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High-quality and complete reference genome assemblies are fundamental for the application of genomics to biology, disease, and biodiversity conservation. However, such assemblies are available for only a few non-microbial species1-4. To address this issue, the international Genome 10K (G10K) consortium5,6 has worked over a five-year period to evaluate and develop cost-effective methods for assembling highly accurate and nearly complete reference genomes. Here we present lessons learned from generating assemblies for 16 species that represent six major vertebrate lineages. We confirm that long-read sequencing technologies are essential for maximizing genome quality, and that unresolved complex repeats and haplotype heterozygosity are major sources of assembly error when not handled correctly. Our assemblies correct substantial errors, add missing sequence in some of the best historical reference genomes, and reveal biological discoveries. These include the identification of many false gene duplications, increases in gene sizes, chromosome rearrangements that are specific to lineages, a repeated independent chromosome breakpoint in bat genomes, and a canonical GC-rich pattern in protein-coding genes and their regulatory regions. Adopting these lessons, we have embarked on the Vertebrate Genomes Project (VGP), an international effort to generate high-quality, complete reference genomes for all of the roughly 70,000 extant vertebrate species and to help to enable a new era of discovery across the life sciences.

Physical activity is important in the self-management of long-term conditions (LTCs). However, implementing physical activity into clinical practice is challenging, due to complex barriers including access to programmes, time pressures, and transport costs, for people with comorbidities, managing multiple responsibilities. Various digital tools exist to overcome these barriers and support wide-scale implementation to help people stay physically active. We explored the experiences, needs and preferences of healthcare professionals and commissioners, regarding the use of digital tools to support people with LTCs to self-manage using physical activity. This included barriers and facilitators to implementing digital tools to support people with LTCs in NHS settings. Semi-structured interviews were conducted (April 2021 to January 2022) in Wessex, southern England, UK. Purposive sampling was used to recruit general practitioners and healthcare professionals, and convenience sampling to recruit commissioners (n = 15). Transcripts were coded to develop conceptual themes allowing comparisons between and among perspectives, with the Normalisation Process Theory (NPT)'s four constructs used to aid interpretation. Results showed that most digital tools supporting physical activity for LTCs, are not well implemented clinically. Current digital tools were seen to lack condition-specificity, usability/acceptability evidence-base, and voluntary sector involvement (i.e., NPT: coherence or 'making sense'). Healthcare professionals and commissioners were unlikely to engage with use of digital tools unless they were integrated into health service IT systems and professional networks (i.e., NPT: cognitive participation), or adaptable to the digital literacy levels of service users and staff (i.e., NPT: collective action-needs for implementation). In practice, this meant being technically, easy to use and culturally accessible (i.e., NPT: collective action-promoting healthcare work). COVID-19 changed professional attitudes towards digital tools, in that they saw them being viable, feasible and critical options in a way they had not done before the pandemic. Implementation was also influenced by endorsement and trustworthiness enhancing the perception of them as secure and evidence-based (i.e., NPT: reflective monitoring). Our findings highlight that consideration must be given to ensuring that digital tools are accessible to both healthcare professionals and patients, have usability/acceptability, and are adaptable to specific LTCs. To promote clinical engagement, digital tools must be evidence-based, endorsed by professional networks, and integrated into existing health systems. Digital literacy of patients and professionals is also crucial for cross-service implementation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Gavin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: National and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice., Methods: An anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil., Results: Most of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011)., Conclusion: Frailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people., (© 2024. The Author(s).)

Frailty is a common condition that leads to multiple adverse outcomes. Frailty should be identified and managed in a holistic, evidence-based and patient-centered way. We aimed to understand how UK healthcare professionals (HCPs) identify and manage frailty in comparison with UK Fit for Frailty guidelines, their frailty training, their confidence in providing support and organizational pathways for this. An online mixed-methods survey was distributed to UK HCPs supporting older people through professional bodies, special interest groups, key contacts, and social media. From 137 responses, HCPs valued frailty assessment but used a mixture of tools that varied by profession. HCPs felt confident managing frailty and referred older people to a wide range of supportive services, but acknowledged a lack of formalized training opportunities, systems, and pathways for frailty management. Clearer pathways, more training, and stronger interprofessional communication, appropriate to each setting, may further support HCPs in frailty management., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To determine the impact of occupational therapy (OT) on the self-management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA)., Methods: Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE- Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type., Results: Of 39 eligible papers, 29 were quantitative (n = 2,029), 4 qualitative (n = 50), and 6 mixed methods (n = 896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long-term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self-management for fatigue., Conclusion: Although patient education is promising for self-managing RA, no strong evidence was found to support OT programs for self-managing fatigue or patient experience and long-term effectiveness. More research is required on lived experience, and the long-term efficacy of self-management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date., (© 2024 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Background and Objectives : Following discharge from hospital, there can be variability in the rehabilitation of patients who have undergone total hip or knee replacement surgery. We invited patients who had had hip or knee replacement surgery to take part in patient and public involvement sessions to help us understand their recovery needs and how rehabilitation services could potentially be improved to meet these needs better. Materials : Patients ( n = 14) were invited to one of two patient advisory group sessions which took place in a university setting. Results : Feedback from patients highlighted the need for an inclusive, evidence-based intervention that would benefit patients experiencing all levels of pain, with differing motivations for recovery. Patients desired social support with others who have had similar surgery to reduce the burden of isolation during rehabilitation. Furthermore, patients valued the involvement of their partners and carers in their rehabilitation, to provide social support and guidance on recovery. Patients also expressed a need for consistent information and expert guidance on all aspects of their recovery. Conclusions : These findings can be used to guide the design of rehabilitation interventions following hip and knee replacement and ensure that patient perspectives inform future practice.

Background: Occupational therapists can support people with rheumatoid arthritis to self-manage their disease symptoms and engage in daily activities. This protocol reports a review to broaden understanding of what is known about the role of occupational therapy in the self-management of rheumatoid arthritis., Methods: Studies involving adults with rheumatoid arthritis, having participated in self-management involving occupational therapy, will be included. Patient involvement will help develop the search strategy by identifying patient-centred interventions and outcomes to complement those identified by researchers. An electronic search will be performed using several bibliographic databases, including grey literature from subject-specific, health-related, and social care databases. Searches will run from the database inception until the date that the search is conducted (December 2021-May 2022). Retrieved studies will be de-duplicated, and the remaining titles and abstracts will be screened by three reviewers. Full texts of all eligible studies will be independently reviewed by the reviewers to select papers for data extraction and quality assessment. Outcomes are function, pain, fatigue and lived experience. For quantitative studies, data will be synthesised using descriptive statistics in text and tables, whereas for qualitative studies, data will be synthesised using thematic synthesis., Discussion: This review will synthesise current evidence on how occupational therapy can help the self-management of rheumatoid arthritis. It will include evidence of best practice, including advice, education and training provided by occupational therapists. These findings can inform future research and the selection of strategies to promote quality of life for people with rheumatoid arthritis., Systematic Review Registration: PROSPERO CRD42022302205., (© 2022 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd.)

Inspiratory muscle training (IMT) improved balance ability and respiratory muscle function in healthy older adults. The current study is a retrospective analysis to explore the relationship between inspiratory muscle function, balance ability, and adaptation to IMT. All participants (total = 129; IMT = 60; age range = 65-85 years) performed inspiratory and balance assessments, including the mini-balance evaluation system test, maximal inspiratory pressure, and peak inspiratory flow tests. Baseline inspiratory muscle function was positively related to balance ability (p < .05), and IMT-induced improvements in inspiratory function (23.3% in maximal inspiratory pressure, 8.0% in peak inspiratory flow rate, 14.9% in maximal peak inspiratory power) were related to improvements in balance (10.6% in mini-balance evaluation system test), with the greatest improvements (17.0%) observed in the oldest participants (76-85 years old, p < .05). In conclusion, with or without IMT, positive associations between inspiratory function and balance ability exist, with greater improvements in inspiratory muscle function related to greater improvements in balance ability.

Older people have an increased risk of falling during locomotion, with falls on stairs being particularly common and dangerous. Step going (i.e., the horizontal distance between two consecutive step edges) defines the base of support available for foot placement on stairs, as with smaller going, the user's ability to balance on the steps may become problematic. Here we quantified how stair negotiation in older participants changes between four goings (175, 225, 275, and 325 mm) and compared stair negotiation with and without a walking approach. Twenty-one younger (29 ± 6 years) and 20 older (74 ± 4 years) participants negotiated a 7-step experimental stair. Motion capture and step-embedded force platform data were collected. Handrail use was also monitored. From the motion capture data, body velocity, trunk orientation, foot clearance and foot overhang were quantified. For all participants, as stair going decreased, gait velocity (ascent p A = 0.033, descent p D = 0.003) and horizontal step clearance decreased (p A = 0.001), while trunk rotation (p D = 0.002) and foot overhang increased (p A,D < 0.001). Compared to the younger group, older participants used the handrail more, were slower across all conditions (p A < 0.001, p D = 0.001) and their foot clearance tended to be smaller. With a walking approach, the older group ( Group x Start interaction) showed a larger trunk rotation (p A = 0.011, p D = 0.015), and smaller lead foot horizontal (p A = 0.046) and vertical clearances (p D = 0.039) compared to the younger group. A regression analysis to determine the predictors of foot clearance and amount of overhang showed that physical activity was a common predictor for both age groups. In addition, for the older group, medications and fear of falling were found to predict stair performance for most goings, while sway during single-legged standing was the most common predictor for the younger group. Older participants adapted to smaller goings by using the handrails and reducing gait velocity. The predictors of performance suggest that motor and fall risk assessment is complex and multifactorial. The results shown here are consistent with the recommendation that larger going and pausing before negotiating stairs may improve stair safety, especially for older users., (Copyright © 2020 Di Giulio, Reeves, Roys, Buckley, Jones, Gavin, Baltzopoulos and Maganaris.)

The inspiratory muscles contribute to balance via diaphragmatic contraction and by increasing intra-abdominal pressure. We have shown inspiratory muscle training (IMT) improves dynamic balance significantly with healthy community-dwellers. However, it is not known how the magnitude of balance improvements following IMT compares to that of an established balance program. This study compared the effects of 8-week of IMT for community-dwellers, to 8-week of the Otago exercise program (OEP) for care-residents, on balance and physical performance outcomes. Nineteen healthy community-dwellers (74 ± 4 years) were assigned to self-administered IMT. Eighteen, healthy care-residents (82 ± 4 years) were assigned to instructor-led OEP. The IMT involved 30 breaths twice-daily at ~50% of maximal inspiratory pressure (MIP). The OEP group undertook resistance and mobility exercises for ~60 minutes, twice-weekly. Balance and physical performance were assessed using the mini Balance Evaluation System Test (mini-BEST) and time up and go (TUG). After 8-week, both groups improved balance ability significantly (mini-BEST: IMT by 24 ± 34%; OEP by 34 ± 28%), with no between-group difference. Dynamic balance sub-tasks improved significantly more for the IMT group (P < 0.01), than the OEP group and vice versa for static balance sub-tasks (P = 0.01). The IMT group also improved MIP (by 66 ± 97%), peak inspiratory power (by 31 ± 12%) and TUG (by -11 ± 27%); whereas the OEP did not. IMT and OEP improved balance ability similarly, with IMT eliciting greater improvement in dynamic balance, whilst OEP improved static balance more than IMT. Unlike IMT, the OEP did not provide additional benefits in inspiratory muscle function and TUG performance. Our findings suggest that IMT offers a novel method of improving dynamic balance in older adults, which may be more relevant to function than static balance and potentially a useful adjunct to the OEP in frailty prevention., Competing Interests: This work was sponsored by Bournemouth University. FF, JG and TW declare no conflicts of interests. AM acknowledges a previous (now expired) beneficial interest in POWERbreathe® inspiratory muscle trainers, in the form of a share of royalty income to the University of Birmingham and a potential share of royalty income to Brunel University. In the past, AM has also provided consultancy services to POWERbreathe® International Ltd., but no longer does so. AM is named on two patents relating to POWERbreathe® products, including the device used in the present study, as well as being the author of two books on inspiratory muscle training. The patents are as follows: European Patent Office Patent No. EP2303417B1 - Dynamic inspiratory muscle training device; United States Patent No. 8 459 255 - Dynamic inspiratory muscle training device. The authors also declare that the results of the present study do not constitute an endorsement by American College of Sport Medicine and that the results are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Introduction: Stair descent is a physically demanding activity of daily life and common risk for falls. Age-related deteriorations in ankle joint capacities make stair descent particularly challenging for older adults in built environments, where larger rise steps are encountered. Exercise training may allow older adults to safely cope with the high biomechanical demands of stair descent. However, little is known about the demands of increased rise stairs for older adults, nor the impact of exercise., Aim: We investigated whether the effects of lower-limb resistance training would alter joint kinetics and movement strategies for older adults when descending standard rise, and increased rise stairs., Methods: Fifteen older adults descended a four-step stair adjusted to standard rise (170 mm), and increased rise (255 mm) on separate visits. Between these two visits, randomly allocated participants underwent 16 weeks of either: resistance exercise training ( n = 8) or habitual activity ( n = 7). Kinetic data were measured from step-mounted force plates, and kinematic data from motion-capture cameras. Training involved twice-weekly sessions of lower-limb resistance exercises (three sets of ∼8 repetitions at ∼80% three-repetition maximum), and static plantarflexor stretching (three, 45 s holds per leg)., Results: Standard stairs - Peak ankle joint moments increased ( p < 0.002) and knee joint moments decreased ( p < 0.01) during descent after exercise training. Peak centre of pressure-centre of mass (CoP-CoM) separations increased in posterior ( p = 0.005) and medio-lateral directions ( p = 0.04) after exercise training. Exercise training did not affect CoM descent velocity or acceleration. Increased rise stairs - Required greater ankle, knee, and hip moments ( p < 0.001), peak downward CoM velocity and acceleration ( p = 0.0001), and anterior-posterior CoP-CoM separation ( p = 0.0001), but lower medial-lateral CoP-CoM separation ( p < 0.05), when compared to standard stair descent. Exercise training did not affect joint kinetics or movement strategies., Discussion: Exercise training increased the maximum joint ROM, strength and force production of the ankle, and enabled a greater ankle joint moment to be produced in single-leg support (lowering phase) during standard stair descent. Descending increased rise stairs raised the task demand; exercise training could not overcome this. Future research should prioritize the ankle joint in stair descent, particularly targeting plantarflexor torque development across stairs of varying riser heights.

To examine the effects of 8-week unsupervised, home-based inspiratory muscle training (IMT) on the balance and physical performance of healthy older adults. Fifty-nine participants (74 ± 6 years) were assigned randomly in a double-blinded fashion to either IMT or sham-IMT, using a pressure threshold loading device. The IMT group performed 30-breath twice daily at ~50% of maximal inspiratory pressure (MIP). The sham-IMT group performed 60-breaths once daily at ~15% MIP; training was home-based and unsupervised, with adherence self-reported through training diaries. Respiratory outcomes were assessed pre- and postintervention, including forced vital capacity, forced expiratory volume, peak inspiratory flow rate (PIFR), MIP, and inspiratory peak power. Balance and physical performance outcomes were measured using the shortened version of the Balance Evaluation System test (mini-BEST), Biodex ® postural stability test, timed up and go, five sit-to-stand, isometric "sit-up" and Biering-Sørensen tests. Between-group effects were examined using two-way repeated measures ANOVA, with Bonferroni correction. After 8-week, the IMT group demonstrated greater improvements (P ≤ 0.05) in: PIFR (IMT = 0.9 ± 0.3 L sec -1 ; sham-IMT = 0.3 L sec -1 ); mini-BEST (IMT = 3.7 ± 1.3; sham-IMT = 0.5 ± 0.9) and Biering-Sørensen (IMT = 62.9 ± 6.4 sec; sham-IMT = 24.3 ± 1.4 sec) tests. The authors concluded that twice daily unsupervised, home-based IMT is feasible and enhances inspiratory muscle function and balance for community-dwelling older adults., (© 2019 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.)

Introduction: Electrostimulation devices stimulate the common peroneal nerve, producing a calf muscle-pump action to promote venous circulation. Whether knee joint angle influences calf neuromuscular activity remains unclear. Our aim was to determine the effects of knee joint angle on lower limb neuromuscular activity during electrostimulation., Methods: Fifteen healthy, older adults underwent 60 min of electrostimulation, with the knee joint at three different angles (0°, 45° or 90° flexion; random order; 20 min each). Outcome variables included electromyography of the peroneus longus , tibialis anterior and gastrocnemius medialis and lateralis and discomfort., Results: Knee angle did not influence tibialis anterior and peroneus longus neuromuscular activity during electrostimulation. Neuromuscular activity was greater in the gastrocnemius medialis ( p  = 0.002) and lateralis ( p  = 0.002) at 90°, than 0° knee angle. Electrostimulation intensity was positively related to neuromuscular activity for each muscle, with a knee angle effect for the gastrocnemius medialis ( p  = 0.05)., Conclusion: Results suggest that during electrostimulation, knee joint angle influenced gastrocnemii neuromuscular activity; increased gastrocnemius medialis activity across all intensities (at 90°), when compared to 0° and 45° flexion; and did not influence peroneus longus and tibialis anterior activity. Greater electrostimulation-evoked gastrocnemii activity has implications for producing a more forceful calf muscle-pump action, potentially further improving venous flow., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: We examined the effect of early-onset of muscle damage and low muscle glycogen on cardiorespiratory and metabolic responses to low-intensity exercise., Methods: Twelve men cycled for 10 min at 50% maximal oxygen uptake before, and 12 h after a morning downhill run (five, 8 min bouts at -12% gradient, with 2 min rests) under normal (NORM) and lowered glycogen (LOW) conditions, following a cross-over design with conditions separated by six weeks. Cardiorespiratory responses were recorded, with oxidation measures derived from stoichiometry equations., Results: Muscle damage symptoms post-downhill (0 h) were similar between conditions. Carbon dioxide ventilatory equivalent increased 12 h post-downhill for LOW (P<0.05), but not NORM (P=0.7). A trend towards decreased respiratory exchange ratio (RER) was shown 12 h post-downhill for LOW (1.00±0.07 to 0.89±0.12, P=0.06), but not NORM (0.94±0.11 to 0.94±0.08; P=0.6). Twelve hours after LOW downhill running fat oxidation increased (0.21±0.18 g·min-1 to 0.36±0.27 g·min-1; P<0.05) and carbohydrate oxidation decreased (2.68±0.52 g·min-1 to 1.98±0.75 g·min-1; P<0.05); NORM oxidation rates were unchanged (fat: 0.26±0.18 g·min-1 to 0.33±0.18 g·min-1; P=0.5; carbohydrate: 2.51±0.49 g·min-1 to 2.29±0.47 g·min-1; P=0.3)., Conclusions: Cycling at low-intensity 12 h post-downhill running with lowered muscle glycogen increased fat oxidation, decreased carbohydrate oxidation and elevated carbon dioxide ventilation. Damaging exercise with reduced glycogen availability increases fat utilization during subsequent low-intensity exercise as little as 12 h later.

Background: Total hip replacement (THR) and total knee replacement (TKR) are common orthopaedic procedures. However, an optimal programme for post-operative rehabilitation has yet to be established. Stair negotiation is a challenging, habitual task, regularly used as a post-operative functional outcome measure; yet as a physical rehabilitation intervention it appears to be rarely used., Aim: The review purpose was to investigate the effectiveness of stair climbing as a rehabilitation intervention for THR and TKR patients., Methods: MEDLINE, PsycINFO, Science Citation Index, CINAHL, SPORTDiscus and the Cochrane Database of Systematic Reviews were searched. The systematic review targeted studies using stair negotiation as a rehabilitation intervention. Randomised and non-randomised controlled trials, pilot studies, and case studies were included; systematic reviews and meta-analyses were excluded., Results: Of 650 articles identified, ten studies were eligible for review. A predefined data table to extract information from selected studies was used. Of the ten identified reports, two prehabilitation and eight rehabilitation studies included stair negotiation exercises as part of multi-modal physical interventions. Outcome measures were classified as: functional self-reported, perceptual, psychological and those relating to quality of life., Conclusion: Studies were methodologically heterogeneous and typically lacked adequate control groups. It was not possible to determine the impact of stair negotiation exercise on the positive outcomes of interventions. Stair negotiation warrants further investigation as a rehabilitation activity., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

Eccentric exercise can result in muscle damage and interleukin-6 (IL-6) secretion. Glycogen availability is a potent stimulator of IL-6 secretion. We examined effects of eccentric exercise in a low-glycogen state on neuromuscular function and plasma IL-6 secretion. Twelve active men (23 ± 4 yr, 179 ± 5 cm, 77 ± 10 kg, means ± SD) completed two downhill treadmill runs (gradient, -12%, 5 × 8 min; speed, 12.1 ± 1.1 km/h) with normal (NG) and reduced muscle glycogen (RG) in randomized order and at least 6 wk apart. Muscle glycogen was reduced using an established cycling protocol until exhaustion and dietary manipulation the evening before the morning run. Physiological responses were measured up to 48 h after the downhill runs. During recovery, force deficits of musculus quadriceps femoris by maximal isometric contractions were similar. Changes in low-frequency fatigue were larger with RG. Voluntary activation and plasma IL-6 levels were similar in recovery between conditions. It is concluded that unaccustomed, damaging eccentric exercise with low muscle glycogen of the m. quadriceps femoris 1) exacerbated low-frequency fatigue but 2) had no additional effect on IL-6 secretion. Neuromuscular impairment after eccentric exercise with low muscle glycogen appears to have a greater peripheral component in early recovery., (Copyright © 2016 the American Physiological Society.)

The study investigated the accumulative effect of concentric-biased and eccentric-biased exercise on cardiorespiratory, metabolic and neuromuscular responses to low-intensity exercise performed hours later. Fourteen young men cycled at low-intensity (~60 rpm at 50% maximal oxygen uptake) for 10 min before, and 12 h after: concentric-biased, single-leg cycling exercise (CON) (performed ~19:30 h) and eccentric-biased, double-leg knee extension exercise (ECC) (~06:30 h the following morning). Respiratory measures were sampled breath-by-breath, with oxidation values derived from stoichiometry equations. Knee extensor neuromuscular function was assessed before and after CON and ECC. Cardiorespiratory responses during low-intensity cycling were unchanged by accumulative CON and ECC. The RER was lower during low-intensity exercise 12 h after CON and ECC (0.88 ± 0.08), when compared to baseline (0.92 ± 0.09; p = 0.02). Fat oxidation increased from baseline (0.24 ± 0.2 g·min(-1)) to 12 h after CON and ECC (0.39 ± 0.2 g·min(-1); p = 0.01). Carbohydrate oxidation decreased from baseline (1.59 ± 0.4 g·min(-1)) to 12 h after CON and ECC (1.36 ± 0.4 g·min(-1); p = 0.03). These were accompanied by knee extensor force loss (right leg: -11.6%, p < 0.001; left leg: -10.6%, p = 0.02) and muscle soreness (right leg: 2.5 ± 0.9, p < 0.0001; left leg: 2.3 ± 1.2, p < 0.01). Subsequent concentric-biased and eccentric-biased exercise led to increased fat oxidation and decreased carbohydrate oxidation, without impairing cardiorespiration, during low-intensity cycling. An accumulation of fatiguing and damaging exercise increases fat utilisation during low intensity exercise performed as little as 12 h later.

Purpose: Exercise-induced muscle damage and lowered glycogen are common during heavy training periods, and may prolong recovery. We examined the effects of lowered glycogen on cardiorespiratory, metabolic and perceptual responses to downhill running., Methods: Twelve men performed two downhill runs (-12 % gradient, 12.1 ± 1.1 km h(-1)) separated by 6 weeks, under normal (NORM) and reduced glycogen (RED) conditions in a crossover design. For RED, participants performed exhaustive cycling at 60 % [Formula: see text]O2max power (95 ± 13 min) in the evening, and the next morning completed a downhill run comprising of five stages of 8 min running, with 2 min recovery (1 % gradient, 8 km h(-1)) between each stage. Expired gas, heart rate, rating of perceived exertion (RPE) and blood lactate (bLa) and glucose were measured for each stage., Results: Blood glucose (P < 0.05) and respiratory exchange ratio (P < 0.01) were lower in RED, than NORM, throughout the downhill run. RED demonstrated higher bLa until stage Four (P < 0.05), and RPE for stages Two and Five (P < 0.05).Ventilatory equivalent of carbon dioxide output ([Formula: see text]/[Formula: see text]) was higher for stages One (P < 0.01), Two and Five (P < 0.05), and oxygen uptake ([Formula: see text] E/[Formula: see text]O2) was lower for stages Three and Four (P < 0.05) for RED., Conclusions: Downhill running with reduced glycogen, elevated fat oxidation and bLa response, and, in part, increased effort perception. The alterations in [Formula: see text] E/[Formula: see text]O2 and bLa may suggest that carbon dioxide removal was somewhat impaired.

The aim of this study was to examine the effect of low muscle glycogen on the neuromuscular responses to maximal eccentric contractions. Fourteen healthy men (22 ± 3 years) performed single-leg cycling (20 min at ~75% maximal oxygen uptake (V̇O2 max); eight 90 s sprints at a 1:1 work-to-rest ratio (5% decrements from 90% to 55% V̇O2 max until exhaustion) the evening before 100 eccentric (1.57 rads(-1)) with reduced (RED) and normal glycogen (NORM). Neuromuscular responses were measured during and up to 48 h after with maximal voluntary and involuntary (twitch, 20 Hz and 50 Hz) isometric contractions. During eccentric contractions, peak torque decreased (RED: -16.1 ± 2.5%; NORM: -6.2 ± 5.1%) and EMG frequency increased according to muscle length. EMG activity decreased for RED only. After eccentric contractions, maximal isometric force was reduced up to 24h for NORM (-13.5 ± 5.8%) and 48 h for RED (-7.4 ± 10.9%). Twelve hours after eccentric contractions, twitch force and the 20:50 Hz ratio were decreased for RED but not for NORM. Immediate involuntary with prolonged voluntary force loss suggests that reduced glycogen is associated with increased susceptibility to mild muscle-damaging eccentric exercise with contributions of peripheral and central mechanisms to be different during recovery., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: This study examined the reproducibility of speed corresponding to specific lactate markers during incremental treadmill running of normal and prolonged stage durations., Design: Nineteen healthy participants (14 male, 5 female) performed repeated, incremental treadmill running trials of 4 and 8 min stages on separate days to examine the test-retest reproducibility of speed at lactate markers. Two trials were completed for each duration in a randomised order., Methods: Fingertip blood samples drawn upon stage completion were analysed for plasma lactate, then used to determine running speed at: 2.0, 3.5, and 4.0 mmol l(-1) fixed blood lactate accumulations (FBLA), a 1 mmol l(-1) rise from baseline, and the markers: the deviation maximum (Dmax), the Dmax of the second curve derivative (D2L(max)), the lactate threshold (LT) and log-log LT., Results: The 2.0 mmol l(-1) FBLA reported the lowest mean bias between 4 min trials (-0.06 km h(-1)), with the narrowest limits of agreement (LoA) (-1.78 to 1.66 km h(-1)). The Dmax had the second lowest bias (0.14 km h(-1)), D2L(max) the second narrowest LoA (-1.93 to 2.90 km h(-1)). For 8 min stages, the 1 mmol l(-1) rise demonstrated, low mean bias (-0.13 km h(-1)) and narrowest LoA (-1.22 to 0.97 km h(-1)) between trials., Conclusions: This preliminary report suggests the reproducibility of running speed at lactate summary markers is influenced by stage duration for incremental treadmill running. Varied marker reproducibility between 4 and 8 min stages indicates different blood lactate response, and therefore workload calculation, according to stage length. Consideration of marker construct is recommended., (Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Purpose: Sleep disordered breathing caused by tonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children. We prospectively studied the preoperative and postoperative rates of nocturnal and daytime incontinence in a group of children with tonsillar hypertrophy undergoing tonsillectomy compared to a matched control group undergoing surgery unrelated to the airway or urinary tract., Materials and Methods: A total of 326 toilet trained children 3 to 15 years old were included, with 257 in the tonsillectomy group and 69 in the control group. Severity of tonsillar hypertrophy was graded preoperatively on a scale of 1 to 4. A voiding questionnaire regarding number of bedwetting and daytime incontinence episodes per week, voids per day, bowel movements per week, secondary or primary enuresis and family history was completed by parents preoperatively, and at 3 and 6 months postoperatively., Results: Preoperatively the respective rates of nocturnal enuresis and daytime incontinence were 33% and 17% in the tonsillectomy group (p=0.89), and 35% and 14% in the control group (p=0.3). The respective cure rates for bedwetting at 3 and 6 months postoperatively were 40% and 50% in the tonsillectomy group (p=0.60), and 35% and 48% in the control group (p=0.61). Similarly no difference was seen in improvement or cure of daytime incontinence at 3 and 6 months postoperatively., Conclusions: We found no association between tonsillar hypertrophy and urinary incontinence before or after tonsillectomy., (Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

The presence of both afferent and efferent renal nerves following renal transplantation was investigated in a canine autotransplant model. The efferent postganglionic sympathetic renal nerves were studied using the glyoxylic acid histofluorescence technique to identify renal tissue adrenergic amines (Grade 0-4). The afferent sensory renal nerves were studied by the systemic blood pressure response to renal arterial injection of capsaicin. In 8 control dogs with native innervated kidneys (Group I), intrarenal injection of capsaicin significantly increased the systemic blood pressure from baseline by 32.4 +/- 6.3 mm. Hg (p less than 0.01). This response was equivalent to the blood pressure increase following injection of capsaicin into the mesenteric artery which was 37.3 +/- 9.8 mm. Hg. The renal tissue histofluorescence grade in this group was 4. Six dogs were studied two to three weeks after autotransplantation of a solitary kidney (Group II). Intrarenal injection of capsaicin did not increase the systemic blood pressure in these animals. Three dogs in this group had no evidence of renal tissue adrenergic amines by histofluorescence (Grade 0); the remaining two animals had renal tissue histofluorescence grades of 1 and 2. Eight dogs were studied 12 to 35 months after autotransplantation of a solitary kidney (Group III). Intrarenal injection of capsaicin in these animals significantly increased the systemic blood pressure from baseline by 10 +/- 1.4 mm. Hg (p less than 0.001). The renal tissue histofluorescence grade in this group ranged from 1 to 3. These data support the presence of both afferent and efferent renal nerves in the kidney at greater than or equal to one year post-transplant.

The utility of captopril renography in the diagnosis of renal artery stenosis was examined in a canine model of renal autotransplantation with and without renal artery clipping. Autotransplantation of the left kidney to the right iliac fossa with contralateral nephrectomy was done in female mongrel dogs. One group served as controls (n = 6). A second group underwent constriction of the external diameter of the renal artery at the time of the operation to produce renal artery stenosis (n = 7). At two weeks postoperatively, glomerular filtration rate was significantly lower in the renal artery stenosis group (26.2 +/- 3.4 ml./min. vs. 38.2 +/- 3.2 ml./min., p less than 0.05), and deteriorated further after captopril administration (17.9 +/- 2.7 ml./min. vs. 26.2 +/- 3.4 ml./min., p less than 0.05). Despite the presence of hemodynamically significant renal artery stenosis, mean arterial pressure was not different between the two groups (134 +/- 4 mm. Hg vs. 132 +/- 6 mm. Hg, control vs. renal artery stenosis, p = NS). Captopril renography did not enable detection of renal artery stenosis in this autotransplant model.