Impact of Time of Day on Glycemia in Response to Postprandial Supramaximal Sprints in Adults With Type 1 Diabetes.

OBJECTIVES: In this study we explore the impact of postprandial exercise timing (morning vs evening) on glycemia in individuals with type 1 diabetes (T1D) during short all-out sprints on a cycle ergometer. METHODS: Ten healthy physically sedentary male (n=7) and female (n=3) volunteers with type 1 diabetes, 22.8±2.8 years of age, and with a diabetes duration of 9.7±5.5 years and glycated hemoglobin level of 8.6±1.2%, underwent comprehensive screening and assessment of their physical health and fitness status before study participation, under the guidance of a physician. Each participant underwent 2 postprandial exercise sessions on separate days: the first in the morning at 8:00 AM and second in the evening at 8:00 PM, both conducted 60 minutes after a standardized meal. RESULTS: Morning exercise showed a less pronounced reduction in plasma glucose (PG) levels compared with evening exercise (-2.01±1.24 vs -3.56±1.6 mmol/L, p=0.03). In addition, higher cortisol levels were observed in the morning vs evening (128.59±34 vs 67.79±26 ng/mL, p<0.001). CONCLUSIONS: Morning repeated sprint exercise conducted in the postprandial state consistent with the protective effect of higher cortisol levels resulted in a smaller reduction in PG levels compared with evening exercise. This highlights the potential influence of exercise timing on glycemic responses and cortisol secretion in the management of T1D.

Radical surgical resection with molecular margins is associated with improved survival in IDH wild-type glioblastoma.

BACKGROUND: Survival is variable in patients with glioblastoma IDH wild-type (GBM), even after comparable surgical resection of radiographically detectable disease, highlighting the limitations of radiographic assessment of infiltrative tumor anatomy. The majority of postsurgical progressive events are failures within 2 cm of the resection margin, motivating supramaximal resection strategies to improve local control. However, which patients benefit from such radical resections remains unknown. METHODS: We developed a predictive model to identify which IDH wild-type GBMs are amenable to radiographic gross-total resection (GTR). We then investigated whether GBM survival heterogeneity following GTR is correlated with microscopic tumor burden by analyzing tumor cell content at the surgical margin with a rapid qPCR-based method for detection of TERT promoter mutation. RESULTS: Our predictive model for achievable GTR, developed on retrospective radiographic and molecular data of GBM patients undergoing resection, had an area under the curve of 0.83, sensitivity of 62%, and specificity of 90%. Prospective analysis of this model in 44 patients found that 89% of patients were correctly predicted to achieve a residual volume (RV) < 4.9cc. Of the 44 prospective patients undergoing rapid qPCR TERT promoter mutation analysis at the surgical margin, 7 had undetectable TERT mutation, of which 5 also had a GTR (RV < 1cc). In these 5 patients at 30 months follow-up, 75% showed no progression, compared to 0% in the group with TERT mutations detected at the surgical margin (P = .02). CONCLUSIONS: These findings identify a subset of patients with GBM that may derive local control benefits from radical resection to undetectable molecular margins.

Applying the en-bloc technique in corpus callosum glioblastoma surgery contributes to maximal resection and better prognosis: a retrospective study.

BACKGROUND: Corpus callosum glioblastoma (ccGBM) is a specific type of GBM and has worse outcomes than other non-ccGBMs. We sought to identify whether en-bloc resection of ccGBMs based on T2-FLAIR imaging contributes to clinical outcomes and can achieve a satisfactory balance between maximal resection and preservation of neurological function. METHODS: A total of 106 adult ccGBM patients (including astrocytoma, WHO grade 4, IDH mutation, and glioblastoma) were obtained from the Department of Neurosurgery in Nanfang Hospital between January 2008 and December 2018. The clinical data, including gender, age, symptoms, location of tumor, involvement of eloquent areas, extent of resection (EOR), pre- and postoperative Karnofsky Performance Status (KPS) scales, and National Institute of Health stroke scale (NIHSS) scores were collected. Propensity score matching (PSM) analysis was applied to control the confounders for analyzing the relationship between the en-bloc technique and EOR, and the change in the postoperative KPS scales and NIHSS scores. RESULTS: Applying the en-bloc technique did not negatively affect the postoperative KPS scales compared to no-en-bloc resection (P = 0.851 for PSM analysis) but had a positive effect on preserving or improving the postoperative NIHSS scores (P = 0.004 for PSM analysis). A positive correlation between EOR and the en-bloc technique was identified (r = 0.483, P < 0.001; r = 0.720, P < 0.001 for PSM analysis), indicating that applying the en-bloc technique could contribute to enlarged maximal resection. Further survival analysis confirmed that applying the en-bloc technique and achieving supramaximal resection could significantly prolong OS and PFS, and multivariate analysis suggested that tumor location, pathology, EOR and the en-bloc technique could be regarded as independent prognostic indicators for OS in patients with ccGBMs, and pathology, EOR and the en-bloc technique were independently correlated with patient's PFS. Interestingly, the en-bloc technique also provided a marked reduction in the risk of tumor recurrence compared with the no-en-bloc technique in tumors undergoing TR, indicating that the essential role of the en-bloc technique in ccGBM surgery (HR: 0.712; 95% CI: 0.535-0.947; P = 0.02). CONCLUSIONS: The en-bloc technique could contribute to achieving an enlarged maximal resection and could significantly prolong overall survival and progression-free survival in patients with ccGBMs.

Including supramaximal verification reduced uncertainty in VO2peak response rate.

Many reports describe using a supramaximal verification phase-exercising at a power output higher than the highest power output recorded during an incremental cardiopulmonary test-to validate VO2max. The impact of verification phases on estimating the proportion of individuals who increased VO2peak in response to high-intensity interval training (HIIT) remains an underexplored area in the individual response literature. This analysis investigated the influence of same-day and separate-day verification phases during repeated measurements (incremental tests-INCR1 and INCR2; incremental tests + supramaximal verification phases-INCR1+ and INCR2+) of VO2peak on typical error (TE) and the proportion of individuals classified as responders (i.e., the response rate) following 4 weeks of HIIT (n = 25) or a no-exercise control period (n = 9). Incorporation of supramaximal verification consistently reduced the standard deviation of individual response, TE, and confidence interval (CI) widths. However, variances were statistically similar across all groups (p > 0.05). Response rates increased when incorporating either one (INCR1 to INCR1+; 24%-48%, p = 0.07) or two (INCR2 to INCR2+; 28%-48%, p = 0.063) supramaximal verification phases. However, response rates remained unchanged when either zero-based thresholds or smallest worthwhile difference response thresholds were used (50% and 90% CIs, all p > 0.05). Supramaximal verification phases reduced random variability in VO2peak response to HIIT. Compared with separate-day testing (INCR2 and INCR2+), the incorporation of a same-day verification (INCR1+) reduced CI widths the most. Researchers should consider using a same-day verification phase to reduce uncertainty and better estimate VO2peak response rate to HIIT.

Extent of Resection and Outcomes of Patients with Primary Malignant Brain Tumors.

OPINION STATEMENT: We have level II evidence that attempting a gross total resection of newly diagnosed suspected glioblastoma is preferred when a maximally safe resection can be attempted. This recommendation extends to elderly patients and those with butterfly gliomas. However, in cases where patients are poor surgical candidates, or for lesions in eloquent areas, subtotal resection or biopsy may be indicated. Recent studies have discussed "supramaximal surgery," which is defined in different ways by different teams, but there is not enough evidence, yet, to make a consistent recommendation for supramaximal resection for specific patients.

Supramaximal resection based on en-bloc technique reduces tumor burden and prolongs survival in primary supratentorial lobar glioblastoma.

PURPOSE: Resection beyond the contrast-enhanced zone contributed to reduce tumor burden and prolong survival in glioblastomas. The optimal extent of resection (EOR) and how to achieve it are worthy of continuous investigation for obtaining a satisfactory balance between maximal resection and the preservation of neurological function. METHODS: A total of 340 adult supratentorial lobar glioblastomas (included astrocytoma, WHO 4, IDH mutation and glioblastoma) were retrospectively evaluated. The clinical data, EOR, technique of resection, postoperative complications, overall survival (OS) and progression-free survival (PFS) were assessed by univariate, multivariate and propensity score matched analysis. Histological staining was performed to comprehend the effect of the membranous structures and the cell distribution in tumoral and peritumoral regions. RESULTS: Supramaximal resection (SMR) was confirmed as resection with 100% EORCE and > 50% EORnCE in glioblastomas by Cox proportional hazards model. Histological results showed SMR reduced the cell density of surgical edge compared to total resection. En-bloc technique based on membranous structures, which had blocking effect on tumoral invasion, contributed to achieve SMR. Moreover, applying en-bloc technique and achieving SMR did not additionally deteriorate neurological function and had similarly effects on the improvement of neurological function. Multivariate analysis confirmed that IDH1 status, technique of resection and EOR were independently correlated with PFS, and > 64 years old, IDH1 status, technique of resection, EOR and preoperative NIHSS were independently correlated with OS. CONCLUSIONS: Applying en-bloc technique and achieving SMR, which could reduce tumor burden and did not increase additional complications, both had remarkedly positive effects on clinical outcomes in patients with primary supratentorial lobar glioblastomas.

Competitive Cross-Country Skiers Have Longer Time to Exhaustion Than Recreational Cross-Country Skiers During Intermittent Work Intervals Normalized to Their Maximal Aerobic Power.

PURPOSE: To investigate differences in time to exhaustion (TTE), O2 uptake (V˙O2), and accumulated O2 deficit (O2def) between competitive and recreational cross-country (XC) skiers during an intermittent-interval protocol standardized for maximal aerobic power (MAP). METHODS: Twelve competitive (maximal V˙O2 [V˙O2max]=76.5±3.8 mL·kg-1·min-1) and 10 recreational (V˙O2max=63.5±6.3 mL·kg-1·min-1) male XC skiers participated. All tests were performed on a rollerski treadmill in the V2 ski-skating technique. To quantify MAP and maximal accumulated oxygen deficit (MAOD), the skiers performed a steady-state submaximal test followed by a 1000-m time trial. After a 60-minute break, TTE, V˙O2, and accumulated O2def were measured during an intermittent-interval protocol (40-s work and 20-s recovery), which was individually tailored to 120% and 60% of each subject's MAP. RESULTS: During the 1000-m time trial, the competitive skiers had 21% (95% CI, 12%-30%) shorter finish time and 24% (95% CI, 14%-34%) higher MAP (all P < .01) than the recreational skiers. No difference was observed in relative exercise intensity (average power/MAP; P = .28), MAOD (P = .18), or fractional utilization of V˙O2max. During the intermittent-interval protocol, the competitive skiers had 34% (95% CI, 3%-65%) longer TTE (P = .03) and accumulated 61% (95% CI, 27%-95%) more O2def (P = .001) than the recreational skiers during work phases. CONCLUSIONS: Competitive XC skiers have longer TTE and accumulate more O2def than recreational XC skiers during an intermittent-interval protocol at similar intensity relative to MAP. This implies that performance in intermittent endurance sports is related to the ability to repeatedly recharge fractions of MAOD.

Lobectomy versus gross total resection for glioblastoma multiforme: A systematic review and individual-participant data meta-analysis.

Overall survival (OS)for glioblastoma multiforme (GBM) has a known association with the extent of tumor resection with gross total resection (GTR) typically considered as the upper limit. In certain regions such as the anterior temporal lobe, more extensive resection by means of a lobectomy may be feasible. In our systematic review and meta-analysis, we aimed to compare the outcomes of lobectomy and GTR for GBM. PubMed and Embase were queriedfor studies that compared the outcomes after lobectomy or GTR for GBM. The primary outcomes were OS, progression-free survival (PFS), and Karnofksy Performance Status (KPS) score at the latest follow-up. The secondary outcomes were seizure control at the latest follow-up and complication rates. Meta-analysis for OS and PFS was performed using individual-participant data reconstructed from published Kaplan-Meier curves. Random-effect meta-analysis was performed for KPS. The secondary outcomes were pooled using descriptive statistics. Of the 795 records screened, 6 were included in our study. Meta-analysis revealed that anterior temporal, frontal, or occipital lobectomy was associated with significantly better OS (p < 0.001) and PFS (p < 0.001) than GTR, but not KPS (MD = 6.37; 95% CI=(-13.80, 26.54); p = 0.536). Anterior temporal lobectomy was associated with significantly better seizure control rates than GTR for temporal GBM (OR = 27; 95% CI=(1.4, 515.9); p = 0.002). There was no statistically significant difference in complication rates between anterior temporal, frontal, or occipital lobectomy and GTR. In conclusion, lobectomy was associated with significantly better OS, PFS, and seizure control than GTR for GBM.

Supramaximal Resection Can Prolong the Survival of Patients with Cortical Glioblastoma: A Volumetric Study.

We aimed to retrospectively determine the resection rate of fluid-attenuated inversion recovery (FLAIR) lesions to evaluate the clinical effects of supramaximal resection (SMR) on the survival of patients with glioblastoma (GBM). Thirty-three adults with newly diagnosed GBM who underwent gross total tumor resection were enrolled. The tumors were classified into cortical and deep-seated groups according to their contact with the cortical gray matter. Pre- and postoperative FLAIR and gadolinium-enhanced T1-weighted imaging tumor volumes were measured using a three-dimensional imaging volume analyzer, and the resection rate was calculated. To evaluate the association between SMR rate and outcome, we subdivided patients whose tumors were totally resected into the SMR and non-SMR groups by moving the threshold value of SMR in 10% increments from 0% and compared their overall survival (OS) change. An improvement in OS was observed when the threshold value of SMR was 30% or more. In the cortical group (n = 23), SMR (n = 8) tended to prolong OS compared with gross total resection (GTR) (n = 15), with the median OS of 69.6 and 22.1 months, respectively (p = 0.0945). Contrastingly, in the deep-seated group (n = 10), SMR (n = 4) significantly shortened OS compared with GTR (n = 6), with median OS of 10.2 and 27.9 months, respectively (p = 0.0221). SMR could help prolong OS in patients with cortical GBM when 30% or more volume reduction is achieved in FLAIR lesions, although the impact of SMR for deep-seated GBM must be validated in larger cohorts.

Effects of Probiotics and Vitamin D3 Supplementation on Sports Performance Markers in Male Mixed Martial Arts Athletes: A Randomized Trial.

BACKGROUND: Strategies targeted at the intestine microbiome seem to be beneficial for professional athletes. The gut-muscle axis is associated with the inflammatory state, glucose metabolism, mitochondrial function, and central nervous system health. All these mechanisms may affect maximal oxygen uptake, muscle strength, and training adaptation. Moreover, the positive effect of certain bacterial strains may be enhanced by vitamin D. Thus, this study aimed to assess and compare the level of selected markers of sports performance of mixed martial arts (MMA) athletes supplemented with vitamin D3 or probiotics combined with vitamin D3. METHODS: A 4-week randomized double-blind placebo-controlled clinical trial was conducted with 23 MMA male athletes assigned to the vitamin D3 group (Vit D; n = 12) or probiotics + vitamin D3 group (PRO + VitD; n = 11). Repeated measures of the creatine kinase level, lactate utilization ratio, and anaerobic performance were conducted. RESULTS: After 4 weeks of supplementation, we found lower lactate concentrations 60 min after the acute sprint interval in the PRO + VitD group when compared to the Vit D group (4.73 ± 1.62 and 5.88 ± 1.55 mmol/L; p < 0.05). In addition, the intervention improved the total work (232.00 ± 14.06 and 240.72 ± 13.38 J kg-1; p < 0.05), and mean power following the anaerobic exercise protocol (7.73 ± 0.47 and 8.02 ± 0.45 W kg-1; p < 0.05) only in the PRO + VitD group. Moreover, there was an improvement in the lactate utilization ratio in the PRO + VitD group compared with the Vit D group as shown by the percentage of T60/T3 ratio (73.6 ± 6.9 and 65.1 ± 9.9%, respectively; p < 0.05). We also observed elevated serum 25(OH)D3 concentrations after acute sprint interval exercise in both groups, however, there were no significant differences between the groups. CONCLUSION: Four weeks of combined probiotic and vitamin D3 supplementation enhanced lactate utilization and beneficially affected anaerobic performance in MMA athletes.

Racial Differences in Blood Pressure and Autonomic Recovery Following Acute Supramaximal Exercise in Women.

Despite the growing popularity of high-intensity anaerobic exercise, little is known about the acute effects of this form of exercise on cardiovascular hemodynamics or autonomic modulation, which might provide insight into the individual assessment of responses to training load. The purpose of this study was to compare blood pressure and autonomic recovery following repeated bouts of acute supramaximal exercise in Black and White women. A convenience sample of twelve White and eight Black young, healthy women were recruited for this study and completed two consecutive bouts of supramaximal exercise on the cycle ergometer with 30 min of recovery in between. Brachial and central aortic blood pressures were assessed by tonometry (SphygmoCor Xcel) at rest and 15-min and 30-min following each exercise bout. Central aortic blood pressure was estimated using brachial pressure waveforms and customized software. Autonomic modulation was measured in a subset of ten participants by heart-rate variability and baroreflex sensitivity. Brachial mean arterial pressure and diastolic blood pressure were significantly higher in Blacks compared to Whites across time (race effect, p = 0.043 and p = 0.049, respectively). Very-low-frequency and low-frequency bands of heart rate variability, which are associated with sympathovagal balance and vasomotor tone, were 22.5% and 24.9% lower, respectively, in Blacks compared to Whites (race effect, p = 0.045 and p = 0.006, respectively). In conclusion, the preliminary findings of racial differences in blood pressure and autonomic recovery following supramaximal exercise warrant further investigations of tailored exercise prescriptions for Blacks and Whites.

The effect of a combined sprint training intervention on sprint force-velocity characteristics in junior Australian football players.

Background: Sprint performance in junior Australian football (AF) players has been shown to be a differentiating quality in ability level therefore developing sprint characteristics via sprint-specific training methods is an important aspect of their physical development. Assisted sprint training is one training method used to enhance sprint performance yet limited information exists on its effect on sprint force-velocity characteristics. Therefore, the main aim of this study was to determine the influence of a combined sprint training intervention using assisted and maximal sprint training methods on mechanical characteristics and sprint performance in junior Australian football players. Methods: Upon completing familiarization and pre-testing, twenty-two male junior Australian football (AF) players (age 14.4 ± 0.3 years, body mass 58.5 ± 10.0 kg, and height 1.74 ± 0.08 m) were divided into a combined sprint training (CST) group (n = 14), and a maximal sprint training (MST) group (n = 8) based on initial sprint performance over 20-meters. Sprint performance was assessed during maximal 20-meter sprint efforts via a radar gun (36 Hz), with velocity-time data used to derive force-velocity characteristics and split times. All subjects then completed a 7-week in-season training intervention consisting of maximal sprinting (MST & CST groups) and assisted sprinting (CST only), along with their usual football specific exercises. Results: Moderate to large pre-post within group effects (-0.65 ≤ ES ≥ 0.82. p ≤ 0.01) in the CST group for relative theoretical maximal force (F0) and power (Pmax) were reflected in improved sprint performance from 0-20 m, thereby creating a more force-oriented F-v profile. The MST group displayed statistically significant pre-post differences in sprint performance between 10-20 m only (ES = 0.18, p = 0.04). Moderate to high relative reliability was achieved across all sprint variables (ICC = 0.65-0.91), except for the force-velocity slope (SFV) and decrement in ratio of forces (DRF) which reported poor reliability (ICC = 0.41-0.44), while the CST group exceeded the pre-post minimal detectable change (MDC) in most sprint variables suggesting a 'true change' in performance across the intervention. Conclusion: It is concluded that implementing a short-term, combined sprint training intervention consisting of assisted and maximal sprint training methods may enhance sprint mechanical characteristics and sprint performance to 20-meters in junior AF players.

Electromagnetic field for supramaximal muscle stimulation: A retrospective study of safety, efficacy, and patient satisfaction in Brazil.

BACKGROUND: Currently, even individuals who do physical activity regularly have some degree of dissatisfaction with their own bodies. The electromagnetic field for supramaximal muscle contraction has been the subject of research. High-intensity supramaximal muscle stimulation (HI-SMS) is a non-invasive technology used to strengthen, firm, and tone the abdominal muscles, arms, buttocks, and thighs and has been indicated for aesthetic purposes. AIMS: The present study aimed to examine the safety and efficacy of HI-SMS used in the abdominal muscles of patients through the analysis of clinical evaluation, biochemical serum profile, and patient satisfaction with the procedure. PATIENTS/METHODS: This is retrospective non-randomized and non-controlled study collected in a private clinic; all data from healthy participants (n = 25), aged between 18 and 55 years, were compiled and analyzed. All received eight 30 min sessions of electromagnetic field ONIX HI-SMS (intensity of the 90%-100%) located in abdominal, twice a week with intervals of 2-3 days. RESULTS: The results show that BMI, fat thickness, and waist circumference improved the body contour after the treatment. There was no statistical difference in the data referring to the values of AST, ALT, ALP, creatinine, cholesterol, LDL-C, VLDL-C, HDL-C, glycemia, LDH, CK, and IL-6. However, there was a reduction of "non-esterified" free fatty acids when compared to baseline. This treatment provided high levels of tolerance, comfort, and high level of satisfaction. CONCLUSIONS: Thus, it can be suggested that the treatment with HI-SMS in abdominal muscles proves to be a safe technology with potential for non-invasive therapy for aesthetic purposes.

Radical supramaximal resection for newly diagnosed left-sided eloquent glioblastoma: safety and improved survival over gross-total resection.

OBJECTIVE: Supramaximal resection (SMR) has arisen as a possible surrogate to gross-total resection (GTR) to improve survival in newly diagnosed glioblastoma (nGBM). However, SMR has traditionally been limited to noneloquent regions and its feasibility in eloquent nGBM remains unclear. The authors conducted a retrospective multivariate propensity-matched analysis comparing survival outcomes for patients with left-sided eloquent nGBM undergoing SMR versus GTR. METHODS: A retrospective review was performed of all patients at our institution who underwent SMR or GTR of a left-sided eloquent nGBM during the period from 2011 to 2020. All patients underwent some form of preoperative or intraoperative functional mapping and underwent awake or asleep craniotomy (craniotomy under general anesthesia); however, awake craniotomy was performed in the majority of patients and the focus of the study was SMR achieved via awake craniotomy and functional mapping with lesionectomy and additional peritumoral fluid attenuated inversion recovery (FLAIR) resection. Propensity scores were generated controlling for age, tumor location, and preoperative Karnofsky Performance Status (KPS) score with the nearest-neighbor algorithm. RESULTS: A total of 102 patients (48 SMR, 54 GTR) were included in this study. The median overall survival (OS) and progression-free survival (PFS) for patients receiving SMR were 22.9 and 5.1 months, respectively. Propensity matching resulted in a final cohort of 27 SMR versus 27 GTR patients. SMR conferred improved OS (21.55 vs 15.49 months, p = 0.0098) and PFS (4.51 vs 3.59 months, p = 0.041) compared to GTR. There was no significant difference in postoperative complication rates or KPS score in SMR compared with GTR patients (p = 0.236 and p = 0.736, respectively). In patients receiving SMR, improved OS and PFS showed a dose-dependent relationship with extent of FLAIR resection (EOFR) on log-rank test for trend (p < 0.001). CONCLUSIONS: SMR by means of awake craniotomy with functional mapping for left-sided eloquent nGBM is safe and confers a survival benefit compared to GTR obtained with lesionectomy alone while preserving postoperative neurological integrity. When tolerated, greater EOFR with SMR may be associated with improved survival.

Reliability of submaximal stimulation for the train-of-four test using acceleromyography and electromyography with individualized stimulation currents.

PURPOSE: The supramaximal stimulation (SMS) of the TOF test causes uncomfortable sensations in patients. We aimed to determine whether the submaximal stimulation would be reliable in TOF tests with reduced painful sensation. METHODS: The accelomyography (AMG) and electromyography (EMG) monitor was applied at each arm and general anesthesia was induced and maintained by total intravenous anesthesia. At extubation, we conducted TOF test three times at each of four different currents: SMS, 70% SMS, 50% SMS, and 30% SMS. The same procedure was performed in the postanesthesia care unit (PACU) only with EMG, and the pain scores on the numerical rating scale (NRS) during the tests were recorded. RESULTS: A total of 36 patients were enrolled. At extubation, TOF ratios with SMS in AMG and EMG were 112.0 ± 13.1% and 93.7 ± 8.9%, respectively. There were no significant differences in TOF ratios between the SMS and lower stimulation intensities. However, 30% and 50% SMS showed significantly higher rates of the unmeasurable results of tests in the PACU. In terms of the stimulation pain, NRS showed a downward pattern as the current decreased and was significantly lower at 50% and 30% SMS than the NRS at SMS. CONCLUSION: The TOF test with submaximal stimulation is still reliable and can reduce stimulation pain. Considering the importance of the TOF results in determining extubation, the authors suggest the minimal current for the TOF test as 70% SMS.

Surgical outcomes of tarsofrontalis sling surgery using silicon rod versus supramaximal levator resection in unilateral congenital ptosis with poor levator function.

PURPOSE: To compare the surgical outcomes of tarsofrontalis sling surgery using silicon rod versus supramaximal levator resection in patients of unilateral congenital ptosis with poor levator function (≤ 4 mm). MATERIALS AND METHODS: This randomized control study was conducted over a period of 18 months. 44 patients were enrolled in the study group. The study population was randomly divided into two groups (22 in each group). In Group A, congenital ptosis was treated with tarsofrontalis sling surgery using silicon rod and supramaximal levator resection was done in the group B. Follow-up examination was done at postoperative day 1, one week, 1 month, 6 months and 12 months. Surgical outcome measures were change in marginal reflex distance-1 (MRD 1), vertical palpebral fissure height (VPFH) and inter-eyelid difference of margin reflex distance 1 and complications in two groups. RESULTS: The mean age of patients in group A was 7.25 ± 6.10 years ranging from 1-18 years and mean age of patients in group B was 5.64 ± 2.44 years ranging from 3 to 11 years. Good surgical outcome was obtained in 73-77% of both groups. MRD1and VPFH increased significantly after surgery from baseline in both the groups (p value < 0.001). Inter-eyelid MRD 1 difference also improved significantly in both groups following ptosis surgery. CONCLUSION: Both supramaximal levator resection and tarsofrontalis sling surgery are equally effective in cases of unilateral ptosis patients with poor levator function and should be part of the surgical armamentarium for treating congenital ptosis.

The effect of exercise hyperpnea on gross efficiency and anaerobic capacity estimates during a 3-min cycle time trial.

This study aimed to analyze the effect of exercise-induced hyperpnea on gross efficiency (GE) and anaerobic capacity estimates during a self-paced 3-min supramaximal cycle time trial (TT). Fourteen highly trained male cyclists performed 7 × 4-min submaximal stages, a 6-min passive rest, a 3-min TT, a 5-min passive rest, and a 6-min submaximal stage. Three models were based on the 7 × 4-min linear regression extrapolation method, using 1) the conventional model (7-YLIN); 2) the same 7-YLIN model but correcting for the additional ventilatory cost (i.e., hyperpnea) (7-YLIN-V-cor); and 3) accounting for linearly declining GE during the TT (7-YLIN-D). The other three models were based on GE from the last submaximal stage, using the conventional model (GELAST) and the same modifications as described for 7+YLIN, i.e., 1) GELAST, 2) GELAST-V-cor, and 3) GELAST-D. The GELAST model generated 18% higher values of anaerobic capacity than the 7-YLIN model (P < 0.05). During the TT, the hyperpnea-corrected model (i.e., 7-YLIN-V-cor or GELAST-V-cor) generated, compared with the respective conventional model (i.e., 7-YLIN or GELAST), ∼0.7 percentage points lower GE and ∼11% higher anaerobic capacity (all, P < 0.05). The post-TT GE was 1.9 percentage points lower (P < 0.001) and the 7-YLIN-D or GELAST-D model generated, compared with the respective conventional model, a lower GE (∼1.0 percentage points) and ∼17% higher anaerobic capacity during the TT (all, P < 0.05). In conclusion, the correction for a declining GE due to hyperpnea during a supramaximal TT resulted in an increased required total metabolic rate and anaerobic energy expenditure compared with the conventional models.NEW & NOTEWORTHY This study demonstrates that GE declines during a 3-min supramaximal cycle TT, which is possibly related to the hyperpneic response during supramaximal exercise. The finding from this study also provides novel insight into how the increased ventilatory energy cost from exercise-induced hyperpnea contributes to decreased GE, increased required total metabolic rate, and increased anaerobic energy expenditure during supramaximal exercise. Therefore, conventional linear models for estimating anaerobic capacity are likely to generate underestimated values.

Comparison of kinematics and kinetics between unassisted and assisted maximum speed sprinting.

Producing comparable/greater ground reaction forces (GRFs) at faster running speeds is beneficial for sprint performance, and assisted sprint training is used to induce faster running speed conditions. This study aimed to demonstrate the characteristics of assisted sprinting at the maximal speed phase and investigate acute differences to control sprinting. Fifteen sprinters completed control and assisted (5 kg) sprints over force platforms. Assisted sprinting increased running speed (9.3% mean difference), while propulsive mean force (-4.3%) and impulse (-12.4%) decreased, suggesting that running speed improvements were caused primarily by assisted pulling force rather than improvements in anteroposterior force production of athletes. In addition, vertical mean force increased (4.2%), probably due to braking mean force (34.2%) and impulse (32.5%) increases. Magnitude of control trial maximum speed was achieved earlier (during acceleration) in assisted trials, and net anteroposterior (includes both braking and propulsive components) mean force (67.2%) and impulse (67.9%) increased at this matched speed, suggesting that assisted sprints could be used to practice producing greater GRFs at comparable speeds. Running speed improvement by pulling force was associated with contact time decreases (r = -.565), suggesting that shortening contact time may be important for effective assisted sprinting.

Different categories of VO2 kinetics in the 'extreme' exercise intensity domain.

The aim of this study was to classify potential sub-zones within the extreme exercise domain. Eight well-trained male cyclists participated in this study. The upper boundary of the severe exercise domain (Pupper-bound) was estimated by constant-work-rate tests. Then three further extreme-work-rate tests were performed in discrete regions within the extreme domain: extreme-1) at a work-rate greater than the Pupper-bound providing an 80-110-s time to task failure; extreme-2) a 30-s maximal sprint; and extreme-3) a 4-s maximal sprint. Different functions were used to describe the behaviour of the V˙O2 kinetics over time. V˙O2 on-kinetics during extreme-1 exercise was best described by a single-exponential model (R2 ≥ 0.97; SEE ≤ 0.10; p < 0.001), and recovery V˙O2 decreased immediately after the termination of exercise. In contrast, V˙O2 on-kinetics during extreme-2 exercise was best fitted by a linear function (R2 ≥ 0.96; SEE ≤ 0.16; p < 0.001), and V˙O2 responses continued to increase during the first 10-20 s of recovery. During the extreme-3 exercise, V˙O2 could not be modelled due to inadequate data, and there was an M-shape recovery V˙O2 response with an exponential decay at the end. The V˙O2 response to exercise across the extreme exercise domain has distinct features and must therefore be characterised with different fitting strategies in order to describe the responses accurately.

Anaerobic work capacity in cycling: the effect of computational method.

PURPOSE: To compare the anaerobic work capacity (AnWC, i.e., attributable anaerobic mechanical work) assessed using four different approaches/models applied to time-trial (TT) cycle-ergometry exercise. METHODS: Fifteen male cyclists completed a 7 × 4-min submaximal protocol and a 3-min all-out TT (TTAO). Linear relationships between power output (PO) and submaximal metabolic rate were constructed to estimate TT-specific gross efficiency (GE) and AnWC, using either a measured resting metabolic rate as a Y-intercept (7 + YLIN) or no measured Y-intercept (7-YLIN). In addition, GE of the last submaximal bout (GELAST) was used to estimate AnWC, and critical power (CP) from TTAO (CP3´AO) was used to estimate mechanical work above CP (W', i.e., "AnWC"). RESULTS: Average PO during TTAO was 5.43 ± 0.30 and CP was 4.48 ± 0.23 W∙kg-1. The TT-associated GE values were ~ 22.0% for both 7 + YLIN and 7-YLIN and ~ 21.1% for GELAST (both P < 0.001). The AnWC were 269 ± 60, 272 ± 55, 299 ± 61, and 196 ± 52 J∙kg-1 for the 7 + YLIN, 7-YLIN, GELAST, and CP3´AO models, respectively (7 + YLIN and 7-YLIN versus GELAST, both P < 0.001; 7 + YLIN, 7-YLIN, and GELAST versus CP3´AO, all P < 0.01). For the three pair-wise comparisons between 7 + YLIN, 7-YLIN, and GELAST, typical errors in AnWC values ranged from 7 to 11 J∙kg-1, whereas 7 + YLIN, 7-YLIN, and GELAST versus CP3´AO revealed typical errors of 55-59 J∙kg-1. CONCLUSION: These findings demonstrate a substantial disagreement in AnWC between CP3´AO and the other models. The 7 + YLIN and 7-YLIN generated 10% lower AnWC values than the GELAST model, whereas 7 + YLIN and 7-YLIN generated similar values of AnWC.