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BACKGROUND: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.METHODS: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.RESULTS: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.CONCLUSIONS: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

The effect of a comprehensive rehabilitation programme, including diet therapy, was studied in overweight male myocardial infarction (MI) patients randomly assigned to a rehabilitation group (n = 69) and a control group (n = 64). The results show a mean weight decrease of 3.8 kg in the rehabilitation group and a mean weight increase of 1.1 kg in the control group (t = -5.78, p less than 0.001). The proportion of patients reducing their weight more than 5 kg was 33% in the rehabilitation group and 5% in the control group (chi 2 = 15.6, p less than 0.001). Patient characteristics which significantly affected the weight change by univariate analysis were age, level of overweight, smoking habits, employment situation and social problems. Multivariate analyses yielded a two-variable model with moderate explanatory power in the rehabilitation group. The model includes the variables Body Mass Index and cessation of smoking before MI.

The present study compared the effects of postexercise carbohydrate plus protein (CHO+PROT) and carbohydrate (CHO)-only supplementation on muscle glycogen metabolism, anabolic cell signaling, and subsequent exercise performance. Nine endurance-trained males cycled twice to exhaustion (muscle glycogen decreased from ~495 to ~125 mmol/kg dry wt) and received either CHO only (1.2 g·kg-1·h-1) or CHO+PROT (0.8/0.4 g·kg-1·h-1) during the first 90 min of recovery. Glycogen content was similar before the performance test after 5 h of recovery. Glycogen synthase (GS) fractional activity increased after exhaustive exercise and remained activated 5 h after, despite substantial glycogen synthesis (176.1 ± 19.1 and 204.6 ± 27.0 mmol/kg dry wt in CHO and CHO+PROT, respectively; P = 0.15). Phosphorylation of GS at site 3 and site 2+2a remained low during recovery. After the 5-h recovery, cycling time to exhaustion was improved by CHO+PROT supplementation compared with CHO supplementation (54.6 ± 11.0 vs. 46.1 ± 9.8 min; P = 0.009). After the performance test, muscle glycogen was equally reduced in CHO+PROT and CHO. Akt Ser473 and p70s6k Thr389 phosphorylation was elevated after 5 h of recovery. There were no differences in Akt Ser473, p70s6k Thr389, or TSC2 Thr1462 phosphorylation between treatments. Nitrogen balance was positive in CHO+PROT (19.6 ± 7.6 mg nitrogen/kg; P = 0.04) and higher than CHO (-10.7 ± 6.3 mg nitrogen/kg; P = 0.009). CHO+PROT supplementation during exercise recovery improved subsequent endurance performance relative to consuming CHO only. This improved performance after CHO+PROT supplementation could not be accounted for by differences in glycogen metabolism or anabolic cell signaling, but may have been related to differences in nitrogen balance.NEW & NOTEWORTHY Endurance athletes competing consecutive days need optimal dietary intake during the recovery period. We report that coingestion of protein and carbohydrate soon after exhaustive exercise, compared with carbohydrate only, resulted in better performance the following day. The better performance after coingestion of protein and carbohydrate was not associated with a higher rate of glycogen synthesis or activation of anabolic signaling compared with carbohydrate only. Importantly, nitrogen balance was positive after coingestion of protein and carbohydrate, which was not the case after intake of carbohydrate only, suggesting that protein synthesis contributes to the better performance the following day.

The present study tested the hypothesis that lower body progressive resistance training (PRT) increases the neural drive expressed as surface electromyographical (EMG) activity in patients with multiple sclerosis (MS). The study was a randomised controlled trial (RCT) including a 12-week follow up period. Thirty-eight MS patients were randomized to an exercise group (n = 19) or a control group (n = 19). During the intervention period, the exercise group performed a 12-week supervised lower body PRT program, whereas the control group maintained their usual daily activity level. After the 12 week intervention period, the exercise group were encouraged to continue training on their own for a 12-week follow up period, while the control group completed the 12-week supervised PRT program. Surface EMG was recorded from vastus lateralis, rectus femoris and semitendinosus during maximal isometric knee extension and knee flexion, before and after the intervention and at follow up. From the recordings, the area under the rectified, low-pass filtered EMG signal (integrated EMG, iEMG) was calculated. Muscle strength was expressed as the angular impulse (AI) and was measured during the same period as the iEMG. After PRT significant improvements for iEMG of vastus lateralis and rectus femoris during maximal knee extension and for semitendinosus during maximal knee flexion and for AI during both maximal knee extension and flexion were found in the exercise group, when compared to the control group. When compared to the post values, all effects, except for AI during knee flexion, were maintained at follow up in the exercise group. When the control group was exposed to PRT, a similar pattern of improvements were found, albeit not all improvements were significant. In conclusion twelve weeks of intense PRT of the lower extremities improved the neural drive expressed as maximal surface EMG activity in patients with MS, with effects persisting 12 weeks after the intervention. The study was registered at clinicalTrials.gov, Protocol no. NCT00381576.

We hypothesised that skeletal muscles of healthy young people have a large variation in oxidative capacity and fibre-type composition, and aimed therefore to investigate glucose metabolism in biopsies and myotubes isolated from musculus vastus lateralis from healthy males with varying degrees of maximal oxygen uptake. Trained and intermediary trained subjects showed higher carbohydrate oxidation in vivo. Fibre-type distribution in biopsies and myotubes did not differ between groups. There was no correlation between fibre-type I expression in biopsies and myotubes. Myotubes from trained had higher deoxyglucose accumulation and fractional glucose oxidation (glucose oxidation relative to glucose uptake), and were also more sensitive to the suppressive action of acutely added oleic acid to the cells. Despite lack of correlation of fibre types between skeletal muscle biopsies and cultured cells, myotubes from trained subjects retained some of their phenotypes in vitro with respect to enhanced glucose metabolism and metabolic flexibility.

It was hypothesised that increased exercise capacity is related to improved quality of life (QoL) in patients with cystic fibrosis (CF). A 12-week individually tailored unsupervised aerobic exercise programme was offered to 42 patients with CF. At the start and at the end of the exercise programme, data on QoL, current exercise habits and preferences, anthropometric data, exercise test, and lung function test were collected. Adherence was observed by a heart rate (HR) monitor. A total of 24 patients accepted to be enrolled in the exercise programme and 14 completed the programme. Another 14 patients declined to be enrolled in the exercise programme but completed the Cystic Fibrosis Questionnaire for Adolescents and Adults (CFQ-R 14+). Four patients did not want to participate at all. The 14 patients completing the exercise programme had a significantly increased VO(2max), but they showed no significant change in total QoL score. However, the scores in the domain of treatment burden and emotional functioning increased significantly. There was no significant difference in QoL and lung function between patients participating in the exercise programme (n = 24) and non-participants (n = 14). A 12-week individually tailored unsupervised aerobic exercise programme where HR monitors were used significantly affected VO(2max). Improvement in QoL could not be demonstrated in this study. It was hypothesised that increased exercise capacity is related to improved quality of life (QoL) in patients with cystic fibrosis (CF). A 12-week individually tailored unsupervised aerobic exercise programme was offered to 42 patients with CF. At the start and at the end of the exercise programme, data on QoL, current exercise habits and preferences, anthropometric data, exercise test, and lung function test were collected. Adherence was observed by a heart rate (HR) monitor. A total of 24 patients accepted to be enrolled in the exercise programme and 14 completed the programme. Another 14 patients declined to be enrolled in the exercise programme but completed the Cystic Fibrosis Questionnaire for Adolescents and Adults (CFQ-R 14+). Four patients did not want to participate at all. The 14 patients completing the exercise programme had a significantly increased VO(2max), but they showed no significant change in total QoL score. However, the scores in the domain of treatment burden and emotional functioning increased significantly. There was no significant difference in QoL and lung function between patients participating in the exercise programme (n = 24) and non-participants (n = 14). A 12-week individually tailored unsupervised aerobic exercise programme where HR monitors were used significantly affected VO(2max). Improvement in QoL could not be demonstrated in this study.

Objective: To test the hypothesis that lower body progressive resistance training (PRT) leads to an increase of the muscle fiber cross-sectional area (CSA) and a shift in the proportion of fiber types in patients with multiple sclerosis (MS). Methods: The present study was a two-arm, randomized controlled trial (RCT). Thirty-eight MS patients (Expanded Disability Status Scale (EDSS) 3—5.5) were randomized to a PRT group (Exercise, n = 19) or a control group (Control, n = 19). The Exercise group performed a biweekly 12-week lower body PRT program [five exercises progressing from 15RM (Repetition Maximum) towards 8RM], whereas the Control group maintained their usual daily activity level during the trial period. Muscle biopsies from vastus lateralis were taken before (pre) and after the trial (post). Thigh volume (TV) was estimated from anthropometric measurements. Isokinetic muscle strength of the knee extensors (KE) and flexors (KF) were evaluated at slow (90°/s) and fast (180°/s) angular velocities. Results: In the Exercise group the mean CSA of all muscle fibers (7.9 ± 15.4% vs. -3.5 ± 9.0%, p = 0.03) and of type II muscle fibers (14.0 ± 19.4% vs. -2.6 ± 15.5%, p = 0.02) increased in comparison with the Control group. No changes occurred in the proportion of fiber types in the Exercise group. Neither was there any change in total TV. Isokinetic strength at KE180, KF90 and KF180 improved significantly after PRT when compared with the control group (10.2—21.3%, p ≤ 0.02). Conclusions: We conclude that progressive resistance training induces a compensatory increase of muscle fiber size in patients with the central nervous system disorder, multiple sclerosis.

Udgivelsesdato: 2008-Jan This review summarizes the existing knowledge regarding the effects of physical exercise in patients suffering from multiple sclerosis (MS). Furthermore, recommendations are given regarding exercise prescription for MS patients and for future study directions. Previously, MS patients were advised not to participate in physical exercise. During recent years, it has been increasingly acknowledged that exercise benefits MS patients. The requirement for exercise in MS patients is emphasized by their physiological profile, which probably reflects both the effects of the disease per se and the reversible effects of an inactive lifestyle. To date the effects of exercise have only been studied in moderately impaired MS patients with an EDSS score of less than 7. Evidence exists for recommending participation in endurance training at low to moderate intensity, as the existing literature demonstrates that MS patients can both tolerate and benefit from this training modality. Also, resistance training of moderate intensity seems to be well tolerated and to have beneficial effects on MS patients, but the methodological quality of the existing evidence is in general low and the number of studies is limited. Only two studies have evaluated the effects of combined resistance- and endurance training, making solid conclusions regarding this training modality impossible. Multiple Sclerosis 2008; 14: 35-53. http://msj.sagepub.com.

The aim of the study was to estimate active knee flexion and active knee extension in athletes and to investigate the potential association of each to different types of sports activity. Active knee extension and active knee flexion was measured in 339 athletes. Active knee extension was significantly higher in women than in men and significantly positively associated with weekly hours of swimming and weekly hours of competitive gymnastics. Active knee flexion was significantly positively associated with participation in basketball, and significantly negatively associated with age and weekly hours of soccer, European team handball and swimming. The results point to sport-specific adaptation of active knee flexion and active knee extension. Udgivelsesdato: 1999-Apr The aim of the study was to estimate active knee flexion and active knee extension in athletes and to investigate the potential association of each to different types of sports activity. Active knee extension and active knee flexion was measured in 339 athletes. Active knee extension was significantly higher in women than in men and significantly positively associated with weekly hours of swimming and weekly hours of competitive gymnastics. Active knee flexion was significantly positively associated with participation in basketball, and significantly negatively associated with age and weekly hours of soccer, European team handball and swimming. The results point to sport-specific adaptation of active knee flexion and active knee extension.

The objective was to estimate the prevalence of knee instability among active athletes and to investigate potential associations to type, amount and duration of sports participation. Based on a questionnaire, 339 athletes provided information about different features of occupation, sports activity and knee instability. The 12-month period prevalence of knee instability and constant or recurrent knee instability, and absence from sport and absence from work due to knee instability, was 22%, 14%, 5% and 1%, respectively. Knee instability as such, and constant or recurrent knee instability were found to be positively associated with female gender and different features of occupational work. In conclusion, knee instability is a commonly reported phenomenon among active athletes. It was found to be independent of the type and the amount of sports activity but highly dependent on female gender, type and amount of occupational work.

The present case-control study included as cases 24 athletes with anterior knee pain, and 17 controls, matching the cases according to gender and age. All cases had their most symptomatic knee examined by magnetic resonance imaging (MRI). Among controls one knee was chosen for examination at random. The MRI of the patella showed articular cartilage lesions in 17 out of 24 cases, whereas among the controls 4 out of 17 had articular cartilage lesions. (Odds Ratio 7.9 (95% confidence interval 1.9-33)). However, presence of articular cartilage lesions was not associated with duration of symptoms or intensity of the anterior knee pain. The present study showed a significant positive association between presence of articular cartilage lesions in the patella and presence of anterior knee pain, but further studies are needed to examine the relationship in detail.

Background. The gastrointestinal tract is highly responsive to the trophic effect of growth hormone (GH). GH stimulates the healing of colonic anastomoses either directly or through insulin-like growth factor I (IGF-I) since specific GH receptor as well as IGF-I receptor have been demonstrated in colon. Aim. To determine whether exogeneous treatment with IGF-I could stimulate the healing of left colonic anastomoses in rats. Methods. After colonic anastomotic operations adult rats were randomised to treatment with either IGF-I (500 μg per day) or vehicle (controls). Anastomotic breaking strength and collagen deposition were determined at day 3 after surgery. Results. IGF-I treatment increased the anastomotic collagen content by 23% compared with controls. This resulted in a lower extensibility of the anastomosis (P

Udgivelsesdato: 2010-Apr Fatigue occurs in the majority of multiple sclerosis patients and therapeutic possibilities are few. Fatigue, mood and quality of life were studied in patients with multiple sclerosis following progressive resistance training leading to improvement of muscular strength and functional capacity. Fatigue (Fatigue Severity Scale, FSS), mood (Major Depression Inventory, MDI) and quality of life (physical and mental component scores, PCS and MCS, of SF36) were scored at start, end and follow-up of a randomized controlled clinical trial of 12 weeks of progressive resistance training in moderately disabled (Expanded Disability Status Scale, EDSS: 3-5.5) multiple sclerosis patients including a Control group (n = 15) and an Exercise group (n = 16). Fatigue (FSS > 4) was present in all patients. Scores of FSS, MDI, PCS-SF36 and MCS-SF36 were comparable at start of study in the two groups. Fatigue improved during exercise by -0.6 (95% confidence interval (CI) -1.4 to 0.4) a.u. vs. 0.1 (95% CI -0.4 to 0.6) a.u. in controls (p = 0.04), mood improved by -2.4 (95% CI -4.1 to 0.7) a.u. vs. 1.1 (-1.2 to 3.4) a.u. in controls (p = 0.01) and quality of life (PCS-SF36) improved by 3.5 (95% CI 1.4-5.7) a.u. vs. -1.0 (95% CI -3.4-1.4) a.u. in controls (p = 0.01). The beneficial effect of progressive resistance training on all scores was maintained at follow-up after further 12 weeks. Fatigue, mood and quality of life all improved following progressive resistance training, the beneficial effect being maintained for at least 12 weeks after end of intervention.

Udgivelsesdato: 2009-Nov-3 OBJECTIVE: To test the hypothesis that lower extremity progressive resistance training (PRT) can improve muscle strength and functional capacity in patients with multiple sclerosis (MS) and to evaluate whether the improvements are maintained after the trial. METHODS: The present study was a 2-arm, 12-week, randomized controlled trial including a poststudy follow-up period of 12 weeks. Thirty-eight moderately impaired patients with MS were randomized to a PRT exercise group (n = 19) or a control group (n = 19). The exercise group completed a biweekly 12-week lower extremity PRT program and was afterward encouraged to continue training. After the trial, the control group completed the PRT intervention. Both groups were tested before and after 12 weeks of the trial and at 24 weeks (follow-up), where isometric muscle strength of the knee extensors (KE MVC) and functional capacity (FS; combined score of 4 tests) were evaluated. RESULTS: KE MVC and FS improved after 12 weeks of PRT in the exercise group (KE MVC: 15.7% [95% confidence interval 4.3-27.0], FS: 21.5% [95% confidence interval 17.0-26.1]; p < 0.05), and the improvements were better than in the control group (p < 0.05). The improvements of KE and FS in the exercise group persisted at follow-up after 24 weeks. Also, the exercise effects were reproduced in the control group during the 12-week posttrial PRT period. CONCLUSIONS: Twelve weeks of intense progressive resistance training of the lower extremities leads to improvements of muscle strength and functional capacity in patients with multiple sclerosis, the effects persisting after 12 weeks of self-guided physical activity. Level of evidence: The present study provides level III evidence supporting the hypothesis that lower extremity progressive resistance training can improve muscle strength and functional capacity in patients with multiple sclerosis.

Muscle damage and soreness are well-known adverse effects of running, especially when covering distances in excess of habitual running activity. Loss of Ca homeostasis is hypothesized to initiate the development of exercise-induced muscle damage. We tested the hypothesis that the Ca content of vastus lateralis muscle increases after a 10- or 20-km run and studied the relations between Ca accumulation and running distance, endurance training, and fiber type distribution.Twenty-four healthy young men and women were divided into two groups who ran either 10 or 20 km. Muscle biopsies and blood samples were collected before, immediately after, and in the days after the run.: The Ca content in muscle biopsies increased from 0.70 +/- 0.02 to 0.93 +/- 0.04 micromol x g wet weight after the 20-km run (P0.001) and was still significantly elevated at 4 and 48 h after the run. In the 10-km runners, however, no significant increase in Ca was found (0.81 +/- 0.03 vs 0.91 +/- 0.06 micromol x g wet weight, P = 0.08). Plasma levels of lactate dehydrogenase and creatine kinase increased after both running distances, the increase being greatest after the 20-km run. Eight of the 10-km runners completed an endurance-training program and subsequently repeated the 10-km run. The response to a new 10-km run with regard to muscle Ca content and parameters of muscle damage was essentially unchanged by training.The degree of muscle damage depends on running distance, and a significant Ca accumulation in muscle is seen after 20 km. Ten weeks of endurance training does not influence Ca homeostasis and muscle damage after 10-km running.

During prolonged exercise, changes in the ionic milieu in and surrounding the muscle fibers may lead to fatigue or damage of the muscle and thereby impair performance. In 10 male subjects, we investigated the effects of 100 km running on muscle and plasma electrolyte contents, muscle Na+-K+ pump content, and plasma concentrations of creatine kinase (CK) and lactate dehydrogenase (LDH). After completion of a 100-km run, significant increases were found in plasma K+ (from 4.0 ± 0.1 to 5.5 ± 0.2 mM, P < 0.001), muscle Na+-K+ pump content (from 334 ± 11 to 378 ± 17 pmol/g, P < 0.05), and total muscle Ca2+ content (from 0.84 ± 0.03 to 1.02 ± 0.04 μmol/g, P < 0.001). There was also a large increase in the plasma levels of the muscle-specific enzymes CK and LDH, which reached peak values at the end of the run and lasted several days after the run, indicating that a significant degree of muscle membrane leakage was present. The simultaneous occurrence of raised cellular Ca2+ content and muscle membrane leakage supports the theory that Ca2+ plays a role in the initiation of degenerative processes in muscles after severe exercise.

The study objectives were to examine the dynamic strength of the quadriceps muscle in athletes, and investigate its association with participation in sport. The study comprised 168 active competitive non- pregnant athletes, aged 14-24 years. The dynamic strength of their quadriceps muscle was measured, and they answered a questionnaire about sports activity and occupation. The dynamic strength of the quadriceps muscle was significantly higher in men than in women, and was positively associated with body weight, years of jogging, years of soccer, and weekly hours of basketball. In conclusion, the dynamic strength of the quadriceps muscle seems to be associated with sports activity. The results suggest sport specific adaptation, which may reflect high levels of running and jumping activity.

The objective of the present cross-sectional study was to estimate one-leg standing balance in athletes and to investigate the relationship with type and amount of sports activity. The study comprised 339 active, competitive, non-pregnant athletes, aged 14-24 years from two sports clubs in the county of Aarhus, Denmark. The athletes answered a questionnaire about occupation and sports activity. One-leg standing balance was measured as the maximum time of one-legged balancing. The mean of the maximum time of one-legged balancing was 29 s (interquartile range 11.25-33.5 s). One-leg standing balance was positively associated with years of participation in basketball and was not associated with sex and age. We conclude that participation in basketball may induce significantly adaptive effects on standing balance.

Immunological assays for fragments of the cartilage large aggregating proteoglycan, aggrecan, have been widely used to monitor cartilage turnover. These assays have commonly employed the monoclonal keratan sulphate antibody, 5D4. Keratan sulphate, however, is present in many tissues and 5D4 affinity is critically dependent on antigen structure. We have therefore raised and characterized a monoclonal antibody (1-F21) that reacts with the core protein of aggrecan without interference from the glycosaminoglycan side chains and, using this antibody, we have optimized a sensitive, competitive ELISA. The within-assay and between-assay coefficients of variation were 4.9–8.9% and 11.1–13.0%, respectively. The mean concentrations of core protein in synovial fluid, serum and urine were 76.4 μg/ml, 104.0 ng/ml and 81.0 ng/ml, respectively. In synovial fluids the concentrations were closely correlated with the concentrations of keratan sulphate as determined by 5D4 ( r = 0.94), whereas in serum and urine there was no obvious correlation between the determinations. These findings show that measurement of both core protein and keratan sulphate results in a more precise description of aggrecan turnover.

The large aggregating proteoglycan from human cartilage, aggrecan, has recently been shown to possess an immunologically detectable domain with close homology to epidermal growth factor (EGF), that is variably expressed by alternative mRNA splicing. Using a competitive ELISA we detected this domain in sera from both patients with RA and normal controls. The EGF-like domain could only be detected after digestion of sera with chondroitinase ABC, which demonstrates its proteoglycan origin. The concentration of the aggrecan EGF-like domain was considerably elevated in sera from patients with RA as compared to the control sera (P < 0.001), and the concentration of the domain increased with age in both the patient (r = 0.58, P < 0.05) and the control (r = 0.66, P < 0.01) group. These results demonstrate that the EGF-like domain of aggrecan could be of value as a marker of RA.

To characterize responders/nonresponders to 2 nonsteroidal antiinflammatory drugs by a combination of start variables in the treatment of patients with osteoarthritis (OA) of the hip(s)/knee(s).Two hundred eight patients participated in a 3-week randomized double blind parallel group trial.The responder rate to tiaprofenic acid and naproxen was 52 and 59%, respectively. Correctly characterized by use of a combination of 6 baseline variables were 79% of the patients treated with tiaprofenic acid and 81% treated with naproxen.Both active drugs were found effective compared with placebo in patients with OA, but with different characteristics.

A double-blind, placebo-controlled, crossover study on the effects of 4 months' growth hormone (GH) treatment was carried out in 22 GH-deficient adults (8 women, 14 men; mean [SEM] age 23.8 [1.2] years). 1 patient was withdrawn because of oedema. Mean total body weight of the other 21 did not change, whereas mean muscle volume of the thigh, estimated by computerised tomography (CT), was significantly higher after GH than after placebo (70.0 [3.7] vs 66.3 [3.1] ml/0.8 cm cross-sectional slice). The mean adipose tissue volume of the thigh and subscapular skinfold thickness fell significantly during GH treatment. Growth hormone caused a small increase in the isometric strength of the quadriceps muscles and a significant rise in exercise capacity (60.8 [7.2] vs 54.2 [6.6] kJ). The heart rate both at rest and after maximum exercise was low during the placebo period and increased significantly during GH treatment. Blood pressure and echocardiographic wall mass of the left ventricle did not change during the study. Growth hormone increased both mean glomerular filtration rate and renal plasma flow from a subnormal level on placebo to a level comparable with that of an age-matched control group. The filtration fraction did not change. Urinary albumin excretion was in the low normal range and was not affected by GH treatment. Finally, GH treatment normalised mean circulating levels of insulin-like growth factor 1 (IGF-1), which were low after the placebo period (96 [9] micrograms/l placebo; 224 [28] micrograms/l GH). These findings suggest that GH, in a conventional replacement dose, has several potentially beneficial effects in GH-deficient adults and therefore encourage future long-term trials.

The functional properties of B lymphocytes in synovial fluid (SF) from patients with rheumatoid arthritis (RA) were analysed by means of a reverse haemolytic plaque forming cell (PFC) assay. SF mononuclear cells spontaneously secreted IgG, but little IgM or IgA. The SF cells failed to respond to the polyclonal B cell activators pokeweed mitogen (PWM) and Epstein-Barr virus. However, SF B cells cocultured with autologous T lymphocytes from the blood and stimulated with PWM secreted IgG but little IgM or IgA. The PFC responses of blood B cells cocultured with autologous SF T cells in the presence of PWM were low; irradiation of the T cells increased the blood B lymphocyte responses, but the differences were not statistically significant. It is concluded that suppressor SF T cells may be partly responsible for the poor response of SF B cells to PWM.

Bronchial response to 6 min exercise performed as treadmill-walking, treadmill-running, ergometer bicycling and free running were compared in 11 subjects with exercise-induced asthma (EIA). The study was performed under control of air temperature and relative humidity. The three different types of exercise were performed on consecutive days, and the ventilation was monitored using pneumotachography and rating of perceived exertion (RPE). The decrease in peak expiratory flow after treadmill-running was 25.5 +/- 4.5% (mean +/- SEM), after bicycle ergometer exercise 26.0 +/- 3.0%, after treadmill-walking 26.0 +/- 3.0% and after free running 27.0 +/- 3.5%. No statistical difference in bronchial response was demonstrated between the four types of exercise. The total ventilation for the 6 min period of exercise was 421, 411 and 427 litres for treadmill-walking, treadmill-running and bicycle ergometer exercise, respectively. It is concluded that the type of work is of little importance in EIA.

Changes in thigh components were investigated with the one-legged inactivity- and training-model using 22 young healthy male soccer players, who for 4-5 weeks had one leg immobilized in a cast. They were investigated before and after the cast period and after 4 weeks' physical training of the inactivated leg. Immobilization induced a significant increase in the subcutaneous thickness and a significant decrease in the circumference of the thigh (p less than 0.01). The calculated lean thigh volume was reduced from 4.93 1 to 4.10 1 (p less than 0.01), whereas the calculated fat thigh volume (1.5 1) was unchanged. The changes reversed after four weeks of progressive dynamic training, but did not reach the pre-immobilized values. Body weight decreased from 73.4 kg to 70.8 kg (p less than 0.01) during the immobilization period and was regained after the training period. The fat fraction of the body was unchanged. It is concluded that the loss in total thigh volume during inactivation in a cast is due to waste of the muscle tissue, and further that this loss is partly concealed by an unchanged fat thigh volume.

Thigh components were estimated by computerized tomography (CT) as well as by anthropometry in two healthy male soccer players (23--29 years), who for 5 weeks had one knee immobilized in a plaster of Paris. The investigations were performed on both thighs just after removal of the cast and after 5 weeks physical training of the inactivated quadriceps muscle. The different components were easily identified on a transverse scan through the middle of the thigh. The quadriceps muscle was 26% smaller after removal of the cast in the inactivated leg as compared with the contralateral leg; no differences were observed in the remaining thigh components. After rehabilitation a specific increase (22%) in the hypotrofic quadriceps muscle was observed, whereas no changes were disclosed in the remaining thigh components. The quadriceps muscle averaged 52% of the lean component in the uninjured thigh, and the subcutaneous part of the total cross-sectional area averaged 15%. The changes in the anthropometrically determined thigh components paralleled those observed by the CT scanning procedure. It is concluded that the loss in the lean thigh volume during immobilization in plaster cast is exclusively due to waste of the quadriceps muscle. CT scanning comprises a new valid tool to study changes in thigh components.

The decrease in pulmonary function, expressed as peak expiratory flow, which is seen in some asthmatics after exercise (exercise-induced asthma (EIA)), has been studied under conditions standardized with regard to ventilation during exercise, room temperature and relative humidity of the inhaled air. Exercise was performed under four different conditions. 1) temperature (T) 15 degrees C and relative humidity (RH) 30%, and 2) T 15 degrees C and RH 70%, 3) T 30 degrees C and RH 30% and 4) T 30 degrees C and RH 70%. Treadmill running was performed on four succeeding days at the same time of day with the four different combined conditions. Identical ventilation during the exercise was secured on each day by monitoring respiratory frequency, tidal volume, minute ventilation and accumulated ventilation. A significantly smaller decrease in pulmonary function occurred when both T and RH were high, whereas the decrease in pulmonary function after exercise was identical when either temperature or relative humidity, or both, were low. It is concluded that the water concentration of the inspired air is negatively correlated to the decrease in pulmonary function after exercise in asthmatics.

The effects of progressive resistance exercise (PRE) training for 4 weeks on the hypotrophic quadriceps muscle were investigated in 23 young healthy male soccer players, who had been immobilized in a plaster cast 4-6 weeks after knee ligament injuries. The subjects were allocated to two training regimes where the injured leg was trained for periods of varying duration, whereas the intensity and frequency of exercise were alike in the two groups. However no significant differences were detected between the two training groups. In the whole material the lean thigh volume of the injured leg increased from 4.09 to 4.47 litres (p less than 0.001), whereas the fat component of the thigh was unchanged. The dynamic strength (1 RM) of the injured leg increased from 14.0 kg to 27.0 kg and amounted to 87% of the control leg after 4 weeks of training. At this time the maximum isometric strength amounted to 114 Nm, which was 63% of strength in the control leg. Succinate dehydrogenase (SDH) in homogenates of muscle biopsy sample increased (i.e. 20%, p less than 0.05) to the same level as found in the control leg. No changes in phosphofructokinase (PFK) were observed. The type I fibre distribution was lower in the immobilized leg than in the control leg. These results indicate that, following muscular hypotrophy resulting from 4-6 weeks of immobilization, dynamic exercise can restore the oxidative potential, whereas the size and strength are only partly recovered.

The relationship of maximal oxygen uptake (VO2 max) with dihydrogenated ergot alkaloids was investigated in twelve young men. They were subjected to graded bicycle exercise with work loads corresponding to 75% and 120% of the load necessary to elicit VO2 max. The exercise tests were performed after intravenous administration of 2 mg dihydroergostin (DE-145) as well as after saline as control, both preparations were given double-blind. VO2 max averaged (SD) 3.36 (0.41) 1/min and no significant difference was disclosed between the DE-145 and the control situation. Normal relationships were observed between VO2 and work load, ventilation, heart rate, cardiac output, central venous pressure and acid-base data, and these relations were unaffected by DE-145 administration. Nausea was constantly seen in all subjects tested with DE-145. It is concluded, that the present dose of DE-145 has no influence on the functional capacity of the oxygen transporting system in sedentary young men.

Thirty patients with rheumatoid arthritis were allocated to either methylprednisolone pulse therapy or placebo at the beginning of treatment with either gold salts, penicillamine, or azathioprine. Methylprednisolone pulse therapy produced an immediate but temporary anti-inflammatory effect lasting for a maximum of four to eight weeks. It also caused a lasting depression of serum IgG, but no effect was observed on the proportion of T and B lymphocytes, proliferative responses, or on concanavalin A induced suppressor cell activity, and there was no effect on the amount of circulating immune complexes. The bone mineral content decreased similarly in the two groups, and methylprednisolone pulses had no effect on the progression of erosions on x rays during an observation period of eight months. A single pulse of methylprednisolone can give a short lasting anti-inflammatory effect but is of little or no value in the long term treatment of rheumatoid arthritis.

By means of recently developed immunochemical assays increased levels of the complement C3c and C3d split products were found in synovial fluids of patients with rheumatoid arthritis (RA) as compared with synovial fluids of patients with traumatic synovitis (TS). In plasma, only the C3d levels were significantly increased compared with plasma levels of patients with TS. Both split products were higher in RA synovial fluids (SF) than in RA plasma. A positive correlation between the C3d concentrations in plasma and the presence of IC in serum was found, and between the C3c levels and the concentration of polymorphonuclear cells in SF of RA patients. Due to differences in turn-over of C3c and C3d determination of plasma C3d levels may be a useful parameter for the evaluation of immunological activity in RA, while measurement of C3c in the synovial fluid may elucidate the actual inflammatory activity in the synovial membranes.

Isokinetic contraction were performed with the knee extensor muscles in 15 young male soccer players. The measurements were obtained by a modified isokinetic device (Orthotron). In the range of motion the angular velocity was constant from 90 degrees to 20 degrees of knee flexion. The angular velocity could be varied from 30 to 360 degrees/s. The overall variation of the pre-set speed and the peak torque, as estimated from duplicate trials through the whole velocity range, averaged 4% and 5%, respectively. The peak torque decreased linearly with increasing angular velocity in a semilogarithmic scale. An estimate of the peak torque-velocity relationship in an experimental subject was obtained from the slope and the fibre composition in the lateral portion of the quandriceps muscle in this group of subjects especially trained in fast movements. It was concluded that the present applied isokinetic device gives the opportunities to measure force-velocity characteristics in the intact quadriceps muscle of man.

The purpose of this investigation was to study the influence of hyperoxia on catecholamine response to dynamic exercise. While breathing either 21 or 100% O2 seven subjects performed submaximal bicycle exercise. Arterial blood pressure was similar in both exercise experiments. The CO2 output was not influenced by 100% O2 breathing, but increments in plasma lactate concentration were reduced. The increases in plasma norepinephrine and epinephrine concentrations and heart rate were significantly lower during 100% O2 than during 21% O2 breathing. The results suggest that O2 plays an important role in the regulation of sympathetic nervous activity during dynamic exercise in humans.

Eleven adult patients with exercise-induced asthma (EIA) were subjected to swimming and bicycle exercise under controlled conditions regarding temperature and relative humidity of the inhaled air, the respiratory frequency, tidal volume, minute ventilation and the accumulated ventilation. Swimming for 6 min was performed on the first day, and the next day the patients performed bicycle exercise. On both days the temperature of the inhaled air was 23% C and the relative humidity 15%. The average accumulated ventilation for the 6 min of exercise was 404 l for bicycle exercise and 419 l for swimming. The decrease in pulmonary function was 31% after bicycle exercise and 30% after swimming. It is concluded that the stimuli for EIA are equally effective whether exercise is performed in the form of swimming or bicycling.