Morphology of the entering and exiting nerve as a differentiating feature of benign from malignant peripheral nerve sheath tumours of the brachial plexus.

OBJECTIVE: To identify if morphology of the entering and exiting nerve involved by a nerve sheath tumour in the brachial plexus can help differentiate between benign (B) and malignant (M) peripheral nerve sheath tumours (PNSTs). MATERIALS AND METHODS: Retrospective review of 85 patients with histologically confirmed primary PNSTs of the brachial plexus over a 12.5-year period. Clinical data and all available MRI studies were independently evaluated by 2 consultant musculoskeletal radiologists blinded to the final histopathological diagnosis assessing for maximal lesion dimension, visibility and morphology of the entering and exiting nerve, and other well-documented features of PNSTs. RESULTS: The study included 47 males and 38 females with mean age 46.7 years (range, 8-81 years). There were 73 BPNSTs and 12 MPNSTs. The entering nerve was not identified in 5 (7%), was normal in 17 (23%), was tapered in 38 (52%) and showed lobular enlargement in 13 (18%) BPNSTs compared with 0 (0%), 0 (0%), 2 (17%) and 10 (83%) MPNSTs respectively. The exiting nerve was not identified in 5 (7%), was normal in 20 (27%), was tapered in 42 (58%) and showed lobular enlargement in 6 (8%) BPNSTs compared with 4 (33%), 0 (0%), 2 (17%) and 6 (50%) MPNSTs respectively. Increasing tumour size, entering and exiting nerve morphology and suspected MRI diagnosis were statistically significant differentiators between BPNST and MPNST (p < 0.001). IOC for nerve status was poor to fair but improved to good if normal/tapered appearance were considered together with improved specificity of 81-91% for BPNST and sensitivity of 75-83%. CONCLUSIONS: Morphology of the adjacent nerve is a useful additional MRI feature for distinguishing BPNST from MPNST of the brachial plexus.

Differential expression of muscle damage in humans following acute fast and slow velocity eccentric exercise.

We sought to determine if the velocity of an acute bout of eccentric contractions influenced the duration and severity of several common indirect markers of muscle damage. Subjects performed 36 maximal fast (FST, n = 8: 3.14 rad x s(-1)) or slow (SLW, n = 7: 0.52 rad x s(-1)) velocity isokinetic eccentric contractions with the elbow flexors of the non-dominant arm. Muscle soreness, limb girth, plasma creatine kinase (CK) activity, isometric torque and concentric and eccentric torque at 0.52 and 3.14 rad x s(-1) were assessed prior to and for several days following the eccentric bout. Peak plasma CK activity was similar in SLW (4030 +/- 1029 U x 1(-1)) and FST (5864 +/- 2664 U x 1(-1)) groups, (p > 0.05). Both groups experienced similar decrement in all strength variables during the 48 hr following the eccentric bout. However, recovery occurred more rapidly in the FST group during eccentric (0.52 and 3.14 rad x s(-1)) and concentric (3.14 rad x s(-1)) post-testing. The severity of muscle soreness was similar in both groups. However, the FST group experienced peak muscle soreness 48 hr later than the SLW group (24 hr vs. 72 hr). The SLW group experienced a greater increase in upper arm girth than the FST group 20 min, 24 hr and 96 hr following the eccentric exercise bout. The contraction velocity of an acute bout of eccentric exercise differentially influences the magnitude and time course of several indirect markers of muscle damage.

Adaptation to chronic eccentric exercise in humans: the influence of contraction velocity.

We compared changes in muscle fibre composition and muscle strength indices following a 10 week isokinetic resistance training programme consisting of fast (3.14 rad x s(-1)) or slow (0.52 rad x s(-1)) velocity eccentric muscle contractions. A group of 20 non-resistance trained subjects were assigned to a FAST (n = 7), SLOW (n = 6) or non-training CONTROL (n = 7) group. A unilateral training protocol targeted the elbow flexor muscle group and consisted of 24 maximal eccentric isokinetic contractions (four sets of six repetitions) performed three times a week for 10 weeks. Muscle biopsy samples were obtained from the belly of the biceps brachii. Isometric torque and concentric and eccentric torque at 0.52 and 3.14 rad x s(-1) were examined at 0, 5 and 10 weeks. After 10 weeks, the FAST group demonstrated significant [mean (SEM)] increases in eccentric [29.6 (6.4)%] and concentric torque [27.4 (7.3)%] at 3.14 rad x s(-1), isometric torque [21.3 (4.3)%] and eccentric torque [25.2 (7.2)%] at 0.52 rad x s(-1). The percentage of type I fibres in the FAST group decreased from [53.8 (6.6)% to 39.1 (4.4)%] while type IIb fibre percentage increased from [5.8 (1.9)% to 12.9 (3.3)%; P < 0.05]. In contrast, the SLOW group did not experience significant changes in muscle fibre type or muscle torque. We conclude that neuromuscular adaptations to eccentric training stimuli may be influenced by differences in the ability to cope with chronic exposure to relatively fast and slow eccentric contraction velocities. Possible mechanisms include greater cumulative damage to contractile tissues or stress induced by slow eccentric muscle contractions.

Acute adaptation to low volume eccentric exercise.

PURPOSE: Many symptoms of eccentric muscle damage can be substantially reduced if a similar eccentric bout is repeated within several weeks of the initial bout. The purpose of this study was to determine whether a nondamaging, low repetition, low volume eccentric exercise bout could also provide a protective/adaptive effect. METHODS: Subjects were assigned to a control (CON), eccentric exercise (ECC), or low volume familiarized eccentric exercise group (LV+ECC). Before the study, the LV+ECC group performed six maximal eccentric contractions during two familiarization sessions. The main eccentric bout targeted the elbow flexor muscle group and consisted of 36 maximal eccentric contractions. Muscle soreness, upper arm girth, elbow angle, creatine kinase activity, isometric torque, and concentric and eccentric torque at 0.52 and 3.14 rad.s-1 were assessed 0, 1, 2, 3, 4, 7, and 10 d postexercise. RESULTS: No evidence of muscle damage was observed as a result of the low volume eccentric bouts. Nevertheless, with the exception of muscle soreness and concentric torque, all variables recovered more rapidly in the LV+ECC group (P < 0.05). CONCLUSION: Adaptation to eccentric exercise can occur in the absence of significant muscle damage. Exposure to a small number of nondamaging eccentric contractions can significantly improve recovery after a subsequent damaging eccentric bout. Furthermore, this adaptation appears to be mode-specific and not applicable to concentric contractions.

Maximising health gain within available resources in the New Zealand public health system.

OBJECTIVE: to obtain intervention-condition-specific investment and disinvestment recommendations which optimise the potential for health gain from existing respiratory diseases resource expenditure; and to trial a health economics technique for this purpose, assessing its usefulness as a means of prioritising health services resource allocation. DESIGN: a programme budgeting and marginal analysis (PBMA) exercise drawing upon the expertise of an advisory group of clinicians, managers and consumer advocates, supported by health authority staff. SETTING: the Southern and Midland health regions in New Zealand which have populations of one million and seven hundred thousand respectively. HEALTH SYSTEM CONTEXT: publicly funded secondary care sector in which regional health authority (RHA) purchasers contract for services with health care providers. METHODS: available evidence on the marginal costs and benefits of services for respiratory diseases was examined by an advisory group who produced investment and disinvestment recommendations by consensus using agreed prioritisation criteria. RESULTS: A list of specific investment and disinvestment proposals. Implementation plans for a number of investments formed part of the business plans for both RHAs in 1997/1998. No disinvestments were planned. CONCLUSIONS: prioritisation methods like PBMA, which are explicit and rational, can produce defensible evidence-based recommendations with the additional benefit of the credibility and support of an expert advisory group. The process encourages co-operative working and may itself have enduring benefits. However, preparation and conduct of such exercises is resource intensive and requires careful planning. This exercise has provided valuable lessons for the conduct of future prioritisation work.

Changes in leg strength 8 and 32 h after endurance exercise.

The aim of this study was to determine the effects of a single bout of endurance exercise on subsequent strength performance. Eight males with a long history of resistance training performed isokinetic, isometric and isotonic leg extension strength tests 8 and 32 h after 50 min of cycle ergometry at 70-110% of critical power. The participants also completed a control condition in which no cycling was performed. Plasma lactate and ammonia were measured before and immediately after each strength test. Isokinetic, isometric and isotonic leg extension torques were not significantly different 8 or 32 h after endurance exercise compared with the control condition (P > 0.05). A large (50.3%), but not statistically significant, increase in plasma ammonia was evident during the strength tests performed 8 h after endurance exercise, while a significant (P < 0.05) increase in ammonia was also seen 32 h after endurance exercise. No significant changes in plasma ammonia were evident in the control condition. Our results suggest that leg extension strength was not compromised by an earlier bout of endurance cycling. However, metabolic activity during the strength tests might have been altered by the preceding bout of endurance exercise.

Concurrent strength and endurance training. A review.

Concurrent strength and endurance training appears to inhibit strength development when compared with strength training alone. Our understanding of the nature of this inhibition and the mechanisms responsible for it is limited at present. This is due to the difficulties associated with comparing results of studies which differ markedly in a number of design factors, including the mode, frequency, duration and intensity of training, training history of participants, scheduling of training sessions and dependent variable selection. Despite these difficulties, both chronic and acute hypotheses have been proposed to explain the phenomenon of strength inhibition during concurrent training. The chronic hypothesis contends that skeletal muscle cannot adapt metabolically or morphologically to both strength and endurance training simultaneously. This is because many adaptations at the muscle level observed in response to strength training are different from those observed after endurance training. The observation that changes in muscle fibre type and size after concurrent training are different from those observed after strength training provide some support for the chronic hypothesis. The acute hypothesis contends that residual fatigue from the endurance component of concurrent training compromises the ability to develop tension during the strength element of concurrent training. It is proposed that repeated acute reductions in the quality of strength training sessions then lead to a reduction in strength development over time. Peripheral fatigue factors such as muscle damage and glycogen depletion have been implicated as possible fatigue mechanisms associated with the acute hypothesis. Further systematic research is necessary to quantify the inhibitory effects of concurrent training on strength development and to identify different training approaches that may overcome any negative effects of concurrent training.

Resistance training frequency: strength and myosin heavy chain responses to two and three bouts per week.

Seventeen subjects performed resistance training of the leg extensor and flexor muscle groups two (2/wk) or three (3/wk) times per week. Changes in the relative myosin heavy chain (MHC) isoform contents (I, IIa and IIx) of the vastus lateralis and isometric, isokinetic and squat-lift one-repetition maximum (1 RM) strength were compared between conditions after both a common training period (6 weeks) and number of training sessions (18). After 6 weeks and 18 sessions (9 weeks for the 2/wk group), increments in 1RM strength for the 3/wk and 2/wk groups were similar [effect size (ES) differences approximately 0.3, 3/wk > 2/wk], whereas the 2/wk group presented greater isokinetic (ES differences = 0.3-1.2) and isometric (ES differences approximately 0.7) strength increases than the 3/wk condition. A significant (P < 0.05) increase in MHC IIa percentage was evident for the 2/wk group after 18 sessions. Both training groups exhibited a trend towards a reduction in the relative MHC IIx and an increase in MHC IIa contents (ES range = 0.5-1.24). However, correlations between changes in the strength and MHC profiles were weak (r2: 0.0-0.5). Thus, isometric and isokinetic strength responses to variations in training frequency differed from 1RM strength responses, and changes in strength were not strongly related to alterations in relative MHC content.

Reliability of an electrophoretic and image processing analysis of human skeletal muscle taken from m. vastus lateralis.

The relative content of myosin heavy chain (MHC) isoforms IIb, IIa and I in human skeletal muscle taken from the m. vastus lateralis of 30 healthy male subjects was analysed using mini-gel electrophoresis. Repeated electrophoretic gels utilizing the same methods were produced for all subjects and the determination of MHC protein bands was performed using a digital scanner and National Institutes of Health (NIH) Image software and laser densitometry. A comparison between the NIH Image processing technique and laser densitometry revealed differences of 6.47%, 6.35% and 6.84% between these measurement techniques for MHC-IIb, -IIa and -I isoforms, respectively. The percentage technical error of measurement (TEM%) between electrophoretic gels was shown to be 19.1%, 17.8% and 14.2%, with regard to percentage of occurrence of MHC-IIb, -IIa and -I isoforms respectively. The variation in electrophoretic gel analyses was shown to be 5.7%, 7.3% and 5.5%, with regard to the percentage of MHC-IIb, -IIa and -I isoforms respectively. Intra-class correlations comparing NIH Image and laser densitometry produced r values in the range 0.38-0.63. Comparisons between and within gel analyses produced r values in the range 0.59-0.94 and 0.93-0.98, respectively. Analyses of variance revealed no significant differences (P < 0.05) between analysis techniques, between gels or within gels for the measurement of MHC-IIb, -IIa and -I isoforms. The inter-gel error between fibre subgroups was moderate for the two type-II MHC populations and less for type-I MHC; the intra-individual error in the measuring technique used for classifying the MHC-IIb, -IIa and -I protein bands was small. The results obtained in this investigation showed consistent trends which may reflect a false classification of the type-II MHC populations for the inter-gel and intra-individual analyses. The NIH Image software and digitizing process was shown to be a valid and reliable method for distinguishing between MHC protein bands of human skeletal tissue as separated by mini-gel electrophoretic techniques.

Differences in muscle contractile characteristics among bodybuilders, endurance trainers and control subjects.

The purpose of this investigation was to compare the myosin heavy chain (MHC) isoform expression of the triceps brachii muscle and isoinertial, isometric and isokinetic strength indices in competitive bodybuilders (CB, n = 5), recreational resistance trainers (RT, n = 5), endurance-trained rowers (ER, n = 5) and control (C, n = 5) subjects. Muscle tissue samples were analysed for MHC isoform content using 6% sodium dodecyl sulphate-polyacrylamide gel electrophoresis. The CB possessed significantly smaller (P < 0.05) percentage of MHC type IIb proteins [12.92 (SD 7.08)%] than RT [30.08 (SD 6.58)%] ER [31.20 (SD 2.74)%] and C [38.22 (SD 2.95)%] groups (i.e. CB < RT approximately ER < C). While the content of MHC type IIa isoforms did not differ significantly between the two resistance-trained groups [CB = 55.76 (SD 5.38)%; RT = 45.72 (SD 7.8)%], CB presented significantly more type IIa MHC isoforms than ER [42.84 (SD 2.98)%] and C [34.72 (SD 1.57)%] subjects (i.e. CB approximately RT > ER approximately C). The MHC type I protein content did not differ significantly among RT [24.20 (SD 4.89)%] ER [25.38 (SD 1.67)%] and C [27.06 (SD 1.81)%] groups. The CB [31.32 (SD 2.67)%] presented significantly more type I MHC isoforms only in comparison with RT. However, when changes in the percentage of MHC type I isoforms were converted to effect sizes (ES), it appeared that low statistical power rather than the absence of an effect accounted for the nonsignificant differences between CB and other groups (i.e. CB > RT approximately ER approximately C). Significant differences existed in isoinertial strength among the trained athletes (i.e. CB > RT > ER approximately C), while isometric and isokinetic strength were not significantly different among any of the trained groups. However, the ES transformation of data demonstrated that large differences existed between resistance-trained groups and ER for isometric and isokinetic strength (i.e. CB approximately RT > ER approximately C). A statistically significant negative correlation (P < 0.001) was found between MHC type IIb isoforms and isoinertial strength index (r = -0.68). The MHC type IIa proteins were positively related to all the strength measures considered (r = 0.51 0.61; P < 0.001). These data demonstrated different patterns of MHC isoform expression among the different groups of athletes and it is suggested that these differences on occasion may affect the expression of strength.

Cross-sectional and longitudinal uses of isoinertial, isometric, and isokinetic dynamometry.

The purposes of this investigation were to assess whether maximal isoinertial (triceps pushdown [TP] and triceps extension [TE]), isometric and isokinetic (1.04, 2.08, 3.14, 4.16, and 5.20 rad.s-1) forearm extension strength measures: 1) presented statistical generality when they were correlated prior to and following 4, 8, and 12 wk of resistance training; 2) were similarly affected by training; and 3) presented statistical generality when their changes as a consequence of training were intercorrelated. Fifteen men (11 experimental and 4 controls) without a history of resistance training participated in the study. Training involved four sets of 8-12 repetitions, each followed by 90-s recovery, at 70-75% one repetition maximum (1RM), three times a week, for 12 wk. Training incorporated the TP, close-grip bench press, and triceps kickback exercises. Prior to and after 4, 8, and 12 wk of training, the intercorrelations among the TP, isometric, and isokinetic indices almost always achieved statistical generality (i.e., r2 > 0.5). It was concluded that the strength measures generally discriminated similarly between subjects. However, the sensitivity of the strength measures to the effects of training were dissimilar. While all strength indices increased with the training, the timing (isoinertial prior to isometric and isokinetic adaptations) and magnitude (TP > TE > isometric > isokinetic) of the adaptations varied greatly. None of the intercorrelations between changes in the strength indices achieved statistical generality. Furthermore, factor (F)-analyses on these changes indicated that in the initial and later stages of training, there were three and four discrete factors, respectively, accounting for strength development. These factors were thought to reflect differential effects of training on the structural, neural (including learning), and mechanical mechanisms underpinning each strength index. Possible applications of this research design in better understanding strength development were also canvassed.

Fracture of the metal tibial tray after Kinematic total knee replacement. A common cause of early aseptic failure.

We reviewed 1567 elective knee replacements performed between 1980 and 1990, using either the Total Condylar prosthesis with an all-plastic tibial component, or the Kinematic prosthesis which has a metal tibial tray. The ten-year probability of survival was 92.1% for the Total Condylar design and 87.9% for the Kinematic. The difference was mainly due to 16 revisions required in the Kinematic series for fracture of the metal base-plate. This was the most common cause of aseptic failure in this group. These fractures were strongly associated with a preoperative varus deformity (hazard ratio (HR) 8.8) and there was a slightly increased risk in males (HR 1.9) and in osteoarthritic knees (HR 1.8). In the nine fractures which occurred within four years of primary implantation (group 1), failure to correct adequately a preoperative varus deformity and the use of a bone graft to correct such a deformity were both strongly associated with fracture (HR 13.9 and 15.8, respectively). In eight fractures which occurred more than five years after primary replacement (group 2) we could detect no significant risk factors. Early complications occurred in two patients after the 16 revision procedures for tray fracture. One had a deep infection and the other refracture of the tray.

Changes in the myosin heavy chain isoform profile of the triceps brachii muscle following 12 weeks of resistance training.

The purpose of this investigation was to determine whether 12 weeks of resistance training, which increased arm girth (5%) and forearm extensor strength (39%), also altered the myosin heavy chain (MHC) characteristics of the triceps brachii muscle. Fifteen healthy, active men volunteered to participate under experimental (n = 11) or control (n = 4) conditions. The experimental group completed four sets of eight to 12 repetitions for each exercise (i.e. triceps pushdown, close grip bench press, triceps kickbacks and biceps curl) with loads of between 70-75% of one repetition maximum (1RM) three times a week. The inter-set and inter-exercise recovery period was only 90 s. Skeletal muscle tissue was removed from the triceps brachii muscle prior to (W0) and following 4 (W4), 8 (W8) and 12 (W12) weeks of the investigation. Samples were analysed for MHC isoform content using 6% sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). MHC isoform composition in the control group did not change significantly. However, the percentage of MHC type IIb isoform decreased significantly from W0 to W4 and again from W4 to W12 [W0: 39.7 (9.2); W12: 29.2 (8.2%)] in the experimental condition. The increments in MHC type IIa [W0: 34.0 (9.9); W12: 41.5 (10.4)] and type I [W0: 26.3 (7.9); W12: 29.3 (9.6)] isoforms were not significant for the experimental group. However, the effect size (ES) transformation of changes in types IIa MHC content was moderate (ES = 0.75). Changes in MHC isoform content were not significantly correlated with changes in 1RM strength for the triceps pushdown exercise. These data indicated that resistance training rapidly, and in an ongoing manner, changed the contractile protein profile of trained skeletal muscle. However, changes in MHC isoform composition in the first 12 weeks of training were not implicated in the development of 1RM triceps pushdown strength.

Strength and power assessment. Issues, controversies and challenges.

Athletic strength and power refer to the forces or torques generated during sporting activity. Their assessment can be used for strength diagnosis or talent identification, to monitor the effects of training interventions and to estimate the relative significance of strength and power to particular athletic pursuits. However, strength and power assessment is a difficult task. Reasons for this include: the fledgling status of research within the area, our limited understanding of the mechanisms underpinning strength and power performance and development, and limitations associated with various forms of dynamometry. This article describes a frame work for the collection of data which may ultimately lead to recommendations for the assessment of strength and power in sporting contexts. Such a framework will be evolutionary and depends upon synergistic improvements in our understanding of: the physiological mechanisms underpinning strength and power development; the effect that various training regimens have upon the development of strength and power; and factors influencing the validity and reliability of dynamometry. Currently, isometric, isoinertial and isokinetic dynamometry are employed in assessment. Each form has its supporters and detractors. Basically, proponents and critics of isokinetic and isometric dynamometry emphasis their apparently high internal and apparently low external [corrected] validity respectively. While the converse applies for isoinertial dynamometry. It appears that all 3 modalities can have acceptable reliability, however this should be established rather than assumed, as the reliability of each can be threatened by a number of considerations (e.g. instruction for isometric tasks, the impact of weight used during weighted jumping tasks, and the effects of gravity and feedback on isokinetic performance). While reliability is a seminal issue in assessment, it is not the only critical issue. Specifically, there has been little research into the correlation between strength and power measures and athletic performance. This work is central to the use of such indices in talent identification. To date, this work has generally been limited to heterogeneous rather than homogeneous groups. More work is required in this area. Furthermore, not all modes of assessment are sensitive or similarly sensitive to various training interventions. This suggests that these modalities are measuring different neuromuscular qualities. How these qualities relate to performance requires more work, and will determine the contexts in which various strength and power assessment modalities and protocols are used.(ABSTRACT TRUNCATED AT 400 WORDS)

Nutritional intake during an ultraendurance running race.

The food and fluid intake of a male ultraendurance runner was recorded throughout a 1,005-km race completed over 9 days. The nutrient analysis showed an average daily energy intake of 25,000 kJ with 62% from carbohydrate, 27% from fat, and 11% from protein. Carbohydrate intake was estimated to be 16.8 g.kg-1.day-1. The protein intake was estimated to be 2.9 g.kg-1.day-1 and water intake to be 11 L per day. These figures are within the recommended levels for ultraendurance athletes. Food and fluid were consumed in small amounts every 15 to 20 min to ensure maintenance of blood glucose levels and adequate hydration. This case study suggests that if the guidelines for prolonged exercise are followed, then athletes can successfully complete ultraendurance events.

Oxygen consumption, heart rate and oxygen pulse associated with selected exercise-to-muscle class elements.

The purpose of the investigation was to determine the relative oxygen consumption (VO2), heart rate and oxygen pulse associated with the constituent elements of an exercise-to-music class. Six women exercise-to-music leaders with a mean(s.d.) age, weight and height of 33.2(5.2) years, 51.0(2.8) kg and 157.9(5.6) cm respectively, completed five distinct exercise-to-music movement elements. The movement elements were of a locomoter (circuit, jump and low impact) and callisthenic (prone and side/supine) nature. The movement elements were distinguishable from one another in terms of their movement patterns, posture and tempo. Relative VO2 values were greatest for the circuit element (40.6 ml kg-1 min-1) and least for the side/supine element (20.0 ml kg-1 min-1). The differences in VO2 between the locomotrr and callisthenic elements were significant (circuit approximately jump approximately low impact > prone approximately side/supine). However, effect size data suggested that the differences between the low impact and jump elements and the prone and side/supine elements were of practical significance (circuit approximately jump > low impact > prone > side/supine). With a single exception similar parametric statistics and effect size trends were identified for absolute heart rate. Specifically, the heart rate associated with the low impact element was not significantly greater than the prone element. The oxygen pulse associated with the locomotor elements was significantly greater than the callisthenic elements (circuit approximately jump approximately low impact > prone > side/supine). This suggested that heart rate may be an inappropriate index for making comparisons between exercise-to-music elements. Reasons for differences in oxygen uptake values between movement elements are discussed.

Acute and chronic response of skeletal muscle to resistance exercise.

Skeletal muscle tissue is sensitive to the acute and chronic stresses associated with resistance training. These responses are influenced by the structure of resistance activity (i.e. frequency, load and recovery) as well as the training history of the individuals involved. There are histochemical and biochemical data which suggest that resistance training alters the expression of myosin heavy chains (MHCs). Specifically, chronic exposure to bodybuilding and power lifting type activity produces shifts towards the MHC I and IIb isoforms, respectively. However, it is not yet clear which training parameters trigger these differential expressions of MHC isoforms. Interestingly, many programmes undertaken by athletes appear to cause a shift towards the MHC I isoform. Increments in the cross-sectional area of muscle after resistance training can be primarily attributed to fibre hypertrophy. However, there may be an upper limit to this hypertrophy. Furthermore, significant fibre hypertrophy appears to follow the sequence of fast twitch fibre hypertrophy preceding slow twitch fibre hypertrophy. Whilst some indirect measures of fibre number in living humans suggest that there is no interindividual variation, postmortem evidence suggests that there is. There are also animal data arising from investigations using resistance training protocols which suggest that chronic exercise can increase fibre number. Furthermore, satellite cell activity has been linked to myotube formation in the human. However, other animal models (i.e. compensatory hypertrophy) do not support the notion of fibre hyperplasia. Even if hyperplasia does occur, its effect on the cross-sectional area of muscle appears to be small. Phosphagen and glycogen metabolism, whilst important during resistance activity appear not to normally limit the performance of resistance activity. Phosphagen and related enzyme adaptations are affected by the type, structure and duration of resistance training. Whilst endogenous glycogen reserves may be increased with prolonged training, typical isotonic training for less than 6 months does not seem to increase glycolytic enzyme activity. Lipid metabolism may be of some significance in bodybuilding type activity. Thus, not surprisingly, oxidative enzyme adaptations appear to be affected by the structure and perhaps the modality of resistance training. The dilution of mitochondrial volume and endogenous lipid densities appears mainly because of fibre hypertrophy.

Psychiatric service use: a cohort study of first attenders.

A retrospective cohort study was undertaken of all 1047 first-ever psychiatric service attenders to Christchurch general psychiatric services in 1981. All episodes of care were examined to the end of 1989. Only 24% of contacts were as an inpatient. Long-term contacts and frequent presenters formed only 15% of the sample. Nearly all cases not immediately discharged remained within the adult general service. Demographic and clinical variables and patterns of resource use are discussed.

Changes in blood glucose levels during a 1005-km running race: a case study.

The blood glucose response of a male ultramarathon runner was monitored throughout a 1005-km race. Before the race the runner had a fasting blood glucose concentration of 5.1 mM. At no stage during the race were his mean blood glucose levels less than 5.8 mM. This was partially attributed to the eating patterns of the athlete, the times at which blood samples were taken, the glycaemic index of food ingested and hyperglycaemia. While there was no evidence of glucosuria, ketones were present in the urine on one day of the event. There were other signs suggesting that at various stages of the event the runner had a metabolic acidosis. Possible reasons for this are discussed.

Acute and chronic responses of skeletal muscle to endurance and sprint exercise. A review.

Skeletal muscle adapts to the stress of endurance and sprint exercise and training. There are 2 main types of skeletal muscle fibre--slow twitch (ST) and fast twitch (FTa, FTb, FTc). Exercise may produce transitions between FT and ST fibres. Sprint training has decreased the proportion of ST fibres and significantly increased the proportion of FTa fibres, while endurance training may convert FTb to FTa fibres, and increase the proportion of ST fibres (i.e. FTb----FTa----FTc----ST). However, the high proportion of ST fibres documented for elite endurance athletes may be simply the result of natural selection. ST fibres function predominantly during submaximal exercise, whereas FT fibres are recruited as exercise intensity approaches VO2max and/or glycogen stores are depleted. Long distance runners have greater ST and FT fibre areas than untrained controls. However, doubt remains as to whether the ST or FT fibre area is greatest in endurance athletes. Increases in FT fibre area seem to occur during the first 2 months of training whereas ST fibre areas appear to increase after 2 to 6 months of training. Sprint training leads to the preferential use of FT fibres and male, but not female sprinters have larger FT fibres than untrained controls. Mitochondrial proteins and oxidative enzymes, as opposed to VO2max, are important determinants of the duration of endurance exercise. Endurance training increases intramuscular glycogen stores in both FT and ST fibres and produces a 'glycogen-sparing' effect which is characterised by an increased free fatty acid (FFA) metabolism. The activity of glycogen synthase is also increased by endurance training. Sprint training increases glycogen concentrations similarly in all fibre types, reduces the rate of glycogen utilisation at submaximal workloads and allows supramaximal workloads to be maintained for longer periods of time. During endurance exercise the pattern of glycogen depletion varies between muscle fibre types and between muscle groups. Glycogen stores in ST fibres are utilised initially, followed by stores in FTa then FTb fibres. Sprint activities are associated with a much greater rate of glycogen depletion. However, it is unlikely that glycogen depletion causes fatigue during sprinting. Sprint work is associated with a preferential depletion of glycogen from FTb then FTa and ST fibres. Endurance training appears to increase triglyceride stores adjacent to mitochondria and ST fibres have greater triglyceride stores than FT fibres. Endurance exercise is associated with a preferential use of triglycerides from ST fibres and endogenous triglycerides may account for over 50% of the total lipid oxidised during exercise.(ABSTRACT TRUNCATED AT 400 WORDS)