Acu-TENS lowers blood lactate levels and enhances heart rate recovery after exercise

Objective:The primary aim of this study is to investigate the effect of application of transcutaneous electrical nerve stimulation over acupuncture points(Acu-TENS)on postexercise blood lactate level.The secondary aim is to explore the effect of Acu-TENS on heart rate recovery and its association with autonomic nervous system.Methods:Twenty healthy subjects(mean age 26.9
1.3)acting as their own controls,were randomized to receive either Acu-TENS or Placebo-TENS as the first of two intervention protocols,implemented one week apart.During Acu-TENS,subjects received 45 min TENS bilaterally over the acupoints Neiguan(PC6).Subjects receiving Placebo-TENS had identical electrode placement but with no electrical output from the TENS unit despite an active output light.Interventions were followed by a 10-min ergometer exercise at 70%age-predicted maximal heart rate.Oxygen consumption and heart rate(HR)were recorded continuously throughout exercise.Blood lactate and blood pressure were taken at 4 time points:prior to,immediately after,at 15-min after exercise,and when HR had returned to baseline values.Results:The post-exercise blood lactate level in the Acu-TENS group was lower than that of the placebo group by 1.12
0.39 mmol/L(p Z 0.01).The Acu-TENS group also had a faster return of HR to pre-exercise level compared to placebo(9.98
4.54 min,p Z 0.047).Heart rate variability analysis inferred reduced sympathetic modulation during exercise after Acu-TENS.There was no between-group difference in post-exercise oxygen consumption.Conclusion:Acu-TENS lowered post-exercise blood lactate level and enhanced heart rate recovery after moderate exercise.The role of Acu-TENS in exercise performance and energy metabolism warrants further investigation.(ClinicalTrails.gov Identifier:NCT01102634)a 2014 Beijing University of Chinese Medicine.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/3.0/).

Trend of blood lactate level in acute aluminum phosphide poisoning

BACKGROUND: Aluminum phosphide(Al P) poisoning is common in the developing countries. There is no specifi c antidote for the treatment of acute Al P poisoning. Early diagnosis of poisoning and outcome predictors may facilitate treatment decisions. The objective of this study was to determine the trend of blood lactate level in acute Al P poisoning to evaluate its role as a prognostic factor.METHODS: This was a prospective study on acute Al P intoxicated patients during one year. Demographic data, clinical and laboratory data on admission, and outcome were recorded in a selfmade questionnaire. Blood lactate levels were analyzed every two hours for 24 hours.RESULTS: Thirty-nine(27 male, 12 female) patients were included in the study. The mortality rate was 38.5%. The mean blood pressure, pulse rate, blood p H and serum bicarbonate level were significantly different between the survivors and non-survivors groups. Blood lactate level was signifi cantly higher in the non-survivors group during 8 to 16 hours post ingestion.CONCLUSION: Blood lactate level could be used as an index of severity of acute Al P poisoning.

Combination of blood lactate level with assessment of blood consumption （ABC） scoring system： A more accurate predictor of massive transfusion requirement

Purpose： Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion （MT） protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption （ABC） score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MTo Methods： The data were retrospectively collected from 165 trauma patients following the trauma acti- vated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score 〉2 as the cut point for MT were defined as the ABC group. All patients who had a score 〉2 with a lactate level 〉4 mmol/dL were defined as the ABC plus lactate level （ABC ＋ L） group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC ＋ L groups. The ability of ABC and ABC ＋ L groups to predict MT was estimated by the area under the receiver operating characteristic curve （AUROC）. Results： Among 165 patients, 15 patients （9%） required massive blood transfusion. There were no sig- nificant differences in age, gender, mechanism of injury or initial vital signs bet^teen the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low （81%, 34%, AUC 0.573）. The sensitivity and specificity were significantly better in the ABC ＋ L group （92%, 42%, AUC = 0.745）. Conclusion： The ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.

Changes of muscle oxygenation and blood lactate concentration of swimming athletes during graded incremental exercise

The sport performance of swimming athletes in three different levels including 5 national high-level swimming athletes, 5 ordinary swimming athletes and 5 college students was investigated by near-infrared spectroscopy （NIRS）. Four parameters of muscle oxygenation and blood lactate （BLa） concentration were simultaneously monitored during incremental exercise on the ergometer. It was found that inflection points of muscle oxygenation and BLa concentration were consistent with the human sport capacity. Moreover, inflection points of muscle oxygenation occurred earlier than those of BLa concentration in ordinary athletes and college students. It implies monitoring changes of muscle oxygenation is superior to BLa measurement under this condition, since BLa test has an unavoidable time lag. Significant correlation （r2 = 0.948; P〈0.05） was observed between inflection points of muscle oxygenation difference and inflection points of BLa concentration on workload. This relationship suggests changes of muscle oxygenation detected by NIRS is beneficial to the evaluation of athletes＇ physiologic function and training load. Considering that muscle oxygenation could be in-vivo and non-invasively mea- sured by NIRS, it may be a better indicator of exercise intensity than BLa measurement in the near future.

The scoring system for patients with severe sepsis after orthotopic liver transplantation

BACKGROUND: Because of the complicated pathological features after liver transplantation, severe sepsis is difficult to treat and often leads to death. This study was undertaken to analyze the role of orthotopic liver transplantation (OLT) in patients with severe sepsis and to evaluate the effect of the scoring system. METHODS: Fifty-six patients conformed to the inclusion criteria. They were divided into two groups: non-OLT group (group A) and OLT group (group B). Besides the general data of the patients, the surveillance of blood lactate, the number of failed organs, acute physiology and chronic health evaluationⅡ(APACHEⅡ) and mutiple organ dysfunction score (MODS) were evaluated at the 1st, 3rd and 7th day after OLT. RESULTS: The mortality during hospitalization was 30% in the non-OLT group and 57.6% in the other group. The level of blood lactate at the 1st day of OLT increased more significantly in the OLT group than in the non-OLT group (P<0.01). It was decreased but higher than that in the non-OLT group in the seven days after OLT. The number of failed organs in the OLT group was greater than that in the non-OLT group (P<0.01). The continuous score of APACHEⅡwas not significantly different in the two groups. But the continuous MODS in the OLT group was higher than that in the non-OLT group (P<0.01), which was consistent with the number of failed organs. CONCLUSIONS: The persistently higher level of blood lactate during 7 days may be a dependent risk factor. Immunosuppression may be another risk factor for OLT patients. The mortality of OLT in patients with severe sepsis in 28 days is almost double that in non-OLT patients. The MODS score is better than the APACHEⅡscore in the assessment of organ failure in OLT patients with severe sepsis. The standard scoring system could be improved or a new scoring system that includes the blood lactate score should be established for liver transplantation.

Effects of compression garments on surface EMG and physiological responses during and after distance running

Background:The few previous studies that focused on the effects of compression garments(CG)on distance running performance have simultaneously measured electromyogram,physiological,and perceptual parameters.Therefore,this study investigated the effects of CG on muscle activation and median frequency during and after distance running,as well as blood-lactate concentration and rating of perceived exertion(RPE)during distance running.Methods:Eight healthy male recreational runners were recruited to randomly perform two 40 min treadmill running trials,one with CG,and the other with control garment made of normal cloth.The RPE and the surface electromyography(EMG)of 5 lower extremity muscles including gluteus maximus(GM),rectus femoris(RF),semitendinosus(ST),tibialis anterior(TA),and gastrocnemius(GAS)were measured during the running trial.The blood-lactate levels before and after the running trial were measured.Results:Wearing CG led to significant lower muscle activation(p<0.05)in the GM(decreased 7.40%-14.31%),RF(decreased 4.39%-4.76%),and ST(decreased 3.42%-7.20%)muscles;moreover,significant higher median frequency(p<0.05)in the GM(increased 5.57%)and ST(increased 10.58%)muscles.Wearing CG did not alter the RPE values or the blood-lactate levels(p>0.05).Conclusion:Wearing CG was associated with significantly lower muscle activation and higher median frequency in the running-related key muscles during distance running.This finding suggested that wearing CG may improve muscle function,which might enhance running performance and prevent muscle fatigue.

Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism

BACKGROUND Superior mesenteric artery embolism(SMAE)has acute onset and fast progression,which seriously threatens the life of patients.Multidetector computed tomography(MDCT)is one of the most important diagnostic methods for SMAE,which plays an important role in the diagnosis and prognosis of SMAE.AIM To evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.METHODS Data from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected.Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.RESULTS Univariate Cox regression model showed that intestinal wall thinning,intestinal wall pneumatosis,blood lactate>2.1 mmol/L and blood pH<7.35 increased the risk of death in patients with SMAE.After adjusting for age,sex,embolic involvement length and embolic distribution region,multivariate Cox regression model I showed that blood lactate>2.1 mmol/L(HR=5.26,95%CI:1.04-26.69,P=0.045)and intestinal wall thinning(HR=9.40,95%CI:1.05-83.46,P=0.044)were significantly increases the risk of death in patients with SMAE.CONCLUSION For patients with SAME,increased blood lactate and intestinal wall thinning are the risk factors for death;hence,close monitoring may reduce the mortality rate.Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.

Physiological and perceptual responses to sprint interval exercise using arm versus leg cycling ergometry

Increases in power output and maximal oxygen consumption(V_O2max)occur in response to sprint interval exercise(SIE),but common use of“all-out”intensities presents a barrier for many adults.Furthermore,lower-body SIE is not feasible for all adults.We compared physiological and perceptual responses to supramaximal,but“nonall-out”SIE between leg and arm cycling exercise.Twenty-four active adults(mean±SD age:[25±7]y;cycling VO_(2)max:[39±7]mL·kg^(-1)·min^(-1))performed incremental exercise using leg(LCE)and arm cycle ergometry(ACE)to determine VO_(2)max and maximal work capacity(Wmax).Subsequently,they performed four 20 s bouts of SIE at 130% Wmax on the LCE or ACE at cadence=120-130 rev/min,with 2 min recovery between intervals.Gas exchange data,heart rate(HR),blood lactate concentration(BLa),rating of perceived exertion(RPE),and affective valence were acquired.Data showed significantly lower(p<0.001)absolute mean([1.24±0.31]L·min^(-1) vs.[1.59±0.34]L·min^(-1);d=1.08)and peak VO_(2)([1.79±0.48]L·min^(-1) vs.[2.10±0.44]L·min^(-1);d=0.70)with ACE versus LCE.However,ACE elicited significantly higher(p<0.001)relative mean([62%±9%]VO_(2)max vs.[57%±7%]VO_(2)max,d=0.63)and peak VO_(2)([88%±10%]VO_(2)max vs.[75%±10%]VO_(2)max,d?1.33).Post-exercise BLa was significantly higher([7.0±1.7]mM vs.[5.7±1.5]mM,p=0.024,d?0.83)for LCE versus ACE.There was no significant effect of modality on RPE or affective valence(p>0.42),and lowest affective valence recorded(2.0±1.8)was considered“good to fairly good”.Data show that non“all-out”ACE elicits lower absolute but higher relative HR and VO_(2) compared to LCE.Less aversive perceptual responses could make this non-all-out modality feasible for inactive adults.

Predictors of mortality in patients with acute smallbowel perforation transferred to ICU after emergency surgery:a single-centre retrospective cohort study

Background Although small-bowel perforation is a life-threatening emergency even after immediate surgical intervention,studies have rarely investigated surgical outcomes due to its relatively low incidence.This study aimed to investigate the outcomes of emergency surgery for patients with small-bowel perforation transferred to the intensive care unit(ICU)and the risk factors for mortality.Methods Consecutive patients with small-bowel perforation who were confirmed via emergency surgery and transferred to the ICU in Zhongshan Hospital,Fudan University(Shanghai,China)between February 2011 and May 2020 were retrospectively analysed.Medical records were reviewed to determine clinical features,laboratory indicators,surgical findings,and pathology.Results A total of 104 patients were included in this study,among whom 18(17.3%),59(56.7%),and 27(26.0%)underwent perforation repair,segmental resection with primary anastomosis,and small-bowel ostomy,respectively.Malignant tumours were the leading cause of perforation in these patients(40.4%,42/104).The overall post-operative complication rate and mortality rates were 74.0%(77/104)and 19.2%(20/104),respectively.Malignant tumour-related perforation(odds ratio[OR],4.659;95%confidence interval[CI],1.269–17.105;P=0.020)and high post-operative arterial blood-lactate level(OR,1.479;95%CI,1.027–2.131;P=0.036)were identified as independent risk factors for post-operative mortality in patients with small-bowel perforation transferred to the ICU.Conclusions Patients with small-bowel perforation who are transferred to the ICU after emergency surgery face a high risk of post-operative complications and mortality.Moreover,those patients with malignant tumour-related perforation and higher post-operative blood-lactate levels have poor prognosis.

The Effects of Ground and Treadmill Running on Energy Metabolism and Muscle Contractile Properties:A Randomized Cross-Over Study

Purpose This study aimed to compare the effects of ground and treadmill running on energy metabolism and muscle con-tractile properties,providing a basis for the general public to choose running venues.Methods Ten male college students(age,20.10±1.53 years;height,176.20±5.49 cm;weight,72.14±8.25 kg;body fat percent,12.41%±4.65%)were recruited in this study.Energy expenditure(EE)was measured using the accelerometer(GT9X)combined with specific estimation equations.Average heart rate(HR)was measured using a heart rate band(Polar).Muscle contractile properties were assessed by measuring muscle displacement(Dm)and contraction velocity(Vc)using tensiomyography(TMG-S1).Blood glucose(Glu)and lactate(Lac)were measured by portable devices(eB-G and Lactate Scout).The running speed was 9 km/h and the duration was 25 min.Two-way ANOVA(protocol×time)was used to analyze the effect of running protocols on energy metabolism and muscle contractile properties.Results EE of treadmill running was significantly higher than EE of ground running(protocol main effect,P<0.001),and HR of treadmill running was significantly higher than that of ground running in the first testing time(protocol simple effect,P=0.026;protocol×time interaction P=0.043).The decrease in Dm of the rectus femoris after treadmill running was significantly higher than that of ground running(protocol main effect,P=0.009).The interaction of different running protocols and testing times on Lac was significant(P=0.025),but all results of the simple effects analysis were not statisti-cally significant(P>0.05).Conclusion Our study found a difference in energy expenditure between treadmill and ground running at 9 km/h with duration of 25 min.In addition,treadmills are more likely to cause a decrease in muscle displacement distance of the rectus femoris measured after exercise than ground running.Future studies are needed to further investigate whether the differences are induced by internal metabolism or the environmental conditions of running.

Comparison of Cardiorespiratory and Metabolic Responses Between Kettlebell Half Marathon and Treadmill Running at the Same Average Oxygen Consumption: A Case Study

Purposes In kettlebell sport(KS)half marathon,the lift of the kettlebell is required for the highest number of repetitions in 30 min.No data are available on cardiorespiratory and metabolic responses during this exercise routine.The aim of the study was to evaluate cardiopulmonary and metabolic responses to KS half marathon compared to 30 min treadmill running,chosen as a reference paradigm of aerobic exercise,at the same average oxygen consumption(VO_(2)).Methods A male elite KS athlete was enrolled in two trials separated by 7 days of rest.In the first trial,one-hand long-cycle KS exercise with a 1/3 body weight kettlebell was performed for 30 min(kettlebell half marathon,KT);in the second trial,30 min treadmill running(TR)was performed at the same average VO2 measured in the first trial(speed 9-10 km/h at 1°uphill inclination).Metabolic and cardiopulmonary assessments[respiratory exchange ratio(RER),tidal volume(TV),breathing frequency(f),minute ventilation(VE)],blood lactate(BL)kinetics,heart rate(HR),and blood pressure(BP)were measured in both experimental sessions.Results The average VO_(2) was 33.3 mL/min/kg in KT and 30.6 mL/min/kg in TR.The subject achieved RER_(peak) 1.17,RER_(mean) 0.98,HR_(peak) 172 bpm(94% HR_(max)),HR_(mean) 86% of HR_(max),BP_(peak) 220/100 mmHg in KT,BL_(peak) 7.2 mmol/L(during trial)in KT and RER_(peak) 1.13,RER_(mean) 0.89,HR_(peak) 142 bpm(78%HR_(max)),HR_(mean) 70% of HR_(max),BP_(peak) 160/80 mmHg,BL_(peak) 3.5 mmol/L(4 min after trial)mmol/L in TR.Conclusion Data indicate that a KS half marathon determines much higher cardiopulmonary and metabolic responses to treadmill running performed at similar VO_(2).