Endoscopic Therapies for Gastroparesis

Abstract

Purpose of Review

Gastroparesis remains a difficult-to-treat disease with limited therapeutic options. Though patients often have a common syndrome of stereotypic symptoms, the underlying pathophysiology is heterogeneous, often leading to variable treatment responses. Due to limitations in medical and surgical therapies, endoscopic options have been increasingly explored. These options can be broadly categorized into pyloric-directed therapy, non-pyloric-directed therapy, and nutritional support. In this review, we will highlight current and emerging endoscopic options, such as gastric per-oral endoscopic myotomy (G-POEM).

Recent Findings

Early retrospective studies on G-POEM offer encouraging results up to one year out, with an acceptable safety profile. Other pyloric-directed therapies, such as pyloric dilation and stenting, have also been explored.

Summary

While emerging endoscopic therapeutic options are encouraging, efficacy will likely depend on a better characterization of underlying pathophysiology and improved patient selection. Future prospective, controlled studies are needed.

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Evidence of the homeostatic regulation with the combination of transcranial direct current stimulation and physical activity

Transcranial direct current stimulation (tDCS) can optimize beneficial effects induced by motor practice in patients with neurological disorders. However, possibly due to homeostatic regulation, the conditioning effects of tDCS are often imprecise and variable, limiting its therapeutic application. Objective to explore the magnitude and direction of the after-effects induced by physical activity (PA) on tDCS-preconditioned cortical excitability (CE). Design First, a crossover experiment was performed with 12 subjects to determine whether a single session of low-, moderate- and high-intensity PA on a treadmill modulates the motor cortical excitability measured by transcranial magnetic stimulation. In a second crossover experiment, we investigated long-lasting changes (until 90 min) of the effects induced by PA (with intensities defined by the first experiment) on motor cortical excitability after the subject had been preconditioned by tDCS (using different polarities). Results and conclusion In Experiment 1, we found that high and moderate-intensity PA modulate the CE. Experiment 2 demonstrated that preconditioning the CE using tDCS homeostatically changes the direction and magnitude of after-effects induced by subsequent PA plasticity caused by motor activity. In conclusion, the results suggest that the direction of after-effects induced by the combination of physical exercise with tDCS on the cortical excitability is regulated within a physiologically defined range. Contact information: Katia Monte-Silva; Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Department of Physical Therapy. Av. Prof. Moraes Rego s/n 50670-900 Recife, Brazil., phone: +55 81-2126 7579/FAX: +55 81-2126 8491. Funding: Monte-Silva K receives a grant from CNPq (308291/2015-8) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Reticulocyte Hemoglobin content (MCHr) in the assessment of iron deficient erythropoiesis in inflammatory bowel disease

In conditions associated with inflammation, biochemical parameters alone could be inadequate for assessing iron status. We investigated the potential utility of mean reticulocyte hemoglobin content (MCHr) in the assessment of the erythropoiesis status in inflammatory bowel disease (IBD).

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Outcomes of Anesthesia Selection in Endovascular Treatment of Acute Ischemic Stroke

Background: The association between anesthesia type and outcomes in patients with acute ischemic stroke undergoing endovascular treatment (EVT) remains a subject of ongoing debate. Methods: This prospective nonrandomized controlled trial included 149 consecutive patients with acute anterior circulation stroke who underwent EVT. The primary outcome was functional independence assessed by the modified Rankin Scale (mRS) after 3 months. Results: A total of 105 (70.5%) and 44 (29.5%) patients undergoing EVT who received conscious sedation (CS) and general anesthesia (GA), respectively. The patients who received GA had similar demographics and basic National Institute of Health Stroke Scale scores (17 vs. 16, P>0.05) as the patients who received CS. The recanalization time (304 vs. 311 min, P=0.940) and the recanalization rate (86.4% vs. 84.1%, P=0.170) did not differ between the patients receiving the different types of anesthesia. The National Institute of Health Stroke Scale at 24 hours was lower in the patients who received CS than in those who received GA (β=−2.26, 95% confidence interval, −5.30 to 0.79). The independence (modified Rankin Scale score 0 to 2) at 3 months was equal between patients who received GA and those who received CS (odds ratio=0.73, 95% confidence interval, 0.32-1.68). The mortality and the morbidity rates did not differ. Conclusions: The data indicated that the selection of GA or CS during EVT had no impact on the independent outcomes of patients with anterior circulation occlusion. Z.M. and R.H. contributed equally. Y.P., Z.M., and R.H.: helped with the study design and manuscript preparation. Y.W., J.L., and F.L.: helped with the data collection and manuscript preparation. X.H. helped with the patient recruitment. X.L. and Y.Z.: helped with the data collection. P.W. and Y.P.: helped with the data analyses. Clinical Trial Registration: www.clinicaltrials.gov (NCT02350283). The trial was funded by the 'Youth Program' (QML20150508) and Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201708) from the Beijing Municipal Administration of Hospitals and programs from National Science and Technology Major Project of China (2011BAI08B02, 2015BAI12B04, and 2015BAI12B02). The authors have no conflicts of interest to disclose. Address correspondence to: Ruquan Han, MD, PhD, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing 100050, PR China (e-mail: ruquan.han@gmail.com). Received November 28, 2017 Accepted March 12, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Effect of Dexmedetomidine on Cerebral Vasospasm and Associated Biomarkers in a Rat Subarachnoid Hemorrhage Model

Background: The α2 adrenergic agonist dexmedetomidine (DEX) has huge potential for protecting against cerebral vasospasm, a leading cause of death and disability after subarachnoid hemorrhage (SAH). Biomarker assays for SAH have recently emerged as tools for predicting vasospasm and outcomes. We investigated the effects of DEX on vasospasm and assessed relevant biomarkers in a rat SAH model. Methods: Male Wistar rats were randomly assigned to sham (n=10), vehicle (n=10), SAH (n=10), or SAH+ DEX (n=10) groups. The SAH and SAH+DEX groups received 0.3 mL injections of autologous blood into the cisterna magna, followed by intraperitoneal injections of normal saline or 10 μg/kg DEX. Forty-eight hours later, neurological deficits as well as the basilar artery (BA) wall thickness and cross-sectional area were measured. Cerebrospinal fluid (CSF) and blood samples were obtained to assess concentrations of interleukin (IL)-6, C-reactive protein (CRP), endothelin-1, and S100-β using enzyme-linked immunosorbent assays. Results: The SAH and SAH+DEX groups exhibited deteriorated neurological function as well as structural and morphological BA vasospasm. The SAH+DEX group showed an improved neurological function score (ie, a 52% decrease), a 10% reduction in wall thickness, and a BA cross-sectional area enlarged by 157%. Compared with the sham group, CSF levels of IL-6 and CRP in the SAH and SAH+DEX groups, as well as serum IL-6 and CRP levels in the SAH group, were significantly elevated. The SAH+DEX group showed significantly lower CSF IL-6 levels than the SAH group. Serum and CSF levels of endothelin-1 and S100-β were similar across all groups. Conclusions: DEX administration reduced the severity of cerebral vasospasm and improved neurological function in SAH rats; this may be closely linked to reduced CSF IL-6 levels. This study was supported by special research grant funded by the Korean Society of Neuroscience in Anesthesiology and Critical Care (KSNACC-2016) for Young Song. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Dong Woo Han, MD, PhD, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 06273, Republic of Korea (e-mail: hanesth@yuhs.ac). Received November 22, 2017 Accepted March 27, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Intracranial Space–occupying Lesion Inducing Intracranial Hypertension Increases the Encephalographic Effects of Isoflurane in a Swine Model

Background: Patients with a brain tumor are susceptible to the hypnotic effect of anesthetics depending on the tumor's size. We investigated whether intracranial space–occupying lesions (ICSOLs) inducing intracranial hypertension increase isoflurane's effect on electroencephalographic (EEG) results. Materials and Methods: After anesthetic induction with isoflurane, 11 swine were studied with regard to isoflurane's effect on EEGs at 0.5% to 2.0% inhalational concentration at sequential stages: baseline 1, ICSOL 1, baseline 2, ICSOL 2, baseline 3. At each ICSOL stage, an intracranial epidural balloon catheter was inflated and the intracranial pressure maintained at twice the baseline pressure. The balloon was deflated after each ICSOL stage (baselines 2 and 3). A 95% spectral edge frequency (SEF), which correlates with anesthetic hypnosis, was used to measure isoflurane's effect. Pharmacodynamics was characterized using a sigmoidal inhibitory maximum effect model for the SEF versus end-tidal concentration. Results: ICSOL shifted the relations between SEF and the effect-site concentration (Ce) downward. Baseline and 50% of the maximum spectral edge effect levels significantly decreased during balloon inflation. The Ce that produced SEF=15 was 1.12 (1.04-1.20) (mean [95% confidence interval])% for baseline 1; 0.92 (0.81-1.03) for ICSOL 1; 1.02 (0.94-1.11) for baseline 2; 0.88 (0.82-0.94) for ICSOL 2; 1.05 (0.93-1.17) for baseline 3. Isoflurane's effect on EEGs increased during balloon inflation, with the alteration tending to recover after balloon deflation. Conclusions: ICSOLs inducing intracranial hypertension increase the EEG effect of isoflurane, and external compression from the brain surface enhances the anesthetic hypnosis despite minimum brain injury. Support was provided solely from institutional and/or departmental sources. The authors have no conflicts of interest to disclose. Address correspondence to: Tadayoshi Kurita, MD, Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan (e-mail: tadkur@hama-med.ac.jp). Received December 20, 2017 Accepted March 22, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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The Brachiocephalic Vein as a Safe and Viable Alternative to Internal Jugular Vein for Central Venous Cannulation

BACKGROUND: Although many studies have compared success and complication rates for central line insertion sites with and without ultrasound, few have examined the use of the brachiocephalic vein for central venous access. The aim of this study was to describe the brachiocephalic vein as an alternative site for elective ultrasound vascular cannulation in adults, and to compare it with the more commonly used internal jugular vein site in terms of procedural difficulties, first pass failure rate, overall failure rate, and safety. METHODS: In this single-center, retrospective cohort study, clinical data from consecutive adult patients undergoing elective ultrasound-guided central venous catheterization of upper body were retrieved from the department database. All of these central venous catheters were requested by department team, none was positioned for surgery. Seven hundred nine patients underwent central venous catheterization via the internal jugular approach and 285 patients via the brachiocephalic route. Patients catheterized via the brachiocephalic vein approach were then compared with those catheterized via the internal jugular vein in terms of ease of catheterization, success rate, and complications. Differences between approaches were assessed by univariate analyses and multivariable analysis. RESULTS: Overall, 994 patients underwent central venous catheterization. A total of 87% had a successful catheter implantation at the first attempt, 6.7% of insertions were difficult, 5.7% were complicated, and 3.4% failed. Procedural difficulty was more frequent with the internal jugular than with the brachiocephalic approach (odds ratio, 0.38; 95% confidence interval, 0.19–0.76; P = .007) after correction for potential confounders. Differences between groups in complication rate (6.3% vs 4.1%) or failure rate (3.4% vs 3.5%) were not significant. CONCLUSIONS: Brachiocephalic cannulation is a reasonable alternative to ultrasound-guided internal jugular vein catheterization. Accepted for publication February 26, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Paolo Federico Beccaria, MD, Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132 Italy. Address e-mail to beccaria.paolo@hsr.it. © 2018 International Anesthesia Research Society

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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A Randomized Trial Comparing the Effect of Fiberoptic Selection and Guidance Versus Random Selection, Blind Insertion, and Direct Laryngoscopy, on the Incidence and Severity of Epistaxis After Nasotracheal Intubation

BACKGROUND: Epistaxis, or nasal bleeding, is a common complication after nasotracheal intubation (NTI). Because such bleeding is likely related to trauma during intubation, use of fiberoptic visualization and guidance rather than direct laryngoscopy may affect the incidence and severity of epistaxis. We compared the incidence of epistaxis after NTI using a fiberoptic versus a direct laryngoscopy approach. METHODS: Seventy patients who were able to breathe easily through unobstructed nostrils and required NTI as part of their anesthetic management were recruited. Exclusion criteria included unequal nasal airflow, nostril obstruction, previous nasal trauma or surgery, and coagulation abnormalities as determined by history. Patients were randomly assigned to undergo NTI with thermosoftened Mallinckrodt nasal Ring-Adair-Elwyn (RAE) tubes via either traditional direct laryngoscopy using a Macintosh blade or fiberoptic nasal intubation. All patients first underwent anesthetic induction and were randomized to blind or fiberoptic groups. Patients in the blind insertion/direct laryngoscopy group were then intubated via a randomly selected nostril. Patients in the fiberoptic group underwent an asleep nasal fiberoptic examination to determine the most patent nostril, followed by tube insertion under fiberoptic guidance. Ten minutes after NTI, the incidence and severity of epistaxis were evaluated and graded by the surgeon, who was blinded to the intubation method. RESULTS: Initial nasal fiberoptic endoscopy identified asymptomatic nasal pathology in 51% of patients: inferior turbinate hypertrophy (28.6%) and deviation of the nasal septum in (22.8%). The incidence of epistaxis was higher in the blind insertion/direct laryngoscopy group (88%) than in the fiberoptic group (51%; relative risk, 0.55; 95% confidence interval, 0.38–0.79; P = .0011). The severity of bleeding was also greater in the blind tube insertion/direct laryngoscopy cohort (Wilcoxon Mann-Whitney odds, 3.5; 95% confidence interval, 1.8–11.1). CONCLUSIONS: Fiberoptic nostril selection and guidance during NTI reduced the incidence and severity of epistaxis when compared with NTI performed via blind insertion and direct laryngoscopy. Accepted for publication March 14, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Jeffrey Leighton Tong, MD, FRCA, Department of Anesthesia and Critical Care, University of Chicago, 5841 S Maryland Ave, MC4028, Chicago, IL 60637. Address e-mail to jtong4@dacc.uchicago.edu. © 2018 International Anesthesia Research Society

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Caution When Dosing Anesthetic Medications: Are We Putting Too Much Weight on Patient Weight?

No abstract available

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Comprehensive Pain Management in the Rehabilitation Patient

No abstract available

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Can Lung Ultrasound Be the First-Line Tool for Evaluation of Intraoperative Hypoxemia?

No abstract available

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Hyperchloremic Intravenous Fluids Should Be Abandoned

No abstract available

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Practical Anesthetic Management: The Art of Anesthesiology

No abstract available

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In Response

No abstract available

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Harmful or Physiologic: Diagnosing Fibrinolysis Shutdown in a Trauma Cohort With Rotational Thromboelastometry

BACKGROUND: Despite its central role in early trauma coagulopathy, abnormal fibrinolysis continues to be poorly understood. Excessive fibrinolysis is a known contributor to mortality. Recent studies with thromboelastography (TEG) suggest decreased fibrinolysis (or shutdown) may be just as harmful. Considering the broad use of 2 different viscoelastic assays, which are not interchangeable, we proposed for the first time to define and characterize fibrinolysis shutdown using rotational thromboelastometry (ROTEM). METHODS: Retrospective cohort study of severely injured patients with admission ROTEM. Shutdown was defined by the best Youden index value of the maximum lysis. Fibrinolysis phenotypes were physiologic, hyperfibrinolysis, and shutdown. Multivariable logistic regression evaluated association between Injury Severity Score and the fibrinolysis phenotypes, and the association among shutdown phenotype with mortality, blood transfusion, and thrombotic events. RESULTS: Five hundred fifty patients were included. Maximum lysis

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In Response

No abstract available

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Pharmacological Basis of Anesthesia: How to Overcome Stagnation?

No abstract available

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Transesophageal Lung Ultrasound Should Be the First-Line Tool to Evaluate Intraoperative Hypoxia

No abstract available

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Wilkie's syndrome in monozygotic twins treated by 3‐D laparoscopic duodenojejunostomy

Asian Journal of Endoscopic Surgery, EarlyView.


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The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review

Prehabilitation benefits among patients undergoing various oncological surgeries have been demonstrated. However, the effects of presurgical exercise and fitness on postoperative ipsilateral upper extremity recovery outcomes in patients with breast cancer surgery are less evident. A systematic review was performed to assess the effects of preoperative exercise and fitness on postmastectomy recovery. Systematic literature search was performed in 12 electronic databases. Study eligibility was accessed using the PICOS (Participants, Interventions, Comparison, Outcome and Study Design) criteria. Six eligible studies were found: three cohort–control and three prospective observational studies. One randomized-controlled trial showed that prehabilitation was beneficial in shoulder range of motion (ROM) and upper extremity functional recovery. One cohort–control study demonstrated that preoperative exercises reduced postoperative pain without increasing the risk of developing a seroma. A prospective cohort study showed that preoperatively active individuals had a significantly better chance of feeling recovered physically at 3 weeks after surgery. Baseline ipsilateral grip strength, shoulder flexion, and abduction ROM were reliable predictors of shoulder flexion and abduction ROM and grip strength improvements at 1 month following breast cancer surgery. One study showed that preoperative conditioning alone without postoperative rehabilitation was insufficient to aid recovery. Implementing exercise program and optimizing preoperative fitness, especially shoulder ROM, before breast cancer surgery in conjunction with individualized rehabilitation program may benefit postmastectomy ipsilateral upper extremity recovery. Correspondence to Ajax Yang, MD, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA Tel: +1 212 824 8361; fax: +1 212 348 5901; e-mail: yang.ajax@gmail.com Received February 11, 2018 Accepted March 21, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A known pathogenic variant in the essential mitochondrial translation gene RMND1 causes a Perrault‐like syndrome with renal defects

Clinical Genetics, EarlyView.


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Bohring‐Opitz syndrome caused by an ASXL1 mutation inherited from a germline mosaic mother

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1249-1252, May 2018.


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Van Maldergem syndrome and Hennekam syndrome: Further delineation of allelic phenotypes

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1166-1174, May 2018.


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Lethal persistent pulmonary hypertension of the newborn in Bohring–Opitz syndrome

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1245-1248, May 2018.


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LIPT1 deficiency presenting as early infantile epileptic encephalopathy, Leigh disease, and secondary pyruvate dehydrogenase complex deficiency

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1184-1189, May 2018.


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Two novel cases expanding the phenotype of SETD2‐related overgrowth syndrome

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1212-1215, May 2018.


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Functional mRNA analysis reveals aberrant splicing caused by novel intronic mutation in WDR45 in NBIA patient

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1049-1054, May 2018.


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Expanding the molecular basis and phenotypic spectrum of ZDHHC9‐associated X‐linked intellectual disability

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1238-1244, May 2018.


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A patient with peripheral demyelinating neuropathy, central dysmyelinating leukodystrophy, Waardenburg syndrome, and severe hypoganglionosis associated with a novel SOX10 mutation

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1195-1199, May 2018.


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Further delineation of achondroplasia–hypochondroplasia complex with long‐term survival

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1225-1231, May 2018.


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2016 Children's Tumor Foundation conference on neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1258-1269, May 2018.


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Worries and needs of adults and parents of adults with neurofibromatosis type 1

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1150-1160, May 2018.


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A novel homozygous mutation in the SLCO2A1 gene causing pachydermoperiostosis: Efficacy of hydroxychloroquine treatment

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1253-1257, May 2018.


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Philtrum length and intercommissural distance measurements at mixed dentition period

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1145-1149, May 2018.


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Comparison of perinatal factors in deletion versus uniparental disomy in Prader–Willi syndrome

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1161-1165, May 2018.


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Novel de novo ZBTB20 mutations in three cases with Primrose syndrome and constant corpus callosum anomalies

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1091-1098, May 2018.


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Low‐level expression of EPG5 leads to an attenuated Vici syndrome phenotype

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1207-1211, May 2018.


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Identification of a novel homozygous ALX4 mutation in two unrelated patients with frontonasal dysplasia type‐2

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1190-1194, May 2018.


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The Society for Craniofacial Genetics and Developmental Biology 40th annual meeting

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1270-1273, May 2018.


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Williams–Beuren syndrome in diverse populations

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1128-1136, May 2018.


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Autosomal recessive otofaciocervical syndrome type 2 with novel homozygous small insertion in PAX1 gene

American Journal of Medical Genetics Part A, Volume 176, Issue 5, Page 1200-1206, May 2018.


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Out of balance: how a binaural coincidence detection circuit responds to unilateral deafferentation

The Journal of Physiology, EarlyView.


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Necrotic amplification loop in acute pancreatitis: pancreatic stellate cells and nitric oxide are important players in the development of the disease

The Journal of Physiology, EarlyView.


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Verbal working memory‐related neural network communication in schizophrenia

Psychophysiology, EarlyView.


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HIIT in the Real World: Outcomes from a 12-Month Intervention in Overweight Adults

Purpose Although high-intensity interval training (HIIT) and moderate-intensity continuous exercise have comparable health outcomes in the laboratory setting, effectiveness studies in real-world environments are lacking. The aim of this study was to determine the effectiveness of an unsupervised HIIT programme in overweight/obese adults over 12 months. Methods 250 overweight/obese adults could choose HIIT or current exercise guidelines of 30 minutes/day moderate-intensity exercise. HIIT participants received a single training session and were advised to independently perform HIIT 3x/week utilizing a variety of protocols. Mixed models, with a random effect for participant, compared differences in weight, body composition, blood pressure, aerobic fitness, physical activity and blood indices at 12 months, adjusting for relevant baseline variables. Results Forty-two percent (n=104) of eligible participants chose HIIT in preference to current guidelines. At 12 months, there were no differences between exercise groups in weight (adjusted difference HIIT vs conventional; 95% CI: -0.44kg; -2.5, 1.6) or visceral fat (-103cm3; -256, 49), although HIIT participants reported greater enjoyment of physical activity (p=0.01). Evidence of adherence to ≥2 sessions/week of unsupervised HIIT (from heart rate monitoring) declined from 60.8% at baseline to 19.6% by 12 months. Participants remaining adherent to HIIT over 12 months (23%) were more likely to be male (67% vs 36%, p=0.03), with greater reductions in weight (-2.7kg; -5.2 -0.2) and visceral fat (-292cm3; -483, -101) than non-adherent participants. Conclusions HIIT was well-accepted by overweight adults and opting for HIIT as an alternative to standard exercise recommendations led to no difference in health outcomes after 12 months. While regular participation in unsupervised HIIT declined rapidly, those apparently adherent to regular HIIT demonstrated beneficial weight loss and visceral fat reduction. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12615000010594) Retrospectively registered Address for correspondence: Professor Rachael Taylor, Department of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand. Email: rachael.taylor@otago.ac.nz, Phone: +64 3 470 9180 The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Competing interests: The authors declare that they have no competing interests. Funding: The SWIFT Study was funded by the University of Otago. RWT is partially funded by a Fellowship from the Karitane Products Society (KPS) Limited. The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; or the decision to submit the article for publication. Accepted for Publication: 10 April 2018 © 2018 American College of Sports Medicine

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Detection of Persisting Concussion Effects on Neuromechanical Responsiveness

Purpose Assessment of various indices of neuromechanical responsiveness for association with concussion history. Methods An observational cohort study included 48 elite athletes (34 males: 23.8 ±4.4 years; 14 females: 25.4 ±4.5 years) who performed visuomotor reaction time (VMRT) tests involving rapid manual contact with illuminated target buttons that included 2 dual-task conditions: 1) simultaneous oral recitation of scrolling text (VMRT+ST) and 2) simultaneous verbal responses to identify the right or left direction indicated by the center arrow of the Eriksen flanker test (VMRT+FT). A whole-body reactive agility (WBRA) test requiring side-shuffle movements in response to visual targets was used to assess reaction time, speed, acceleration, and deceleration. Results Concussion occurrence at 2.0 ±2.3 years prior to testing was reported by 21 athletes. Strong univariable associations were found for VMRT+FT left minus right difference ≥15 ms (OR=7.14), VMRT+ST outer 2-ring to inner 3-ring ratio ≥1.28 (OR=4.58), and WBRA speed asymmetry ≥7.7% (OR=4.67). A large VMRT+FT X VMRT+ST interaction effect was identified (OR=25.00). Recursive partitioning identified a 3-way VMRT+FT X VMRT+ST X WBRA interaction that had 100% positive predictive value for identification of athletes with concussion history, whereas negative status on all 3 factors had 90% negative predictive value. Conclusion Performance on dual-task VMRT tests and the WBRA test identified neuromechanical responsiveness deficiencies among elite athletes who reported a history of concussion. Corresponding Author: Gary Wilkerson, University of Tennessee at Chattanooga, 615 McCallie Avenue, Dept. 6606, Chattanooga, TN 37403. Email: Gary-Wilkerson@utc.edu. Phone: 423-290-9160. Fax: 423-425-1734 The reported data were acquired from equipment loaned to the US Olympic Committee by Dynavision International and Traq Global, Ltd. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and statement that results of the present study do not constitute endorsement by ACSM. The research was conducted in facilities of the US Coalition for the Prevention of Illness and Injury in Sport, which is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC). One of the authors (GBW) has previously received a speaking honorarium and travel expense reimbursement from Dynavision International, and he has previously provided consulting services to Traq Global, Ltd. Accepted for Publication: 14 April 2018 © 2018 American College of Sports Medicine

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The Problem with “Magnitude-Based Inference”

Purpose A statistical method called "Magnitude-Based Inference" (MBI) has gained a following in the sports science literature, despite concerns voiced by statisticians. Its proponents have claimed that MBI exhibits superior Type I and Type II error rates compared with standard null hypothesis testing for most cases. I have performed a re-analysis to evaluate this claim. Methods Using simulation code provided by MBI's proponents, I estimated Type I and Type II error rates for clinical and non-clinical MBI for a range of effect sizes, sample sizes, and smallest important effects. I plotted these results in a way that makes transparent the empirical behavior of MBI. I also re-ran the simulations after correcting mistakes in the definitions of Type I and Type II error provided by MBI's proponents. Finally, I confirmed the findings mathematically; and I provide general equations for calculating MBI's error rates without the need for simulation. Results Contrary to what MBI's proponents have claimed, MBI does not exhibit "superior" Type I and Type II error rates to standard null hypothesis testing. As expected, there is a tradeoff between Type I and Type II error. At precisely the small-to-moderate sample sizes that MBI's proponents deem "optimal," MBI reduces the Type II error rate at the cost of greatly inflating the Type I error rate—to two to six times that of standard hypothesis testing. Conclusions MBI exhibits worrisome empirical behavior. In contrast to standard null hypothesis testing, which has predictable Type I error rates, the Type I error rates for MBI vary widely depending on the sample size and choice of smallest important effect, and are often unacceptably high. MBI should not be used. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Corresponding Author: Dr. Kristin L. Sainani, Department of Health Research and Policy, 150 Governor's Lane, HRP Redwood Building, Stanford, California 94305. The author did not receive financial support and has no conflicts of interest to disclose related to this work. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 6 April 2018 © 2018 American College of Sports Medicine

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Effects of Exercise on ASC Methylation and IL-1 Cytokines in Heart Failure

Introduction/Purpose Inflammation contributes to heart failure (HF) progression and the interleukin (IL)-1 cytokine IL-1β is implicated in this process. The adaptor protein ASC is necessary for inflammasome activation of IL-1β. Lower ASC methylation is associated with worse outcomes in HF. The purpose of this study was to examine the effects of exercise on changes in ASC methylation and activation of the interleukin-1 family cytokine IL-1β in persons with HF. Methods Participants (N=54) were randomized to receive exercise intervention (n=38) or attention control (n=16) for 3 months. Percent methylation of the ASC gene, plasma IL-1β, and ASC mRNA and were obtained at baseline, 3 months, and 6 months. Results ASC methylation was higher in the exercise group as compared to control at 3 months (6.10±0.5% vs. 5.80±0.4%; p=.04) and 6 months (6.07±0.4 vs. 5.82±0.4; p=.04). Plasma IL-1β was lower in the exercise group at 3 months (1.43±0.5 pg/mL vs. 2.09±1.3 pg/mL; p=.02) and 6 months (1.49±0.5 pg/mL vs. 2.13±1.4 pg/mL; p=.004). ASC mRNA expression was negatively associated with ASC methylation at baseline (r=-.97, p=.001), 3 months (r=-.90, p=.001), and 6 months (r=-.81, p=.001). ASC mRNA was lower than baseline at 3 months (p=.004) and 6 months (p=.002) among those in the exercise group. ASC methylation was positively associated with six-minute walk test (6MWT) at baseline (r=.517, p<.001 months p=".004)," and conclusions exercise was related to increased mean percent asc methylation decreased il-1 mrna gene expression in hf. epigenetic regulation of can be a biological mechanism by which promote better outcomes supported part national institutes health institute nursing research grant number r. gary the heart failure society america b. butts center for advancing translational sciences under award ul1tr000454. effort funded numbers t32nr012715 s. dunbar content is solely responsibility authors does not necessarily represent official views health. results this study are presented clearly honestly without fabrication falsification or inappropriate data manipulation. present do constitute endorsement acsm. conflicts interest: none bb rg ec sd. jb consultant amgen bayer cardiocell celladon novartis stealth peptide relypsa z pharma trevena zensun. accepted publication: april american college sports medicine>

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A Review of Accelerometer-based Activity Monitoring in Cancer Survivorship Research

Background In the cancer survivorship context, physical activity and sedentary behaviour have been measured using different methods and tools. Purpose To conduct a narrative review of published research in cancer survivor populations to summarise the quality and identify gaps in reporting on accelerometer data collection, data processing, and outcome measures in cancer survivors. Methods An initial PubMed® search of papers published in English was conducted in January 2017, and a final search was conducted in May 2017. Variables extracted included study characteristics, methods for accelerometry data collection (e.g., device used), data processing (e.g., cut points used), and data reporting (e.g., time spent in different activity intensities). Results A total of 46 papers were eligible for inclusion in the review. The majority of studies (34 of 46) targeted a single cancer group and 18 of these 34 studies were in survivors of breast cancer. Half of the studies (54%) used an ActiGraph® accelerometer. Methods of accelerometer data processing varied across studies. Definitions of non-wear time, vectors used during processing, and filters applied during processing were reported by 51%, 60% and 8% of studies, respectively. Most studies reported MVPA (78%), 50% reported sedentary time, and 43% reported light intensity activity. Cut points to categorise these activities varied between studies. Conclusion This narrative review highlights inconsistency in the methods used to collect, process, and report accelerometry data across cancer survivor studies. Accelerometry has potential to add detailed knowledge of the levels and patterns of physical activities and sedentary behaviours across the cancer spectrum. Recommendations are made to improve data processing and reporting methods to maximise the scientific validity of future accelerometer research in this field. Corresponding author: A/Prof Jeff Vallance, Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, Canada, T9S-3A3, email: jeffv@athabascau.ca Phone: +1 (403) 977-4338 Peddle-McIntyre and Cavalheri are supported by Cancer Council of Western Australia Postdoctoral Research Fellowships. Boyle is supported by a National Health and Medical Research Council Early Career Fellowship (1072266). Jeffery is supported by an Australian Lung Foundation and an Edith Cowan University PhD scholarship. Lynch is supported by a National Breast Cancer Foundation Fellowship (ECF-15-012). Vallance is supported by the Canada Research Chairs Program. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 9 April 2018 © 2018 American College of Sports Medicine

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EFFECTS OF AGE AND SEX ON INSPIRATORY MUSCLE ACTIVATION PATTERNS DURING EXERCISE

Purpose Characterize the effects of age, sex, and their interaction on inspiratory muscle activation patterns during exercise. Methods Twenty younger (20-30y, n=10 women) and twenty older (60-80y, n=10 women) subjects performed an incremental cycle exercise test. Electromyography of the scalene (EMGsca) and sternocleidomastoid (EMGscm) muscles were measured using skin surface electrodes, while diaphragm electromyography (EMGdi) and esophageal and transdiaphragmatic pressures were measured using an esophageal catheter. Electromyography data were transformed into root-mean-square with a 100ms time constant. Esophageal (PTPes) and diaphragmatic (PTPdi) pressure-time products were used as indices of total inspiratory muscle pressure production and diaphragmatic pressure production, respectively. Results At absolute minute ventilations (V[Combining Dot Above]E), women and older subjects had greater EMGdi than men and younger subjects, respectively (all p0.05). Women had greater EMGsca activity than men at absolute and relative levels of V[Combining Dot Above]E (all p0.05). At absolute and relative levels of V[Combining Dot Above]E, women and older subjects had greater EMGscm than men and younger subjects, respectively (all p0.05). No significant interactions between age and sex were noted (all p>0.05). Conclusion Age and sex significantly affect inspiratory muscle activation patterns during exercise; however, the extent of the effects depends on whether comparisons are made at absolute or relative V[Combining Dot Above]E. Corresponding Author: Yannick Molgat-Seon, PhD, 6108 Thunderbird Blvd, Vancouver, BC, Canada, V6T 1Z3, E-mail: yannick.molgat-seon@hli.ubc.ca. This study was supported by the British Columbia Lung Association (BCLA). YMS, PBD, and AHR were supported by graduate scholarships from the Natural Sciences and Engineering Research Council of Canada (NSERC). PBD and MRS were supported by fellowships from the University of British Columbia and BCLA. JAG was supported by a Scholar Award from the Michael Smith Foundation for Health Research, a New Investigator Award from the Providence Health Care Research Institute and St. Paul's Hospital Foundation, and a Canadian Institutes of Health Research Clinical Rehabilitation New Investigator Award. The funders had no role in the study design, data collection and analysis, or preparation of the manuscript. Conflicts of Interest: YM, PBD, AHR, MRS, LMR, JDR, JAG, and AWS do not have any conflicts of interest to report relevant to this manuscript. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 16 April 2018 © 2018 American College of Sports Medicine

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CA-MRSA Infection Rates and Management among Student-Athletes

Purpose Although community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have reduced among inpatient populations, the incidence in athletics continues to range greatly dependent on the sport. Over the 2015-2016 and 2016-2017 school years, we assessed the annual CA-MRSA incidence, sport risk, referral practices, and management protocols or interventions among high school and intercollegiate athletics. Methods This study targeted high school and intercollegiate athletic programs across the United States. For the 2015-2016 study, 269 athletic trainers completed a one-time questionnaire. In the 2016-2017 study, 217 athletic trainers reported data bimonthly during the academic year. Each questionnaire targeted demographic information, physician-confirmed CA-MRSA infection occurrence, and management of CA-MRSA infections and bacterial skin lesions. Results The CA-MRSA infection incidence was 26.8 per 10,000 athletes (95% confidence interval [CI], 24-30) in 2015-2016 and 20.3 per 10,000 athletes (95% CI, 18-23) in 2016-2017. The CA-MRSA infection incidence was high in wrestling and football compared to the general student-athlete population. During the 2015-2016 study, the wrestling incidence rate was 248.3 per 10,000 (95% CI, 204-302); the football incidence rate was 71.0 per 10,000 (95% CI, 60-85). In the 2016-2017 study, the wrestling incidence rate was 100.0 per 10,000 (95% CI, 66-151); the football incidence rate was 81.8 per 10,000 (95% CI, 68-99). At least 23% of respondents denoted at least one physician-confirmed CA-MRSA infection within their populations (2015-2016, 39%, n=105; 2016-2017, 23.5%, n=51). In the 2015-2016 survey, respondents indicated that athlete education and environmental decontamination were the most utilized management steps (51.8%, n=582). Conclusion Despite increased awareness of CA-MRSA, more educational efforts focusing on best practices and education are needed, especially with athletes and the medical community involved in their care. Corresponding Author: Tim Braun, PhD, LAT, ATC, CSCS, Assistant Professor, Idaho State University, 921 S 8th Avenue, STOP 8105, Pocatello, ID 83209, Tbraun30@yahoo.com. No funding was received for this work. The authors declare that they have no conflicts of interest. The results are presented clearly, honestly, and without fabrication, falsification or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Accepted for Publication: 9 April 2018 © 2018 American College of Sports Medicine

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Short-Term (<8 Weeks) High-Intensity Interval Training in Diseased Cohorts

Background & Aim Exercise training regimes can lead to improvements in measures of cardiorespiratory fitness (CRF), improved general health, and reduced morbidity and overall mortality risk. High intensity interval training (HIIT) offers a time-efficient approach to improve CRF in healthy individuals, but the relative benefits of HIIT compared to traditional training methods are unknown in across different disease cohorts. Methods This systematic review and meta-analysis compares CRF gains in randomised controlled trials of short-term (

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Heat Loss is Impaired in Older Men on the Day following Prolonged Work in the Heat

PURPOSE Prolonged work in the heat may exacerbate the rise in core temperature on the next work day, especially in older workers who display impairments in whole-body heat loss that increase body heat storage and core temperature relative to young adults during heat stress. We therefore evaluated whether whole-body heat loss in older adults was impaired on the day following prolonged work in the heat. METHODS Whole-body heat exchange and heat storage were assessed in nine older (53-64 years) males during three, 30-min bouts of semi-recumbent cycling at fixed rates of metabolic heat production (150 (Ex1), 200 (Ex2), 250 W.m-2 (Ex3)), each separated by 15-min recovery, in hot-dry conditions (40°C, 20% relative humidity), immediately prior to (Day 1), and on the day following (Day 2), a prolonged, work simulation (~7.5 h) involving moderate-intensity intermittent exercise in hot-dry conditions (38°C, 34% relative humidity). Total heat loss (evaporative ± dry heat exchange) and metabolic heat production were measured using direct and indirect calorimetry, respectively. Body heat storage was quantified as the temporal summation of heat production and loss. RESULTS Total heat loss (mean±SD) during Ex1 did not differ between Day 1 and 2 (151±15 and 147±14 W.m-2, respectively; P=0.27), but was attenuated on Day 2 during Ex2 (181±15 W.m-2) and Ex3 (218±16 W.m-2) relative to Day 1 (192±14 and 230±19 W.m-2, respectively; both P

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International Organization of Psychophysiology

Publication date: May 2018
Source:International Journal of Psychophysiology, Volume 127





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Editorial Board

Publication date: May 2018
Source:International Journal of Psychophysiology, Volume 127





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