The effect of krill oil supplementation on skeletal muscle function and size in older adults: A randomised controlled trial.

BACKGROUND & AIMS: The aim of this study was to determine the effect of krill oil supplementation, on muscle function and size in healthy older adults. METHODS: Men and women, aged above 65 years, with a BMI less than 35kg/m2, who participated in less than 1h per week of structured self-reported exercise, were enrolled in the study (NCT04048096) between March 2018 and March 2020. Participants were randomised to either control or krill oil supplements (4g/day) for 6 months in this double blind randomised controlled trial. At baseline, 6 weeks and 6 months, knee extensor maximal torque was measured as the primary outcome of the study. Secondary outcomes measured were grip strength, vastus lateralis muscle thickness, short performance physical battery test, body fat, muscle mass, blood lipids, glucose, insulin, and C-Reactive Protein, neuromuscular (M-Wave, RMS and voluntary activation), and erythrocyte fatty acid composition. RESULTS: A total of 102 men and women were enrolled in the study. Ninety-four participants (krill group (26 women and 23 men) and placebo group (27 women and 18 men)) completed the study (mean (SD): age 71.2 (5.1) years and weight 71.8 (12.3) kg). Six months supplementation with krill oil resulted in, an increase in knee extensor maximal torque, grip strength and vastus lateralis muscle thickness, relative to control (p<0.05). The 6-month treatment effects were 9.3% (95%CI: 2.8, 15.8%), 10.9% (95%CI: 8.3, 13.6%) and 3.5% (95%CI: 2.1, 4.9%) respectively. Increases in erythrocyte fatty acid profile were seen with krill oil for EPA 214% (95%CI: 166, 262%), DHA 36% (95%CI: 24, 48%) and the omega-3 index 61% (95%CI: 49, 73%), relative to control (p < 0.05). Krill oil resulted in an increased, relative to control (p < 0.05), M-Wave of 17% (95%CI: 12.7, 38.1%) but there was no effect of krill oil on RMS, voluntary activation, or on any other secondary outcomes such as performance of the short performance physical battery test or quality of life. CONCLUSION: Krill oil supplementation for 6 months results in statistically and clinically significant increases in muscle function and size in healthy older adults. GOV IDENTIFIER: NCT04048096.

Reliability of Trunk Muscle Electromyography in the Loaded Back Squat Exercise.

Trunk muscle activation (TMA) has been reported during back squat exercise, however reliability and sensitivity to different loads alongside kinematic measures has not. Hence the aim was to determine the interday reliability and load sensitivity of TMA and kinematics during back squats. 10 males performed 3 test sessions: 1) back squat 1RM, 2) and 3) 3 reps at 65, 75, 85 and 95% of system mass max (SMmax). Kinematics were measured from an electrogoniometer and linear transducer, and surface electromyography (sEMG) recorded 4 muscles of the trunk: rectus abdominis (RA), external oblique (EO), upper lumbar erector spinae (ULES) and lumbar sacral erector spinae (LSES), and a reference leg muscle, the vastus lateralus (VL). sEMG amplitude was root mean squared (RMS). No differences (p>0.05) found between tests for any kinematic and RMS data. CV demonstrated moderate interday reliability (~16.1%) for EO, LSES and ULES but not RA (29.4%) during the velocity-controlled eccentric phase; whereas it was moderately acceptable for just LSES and ULES (~17.8%) but not RA and EO (27.9%) during the uncontrolled concentric phase. This study demonstrated acceptable interday reliability for kinematic data while sEMG for most trunk muscle sites was moderately acceptable during controlled contraction. sEMG responded significantly to load.

Cognitive rehabilitation group intervention for breast cancer survivors: results of a randomized clinical trial.

PURPOSE: We conducted a randomized clinical trial evaluating the efficacy of a cognitive rehabilitation (CR) intervention compared with a wait list (WL) control condition on cognitive complaints, neuropsychological and brain functioning in breast cancer survivors (BCS). METHODS: The small group intervention of five sessions included psychoeducation and cognitive exercises. ELIGIBILITY: Disease-free BCS with cognitive complaints, diagnosed with stage I, II or III breast cancer, completed primary treatment 18 months to 5 years earlier. Neurocognitive test data and cognitive complaints on the Patient's Assessment of Own Functioning Inventory (PAOFI) were assessed at baseline (T1), immediately post-intervention (T2), and 2 months later (T3). A subgroup of participants underwent resting state quantitative electroencephalography (qEEG) at all three assessment time points. RESULTS: Forty-eight participants [mean age (SD) 53.8 (8.2)] completed T1 assessments, and 29 participants had analyzable qEEG data. The CR group improved significantly over time compared with the WL group on PAOFI total and memory scores (both p = .01) and on Rey Auditory Verbal Learning Test (RAVLT) total (trials I-V) (p = .02) and RAVLT delayed recall (p = .007) scores. On qEEG, the CR group showed a significant decrease in delta 'slow wave' power (p = .02) and an increase in the frontal distribution of alpha power (p = .04) from T1 to T2. CONCLUSIONS: BCS in the CR group showed immediate and sustained improvements in self-reported cognitive complaints and memory functioning on neurocognitive testing. Results of the qEEG substudy provide some support for neurophysiological changes underlying the intervention. Copyright © 2015 John Wiley & Sons, Ltd.

Neuromuscular response differences to power vs strength back squat exercise in elite athletes.

The study's aim was to establish the neuromuscular responses in elite athletes during and following maximal 'explosive' regular back squat exercise at heavy, moderate, and light loads. Ten elite track and field athletes completed 10 sets of five maximal squat repetitions on three separate days. Knee extension maximal isometric voluntary contraction (MIVC), rate of force development (RFD) and evoked peak twitch force (Pt) assessments were made pre- and post-session. Surface electromyography [root mean square (RMS)] and mechanical measurements were recorded during repetitions. The heavy session resulted in the greatest repetition impulse in comparison to moderate and light sessions (P < 0.001), while the latter showed highest repetition power (P < 0.001). MIVC, RFD, and Pt were significantly reduced post-session (P < 0.01), with greatest reduction observed after the heavy, followed by the moderate and light sessions accordingly. Power significantly reduced during the heavy session only (P < 0.001), and greater increases in RMS occurred during heavy session (P < 0.001), followed by moderate, with no change during light session. In conclusion, this study has shown in elite athletes that the moderate load is optimal for providing a neuromuscular stimulus but with limited fatigue. This type of intervention could be potentially used in the development of both strength and power in elite athletic populations.

Reproducibility of limb power outputs and cardiopulmonary responses to exercise using a novel swimming training machine.

The purpose of this study was to determine the reproducibility of limb power outputs and cardiopulmonary responses, to incremental whole-body exercise using a novel swimming training machine. 8 swimmers with a mean age of 23.7 ± 4.6 (yrs), stature 1.77 ± 0.13 (m) and body mass of 74.7 ± 2.8 (kg) gave informed consent and participated in repeat exercise testing on the machine. All subjects performed 2 incremental exercise tests to exhaustion using front crawl movements. From these tests peak oxygen consumption (VO(2peak)), peak heart rate (HR(peak)), peak power output (W (peak)) and individual limb power outputs were determined. Results showed there were no significant differences between test 1 and 2 for any variable at exhaustion, and the CV% ranged from 2.8 to 3.4%. The pooled mean values were; VO(2peak) 3.7 ± 0.65 L.min⁻¹, HR (peak) 178.7 ± 6.6 b.min⁻¹ and W (peak) 349.7 ± 16.5 W. The mean contributions to the total power output from the legs and arms were (37.3 ± 4.1% and 62.7 ± 5.1% respectively). These results show that it is possible to measure individual limb power outputs and cardiopulmonary parameters reproducibly during whole-body exercise using this training machine, at a range of exercise intensities.

Brain functional changes (QEEG cordance) and worsening suicidal ideation and mood symptoms during antidepressant treatment.

OBJECTIVE: Antidepressant medications are efficacious overall; however, some individuals experience worsening mood symptoms and increased suicidal ideation (SI) during treatment. We examined the quantitative electroencephalographic (QEEG) cordance biomarker of brain function biomarker in relation to treatment-emergent symptom worsening. METHOD: Seventy-two major depressive disorder (MDD) subjects were treated with fluoxetine 20 mg (n = 13), venlafaxine 150 mg (n = 24), or placebo (n = 35) under double-blind conditions. Behavioral ratings determined whether each subject demonstrated worsening of depressed mood, anxiety, or SI during treatment. QEEG cordance data were analyzed to determine whether symptom worsening was associated with neurophysiological changes. RESULTS: Antidepressant treatment-emergent SI (13.5%) was associated with a large transient decrease in midline-and-right-frontal (MRF) cordance 48 h after start of medication. CONCLUSION: Hypothesis-generating results suggest a pattern of functional changes in midline and right frontal brain regions associated with antidepressant treatment-emergent SI in MDD.

Brain functional changes during placebo lead-in and changes in specific symptoms during pharmacotherapy for major depression.

OBJECTIVE: Brain functional changes during placebo lead-in have been associated with antidepressant response in clinical trials for major depressive disorder (MDD); however, the relationship between such non-pharmacodynamic changes in brain function and changes in specific symptoms is unknown. METHOD: Fifty-eight adults with MDD completed a 1-week single-blind placebo lead-in preceding 8 weeks of double-blind randomized treatment with fluoxetine or venlafaxine (n = 30) or placebo (n = 28). Brain functional change during lead-in was assessed using quantitative electroencephalographic (qEEG) prefrontal theta-band cordance. Symptoms were assessed using the Symptom Checklist-90-Revised (SCL-90-R). RESULTS: The multiple regression model examining the qEEG parameter in relation to SCL-90-R subscales was significant [F(9,9) = 4.27, P = 0.021, R(2) = 0.81] in females, with a significant association for the interpersonal sensitivity subscale (beta coefficient = 1.94, P = 0.001). CONCLUSION: Prefrontal neurophysiologic change during placebo lead-in may indicate subsequent antidepressant-related improvement in symptoms of interpersonal sensitivity.

Effect of lower limb massage on electromyography and force production of the knee extensors.

OBJECTIVE: To evaluate the effect of massage on force production and neuromuscular recruitment. METHODS: Ten healthy male subjects performed isokinetic concentric contractions on the knee extensors at speeds of 60, 120, 180, and 240 degrees /s. These contractions were performed before and after a 30 minute intervention of either rest in the supine position or lower limb massage. Electromyography (EMG) and force data were captured during the contractions. RESULTS: The change in isokinetic mean force due to the intervention showed a significant decrease (p<0.05) at 60 degrees /s and a trend for a decrease (p = 0.08) at 120 degrees /s as a result of massage compared with passive rest. However, there were no corresponding differences in any of the EMG data. A reduction in force production was shown at 60 degrees /s with no corresponding alteration in neuromuscular activity. CONCLUSIONS: The results suggests that motor unit recruitment and muscle fibre conduction velocity are not responsible for the observed reductions in force. Although experimental confirmation is necessary, a possible explanation is that massage induced force loss by influencing "muscle architecture". However, it is possible that the differences were only found at 60 degrees /s because it was the first contraction after massage. Therefore muscle tension and architecture after massage and the duration of any massage effect need to be examined.

Effects of supramaximal exercise on the electromyographic signal.

AIM: To determine the neuromuscular recruitment characteristics during supramaximal exercise. METHODS: Ten healthy subjects completed the Wingate anaerobic test (WAT) cycling protocol. Electromyographic (EMG) data and rate of fatigue were recorded throughout the cycling. RESULTS: The mean (SD) rate of fatigue (decrease in power output) was 44.5 (8.6)%. No significant change was found in EMG amplitude. A significant decrease (p<0.01) in mean power frequency spectrum was found over the 30 second period. CONCLUSIONS: During WAT, mean power frequency spectrum was attenuated with no decline in EMG amplitude, which may be caused by an accumulation of metabolites in the periphery. However, it is also possible that the feedback loop from intramuscular metabolism to the central nervous system is unable, within the 30 second period of the WAT, to affect neural recruitment strategy.

EMG amplitude in maximal and submaximal exercise is dependent on signal capture rate.

This study analysed the effect of different electromyographic (EMG) capture rates during maximal voluntary contraction, submaximal and maximal dynamic cycling activity on EMG amplitude and signal characteristics. Ten healthy subjects participated in this study. Peak power output (PPO) and maximal isometric force output (MVC) were measured, followed by a progressive cycle ride on a cycle ergometer. Electromyographic (EMG) data were simultaneously captured during the MVC and cycling activities at frequencies of 32, 64, 128, 256, 512, 1024 and 1984 Hz. Significant differences in amplitude were found (p < 0.01) between MVC, submaximal (SUB) and maximal cycling activities (PWATT) for all capture rates. Asymptote values for IEMG amplitude occurred at EMG capture rates of 1604 +/- 235.6 Hz during MVC, 503.1 +/- 236.2 Hz during PWATT and 326.2 +/- 105.4 Hz during SUB cycling activity and were significantly different (p < 0.01). No significant differences were found for force/EMG ratios between PWATT and MVC at 1984 Hz capture rates (3.8 +/- 1.7 N/V vs 2.5 +/- 0.9 N/V) while significant differences occurred at 32 Hz capture rate (6.2 +/- 3.8 vs 16.0 +/- 8.0; p < 0.01). Low correlations were found between EMG activity captured at 1984 Hz during PWATT and lean thigh volume (r = 0.36) and MVC (r = 0.32). Asymptote values found on this study suggest that data captured below 326 Hz for SUB, 503 Hz for PWATT and 1604 Hz for MVC are not reliable. Therefore apparatus capturing EMG data at low frequencies from these values cannot be used for quantitative data analyses.

The effects of heat stress on neuromuscular activity during endurance exercise.

This study analysed the effect of hot (35 degrees C) and cold (15 degrees C) environments on electromyographic (EMG) signal characteristics, skin and rectal temperatures and heart rate during progressive endurance exercise. Eight healthy subjects performed three successive 15-min rides at 30%, 50% and 70% of their peak sustained power output and then cycled at increasing (15 W/min) work rates to exhaustion in both 35 degrees C and 15 degrees C environments. Skin and rectal temperatures, heart rate and EMG data were measured during the trials. The skin temperatures were higher and the subjects felt more uncomfortable in the hot conditions (Bedford scale) ( P<0.01). Rectal temperature was slightly, but not significantly, higher under hot conditions. Heart rate was significantly higher in the hot group (between condition P<0.05). Peak power output (267.4+/-67.7 W vs. 250.1+/-61.5 W) and time-to-exhaustion (55.7+/-16.7 min vs. 54.5+/-17.1 min) (COLD vs. HOT) were not different between conditions. There were no differences in integrated EMG (IEMG) or mean power frequency spectrum between conditions. Rating of perceived exertion increased similarly in both conditions over time. Although the hot conditions increased heart rate and skin temperature, there were no differences in muscle recruitment or maximal performance, which suggests that the thermal stress of 35 degrees C, in combination with exercise, did not impair maximal performance in this study.

Effects of microtubule-associated protein (MAP) expression on methylmercury-induced microtubule disassembly.

The sensitivity of microtubules (MTs) to methylmercury- (MeHg) induced disassembly was compared in undifferentiated, MAP1A- and MAP2C-transfected, and neuronally differentiated P19 Embyronal Carcinoma (EC) cells. The extent of MT disassembly was examined qualitatively by immunofluorescence microscopy and Western blotting and quantitatively by dot blotting of polymer and soluble proteins extracts. Immunofluorescence microscopy showed that MeHg disassembled MTs in a time- and dose-dependent manner and that MTs in both MAP2C-transfected and neuronally differentiated cells, but not those in MAP1A-transfected cells, were significantly more resistant to MeHg-induced MT depolymerization than those in undifferentiated cells. These results suggest that MAP2C has a greater ability to stabilize MTs against MeHg-induced disassembly than MAP1A. Surprisingly, however, when the extent of MT disassembly was assessed by Western blotting and by quantitative dot blotting, no change was observed in the amounts of tubulin, MAP2, or MAP1A, in the polymer and soluble fractions in MeHg-treated samples, compared to the control cells that were not treated. These data show that, although MeHg treatment resulted in the disassembly of MTs, they were not depolymerized as detergent-soluble subunits, but rather appeared to form insoluble tubulin-MAP oligomers or aggregates.

Nutrition management of patients with neoplastic disease of the head and neck treated with radiation therapy.

Neoplastic lesions of the head and neck are primarily squamous cell carcinomas of the aerodigestive tract mucosa. Approximately 43,000 new cases of head and neck cancer (8.5% of all malignancies) are diagnosed in the United States each year. Tumors, with a male predominance at age 50 to 60 years, generally occur on the surface of the mucosal lining of the oral cavity, oropharynx, nasopharynx, larynx, maxillary sinus, salivary glands, and the thyroid gland. Tobacco, alcohol, and the combination of tobacco and alcohol are the principle causative agents of head and neck neoplasms. The use of these carcinogenic agents often has a negative impact on lifestyle, and it is not unusual for significant nutritional deficiencies to exist in this population before diagnosis of head and neck cancer. Definitive and adjuvant cancer treatment modalities are rigorous, and sequelae associated with the therapy often further impair nutritional status and increase morbidity. Auspicious nutrition assessment and management before the initiation of therapy can have a significant impact on the course of treatment and the patient's quality of life.

Yellow nail syndrome associated with empyema.

The yellow nail syndrome is a rare condition consisting of slow-growing dystrophic nails and oedema, usually affecting the ankles, and probably due to defective lymphatic drainage. Its association with mild chronic pulmonary disease has been recognized. We describe a case initially complicated by a recurrent pleural effusion but, more importantly, by the development of bronchiectasis and thoracic empyema.

Pulmonary infection with mycobacterium xenopi: review of treatment and response.

Forty seven patients (82% male) with pulmonary infection caused by Mycobacterium xenopi have been reviewed. Pre-existing lung disease was present in 35 (75%). In 21 patients the disease was characterised by a subacute illness developing over a period of two to four months, while in another 20 patients there was a longer history of chronic respiratory problems often associated with slowly progressive changes evident from chest radiographs. Response to treatment was poor and unpredictable, and was not related to the results of in vitro sensitivity tests, pre-existing lung disease, or mode of onset of symptoms. Eleven patients (23%) were cured with chemotherapy. The best drug regimen appeared to be rifampicin and isoniazid combined with either streptomycin or ethambutol. Another 12 (26%) showed favourable responses to drug treatment initially, but eventually relapsed. Four patients had progressive disease while receiving prolonged courses of chemotherapy. Resection was performed in five patients with resultant cure in four. Since the prognosis with drug treatment alone is so unpredictable it is suggested that resection might be part of first line treatment, and that it should usually be performed if patients fail to respond to initial chemotherapy or if they relapse.

Retrospective survey of the management of miliary tuberculosis in South and West Wales, 1976-8.

In a survey of 1000 patients with tuberculosis 28 were found to have miliary disease. Half of these patients were over 60 years old. Anorexia and weight loss were present in 19 (70%) and pyrexia in 17 (63%). A factor predisposing to tuberculosis or a history of recent contact was found in 12 (43%), and 21 (75%) had positive cultures. Seventeen (61%) had classical miliary shadowing while four (14%) had cryptic miliary tuberculosis with no radiological evidence of tuberculosis. The remaining seven patients (25%) had radiological changes consistent with pulmonary tuberculosis, but no miliary shadows. Of those who completed chemotherapy, only five (42%) received 18 months' treatment. Nine patients (32%) died from their miliary tuberculosis. Failure to consider the diagnosis, leading to a delay in starting chemotherapy, appeared to be a major problem.

Pulmonary infection with Mycobacterium kansasii in Wales, 1970-9: review of treatment and response.

Thirty-five patients (88% male) with pulmonary infection caused by Mycobacterium kansasii have been reviewed. Sixty-six per cent had pre-existing lung disease, chronic bronchitis and emphysema accounting for half of the disorders. Unilateral lesions were present in 69% of patients whose chest radiographs were reviewed and 90% had cavitating disease. The development of unilateral or bilateral disease appeared to be independent of any delay in starting treatment. Five patients died while receiving treatment, but none of these deaths was due to M kansasii infection. The remaining 30 patients were successfully treated with drug regimens, all of which included rifampicin and 86% of which included ethambutol. There was 100% sputum conversion, with no relapses after a mean follow-up period of five-and-a-half years. Rifampicin and ethambutol given for a mean period of 15 months appeared to be a non-toxic, effective combination.

Management of extra-pulmonary tuberculosis (excluding miliary and meningeal) in south and west Wales (1976-8).

In a retrospective survey of the management of extrapulmonary tuberculosis lymph node and genitourinary tuberculosis were found more commonly than bone and joint or gynaecological disease. Only 29% of patients received 18 moths' chemotherapy while 31% received nine to 12 months' treatment with rifampicin and isoniazid regimens and 34% had short-course chemotherapy with other regimens. Five patients were not offered any chemotherapy after diagnosis, and in five patients the diagnosis was overlooked because of administrative errors. One patient died from tuberculosis (renal). Poor drug compliance appeared less of a problem than in pulmonary tuberculosis. Only 14% of patients had their disease managed solely by consultants who were not specialists in chest disease. Liaison with a chest consultant did not necessarily ensure chemotherapy for 18 moths.