A multi-ingredient, pre-workout supplement is apparently safe in healthy males and females.

BACKGROUND: Pre-workout supplements (PWS) have become increasingly popular with recreational and competitive athletes. While many ingredients used in PWS have had their safety assessed, the interactions when combined are less understood. OBJECTIVE: The purpose of this study was to examine the safety of 1 and 2 servings of a PWS. DESIGN: Forty-four males and females (24.4±4.6 years; 174.7±9.3 cm; 78.9±18.6 kg) from two laboratories participated in this study. Subjects were randomly assigned to consume either one serving (G1; n=14) or two servings (G2; n=18) of PWS or serve as an unsupplemented control (CRL; n=12). Blood draws for safety panels were conducted by a trained phlebotomist before and after the supplementation period. RESULTS: Pooled data from both laboratories revealed significant group×time interactions (p<0.05) for mean corpuscular hemoglobin (MCH; CRL: 30.9±0.8-31.0±0.9 pg; G1: 30.7±1.1-30.2±0.7 pg; G2: 30.9±1.2-30.9±1.1 pg), MCH concentration (CRL: 34.0±0.9-34.4±0.7 g/dL; G1: 34.1±0.9-33.8±0.6 g/dL; G2: 34.0±1.0-33.8±0.8 g/dL), platelets (CRL: 261.9±45.7-255.2±41.2×10(3)/µL; G1: 223.8±47.7-238.7±49.6×10(3)/µL; G2: 239.1±28.3-230.8±34.5×10(3)/µL), serum glucose (CRL: 84.1±5.2-83.3±5.8 mg/dL; G1: 86.5±7.9-89.7±5.6 mg/dL; G2: 87.4±7.2-89.9±6.6 mg/dL), sodium (CRL: 137.0±2.7-136.4±2.4 mmol/L; 139.6±1.4-140.0±2.2 mmol/L; G2: 139.0±2.2-138.7±1.7 mmol/L), albumin (CRL: 4.4±0.15-4.4±0.22 g/dL; G1: 4.5±0.19-4.5±0.13 g/dL; G2: 4.6±0.28-4.3±0.13 g/dL), and albumin:globulin (CRL: 1.8±0.30-1.8±0.28; G1: 1.9±0.30-2.0±0.31; G2: 1.8±0.34-1.8±0.34). Each of these variables remained within the clinical reference ranges. CONCLUSIONS: The PWS appears to be safe for heart, liver, and kidney function in both one-serving and two-serving doses when consumed daily for 28 days. Despite the changes observed for select variables, no variable reached clinical significance.

Subcutaneous and segmental fat loss with and without supportive supplements in conjunction with a low-calorie high protein diet in healthy women.

BACKGROUND: Weight loss benefits of multi-ingredient supplements in conjunction with a low-calorie, high-protein diet in young women are unknown. Therefore, the purpose of this study was to investigate the effects of a three-week low-calorie diet with and without supplementation on body composition. METHODS: Thirty-seven recreationally-trained women (n = 37; age = 27.1 ± 4.2; height = 165.1 ± 6.4; weight = 68.5 ± 10.1; BMI = 25.1 ± 3.4) completed one of the following three-week interventions: no change in diet (CON); a high-protein, low-calorie diet supplemented with a thermogenic, conjugated linoleic acid (CLA), a protein gel, and a multi-vitamin (SUP); or the high-protein diet with isocaloric placebo supplements (PLA). Before and after the three-week intervention, body weight, %Fat via dual X-ray absorptiometry (DXA), segmental fat mass via DXA, %Fat via skinfolds, and skinfold thicknesses at seven sites were measured. RESULTS: SUP and PLA significantly decreased body weight (SUP: PRE, 70.47 ± 8.01 kg to POST, 67.51 ± 8.10 kg; PLA: PRE, 67.88 ± 12.28 kg vs. POST, 66.38 ± 11.94 kg; p ≤ 0.05) with a greater (p ≤ 0.05) decrease in SUP than PLA or CON. SUP and PLA significantly decreased %Fat according to DXA (SUP: PRE, 34.98 ± 7.05% to POST, 32.99 ± 6.89%; PLA: PRE, 34.22 ± 6.36% vs. POST, 32.69 ± 5.84%; p ≤ 0.05), whereas only SUP significantly decreased %Fat according to skinfolds (SUP: PRE, 27.40 ± 4.09% to POST, 24.08 ± 4.31%; p ≤ 0.05). SUP significantly (p ≤ 0.05) decreased thicknesses at five skinfolds (chest, waist, hip, subscapular, and tricep) compared to PLA, but not at two skinfolds (axilla and thigh). CONCLUSIONS: The addition of a thermogenic, CLA, protein, and a multi-vitamin to a three-week low-calorie diet improved weight loss, total fat loss and subcutaneous fat loss, compared to diet alone.

Caloric expenditure of aerobic, resistance, or combined high-intensity interval training using a hydraulic resistance system in healthy men.

Although exercise regimens vary in content and duration, few studies have compared the caloric expenditure of multiple exercise modalities with the same duration. The purpose of this study was to compare the energy expenditure of single sessions of resistance, aerobic, and combined exercise with the same duration. Nine recreationally active men (age: 25 ± 7 years; height: 181.6 ± 7.6 cm; weight: 86.6 ± 7.5 kg) performed the following 4 exercises for 30 minutes: a resistance training session using 75% of their 1-repetition maximum (1RM), an endurance cycling session at 70% maximum heart rate (HRmax), an endurance treadmill session at 70% HRmax, and a high-intensity interval training (HIIT) session on a hydraulic resistance system (HRS) that included repeating intervals of 20 seconds at maximum effort followed by 40 seconds of rest. Total caloric expenditure, substrate use, heart rate (HR), and rating of perceived exertion (RPE) were recorded. Caloric expenditure was significantly (p ≤ 0.05) greater when exercising with the HRS (12.62 ± 2.36 kcal·min), compared with when exercising with weights (8.83 ± 1.55 kcal·min), treadmill (9.48 ± 1.30 kcal·min), and cycling (9.23 ± 1.25 kcal·min). The average HR was significantly (p ≤ 0.05) greater with the HRS (156 ± 9 b·min), compared with that using weights (138 ± 16 b·min), treadmill (137 ± 5 b·min), and cycle (138 ± 6 b·min). Similarly, the average RPE was significantly (p ≤ 0.05) higher with the HRS (16 ± 2), compared with that using weights (13 ± 2), treadmill (10 ± 2), and cycle (11 ± 1). These data suggest that individuals can burn more calories performing an HIIT session with an HRS than spending the same amount of time performing a steady-state exercise session. This form of exercise intervention may be beneficial to individuals who want to gain the benefits of both resistance and cardiovascular training but have limited time to dedicate to exercise.

Ingesting a preworkout supplement containing caffeine, creatine, ß-alanine, amino acids, and B vitamins for 28 days is both safe and efficacious in recreationally active men.

The purpose of this study was to determine the safety and efficacy of consuming a preworkout supplement (SUP) containing caffeine, creatine, ß-alanine, amino acids, and B vitamins for 28 days. We hypothesized that little to no changes in kidney and liver clinical blood markers or resting heart rate and blood pressure (BP) would be observed. In addition, we hypothesized that body composition and performance would improve in recreationally active males after 28 days of supplementation. In a double-blind, placebo-controlled study, participants were randomly assigned to ingest one scoop of either the SUP or placebo every day for 28 days, either 20 minutes before exercise or ad libitum on nonexercise days. Resting heart rate and BP, body composition, and fasting blood samples were collected before and after supplementation. Aerobic capacity as well as muscular strength and endurance were also measured. Significant (P < .05) main effects for time were observed for resting heart rate (presupplementation, 67.59 ± 7.90 beats per minute; postsupplementation, 66.18 ± 7.63 beats per minute), systolic BP (presupplementation, 122.41 ± 11.25 mm Hg; postsupplementation, 118.35 ± 11.58 mm Hg), blood urea nitrogen (presupplementation, 13.12 ± 2.55 mg/dL; postsupplementation, 15.24 ± 4.47 mg/dL), aspartate aminotransferase (presupplementation, 34.29 ± 16.48 IU/L; postsupplementation, 24.76 ± 4.71 IU/L), and alanine aminotransferase (presupplementation, 32.76 ± 19.72 IU/L; postsupplementation, 24.88 ± 9.68 IU/L). Significant main effects for time were observed for body fat percentage (presupplementation, 15.55% ± 5.79%; postsupplementation, 14.21% ± 5.38%; P = .004) and fat-free mass (presupplementation, 70.80 ± 9.21 kg; postsupplementation, 71.98 ± 9.27 kg; P = .006). A significant decrease in maximal oxygen consumption (presupplementation, 47.28 ± 2.69 mL/kg per minute; postsupplementation, 45.60 ± 2.81 mL/kg per minute) and a significant increase in percentage of oxygen consumption per unit time at which ventilatory threshold occurred (presupplementation, 64.38% ± 6.63%; postsupplementation, 70.63% ± 6.39%) and leg press one-repetition maximum (presupplementation, 218.75 ± 38.43 kg; postsupplementation, 228.75 ± 44.79 kg) were observed in the SUP only. No adverse effects were noted for renal and hepatic clinical blood markers, resting heart rate, or BP. Supplements containing similar ingredients and doses should be safe for ingestion periods lasting up to 28 days in healthy, recreationally trained, college-aged men.

An amino acid-electrolyte beverage may increase cellular rehydration relative to carbohydrate-electrolyte and flavored water beverages.

BACKGROUND: In cases of dehydration exceeding a 2% loss of body weight, athletic performance can be significantly compromised. Carbohydrate and/or electrolyte containing beverages have been effective for rehydration and recovery of performance, yet amino acid containing beverages remain unexamined. Therefore, the purpose of this study is to compare the rehydration capabilities of an electrolyte-carbohydrate (EC), electrolyte-branched chain amino acid (EA), and flavored water (FW) beverages. METHODS: Twenty men (n = 10; 26.7 ± 4.8 years; 174.3 ± 6.4 cm; 74.2 ± 10.9 kg) and women (n = 10; 27.1 ± 4.7 years; 175.3 ± 7.9 cm; 71.0 ± 6.5 kg) participated in this crossover study. For each trial, subjects were dehydrated, provided one of three random beverages, and monitored for the following three hours. Measurements were collected prior to and immediately after dehydration and 4 hours after dehydration (3 hours after rehydration) (AE = -2.5 ± 0.55%; CE = -2.2 ± 0.43%; FW = -2.5 ± 0.62%). Measurements collected at each time point were urine volume, urine specific gravity, drink volume, and fluid retention. RESULTS: No significant differences (p > 0.05) existed between beverages for urine volume, drink volume, or fluid retention for any time-point. Treatment x time interactions existed for urine specific gravity (USG) (p < 0.05). Post hoc analysis revealed differences occurred between the FW and EA beverages (p = 0.003) and between the EC and EA beverages (p = 0.007) at 4 hours after rehydration. Wherein, EA USG returned to baseline at 4 hours post-dehydration (mean difference from pre to 4 hours post-dehydration = -0.0002; p > 0.05) while both EC (-0.0067) and FW (-0.0051) continued to produce dilute urine and failed to return to baseline at the same time-point (p < 0.05). CONCLUSION: Because no differences existed for fluid retention, urine or drink volume at any time point, yet USG returned to baseline during the EA trial, an EA supplement may enhance cellular rehydration rate compared to an EC or FW beverage in healthy men and women after acute dehydration of around 2% body mass loss.

Bilateral pulmonary metastectomy through a unilateral single-port thoracoscopic approach.

A 58-year-old woman underwent radical proctectomy 19 months prior to admission. The initial diagnosis was rectal adenocarcinoma of pathological stage T2N0M0. She was discharged five days after the operation. She was followed by abdominal computed tomographic (CT) scan at 3, 9 and 18 months after the operation. Eighteen months after the operation, follow-up abdominal CT scan revealed tiny nodules in the bilateral lower lobes. Subsequent CT scan of the chest showed two tiny nodules in the right lower lobe and a single tiny nodule in left lower lobe. She then underwent single port thoracoscopic surgery through the right side for resection of the nodules. Using a single port wound, we excised the two tiny nodules on the right side and the one tiny nodule in the left lower lobe across the mediastinum. She was discharged four days later. The final pathology report showed those three nodules were metastases from an adenocarcinoma in the colon.

Treatment of bilateral empyema thoracis using unilateral single-port thoracoscopic approach.

A variety of disease in the chest can be treated with thoracoscopic surgery. Although with limited experience, thoracoscopic surgery can be performed with single-port approach. Theoretically, single-port approach can be applied in treating bilateral pleural effusions. Here we reported a case of 28-year-old man with the diagnosis of septic embolization of the lung with complications of bilateral empyema. He was treated with single-port thoracoscopic surgery for decortication of right pleural space and deloculation of left pleural space. After prolonged course of antibiotics for 21 days, the patient was discharged. After follow-up for 3 months, the patient recovered well and had no evidence of recurrence.

28 days of creatine nitrate supplementation is apparently safe in healthy individuals.

BACKGROUND: Creatine monohydrate has become a very popular nutritional supplement for its ergogenic effects. The safety of creatine monohydrate has previously been confirmed. However with each novel form of creatine that emerges, its safety must be verified. Therefore, the purpose of this study was to examine the safety of a novel form of creatine, creatine nitrate (CN), over a 28 day period. METHODS: 58 young males and females (Pooled: 24.3 ± 3.9 years, 144.9 ± 8.0 cm, 74.2 ± 13.0 kg) participated in this study across two laboratories. Subjects were equally and randomly assigned to consume either 1 g (n = 18) or 2 g (n = 20) of CN or remained unsupplemented (n = 20). Blood draws for full safety panels were conducted by a trained phlebotomist prior to and at the conclusion of the supplementation period. RESULTS: Pooled data from both laboratories revealed significant group x time interactions for absolute lymphocytes and absolute monocytes (p < 0.05). Analysis of the 1 g treatment revealed lab x time differences for red blood cell distribution width, platelets, absolute monocytes, creatinine, blood urea nitrogen (BUN):creatinine, sodium, protein, and alanine aminotransferase (ALT) (p < 0.05). Analysis of the 2 g treatment revealed lab x time differences for BUN:creatinine and ALT (p < 0.05). BUN and BUN:creatinine increased beyond the clinical reference range for the 2 g treatment of Lab 2, but BUN did not reach statistical significance. CONCLUSION: Overall, CN appears to be safe in both 1 g and 2 g servings daily for up to a 28 day period. While those with previously elevated BUN levels may see additional increases resulting in post-supplementation values slightly beyond normal physiological range, these results have minor clinical significance and are not cause for concern. Otherwise, all hematological safety markers remained within normal range, suggesting that CN supplementation has no adverse effects in daily doses up to 2 g over 28 days and may be an alternative to creatine monohydrate supplementation.

Video-guided tube thoracostomy with use of an electrical nonfiberoptic endoscope.

PURPOSE: Tube thoracostomy is a common and generally safe procedure. However, potential hazards can occur during placement of the chest tube. Inasmuch as unexpected injuries may arise from tube thoracostomy, we propose a novel video-guided method. DESCRIPTION: We used an independent complementary metal oxide semiconductor image sensor with a processing chip to obtain a front view image of the chest cavity. The device is connected to an aluminum shaft with four small light-emitting diode crystals in the tip, and a detachable small monitor with a battery inside. The apparatus is small and can be used to direct vision-guided tools in tube thoracostomy. EVALUATION: We performed video-guided tube thoracostomy in 6 patients with pleural adhesions. All patients experienced good tolerance to the procedure and had no immediate adverse events. The thoracostomies were performed by a single surgeon with good acceptability, and each procedure was completed in less than 10 minutes. CONCLUSIONS: In some cases of pleural adhesion, the video-guided thoracostomy may be a safer alternative to non-image guided tube thoracostomy.

Ingesting a pre-workout supplement containing caffeine, B-vitamins, amino acids, creatine, and beta-alanine before exercise delays fatigue while improving reaction time and muscular endurance.

BACKGROUND: The purpose of this study was to determine the effects of the pre-workout supplement Assault™ (MusclePharm, Denver, CO, USA) on upper and lower body muscular endurance, aerobic and anaerobic capacity, and choice reaction time in recreationally-trained males. Subjective feelings of energy, fatigue, alertness, and focus were measured to examine associations between psychological factors and human performance. METHODS: Twelve recreationally-trained males participated in a 3-week investigation (mean +/- SD, age: 28 +/- 5 y, height: 178 +/- 9 cm, weight: 79.2 +/- 15.7 kg, VO2max: 45.7 +/- 7.6 ml/kg/min). Subjects reported to the human performance laboratory on three separate occasions. All participants completed a baseline/familiarization day of testing that included a maximal graded exercise test for the determination of aerobic capacity (VO2max), one-rep maximum (1-RM) for bench and leg press to determine 75% of 1-RM, choice reaction tests, and intermittent critical velocity familiarization. Choice reaction tests included the following: single-step audio and visual, one-tower stationary protocol, two-tower lateral protocol, three-tower multi-directional protocol, and three-tower multi-directional protocol with martial arts sticks. Subjects were randomly assigned to ingest either the supplement (SUP) or the placebo (PL) during Visit 2. Subjects were provided with the cross-over treatment on the last testing visit. Testing occurred 20 min following ingestion of both treatments. RESULTS: Significant (p < 0.05) main effects for the SUP were observed for leg press (SUP: 13 ± 6 reps, PL: 11 ± 3 reps), perceived energy (SUP: 3.4 ± 0.9, PL: 3.1 ± 0.8), alertness (SUP: 4.0 ± 0.7, PL: 3.5 ± 0.8), focus (SUP: 4.1 ± 0.6, PL: 3.5 ± 0.8), choice reaction audio single-step (SUP: 0.92 ± 0.10 s, PL: 0.97 ± 0.11 s), choice reaction multi-direction 15 s (SUP: 1.07 ± 0.12 s, PL: 1.13 ± 0.14 s), and multi-direction for 30 s (SUP: 1.10 ± 0.11 s, PL: 1.14 ± 0.13 s). CONCLUSIONS: Ingesting the SUP before exercise significantly improved agility choice reaction performance and lower body muscular endurance, while increasing perceived energy and reducing subjective fatigue. These findings suggest that the SUP may delay fatigue during strenuous exercise.