Endometrial cancer patients understanding and interest in weight loss surgery.

OBJECTIVE: Obesity is a risk factor for endometrial hyperplasia (EH), endometrial intraepithelial neoplasia (EIN), and early type 1 endometrial cancer (EC) in 70%-90% of patients and is often a significant contributor to overall morbidity and mortality due to comorbidities. In 2011, bariatric surgery (BS) with lifestyle modification was identified as an intervention for reduction in overall mortality as well as risk for gynecologic cancers (Tsui et al., 2021). Our aim was to assess awareness of obesity as a risk factor and understanding of BS in an underinsured obese patient population with EC or EH. METHOD: This IRB-approved survey was distributed to patients with type I EC or EH within the past 5 years and a BMI >30. Questions addressed demographics, health habits, cancer and obesity awareness, as well as benefits and concerns about undergoing BS. Information was provided about dietary requirements after BS, and then interest in BS was surveyed. RESULTS: 61.2% of surveyed patients were interested in bariatric surgery for weight loss after receiving education about the procedure. Interest in bariatric surgery was correlated with higher BMI, higher ideal and comfortable weight loss in pounds and higher estimated weight loss that could be obtained with bariatric surgery. Additionally, patients who were interested in BS had better understanding of the risks of obesity with cancer overall. CONCLUSION: Obese patients with history of EC/EIN/EH are aware of hazards associated with excess weight and understand the relationship between EC/EIN/EH diagnosis and obesity, and overall are very interested in BS as a modality to improve their health.

Generation of reactive oxygen species after exhaustive aerobic and isometric exercise.

UNLABELLED: Many studies have implicated elevated oxygen consumption (VO2) associated with aerobic exercise as contributing to oxidative stress. Only a few studies have investigated nonaerobic exercise and its relation to pro-oxidant and antioxidant activities. PURPOSE: The purpose of this study was to compare biomarkers of oxidative stress: lipid peroxidation, protein oxidation, and total antioxidants in blood after exhaustive aerobic (AE) and nonaerobic isometric exercise (IE). METHODS: Blood samples were collected from 12 subjects who performed a maximum AE and IE test and were analyzed for thiobarbituric acid (TBARS), carbonyls, lipid hydroperoxides (LH), and oxygen radical absorbance capacity (ORAC). RESULTS: VO2 increased 14-fold with AE compared with 2-fold with IE. Protein carbonyls increased 67% (P < 0.05) pre- to immediately and 1 h post-AE, and 12% pre- to immediately post-IE and returned to baseline 1 h post-IE. TBARS did not increase significantly with either treatment. LH increased 36% above rest during IE compared with 24% during AE (P < 0.05). ORAC increased 25% (P < 0.05) pre- to post-AE, compared with 9% (P < 0.05) pre- to post-IE. CONCLUSION: There was evidence of oxidative stress after both exhaustive aerobic and isometric exercise. Lipid hydroperoxides, protein carbonyls, and total antioxidants increased after both IE and AE. Due to the different metabolic demands of aerobic and isometric exercise, we can rule out a mass action effect of VO2 as the sole mechanism for exercise-induced oxidative stress.

Swim training alters sympathoadrenal and endocrine responses to hemorrhage in borderline hypertensive rats.

Swim training alters cardiovascular, sympathoadrenal, and endocrine responses to hemorrhage in borderline hypertensive rats (BHR). The effects of 10, 20, and 30% blood volume hemorrhages on cardiovascular, sympathoadrenal, and endocrine function in swim-trained (T; 2 h/day, 5 day/wk for 10-12 wk) and age-matched, untrained, sedentary, control (UT) borderline hypertensive rats (BHR) were assessed. Heart rate (HR) in UT BHR was significantly greater during the baseline (rest) period than T BHR. HR increased slightly from baseline in both groups after 10% hemorrhage but was significantly decreased in both groups after 20 and 30% hemorrhages. The decrease was eliminated by atropine (1 mg/kg iv). Systolic (SBP) and diastolic (DBP) blood pressures decreased significantly after 20 and 30% hemorrhages in both T and UT BHR but were not different between the groups at these times. Plasma norepinephrine levels were significantly increased above baseline after 20 and 30% hemorrhages in UT BHR and were significantly greater in UT BHR than T BHR after 30% hemorrhage. Plasma glucose levels increased significantly after 30% hemorrhage in both groups but were significantly greater in UT BHR than T BHR. Both plasma norepinephrine and plasma epinephrine levels showed strong positive correlations with plasma glucose. After 20 and 30% hemorrhages, plasma insulin levels were unchanged in T BHR but were significantly decreased in UT BHR. Plasma insulin levels were significantly less in UT than T BHR after 30% hemorrhage. These results suggest that swim training alters the effect that hemorrhage exerts on endocrine and sympathoadrenal function in BHR.(ABSTRACT TRUNCATED AT 250 WORDS)

Swim training alters renal and cardiovascular responses to stress in borderline hypertensive rats.

The present study assessed the effects of 40 min of tail shock stress (1-s shock, 0.2 mA every 30 s) on renal and cardiovascular function in swim-trained (T), water-immersed (IM), and untrained (UT) borderline hypertensive rats (BHR). T BHR swam for 2 h/day 5 days/wk for 10-12 wk, whereas IM BHR on the same schedule were placed in water at neck level and were not permitted to swim. Age-matched sedentary controls were paired one each with the exercise group (group 1) and the immersion group (group 2). Heart rate was significantly greater in UT than in T BHR (P = 0.09) during baseline (rest). Heart rate responses during stress were not different between UT and IM BHR (group 2). Systolic and diastolic blood pressures during stress and recovery were not different between UT BHR and T or IM BHR. Urine flow rate was significantly increased from baseline during the first 20 min of stress in UT and IM BHR only. Changes in glomerular filtration rate were not consistent across studies. Renal blood flow decreased significantly from baseline during tail shock stress in UT but not T BHR. Plasma glucose levels were significantly increased above baseline during the second 20 min of stress in UT BHR only and were significantly greater than those in the T BHR. Plasma insulin levels in UT BHR were significantly decreased from baseline during tail shock stress and recovery but were unchanged from baseline in T BHR. These observations suggest that swim training independent of water immersion alters the effect that stress exerts on renal and cardiovascular function in BHR, which results in better fluid and electrolyte conservation in T BHR.

Isometric exercise training lowers resting blood pressure.

Both rhythmic and "resistive" (weight lifting) exercise training can produce modest decreases in resting blood pressure. The next logical point along an exercise continuum consisting of different proportions of rhythmic and isometric efforts is a strictly isometric effort. The purpose of these studies was to assess the effects of isometric, handgrip exercise training on resting blood pressure. To avoid the extreme pressor responses elicited by fatiguing isometric efforts, the isometric exercise training used in this study consisted of brief handgrip contractions separated by rest periods. Modest repeated rises in systolic and diastolic pressures therefore served as the putative stimuli for training adaptations in resting blood pressures. Human subjects in study 1 trained with four, 2-min isometric handgrip contractions with 3-min rests between contractions. The intensity of the contractions was equal to 30% of their maximal effort for each day. The bouts of isometric exercise were performed three times per week for 8 wk. Study 2 training consisted of four contractions of 50% of maximum effort held for a duration of 45 s with 1-min rests. These were performed 5 d.wk-1 for 5 wk. In Study 1, all eight trained subjects had a significant decline in both systolic and diastolic resting blood pressures, with group averages of 12.5 and 14.9 mm Hg, respectively. Seven matched control subjects who did not train had no change in resting pressures. In study 2, subjects were trained in their home or workplace and experienced significant mean declines in resting systolic and diastolic pressures of 9.5 and 8.9 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Transient and steady-state cardiopulmonary responses to combined rhythmic and isometric exercise.

The transient and steady-state cardiopulmonary responses to combined rhythmic (R) and isometric (I) exercise were examined in nine subjects. Isometric exercise at 30% maximal voluntary contraction (MVC) was started 1.5 min prior to either a 50% or 75% maximal oxygen uptake (VO2max) cycle ride and continued for 1.5 min into the 10-min R. Systolic (Pas) and diastolic (P(ad)) blood pressure, heart rate (fc), inspired ventilation volumes (VI), and oxygen uptake (VO2) were recorded every 30 s throughout each experiment. Responses to I effort alone were recorded for comparison with experiments in which the combined exercises were performed during the first 1.5 min when R had not yet begun. Pas responses in the first 1.5 min of I (no R) showed the typical rapid linear increase. Addition of the R effort further increased Pas to levels which remained nearly constant (steady state) throughout R. R alone produced a slower Pas increase to approximately the same steady-state levels as those of the combined R and I exercise. For P(ad), the linear increase which occurred during the first 1.5 min of I was attenuated with the superimposition of R. Following cessation of I, P(ad) fell rapidly during continued R to levels not different from experiments with R alone. The fc during I alone increased slightly. As I continued, the onset of the R induced a further rapid increase in fc to levels not different from R alone. The VI showed a similar response to fc. VO2 during I alone did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiopulmonary responses to combined rhythmic and isometric exercise in humans.

A rhythmic (R) and an isometric (I) exercise were performed separately and in combination to assess their additive effects on arterial systolic (P(as)) and diastolic (P(ad)) blood pressures, heart rate (fc), and minute ventilation (VI). The isometric effort consisted of a 40% maximal voluntary handgrip contraction (MVC) performed for a duration of 80% of a previously determined 40% MVC fatiguing effort. The R effort consisted of a 13-min cycle effort at 75% maximum oxygen consumption (VO2max). For the combined efforts, I was performed starting simultaneously with or ending simultaneously with R. Data on nine subjects yield statistically significant evidence (P less than 0.05) that the effects of I and R are not additive for the following three cases: (1) P(as) when I and R are ended simultaneously (I alone = 4.9, SEM 0.5 kPa increase; R alone = no significant change from steady state; I + R = 1.2, SEM 0.4 kPa increase), (2) P(ad) when I and R are started simultaneously (I alone = 4.1, SEM 0.4 kPa increase; R alone = 0.7, SEM 0.3 kPa decrease; I + R = 1.9, SEM 0.4 kPa increase), and (3) P(ad) when I and R are ended simultaneously (I alone = 4.1, SEM 0.4 kPa increase; R alone = 0.3, SEM 0.5 kPa decrease; I + R = 0.8, SEM 0.3 kPa increase). For all other variables and cases, there is not sufficient evidence to conclude that the effects of I and R are not additive. We conclude that R and I exercises do not invariably produce strictly additive cardiopulmonary responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of different body postures on the pressures generated during an L-1 maneuver.

Changes in blood pressure, intrathoracic pressure, heart rate and the electromyographic activity of various muscle groups were determined while nine male subjects performed 15-s L-1 straining maneuvers at four spine-to-thigh angles (70, 84, 94, and 105 degrees) and two seatback angles (30 and 60 degrees). There was no significant difference between the changes in these variables due to the different body positions. At the onset of the L-1, arterial pressure immediately increased to 195 +/- 5 mm Hg, but fell progressively during the next 5 s to 160 +/- 5 mm Hg. It remained constant during the next 5 s of the maneuver and then recovered to 180 +/- mm Hg during the last 5 s of the maneuver. Esophageal pressure followed essentially the same pattern of response, but heart rate progressively increased during the entire L-1. No one muscle group was utilized more than another. Inflation of an anti-G suit to 4 PSI had no effect on the variables measured. Generation of high arterial pressures during L-1 maneuvers is transitory and not affected either positively or negatively by altering subject body position.

Plasticity of the mechanism subserving inspiratory load perception.

The objective of this study was to determine the stability of the function describing subjects' magnitude estimates of added inspiratory resistive loads following short-term exposure (STE) to a high but nonfatiguing, inspiratory load. Four inspiratory resistive loads (8.9-35.7 cmH2O X l-1 X s) were presented twice each in random order. Subjects were asked to estimate load magnitude by force of handgrip. Perceptual performance was quantified using Stevens power law, psi = k phi n, where psi is the subject's estimate, k is a constant, and phi is the peak mouth pressure developed against the load. The exponent n represents the slope of the line in the plot of log psi vs. log phi. After a 2-min period in which subjects were required to generate 80% of their maximum inspiratory pressure against a high resistance, the load estimation protocol was repeated. Estimates were significantly reduced compared to control; however, there was no significant difference in the exponent for magnitude functions between conditions. Similar results were obtained in a second parallel experiment involving magnitude estimation of weights lifted by the elbow flexors. The results suggest plasticity in the mechanism(s) subserving sensation of added loads to breathing and that such plasticity is a general feature of sensation arising from nonrespiratory muscles as well.

Relationship of transdiaphragmatic pressure and latencies for detecting added inspiratory loads.

The purpose of this investigation was to measure changes in transdiaphragmatic pressure (Pdi) developed during graded elastic (E) and resistive (R) loaded breaths and to correlate the emergence of such changes with the load-dependent alterations in latency for detection (Tdet). Five healthy adults were studied using three protocols, i.e., graded E, graded R, and graded R in the presence of elevated background R. In each protocol, loads were added for single inspirations, 10 times in random order and separated by three to five unloaded breaths. Subjects pressed a signal marker as soon as loads were detected. Inspiratory flow (VI), inspired volume (VI), mouth pressure, and Pdi of loaded breaths and the preceding unloaded breaths were recorded and computer averaged. Patterns of VI and VI were not altered prior to detection of the smallest added E and R loads but decreased with the higher loads. Group mean patterns of Pdi showed graded increases during loaded breaths. Augmentation of Pdi preceded Tdet and occurred earlier as Tdet decreased with graded E and R loads. Elevating the background R delayed both Tdet of added R and the augmentation of Pdi. Results are consistent with the hypothesis that load-induced changes in diaphragmatic tension may play a sensory role in detection of inspiratory loads.

Effect of background loading on perception of inspiratory loads.

The effect of background loading on magnitude estimation of added elastic and resistive inspiratory loads was determined. An analogous study involving estimation of the heaviness of weights in the hand was also performed. Perceptual performance was assessed using Stevens' power law psi = k phi n, where psi is the subjective magnitude, phi is the peak mouth pressure generated with an inspiratory load or the weight of the load in grams for the heaviness estimation, and the exponent n characterizes perceptual performance. The value of n was determined for the control and background conditions for each study. The results for both inspiratory loading studies and the heaviness estimation experiment indicate that background loading is associated with a significant increase in the exponent for magnitude estimation (P less than 0.05). Adjustment of the stimulus scale by subtracting the difference in peak mouth pressures generated during resting breathing between control and background-loaded conditions for the inspiratory loading studies, or the weight of the background load in the heaviness estimation experiment, converted the exponents obtained under background-loaded conditions to values that were not significantly different from those for control (P greater than 0.05). These results are consistent with the theory suggesting that an increase in detection threshold, produced by the background load, is responsible for the increase in exponent for magnitude estimation.

Ventilatory responses to static handgrip exercise.

Previous research indicates that fatiguing static exercise causes hyperventilation and a decrease of end-tidal CO2 partial pressure PETCO2. The objectives of this study were 1) to examine the changes in pattern of breathing during static exercise, and 2) to define the isocapnic ventilatory response. Six healthy males were studied once a week at one of three levels of static handgrip exercise: 15, 25, or 30% maximum voluntary contraction (MVC) was sustained for 5 min while holding PETCO2 constant or allowing it to run free. During 25 and 30% MVC, we observed 1) progressive increases in mean tidal volume (VT), inspiratory ventilation (VI), VT/TI, heart rate (HR), and arterial BP, 2) increased breath-to-breath variability of VT, 3) no significant changes in respiratory frequency (f), and 4) progressive decreases in PETCO2. Keeping PETCO2 constant at preexercise levels did not change the pattern or magnitude of the ventilatory response to exercise. The time course and magnitude of the subjects' perceived effort resembled the time course and magnitude of the ventilatory response. The variability of VT during the response to static exercise suggests an element of control instability. The identical ventilatory responses during hypocapnic and isocapnic conditions may result from the slow response of the central chemoreceptors; an overriding influence of muscle afferents; and/or increased central command arising with fatigue.

Ability of healthy men to discriminate between added inspiratory resistive and elastic loads.

Previous studies of the latencies for the detection of inspiratory resistive (R) and elastic (E) loads revealed that R loads were detected earlier in the loaded breath than E loads (Respir. Physiol. 34: 267--77, 1978). These results suggested that the load information generated by R and E loads have different temporal patterns. We hypothesized that these differences might provide a mechanism for subjects to accurately discriminate between R and E loads and secondly, that the R and E load sensations perceived by subjects should have different temporal characteristics. To test these hypotheses we studied six healthy subjects in a two-part study. In this first, two levels of R and E loads (near threshold and 4--5 times threshold) were randomly presented for single inspirations separated by 3--6 unloaded breaths for a total of 10 presentations each. Subjects indicated detection and type of load perceived by pressing R or E marker buttons. In the second part, using the same loading protocol, subjects squeezed a hand grip dynamometer to express the pattern of perceived load sensation. Results indicate that subjects cannot discriminate between near-threshold R and E load but can discriminate between R and E loads 4--5 times threshold with considerable accuracy. Mean grip responses show that perceived load sensations arise earlier and reach maximum values sooner during R loaded breaths. Grip responses are consistent with the previously reported differences in R and E detection latencies and support the hypothesis that load discrimination is mediated by differences in the temporal pattern of load information generated during R and E loaded breaths.

Effect of chest cage restriction on perception of added airflow resistance.

The effect of restricting chest expansion on the detection of resistive loads added to inspiration was assessed in 6 healthy male subjects. Restriction was accomplished using an adjustable chest clamping device. Load detection scores obtained with and without chest clamping were plotted against deltaR and the Weber Fraction (deltaR/Ro), where deltaR is the added load and Ro is the initial resistive load (i.e. subject's R plus minimal R of the apparatus). Results indicate that restricting chest expansion does not alter the ability of healthy subjects to detect added inspiratory resistive loads. It is concluded that perception of such loads is not dependent upon sensory information from the chest wall.

Respiratory responses to simultaneous static and rhythmic exercises in humans.

1. Six male subjects performed simulataneous static (hand-grip) and rhythmic (bicycle ergometer) exercises while their respiratory responses were measured. 2. Oxygen consumption increased with the intensity of rhythmic work load, with a modest additional oxygen consumption accompanying the addition of static effort during the rhythmic exercise. 3. Minute ventilation (VE) increased directly with rhythmic exercise, but increased disproportionately to the metabolic need when static effort was added. The mean increment of VE elicited by the static exercise influence was nearly constant at 20 l/min, regardless of the rhythmic load present. 4. Possible reflex mechanisms which result in disruption of the normally well-matched ventilation and metabolic oxygen demands whenever static effort is present are discussed.