It may be essential for the athlete to train in cycles in order to induce optimal improvements and prevent overtraining. Without sufficient recovery time, adaptation may not occur and the athlete may develop the symptoms of overtraining due to continuous and/or excessive exposure to training stress. Training in cycles provides guidelines for the times in the training programme when regeneration should be complete, and therefore the times when the athlete can be screened for overtraining without confusing the fatigue of overload training with that of overtraining. A periodised training structure provides guidelines for conducting research into the mechanisms of training adaptation and overtraining.
Objective To assess the effects that exercise-induced plasma volume changes (PVCs) have on the interpretation of biochemical and hormonal parameters in the blood of athletes after high-intensity exercise. It was hypothesized that two unrelated high-intensity exercise protocols, performed by two separate subject groups each using different exercise modes, would result in similar percentage changes in plasma volume (%ΔPV). It was further hypothesized that the %ΔPV, measured in both protocols, would comparably influence the interpretation of biochemical variables measured following exercise. Design An experimental before–after trial on volunteers was performed. Two different exercise modes employing two different high-intensity acute exercise protocols were investigated. Eight male swimmers performed an interval training session (ITS) consisting of 15 × 100-m freestyle efforts at 95% of their maximal exercise intensity, and eight male runners performed a multistage discontinuous treadmill test (MSD) to volitional exhaustion. Setting The Human Performance Laboratory at the Department of Human Movement at the University of Western Australia. Main outcome measures Blood samples obtained before, immediately after, and 30, 60, and 120 min during recovery were analyzed for plasma volume changes, urea, uric acid, creatinine, albumin, calcium, iron, transferrin, testosterone, cortisol, and sex hormone-binding globulin (SHBG). Main results The ITS and MSD protocols produced similar and significant alterations (p < 0.01) in plasma volume. Both protocols also elicited significant fluctuations (p < 0.01) in the concentration of most of the parameters measured (excluding iron). When albumin, transferrin, testosterone, and SHBG values were adjusted for the significant %ΔPV, their concentrations did not change over the experimental period, suggesting that the changes in measured concentration of these parameters may be, in part, due to changes in plasma volume. However, urea, uric acid, creatinine, calcium, and cortisol, when corrected for %ΔPVC, still demonstrated significant changes (p < 0.01). Conclusions It is recommended, when sampling biochemical and hormonal parameters in blood following an acute bout of exercise, that corrections for PVCs should be conducted. Apparent changes in blood solutes may reflect PVCs. PVCs should be taken into consideration when interpreting results regardless of exercise protocol and exercise mode performed.
Clinicians providing diabetes-related skin and wound care face complex barriers associated with patients’ access and funding for foot care and footwear. We sought to understand the barriers and solutions to the delivery of best practices in wound care.
C3H mice immunized with rat erythrocytes developed autoimmune haemolytic anaemia which was very similar to the `warm-type' autoimmune haemolytic anaemia of man. There was evidence of anaemia, reticulocytosis, shortened survival times of 51Cr-labelled erythrocytes in vivo, and a high incidence of positive direct Coombs' tests. There was no evidence of spherocytosis or of increased susceptibility to osmotically induced lysis. Bone marrow smears showed evidence of erythroid hyperplasia. Splenectomized mice were more severely affected than unsplenectomized mice. In these mice anaemia was more severe, individual positive direct Coombs' tests were stronger; 51Cr-labelled erythrocytes were cleared faster and the compensatory erythroid hyperplasia was less marked. After immunization was stopped both groups of mice quickly became haematologically normal. However, in mice in which immunization was continued, the blood pictures eventually reverted towards normal except for the persistent positive direct Coombs' tests. C57/B1 mice were also susceptible to the disease process but to a much lesser degree than C3H mice.
This article explores the prevalence of lymphedema and chronic edema in Canada, emphasizing the challenges in obtaining accurate estimates due to diverse causes and complex diagnostic criteria. Authors Keast and Towers address multiple prevalence factors, particularly highlighting the significant role of obesity, which surpasses cancer as the primary contributor to lymphedema cases in Canada. Additional risk factors include chronic venous insufficiency, reduced mobility, and certain types of surgeries. While prevalence estimates vary, conservative figures suggest over a million Canadians may be affected. The authors advocate for improved prevention, screening, and management strategies and call for greater research to refine prevalence data and inform healthcare policy.
OBJECTIVE: To develop and validate an assessment tool—the Leg Ulcer Measurement Tool (LUMT)—that would be able to detect changes in the appearance of lower extremity ulcers. SUBJECTS: Twenty-two subjects with chronic leg ulcers of various etiologies (arterial, venous, diabetes) participated in the validation study. DESIGN: An interdisciplinary panel consisting of 9 local wound care specialists confirmed content validity. Concurrent criterion validity was determined by correlation of the size domain (1 of 14 clinician-rated domains in the LUMT) with acetate tracing measurement of wound surface area. Reliability was determined using repeated assessments by 4 wound care specialist and 2 inexperienced evaluators; responsiveness was determined using monthly reassessments by a single rater for 4 months. RESULTS: Concurrent criterion validity was r = 0.82. Excellent values of intrarater and interrater reliability (ICC > 0.75) were obtained for total LUMT scores and for many of the 14 individual domains; however, several domains were found to be less reproducible. The LUMT detected change in wound status over time (responsiveness coefficient = 0.84). CONCLUSION: The LUMT can be used by 1 or more assessors, with relatively little previous training, to make reproducible evaluations of lower extremity ulcer appearance and to document change in appearance over time. The LUMT represents a novel assessment tool specifically designed and validated for clinical or research use on chronic leg ulcers.
The local and systemic cell-mediated immune (CMI) responses to influenza virus infection in mice were examined by leukocyte migration inhibition and lymphocyte-mediated cytotoxicity tests. Mice were inoculated intranasally with 5 50% lethal doses of the A/WSN (H0N1) strain of influenza virus. Cells from the lymph nodes draining the upper and lower respiratory tract were used to measure the local response, and the spleen was the source of cells used for systemic determinations. The local response by pulmonary lymph node cells was greater and appeared earlier than was observed systemically in the spleen. The specificity of the CMI response was investigated by using a heterologous virus strain, A/Jap (H2N2), and recombinants A/Jap-NWS (H2N1) and A/NWS-Jap (H0N1), obtained from a cross between A/Jap (H2N2) and a virus, A/NWS (H0N1), with surface antigenic specificity similar to that of the inoculated virus. From the results of both tests used as correlates of CMI, it appeared that the response was specific against the hemagglutinin component of the inoculated virus. No reactivity was observed against the heterologous virus A/Jap (H2N2) nor against the recombinant A/Jap-NWS (H2N1) bearing the same neuradminidase as that of the inoculated virus.
Ultraviolet light C (light wavelength 200 nm to 290 nm) has been shown to kill cultures of antibiotic resistant strains of bacteria such as methicillin-resistant Staphylococcus aureus. To evaluate the ability of ultraviolet light C to reduce the amount and type of bacteria present in chronically infected ulcers, as well as to establish the test-retest reliability of the semi-quantitative swab technique, a prospective, one-group, pre-post treatment study was conducted among patients receiving treatment in several in- and outpatient facilities and nursing homes. Individuals with chronic ulcers exhibiting at least two signs of infection and critically colonized with bacteria (n = 22) received a single 180-second treatment using an ultraviolet light C lamp (wavelength = 254 nm) placed 1 inch from the wound bed. Semi-quantitative swabs taken immediately before and after UVC treatment were used to assess changes in the bacterial bioburden present within the wound bed. Results demonstrated excellent test-retest reliability of the semi-quantitative swab technique used to evaluate the type and amount of bacteria present in chronic wounds (Cohen's kappa = 0.92). Assessment of wound bioburden using semi-quantitative swabs revealed a statistically significant (P <0.0001) reduction in the relative amount of bacteria following a single treatment of ultraviolet light C. The greatest reduction in semi-quantitative swab scores following ultraviolet light C treatment were observed for wounds colonized with the bacteria Pseudomonas aeruginosa and wounds colonized with only one species of bacteria. Significant (P <0.05) reductions in the relative amount of bacteria also were observed in 12 ulcers in which methicillin-resistant Staphylococcus aureus was present. These results confirm previous laboratory studies and demonstrate that ultraviolet light C can kill bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus present in superficial layers of chronic wounds.
Patients with hemoglobin greater than or equal to 100 g/L may have difficulty healing pressure ulcers because of impaired tissue oxygenation. Decreased hemoglobin is often anemia of chronic disease and may be due to the effects of inflammatory cytokines on erythroid progenitor cells. Recombinant human erythropoietin has been found to reverse anemia of chronic disease and may act as a growth factor in wound healing. To review the effect of 6 weeks of subcutaneous recombinant human erythropoietin 75 IU/kg administered 3 times weekly to resolve refractory anemia of chronic disease and heal Stage IV pressure ulcers, a retrospective chart review was conducted of four spinal cord injured patients (all men, mean age 59 years +/- 19) with Stage IV pressure ulcers and multiple comorbid conditions. The patients received recombinant human erythropoietin either through an inpatient spinal cord rehabilitation unit or an outpatient wound management clinic as part of interdisciplinary care. Mean hemoglobin increased from 88 +/- 7.4 g/L to 110 +/- 3.7 g/L. Mean ulcer surface area decreased from 42.3 cm2 (+/- 40.2) to 37.3 cm2 (+/- 44.3) despite extensive deroofing of one ulcer and subsequent increase in size. Mean ulcer depth decreased from 2.3 cm (+/- 1.2) to 1.2 cm (+/- 1.0). Human recombinant erythropoietin shows promise in resolving the refractory anemia of chronic disease associated with Stage IV pressure ulcers. Further study is suggested.
This chapter contains sections titled: Introduction Erythropoietin as a Potential Growth Factor in Wound Healing Clinical Experience with Recombinant Human Erythropoietin and Patients with Pressure Ulcers Conclusions and Future Research References
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