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BMJ Open Jun 2024Patients with cirrhosis awaiting liver transplantation (LT) are often frail, and malnourished. The period of time on the waitlist provides an opportunity to improve...
INTRODUCTION
Patients with cirrhosis awaiting liver transplantation (LT) are often frail, and malnourished. The period of time on the waitlist provides an opportunity to improve their physical fitness. Prehabilitation appears to improve the physical fitness of patients before major surgery. Little is known about prehabilitation in patients with cirrhosis. The aim of this feasibility study will be to investigate the feasibility, safety, and effectiveness of a multimodal prehabilitation programme in this patient population.
METHODS AND ANALYSIS
This is an open-label single-arm feasibility trial recruiting 25 consecutive adult patients with cirrhosis active on the LT waiting list of the McGill University Health Centre (MUHC). Individuals will be excluded based on criteria developed for the safe exercise training in patients with cirrhosis. Enrolled individuals will participate in a multimodal prehabilitation programme conducted at the PeriOperative Programme complex of the MUHC. It includes exercise training with a certified kinesiologist (aerobic and resistance training), nutritional optimisation with a registered dietician and psychological support with a nurse specialist. The exercise training programme is divided into an induction phase with three sessions per week for 4 weeks followed by a maintenance phase with one session every other week for 20 weeks. Aerobic training will be individualised based on result from cardiopulmonary exercise testing (CPET) and will include a high-intensity interval training on a cycle ergometer. Feasibility, adherence and acceptability of the intervention will be assessed. Adverse events will be reviewed before each visit. Changes in exercise capacity (6-minute walk test, CPET, liver frailty index), nutritional status and health-related quality of life will be assessed during the study. Post-transplantation outcomes will be recorded.
ETHICS AND DISSEMINATION
The research ethics board of the MUHC has approved this study (2021-7646). Our findings will be submitted for presentation at national and international conferences, and for peer-reviewed publication.
TRIAL REGISTRATION NUMBER
NCT05237583.
Topics: Humans; Liver Transplantation; Feasibility Studies; Liver Cirrhosis; Preoperative Exercise; Waiting Lists; Quality of Life; Physical Fitness; Adult; Exercise Therapy; Male; Female
PubMed: 38925705
DOI: 10.1136/bmjopen-2023-081362 -
Anais Da Academia Brasileira de Ciencias 2024Klebsiella pneumoniae (K. pneumoniae) is a major cause of healthcare-associated infections and plays a prominent role in the widespread antibiotic resistance crisis....
Klebsiella pneumoniae (K. pneumoniae) is a major cause of healthcare-associated infections and plays a prominent role in the widespread antibiotic resistance crisis. Accurate identification of carbapenemases is essential to facilitate effective antibiotic treatment and reduce transmission of K. pneumoniae. This study aimed to detect carbapenemase production in carbapenem-resistant K. pneumoniae strains using phenotypic and genotypic methods. A total of 67 carbapenem-resistant K. pneumoniae strains obtained from various clinical samples were utilized for identification and antimicrobial susceptibility by the Vitek 2 Compact system (Biomerieux, France). Carbapenemase production was determined by using the Polymerase chain reaction, Blue-carba test (BCT) and Carbapenem inactivation method (CIM). Out of the isolates, 59 (88.1%) were positive bla OXA-48, 16 (23.9%) bla IMP, and five (7.5%) were positive bla NDM. No bla KPC genes were detected. The CIM identified 62 (92.5%), BCT identified 63 (94%) of PCR-positive isolates. The sensitivity and specificity of the BCT and the CIM were determined to be 96.7%, 40%, and 96.7%, 25% respectively. The bla OXA-48 gene was found to be the most prevalent in K. pneumoniae isolates. Early identification of carbapenem resistance plays a vital role in designing effective infection control strategies and mitigating the emergence and transmission of carbapenem resistance, thus reducing healthcare-associated infections.
Topics: Klebsiella pneumoniae; Humans; Phenotype; Microbial Sensitivity Tests; Genotype; Anti-Bacterial Agents; Carbapenems; beta-Lactamases; Polymerase Chain Reaction; Bacterial Proteins; Klebsiella Infections; Carbapenem-Resistant Enterobacteriaceae
PubMed: 38922280
DOI: 10.1590/0001-3765202420231322 -
Sports (Basel, Switzerland) Jun 2024(1) Background: The aim of this paper is to analyze the acute effects of different velocity loss (VL) thresholds during a full squat (SQ) with blood-flow restriction...
(1) Background: The aim of this paper is to analyze the acute effects of different velocity loss (VL) thresholds during a full squat (SQ) with blood-flow restriction (BFR) on strength performance, neuromuscular activity, metabolic response, and muscle contractile properties. (2) Methods: Twenty strength-trained men performed four protocols that differed in the VL achieved within the set (BFR0: 0% VL; BFR10: 10% VL; BFR20: 20% VL; and BFR40: 40% VL). The relative intensity (60% 1RM), recovery between sets (2 min), number of sets (3), and level of BFR (50% of arterial occlusion pressure) were matched between protocols. Tensiomyography (TMG), blood lactate, countermovement jump (CMJ), maximal voluntary isometric SQ contraction (MVIC), and performance with the absolute load required to achieve 1 m·s at baseline measurements in SQ were assessed before and after the protocols. (3) Results: BFR40 resulted in higher EMG alterations during and after exercise than the other protocols ( < 0.05). BFR40 also induced greater impairments in TMG-derived variables and BFR10 decreased contraction time. Higher blood lactate concentrations were found as the VL within the set increased. BFR0 and BFR10 showed significantly increased median frequencies in post-exercise MVIC. (4) Conclusions: High VL thresholds (BFR40) accentuated metabolic and neuromuscular stress, and produced increased alterations in muscles' mechanical properties. Low VL could potentiate post-exercise neuromuscular activity and muscle contractile properties.
PubMed: 38921865
DOI: 10.3390/sports12060171 -
Sports (Basel, Switzerland) May 2024The aim of this systematic review was to assess the effects of plyometric-jump training (PJT) on the physical fitness of youth with cerebral palsy (CP) compared with... (Review)
Review
The aim of this systematic review was to assess the effects of plyometric-jump training (PJT) on the physical fitness of youth with cerebral palsy (CP) compared with controls (i.e., standard therapy). The PRISMA 2020 guidelines were followed. Eligibility was assessed using the PICOS approach. Literature searches were conducted using the PubMed, Web of Science, and SCOPUS databases. Methodological study quality was assessed using the PEDro scale. Data were meta-analyzed by applying a random-effects model to calculate Hedges' g effect sizes (ES), along with 95% confidence intervals (95% CI). The impact of heterogeneity was assessed ( statistic), and the certainty of evidence was determined using the GRADE approach. Eight randomized-controlled studies with low-to-moderate methodological quality were included, involving male (n = 225) and female (n = 138) youth aged 9.5 to 14.6 years. PJT interventions lasted between 8 and 12 weeks with 2-4 weekly sessions. Compared with controls, PJT improved the muscle strength (ES = 0.66 [moderate], 95% CI = 0.36-0.96, < 0.001, = 5.4%), static (ES = 0.69 [moderate], 95% CI= 0.33-1.04, < 0.001, = 0.0%) and dynamic balance (ES = 0.85 [moderate], 95% CI = 0.12-1.58, = 0.023, = 81.6%) of youth with CP. Therefore, PJT improves muscle strength and static and dynamic balance in youth with CP compared with controls. However, more high-quality randomized-controlled trials with larger sample sizes are needed to provide a more definitive recommendation regarding the use and safety of PJT to improve measures of physical fitness.
PubMed: 38921846
DOI: 10.3390/sports12060152 -
Sports (Basel, Switzerland) May 2024Stretch-induced force deficit suggests an acute stretch-specific strength capacity loss, which is commonly attributed to EMG reductions. Since those deficits could also...
PURPOSE
Stretch-induced force deficit suggests an acute stretch-specific strength capacity loss, which is commonly attributed to EMG reductions. Since those deficits could also be attributed to general fatigue induced by overloading the muscle, this study aimed to compare stretching with an exhausting calf raise programme to compare strength and stretching responses.
METHOD
This study included 16 participants with different, high-duration calf muscle stretching effects (10, 20, 30 min of stretching) with resistance training (RT) (3 × 12 repetitions) performed until muscle failure, by using a cross-over study design with pre-post comparisons. Strength was tested via isometric plantar flexor diagnostics, while flexibility was assessed using the knee-to-wall test (KtW) and an isolated goniometer test.
RESULTS
Using a three-way ANOVA, RT strength decreases were greater compared to 10 and 20 min of stretching ( = 0.01-0.02), but similar to those of 30 min of stretching. ROM in the KtW showed no specific stretch-induced increases, while only the stretching conditions enhanced isolated tested ROM ( < 0.001-0.008). No RT-related isolated ROM increases were observed.
CONCLUSIONS
The results showed both interventions had similar effects on strength and ROM in the calf muscles. More holistic explanatory approaches such as fatigue and warm-up are discussed in the manuscript and call for further research.
PubMed: 38921839
DOI: 10.3390/sports12060145 -
Autonomic Rebound Following Maximal Exercise in Bodybuilders and Recreationally Active Participants.Sports (Basel, Switzerland) May 2024The off-season for natural bodybuilders (BB) is characterized by increased training loads and fluctuations in caloric intake, which may lead to insufficient recovery....
The off-season for natural bodybuilders (BB) is characterized by increased training loads and fluctuations in caloric intake, which may lead to insufficient recovery. The autonomic nervous system (ANS) plays a pivotal role in recovery. The purpose of this study was to evaluate resting ANS activity and recovery following a maximal exercise bout in off-season BB and compare them to those of recreationally active individuals. Fifteen males participated; 7 recreationally active (RA) (24.6 ± 2.1 years, 81.1 ± 10.8 kg) and 8 BB (21.8 ± 2.9 years, 89.3 ± 13.0 kg). Each performed a graded exercise test. Heart rate variability (HRV) was measured at rest and during a 45 min recovery period. HRV was analyzed as: root mean square of successive differences (lnRMSSD), standard deviation of normal-to-normal sinus beats (lnSDNN), high frequency (lnHF), low frequency (lnLF), and the ratio of low frequency to high frequency (lnLF/lnHF). A one-way ANOVA showed no differences for any resting marker of HRV, HR, and HR recovery. A significant depression in all markers of HRV was observed in the BB group at the 15 min point, and no recovery was observed before 45 min when compared to RA. The results of this study demonstrated depressed HRV recovery following the graded exercise test in BB when compared to the RA group.
PubMed: 38921837
DOI: 10.3390/sports12060143 -
Journal of Functional Morphology and... Jun 2024The fire service suffers from high rates of cardiovascular disease and poor overall health, and firefighters often suffer fatal and non-fatal injuries while on the job.... (Review)
Review
The fire service suffers from high rates of cardiovascular disease and poor overall health, and firefighters often suffer fatal and non-fatal injuries while on the job. Most fatal injuries result from sudden cardiac death, while non-fatal injuries are to the musculoskeletal system. Previous works suggest a mechanistic link between several health and performance variables and injury risk. In addition, studies have suggested physical activity and nutrition can improve overall health and occupational performance. This review offers practical applications for exercise via feasible training modalities as well as nutritional recommendations that can positively impact performance on the job. Time-efficient training modalities like high-intensity interval training and feasible modalities such as resistance training offer numerous benefits for firefighters. Also, modifying and supplementing the diet and can be advantageous for health and body composition in the fire service. Firefighters have various schedules, making it difficult for planned exercise and eating while on shift. The practical training and nutritional aspects discussed in this review can be implemented on-shift to improve the overall health and performance in firefighters.
PubMed: 38921641
DOI: 10.3390/jfmk9020105 -
Biomimetics (Basel, Switzerland) May 2024Standard alternating leg motions serve as the foundation for simple bipedal gaits, and the effectiveness of the fixed stimulus signal has been proved in recent studies....
Standard alternating leg motions serve as the foundation for simple bipedal gaits, and the effectiveness of the fixed stimulus signal has been proved in recent studies. However, in order to address perturbations and imbalances, robots require more dynamic gaits. In this paper, we introduce dynamic stimulus signals together with a bipedal locomotion policy into reinforcement learning (RL). Through the learned stimulus frequency policy, we induce the bipedal robot to obtain both three-dimensional (3D) locomotion and an adaptive gait under disturbance without relying on an explicit and model-based gait in both the training stage and deployment. In addition, a set of specialized reward functions focusing on reliable frequency reflections is used in our framework to ensure correspondence between locomotion features and the dynamic stimulus. Moreover, we demonstrate efficient sim-to-real transfer, making a bipedal robot called BITeno achieve robust locomotion and disturbance resistance, even in extreme situations of foot sliding in the real world. In detail, under a sudden change in torso velocity of -1.2 m/s in 0.65 s, the recovery time is within 1.5-2.0 s.
PubMed: 38921190
DOI: 10.3390/biomimetics9060310 -
Insects May 2024The study assessed the trapping efficacy of locally modified (1) Gravid Aedes Trap (GAT) lined with insecticide-treated net (ITN) as a killing agent and (2) Autocidal...
The study assessed the trapping efficacy of locally modified (1) Gravid Aedes Trap (GAT) lined with insecticide-treated net (ITN) as a killing agent and (2) Autocidal Gravid Ovitrap (AGO) with sticky board in the semi-field system (SFS) and field setting. Fully balanced Latin square experiments were conducted to compare GAT lined with ITN vs. AGO, both with either yeast or grass infusion. Biogent-Sentinel (BGS) with BG-Lure and no CO was used as a standard trap for mosquitoes. In the SFS, GAT outperformed AGO in collecting both nulliparous (65% vs. 49%, OR = 2.22, [95% CI: 1.89-2.60], < 0.001) and gravid mosquitoes (73% vs. 64%, OR = 1.67, [95% CI: 1.41-1.97], < 0.001). Similar differences were observed in the field. Yeast and grass infusion did not significantly differ in trapping gravid mosquitoes (OR = 0.91, [95% CI: 0.77-1.07], = 0.250). The use of ITN improved mosquito recapture from 11% to 70% in the SFS. The same trend was observed in the field. Yeast was chosen for further evaluation in the optimized GAT due to its convenience and bifenthrin net for its resistance management properties. Mosquito density was collected when using 4× GATs relative to BGS-captured gravid mosquitoes 64 vs. 58 (IRR = 0.82, [95% CI: 0.35-1.95], = 0.658) and showed no density dependence. Deployment of multiple yeast-baited GAT lined with bifenthrin net is cost-effective (single GAT < $8) compared to other traps such as BGS ($160).
PubMed: 38921116
DOI: 10.3390/insects15060401 -
Current Issues in Molecular Biology May 2024Physical activity is integral to metabolic health, particularly in addressing insulin resistance and related disorders such as type 2 diabetes mellitus (T2DM). Studies... (Review)
Review
Physical activity is integral to metabolic health, particularly in addressing insulin resistance and related disorders such as type 2 diabetes mellitus (T2DM). Studies consistently demonstrate a strong association between physical activity levels and insulin sensitivity. Regular exercise interventions were shown to significantly improve glycemic control, highlighting exercise as a recommended therapeutic strategy for reducing insulin resistance. Physical inactivity is closely linked to islet cell insufficiency, exacerbating insulin resistance through various pathways including ER stress, mitochondrial dysfunction, oxidative stress, and inflammation. Conversely, physical training and exercise preserve and restore islet function, enhancing peripheral insulin sensitivity. Exercise interventions stimulate β-cell proliferation through increased circulating levels of growth factors, further emphasizing its role in maintaining pancreatic health and glucose metabolism. Furthermore, sedentary lifestyles contribute to elevated oxidative stress levels and ceramide production, impairing insulin signaling and glucose metabolism. Regular exercise induces anti-inflammatory responses, enhances antioxidant defenses, and promotes mitochondrial function, thereby improving insulin sensitivity and metabolic efficiency. Encouraging individuals to adopt active lifestyles and engage in regular exercise is crucial for preventing and managing insulin resistance and related metabolic disorders, ultimately promoting overall health and well-being.
PubMed: 38920999
DOI: 10.3390/cimb46060327