Binding Potassium to Improve Treatment With Renin-Angiotensin-Aldosterone System Inhibitors: Results From Multiple One-Stage Pairwise and Network Meta-Analyses of Clinical Trials.

This manuscript presents findings from the first dichotomous data pooling analysis on clinical trials (CT) regarding the effectiveness of binding potassium. The results emanated from pairwise and network meta-analyses aiming evaluation of response to commercial potassium-binding polymers, that is, to achieve and maintain normal serum potassium (n = 1,722), and the association between this response and an optimal dosing of renin-angiotensin-aldosterone system inhibitors (RAASi) needing individuals affected by heart failure (HF) or resistant hypertension, who may be consuming other hyperkalemia-inducing drugs (HKID) (e.g., ß-blockers, heparin, etc.), and frequently are affected by chronic kidney disease (CKD) (n = 1,044): According to the surface under the cumulative ranking area (SUCRA), sodium zirconium cyclosilicate (SZC) (SUCRA >0.78), patiromer (SUCRA >0.58) and sodium polystyrene sulfonate (SPS) (SUCRA <0.39) were different concerning their capacity to achieve normokalemia (serum potassium level (sK+) 3.5-5.0 mEq/L) or acceptable kalemia (sK+ ≤ 5.1 mEq/L) in individuals with hyperkalemia (sK+ >5.1 mEq/L), and, when normokalemia is achieved, patiromer 16.8-25.2 g/day (SUCRA = 0.94) and patiromer 8.4-16.8 g/day (SUCRA = 0.41) can allow to increase the dose of spironolactone up to 50 mg/day in subjects affected by heart failure (HF) or with resistant hypertension needing treatment with other RAASi. The potential of zirconium cyclosilicate should be explored further, as no data exists to assess properly its capacity to optimize dosing of RAASi, contrarily as it occurs with patiromer. More research is also necessary to discern between benefits of binding potassium among all type of hyperkalemic patients, for example, patients with DM who may need treatment for proteinuria, patients with early hypertension, etc. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020185614, CRD42020185558, CRD42020191430.

The Role of Galectin-3 and ST2 in Cardiology: A Short Review.

Galectin-3 is a lectin that binds beta-galactosides. It is involved in cardiac remodeling and fibrosis through the activation of macrophages and fibroblasts. ST2 is secreted by myocardial cells due to cardiac overload. These two biomarkers have been traditionally studied in the field of heart failure to guide medical therapy and detect the progression of the disease. Nevertheless, there are novel evidences that connect galectin-3 and ST2 with coronary heart disease and, specifically, with atrial fibrillation. The aim of this article is to concisely review the diagnostic and prognostic role of galectin-3 and ST2 in different cardiac diseases.

Inspiratory Muscle Training Program Using the PowerBreath®: Does It Have Ergogenic Potential for Respiratory and/or Athletic Performance? A Systematic Review with Meta-Analysis.

This systematic review and meta-analysis aim to provide scientific evidence regarding the effects of training on respiratory muscle training's impact with the PowerBreath®. A systematic analysis based on the PRISMA guides and a conducted research structured around the bases of Web of Science, Scopus, Medline/PubMed, SciELO y Cochrane Library Plus. Six articles published before January 2021 were included. The documentation and quantification of heterogeneity in every meta-analysis were directed through Cochran's Q test and the statistic I2; additionally, a biased publication analysis was made using funnel plots, whose asymmetry was quantified Egger's regression. The methodological quality was assessed through McMaster's. PowerBreath® administering a ≥ 15% resistive load of the maximum inspiratory pressure (PIM) achieves significant improvements (54%) in said pressure within 4 weeks of commencing the inspiratory muscle training. The maximal volume of oxygen (VO2max) considerable enhancements was achieved from the 6 weeks associated with the maximum inspiratory pressure ≥ 21.5% post inspiratory muscle training onwards. Conversely, a significant blood lactate concentration decrement occurred from the 4th week of inspiratory muscle training, after a maximum inspiratory pressure ≥ 6.8% increment. PowerBreath® is a useful device to stimulate sport performance and increase pulmonary function.

Evaluación deportiva, muscular y hormonal en deportistas de CrossFit que emplean la “Elevation Training Mask” / Athletic, muscular and hormonal evaluation in CrossFit athletes using the “Elevation Training Mask”

Introducción: La posibilidad de realizar entrenamientos intensos sin caer en estados de fatiga crónica, estimula el uso dedispositivos que mejoren la funcionalidad muscular y hormonal en deportistas. La Elevation Training Mask (Training Mask LLC)(ETM) permite la aplicación de hipoxia durante el ejercicio. La ETM se integra en las rutinas de entrenamiento incrementandoel estímulo físico para mejorar el rendimiento. Objetivo: Evaluamos el impacto de la ETM sobre los entrenamientos del día o Workouts of the Day (WODs), el comporta-miento muscular y hormonal en deportistas de Crossfit®.Material y método: Estudio de cohorte prospectivo. Durante 12 semanas 20 practicantes de Crossfit® entrenaban 60 minutos3 días a la semana fueron divididos aleatoriamente en 2 grupos, grupo control (GC) (n=10) y grupo ETM (GE) (n=10) aplicandouna altitud simulada adicional progresiva entre 914 y 2743 metros. Los WODs (press, squat, deadlift, CF total y grace), marca-dores maculares: lactato deshidrogenasa (LDH); creatina quinasa (CK); mioglobina (Mb) y hormonas: testosterona (T); cortisol(C), se evaluaron en 2 momentos del estudio: día 1 (T1) y día 84 (T2).Resultados: Todos los WODs y los parámetros LDH, CK, Mb, TT y C no mostraron ninguna diferencia significativa (p>0,05)en la interacción grupo tiempo. En el GE se observó un porcentaje de cambio (Δ) entre T1 y T2 sustancialmente menor enMb (-16,01±25,82%), CK (6,16±26,05%) y C (-0,18±4,01%) que en GC (Mb:-0,94±4,395; CK: 17,98±27,19%; C: 4,56±3,44%). LosΔ T1-T2 en los WODs fueron similares. Conclusión: Tras 12 semanas de entrenamiento en condiciones simuladas de hipoxia con ETM no existen mejoras del rendi-miento deportivo evaluadas mediante los WODs. Sin embargo, la mayor tendencia a disminuir de Mb, CK y C, tras usar la ETM,podrían estimular la recuperación e indicar un menor catabolismo muscular del atleta de Crossfit® a largo plazo.(AU)

Introduction: The possibility of performing intense workouts without falling into states of chronic fatigue stimulates theuse of devices that improve muscular and hormonal functionality in athletes. The Elevation Training Mask (Training Mask LLC)(ETM) allows the application of hypoxia during exercise. The ETM is integrated into training routines increasing the physicalstimulus to improve performance.Objective: We evaluated the impact of ETM on Workouts of the Day (WODs), muscular and hormonal behavior in Crossfit®athletes.Material and method: Prospective cohort study. During 12 weeks 20 Crossfit® athletes trained 60 minutes 3 days a weekwere randomly divided into 2 groups, control group (CG) (n=10) and ETM group (EG) (n=10) applying an additional progressivesimulated altitude between 914 and 2743 meters. WODs (press, squat, deadlift, total CF and grace), macular markers: lactatedehydrogenase (LDH); creatine kinase (CK); myoglobin (Mb) and hormones: testosterone (T); cortisol (C), were evaluated at2 time points of the study: day 1 (T1) and day 84 (T2). Results: All WODs and parameters LDH, CK, Mb, T and C showed no significant difference (p>0.05) in the time group interaction.In EG, a substantially lower percentage change (Δ) between T1 and T2 was observed in Mb (-16.01±25.82%), CK (6.16±26.05%)and C (-0.18±4.01%) than in CG (Mb: -094±4.39%; CK: 17.98±27.19%; C: 4.56±3.44%). The Δ T1-T2 in the WODs were similar.Conclusion: After 12 weeks of training under simulated hypoxia conditions with ETM there are no improvements in athleticperformance assessed by WODs. However, the greater tendency to decrease Mb, CK and C, after using ETM, could stimulaterecovery and indicate a lower muscle catabolism of the Crossfit® athlete in the long term.(AU)