Extremely short duration sprint interval training improves vascular health in older adults

Exercise improves health and physical function in older people, but very few older people participate although the trend is for increasing participation. This study sought to determine whether short duration sprint interval training (SIT) improves health and physical function in older people. Seventeen (9 M and 8 F) older adults (age 66 ± 3 years) were recruited. Participants had blood pressure, physical function and blood lipid profile measured and were then allocated to a control group (CON n = 7) or a SIT group (n = 10). The control group maintained daily activities; the SIT group performed 10 weeks of twice-weekly training sessions of 6-s sprints. By week 10, training sessions lasted 11.6 ± 0.6-min. Ten weeks of SIT resulted in significant changes in pulse pressure (CONpre 59 ± 18 mmHg; CONpost 60 ± 9 mmHg; SITpre 56 ± 14 mmHg; SITpost 49 ± 7 mmHg; p = 0.007), mean blood pressure (CONpre 100 ± 10 mmHg; CONpost 97 ± 11 mmHg; SITpre 102 ± 7 mmHg; SITpost 93 ± 8 mmHg; p = 0.003), timed get up and go (CONpre 6.9 ± 1.1 s; CONpost 6.9 ± 1.0 s; SITpre 7.4 ± 1.2 s; SITpost 6.6 ± 1.0 s; p = 0.005), loaded 50 m walk (CONpre 6.9 ± 1.1 s; CONpost 6.9 ± 1.0 s; SITpre 7.4 ± 1.2 s; SITpost 6.6 ± 1.0 s; p = 0.005),and total cholesterol: HDL cholesterol ratio (CONpre 4.2 ± 0.7; CONpost 4.0 ± 0.7; SITpre 4.4 ± 1.1; SITpost 3.2 ± 0.7; p = 0.01). SIT is an effective way to maintain blood pressure, lipid profile, and physical function during aging and is an effective tool for promoting optimal aging

Vascular Health in American Football Players: Cardiovascular Risk Increased in Division III Players

Studies report that football players have high blood pressure (BP) and increased cardiovascular risk. There are over 70,000 NCAA football players and 450 Division III schools sponsor football programs, yet limited research exists on vascular health of athletes. This study aimed to compare vascular and cardiovascular health measures between football players and nonathlete controls. Twenty-three athletes and 19 nonathletes participated. Vascular health measures included flow-mediated dilation (FMD) and carotid artery intima-media thickness (IMT). Cardiovascular measures included clinic and 24 hr BP levels, body composition, VO2 max, and fasting glucose/cholesterol levels. Compared to controls, football players had a worse vascular and cardiovascular profile. Football players had thicker carotid artery IMT (0.49 ± 0.06 mm versus 0.46 ± 0.07 mm) and larger brachial artery diameter during FMD (4.3 ± 0.5 mm versus 3.7 ± 0.6 mm), but no difference in percent FMD. Systolic BP was significantly higher in football players at all measurements: resting (128.2 ± 6.4 mmHg versus 122.4 ± 6.8 mmHg), submaximal exercise (150.4 ± 18.8 mmHg versus 137.3 ± 9.5 mmHg), maximal exercise (211.3 ± 25.9 mmHg versus 191.4 ± 19.2 mmHg), and 24-hour BP (124.9 ± 6.3 mmHg versus 109.8 ± 3.7 mmHg). Football players also had higher fasting glucose (91.6 ± 6.5 mg/dL versus 86.6 ± 5.8 mg/dL), lower HDL (36.5±11.2 mg/dL versus 47.1±14.8 mg/dL), and higher body fat percentage (29.2±7.9% versus 23.2±7.0%). Division III collegiate football players remain an understudied population and may be at increased cardiovascular risk

Invasive monitoring of the clinical effects of high intra-abdominal pressure for insertion of the first trocar.

Background: To analyze the effects of transitory, high intra-abdominal pressure on clinical, hemodynamic, blood gas and metabolic parameters.

Methods: Sixty-seven laparoscopic patients were divided into groups P12 (n = 30, maximum intra-abdominal pressure of 12 mmHg) and P20 (n = 37, maximum intra-abdominal pressure of 20 mmHg). Through radial artery cannulation, mean arterial pressure (MAP) was assessed and blood gas analysis – pH, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), bicarbonate (HCO3) and base excess (BE) – was performed. These parameters were evaluated in both groups at time point zero, before CO2 insufflation; at time point one (TP1), when intra-abdominal pressure of 12 mmHg was reached in both groups; at time point two (TP2), 5 minutes after reaching intra-abdominal pressure of 12 mmHg in group P12 and of 20 mmHg in group P20; and at time point three (TP3), 10 minutes after reaching intra-abdominal pressure of 12 mmHg in group P12 and 10 minutes after TP1 in group P20, when intra-abdominal pressure decreased from 20 mmHg to 12 mmHg. Values out of the normal range or the occurrence of atypical phenomena suggestive of organic disease indicated clinical changes.

Results: Significant variations in MAP, pH, HCO3 and BE were observed in group P20; these changes, however, were within normal limits. Clinical changes were also within normal limits, and no pathological phenomena were observed.

Conclusions: Brief, intra-abdominal hypertension for the insertion first trocar insertion causes variations in MAP, pH, HCO3 and BE without adverse effects, and it may protect from iatrogenic injury

Epidemiology of blood pressure and hypertension in the adult Maltese community

Raised blood pressure is thought to be highly prevalent among the Maltese community. This has been a clinical impression probably partly based on the assumption that the Maltese prevalence rates are consistent with the epidemic rates obtained in most European countries and the United States. A study was undertaken in order to acquire scientific information on blood pressure, hypertension and its awareness among the Maltese population aged between 25 and 64 years. The mean systolic blood pressures were 138 mmHg (SD 16) for males and 138 mmHg (SD 20) for females. The mean diastolic blood pressures were 86.2 mmHg (SD 10) for males and 85.5 mmHg (SD 11) for females. The prevalence of hypertension was 26%. Only about 10% of persons suffering from hypertension had their blood pressure under adequate control.peer-reviewe

Measuring the effect of airway pressure on pulmonary arterial diameter in the intact rat lung

To study the relationship between transpulomnary pressure (Ptp), intravascular pressure (Pv), and the pulmonary arterial tree structure, morphometric measurements of pulmonary arterial trees were made in intact lungs from Sprague-Dawley rats. Using cone beam micro-CT and techniques we developed for imaging small animal lungs, volumetric CT data were acquired for Ptp from 0 - 12 mmHg and Pv from 5 - 30 mmHg. The diameter, D (measured range approximately 0.08-2.0 mm), vs. pressure, P, relation can be described by D(P) = D(0)(1+ α P), where α is a distensibility coefficient. Unlike studies performed in larger animals, where changes in either Ptp or Pv had nearly identical effect on vessel distensibility, we found that there is only a small dependence of arterial diameter on Ptp in the rat. For example, using the above relation where P=Ptp and Pv is held constant at 12mmHg, alpha = 0.55±0.42(SE) %/mmHg, compared with when P=Pv and Ptp is held at 12mmHg, alpha = 2.59±0.17(SE) %/mmHg

Rate Control Management of Atrial Fibrillation: May a Mathematical Model Suggest an Ideal Heart Rate?

Background. Despite the routine prescription of rate control therapy for atrial fibrillation (AF), clinical evidence demonstrating a heart rate target is lacking. Aim of the present study was to run a mathematical model simulating AF episodes with a different heart rate (HR) to predict hemodynamic parameters for each situation. Methods. The lumped model, representing the pumping heart together with systemic and pulmonary circuits, was run to simulate AF with HR of 50, 70, 90, 110 and 130 bpm, respectively. Results. Left ventricular pressure increased by 56.7%, from 33.92+-37.56 mmHg to 53.15+-47.56 mmHg, and mean systemic arterial pressure increased by 27.4%, from 82.66+-14.04 mmHg to 105.29+-7.63 mmHg, at the 50 and 130 bpm simulations, respectively. Stroke volume (from 77.45+-8.5 to 39.09+-8.08 mL), ejection fraction (from 61.1+-4.4 to 39.32+-5.42%) and stroke work (SW, from 0.88+-0.04 to 0.58+-0.09 J) decreased by 49.5, 35.6 and 34.2%, at the 50 and 130 bpm simulations, respectively. In addition, oxygen consumption indexes (rate pressure product, RPP, tension time index per minute, TTI/min, and pressure volume area per minute, PVA/min) increased from the 50 to the 130 bpm simulation, respectively, by 185.7% (from 5598+-1939 to 15995+-3219 mmHg/min), 55.5% (from 2094+-265 to 3257+-301 mmHg s/min) and 102.4% (from 57.99+-17.9 to 117.37+-25.96 J/min). In fact, left ventricular efficiency (SW/PVA) decreased from 80.91+-2.91% at 50 bpm to 66.43+-3.72% at the 130 bpm HR simulation. Conclusion. Awaiting compulsory direct clinical evidences, the present mathematical model suggests that lower HRs during permanent AF relates to improved hemodynamic parameters, cardiac efficiency, and lower oxygen consumption.Comment: 9 page

Buttressing staples with cholecyst-derived extracellular matrix (CEM) reinforces staple lines in an ex vivo peristaltic inflation model

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ Springer Science + Business Media, LLC 2008Background - Staple line leakage and bleeding are the most common problems associated with the use of surgical staplers for gastrointestinal resection and anastomotic procedures. These complications can be reduced by reinforcing the staple lines with buttressing materials. The current study reports the potential use of cholecyst-derived extracellular matrix (CEM) in non-crosslinked (NCEM) and crosslinked (XCEM) forms, and compares their mechanical performance with clinically available buttress materials [small intestinal submucosa (SIS) and bovine pericardium (BP)] in an ex vivo small intestine model. Methods - Three crosslinked CEM variants (XCEM0005, XCEM001, and XCEM0033) with different degree of crosslinking were produced. An ex vivo peristaltic inflation model was established. Porcine small intestine segments were stapled on one end, using buttressed or non-buttressed surgical staplers. The opened, non-stapled ends were connected to a peristaltic pump and pressure transducer and sealed. The staple lines were then exposed to increased intraluminal pressure in a peristaltic manner. Both the leak and burst pressures of the test specimens were recorded. Results - The leak pressures observed for non-crosslinked NCEM (137.8 ± 22.3 mmHg), crosslinked XCEM0005 (109.1 ± 14.1 mmHg), XCEM001 (150.1 ± 16.0 mmHg), XCEM0033 (98.8 ± 10.5 mmHg) reinforced staple lines were significantly higher when compared to non-buttressed control (28.3 ± 10.8 mmHg) and SIS (one and four layers) (62.6 ± 11.8 and 57.6 ± 12.3 mmHg, respectively) buttressed staple lines. NCEM and XCEM were comparable to that observed for BP buttressed staple lines (138.8 ± 3.6 mmHg). Only specimens with reinforced staple lines were able to achieve high intraluminal pressures (ruptured at the intestinal mesentery), indicating that buttress reinforcements were able to withstand pressure higher than that of natural tissue (physiological failure). Conclusions - These findings suggest that the use of CEM and XCEM as buttressing materials is associated with reinforced staple lines and increased leak pressures when compared to non-buttressed staple lines. CEM and XCEM were found to perform comparably with clinically available buttress materials in this ex vivo model.Enterprise Irelan

A community programme to reduce salt intake and blood pressure in Ghana

Background In Africa hypertension is common and stroke is increasing. Detection, treatment and control of high blood pressure (BP) is limited. BP can be lowered by reducing salt intake. In Africa salt is added to the food by the consumer, as processed food is rare. A population-wide approach with programmes based on health education and promotion is thus possible. Methods We carried out a community-based cluster randomised trial of health promotion in 1,013 participants from 12 villages (628 women, 481 rural dwellers); mean age 55 years to reduce salt intake and BP. Average BP was 125/74 mmHg and urinary sodium (UNa) 101 mmol/day. A health promotion intervention was provided over 6 months to all villages. Assessments were made at 3 and 6 months. Primary end-points were urinary sodium excretion and BP levels. Results There was a significant positive relationship between salt intake and both systolic (2.17 mmHg [95% CI 0.44 to 3.91] per 50 mmol of UNa per day, p < 0.001) and diastolic BP (1.10 mmHg [0.08 to 1.94], p < 0.001) at baseline. At six months the intervention group showed a reduction in systolic (2.54 mmHg [-1.45 to 6.54]) and diastolic (3.95 mmHg [0.78 to 7.11], p = 0.015) BP when compared to control. There was no significant change in UNa. Smaller villages showed greater reductions in UNa than larger villages (p = 0.042). Irrespective of randomisation, there was a consistent and significant relationship between change in UNa and change in systolic BP, when adjusted for confounders. A difference in 24-hour UNa of 50 mmol was associated with a lower systolic BP of 2.12 mmHg (1.03 to 3.21) at 3 months and 1.34 mmHg (0.08 to 2.60) at 6 months (both p < 0.001). Conclusion In West Africa the lower the salt intake, the lower the BP. It would appear that a reduction in the average salt intake in the whole community may lead to a small but significant reduction in population systolic BP

Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?

INTRODUCTION AND HYPOTHESIS: Our aim was to explore the association between anal incontinence (AI) and persistent anal sphincter defects diagnosed with 3D endoanal (EAUS), introital (IUS) and transperineal ultrasound (TPUS) in women after obstetric anal sphincter injury (OASI) and study the association between sphincter defects and anal pressure. METHODS: We carried out a cross-sectional study of 250 women with OASI recruited during the period 2013-2015. They were examined 6-12 weeks postpartum or in a subsequent pregnancy with 3D EAUS, IUS and TPUS and measurement of anal pressure. Prevalence of urgency/solid/liquid AI or flatal AI and anal pressure were compared in women with a defect and those with an intact sphincter (diagnosed off-line) using Chi-squared and Mann-Whitney U test. RESULTS: At a mean of 23.6 (SD 30.1) months after OASI, more women with defect than those with intact sphincters on EAUS had AI; urgency/solid/liquid AI vs external defect: 36% vs 13% and flatal AI vs internal defect: 27% vs 13%, p < 0.05. On TPUS, more women with defect sphincters had flatal AI: 32% vs 13%, p = 0.03. No difference was found on IUS. Difference between defect and intact sphincters on EAUS, IUS and TPUS respectively was found for mean [SD] maximum anal resting pressure (48 [13] vs 55 [14] mmHg; 48 [12] vs 56 [13] mmHg; 50 [13] vs 54 [14] mmHg) and squeeze incremental pressure (33 [17] vs 49 [28] mmHg; 37 [23] vs 50 [28] mmHg; 36 [18] vs 50 [30] mmHg; p < 0.01). CONCLUSIONS: Endoanal ultrasound had the strongest association with AI symptoms 2 years after OASI. Sphincter defects detected using all ultrasound methods were associated with lower anal pressure