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A 28-year-old woman presented with complaints of breathlessness on exertion NYHA class II and palpitations for the past 2 years. On examination she had irregularly irregular pulse and mid-diastolic murmur at the apex. An ECG revealed atrial fibrillation with controlled ventricular rate. Her

Long-standing research in animal models and humans with stroke or incomplete spinal cord injury (iSCI) indicate that specific physical training variables, such as the specificity and amount of practice, may influence neurologic recovery and locomotor function. More recent data highlight the contributions of exercise intensity, as estimated indirectly by cardiovascular exertion, as potentially more important than previously considered. The effects of exercise intensity are well described in neurologically intact individuals, although confusion regarding the definitions of intensity and safety concerns have limited its implementation during physical rehabilitation of patients with neurologic injury. The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can influence locomotor function after neurologic injury. To extend these findings, we describe previous attempts to implement moderate to high intensity interventions during physical rehabilitation of patients with neurologic injury, including the utility of specific strategies to facilitate implementation, and to navigate potential barriers that may arise during implementation efforts.

A 37-year-old man presented to the ENT outpatient clinic with progressive dysphagia and breathlessness on exertion for a year. The patient was tachypnoeic, with mild inspiratory stridor and orthopnoea. The neck had a generalised swelling, but no mass was clinically palpable. Indirect laryngoscopy

An 84-year-old woman with a history of hypertension, diabetes mellitus, dyslipidaemia and aortic stenosis (AS) was referred to our hospital for transcatheter aortic valve implantation (TAVI). She occasionally recognised dyspnoea on exertion for the last 2 years, but she had no symptoms of chest pain

We herein report a 66-year-old man with locally advanced non-small-cell lung cancer (NSCLC) who developed durvalumab-associated myocarditis. The patient underwent durvalumab administration every two weeks following concurrent chemoradiotherapy (CCRT), without any adverse events or apparent disease progression. He presented with fatigue and dyspnea on exertion seven months after the first administration. Myocarditis was suspected based on laboratory data, an electrocardiogram, echocardiography, and magnetic resonance imaging findings. The definitive diagnosis was confirmed by a myocardial biopsy. Myocarditis was alleviated by cessation of durvalumab and corticosteroid therapy. This is a noteworthy case to describe late-onset myocarditis following the administration of durvalumab for NSCLC.

IntroductionTo train and prepare cadets for a career as firefighters in Rio de Janeiro, the second-year students of the Officers Training Course are submitted to a Search, Rescue, and Survival Training (SRST) course, which is characterized by long periods of high physical exertion and sleep restriction during a 9-day instruction module, and food restriction during a 7-day survival module. The present study investigated changes in the body composition of 39 male cadets submitted to SRST during training and 4 weeks of recovery with no restrictions in food consumption.Materials and MethodsEach cadet was evaluated by anthropometric measurements at six time points: pre-SRST; after the first module; after the second module; and after 1, 2, and 4 weeks of recovery. Measurements included body girths and skinfolds, to estimate trunk (chest and waist) and limbs (arm and thigh) dimensions, as well as body composition. Repeated measures ANOVA and Friedman test were applied (depending on each data distribution).ResultsStatistically significant decreases in body weight (76.2; 69.8-87.2 to 63.9; 58.9-73.5 kg) and fat free mass (FFM, 69.2; 63.7-77.2 to 60.1; 56.2-68.0 kg) were observed following the second module of SRST. Following a single week of recovery, the FFM returned to pre-SRST values. Body weight returned to pre-training levels in 2 weeks. Body fat percentage and mass also significantly decreased during SRST (9.0; 7.7-12.3 to 6.5; 5.1-9.3% and 6.9; 5.6-10.0 to 6.9; 5.6-10.0 kg, respectively), which showed a slower and more gradual recovery that reached pre-SRST values after 4 weeks. The girths of arm, thigh, chest and waist significantly decreased due to SRST. The girths of the limbs (arm and thigh) returned to pre-training values after one month of recovery, while the girths of the trunk (chest and waist) did not return to pre-SRST values during the study period.ConclusionsThe findings suggest that men who experience periods of high energy demands and sleep restriction followed by a period of food restriction will endure unavoidable physical consequences that can be mostly reversed by a 1-month recovery.

Relevance. Assessment of the functional state of the body is one of the leading tasks of physiology. The article deals with the analysis of the initial vegetative status of students with different levels of motor activity. Materials and Methods. Registration and analysis of the heart rate variability was carried out with the help of a modern complex electrophysiological laboratory CONAN - 4.5. The heart activity of students engaged in physical culture within the educational process was evaluated on the basis of heart rate variability analysis. Results and Discussion. It was revealed that among the entire studied array of students (with the differentiation of the initial vegetative status calculated according to muscle tension index), normotonics are characterized by an optimal ratio between the parasympathetic and sympathetic divisions of the autonomic nervous system. At the same time, the value of the coefficient of physical activity in the studied group was determined at the level of 1.730.1. Conclusion. For vagotonics, the value of the triangular index was 2.50.2 conventional units (CU), which confirms the idea of an increase in the influence on the autonomic nervous system. The value for normotonics is 2.20.1 CU. This group was characterized by the balance between the sympathetic and parasympathetic parts of the autonomic nervous system. In sympathicotonics - 1.90.5 CU, which confirms the idea of increasing the influence of the sympathetic division of the autonomic nervous system. In hypersympathicotonics-1.10.4 CU. To ensure adequate functioning of the cardiovascular system and for normal adaptation to physical exertion in students, it is necessary to form a level of motor activity that quantitatively corresponds to a coefficient of physical activity of at least 1.75.

A 47-year-old man presented with problems of progressive abdominal distension for 3 months, associated with dull aching abdominal pain, increasing with food intake. He gave a 1-month history of shortness of breath on exertion and swelling of the lower limbs. On examination, he was pale and

ObjectiveInvestigate whether resuming physical activity (PA) at 72 hours post concussion is safe and reduces symptoms at 2 weeks, compared with resting until asymptomatic.MethodsReal-life conditions, multicentre, single-blinded randomised clinical trial, conducted in three Canadian paediatric emergency departments (ED). Children/youth aged 10–Results456 randomised participants (EG: N=227; mean (SD) age=13.3 (2.1) years; 44.5% women; CG: N=229; mean (SD) age=13.3 (2.2) years; 43.7% women) were analysed. No AE were identified. ITT analysis showed no strong evidence of a group difference at 2 weeks (adjusted mean difference=−1.3 (95% CI:−3.6 to 1.1)). In adherent participants, initiating PA 72 hours post injury significantly reduced symptoms 2 weeks post injury, compared with rest (adjusted mean difference=−4.3 (95% CI:−8.4 to –0.2)).ConclusionSymptoms at 2 weeks did not differ significantly between children/youth randomised to initiate PA 72 hours post injury versus resting until asymptomatic; however, many were non-adherent to the intervention. Among adherent participants, early PA was associated with reduced symptoms at 2 weeks. Resumption of PA is safe and may be associated with milder symptoms at 2 weeks.Level of evidence1b.Trial registration numberNCT02893969.Registry namePediatric Concussion Assessment of Rest and Exertion (PedCARE).

NEW FINDINGS: What is the central question of this study? Are chronotropic responses to a 6-minute walk test different in women with post-acute coronavirus disease 2019 (COVID-19) syndrome compared with control subjects? What is the main finding and its importance? Compared with control subjects, the increase in heart rate was attenuated and recovery delayed after a 6-minute walk test in participants after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Women reporting specific symptoms at time of testing had greater impairments compared with control subjects and SARS-CoV-2 participants not actively experiencing these symptoms. Such alterations have potential to constrain not only exercise tolerance but also participation in free-living physical activity in women during post-acute recovery from COVID-19. ABSTRACT: The short-term cardiopulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well defined. However, the implications of cardiopulmonary sequelae, persisting beyond acute illness, on physical function are largely unknown. Herein, we characterized heart rate responses to and recovery from a 6-minute walk test (6MWT) in women ∼3 months after mild-to-moderate SARS-CoV-2 infection compared with non-infected control subjects. Forty-five women (n = 29 SARS-CoV-2; n = 16 controls; age = 56 ± 11 years; body mass index = 25.8 ± 6.0 kg/m2 ) completed pulmonary function testing and a 6MWT. The SARS-CoV-2 participants demonstrated reduced total lung capacity (84 ± 8 vs. 93 ± 13%; P = 0.006), vital capacity (87 ± 10 vs. 93 ± 10%; P = 0.040), functional residual capacity (75 ± 16 vs. 88 ± 16%; P = 0.006) and residual volume (76 ± 18 vs. 93 ± 22%; P = 0.001) compared with control subjects. No between-group differences were observed in 6MWT distance (P = 0.194); however, the increase in heart rate with exertion was attenuated among SARS-CoV-2 participants compared with control subjects (+52 ± 20 vs. +65 ± 18 beats/min; P = 0.029). The decrease in heart rate was also delayed for minutes 1-5 of recovery among SARS-CoV-2 participants (all P

Background:Vascular rings cause respiratory symptoms in children. Treatment consists of surgical division; however, data regarding mid-term results are scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery.Methods:Retrospective chart review of consecutive patients who underwent vascular ring surgery. Mid-term follow-up consisted of clinic visits and telephone questionnaire over a 1-year period sampling at five points in time.Results:Follow-up of 85 patients who underwent vascular rings surgery revealed significant symptomatic improvement within 6 months. In total, 50% were symptomatic to some degree at their last documented clinic visit complaining of stridor (36.8%), cough (34.2%), wheezing (10.5%), dyspnoea on exertion (10.5%), or recurrent respiratory infections (23.7%). By telephone questionnaires, 83% described a significant improvement in respiratory symptoms, 63.4% had some residual symptoms, 36.6% stridor, 38.8% chronic cough, 32.4% bronchodilator use,18.3% had at least one episode of pneumonia per year, 31% of children had dyspnoea or respiratory limitation, and 12.7% while doing physical activities. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up.Conclusions:Surgical division of vascular rings results in significant clinical improvement within 1 year; nevertheless, some patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. Further evaluation is warranted to assess the nature of residual symptoms and explore whether anatomical causes can be identified leading to surgical modifications.

Introduction: Paramedic duties include assessing, treating, and maneuvering patients in physically challenging environments. Whether clinical skills and patient care are affected by these occupational demands is unknown. High-fidelity simulation affords the opportunity to study this in a controlled setting. Methods: Using a randomized crossover design, 11 regional paramedicine students and graduates (mean ± SD age = 23 ± 2 years) completed two, 20-minute high-fidelity simulations that included cardiopulmonary resuscitation (CPR) immediately after either an acute bout of occupational physical activity (OPA) or a rest period (REST). Heart rate, respiratory rate, and mean arterial pressure were measured throughout. Clinical performance was scored using the Global Rating Score and a patient care record. Measures of CPR efficacy were recorded in the manikin. Results: There were no significant differences in Global Rating Score (P = 0.07, ES = 0.03) or CPR efficacy between conditions. Patient care record accuracy was higher after the OPA versus REST simulations (mean ± SD = 61.8 ± 12.6% vs. 55.5 ± 12.0%, P = 0.03, ES = 0.5). Mean heart rate was higher during OPA simulations versus REST simulations (121 ± 14 vs. 84 ± 9 beats per minute, P < 0.01, ES = 3.1), as was mean respiratory rate (19 ± 3 vs. 16 ± 3 breaths per minute, P < 0.01, ES = 1.0). Mean arterial pressure was higher for OPA versus REST at simulation start (105 ± 11.3 vs. 95.8 ± 11.8 mm Hg, P = 0.01, Effect Size = 0.8), although not different after simulation. Conclusions: Paramedicine students including recent graduates performed as well, or better, in a simulated clinical scenario immediately after occupation-specific acute physical exertion compared with a REST, despite higher physiological exertion. Whether this is the case for more experienced but potentially less physically fit paramedics in the workforce warrants investigation.

The current study set out to determine the effect of diving on several physiological variables and stem cells in commercial divers for various years. Twelve divers and six non-divers were divided into three groups: 11 non-divers (1st group), two divers with a diving history of 5-6 years (2nd group), and three divers with a diving history of 9-10 years (3rd group). Physiological measurements of pulse, blood pressure, dynamic breathing functions, stem cells CD34+, and cortisol were performed before and after physical exertion during a day dive at a depth of 25-30 meters in the pressure room. The results showed a significant difference in pulse, blood pressure, stem cells, and cortisol, while no change in dynamic breathing functions after exertion. Further, diving for different years may positively affect biological changes of stem cells CD34+ in the adaptation process but may harm dynamic breathing functions. Therefore, periodic lung function evaluation should be encouraged to check for potential harm to divers. In our conclusion, diving for different years may have a positive effect on biological changes of stem cells CD34+ in the adaptation process, while a negative effect may be induced in a dynamic breathing function. Periodic lung function evaluation should be encouraged to monitor potential harm to the divers.

Study design Cross-sectional cohort study. Objectives To compare ratings of perceived exertion (RPE) on Borg’s 6–20 RPE scale and Category Ratio 10 (CR10) in able-bodied (AB) participants during upper and lower body exercise, and recreationally active participants with paraplegia (PARA) and athletes with tetraplegia (TETRA) during upper body exercise only. Setting University and rehabilitation centre-based laboratories in UK and Netherlands. Methods Twenty-four participants were equally split between AB, PARA, and TETRA. AB performed maximal tests using cycle (AB-CYC) and handcycle (AB-HC) ergometry. PARA and TETRA performed maximal handcycle and wheelchair propulsion tests, respectively. Oxygen uptake (V̇O2) and blood lactate concentration were monitored throughout. RPE was rated each stage on Borg’s RPE scale and CR10. Thresholds were identified according to log-V̇O2 plotted against log-blood lactate (LT1), and 1.5 mmol L−1 greater than LT1 (LT2). Results RPE from both scales were best fit against each other using a quadratic model, with high goodness of fit between scales that was independent of exercise mode and participant group (range R2: 0.965–0.970, P 2 was significantly greater in TETRA (P 1 or LT2 between groups on Borg’s RPE scale or CR10. Conclusion Strong association between Borg’s RPE scale and CR10 suggests they can be used interchangeably. RPE at lactate thresholds were independent of mode of exercise and level of spinal cord injury. However, inter-individual variation precludes from making firm recommendations about using RPE for prescribing homogenous exercise intensity.

A man in his 60s was hospitalised for dyspnoea with minimal exertion and at rest. His medical history includes hypertension, non-ischaemic cardiomyopathy, left bundle branch block and congestive heart failure (HF). He had received a cardiac resynchronisation therapy implantable cardioverter-defibrillator (CRT-D) 2 years prior to the current admission, with initial improvement in symptoms, after which he was lost for follow-up. He is currently on a medical regimen that includes a β-blocker, a loop diuretic and an angiotensin receptor blocker. Physical exam reveals elevated jugular venous pressure, crackles at both bases and a third heart sound. The chest X-ray (CXR) is …

Purpose: We investigated whether varying the number of repetitions of high-intensity exercise during work-matched warm-ups modulates physiological responses (heart rate, metabolic responses, and core temperature), perceptions (ratings of perceived exertion, effort of breathing), readiness for exercise, and short-term exercise performance. Methods: Ten physically active young males performed a 30-s Wingate anaerobic test (WAnT) following a warm-up consisting of submaximal constant-workload cycling at 60% maximal oxygen uptake with no high-intensity cycling (constant-workload warm-up) or with 1, 4, or 7 repetitions of 10 s of high-intensity cycling at 110% maximal oxygen uptake. All warm-ups were matched for duration (10 min) and total work. Results: Warm-ups with seven repetitions of high-intensity cycling resulted in higher ratings of perceived whole-body exertion and effort of breathing than the constant-workload warm-up. Warm-up with four repetitions of high-intensity cycling produced greater readiness for a 30-s WAnT (7.33 ± 0.73 AU) than the constant-workload warm-up (6.33 ± 0.98 AU) (P = .022). Physiological responses did not differ among the four warm-up conditions, though peak heart rate was slightly higher (~5 beats/min) during warm-up with four or seven repetitions of high-intensity cycling than during the constant-workload warm-up. Peak, mean, and minimum power output during the 30-s WAnT did not differ among the four warm-up conditions. Conclusions: These results suggest that the effects of warm-ups with intermittent high-intensity exercise on physiological responses and short-term high-intensity exercise performance do not greatly differ from a warm-up with a work-matched submaximal constant-workload. However, they appear to modulate perceptions and readiness as a function of the number of repetitions of the high-intensity exercise.

Introduction Members of the Canadian Armed Forces (CAF) are required to meet the minimum standards of the Fitness for Operational Requirements of CAF Employment (FORCE) job-based simulation test (JBST) and must possess the capacity to perform other common essential tasks. One of those tasks is to perform basic fire management tasks during fire emergencies to mitigate damage and reduce the risk of injuries and/or death until professional firefighters arrive at the scene. To date however, the physiological demands of common firefighting tasks have mostly been performed on professional firefighters, thus rendering the transferability of the demands to the general military population unclear. This pilot study aimed to quantify, for the first time, the physiological demands of basic fire management tasks in the military, to determine if they are reflected in the FORCE JBST minimum standard. We hypothesized that the physiological demands of basic fire management tasks within the CAF are below the physiological demands of the FORCE JBST minimum standard, and as such, be lower than the demands of professional firefighting. Materials and methods To achieve this, 21 CAF members (8 females; 13 males; mean [SD] age: 33 [10] years; height: 174.5 [10.5] cm; weight: 85.4 [22.1] kg, estimated maximal oxygen uptake [$\dot V$O2peak]: 44.4 (7.4) mL kg−1 min−1) participated in a realistic, but physically demanding, JBST developed by CAF professional firefighting subject matter experts. The actions included lifting, carrying, and manipulating a 13-kg powder fire extinguisher and connecting, coupling, and dragging a 38-mm fire hose over 30 m. The rate of oxygen uptake ($\dot V$O2), heart rate, and percentage of heart rate reserve were measured continuously during two task simulation trials, which were interspersed by a recovery period. Rating of perceived exertion (6-no exertion; 20-maximal exertion) was measured upon completion of both task simulations. Peak $\dot V$O2 ($\dot V$O2peak) was estimated based on the results of the FORCE JBST. Results The mean (SD) duration of both task simulation trials was 3:39 (0:19) min:s, whereas the rest period in between both trials was 62 (19) minutes. The mean O2 was 21.1 (4.7) mL kg−1 min−1 across trials, which represented 52.1 (12.2) %$\dot V$O2peak and ∼81% of the FORCE JBST. This was paralleled by a mean heart rate of 136 (18) beats min−1, mean percentage of heart rate reserve of 61.2 (10.8), and mean rating of perceived exertion of 11 ± 2. Other physical components of the JBST consisted of lifting, carrying, and manipulating a 13-kg load for ∼59 seconds, which represents 65% of the load of the FORCE JBST. The external resistance of the fire hose drag portion increased up to 316 N, translating to a total of 6205 N over 30 m, which represents 96% of the drag force measured during the FORCE JBST. Conclusions Our findings demonstrate that the physiological demands of basic fire management tasks in the CAF are of moderate intensity, which are reflected in the CAF physical fitness standard. As such, CAF members who achieve the minimum standard on the FORCE JBST are deemed capable of physically performing basic fire management tasks during fire emergencies.

The Indian population is predisposed to acute coronary syndrome at a younger age, but very few cases are reported at high altitude. Acute coronary syndrome is frequently associated with multiple cardiovascular risk factors. During management of seven young patients with acute coronary syndrome, it was found that none of them had conventional cardiovascular risk factors including recent physical exertion. It is a known fact that the risk of vascular thrombosis increases by 30 times in Indian soldiers after a long stay at high altitude. Therefore, it is necessary to carry out the tests for procoagulant markers to know whether the acute coronary syndrome was because of the prothrombotic state, and if yes, was high altitude responsible for the procoagulant state or whether the person per se had a procoagulant syndrome. With the absence of these tests at hospitals at high-altitude areas, it becomes difficult to ascertain the exact cause of acute coronary syndrome. This study highlights the importance of aggressively testing for procoagulant markers in young patients presenting with chest pain at high altitude, even in the absence of traditional risk factors.

Supplemental digital content is available in the text., Objective This report describes persistent symptoms associated with post-acute COVID-19 syndrome (PACS) and the impact of these symptoms on physical function, cognitive function, health-related quality of life, and participation. Design This study used a cross-sectional observational study design. Patients attending Mount Sinai’s post-acute COVID-19 syndrome clinic completed surveys containing patient-reported outcomes. Results A total of 156 patients completed the survey, at a median (range) time of 351 days (82–457 days) after COVID-19 infection. All patients were prevaccination. The most common persistent symptoms reported were fatigue (n = 128, 82%), brain fog (n = 105, 67%), and headache (n = 94, 60%). The most common triggers of symptom exacerbation were physical exertion (n = 134, 86%), stress (n = 107, 69%), and dehydration (n = 77, 49%). Increased levels of fatigue (Fatigue Severity Scale) and dyspnea (Medical Research Council) were reported, alongside reductions in levels of regularly completed physical activity. Ninety-eight patients (63%) scored for at least mild cognitive impairment (Neuro-Qol), and the domain of the EuroQol: 5 dimension, 5 level most impacted was Self-care, Anxiety/Depression and Usual Activities. Conclusions Persistent symptoms associated with post-acute COVID-19 syndrome seem to impact physical and cognitive function, health-related quality of life, and participation in society. More research is needed to further clarify the relationship between COVID-19 infection and post-acute COVID-19 syndrome symptoms, the underlying mechanisms, and treatment options.

Context After a sport-related concussion, many athletes experience persisting neurophysiological alterations. These alterations may be absent at rest but emerge during moments of physiological stress. Unnoticed and untreated neurophysiological dysfunction may negatively affect long-term neurologic health in adolescent athletes, as they are at a critical point in development. Objective To assess cardio-autonomic functioning in athletes with and those without a history of concussion by quantifying measures of heart rate variability (HRV) during times of physical and mental exertion. Design Case-control study. Setting Research laboratory. Patients or Other Participants Thirty-four male Hockey Quebec Midget-AAA hockey players were separated into those with (n = 16; age = 16.06 ± 0.73 years, body mass index = 23.29 ± 1.79) and those without (n = 18; age = 15.98 ± 0.62 years, body mass index = 23.60 ± 2.49) a history of concussion. Intervention(s) All athletes underwent a series of HRV recording sessions (1) at rest, (2) while completing a cognitive task at rest, and (3) while completing a cognitive task after a bout of submaximal aerobic exercise. Main Outcome Measure(s) Time-domain measures of HRV, including mean NN intervals, SD of NN intervals, and root mean square of successive NN interval differences, were quantified for each assessment. Results No differences in characteristics were evident between groups. No between-groups differences in HRV at rest were observed. However, during the cognitive task at rest and after aerobic exercise, athletes with a history of concussion demonstrated a higher SD of NN intervals (78.1 ± 4.3 versus 63.2 ± 4.1 milliseconds and 71.2 ± 4.3 versus 65.2 ± 3.8 milliseconds, respectively; F1,31 = 4.31, P = .046) and root mean square of successive NN interval differences (75.8 ± 6.0 versus 59.0 ± 5.6 milliseconds and 74.0 ± 5.5 versus 59.0 ± 5.2 milliseconds, respectively; F1,31 = 4.88, P = .04) than athletes without a history of concussion. Conclusions Concussive injuries may result in long-term cardio-autonomic dysfunction. These deficits may not be present at rest but may be triggered by physiological stress.

Introduction. At present, the patterns of changes in the levels of biomarkers and the relationship of changes in their values with the pathogenesis of diseases caused by the impact of adverse factors of labour activity are not sufficiently studied. The most unresolved issues are the choice of informative laboratory indicators and diagnostic test systems in investigating the impact of physical factors on the working environment (vibration and physical overload) neurohumoral regulation: pituitary-adrenal pituitary-thyroid, pituitary-gonadal system and hormonal indicators of carbohydrate metabolism. The aim of the study was to determine diagnostic hormonal markers and integral indices to identify early changes in the neurohumoral status in the body of workers under the influence of working environment factors. Materials and methods. 330 workers of mining and machine-building enterprises were examined. Of these, 128 people with vibration disease, 45 people - with lumbosacral radiculopathy, combined pathology (vibration disease and lumbosacral radiculopathy) was detected in 60 persons. The preclinical stage (initial signs of diseases) was noted in 97 workers. Laboratory studies included hormones and integral indices of the pituitary-adrenal, pituitary-thyroid, pituitary-gonadal system, carbohydrate metabolism. To select the diagnostic significance of laboratory biomarkers, diagnostic sensitivity, prenosological value, pathognomonicity, direction, severity, and selectivity of changes in biomarker levels were evaluated. Results. The combined effect of vibration and physical overload on the body of workers was found to have a unidirectional and systemic impact on the levels of hormones of the pituitary-adrenal, pituitary-thyroid and pituitary-gonadal systems, increases insulin resistance. The severity of changes in neurohumoral regulation indicators depends on the nature and severity of the occupational neurological disease. The highest diagnostic sensitivity (Df = 72–74%) in vibration disease and its combination with lumbosacral radiculopathy was obtained for pituitary-gonadal hormones and indicators of insulin resistance. The lowest values of Dh are typical for the hormones of the pituitary-thyroid system (no more than 14%). To identify early changes in neurohumoral regulation in the body under the influence of vibration and physical exertion, it is most informative to determine the concentration of total testosterone, luteinizing hormone and insulin, as well as the integral pituitary-adrenal index, insulin resistance indices. To identify hidden disorders of the pituitary-thyroid system, the definition of the essential thyroid index can be used. Discussion. The results obtained allowed us to assess the nature of changes in the levels of hormones of the pituitary-adrenal, pituitary-thyroid and pituitary-gonadal systems and carbohydrate metabolism and to propose informative laboratory biomarkers reflecting early changes in neurohumoral regulation under the influence of physical factors of the working environment. Conclusions. To identify early changes in neurohumoral regulation in the body of workers under the influence of vibration and physical exertion, the most informative is the determination of the concentration of total testosterone, luteinizing hormone and insulin, the integral pituitary-adrenal index, and insulin resistance indices. To identify hidden disorders of the pituitary-thyroid system, the definition of the integral thyroid index can be used. Conflict of interest. The authors declare no conflict of interest. Acknowledgement. The study had no sponsorship.

Introduction: Severe Acute Respiratory Infection (SARI) is a disease of the respiratory system. It is a symptomatic disease with different types of causative agent, and whose definite treatment and cure depends on the type of pathogens, nature of onset, severity of symptoms and the host factors [1]. SARI is one of the major leading cause of disease among children and person with suppressed immunity. The National Health Profile 2019 recorded 41,996,260 cases and 3,740 deaths from Severe Acute Respiratory Infection (SARI) across India in 2018. In 2017, acute respiratory infections accounted for 69% of the total cases of communicable diseases and caused 23% of such death. There were as many as 40,810,524 and 3,164 deaths from such infections. Males and females are affected equally [2]. Case Presentation: A female patient of 72 years from Bodhadi, Kinwat, Nanded was admitted to Medicine Intensive Care Unit (MICU), Acharya Vinoba Bhave Rural Hospital on 26th March 2021 with a chief complaint of breathlessness on exertion for 4 days high grade fever for 15 days prior to the date of admission. My patient is a known case of Hypertension and Typhoid and had undergone Left Nephrectomy.

Context: The rating of perceived effort (RPE) is a common method used in clinical practice for monitoring, loading control, and resistance training prescription during rehabilitation after rupture and anterior cruciate ligament reconstruction (ACLR). It is suggested that the RPE results from the integration of the afferent feedback and corollary discharge in the motor and somatosensory cortex, and from the activation of brain areas related to emotions, affect, memory, and pain (eg, posterior cingulate cortex, precuneus, and prefrontal cortex). Recent studies have shown that rupture and ACLR induce neural adaptations in the brain commonly associated with the RPE. Therefore, we hypothesize that RPE could be affected because of neural adaptations induced by rupture and ACLR. Study Design: Clinical review. Level of Evidence: Level 5. Results: RPE could be directly altered by changes in the activation of motor cortex, posterior cingulate cortex, and prefrontal cortex. These neural adaptations may be induced by indirect mechanisms, such as the afferent feedback deficit, pain, and fear of movement (kinesiophobia) that patients may feel after rupture and ACLR. Conclusion: Using only RPE for monitoring, loading control, and resistance training prescription in patients who had undergone ACLR could lead to under- or overdosing resistance exercise, and therefore, impair the rehabilitation process. Strength-of-Recommendation Taxonomy: 3C.

Purpose: to investigate the characteristics of carbohydrate metabolism indicators in patients with metabolic syndrome before the beginning of rehabilitation effects as well as to trace the dynamics of indicators in the process of application of our physical therapy comprehensive program. Material and methods. The survey involved 70 women with metabolic syndrome, who were divided into the main (MG) (35 women) and control (CG) (35 women) groups with the average age in the MG 31.49±0.71-year-olds, in the CG – 31,06±0,57 -year-old. In the main group, a physical therapy program was applied for patients with metabolic syndrome, which includes a hypo caloric diet with a hypolipidemic focus; therapeutic massage according to the method of P.B. Efimenko for patients alimentary-constitutional obesity; medical gymnastics using elements of sports-oriented aerobics and special physical exercises based on Pilates gymnastics using fitballs and expanders; morning hygienic gymnastics; limited walking in combination with breathing exercises, taking into account the activity of the autonomic nervous system. Result. As a result of a comprehensive and developed physical therapy program that was justified and applied for 4 months for patients with metabolic syndrome, the studied carbohydrate metabolism parameters changed significantly. Main group women showed significantly improved indicators of glycemia on empty stomach: from 8,85±1,54 to 5,98±0,81mmol / l, glycemia after eating: from 11,47±1,85 to 7,68±0,86mmol / l and reached the target levels of diabetes compensation and diagnostic criteria for the metabolic syndrome. Conclusions: physical exercises contribute to the improvement and normalization of carbohydrate metabolism. They restore adaptation to physical exertion and normalize the function of the cardiovascular system, motor activity and psychoemotional state as well.

The Buffalo Concussion Treadmill Test (BCTT) is a safe and validated tool to assess exercise tolerance after sport-related concussion (SRC). Sex differences may affect the interpretation of this systematic exertion test in the concussed population, which is important for clinicians. The purpose of this study was to examine sex differences in BCTT performance in adolescents with acute SRC.Prospective cohort.Male (n = 103, 15.3 ± 2 years) and female (n = 87, 15.1 ± 2 years) adolescents with SRC performed the BCTT within 10 days of injury. Heart rate (HR), HR threshold (HRt), Delta HR (difference between resting HR and HRt), symptom severity on Visual Analog Scale (VAS) and symptoms exacerbated on the BCTT were collected and compared.Males had lower resting HR (M: 70.9 ± 12 vs F: 75.7 ± 13 bpm, p 0.01) and reached a lower HRt than females (M: 134.7 ± 23 vs F: 141.5 ± 25 bpm, p = 0.05). Sexes did not differ on Delta HR (M: 63.8 ± 26 vs F: 65.9 ± 24 bpm, p = 0.57), total treadmill time (M: 9.3 ± 5 vs F: 8.4 ± 4 min, p = 0.20), maximum VAS (M: 5.0 ± 2 vs F: 5.4 ± 2, p = 0.18) or incidence of a change in VAS (M: 91% vs F: 94%, p = 0.43) on the BCTT.Although males may reach symptom exacerbation at a slightly lower mean HRt than females on the BCTT within 10 days of SRC, the BCTT provides comparable information and both sexes reach symptom exacerbation at similar Delta HR.

Motivational symptoms such as anergia, fatigue, and reduced exertion of effort are seen in depressed people. To model this, nucleus accumbens (Nacb) dopamine (DA) depletions are used to induce a low-effort bias in rodents tested on effort-based decision-making. We evaluated the effect of the catecholamine uptake blocker bupropion on its own, and after administration of tetrabenazine (TBZ), which blocks vesicular storage, depletes DA, and induces depressive symptoms in humans. Male CD1 mice were tested on a 3-choice-T-maze task that assessed preference between a reinforcer involving voluntary physical activity (running wheel, RW) vs. sedentary activities (sweet food pellet intake or a neutral non-social odor). Mice also were tested on the forced swim test (FST), two anxiety-related measures (dark-light box (DL), and elevated plus maze (EPM)). Expression of phosphorylated DARPP-32 (Thr34 and Thr75) was evaluated by immunohistochemistry as a marker of DA-related signal transduction. Bupropion increased selection of RW activity on the T-maze. TBZ reduced time running, but increased time-consuming sucrose, indicating an induction of a low-effort bias, but not an effect on primary sucrose motivation. In the FST, bupropion reduced immobility, increasing swimming and climbing, and TBZ produced the opposite effects. Bupropion reversed the effects of TBZ on the T-maze and the FST, and also on pDARPP32-Thr34 expression in Nacb core. None of these manipulations affected anxiety-related parameters. Thus, bupropion improved active behaviors, which were negatively motivated in the FST, and active behaviors that were positively motivated in the T-maze task, which has implications for using catecholamine uptake inhibitors for treating anergia and fatigue-like symptoms. Funding for open access charge: CRUE-Universitat Jaume I

Background Most meatpacking workers have pain affecting their back, arms, and/or wrists from work-related repetitive motions, forceful exertion, and awkward positioning. Chronic musculoskeletal pain is associated with obesity, hypertension, type II diabetes, heart attack, and stroke. Hispanic/Latino workers in the meatpacking industry are a vulnerable population; limited English, lack of health insurance, and fear of deportation often deter them from seeking care where preventable cardiovascular risks might be detected. The purpose of this study was to examine perceived health and actual cardiovascular risk among Hispanic/Latino meatpacking workers with musculoskeletal pain in Nebraska. Methods Structured interviews were used to examine perceived health, awareness of cardiometabolic risk, and capacity for health self-management. Body mass index (BMI), lipids, blood pressure, Hemoglobin A1c (HbA1c), and cardiorespiratory fitness (step test) were used to examine cardiovascular risk. Findings Of those interviewed ( n = 39), musculoskeletal pain affected usual life activities in 64% ( n = 25) of participants. Of those tested ( n = 30), 93% ( n = 28) had a BMI > 30 kg/m2, 86% ( n = 26) had at least one lipid abnormality, 50% ( n = 15) had blood pressure > 120/80 mm Hg, and 43% ( n = 13) had an HbA1c > 5.7%. Males had greater fitness than females ( p = .03), but also greater lifetime risk of heart attack or stroke compared with females ( p = .02). Conclusion/Application to Practice In this sample, cardiovascular risk exceeded that found in the general Hispanic population in the United States. Occupational health nurses can assist workers to be aware of their risk by measuring and providing culturally and linguistically appropriate education on blood pressure, BMI, cholesterol, and HbA1c.

The study examined the effects of adding a loaded stretch in the inter-set rest period (ISS) compared to traditional resistance training (TR) on muscular adaptations in resistance-trained males. Twenty-six subjects were randomly assigned into two groups (ISS: n=12; TR: n=14) and underwent an 8-week training regimen. Subjects in ISS underwent an additional loaded stretch for 30 s at 15% of their working load from the prior set during the inter-set rest periods. Muscle thickness of the pectoralis major at the belly (BMT) and lateral (LMT) portions, One-repetition maximum (1RM) and repetitions-to-failure (RTF) on the bench press exercise were measured at baseline and post 8 weeks of training. Additionally, volume load and perceptual parameters for exertion and recovery were measured. Both groups had similar total volume load and average perceptual parameters (p>0.05). There was a main time effect (p0.05). Our results suggest that addition of a loaded ISS does not affect muscular adaptations either positively or negatively in resistance-trained males.

Introduction. Primary cardiac tumors are rare, and the autopsy detection rate does not exceed 0.003%. Approximately 80% of primary heart tumors are benign, 50% of them are myxomas. Diagnosis of cardiac tumors at present in the presence of transesophageal echocardiography is not difficult in most cases. Surgical treatment of mixomas became possible after the introduction of open-heart surgery under cardiopulmonary bypass into clinical practice. After verification of the tumor, its surgical removal is indicated. In the practice of large cardiac surgery clinics, the experience of radical treatment of heart neoplasms is relatively small; therefore, the analysis of tactical approaches and results of operations in this pathology is of absolute interest.Aim of study. To present an analysis of 10 years’ experience in surgical treatment of cardiac mixomas. Material and methods The results of treatment of 58 patients with myxomas who underwent surgical removal of the neoplasm of the heart are presented.Results. Hospital mortality after surgical removal of myxoma was 1.7%, 1 patient died. All patients, we have the long-term period data about, noted a significant improvement in well-being, a decrease or disappearance of dyspnea at rest and/or during exertion, and no recurrence of myxoma was noted. Conclusion. The data obtained indicate, on the whole, good immediate results and high quality of life of patients in the long-term period operated on for heart mixomas.

Background Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe hereditary channelopathy characterized by the presence of ventricular arrhythmias triggered by adrenergic stimuli, usually diagnosed in the first two decades of life. Genetic variants in the cardiac ryanodine receptor gene are the most frequently occurring that cause an increase in intracellular calcium concentration and thus induce ventricular arrhythmias due to a delayed after depolarisation-induced triggered activity. Case presentation We present the case of a 74-year-old male, a regular athlete with no relevant family history who suffered from sinus dysfunction and frequent premature ventricular complexes with no symptoms. A treadmill test revealed severe polymorphic ventricular arrhythmias which led to the suspicion of CPVT. A genetic study was undertaken, and it identified a rare genetic variant in the RYR2 gene which was possibly associated with its development in heterozygosity: c.14465G > A, p.Arg4822His. While evaluating the co-segregation, we observed that most of his relatives exhibit polymorphic ventricular arrhythmias with exertion without symptoms and carried the same variant. Conclusions We described, for the first time, the clinical characteristics and co-segregation of a family diagnosed with CPVT secondary to a little-known genetic variant of the RYR2 gene. It is a variant that, in our case study, suggests an association with a very good prognosis.

Purpose This study aims to investigate the effects of a 10-min vocal exertion task on voice and respiratory measures, to determine whether restorative strategies can mitigate these effects after cessation of exertion, and to assess whether these strategies continue to reduce these detrimental effects when vocal exertion is resumed. Method A prospective, repeated-measures design was used. On consecutive days, 20 participants (equal men and women) completed two vocal exertion tasks separated by 10 min of restoration strategies: vocal rest or controlled phonation (low-level tissue mobilization using straw phonation). Voice and respiratory data were collected at baseline, following the first exertion task, after restoration strategies, and after the second exertion task. Outcome measures included (a) vocal effort, (b) phonation threshold pressure, (c) maximum and minimum fundamental frequencies, (d) cepstral peak prominence of connected speech, (e) lung volume initiation and termination, (f) percent vital capacity expended per syllable, and (g) number of syllables per breath group. Results A worsening of phonation threshold pressure ( p < .001), vocal effort ( p < .001), and increase of minimum fundamental frequency ( p = .007) were observed after vocal exertion. Lung volume initiation ( p < .001) and lung volume termination ( p < .001) increased. These changes were largely reversed by restoration strategies, but only controlled phonation prevented exertion-induced changes in respiratory kinematic measures on a subsequent vocal exertion task. Conclusions Exertion-induced voice changes occur rapidly and may be mitigated by either controlled phonation or vocal rest. Controlled phonation is recommended as a superior strategy due to evidence of a protective effect on a successive vocal exertion task.

A 51-year-old woman with adult T-cell leukemia-lymphoma was hospitalized in order to undergo allogeneic hematopoietic stem-cell transplantation. On day 29 after transplantation, she began to experience hypoxia upon exertion. Chest computed tomography revealed centrilobular granular shadows, and pulmonary function tests revealed a remarkable obstructive ventilatory impairment compared to before transplantation. A histopathological analysis following a transbronchial lung cryobiopsy revealed acute graft-versus-host disease (GVHD). We herein report a rare case of histopathologically diagnosed acute pulmonary GVHD with spontaneous remission.

Background:Although coronary artery bypass grafting is not frequently performed in children, Kawasaki disease is one of the most common indications for coronary artery bypass grafting in children. Here, we reviewed the long-term clinical outcomes including graft patency after coronary artery bypass grafting.Methods:Between March 2004 and March 2013, six patients with Kawasaki disease underwent coronary artery bypass grafting. All patients were male. Their median age was 13.0 years (interquartile range, 7.8–17.8 years) at the timing of coronary artery bypass grafting, and the median age at the onset of Kawasaki disease was 3.3 years (interquartile range, 1.0–7.0 years). Four patients presented with multiple lesions including aneurysms.Results:The median follow-up duration was 12.1 years (interquartile range, 9.5–13.1 years), and there were no operative complications or overall mortality. One patient had pre-operative symptoms such as exertional chest pain and dyspnoea on exertion, whereas one patient had ventricular tachyarrhythmia. There was an improvement in subjective symptoms after surgery in two patients. The left internal thoracic artery, right internal thoracic artery, and saphenous vein were used in five (83.3%), one (16.7%), and two (33.3%) cases, respectively. In all six patients, post-operative single-photon emission CT findings showed improved perfusion compared with pre-operative single-photon emission CT. All grafts were patent as confirmed by coronary angiography or CT angiography.Conclusions:Coronary artery bypass grafting could be a good surgical option in children with coronary lesions caused by Kawasaki disease in terms of graft patency and myocardial perfusion.

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome of shortness of breath and/or exercise intolerance secondary to elevated left ventricular filling pressures at rest or with exertion either as a result of primary diastolic dysfunction (primary HFpEF) or secondary to specific underlying causes (secondary HFpEF). In secondary HFpEF, early intervention of underlying valvular heart disease generally improves symptoms and prolongs survival. In primary HFpEF, there is increasing awareness of the existence and prognostic implications of secondary atrioventricular valve regurgitation. Further studies will clarify their mechanisms and the effectiveness of valvular intervention in this intriguing HFpEF subgroup.

When long breaks occur in food intake, as well as pre-workout, restorative nutrition and additional energy supply to the body during intense physical activity, athletes and many people in their daily life use foods that are similar in form of release and partially in function to traditional chocolate bars. According to their functional characteristics, such products are divided into three main groups - energy, high protein and grain bars. The main purpose of energy bars is to provide the human body with a source of additional energy, especially in situations where significant physical and mental endurance is required. The task of high protein sports bars is to provide the human body with building materials for the restoration of muscle tissues, which are actively damaged during intense physical exertion, as well as for the start of muscle tissue growth. Grain bars can help lower blood sugar levels, which can arise from consuming large amounts of fast carbohydrates in a daily diet, and improve the functioning of the digestive system. All these products additionally enrich the body with biologically active substances that are vital for athletes. The synergistic interaction of the functional ingredients in the composition accelerates the recovery of physical strength during and after fitness sessions. The ergogenic properties of the developed food product were confirmed by control tests on individuals engaged in fitness every day: a course intake of fitness bars for 30 days in an amount of 50 g / day after training contributed to an increase in the strength index, speed-strength endurance, and overall physical performance of the subjects. The use of fitness bars in the diet is an additional adaptogenic factor to optimize the effect of training sessions.

In the second mature age, women increase the prevalence of arterial hypertension, often complicating hypertensive crises. This circumstance requires improving the recovery options for this category of patients. It seems very promising to be used for this in women with arterial hypertension regular physical exertion for the purpose of their overall recovery, reducing the level of blood pressure and the prevention of hypertensive crises. To easily be the effects of the hypertensive crisis, a complex of muscular loads was developed, the effectiveness of which was estimated in comparison with traditionally appointed patients in such patients of the recovery. Women were examined 36-55 years, who had over a month ago, hypertensive crisis. The women who have been rehabilitated under the author's scheme, have been rejected in the study, have shown a more pronounced improvement of the indicators registered in the study. The optimization of the function of the cardiovascular system turned out to be more pronounced than as a result of traditional recovery. The tested version of regular muscle training provides optimization of processes in the heart and vessels of women suffering from arterial hypertension, lowering the risk of repetition of their hypertensive crisis.

Background: Hyperlipidaemia is one of the most important conditions to cause atherosclerosis. Atherosclerosis is a major risk factor for coronary artery disease (CAD). CAD has become the epidemic of modern civilization in which Hyperlipidaemia predominantly contributes to its pathogenesis. There are certain atherogenic ratios that are strongly predictive of CAD. Three important atherogenic ratios are Atherogenic Index of Plasma (AIP), Castelli’s Risk Index I & II (CRI-I &CRI-II). We studied the significance of these atherogenic ratios in a case study having hyperlipidaemia by giving Ayurvedic drug Sookshma eladi choornam. Methods: A 53-year-old patient presented with tiredness, shortness of breath on exertion, heaviness of the body parts for the past 4 months. Management was done on OPD based treatment. The patient was administered 3 grams of Sookshma eladi choornam orally with go ghrita as anupana. Result: There was a marked reduction in symptoms like tiredness, heaviness and shortness of breath with three months of treatment. The lipid values after three months of treatment and follow up of one month showed a marked reduction in TC(Total Cholesterol), TG(Triglyceride), LDL-C(Low density lipoprotein – Cholesterol) and increase in HDL(High density lipoprotein – Cholesterol). Conclusion: Significant result was observed in both subjective symptoms and in objective parameters after administering Sookshma eladi choornam.

Purpose This cross-sectional study aimed to determine if age and perceived job exertion (PJE) moderate the effect of gender on upper extremity (UE) disorders in injured workers. Methods We sampled a consecutive cohort of patients attending a specialty clinic for injured workers with UE musculoskeletal problems. We measured UE disability and pain using the Quick Disability of the Arm, Shoulder, and Hand (QDASH). Participants reported their PJE on a Global Rating of Change scale ranging from 1 (minimal perceived exertion) to 15 (maximal perceived exertion). Linear regression was used to explore the effect of gender on QDASH. We probed the moderating role of age and PJE using floodlight regression and identified the Johnson-Neyman (JN) region of age and PJE, where the effect of gender on QDASH becomes significant at the 95% level. Results We analyzed 418 participants, of whom 44% were women. The effect of gender on QDASH was significant for women aged 49 or younger (JN-region border: Age = 48.5, effect = 4.4, SE = 2.2, p = 0.05). Women workers with UE disorders younger than 49 years old report higher levels of pain and disability than do men. After the age of 49 years, both men and women workers experience a similar worsening of UE pain and disability with increasing age. Pain and disability increase with increased perceived job demands similarly for both men and women workers. Conclusions Women younger than 49 years had higher levels of UE pain and disorders than men. Both men and women workers reported higher UE disability with an increase in their PJE.

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has spread at an alarming rate worldwide. Its dominant feature is arterial hypoxemia seen due to ventilation perfusion mismatch. This causes reduced oxygen diffusion that affects functional capacity. Six-minute walk test is one of the commonly used test which is used to assess functional ability. However, it is more time-consuming and requires a 30-m corridor which is not always easily available. Studies have shown that the 1-minute sit to stand test (1-MSTST) is also useful for assessing functional capacity of patients with respiratory dysfunction. The aim of the study was to understand COVID-19 patient’s response to 1-MSTST with respect to number of repetitions, oxygen saturation, heart rate and perceived rate of exertion. Statistically significant difference was seen in pre and post parameters of heart rate (Pre: 91.73 ±17.12, Post: 116.06 ± 20.18, p< 0.0001); SpO2 (Pre: 97.04 ± 3.37, Post: 95.40 ± 3.93, p=0.005) and RPE (Pre: 0. 07 ± 0.25, Post: 1.49 ± 1.22, p< 0.0001). A mean of 21.26 ± 6.84 repetitions of sit to stand were performed in a minute. COVID-19 patients, thus, have significantly reduced functional capacity similar to that of patients with other respiratory dysfunctions. Thus, results of this study will enable therapist to plan the rehabilitation in COVID-19 patients to improve their functional capacity. This will enhance their ability to perform in activities of daily living and to participate in societal work and therefore will help in improving their quality of life. Key words: COVID-19, Physiotherapy, Sit to stand test, Functional Capacity Rehabilitation.

Amyloid transthyretin (ATTR) depositions cause left ventricular (LV) hypertrophy, diastolic dysfunction, and heart failure. The time course of changes in LV geometry and diastolic dysfunction has not been fully reported in patients with ATTR cardiomyopathy. A 79‐year‐old woman with previous myocardial infraction presented with shortness of breath on exertion, and progressive bilateral lower extremity weakness and polyneuropathy. She was diagnosed with Val30Met hereditary ATTR cardiomyopathy by cardiac biopsy and genetic testing. During the past 5 year period, significant LV concentric remodelling with small LV cavity occurred, resulting in an increased LV stiffness and prolonged LV relaxation. This case report highlights the time course of changes in LV geometry and diastolic function and the importance of early diagnosis of ATTR cardiomyopathy.

In INTERSTROKE, we explored the association of anger or emotional upset and heavy physical exertion with acute stroke, to determine the importance of triggers in a large, international population.INTERSTROKE was a case-control study of first stroke in 32 countries. Using 13 462 cases of acute stroke we adopted a case-crossover approach to determine whether a trigger within 1 hour of symptom onset (case period), vs. the same time on the previous day (control period), was associated with acute stroke. A total of 9.2% (n = 1233) were angry or emotional upset and 5.3% (n = 708) engaged in heavy physical exertion during the case period. Anger or emotional upset in the case period was associated with increased odds of all stroke [odds ratio (OR) 1.37, 99% confidence interval (CI), 1.15-1.64], ischaemic stroke (OR 1.22, 99% CI, 1.00-1.49), and intracerebral haemorrhage (ICH) (OR 2.05, 99% CI 1.40-2.99). Heavy physical exertion in the case period was associated with increased odds of ICH (OR 1.62, 99% CI 1.03-2.55) but not with all stroke or ischaemic stroke. There was no modifying effect by region, prior cardiovascular disease, risk factors, cardiovascular medications, time, or day of symptom onset. Compared with exposure to neither trigger during the control period, the odds of stroke associated with exposure to both triggers were not additive.Acute anger or emotional upset was associated with the onset of all stroke, ischaemic stroke, and ICH, while acute heavy physical exertion was associated with ICH only.

Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) affects approximately 250,000 people in the UK. The condition varies in severity causing long-term physical and cognitive fatigue which is not alleviated by rest. Whilst the pathology is not understood, recent evidence suggests metabolic abnormalities may be associated with the manifestation of symptoms, particularly involving the metabolism of glucose and energy production. The use of ketone bodies as an alternative energy substrate may be beneficial to people with ME/CFS, in order to by-pass the glycolytic pathway, enhance energy production and reduce fatiguing outcomes. Study Design and Methods: Using a pragmatic collective case study with repeated measures methodology we investigated the feasibility of following a ketogenic diet and potential effects of the high fat, low carbohydrate diet on response to physical activity in people with ME/CFS (n=3) and healthy controls (n=3) using a submaximal exercise stress test both with and without dietary intervention. Exercise tolerance (mins), rate of oxygen consumption (VO2) to workload (75W), respiratory exchange ratio (RER), rate of perceived effort (RPE) and lactate response were measured throughout and descriptive statistics performed. Results: We found that the ketogenic diet was followed, with compliance higher in the pwME/CFS. Variations in response following the ketogenic diet was observed across individuals in minutes performed, VO2, HR, RER, and RPE post diet but the KD only limited exercise capacity in the control individuals. Individuals responded differently to the KD but group trends have been reported as means and standard deviation. The KD resulted in a decrease in RER at submax in the controls with a mean change of 0.07 from baseline (0.86 ± 0.1) to post intervention (0.79 ± 0.1) compared to a mean change of 0.02 in the ME/CFS from baseline (1.03 ± 0.1) to post intervention (1.01 ± 0.1). A decrease in VO2 (L/min) at submax showed a mean change of 0.06 (L/min) in the pwME/CFS at baseline (1.34 ± 0.1) to post intervention (1.27 ± 0.2) compared to a mean change of 0.07 (L/min) in the controls at baseline (1.40 ± 0.3) to post intervention (1.33 ± 0.2). HR (bpm) at submax decreased in all individuals, with a mean change of 4 (bpm), with pwME/CFS at baseline (139 ± 8.2) to post intervention (135 ± 14) and control individuals at baseline (107 ± 7.8) to intervention (103 ± 3.2). RPE at submax decreased in the pwME/CFS from baseline (6 ± 1.0) to post intervention (5 ± 2.1) whereas the controls increased from baseline (2 ± 1.0) to post intervention (3 ± 1.5). Conclusion: Our observations suggest individualised but metabolic flexibility in healthy individuals is achievable via dietary manipulation showing the ability to switch from glucose to fats under controlled conditions. The different response in substrate utilisation in individuals with ME/CFS suggests that potential metabolic abnormalities may be present in ME/CFS. Further investigation is now warranted in order to assess whether the KD is beneficial for people with ME/CFS

In the modern world with the advent of devices that facilitate work (computer, technical equipment) has decreased sharply motor activity of people compared to previous decades. This, in the end, leads to a decrease in human functionality, as well as various diseases. Today, purely physical work does not play a significant role, it is replaced by mental. Intellectual work dramatically reduces the efficiency of the body. Lack of human energy expenditure leads to inconsistencies in the functioning of individual systems (muscular, skeletal, respiratory, cardiovascular) and the body as a whole with the environment, as well as reduced immunity and impaired metabolism. Exercise affects all muscle groups, joints, ligaments, which become strong, increase muscle volume, elasticity, strength and rate of contraction. Increased muscle activity forces the heart, lungs and other organs and systems of our body to work with additional load, thereby increasing the functional capabilities of man, his resistance to adverse environmental influences. Regular exercise primarily affects the musculoskeletal system, muscles. When you exercise, the muscles generate heat, to which the body responds by increased sweating. During exercise, blood flow increases: the blood brings oxygen and nutrients to the muscles, which in the process of life break down, releasing energy. When movements in the muscles additionally open reserve capillaries, the amount of circulating blood increases significantly, which causes an improvement in metabolism. In response to the reaction of the human body to exercise, the first place is occupied by the influence of the cerebral cortex on the regulation of the functions of the basic systems: there is a change in the cardiorespiratory system, gas exchange, metabolism, and others. Exercises enhance the functional restructuring of all parts of the musculoskeletal system, cardiovascular and other systems, improve tissue metabolism. Under the influence of moderate physical activity increases the efficiency of the heart, hemoglobin and red blood cell count, increases the phagocytic function of the blood. Improves the function and structure of the internal organs, improves chemical processing and promotion of food in the intestine. The combined activity of muscles and internal organs is regulated by the nervous system, the function of which is also improved by regular exercise. If the muscles do not work - their nutrition deteriorates, volume and strength decrease, elasticity and resilience decrease, they become weak, sluggish. Restrictions in movement (hypodynamia), passive lifestyle lead to various pre-pathological and pathological changes in the human body. So, the American doctors, having deprived volunteers of movements by imposing of high plaster and having kept to them a normal diet, were convinced that in 40 days at them muscle atrophy began and fat has accumulated. At the same time increased the reactivity of the cardiovascular system and decreased basal metabolism. However, during the next 4 weeks, when the subjects began to move actively (with the same diet), the above phenomena were eliminated, the muscles were strengthened and hypertrophied. Thus, due to physical exertion, recovery was possible both in functional and structural terms. Exercise has a multifaceted effect on the human body, increasing its resistance to adverse environmental influences. For example, physically trained people have better tolerance to oxygen starvation than untrained people. High ability to work at increase of body temperature over 38 ° C during physical exertions is noted. It has been noticed that radiologists who exercise have a lower degree of influence of penetrating radiation on the morphological composition of the blood. Animal experiments have shown that regular muscle training slows the development of malignant tumors. Regular exercise in physical education promotes good health and affects the various physiological adaptations of the neuromuscular, cardiovascular and respiratory systems of the human body. Types of physical activities are considered: aerobic, anaerobic, interval and hypoxic physical activities.

Globally, there is increasing recognition that agricultural workers are at risk for chronic kidney disease of unknown etiology (CKD u). Recurrent heat exposure, physical exertion, dehydration, muscle damage, and inflammation are hypothesized to contribute to the development of CKD u, but the relative importance of these processes and the interactions among them remain unclear. Moreover, there is a need to identify biomarkers that could distinguish individuals who are at greatest risk for kidney damage to target preventative interventions for CKD u. In this study, we evaluated dehydration and markers of inflammation, muscle damage, and renal function in agricultural workers at a non-workday baseline assessment. Urine specific gravity and kidney function were measured before and after work shifts on three subsequent days, and heat index, core body temperature, and heart rate were monitored during the work shifts. A combination of direct comparisons and machine learning algorithms revealed that reduced levels of uromodulin and sodium in urine and increased levels of interleukin-6 and C-reactive protein in serum were indicative of dehydration at baseline, and that dehydration, high body mass index, reduced urine uromodulin, and increased serum interleukin-6, C-reactive protein, and lipopolysaccharide-binding protein at baseline were predictive of acute kidney injury on subsequent workdays. Our findings suggest a method for identifying agricultural workers at greatest risk for kidney injury and reveal potential mechanisms responsible for this process, including pathways overlapping in dehydration and kidney injury. These results will guide future studies confirming these mechanisms and introducing interventions to protect kidney health in this vulnerable population.

OBJECTIVES/HYPOTHESIS To investigate the effects of acute vocal exertion on individuals with vocal fatigue and to determine whether semi-occluded vocal tract exercises (SOVTEs) are more effective than vocal rest in mitigating acute effects. STUDY DESIGN Prospective, repeated-measures design. METHODS On consecutive days, 10 individuals (6 males, 4 females) with scores indicating vocal fatigue on the Vocal Fatigue Index completed two 10-minute vocal exertion tasks. Vocal rest or SOVTEs were interspersed in counterbalanced order between exertion tasks. Respiratory kinematic, acoustic, aerodynamic, and self-perceptual measures were collected at baseline, following vocal exertion, following SOVTE/vocal rest, and following the second exertion task. RESULTS Acute vocal exertion worsened phonation threshold pressure (P

The purpose of the study was to assess the metabolic status of the body when correcting the diet with a concentrated natural product. Materials and methods. The diet of athletes was analyzed. The leading group (n = 15) received concentrated food products (CNP) for 20 days: No. 1 - 30.0 g and No. 2 - 20 g each. Blood indices including (total protein, uric acid, urea, creatinine, total cholesterol, high and low-density lipoprotein cholesterol, triglycerides, glucose, amylase) were assessed metabolic status: taken before, after, and in one month of taking CNP Results. The diet’s calorie content was 5953.2-6494.4 kcal/day in the main and the comparison group corresponding to this cohort’s physiological need. The proportions of protein and fat exceeded the recommended ones; deficiency of carbohydrates accounted for 8.7%. The inclusion of CNP increased the ratio of slow carbohydrates, vitamins, minerals, and minor food components. In the leading group, the increase in urea and uric acid was less significant in terms of average indices, and the proportion of such people increased. Creatinine was significantly higher than baseline within one month after CNP administration. The increase in the proportion of people with increased total cholesterol is 2.9 times less; the share with a borderline high level decreased by 15.5%, in the comparison group, it increased by 5.6%. The proportion with low-density lipoproteins exceeding the reference value decreased from 61.5% to 30.0% in the comparison group - without dynamics (55.6%) and signs of dyslipidemia increased. In the main group, within the normal range, 76.9% of individuals had an increase in glucose, amylase by 5.7% (p = 0.049). Conclusion. The diet is not macronutrient balanced. The use of CNP affected the metabolism of proteins, fats, and carbohydrates. It proved a more adequate energy supply for the activities of the persons of the main group. There has been shown the possibility of correcting the body’s metabolic processes with food products that reduces the risk of developing prenosological conditions during physical exertion, particularly fatigue and cardiovascular pathology.

Introduction Primary cardiac synovial sarcoma is an exceedingly rare soft tissue malignant tumor, involving either the pericardium or chambers, with a striking male predominance, prevalently seen in the fourth decade. These tumours most commonly present as breathlessness on exertion. These patients readily exhibit gastrointestinal and systemic symptoms but sometimes the presentation can be fallacious. Methods A 37-year old male presented with fever, breathlessness on exertion and hematuria who was managed for dengue feverat another hospital. Patient also had features of right heart failure and congestive hepatomegaly. Patient was evaluated thoroughlyand diagnosed as right atrial tumour mass for which surgical resection was done. Results The tumour mass was diagnosed as right atrial biphasic synovial sarcoma after immunohistochemistry. Patient also had thrombocytopenia which was due to increased consumption of platelets. Conclusions Right heart biphasic synovial sarcoma, arising from the tricuspid valve in association with thrombocytopenia and right heart failure is an extremely rare entity and that can have a deceptive presentation.

The purpose of study was to determine the biomechanical, physiological, and subjective effect of a Passive Exoskeleton device (called Ergo-Vest) among 20 waste collectors in the working environment. Compression force and moment on L4/L5 related to 400 critical postures of the participants were estimated using the 3DSSPP software. The heart rate and energy expenditure are measured as the physiological strain using the Polar RS400 Heart Rate Monitor. Borg scale perceived exertion, system usability scale, and ergonomic design indicators of the device were collected as the subjective parameters. Compression force and moment on L4/L5 disc were decreased when the Ergo-Vest was utilised. There was no significant difference in energy expenditure and heart rate with and without the device. The workers' perceived physical exertion was decreased while using the Ergo-Vest. From the perspective of end users, the usability and ergonomic design features of the Ergo-Vest was acceptable. Practitioner summary: The prevalence of musculoskeletal disorders is high among the Iranian waste collectors. To mitigate this occupational problem, the effect of a passive exoskeleton for lower-back support (Ergo-Vest) was investigated on the workers' spine loading, physiological parameters, and perceived physical exertion. The result shows spine force reduction and lower subjective responses.

Although our coronary circulation evolved to meet demands during marked physical exertion for “fight or flight” survival, complex and multilayered control mechanisms reduce flow during oth...

Hard metal lung disease (HMLD) is rarely diagnosed and is caused by the occupational inhalation of hard metal dust, mainly cobalt. The diagnosis of HMLD is based on a thorough occupational dust exposure combined with clinical–radiological–histological findings. We present a series of four Chinese workers who had occupational exposure to cobalt acid lithium or cobalt and tungsten dust. Four patients all complained of intermittent cough, chest tightness, or shortness of breath on exertion. High-resolution computed tomography scans presented bilateral ground-glass attenuation, consolidations, and/or reticular opacities with diffuse small nodules. Histologic findings showed that interstitial inflammation and fibrotic lesions distributed peribronchioles. The infiltrations by macrophages as well as visible multinucleated giant cells indicated giant cell interstitial pneumonia (GIP). Cobalt was detectable in the lung tissues of two patients measured by inductively-coupled plasma mass spectrometry. The first patient was diagnosed with cobalt-related interstitial lung disease (ILD), while the others were HMLD. GIP is the classic pathology of cobalt-related ILD or HMLD. One of the patients showed spontaneous remission after the cessation of exposure, while the other three recovered within 6–32 weeks after avoiding occupational exposure and using corticosteroids. At follow-up, all four patients showed no recurrence. A multidisciplinary diagnostic panel including occupational cobalt exposure evaluation is beneficial to recognize cobalt-related ILD or HMLD and to indicate the necessity of prevention.