Case Report: Unveiling an Incidentally Diagnosed Extrapulmonary Small Cell Carcinoma of the Rectum.

Extrapulmonary small cell carcinoma (EPSCC) is a rare malignancy with distinct clinical and pathological characteristics. We present the case of a 72-year-old male diagnosed with EPSCC of the rectum during a routine screening colonoscopy. The patient was asymptomatic, and pathological examination revealed a rectal mass displaying features of small cell carcinoma (SCC) associated with tubular adenoma. The treatment comprised radiation therapy and cisplatin/etoposide chemotherapy. This case underscores the importance of considering EPSCC as a potential diagnosis in patients with rectal masses, necessitating further studies to optimize treatment strategies.

Myocardial performance index as a measure of global left ventricular function improves following isometric exercise training in hypertensive patients.

As the leading cause of cardiovascular disease and mortality, hypertension remains a global health problem. Isometric exercise training (IET) has been established as efficacious in reducing resting blood pressure (BP); however, no research to date has investigated its effects on the myocardial performance index (MPI). Twenty-four unmedicated hypertensive patients were randomized to 4 weeks of IET and a control period in a crossover design. Tissue Doppler imaging was used to acquire cardiac time intervals pre- and post-IET and during the control periods. IET significantly improved all measures of cardiac time intervals, including isovolumic relaxation time (83.1 ± 10.3 vs. 76.1 ± 11.2 ms, p = 0.006), isovolumic contraction time (84.8 ± 10.3 vs. 72.8 ± 6.4 ms, p < 0.001), ejection time (304.6 ± 30.2 vs. 321.4 ± 20.8 ms, p = 0.015) and the MPI (0.56 ± 0.09 vs. 0.47 ± 0.05, p < 0.001). This is the first study to demonstrate that IET significantly improves cardiac time intervals. These findings may have important clinical implications, highlighting the potential utility of IET in the management of cardiac health in hypertensive patients.

One year of isometric exercise training for blood pressure management in men: a prospective randomized controlled study.

OBJECTIVE: Isometric exercise training (IET) over 4-12 weeks is an effective antihypertensive intervention. However, blood pressure (BP) reductions are reversible if exercise is not maintained. No work to date has investigated the long-term effects of IET on resting BP. METHODS: We randomized 24 unmedicated patients with high-normal BP to a 1-year wall squat IET intervention or nonintervention control group. Resting BP and various clinically important haemodynamic variables, including heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were measured pre and post the 1-year study period. RESULTS: One year of IET produced statistically significant reductions in resting systolic (-8.5 ±â€Š5 mmHg, P  < 0.001) and diastolic (-7.3 ±â€Š5.8 mmHg, P  < 0.001) BP compared with the control group. There was also a significant reduction in resting HR (-4.2 ±â€Š3.7 b/min, P  = 0.009) and a significant increase in SV (11.2 ±â€Š2.8 ml, P  = 0.012), with no significant change in CO (0.12 ±â€Š2.8 l/min, P  = 0.7). TPR significantly decreased following IET (-246 ±â€Š88 dyne·s/cm 5 , P  = 0.011). Adherence to the IET sessions was 77% across all participants (3x IET sessions per week), with no participant withdrawals. CONCLUSION: This novel study supports IET as an effective long-term strategy for the management of resting BP, producing clinically important, chronic BP adaptations in patients at risk of hypertension. Importantly, this work also demonstrates impressive long-term adherence rates, further supporting the implementation of IET as a means of effective BP management in clinical populations.

Myocardial work and left ventricular mechanical adaptations following isometric exercise training in hypertensive patients.

PURPOSE: Hypertension is a major risk factor for cardiovascular disease. Isometric exercise training (IET) reduces resting and ambulatory blood pressure; however, few studies have investigated the myocardial adaptations following IET. METHODS: We randomly assigned 24 unmedicated hypertensive patients in a cross-over study design to 4-weeks of IET and control period, separated by a 3-week washout period. Speckle tracking echocardiography was used to measure left ventricular (LV) mechanics, and global myocardial work indices were derived from non-invasive LV pressure-strain loops constructed from global longitudinal strain (GLS) indexed to brachial systolic blood pressure. RESULTS: IET significantly improved GLS (- 2.3 ± 2%, p < 0.001) and global work efficiency (2.8 ± 2%, p < 0.001), and significantly reduced global wasted work (- 42.5 ± 30 mmHg%, p < 0.001) with no significant change during the control period. CONCLUSIONS: This is the first evidence to demonstrate that IET significantly improved cardiac health in a relevant patient population. Our findings have important clinical implications for patients with high blood pressure and support the role of IET as a safe and viable therapeutic and preventative intervention in the treatment of hypertension.

Left ventricular mechanical, cardiac autonomic and metabolic responses to a single session of high intensity interval training.

PURPOSE: High-intensity interval training (HIIT) produces significant health benefits. However, the acute physiological responses to HIIT are poorly understood. Therefore, we aimed to measure the acute cardiac autonomic, haemodynamic, metabolic and left ventricular mechanical responses to a single HIIT session. METHODS: Fifty young, healthy participants completed a single HIIT session, comprising of three 30-s maximal exercise intervals on a cycle ergometer, interspersed with 2-min active recovery. Cardiac autonomics, haemodynamics and metabolic variables were measured pre-, during and post-HIIT. Conventional and speckle tracking echocardiography was used to record standard and tissue Doppler measures of left ventricular (LV) structure, function and mechanics pre- and post-HIIT. RESULTS: Following a single HIIT session, there was significant post-exercise systolic hypotension (126 ± 13 to 111 ± 10 mmHg, p < 0.05), parallel to a significant reduction in total peripheral resistance (1640 ± 365 to 639 ± 177 dyne⋅s⋅cm5, p < 0.001) and significant increases in baroreceptor reflex sensitivity and baroreceptor effectiveness index (9.2 ± 11 to 24.8 ± 16.7 ms⋅mmHg-1 and 41.8 ± 28 to 68.8 ± 16.2, respectively) during recovery compared to baseline. There was also a significant increase in the low- to high-frequency heart rate variability ratio in recovery (0.7 ± 0.48 to 1.7 ± 1, p < 0.001) and significant improvements in left ventricular global longitudinal strain (- 18.3 ± 1.2% to - 29.2 ± 2.3%, p < 0.001), and myocardial twist mechanics (1.27 ± 0.72 to 1.98 ± 0.72°·cm-1, p = 0.028) post-HIIT compared to baseline. CONCLUSION: A single HIIT session is associated with acute improvements in autonomic modulation, haemodynamic cardiovascular control and left ventricular function, structure and mechanics. The acute responses to HIIT provide crucial mechanistic information, which may have significant acute and chronic clinical implications.

Continuous cardiac autonomic and haemodynamic responses to isometric exercise in females.

PURPOSE: Hypertension is associated with impaired haemodynamic control mechanisms and autonomic dysfunction. Isometric exercise (IE) interventions have been shown to improve autonomic modulation and reduce blood pressure (BP) predominantly in male participants. The physiological responses to IE are unexplored in female populations; therefore, this study investigated the continous cardiac autonomic and haemodynamic response to a single bout of IE in a large female population. METHODS: Forty physically inactive females performed a single, individually prescribed isometric wall squat training session. Total power spectral density of heart rate variability (HRV) and associated low-frequency (LF) and high-frequency (HF) power spectral components were recorded in absolute (ms2) and normalised units (nu) pre, during and post an IE session. Heart rate (HR) was recorded via electrocardiography and baroreceptor reflex sensitivity (BRS) via the sequence method. Continuous blood pressure was recorded via the vascular unloading technique and stroke volume via impedance cardiography. Total peripheral resistance (TPR) was calculated according to Ohm's law. RESULTS: During IE, there were significant reductions in HRV (p < 0.001) and BRS (p < 0.001), and significant increases in heart rate (p < 0.001), systolic, mean and diastolic BP (p < 0.001 for all). In recovery following the IE session, cardiac autonomic parameters returned to baseline (p = 0.974); however, total peripheral vascular resistance significantly reduced below baseline (p < 0.001). This peripheral vascular response was associated with significant reductions in systolic (-17.3 ± 16.5 mmHg, p < 0.001), mean (-18.8 ± 17.4 mmHg, p < 0.001) and diastolic BP (-17.3 ± 16.2 mmHg, p < 0.001), below baseline. CONCLUSION: A single IE session is associated with improved haemodynamic cardiovascular responses in females. Cardiac autonomic responses return to baseline values, which suggests that alternative mechanisms are responsible for the post-exercise haemodynamic improvements in females. Future mechanistic research is required to investigate the acute and chronic effects of IE in female populations with different resting BP profiles.

Ambulatory blood pressure adaptations to high-intensity interval training: a randomized controlled study.

OBJECTIVE: Hypertension remains the leading cause of cardiovascular disease and premature mortality globally. Although high-intensity interval training (HIIT) is an effective nonpharmacological intervention for the reduction of clinic blood pressure (BP), very little research exists regarding its effects on ambulatory BP. The aim of this study was to measure alterations in ambulatory and clinic BP following HIIT in physically inactive adults. METHODS: Forty-one participants (22.8 ±â€Š2.7 years) were randomly assigned to a 4-week HIIT intervention or control group. The HIIT protocol was performed on a cycle ergometer set against a resistance of 7.5% bodyweight and consisted of 3 × 30-s maximal sprints separated with 2-min active recovery. Clinic and ambulatory BP was recorded pre and post the control period and HIIT intervention. RESULTS: Following the HIIT intervention, 24-h ambulatory BP significantly decreased by 5.1 mmHg in sBP and 2.3 mmHg in dBP (P = 0.011 and 0.012, respectively), compared with the control group. In addition, clinic sBP significantly decreased by 6.6 mmHg compared with the control group (P = 0.021), with no significant changes in dBP and mean BP (mBP). Finally, 24-h ambulatory diastolic, daytime sBP, mBP and dBP, and night-time sBP and mBP variability significantly decreased post-HIIT compared with the control group. CONCLUSION: HIIT remains an effective intervention for the management of BP. Our findings support enduring BP reduction and improved BP variability, which are important independent risk factors for cardiovascular disease.

Left atrial mechanics and aortic stiffness following high intensity interval training: a randomised controlled study.

PURPOSE: High intensity interval training (HIIT) has been shown to improve important health parameters, including aerobic capacity, blood pressure, cardiac autonomic modulation and left ventricular (LV) mechanics. However, adaptations in left atrial (LA) mechanics and aortic stiffness remain unclear. METHODS: Forty-one physically inactive males and females were recruited. Participants were randomised to either a 4-week HIIT intervention (n = 21) or 4-week control period (n = 20). The HIIT protocol consisted of 3 × 30-s maximal cycle ergometer sprints with a resistance of 7.5% body weight, interspersed with 2-min of active unloaded recovery, three times per week. Speckle tracking imaging of the LA and M-Mode tracing of the aorta was performed pre and post HIIT and control period. RESULTS: Following HIIT, there was significant improvement in LA mechanics, including LA reservoir (13.9 ± 13.4%, p = 0.033), LA conduit (8.9 ± 11.2%, p = 0.023) and LA contractile (5 ± 4.5%, p = 0.044) mechanics compared to the control condition. In addition, aortic distensibility (2.1 ± 2.7 cm2 dyn-1 103, p = 0.031) and aortic stiffness index (- 2.6 ± 4.6, p = 0.041) were improved compared to the control condition. In stepwise linear regression analysis, aortic distensibility change was significantly associated with LA stiffness change R2 of 0.613 (p = 0.002). CONCLUSION: A short-term programme of HIIT was associated with a significant improvement in LA mechanics and aortic stiffness. These adaptations may have important health implications and contribute to the improved LV diastolic and systolic mechanics, aerobic capacity and blood pressure previously documented following HIIT.

Neurohumoral and ambulatory haemodynamic adaptations following isometric exercise training in unmedicated hypertensive patients.

OBJECTIVE: Hypertension remains the leading modifiable risk factor for cardiovascular disease. Isometric exercise training (IET) has been shown to be a useful nonpharmacological intervention for reducing resting blood pressure (BP). This study aimed to measure alterations in office BP, ambulatory BP, cardiac autonomic modulation and inflammatory and vascular biomarkers following a programme of IET in unmedicated hypertensive patients. METHODS: Twenty-four unmedicated stage 1 hypertensive patients (age 43.8 ±â€Š7.3 years; height, 178.1 ±â€Š7 cm; weight 89.7 ±â€Š12.8 kg) were randomly assigned in a cross-over study design, to 4-weeks of home-based IET and control period, separated by a 3-week washout period. Office and ambulatory BP, cardiac autonomic modulation, and inflammatory and vascular biomarkers were recorded pre and post-IET and control periods. RESULTS: Clinic and 24-h ambulatory BP significantly reduced following IET by 12.4/6.2 and 11.8/5.6 mmHg in SBP/DBP, respectively (P < 0.001 for both), compared with the control. The BP adaptations were associated with a significant (P = 0.018) reduction in the average real variability of 24-h ambulatory BP following IET, compared with control. Cardiac autonomic modulation improved by 11% (P < 0.001), baroreceptor reflex sensitivity improved by 47% (P < 0.001), and IL-6 and asymmetric dimethylarginine reduced by 10% (P = 0.022) and 19% (P = 0.023), respectively, which differed significantly to the control period. CONCLUSION: This is the first evidence of durable BP reduction and wider cardiovascular disease risk benefits of IET in a relevant patient population. Our findings support the role of IET as a safe and viable therapeutic and preventive intervention in the treatment of hypertension.

Cardiac autonomic and left ventricular mechanics following high intensity interval training: a randomized crossover controlled study.

Physical inactivity and sedentary behavior is associated with increased cardiovascular disease risk. Short duration high-intensity interval training (HIIT) has been shown to improve important health parameters. The aim of the present study was to assess the combined adaptations of the cardiac autonomic nervous system and myocardial functional and mechanical parameters to HIIT. Forty physically inactive and highly sedentary men completed two weeks of HIIT and control period. The HIIT protocol consisted of 3 × 30-s maximal cycle ergometer sprints against a resistance of 7.5% body weight, interspersed with 2 min of active recovery. Total power spectral density (PSD) and associated low-frequency (LF) and high-frequency (HF) power spectral components of heart rate variability were recorded. Conventional and speckle tracking echocardiography recorded left ventricular (LV) structural, functional, and mechanical parameters. HIIT produced a significant increase in total log-transformed (ln) PSD and ln HF and a significant decrease in LF/HF ratio (all P < 0.05) compared with the control period. HIIT produced significant improvements in LV diastolic function, including lateral E', estimated filling pressure (E/E' ratio), E deceleration time, and isovolumetric relaxation time ( P < 0.05 for all). Fractional shortening was the only conventional marker of LV systolic function to significantly improve ( P < 0.05). In this setting, there were significant improvements in global peak systolic strain rate, early and late diastolic strain rate, and early to late diastolic strain rate ratio, as well as apical rotation, apical systolic and diastolic rotation velocity, apical radial and circumferential strain and strain rate, LV torsion, and LV systolic and diastolic torsion velocity (all P < 0.05). A short-term program of HIIT was associated with a significant increase in cardiac autonomic modulation, demonstrated by a residual increase in cardiac vagal activity as well as significantly improved cardiac function and mechanics. This study demonstrates that HIIT may be an important stimulus to reduce the health implications associated with physical inactivity and sedentary behavior. NEW & NOTEWORTHY This is the first study to measure the combined adaptations of the cardiac autonomic nervous system and myocardial function and mechanics following high-intensity interval training (HIIT). This study demonstrates that a 2-wk HIIT intervention provides significant improvements in cardiac autonomic modulation and myocardial function and mechanics in a large cohort of young physically inactive and highly sedentary individuals. HIIT may be a powerful stimulus to reduce the health implications associated with physical inactivity and sedentary behavior.

Continuous Cardiac Autonomic and Hemodynamic Responses to Isometric Exercise.

PURPOSE: Elevated arterial blood pressure (BP) is associated with autonomic dysfunction and impaired hemodynamic control mechanisms. Isometric exercise (IE) training has been demonstrated effective at reducing BP; however, the continuous cardiovascular responses during IE are underinvestigated. We hypothesized that reflex autonomic cardiovascular control is an important mediator in reducing BP. To test our hypothesis, we investigated continuous cardiac autonomic modulation and baroreceptor reflex sensitivity (BRS) in response to IE. METHODS: Twenty-five prehypertensive participants performed a single IE wall squat training session. Total power spectral density (PSD) of HR variability (HRV) and associated low-frequency (LF) and high-frequency (HF) power spectral components were recorded in absolute (ms) and normalized units (nu) before, during, and after an IE session. HR was recorded via electrocardiography and BRS via the sequence method. Continuous BP was recorded via the vascular unloading technique and stroke volume via impedance cardiography. Total peripheral resistance was calculated according to Ohm's law. RESULTS: During IE, there were significant reductions in HRV (P < 0.05) and BRS (P < 0.05) and significant increases in HR (P < 0.001), systolic, diastolic, and mean BP (all P < 0.001). In recovery from IE, HRV (P < 0.001), HFnu (P < 0.001), and BRS (P < 0.001) significantly increased with a significant decrease in LFnu (P < 0.001) and LF:HF ratio (P < 0.001), indicative of predominant parasympathetic over sympathetic activity. This autonomic response was associated with a significant reduction in systolic (23.2 ± 18.1 mm Hg, P < 0.001), diastolic (18.7 ± 16.9 mm Hg, P < 0.001), and mean (15.8 ± 15.5 mm Hg, P < 0.001) BP, below baseline and a significant reduction in total peripheral resistance (P < 0.001). CONCLUSIONS: A single IE session is associated with improved cardiac autonomic modulation and hemodynamic cardiovascular control in prehypertensive males. These acute responses may be mechanistically linked to the chronic reductions in resting BP reported after IE training interventions.

Acute cardiac functional and mechanical responses to isometric exercise in prehypertensive males.

Isometric exercise (IE) training has been shown to reduce resting arterial blood pressure (ABP) in hypertensive, prehypertensive, and normotensive populations. However, the acute hemodynamic response of the heart to such exercise remains unclear. We therefore performed a comprehensive assessment of cardiac structure, function, and mechanics at rest and immediately post a single IE session in 26 male (age 44.8 ± 8.4 years) prehypertensive participants. Conventional echocardiography recorded standard and tissue Doppler measures of left ventricular (LV) structure and function. Speckle tracking echocardiography was used to measure LV global longitudinal, circumferential, and radial strain and strain rate. From this data, apical and basal rotation and rotational velocities, LV twist, systolic twist velocity, untwist velocity, and torsion were determined. IE led to a significant post exercise reduction in systolic (132.6 ± 5.6 vs. 109.4 ± 19.6 mmHg, P < 0.001) and diastolic (77.6 ± 9.4 vs. 58.8 ± 17.2 mmHg, P < 0.001) blood pressure, with no significant change in heart rate (62 ± 9.4 vs. 63 ± 7.5b·min-1, P = 0.63). There were significant reductions in LV end systolic diameter (3.4 ± 0.2 vs. 3.09 ± 0.3 cm, P = 0.002), LV posterior wall thickness (0.99 ± 0.1 vs. 0.9 ± 0.1 cm, P = 0.013), relative wall thickness (0.4 ± 0.06 vs. 0.36 ± 0.05, P = 0.027) estimated filling pressure (E/E' ratio 6.08 ± 1.87 vs. 5.01 ± 0.82, P = 0.006) and proportion of participants with LV concentric remodeling (30.8% vs. 7.8%, P = 0.035), and significant increases in LV ejection fraction (60.8 ± 3 vs. 68.3 ± 4%, P < 0.001), fractional shortening (31.6 ± 4.5 vs. 39.9 ± 5%, P < 0.001), cardiac output (4.3 ± 0.7 vs. 6.1 ± 1L·min-1, P < 0.001), and stroke volume (74.6 ± 11 vs. 96.3 ± 13.5 ml, P < 0.001). In this setting, there were significant increases in global longitudinal strain (-17.8 ± 2.4 vs. -20 ± 1.8%, P = 0.002) and strain rate (-0.88 ± 0.1 vs. -1.03 ± 0.1%, P < 0.001), basal rotation (-5 ± 3.5 vs. -7.22 ± 3.3°, P = 0.047), basal systolic rotational velocity (-51 ± 21.9 vs. -79.3 ± 41.3°·s-1, P = 0.01), basal diastolic rotational velocity (48.7 ± 18.9 vs. 62.3 ± 21.4°·s-1, P = 0.042), LV twist (10.4 ± 5.8 vs. 13.8 ± 5°, P = 0.049), systolic twist velocity (69.6 ± 27.5 vs. 98.8 ± 35.8°·s-1, P = 0.006), and untwist velocity (-64.2 ± 23 vs. -92.8 ± 38°·s-1, P = 0.007). These results suggest that IE improves LV function and mechanics acutely. This may in turn be partly responsible for the observed reductions in ABP following IE training programs and may have important implications for clinical populations.