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Purpose:This study examined the effects of a five-week intervention combining vigorous interval training (VIT) with diet among twenty-four obese adolescents. Fourteen girls and ten boys (aged 14–15) schooled in a pediatric rehabilitation center participated. Methods:The VIT intensity was targeted and remained above 80% of maximal heart rate (HR) and over six kilocalories per minute. Pre- and postintervention measures were body composition (BMI, weight, body fat percentage), physical self-perceptions (PSP), physical fitness (6-min walking distance and work) and its associated physiological responses (HRpeak and blood lactate concentration). A series of two-way analyses of variance or covariance controlling for weight loss were used to examine the changes. Results:Significant improvements were found in body composition, physical fitness and PSP (endurance, activity level, sport competence, global physical self-concept and appearance). In addition, boys presented higher levels of perceived strength and global physical self-concept than girls. Finally, there was a significant increase in perceived endurance, sport competence, and global physical self-concept in girls only. Conclusion:This five-week VIT program combined with diet represents an effective means for improving body composition, physical fitness, and PSP in obese adolescents, the effects on PSP being larger among girls.

Aim Neuromuscular electrical stimulation (NMES) causes early onset of neuromuscular fatigue. Peripheral electrophysiological explorations suggest that supra-spinal alterations are involved through sensitive afferent pathways. As sensory input is projected over the primary somatosensory cortex (S1), S1 area involvement in inhibiting the central motor drive can be hypothesized. This study assessed cortical activity under a fatiguing NMES protocol at low frequency. Methods Twenty healthy males performed five NMES sequences of 17 trains over the plantar flexors (30 Hz, 4 s on/6 s off). Before and after each sequence, neuromuscular tests composed of maximal voluntary contractions (MVCs) were carried out. Cortical activity was assessed during MVCs with functional near-infrared spectroscopy over S1 and primary motor (M1) areas, through oxy- [HbO] and deoxy-haemoglobin [HbR] variation. Electrophysiological data (H-reflex during MVC, EMG activity and level of voluntary activation) were also recorded. Results MVC torque significantly decreased after the first 17 NMES trains (P

International audience; The aim of this study was to compare cardiovascular hemodynamics and cerebral oxygenation/perfusion (COP) during and after maximal incremental exercise in obese individuals according to their aerobic fitness versus age-matched healthy controls (AMHC). Fifty-four middle-aged obese (OB) and 16 AMHC were recruited. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamics (impedance cardiography), and left frontal COP (near-infrared spectroscopy: NIRS) were measured continuously during a maximal incremental ergocycle test. During recovery, reoxygenation/perfusion rate (ROPR: oxyhemoglobin: Delta O(2)Hb, deoxyhemoglobin: Delta HHb and total hemoglobin: Delta tHb; with NIRS) was also measured. Obese participants (OB, n = 54) were divided into two groups according to the median VO2 peak: the low-fit obese (LF-OB, n = 27) and the high-fit obese (HF-OB, n = 27). During exercise, end tidal pressure of CO2 (PETCO2), and COP (Delta O(2)Hb, Delta HHb and Delta tHb) did not differ between groups (OB, LF-OB, HF-OB, AMHC). During recovery, PETCO2 and ROPR (Delta O(2)Hb, Delta HHb and DtHb) were similar between the groups (OB, LF-OB, HF-OB, AMHC). During exercise and recovery, cardiac index was lower (P < 0.05) in LF-OB versus the other two groups (HF-OB, AMHC). As well, systolic blood pressure was higher during exercise in the OB, LF-OB and HF-OB groups versus AMHC (P < 0.05). When compared to AMHC, obese individuals (OB, LF-OB, HF-OB) have a similar cerebral vasoreactivity by CO2 and cerebral hemodynamics during exercise and recovery, but a higher systolic blood pressure during exercise. Higher fitness in obese subjects (HF-OB) seems to preserve their cardiopulmonary and cardiac function during exercise and recovery.

IF 4.134; International audience; The sense of taste is responsible for the detection and ingestion of food to cover energetic requirements in health and disease. The change in taste perception might lead to malnutrition that is usually one of the frequent causes of morbidity and mortality in patients with cancer. In this review, we summarize the mechanisms of taste perception and how they are altered in cancer. We also address the question of the implication of inflammation, responsible for the alterations in taste modalities. We highlight the role of radio- and chemotherapy in the modulation of taste physiology. Other several factors like damage to taste progenitor cells and disruption of gut microbiota are also dealt with relation to taste perception in cancer. We further shed light on how to restore taste acuity, by using different preventive methods, dietary modifications and pharmacotherapy in subjects with advanced cancer state.

Background The alarming progression of pediatric obesity is associated with the development of sleep-disordered breathing (SDB), and both exhibit similar adverse cardiometabolic health outcomes. Physical activity level (PAL) may counteract sleep and metabolic disturbances. The present study investigates i) the association between the metabolic syndrome in childhood obesity and SDB, ii) the impact of SDB severity on cardiometabolic risk scores and PAL in children with obesity. Methods Maturation status (Tanner stages), anthropometric (height, weight, body mass index, waist circumference, body adiposity index) and cardiometabolic characteristics (systolic and diastolic blood pressure, lipid and glycemic profiles) were assessed in 83 obese children (mean ± SD, age: 10.7 ± 2.7 years). PAL and SDB were investigated with a step test and interviews, and an overnight sleep monitor, respectively. The presence or absence of metabolic syndrome (MS) was established and continuous cardiometabolic risk scores were calculated (MetScoreBMI and MetScoreWC). Results Obese children with (61.4%) and without (38.6%) MS present similar SDB. SDB severity is associated with increased insulin concentrations, MetScoreBMI and MetScoreWC (p Conclusions In a context where no consensus exists for SDB diagnosis in children, our results suggest the influence of SDB severity on cardiometabolic risk factors. Further studies are needed to explore the association between PAL and both metabolic and sleep alterations in obese children.

International audience; High-intensity exercise may pose a risk to patients with postconcussion syndrome (PCS) when symptomatic during exertion. The case of a paralympic athlete with PCS who experienced a succession of convulsion-awakening periods and reported a marked increase in postconcussion symptoms after undergoing a graded symptom-limited aerobic exercise protocol is presented. Potential mechanisms of cerebrovascular function failure are then discussed.

International audience; The THESEUS project (Towards Human Exploration of Space: aEUropean Strategy) was initiated within the seventh FrameworkProgramme by the European Commission. This project aimed toprovide a cross-cutting, life science-based roadmap for Europe’sstrategy towards human exploration of space, especially for deepspace missions and its relevance to applications on Earth. Toaddress these challenges, relevance of space research on thecardiovascular system, the lungs and kidneys, was discussed in anexpert group and its principal conclusions will be presented in thisarticle.

International audience; This study aimed to compare the response of salivary hormones of track and field athletes induced by preparation and pre-competitive training periods in an attempt to comment on the physiological effects consistent with the responses of each of the proteins measured. Salivary testosterone, cortisol, alpha-amylase, immunoglobulin A (IgA), chromogranin A, blood creatine kinase activity, and profile of mood state were assessed at rest in 24 world-class level athletes during preparation (3 times in 3 months) and pre-competitive (5 times in 5 weeks) training periods. Total mood disturbance and fatigue perception were reduced, while IgA (+61%) and creatine kinase activity (+43%) increased, and chromogranin A decreased (−27%) during pre-competitive compared to preparation period. A significant increase in salivary testosterone (+9 to +15%) and a decrease in testosterone/cortisol ratio were associated with a progressive reduction in training load during pre-competitive period (P < 0.05). None of the psycho-physiological parameters were significantly correlated to training load during the pre-competitive period. Results showed a lower adrenocortical response and autonomic activity, and an improvement of immunity status, in response to the reduction in training load and fatigue, without significant correlations of salivary hormones with training load. Our findings suggest that saliva composition is sensitive to training contents (season period) but could not be related to workload resulting from track and field athletics training.

Import JabRef | WosArea Physiology; Sport Sciences; International audience; The use of electrical stimulation (ES) can contribute to our knowledge of how our neuromuscular system can adapt to physical stress or unloading. Although it has been recently challenged, the standard technique used to explore central modifications is the twitch interpolated method which consists in superimposing single twitches or high-frequency doublets on a maximal voluntary contraction (MVC) and to compare the superimposed response to the potentiated response obtained from the relaxed muscle. Alternative methods consist in (1) superimposing a train of stimuli (central activation ratio), (2) comparing the MVC response to the force evoked by a high-frequency tetanus or (3) examining the change in maximal EMG response during voluntary contractions, if this variable is normalized to the maximal M wave, i.e. EMG response to a single stimulus. ES is less used to examine supraspinal factors but it is useful for investigating changes at the spinal level, either by using H reflexes, F waves or cervicomedullary motor-evoked potentials. Peripheral changes can be examined with ES, usually by stimulating the muscle in the relaxed state. Neuromuscular propagation of action potentials on the sarcolemma (M wave, high-frequency fatigue), excitation-contraction coupling (e.g. low-frequency fatigue) and intrinsic force (high-frequency stimulation at supramaximal intensity) can all be used to non-invasively explore muscular function with ES. As for all indirect methods, there are limitations and these are discussed in this review. Finally, (1) ES as a method to measure respiratory muscle function and (2) the comparison between electrical and magnetic stimulation will also be considered.

International audience; Aim: Voluntary apnoea induces several physiological adaptations, including bradycardia, arterial hypertension and redistribution of regional blood flows. Elite breath-hold divers (BHDs) are able to maintain very long apnoea, inducing severe hypoxaemia without brain injury or black-out. It has thus been hypothesized that they develop protection mechanisms against hypoxia, as well as a decrease in overall oxygen uptake. Methods: To test this hypothesis, the apnoea response was studied in BHDs and non-divers (NDs) during static and dynamic apnoeas (SA, DA). Heart arterial oxygen saturation (SaO(2)), and popliteal artery blood flow were rate, recorded to investigate the oxygen-conserving effect of apnoea response, and the internal carotid artery blood flow was used to examine the mechanisms of cerebral protection. Results: The bradycardia and peripheral vasoconstriction were accentuated in BHDs compared with NDs (P < 0.01), in association with a smaller SaO(2) decrease (-2.7% vs. -4.9% during SA, P < 0.01 and -6% vs. -11.3% during DA, P < 0.01). Greater increase in carotid artery blood flow was also measured during apnoea in BHDs than in controls. Conclusion: These results confirm that elite divers present a potentiation of the well-known apnoea response in both SA and DA conditions. This response is associated with higher brain perfusion which may partly explain the high levels of world apnoea records.

International audience; BACKGROUND: Parecoxib, a selective cyclooxygenase-2 inhibitor, may reduce postoperative pain without increasing bleeding when administered before surgery. METHODS: We randomly assigned 62 patients scheduled for total hip arthroplasty to the following IV dosing schedule: 1) placebo at induction, at wound closure, and 12 h after induction (control); 2) parecoxib 40 mg at induction, placebo at wound closure, and parecoxib 40 mg 12 h after induction (pre); or, 3) placebo at induction, parecoxib 40 mg at wound closure, and parecoxib 40 mg 12 h after induction (post). Pain scores at rest and with movement were recorded every 4 h for 24 h using a visual analog scale. Treatment side effects were recorded every 4 h. Red cell loss for 5 days after surgery was calculated. RESULTS: Postoperative pain scores were less in the pre and post groups than in the control group. Postoperative bleeding was similar in the three groups. There were no significant differences between the pre and post groups, nor was their any trend suggesting a preemptive analgesic efficacy from preincision administration of parecoxib. Morphine use in the Postanesthesia Care Unit was reduced in the pre and post groups compared with the control group (14.2 +/- 2.0, and 15.7 +/- 2.0, vs 20.4 +/- 2.3 mg), although the trend was only significant (P < 0.05) in the pre group. The first pain score was also reduced in the pre and post groups compared to the control group (56.1 +/- 7.5 and 64.2 +/- 7.0 vs 78.3 +/- 5), but this was also only significant for the pre group (P = 0.001). The delay for first analgesic demand was increased for both the pre and post group compared to the control group (38 +/- 9 and 28.2 +/- 6.6 vs 18 +/- 6 min) but, again, this was only significant for the pre group (P = 0.05). Twenty-four hour consumption of morphine was similar in the pre (26 +/- 12 mg) and post groups (25 +/- 13 mg); both were significantly less than in the control group (47 +/- 27 mg, P < 0.001). CONCLUSIONS: Administration of parecoxib before hip arthroplasty did not provide preemptive analgesia. There was a trend towards improved analgesia immediately after surgery with preincision administration, consistent with the expected time course of nonsteroidal antiinflammatory drug's effect. Perioperative parecoxib administration, consisting of two injections spaced 12 h apart, improved postoperative analgesia over the first 24 h without increasing bleeding.

International audience; The purpose of this cross-sectional study was to investigate the change in 100-km running performance and in the age of peak performance for 100-km ultramarathoners. Age and running speed of the annual fastest women and men in all 100-km ultramarathons held worldwide between 1960 and 2012 were analyzed in 148,017 finishes with 18,998 women and 129,019 men using single, multivariate, and nonlinear regressions. Running speed of the annual fastest men increased from 8.67 to 15.65 km.h(-1) and from 8.06 to 13.22 km.h(-1) for the annual fastest women. For the annual 10 fastest men, running speed increased from 10.23 ± 1.22 to 15.05 ± 0.29 km.h(-1) (p < 0.0001) and for the annual 10 fastest women from 7.18 ± 1.54 to 13.03 ± 0.18 km.h(-1) (p < 0.0001). The sex difference decreased from 56.1 to 16.3% for the annual fastest finishers (p < 0.0001) and from 46.7 ± 8.7% to 14.0 ± 1.2% for the annual 10 fastest finishers (p < 0.0001). The age of the annual fastest men increased from 29 to 40 years (p = 0.025). For the annual fastest women, the age remained unchanged at 35.0 ± 9.7 years (p = 0.469). For the annual 10 fastest women and men, the age remained unchanged at 34.9 ± 3.2 (p = 0.902) and 34.5 ± 2.5 years (p = 0.064), respectively. To summarize, 100-km ultramarathoners became faster, the sex difference in performance decreased but the age of the fastest finishers remained unchanged at ∼ 35 years. For athletes and coaches to plan a career as 100-km ultramarathoner, the age of the fastest female and male 100-km ultramarathoners remained unchanged at ∼ 35 years between 1960 and 2012 although the runners improved their performance over time.

International audience; The purpose of this study was to assess the prognostic value of a large panel of cytokines in aggressive non-Hodgkin's lymphoma (NHL) and to confront it to parameters of the International Prognostic Index (IPI). It investigated the concomitant determination of interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R), interleukin-4 (IL-4), interleukin-6 (IL-6) and interleukin-10 (IL-10) on a uniform population of 116 previously untreated patients. Commercially available enzyme-linked immunoassay kits were used for cytokines measurements. Results were correlated with complete remission (CR), overall survival (OS) and failure free survival (FFS). In univariate analysis, sIL-2R and IL-6 demonstrated prognostic significance for CR (p = 0.016 and p = 0.048), OS (p = 0.0011 and p = 0.0387) and FFS (p = 0.0001 and p = 0.0363), but multi-variate analysis failed to demonstrate an independent prognostic significance. In the intermediate group risk defined by IPI, patients presenting high level of sIL-2R or IL-6 demonstrated lower CR rate and survival than those with low level. In conclusion, sIL-2R and IL-6 serum levels are elevated in high grade NHL and are correlated to CR, OS and FFS, but this study did not support their independent prognostic value. However, sIL-2R and IL-6 measurements may improve risk assignment by IPI and allow a better prognostic evaluation of patients with intermediate prognosis NHL.

International audience; Torque time integral (TTI) is the combination of intensity and duration of a contraction. The aim of this study was to compare neuromuscular alterations following different isometric sub-maximal contractions of the knee extensor muscles but with similar TTI. Sixteen participants performed 3 sustained contractions at different intensities (25 %, 50 %, and 75 % of Maximal Voluntary Contraction (MVC) torque) with different durations (68.5 +/- 33.4 s, 35.1 +/- 16.8 s and 24.8 +/- 12.9 s, respectively) but similar TTI value. MVC torque, maximal voluntary activation level (VAL), M-wave characteristics and potentiated doublet amplitude were assessed before and immediately after the sustained contractions. EMG activity of the vastus lateralis (VL) and rectus femoris (RF) muscles was recorded during the sustained contractions. MVC torque reduction was similar in the 3 conditions after the exercise (-23.4 +/- 2.7 %). VAL decreased significantly in a similar extent (-3.1 +/- 1.3 %) after the 3 sustained contractions. Potentiated doublet amplitude was similarly reduced in the 3 conditions (-19.7 +/- 1.5 %), but VL and RF M-wave amplitudes remained unchanged. EMG activity of VL and RF muscles increased in the same extent during the 3 contractions (VL: 54.5 +/- 40.4 %; RF: 53.1 +/- 48.7 %). These results suggest that central and peripheral alterations accounting for muscle fatigue are similar following isometric contractions with similar TTI. TTI should be considered in the exploration of muscle fatigue during sustained isometric contractions.

The possible peripheral and/or central origin in the mechanisms responsible for day-time fluctuation in maximal torque of the triceps surae muscle were investigated with a special emphasis on antagonist muscle coactivation. Eleven healthy male subjects (physical education students) took part in this investigation. The electromechanical properties of the plantar flexor muscles were recorded at two different times of day: between 06:00 h and 08:00 h in the morning and between 17:00 h and 19:00 h in the evening. To investigate peripheral mechanisms, the posterior tibial nerve was stimulated at rest, using percutaneous electrical stimuli, to evoke single twitch, double twitch, and maximal tetanic contraction (100 Hz). Maximal voluntary contraction of the plantar flexors was also assessed by means of the relative electromyographic activity of respective agonist and antagonist muscles (soleus, gastrocnemius medialis, gastrocnemius lateralis, and tibialis anterior). A double twitch was delivered during maximal voluntary plantar flexion to record muscle activation (i.e., interpolated twitch technique). The coactivation level of the tibialis anterior muscle during plantar flexion was calculated. The results indicated a significant decrease in maximal voluntary muscle torque of triceps surae in the evening as compared with the morning (-7.0 %; p < 0.05). Concerning the central command, when extrapolated by the twitch interpolation technique, the decrease in mean activation level of -6.8 % was consistent with the fluctuation in torque (-7.0 %). Soleus muscle electromyographic activity (normalized to the M-wave) showed a significant decline (21.6 %; p < 0.001). Moreover, individual changes in MVC percentage were significantly related to those of normalized electromyographic activity of the soleus muscle (r = 0.688; p < 0.01). Thus, it indicated that the subject's capacity to activate the soleus muscle was affected by the time of day. The coactivation level in the tibialis anterior muscle during plantar flexion did not change significantly in the evening. Concerning peripheral mechanisms, we observed a decrease in maximal M-wave amplitude for soleus and gastrocnemii, associated with unchanged single twitch and tetanus torque. To conclude, impairment in soleus muscle central command seemed to be the mechanism in the origin of torque failure. Such information would be of importance in the investigation of day-time fluctuations in complex motor task performances implicating the triceps surae muscle.

Introduction: In vitamin K antagonist (VKA)-treated patients with severe hemorrhage, guidelines recommend prompt VKA reversal with prothrombin complex concentrate (PCC) and vitamin K. The aim of this observational cohort study was to evaluate the impact of guideline concordant administration of PCC and vitamin K on seven-day mortality. Methods: Data from consecutive patients treated with PCC were prospectively collected in 44 emergency departments. Type of hemorrhage, coagulation parameters, type of treatment and seven-day mortality mortality were recorded. Guideline-concordant administration of PCC and vitamin K (GC-PCC-K) were defined by at least 20 IU/kg factor IX equivalent PCC and at least 5 mg of vitamin K performed within a predefined time frame of eight hours after admission. Multivariate analysis was used to assess the effect of appropriate reversal on seven-day mortality in all patients and in those with intracranial hemorrhage (ICH). Results: Data from 822 VKA-treated patients with severe hemorrhage were collected over 14 months. Bleeding was gastrointestinal (32%), intracranial (32%), muscular (13%), and “other” (23%). In the whole cohort, seven-day mortality was 13% and 33% in patients with ICH. GC-PCC-K was performed in 38% of all patients and 44% of ICH patients. Multivariate analysis showed a two-fold decrease in seven-day mortality in patients with GC-PCC-K (odds ratio (OR) = 2.15 (1.20 to 3.88); P = 0.011); this mortality reduction was also observed when only ICH was considered (OR = 3.23 (1.53 to 6.79); P = 0.002). Conclusions: Guideline-concordant VKA reversal with PCC and vitamin K within eight hours after admission was associated with a significant decrease in seven-day mortality.

International audience; BACKGROUND: Age and peak performance in ultra-endurance athletes have been mainly investigated in long-distance runners and triathletes, but not for long-distance swimmers. The present study investigated the age and swimming performance of elite ultra-distance swimmers competing in the 5-, 10- and 25-km Fédération Internationale de Natation (FINA) World Cup swimming events. METHODS: The associations of age and swimming speed in elite male and female swimmers competing in World Cup events of 5-, 10- and 25-km events from 2000 to 2012 were analysed using single and multi-level regression analyses. RESULTS: During the studied period, the swimming speed of the annual top ten women decreased significantly from 4.94 ± 0.20 to 4.77 ± 0.09 km/h in 5 km and from 4.60 ± 0.04 to 4.44 ± 0.08 km/h in 25 km, while it significantly increased from 4.57 ± 0.01 to 5.75 ± 0.01 km/h in 10 km. For the annual top ten men, peak swimming speed decreased significantly from 5.42 ± 0.04 to 5.39 ± 0.02 km/h in 5 km, while it remained unchanged at 5.03 ± 0.32 km/h in 10 km and at 4.94 ± 0.35 km/h in 25 km. The age of peak swimming speed for the annual top ten women remained stable at 22.5 ± 1.2 years in 5 km, at 23.4 ± 0.9 years in 10 km and at 23.8 ± 0.9 years in 25 km. For the annual top ten men, the age of peak swimming speed increased from 23.7 ± 2.8 to 28.0 ± 5.1 years in 10 km but remained stable at 24.8 ± 1.0 years in 5 km and at 27.2 ± 1.1 years in 25 km. CONCLUSION: Female long-distance swimmers competing in FINA World Cup races between 2000 and 2012 improved in 10 km but impaired in 5 and 25 km, whereas men only impaired in 5 km. The age of peak performance was younger in women (approximately 23 years) compared to men (about 25-27 years).

International audience; BackgroundRecent findings showed that elite Ironman triathletes competing in ‘Ironman Hawaii’ improved both split and overall race times. The present study investigated whether elite athletes also improved in transition time (i.e. time needed between disciplines for changing clothes and equipment).MethodsChanges in split times, overall race times and transition times (i.e. expressed in absolute and relative terms) in the annual fastest competing in ‘Ironman Hawaii’ were investigated using linear, non-linear and multi-level regression analyses. To detect a potential difference in transition times between different race distances, we compared transition times in ‘Ironman Hawaii’ to transition times in the World Championships ‘Ironman 70.3’ covering the half distance of the Ironman distance triathlon.ResultsIn ‘Ironman Hawaii’, transition times remained unchanged for the annual fastest women but increased linearly for the annual fastest men. For the annual ten fastest, transition times increased linearly for women and men in both absolute and relative terms. The sex difference in transition times remained unchanged for the annual fastest, but decreased linearly for the annual ten fastest. In ‘Ironman 70.3’, transition times remained unchanged for the annual fastest. For the annual ten fastest, transition times decreased linearly for both women and men in absolute and relative terms. The sex difference in transition times remained unchanged for both the annual fastest and the annual ten fastest. Transition times were faster in ‘Ironman 70.3’ for women in 2011 and for men in 2006, 2007, and 2010-2013. In relative terms, transition times were faster in ‘Ironman 70.3’compared to ‘Ironman Hawaii’ during 2006-2013. The sex difference in transition times remained unchanged.ConclusionsIn ‘Ironman Hawaii’, transition times increased for both women and men whereas the sex difference decreased. In ‘Ironman 70.3’, transition times decreased for both women and men whereas the sex difference remained unchanged. Generally, transition times were slower in ‘Ironman Hawaii’ compared to ‘Ironman 70.3’.

Introduction Cardiac surgery is frequently needed in patients with infective endocarditis (IE). Acute kidney injury (AKI) often complicates IE and is associated with poor outcomes. The purpose of the study was to determine the risk factors for post-operative AKI in patients operated on for IE. Methods A retrospective, non-interventional study of prospectively collected data (2000–2010) included patients with IE and cardiac surgery with cardio-pulmonary bypass. The primary outcome was post-operative AKI, defined as the development of AKI or progression of AKI based on the acute kidney injury network (AKIN) definition. We used ensemble machine learning (“Super Learning”) to develop a predictor of AKI based on potential risk factors, and evaluated its performance using V-fold cross validation. We identified clinically important predictors among a set of risk factors using Targeted Maximum Likelihood Estimation. Results 202 patients were included, of which 120 (59%) experienced a post-operative AKI. 65 (32.2%) patients presented an AKI before surgery while 91 (45%) presented a progression of AKI in the post-operative period. 20 patients (9.9%) required a renal replacement therapy during the post-operative ICU stay and 30 (14.8%) died during their hospital stay. The following variables were found to be significantly associated with renal function impairment, after adjustment for other risk factors: multiple surgery (OR: 4.16, 95% CI: 2.98-5.80, p

Background The aims of the present study were, firstly, to investigate in a cross-sectional analysis the age of peak Ironman performance within one calendar year in all qualifiers for Ironman Hawaii and Ironman Hawaii; secondly, to determine in a longitudinal analysis on a qualifier for Ironman Hawaii whether the age of peak Ironman performance and Ironman performance itself change across years; and thirdly, to determine the gender difference in performance. Methods In a cross-sectional analysis, the age of the top ten finishers for all qualifier races for Ironman Hawaii and Ironman Hawaii was determined in 2010. For a longitudinal analysis, the age and the performance of the annual top ten female and male finishers in a qualifier for Ironman Hawaii was determined in Ironman Switzerland between 1995 and 2010. Results In 19 of the 20 analyzed triathlons held in 2010, there was no difference in the age of peak Ironman performance between women and men (p > 0.05). The only difference in the age of peak Ironman performance between genders was in ‘Ironman Canada’ where men were older than women (p = 0.023). For all 20 races, the age of peak Ironman performance was 32.2 ± 1.5 years for men and 33.0 ± 1.6 years for women (p > 0.05). In Ironman Switzerland, there was no difference in the age of peak Ironman performance between genders for top ten women and men from 1995 to 2010 (F = 0.06, p = 0.8). The mean age of top ten women and men was 31.4 ± 1.7 and 31.5 ± 1.7 years (Cohen's d = 0.06), respectively. The gender difference in performance in the three disciplines and for overall race time decreased significantly across years. Men and women improved overall race times by approximately 1.2 and 4.2 min/year, respectively. Conclusions Women and men peak at a similar age of 32–33 years in an Ironman triathlon with no gender difference. In a qualifier for Ironman Hawaii, the age of peak Ironman performance remained unchanged across years. In contrast, gender differences in performance in Ironman Switzerland decreased during the studied period, suggesting that elite female Ironman triathletes might still narrow the gender gap in the future.

Epub 2012 Oct 30; Assessing implicit learning in the continuous pursuit-tracking task usually concerns a repeated segment of target displacements masked by two random segments, as referred to as Pew's paradigm. Evidence for segment learning in this paradigm is scanty and contrasts with robust sequence learning in discrete tracking tasks. The present study investigates this issue with two experiments in which participants (N = 56) performed a continuous tracking task. Contrary to Pew's paradigm, participants were presented with a training sequence that was continuously cycled during 14 blocks of practice, but Block 12 in which a transfer sequence was introduced. Results demonstrate sequence learning in several conditions except in the condition that was obviously the most similar to previous studies failing to induce segment learning. Specifically, it is shown here that a target moving too slowly combined with variable time at which target reversal occurs prevents sequence learning. In addition, data from a post-experimental recognition test indicate that sequence learning was associated with explicit perceptual knowledge about the repetitive structure. We propose that learning repetition in a continuous tracking task is conditional on its capacity to (1) allow participants to detect the repeated regularities and (2) restrict feedback-based tracking strategies.

Introduction Guidelines dealing with severe sepsis and septic shock mostly rely on randomized controlled trials (RCTs) to ensure the best standards of care for patients. However, patients included in high-quality studies may differ from the routine population and alter external validity of recommendations. We aimed to determine to what extent non-inclusion criteria of RCTs dealing with severe sepsis and septic shock may affect application of their conclusions in routine care. Methods In a first step, the MEDLINE database was searched for RCTs treating severe sepsis and septic shock patients between 1992 and 2008, and non-inclusion criteria for these studies were abstracted. Two reviewers independently evaluated the articles, which were checked by a third reviewer. We extracted data on the study design, main intervention, primary endpoint, criteria for inclusion, and criteria for non-inclusion. In a second step, the distribution of the non-inclusion criteria was observed in a prospective multicenter cohort of severe sepsis and septic shock patients (Cub-Rea network, 1992 to 2008). Results We identified 96 articles out of 7,012 citations that met the screening criteria. Congestive heart failure (35%) and cancer (30%) were frequent exclusion criteria in selected studies, as well as other frequent disorders such as gastrointestinal and liver diseases and all causes of immune suppression. Of the 67,717 patients with severe sepsis and septic shock in the Cub-Rea database, 40,325 (60%) experienced at least one of the main exclusion criteria, including 11% of congestive heart failure patients and 11% of cancer patients. In addition, we observed a significant trend for increasing number of patients with these criteria along time. Conclusion Current exclusion criteria for RCTs dealing with severe sepsis and septic shock excluded most patients encountered in daily practice and limit external validity of the results of high-quality studies.

Background The present study examined the sex difference in swimming (7.8 km), cycling (360 km), running (84 km), and overall race times for Double Iron ultra-triathletes. Methods Sex differences in split times and overall race times of 1,591 men and 155 women finishing a Double Iron ultra-triathlon between 1985 and 2012 were analyzed. Results The annual number of finishes increased linearly for women and exponentially for men. Men achieved race times of 1,716 ± 243 min compared to 1,834 ± 261 min for women and were 118 ± 18 min (6.9%) faster (p < 0.01). Men finished swimming within 156 ± 63 min compared to women with 163 ± 31 min and were 8 ± 32 min (5.1 ± 5.0%) faster (p < 0.01). For cycling, men (852 ± 196 min) were 71 ± 70 min (8.3 ± 3.5%) faster than women (923 ± 126 min) (p < 0.01). Men completed the run split within 710 ± 145 min compared to 739 ± 150 min for women and were 30 ± 5 min (4.2 ± 3.4%) faster (p = 0.03). The annual three fastest men improved race time from 1,650 ± 114 min in 1985 to 1,339 ± 33 min in 2012 (p < 0.01). Overall race time for women remained unchanged at 1,593 ± 173 min with an unchanged sex difference of 27.1 ± 8.6%. In swimming, the split times for the annual three fastest women (148 ± 14 min) and men (127 ± 20 min) remained unchanged with an unchanged sex difference of 26.8 ± 13.5%. In cycling, the annual three fastest men improved the split time from 826 ± 60 min to 666 ± 18 min (p = 0.02). For women, the split time in cycling remained unchanged at 844 ± 54 min with an unchanged sex difference of 25.2 ± 7.3%. In running, the annual fastest three men improved split times from 649 ± 77 min to 532 ± 16 min (p < 0.01). For women, however, the split times remained unchanged at 657 ± 70 min with a stable sex difference of 32.4 ± 12.5%. Conclusions To summarize, the present findings showed that men were faster than women in Double Iron ultra-triathlon, men improved overall race times, cycling and running split times, and the sex difference remained unchanged across years for overall race time and split times. The sex differences for overall race times and split times were higher than reported for Ironman triathlon.

TO THE EDITOR: A recent study of Trappe et al. (3) showed that the aerobic power of octogenarian lifelong endurance athletes was approximately double that of untrained octogenarians (38 vs. 21 ml·kg 1 ·min 1 ). These remarkable aerobic capacities are the highest ever recorded in this age group. However, the impact of the identified physiological capacities on actual endurance performances has not been addressed, as no running performance indicators of the octogenarian athletes were provided in this study. We hereby suggest that, although trained octogenarian athletes can achieve levels of aerobic fitness well above their untrained counterpart, as a group they actually have not yet reached their limits of endurance performance. During the past decades, masters athletes (40 yr of age) have dramatically improved their performance in endurance events such as marathon running. An analysis of performances at the New York City Marathon during the 1980 –2010 period showed that running times of the best male masters runners between 65 and 79 years of age decreased significantly (2). However, due to the low rate of participation of athletes older than 80 years, the performances of octogenarian finishers were not analyzed. The current marathon world record for a male octogenarian athlete was set in 2011 at the Toronto marathon by a Canadian athlete (Ed Whitlock, age 80) who ra n3h1 5 min 54 s(http://

Background The aim of the present study was to compare the trends in participation, performance and age of finishers in ‘Badwater’ and ‘Spartathlon’ as two of the toughest ultramarathons in the world of more than 200 km of distance. Methods Running speed and age of male and female finishers in Badwater and Spartathlon were analyzed from 2000 to 2012. Age of peak performance and sex difference in running speed were investigated during the studied period. Results The number of female and male finishes increased in Badwater and Spartathlon. Women accounted on average for 21.5% ± 6.9% in Badwater and 10.8% ± 2.3% in Spartathlon. There was a significant increase in female participation in Badwater from 18.4% to 19.1% (p < 0.01) and in Spartathlon from 11.9% to 12.5% (p = 0.02). In men, the age of finishers was higher in Badwater (46.5 ± 9.3 years) compared to Spartathlon (44.8 ± 8.2 years) (p < 0.01). The age of female finishers of both races was similar with 43.0 ± 7.5 years in Badwater and 44.5 ± 7.8 years in Spartathlon (p > 0.05). Over the years, the age of the annual five fastest men decreased in Badwater from 42.4 ± 4.2 to 39.8 ± 5.7 years (p < 0.05). For women, the age remained unchanged at 42.3 ± 3.8 years in Badwater (p > 0.05). In Spartathlon, the age was unchanged at 39.7 ± 2.4 years for men and 44.6 ± 3.2 years for women (p > 0.05). In Badwater, women and men became faster over the years. The running speed increased from 7.9 ± 0.7 to 8.7 ± 0.6 km/h (p < 0.01) in men and from 5.4 ± 1.1 to 6.6 ± 0.5 km/h (p < 0.01) in women. The sex difference in running speed remained unchanged at 19.8% ± 4.8% (p > 0.05). In Spartathlon, the running speed was stable over time at 10.8 ± 0.7 km/h for men and 8.7 ± 0.5 km/h for women (p > 0.05). The sex difference remained unchanged at 19.6% ± 2.5% (p > 0.05). Conclusions These results suggest that for both Badwater and Spartathlon, (a) female participation increased, (b) the fastest finishers were approximately 40 to 45 years, and (c) the sex difference was at approximately 20%. Women will not outrun men in both Badwater and Spartathlon races. Master ultramarathoners can achieve a high level of performance in ultramarathons greater than 200 km under extreme conditions.

International audience; ABSTRACT: Human serum albumin (HSA) has been used for a long time as a resuscitation fluid in critically ill patients. It is known to exert several important physiological and pharmacological functions. Among them, the antioxidant properties seem to be of paramount importance as they may be implied in the potential beneficial effects that have been observed in the critical care and hepatological settings. The specific antioxidant functions of the protein are closely related to its structure. Indeed, they are due to its multiple ligand-binding capacities and free radical-trapping properties. The HSA molecule can undergo various structural changes modifying its conformation and hence its binding properties and redox state. Such chemical modifications can occur during bioprocesses and storage conditions of the commercial HSA solutions, resulting in heterogeneous solutions for infusion. In this review, we explore the mechanisms that are responsible for the specific antioxidant properties of HSA in its native form, chemically modified forms, and commercial formulations. To conclude, we discuss the implication of this recent literature for future clinical trials using albumin as a drug and for elucidating the effects of HSA infusion in critically ill patients.

Background In recent years, there was an increased interest in investigating the gender difference in performance and the age of peak performance in ultra-endurance performances such as ultra-triathlon, ultra-running, and ultra-swimming, but not in ultra-cycling. The aim of the present study was to analyze the gender difference in ultra-cycling performance and the age of peak ultra-cycling performance in the 720-km ‘Swiss Cycling Marathon’, the largest European qualifier for the ‘Race Across America’. Methods Changes in the cycling speed and age of 985 finishers including 38 women and 947 men competing in the Swiss Cycling Marathon from 2001 to 2012 covering a distance of 720 km with a change of altitude of 4,993 m were analyzed using linear regression. Results The gender difference in performance was 13.6% for the fastest cyclists ever, 13.9% ± 0.5% for the three fastest cyclists ever and 19.1% ± 3.7% for the ten fastest cyclists ever. The gender difference in performance for the annual top three women and men decreased from 35.0% ± 9.5% in 2001 to 20.4% ± 7.7% in 2012 (r 2 = 0.72, p = 0.01). The annual top three women improved cycling speed from 20.3 ± 3.1 km h−1 in 2003 to 24.8 ± 2.4 km h−1 in 2012 (r 2 = 0.79, p < 0.01). The cycling speed of the annual top three men remained unchanged at 30.2 ± 0.6 km h−1 (p > 0.05). The age of peak performance for the ten fastest finishers ever was 35.9 ± 9.6 years for men and 38.7 ± 7.8 years for women, respectively (p = 0.47). Conclusions The gender difference in ultra-cycling performance decreased over the 2001 to 2012 period in the 720-km Swiss Cycling Marathon for the annual top three cyclists and reached approximately 14%. Both women and men achieved peak performance at the age of approximately 36 to 39 years. Women might close the gender gap in ultra-endurance cycling in longer cycling distances. Future studies need to investigate the gender difference in performance in the Race Across America, the longest nonstop and non-drafting ultra-cycling race in the world.

International audience; INTRODUCTION: To provide up-to-date information on the prognostic factors associated with 28-day mortality in a cohort of septic shock patients in intensive care units (ICUs). METHODS: Prospective, multicenter, observational cohort study in ICUs from 14 French general (non-academic) and university teaching hospitals. All consecutive patients with septic shock admitted between November 2009 and March 2011 were eligible for inclusion. We prospectively recorded data regarding patient characteristics, infection, severity of illness, life support therapy and discharge. RESULTS: Among 10,941 patients admitted to participating ICUs between October 2009 and September 2011, 1495 (13.7%) patients presented inclusion criteria for septic shock and were included. Invasive mechanical ventilation was needed in 83.9% (n=1248), inotropes in 27.7% (n=412), continuous renal replacement therapy in 32.5% (n=484) and hemodialysis in 19.6% (n=291). Mortality at 28 days was 42% (n=625). Variables associated with time to mortality, right-censored at day 28: age (for each additional 10 yrs) (hazard ratio, HR=1.29; 95% confidence interval [CI]: 1.20-1.38), immunosuppression (HR=1.63; 95%CI: 1.37-1.96), Knaus class C/D score versus class A/B score (HR=1.36; 95%CI:1.14-1.62) and Sepsis-related Organ Failure Assessment (SOFA) score (HR=1.24 for each additional point; 95%CI: 1.21-1.27). Patients with septic shock and renal/urinary tract infection had a significantly longer time to mortality (HR=0.56; 95%CI: 0.42-0.75). CONCLUSION: Our observational data of consecutive patients from real-life practice confirm that septic shock is common and carries high mortality in general intensive care unit populations. Our results are in contrast with the clinical trial setting, and could be useful for healthcare planning and clinical study design.

Purpose: To investigate changes in diffusion tensor imaging (DTI) measures in limbic system white matter of patients with temporal lobe epilepsy (TLE) using diffusion tensor tractography. Materials and Methods: DTI metrics including fractional anisotropy (FA), λ1, λ2, λ3, and trace (Tr) coefficients were obtained from tractography for bilateral fornix, superior and inferior cingulum fibers in 18 patients and 10 healthy controls. Hippocampal signal-to-noise ratio (SNR) quantitative analysis was performed in order to confirm the magnetic resonance imaging (MRI) hippocampal lesion presence or absence in TLE patients. Results: Nine patients presented unilateral hippocampal sclerosis (TLE+HS) and nine patients had no signal abnormalities on conventional MRI (TLE−HS). On the ipsilateral seizure side, all three investigated tracts showed significant DTI indices abnormalities in both patient groups when compared with controls, most marked on the inferior cingulum. Contralateral to the seizure side, the three tracts presented significant DTI parameters in only the TLE+HS group when compared with controls. Conclusion: The DTI abnormalities found in the TLE−HS group may suggest that in the inferior cingulum the structural integrity is more affected than in the fornix or superior cingulum white matter bundles. The eigenvalues taken separately add complementary information to the FA and Tr metrics and may be useful indices in better understanding the architectural reorganization of limbic system tracts in TLE patients without HS. J. Magn. Reson. Imaging 2012;36:561–568. © 2012 Wiley Periodicals, Inc.

BackgroundDespite the recommended guidelines, the neonatal management of pain and discomfort often remains inadequate. The purpose of the present study was to determine whether adding a pain and discomfort module to a computerized physician order entry (CPOE) system would improve pain and discomfort evaluation in premature newborns under invasive ventilation.MethodsAll newborns ResultsA total of 122 patients were included: 53 before and 69 after the incorporation of the module. The mean age was 30 (3) weeks GA. After the module was included, the percentage of patients who benefited from at least one pain and discomfort assessment per day increased from 64% to 88% (p p p p ConclusionsAdding a pain and discomfort tool to the CPOE system was a simple and effective way to improve the systematic evaluation of premature newborns who required ventilatory assistance.

International audience; ABSTRACT: INTRODUCTION: Inadequate initial treatment and delayed hemodynamic stabilization (HDS) may be associated with increased risk of death in severe sepsis patients. METHODS: in order to compare the hemodynamic efficacy and safety of 6% HES 130/0.4 and NaCl 0.9% for HDS in patients with severe sepsis, we designed a prospective, multicenter, active-controlled, double-blind, randomized study in Intensive care units. RESULTS: 174 out of 196 patients reached HDS (88 and 86 patients for HES and NaCl, respectively). Significantly less HES was used to reach HDS versus NaCl (1,379 886 ml in the HES group and 1,709 1,164 ml in the NaCl group [Mean difference = -331 1,033, 95% CI -640 to -21, p=0.0185). Time to reach HDS was 11.8 10.1 hours versus 14.3 11.1 hours for HES and NaCl, respectively. Total quantity of study drug infused over four consecutive days, ICU and hospital LOS, and area under the curve of SOFA Score were comparable. Acute renal failure occurred in 24 (24.5%) and 19 (20%) patients for HES and NaCl, respectively (p=0.454). There was no difference between AKIN and RIFLE criteria among groups and no difference in mortality, coagulation, or pruritus up to 90 days after treatment initiation. CONCLUSION: Significantly less volume was required to achieve HDS for HES versus NaCl in the initial phase of fluid resuscitation in severe sepsis patients without any difference for adverse events in both groups.

International audience; UNLABELLED: ABSTRACT: BACKGROUND: Previous studies have shown a good agreement between central venous pressure (CVP) measurements from catheters placed in superior vena cava and catheters placed in the abdominal cava/common iliac vein. However, the influence of intra-abdominal pressure on such measurements remains unknown. METHODS: We conducted a prospective, observational study in a tertiary teaching hospital. We enrolled patients who had indwelling catheters in both superior vena cava (double lumen catheter) and femoroiliac veins (dialysis catheter) and into the bladder. Pressures were measured from all the sites, CVP, femoroiliac venous pressure (FIVP), and intra-abdominal pressure. RESULTS: A total of 30 patients were enrolled (age 62 ± 14 years; SAPS II 62 (52-76)). Fifty complete sets of measurements were performed. All of the studied patients were mechanically ventilated (PEP 3 cmH20 (2-5)). We observed that the concordance between CVP and FIVP decreased when intra-abdominal pressure increased. We identified 14 mmHg as the best intra-abdominal pressure cutoff, and we found that CVP and FIVP were significantly more in agreement below this threshold than above (94% versus 50%, P = 0.002). CONCLUSIONS: We reported that intra-abdominal pressure affected agreement between CVP measurements from catheter placed in superior vena cava and catheters placed in the femoroiliac vein. Agreement was excellent when intra-abdominal pressure was below 14 mmHg.

International audience; IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality.ResultsIn total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups.ConclusionsDiagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.

Background The fastest Ironman race times in ‘Ironman Hawaii’ were achieved in very recent years. This study investigated the change in sex difference in both race performance and the age of peak performance across years in the top ten athletes for split disciplines and overall race time in the ‘Ironman Hawaii’ between 1983 and 2012. Methods Changes in split times, overall race times, and age of athletes across years for the top ten overall and the fastest swimmers, cyclists, and runners were investigated using regression analyses and analyses of variance. Results Between 1983 and 2012, the overall top ten men and women finishers improved their swimming (only men), cycling, running, and overall race times. The sex difference in overall race time decreased significantly (p = 0.01) from 15.2% to 11.3% across time. For the split disciplines, the sex difference remained unchanged (p > 0.05) for swimming (12.5 ± 3.7%) and cycling (12.5 ± 2.7%) but decreased for running from 13.5 ± 8.1% to 7.3 ± 2.9% (p = 0.03). The time performance of the top ten swimmers remained stable (p > 0.05), while those of the top ten cyclists and top ten runners improved (p p > 0.05) in swimming (8.0 ± 2.4%), cycling (12.7 ± 1.8%), and running (15.2 ± 3.0%). Between 1983 and 2012, the age of the overall top ten finishers and the fastest swimmers, cyclists, and runners increased across years for both women and men (p Conclusions To summarize, for the overall top ten finishers, the sex difference decreased across years for overall race time and running, but not for swimming and cycling. For the top ten per discipline, the sex difference in performance remained unchanged. The athletes improved their performances across years although the age of peak performance increased.

International audience; IntroductionThe benefits of transporting severely injured patients by helicopter remain controversial. This study aimed to analyze the impact on mortality of helicopter compared to ground transport directly from the scene to a University hospital trauma center.MethodsThe French Intensive Care Research for Severe Trauma cohort study enrolled 2,703 patients with severe blunt trauma requiring admission to University hospital intensive care units within 72 hours. Pre-hospital and hospital clinical data, including the mode of transport, (helicopter (HMICU) versus ground (GMICU), both with medical teams), were recorded. The analysis was restricted to patients admitted directly from the scene to a University hospital trauma center. The main endpoint was mortality until ICU discharge.ResultsOf the 1,958 patients analyzed, 74% were transported by GMICU, 26% by HMICU. Median injury severity score (ISS) was 26 (interquartile range (IQR) 19 to 34) for HMICU patients and 25 (IQR 18 to 34) for GMICU patients. Compared to GMICU, HMICU patients had a higher median time frame before hospital admission and were more intensively treated in the pre-hospital phase. Crude mortality until hospital discharge was the same regardless of pre-hospital mode of transport. After adjustment for initial status, the risk of death was significantly lower (odds ratio (OR): 0.68, 95% confidence interval (CI) 0.47 to 0.98, P = 0.035) for HMICU compared with GMICU. This result did not change after further adjustment for ISS and overall surgical procedures.ConclusionsThis study suggests a beneficial impact of helicopter transport on mortality in severe blunt trauma. Whether this association could be due to better management in the pre-hospital phase needs to be more thoroughly assessed.

International audience; BackgroundThe age-related decline in performance has been investigated in swimmers, runners and triathletes. No study has investigated the age-related performance decline in ultra-triathletes. The purpose of this study was to analyse the age-related declines in swimming, cycling, running and overall race time for both Triple Iron ultra-triathlon (11.4-km swimming, 540-km cycling and 126.6-km running) and Deca Iron ultra-triathlon (38-km swimming, 1,800-km cycling and 420-km running).MethodsThe age and performances of 423 male Triple Iron ultra-triathletes and 119 male Deca Iron ultra-triathletes were analysed from 1992 to 2010 using regression analyses and ANOVA.ResultsThe mean age of the finishers was significantly higher for Deca Iron ultra-triathletes (41.3 ± 3.1 years) compared to a Triple Iron ultra-triathletes (38.5 ± 3.3 years) (P ConclusionsThe magnitudes of age-related declines in performance in the three disciplines of ultra-triathlon differ slightly between Triple and Deca Iron ultra-triathlon. Although the ages of Triple Iron ultra-triathletes were on average younger compared to Deca Iron ultra-triathletes, the fastest race times were achieved between 25 and 44 years for both distances. Further studies should investigate the motivation and training of ultra-triathletes to gain better insights in ultra-triathlon performance.

International audience; INTRODUCTION: Recently, newer assays for cardiac troponin (cTn) have been developed which are able to detect changes in concentration of the biomarker at or below the 99th percentile for a normal population. The objective of this study was to compare the diagnostic performance of a new high-sensitivity troponin T (HsTnT) assay to that of conventional cTnI for the diagnosis of acute myocardial infarction (AMI) according to pretest probability (PTP). METHODS: In consecutive patients who presented to our emergency departments with chest pain suggestive of AMI, levels of HsTnT were measured at presentation, blinded to the emergency physicians, who were asked to estimate the empirical PTP of AMI. The discharge diagnosis was adjudicated by two independent experts on the basis of all available data. RESULTS: A total of 317 patients were included, comprising 149 (47%) who were considered to have low PTP, 109 (34%) who were considered to have moderate PTP and 59 (19%) who were considered to have high PTP. AMI was confirmed in 45 patients (14%), 22 (9%) of whom were considered to have low to moderate PTP and 23 (39%) of whom were considered to have high PTP (P < 0.001). In the low to moderate PTP group, HsTnT levels ≥ 0.014 μg/L identified AMI with a higher sensitivity than cTnI (91%, 95% confidence interval (95% CI) 79 to 100, vs. 77% (95% CI 60 to 95); P = 0.001), but the negative predictive value was not different (99% (95% CI 98 to 100) vs. 98% (95% CI 96 to 100)). There was no difference in area under the receiver operating characteristic (ROC) curve between HsTnT and cTnI (0.93 (95% CI 0.90 to 0.98) vs. 0.94 (95% CI 0.88 to 0.97), respectively). CONCLUSIONS: In patients with low to moderate PTP of AMI, HsTnT is slightly more useful than cTnI. Our results confirm that the use of HsTnT has a higher sensitivity than conventional cTnI.

International audience; ABSTRACT: Helium is a low-density inert gas whose physical properties are very different from those of nitrogen and oxygen. Such properties could be clinically useful in the adult critical care setting, especially in patients with upper to more distal airway obstruction requiring moderate to intermediate levels of FiO2. However, despite decades of utilization and reporting, it is still difficult to give any firm clinical recommendation in this setting. Numerous case reports are available in the context of upper airway obstruction of different origins, but there is a lack of controlled studies for this indication. One study reported a helium-induced beneficial effect on surrogates of work of breathing after extubation in non-COPD patients, possibly in relation to laryngeal consequences of tracheal intubation. Physiological benefits of helium-oxygen breathing have been demonstrated in the context of acute severe asthma, but there is a lack of large controlled studies demonstrating an effect on pertinent clinical endpoints, except for a study reported only as an abstract, which mentioned a reduction in the intubation rate in helium-treated patients. Finally, there are a number of physiological studies in the context of COLD-COPD patients demonstrating a beneficial effect, mainly by a reduction in the resistive inspiratory work of breathing but also by a reduction in hyperinflation. Reduction of hypercapnia was mainly observed in spontaneously breathing and noninvasively ventilated helium-treated patients but not in intubated patients during controlled ventilation, suggesting that the decrease in PaCO2 was mainly in relation to a diminution in CO2 production, related to the diminution in work of breathing and not an improved alveolar ventilation. Moreover, there is little evidence that helium-oxygen could improve parameters of heterogeneity in such patients. Two RCTs were unable to demonstrate a reduction in the intubation rate in such setting, but they were likely underpowered. An adequately powered international multicentric study is ongoing and will help to determinate the exact place of the helium-oxygen mixture in the future. The place of the mixture during the weaning period will deserve further evaluation.

The present study aimed to compare muscle architecture and electromyographic activity during isotonic (IT) and isokinetic (IK) knee extensors eccentric contractions. Seventeen subjects were assigned in test and reproducibility groups. During test session, subjects performed two IT and two IK sets of eccentric contractions of knee extensor muscles. Torque, angular velocity, VL architecture and EMG activity of agonist (vastus lateralis, VL; vastus medialis; rectus femoris) and antagonist (semitendinosus; biceps femoris, BF) muscles were simultaneously recorded and averaged on a 5 window. Torque–angle and angular velocity–angle relationships exhibited differences in mechanical load between the IT and IK modes. Changes in muscle architecture were similar in both modes, since VL fascicles length increased and fascicle angle decreased, resulting in a decrease in muscle thickness during eccentric contraction. Agonist activity and BF co-activity levels were higher in IT mode than in IK mode at short muscle lengths, whereas agonist activity was higher in IK mode than in IT mode at long muscle lengths. Differences in mechanical load between both modes induced specific neuromuscular responses in terms of agonist activity and antagonist coactivity. These results suggest that specific neural adaptations may occur after IT or IK eccentric training. This hypothesis needs to be tested in order to gain new insights concerning the most effective eccentric protocols based on whether the objective is sportive or clinical.

International audience; PURPOSE: Diffusion tensor imaging (DTI) can provide quantitative information of brain abnormalities in patients with temporal lobe epilepsy (TLE) that are not detectable with conventional magnetic resonance imaging (MRI).METHODS: Seventeen patients with medically TLE were selected for the study. The patients and ten healthy subjects underwent 25 directions DTI acquisition. The patients were separated into two groups based on the MRI findings: eight TLE MRI-negative patients with no signal abnormalities on conventional MRI and nine TLE patients with hippocampal sclerosis (HS). Fractional anisotropy (FA), mean diffusivity (MD), and the three diffusivities (lambda(1), lambda(2) and lambda(3)) were measured in bilateral hippocampi of controls, MRI-negative, and HS patients. Comparisons between the three groups were performed for hippocampi ipsi- and contralateral to epileptogenic zone.RESULTS: The ipsilateral hippocampus of MRI-negative patients presented statistical increased anisotropy and no significant difference in diffusivities versus controls. Significant differences in anisotropy and diffusivities were detected between the ipsilateral hippocampus of HS when compared with controls.CONCLUSION: DTI depicted hippocampal abnormalities in TLE patients with a normal conventional MRI different from those found in patients with HS. Diffusivity and anisotropy indices provide significant differences inside hippocampus and should be jointly considered to improve the DTI measurements specificity in TLE patients.

International audience; BACKGROUND: Sudden cardiac death (SCD) is the predominant cause of mortality in patients with mild heart failure (HF). This 2-year follow-up, multicenter, cohort study aimed to assess the extent to which implantable cardioverter defibrillators (ICDs), by reducing SCD, lead to predominant progressive HF death in mildly symptomatic HF patients at baseline in daily medical practice. METHODS: Between June 2001 and June 2003, 1,030 New York Heart Association II patients received an ICD in 22 French centers. Sudden cardiac death and progressive HF mortality rates were assessed using competing risk methodology, and predictors for progressive HF at baseline were tested in a multivariate regression model. RESULTS: During a mean follow-up of 22 +/- 6 months, 114 deaths occurred: 12 (10.5%) due to SCD and 52 (45.6%) due to progressive HF (24-month cause-specific mortality rates of 1.2% [95% CI 0.6-1.9] and 5.4% [95% CI 4.0-6.8], respectively). Diuretics use (hazard ratio [HR] 2.8, 95% CI 1.5-5.5, P = .002), history of atrial fibrillation (HR 2.09, 95% CI 1.2-3.65, P = .01), and low ejection fraction (HR 2.7, 95% CI 1.4-4.8, P = .0008) were independent predictors for progressive HF death, whereas beta-blocker therapy was a protector (HR 0.6, 95% CI 0.3-0.9, P = .04). Half of the patients (48%) who died from progressive HF within 2 years of ICD implant initially presented with enlarged QRS (> or =120 milliseconds). CONCLUSIONS: Because of ICD efficiency, progressive HF is the main cause of death within 2 years of implant, although these patients are only mildly symptomatic at implantation. In addition to optimal pharmacologic therapy, these results raise the question of systematically implanting ICDs with cardiac resynchronization therapy in patients with electrical asynchronism at baseline.

International audience; A new device to study isoload eccentric exercise. J Strength Cond Res 24(X): 000–000, 2010—This study was designed to develop a new device allowing mechanical analysis of eccentric exercise against a constant load, with a view in mind to compare isoload (IL) and isokinetic (IK) eccentric exercises. A plate-loaded resistance training device was integrated to an IK dynamom-eter, to perform the acquisition of mechanical parameters (i.e., external torque, angular velocity). To determine the muscular torque produced by the subject, load torque was experimentally measured (T Lexp) at 11 different loads from 30° to 90° angle (0° = lever arm in horizontal position). T Lexp was modeled to take friction effect and torque variations into account. Validity of modeled load torque (T Lmod) was tested by determining the root mean square (RMS) error, bias, and 2SD between the descending part of T Lexp (from 30° to 90°) and T Lmod. Validity of T Lexp was tested by a linear regression and a Passing–Bablok regression. A pilot analysis on 10 subjects was performed to determine the contribution of the torque because of the moment of inertia to the amount of external work (W). Results showed the validity of T Lmod (bias = 0%; RMS error = 0.51%) and T Lexp SEM = 4.1 NÁm; Intraclass correlation coefficient (ICC) = 1.00; slope = 0.99; y-intercept = 20.13). External work calculation showed a satisfactory reproducibility (SEM = 38.3 J; ICC = 0.98) and moment of inertia contribution to W showed a low value (3.2 6 2.0%). Results allow us to validate the new device developed in this study. Such a device could be used in future work to study IL eccentric exercise and to compare the effect of IL and IK eccentric exercises in standardized conditions.

International audience; compliance in divers exposed to repeated hyperoxia using rebreather equipment. Aviat Space Environ Med 2009; 80: 482 – 4. Background: Acute hyperoxic exposure is known to modify cardio-vascular parameters like a decrease in cardiac output, arterial vasocon-striction, and autonomic nervous system changes. We hypothesized that repeated hyperbaric hyperoxic exposures, as experienced by military oxygen divers, lead to long-term arterial alterations. Methods: Arterial blood pressure measurements and pulse wave velocity (PWV) recordings were performed during basal conditions in 15 elite military oxygen divers, and compared to 15 non-diver controls. The two groups were matched appropriately for physical characteristics (age: 35 6 5 yr, weight: 77 6 8 kg, height: 177 6 6 cm, body mass index: 24.6 6 2.0 kg z m 2 2), and aerobic capacity (V O 2 max : 52 6 7 ml z min 2 1 z kg 2 1). Results: No signifi cant difference was found in systolic blood pressure (120 6 11 mmHg), dia-stolic blood pressure (70 6 8 mmHg), or pulse pressure (50 6 7 mmHg). Furthermore, there was no signifi cant difference in the carotid-femoral PWV (6.7 6 0.9 m z s 2 1), the carotid-radial PWV (8.7 6 1.7 m z s 2 1), or the carotid-pedal PWV (8.1 6 1.1 m z s 2 1) between divers and controls. Conclusion: No difference in arterial compliance was observed in physically well-trained military oxygen divers in comparison with matched controls.

International audience; This study was aimed at investigating whether repeated SCUBA diving might induce long term cardiovascular and autonomic modifications. In 11 military mine clearance diving students, arterial compliance (ultrasound scan study of brachial artery and ratio of stroke volume to pulse pressure: SV/PP), resting spectral analyses of heart rate and blood pressure variability, and a cold pressor test were performed before and after a 15-week military diving training course. After the diving training, arterial compliance was improved, as indicated by the significant increase in brachial arterial compliance (from 24+/-10 to 37+/-14 ml.mmHg (-1)) and SV/PP (from 1.7+/-0.2 to 1.9+/-0.2 ml.mmHg (-1)), and by the significant decrease in systolic, diastolic and pulse pressures (from 130+/-8 to 120+/-7; from 71+/-4 to 67+/-4; and from 58+/-8 to 53+/-5 mmHg, respectively). The peak oxygen uptake increased significantly from 54.3+/-2.0 to 56.8+/-4.0 mL.kg (-1).min (-1). Finally, the vasoconstrictive response during the cold pressor test increased (p

International audience; Background: The diving response includes cardiovascular adjustments known to decrease oxygen uptake and thus prolong apnea duration. As this diving response is in part characterized by a pronounced decrease in heart rate (HR), it is thought to be vagally mediated.Methods: In five professional breath-hold divers (BHDs) and fi ve less-trained controls (CTL), we investigated whether the diving response is in fact associated with an increase in the root mean square successive difference of the R-R intervals (RMSSD), a time-domain heart rate variability (HRV) index. HR behavior and arterial oxygen saturation (S a O 2) were continuously recorded during one maximal apnea. Short-term changes in S a O 2 , HR, and RMSSD were calculated over the complete apnea duration.Results: BHDs presented bi-phasic HR kinetics, with two HR decreases (32 6 17% and 20 6 10% of initial HR). The second HR decrease, which was concomitant to the pronounced S a O 2 decrease, was also simultaneous to a marked increase in RMSSD. CTL showed only one HR decrease (50 6 10% of initial HR), which appeared before the concomitant S a O 2 and RMSSD changes. When all subject data were combined, arterial desaturation was positively correlated with total apnea time (r 5 0.87, P , 0.01).Conclusion: This study indicates that barorefl ex stimulation and hypoxia may be involved in the bi-phasic HR response of BHDs and thus in their longer apnea duration.

The aim of this study was to analyse the effect of pedalling rate on the pattern of mechanical torque application and on neuromuscular fatigue during prolonged cycling exercise. Eleven well-trained individuals performed three 1-h pedalling sessions, at 50 rev.min-1, 110 rev.min-1 and a freely chosen cadence, at an intensity corresponding to 65% of their maximal aerobic power. The mechanical torque applied on the right pedal was recorded for 30 s every 5 min while pedalling. Contractile and neural properties of the quadriceps and hamstring muscles were analysed before and immediately after each of the three pedalling sessions. The post-exercise reduction in knee extensors maximal voluntary contraction was significant (P

Background—Progression of pulmonary hypertension (PH) is associated with increased lung expression of the serotonin transporter (5-HTT), which leads to hyperplasia of the pulmonary artery smooth muscle cells (PA-SMCs). Given the postulated causal relation between 5-HTT overexpression and PH, we herein investigated whether the highly selective 5-HTT inhibitor fluoxetine prevented and/or reversed PH induced by monocrotaline (MCT) in rats. Selective 5-HT1B/1D, 5-HT2A, and 5-HT2Breceptor antagonists were used for comparative testing.Methods and Results—MCT injection (60 mg/kg SC) was followed by an early peak in lung 5-HTT expression on day 1, which preceded the onset of PH. Established PH on day 15 was associated with a sustained 5-HTT increase. Continued fluoxetine treatment completely prevented PA-SMC proliferation and PH development and also suppressed the late 5-HTT increase, without affecting the early peak. The 5-HT receptor antagonists did not affect PH. Fluoxetine (10 mg · kg−1· d−1PO) started 3 weeks after MCT injection completely reversed established PH, normalizing PA pressure and structure. MCT-induced PH was also associated with increased expression of various cytokines, but only interleukin-1β and monocyte chemotactic protein-1 increased at the early phase and stimulated 5-HTT expression by cultured PA-SMCs.Conclusion—Upregulation of lung 5-HTT induced by MCT appears necessary to initiate the development of pulmonary vascular remodeling, whereas a sustained increase in 5-HTT expression may underlie both the progression and the maintenance of MCT-induced PH. Complete reversal of established PH by fluoxetine provides a rationale for new therapeutic strategies in human PH.

Purpose Onycholysis and skin toxicity occur in approximately 30% of patients treated with docetaxel. We investigated the efficacy and safety of an Elasto-Gel (84400 APT Cedex, Akromed, France) frozen glove (FG) for the prevention of docetaxel-induced onycholysis and skin toxicity. Patients and Methods Patients receiving docetaxel 75 mg/m2 alone or in combination chemotherapy were eligible for this case-control study. Each patient wore an FG for a total of 90 minutes on the right hand. The left hand was not protected and acted as the control. Onycholysis and skin toxicity were assessed at each cycle by National Cancer Institute Common Toxicity Criteria and documented by photography. Wilcoxon matched-pairs rank test was used. Results Between August 2002 and September 2003, 45 patients were evaluated. Onycholysis and skin toxicity were significantly lower in the FG-protected hand compared with the control hand (P = .0001). Onycholysis was grade (G) 0 in 89% v 49% and G1 to 2 in 11% v 51% for the FG-protected hand and the control hand, respectively. Skin toxicity was G0 in 73% v 41% and G1 to 2 in 27% v 59% for the FG-protected and the control hand, respectively. Median time to nail and skin toxicity occurrence was not significantly different between the FG-protected and the control hand, respectively (106 v 58 days for nail toxicity; 57 v 58 days for skin toxicity). Five patients (11%) experienced discomfort due to cold intolerance. Conclusion FG significantly reduces the nail and skin toxicity associated with docetaxel and provides a new tool in supportive care management to improve a patient's quality of life.

The present study deals with the question whether 24-week strength training alters neuromechanical properties of plantar flexors in elderly people (73-83 years). The first purpose of the present study was to evaluate the effect of strength training on musculotendinous (MT) stiffness of the triceps surae (TS). The training was performed twice per week and mainly consisted of three series of ten repetitions of calf-rise and leg-press exercises at 75% of the three-repetition maximum. Using quick-release movements at different levels of submaximal torques performed measurements of MT stiffness. Surface electromyograms (EMG) of each part of the TS and the tibialis anterior were also recorded. A stiffness index (SI), defined as the slope of the angular stiffness-torque relationship (SI(MT-Torque)), was used to quantify changes in MT stiffness. Results showed a significant decrease in SI(MT-Torque) by 25.2% following training (P < 0.05). The second purpose of the study was to evaluate whether neural mechanism has influences on this decrease. Therefore, an activation SI, defined as the slope of the angular stiffness-EMG relationship (SI(MT-EMG)) was used to overcome the influence of changes in agonist activity, and thus to quantify changes in MT intrinsic elastic properties. SI(MT-EMG) only decreased by 11.2% following training (P < 0.05). The present results underlined that MT stiffness decreases following training in elderly individuals, counterbalancing the effect of ageing. These changes seem not only to be due to peripheral but also to neural adaptations.

International audience; Background: PSA DT has been reported as a prognostic factor in prostate cancer patients (pts) who relapse after radical prostatectomy, radiation or hormonal therapy. The rate at which the PSA is rising is known to correlate with cancer aggressiveness. We evaluated the interest of the initial PSA DT value, before start of chemotherapy (CT), as a surrogate end point for survival of metastatic HRPC pts. Methods: PSA DT was calculated as log x 2 divided by the slope of the log PSA line (the difference in the 2 log PSA values divided by the time between). A minimum of three PSA measurements were required, maximum three months before start of CT. The primary outcome measure was overall survival. Differences in survival rates and PSA DT were calculated using the log-rank and Cox hazard regression methods, stratified according to CT regimen. All statistical tests were two-sided. Hazard ratio (HR) and relative risk reduction were also estimated with 95% confidence interval (CI). Results: A retrospective analysis was performed on 202 metastatic HRPC pts, registered from June 1999 to July 2004 in a single institution. Pts received as first-line CT: docetaxel- (77%) or mitoxantrone (23%) based regimen. The median PSA DT value was 44 days (range 5-1028 days) and median interval between two consecutive PSA determinations before CT (used tu estimate the PSA DT) was 21 days. Overall, there were 124 deaths (61%). Median survival was 14.3 months (95% CI, 10.5 to 18 months) for pts with PSA DT < 44 days vs 25.6 months (95% CI, 16.3 to 34.9 months) for pts with PSA DT > 44 days. There were significant differences between survival distributions of PSA DT categories (log-rank, p=0.006), independently of CT regimen. The stratified HR was 0.61 (95% CI, 0.43 to 0.87) with a relative risk reduction of 39% (95% CI, 13% to 57%). Conclusions: A low PSA DT before onset of CT in HRPC pts was associated with an increased risk of death. This parameter could be a potential auxiliary end point in the evaluation of new cytotoxic drugs in metastatic HRPC setting. These data may be also useful in the design of clinical trials and the identification of men for enrolment into experimental protocols.