnemius and soleus. Our findings indicate that exercise selection can influence regional hypertrophy of the muscles of the lower limbs and evidence of differences can be measured within 8 weeks

Throwing cold water on muscle growth: a systematic review with meta-analysis of the effects of post-exercise cold water immersion on resistance training-induced hypertrophy.

The purpose of this paper was to systematically review the literature and perform a meta-analysis of the existing data on the effects of post-exercise cooling coupled with resistance training (RT) on gains in measures of muscle growth. To locate relevant studies, we comprehensively searched the PubMed/MEDLINE, Scopus and Web of Science databases. A total of 8 studies met the inclusion criteria; all investigated cold water immersion (CWI) as the means of cold application. Preliminary analyses conducted on non-controlled effect sizes provided strong evidence of hypertrophic adaptations with RT that were likely to be at least small in magnitude (SMD0.5 = 0.36 [95%CrI: 0.10 to 0.61]; p(>0) = 0.995, p(>0.1) = 0.977). In contrast, non-controlled effect sizes provided some evidence of hypertrophic adaptations with CWI + RT that were likely to be small to negligible in magnitude (SMD0.5 = 0.14 [95%CrI: -0.08 to 0.36]; p(>0) = 0.906, p(>0.1) = 0.68). The primary analysis conducted on comparative effect sizes provided some evidence of greater relative hypertrophic adaptations with RT compared to CWI + RT (cSMD0.5 = -0.22 [95%CrI: -0.47 to 0.04]), with differences likely to be greater than zero (p(<0) = 0.957) and of at least a small magnitude of effect (p(< -0.1) = 0.834). Meta-regression did not indicate a potential moderation effect of training status (β_Trained:Untrained_0.5 = -0.10 [95%CrI: -0.65 to 0.43] p(<0) = 0.653). In conclusion, based on the current data, the application of CWI immediately following bouts of RT may attenuate hypertrophic changes

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Item does not contain fulltextOBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use