Changes in blood lactate and muscle activation in elite rock climbers during a 15-m speed climb

Abstract

Purpose

The purpose of this study was to investigate the changes in blood lactate concentration (BL) and muscle activity patterns during a 15-m speed climbing competition that consisted of ten consecutive climbing actions on a standardized artificial wall in trained rock climbers.

Methods

Twelve trained rock climbers participated in this study. Surface electromyography (sEMG) and video signals were synchronized and recorded during climbing. The blood lactate was also tested 3 min after completing the climb.

Results

The average climbing time was 8.1 ± 2.1 s for the 15-m speed climb across all subjects, accompanied by a BL of 7.6 ± 1.9 mmol/L. The climbing speed and power firstly increased and then slightly decreased relative to peak value during the 15-m speed climbing. The results showed there was a positive correlation between the BL and the climbing time, r = 0.59, P = 0.043. The sEMG showed the flexor digitorum superficialis (FDS) electric activity was the highest, followed by the biceps brachii (BB) and latissimus dorsi. The instantaneous median frequency of sEMG of FDS and BB significantly decreased during the 15-m speed climbing. All the participants showed the higher sEMG RMS (%) in the terminal phase than that in the initial phase, especially with a greater increase in the left upper limbs. However, the lower limbs muscles presented no significant changes in the sEMG amplitude during climbing.

Conclusions

The FDS and BB play an important role in completing the 15-m speed climbing. The median frequency of arm EMG decreased more than that of legs, suggesting more fatigue. The blood lactate concentration increases in the current study suggest that a certain amount of glycolysis supplies energy in completing 15-m speed rock climbing. Based on the current data, it is suggested that muscular endurance of FDS and BB muscles in upper limbs should be improved for our climbers in this study.

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Associations between sensorimotor gating mechanisms and athletic performance in a variety of physical conditioning tests

Abstract

Purpose

The elite athlete is fine-tuned all around to deliver favorable results in sporting events. In this study, we address the question of whether basic movements—such as reflexes—and heterogeneous attentional modulation components—such as sensorimotor gating mechanisms—are also tuned up to maximize the results of middle-distance runners in physical conditioning tests.

Methods

We selected an array of professional middle-distance runners and healthy counterparts that were submitted to measurement of (1) physical conditioning parameters, including somatotype, jump, strength, and flexibility tests; and (2) sensorimotor gating mechanisms, including acoustic startle reflex, prepulse inhibition, and habituation.

Results

Our results showed athletes scored better on the athletic tests compared to controls, as expected. They also exhibited a lower startle amplitude, while maintaining higher prepulse inhibition values. They reacted faster to the acoustic stimuli, and sex-related differences—found in controls—were not present in athletes. Our data also pointed out to substantial correlations between sensorimotor gating and physical conditioning parameters.

Conclusions

All in all, these data may point to physical conditioning-driven neural plasticity of brain sensorimotor gating circuits in charge of triggering involuntary movements to harness control and efficiency over reflexed muscle activity.

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Thoracoscopic truncal vagotomy versus surgical revision of the gastrojejunal anastomosis for recalcitrant marginal ulcers

Abstract

Introduction

Marginal ulcer is a common complication following Roux-en-Y gastric bypass with incidence rates between 1 and 16%. Most marginal ulcers resolve with medical management and lifestyle changes, but in the rare case of a non-healing marginal ulcer there are few treatment options. Revision of the gastrojejunal (GJ) anastomosis carries significant morbidity with complication rates ranging from 10 to 50%. Thoracoscopic truncal vagotomy (TTV) may be a safer alternative with decreased operative times. The purpose of this study is to evaluate the safety and effectiveness of TTV in comparison to GJ revision for treatment of recalcitrant marginal ulcers.

Methods

A retrospective chart review of patients who required surgical intervention for non-healing marginal ulcers was performed from 1 September 2012 to 1 September 2017. All underwent medical therapy along with lifestyle changes prior to intervention and had preoperative EGD that demonstrated a recalcitrant marginal ulcer. Revision of the GJ anastomosis or TTV was performed. Data collected included operative time, ulcer recurrence, morbidity rate, and mortality rate.

Results

Twenty patients were identified who underwent either GJ revision (n = 13) or TTV (n = 7). There were no 30-day mortalities in either group. Mean operative time was significantly lower in the TTV group in comparison to GJ revision (95.7 ± 16 vs. 227.5 ± 89 min, respectively, p = 0.0022). Recurrence of ulcer was not significant between groups and occurred following two GJ revisions (15%) and one TTV (14%). Complication rates were not significantly different with 62% in the GJ revision group and 57% in the TTV group. Approximately 38% (5/13) of GJ revisions and 28% (2/7) of TTV patients experienced complications with Clavien–Dindo scores > 3. There was no difference in postoperative symptoms between both groups.

Conclusions

Our results demonstrate that thoracoscopic vagotomy may be a better alternative with decreased operative times and similar effectiveness. However, further prospective observational studies with a larger patient population would be beneficial to evaluate complication rates and ulcer recurrence rates between groups.

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Closed Facebook™ groups and CME credit: a new format for continuing medical education

Abstract

Background

The International Hernia Collaboration (IHC) is a closed Facebook™ group that allows international surgeons to post clinical questions and exchange transparent feedback with the intent to optimize patient outcomes. Despite the educational value of closed FB groups, CME credits have not been available to members. To determine feasibility of and user interest in earning CME credit through social media, the IHC piloted a series of expert lectures followed by an interactive Facebook Live session as a novel pathway offering CME credit.

Methods

Nine monthly lectures and Facebook Live sessions were presented. CME credit was offered for the final seven lectures. Participation in the form of views, comments, and likes was quantified by a Facebook analytics service and an engagement score, defined as [(the number of comments × 2) + (the number of reactions)], was calculated for each lecture and Facebook Live session. CME credit was obtained through a two-question quiz.

Results

Of 5400 + Facebook members of the IHC, an average of 1116 (20.4 ± 4.0%) viewed the live session event following each lecture (n = 9 events). The average Facebook engagement score for Facebook Live was 259 ± 75, a significant difference with the average Facebook engagement score on the IHC (40.8) over the same time period (p < 0.001). On average, 16 users [range 8–35, (n = 7 events)] claimed CME credit for each educational series.

Conclusions

Closed Facebook groups can be a useful media to offer educational content and CME credit. The pilot IHC Lecture and Facebook Live series offering CME credit resulted in significantly more engagement amongst its members compared to other posts during the same time period. A small portion of participants qualified for CME credit. Future social media educational series may increase participants qualifying for CME by streamlining the interface to obtain CME credit.

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Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors

Abstract

Background

Duodenum-preserving total pancreatic head resection (DPPHRt) is an accepted alternative surgical procedure for benign or low-grade malignant tumors of the pancreatic head by preserving the duodenum with its intact blood supply from the pancreatic duodenal arterial arcade. This study describes our experience in laparoscopic DPPHRt (LDPPHRt). To our knowledge, this is the first description of this novel minimally invasive operation.

Methods

From August 2016 to May 2017, all consecutive patients who underwent LDPPHRt for pancreatic head lesions at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital in Guangzhou, China were enrolled into this retrospective study.

Results

There were ten women and two men. The average age was 37.3 years (range 8–61 years). The average diameter of the pancreatic head lesions on pre-operative CT/MR was 3.7 cm (range 2–4.8 cm). All the LDPPHRt procedures were performed successfully. There was no peri-operative death. The average operative time was 272.5 min (range 210–320 min). The average blood loss was 215 ml (range 50–450 ml). Post-operative complications included pancreatic fistula grade B (two patients, or 16.7%) and biliary fistula (two patients, or 16.7%). All the complications responded well to conservative treatment. The mean post-operative hospital stay was 11.5 days (range 6–25 days).

Conclusions

LDPPHRt provided a minimally invasive approach with good organ-preservation for benign or low-grade malignant tumors of the pancreatic head. The long-term oncological outcomes, and the exocrine and endocrine pancreatic functions after this operation require further studies.

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EUS-guided irreversible electroporation using endoscopic needle-electrode in porcine pancreas

Abstract

Background

Endoscopic irreversible electroporation (IRE) can be performed using a flexible, thin, needle-shaped electrode for an endoscopic ultrasound (EUS)-guided procedure. This study aimed to evaluate the feasibility and efficacy of performing EUS-guided IRE with endoscopic needle-electrode in porcine pancreas.

Methods

Experimental endoscopic IRE on the pancreas were performed by EUS-guided approach in three pigs and compared with surgical approach in three pigs. The animals were killed after 24 h and their pancreases collected.

Results

IRE ablation using endoscopic needle-electrode was successful technically in EUS-guided approaches for the pancreas. Immediately following IRE, the ablated pancreatic tissue showed no gross change except focal hemorrhage. H&E staining presented a well-demarcated ablation site measuring 1.0–1.5 cm in diameter in the pancreas. TUNEL immunohistochemistry showed diffuse cell death along the puncture site 24 h after IRE. No complication was observed in pigs after endoscopic IRE ablation.

Conclusion

EUS-guided IRE ablation was feasible and effective for pancreas using the newly developed device.

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A task and performance analysis of endoscopic submucosal dissection (ESD) surgery

Abstract

Background

ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries.

Methods

We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons.

Results

The average time of the marking, injection, and circumferential cutting phases are 203.4 (σ: 205.46), 83.5 (σ: 49.92), 908.4 s. (σ: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (σ: 908.43). We also performed correlation analysis (Pearson's test) among the performance scores of the tasks. There is a moderate positive correlation (R = 0.528, p = 0.0355) between marking scores and total scores, a strong positive correlation (R = 0.7879, p = 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (R = 0.7095, p = 0.0021) between circumferential cutting and submucosal dissection and marking scores.

Conclusions

We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.

Graphical abstract

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