Comparison of High-Intensity vs. High-Volume Resistance Training on the BDNF Response to Exercise

This study compared the acute and chronic response of circulating plasma brain-derived neurotrophic factor (BDNF) to high-intensity low-volume (HI) and low-intensity high volume (HV) resistance training. Twenty experienced resistance-trained men (23.5 ± 2.6 y, 1.79 ± 0.05 m, 75.7 ± 13.8 kg) volunteered for this study. Before the resistance training program (PRE), participants performed an acute bout of exercise using either the HI [3-5 reps; 90% of one repetition maximum (1RM)] or HV (10–12 reps; 70% 1RM) training paradigm. The acute exercise protocol was repeated after 7 wk of training (POST). Blood samples were obtained at rest (BL), immediately (IP), 30 min (30P), and 60 min (60P) post exercise at PRE and POST. A three-way repeated measure ANOVA was used to analyze acute changes in BDNF concentrations during HI and HV resistance exercise and the effect of 7 wk of training. No training × time × group interaction in BDNF was noted (P = 0.994). Significant main effects for training (P = 0.050) and time (P \u3c 0.001) in BDNF were observed. Significant elevations in BDNF concentrations were seen from BL at IP (P = 0.001), 30P (P \u3c 0.001), and 60P (P \u3c 0.001) in both HI and HV combined during PRE and POST. BDNF concentrations were also observed to increase from PRE to POST when collapsed across groups and time. No significant group × training interaction (P = 0.342), training (P = 0.105), or group (P = 0.238) effect were noted in the BDNF area under the curve response. Results indicate that BDNF concentrations are increased after an acute bout of resistance exercise, regardless of training paradigm, and are further increased during a 7-wk training program in experienced lifters

Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Background Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. Methods Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. Results A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). Conclusions Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.

Effects of b-hydroxy-bmethylbutyrate free acid and cold water immersion on postexercise markers of muscle damage.

Abstract The aim of the current study was to examine the effects of cold water immersion (CWI) with and without the free acid form of b-hydroxy-b-methylbutyrate (HMB-FA) on markers of muscle damage following acute lower body resistance exercise. Forty recreationally resistance-trained men (22.3 ± 2.4 years) were randomly divided into one of the four groups: (1) Placebo (PL); (2) HMB-FA; (3) HMB-FA-CWI; (4) PL-CWI. HMB-FA groups ingested 3 g day -1 and CWI groups submersed their lower body into 10-12°C water for 10-min postexercise. No differences between groups were observed for CK; however, PL-CWI had significantly greater elevations in myoglobin 30-min post-exercise compared to HMB-FA (p = 0.009) and PL (p = 0.005), and HMB-FA-CWI was significantly greater than HMB-FA (p = 0.046) and PL (p = 0.028). No differences between groups were observed for IL-6 and IL-10, although CRP was significantly greater 24-h post-exercise for PL-CWI compared to HMB-FA-CWI (p = 0.02) and HMB-FA (p = 0.046). Only HMB-FA-CWI showed significantly (p = 0.02) greater improvements in average power per repetition. CWI appeared to elevate myoglobin compared to other groups, while HMB-FA may have attenuated the increase in CRP when combined with CWI. Nevertheless, HMB-FA or CWI treatments did not appear to provide benefit over PL for recovery. Instead, the combination of CWI and HMB-FA improved performance recovery compared to other groups

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection:an international, multi-centre, prospective audit

Introduction: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30–0.92, P = 0.02) but MBP was not (OR 0.92, 0.63–1.36, P = 0.69) compared to NBP. Conclusion: This non-randomised study adds ‘real-world’, contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice

Evaluating the incidence of pathological complete response in current international rectal cancer practice

The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials

Comparison of High Intensity versus High Volume Resistance Training on the BDNF Response to Exercise

This study compared the acute and chronic response of circulating plasma brain-derived neurotrophic factor (BDNF) to high-intensity low-volume (HI) and low-intensity high volume (HV) resistance training. Twenty experienced resistance trained men (23.5±2.6 y, 1.79±0.05 m, 75.7±13.8 kg) volunteered for this study. Prior to the resistance training program (PRE), participants performed an acute bout of exercise using either the HI (3-5 reps; 90% of one repetition maximum [1RM]) or HV (10-12 reps; 70% 1RM) training paradigm. The acute exercise protocol was repeated following 7-weeks of training (POST). Blood samples were obtained at rest (BL), immediately- (IP), 30-min (30P) and 60-min (60P) post exercise at PRE and POST. A 3-way repeated measure ANOVA was used to analyze acute changes in BDNF concentrations during HI and HV resistance exercise at PRE and POST. No training x time x group interaction in BDNF was noted (p=0.994). Significant main effects for training (p=0.050) and time (p\u3c0.001) in BDNF were observed. Significant elevations in BDNF concentrations were seen from BL at IP (p=0.001), 30P (p\u3c0.001), and 60P (p\u3c0.001) in both HI and HV combined during PRE and POST. BDNF concentrations were also observed to increase from PRE to POST when collapsed across groups and time. No significant group x training interaction (p=0.342), training (p=0.105), or group (p=0.238) effect were noted in the BDNF area under the curve response. Results indicate BDNF concentrations are increased after an acute bout of resistance exercise, regardless of training paradigm, and are further increased during a 7-week training program in experienced lifters

Resistance Exercise Selectively Mobilizes Monocyte Subsets: Role Of Polyphenols

Purpose To examine the impact of polyphenol supplementation on the recruitment, mobilization, and activation of monocyte subsets after resistance exercise. Methods Thirty-eight recreationally active males (22.1 ± 3.1 yr; 173.9 ± 7.9 cm; 77.8 ± 14.5 kg) were assigned to 28 d of polyphenol blend (PPB) supplementation, placebo (PL), or control (CON). Blood samples were obtained before (PRE) postresistance exercise, immediately (IP) postresistance exercise, 1 h (1H) postresistance exercise, 5 h (5H) postresistance exercise, 24 h (24H) postresistance exercise, and 48 h (48H) postresistance exercise (PPB/PL) or rest (CON). Fine-needle biopsies were obtained from the vastus lateralis at PRE, 1H, 5H, and 48H. Circulating concentrations of macrophage chemoattractant protein-1 (MCP-1) and fractalkine, as well as intramuscular MCP-1 were analyzed via multiplex assay. Changes in the proportions and expression of CD11b on monocyte subsets were assessed via flow cytometry. Results Circulating MCP-1 increased in PPB and PL at IP with further increases at 5H. Intramuscular MCP-1 was increased at 1H, 5H, and 48H in all groups. Classical monocyte proportions were reduced in PPB and PL at IP, and increased at 1H. Nonclassical monocytes were increased in PPB and PL at IP, whereas intermediate monocytes were increased at IP, and reduced at 1H. Intermediate monocytes were increased in PPB at 24H and 48H. CD11b expression was reduced on PPB compared with PL and CON at PRE on intermediate and nonclassical monocytes. Conclusions Resistance exercise may elicit selective mobilization of intermediate monocytes at 24H and 48H, which may be mediated by tissue damage. Additionally, polyphenol supplementation may suppress CD11b expression on monocyte subsets at rest

Monocyte Recruitment After High-Intensity And High-Volume Resistance Exercise

The innate immune response is generally considered to have an important role in tissue remodeling after resistance exercise. Purpose The purpose of this study was to compare changes in markers of monocyte recruitment after an acute bout of high-intensity (HVY) versus high-volume (VOL) lower-body resistance exercise. Methods Ten resistance-trained men (24.7 ± 3.4 yr, 90.1 ± 11.3 kg, 176.0 ± 4.9 cm) performed each protocol in a randomized, counterbalanced order. Blood samples were collected at baseline, immediately (IP), 30 min (30P), 1 h (1H), 2 h (2H), and 5 h (5H) postexercise. Plasma concentrations of monocyte chemoattractant protein 1 (MCP-1), tumor necrosis factor alpha (TNF-α), myoglobin, and cortisol were measured via assay. Tumor necrosis factor receptor 1 (TNFr1), macrophage-1 antigen (cluster of differentiation 11b [CD11b]), and C-C chemokine receptor 2 (CCR2) expression levels were measured using flow cytometry. TNFr1 and CD11b were assessed on CD14 ++ CD16 - monocytes, whereas CCR2 was assessed on CD14 + monocytes. Results Plasma myoglobin concentrations were significantly greater after HVY compared with VOL (P \u3c 0.001). Changes in plasma TNF-α, MCP-1, and expression levels of CCR2 and CD11b were similar between HVY and VOL. When collapsed across groups, TNF-α was significantly increased at IP, 30P, 1H, and 2H (P values \u3c 0.05), whereas MCP-1 was significantly elevated at all postexercise time points (P values \u3c 0.05). CCR2 expression on CD14 + monocytes was significantly lower at IP, 1H, 2H, and 5H (P values \u3c 0.05). CD11b expression on CD14 ++ CD16 - was significantly greater at IP (P \u3c 0.014) and 1H (P = 0.009). TNFr1 expression did not differ from baseline at any time point. Plasma cortisol concentrations did not seem to be related to receptor expression. Conclusions Results indicate that both HVY and VOL protocols stimulate a robust proinflammatory response. However, no differences were noted between resistance exercise training paradigms