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This study tested the hypothesis that acute moderate normobaric hypoxia augments circulating thyroid hormone concentrations during and following 1 h of cold head-out water immersion (HOWI), compared with when cold HOWI is completed during normobaric normoxia. In a randomized crossover single-blind design, 12 healthy adults (27 ± 2 yr, 2 women) completed 1 h of cold (22.0 ± 0.1°C) HOWI breathing either normobaric normoxia (F I O 2 = 0.21) or normobaric hypoxia (F I O 2 = 0.14). Free and total thyroxine (T3) and triiodothyronine (T4), and thyroid-stimulating hormone (TSH) concentrations were measured in venous blood samples obtained before (baseline), during (15-, 30-, and 60 min), and 15 min following HOWI (post-), and were corrected for changes in plasma volume. Arterial oxyhemoglobin saturation and core (rectal) temperature were measured continuously. Arterial oxyhemoglobin saturation was lower during hypoxia (90 ± 3%) compared with normoxia (98 ± 1%, P < 0.001). Core temperature fell from baseline (normoxia: 37.2 ± 0.4°C, hypoxia: 37.2 ± 0.4°C) to post-cold HOWI (normoxia: 36.4 ± 0.5°C, hypoxia: 36.3 ± 0.5°C, P < 0.001) in both conditions but did not change differently between conditions (condition × time: P = 0.552). Circulating TSH, total T3, free T4, total T3, and free T4 concentrations demonstrated significant main effects of time (all P ≤ 0.024), but these changes did not differ between normoxic and hypoxic conditions (condition × time: all P ≥ 0.163). These data indicate that acute moderate normobaric hypoxia does not modify the circulating thyroid hormone response during 1 h of cold HOWI. NEW & NOTEWORTHY: Acute head-out cold (22°C) water immersion (HOWI) decreased core temperature and increased thermogenesis. This thermogenic response was paralleled by the activation of the hypothalamic-pituitary-thyroid axis, as evidenced by changes in thyroid hormones. However, cold HOWI in combination with moderate normobaric hypoxia did not modify the thermogenic nor the circulating thyroid hormone response. This finding suggests that hypoxia-induced alterations in thyroid hormone concentrations are unlikely to acutely contribute to adaptations resulting from repeated cold-water exposures. [ABSTRACT FROM AUTHOR]

Background The United States (US) Expanded Access Program (EAP) to coronavirus disease 2019 (COVID-19) convalescent plasma was initiated in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. While randomized clinical trials were in various stages of development and enrollment, there was an urgent need for widespread access to potential therapeutic agents. The objective of this study is to report on the demographic, geographical, and chronological characteristics of patients in the EAP, and key safety metrics following transfusion of COVID-19 convalescent plasma. Methods and findings Mayo Clinic served as the central institutional review board for all participating facilities, and any US physician could participate as a local physician-principal investigator. Eligible patients were hospitalized, were aged 18 years or older, and had-or were at risk of progression to-severe or life-threatening COVID-19; eligible patients were enrolled through the EAP central website. Blood collection facilities rapidly implemented programs to collect convalescent plasma for hospitalized patients with COVID-19. Demographic and clinical characteristics of all enrolled patients in the EAP were summarized. Temporal patterns in access to COVID-19 convalescent plasma were investigated by comparing daily and weekly changes in EAP enrollment in response to changes in infection rate at the state level. Geographical analyses on access to convalescent plasma included assessing EAP enrollment in all national hospital referral regions, as well as assessing enrollment in metropolitan areas and less populated areas that did not have access to COVID-19 clinical trials. From April 3 to August 23, 2020, 105,717 hospitalized patients with severe or life-threatening COVID-19 were enrolled in the EAP. The majority of patients were 60 years of age or older (57.8%), were male (58.4%), and had overweight or obesity (83.8%). There was substantial inclusion of minorities and underserved populations: 46.4% of patients were of a race other than white, and 37.2% of patients were of Hispanic ethnicity. Chronologically and geographically, increases in the number of both enrollments and transfusions in the EAP closely followed confirmed infections across all 50 states. Nearly all national hospital referral regions enrolled and transfused patients in the EAP, including both in metropolitan and in less populated areas. The incidence of serious adverse events was objectively low ( Conclusions These results suggest that the EAP provided widespread access to COVID-19 convalescent plasma in all 50 states, including for underserved racial and ethnic minority populations. The study design of the EAP may serve as a model for future efforts when broad access to a treatment is needed in response to an emerging infectious disease. Trial registration ClinicalTrials.gov NCT#: NCT04338360., Author(s): Jonathon W. Senefeld 1, Patrick W. Johnson 2, Katie L. Kunze 3, Evan M. Bloch 4, Noud van Helmond 1,5, Michael A. Golafshar 3, Stephen A. Klassen 1, Allan [...]

Purpose: To describe the heart-rate (HR) response during a prolonged, submaximal, multirepetition swimming bout (ie, typical early-season swimming training), as there is currently little or no literature on this topic. Methods: A total of 12 collegiate swimmers were instructed to complete sixty 91.4-m (100-yd) freestyle repetitions at their fastest sustainable pace, allowing between 5 and 10 seconds of rest between repetitions. Each swimmer was outfitted with a cardiotachometer, whichmonitored HR throughout the trial. Completion time (CT) was also recorded for each repetition. Individual means of HR and CT were calculated, and linear mixed models were used to determine the trend across repetitions and between- and within-subject SD for HR and CT. Results: The mean (SD) value for HR was 167.8 (10.8) beats per minute (bpm), for CT was 68.7 (4.1) seconds, and for percentage of best time was 71.2% (4.5%). There was no change (Δ rep 55-6) inHR (-0.1 bpm; 95% confidence interval, -6.8 to 6.6 bpm; P = .97), whereas CT increased (3.0 s; 95% confidence interval, 1.5-4.4 s; P = .001). The between-subjects SD (95%confidence interval) for HR was 12.6 (8.4-19.3 bpm) and for CT was 4.6 (3.1-7.0 s). The within-subject SDs for HR and CT were 4.0 (3.8-4.3 bpm) and 0.9 (0.8-0.95 s), respectively. Conclusions: The inherent individual variability between swimmers in HR during training suggests that coaches carefully consider the common practice of prescribing workout intensity using rigid HR zones. [ABSTRACT FROM AUTHOR]

Recently, a commercially available starting 'ledge' designed to reduce foot slippage during the execution of the backstroke start was introduced in competit ive swimming. For the purpose of identifying potential safety consequences, the present study investigated the effect of ledge use on head depths, speeds, and distances in backstroke starts of athletes with no prior or only novice familiarity of the ledge. Competitive backstroke starts were performed with and without ledges by high school-aged (14.5 to 19.2 yr, N = 61) swimmers in 1.52 m of water during a closed testing session. A SIMI Reality Motion System in a calibrated space using three cameras was employed for filming starts. Dependent measures were initia l head height (Yset), distance from wall at entry (Xentry), entry angle (Angleentry), horizontal velocity at head entry (XVelentry), resultant velocity at entry (ResVelentry), maximum depth of the center of the head (Ymhd), resultant velocity at maximum head depth (ResVelmhd), and distance from the wall at maximum head depth (Xmhd). The ledge (L) condition showed significant increases compared to the non-ledge (NL) condition in Xent ry (L 1.61 ± 0.59 m, NL 1.50 ± 0.53 m, p < .001), ResVelent ry (L 3.44 ± 0.97 m·s-1, NL 3.08 ± 1.00 m·s-1, p < .001), Angleent ry (L 43.13 ± 16.97, NL 39.66 ± 18.11, p = .030), Xmhd (L 4.18 ± 0.58 m, NL 4.09 ± 0.63 m, p = .008), and Ymhd (L 0.54 ± 0.21 m, NL 0.49 ± 0.18, p <.001). Backstroke starts using the ledge modestly affected 5 of 8 dependent measures in a direction arguably associated with an increased risk to the novice swimmer. [ABSTRACT FROM AUTHOR]

Background: Insertional Achilles tendinopathy (IAT) is a common cause of chronic posterior heel pain. Surgical intervention reproducibly improves patients' pain and functional status. We hypothesized that patients older than 60 years would have similar improvements in pain and function and low rates of complications after surgery for IAT when compared to a younger cohort. Methods: Retrospective review of adult case series in patients undergoing surgical management of IAT. Patients were stratified into those 60 years and younger and those older than 60 years. Patients with prior or concomitant surgical procedures and revisions were excluded. Visual analog scale (VAS), Short Form--36 Physical Component Summary and Mental Component Summary (SF-36 PCS/MCS) scores, wound infection, and recurrence, defined as a redevelopment of heel pain in the operative extremity within 6 months, were assessed with a minimum follow-up of 12 months. Statistical analysis was performed using linear regression mixed models and χ² analysis. Thirty-seven patients were enrolled, with 38 operative heels. The younger cohort had an average age of 49.1 (range, 26-60) years. The older group had an average age of 66.8 (range, 61-76) years. Results: VAS and SF-36 PCS scores for the entire cohort significantly improved at 6 and 12 months postoperatively (P < .001). Postoperative SF-36 MCS scores for the cohort significantly improved only at 12 months (P < .001). No significant differences between the young and elderly were seen with regard to improvements in VAS and SF-36 PCS/MCS at 6 or 12 months postoperatively. Multiple linear regression models showed no significant difference between age groups and VAS score, SF-36 PCS/MCS, or change in pain scores after controlling for comorbidities. No significant difference in overall complication rates was seen between the 2 groups (4.9% vs 29.4%, P = .104). There was 1 recurrence of heel pain in the younger group and 4 recurrences of pain in the older group (23.5%) at 6 months, of which 2 resolved at 1 year. There was 1 case of a superficial wound infection requiring antibiotics in the older cohort (5.9%). No patients required surgical revision. Conclusion: Surgical management of IAT in an older population produced similar improvements in clinical results when compared to a younger cohort, with no significant increase in postoperative complications. [ABSTRACT FROM AUTHOR]

Gas-collection masks are used as a comfortable alternative to the traditional mouthpiece and noseclip during exercise testing protocols in human performance laboratories. However, these masks may introduce potential problems which could affect metabolic and ventilatory parameters, including gas leaks and added dead space. Therefore, the purpose of this study was to compare breathing mechanics, gas exchange variables and ratings of perceived breathlessness (RPB) during high-intensity exercise between a mouthpiece and face mask. Fourteen men [⩒O2peak = 55.3 ± 7.3 ml·kg−1·min−1] were recruited to perform 6 min of cycle ergometry (Velotron Pro, RacerMate, Inc., Seattle, WA) at a work rate corresponding to 90% of ⩒O2peak while breathing on either (1) a mouthpiece (Hans Rudolph, KC, KS) with nose clip, or (2) a face mask (7450, Hans Rudolph, KC, KS). The difference in ⩒E between the mouthpiece (156.8 ± 23.3 L/min) and face mask (153.3 ± 21.8 L/min) was not significant (p = 0.534). Similarly, there were no significant differences in breathing mechanics, gas exchange variables or RPB. These data suggest that the facemask can continue to be used interchangeably with the mouthpiece and may even be a more comfortable alternative during high-intensity exercise. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 has been associated with myocardial involvement in collegiate athletes. The first report from the Big Ten COVID-19 Cardiac Registry (Registry) was an ecological study that reported myocarditis in 37 of 1597 athletes (2.3%) based on local clinical diagnosis. Our objective was to assess the relationship between athlete and clinical characteristics and myocardial involvement., Design: Cross-sectional study., Setting: We analyzed data from 1218 COVID-19 positive Big Ten collegiate athletes who provided informed consent to participate in the Registry., Participants: 1218 athletes with a COVID-19-positive PCR test before June 1, 2021., Assessment of Independent Variables: Demographic and clinical characteristics of athletes were obtained from the medical record., Main Outcome Measures: Myocardial involvement was diagnosed based on local clinical, cardiac magnetic resonance (CMR), electrocardiography, troponin assay, and echocardiography. We assessed the association of clinical factors with myocardial involvement using logistic regression and estimated the area under the receiver operating characteristic (ROC) curve., Results: 25 of 1218 (2.0%) athletes met criteria for myocardial involvement. The logistic regression model used to predict myocardial involvement contained indicator variables for chest pain, new exercise intolerance, abnormal echocardiogram (echo), and abnormal troponin. The area under the ROC curve for these indicators was 0.714. The presence of any of these 4 factors in a collegiate athlete who tested positive for COVID-19 would capture 55.6% of cases. Among noncases without missing data, 86.9% would not be flagged for possible myocardial involvement., Conclusion: Myocardial involvement was infrequent. We predicted case status with good specificity but deficient sensitivity. A diagnostic approach for myocardial involvement based exclusively on symptoms would be less sensitive than one based on symptoms, echo, and troponin level evaluations. Abnormality of any of these evaluations would be an indication for CMR., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This study tested the hypotheses that 1 ) spleen volume increases during head-out-of-water immersion (HOWI) and returns to pre-HOWI values postdiuresis, and 2 ) the magnitude of apnea-induced spleen contraction increases when preapnea spleen volume is elevated. Spleen volume was measured before and after a set of five apneas in 12 healthy adults (28 ± 5 yr, 3 females) before, during (at 30 and 150 min), and 20 min after temperate temperature (36 ± 1°C) HOWI. At each time point, spleen length, width, and thickness were measured via ultrasound, and spleen volume was calculated using the Pilström equation. Compared with pre-HOWI (276 ± 88 mL), spleen volume was elevated at 30 (353 ± 94 mL, P < 0.01) and 150 (322 ± 87 mL, P < 0.01) min of HOWI but returned to pre-HOWI volume at post-HOWI (281 ± 90 mL, P = 0.58). Spleen volume decreased from pre- to postapnea bouts at each time point ( P < 0.01). The magnitude of reduction in spleen volume from pre- to postapneas was elevated at 30 min of HOWI (-69 ± 24 mL) compared with pre-HOWI (-52 ± 20 mL, P = 0.04) but did not differ from pre-HOWI at 150 min of HOWI (-54 ± 16 mL, P = 0.99) and post-HOWI (-50 ± 18 mL, P = 0.87). Thus, spleen volume is increased throughout 180 min of HOWI, and whereas apnea-induced spleen contraction is augmented after 30 min of HOWI, the magnitude of spleen contraction is unaffected by HOWI thereafter.